Determinants and Causes of Neonatal Mortality in Jimma Zone,Southwest Ethiopia: A Multilevel Analysis of Prospective Follow Up Study

Background

Ethiopia is among the countries with the highest neonatal mortality with the rate of 37 deaths per 1000 live births. In spite of many efforts by the government and other partners, non-significant decline has been achieved in the last 15 years. Thus, identifying the determinants and causes are very crucial for policy and program improvement. However, studies are scarce in the country in general and in Jimma zone in particular.

Objective

To identify the determinants and causes of neonatal mortality in Jimma Zone, Southwest Ethiopia.

Methods

A prospective follow-up study was conducted among 3463 neonates from September 2012 to December 2013. The data were collected by interviewer-administered structured questionnaire and analyzed by SPSS V.20.0 and STATA 13. Verbal autopsies were conducted to identify causes of neonatal death. Mixed-effects multilevel logistic regression model was used to identify determinants of neonatal mortality.

Results

The status of neonatal mortality rate was 35.5 (95%CI: 28.3, 42.6) per 1000 live births. Though significant variation existed between clusters in relation to neonatal mortality, cluster-level variables were found to have non-significant effect on neonatal mortality. Individual-level variables such as birth order, frequency of antenatal care use, delivery place, gestation age at birth, premature rupture of membrane, complication during labor, twin births, size of neonate at birth and neonatal care practice were identified as determinants of neonatal mortality. Birth asphyxia (47.5%), neonatal infections (34.3%) and prematurity (11.1%) were the three leading causes of neonatal mortality accounting for 93%.

Conclusions

This study revealed high status of neonatal mortality in the study area. Higher-level variables had less importance in determining neonatal mortality. Individual level variables related to care during pregnancy, intra-partum complications and care, neonatal conditions and the immediate neonatal care practices were identified as determinant factors. Improving antenatal care, intra-partum care and immediate neonatal care are recommended.     

Occurrence, seasonality and genetic diversity of Vibrio vulnificus in coastal seaweeds and water along the Kii Channel, Japan

Vibrio vulnificus is a ubiquitous toxigenic bacterium found in a coastal environment but little is known about its occurrence and seasonality among seaweeds, which are widely consumed as seafood in Japan. Therefore, we have observed the bacterium's abundance in seawater and seaweed samples from three areas of the Kii Channel, Japan, during June 2003 to May 2004. A total of 192 samples were collected: 24 from each source in summer, autumn, winter and spring. The samples were selectively cultivated following the most probable number (MPN) technique. Vibrio vulnificus population ranged from 0 to 10(3) MPN 100 mL(-1) seawater or 10 g seaweeds; higher counts were observed during summer. The optimum temperature, salinity and pH for the bacterium were 20-24 degrees C, 24-28 p.p.t. and 7.95-8.15, respectively. However, seaweeds always contained higher V. vulnificus than seawater. Among 280 V. vulnificus strains, detected by species-specific colony hybridization and PCR, 78, 74, 11 and 16 were from seaweeds and 46, 42, 2 and 11 were from seawater during summer, autumn, winter and spring, respectively. Ribotyping of 160 selected strains revealed a higher genotypic diversity (18 patterns) among strains from seaweeds than from seawater (10 patterns). Seaweeds can thus act as a potential habitat for V. vulnificus and are more unsafe for consumption during summer.     

Population structure and group size of geladas (Theropithecus gelada) at Chenek,Simien Mountains National Park,Ethiopia

The aim of this study was to investigate population structure and group size of geladas (Theropithecus gelada) at Chenek, Simien Mountains National Park. The study was carried out from January 2010 to June 2011 using total count method by classifying the study site into five different blocks. Size of the group was determined by counting individuals of geladas within an hour interval. A total of 397 geladas were counted and the ratio of adult males to adult females was 1 : 1.25, and this difference showed statistical significant (t = 8.157, P < 0.05). There was also significant difference between adult females with juveniles and infants (t = 21.027, P < 0.05). Population structure of geladas in a band comprised a single reproductive male and a number of females, subadults, juveniles and infants. Fission and fusion of individual geladas among different bands were observed during the study period. Geladas at the study site showed population growth and were seen competing for available food. They also stole food from local people and tourists and were seen to be interactive with people. Thus, the interference of people and livestock within the geladas natural habitat should be minimized to avoid human disturbance on the species and its natural habitat.     

Colocalization of neuropeptides and NADPH-diaphorase in the intra-adrenal neuronal cell bodies and fibres of the rat

Colocalization of vasoactive intestinal peptide, neuropeptide Y, calcitonin gene-related peptide, substance P, and tyrosine hydroxylase, respectively, with NADPH-diaphorase staining in rat adrenal gland was investigated using the double labelling technique. All vasoactive intestinal peptide- and some neuropeptide Y-immunoreactive intrinsic neuronal cell bodies seen in the gland were double stained with NADPH-diaphorase. Double labelling also occurred in some nerve fibres immunoreactive to vasoactive intestinal peptide and neuropeptide Y in the medulla and cortex. No colocalization of calcitonin gene-related peptide, substance P or tyrosine hydroxylase immunoreactivity with NADPH-diaphorase staining was observed. However, nerve fibres with varicosities immunoreactive for all the neuropeptides examined were closely associated with some of the NADPH-diaphorase-stained neuronal cell bodies. Thus, in rat adrenal gland, nitric oxide is synthesized in all ganglion cells containing vasoactive intestinal peptide and in some containing neuropeptide Y, but not in those containing calcitonin gene-related peptide, substance P or tyrosine hydroxylase.     

Diet and activity patterns of Arsi geladas in low-elevation disturbed habitat south of the Rift Valley at Indetu,Ethiopia

Understanding the basic natural history of threatened primate taxa is crucial to developing and implementing successful conservation strategies for them. Data on feeding ecology and activity patterns are particularly important for identifying the strategies through which primates invest time and foraging effort towards survival and reproduction at a given locale. Here, we report the results of the first study of the diet and activity budget of Arsi geladas, a population of < 1000 individuals endemic to a heavily disturbed region of the southern Ethiopian Highlands and believed to represent a new taxon of geladas. We conducted our research on a band of 34 individuals belonging to five, one-male units at Indetu, eastern Arsi, Ethiopia, from August 2010 to May 2011 (excluding March 2011). Feeding accounted for 41.7% of total scans, followed by moving (20.3%), resting (19.0%), and social behavior (19.0%). Feeding and moving increased and resting and socializing decreased during the dry season when food availability was probably lower than during the wet season. Geladas ate mostly graminoid leaves (51.7% of feeding scans) though they also consumed graminoid rhizomes (24.4%), forb tubers (7.1%), forb leaves (7.1%), cactus, shrub, and tree fruits (3.6%), graminoid corms (1.7%), forb roots (1.6%), and unidentified items (3.0%). Underground foods (corms, rhizomes, roots, and tubers) accounted for 22–47% (mean = 35%) of the monthly (n = 9) diet and were eaten slightly more during the wet season than during the dry season. Contributions of human crops to the gelada diet could not be quantified without creating conflict between farmers and researchers, though we did note that geladas visited farms on 5–10% of study days. Threats from farmers, children, and dogs limited the geladas’ access to crops once they entered the farms. Further research involving questionnaire surveys of farmers, direct observation of crop damage by geladas, and DNA metabarcoding of gelada feces are crucial to the development of strategies to mitigate human-gelada conflict in the densely populated Arsi Zone of Ethiopia.     

Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia,India and South Africa

Objective

To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit.

Design

Diagnostic accuracy study.

Setting

Ethiopia, India and South Africa.

Methods

Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam.

Results

Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa.

Conclusion

The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability.     

A Recombinant Positive Control for Serology Diagnostic Tests Supporting Elimination of Onchocerca volvulus

Background

Serological assays for human IgG4 to the Onchocerca volvulus antigen Ov16 have been used to confirm elimination of onchocerciasis in much of the Americas and parts of Africa. A standardized source of positive control antibody (human anti-Ov16 IgG4) will ensure the quality of surveillance data using these tests.

Methodology/Principal Findings

A recombinant human IgG4 antibody to Ov16 was identified by screening against a synthetic human Fab phage display library and converted into human IgG4. This antibody was developed into different positive control formulations for enzyme-linked immunosorbent assay (ELISA) and rapid diagnostic test (RDT) platforms. Variation in ELISA results and utility as a positive control of the antibody were assessed from multiple laboratories. Temperature and humidity conditions were collected across seven surveillance activities from 2011–2014 to inform stability requirements for RDTs and positive controls. The feasibility of the dried positive control for RDT was evaluated during onchocerciasis surveillance activity in Togo, in 2014. When the anti-Ov16 IgG4 antibody was used as a standard dilution in horseradish peroxidase (HRP) and alkaline phosphatase (AP) ELISAs, the detection limits were approximately 1ng/mL by HRP ELISA and 10ng/mL by AP ELISA. Positive control dilutions and spiked dried blood spots (DBS) produced similar ELISA results. Used as a simple plate normalization control, the positive control antibody may improve ELISA data comparison in the context of inter-laboratory variation. The aggregate temperature and humidity monitor data informed temperature parameters under which the dried positive control was tested and are applicable inputs for testing of diagnostics tools intended for sub-Saharan Africa. As a packaged positive control for Ov16 RDTs, stability of the antibody was demonstrated for over six months at relevant temperatures in the laboratory and for over 15 weeks under field conditions.

Conclusions

The recombinant human anti-Ov16 IgG4 antibody-based positive control will benefit inter-laboratory validation of ELISA assays and serve as quality control (QC) reagents for Ov16 RDTs at different points of the supply chain from manufacturer to field use.     

Population dynamics of the Ethiopian endemic rodent Praomys albipes in the Menagesha State Forest

Bimonthly live-trapping over 15 months of 1 ha grid in the Menagesha State Forest, Ethiopia, revealed six species of rodents, dominated by Praomys albipes (64.3% of the catch). All age groups were recorded at each trapping occasion, and pregnant females were observed throughout the year. Both snap-trapping and captive breeding programmes suggest a mean litter size greater than 4 (range 2–8). Despite this, the monthly density and biomass of captured rodents declined towards the last trapping occasions from 35 to 12/ha and 1546 to 454 g/ha, respectively.     

Species composition,abundance and habitat association of rodents and insectivores from Chilalo–Galama Mountain range,Arsi, Ethiopia

A study on the ecology of rodents and insectivores on Mount Chilalo and the Galama Mountain range was conducted during August, 2007–April, 2008. Study grids were marked in nine randomly selected habitats. Sherman live traps and snap traps were used to capture the small mammals. A total of 2525 (including recaptures) individual rodents and insectivores were captured in 5488 (Sherman) and 1590 (snap) trap‐nights. Among the live‐trapped animals, 2037 (96.2%) and 80 (3.8%) were rodents and insectivores, respectively, that comprised 17 species. These were as follows: Arvicanthis abyssinicus, Arvicanthis blicki, Arvicanthis dembeensis, Lophuromys flavopunctatus, Lophuromys melanonyx, Mastomys natalensis, Mus mahomet, Otomys typus, Rattus rattus, Stenocephalemys albipes, Stenocephalemys albocaudata, Stenocephalemys griseicauda, Crocidura glassi, Crocidura flavescens and Crocidura thalia. Tachyoryctes splendens and Hystrix cristata were sighted but not captured. Endemics to Ethiopia constituted 60% of the trapped small mammals. Lophuromys flavopunctatus was the most abundant and widely distributed rodent species, while M. mahomet was the least. The altitudes between 3301 and 3400 m asl had the highest species composition and abundance although it is second in number of catches per trap‐nights. The majority of rodents and insectivores were associated with montane forest habitat, whereas the least were in the shrubland. Anthropogenic effects were witnessed affecting the distribution of small mammals.     

Maternal Complications and Women's Behavior in Seeking Care from Skilled Providers in North Gondar,Ethiopia

Background

Maternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women''s experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study.

Methods

This study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles) using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders.

Results

Out of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7%) reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6%) sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider.

Conclusion

Nearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved in not using skilled maternal care.