Prevalence and intensity of soil-transmitted helminths infection among individuals in model and non-model households, South West Ethiopia: A comparative cross-sectional community based study

Soil-transmitted helminths (STH) is a term used to refer to infections caused by intestinal worms mainly due to A. lumbricoides, T. trichiura, and hookworm species which are transmitted through contaminated soil. This study was conducted to assess the prevalence and intensity of STHs infection among individual members living within the selected household heads (HHs) certified either as a model HHs or non-model HHs based on the implementation level of a training program known as the Health Extension Program (HEP). A community-based comparative cross-sectional study was conducted from April to June 2018 at Seka Chekorsa Woreda, Jimma zone. Model and non-model HHs were selected systematically from each of the randomly selected district villages employing a multistage sampling technique. Sociodemographic and risk factors data associated with STHs infections were collected using a pre-tested structured questionnaire. Parasitological stool sample microscopic examination was done using saline wet mount and Kato Katz thick smear technique. Data analysis was performed using SPSS software version 20 for descriptive statistics, comparison, and logistic regression at a p-value < 0.05 for statistical significance. Overall, 612 individuals were recruited in the study from 120 randomly selected HHs. The prevalence of STHs infections was found to be 32.4%. A total of 45 (14.7%) model and 153 (50.0%) non-model individual participants were positive for at least one species of STHs showing a significant difference between individuals in model and non-model HHs (AOR: 6.543, 95% CI; 4.36-9.82, P<0.001). The dominant STHs were T. trichiura (21.6%) followed by A. lumbricoides (6.4%) and hookworms (2.3%). The intensity of T. trichiura and A. lumbricoides infection have shown a significant difference (p<0.05) while hookworm species infection was not significantly different (p>0.05) for the individuals in the HHs groups. On the other hand, the households training status, age of participants, and latrine use pattern were found significant predictors of STHs infection prevalence in the multivariate analysis (P<0.05). Therefore, the prevalence and intensity of STHs infection was higher among individuals living in a non-model HHs than model HHs.

Ketamine Sedation After Administration of Oral Contrast: A Retrospective Cohort Study

BACKGROUND

The American Academy of Pediatrics and American Society of Anesthesiologists have published consensus-based fasting guidelines intended to reduce the risk of pulmonary aspiration. The purpose of our study was to compare the rate of adverse events in patients sedated with ketamine within 2 hours of oral contrast intake to those who were nil per os (NPO).

METHODS

A retrospective cohort review of a database of children between July 2008 and May 2011. The rate of adverse events in children sedated with ketamine after intake of oral contrast for an abdominal computed tomography were compared with those sedated without taking oral contrast.

RESULTS

One hundred and four patients sedated for a computed tomography scan; 22 patients were sedated within 2 hours of taking oral contrast, and 82 were NPO. The 2 groups were comparable with regard to gender, race, and American Society of Anesthesiologists status. The mean (SD) time between the second dose of oral contrast and induction of sedation was 58 (24) minutes. Vomiting occurred in 4 of 22 patients in the oral contrast group (18%; 95% confidence interval 2%-34%) and 1 of 82 patients in the NPO group (1%; 95% confidence interval, 0%, 4%; P < .001). There was no difference in oxygen desaturation between the groups (P = .6).

CONCLUSIONS

Children who received oral contrast up to 58 minutes before ketamine sedation had a higher rate of vomiting than those who did not receive oral contrast. We did not identify cases of clinical aspiration, and the incidence of hypoxia between the 2 groups was not statistically significant.

Comparison of dexmedetomidine with pentobarbital for pediatric MRI sedation

BACKGROUND AND OBJECTIVE

Intravenous pentobarbital has been used in the past to sedate pediatric patients in preparation for MRI; however, the drug has unpredictable sedation time. Dexmedetomidine, because of its short half-life, is gaining popularity for pediatric MRI sedation in settings where the use of propofol is restricted for nonanesthesiologists. The objective was to compare induction time, recovery time, total sedation time, sedation failure rate, and adverse outcomes of patients sedated with pentobarbital and dexmedetomidine in preparation for pediatric MRI.

METHODS

We reviewed a sedation database that contains clinical data for all children undergoing MRI studies while sedated with pentobarbital or dexmedetomidine between May 15, 2008, and October 30, 2010.

RESULTS

During the study period, 281 sedations were induced in preparation for MRI (160 with pentobarbital, and 121 with dexmedetomidine). The 2 groups were comparable with regard to age, weight, gender, and American Society of Anesthesiologists status. The dexmedetomidine group had a significantly shorter recovery time (39 ± 21 vs 49 ± 27 minutes [P = .002]) and total sedation time (107 ± 28 vs 157 ± 44 minutes [P = .0001]). Induction time was similar between the groups. The adverse event rate for the study population was 3%.

CONCLUSIONS

Dexmedetomidine and pentobarbital can both be used successfully for MRI sedation in children. However, dexmedetomidine had a significantly shorter recovery time and total sedation time in our population.

Utilization of PMTCT services and associated factors among pregnant women attending antenatal clinics in Addis Ababa, Ethiopia

BACKGROUND

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) remains the major source of HIV infection in young children. Targeting pregnant women attending antenatal clinics provide a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT) programmes against HIV infection of newborn babies. This study aimed to investigate factors associated with the acceptability and utilization of PMTCT of HIV.

METHODS

An institution based cross-sectional study was conducted in April 2010 using exit interviews with 843 pregnant women attending antenatal care (ANC) clinics of 10 health centers and two hospitals in Addis Ababa, Ethiopia. Trained nurses administered structured questionnaires to collect data on socio-demographic characteristics, knowledge about MTCT, practice of HIV testing and satisfaction with the antenatal care services. Six focus group discussions among pregnant women and 22 in-depth interviews with service providers complemented the quantitative data.

RESULTS

About 94% of the pregnant women visited the health facility for ANC check-up. Only 18% and 9% of respondents attended the facility for HIV counselling and testing (HCT) and receiving antiretroviral prophylaxis, respectively. About 90% knew that a mother with HIV can pass the virus to her child, and MTCT through breast milk was commonly cited by most women (72.4%) than transmission during pregnancy (49.7%) or delivery (49.5%). About 94% of them reported that they were tested for HIV in the current pregnancy and 60% replied that their partners were also tested for HIV. About 80% of the respondents reported adequacy of privacy and confidentiality during counseling (90.8% at hospitals and 78.6% at health centers), but 16% wished to have a different counselor. Absence of counselors, poor counselling, lack of awareness and knowledge about HCT, lack of interest and psychological unpreparedness were the main reasons cited for not undergoing HIV testing during the current pregnancy.

CONCLUSIONS

HIV testing among ANC attendees and knowledge about MTCT of HIV was quite high. Efforts should be made to improve the quality and coverage of HCT services and mitigate the barriers preventing mothers from seeking HIV testing. Further research should be conducted to evaluate the uptake of antiretroviral prophylaxis among HIV-positive pregnant women attending ANC clinics.

Development of pediatric emergency medicine at Addis Ababa University/Tikuranbessa Specialized Hospital, Ethiopia

BACKGROUND

In the world emergencies occur everywhere, and each day they consume ressources regardless of whether there are systems capable of achieving good outcomes. Low-income countries suffer the most highest rates of every category of injury--from traffic and the highest rates of acute complications of communicable diseases including tuberculosis, malaria and HIV.

OBJECTIVE

To describe the development of pediatrics emergency medicine at Tikur Anbesa Specialized Hospital

METHODS

A twinning partnership model was used in developing a pediatric emergency medicine training program helps in development of pediatrics emergency system.

RESULTS

Strengthening the capacity of Addis Ababa University (AAU), Tikur Anbessa Hospital (TASH) to provide pediatric emergency medical services through improved organization of the pediatrics emergency department and strengthening of continuing education opportunities for faculty and staff capacity building by this improving quality of care in pediatrics patients in the country.

CONCLUSION

The Addis Ababa University, University of Wiscosin and People to People partners intend to continue working together to strengthening and developing effetive systems to deliver quality pediatrics emergency medicine care troughout all regions of Ethiopia.

Acute bronchiolitis

Bronchiolitis is the most common lower respiratory tract infection to affect infants and toddlers. High-risk patients include infants younger than 3 months, premature infants, children with immunodeficiency, children with underlying cardiopulmonary or neuromuscular disease, or infants prone to apnea, severe respiratory distress, and respiratory failure. Bronchiolitis is a self-limited disease in healthy infants and children. Treatment is usually symptomatic, and the goal of therapy is to maintain adequate oxygenation and hydration. Use of a high-flow nasal cannula is becoming common for children with severe bronchiolitis.

A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis

BACKGROUND

Bronchiolitis, the most common infection of the lower respiratory tract in infants, is a leading cause of hospitalization in childhood. Corticosteroids are commonly used to treat bronchiolitis, but evidence of their effectiveness is limited.

METHODS

We conducted a double-blind, randomized trial comparing a single dose of oral dexamethasone (1 mg per kilogram of body weight) with placebo in 600 children (age range, 2 to 12 months) with a first episode of wheezing diagnosed in the emergency department as moderate-to-severe bronchiolitis (defined by a Respiratory Distress Assessment Instrument score > or =6). We enrolled patients at 20 emergency departments during the months of November through April over a 3-year period. The primary outcome was hospital admission after 4 hours of emergency department observation. The secondary outcome was the Respiratory Assessment Change Score (RACS). We also evaluated later outcomes: length of hospital stay, later medical visits or admissions, and adverse events.

RESULTS

Baseline characteristics were similar in the two groups. The admission rate was 39.7% for children assigned to dexamethasone, as compared with 41.0% for those assigned to placebo (absolute difference, -1.3%; 95% confidence interval [CI], -9.2 to 6.5). Both groups had respiratory improvement during observation; the mean 4-hour RACS was -5.3 for dexamethasone, as compared with -4.8 for placebo (absolute difference, -0.5; 95% CI, -1.3 to 0.3). Multivariate adjustment did not significantly alter the results, nor were differences detected in later outcomes.

CONCLUSIONS

In infants with acute moderate-to-severe bronchiolitis who were treated in the emergency department, a single dose of 1 mg of oral dexamethasone per kilogram did not significantly alter the rate of hospital admission, the respiratory status after 4 hours of observation, or later outcomes. (ClinicalTrials.gov number, NCT00119002 [ClinicalTrials.gov].).

Emergency Medical Treatment and Labor Act: the basics and other medicolegal concerns

The Emergency Medical Treatment and Labor Act (EMTALA) was enacted by Congress because of its concern with an increasing number of reports that hospital emergency rooms were refusing to accept or treat individuals with emergency conditions if the individuals did not have insurance. With increasingly crowded emergency departments and a decreasing number of emergency departments, a periodic review of the effect that EMTALA has on the emergency medical services will prevent unintended consequences of this well-intentioned act.