Immediate health and economic impact of the Tigray war on internally displaced persons and hosting households

Globally, war is the major cause of displacement from the usual place of the biological environment. The war of Tigray exposed thousands of people to internal displacement and migration. Evidence has shown that displaced people and migrants shoulder the health and economic burden to ensure survival. However, evidence of the impact of the war on health and the economy related to the displaced people and their hosting communities is not documented. Thus, this study aimed to investigate the health and economic impact of the war on displaced people and the hosting community. A community-based survey was conducted among randomly selected 3572 households of 48 woredas/districts from August 06 to 30/2021 in Tigray. Each district had 4 enumeration sites and there were 20 households (HHs) to be sampled per each enumeration site. Data were collected using a pretested structured questionnaire using face-to-face interviews of displaced and hosting household heads. The entered data is exported to SPSS version 26 statistical packages for data analysis. Summary statistics and geo-spatial analysis was computed. The war had a significant impact on the health and economy of the community of Internally Displaced People (cIDPs) and hosting households. There were 12,691 cIDPs and 3572 hosting HHs. About 12.3% had chronic illness12.3% of (cIDP) who had chronic diseases and follow-up medication was forced to stop their medication. 536 (15%) civilian family members of cIDPs were killed at their homes. During the war, 244 (6.83%) of civilian family members faced physical disability. Consequentially, 43.8% and 58.8% of respondents of cIDPs suffered from severe depression and post-traumatic stress disorder. The war had a significant amount of personal resources such as domestic animals, cereals, cars, machinery, and HH furniture was looted and vandalized by the perpetrator forces from the cIDPs and hosting HHs. The range of family size in the hosting households was 3 to 22. The war had a significant health and economic impact on both cIDPs and hosting HHs. cIDPs suffered from various illnesses and disabilities related to the war with no medical access and follow-up care leading them to stressful situations such as depression and PTSD. There was also a huge economic damage and distraction which threatens the survival of the survivors.

Rape survivors' experience in Tigray: a qualitative study

INTRODUCTION

As consequences of war, women and girls are the most likely segment of society to be impacted by violence. War also affects the critical facilities and makes the situation worse as victims cannot get the vital basic services. According to media and unpublished reports, Tigrayan women have been victimized by gang rape and sexual violence. Furthermore, there is substantive evidence of intentional destruction and vandalization of health facilities due to the one-year-old-armed conflict. This study aimed to explore experiences of rape survivors in areas hit by armed conflict in the Tigray region of Ethiopia.

METHODS

In this qualitative study, a phenomenological study design was employed among Tigrayan sexual assault survivors in a war-ravaged of Tigray. Survivors were selected purposively and included in the study for an in-depth interview. An interview guide was used to collect the data. Audio records from the in-depth interviews in Tigrigna were transcribed verbatim and then translated into English for analysis. Atlas-ti 7 software was used to code the interview transcripts of the qualitative data, and categorizations and thematizing of the codes were done. Direct quotes were used to describe categories or themes.

RESULTS

Ten women who were survivors of sexual violence and rape related to the war in Tigray participated in the interview. The age of the women ranged between 16 and 30 years with a mean age of 21.7. Among the participants, five were teenagers, six were single and/or economically dependent on their family or husband, and two did not attend any school and were not able to read and write. This study has generated five major thematic areas: (1) infliction of long-lasting trauma on children (2) effects of the rape (3) means of escaping from rape and killings (4) home remedies as means of life saving in war affected areas, and (5) beyond rape.

CONCLUSIONS

Rape in war-stricken Tigray has been widespread which includes teenagers and it caused immense psychological and physical damage to the survivors and their families. Damage of critical facilities such as the absence of safe houses for survivors and health services was an added complexity to the victims of rape. Hence, a coordinated effort by the government of Tigray and international partners is required to heal, support and rehabilitate the victims and rebuild the damaged health institutions and reequip the health facilities.

A facility-based study of lipids, glucose levels and their correlates among pregnant women in public hospitals of northern Ethiopia

BACKGROUND

Lipids and glucose concentrations in the blood rise during pregnancy period. Poor control of these analytes results in cardio metabolic dysfunction. Despite this, there are no documented studies which investigate lipids and glucose among pregnant women in Tigrai, northern Ethiopia.

OBJECTIVE

The objective of this study was to assess lipid and glucose levels and identify their correlates among pregnant women in Tigrai, northern Ethiopia.

METHOD

We conducted a facility-based cross sectional study comprising of systematically selected 200 pregnant women from July to October 2021. Those who were severely ill were excluded from the study. We used a structured questionnaire to collect socio-demographic and clinical characteristics of pregnant women. Lipids such as triglycerides, low density lipoprotein, cholesterol and blood glucose were also measured using Cobas C311 chemistry machine from plasma samples. The data were analyzed using SPSS version 25. Logistic regression was performed and statistical significance was declared at p-value < 0.05.

RESULT

Proportion of pregnant women with cholesterol, triglyceride, low density lipoprotein and blood glucose levels above the upper limit of the normal range used for clinical decision were 26.5%, 43%, 44.5% and 21%, respectively. Pregnant women's income > = 10,000 ETB (AOR = 3.35; 95%CI: 1.46-7.66), age (AOR = 3.16; 95%CI: 1.03-9.68), gestational age 29-37 weeks (AOR = 8.02; 95%CI: 2.69-23.90) and having systolic blood pressure greater than 120 mmHg (AOR = 3.99; 95%CI: 1.64-9.75) demonstrated statistically significant association with raised levels of lipids.

CONCLUSION AND RECOMMENDATION

Proportion of pregnant women with out of normal range values of lipids, particularly triglycerides and low density lipoprotein, is high. Gestational age is a strong predictor of increase in blood levels for both lipids. Provision of life style related health education and dietary intake to pregnant mothers matters. Moreover, monitoring lipid profile and glucose level during antenatal care period is essential.

Assessment of Surgery and Anesthesia Services and Patients’ Attitude Towards Informed Consent: The Case of a Specialized and Comprehensive University Hospital in Northern Ethiopia

Objective: Healthcare providers need to establish close relationships with patients planning to undergo major elective surgery as this helps produce positive patient outcomes. This study aimed at investigating surgery and anesthesia services and patients’ attitude toward informed consent at Ayder comprehensive specialized university hospital, in Northern Ethiopia. Material and Methods: A facility-based cross-sectional study was conducted in the biggest health facility in Northern Ethiopia. Four hundred ten patients with major elective surgery were recruited. A structured questionnaire was used to collect socio-demographics, anesthesia and surgery services and the attitude of patients toward informed consent. Descriptive results were presented using frequencies and tables. Regression analysis was accompanied by an odds ratio and a 95% confidence interval was run to identify factors associated with the outcome variable. Results: Study participants’ mean age was 36.1+11.7. Around two-thirds (71.7%) and one-fourth (26.6%) of the study participants were informed about their proposed surgical procedure and its possible complications, respectively. Two hundred ninety four (66.8%) and 88 (21.5%) were made aware of the type of anesthesia that was going to be administered and possible complications. About half (50.7%) had expressed a positive attitude towards informed consent. Rural residents have about twice (AOR=1.9; 95% CI: 1.06-2.73) higher odds of expressing a positive attitude towards the informed consent than their counterparts. Conclusion: The study revealed that the proportion of patients who were informed about their anesthesia-surgery services was moderate. Besides, patients’ attitude toward informed consent was poor. The residence was a good predictor of positive patients’ attitudes toward informed consent. Thus, healthcare professionals in the surgery department should establish clear and transparent communication with patients about surgery and anesthesia-related services.

Prevalence of Orthohantavirus-Reactive Antibodies in Humans and Peri-Domestic Rodents in Northern Ethiopia

In 2012, Tigray orthohantavirus was discovered in Ethiopia, but its seasonal infection in small mammals, and whether it poses a risk to humans was unknown. The occurrence of small mammals, rodents and shrews, in human inhabitations in northern Ethiopia is affected by season and presence of stone bunds. We sampled small mammals in two seasons from low- and high-density stone bund fields adjacent to houses and community-protected semi-natural habitats in Atsbi and Hagere Selam, where Tigray orthohantavirus was first discovered. We collected blood samples from both small mammals and residents using filter paper. The presence of orthohantavirus-reactive antibodies in blood was then analyzed using immunofluorescence assay (human samples) and enzyme linked immunosorbent assays (small mammal samples) with Puumala orthohantavirus as antigen. Viral RNA was detected by RT-PCR using small mammal blood samples. Total orthohantavirus prevalence (antibodies or virus RNA) in the small mammals was 3.37%. The positive animals were three Stenocephalemys albipes rats (prevalence in this species = 13.04%). The low prevalence made it impossible to determine whether season and stone bunds were associated with orthohantavirus prevalence in the small mammals. In humans, we report the first detection of orthohantavirus-reactive IgG antibodies in Ethiopia (seroprevalence = 5.26%). S. albipes lives in close proximity to humans, likely increasing the risk of zoonotic transmission.

Risk Factors of Birth Asphyxia Among Neonates Born in Public Hospitals of Tigray, Northern Ethiopia

Introduction

Birth asphyxia is defined by the World Health Organization as not initiating and maintaining default breathing at birth. Approximately 24% of neonatal deaths occurred annually worldwide due to birth asphyxia. About 3% of the 120 million neonates born each year acquire asphyxia in third world countries. Long-term survivors may experience cerebral palsy, delay in growth, vision, hearing and intellectual deficiency, epilepsy, difficulties with communication and behavior. Thus, this study aims to determine the risk factors of birth asphyxia among neonates who were delivered at public hospitals of Tigray, Ethiopia.

Materials and Methods

Hospital-based unmatched case-control study design was implemented on 390 samples from January to February 2018. Data were collected by interviews using a structured questionnaire and checklist. The collected data were coded and entered using EpiData version 3.1 statistical software and transported to statistical package for social science (SPSS) version 20 software for analysis. Cross-tabulation and odds ratio with 95% confidence interval were computed. Bivariate logistic regression and multivariable logistic regression were done. Multicollinearity was checked. Goodness of fit was checked by the Hosmer–Lemeshow test.

Results

A total of 260 controls and 130 cases were enrolled in the study. Multivariable logistic regression showed that Primi-parity [AOR 5.5 (CI: 2.5, 12.3)], pre-eclamcia/pregnancy-induced hypertension [AOR12.4 (CI: 4.17, 37.15)], post-term pregnancy [AOR 2.73 (CI: 1.00, 7.55)] meconium-stained liquor [AOR 29.2 (CI: 12.0, 71.1)], cord entangled [AOR 5.67 (CI: 1.66,19.3)] and non-vertex presentation [AOR 5.49 (CI: 2.20,13.7)] were found to be risk factors for perinatal birth asphyxia.

Conclusion and Recommendations

Intrapartum factors and neonatal factors in the index pregnancy have an association with perinatal birth asphyxia. The research finding suggests effective antenatal care follow-up and follow-up of labor progress using partograph after labor initiation.

A facility-based study of factors associated with perinatal mortality in Tigray, northern Ethiopia

OBJECTIVE

To identify perinatal mortality risk factors in the Southern Zone of Tigray, northern Ethiopia.

METHODS

The present unmatched case-control study included data from 20 health facilities; stillbirths and neonatal deaths were included as a case group and patients with neonates who survived until discharge or day 7 postpartum were included as a control group. Perinatal mortality risk factors were investigated using bivariate and multivariate logistic regression analyses.

RESULTS

There were 126 and 252 patients included in the case and control groups, respectively. Prematurity (adjusted odds ratio [AOR] 12.2; 95% confidence interval [CI] 3.46-43.17; P<0.001), delivery weight below 2500 g (AOR 11.5, 95% CI 3.16-42.36; P<0.001), and fewer prenatal visits (AOR 5.4; 95% CI 0.80-36.63; P=0.028) were determinants of perinatal mortality. Partograph use (AOR 0.2; 95% CI 0.08-0.48; P<0.001) and seeking labor care at the start of labor (AOR 0.1; 95% CI 0.01-0.96; P=0.010) were protective. Short childbirth interval (<2 years) (AOR 2.2; 95% CI 1.03-5.09; P=0.013), distance to facility (AOR 3.7; 95% CI 1.56-9.02; P=0.007), and lack of iron supplementation (AOR 3.3; 95% CI 1.16-9.76; P=0.021) were also predictors of perinatal mortality.

CONCLUSION

Perinatal mortality was linked to prematurity and low delivery weight. Interventions including partograph and auscultation, as well as subsidizing transport and iron supplementation, could help in this region.

A single amino acid substitution in the viral polymerase creates a temperature-sensitive and attenuated recombinant bovine parainfluenza virus type 3

Bovine parainfluenza virus type 3 (bPIV3) is under development as a live virus vaccine vector. The RNA genome of a recombinant bPIV3 harbored four nucleotide changes, one of which resulted in a mutation of the viral polymerase (A. A. Haller et al., 2000, J. Virol. 74, 11626-11635). The contribution of this conservative amino acid substitution (I1103V) in the polymerase to the temperature-sensitive and attenuation phenotypes of r-bPIV3 was investigated by creating a new virus, r-bPIV3(I), that expressed the wild-type polymerase. r-bPIV3(I) was not temperature-sensitive for growth in vitro and the replication of r-bPIV3(I) was no longer restricted in hamsters. The effect of the amino acid substitution in the polymerase was also studied in a chimeric bovine/human PIV3, a virus that displayed temperature-sensitive and attenuated phenotypes (A. A. Haller et al., 2000, J. Virol. 74, 11626-11635). It was not clear whether these defects were due to the impaired polymerase or the replacement of the bPIV3 surface glycoproteins with those of hPIV3. The results showed that the altered polymerase was indeed responsible for the temperature-sensitive phenotype of bovine/human PIV3 but did not appear to play a role in the attenuation phenotype.

Expression of the surface glycoproteins of human parainfluenza virus type 3 by bovine parainfluenza virus type 3, a novel attenuated virus vaccine vector

Bovine parainfluenza virus type 3 (bPIV3) is being evaluated as an intranasal vaccine for protection against human PIV3 (hPIV3). In young infants, the bPIV3 vaccine appears to be infectious, attenuated, immunogenic, and genetically stable, which are desirable characteristics for an RNA virus vector. To test the potential of the bPIV3 vaccine strain as a vector, an infectious DNA clone of bPIV3 was assembled and recombinant bPIV3 (r-bPIV3) was rescued. r-bPIV3 displayed a temperature-sensitive phenotype for growth in tissue culture at 39 degrees C and was attenuated in the lungs of Syrian golden hamsters. In order to test whether r-bPIV3 could serve as a vector, the fusion and hemagglutinin-neuraminidase genes of bPIV3 were replaced with those of hPIV3. The resulting bovine/human PIV3 was temperature sensitive for growth in Vero cells at 37 degrees C. The replication of bovine/human PIV3 was also restricted in the lungs of hamsters, albeit not as severely as was observed for r-bPIV3. Despite the attenuation phenotypes observed for r-bPIV3 and bovine/human PIV3, both of these viruses protected hamsters completely upon challenge with hPIV3. In summary, bPIV3 was shown to function as a virus vector that may be especially suitable for vaccination of infants and children against PIV3 and other viruses.