Respiratory-related deaths and associated factors in Alicho-Weriro district, southern Ethiopia: verbal autopsy data analysis

BACKGROUND

Respiratory diseases disproportionately affect people living in resource-limited settings. However, obtaining information that explains respiratory-related deaths has been difficult, mainly due to a lack of medical certification of death and the fact that most deaths occur outside of health institutions. This study aimed to determine the proportion of respiratory-related deaths and identify associated factors in Alicho-Weriro district, southern Ethiopia, using the verbal autopsy method.

METHODS

A community-based cross-sectional study was conducted from April to June 2022. All deceased people in the study area from January 2020 to December 2021 were included in the study. Trained physicians ascertained the cause of death from verbal autopsy data that were collected using a pre-tested and modified WHO-designed questionnaire. The binary logistic regression models were used to identify factors associated with respiratory-related deaths.

RESULTS

Respiratory-related deaths accounted for 25% of the deaths from all causes, with 20.8% of male and 29.5% of female deaths. Of which, 9.7% were from tuberculosis, 8.3% were from asthma and 6.2% were from acute lower-respiratory tract infections. Moreover, being female (adjusted OR, AOR: 3.3; 95% CI: (1.75 to 6.22)), age 50-64 years (AOR: 9.3; 95% CI: (1.16 to 73.90)), age above 64 years (AOR: 8.9; 95% CI: (1.130 to 70.79)), family size of five persons or more (AOR: 1.9; 95% CI: (1.15 to 3.29)), smoking (AOR: 3.9; 95% CI: (1.86 to 8.35)), using wood and/or animal dung for household cooking (AOR: 6.6; 95% CI: (1.92 to 22.59)) and poor house ventilation (AOR: 3.1; 95% CI: (1.75 to 5.38)) were significantly associated with increased odds of dying from respiratory-related diseases.

CONCLUSION

This study has determined that about a quarter of deaths from all causes were due to respiratory diseases, mainly tuberculosis, asthma and acute lower respiratory tract infections. Therefore, interventions to reduce this burden should focus on supporting early case detection and treatment, promoting healthy lifestyles, exercising women's equality at the household level and improving housing conditions.

Prevalence of Hepatitis B Virus Infection and Associated Factors Among High School Students in Shinshicho Town, Southern Ethiopia

Background

Early identification of people living with hepatitis B virus infection is required to initiate treatment and care, prevent community transmission, and expand vaccination. However, only an estimated 10% of people living with chronic hepatitis B infection are diagnosed, and only 2% are on treatment globally. This study aimed to assess the prevalence of hepatitis B virus infection and its associated factors among high school students in Shinshicho Town, southern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among 380 high school students in Shinshicho Town, southern Ethiopia, from September to October 2022. A laboratory investigation of hepatitis B surface antigen was done to determine infection status. An odds ratio with a 95% confidence interval was used to declare statistical significance.

Results

The prevalence of hepatitis B virus infection among high school students in Shinshicho town was observed to be 7.6% (95% CI: 5.5, 10.5%). Age 20 to 24 years [AOR: 2.7; 95% CI: (1.0-7.0)], rural residence [AOR: 3.4; 95% CI: (1.3-8.9)], and history of unprotected drug injection [AOR: 11.3; 95% CI: (3.7-34.8)] were independently associated with hepatitis B virus infection.

Conclusion

A high prevalence of hepatitis B virus infection was observed among high school students in this study. Therefore, strengthening the school-based screen-and-treat program, especially targeting students from rural areas and young adults, and conducting awareness campaigns about the importance of practicing safe behaviors, such as avoiding unprotected drug injections, could contribute to the prevention and control of hepatitis B virus infection among high school students.

Prevalence of undiagnosed hypertension and associated factors among adults in Durame town, Southern Ethiopia: a cross-sectional study

Background

Undiagnosed hypertension is a major public health problem causing severe cardiovascular disorders that are responsible for a high proportion of morbidities and mortalities, especially among adults living in low-income countries. However, there is a paucity of information that describes its epidemiology in Ethiopia. This study aimed to assess the prevalence of undiagnosed hypertension and associated factors among adults in Durame town, southern Ethiopia.

Methods

A community-based cross-sectional study was conducted from July to September 2022. Data were collected from 526 randomly selected adults aged ≥18 years using a pre-tested questionnaire. The binary logistic regression models were used to identify factors associated with undiagnosed hypertension.

Results

The prevalence of undiagnosed hypertension among adults in Durame town, southern Ethiopia, was found to be 14.0% (95% CI: 11.2-17.1). Family history of hypertension [AOR = 6.9, 95% CI: (3.62, 13.27)], drinking too much alcohol [AOR = 5.7, 95% CI: (2.97, 10.75)], physical inactivity [AOR = 2.5, 95% CI: (1.34, 4.73)], consuming street foods regularly [AOR = 2.8, 95% CI: (1.28, 6.01)], and seeking healthcare for hypertensive symptoms without serious illness [AOR = 2.4, 95% CI: (1.28, 4.56)] were significantly associated with developing undiagnosed hypertension.

Conclusion

The study has revealed that one in seven adults had undiagnosed hypertension in the study area. Thus, interventions to prevent hypertension should target increasing awareness among people with a family history of hypertension, controlling excessive alcohol consumption, promoting physical exercise, regulating street food markets, and improving the health-seeking behavior of adults in urban settings.

House-wall modification after indoor residual spraying in Shashogo district, southern Ethiopia

BACKGROUND

Indoor residual spraying has been a key national malaria prevention and control strategy in Ethiopia. However, there is a gap in monitoring and evaluation of house-wall modification after indoor residual spraying before the end of residual lifespan. This study has determined the prevalence of house-wall modification after indoor residual spraying and identified the associated factors in Shashogo district, southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from April to May 2022. Data were collected from 640 randomly selected households using a pre-tested questionnaire and an observational checklist. The binary logistic regression models were used to identify factors associated with house-wall modification after indoor residual spraying before the end of the potency period.

RESULTS

The prevalence of house-wall modification after indoor residual spraying was found to be 30.4% (95% CI 27.4-34.2%). Educational status of could not read and write [AOR = 1.76, 95% CI (1.16, 2.68)], monthly income of more than birr 3000 [AOR = 3.27, 95% CI (1.78, 6.01)], low level of knowledge about indoor residual spraying [AOR = 3.81, 95% CI (2.39, 6.06)], lack of information within two weeks before spraying [AOR = 2.23, 95% CI (1.44, 3.46)], absence of supervision after spraying [AOR = 1.79, 95% CI (1.14, 2.81)], absence of stagnant water near house [AOR = 3.36, 95% CI (2.13, 5.39)], and thatched roof [AOR = 1.82, 95% CI (1.04, 3.16)] were factors significantly associated with house-wall modification after indoor residual spraying.

CONCLUSION

This study has revealed that the prevalence of house-wall modification after indoor residual spraying before the end of the residual lifespan in the study area was higher compared to other studies in developing countries. Therefore, special emphasis should be given to providing community education about indoor residual spraying, conducting regular supervision before and after residual spraying, enforcing some legislative strategies for modifying the house-wall before six months after spraying, and improving environmental and housing conditions.

Neglected burden of injuries in Ethiopia, from 1990 to 2019: a systematic analysis of the global burden of diseases study 2019

Background

The 2030 agenda for sustainable development goals has given injury prevention new attention, including halving road traffic injuries. This study compiled the best available evidence on injury from the global burden of diseases study for Ethiopia from 1990 to 2019.

Methods

Injury data on incidence, prevalence, mortality, disability-adjusted life years lost, years lived with disability, and years of life lost were extracted from the 2019 global burden of diseases study for regions and chartered cities in Ethiopia from 1990 to 2019. Rates were estimated per 100,000 population.

Results

In 2019, the age-standardized rate of incidence was 7,118 (95% UI: 6,621-7,678), prevalence was 21,735 (95% UI: 19,251-26,302), death was 72 (95% UI: 61-83), disability-adjusted life years lost was 3,265 (95% UI: 2,826-3,783), years of live lost was 2,417 (95% UI: 2,043-2,860), and years lived with disability was 848 [95% UI: (620-1,153)]. Since 1990, there has been a reduction in the age-standardized rate of incidence by 76% (95% UI: 74-78), death by 70% (95% UI: 65-75), and prevalence by 13% (95% UI: 3-18), with noticeable inter-regional variations. Transport injuries, conflict and terrorism, interpersonal violence, self-harm, falls, poisoning, and exposure to mechanical forces were the leading causes of injury-related deaths and long-term disabilities. Since 1990, there has been a decline in the prevalence of transport injuries by 32% (95% UI: 31-33), exposure to mechanical forces by 12% (95% UI: 10-14), and interpersonal violence by 7.4% (95% UI: 5-10). However, there was an increment in falls by 8.4% (95% UI: 7-11) and conflict and terrorism by 1.5% (95% UI: 38-27).

Conclusion

Even though the burden of injuries has steadily decreased at national and sub-national levels in Ethiopia over the past 30 years, it still remains to be an area of public health priority. Therefore, injury prevention and control strategies should consider regional disparities in the burden of injuries, promoting transportation safety, developing democratic culture and negotiation skills to solve disputes, using early security-interventions when conflict arises, ensuring workplace safety and improving psychological wellbeing of citizens.

Dietary non-adherence and associated factors among individuals with diabetes who are on treatment follow up at Felege-Hiwot Referral Hospital, Northwest Ethiopia

Difficulty in adhering to the recommended diet is a common problem in individuals with diabetes mellitus (DM). Dietary non-adherence among diabetic individuals leads to diabetes related complication and death. As far as our search established, there is a scarcity of scientific evidence of dietary non-adherence of individuals with diabetes to the recommended diet in Ethiopia, specifically in the Northwest part of the country. Hence, this study aims to assess the dietary non-adherence and associated factors among individuals with diabetes at Felege-Hiwot Referral Hospital, Bahir Dar city, Northwest Ethiopia. An institution-based cross-sectional study was conducted on 385 systematically selected individuals with diabetes following their treatment from March to April 2017. Quantitative data were collected using a pre-tested and structured questionnaire. The dependent variable association with explanatory variables was determined using logistic regression. Statistical significance was considered at p-value <0.05 with 95% CI. The overall proportion of dietary non-adherence among participants was 46.8% (95% CI: 41.1-52.0). Living rurally (AOR = 3. 75; 95% CI: 2.12-6.63), duration of diabetes less than 5 years (AOR = 2. 81; 95% CI: 1.22-6.50), did not receive nutritional education (AOR = 5. 88; 95% CI: 3.30-10.48), poor social support (AOR = 3. 84; 95% CI: 1.74-8.46) and did not make choices when eating out (AOR = 3. 49; 95% CI: 2.09-5.81) were significantly associated with dietary non-adherence. Nearly half of the individuals with diabetes involved in this study did not adhere to the recommended diet. This problem could be addressed through the provision of nutritional education and strengthening social support to adhere to diabetes dietary recommendations. Therefore, health professional and nutritional educators should take appropriate action to increase the proportion of dietary adherence of individuals with diabetes.

Estimating the spatial risk of tuberculosis distribution in Gurage zone, southern Ethiopia: a geostatistical kriging approach

Background

In low-income countries it is difficult to obtain complete data that show spatial heterogeneity in the risk of tuberculosis within-and-between smaller administrative units. This may contribute to the partial effectiveness of tuberculosis control programs. The aim of this study was to estimate the spatial risk of tuberculosis distribution in Gurage Zone, Southern Ethiopia using limited spatial datasets.

Methods

A total of 1601 patient data that were retrieved from unit tuberculosis registers were included in the final analyses. The population and geo-location data were obtained from the Central Statistical Agency of Ethiopia. Altitude data were extracted from ASTER Global Digital Elevation Model Version 2. Aggregated datasets from sample of 169(40%), 254(60%) and 338(80%) kebeles were used to estimate the spatial risk of TB distribution in the Gurage Zone by using a geostatistical kriging approach. The best set of input parameters were decided based on the lowest prediction error criteria of the cross-validation technique. ArcGIS 10.2 was used for the spatial data analyses.

Results

The best semivariogram models were the Pentaspherical, Rational Quadratic, and K-Bessel for the 40, 60 and 80% spatial datasets, respectively. The predictive accuracies of the models have improved with the true anisotropy, altitude and latitude covariates, the change in detrending pattern from local to global, and the increase in size of spatial dataset. The risk of tuberculosis was estimated to be higher at western, northwest, southwest and southeast parts of the study area, and crossed between high and low at west-central parts.

Conclusion

This study has underlined that the geostatistical kriging approach can be applied to estimate the spatial risk of tuberculosis distribution in data limited settings. The estimation results may help local public health authorities measure burden of the disease at all locations, identify geographical areas that require more attention, and evaluate the impacts of intervention programs.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5711-3) contains supplementary material, which is available to authorized users.

Spatial and space-time clustering of tuberculosis in Gurage Zone, Southern Ethiopia

INTRODUCTION

Spatial targeting is advocated as an effective method that contributes for achieving tuberculosis control in high-burden countries. However, there is a paucity of studies clarifying the spatial nature of the disease in these countries. This study aims to identify the location, size and risk of purely spatial and space-time clusters for high occurrence of tuberculosis in Gurage Zone, Southern Ethiopia during 2007 to 2016.

MATERIALS AND METHODS

A total of 15,805 patient data that were retrieved from unit TB registers were included in the final analyses. The spatial and space-time cluster analyses were performed using the global Moran's I, Getis-Ord [Formula: see text] and Kulldorff's scan statistics.

RESULTS

Eleven purely spatial and three space-time clusters were detected (P <0.001).The clusters were concentrated in border areas of the Gurage Zone. There were considerable spatial variations in the risk of tuberculosis by year during the study period.

CONCLUSIONS

This study showed that tuberculosis clusters were mainly concentrated at border areas of the Gurage Zone during the study period, suggesting that there has been sustained transmission of the disease within these locations. The findings may help intensify the implementation of tuberculosis control activities in these locations. Further study is warranted to explore the roles of various ecological factors on the observed spatial distribution of tuberculosis.

Occupational injuries among building construction workers in Addis Ababa, Ethiopia

Background

Occupational injuries can pose direct costs, like suffering, loss of employment, disability and loss of productivity, and indirect costs on families and society. However, there is a dearth of studies clarifying the situation in most of Subsaharan African countries, like Ethiopia. The present study determined the prevalence of injury and associated factors among building construction employees in Addis Ababa, Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among building construction employees in Addis Ababa, Ethiopia from February to April 2015. Multi-stages sampling followed by simple random sampling techniques was used to select the study participants. The sample size of the study was 544. A pre-tested and structured questionnaire was used to collect data. Multivariable analyses were employed to see the effect of explanatory variables on injury.

Results

The prevalence of injury among building construction employees was reported to be 38.3 % [95 % CI: (33.9, 42.7)] in the past 1 year. Use of personal protective equipments, work experience, khat chewing were factors significantly associated with injury.

Conclusion

This is among the few studies describing construction health and safety in Ethiopia. In this study a relatively higher prevalence of injury was reported among building construction employees compared to other studies. If urgent interventions are not in place, the absence from work, loss of productivity and work-related illnesses, disabilities and fatalities will continue to be a major challenge of the construction industry in the future. Therefore, programs to mitigate the burden borne by construction-related injuries should focus on areas, such as provision of safety trainings, promoting use of PPE and monitoring substance abuse in workplace.

Stigma against Tuberculosis Patients in Addis Ababa, Ethiopia

Background

Stigma attached to tuberculosis contributes to the limited effectiveness of current TB control approaches. However, there is a dearth of studies that explore the causes of stigma attached to tuberculosis and its effects on patients and tuberculosiscontrol programs in Ethiopia.

Methods

An institution-based qualitative study was conducted at St. Peter Tuberculosis Specialized Hospital in Addis Ababa, Ethiopia from July to August, 2015. Ten in-depth interviews and 6 key-informant interviews were carried out among tuberculosis patients and healthcare workers, respectively.The Open Code computer software package was used to analyze the data thematically.

Results

The study revealed that fear of infection and inappropriate health education messages by media were the main causes of tuberculosis stigma. The patients experienced isolation within their family and community, separation, and financial crisis. The stigma attached to tuberculosis may contribute to delayed healthcare seeking, poor treatment adherence, and poor prognosis.

Conclusion

Interventions thatreduce the stigma attached to tuberculosis should target on areas, such as creating community awareness, patient counseling on problem-solving and emotional skills, preparing culturally sensitive and scientifically sound media messages, providing financial support for the patients, and enhancing the qualities of the healthcare workers, such as empathy, concern, respect for the patient and cultural sensitivity.

Awareness of occupational hazards and associated factors among welders in Lideta Sub-City, Addis Ababa, Ethiopia

Background

Welding is a manufacturing industry where workers could be exposed to several hazards. However, there is a dearth of studies clarifying the situation in Ethiopia. The present study determined the level of awareness of occupational hazards and associated factors among welding employees at Lideta Sub-City, Addis Ababa, Ethiopia.

Methods

A work site-based cross-sectional study was conducted among welding employees Lideta Sub-City, Addis Ababa, Ethiopia from April to May 2015. Stratified sampling followed by simple random sampling techniques was used to select the study participants. A pilot tested and structured questionnaire was used to collect data. Multivariable analyses were employed to see the effect of explanatory variables on workers’ awareness of occupational hazards.

Results

According to our criteria of awareness 86.5 % of surveyed workers were aware of occupational hazards. A higher work experience, presence of work regulation, job satisfaction, being married, being single, and a higher educational status were factors significantly associated with workers’ awareness of occupational hazards.

Conclusion

This study revealed that the level of awareness of occupational hazards among welders was high. However, this does not mean that there will be no need for further strengthening of the safety measures as significant proportions of the workers still had low awareness. Interventions to boost workers awareness of occupational hazards should focus on areas, such as provision of safety trainings, promotion of safety advocacy, and enforcement of appropriate workplace safety regulation.

Utilization of personal protective equipment and associated factors among textile factory workers at Hawassa Town, Southern Ethiopia

BACKGROUND

Use of personal protective equipment is one of the important measures to safeguard workers from exposure to occupational hazards, especially in developing countries. However, there is a dearth of studies describing personal protective equipment utilization in Ethiopia. The present study has determined the magnitude of personal protective equipment utilization and identified associated factors among textile factory workers at Hawassa Town, southern Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among textile factory workers at Hawassa Town, southern Ethiopia from January to March 2014. Stratified sampling followed by simple random sampling techniques was used to select the total of 660 study participants. A pre-tested and structured questionnaire was used to collect data. Multivariate analyses were employed to see the effect of explanatory variables on dependent variable.

RESULTS

The magnitude of personal protective equipment utilization was 82.4 %. Service duration of >10 years [AOR: 0.23, 95 % CI: (0.09, 0.58)], availability of personal protective equipments [AOR: 21.73, 95 % CI: (8.62, 54.79)], shift work [AOR: 2.28, 95 % CI: (1.12, 4.66)], alcohol drinking [AOR: 0.26, 95 % CI: (0.10, 0.66)], and cigarette smoking [AOR: 0.20, 95 % CI: (0.05, 0.78)] were factors significantly associated with use of personal protective equipment.

CONCLUSION

In this study a relatively higher personal protective equipment utilization rate was reported compared to other studies in developing countries. However, this does not mean that there will be no need for further strengthening the safety programs as there are significant proportion of the workers still does not use all the necessary personal protective equipment during work. Interventions to promote use personal protective equipment should focus on areas, such as service duration, availability of protective equipment, presence of shift work, and control of substance abuse.

Sickness absenteeism and associated factors among horticulture employees in lume district, southeast Ethiopia

Background

Sickness absenteeism is the major occupational health problem in developing countries where the majority of working population are engaged in hazardous sectors, such as agriculture. However, there is a dearth of studies clarifying the situation in most of Subsaharan African countries, like Ethiopia. The present study determined the magnitude of sickness absenteeism and associated factors among horticulture employees in Lume District, southeast Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among horticulture employees in Lume District, southeast Ethiopia from March to May 2014. Stratified sampling followed by simple random sampling techniques was used to select the study participants. A pre-tested and structured questionnaire was used to collect data. Multivariable analyses were employed to see the effect of explanatory variables on dependent variable.

Results

The magnitude of sickness absenteeism was 58.8 % [95 % CI: (54.9, 62.5)] in the past three months. Absence of periodic medical checkup, working for more than 48 h per week, working overtime, job dissatisfaction, and job stress were factors significantly associated with sickness absenteeism.

Conclusions

In this study a relatively higher rate of sickness absenteeism was reported compared to other studies. Interventions to reduce sickness absenteeism should focus on areas, such as periodic medical checkup, monitoring work schedules, improving employees’ job satisfaction, and managing job stress.

Appropriate health-seeking behavior and associated factors among people who had cough for at least two weeks in northwest Ethiopia: a population-based cross-sectional study

Background

Tuberculosis remains the major debilitating public health problem in Ethiopia. However, studies to understand the patients’ perspectives on the illness and their health-seeking behavior have been few in the country. In this study, we seek to investigate the magnitude of appropriate health-seeking behavior and factors associated with tuberculosis among people who had cough for at least two weeks.

Methods

A population-based cross-sectional study was conducted from July to October 2012 in Dabat, northwest Ethiopia. All people aged ≥15 years and had cough for at least two weeks were included in the study. Data collected by using a pre-tested and structured questionnaire were entered and cleaned using the Epi Info version 2002 statistical software. The statistical Package for the Social Sciences Version 16.0 was also employed for descriptive and logistics regression analysis.

Results

Out of the 25,701 people aged ≥15 years surveyed, the proportion of people who had cough for at least two weeks was reported to be 843(3.3%). Appropriate health-seeking behavior towards tuberculosis was reported by 674(80.0%) of them. Factors significantly associated with health-seeking behavior for tuberculosis were being female [AOR: 0.56, 95%CI: (0.39-0.79)], high monthly real per capita income [AOR: 1.66, 95%CI: (1.15-2.38)], large family size [AOR: 0.50, 95%CI: (0.35-0.72)], and use of traditional-healing practices [AOR: 13.27, 95%CI: (9.10-25.41)].

Conclusion

This study showed that the magnitude of appropriate health-seeking behavior during the event of chronic cough was high. However, this doesn’t mean that there will be no need for further strengthening of the intervention activities as significant proportions of the study communities still demonstrate inappropriate health-seeking behavior. So tuberculosis control programs need to emphasize factors, such as sex, family size, socioeconomic inequalities, and traditional-healing practices in resource-poor settings.

Agreement between physicians and the InterVA-4 model in assigning causes of death: the role of recall period and characteristics specific to the deceased and the respondent

BACKGROUND

In the absence of routine death registration, the InterVA model is a new methodology being used as a physician alternative method to interpret verbal autopsy (VA) data in resource-poor settings. However, various studies indicate that there are significant discrepancies between the two approaches in assigning causes of deaths. This study evaluated the role of recall period and characteristics that were specific to the deceased and the respondent in affecting the level of agreement between the approaches.

METHODS

A population-based cross-sectional study was conducted from March to April, 2012. All adults aged ≥14 years and died between 01 January, 2010, and 15 February, 2012, were included in the study. Data were collected by using a pre-tested and modified WHO designed verbal autopsy questionnaire. The verbal autopsy interviews were reviewed by the InterVA-4 model and the physicians. Cohen's kappa statistic with 95% CI was applied to compare the strength of the agreement between the model and the physician review.

RESULTS

A total of 408 VA interviews were successfully completed and reviewed by the InterVA model and the physicians. Both approaches showed an overall agreement in 294 (72.1%) of the cases [kappa = 0.48, 95% CI: 0.42 - 0.60]. The level of agreement between the approaches was low [kappa ≤0.40] when the deceased was female, 50 and above years old, single, illiterate, rural dweller, belonged to a family of 1-4 people living together, and died at home. This was also true when the recall period was ≤1 year, and the respondent was a relative other than parent/marital partner, lived with the deceased, and had medical information.

CONCLUSION

This study identified important variables affecting the strength of agreement between the InterVA-4 model and the physician in assigning causes of death. The results are believed to significantly contribute to the process of identifying the actual underlying causes of deaths in the population, and may thus serve to promote informed health policy decisions in resource-poor settings.

Evaluating the performance of interpreting Verbal Autopsy 3.2 model for establishing pulmonary tuberculosis as a cause of death in Ethiopia: a population-based cross-sectional study

Background

In resource- poor settings, verbal autopsy data are often reviewed by physicians in order to assign the probable cause of death. But in addition to being time and energy consuming, the method is liable to produce inconsistent results. The aim of this study is to evaluate the performance of the InterVA 3.2 model for establishing pulmonary tuberculosis as a cause of death in comparison with physician review of verbal autopsy data.

Methods

A population-based cross-sectional study was conducted from March to April, 2012. All adults aged ≥14 years and died between 01 January 2010 and 15 February 2012 were included in the study. Data were collected by using a pre-tested and modified WHO designed verbal autopsy questionnaire. The verbal autopsy interviews were reviewed by the InterVA model and the physicians. Cohen’s kappa statistic, receiver operating characteristic curves, sensitivity, and specificity values were applied to compare the agreement between the InterVA model and the physician review.

Results

A total of 408 adult deaths were studied. The proportion of tuberculosis-specific mortality was established to be 36.0% and 23.0% by the InterVA model and the physicians, respectively. The InterVA model predicted pulmonary tuberculosis as a cause of death with the probability of 0.80 (95% CI: 0.75-0.85). In classifying all deaths as tuberculosis and non-tuberculosis, the sensitivity and specificity values were 0.82 and 0.78, respectively. A moderate agreement was found between the model and physicians in assigning pulmonary tuberculosis as a cause of deaths [kappa= 0.5; 95% CI: (0.4-0.6)].

Conclusions

This study has revealed that the InterVA model showed a more promising result as a community-level tool for generating pulmonary tuberculosis-specific mortality data from verbal autopsy. The conclusion is believed to provide policymakers with a highly needed piece of information for allocating resources for health intervention.

Allogeneic stem cell transplantation corrects biochemical derangements in MNGIE

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a multisystemic autosomal recessive disease due to primary thymidine phosphorylase (TP) deficiency. To restore TP activity, we performed reduced intensity allogeneic stem cell transplantations (alloSCTs) in two patients. In the first, alloSCT failed to engraft, but the second achieved mixed donor chimerism, which partially restored buffy coat TP activity and lowered plasma nucleosides. Thus, alloSCT can correct biochemical abnormalities in the blood of patients with MNGIE, but clinical efficacy remains unproven.

Study on coccidiosis of scavenging indigenous chickens in Central Ethiopia

An investigation was made into coccidiosis of 190 scavenging indigenous chickens between September 2000 and April 2001 in three selected agroclimatic zones, in central Ethiopia. This was done through clinical, postmortem and microscopic examinations. Data were processed by chi-square and Mantel-Haenzel test. The study indicated that 25.8% (49/190) of the chickens were infected with coccidiosis and found to harbour one to four different species of Eimeria. Of these infected chickens, 30 (15.8%) and 19 (10.0%) were positive for clinical and sub-clinical coccidiosis, respectively. There was a significant altitude difference (chi2 = 14.7, p <0.001) in coccidiosis prevalence: 42.2% in chickens from highland region followed by 21.5% in mid-altitude and 13.1% in low-altitude areas. When quantified, the prevalence of coccidiosis was 2.66 and 4.83 times higher in the high-altitude than in mid-altitude (odds ratio, OR = 2.66, p<0.05) and low-altitude (OR = 4.83, p<0.001) chickens. The pathogenic Eimeria species responsible for clinical coccidiosis were E. necatrix, E. acervulina, E. maxima and E. tenella. With increasing demand for poultry products in developing countries, knowledge of production constraints in traditional management practices could help devise control strategies for constraints on backyard poultry production systems.

T-cell responses to Mycobacterium avium PPD antigens in gastro-intestinal helminth co-infected chickens in Central Ethiopia

A cross-sectional study was conducted on extensively reared chickens of three selected agro-climatic zones in Central Ethiopia to examine the predisposing effect of gastro-intestinal helminthes to intestinal Mycobacterium avium when it occurs as co-infection. This was done through a Lymphocyte Stimulation Test (LST) using avian PPD on peripheral blood mononuclear cells obtained from the blood of chickens and gross examination of digestive tract for the presence of helminth parasites. Data were analyzed using the statistical softwares SAS (1994) and Intercooled STATA version 6. Fourteen (14.7%) out of the 95 examined chickens were positive in in vitro LST showing stimulation index (SI) > or = 2. There was a significant (chi2 = 9.93, P < 0.01) difference in prevalence of M. avium by altitude: highest in chickens from lowland (27.8%) areas, followed by 13.3% in chickens from mid altitude and none was reacted to LST from highland region. A significant relationship (chi2 = 9.58, P < 0.01) in cestode co-infection with M. avium was found. There was no significant (chi2 = 1.66, P > 0.05) relationship in nematode co-infection with M. avium.

Phenotypic variability in a Spanish family with MNGIE

Clinical, biochemical, and genetic features of a Spanish family with mitochondrial neurogastrointestinal encephalomyopathy are reported. The proband presented with severe gastrointestinal dysmotility and the affected sister had extraocular muscle weakness. In both affected individuals, biochemical defects of thymidine phosphorylase and a pathogenic G-to-A transition mutation at nucleotide 435 in the thymidine phosphorylase gene were identified. The first thymidine phosphorylase mutation identified in Spain showed phenotypic variability at onset.

Defects of intergenomic communication: autosomal disorders that cause multiple deletions and depletion of mitochondrial DNA

Depletion and multiple deletions of mitochondrial DNA (mtDNA) have been associated with a growing number of autosomal diseases that have been classified as defects of intergenomic communication. MNGIE, an autosomal recessive disorder associated with mtDNA alterations is due to mutations in thymidine phosphorylase that may cause imbalance of the mitochondrial nucleotide pool. Subsequently, mutations in the mitochondrial proteins adenine nucleotide translocator 1, Twinkle, and polymerase gamma have been found to cause autosomal dominant progressive external ophthalmoplegia with multiple deletions of mtDNA. Uncovering the molecular bases of intergenomic communication defects will enhance our understanding of the mechanisms responsible for maintaining mtDNA integrity.

Leber's hereditary optic neuropathy mitochondrial DNA mutations in normal-tension glaucoma

BACKGROUND

in Leber's hereditary optic neuropathy, increased optic nerve cupping has been reported by several authors. Recently, a mitochondrial DNA (mtDNA) mutation at nucleotide 11778 typically associated with Leber's hereditary optic neuropathy (LHON) was identified in a patient treated for glaucoma but lacking typical signs of LHON. The question arises: should all normal-tension glaucoma patients be further evaluated for LHON?

METHODS

we screened 54 unselected patients with normal-tension glaucoma (age range 20-96 years, 16 men and 38 women) for the primary mtDNA LHON mutations at nucleotides 3460, 11778 and 14484.

RESULTS

none of the patients harboured the mtDNA mutations at nucleotides 3460, 11778 or 14484 (95% confidence intervals for each mutation ranged from 0% to 5.3%).

CONCLUSIONS

primary LHON mtDNA mutations are rare or absent in unselected normal-tension glaucoma patients. Therefore, unselected normal-tension glaucoma patients should not be screened for these mutations. It is probable that only normal-tension glaucoma patients with atypical features (rapid progression, early deep central scotoma, pallor of neuroretinal rim, elevated disc, peripapillary teleangiectasia) or a positive family history of visual loss compatible with a matrilinear transmission should be further evaluated.

Helicobacter pylori-selective antibacterials based on inhibition of pyrimidine biosynthesis

We report the discovery of a class of pyrazole-based compounds that are potent inhibitors of the dihydroorotate dehydrogenase of Helicobacter pylori but that do not inhibit the cognate enzymes from Gram-positive bacteria or humans. In culture these compounds inhibit the growth of H. pylori selectively, showing no effect on other Gram-negative or Gram-positive bacteria or human cell lines. These compounds represent the first examples of H. pylori-specific antibacterial agents. Cellular activity within this structural class appears to be due to dihydroorotate dehydrogenase inhibition. Minor structural changes that abrogate in vitro inhibition of the enzyme likewise eliminate cellular activity. Furthermore, the minimum inhibitory concentrations of these compounds increase upon addition of orotate to the culture medium in a concentration-dependent manner, consistent with dihydroorotate dehydrogenase inhibition as the mechanism of cellular inhibition. The data presented here suggest that targeted inhibition of de novo pyrimidine biosynthesis may be a valuable mechanism for the development of antimicrobial agents selective for H. pylori.

Mitochondrial neurogastrointestinal encephalomyopathy: an autosomal recessive disorder due to thymidine phosphorylase mutations

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder defined clinically by severe gastrointestinal dysmotility; cachexia; ptosis, ophthalmoparesis, or both; peripheral neuropathy; leukoencephalopathy; and mitochondrial abnormalities. The disease is caused by mutations in the thymidine phosphorylase (TP) gene. TP protein catalyzes phosphorolysis of thymidine to thymine and deoxyribose 1-phosphate. We identified 21 probands (35 patients) who fulfilled our clinical criteria for MNGIE. MNGIE has clinically homogeneous features but varies in age at onset and rate of progression. Gastrointestinal dysmotility is the most prominent manifestation, with recurrent diarrhea, borborygmi, and intestinal pseudo-obstruction. Patients usually die in early adulthood (mean, 37.6 years; range, 26-58 years). Cerebral leukodystrophy is characteristic. Mitochondrial DNA (mtDNA) has depletion, multiple deletions, or both. We have identified 16 TP mutations. Homozygous or compound heterozygous mutations were present in all patients tested. Leukocyte TP activity was reduced drastically in all patients tested, 0.009 +/- 0.021 micromol/hr/mg (mean +/- SD; n = 16), compared with controls, 0.67 +/- 0.21 micromol/hr/mg (n = 19). MNGIE is a recognizable clinical syndrome caused by mutations in thymidine phosphorylase. Severe reduction of TP activity in leukocytes is diagnostic. Altered mitochondrial nucleoside and nucleotide pools may impair mtDNA replication, repair, or both.

Diversity of lung and spleen immune responses in mice with slowly progressive primary tuberculosis

The aim of the present study was to assess the compartmentalized immune response, in terms of cytokine secretion and cell activation, in lungs and spleens of mice with slowly progressive primary tuberculosis. Immunocyte populations from both organs were isolated and stimulated with concanavalin A, purified protein derivatives and MPT 59. Production of interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) was measured using an enzyme-linked immunosorbent assay, and cell activation was measured using a tetrazolium colorimetric assay. The IFN-gamma and IL-4 levels in the supernatants of Mycobacterium tuberculosis antigen (Ag)-stimulated lung immunocytes from infected mice were higher than the levels from uninfected mice. However, only IL-4 levels were raised in the supernatants of Ag-stimulated spleen immunocytes from infected mice. Spontaneous and Ag-stimulated immunocyte activation was lower only in the lungs of infected mice compared with uninfected mice. The level of lung immunocyte activation was inversely associated with the extent of gross pulmonary pathology. In conclusion, cytokine secretion and cell activation were different between lungs and spleens in slowly progressive primary murine tuberculosis. Cytokine diversity may explain the confinement of tuberculous lesions in the lungs and the absence of lesions in the spleens of mice with slowly progressive tuberculosis.