Genetic diversity and structure of the coffee leaf rust fungus Hemileia vastatrix across different coffee management systems in Ethiopia / Diversidad genética y estructura del hongo de la roya del café Hemileia vastatrix en diferentes sistemas de manejo del café en Etiopía

Although coffee leaf rust (CLR), caused by Hemileia vastatrix, poses an increasing threat to coffee production in Ethiopia, little is known regarding its genetic diversity and structure and how these are affected by coffee management. Here, we used genetic fingerprinting based on sequence-related amplified polymorphism (SRAP) markers to genotype H. vastatrix samples from different coffee shrubs, across 40 sites, covering four coffee production systems (forest coffee, semi plantation coffee, home garden coffee, and plantation coffee) and different altitudes in Ethiopia. In total, 96 H. vastatrix samples were successfully genotyped with three primer combinations, producing a total of 79 scorable bands. We found 35.44% of amplified bands to be polymorphic, and the polymorphic information content (PIC) was 0.45, suggesting high genetic diversity among our CLR isolates. We also found significant isolation-by-distance across the samples investigated and detected significant differences in fungal genetic composition among plantation coffee and home garden coffee and a marginally significant difference among plantation coffee and forest coffee. Furthermore, we found a significant effect of altitude on CLR genetic composition in the forest coffee and plantation systems. Our results suggest that both spore dispersal and different selection pressures in the different coffee management systems are likely responsible for the observed high genetic diversity and genetic structure of CLR isolates in Ethiopia. When selecting Ethiopian coffee genotypes for crop improvement, it is important that these genotypes carry some resistance against CLR. Because our study shows large variation in genetic composition across relatively short geographical distances, a broad selection of rust isolates must be used for coffee resistance screening.(AU)

National estimate and associated factors of myopia among schoolchildren in Ethiopia: A systematic review and meta-analysis

Introduction Myopia is a global public health concern that has a significant socioeconomic and psychological impact on schoolchildren. If Myopic patients are not detected early, they are exposed to retinal detachment, cataracts, and glaucoma. There have been previous studies conducted in Ethiopia, but there is significant inconsistency among studies. Hence, the aim of this study was to provide a single figure as well as associated factors for Myopia among Ethiopian schoolchildren. Method The national and international databases and gray literature were searched for important research articles. This review included school-based cross-sectional studies that were reported in English. The data were extracted using Microsoft word and exported to Stata™ Version 17.0 statistical software for further management and analysis .The presence of heterogeneity was checked using Cochrane Q test via fixed effects model and presented by forest plots with 95% CI. Due to the presence of substantial heterogeneity, I2 test using random effects model was computed to estimate the effect size. The existing heterogeneity among studies was explained by regional difference. To identify factors associated with myopia, meta regression was computed and significant factors was reported using OR with 95% CI. Results In this systematic review and meta-analysis, 12 studies with a total of 9688 schoolchildren were included. The national estimate of myopia among schoolchildren in Ethiopia was 6.49% (95%CI: 4.86, 8.12). Having family history of myopia (OR: 9.18, 95%CI: 3.5,24.02) and being female (OR: 0.94, 95% CI: 0.50, 0.98) were the identified factors associated with myopia. Conclusion Myopia is one of the most prevalent childhood health condition in Ethiopia, which affects about one in every fourteen schoolchildren. Schoolchildren who had family history of myopia and being female were the identified risk factors of myopia among schoolchildren. ... (AU)

Physical activity and sports performance among Ethiopianuniversity students: the moderating role of self-esteem and the mediating effect of stress / Actividad física y rendimiento deportivo entre estudiantes universitarios etíopes: el papel moderador de la autoestima y el efecto mediador del estrés

The primary objective of this study was to investigate the impact of physical activity (PHA) on the academic performance (ACP) of university athletes in Ethiopia. The study also examined the moderating effect of self-esteem (SEE) and the mediating effect of stress control. In order to achieve the objectives of this study, the researchers adopted a quantitative cross-sectional design and employed well-established measurement instruments to evaluate the aforementioned variables. A purposive sampling technique was employed to gather data from a sample of 300 university sports students. The findings obtained from the application of Partial Least Squares (PLS)-Structural Equation Modelling (SEM) indicate a statistically significant and positive correlation between physical health attributes (PHA) and academic performance indicators (ACP). These results underscore the importance of incorporating physical fitness components into the academic curricula designed for university athletes. The study additionally showcased the efficacy of PHA as a stress management strategy by highlighting its notable impact on reducing stress levels. Furthermore, it has been observed that self-efficacy expectations (SEE) play a moderating role in the relationship between perceived academic performance (PHA) and academic career planning (ACP), thus emphasising the potential benefits of interventions aimed at enhancing SEE among students belonging to this particular demographic. The aforementioned observations contribute to a comprehensive understanding of the academic and psychological well-being of Ethiopian university athletes. Furthermore, they offer recommendations for tailored educational strategies aimed at fostering their overall development.(AU)

Staphylococcus aureus in cow milk and milk products in Ambo and Bako towns, Oromia, Ethiopia: prevalence, associated risk factors, hygienic quality, and antibiogram / Staphylococcus aureus en leche de vaca y productos lácteos en las ciudades de Ambo y Bako, Oromia, Etiopía: prevalencia, factores de riesgo asociados, calidad higiénica y antibiograma

Background: Staphylococcus aureus (S. aureus) is a foodborne bacterial pathogens that can cause staphylococcal food poisoning and contaminate food of animal origin worldwide. The current study was conducted to estimate the prevalence and assess risk factors, hygienic quality, and antibiogram of S. aureus in raw milk and milk products of cows in Ambo and Bako towns, Ethiopia. Results: The overall prevalence of S. aureus in milk and milk products was 15.6% (94/601) with the highest prevalence in bulk tank raw milk (17.50%) and the lowest in “Ergo” (13.11%). High S. aureus contamination at farm level were associated with poor farm hygiene, extensive management system, medium farm size, loose housing, and less frequent removal of bedding. At the cow level, a high S. aureus isolation rate was observed in crossbred cows; cows with age equal to or greater than 5 years old, tick infestation, history of mastitis treatment, and udder washing were not practiced before milking. On the other hand, the type of container, hygiene of milk handler, and container were the major risk factors for bulk tank milk contamination with S. aureus. S. aureus counts ranging from 1.25 × 104 to 1.92 × 104 CFU/mL were detected in 28.33% of the bulk tank milk samples.. Antimicrobial susceptibility test showed higher resistance of S. aureus to amoxicillin (98.48%), oxacillin (98.48%), ampicillin (98.48%), cefoxitin (92.42%), and tetracycline (83.33%), with 43.94% of isolates showing multidrug resistance (MDR). The high prevalence of oxacillin and cefoxitin-resistant isolates, which is a possible indicator of the existence of methicillin-resistant Staphylococcus aureus (MRSA), was also noted in the current study...(AU)

Cross-sectional study on breastfeeding related practices in rural Ethiopia: nutritional and socio-cultural aspects / Estudio transversal sobre prácticas relacionadas con la lactancia materna en Etiopía rural: Aspectos nutricionales y socioculturales

Introduction: There is strong evidence that the preven-tion of malnutrition in infants and children improves with ex-clusive breastfeeding during the first 6 months. Objectives: This cross-sectional community-based studyof 101 women aims to describe breastfeeding related prac-tices in two rural villages of the Oromia region of Ethiopia.Methods: Women having a live child under 4 years of agewere eligible for inclusion. Data were collected through semi-structured face-to-face interviews about maternal habits regard-ing breastfeeding, socio-cultural aspects and living conditions. Results: Only 3% of women followed WHO recommenda-tions and initiated breastfeeding <1h after birth. 35% startedbreastfeeding >1h after birth and 62% practiced pre-lactealfeeding. 48,6% of the mothers who initiated breastfeeding>1h after birth and 68.3% of the women who practiced pre-lacteal feeding gave birth at home and were attended by rel-atives while all who initiated breastfeeding <1h after birthgave birth in health centers. Conclusions: The information generated from this studycould be useful to design appropriate strategies for a nutri-tional education intervention program for women.(AU)

Introducción: Existe fuerte evidencia de que la prevención de la desnutrición en lactantes y niños mejora con la lactancia materna exclusiva durante los primeros 6 meses. Objetivos: Este estudio comunitario transversal de 101 mujeres tiene como objetivo describir las prácticas relacionadas con la lactancia materna en dos aldeas rurales de la región de Oromia en Etiopía. Métodos: Las mujeres que tenían un hijo vivo menor de 4 años fueron elegibles para su inclusión. Los datos fueron recolectados a través de entrevistas cara a cara semiestructuradas sobre hábitos maternos en relación con la lactancia materna, aspectos socioculturales y condiciones de vida. Resultados: Solo el 3% de las mujeres siguieron las recomendaciones de la OMS e iniciaron la lactancia materna <1h después del parto. El 35% inició lactancia materna >1h después del nacimiento y el 62% practicaba alimentación preláctea. El 48,6% de las madres que iniciaron la lactancia materna >1h después del parto y el 68,3% de las mujeres que practicaron lactancia preláctea dieron a luz en casa y fueron atendidas por familiares mientras que todas las que iniciaron la lactancia materna <1h después del parto dieron a luz en centros de salud. Conclusiones: La información generada a partir de este estudio podría ser útil para diseñar estrategias apropiadas para un programa de intervención de educación nutricional para mujeres.(AU)

Limitaciones del ensayo Xpert-MTB/RIF® en el diagnóstico inicial de tuberculosis en el contexto de un hospital rural en Etiopia / Limitations of the Xpert-MTB/RIF® assay in the initial diagnosis of tuberculosis in the context of a rural hospital in Ethiopia

Introducción. Evaluar la implantación del Xpert-MTB/RIF®, como técnica de diagnóstico precoz, en una zona rural de Etiopía. Material y métodos. Se recogieron retrospectivamente los datos de aquellos pacientes mayores de 13 años a los que se solicitó la prueba Xpert MTB/RIF® en un hospital rural situado a 45 km del laboratorio de referencia, durante los 3 primeros años de su implantación (abril 2015-abril 2018). Resultados. Se evaluaron 306 pacientes mayores de 13 años, en 85 (27,8%) hubo un error en el procesamiento de la prueba y no se obtuvo el resultado. De las 221 muestras con resultados, la mediana de tiempo entre la obtención de la muestra y la recepción del resultado fue de 21 días y 42 de ellas fueron positivas (19%, IC 95%: 14,2-24,9%). La muestra de mayor rentabilidad diagnóstica fue la adenopatía (88,8%; [8/9];p<0.001). Conclusiones. Hay más diagnósticos bacteriológicos con Xpert-MTB/RIF®, pero con una tardanza en obtener el resultado y no se logra su principal objetivo que es diagnóstico precoz. (AU)

Introduction. To evaluate the implementation of Xpert-MTB/RIF®, as an early diagnosis technique, in a rural area of Ethiopia. Material and methods. Data were retrospectively collected from those patients over 13 years of age who were requested to take the Xpert MTB/RIF® test in a rural hospital located 45 km from the reference laboratory, during the first 3 years of its implementation (2015, April -2018, April). Results. A total of 306 patients older than 13 years were evaluated, in 85 (27.8%) there was an error in the processing of the test and the result was not obtained. Of the 221 samples with results, the median time between obtaining the sample and receiving the result was 21 days and 42 of them were positive (19%, 95% CI: 14.2-24.9%). The sample with the highest diagnostic yield was adenopathy (88.8%; [8/9]; p<0.001). Conclusions. There are more bacteriological diagnoses with Xpert-MTB/RIF®, but with a delay in obtaining the result and its main objective, which is early diagnosis, is not achieved. (AU)

Vaccine matching and antigenic variability of foot-and-mouth disease virus serotypes O and A from 2018 Ethiopian isolates / Coincidencia de vacunas y variabilidad antigénica de los serotipos O y A del virus de la fiebre aftosa de aislamientos etíopes de 2018

Foot-and-mouth disease (FMD) is highly infectious, limits live animal trade, and affects ranchers owing to the loss of animal yield. The present study was designed to perform vaccine matching for field FMD virus isolates from clinically diseased cattle and assess the antigenic properties of the field isolates against the current vaccine strains used for vaccine production at the National Veterinary Institute, Ethiopia. Both sequencing and reverse transcription-polymerase chain reactions were used for distinguishing between the viral strains. To evaluate the serological relationship of the vaccine strain with these field isolates (r1 value), in vitro cross-neutralization was performed using ETH/6/2000 and ETH/38/2005 antisera. Infectious field FMD viral samples represented serotypes A and O. Sequence analysis showed that serotype A VP1/1D possessed amino acid variability at positions 28 and 42 to 48, 138, 141, 142, 148, 156, 173, and 197 compared with the ETH/6/2000 vaccine strain, whereas serotype O possessed amino acid variability at positions 45, 48, 138, 139, 140, 141, and 197 compared with the ETH/38/2005 vaccine strain. Based on the one-dimensional virus neutralization test, serotypes A and O demonstrated antigenic matching of up to 13/17 (76.47%) with the vaccine strain, except for the isolates ETH/40/2018, ETH/48/2018, ETH/55/2018, and ETH/61/2018, which had r-values less than 0.3. Therefore, the currently used vaccine strains ETH/38/2005 for serotype O and ETH/6/2000 for serotype A protected against all and most field viruses characterized as serotypes O and A, respectively, and amino acid residue variation was observed in different FMD virus B-C loops, G-H loops, and C-termini of VP1 at sites 1 and 3 in both serotypes.(AU)

Asociación entre desnutrición crónica y distensión abdominal en preescolares de Mizantéferi, sur-oeste de Etiopía / Association between chronic malnutrition and abdominal distension in prescholars of Mizantéferi, south-west Ethiopia

INTRODUCCIÓN: La desnutrición crónica es un problema de salud pública que afecta a 155 millones de menores de 5 años en el mundo. Un niño desnutrido es más susceptible a infecciones como las parasitarias intestinales causadas por helmintos y protozoos. Estas enfermedades dañan el estado de salud, contribuyendo al círculo vicioso entre desnutrición e infección. OBJETIVOS: El propósito de este estudio fue analizar la relación de la distensión abdominal y el retraso en el crecimiento. MÉTODOS: La muestra fue de 161 niños y niñas entre 3 y 6 años asistentes a un centro escolar en Mizantéferi, Etiopia. Se clasificaron en función de la talla para la edad de acuerdo a las referencias de crecimiento de la OMS, así como según su grado de distensión abdominal. RESULTADOS: Existe una asociación (p < 0.005). entre crecimiento retardado y distensión abdominal. El paso de desnutrición leve a moderada o de moderada a grave incrementa el riesgo de distensión abdominal 1,67 veces (IC95% 1,19 - 2,38). CONCLUSIONES: La distensión abdominal es un indicador fácil de reconocer que alerta sobre una potencial parasitosis intestinal

INTRODUCTION: Stunting is a public health problem that affects 155 million children under the age of five worldwide. A malnourished child is more susceptible to infections such as intestinal parasites caused by helminths and protozoa. These diseases damage health status, contributing to the vicious circle between malnutrition and infection. OBJECTIVES: The purpose of this study was to analyse the relationship between abdominal distension and growth retardation. METHODS: The sample was 161 children aged 3-6 years attending a school in Mizantéferi, Ethiopia. They were classified according to height-for-age according to WHO growth references, as well as according to their degree of abdominal distension. RESULTS: There is an association (p < 0.005) between growth retardation and abdominal distension. The change from mild to moderate or moderate to severe malnutrition increases the risk of abdominal distension 1.67 times (CI95% 1.19 - 2.38). CONCLUSIONS: Abdominal distension is an easily recognized indicator that warns of potential intestinal parasitosis

Macroscopic morphological variation of human placenta in normotensive and pre-eclamptic pregnant mothers, Northwest Ethiopia

The normal growth and development of the fetus depends on the proper growth and functioning of the placenta. The macroscopic morphology of the placenta is highly affected by pre-eclampsia. This study was carried out to assess macroscopic morphological variation of the human placenta among normotensive and pre-eclamptic pregnant mothers in Northwest Ethiopia. A cross-sectional study was conducted on 200 term placentas. One hundred fifty placentas from normotensive mothers and 50 placentas from pre-eclamptic mothers were included in the study. Placental parameters such as shape, weight, diameter, thickness and number of cotyledons were examined. Fetal weight was also detected. The data were analyzed by using independent two-sample t-test and chi-square test. According to this study, the majority (68%) of placentas in normotensive participants were discoid-shaped and 18% oval. While 54% of placenta in pre-eclamptic mothers were oval-shaped and 24% were irregular. Mean placental weight, diameter and number of cotyledon in pregnant mothers with pre-eclampsia were significantly reduced as compared to normotensive mothers. The mean birth weight in pre-eclamptic pregnancies was significantly (p = 0.0001) lower than the mean birth weight in normotensive pregnancies. As a conclusion, mean fetal weight, placental weight, diameter, thickness and numbers of cotyledon in pre-eclamptic mothers were significantly lower than in normotensive mothers (p-value < 0.05). Placenta shape difference between normotensive and pre-eclamptic mothers was detected (p-value < 0.001)

No disponible

Magnitude and determinants of uncontrolled blood pressure among hypertensive patients in Ethiopia: hospital-based observational study

Background: Hypertension is an important public health problem worldwide. There is lack of data on uncontrolled blood pressure in developing countries. Objectives: To determine the magnitude and predicting factors of uncontrolled blood pressure in hypertensive patients attending Gondar university hospital, Ethiopia. Methods: A hospital-based cross-sectional survey was conducted from July 2015 to March 2016. All hypertensive patients were followed and the blood pressure levels were measured. Binary logistic regression analysis was done to determine the predictors of uncontrolled blood pressure. A p-value of <0.05 was set at priori with 95% confidence interval to test the level of significance. Results: Of the total 578 hypertension patients, 543 (93.9%) fulfilled the study criteria and were included in the final analysis. The mean age of the participants was 55.96±14.6 years. Nearly two-third (58.2%) of the participants were females. More than one-tenth (11.4%) of the respondents had uncontrolled blood pressure. High salt intake carried six times more risk of uncontrolled blood pressure. Elderly individuals had lower risk as compared to young age group. However, comorbidities were not related with uncontrolled blood pressure. Conclusions: Blood pressure control was relatively high in the hospital studied. High salt intake was strongly linked with uncontrolled blood pressure. Individuals with high salt intake should be followed for their medication experience and disease knowledge

No disponible

Lepra en mujeres: estigma y dolor / No disponible

La lepra o enfermedad de Hansen es una enfermedad infecciosa crónica incapacitante. Esta enfermedad permanece en el olvido de la ciencia y de la investigación en el campo de la salud; las mujeres que la padecen sufren doblemente la exclusión, por su condición de enfermas y de mujeres. Ser mujer hará que tengan menos probabilidades que los hombres de ser diagnosticadas a tiempo, aumentando el riesgo de desarrollar una discapacidad de por vida. Lo que hace que se observe, dentro de la propia exclusión de la enfermedad, una triple discriminación en las mujeres y niñas enfermas de lepra, por su género, por las discapacidades que resultan de la enfermedad y por sufrir el impacto del estigma, lo que acentúa aún más su pobreza

Leprosy or Hansen's disease is a chronic disabling infectious disease. This disease remains in the oblivion of science and research in the field of health; women who suffer from it suffer double exclusion, because they are sick and women. Being a woman will make them less likely than men to be diagnosed early, increasing the risk of developing a disability for life. What makes observed, within the exclusion of the disease itself, a triple discrimination in women and girls suffering from leprosy, by their gender, by the disabilities that result from the disease and by suffering the impact of stigma, which it further accentuates their poverty

Challenges and opportunities of clinical pharmacy services in Ethiopia: a qualitative study from healthcare practitioners' perspective

Background: Currently, clinical pharmacists have in-depth therapeutic knowledge and scientific skills to act as drug therapy experts in healthcare settings. Objective:The aim of this study was to assess the opportunities and challenges of clinical pharmacy services from the health practitioners’ perspective in University of Gondar (UOG) hospital Ethiopia. Methods: A qualitative study was performed using face-to-face in-depth interviews with health practitioners who were directly involvedin clinical pharmacy services (clinical pharmacists, physicians, and nurses) in UOG hospital. Results: A total of 15 health professionals from various specialties were interviewed to express their views towards clinical pharmacists’ competencies and identified challenges and opportunities regarding their clinical services. Based on inter-viewees report,the opportunities for clinical pharmacists includes acceptance of their clinical services among health specialties, new government policy and high patient load in hospital. However, inadequacy of service promotions, lack of continuity of clinical pharmacy services in wards, poor drug information services, lack of commitment, lack of confidence among clinical pharmacists, conflict of interest due to unclear scope of practice, and absence of cooperation with health workers were some of the challenges identified by the interviewees. Conclusion: We identified health professionals working in UOG hospital are receptive towards clinical pharmacy services, but identified some of the potential challenges that needed to be focused to strengthen and promote clinical pharmacy services. Further, the opportunities at hand also need to be utilized astutely to boost the services (AU)

No disponible

The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study

Background: Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients. Objective: This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus. Methods: A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65) received the usual care while patients in the intervention group (n=62) received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6‐months with medication adherence (using Morisky medication adherence scale) and number of hospital admissions as the main outcome variables. Results: A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month) compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value<0.01). Furthermore, at the 6-month follow-up, only 23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (p< 0.001). Conclusions: The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes (AU)

No disponible

Características epidemiológicas en pacientes ingresados por lepra en un hospital rural de referencia en Etiopía durante 14 años / No disponible

Introducción: El objetivo del estudio fue analizar las características clínico epidemiológicas y evolutivas de los de los pacientes ingresados en una sala de hospitalización específica de la lepra. Métodos: Recogida retrospectiva de datos de pacientes ingresados por lepra usando los libros de registro de admisión desde septiembre 2002 hasta septiembre 2016 en el Hospital General Rural de Gambo. Resultados: Durante el período de estudio hubo 2.134 ingresos en la sala de lepra; de ellos 1.386 (64,9%) fueron hombres, el ratio de admisiones hombres /mujeres fue 1,9. Ciento ochenta pacientes (8,4%) pacientes tenían 18 años o menos. El número de casos nuevos fue 287 (13,4%) frente a los antiguos casos 1.847 (86,6%). Mil setecientos ochenta y cuatro pacientes presentaban lepra multibacilar (83,6%). El principal diagnóstico durante el ingreso fueron úlceras de piel neuropáticas (n=1280; 60%). Otros diagnósticos por orden de frecuencia fueron leprorreacción (n=305; 14,3%) y neuropatía (n=132; 6,2%). La mediana de estancia en el hospital fue 58 días (recorrido intercuartílico: 31-96,5). La mayoría de los pacientes se recuperaron satisfactoriamente al alta 1.822 (84,9%). La mortalidad fue baja 1,7%. Conclusiones: La mayoría de los pacientes eran varones, que ingresaron en el curso de la enfermedad (en tratamiento o antiguos leprosos), la mayoría adultos y principalmente por ulceraciones

Introduction: The objective of the study was to analyze the clinical and evolutionary characteristics of the patients admitted to a specific hospitalization room for leprosy at the Hospital Rural of Gambo .Methods: Retrospective data collection of patients admitted for leprosy using the admission logbooks from September 2002 to September 2016 at the General Rural Hospital of Gambo. Results: During the study period, there were 2,134 admissions in the leprosy ward; there were 1,386 (64.9%) men, the ratio of admissions for men / women was 1.9. One hundred and eighty patients (8.4%) were 18 years or younger. The number of new cases was 287 (13.4%) compared to the old cases, 1,847 (86.6%). One thousand seven hundred and eighty four patients presented multibacillary leprosy (83.6%). The main diagnosis during admission was neuropathic skin ulcers (n = 1280; 60%). Other diagnoses in order of frequency were leprosy reactions (n = 305, 14.3%) and neuropathy (n = 132, 6.2%). The median hospital stay was 58 days (interquartile range: 31-96.5). The majority of the patients recovered satisfactorily at the 1822 discharge (84.9%). Mortality was low 1.7%. Conclusions: The majority of the patients were men, who entered the course of the disease (in treatment or old lepers), most of them adults and mainly ulcerations

Self-reported and actual involvement of community pharmacists in patient counseling: a cross-sectional and simulated patient study in Gondar, Ethiopia

Background: Community pharmacists play a crucial role in reducing medication related health problems and improving the patient’s overall wellbeing. Evidence suggests that community pharmacist led counseling services result in a better clinical and self-reported outcome, including a higher level of satisfaction and quality of life. Objective: This study aims to document self-reported and actual levels of community pharmacists’ involvement in the provision of patient counseling and barriers that limit their involvement in such services. Methods: Simulated patient visits and a cross-sectional survey of community pharmacists were employed in Gondar town, Ethiopia between March 15 and May 15, 2016 to observe actual counseling practices and to assess their reported counseling practices respectively. Four different scenarios were developed for the simulated patient visit. A well designed questionnaire and an assessment form were used for the survey and simulated patient visit. Results: In the cross-sectional survey, 84 pharmacists were approached and 78 agreed to participate (92.8 % response rate). Of the respondents, 96.1% agreed/strongly agreed that patient counseling is important and 69.3% strongly agreed that patient counseling should be a professional duty. The most frequent information provided to patients were dosing schedule of drugs, how to take medication, and drug-food interaction. Majority of community pharmacists either strongly agreed (42.1%) or agreed (51.3%) that patients are comfortable towards their counseling practice. A total of 48 simulated visits were conducted and a medicine was dispensed in all visits. In all four scenarios, dosage schedule (100%), how to take medication (97.6%) and drug-food interaction (69.1%) were the most common type of information provided while what to do when dose is missed (100%), contraindication (95.2%) and the importance of compliance or adherence (92.9%) were the most commonly ignored types of information. Conclusions: The present study emphasizes the existing gap in self-reported and actual counseling practices by community pharmacist in Gondar town, Ethiopia. Hence, the ministry of health, local health policy makers and other stakeholders should collaborate to design interventions to improve community pharmacists’ dispensing and counseling practice (AU)

No disponible

Acuerdo de colaboración entre el Hospital Ayder y Etiopia-Utopía ONG / Collaboration agreement between Ayder Hospital and Ethiopia-Utopía NGO

En el ámbito del convenio de julio de 2014 entre el Servicio Vasco de Salud/Osakidetza y el Hospital Universitario Ayder de Mekelle en Etiopía, comienza una colaboración en respuesta a la demanda de necesidades del centro, entre otras de Cirugía Plástica, a través de la organización no gubernamental Etiopía-Utopía. Uno de los objetivos se concreta en la colaboración con Ortopedia y Cirugía General, así como en la asistencia a quemados. También se definen objetivos de mantenimiento, infraestructura y otras especialidades no menos importantes. Comenzamos con una estancia de un mes, marzo a abril de 2015, colaborando en consultas, salas y realizando 18 cirugías en 17 pacientes, además de tratar aspectos docentes y de material sanitario. Más tarde desarrollamos una segunda campaña entre julio y agosto de 2016, ya con la colaboración de cirujanos plásticos locales, en la que llevamos a cabo 38 procedimientos quirúrgicos. En estas campañas insistimos en la necesidad de integración con el personal médicosanitario a través de los médicos residentes para romper el obstáculo idiomático de comunicación con los pacientes que sólo se expresan en las lenguas indígenas propias. Superados y reflexionados críticamente los resultados de los primeros contactos, la experiencia nos llevó a concretar los objetivos con mayor precisión y a plantearlos bajo la perspectiva del campo de la Cirugía Plástica, no sólo en la atención a pacientes quemados, sino para atender una demanda asistencial diferente, mayor y adaptada a la realidad. Exponemos nuestra experiencia en 3 vertientes: la asistencial, la docente y la de información para la prevención de quemaduras, que además están influidas por las aportaciones materiales y los cambios necesarios, con lo que los resultados obtenidos son sin duda mejorables, pero también críticamente satisfactorios salvo en el objetivo de la prevención (AU)

In the ambit of of July 2014 agreement between the Basque Health Service/Osakidetza and the University Hospital Ayder of Mekelle in Ethiopia, collaboration in response to the demand center needs was initiated, including Plastic Surgery, through the nongovernmental organization Ethiopia-Utopia. One of the objectives embodied collaboration with Orthopedics and General Surgery, as well as in assisting burned patients. Maintenance objectives, infrastructure and other no less important specialties are also defined. We started with a stay of one month, from March to April 2015, working in consultation rooms and performing 18 surgeries in 17 patients, in addition to treating teaching and hospital aspects. Later on, we follow with a second stay between June and July 2016, this time with the collaboration of local plastic surgeons and 38 surgical procedures performed. We emphasized about the necessary integration with the medical and health personnel through medical residents to break the language barrier and get in communication with patients who only expressed in the indigenous languages. Overcome and critically reflected upon the results of the first contacts, the experience led us to realize the objectives more precisely and raise them from the perspective of the field of Plastic Surgery, not only in the care of burn patients, but to meet a different demand for care, more adapted to reality. We describe our experience in 3 aspects: care, teaching and information for the prevention of burns, which are also influenced by material inputs and necessary changes, so that the results are certainly for improvement but also critically successful except the goal of prevention (AU)

Características de los niños con enfermedad tuberculosa en Meki (Etiopía): el reto del diagnóstico con recursos limitados / Characteristics of children with tuberculosis in Meki (Ethiopia): the challenge of diagnosis with limited resources

Introducción: La tuberculosis (TB), una enfermedad prevenible y curable, es la primera causa de morbimortalidad en Etiopía. El diagnóstico en niños presenta importantes retos, debido al carácter paucibacilar de la enfermedad. Describimos las características de los niños diagnosticados de enfermedad tuberculosa (ETB) en la clínica Let Children Have Health de Meki, Etiopía. Métodos: Estudio descriptivo-retrospectivo de los niños diagnosticados de ETB desde enero hasta diciembre de 2013. Se incluyeron las características antropométricas, clínicas, analíticas y radiológicas. Se clasificó la ETB confirmada, probable y posible según los criterios en el momento del diagnóstico, y la afectación de ETB en pulmonar y extrapulmonar (cualquier forma de manifestación extratorácica, incluida la TB miliar). Resultados: Se diagnosticaron 38 niños: 35 con TB probable y 3 con TB posible. El cultivo de icobacterias no estuvo disponible. La mediana de edad fue de 8 años. El 50% presentó TB pulmonar, el 37% ETB mixta, 4 niños formas extrapulmonares y 1 TB miliar. En el momento del diagnóstico, 32 niños (84%) referían tos, 31 (81%) fiebre y 15 (39%) adenitis; 15 (39,5%) tenían antecedentes familiares de ETB, y ninguno de ellos había recibido quimioprofilaxis como contacto. Se detectó desnutrición aguda (diagnosticada a partir del perímetro medio del brazo o de la relación peso/talla) en 13 niños (31%). Cuatro niños presentaron baciloscopia en esputo positiva (todos mayores de 7 años). En 1 niño se confirmó el diagnóstico por baciloscopia positiva mediante punción-aspiración con aguja fina de adenopatía, y otro precisó cirugía por obstrucción intestinal, con baciloscopia positiva en las muestras quirúrgicas. Se realizó el test de Mantoux a 13 niños, que resultó positivo en 9. Se realizó el test rápido del virus de la inmunodeficiencia humana a 22 niños, cuyos resultados fueron todos negativos. La evolución de todos los niños fue buena. Conclusiones: El diagnóstico de ETB continúa siendo tardío. Debe promoverse la identificación y la administración de quimioprofilaxis a los niños expuestos, además de la búsqueda activa de ETB en programas ya implementados, como el programa de desnutrición local. La presentación extrapulmonar es muy prevalente, por lo que siempre debe tenerse en cuenta (AU)

Introduction: Tuberculosis (TB), a preventable and curable disease, is the first cause of morbidity and mortality in Ethiopia. The diagnosis in children presents important challenges due to paucibacillary character of the disease. We describe the characteristics of children diagnosed of TB at the Pediatric Clinic Let Children Have Health in Meki, Ethiopia. Methods: Retrospective study of children diagnosed of TB from January to December 2013. Anthropometric, clinical, laboratory and radiological findings at the time of diagnosis were included. TB was classified as confirmed TB, probable TB and possible TB for categories at diagnostic. And by involvement: pulmonary TB and extrapulmonary TB (any form of extrathoracic manifestations, including TB miliary). Results: 38 children were diagnosed: 35 probable TB, 3 possible TB; mycobacterium culture was not available. The median age was 8 years. 50% of them had pulmonary TB, 37% mixed TB, 4 children extra-pulmonary forms and 1 miliary TB. At the time of diagnosis, 32 (84%) reported cough, 31 (81%) fever, 15 (39%) lymphadenitis. 15 (39.5%) had a family history of TB, none of them had received quimioprophylaxis contact. Malnutrition (defined by mid upper arm circumference or weight/height) was detected in 13 children (34%). Four children had positive smear sputum (all of them older than 7 years). In a child diagnosis was confirmed by smear-positive in lymph node biopsy, and one required surgery due to intestinal obstruction, smear positive in surgical specimens. Mantoux was performed in 13 children, remaining positive in 9. HIV rapid test was conducted to 22 children, all of them were negative. The evolution of all children was good. Conclusions: Diagnosis of TB continues being delayed. Identification of exposed children and active searching in other programs already implemented such as local program malnutrition should be promoted. Extrapulmonary presentation is very prevalent and should always be considered (AU)

Un día de hambre / Um dia da fome / A day of hunger

Mi vivencia en África como cooperante me hizo reflexionar sobre la importancia de la muerte de un hijo y la mirada desde diferentes situaciones y culturas. En la sociedad europea, suponemos que los progenitores deben sobrevivir a sus hijos y que darían la vida por sus hijos. En Etiopía donde familias no tienen dinero suficiente para asegurarse un aporte mínimo de los alimentos necesarios, las madres vienen en tan malas condiciones que son incapaces de dar la lactancia, y las personas están acostumbradas a que los primeros años son los más críticos, los más difíciles, en que están acostumbrados a perder en esos años a sus hermanos, hijos, nietos, sobrinos o amigos (AU)

Minha experiência como voluntário na África me fez refletir sobre a importância da morte de uma criança e olhar para diferentes situações e culturas. Na sociedade europeia, assumimos que os pais devem sobreviver a seus filhos e que morreria por seus filhos. Na Etiópia, onde as famílias não têm condições de fazer uma contribuição mínima de alimentos necessária, as mães vêm em tão má forma que eles são incapazes de dar a amamentação, e as pessoas estão acostumadas aos primeiros anos são os mais críticos, o mais difícil, já que eles estão acostumados a perder naqueles anos a seus irmãos, filhos, netos, sobrinhos e amigos (AU)

My experience as a volunteer in Africa made me reflect on the importance of the death of a child and look for different situations and cultures. In European society, we assume that parents should outlive their children and who would die for their children. In Ethiopia where families can not afford to make a minimum contribution of food needed, mothers come in such bad shape that they are unable to give breastfeeding, and people are accustomed to the early years are the most critical, the most difficult, as they are accustomed to losing in those years to his brothers, sons, grandsons, nephews and friends (AU)

Comparison of anti-retroviral therapy treatment strategies in prevention of mother-to-child transmission in a teaching hospital in Ethiopia / Comparación de estrategias de tratamiento antirretroviral en prevención de transmisión madre a hijo en un hospital universitario de Etiopia

Background: More than 90% of Human immunodeficiency virus (HIV) infection in children is acquired due to mother-to-child transmission, which is spreading during pregnancy, delivery or breastfeeding. Method: A hospital based retrospective cohort study was conducted on HIV infected pregnant mothers who gave birth and had follow up at anti-retroviral therapy (ART) clinic for at least 6 months during a time period paired with their infants. The primary and secondary outcomes were rate of infant infection by HIV at 6 weeks and 6 months respectively. The Chi-square was used for the comparison of categorical data multivariate logistic regression model was used to identify the determinants of early mother-to-child transmission of HIV at 6 weeks. Cox proportional hazard model was used to analyze factors that affect the 6 month HIV free survival of infants born to HIV infected mothers. Results: A total of 180 mother infant pairs were considered for the final analysis, 90(50%) mothers received single dose nevirapine (sdNVP) designated as regimen-3, 67 (37.2%) mothers were on different types of ARV regimens commonly AZT + 3TC + NVP (regimen-1), while the rest 23 (12.8%) mothers were on short course dual regimen AZT + 3TC + sdNVP (regimen-2). Early mother-to-child transmission rate at 6 weeks for regimens 1, 2 and 3 were 5.9% (4/67), 8.6% (2/23), and 15.5% (14/90) respectively. The late cumulative mother-to-child transmission rate of HIV at 6 months regardless of regimen type was 15.5% (28/180). Postnatal transmission at 6 months was 28.5% (8/28) of infected children. Factors that were found to be associated with high risk of early mother-to-child transmission of HIV include duration of ARV regimen shorter than 2 months during pregnancy (OR=4.3, 95%CI =1.38-13.46), base line CD4 less than 350 cells/cubic mm (OR=6.98, 95%CI=0.91-53.76), early infant infection (OR=5.4, 95%CI=2.04-14.4), infants delivered home (OR=13.1, 95%CI=2.69-63.7), infant with birth weight less than 2500 g (OR=6.41, 95%CI=2.21-18.61), and mixed infant feeding (OR=6.7, 95%CI=2.2-20.4). Antiretroviral regimen duration less than 2 months, maternal base line CD4 less than 350 cells/cubic mm and mixed infant feeding were also important risk factors for late infant infection or death. Conclusion: The effectiveness of multiple antiretroviral drugs in prevention of early mother-to-child transmission of HIV was found to be more effective than that of single dose nevirapine, although, the difference was not statistically significant. But in late transmission, a significant difference was observed in which infants born to mother who received multiple antiretroviral drugs were less likely to progress to infection or death than infants born to mothers who received single dose nevirapine (AU)

Antecedentes: Más del 90% de la infección por virus de inmunodeficiencia humana (VIH) en niños es adquirida debido a una transmisión madre-hijo que se establece durante el embarazo, parto o lactación. Objetivo: Determinar la efectividad de antiretrovirales altamente activos en la prevención de la transmisión madre-hijo del VIH y sus factores asociados en el Hospital Universitario de JIMMA (JUSH). Método: Se realizó un estudio de cohorte retrospectiva sobre madres que dieron a luz infectadas de VIH y tuvieron seguimiento en la Clinica de tratamiento antirretroviral (ART) por al menos un periodo de 6 meses emparejado con sus hijos. Los resultados primarios y secundarios fueron la tasa de infección por VIH en niños a las 6 semanas y 6 meses, respectivamente. Se utilizó el chi-cuadrado para comparación de los datos categóricos y un modelo de regresión logística multivariado para identificar los determinantes de transmisión temprana madre-hijo a las 6 semanas. Se usó el modelo de riesgo proporcional de Cox para analizar los factores que afectaron la supervivencia libre de VIH a 6 meses de niños nacidos de madres con VIH. Resultados: Se consideraron un total de 180 pares madre/hijo para el análisis final, 90 (50%) madres recibieron una dosis única de nevirapina (sdNVP) denominado régimen-3, 67 (37,2%) madres recibieron diferentes tipos de regímenes ARV, normalmente AZT+3TC+NVP (régimen-1), mientras que las restantes 23 (12,8%) estuvieron a tratamiento con un régimen corto de AZT + 3TC + sdNVP (régimen-2). La tasa temprana de transmisión madre-hijo a 6 semanas para los regímenes 1, 2 y 3 fue 5,9% (4/67), 8,6% (2/23), y 15,5% (14/90), respectivamente. La tasa tardía acumulativa de transmisión madre-hijo a los 6 meses, independientemente del régimen, fue del 15,5% (28/180). La transmisión postnatal a 6 meses fue del 28,5% (8/28) de los niños infectados. Los factores que se encontraron asociados a alto riesgo de transmisión de VIH madre-hijo incluían la duración del régimen ARV menor de 2 meses durante el embarazo (OR=4,3; 95%CI =1,38-13,46), CD4 al inicio de menos de 350 células/mm cubico (OR=6,98; 95%CI=0,91-53,76) , infección temprana del niño (OR=5,4, 95%CI=2,04-14,4), niños nacidos en casa (OR=13,1; 95%CI=2,69-63,7), niños nacidos con peso menor de 2500 g (OR=6,41; 95%CI=2,21-18,61), y alimentación infantil mixta (OR=6,7; 95%CI=2,2-20,4). La duración del régimen menor de 2 meses, las CD4 iniciales en menos de 350 celulas7mm cubico y la alimentación infantil mixta fueron también factores de riesgo importantes para infección infantil tardía y muerte. Conclusión: se encontró que la efectividad de los tratamientos antirretrovirales múltiples para la prevención de transmisión temprana madre-hijo de VIH era más efectiva que la dosis única de nevirapina, aunque la diferencia no era estadísticamente significativa. Pero en transmisión tardía, se observó una diferencia significativa en la que los niños nacidos de madres que recibieron tratamientos antirretrovirales múltiples tenían menos probabilidad de progresar hacia la infección que los niños de madres tratadas con una dosis única de nevirapina (AU)

Adopción internacional de Etiopía en un período de 5 años / International adoption from Ethiopia in a 5-year period

INTRODUCCIÓN: La adopción internacional (AI) en nuestro país es un fenómeno reciente, siendo Etiopía uno de los países de origen más frecuentes. El objetivo principal del estudio es determinar la prevalencia de enfermedades infecciosas en los niños adoptados procedentes de Etiopía y valorar su estado nutricional. MÉTODO: Estudio de cohortes prospectivo, observacional. Se evalúa una cohorte de 251 niños adoptados en España procedentes de Etiopía (período del 1 de enero del 2006 y al 31 de diciembre del 2010). RESULTADOS: La edad media fue de 7 meses (90% de ellos menores de 5 años). Se detectó alguna anomalía en la exploración física en el 56,6%. La mitad de la muestra presentó un peso por debajo del tercer percentil, encontrándose algún grado de malnutrición en el 65% de los niños. Desde el punto de vista infeccioso, el hallazgo más frecuente fue la afectación cutánea. El 15,1% de los pacientes presentaba diarrea en el momento de la exploración. En las pruebas analíticas destacan: leucocitosis > 15.000/μL en el 8,8% e hipertransaminasemia en el 29% de los pacientes. La serología de VIH fue positiva en el 4,8% de los casos, mientras que la PCR-VIH fue positiva en el 0,8%. CONCLUSIONES: Predomina la adopción en los 5 primeros años de la vida. El bajo peso fue el hallazgo más frecuente en esta muestra. Las enfermedades infecciosas deberían ser sistemáticamente descartadas, incluso con la utilización de PCR-VIH dado que la exposición al virus no es infrecuente

INTRODUCTION: An increase in the number of internationally adopted children has been observed in the last few years. The country of origin that has experienced a greater increase is Ethiopia. The health of internationally adopted children from Ethiopia has not been extensively assessed to date. The main objective of the study is to determine the prevalence of infectious diseases in children adopted from Ethiopia, and to assess their nutritional status. METHOD: A prospective, observational cohort study was conducted using the medical records of 251 children adopted from Ethiopia to Spain in the period from Jan 1, 2006 and December 31, 2010. RESULTS: The mean age of the children was 7 months (range 1-120). Abnormalities were detected on physical examination in 56.6%. In 90% of cases the child was less than 5 years-old. Half of the sample had a weight below the third percentile, with some degree of malnutrition in 65% of the children. HIV exposure was not uncommon (4.8%). CONCLUSIONS: Low weight and acute gastroenteritis were the main findings in this cohort. Infectious diseases should be systematically assessed