Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys.

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

Prevalence of Trachoma After Three Rounds of Antibiotic Mass Drug Administration in 13 Woredas of Gambella Region, Ethiopia.

BACKGROUND: Following baseline surveys in 2013 and 2014, trachoma elimination interventions, including three rounds of azithromycin mass drug administration (MDA), were implemented in 13 woredas (administrative districts) of Gambella Regional State, Ethiopia. We conducted impact surveys to determine if elimination thresholds have been met or if additional interventions are required. METHODS: Cross-sectional population-based surveys were conducted in 13 woredas of Gambella Regional State, combined into five evaluation units (EUs), 6─12 months after their last MDA round. A two-stage systematic (first stage) and random (second stage) sampling technique was used. WHO-recommended protocols were implemented with the support of Tropical Data. Household water, sanitation and hygiene (WASH) access was assessed. RESULTS: The age-adjusted prevalence of trachomatous inflammation - follicular (TF) in 1-9-year-olds in the five EUs ranged from 0.3-19.2%, representing a general decline in TF prevalence compared to baseline estimates. The age- and gender-adjusted prevalence of trachomatous trichiasis (TT) unknown to the health system in those aged ≥ 15 years ranged from 0.47-3.08%. Of households surveyed, 44% had access to an improved drinking water source within a 30-minute return journey of the house, but only 3% had access to an improved latrine. CONCLUSION: In two EUs, no further MDA should be delivered, and a surveillance survey should be conducted after two years without MDA. In one EU, one further round of MDA should be conducted followed by another impact survey. In two EUs, three further MDA rounds are required. Surgery, facial cleanliness and environmental improvement interventions are needed throughout the region.

Prevalence of Trachoma after Implementation of Trachoma Elimination Interventions in Oromia Regional State, Ethiopia: Results of Impact Surveys in 131 Evaluation Units Covering 139 Districts.

PURPOSE: To determine the prevalence of trachomatous inflammation-follicular (TF), trachomatous trichiasis (TT), water, sanitation, and hygiene (WASH) access in 131 evaluation units (EUs) after implementation of trachoma elimination interventions in Oromia Region, Ethiopia. METHODOLOGY: A population-based cross-sectional survey was conducted in each EU using the World Health Organization-recommended two-stage cluster-sampling methodology. Twenty-six clusters, each with a mean of 30 households were enumerated in each EU. All residents aged ≥1 year in selected households were examined for TF and TT. Information on WASH access in surveyed households was also collected through questioning the household head and direct observation. RESULTS: A total of 419,858 individuals were enumerated in 131 EUs, of whom 396,134 (94%) were examined, 54% being female. Age-adjusted EU-level prevalence of TF in children aged 1-9 years ranged from 0.15% (95% confidence interval [CI]: 0.0-0.4) to 37.5% (95% CI: 31.1-43.7). The TF prevalence was <5% in 73/131 (56%) EUs. The EU-level age- and gender-adjusted prevalence of TT unknown to the health system among people aged ≥15 years ranged from 0.001% (95% CI: 0.00-0.02) to 2.2% (95% CI: 1.1-3.1) with 37/131 (28%) EUs having a prevalence <0.2%. Only 48% of all households surveyed had access to improved water sources for drinking. Approximately 96% of households did not have an improved latrine. CONCLUSION: Oromia is on the path towards elimination of trachoma as a public health problem.

Prevalence of Trachoma in Pre-validation Surveillance Surveys in 11 Evaluation Units (Covering 12 Districts) in Oromia Regional State, Ethiopia: Results from 2018-2020.

PURPOSE: Interventions to reduce the prevalence of trachoma and transmission of ocular Chlamydia trachomatis have been implemented in Oromia Region, Ethiopia. Following an impact survey in which the trachomatous inflammation-follicular (TF) prevalence in 1-9-year-olds is <5%, a surveillance survey is recommended 2 years later, without additional antibiotic treatment. We report results of surveillance surveys in 11 evaluation units (EUs) covering 12 districts in Oromia Region, to plan whether future interventions are needed. METHOD: We use a two-stage cluster-sampling cross-sectional survey design. In each EU, 26 clusters (villages) were systematically selected with probability proportional to size; from each cluster, 30 households were selected using compact segment sampling. Water, sanitation and hygiene (WASH) access was assessed in all selected households. All residents of selected households aged ≥1 year were examined for TF and trachomatous trichiasis (TT) by certified graders. RESULT: Of 31,991 individuals enumerated, 29,230 (91% of) individuals were examined. Eight EUs had an age-adjusted TF prevalence in 1-9-year-olds of ≥5% and seven had a TT prevalence unknown to the health system among adults aged ≥15 years of ≥0.2%. About one-third of visited households had access to an improved water source for drinking, and 5% had access to an improved latrine. CONCLUSION: Despite TF reductions to <5% at impact survey, prevalence recrudesced to ≥5% in all but three of the 11 EUs. Operational research is needed to understand transmission dynamics and epidemiology, in order to optimise elimination strategies in high-transmission settings like these.

Prevalence of Trachoma in Benishangul Gumuz Region, Ethiopia, after Implementation of the SAFE Strategy: Results of Four Population-Based Surveys.

PURPOSE: We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds in Benishangul Gumuz (BGZ) region, Ethiopia. This will help to assess progress towards the elimination of trachoma as a public health problem and determine the need for future interventions against trachoma in the region. METHODS: Cross-sectional population-based trachoma prevalence surveys were conducted in four evaluation units (EUs) of BGZ using World Health Organization-recommended survey methodologies. Individuals were examined for clinical signs of trachoma. Household access to water, sanitation and hygiene facilities (WaSH) was assessed. RESULTS: A total of 11,778 people aged ≥1 year were examined. The prevalence of TF in 1-9-year-olds was <5% in three EUs and ≥5% in one EU. The prevalence of TT unknown to the health system in people aged ≥15-years was ≥0.2% in all four EUs. The proportion of households with an improved drinking water source within a 30-minute round-trip ranged from 27-60%. The proportion of households with an improved latrine ranged from <1-6%. CONCLUSIONS: Surgical interventions for TT are required in all EUs in BGZ. One annual round of mass drug administration (MDA) of azithromycin is required in one EU before resurvey to reassess progress in lowering TF prevalence below the WHO elimination threshold of 5% in 1-9-year-olds. MDA should be stopped in the other three EUs and trachoma surveillance surveys should be conducted at least 24 months after the surveys described here. Ongoing strengthening of WaSH infrastructure may help sustain the low prevalence of trachoma.

Size Effect of Nanoceria Blended with CIME Biodiesel on Engine Characteristics.

Diesel fuel blends with biodiesels are expected to mitigate the rising price and demand of conventional fuels. Biodiesel fuel blends are also known to reduce engine emissions. Biodiesel is produced from various sources, one of which is Calophyllum Inophyllum methyl ester biodiesel (CIMEBD). Even though it serves to mitigate the energy crisis and has a low overall carbon footprint, CIMEBD has certain negative issues relating to engine performance and emission characteristics. Nanoparticle (NP) addition is known to enhance the engine performance characteristics of next generation biofuels. CeO2 (cerium oxide or ceria) NPs of varying size are used in this study along with 25:75 biodiesel-diesel (BD) blend and a fixed NP concentration of 90 ppm. Ceria NP-doped fuel is shown to have better engine performance compared to diesel and BD blend for all load conditions. Improvements in brake thermal efficiency (BTE) and brake-specific fuel consumption (BSFC) values equal to +30% and -46%, respectively, are observed from experiments for ceria NP-doped biodiesel, compared to diesel-biodiesel (BD) blend. Ceria NPs in the 20 to 40 nm range have optimum engine performance characteristics. Compared to BD blends, NP-doped biodiesel shows improvements in NOx, CO, CO2, UHC, and soot parameters up to -35%, -60%, -35%, -38%, and -40%, respectively. Likewise, the optimum size of ceria NPs is in the range 20-40 nm for better emission characteristics.

Safe water supply challenges for hand hygiene in the prevention of COVID-19 in Southern Nations, Nationalities, and People's Region (SNNPR), Ethiopia.

BACKGROUND: Proper hand hygiene practices are critical in disease prevention and control, including preventing the spread of the COVID-19 pandemic, but according to a recent global report, three billion people lack access to basic hand washing facilities (soap and water) at home. Therefore, this study aimed to determine the challenges related to safe and adequate water provision for hand hygiene in the prevention of COVID-19 in Gedeo Zone, SNNPR, Ethiopia. METHODS: An institutional-based cross-sectional study design was used to assess the challenges associated with safe water supply in the prevention of COVID-19 in Gedeo Zone. Simple random sampling was used. The water sector's challenges were assessed using in-depth interviews with key informants. Water samples were collected from hand washing stations using a sterile bottle and the standard tap water sampling procedure. Bacterial analysis was carried out using membrane filtration techniques. The Wagtech Palin test and the Delagua portable water testing kit procedure was used to analyze World Health Organization (WHO) critical physicochemical parameters. RESULT: The physicochemical analysis of the sample water from the hand washing facilities reveals that the pH (6.5-8) is within the WHO guideline in all samples except Gedeb town (11.1%). The residual chlorine in the samples was less than 0.2 mg/l, which is below the standard in all towns, but 15.8% of the samples in Wonago town were between 0.2-0.5mg/l. Faecal coliforms were not found in 27.5%, 21.0%, 16.6%, and 40.7% of the samples collected in Dilla, Wonago, Yirgachefe, and Gedeb town, respectively. The remaining samples were all positive for faecal coliforms. Unbalanced demand versus supply, inaccessibility, supply interruptions, financial constraints, a scarcity of competent human resources, a lack of regular water quality assessments, and a lack of stakeholder support were all identified as major challenges by all water sectors of the study towns. The majority of hand washing water samples from all of the study towns were bacteriologically unsafe. The water sector must work hard to ensure that the community has safe drinking water. All responsible bodies and potential stakeholders must support the water sectors in the Gedeo zone.

Acceptability and Factors Associated with Immediate Postpartum Intrauterine Contraceptive Device Use Among Women Who Gave Birth at Government Hospitals of Gamo Zone, Southern Ethiopia, 2019.

BACKGROUND: An intrauterine contraceptive device is suitable for women of all reproductive age groups for preventing unwanted pregnancies. Immediate postpartum family planning (PPFP) services need to be emphasized when the woman leaves the hospital. Despite the accepted demand for PPFP, many women do not access the services. Therefore, this study aimed to assess acceptability and factors associated with immediate postpartum intrauterine contraceptive device use among women who gave birth at government hospitals of Gamo Zone, Southern Ethiopia. METHODS: A cross-sectional study was conducted from March 1 to 30, 2019 with 452 participants studied using systematic random sampling technique. Data was collected using a pretested interviewer-administered questionnaire from March 1 to 30, 2019. The data were coded, cleaned and entered into Epi-data manager version 4.2.2.1 and exported to SPSS version 23 for advanced analysis. Binary logistic regression was performed to identify associated factors of immediate PPIUCD acceptability. RESULTS: This study revealed that about 161 (35.6%) in 95% CI (31.0, 39.6) of the study participants accepted immediate PPIUCD. Multiparty (AOR = 2.33, 95% CI, (1.29, 4.20)), completed antenatal follow up (AOR = 3.65, 95% CI, (2.22, 5.99)), counselling (AOR= 8.38, 95% CI, (4.85, 14.48)) and prior discussion (AOR=2.57, 95% CI, (1.51, 4.36)) were statistically significant. CONCLUSION AND RECOMMENDATION: Even though 58% of the mothers were counselled about PPIUCD during the important cascade of pregnancy and 53% of the mothers completed antenatal service, efforts need to improve antenatal care services and integrate counselling services through the whole cascade of pregnancy.

Use and Conservation of Medicinal Plants by Indigenous People of Gozamin Wereda, East Gojjam Zone of Amhara Region, Ethiopia: An Ethnobotanical Approach.

An ethnobotanical study of medicinal plants (MPs) used by the local community has been carried out from January 5, 2014, to February 15, 2015, in Gozamin Wereda of East Gojjam Zone, Ethiopia. The purpose of this study was to identify and document the use and conservation of MPs, along with indigenous knowledge of Gozamin community. Data were collected using semistructured interview, field observation, and focus group discussions. The collected data were assessed quantitatively using fidelity level, Jaccard's Coefficient of Similarity, paired comparisons, direct matrix, and preference rankings. In total 93 MPs distributed under 51 families and 87 genera were identified and for each taxon a local name (Amharic) was documented. Asteraceae with 9 (9.68%) species and Solanaceae with 7 (7.53%) species were families represented by more species in the study area. Out of these MPs collected, 80 plant species were used for the treatment of human ailments, 24 species were used against livestock diseases, and 11 common plant species were listed in both cases. The most frequently used plant parts were the leaves followed by the roots. The major threats to MPs in the study area were agricultural expansion, overgrazing, fire wood collection, mining, and cutting down trees for construction and furniture. Therefore, there is a need for appropriate in situ and ex situ conservation measures.

Knowledge and Practice of Clinicians regarding Syndromic Management of Sexually Transmitted Infections in Public Health Facilities of Gamo Gofa Zone, South Ethiopia.

Background. Sexually Transmitted Infections (STIs) are the leading causes of morbidity among young adults. This study assessed the knowledge and practice of clinicians regarding syndromic management of STIs in public health facilities of Gamo Gofa Zone, Southern Ethiopia. Methods. Facility based cross-sectional study with mixed methods of data collection was conducted in public health facilities of Gamo Gofa Zone. The study included 250 clinicians and 12 health facilities, 26 mystery clients were hired, and 120 STI patient cards were reviewed. Data was entered in EPI info version 7.0.1 and analyzed by SPSS version 20. Results. Of the participated clinicians, 32 (12.8%) were trained on syndromic management of STIs. Highest knowledge of clinicians was for urethral discharge (27.2%). Professional category of clinicians and type of health facility (AOR = 0.194; 95% CI = 0.092, 0.412) were determinants of urethral discharge knowledge. Of the cards reviewed, only in 8.3% of cards and 19.23% of mystery clients did the clinicians correctly follow the guideline. Conclusion. Knowledge and practice of clinicians regarding syndromic management of STIs in study area were poor. Efforts should be made to increase the knowledge of clinicians by providing training on syndromic management of STIs and supportive supervision should be regular.

Seroprevalence of syphilis among HIV-infected individuals in Addis Ababa, Ethiopia: a hospital-based cross-sectional study.

OBJECTIVE: To determine the prevalence of syphilis and its risk factors among people with HIV at a hospital in Ethiopia. DESIGN: A hospital-based cross-sectional study. SETTING: This study was conducted at one of the largest public hospitals in Addis Ababa , Ethiopia. PARTICIPANTS: A consecutive 306 HIV-positive patients were recruited prospectively from January to March 2010. For comparative purposes, 224 HIV-negative consecutive attendees at the voluntary counselling and testing centre in the same period were also included. Participants under 15 years of age and treated for syphilis and with a CD4 T-cell count below 50 cells/mm(3) were excluded. OUTCOME MEASURES: Blood samples and data on sociodemographic and risk factors for syphilis were collected. Sera were screened for syphilis using rapid plasma reagin (RPR) test, and those positives were retested using Treponema pallidum haemagglutination assay (TPHA) test. RESULTS: The seroprevalence of syphilis among HIV-infected individuals was 9.8% compared with 1.3% among HIV-uninfected individuals, OR 8.01 (95% CI 2.4 to 26.6; p=0.001). A comparable rate of syphilis was found among men (11%) and women (8.9%) with HIV infection. Syphilis prevalence non-significantly increased with age, with the highest rate in 40-49 years of age (16.9%). Except a history of sexually transmitted infections, which was associated with syphilis OR 2.25 (95% CI 1.03 to 4.9; p=0.042), other risk factors did not raise the odds of infection. CONCLUSIONS: The high prevalence of syphilis among people with HIV infection highlights the need to target this population to prevent the transmission of both infections. Screening all HIV-infected people for syphilis and managing those infected would have clinical and epidemiological importance.

Prevalence and risk factors of Hepatitis C among individuals presenting to HIV testing centers, Hawassa city, Southern Ethiopia.

BACKGROUND: Hepatitis C virus (HCV), either alone or in combination with Human Immunodeficiency virus (HIV), constitutes a major public health concern. This study was conducted to describe the prevalence and risk factors for HCV infection in people with and without HIV infection. METHODS: Blood samples and data on socio-demographic and risk factors for HCV infection were collected from consecutive 400 HIV- positive and 400 HIV- negative individuals attending HIV testing centers in Hawassa city, from October to December, 2008. All sera were tested for antibody to HCV infection (anti-HCV) using enzyme linked immunosorbent assay (ELISA). Sera positive for anti-HCV were further tested for viral ribonucleic acid (RNA) levels using real-time polymerase chain reaction. RESULTS: The rate of anti-HCV positivity was 10.5% in the HIV- infected individuals compared with 6% in the HIV negative group (p = 0.002). HCV-RNA was detected in 9.1% of anti-HCV positive samples and rates were comparable between HIV- infected and HIV- non-infected individuals. There was no significant difference in odds of HCV infection in participants with and without HCV risk factors in either HIV sero-group. CONCLUSION: HIV infected individuals had significantly higher rate of anti-HCV although most of them showed no evidence of viraemia. Hence, while priority should be given for HIV infected patients, testing those with anti-HCV for HCV-RNA remains important.