Seasonal variation, treatment outcome, and its associated factors among the snakebite patients in Somali region, Ethiopia.

Background: Snakebite is a major cause of mortality and morbidity in many areas, particularly in the rural tropics, and is a major public health problem around the world. It also imposes significant economic burdens on snakebite victims due to treatment-related expenses and lost productivity. Objective: The purpose of this study was to assess seasonal variation, treatment outcomes, and its associated factors among snakebite in Denan health center in the Somali region, Ethiopia. Method: A facility-based cross-sectional study was conducted from 10 to 30 September 2020 in Denan health center, Somali region, Ethiopia. All snakebite cases in Denan health center from 1 September 2015 to 31 August 2020 were included. Data were collected using a pre-tested structured checklist from the patient cards. Data were entered into EpiData version 3.1 and analyzed using SPSS version 22 (IBM SPSS Statistics, 2013). The prevalence was reported by proportion with 95% confidence interval (CI) and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio with 95% CI. Statistical significance was declared at p-value < 0. 05. Result: The overall prevalence of poor outcome of venomous snakebites was 31.4% (95% CI 26.3% 35.4%). Study participants with an age of less than 10 years old (AOR = 2.01; 95% CI 1.39, 4.05), age between 10 and 30 years old (AOR = 2.06; 95% CI 1.39, 9.30), arrival times greater than or equal to 6 hours (AOR = 2.37; 95% CI 1.39, 4.05), and timing of snakebite (AOR = 0.49; 95% CI 0.31-0.87) were factors found to be significantly associated with poor treatment outcome. Conclusion: According to this study, about one in every three snakebite patients have a poor outcome. Patients with poor outcomes were those who did not improve as a result of treatment or died as a result of it. Designing appropriate engagement of public health education about snakebite prevention techniques, particularly during entry and exit of rainy seasons and establishment of appropriate case management protocol is strongly recommended, as well as increasing the accessibility or availability of antivenoms will undoubtedly have a significant impact on the reduction of mortality and disability related to that of the snakebites.

Case Report: Khat Chewing and Acute Myocardial Infarction in Two Young Men without Underlying Risk Factors.

Khat (Catha edulis) chewing is linked to several social, psychological, and health-related problems. Studies show that khat is associated with gastrointestinal and nervous system diseases. However, little is known about khat's effect on the cardiovascular system. This case report describes acute myocardial infarction (AMI) among two young adults who chew khat frequently, but who do not have underlying cardiovascular disease (CVD) risk factors. Case 1 is a 29-year-old apparently healthy man who presented with severe, squeezing, left-side chest pain after consumption of khat. Most of the laboratory results were within the normal range except for his serum troponin level, which was 400 times more than the normal limit. The patient was diagnosed with Killip class IV, ST-segment elevation, anteroseptal AMI. Case 2 is a 25-year-old man who is a frequent khat chewer. He presented with sudden-onset, severe, squeezing, retrosternal chest pain after khat chewing and vigorous activity. The patient was diagnosed with (Killip class III) acute ST-elevation myocardial infarction with cardiogenic pulmonary edema. These case reports describe two young adult male patients who were confirmed of having AMI with no known risk factors. Both cases had a similar history of frequent khat chewing and the onset of AMI after it, implying that khat could be an important CVD risk factor among young adults. Hence, it is essential to explore further the epidemiology and association between khat use and AMI. Both molecular and population-level studies could help to establish the causal relationship of khat and CVD.

Prevalence of rheumatic heart disease among school children in Ethiopia: A multisite echocardiography-based screening.

BACKGROUND: Auscultation-based surveys in Ethiopia conducted in the late 1990's reported a rural prevalence of 4.6/1000 and an urban prevalence of 6.4/1000 of rheumatic heart disease (RHD). With echo-based screening, we aimed to estimate the national prevalence of RHD in school children by taking school-based samples from six regions across the country using the 2012 World Heart Federation echocardiographic criteria. PATIENTS AND METHODS: We conducted a cross-sectional echocardiographic screening of RHD in school children aged 6-18years from 28 randomly selected primary and secondary schools found in six different geographic regions of Ethiopia. We used the standardized WHF echocardiographic criteria. RESULTS: A total of 3238 children (48.5% females) were screened. The mean age was 13.2±3.2years. Of these, 44 patients (1.4%) met the WHF criteria for definite RHD, while 15 (0.5%) met the criteria for borderline disease, yielding a prevalence of 19 [13.9-23.4, 95% CI] cases per 1000 school children between the ages of 6-18years. The majority of those who tested positive were girls (26/44). The prevalence was lowest in children aged 6-9years and otherwise uniformly distributed across ages 10-18years. Definite RHD involved the mitral valve in 42 subjects, 39 of whom had mitral regurgitation and 3 with mitral stenosis. The aortic valve was affected in 6 children. The ratio of definite to borderline cases was 2.9. CONCLUSION: This study demonstrated a consistent pattern of high prevalence of asymptomatic RHD with definite disease predominating over borderline involvement across six regions of Ethiopia.