Effect of the enhancing nutrition and antenatal infection treatment (ENAT) intervention on birth weight in Ethiopia: a cluster randomized controlled trial.

BACKGROUND: The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) intervention was implemented in Ethiopia to improve newborn birth weight (BW) by strengthening the contents and quality of antenatal care (ANC), especially point-of-care testing for maternal infections. This study examined the effect of the ENAT intervention on birth weight. METHODS: We conducted a cluster randomized controlled trial of 22 clusters (health centers), randomized equally between 11 intervention and 11 control clusters. This study enrolled and followed pregnant women from ANC booking to the end of pregnancy or loss to follow-up. The primary outcome was mean BW, and the incidence of low birth weight (LBW) was the secondary outcome. We presented univariate comparisons of outcomes between the intervention and control arms for mean BW and LBW. Multilevel analyses using random effects models were performed to adjust for clustering and individual-level covariates. RESULTS: We enrolled and followed up 4,868 and 4,821 pregnant women in the intervention and control arms, respectively, from March 2021-July 2022. During follow-up, 3445 pregnant women in the intervention and 3192 in the control delivered in the health centers, and BW measurements of their babies were recorded within 48 h. The mean BW was 3,152 g (standard deviation (SD) = 339.8 g) in the intervention and 3,044 g (SD = 353.8 g) in the control arms (mean difference, 108 g; 95% confidence interval (CI): 91.3-124.6; P = 0.000). Adjusting for clustering and several covariates, the mean BW remained significantly higher in the intervention arm than in the control arm (adjusted ß coef., 114.3; p = 0.011). The incidence of LBW was 4.7% and 7.3% in the intervention and control arms, respectively. The adjusted risk of LBW was significantly lower by 36% in the intervention arm than in the control arm (adjusted relative risk, 0.645; p = 0.027). CONCLUSION: This study provided sufficient evidence of the effectiveness of the ENAT intervention in improving birth weight in the study population. The intervention demonstrated that an increase in birth weight can be attained by availing point-of-care testing, strengthening infection prevention, and maternal nutrition within the ANC platform of public health facilities in a low-income setting. TRIAL REGISTRATION: Registered at Pan African Clinical Trial Registry (PACTR) database dated 09/05/2023, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25493 . The unique identification number for the registry is PACTR202305694761480.

Correction to: Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia.

The article "Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia" written by Y. Wang, C. A. Comins, A. Mulu, S. A. Abebe, K. Belete, T. T. Balcha, S. Baral, S. R. Schwartz, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 27th May 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 19th September 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia.

Adolescent girls and young women (AGYW) remain underserved and at risk for HIV acquisition in Ethiopia. However, there is significant risk heterogeneity among AGYW with limited consensus on optimal strategies of identifying vulnerable AGYW. This study assessed the utility of venue-based sampling approaches to identify AGYW at increased risk for HIV infection. Venue mapping and time-location-sampling (TLS) methods were used to recruit AGYW from three sub-cities of Addis Ababa, February-June 2018. Interviewer-administered surveys captured socio-demographic and behavioral characteristics. Measures of AGYW vulnerability were assessed geographically and described by venue type. A total of 2468 unique venues were identified, of which 802 (32%) were systematically selected for validation and 371 (46%) were eligible including many sites that would traditionally not be included as venues in need of HIV prevention services. Overall, 800 AGYW were enrolled across 81 sampled venues. AGYW reached were largely out-of-school (n = 599, 75%) with high proportions of AGYW reporting transactional sex (n = 101, 12.6%), food insecurity (n = 165, 20.7%) and migration (n = 565, 70.6%). Taken together, these data suggest the utility of TLS methods in reaching vulnerable, out-of-school AGYW in Addis Ababa, Ethiopia.

Public perception and awareness of waste management from Benin City.

Poor waste management is increasingly becoming a major challenge for municipalities, globally. Unlike previous waste management studies in Nigeria, this study examines the implications of waste management to regional greenhouse gas emissions based on awareness levels and perception of urban inhabitants. Benin City was divided into four residential zones: core, intermediate, suburban, and planned estates. Blocking was utilized to collect data from a total of 2720 randomly selected inhabitants through a self-administered survey. Results reveals low awareness level in terms of indiscrimination dumping of waste, thereby promoting sustainable mitigation and adaptation measures region-wide. It is imperative to integrate various aspects of regional government services such as infrastructure, urban planning and development, socioeconomics, public health, and regulation enforcement. Waste management policy is strengthened via working groups, community, and regional authorities.

Setting up pharmacovigilance based on available endTB Project data for bedaquiline.

SETTING: Active pharmacovigilance (PV) is recommended for TB programmes, notably for multidrug-resistant TB (MDR-TB) patients treated with new drugs. Launched with the support of UNITAID in April 2015, endTB (Expand New Drug markets for TB) facilitated treatment with bedaquiline (BDQ) and/or delamanid of >2600 patients in 17 countries, and contributed to the creation of a central PV unit (PVU).OBJECTIVE: To explain the endTB PVU process by describing the serious adverse events (SAEs) experienced by patients who received BDQ-containing regimens.DESIGN: The overall PV strategy was in line with the 'advanced´ WHO active TB drug safety monitoring and management (aDSM) system. All adverse events (AEs) of clinical significance were followed up; the PVU focused on signal detection from SAEs.RESULTS and CONCLUSION: Between 1 April 2015 and 31 March 2019, the PVU received and assessed 626 SAEs experienced by 417 BDQ patients. A board of MDR-TB/PV experts reviewed unexpected and possibly drug-related SAEs to detect safety signals. The experts communicated on clusters of risks factors, notably polypharmacy and off-label drug use, encouraging a patient-centred approach of care. Organising advanced PV in routine care is possible but demanding. It is reasonable to expect local/national programmes to focus on clinical management, and to limit reporting to aDSM systems to key data, such as the SAEs.

Level of asthma control and risk factors for poor asthma control among clinic patients seen at a Referral Hospital in Addis Ababa, Ethiopia.

OBJECTIVE: Uncontrolled asthma negatively impacts patients, families, and the community. The level of symptom control among asthmatics in Ethiopia has not been well studied. We investigated the level of asthma control and risk factors for poor asthma control in clinic patients seen in the largest public hospital in Ethiopia. RESULTS: In this cross-sectional study, we studied all 182 consecutive subjects with a physician diagnosis of asthma who were seen in chest clinic at Tikur Anbessa Specialized Hospital between July and December 2015. Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years and the median duration of asthma was 20 ± 12.7 years. One hundred and seventeen subjects (64.3%) had nighttime awakening due to asthma. Fifty-eight (31%) were not using controller medications and 62 (34.6%) had improper inhaler technique. Only 44 (24.2%) subjects had well-controlled asthma. On multivariate analysis, variables associated with uncontrolled asthma included: use of biomass fuel for cooking, longer duration of asthma (> 30 year), incorrect inhalation technique, and asthma exacerbation in the last 12 months. Most asthmatics attending in the largest public hospital in Ethiopia, had uncontrolled asthma. Several risk factors for poor asthma control were identified. Improved asthma control is possible through directed interventions.

Demographic, clinical, and neurocognitive correlates of everyday functional impairment in severe mental illness.

Although cognitive deficits often accompany severe mental illness, their implications for everyday functioning remain poorly understood. In this study, an occupational therapist (OT) rated the everyday functioning of 105 adult psychiatric patients. Using demographic, clinical, and cognitive variables, the authors tested alternative models to account for the observed variability in OT ratings. Although age, education, and the presence of schizophrenia each contributed to a model that accounted for 27% of the variation in functional independence, adding terms for auditory divided attention and verbal learning increased the proportion of explained variance to 45% and decreased the beta weights for age and education--but not schizophrenia--to nonsignificant levels. These findings demonstrate the relevance of cognitive performance to everyday functioning in severe mental illness. They are discussed with respect to hypothesized determinants of psychiatric disability.

Prevalence of risk factors for trachoma in a rural locality of north-western Ethiopia.

BACKGROUND: In Ethiopia, the prevalence of blindness has been estimated to be 1.5%. According to a survey done in collaboration with WHO in 1981, the leading cause of blindness in Ethiopia was trachoma (42%) followed by cataract (29%). The problem is mainly seen in the rural areas of the country. OBJECTIVE: To determine the prevalence and associated risk factors of trachoma in a rural locality of north-western Ethiopia. DESIGN: Cross-sectional survey. SUBJECTS: One thousand seven hundred and eighteen individuals participated in the study. MAIN OUTCOME MEASURES: Grades of trachoma--the WHO simplified method of clinical signs was used to determine the various grades of trachoma. RESULTS: The overall prevalence rate of trachoma of the locality was 59.2% while the prevalence rate of active trachoma was found to be 52.4%. Higher frequency of trachoma was observed among females aged 15 years and above than males of the corresponding age group, and this finding was statistically significant (chi2-test, p < 0.001). Child care-taking among women, habits and frequency of face washing, presence of cooking places in living rooms and sharing of same rooms with animals have been found to be highly associated with trachoma (p < 0.001). CONCLUSION: Based on the results of this study, the following recommendations are made, among others: (i) the development of a system aimed at educating and convincing the people to maintain high personal and environmental hygiene and; (ii) the strengthening of the nearby health centres to incorporate activities like correction of lid deformities to prevent further loss of eye vision due to corneal damage are recommended.

Management of children with ARI and/or diarrhoea in Addis Ababa, Ethiopia.

This study, conducted between May 9 and May 19, 1994 in twenty health centres in Addis Ababa, looks at the quality of care provided for children presenting to public sector health centres in Addis Ababa with ARI and/or diarrhoea. As has been documented in other countries, both developing and developed, inappropriate prescription of medications is common in Addis Ababa. Forty four per cent of children received useless or potentially harmful drugs; in 97 of 99 cases of "sore throat", antibiotics were prescribed; only 14 of 116 children with the diagnosis of "common cold" received no medication. While 88 percent of children with diarrhoea received ORS, and 39 per cent of children with pneumonia were given appropriate medications, few caretakers knew how to use them properly. Caretakers' knowledge of appropriate home care of children with ARI and diarrhoea (feeding, use of fluids and indication for return to the clinic) was found to be deficient. Causes for poor quality of care are discussed, and recommendations for solving some of the problems identified, and for further research, are presented.

Serological study of louse borne and flea borne typhus in Addis Ababa.

A total of 500 subjects (288 males and 212 females) were tested in Addis Ababa, Ethiopia, in Virology and Rickettsiology Division of the National Research Institute of Health, in 1987, for anti R. prowazekii using Complement Fixation Test (CFT). Out of these 58 subjects (41 males and 17 females) were also tested for anti R. typhi using the same test. The study population included three groups. Group I included 200 patients referred to the National Research Institute of Health (NRIH) for the Weil-Felix test for the diagnosis of typhus. Group II consisted of 200 patients with febrile illness visiting the Outpatient Department (OPD) of St. Paul's Hospital. Group III included 100 blood donors' serum samples included from previous collections. The blood donors had no sign of febrile illness during the collection of the blood samples. The results showed that anti R. prowazekii was detected in 38 subjects (7.6%). The sex ratio among the positive subjects indicated that there were 32 males (22%) and 6 females (2.8%). From the 58 subjects who were also tested for anti R-typhi only 7 (5 males and 2 females) (12%) were found to be positive. Only one person was found to be positive both for anti R. prowazekii and anti R-typhi. From 200 samples (Group-I) tested both by the Weil-Felix test and by Complement Fixation Test for anti R. prowazekii only 4 samples were positive by both test, thus showing very low percent agreement.(ABSTRACT TRUNCATED AT 250 WORDS)

Cryptosporidiosis in children seen at the children's clinic of Yekatit 12 Hospital, Addis Ababa.

The stools of 214 children under five years of age with diarrhoea were examined for Cryptosporidium oocysts using the Modified Ziehl Nelson Technique. Twelve (5.6%) of the children had Cryptosporidium oocysts in their faeces. All of these were above 6 months of age and were either partially or fully weaned. There were 15 exclusively breast fed children of whom 11 were less than 6 months of age. None of these cases had the evidence of Cryptosporidial infection. The present study indicates the importance of Cryptosporidium as a possible etiologic agent in patients with diarrhoeal diseases. However, a comprehensive investigation is needed in order to rule out other enteropathogens.

PIP: During March 1992 to March 1993, in Addis Ababa, Ethiopia, health workers collected stool samples from 214 children under 5 years old with diarrhea who were attending the children's clinic of Yekatit 12 Hospital. The prepared thin smears were microscopically examined for Cryptosporidium oocysts at 40x and 100X magnifications. 12 (5.6%) children 1-43 months old (7 boys, 5 girls) had Cryptosporidium oocysts. Nine children had watery diarrhea. The other 3 had watery mucoid diarrhea. Nine children had vomiting. All 12 children had a temperature somewhat higher than 38 degrees Celsius. They were either partially or fully weaned. 15 children with no Cryptosporidium oocysts were exclusively breast fed. The last two statements suggest that, in children with diarrhea, there is an association between breast feeding and Cryptosporidium infection. 11 of the 15 patients with no oocysts were less than 6 months old.

Effects of protein concentration on responses to dietary tryptophan by chicks.

1. Chicks were fed from 4 to 18 d on 40 diets containing all combinations of 8 crude protein (CP) concentrations (from 160 to 300 g/kg) and 5 tryptophan concentrations (from 7.5 to 13.5 g tryptophan/kg CP). 2. At each protein concentration there were responses in growth rate and in efficiency of food utilisation to supplementation with tryptophan. Curves were fitted to estimate the maximum response at each protein concentration. 3. The amounts of tryptophan required (g/kg) for maximum growth and maximum food efficiency were each linear functions of dietary protein concentration. The chick's requirement for tryptophan can be expressed as 12 g/kg CP. 4. It is concluded that a fixed ratio of tryptophan to protein should be specified in practical diet formulation, rather than a minimum dietary concentration of tryptophan.

Note on the effects of protein concentration on responses to dietary lysine by chicks.

1. This paper gives further analyses of data from previously reported trials in which chicks were fed diets with protein concentrations ranging from 140 to 280 g/kg diet, with the lysine content varied at each protein concentration. 2. Alternative methods of estimating the lysine requirement, at each concentration of protein, are investigated. 3. Although these methods produce rather different estimates of requirement, they do not change the conclusion that the lysine needed for maximum growth or maximum efficiency of food utilisation is a linear function of dietary protein concentration throughout the range from 140 to 280 g crude protein/kg. 4. It is concluded that lysine requirements for growing chicks should be specified as a proportion of the protein and not as a proportion of the diet.

Effects of arginine and protein on chicks' responses to dietary lysine.

1. A chick experiment was designed to test whether the proven effect of excess protein on the requirement for lysine was associated with the arginine content of the protein. 2. Protein contents of 180, 220, 260 and 300 g/kg diet were fed in combination with lysine concentrations of 38, 43, 48, 53 and 58 g/kg crude protein and arginine concentrations of 49.4 or 68.4 g/kg crude protein. 3. Growth rate and efficiency of food utilisation were not significantly affected by the arginine content of the protein. Significant responses to lysine were obtained at all protein contents. 4. Lysine required for maximum growth or maximum food efficiency increased in direct proportion to the protein content of the diet and was not affected by arginine content of the diet within the range of concentrations tested.

Efficacy of RM110, a novel trypanocide, in the treatment of Trypanosoma evansi infections in camels.

Camels artificially infected with a field stock of Trypanosoma evansi isolated from a camel near Gewane, Ethiopia were cured by treatment with RM110, administered by subcutaneous injection at 0.3 or 0.6 mg/kg body weight. Local reactions were mild and transient. Further evaluation of RM110 is indicated, in particular the determination of minimum curative doses for this and other T. evansi stocks in camels.

Effects of dietary protein concentration on the response of growing chicks to methionine.

1. Experiments were conducted independently at two stations to measure the requirement for methionine in chick diets with crude protein (CP) varying in 8 steps from 140 to 280 g/kg diet (experiment 1) or from 90 to 300 g/kg (experiment 2). 2. Protein composition was the same at all protein concentrations within a trial. The diet was designed to be first-limiting in methionine and DL-methionine was added to provide 5 ratios of methionine to CP at each protein concentration. 3. Methionine required for maximum growth rate or maximum efficiency of food utilisation was estimated at each protein concentration by fitting a quadratic regression equation to the relevant data. The requirement was also estimated by fitting the Reading model to data for growth rate and methionine intake. 4. In both trials and by all three methods of estimation, the methionine requirement (g/kg diet) for maximum performance increased as a linear function of dietary CP concentration and nearly in direct proportion to CP. 5. It is concluded that diets which contain surplus protein, beyond that needed to maximise growth rate or food efficiency, need supplementation with methionine beyond that required when dietary protein is just adequate. A suitable rule for practical formulation is that methionine concentration in chick diets should be not less than 0.025 times the dietary CP concentration.