First identification and coinfection detection of Enterocytozoon bieneusi, Encephalitozoon spp., Cryptosporidium spp. and Giardia duodenalis in diarrheic pigs in Southwest China.

BACKGROUND: Enterocytozoon bieneusi, Encephalitozoon spp., Cryptosporidium spp., and Giardia duodenalis (G. intestinalis) are enteric pathogens that cause diarrhea in pigs. This study aimed to determine the prevalence of these enteric parasites and their coinfection with E. bieneusi in diarrheic pigs in Southwest China (Chongqing and Sichuan) using nested polymerase chain reaction (nPCR) based methods. RESULTS: A total of 514 fecal samples were collected from diarrheic pigs from 14 pig farms in Chongqing (five farms) and Sichuan (nine farms) Provinces. The prevalence of Encephalitozoon spp., Cryptosporidium spp. and G. duodenalis was 16.14% (83/514), 0% (0/514), and 8.95% (46/514), respectively. Nested PCR revealed 305 mono-infections of E. bieneusi, six of E. cuniculi, two of E. hellem, and nine of G. duodenalis and 106 concurrent infections of E. bieneusi with the other enteric pathogens. No infections of E. intestinalis and Cryptosporidium species were detected. The highest coinfection was detected between E. bieneusi and E. cuniculi (10.5%, 54/514), followed by E. bieneusi and G. duodenalis (5.8%, 30/514) and E. bieneusi and E. hellem (2.9%, 15/514). E. bieneusi was the most frequently detected enteric pathogen, followed by E. cuniculi, G. duodenalis and E. hellem. There was a significant age-related difference in the prevalence of E. cuniculi in fattening pigs (χ2 = 15.266, df = 3, P = 0.002) and G. duodenalis in suckling pigs (χ2 = 11.92, df = 3, P = 0.008) compared with the other age groups. Sequence analysis of the ITS region of Encephalitozoon species showed two genotypes (II and III) for E. cuniculi and one (TURK1B) for E. hellem. Only G. duodenalis assemblage A was identified in all nested PCR-positive samples. E. bieneusi was found more often than other enteric pathogens. CONCLUSIONS: This study showed that E. bieneusi, Encephalitozoon spp. [E. cuniculi and E. hellem] and G. duodenalis were common enteric parasites in diarrheic pigs in Chongqing and Sichuan Provinces. In case of both mono-infection and coinfection, E. bieneusi was the most common enteric pathogen in diarrheic pigs. Thus, it may be a significant cause of diarrhea in pigs. Precautions should be taken to prevent the spread of these enteric parasites.

The Pattern of COVID-19 in Horn of Africa countries, from March-December 2020.

Background: Coronavirus-19 (COVID-19) is a novel, highly infectious, and potentially fatal communicable pandemic disease. It has taken longer to reach Africa than the other continents. Objective: To examine the pattern of COVID-19 in the Horn of Africa countries from March to December 2020. Methods: A prospective cross-sectional study in which the total number of daily reported cases and deaths were collected from the official website of the World Health Organization (WHO) and Worldometer. Data were standardized based on the total population provided by World Population Prospects 2020 per million. Data sources of WHO reports and governmental reports from March to December 2020 were analyzed in this study. Data extraction was done using the microsoft excel spreadsheet tool, variables relating to the countries were computed in terms of frequencies and percentages. Results: The findings revealed that as of 31st December 2020, 136,129 (7590 per million) cases were reported from the four countries in the Horn of Africa. The overall case fatality rate (CFR) in the Horn of Africa was 1.14%. The majority of the cases were reported from Djibouti (77.20%), followed by Ethiopia (14.07%), Eritrea (4.87%), and Somalia (3.86%). The highest case fatality rate (0.81%) was from Djibouti, and the lowest (0.01%) was from Eritrea. Conclusions: The epidemiological pattern of COVID-19 among the Horn of African countries seems to have slow progress, given the prevalence of the new infections remains low, and the death toll seems stable throughout the study periods, except for Djibouti. Hence, the prevention control measures implemented in the countries should be further strengthened and supported. It is recommended that relevant stakeholders responsible for tackling the COVID-19 pandemic should put up measures to curb the spread of the virus in the region and set up a crisis management system to combat future pandemics.

Community knowledge and practice of malaria prevention in Ghindae, Eritrea, a Cross-sectional study.

Background: Little is known about community knowledge and practice towards malaria prevention in Ghindae, Eritrea. Methodology: A community based cross-sectional study design was employed among 380 households. Participants were selected systematically. Result: More than eight-tenth (86.5%) of the respondents had heard information about malaria preceding the survey; health facilities (54.1%), television (23.7%). Majority (94.2%) mentioned mosquito bite as the main mode of malaria transmission. Fever was the predominantly (89.2%) identified sign/symptoms of malaria. ITN (84.4%) and environmental sanitation (67.3%) were well recognized preventive measures for malaria. Though most households (91%) possess bed nets, but only 37% were ragged on observation. Overall, 64% of the respondents have satisfactory knowledge and 57.3% had adequate practice towards malaria prevention. Malaria knowledge was significantly associated with increased age (p=0.001) and district areas (p=0.022). Malaria prevention practice was significantly associated with Tigrigna and Saho ethnic group (p=0.013), and districts (p=0.02). Districts showed significant difference with an OR=4.56 (95%CI, 1.29-16.09) on knowledge for district 04 and OR=1.98(95%-CI, 1.21-3.26) on practice for district 03 compared to district 01. Knowledge was associated with prevention (OR=1.99, 95%CI, 1.28-3.09). Conclusion: Overall community knowledge and practice towards malaria prevention were satisfactory. Furthermore, comprehensive community interventions are paramount for effective sustainable control.

Associations between life-course household wealth mobility and adolescent physical growth, cognitive development and emotional and behavioral problems: A birth cohort in rural western China.

Background: Parental household wealth has been shown to be associated with offspring health conditions, while inconsistent associations were reported among generally healthy population especially in low- and middle- income countries (LMICs). Whether the household wealth upward mobility in LMICs would confer benefits to child health remains unknown. Methods: We conducted a prospective birth cohort of children born to mothers who participated in a randomized trial of antenatal micronutrient supplementation in rural western China. Household wealth were repeatedly assessed at pregnancy, mid-childhood and early adolescence using principal component analysis for household assets and dwelling characteristics. We used conditional gains and group-based trajectory modeling to assess the quantitative changes between two single-time points and relative mobility of household wealth over life-course, respectively. We performed generalized linear regressions to examine the associations of household wealth mobility indicators with adolescent height- (HAZ) and body mass index-for-age and sex z score (BAZ), scores of full-scale intelligent quotient (FSIQ) and emotional and behavioral problems. Results: A total of 1,188 adolescents were followed, among them 59.9% were male with a mean (SD) age of 11.7 (0.9) years old. Per SD conditional increase of household wealth z score from pregnancy to mid-childhood was associated with 0.11 (95% CI 0.04, 0.17) SD higher HAZ and 1.41 (95% CI 0.68, 2.13) points higher FSIQ at early adolescence. Adolescents from the household wealth Upward trajectory had a 0.25 (95% CI 0.03, 0.47) SD higher HAZ and 4.98 (95% CI 2.59, 7.38) points higher FSIQ than those in the Consistently low subgroup. Conclusion: Household wealth upward mobility particularly during early life has benefits on adolescent HAZ and cognitive development, which argues for government policies to implement social welfare programs to mitigate or reduce the consequences of early-life deprivations. Given the importance of household wealth in child health, it is recommended that socioeconomic circumstances should be routinely documented in the healthcare record in LMICs.

Effects of antenatal micronutrient supplementation regimens on adolescent emotional and behavioral problems: A 14-year follow-up of a double-blind, cluster-randomized controlled trial.

BACKGROUND & AIMS: Antenatal multiple micronutrient supplementation has been shown to have beneficial effects on birth outcomes and may improve child development. However, whether there is an effect of antenatal micronutrient supplementation strategies on offspring socioemotional outcomes remains unknown. We aimed to examine the effect of antenatal folic acid (FA), iron-folic acid (IFA), and multiple micronutrient (MMN) supplementation on adolescent emotional and behavioral outcomes. METHODS: We conducted a double-blind, cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2006. Pregnant females were randomized by village to receive either daily (i) 400 µg FA, (ii) IFA containing 60 mg iron and 400 µg FA or (iii) MMN supplementation containing 30 mg iron, 400 µg FA plus 13 additional vitamins and minerals. A 14-year follow-up of their offspring was conducted in 2016. Adolescents were administered the locally adapted Youth Self-Report-2001 (YSR-2001) which produced internalizing, externalizing, and total behavior problem scores. We applied generalized estimating equations to assess the effect of the randomized regimens on YSR-2001 scores and explored the potential effect modification by household wealth and initial timing and duration of supplementation. RESULTS: A total of 1920 adolescents were included in the analysis, 1130 (58.9%) were male, and the mean (SD) age was 11.8 (0.78) years. Adolescents in IFA group had lower total (mean difference (MD): -2.89; 95% CI -5.73, -0.04) and externalizing (MD: -0.97; 95% CI -1.79, -0.15) problem scores as compared to those in FA group. There was no effect of MMN on behavior problem scores as compared to IFA and FA alone. Although, in effect modification analyses, MMN appeared to have greater beneficial effects in wealthier households than IFA and FA alone. CONCLUSIONS: Iron supplementation during pregnancy reduced adolescent emotional and behavioral problem scores which provides additional support for expanding coverage of iron-containing prenatal supplements in resource-limited settings. TRIAL REGISTRATION: isrctn. org Identifier: ISRCTN08850194.

The impact of early-life antibiotics and probiotics on gut microbial ecology and infant health outcomes: a Pregnancy and Birth Cohort in Northwest China (PBCC) study protocol.

BACKGROUND: Unreasonable use of antibiotics and probiotics can alter the gut ecology, leading to antibiotic resistance and suboptimal health outcomes during early life. Our study aims are to clarify the association among antibiotic and probiotic exposure in early life, the microecology of the gut microbiota, and the development of antibiotic resistance; to investigate the long-term impact of antibiotics and probiotics on the health outcomes of infants and young children; and to provide a theoretical basis for the rational use of antibiotics and probiotics from a life course perspective. METHODS: The study is a prospective, longitudinal birth cohort study conducted in Shaanxi Province, China from 2018 to 2024. A total of 3,000 eligible mother-child pairs will be enrolled from rural, suburban, and urban areas. The recruitment of the participants begins at pregnancy, and the newborns will be followed up for 2 years at successive timepoints: within 3 days after birth, 42 days after birth, and at 3, 6, 12, 18, and 24 months of age. Sociodemographic data, environmental exposures, dietary patterns, psychological conditions, and medical and drug histories are collected. Cognitive and behavioural development among infants and young children and questionnaires on antibiotic knowledge and behaviour among caregivers will be collected at 12 and 24 months of age. The faecal samples are collected and analysed by 16S rRNA high-throughput sequencing and quantitative PCR (qPCR) for antibiotic resistance genes. DISCUSSION: The findings will inform antibiotic and probiotic use for pregnant women and infants and contribute to establishing rational use strategies of antibiotics and probiotics for paediatricians, health practitioners, and drug administration policy-makers. TRIAL REGISTRATION: The study was registered on the Chinese Clinical Trial Registry (ChiCTR) platform, http://www.chictr.org.cn (Record ID: ChiCTR2100047531, June 20, 2021).

Construct validity and reliability Amharic version of perceived stress scale (PSS-10) among Defense University students.

BACKGROUND: Perceived stress scale (PSS) is the most widely used tool for assessing stressful life events and its management. However, its validity and Reliability in Ethiopian Amharic language is not assessed. OBJECTIVE: To translate the perceived stress scale (version PSS-10) and assess its validity among Defense University students in Bishoftu, Ethiopia. METHOD: From March to May 2020, an anonymous, self-managed questionnaire was used to collect the data on 758 undergraduate students of Defense University in Bishoftu, Ethiopia. Exploratory and Confirmatory factor analyses were employed to assess the factor structure and construct validity of Amharic version of the PSS-10. Composite reliability coefficient and Item total correlation were calculated to assess the internal consistency of Amharic version of the PSS-10. RESULT: Exploratory factor analysis resulted in a two-dimensional PSS-10 with Eigenvalues of 3.4 and 1.6, which explained 50.7% of the variance. Confirmatory factor analysis indicates a good model fit of the two correlated factors (Comparative fit index (CFI) = 0.96 with root mean square error of approximation (RMSEA) = 0.04[0.03-0.06] and standardize root mean residual (SRMR) = 0.040). The internal consistency of PSS-10 and the Negative factor were in acceptable range, whereas the Positive factor was marginally acceptable (0.77, 0.78, and 0.68) respectively. CONCLUSION: The Amharic translated version of PSS-10 was found to be a valid and reliable instrument to measure the perceived stress level among university students.

Determinants of therapy failure among adults on first-line antiretroviral therapy in Asmara, Eritrea: a multicenter retrospective matched case-control study.

BACKGROUND: Information on treatment failure (TF) in People living with HIV in a data-poor setting is necessary to counter the epidemic of TF with first-line combined antiretroviral therapies (cART) in sub-Saharan Africa (SSA). In this study, we examined the risk factors associated with TF in Asmara, Eritrea from 2001 to 2020. METHODS: A multicenter, retrospective 1:2 matched (by age and gender) case-control study was conducted in four major hospitals in Asmara, Eritrea on adults aged ≥ 18 years who were on treatment for at least 6 months. Cases were patients who fulfills at least one of the WHO therapy failure criterion during the study period. Controls were randomly selected patients on first-line treatment and plasma viral load < 1000 copies/ml in their latest follow-up measurement. Multivariable logistic regression analysis was conducted to identify risk factors for TF. All P-values were 2-sided and the level of significance was set at P < 0.05 for all analyses. RESULTS: Of the 1068 participants (356 cases; 712 controls), 585 (54.7%) were females. The median age at treatment initiation was 46 years [interquartile range (IQR): 39-51]. Median time to combined antiretroviral therapy (cART) failure was 37 months (IQR = 24-47). In the multivariate analysis, factors associated with increased likelihood of TF included initial nucleoside reverse transcriptase inhibitors (NRTI) backbone (Zidovudine + Lamivudine (AZT + 3TC): adjusted odds ratio (aOR) = 2.70, 95% Confidence interval (CI): 1.65-4.41, P-value < 0.001), (Abacavir + lamivudine (ABC + 3TC): aOR = 4.73, 95%CI: 1.18-18.92, P-value = 0.028], and (Stavudine + Lamivudine (D4T + 3TC): aOR = 5.00; 95% CI: 3.03-8.20, P-value < 0.001) in comparison to Emtricitabine and Tenofovir diproxil fumarate (FTC + TDF). Additional associations included prior exposure to cART (aOR = 2.28, 95%CI: 1.35-3.86; P- value = 0.002), record of sub-optimal drug adherence (aOR = 3.08, 95%CI: 2.22-4.28; P < 0.001), ambulatory/bedridden at presentation (aOR = 1.61, 95%CI: 1.12-4.28; P-value = 0.010), presence of comorbidities (aOR = 2.37; 95%CI: 1.36-4.10, P-value = 0.002), duration of cART (< 5 years: aOR: 5.90; 95% CI: 3.95-8.73, P-value < 0.001), and use of SMX-TMP prophylaxis (aOR = 2.00, 95%CI, 1.44-2.78, P-value < 0.001). CONCLUSION: Our findings underscore the importance of optimizing cART adherence, diversification of cART regimens, and interventions directed at enhancing early HIV diagnosis, prompt initiations of treatment, and improved patient-focused monitoring of treatment response.

Head circumference trajectories during the first two years of life and cognitive development, emotional, and behavior problems in adolescence: a cohort study.

The associations of early-life head circumference (HC) with child neurodevelopmental and mental health among generally healthy population remain unclear. We aimed to examine the associations of early-life HC trajectories with cognitive development and emotional and behavioral problems in adolescence and to identify the HC growth-sensitive period. We conducted a prospective, community-based birth cohort study in rural western China, and 745 adolescents aged 10-14 years were followed between June and December 2016. We assessed their HC eight times during the first 2 years of life and their adolescent cognitive, emotional, and behavioral outcomes using the Wechsler Intelligence Scale for Children-IV and Youth Self-Report-2001, respectively. We applied group-based trajectory modeling to identify the HC trajectories and conditional growth to derive the HC growth-sensitive periods. We identified five distinct HC trajectories characterized as Start below average-then decrease (7.8% of the sample), Start below average-then increase (6.8%), Start average-then decrease (33%), Consistently average (38%), and Consistently above average (14%). Infants in the trajectory of consistently above average had higher cognitive scores in adolescence compared to those from suboptimal trajectories, with adjusted mean differences ranging from 2.84 to 8.99 points. The conditional gains showed that the HC growth-sensitive period was between 0 and 18 months for child cognition. We found null associations between HC measures and adolescent emotional and behavioral problem scores. CONCLUSION: Early-life HC trajectories were associated with adolescent cognitive development. HC may serve as an inexpensive screening tool to monitor child development at risk during the first 18 months, particularly in resource-limited settings. WHAT IS KNOWN: • Postnatal head circumference (HC) has been shown to be associated with cognitive development in infants who were born premature and/or fetal growth restriction, while inconsistent associations were reported among generally healthy populations, especially in low- and middle- income countries, challenging its utility in public health practices. WHAT IS NEW: • Adolescents in the HC growth trajectory of consistently above average had higher cognitive scores compared to those with other suboptimal trajectories, while null findings were observed for adolescent emotional and behavioral health. • HC may serve as an inexpensive screening tool to monitor child development at risk during the first 18 months of life, particularly in resource-limited settings.

Trends of under-five mortality and associated risk factors in Zambia: a multi survey analysis between 2007 and 2018.

BACKGROUND: Mortality at a young age is key to public health measures. This study aims to describe the burden, trend, and associated factors of under-five mortality rate (U5MR) in Zambia from 2007-to-2018. METHOD: A sample of 29,274 children under-five were analyzed from the Zambia demographic and health survey (ZDHS). Univariate and bivariate analysis were used to identify factors influencing U5M. RESULT: Pooled prevalence of U5MR in Zambia was 84.4/ 1000 live-births. Over 15 years, U5M has declined by 49% (from 118.7 to 60.5/1000 live-births). Compared to children of teenage (≤19 years) mothers the likelihood of U5M was lower by 24 to 37% among children of 20 to 34 years old mothers. The likelihood of U5M was lower by 23% (AOR, 0.77 95%CI, 0.58-1.04) for poorest, 27% (AOR, 0.73 95%CI, 0.55-0.98) for poorer, and 19% (AOR, 0.81 95%CI, 0.62-1.07) for middle as compared to the richest households. The likelihood of U5M was 21% (AOR, 0.79 95%CI, 0.67-0.93) lower among rural residents. Multiple-born children died 2.54 times (95%CI, 1.95-3.98) higher than the single-born. Male children (AOR, 1.28, 95% CI, 1.23-1.46), smaller than average birth size (AOR, 1.78; 95% CI, 1.52-2.09), and no ANC visit (AOR, 3.17, 95% CI, 2.74-3.67) were associated with U5M. The likelihoods of U5M were significantly higher in the Eastern, Luapula, and Muchinga regions than in the Central. CONCLUSION: This study revealed that Zambia has made a gain on child survival. Further efforts targeting mothers, children, and provinces are needed to scale up the decline and achieve the SDG3.

Determinants of antenatal care use in nine sub-Saharan African countries: a statistical analysis of cross-sectional data from Demographic and Health Surveys.

OBJECTIVE: To explore the factors associated with antenatal care (ANC) visits. DESIGN: A secondary data analysis from cross-sectional studies was conducted. SETTING: Sub-Saharan Africa. PARTICIPANTS: 56 002 women aged 15-49 years in Ghana (3224), Kenya (10 981), Malawi (9541), Namibia (2286), Rwanda (4416), Senegal (6552), Tanzania (5536), Uganda (7979) and Zambia (5487) were analysed. OUTCOMES: 4+ANC visits. RESULTS: Overall, 55.52% (95% CI: 55.11% to 55.93%) of women made 4+ANC visits. The highest 4+ANC visits were in Ghana (85.6%) and Namibia (78.9%), and the lowest were in Senegal (45.3%) and Rwanda (44.5%). Young women 15-19 years had the lowest uptake of 4+ANC visits. Multivariable analysis indicated that the odds of 4+ANC visits were 14% lower among women from rural areas compared with those living in towns (adjusted OR (AOR) 0.86; 95% CI: 0.81 to 0.91). This difference was significant in Kenya, Malawi, Senegal and Zambia. However, in Zambia, the odds of 4+ANC visits were 48% higher (AOR 1.48; 95% CI: 1.2 to 1.82) among women from rural compared with urban areas. Women with higher educational level had more than twofold higher odds of 4+ANC visits in seven of the nine countries, and was significant in Kenya, Malawi, Rwanda and Zambia. Compared with the poorest household wealth category, odds of 4+ANC visits increased by 12%, 18%, 32% and 41% for every 20% variation on the wealth quantile. Women in their first-time pregnancy had higher odds of 4+ANC visits compared with others across all countries, and women who had access to media at least once a week had a 22% higher probability of 4+ANC visits than women who had no access to media (AOR 1.22, 95% CI: 1.15 to 1.29). CONCLUSION: The number of ANC visits was considered to be inadequate with substantial variation among the studied countries. Comprehensive interventions on scaling uptake of ANC are needed among the low-performing countries. Particular attention should be given to women of low economic status and from rural areas.

Patterns and Determinants of the Double Burden of Malnutrition Among Adolescents: A 14-Year Follow-Up of a Birth Cohort in Rural China.

OBJECTIVE: To examine the prevalence of the double burden of malnutrition and its associated factors among adolescents in rural China. STUDY DESIGN: A birth cohort of adolescents born to women in northwestern China who participated in a double-blind, randomized, controlled trial of micronutrient supplementation during pregnancy from August 2002 to January 2006 was enrolled. Follow-up was conducted from June to December 2016. RESULTS: A total of 2115 participants were analyzed (median age 12 years; IQR ± 1), the majority of whom were male (59.7%). The nutritional status distribution was 17.72% underweight, 8.62% overweight, 0.96% obese, and 2.58% stunted. Girls were less likely to be overweight/obese (relative risk ratio [RRR] 0.67, 95% CI 0.48-0.92) but more likely to be underweight (RRR 1.65, 95% CI 1.25-2.17) or stunted (RRR 2.26, 95% CI 1.21-4.22). Children of underweight mothers (RRR 1.63, 95% CI 1.19-2.25) with a history of small for gestational age (RRR 1.64, 95% CI 1.14-2.36) or described as being a "picky eater" (RRR 1.53, 95% CI 1.18-1.99) had a greater risk of being underweight. Children whose fathers' education was primary or below (RRR 2.25, 95% CI 1.11-4.59), with maternal height <150.1 cm (RRR 2.46, 95% CI 1.12-5.39), or who had mothers with underweight (RRR 2.80, 95% CI 1.37-5.72) had a greater likelihood of stunting. Overweight/obesity was associated with high and middle household wealth (RRR 1.62, 95% CI 1.14-2.32), mothers with overweight (RRR 1.86, 95% CI 1.25-2.78), and picky eating (RRR 0.62, 95% CI 0.46-0.84). CONCLUSIONS: Malnutrition (undernutrition and overweight/obesity) is common in rural Chinese adolescents and is associated with perinatal, genetic, and economic conditions.

Novel sampling methods for monitoring Anopheles arabiensis from Eritrea.

BACKGROUND: Studies comparing novel collection methods for host seeking and resting mosquitoes A. arabiensis were undertaken in a village in Eritrea. Techniques included an odor baited trap, a novel tent-trap, human landing collection and three methods of resting collection. A technique for the collection of mosquitoes exiting vegetation is also described. Pre-gravid rates were determined by dissection of host seeking insects and post-prandial egg development among insects collected resting. RESULTS: Overall 5,382 host-seeking, 2,296 resting and 357 A. arabiensis exiting vegetation were collected. The Furvela tent-trap was the most efficient, risk-free method for the collection of outdoor host-seeking insects, whilst the Suna trap was the least effective method. Mechanical aspirators (the CDC backpack or the Prokopack aspirator) were superior to manual aspiration in a dark shelter but there was no advantage over manual aspiration in a well-lit one. An estimated two-thirds of newly-emerged mosquitoes went through a pre-gravid phase, feeding twice before producing eggs. Mosquitoes completed gonotrophic development in a dark shelter but left a well-lit shelter soon after feeding. One blood-fed female marked in the village was recaptured 2 days after release exiting vegetation close to the oviposition site and another, shortly after oviposition, attempting to feed on a human host 3 days after release. Exit rates of males from vegetation peaked 3 min after the initial male had left. Unfed and gravid females exited approximately 6 min after the first males. CONCLUSIONS: Furvela tent-traps are suitable for the collection of outdoor biting A. arabiensis in Eritrea whilst the Prokopack sampler is the method of choice for the collection of resting insects. Constructing well-lit, rather than dark, animal shelters, may encourage otherwise endophilic mosquitoes to leave and so reduce their survival and hence their vectorial capacity.

Patients' perception of the outpatient pharmaceutical service quality in hospital pharmacies with auditable pharmaceutical transactions and services in Ethiopia: a cross-sectional study.

OBJECTIVE: To ensure the availability of quality pharmaceutical products and effective pharmaceutical services, a package of interventions named auditable pharmaceutical transactions and services (APTS), was implemented in the tertiary and secondary hospitals across Ethiopia since 2014. This study aimed to evaluate outpatients' perception of pharmaceutical service quality in hospitals with APTS in Ethiopia. DESIGN: Cross-sectional study. SETTING: Seven hospitals of Tigray, Ethiopia. PARTICIPANTS: 794 patients coming for pharmaceutical services. MAIN OUTCOME MEASURES: SERVQUAL instrument was employed to collect the patient's perception of pharmaceutical services. The mean perception score of pharmaceutical service quality was the main outcome measurement. RESULTS: Out of 810 patients approached, 794 participated in the study (response rate of 98.02%). Overall, the mean perception score of the service quality was 3.1 of 5. Among the five dimensions of SERVQUAL, dimension of empathy achieved the highest result with a mean score of 3.71, and tangibility was the second (3.19), followed by responsiveness (3.08), assurance (2.87) and reliability (2.81). The perception of patients in tertiary hospitals of service quality was more positive compared with patients in secondary hospitals (3.265>3.011, p=0.04). However, the difference was only significant in the dimension of assurance when considering the five dimensions separately. Respondents who were older, widowed, illiterate, farmer, retired or Orthodox were found to have better quality service experience compared with others (p=0.001). CONCLUSION: Generally, outpatients' perception of pharmaceutical service quality was positive. However, two dimensions of the service quality (assurance and reliability) were negatively perceived. To improve the service quality, we recommended the following: (1) managers should provide more training for pharmacists to strengthen their professional knowledge and encourage them to cooperate with other professionals; (2) the government needs to develop guidelines on information provided to patients and train the pharmacists to follow them; (3) hospitals can apply various procurement methods and efficient inventory management methods.

Predictors of HIV/AIDS comprehensive knowledge and acceptance attitude towards people living with HIV/AIDS among unmarried young females in Uganda: a cross-sectional study.

BACKGROUND: Youth in general and young females, in particular, remain at the center of HIV/AIDS epidemic. To avoid and prevent HIV infection, comprehensive knowledge as well as correct understanding of transmission and prevention strategies are crucial. Thus, the aim of this study is to explore the predictors of comprehensive knowledge on HIV/AIDS and accepting attitude towards PLWHIV. METHODS: A cross-sectional study was conducted using data from the 2016 Uganda Demographic Health Survey. A two-stage probability sampling method was applied and data were collected using a standard questionnaire. Of the total 8674 women aged 15-49 years, 1971 eligible women aged 15-24 years were included in this analysis. Data analysis was done using SPSS version 23. A Chi-square test followed by logistic regression analysis was used to explore the relationship between specific explanatory variables and outcome variables. The results were reported using odds ratios with 95% confidence interval. P value less than 0.05 was considered as statistically significant. RESULTS: Overall, 99.3% of the unmarried women aged 15-24 years were aware of HIV/AIDS, but only 51.9% had comprehensive knowledge on HIV/AIDS. Around 70% of the respondents were aware that "using condoms every time when having sex" and "having only one faithful uninfected partner" can prevent HIV transmission. About 68% of the unmarried women rejected at least two common local misconceptions about HIV/AIDS. An alarmingly small (20.6%) proportion of the respondents had a positive acceptance attitude towards PLWHIV. All variables were significantly associated with having comprehensive knowledge on HIV/AIDS in the unadjusted logistic regression analysis. After adjustment, older age (20-24 years), being educated, wealthier, and ever been tested for HIV/AIDS became predictors of adequate comprehensive HIV/AIDS knowledge. Moreover, respondents with adequate comprehensive knowledge of HIV/AIDS were more likely (OR 1.64, 95% CI 1.30-2.08) to have a positive acceptance attitude towards PLWHIV than their counterparts. CONCLUSION: Our study demonstrated a remarkably high level of awareness about HIV/AIDS among study participants, but the knowledge and positive acceptance attitude towards PLWHIV were not encouraging. Thus, endeavors to expand and strengthen educational campaigns on HIV/AIDS in communities, health facilities, and schools are highly recommended. Attention should particularly focus on young-aged and disadvantaged women with low educational level, poor socioeconomic status and those who have never been tested for HIV/AIDS.

Neonatal Hypernatremic Dehydration Associated with Lactation Failure.

Hypernatremic dehydration secondary to lactation failure remains a potentially life-threatening condition in countries where advanced laboratory investigations are scarce. An 11-day term baby with excessive weight loss (33.6%), reduced urine output, fever, jaundice, doughy skin, opisthotonus posturing, and tachycardia with poor perfusion was presented to our neonatal care. The baby was diagnosed with shock with hypernatremic dehydration. An initial bolus of 20 ml/kg of N/S was repeated 3 times (each over 20 minutes), i.e., a total of 204 ml was given over 1 hr, until the vital signs were normalized to PR-145, RR-45, T-37.2°C, SPO2-100%, and CRT < 3 seconds, and the baby began to void urine. Free water deficit and sodium excess was managed by gradual and slow correction over 72 hours to prevent cerebral oedema and neurologic sequelae. The baby required reconstituted solutions of 5% D/W + 1/2 N/S at a rate of 27 ml/hr for 72 hrs. Sepsis and hyperbilirubinemia were treated with antibiotics and phototherapy. Management of symptomatic hypernatremic dehydration must be considered in settings with inadequate laboratory facilities.

Neonatal mortality and associated factors in the specialized neonatal care unit Asmara, Eritrea.

BACKGROUND: Limited knowledge on the magnitude of neonatal mortality and associated factors is hampering early intervention in African countries. OBJECTIVE: To determine neonatal mortality and associated factors in the Specialized Neonatal Care Unit Asmara, Eritrea. METHODS: Medical records of all neonates admitted to the Specialized Neonatal Care Unit in 2016 were reviewed using a cross-sectional study. The most important causes of admission and mortality were analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the strength of risk factors associated with neonatal mortality. Variables significant at P < 0.20 level in the univariate analysis were retained in the multivariate model. Model fit was evaluated using Hosmer and Lemeshow test (Chi-square = 12.89, df = 8; P = 0.116), implies the model's estimates fit the data at an acceptable level. Collinearity was assessed using variance inflation factor (VIF) < 4. P-value < 0.05 was considered statistically significant. RESULTS: Of the 1204 (59.9% boys and 40.1% girls) neonates admitted in 2016, 79 (65.6/1000 live births) died. The major causes of admission were sepsis (35.5%), respiratory distress syndrome (15.4%) and perinatal asphyxia (10%). Major causes of death were respiratory distress syndrome (48.1%); extremely low birth weight (40.9%) and very low birth weight (30.5%). After adjustment, low birth weight (Adjusted odds ratio (AOR) = 4.55, 95% CI,1.97-10.50), very low birth weight (AOR = 19.24, 95% CI, 5.80-63.78), late admission (24 h after diagnosis) (AOR = 2.96, 95% CI, 1.34-6.52), apgar score (in 1 min AOR = 2.28, 95% CI, 1.09-4.76, in 5 min AOR = 2.07, 95% CI, 1.02-4.22), and congenital abnormalities (AOR = 3.95, 95% CI, 1.59-9.85) were significantly associated with neonatal mortality. Neonates that stayed > 24 h in the Specialized Neonatal Care Unit (AOR = 0.23, 95% CI, 0.11-0.46) had a lower likelihood of death. Overall 95.8% of mothers of neonates attended antenatal care and 96.6% were facility delivered. None of the maternal conditions were associated with neonatal mortality in this study. CONCLUSIONS: Low birth weight, late admission, low apgar scores and congenital abnormalities were significantly associated with neonatal mortality in the Specialized Neonatal Care Unit. Early management of low birth weight, preterm births, and neonatal complications should be the priority issues for controlling local neonatal deaths.

Correction to: Patterns of bone marrow aspiration confirmed hematological malignancies in Eritrean National Health Laboratory.

[This corrects the article DOI: 10.1186/s12878-019-0138-3.].

Malaria Risk Stratification and Modeling the Effect of Rainfall on Malaria Incidence in Eritrea.

Background: Malaria risk stratification is essential to differentiate areas with distinct malaria intensity and seasonality patterns. The development of a simple prediction model to forecast malaria incidence by rainfall offers an opportunity for early detection of malaria epidemics. Objectives: To construct a national malaria stratification map, develop prediction models and forecast monthly malaria incidences based on rainfall data. Methods: Using monthly malaria incidence data from 2012 to 2016, the district level malaria stratification was constructed by nonhierarchical clustering. Cluster validity was examined by the maximum absolute coordinate change and analysis of variance (ANOVA) with a conservative post hoc test (Bonferroni) as the multiple comparison test. Autocorrelation and cross-correlation analyses were performed to detect the autocorrelation of malaria incidence and the lagged effect of rainfall on malaria incidence. The effect of rainfall on malaria incidence was assessed using seasonal autoregressive integrated moving average (SARIMA) models. Ljung-Box statistics for model diagnosis and stationary R-squared and Normalized Bayesian Information Criteria for model fit were used. Model validity was assessed by analyzing the observed and predicted incidences using the spearman correlation coefficient and paired samples t-test. Results: A four cluster map (high risk, moderate risk, low risk, and very low risk) was the most valid stratification system for the reported malaria incidence in Eritrea. Monthly incidences were influenced by incidence rates in the previous months. Monthly incidence of malaria in the constructed clusters was associated with 1, 2, 3, and 4 lagged months of rainfall. The constructed models had acceptable accuracy as 73.1%, 46.3%, 53.4%, and 50.7% of the variance in malaria transmission were explained by rainfall in the high-risk, moderate-risk, low-risk, and very low-risk clusters, respectively. Conclusion: Change in rainfall patterns affect malaria incidence in Eritrea. Using routine malaria case reports and rainfall data, malaria incidences can be forecasted with acceptable accuracy. Further research should consider a village or health facility level modeling of malaria incidence by including other climatic factors like temperature and relative humidity.

Patterns of bone marrow aspiration confirmed hematological malignancies in Eritrean National Health Laboratory.

Background: Even though the incidences of hematologic malignancies have received considerable attentions globally, there is paucity of information on patterns of hematologic malignancy in Eritrea. The study was conducted to determine the distribution of various hematologic malignancies among patients who have received bone marrow examination, in the Eritrean National Health Laboratory. Methods: A retrospective descriptive study design was used to determine the patterns of Hematologic malignancies diagnosed at the Eritrean National Health Laboratory from October 2015 to July 2017. Results: Out of 207 patients who did bone marrow aspiration 52 patients were hematologic malignancy cases. The male to female ratio was 1:1. The age of the patients ranged from 2 to 80 years. Of the 52 patients 19, were less than 20 years of age and the remaining 33 were 20 years and above. Acute leukemia was the most common hematologic malignancy in the study area. It affected 18 of the cases followed by chronic myelogenous leukemia, chronic lymphocytic leukemia, myelodysplastic syndromes, multiple myeloma, and myeloprofilerative neoplasms. The presenting signs and symptoms in their decreasing frequency were generalized body weakness/fatigue, splenomegaly, fever, anemia, and lymphadenopathy. More than two-third of the patients had total leukocyte count greater than 10,000/µl. Conclusion: This study shows that hematologic malignancies are not uncommon in Eritrea.