Increasing Prevalence of Artemisinin-Resistant HRP2-Negative Malaria in Eritrea.

BACKGROUND: Although the clinical efficacy of antimalarial artemisinin-based combination therapies in Africa remains high, the recent emergence of partial resistance to artemisinin in Plasmodium falciparum on the continent is troubling, given the lack of alternative treatments. METHODS: In this study, we used data from drug-efficacy studies conducted between 2016 and 2019 that evaluated 3-day courses of artemisinin-based combination therapy (artesunate-amodiaquine or artemether-lumefantrine) for uncomplicated malaria in Eritrea to estimate the percentage of patients with day-3 positivity (i.e., persistent P. falciparum parasitemia 3 days after the initiation of therapy). We also assayed parasites for mutations in Pfkelch13 as predictive markers of partial resistance to artemisinin and screened for deletions in hrp2 and hrp3 that result in variable performance of histidine rich protein 2 (HRP2)-based rapid diagnostic tests for malaria. RESULTS: We noted an increase in the percentage of patients with day-3 positivity from 0.4% (1 of 273) in 2016 to 1.9% (4 of 209) in 2017 and 4.2% (15 of 359) in 2019. An increase was also noted in the prevalence of the Pfkelch13 R622I mutation, which was detected in 109 of 818 isolates before treatment, from 8.6% (24 of 278) in 2016 to 21.0% (69 of 329) in 2019. The odds of day-3 positivity increased by a factor of 6.2 (95% confidence interval, 2.5 to 15.5) among the patients with Pfkelch13 622I variant parasites. Partial resistance to artemisinin, as defined by the World Health Organization, was observed in Eritrea. More than 5% of the patients younger than 15 years of age with day-3 positivity also had parasites that carried Pfkelch13 R622I. In vitro, the R622I mutation conferred a low level of resistance to artemisinin when edited into NF54 and Dd2 parasite lines. Deletions in both hrp2 and hrp3 were identified in 16.9% of the parasites that carried the Pfkelch13 R622I mutation, which made them potentially undetectable by HRP2-based rapid diagnostic tests. CONCLUSIONS: The emergence and spread of P. falciparum lineages with both Pfkelch13-mediated partial resistance to artemisinin and deletions in hrp2 and hrp3 in Eritrea threaten to compromise regional malaria control and elimination campaigns. (Funded by the Bill and Melinda Gates Foundation and others; Australian New Zealand Clinical Trials Registry numbers, ACTRN12618001223224, ACTRN12618000353291, and ACTRN12619000859189.).

Phylogenetic analysis of Newcastle disease virus detected in Eritrea between 2017 and 2021.

Thirty-five samples collected from chickens in 13 commercial farms in Eritrea between 2017 and 2021 following reports of disease were screened for Newcastle disease virus. Seventeen samples (50%) were shown to be positive by RT-PCR. An initial analysis of partial fusion (F) gene sequences of 10 representative samples indicated that the viruses belonged to subgenotype VII.1.1. Subsequently, full F gene sequence analysis of four of these representative samples confirmed the genotype of the viruses but also revealed that they were not identical to each other suggesting different origins of the VII.1.1 subgenotype viruses circulating in Eritrea. These data have implications for the control of Newcastle disease within the poultry population in Eritrea.

Current situation of fungal diseases in Eritrea.

The epidemiology of fungal infections in Eritrea is unknown. Most cases are under-reported due to a lack of diagnostics. This study estimates the burden of serious fungal infections and highlights treatment and diagnostic gaps in the country. All publications related to fungal infections were identified by searches using PubMed/Medline and Google Scholar. Where no data were available, data from neighbouring countries, then sub-Saharan African countries, then other parts of the world were considered for deriving estimates. The Eritrea population was 3,546,427 in 2020. In 2020, HIV/AIDS patients numbered 1400 and TB incidence were 2875. The five-year adult prevalence of asthma (2016-2020) was 41,390, and the total prevalence estimate of chronic obstructive pulmonary disease (COPD) was 308,328. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in AIDS patients was estimated at 96 and 205 cases. Oesophageal candidiasis incidence is 715 HIV-infected patients. Chronic pulmonary aspergillosis prevalence, including post-tuberculosis cases, was estimated at 1399 (39/100,000). Fungal asthma has a prevalence of 1035 and 1366 in adults. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 59,391 and 342,585, respectively. There are no data on candidaemia, but it is estimated at 5/100,000 (177 cases annually). Invasive aspergillosis in leukaemia, lung cancer, COPD and HIV is estimated at 540 cases and fungal keratitis in 514 cases annually. Serious fungal infections are prevalent in Eritrea with approximately 408,164 people (11.5%) affected annually. Studies on fungal diseases to improve diagnosis and treatment are required with the implementation of a national surveillance program.

Demographic, Clinical Profile and Outcomes of Neonates Admitted to Neonatal Intensive Care Unit of Dekemhare Hospital, Eritrea.

BACKGROUND: Ninety-six percent of the world's 3 million neonatal deaths occur in developing countries where the majority of births occur outside health facility. The objective of this study was to evaluate the demographic, clinical profile and outcome of neonates admitted to Neonatal Intensive Care Unit of Dekemhare Hospital of Eritrea. METHODS: The study was a retrospective register-based review of all neonates admitted from January 2018 to December 2021 to Dekemhare Hospital. Overall, 509 neonates were enrolled in this study. Data were collected from neonatal register book from January 5 to February 5, 2022 by general practitioners using a predesigned data collection tool. Data entry was done using CSpro 7.3 and analyzed through SPSS version 22. Results were presented in frequencies, percent and odds ratio. Univariable and multivariable analysis was done to measure the association between the variables. RESULTS: Three quarter (75.6%) of the neonates had normal birth weight and 80.0% were term. Majority (75.4%) of the neonates was delivered vaginally and 92.7% were delivered at health facility. Neonatal infection (33.0%), birth asphyxia (20%) and prematurity (14.3%) were the top three primary causes of neonatal admission to the Neonatal Intensive Care Unit. Furthermore, 31% of neonatal deaths occurred during 24-72 hours of their life and the mortality rate was 16.3%. Multivariable analysis indicated that low birth weight (AOR: 7.28; 95%CI: 2.85-18.55) increased neonatal mortality. Whereas delivery at health facility (AOR: 0.17; 95%CI: 0.06-0.47), hospital stay 4-7 days (AOR: 0.06; 95% CI: 0.02-0.23) and above 8 days (AOR: 0.06; 95%CI: 0.02-0.23) were showing protective effect on neonatal mortality. CONCLUSION: Congenital abnormality, prematurity and birth asphyxia had higher case fatality rate. And, low birth weight, delivery at health facility and hospital stay were found to be predictors of neonatal mortality. Training of health professionals on neonatal resuscitation, further improvement on the diagnostic setup, treatment tools, infrastructure and raising community awareness to deliver at health facility are crucial to decrease the neonatal mortality in Eritrea.

High incidence of type 1 diabetes in adolescents and young adults in Eritrea.

BACKGROUND: Eritrea has no data on type 1 diabetes incidence in children and youth; therefore, a study was undertaken to determine this in persons aged <25 years. METHODS: Data were collected on new type 1 diabetes diagnoses during 2019, from district, provincial and national hospitals. Type 1 diabetes was diagnosed according to standard WHO criteria. No secondary ascertainment source was available. 95% confidence intervals were computed based on approximation to the Poisson distribution, and age and gender effects were analysed with Poisson regression. RESULTS: There were 532 new cases of type 1 diabetes. Mean ± standard deviation (range) age of diagnosis was 16.2 ± 5.7 (1.5-24.9) years, and peak age group was 15-19 years (n = 200, 37.6%), with mode at 18 years. Incidence <15 years was 11.5/100,000 individuals [9.9-13.2], with the highest incidence in the 10-14 years group (19.0/100,000 [15.5-23.1]). Incidence then peaked in the 15-19 years age group (50.2/100,000 [43.5-57.7]) and remained high in the 20-24 years group (46.2/100,000 [39.0-54.3]). There was a male:female ratio of 1.37 (p = 0.001). Two hundred and thirty-eight (44.7%) presented in diabetic ketoacidosis. CONCLUSION: Type 1 diabetes incidence in Eritrea is moderate <15 years, and high 15-24 years. The 15-19 and 20-24 years rates appear to be the highest published to date. Given the study was only for one year, further confirmatory prospective information will clarify the situation and document trends. Assessment of the type 1 diabetes phenotypes that are occurring in Eritrea is also indicated.

Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-sectional study.

BACKGROUND: Understanding the natural history of chronic hepatitis B (CHB) virus infection is important for determining optimal management and predicting prognosis in patients. The aim of this study was to determine the prevalence of different phases of CHB infection among Eritrean patients and to identify the proportion of patients who are eligible for treatment according to the latest American Association for the Study of Liver Diseases (AASLD) guidelines. METHODS: This cross-sectional study enrolled 293 CHB patients (213 males and 80 females) between Jan 2017 and Feb 2019. The patients were classified into immune-tolerant, immune-active, and inactive CHB phases of the infection, which is based on the results of Hepatitis B virus (HBV) serological panel (HBsAg, anti-HBc total, HBeAg, and anti-HBe), ALT levels, and HBV DNA viral load. The 2018 AASLD guidelines were also used to identify patients who needed treatment. RESULTS: The mean age of the patients was 41.66 ± 13.84 years. Of these, 3 (1.0%) were at the immune tolerant phase, 58 (19.8%) at the immune-active CHB phase, and 232 (79.2%) at the inactive CHB phase. As most subjects (93%) were HBeAg-negative, based on AASLD guidelines, only 5 (1.7%) were currently eligible for treatment. CONCLUSIONS: Our data show that CHB patients in Eritrea were predominantly in the inactive CHB phase. Although initiating antiviral therapy is not recommended in these patients, periodic assessment of liver function and disease severity should be considered in patients older than 40 years. The immune-tolerant phase had the fewest patients, most of whom were aged above 20 years, attesting to the success of incorporating HBV vaccine in the national childhood immunization program since 2002. Our study shows that adopting AASLD treatment guidelines with adjustments to suit the local setting is a suitable option in the management of Eritrean CHB patients.

High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands.

Three quarters of tuberculosis (TB) patients in the Netherlands are foreign-born; 26% are from Eritrea or Somalia. We analyzed TB incidence rates in asylum seekers from Eritrea and Somalia in the first 5 years after arrival in the Netherlands (2013-2017) and performed survival analysis with Cox proportional hazards regression to analyze the effect of age and sex on the risk for TB. TB incidence remained high 5 years after arrival in asylum seekers from Eritrea (309 cases/100,000 person-years) and Somalia (81 cases/100,000 person-years). Age >18 years was associated with a higher risk for TB in asylum seekers from Eritrea (3.4 times higher) and Somalia (3.7 times higher), and male sex was associated with a 1.6 times higher risk for TB in asylum seekers from Eritrea. Screening and treating asylum seekers from high-incidence areas for latent TB infection upon arrival would further reduce TB incidence in the Netherlands.

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.

Prevalence and associated factors of postpartum depression among postpartum mothers in central region, Eritrea: a health facility based survey.

BACKGROUND: Postpartum depression (PPD) is a mood disorder that occurs within the first 12 months after delivery. It affects 20 to 40% of women living in the low-income countries. In resource limited countries discovering the predictors of PPD is important as it allows close follow-up and targeted screening of at risk mothers. The objective of this study was to assess the magnitude and predictors of PPD among recently delivered mothers in Central Region of Eritrea. METHODS: This study used analytical cross-sectional study design to evaluate the magnitude of and factors associated with postpartum depression among 380 randomly selected mothers. The study was conducted in four primary health care facilities of Zoba Maekel (Central Region), Eritrea. A structured closed-ended questionnaire was used to capture the socio-demographic and maternity related information of the study participants. The standard Diagnostic and Statistical Manual of Mental Disorders Fifth Edition was used to assess depression. The dependent variable for this study was status of the mother with regard to PPD. The socio-demographic and maternity related variables of the mothers, presumed to influence the likelihood of developing postpartum depression, were the independent variables. RESULTS: In this study the prevalence of PPD was found to be 7.4%. Mother's who are housewives were less likely to develop PPD (AOR = 0.24, 95% CI: 0.06-0.97; p = 0.046), whereas, mothers with perceived low economic status (AOR = 13.33, 95% CI: 2.66-66.78; p = 0.002), lack of partner support (AOR = 5.8, 95% CI: 1.33-25.29; p = 0.019), unplanned pregnancy (AOR = 3.39, 95% CI: 1.24-9.28; p = 0.017), maternal illness after delivery (AOR = 7.42, 95% CI: 1.44-34.2; p = 0.016), and reside in Southwest-Asmara (AOR = 6.35, 95% CI: 1.73-23.23; p = 0.05) had statistically significant higher odds of postpartum depression. CONCLUSIONS: In the current study setting, factors that associated with PPD are grouped in to two domains; the woman's potential to bear the forthcoming responsibility and the social support they get after delivery. The findings of this study imply the need to introduce an active screening program for PPD the health facilities as part of the postpartum care.

Prevalence of self-medication with antibiotics and associated factors in the community of Asmara, Eritrea: a descriptive cross sectional survey.

BACKGROUND: Development of drug resistance caused by self-medication with antibiotics, can be seen as one of the growing global threats. Self-medication is defined as the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms. The purpose of this study is to assess the practice of self-medication with antibiotics and associated factors among the community of Asmara, Eritrea. METHODS: This was a community based descriptive cross-sectional study conducted in 16 selected sub-districts of Asmara from September to November 2017. A Two-stage cluster sampling was employed to select study sites and participants. Data was collected in a face to face interview with a structured questionnaire and entered to CSPro version 6.2. Descriptive statistics, cross-tabulation and logistic regression were executed using SPSS version 22. RESULTS: A total of 580 study participants were recruited with a response rate of 99.5% (N = 577). The prevalence of Self-medication with antibiotics (SMA) in this study was found to be 45.1% [95% CI (40.5, 49.6)] and majority of them practiced once or twice in a period of 12 months. The main reasons for SMA were previous successful experience (34.4%) and the illness being 'not serious enough to seek medical care' (25.7%). Of those who self-medicated, 84.1% of used amoxicillin at least once. Wound infection (17.9%) and sore throat (13.9%) were the most self-recognized complaints that required self-medication. Antibiotics were supplied and recommended mostly by the community drug outlets. Only Sex (p = 0.046), knowledge (p = 0.019) and attitude (p < 0.001) of the participants were found significantly associated with the practice of SMA in the multivariate logistic regression. CONCLUSIONS: Though majority of the respondents considered self-medication with antibiotics as inappropriate practice, about half of them were practicing it anyway. Therefore immediate attention from relevant bodies is required.

Major Threat to Malaria Control Programs by Plasmodium falciparum Lacking Histidine-Rich Protein 2, Eritrea.

False-negative results for Plasmodium falciparum histidine-rich protein (HRP) 2-based rapid diagnostic tests (RDTs) are increasing in Eritrea. We investigated HRP gene 2/3 (pfhrp2/pfhrp3) status in 50 infected patients at 2 hospitals. We showed that 80.8% (21/26) of patients at Ghindae Hospital and 41.7% (10/24) at Massawa Hospital were infected with pfhrp2-negative parasites and 92.3% (24/26) of patients at Ghindae Hospital and 70.8% (17/24) at Massawa Hospital were infected with pfhrp3-negative parasites. Parasite densities between pfhrp2-positive and pfhrp2-negative patients were comparable. All pfhrp2-negative samples had no detectable HRP2/3 antigen and showed negative results for HRP2-based RDTs. pfhrp2-negative parasites were genetically less diverse and formed 2 clusters with no close relationships to parasites from Peru. These parasites probably emerged independently by selection in Eritrea. High prevalence of pfhrp2-negative parasites caused a high rate of false-negative results for RDTs. Determining prevalence of pfhrp2-negative parasites is urgently needed in neighboring countries to assist case management policies.

Seroprevalence of transfusion-transmissible infections among blood donors at National Blood Transfusion Service, Eritrea: a seven-year retrospective study.

BACKGROUND: Blood transfusion is associated with several risks particularly exposure to blood transfusion-transmissible infections (TTI), including: Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human immunodeficiency virus (HIV) and Syphilis, among others. The threat posed by these blood-borne pathogens is disproportionately high in Sub-Saharan Africa (SSA). This fact underscores the need for continuous surveillance of TTIs in the region. Therefore, the study objectives were to evaluate the prevalence of TTIs and donor characteristics associated with positivity for TTIs at the National Blood Transfusion Center (NBTC) in Asmara, Eritrea. METHODS: A retrospective analysis of blood donors' records covering the period from January 2010 to December 2016 was undertaken. The records were analyzed to evaluate the annualised cumulative prevalence of TTIs. Chi-square test (χ2) or Fisher's exact test was used to evaluate the relationship between serological positivity and particular donor characteristics. Logistic regression was fitted to identify factors associated with cumulative TTIs positivity. A P-value < 0.05 was considered statistically significant. RESULT: A total of 60,236 consecutive blood donors were screened between 2010 and 2016. At least 3.6% of donated blood was positive for at least one TTI and 0.1% showed evidence of multiple infections. The sero-prevalence of HBV, HCV, HIV, syphilis and co-infection was 2.0, 0.7, 0.3 and 0.6%, respectively. Sex, type of donor and region were associated with TTI positivity. Except for donation frequency, there was a significant relationship (P < 0.005) between HBV, HCV, HIV and syphilis sero-positivity and other donor characteristics evaluated in the study. CONCLUSION: The result demonstrates that Eritrea has relatively low TTI prevalence compared to other countries in Sub-Saharan Africa. However, the prevalence, particularly that of HCV, increased significantly in 2016. Enhancing donor screening and additional research utilizing nucleic acid based techniques should therefore be prioritized.

Prevalence of bovine tuberculosis in cattle, goats, and camels of traditional livestock raising communities in Eritrea.

BACKGROUND: The aim of the current study was to assess the prevalence of bovine tuberculosis (BTB) in cattle, goats, and camels, and its zoonotic potential within the traditional livestock raising communities in four regions of Eritrea. The Single Intradermal Comparative Tuberculin Test (SICTT) as indicator of M. bovis infection was conducted on 1077 cattle, 876 goats, and 195 camels. To elucidate possible risk factors for BTB transmission between animals and its potential zoonotic implication, questionnaire based face-to-face interviews were conducted in households of which 232 raised cattle, 128 goats, and 29 camels. RESULTS: The results of the SCITT were interpreted using the OIE standard (> 4 mm cut-off) for positive responses. In cattle, individual animal (n = 1077) and herd (n = 413) prevalences were 1.2% (n = 13) [Confidence Interval (CI) 95% CI, 1.0-1.3%] and 3.2% (n = 13) (95% CI, 3.0-3.4%), respectively. In goats (n = 876), none of the animals was positive. In camels, individual animal (n = 195) and herd (n = 70), BTB prevalences were 1.5% (n = 3) (95% CI,1.4-1.6%) and 2.9(n = 2) (95% CI, 0.9-4.6%), respectively. Overall, male animals were more at risk (OR = 2.6; 95% CI:1.0-8.7) when compared to females. Sharing of water points, introduction of new animals into herds and migration of animals over large distances were common events that may contribute to intra and inter-species transmission of BTB. Consumption of raw milk, lack of BTB transmission awareness, and low levels of education were common in the farming communities. CONCLUSION: The current study highlighted a low prevalence of M. bovis in cattle, goats and camels in extensive traditional livestock in Eritrea. Despite this, the spatial distribution of affected animals across most of the sampled regions and consumption of unpasteurized milk warrants surveillance, cautious and timely control measures for the disease.

Causes of Childhood Vision Impairment in the School for the Blind in Eritrea.

SIGNIFICANCE: Our study provides the much-needed evidence on causes of childhood blindness in Eritrea. This will assist authorities to plan appropriate strategies and implement preventive, curative, and rehabilitative services to address these causes of vision loss in children in this resource-limited country. PURPOSE: This study aims to identify the causes of severe vision impairment and blindness in children attending the only school for the blind in Eritrea. METHODS: All children enrolled in the school were examined, and the World Health Organization form for the examination of visually impaired children was used to record the data. Examination included visual acuity, refraction, anterior segment, and fundus assessment. Causes of vision loss for children with severe vision impairment (visual acuity <6/60 to 3/60) and blindness (visual acuity <3/60) are reported. Causes were classified by the anatomical site affected and by underlying etiology based on the timing of the insult and causal factor. RESULTS: A total of 92 children were examined, and 71 (77.2%) of them had severe vision impairment and blindness. The major causes of vision loss were corneal scars (16.9%), cataract (12.7%), phthisis bulbi (11.3%), congenital eye deformities (11.3%), optic atrophy (9.3%), and presumed chorioretinal Toxoplasma scars (7.0%). Hereditary factors were the major known etiological category (15.5%) followed by the sequel of eye injuries (12.7%). Blindness due to vitamin A deficiency was not found, whereas infectious causes such as measles and ophthalmia neonatorum were relatively absent (one case each). Potentially avoidable causes of vision impairment were accounted for in 47.9% of children. CONCLUSIONS: This study provides the first direct evidence on childhood vision impairment in Eritrea. Despite the limitations, it is clearly shown that nearly half of the vision loss is due to avoidable causes. Thus, preventive public health strategies, specialist pediatric eye care, and rehabilitative services are recommended to address childhood vision impairment in Eritrea.

Prevalence of dental caries and associated factors among 12 years old students in Eritrea.

BACKGROUND: Dental caries is one of the most prevalent diseases of childhood in developing countries. However, there is a paucity of epidemiological data on the prevalence and associated factors of dental caries in Eritrea. The objective of this study was to assess the prevalence and associated factors of dental caries among 12 years old school children in Eritrea. METHODS: A school based cross sectional study was conducted among 225 twelve years old students in two selected schools. One school from randomly selected urban and rural subzones of the country were selected. WHO adopted questionnaire and a standard checklist were used to collect relevant data. To assess dental caries, two examiners were calibrated by a certified dentist and inter observer agreement was calculated using the Cohen's Kappa statistic (0.82). All data analysis was done using SPSS version 20. RESULTS: The prevalence of dental caries was 78%, without significant difference between males (78%) and females (79%).The mean DMFT value was 2.50 (±2.21). The decayed component contributed 98.3% of the score as it had 2.44 (±1.2) share to the mean DMFT value. The first molar was the most affected tooth with a DMFT value of 1.55 (±1.36). The mean significant caries index score (SiC) was 4.97 (±1.9) which is higher than the upper limit of SiC value of 3 set by the WHO as a global average. More than half of the respondents had never visited a dentist and out of the students who had utilized a dental health facility, 82% of visits were due to dental pain while visits for regular checkups were cited by only 6.6% of the respondents. CONCLUSION: Dental caries was found to be a common public health problem among 12 years old Eritrean students. The prevalence of dental caries, mean DMFT and SiC scores were higher than the average score of other developing countries. Gaps in dental health service utilization, dental health practices and suboptimal water fluoride levels contribute to poor dental health among school children in Eritrea.

Prevalence and Pattern of Mandibular Third Molar Impaction in Eritrean Population: A Retrospective Study.

INTRODUCTION: The most commonly impacted tooth in the oral cavity is the mandibular third molar. Various etiologic factors have been suggested for impacted mandibular third molars. The pattern and prevalence of impacted mandibular third molars vary with different population and region. This study throws light on the prevalence and pattern of impacted mandibular third molars in Eritrea, East Africa. This is the first reported study regarding the same from Eritrea. AIM: To assess the prevalence and pattern of impacted mandibu-lar third molars in the population of Eritrea, East Africa by conducting a retrospective study from January 2009 to January 2014. MATERIALS AND METHODS: This study was conducted in the Department of Oral and Maxillofacial Surgery, Orotta School of Medicine and Dental Medicine and the Orotta Referral Medical and Surgical Hospital, Asmara, Eritrea. A total of 1,813 clinical and radiographic records [orthopantomograms] were assessed and 276 cases were selected for the study as per the inclusion criteria. They were evaluated for the frequency among the various age groups, gender and region along with the sides affected, angulation and level of impaction. The presence of systemic conditions and associated pathologies was also assessed according to the type of impaction. RESULTS: The average age of these patients in the study was found to be 30 years, with the 20 to 30 years age group being the most affected (67.4%). Females (53.3%) were affected more than the males (46.7%). People from the Asmara region showed significantly more prevalence (79.7%) than the adjoining areas (20.3%). Mesioangular impaction was the most common angulation with a definite relationship to the age groups (p = 0.032). The level of impaction had no significant relationship to the age groups, gender, or region, although class I position A was found to be the most common type. Mesioangular class I position A impac-tion showed an apparent relationship with underlying systemic conditions, but it was statistically insignificant. Mesioangular impaction was found to be associated with the most number of pathologies (p = 0.001). CONCLUSION: The prevalence of mandibular impaction was less in Eritrea (15.2%) compared with other populations. This study provides useful baseline data for the prevalence and pattern of mandibular impaction in the Eritrean population. CLINICAL SIGNIFICANCE: This study throws light on the pattern, type, and frequency of mandibular impacted teeth as per age, sex, and region among the population of Eritrea.

Prevalence and risk factors of bovine tuberculosis in dairy cattle in Eritrea.

BACKGROUND: The prevalence of bovine tuberculosis (BTB) in dairy cattle in the three major milk producing regions of Eritrea was assessed by subjecting 15,354 dairy cattle, 50 % of Eritrea's dairy cattle population, to the single intradermal comparative tuberculin test (SICTT). Skin test results were interpreted according to guidelines of the World Organization for Animal Health (OIE) with >4 mm as cutoff in skin thickness increase. In addition, we studied the relation between 'physiological' variables related to pregnancy and lactation, and the variable 'region' on the probability to be skin test positive. RESULTS: The BTB prevalences at animal and herd levels were: 21.5% and 40.9% in Maekel, 7.3% and 10% in Debub, and 0.2% and 1.6% in the Anseba region, respectively. Overall, in the regions included, prevalence was 11.3% (confidence interval (CI) 95% CI, 11.29 - 11.31%) and 17.3% (95% CI, 17.27-17.33%), at animal and herd level, respectively. Considering positive herds only, the animal BTB prevalence was 36.8%, 30.1%, and 1.8%, in Maekel, Debub and Anseba, respectively, and the overall animal prevalence within these herds was 32%. In adult dairy cattle the probability of positive reactivity in the SICTT test was highest in pregnant animals as compared to the other categories. CONCLUSION: This study reports persistent prevalence of BTB as defined by positive SICTT in the dairy sector of Eritrea, especially in the regions of Maekel and Debub that are located in the central highlands of the country. To our understanding this is the first report that has encompassed all the major dairy farms in Eritrea and it will be instrumental in advocating future BTB control programs in the dairy sector.

Gains attained in malaria control coverage within settings earmarked for pre-elimination: malaria indicator and prevalence surveys 2012, Eritrea.

BACKGROUND: Eritrea, like most countries in sub-Saharan Africa, has expended much effort towards malaria control with the view of transitioning from reduction of the disease burden to elimination. This paper reports on the level of achievement as highlighted by the follow-on, malaria-endemic area representative, survey that aimed to provide data and to assess progress on malaria indicators and parasite prevalence at household level across the country. METHODS: In 2012, data were collected using a two-stage stratified cluster random sample of 1887 households in 96 clusters (villages in rural areas and census enumeration areas in urban centers) during a malaria indicator and prevalence survey in Eritrea. The survey determined parasite prevalence in vulnerable population groups and evaluated coverage, use and access to malaria control services. Standardized Roll-Back Malaria Monitoring and Evaluation Reference Group household and women's questionnaires were adapted to the local situation and used for collection of data that were analysed and summarized using descriptive statistics. RESULTS: The results of the survey showed that 90% (95% CI 89-91) of households owned at least one mosquito net. The proportion of the population with access to an insecticide-treated net (ITN) in their household was 55% (95% CI 54-56). The utilization of ITNs was 67% (95% CI 65-70) for children under 5 years and 60% (95% CI 58-63) for pregnant women (OR: 0. 73(95% CI 0.62-0.85); P = 0.52). Only 28% (95% CI 26-30) of households were covered by indoor residual spraying (IRS) the previous year with significant heterogeneity by zoba (Debub 50 % (95% CI 45-54) vs Gash Barka 32 % (95% CI 28-36); OR = 0. 47 (95% CI 0.36-0.61), P = 0.05). Malaria parasite prevalence was low; 1.1% (95% CI 0.9-1.3) in the general population and 1.4% (95% CI 1.0-2.0) in children under five and 0.7% (95% CI 0.4-1.1) among women aged 15-49 years. Only 19% (95% CI 15-26) of children under five had fever in the 2 weeks preceding the survey, with 61% (95% CI 54.1-67.1) seeking treatment from a health facility. Data on knowledge levels show that 92% reported that malaria is transmitted by mosquitoes, 92% mentioned that the use of mosquito nets could prevent malaria, 47% knew malaria prevention medication, 83% cited fever as a sign and symptom of malaria, and 35% had heard or seen malaria awareness messages. CONCLUSION: Notwithstanding confounders, the observed low malaria parasite prevalence could be associated with malaria intervention coverage, access and utilization as well as high and equitable knowledge levels in the population. This indicates that Eritrea is on the right track towards pre-elimination. However, technical and infrastructure capacity should be strengthened to facilitate implementation, surveillance, monitoring, and evaluation.