Visual Inspection with Acetic Acid Positivity in Screening and Early Detection of Cervical Dysplasia in Africa, 2023: A Meta-Analysis.

Background: Visual Inspection with Acetic acid (VIA) is the best feasible method of screening and early detecting for cervical dysplasia for resource limited settings like Africa. There is no study that can represent Africa on VIA positivity. Therefore, this metaanalysis was planned to verify the best available articles to pool the visual inspection with acetic acid positivity in screening and early detection of cervical dysplasia in Africa. Methods: The Cochrane Library, Web of Science, PubMed, Scopus, free Google database search engines, Google Scholar, and Science Direct databases were used to conduct a true search of this research article. STATA version 14.0 was used to do the metaanalysis. This meta-analysis was registered in PROSPERO database under the identity pf CRD42023392197. Result: This meta-analysis analyzed data from 21,066 women who had VIA examination to estimate the pooled VIA positivity in Africa. The overall pooled effect estimate of VIA positivity in Africa was 11.93 (95%CI: 11.48-12.37). Age <16 year during first intercourse 2.58(95%CI: 1.53-3.62), lifetime sexual partner ≥2 3.92(95%CI: 2.05-5.78) and HIV positivity 2.92(95%CI: 1.72-4.12) were the significant variables which influence VIA positivity. Conclusion: Overall pooled effect estimate of VIA positivity in Africa was high compared to other continents. The main factors that affect VIA positivity are age at first sexual contact being under 16 years old, the number of lifetime sexual partners being at least two, and HIV positivity. Therefore, the WHO's goal of creating Africa free of cervical cancer is still one that requires significant effort.

Prevalence of insomnia and associated factors among postpartum mothers in Southern Ethiopia, a community-based cross-sectional study.

Insomnia has become a global public health concern, particularly among postpartum women. Minimal sleep interruption related to newborn care is normally expected, insomnia, however has negative impact during the postpartum period. Although its causes and contributing factors are poorly understood, it has a wide-ranging impact on the mother and her infant. So far, studies in Ethiopia have focused on the general community, neglecting mothers in the postpartum period. Thus, this study aimed to assess the prevalence of insomnia and the factors associated with it. A community-based cross-sectional study included 451 study participants who were chosen using a simple random sampling technique. A structured, pretested, and interviewer-administered questionnaire was used to collect data. After entering the data into EpiData version 3.1, it was exported to the Statistical Package for Social Sciences version 26 for analysis. Bivariable and multivariable binary logistic regression analyses were carried out. Variables with a P-value of 0.2 in the bivariable analysis were included in the multivariable analyses. Those with a P-value of 0.05 were declared statistically significant in the final model. The current study included 444 mothers in total. Insomnia was prevalent among 23.2% (95% CI: 19.3%, 27.4%) of mothers who had given birth within the previous 12 months. Insomnia was associated with unplanned index pregnancy [AOR = 4.4, 95% CI (2.2, 8.7)], alcohol consumption [AOR = 3.0, 95% CI (1.4, 6.5), low social support [AOR = 9.7, 95% CI (4.4, 21.1)], medium social support [AOR = 2.2, 95% CI (1.1, 4.3)] and depression [AOR = 10.7, 95% CI (5.7, 20.0). A planned index pregnancy, abstaining from alcohol, and recognizing and treating postpartum depression were all advised.

Prevalence of posttraumatic stress disorder and associated factors among displaced people in Africa: a systematic review and meta-analysis.

Background: The number of people who have been displaced from their homes due to violence, conflict, and natural disasters. The displaced persons are vulnerable to PTSD; however, being women, individuals with lower socio-economic status and intense exposure to physical assault are more vulnerable. The reviews stated that the pooled prevalence of PTSD among refugees in high-income countries was higher than the general population. However, there has been no review done on PTSD among displaced persons in Africa. Therefore, the aim of this review was to summarise the most recent data evidence on the pooled prevalence of posttraumatic stress disorder and the pooled effect of associated factors on adult displaced people in Africa. Methods: We used an appropriate guideline for systematic reviews and meta-analyses reports, which is the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This review protocol was registered in PROSPERO (CRD42023411371). The publications were identified from PubMed/Medline, EMBASE, the Cochrane Library, Scopus databases, and other grey searches of Google Scholar and World Health Organisation (WHO) reports. The data was extracted in Microsoft Excel, and then it will be imported into STATA 11.0 for analysis. Results: We have included 10 studies conducted in African countries with 5287 study participants. In this meta-analysis, the pooled prevalence of PTSD among displaced people in Africa was 55.64 (95% CI: 42.76-68.41%). Further, in subgroup analysis regarding the study participants, the pooled prevalence of PTSD among internally displaced people and refugees was 56.35% and 54.04%, respectively. Among the associated factors, being female, unemployed, and depression were significantly related to PTSD among displaced people. Conclusions: In this review, the pooled prevalence of PTSD among displaced people in Africa was high. Demographic characteristics (female, single, and unemployed), substance use disorder, and depression were risk factors for PTSD among displaced people. This finding might help the stakeholders (mental health policy makers, administrators, and mental health professionals) to address the prevention, early screening, and management of PTSD among displaced people and to give attention to more vulnerable bodies. Systematic review registration: PROSPERO, identifier CRD42023411371.

Prevalence of premenstrual syndrome and its associated factors in Africa: a systematic review and meta-analysis.

Background: Clinical research and epidemiological studies have shown that many women experience physical and behavioral symptoms that begin during the luteal phase of the menstrual cycle and terminate around the onset of menses; this is called premenstrual syndrome. The reviews stated that the pooled prevalence of premenstrual syndrome was around 50 percent. However, there has been no review done on premenstrual syndrome in Africa. Therefore, the aim of this systematic review and meta-analysis was to summarize the most recent data evidence on the pooled prevalence of premenstrual syndrome and its pooled effect of associated factors in Africa. Method: We used an appropriate guideline for systematic reviews and meta-analyses reports, which is the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This review protocol was registered in PROSPERO (CRD42023414021). The publications were identified from PubMed/Medline, EMBASE, Scopus databases, and other grey searches. The included papers were the original data that reported the prevalence of premenstrual syndrome and associated factors published, in English, and papers available online from January 1, 2000, to May 30, 2023. The data was extracted in Microsoft Excel, and then it would be imported into STATA 11.0 for analysis. Results: We have included 16 studies conducted in African countries with 6530 study participants. In this meta-analysis, the pooled prevalence of premenstrual syndrome among the reproductive-age participants in Africa was 46.98 (95% CI: 28.9-65.06%). Further, in subgroup analysis, the pooled prevalence of premenstrual syndrome was 57.32% in Nigeria, 43.8% in Ethiopia, and 38.6% among university students and 66.04% among secondary school students. Among associated factors, the early age of menarche was significantly related to premenstrual syndrome. Conclusion: In this review, the pooled prevalence of premenstrual syndrome in Africa was high. Among factors, the early age of menarche was a risk factor for premenstrual syndrome. This finding might help the stakeholders (mental health policy makers, administrators, and mental health professionals) to address prevention, early screening, and management of PMS among reproductive-age women, and to give attention to more vulnerable bodies. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023414021.

The role of landscape management practices to address natural resource degradation and human vulnerability in Awash River basin, Ethiopia.

Landscape management practices (LMP) support addressing the vulnerability of small-scale producers (SSPs) through providing a means of sustaining and strengthening community livelihoods and building their resilience and the environment. However, addressing the vulnerability of SSPs through the implementation of LMP requires meaningful community engagement and assessing the benefits and costs from the perspective of local communities. This study was conducted in two watersheds, Maybar-Felana and Gelana, in the Awash River basin, Ethiopia. The study assessed the links between natural resource degradation and the vulnerability of SSPs, local communities' opinion on the benefits and costs of LMP and the implications of implementing LMP for addressing vulnerability. It gathered and analyzed data through key informant interviews (KII), focus group discussions (FGDs) and GIS and remote sensing techniques. Diverse LMP such as afforestation/reforestation, exclosures, terrace and bunds and crop- and soil-based soil amendments were adopted in the studied watersheds. These practices contributed to the improvement of natural resources such as forests and the services they provide. Over the last 21 years (2000-2021), forest cover increased by 11.5 and 42.5% in Maybar-Felana and Gelana watersheds, respectively, while shrublands increased by 41.1% in Maybar-Felana. In line with this, the SSPs identified multiple benefits of LMP including the restoration of degraded vegetation, reducing runoff and soil loss, improving access to water for multiple uses and increasing agricultural productivity. The adopted LMP contributed to reducing livelihood vulnerability through reducing incidents of weather extremes such as flood and drought, improving food and water security, enhancing resource availability, and building livelihood assets. The SSPs also identified multiple economic and social costs of LMP, suggesting that addressing the economic and social costs through balancing short-term economic losses with long-term environmental benefits of interventions is crucial to sustaining the LMP and the benefits they provide.

Multicentre Cross-Sectional Study Describing Postoperative Wound Care Practice in Northeast Ethiopia.

Background: Postoperative care is the management of a patient after surgery that includes care given during the immediate postoperative period. Postoperative complications are continuing to be a major source of morbidity following operative procedures. Postoperative wound infection delays the patient's recovery, increases discomfort, and prolongs the hospital stay. Objective: The study aimed to assess among nurses working in governmental hospitals in the south Wollo zone and Oromia special zone, northeast Ethiopia, 2020. Methods: Institution-based cross-sectional study design was conducted on governmental hospitals in the south Wollo zone and Oromia special zone. Variables in multivariable logistic regression, p-value < 0.05 was used to declare statistical significance. Result: From a total of 411 samples, 402 nurses responded to the questionnaire, with a response rate of 97.81%. This study showed that 49.8% of participants had good practice. The availability of a wound management tool was 1.6 times more likely to promote good practice than the lack of a wound assessment tool. Nurses who had documented their wound assessment and management activities were 2.1 times more likely to have good practice than those who hadn't documented. Conclusion: This study showed that half of the participants had poor wound care practices. Regarding associated factors, the availability of wound management tools and documentation of wound assessment and management had a significant association with the nurse's poor wound care practice. On the basis of these results, health policymakers and hospital administrators should develop a program to train nurses in wound care practice, and it helps as a reference for the researchers to further study.

Post-traumatic stress disorder and its associated factors among war-affected residents in Woldia town, North East Ethiopia, 2022; community based cross-sectional study.

INTRODUCTION: Post-traumatic stress disorder is marked by increased stress and anxiety following exposure to a traumatic or stressful event. Events of conflict and war-related traumas were commonly reported situations and people who have undergone through have a higher tendency to develop PTSD Woldia town had been under a serious military surge and a five-month encroachment, so the expected destruction in property, impact on physical, social and mental health of civilians was potentially high. More importantly, there is no study that investigated the significance of association between war-related traumatic events and post-traumatic stress disorder in the area. so this study aims to assess prevalence of post-traumatic stress disorder and its associated factors among war-affected residents in Woldia town, North East Ethiopia, 2022. METHOD: A community-based cross-sectional study design was employed by using a multi-stage systematic random sampling technique from May-15 to June-15/2022. A total of 609 participants were enrolled. PTSD was measured by the post-traumatic stress disorder checklist for DSM-5 (PCL-5). Data were entered by Epi data version 4.6.0.2 and analyzed using STATA version 14. Bivariable and Multivariable logistic regression analysis was done to identify associated factors to PTSD and P-values less than 0.05 were considered statistically significant. RESULTS: The overall prevalence of PTSD was 56.28%. Destruction/looting of property (AOR = 1.6,95%CI,1.11-2.47), murder/injury of family member (AOR = 2.1,95% CI,1.37-3.22), witness of murder of family member/others (AOR = 1.6,95% CI,1.01-2.71), unlawful imprisonment (AOR = 1.7, 95%CI, 1.06-2.74), depression (AOR = 2, 95%CI, 1.37-2.93), anxiety (AOR = 3.3, 95%CI,2.26-4.97), experience trauma on themselves (AOR = 2.0,95%CI,1.22-3.58), poor (AOR = 3.1,95%CI,1.60-6.04) and moderate (AOR = 3.0, 95%CI, 1.56-5.87) social support were statistically associated with PTSD at a p-value < 0.05. CONCLUSION: The study reveals that the prevalence of PTSD was high in Woldia town following an armed conflict between Federal Government and Tigray forces. Destruction/looting of property, murder/injury of family, witness murder of family/others, unlawful imprisonment, depression, anxiety, experience on themselves, poor and moderate social support were statistically associated with PTSD. Hence, encourage organization working on mental health, routine patient assessment with a history of trauma, facilitating means to support affected residents is recommended.

Prevalence and associated factors of structural congenital anomalies in resource limited setting, 2023: a systematic review and meta-analysis.

Background: Several studies have been conducted on structural congenital anomalies (CA). However, there is a paucity of studies that provide a comprehensive review of structural anomalies. We aimed to verify the available research articles to pool the possible risk factors of structural CA in resource-limited settings. Setting: The research articles were genuinely searched using PubMed, Scopus, Cochrane Library, Web of Science, free Google database search engines, Google Scholar, and ScienceDirect databases. Published studies were searched and screened for inclusion in the final analysis, and studies without sound methodologies and review and meta-analysis were not included in the analysis. Participants: This review analyzed data from 95,755 women who gave birth as reported by primary studies. Ten articles were included in this systematic review and meta-analysis. The articles that had incomplete information and case reports were excluded from the study. Results: The overall pooled effect estimate (EI) of structural CA was 5.50 (4.88-6.12) per 100 births. In this systematic review and meta-analysis, maternal illness EI with odds ratio (OR) = 4.93 (95% CI: 1.02-8.85), unidentified drug use with OR = 2.83 (95% CI: 1.19-4.46), birth weight with OR = 4.20 (95% CI: 2.12-6.28), chewing chat with OR = 3.73 (95% CI: 1.20-6.30), chemical exposure with OR = 4.27 (95% CI: 1.19-8.44), and taking folic acid tablet during pregnancy with OR = 6.01 (95% CI: 2.87-14.89) were statistically significant in this meta-regression. Conclusions: The overall pooled effect estimate of structural CA in a resource-limited setting was high compared to that in countries with better resources. Maternal illness, unidentified drug use, birth weight, chewing chat, chemical exposure, and never using folic acid were found to be statistically significant variables in the meta-regression. Preconception care and adequate intake of folic acid before and during early pregnancy should be advised. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022384838.

Structural congenital anomalies in resource limited setting, 2023: A systematic review and meta-analysis.

BACKGROUND: A number of studies have looked at neonatal structural birth defects. However, there is no study with a comprehensive review of structural anomalies. Therefor we aimed to verify the best available articles to pool possible risk factors of structural congenital anomalies in resource limited settings. SETTING: Genuine search of the research articles was done via PubMed, Scopes, Cochrane library, the Web of Science; free Google database search engines, Google Scholar, and Science Direct databases. Published and unpublished articles were searched and screened for inclusion in the final analysis and Studies without sound methodologies, and review and meta-analysis were not included in this analysis. PARTICIPANTS: This review analyzed data from 95,755 women who have birthed from as reported by primary studies. Ten articles were included in this systematic review and meta-analysis. Articles which have no full information important for the analysis and case reports were excluded from the study. RESULTS: The overall pooled effect estimate of structural congenital anomalies was 5.50 [4.88-6.12]. In this systematic review and meta-analysis maternal illness effect estimate (EI) with odds ratio (OR) = 4.93 (95%CI 1.02-8.85), unidentified drug use OR = 2.83 (95%CI 1.19-4.46), birth weight OR = 4.20 (95%CI 2.12-6.28), chewing chat OR = 3.73 (95%CI 1.20-6.30), chemical exposure OR = 4.27 (95%CI 1.19-8.44) and taking folic acid tablet during pregnancy OR = 6.01 (95%CI 2.87-14.89) were statistically significant in this meta-regression. CONCLUSIONS: The overall pooled effect estimate of structural congenital anomalies in a resource limited setting was high compared to better resource countries. On the Meta-regression maternal illness, unidentified drug use, birth weight, chewing chat, chemical exposure and never using folic acid were found to be statistically significant variables Preconception care and adequate intake of folic acid before and during early pregnancy should be advised.

Do pregnant African women exercise? A meta-analysis.

INTRODUCTION: Antenatal exercise can reduce gestational weight gain, backache; pregnancy induced medical disorders, caesarean section rates, and improves pregnancy outcomes. American College of Obstetrics and Gynecology (ACOG) recommends prenatal exercise, which is associated with minimal risk and has been shown to be beneficial for pregnancy outcomes, although some exercise routines may need to be modified. Consequently, this meta-analysis is intended to verify the pooled practice of antenatal exercise in Africa using available primary articles. METHODS: Genuine search of the research articles was done via PubMed, Scopes, Cochrane library, the Web of Science; free Google databases search engines, Google Scholar, and Science Direct databases. Published and unpublished articles were searched and screened for inclusion in the final analysis and Studies without sound methodologies, and review and meta-analysis were not included in this analysis. The Newcastle-Ottawa scale was used to assess the risk of bias. If heterogeneity exceeded 40%, the random effect method was used; otherwise, the fixed-effect method was used. Meta-analysis was conducted using STATA version 14.0 software. Publication bias was checked by funnel plot and Egger test. RESULTS: This review analyzed data from 2880 women on antenatal care contact from different primary studies. The overall pooled effect estimate of antenatal exercise in Africa was 34.50(32.63-36.37). In the subgroup analysis for pooled antenatal exercise practice by country, it was 34.24 (31.41-37.08) in Ethiopia and 37.64(34.63-40.65) in Nigeria. CONCLUSION: The overall pooled effect estimate of antenatal exercise in Africa was low compared to other continent. As it was recommended by ACOG antenatal exercise to every patient in the absence of contraindications, it should be encouraged by professionals providing antenatal care service.

Factors associated with stress-related symptoms among people with epilepsy in Ethiopia, a cross-sectional study.

Introduction: Stress is a common psychological problem present in people with epilepsy and has a serious impact on the health-related satisfaction of people with epilepsy and their cohabiters. This study aimed to assess the magnitude and related factors of stress. Methods: A hospital-based cross-sectional study was carried out among 301 systematically chosen people with epilepsy. The seven stress-related items of the Depression, Anxiety, and Stress -21 questionnaire was used to measure stress. Data were entered using Epi Info and analyzed by SPSS version 25. Predictors with a p-value < 0.20 in the bivariate logistic regression were transferred into the multivariate model. A p-value of less than 0.05 was viewed as statistically significant. Result: The prevalence of stress symptoms in this study was 23.9%. Daily labor occupational status with Adjusted Odds ratio [(AOR) = 0.042, 95% CI: 0.004, 0.469], onset of illness at the age of 18 years and above (AOR = 0.188, 95% CI: 0.046, 0.771), perceived stigma (AOR = 3.320, 95% CI: 1.345, 8.200), the presence of anxiety symptoms (AOR = 8.275, 95% CI: 3.345, 20.471), and belief that the condition is untreatable (AOR = 6.360, 95% CI: 1.647, 24.562) were significantly associated factors. Conclusion: The occurrence of stress was high, and it reinforced that there is a requisite for the identification and handling of stress-related symptoms among people with epilepsy.

The magnitude of perinatal depression and associated factors among women in Kutaber woreda public health institution and Boru Meda general hospital, Ethiopia, 2022: a cross-sectional study.

Background: Perinatal depression, characterized by the presence of depressive symptoms during pregnancy and/or within the first 12 months postpartum, poses a significant global public health concern. It contributes to a multitude of health risks for mothers, their infants, and their families. Understanding of perinatal depression and its associated factors is crucial for effective prevention and intervention strategies. However, there is a lack of comprehensive research on this topic in Ethiopia. Therefore, this study aims to determine the prevalence and factors contributing to perinatal depression among Ethiopian women. Methods: An institutional-based cross-sectional study was conducted, involving 552 women receiving perinatal services at Kutaber district health institution and Boru Meda General Hospital. Study participants were selected through systematic random sampling techniques. Perinatal depression was assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). The associations between various determinants and perinatal depression were examined using binary logistic regression, and factors with a p-value of less than 0.2 were included in the multiple logistic regression analysis. A p-value less than 0.05 was considered statistically significant. Results: The prevalence of perinatal depression was found to be 32.2%. The prevalence of perinatal depression was found to be 32.2%. Factors significantly associated with perinatal depression included being a student [adjusted odds ratio (AOR) = 4.364, 95% confidence interval (CI): 1.386, 13.744], experiencing excessive pregnancy-related concerns (AOR = 1.886, 95% CI: 1.176, 3.041), past substance use (AOR = 2.203, 95% CI: 1.149, 4.225), the presence of anxiety symptoms (AOR = 3.671, 95% CI: 2.122, 6.352), experiencing stress symptoms (AOR = 6.397, 95% CI: 3.394-12.055), and daytime sleepiness (AOR = 2.593, 95% CI: 1.558, 4.316). Conclusion: The findings of this study indicate a relatively high prevalence and valuable factors associated with perinatal depression. It highlights the need for a comprehensive approach to perinatal mental health that takes into account not only the biological aspects of pregnancy but also the psychological, social, and lifestyle factors that can impact a person's mental well-being during this critical period.

Factors associated with perinatal substance use among Ethiopian women: an institutional-based cross-sectional study.

Introduction: Substance use during the perinatal period is a significant public health concern, as it can have potential adverse effects on maternal and neonatal health outcomes. Unexpectedly, no previous studies have been conducted to assess the prevalence of substance use during the perinatal period among Ethiopian women. Therefore, this study aimed to determine the magnitude of substance use and its determinant factors during the perinatal period. Method: We conducted a hospital-based descriptive cross-sectional study among a systematically selected sample of 418 women who attended perinatal care between May and July 2022. Data were collected using an interviewer-administered structured questionnaire. Multivariate logistic regression analysis, with a 95% confidence interval and p-values less than 0.05, was employed to identify factors associated with substance use behavior. Result: The prevalence of perinatal substance use was found to be 38.3% (95% CI: 33.5-43.5). Of the women who used substances, 109 (26.1%) reported using chat, 46 (11.0%) reported alcohol consumption, and 5 (1.20%) reported using shisha. Factors significantly associated with substance use behavior during the perinatal period included a history of obstetric complications (AOR = 1.722, 95% CI: 1.022-2.902), the presence of chronic medical conditions (AOR = 3.784, 95% CI: 2.164-6.615), experiencing physical abuse (AOR = 5.323, 95% CI: 2.171-13.050), depression (AOR = 1.963, 95% CI: 1.028-3.749), and experiencing sleep disturbances (AOR = 2.016, 95% CI: 0.975-4.168). Conversely, giving birth to a live baby was found to be a protective factor against substance use behavior (AOR = 0.389, 95% CI: 0.187-0.810). Discussion: This study highlights a high prevalence of substance abuse among women during the perinatal period. In light of these findings, a comprehensive approach is recommended to address perinatal substance use among Ethiopian women. This should include the integration of preventive educational programs into perinatal care.

Prevalence and associated factors of anxiety disorder symptoms among people with epilepsy in Mekelle, Ethiopia, 2019: Institutional-based cross-sectional study.

AIM: Anxiety can have a profound influence on the health-related quality of life of people with epilepsy and caregivers. The study aimed to assess the prevalence and associated factors of anxiety disorder among people with epilepsy. DESIGN: An institutional-based cross-sectional study was conducted. METHOD: From 18 April 2019-30 May 2019, systematically selected 300 peoples with epilepsy were recruited. Anxiety was assessed by using the generalized anxiety disorder-7 (GAD-7). The data were entered by using Epi Info and analysed by SPSS version 25. RESULT: The prevalence of anxiety was 38.3%. Secondary educational status, medication-related side effect, substance use history, seizure-related physical trauma, stress symptoms and a mental illness belief were significantly associated factors. The prevalence of anxiety disorder symptom was high, and it reinforced the need for recognition and treatment of mental disorders in people with epilepsy.

Decentralization of Acid Fast Bacilli (AFB) External Quality Assurance Using Blind Rechecking for Sputum Smear Microscopy in Ethiopia.

INTRODUCTION: Ethiopia achieved a rapid expansion of TB microscopic centers for acid fast bacilli (AFB). However, external quality assurance (EQA) services were, until recently, limited to few regional and sub-regional laboratories. In this paper, we describe the decentralization experience and the result of EQA using random blinded rechecking. MATERIALS AND METHODS: The routine EQA quarterly report was compiled and analyzed. A positive result by the microscopic center while the EQA center reported negative result is categorized as false positive (FP). A negative result by the microscopic center while the EQA center reported positive is considered false negative (FN). The reading of EQA centers was considered a gold standard to compute the sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV) of the readings of microscopic centers. RESULTS: We decentralized sputum smear AFB EQA from 4 Regional Laboratories (RRLs) to 82 EQA centers and enrolled 956 health facilities in EQA schemes. Enrollment of HFs in EQA was gradual because it required training and mentoring laboratory professionals, institutionalizing internal QA measures, equipping all HFs to perform diagnosis, and establishing more EQA centers. From 2012 to 2014 (Phase I), the FP rate declined from 0.6% to 0.2% and FN fell from as high as 7.6% to 1.6% in supported health facilities (HFs). In HFs that joined in Phase II, FN rates ranged from 5.6 to 7.3%. The proportion of HFs without errors has increased from 77.9% to 90.5% in Phase I HFs and from 82.9% to 86.9% in Phase II HFs. Overall sensitivity and specificity were 95.0% and 99.7%, respectively. PPV and NPV were 93.3% and 99.7%, respectively. CONCLUSION: Decentralizing blinded rechecking of sputum smear microscopy is feasible in low-income settings. While a comprehensive laboratory improvement strategy enhanced the quality of microscopy, laboratory professionals' capacity in slide reading and smear quality requires continued support.

Antibacterial activities of selected medicinal plants in traditional treatment of human wounds in Ethiopia.

OBJECTIVE: To evaluate the activity of selected Ethiopian medicinal plants traditionally used for wound treatment against wound-causing bacteria. METHODS: Samples of medicinal plants (Achyranthes aspera, Brucea antidysenterica, Datura stramonium, Croton macrostachyus, Acokanthera schimperi, Phytolacca dodecandra, Millettia ferruginea, and Solanum incanum) were extracted using absolute methanol and water and tested for their antimicrobial activities against clinical isolates and standard strains of wound-causing bacteria using agar well diffusion and micro titer plate methods. RESULTS: Most of the plant extracts had antibacterial activities, among which Acokanthera schimperi and Brucea antidysenterica inhibited growth of 100% and 35% of the test organisms, respectively. Methanolic extracts had higher activities compared with their corresponding aqueous extracts. The most susceptible organism to the extracts was Streptococcus pyogens while the most resistant were Escherichia coli and Proteus vulgaris. CONCLUSIONS: This finding justifies the use of the plants in wound healing and their potential activity against wound-causing bacteria. Their toxicity level and antimicrobial activity with different extraction solvents should further be studied to use them as sources and templates for the synthesis of drugs to control wound and other disease-causing bacteria.

Occurrence of extended spectrum beta-lactamase enzymes in clinical isolates of Klebsiella species from Harar region, eastern Ethiopia.

Extended Spectrum beta-Lactamases (ESBLs) producer and multidrug resistant Klebsiella spp. are becoming a major nosocomial pathogen globally. There are no documented reports yet on the occurrence of ESBL enzymes in Klebsiella spp. species from Ethiopia. This study was undertaken to isolate and determine the occurrence of ESBLs and multi-drug resistant Klebsiella spp. in different clinical samples obtained from patients. A cross-sectional survey was conducted in four different hospitals of Harar region (Hiwot Fana, Misrak-Arbegnoch, Police and Army) from December 2003 to February 2004. Three hundred and eighty four clinical specimens (202 sputum, 164 urine and 18 pus) were collected from patients admitted in different wards. Antimicrobial susceptibilities were performed on 57 clinical isolates by standard disk diffusion procedures against eight antimicrobial agents. The ESBLs detection was made by using cefotaxime and ceftazidime alone and in combination with clavulanate. A total of 57 (15%) Klebsiella spp. were isolated from 384 patients. Of the 57 isolates, 33 (58%) were from sputum, 18 (31.5%) from urine and 6 (10.5%) from pus. Of the 57 Klebsiella spp., 54 (94.7%) were identified as K. pneumoniae and 3 (5.3%) as K. oxytoca. Resistance was found against cephalosporins [cefotaxime (39.0%), cefoxitin (39.0%), ceftazidime (40.0%), ceftriaxone (40.0%), cephalothin (42.0%)], chloramphenicol (70.0%), gentamicin (61.0%) and trimethoprim-sulphamethoxazole (65.0%). Analyzed Klebsiella isolates were characterized also by a high degree of multi-resistance (67.0%). In 19/57 (33.3%) of the Klebsiella isolates, ESBL production was detected. Rates of detection of ESBL producers were 42.1, 26.3, 26.3 and 5.3% in Hiwot-Fana, Misrak-Arbegnoch, Police and Army hospitals, respectively. Multi-drug resistant isolates were more prevalent among the ESBLs producers (95.0%) than non-producers (53.0%) (p=0.24). In conclusion, our results show that awareness of ESBL production by Klebsiella spp. is clinically important. In the absence of infection control measures, ESBL producing organisms readily pass horizontally from patient to patient. These strains also transiently colonize the hands of hospital staff members, thereby facilitating patient-to-patient transmission of the organism.