Effect of COVID-19 pandemic on the incidence of acute diarrheal disease and pneumonia among under 5 children in Ethiopia- A database study.

COVID-19 has had a devastating impact on preventable and treatable pediatric diseases in Ethiopia. This study looks at the impact of COVID-19 on pneumonia and acute diarrheal diseases in the country, as well as the differences between administrative regions. In Ethiopia, we conducted a retrospective pre-post study to assess the impact of COVID-19 on children under the age of five who had acute diarrhea and pneumonia and were treated in health facilities during the pre-COVID-19 era (March 2019 to February 2020) and the COVID-19 era (March 2020 to February 2021). From the National Health Management District Health Information System (DHIS2, HMIS), we retrieved data on total acute diarrheal disease and pneumonia, along with their regional and monthly distribution. We calculated incidence rate ratios comparing the rates of acute diarrhea and pneumonia during the pre-and post-COVID-19 eras and adjusted for the year, using Poisson regression. The number of under-five children treated for acute pneumonia decreased from 2,448,882 before COVID-19 to 2,089,542 ((14.7% reduction (95%CI;8.72-21.28), p<0.001)) during COVID-19. Similarly, the number of under-five children treated for acute diarrheal disease decreased from 3,287,850 in pre-COVID-19 to, 2,961,771((9.91% reduction (95%CI;6.3-17.6%),p<0.001)) during COVID-19. In the majority of the administrative regions studied, pneumonia and acute diarrhea diseases decreased during COVID-19, but they increased in Gambella, Somalia, and Afar. During the COVID-19 period, the greatest reduction of children with pneumonia (54%) and diarrhea disease (37.3%) was found in Addis Ababa (p<0.001). The majority of administrative regions included in this study have seen a decrease in pneumonia and acute diarrheal diseases among children under the age of five, while three regions namely, Somalia, Gambela, and Afar saw an increase in cases during the pandemic. This emphasizes the importance of using tailored approaches in mitigating the impact of infectious diseases such as diarrhea and pneumonia during situations of a pandemic such as COVID-19.

Effect of Package of Interventions on the Use and Quality of Postpartum Family Planning Services at Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia.

Background: Postpartum Family Planning (PPFP), which aims to prevent high risk unintended and closely spaced pregnancies during the first year following childbirth, is one of the highest impact interventions to avoid increased risk of premature birth, low birth weight, fetal and neonatal death, and adverse maternal health outcomes. This study aimed to assess the combined effect of a package of interventions on the use and quality of PPFP services at Y12HMC, Addis Ababa Ethiopia. Method: Cross-sectional study design was conducted to evaluate the effect of the package of chosen interventions: creating a private counseling space near the postpartum ward and providing training for health care providers on the WHO decision tool kit and Long Acting Contraceptive Methods (LACM). Interviews were conducted with 470 women (235 before and 235 after the intervention). Frequency tables and graphs were used to describe the study variables and statistical significance between pre and post intervention indicators was declared at P value <.05. Results: From 470 participants, 421 respondents participated which makes response rate of 90%. The majority of the participants were in the age category 20 to 29 years, married/lived together, completed at least primary education and had more than one child both at baseline and post intervention. The proportion of women who chose PPFP increased from 55.8% at baseline to 69% after the intervention. The most preferred contraceptive method was implant. The overall service satisfaction level of the study participants was 95.4% post intervention, significantly higher than at baseline (78%, P < .05). Providers indicated that clients are satisfied with the service and that the institutional structure is appropriate for delivering integrated services following the intervention. Conclusion: This study demonstrated that quality improvement interventions like creating a private counseling space and providing training using WHO decision tool kit can achieve significant improvement on satisfaction of clients and PPFP uptake.

Indications, Challenges, and Characteristics of Successful Implementation of Perioperative Registries in Low Resource Settings: A Systematic Review.

Perioperative registries can be utilised to track outcomes, develop risk prediction models, and make evidence-based decisions and interventions. To better understand and support initiatives to establish clinical registries, this study aimed to assess the indications, challenges, and characteristics of successful perioperative registries in low-resource settings, where there is unmet surgical demand and patients have a mortality rate up to double that of high-income countries. We conducted a librarian-assisted literature search of international research databases of articles published between January 1969 and January 2021. Studies were filtered using predefined criteria and responses to two Mixed Method Appraisal Tool screening questions. A Direct Content Analysis Method was used to synthesis. e data for eligible studies based on predefined criteria. The search identified 2793 abstracts. After removing duplicates and excluding studies that did not meet eligibility criteria, twelve studies were included, conducted in South America (n = 4), Africa (n = 5), the Middle East (n = 2), and Asia (n = 1). The lack of context-specific data for determining and evaluating patient outcomes (n = 7) was the major indication for implementation. Organising local research teams and engaging stakeholders in the host country were associated with successful implementation. Inadequate funding for data collectors and monitoring data quality were identified as challenges (n = 4). The goal of a perioperative registry is to generate data to influence and support quality improvement, and national surgical policies. Efforts to establish perioperative registries in low- and middle-income countries should engage local teams and stakeholders and seek to overcome challenges in data collection and monitoring.

Impact of COVID-19 pandemic on TB prevention and care in Addis Ababa, Ethiopia: a retrospective database study.

OBJECTIVE: The current COVID-19 pandemic in Ethiopia could cause severe dysfunction in tuberculosis (TB) treatment, diagnostic services, and prevention and control efforts. In this study, we evaluated the effect of COVID-19 on TB service indicators in Addis Ababa, where more than two-thirds of the country's COVID-19 morbidity was recorded. DESIGN: We performed a comparative retrospective study to evaluate the impact of COVID-19 on TB services during the pre-COVID-19 era (from April 2019 to March 2020) and the COVID-19 era (from April 2020 to March 2021) in Addis Ababa, Ethiopia. We extracted data on total TB detection rate, TB treatment success rate, isoniazid prophylaxis therapy, and drug susceptibility tests and others from the health information system. Using Poisson regression, we estimated the incidence rate ratios and the absolute number difference of the indicators (number per quarter and year) in the COVID-19 and pre-COVID-19 eras. RESULTS: Compared with the pre-COVID-19 era, the total TB detection, bacteriologically confirmed TB, TB treatment success rate, latent TB infection treatment and community health workers' engagement in TB detection decreased, respectively, by 11%, 11.8%, 17%, 44.7% and 77.2% during the COVID-19 period. Rifampicin resistance increased by 27.7% during the same period. Comparative analysis showed a significant decline in these TB service indicators (p<0.001) CONCLUSION: The COVID-19 pandemic has had a negative impact on TB service indicators in Addis Ababa. This highlights the importance of reinforcing TB services, including adopting alternative digital health technology to screen for TB and integrating TB and COVID-19 services to mitigate COVID-19's challenges to TB prevention and care.

Guideline Recommendations for Empirical Antimicrobial Therapy: An Appraisal of Research Evidence for Clinical Decision-Making in Ethiopia.

INTRODUCTION: The rapid spread of drug resistance is forcing standard treatment guidelines (STGs) to become more appropriate with due consideration of the evidence on the antimicrobial resistance (AMR) situation in Ethiopia. Therefore, we aimed to assess the local AMR recommendations in the STGs for empirical antibacterial prescriptions for the five common infectious syndromes. We also determined the quality of AMR reviews conducted in the country. METHODS: We conducted a review of the STGs used in the health centers, general hospitals, and primary hospitals in Ethiopia and assessed the AMR recommendations in STGs for empirical antibacterial prescriptions for community-acquired pneumonia (CAP), urinary tract infection (UTI), tonsillopharyngitis, acute otitis media (AOM), and bacterial dysentery. Next, we performed an overview of AMR reviews published in Ethiopia. We used the MEDLINE/PubMed, Embase, Cochrane Library, and Google Scholar databases to identify AMR reviews. The review characteristics were extracted. We also evaluated the quality of each included AMR review using a measurement tool to assess the systematic review scale (AMSTAR 2). RESULTS: A total of 6 STGs and 12 AMR reviews conducted in the country were included. The choice of empirical antibacterials for similar infectious syndromes (and editions) was comparable across the three levels of the health care system. None of the STGs evaluated included the local AMR recommendations for empirical antibacterial prescriptions for five common infectious syndromes. Of all the AMR reviews included, 75% had low and below methodologic quality, and none had a high-quality score using the AMSTAR 2 tool. CONCLUSION: Standard treatment guidelines did not consider local AMR recommendations for empirically prescribing antibacterials for common infectious syndromes. The AMR reviews published in the country produced poor methodologic quality evidence for clinical applications. This highlights the need to improve the methodologic quality to provide the best available evidence for clinical decision-making and curb the ongoing AMR in Ethiopia. TRIAL REGISTRATION: Retrospectively registered (15/07/2020).

Maternal and neonatal services in Ethiopia: measuring and improving quality.

PROBLEM: Maternal and neonatal mortality remains high in low- and middle-income countries, with poor quality of intrapartum care as a barrier to further progress. APPROACH: We developed and tested a method of measuring the quality of maternal and neonatal care that could be embedded in a larger national performance management initiative. The tool used direct observations and medical record reviews to score quality in nine domains of intrapartum care. We piloted and evaluated the tool in visits to the 18 lead hospitals that have responsibility to promote and coordinate quality improvement efforts within a hospital cluster in Ethiopia. Between baseline and follow-up assessments, staff from a national quality collaborative alliance provided hospital-based training on labour and delivery services. LOCAL SETTING: Ethiopia has invested in hospital quality improvement for more than a decade and this tool was integrated into existing quality improvement mechanisms within lead hospitals, with the potential for scale-up to all government hospitals. RELEVANT CHANGES: Significant improvements in quality of intrapartum care were detected from baseline (June-July 2015) to follow-up (February-March 2016) in targeted hospitals. The overall mean quality score rose from 65.6 (standard deviation, SD: 10.5) to 91.2 (SD: 12.4) out of 110 items (P < 0.001). LESSONS LEARNT: The method was feasible, requiring a total of 3 days and two to three trained data collectors per hospital visit. It produced data that detected substantial changes made during 8 months of national hospital quality improvement efforts. With additional replication studies, this tool may be useful in other low- and middle-income countries.

Mechanistic Investigation of Molybdate-Catalysed Transfer Hydrodeoxygenation.

The molybdate-catalysed transfer hydrodeoxygenation (HDO) of benzyl alcohol to toluene driven by oxidation of the solvent isopropyl alcohol to acetone has been investigated by using a combination of experimental and computational methods. A Hammett study that compared the relative rates for the transfer HDO of five para-substituted benzylic alcohols was carried out. Density-functional theory (DFT) calculations suggest a transition state with significant loss of aromaticity contributes to the lack of linearity observed in the Hammett study. The transfer HDO could also be carried out in neat PhCH2 OH at 175 °C. Under these conditions, PhCH2 OH underwent disproportionation to yield benzaldehyde, toluene, and significant amounts of bibenzyl. Isotopic-labelling experiments (using PhCH2 OD and PhCD2 OH) showed that incorporation of deuterium into the resultant toluene originated from the α position of benzyl alcohol, which is in line with the mechanism suggested by the DFT study.

Testing computational models of hyperpolarizability in a merocyanine dye using spectroscopic and DFT methods.

The structural and electronic properties of a highly solvatochromic merocyanine dye, 2-(3-cyano-5,5-dimethyl-4-(3-(1-octadecylpyridin-4(1H)-ylidene)prop-1-enyl)furan-2(5H)-ylidene)malononitrile (pyr3pi), have been investigated using UV-vis, NMR, hyper-Rayleigh scattering, and Raman spectroscopies and further interpreted using computational chemistry. Spectroscopic data indicate that pyr3pi exists in its zwitterionic form even in low polarity solvents with electronic absorption spectra showing a hypsochromic shift with an increase in solvent polarity and NMR experiments indicating an increasingly zwitterionic structure in chloroform as the temperature is lowered. Raman spectra in increasingly polar solvents show small variations of the structure that are consistent with a change toward a structure with more zwitterionic character. However, comparison of the calculated and experimental vibrational energies and intensities and comparison of NMR coupling constants with calculated bond order indicate that calculations underestimate the amount of charge separation seen in low polarity solvents. Although for this system density functional theory (DFT) calculations and the two-state model qualitatively reproduce negative solvatochromism, they fail to reproduce the trends in hyperpolarizability seen experimentally. This is attributed to solvent field DFT calculations underestimating the degree of charge separation in reaction fields representing low polarity solvents.

Symmetrical and nonsymmetrical chromophores with Tröger's base skeleton: chiroptical, linear, and quadratic nonlinear optical properties--a joint theoretical and experimental study.

We report on the novel chiral push-pull chromophores derived from 6H,12H-5,11-methanodibenzo[b,f][1,5]diazocine (Tröger's base skeleton). The synthesis of symmetrical chromophores featuring two identical acceptors, as well as the synthesis of unsymmetrical chromophores featuring only one acceptor is given. Symmetrical chromophores were prepared in the enantiomerically pure form and their chiroptical properties were investigated. Second-order nonlinear optical (NLO) properties of new chromophores were investigated with the aid of hyper-Rayleigh scattering (HRS). The detailed theoretical analysis of the second-order NLO properties of the chromophores was also undertaken. The joint theoretical and experimental studies of chromophores derived from Tröger's base skeleton, in comparison with benchmark chromophores featuring a dimethylamino group as the donor, provided insight into the relationship between the structure of the new chromophores and their NLO properties.

Length-dependent convergence and saturation behavior of electrochemical, linear optical, quadratic nonlinear optical, and cubic nonlinear optical properties of dipolar alkynylruthenium complexes with oligo(phenyleneethynylene) bridges.

The syntheses of trans-[Ru{4,4'-C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(4)NO(2)}Cl(dppm)(2)] (19), trans-[Ru{4,4',4''-C[triple bond]CC(6)H(4)C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(4)NO(2)}Cl(dppm)(2)] (20), trans-[Ru{4,4',4'',4'''-C[triple bond]CC(6)H(4)C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(4)NO(2)}Cl(dppe)(2)] (21), trans-[Ru{4,4',4'',4'''-C[triple bond]CC(6)H(4)C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(4)NO(2)}Cl(dppm)(2)] (22), trans-[Ru{4,4',4'',4'''-C[triple bond]CC(6)H(4)C[triple bond]CC(6)H(4)C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(4)NO(2)}Cl(dppm)(2)] (23), and trans-[Ru{4,4',4'',4''',4''''-C[triple bond]CC(6)H(4)C[triple bond]CC(6)H(4)C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(2)[2,5-(OEt)(2)]C[triple bond]CC(6)H(4)NO(2)}Cl(dppm)(2)] (24) are reported, together with those of precursor alkynes, complexes with the donor-pi-bridge-acceptor formulation that affords efficient quadratic and cubic NLO compounds; the identity of 19 was confirmed by a structural study. The electrochemical properties of 19-24 and related complexes with shorter pi-bridge ligands were assessed by cyclic voltammetry, and the linear optical, quadratic nonlinear optical, and cubic nonlinear optical properties were assayed by UV-vis-NIR spectroscopy, hyper-Rayleigh scattering studies at 1064 and 1300 nm, and broad spectral range femtosecond Z-scan studies, respectively. The Ru(II/III) oxidation potentials and wavelengths of the optical absorption maxima decrease on pi-bridge lengthening, until the tri(phenyleneethynylene) complex is reached, further chain lengthening leaving these parameters invariant; theoretical studies employing time-dependent density functional theory have shed light on this behavior. The quadratic nonlinearity beta(1064) and two-photon absorption cross-section reach maximal values at this same pi-bridge length, a similar saturation behavior that may reflect a common importance of ruthenium-to-alkynyl ligand charge transfer in electronic and optical behavior in these molecules.

Organometallic complexes for nonlinear optics. 43. Quadratic optical nonlinearities of dipolar alkynylruthenium complexes with phenyleneethynylene/phenylenevinylene bridges.

The syntheses of trans-[Ru(4,4'-C[triple bond]CC(6)H(4)C[triple bond]CC(6)H(4)NO(2))Cl(dppe)(2)] (19) and the systematically varied complexes trans-[Ru(4,4',4''-C[triple bond]CC(6)H(4)X(2)C(6)H(4)Y(2)C(6)H(4)NO(2))Cl(L(2))(2)] [L(2) = dppe, X(2) = C[triple bond]C, Y(2) = (E)-CH=CH (12), C[triple bond]C (18); L(2) = dppe, X(2) = (E)-CH=CH, Y(2) = C[triple bond]C (14), (E)-CH=CH (16); L(2) = dppm, X(2) = C[triple bond]C, Y(2) = (E)-CH=CH (13); L(2) = dppm, X(2) = (E)-CH=CH, Y(2) = C[triple bond]C (15), (E)-CH=CH (17)] are reported, the latter being donor-bridge-acceptor complexes varying in bridge composition by replacement of yne with E-ene linkages, together with their cyclic voltammetric data, linear optical, and quadratic nonlinear optical response data. Ru(II/III) oxidation potentials increase on replacing yne linkage by E-ene linkage at the phenylene adjacent to the metal center, and on replacing dppe by dppm co-ligands. The low-energy optical absorption maxima occur in the region 20,400-23,300 cm(-1) and are metal-to-ligand charge-transfer (MLCT) in origin; these bands undergo a blue-shift upon pi-bridge lengthening by addition of phenyleneethynylene units, and on replacing E-ene linkages by yne linkages. Time-dependent density functional theory calculations on model complexes have suggested assignments for the low-energy bands. The optical spectra of selected oxidized species contain low-energy ligand-to-metal charge transfer (LMCT) bands centered in the region 9760-11,800 cm(-1). Quadratic molecular nonlinearities from hyper-Rayleigh scattering (HRS) studies at 1064 nm reveal an increase in the two-level-corrected beta(0) value on pi-bridge lengthening, a trend that is not seen with beta values because of the blue-shift in lambda(max) for this structural modification. Replacing yne linkages by E-ene linkage at the phenylene adjacent to the metal center or dppm co-ligand by dppe results in an increase in beta and beta(0) values. In contrast, quadratic molecular nonlinearities by HRS at 1300 nm or electric field-induced second-harmonic generation (EFISH) studies at 1907 nm do not afford clear trends.

Alkynyl expanded donor-acceptor calixarenes: geometry and second-order nonlinear optical properties.

A number of wide- and narrow-rimmed functionalized alkynylcalix[4]arenes have been synthesized by Sonogashira coupling. With respect to their optical properties, these donor-acceptor systems are treated as ensembles of covalently linked, electronically independent tolane subchromophores. Linear UV/visible and fluorescence spectroscopic investigations revealed that the charge-transfer character of the electronic transitions in calixarenes, and also the second-order nonlinear optical (NLO) properties depend on the electron-withdrawing nature of the terminal ethynylphenyl substituent (NO(2), CF(3), H). The nitro derivatives display high values of the quadratic hyperpolarizability beta. Not only do the (nonlinear) optical properties of the target compounds depend on the number and relative disposition of the subchromophores, but also on the geometry of the calixarenes. In particular, the opening angle of the calixarene cavity can be determined by the substitution pattern of the calixarene scaffold (wide- versus narrow-rim substitution) and the number of the acetylene functions introduced. Both the NLO properties and the conformational issues are conveniently assessed by using hyper-Rayleigh scattering (HRS) in solution, and supported by X-ray crystallography in the solid state.