Zinc deficiency and associated factors among pregnant women's attending antenatal clinics in public health facilities of Konso Zone, Southern Ethiopia.

BACKGROUND: Zinc is an essential mineral known to be important for the normal physiological functions of the immune system. It is one of the basic nutrients required during pregnancy for the normal development and growth of the fetus. However, Zinc deficiency during pregnancy causes irreversible effects on the newborn such as growth impairment, spontaneous abortion, congenital malformations and poor birth outcomes. Even though, the effect of Zinc deficiency is devastating during pregnancy, there is scarcity of evidence on Zinc deficiency and related factors among pregnant women in the current study area. OBJECTIVE: To assess Zinc deficiency and associated factors among pregnant women attending antenatal clinics in public health facilities of Konso Zone, Southern Ethiopia. METHODS: Institution based cross-sectional study was conducted among randomly selected 424 pregnant mothers. Data were collected using pre tested questionnaire (for interview part), and 5 blood sample was drawn for serum zinc level determination. Data were entered to Epi-Data version 3.1 software and exported to SPSS version 25 for analysis. Binary logistic regression analysis was computed and independent variables with a p-value ≤ 0.25 were included in multivariable analysis. Serum zinc level was determined using atomic absorption spectroscopy by applying clean and standard procedures in the laboratory. Finally adjusted odds ratio with 95% confidence level, P-value < 0.05 was used to identify significant factors for Zinc deficiency. RESULT: The prevalence of Zinc deficiency was found to be 128 (30.26%) with the mean serum zinc level of 0.56±0.12 g/dl. Age, 25-34 years [AOR 2.14 (1.19,3.82)], and 35-49 years [AOR 2.59 (1.15, 5.85)], type of occupation, farming [AOR 6.17 (1.36, 28.06)], lack of antenatal follow up during pregnancy [AOR 3.57 (1.05,12.14)], lack of freedom to purchase food items from market [AOR 3.61 (1.27, 10.27)], and inadequate knowledge on nutrition [AOR 3.10(1.58, 6.08)] were factors associated with Zinc deficiency. CONCLUSION: Zinc deficiency is a public health problem among pregnant mothers in the current study area. Improving maternal nutritional knowledge, motivating to have frequent antenatal follow up, and empowering to have financial freedom to purchase food items from market were the modifiable factors to reduce Zinc deficiency. Nutritional intervention that focused on improving nutritional knowledge and insuring access to Zinc sources food items should be delivered for pregnant mothers.

Establishing an Ultrasound Screening Protocol for Chronic Liver Disease with a Handheld Device: A Pilot Project in Southern Ethiopia.

Chronic liver disease (CLD) poses significant challenges in the developing world. The prevalence of this problem and the health burden on local health services are not well understood. The diagnosis and monitoring of CLD are difficult in these settings because of limited access to expensive imaging with limited mobility and/or liver biopsy. The aim of this project was to develop and implement an efficient evidence-based robust ultrasound protocol for the assessment of chronic liver disease using a hand-held ultrasound device that could be effectively used in the developing world. A protocol was established using scoring systems that have established accuracy for the diagnosis of hepatic fibrosis/cirrhosis and hepatic steatosis. Included in the protocol was the identification of hepatic masses, portal venous enlargement, hepatic size and splenic size. Hepatic steatosis was common, identified in 46 of 94 participants (49%). Hepatic fibrosis was observed in only 13 of 94 participants (14%). A significant limitation of the methodology was the inability to validate the results with biopsy or other forms of cross-sectional imaging. The protocol was successfully implemented in a community in a rural setting in South Ethiopia with a mean examination time of around 6 min. It is feasible to use handheld ultrasound for the screening of CLD in remote settings. This project provides an evidence-based framework for further studies in this area.

Antibacterial, Antifungal, and Cytotoxic Activity of Excoecaria agallocha Leaf Extract.

BACKGROUND: Mangroves contain several bioactive compounds, some of which have been used for centuries as remedies for several ailments. METHODS: Foliar parts of Excoecaria agallocha were extracted in organic solvents and in water using a Soxhlet apparatus and evaluated for antimicrobial activity against nine type-culture pathogens, six clinical isolates, and two fungal pathogens with agar well diffusion assays. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined by broth dilution and extracts further subjected to brine-shrimp cytotoxic assays using Artemia salina. Chemical constituents were analyzed with thin-layer chromatography (TLC), gas chromatography-mass spectroscopy (GC-MS), and Fourier-transform infrared spectroscopy (FT-IR). RESULTS AND DISCUSSION: Ethyl acetate extract displayed the broadest antimicrobial activity. Isolates of Staphylococcus aureus were found to be the most susceptible among the clinical and type-culture groups corresponding to inhibition zones: 17.3±1.1 and 23.5±1.3 mm in diameter, respectively. Anticandidal activity was found to be lower against Candida albicans and C. tropicalis (10.3±0.6 and 11.9±0.85 mm diameter). Also, this extract was found to be bactericidal for S. aureus and Micrococcus luteus (MBC:MIC ≤2). C cytotoxic activity LD50 was 521 µg/mL. On GC-MS, squalene [(6E, 10E, 4E, 18E)-2,6,10,15,19,23-hexamethyltetracosa-2,6,10,14,18,22-hexaene] was the major compound. Bioassay-guided (antibacterial) TLC revealed the presence of one major active fraction, F2, with an Rf value of 1.21. FT-IR analysis of this fraction also implied that it was squalene, which might have a functional role in the mechanism of chemical defense.

Adherence with COVID-19 Preventive Measures and Associated Factors Among Residents of Dirashe District, Southern Ethiopia.

INTRODUCTION: COVID-19 is one of the huge general wellbeing crisis for the planet. Since its first recognition, over 90.2 and 1.9 million people are infected and dead, respectively. Although it is not easily available for low-income countries, after many trials vaccination is initiated by some industrialized nations. However, still now there is no effective treatment for the infection. Henceforth, adherence with COVID-19 preventive and control measures is the only option to stop its spread and minimize its disastrous impact, especially, in developing nations like Ethiopia. Knowledge and behavior change are pillars to engage with preventive measures. Thus, the motivation behind this study was to assess communities' adherence with COVID-19 preventive measures and its associated factors among inhabitants of Dirashe district, Southern Ethiopia. MATERIALS AND METHODS: A cross-sectional study was directed among 648 inhabitants in Dirashe district from June 20 to July 5, 2020. A multistage sampling technique was applied to select the participants. A pretested, validated and reliable interviewer-administered survey tool comprising the socio-demographic characteristics, knowledge (α = 0.78), and adherence with COVID-19 preventive measures (α = 0.73) was used. The data were assorted electronically using Open Data Kit (ODK) collect version 1.17.2 android application and exported to Stata version 15.0 for analysis. Adjusted odds ratio (aOR) with 95% CI was used to identify variables associated with the community's adherence with COVID-19 preventive measures. RESULTS: An aggregate of 644 inhabitants were participated in this study; of them, only 12.3% [95% confidence interval (CI): 9.8, 15.1] adhered to the recommended COVID-19 preventive measures. Likewise, 63.51% [95% CI: 59.7, 67.2] and 54.5% [95% CI: 50.6, 58.4] of the participants had good knowledge and favorable attitude towards COVID-19 preventive measures, respectively. Urban residence [aOR: 9.74, 95% CI: 4.72, 20.10], favorable attitude [aOR: 1.97, 95% CI: 1.05, 3.68] and concerned about COVID-19-related stigma [aOR: 2.43, 95% CI: 1.02, 5.79] were independently associated with communities adherence with COVID-19 preventive measures. CONCLUSION: In general, communities' adherence to the recommended COVID-19 preventive measures was very low in the area. Addressing underprivileged population groups, disseminating teaching aids in local languages, behavioral change communications, and law enforcement is imperative to strengthen COVID-19 prevention practice.

Sero-prevalence and risk factors for hepatitis B virus infection among the consumers of the alcoholic beverage, cheka in Konso zone, southwestern Ethiopia.

INTRODUCTION: Hepatitis B virus (HBV) is a hepatotropic and partially double stranded deoxyribonucleic acid (DNA) virus that causes the immune-mediated killing of infected liver cells. It is a public health conundrum due to its considerable morbidity and mortality. Cheka is a cereal and vegetable-based fermented beverage that is consumed as a key dietary component in the southwestern parts of Ethiopia. This study was aimed to assess the seroprevalence of hepatitis B surface antigen (HBsAg) and associated risk factors among cheka consumers in the Konso community, southwest of Ethiopia. METHODS: A community-based cross-sectional study was conducted in a total of 633 cheka consumers between October 01, 2018, and May 31, 2019. The socio-demographic characteristics and associated factors were collected using a pre-tested semi-structured questionnaire. HBV infection was screened using immune-chromatographic strip tests and positive results were further confirmed with ELISA. RESULTS: The prevalence of HBV was found to be 18.2% (95% CI, 15.1-21.5). Gender (male) (AOR = 1.757:95% CI, 1.009-3.059), age (35-44 yrs), (AOR = 4.123:95% CI, 1.718-9.892), nature of the job (daily laborer) (AOR = 4.551:95% CI, 1.115-18.57), awareness about the transmission of the disease (AOR = 2.056:95% CI, 1.074-3.934) and previous history of contacts with patients having liver diseases (AOR = 2.496:95% CI, 1.187-5.248) were identified as factors which are being significantly associated with the HBV infection. CONCLUSIONS: Very high endemic levels of HBV infection are identified in the study. Male participants of age between 35 and 44 years, who are daily laborers and are aware of HBV transmission, with a previous history of contacts with patients having liver diseases were even at higher risk of HBV infection. The need for more research to find the links between cheka consumption and other mechanisms of HBV cross-infection in these communities is indicated.

Evaluation of the performance of clinical predictors in estimating the probability of pulmonary tuberculosis among smear-negative cases in Northern Ethiopia: a cross-sectional study.

OBJECTIVES: To evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests. DESIGN: A cross-sectional study. SETTING: Two public referral hospitals in Tigray, Ethiopia. PARTICIPANTS: A total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study. PRIMARY AND SECONDARY OUTCOME MEASURES: A total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done. RESULTS: The strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84-0.87) and culture-negative (AUC 0.64-0.69) PTB. CONCLUSIONS: Our finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.

In vitro antibacterial activity of medicinal plants against biofilm-forming methicillin-resistant Staphylococcus aureus: efficacy of Moringa stenopetala and Rosmarinus officinalis extracts.

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) is slowly rising in Ethiopia for the past few decades. Therefore, novel classes of antibiotics are indispensable to combat the increased incidence of newly emerging multidrug-resistant bacteria like MRSA. Terrestrial flora is considered as a reservoir of novel bioactive secondary metabolites as they have provided us with the largest array of natural products. In this background, the present study is intended to evaluate the in-vitro antibacterial efficacy of five medicinal plants (Ocimum lamiifolium Hochst. ex Benth., Rosmarinus officinalis L, Catharanthus roseus Linn., Azadirachta indica A. Juss and Moringa stenopetala Bac) against a panel of seven biofilm-forming MRSA. The leaves of the plants were extracted in organic solvents of varying polarity and the resultant crude extracts of respective medicinal plants were inspected for their antimicrobial activity by well diffusion technique. Minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) of the plant extracts against MRSA were determined by the broth dilution method. Besides, an anti-biofilm assay of the most potent plant extract was also performed, after which its chemical constituents were delineated by combined Gas Chromatographic and Mass Spectroscopic profiling (GC-MS). The results revealed that, of the five plants, three species including M. stenopetala, R. officinalis, and O. lamifolium exhibited significant antibacterial activity. Organic solvents with high and medium polarity were excellent in extracting antimicrobials compared to nonpolar solvents. The broadest and highest rank of activity was observed in the crude ethanolic extract of M. stenopetala. Based on the MIC/MBC ratio, the crude ethanolic extract of M. stenopetala was determined to be bacteriostatic. Anti-biofilm assay showed that the extract of M. stenopetala fairly inhibited the growth of MRSA in the preformed biofilm matrix. The GC-MS analysis of M. stenopetala revealed the presence of twelve compounds with antimicrobial activity. The present study provides new insight into the development of novel drug leads to the management of MRSA.

Knowledge and practice of essential newborn care among postnatal mothers in Addis Ababa City Health Centers, Ethiopia

Essential newborn care is a wide-ranging approach planned to improve the health of newborn through interventions after pregnancy. In Ethiopia, about 120,000 newborns die every year in the first weeks of life which accounts for 42% of all deaths of under-five mortality. Therefore this study is aimed to assess the knowledge and practice of essential newborn care practices among mothers in Addis Ababa, Ethiopia. A facility-based cross-sectional study was conducted amog the enroll 576 women in the first six weeks of post-partum who attending ANC in Addis Abeba Health facility. Written consent was obtained from each participated individuals before the actual data taken. Data were gathered by using pre tested standard questionnaire. The collected data were uploaded to computer using EpiData version 3.1. and the analysis was made through SPSS package version 21. Logistic regression was carried out to assess possible associations. The strength of association was measured at P<0.05 with 95% confidence interval. The study revealed that the level of essential newborn care practices was 38.8%. Education and advise about essential newborn care practices during and after birth by skilled birth attendants (OR=2.17, 95%, CI=1.42,3.31), home visit by health extension worker (OR=1.55, 95% CI=1.03,2.32) and place of delivery at health center (OR=7.69, 95% CI =1.32, 36.42), at private health facility (OR=9.18, 95% CI=1.32, 63.75) and government hospital (OR=6.68, 95% CI =1.32, 33.87) were found to have statistically significant association with essential newborn care practices. The result of this study has indicated that the level of essential newborn care practices was low. A home visit by health extension workers, the timing of postnatal care visit by skilled birth attendants, advice about essential newborn care practices during and after pregnancy and place of delivery were found to be independent predictors of essential newborn care practices in the study area. Government should take remedial action to improve newborn care practice

Adherence to Iron-Folate Supplementation and Associated Factors among Pastoralist's Pregnant Women in Burji Districts, Segen Area People's Zone, Southern Ethiopia: Community-Based Cross-Sectional Study.

BACKGROUND: Iron deficiency anemia among pregnant women is one of the most common public health problems in developing country particularly in Ethiopia. Iron/folic acid supplementation with optimal adherence is the main cost-effective strategy for prevention and control of iron deficiency anemia in pregnant women. However, level of adherence to iron/folic acid supplementation and its associated factors were not well identified in study area. Therefore, the aim of this study was to determine the level of adherence to iron/folic acid supplementation and associated factors among pregnant women in Burji Districts, southern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 317 pregnant women in Burji Districts from March to April 2017 using interviewer administered questionnaires. Data were entered into Epi Info 3.5.1 and exported to SPSS version 20.0 for analysis. Binary and multivariable logistic regression was used to identify factors associated with iron/folic acid supplementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value <0.05 were used to declare statistical significance. RESULTS: Among women participating in the study, 163(51.4%) were adherent to iron/folate acid supplementation. Factors significantly associated with adherence to iron and folic acid supplementation were maternal educational status (AOR: 2.47, 95% CI: 1.13-4.97), early registration for ANC (AOR: 2.49, 95% CI: 1.45 - 4.27), history of anemia during current pregnancy (AOR: 2.02, 95% CI: 1.09-3.72), and knowledge about iron and folic acid supplementation (AOR: 1.96, 95% CI: 1.02-3.76). Forgetfulness and fear of side effects were among the leading reasons of pregnant women for nonadherence to iron and folic acid supplementation. CONCLUSIONS: This study revealed that adherence to iron /folic acid supplementation was found to be 51.4%. Maternal educational status, early registration for ANC, history of anemia during current pregnancy, and knowledge about iron and folic acid supplementation were significant factors associated with adherence to iron/folic acid supplementation among pastoralist's pregnant women. Therefore, anemia prevention strategy should include strengthening giving awareness, counseling, strengthening community health education, and participation in health programs which are necessary to improve the uptake of iron/folic acid supplements.

Serum Transthyretin Level as a Plausible Marker for Diagnosis of Child Acute Malnutrition.

Malnutrition is a major underlying condition for mortality in children under five years of age in developing countries, particularly in Ethiopia. The most important forms of malnutrition in Ethiopia are protein and energy deficiencies. There is no reliable laboratory method at present to assess acute malnutrition. Transthyretin is a homotetrameric serum protein with half-life of two days. The main objective of this study was to assess the estimation of serum transthyretin level as a useful diagnostic method to evaluate nutritional status of children. We used a newly designed transthyretin test kit to evaluate nutritional status of children admitted to our hospital. There is no national reference standard; hence we made a comparative study using anthropometric measurements and measurement of serum albumin level. A total of 102 children (51 controls and 51 study subjects) were included in this study. Transthyretin was found to be more sensitive to changes in acute malnutrition than albumin, and its level reflects recent dietary intake compared to overall nutritional status. The method is more sensitive and reliable for detection of acute malnutrition, along with anthropometric methods. Measurement of serum transthyretin level can be used as a valuable diagnostic method for assessment of acute malnutrition among children.