Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe.

BACKGROUND: Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. METHODS: We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. RESULTS: Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. CONCLUSIONS: Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.

Country of Birth of Children With Diagnosed HIV Infection in the United States, 2008-2014.

BACKGROUND: Diagnoses of HIV infection among children in the United States have been declining; however, a notable percentage of diagnoses are among those born outside the United States. The impact of foreign birth among children with diagnosed infections has not been examined in the United States. METHODS: Using the Centers for Disease Control and Prevention National HIV Surveillance System, we analyzed data for children aged <13 years with diagnosed HIV infection ("children") in the United States (reported from 50 states and the District of Columbia) during 2008-2014, by place of birth and selected characteristics. RESULTS: There were 1516 children [726 US born (47.9%) and 676 foreign born (44.6%)]. US-born children accounted for 70.0% in 2008, declining to 32.3% in 2013, and 40.9% in 2014. Foreign-born children have exceeded US-born children in number since 2011. Age at diagnosis was younger for US-born than foreign-born children (0-18 months: 72.6% vs. 9.8%; 5-12 years: 16.9% vs. 60.3%). HIV diagnoses in mothers of US-born children were made more often before pregnancy (49.7% vs. 21.4%), or during pregnancy (16.6% vs. 13.9%), and less often after birth (23.7% vs. 41%). Custodians of US-born children were more often biological parents (71.9% vs. 43.2%) and less likely to be foster or nonrelated adoptive parents (10.4% vs. 55.1%). Of 676 foreign-born children with known place of birth, 65.5% were born in sub-Saharan Africa and 14.3% in Eastern Europe. The top countries of birth were Ethiopia, Ukraine, Uganda, Haiti, and Russia. CONCLUSIONS: The increasing number of foreign-born children with diagnosed HIV infection in the United States requires specific considerations for care and treatment.

Hepatitis a screening for internationally adopted children from hepatitis A endemic countries.

Screening for hepatitis A virus (HAV) infection is not currently routinely recommended in internationally adopted children. International adoptees seen at the University of Minnesota International Adoption Clinic from 2006 to 2010 were assessed for acute HAV infection (positive HAV immunoglobulin M). Thirty of the 656 children screened (4.6%) were acutely HAV infected. HAV-infected children emigrated from Ethiopia (16), Guatemala (4), China (2), Colombia (2), Haiti (2), Philippines (2), Liberia (1), and Nepal (1). Infection was most frequent among children younger than 2 years (6.7%). No symptoms distinguished children with acute HAV infection from uninfected children. HAV infection caused significant social disruption, including separation of children from their ill adoptive parents during the initial weeks postarrival, a period important for postadoption adjustment and attachment. All international adoptees arriving from countries with high or intermediate HAV endemicity should be screened for HAV infection on arrival to the United States.

Is the prevalence of ER-negative breast cancer in the US higher among Africa-born than US-born black women?

Previous studies have reported that the prevalence of ER-negative tumors in breast cancer patients is much higher in black women than in white women in the US. Herein, we examine whether the proportion (prevalence) in Africa-born black breast cancer patients residing in the US is similar to those in US-born black patients. We obtained information on invasive female breast cancers diagnosed during 1996-2008 in 17 Surveillance Epidemiology and End Results cancer registries according to select place of birth: Western-Africa-born, Eastern-Africa-born, Jamaica-born, and US-born blacks and US-born whites. The majority of Western-Africa-born and Eastern-Africa-born blacks were from Nigeria (64 %) and Ethiopia (74 %), respectively. We examined group variations in ER status using Chi-squared tests and the prevalence of ER-negative tumors in Africa-born blacks compared to US-born blacks, expressed as prevalence ratio (PRR), using multivariable regression models. The prevalence of ER-negative tumors significantly varied from 22.0 % (n = 41/186) in Eastern-Africa-born to 32.9 % (n = 47/143) in Western-Africa-born blacks. After adjustment for differences in age at diagnosis and other covariates, compared to US-born blacks, the prevalence was similar in Western-Africa-born (PRR = 0.87; 95 % CI 0.70-1.08) and Jamaica-born blacks (PRR = 0.88; 95 % CI 0.74-1.03), but significantly lower in Eastern-Africa-born blacks (PRR = 0.58; 95 % CI 0.44-0.75). Notably, the ER-negative prevalence in Eastern-Africa-born black was comparable to the US-born whites with breast cancer. Our findings highlight the heterogeneity of breast cancer among black women in the US, which should be considered in future studies of hormone receptor status in these women.

[Neuropsychological profile of internationally adopted children in Catalonia]. / Perfil neuropsicológico de niños adoptados internacionalmente en Cataluña.

INTRODUCTION: During the last years, International adoption has increased significantly in our country over the last few years. China, Russia, Colombia and Ethiopia represent 77% of international adoptions in Spain. Cognitive and behavioural aspects are very important for an adequate social, family and school integration of these children. OBJECTIVE: To describe the neuropsychological profiles of a group of internationally adopted children in Catalonia from China, Russia, Colombia and Ethiopia. PATIENTS AND METHODS: Neuropsychological examination of 49 children from international adoption (6 of Chinese origin, 24 from Russia, 13 from Colombia and 6 of Ethiopian origin). RESULTS: The group of Chinese origin obtained average scores of all functions evaluated. The Russian origin group was below the average for, selective attention, phonetic verbal fluency, control of impulsivity, mechanics and reading comprehension, and spelling. Scores on the impulse control in the Colombian origin group were below average. The group of Ethiopian origin obtained average scores in all functions evaluated except for spelling difficulties. CONCLUSION: Children adopted from Russia have greater neuropsychological difficulties than the others. Most pre-adoption history is unknown; therefore we are unable to determine the origin of these difficulties. Maternal alcohol consumption during pregnancy and the institutional environment could be influencing factors in neuropsychological delay. Inclusion of neuropsychological assessment in health protocols for these children is recommended if they develop suggestive signs of cognitive and/or behavioral impairment.

Hepatitis A among international adoptees and their contacts.

We identified 27 cases of hepatitis A among international adoptees (5 persons), their direct or indirect contacts (20 persons), and unvaccinated travelers to the adoptees' countries (2 persons). Most cases occurred among nontraveling contacts of adoptees, suggesting the need to extend prevention guidelines to include hepatitis A vaccination for at-risk nontravelers.

Experiencia de los grupos de auto-cuidado en personas afectadas de lepra: ALERT, Etiopía

Este trabajo describe el desarrollo de los grupos de auto-cuidado en Etiopía por ALERT, y los éxitos y fracasos del proceso. Se iniciaron los grupos en 1995 en respuesta a los dos principales problemas: el número cada vez mayor de individuos dependientes de ALERT para curar sus heridas a pesar de los años empleados en educación sanitaria y los recursos financeros tan limitados de ALERT para material de cura. En diciembre de 1999, había un total de 72 grupos estabelecidos. La pertenencia a los grupos es voluntaria. Ha habido muchos resultados positivos. Los grupos han asumido la responsabilidad de controlar sus propios recursos y administrar su material de cura. Se atiende más al aspecto de higiene personal. También demuestran mayor interés en la participación comunitaria, restauración de la dignidad y auto-respeto y el sentido de pertenencia a la comunidad. Además, algunos miembros prestan más atención a su medio local al construir letrinas y zonas para eliminación de residuos. El personal de ALERT comprometido en esta iniciativa ha cambiado su papel en cuanto cambia de un servicio de lpera a un grupo de auto-cuidado, pero no todos tuvieron éxito en esta transición. El desafío del programa es su mantenimiento y futuro desarrollo a través del Programa de Control Nacional de la Lepra y Tuberculosis, la Asociación Nacional Etíope para ex pacientes de lepra y posibilidad de otras organizaciones.

El modelo de neuropatía relacionado con la lepra en los paceintes AMFES de Etiopía: definiciones, factores de riesgo y resultado

El trabajo evaluación en el campo de MDT (AMFES) de ALERT empezó en 1988 con un control y seguimiento de los pacientes diez años después de finalizar el tratamiento (RFT). Este trabajo describe los hallazgos obtenidos en esta cohorte en relación a la neuropatía y deterioro neural. Se incluyen 594 nuevos casos de lepra, 300 multibacilares (MB) y 294 paucibacilares (PB). El 55% de los pecientes presentó algún grado de deterioro funcional neural (NFI) después de iniciar la multiterapia (MDT). La incidencia total para la neuropatía era de 39 episodios por 100 PYAR durante el primer año del diagnóstico, disminuyendo gradualmente hasta 12 episodios por 100 PYAR en el sexto año. En los pacientes sin deterioro en el momento del diagnóstico, la incidencia de neuropatía era de 25 episodios por 100 PYAA para casos MB y 11 por 100 PYAR para PB en el primer año; en el 33% de los casos MB cuyo primer episodio de neuropatía se presentó después del diagnóstico, el primer episodio después del primer año o después del intervalo pre-fijado de tratamiento. Se informó más detalladamente de 73 pacientes con neuropatía después del diagnóstico: 34 (47%) con sólo un nervio comprometido y entre ellos 25 (73%) con un único episodio agudo de neuropatía. Nueve (27%) presentaron más episodios. En 39 (53%) habían más de un nervio implicado y de entre ellos 16 (41%) con episodio agudo único, mientras el 23 (59%) presentaron más episodios. Se definen los términos neuropatía "crónica y recurrente" y se aplican en la descripción del modelo de neuropatía en los casos repetitivos. El tratamiento con esteroides consigue una recuperación total en el 88% de los nervios con neuropatía aguda en el grupo de pacientes sin deterioro al inicio del estudios, pero sólo el 51% en los que presenta neuropatía crónica o recurrente. El tiempo medio de recuperación de la neuropatía aguda era de aproximadamente seis meses, pero en algunos casos se presentó gradualmenteentre los dos a trea años. Resulta menos probable recuperación total de una neuropatía grave que de una leve o moderada. También se recuperaron el 42% de los nervios con neuropatía aguda no tratados con esteroides. el grupo de pacientes con deterioro muy crónico en el momento del diagnóstico, la plena recuperación de la función neural tuvo lugar en 87/374 (25%) de los nervios...

Evaluación en el campo sobre MDT por ALERT estudio descriptivo de la lepra en Etiopía. Pacientes, métodos y características básicas

Publicado el 30 de junio de 2000. El estudio de evaluación enm el campo de la MDT (AMFES) por ALERT es un largo estudio prospectivo de 650 pacientes ((594 nuevos caos y 56 recidivas) después de la monoterapia con dapsona, tratdos con multiterapia (MDT) de duración fija como recomienda la OMS. El seguimiento ha sido durante 11 años desde el inicio del tratamiento. Este trabajo representa la metodología del trabajo y las características básicas del cohorte, mientras que en otros trabajos se examina la incidencia y posible factores de riesgo para las distintas complicaciones de la lepra, incluyendo recidivas, reacciones y deterioro funcional neural. Se describen los métodos de diagn´sotico, clasificación y tratamiento con MDT, se evalúa la función neural en cada visita a la clínica con metodología estandarizada, de manera que las reacciones y el deterioro pueda detectarse precozmente y se tratados. el 84% de los nuevos casos presentaron engrosamiento, en al menos un nervio, siendo el cubital el más afectado comúnmente. El 77% de los casos completó el tratamiento con sólo una reacción adversa a la MDT. El 28% de los pacientes recibieron esteroides en un momento u otro, casi siempre de nuevos deterioros de la función neural un 3% de ellos desarrolló complicaciones significativas durante el tratamiento con esteroides. Veintinueve pacientes (5%) fueron hospitalizados incluyendo 14 pacientes con cirugía mayor. el 61% de las mujeres mayores de 19 años tuvieron al menos un embarazo, pero los embarazos eran mucho menos frecuentes después del diagnóstico de lepra.

Knowledge and attitude of health professionals in relation to the integration of leprosy control into the general health service in Ethiopia

Since the introduction of multidrug therapy for leprosy patients, the integration of leprosy control in the general health service (GHS) system has been an issue of debate. In Ethiopia, the present policy stresses integrated management of diseases. In spite of the policy, however, leprosy control was a vertical program until 1998 in most parts of the country. A descriptive cross-section study was conducted in the southern region of Ethiopia from October 1996 to March 1997 to determine the levels of involvement of the GHS staff and to identify obstacles to their involvement in the management of leprosy patients. Through a written questionnaire, data were collected from 240 GHS staff, including doctors, nurses and health assistants. It was found that 6% of the GHS staff was involved in leprosy control activities, mainly case finding and health education. Negative attitudes toward leprosy workers were held by 13% of the GHS staff while 40% had intermediate attitudes and the remaining 47% had positive attitudes. Statistically significant differences were found with regard to the level of knowledge among different health professionals, type of health institutions and years of service. The levels of involvement, knowledge and attitude of GHS staff showed that lack of integration and training were core problems. Hence, policy makers should give due attention to promoting the involvement of the GHS staff by integrating the program into the GHS system using the approach already in place in certain parts of the country.

Inter- Observer Variability in the Assessment of Nerve Function in Leprosy Patients in Ethiopia

Resumo: One of the major problems in leprosy is to detect any change in nerve function early enough so as to increase the chances of recovery and prevent disability. Several tests have been developed to assess nerve function and are used in leprosy control programs worldwide, but they are frequently performed by different workers on different occasions and under variable conditions. In this study we investigated the variability between different groups of observers in the assessment of nerve function in leprosy patients in Ethiopia. Sensory function was assessed by using a set of nylon monofilaments (NF) and a ball-point pen (BP), and motor function was assessed by using voluntary motor testing (VMT). We also studied the variability between observers in the assessment of the clinical signs of neuritis. Duplicate measurements were performed in random order on 50 leprosy patients by two physio-technicians and on 50 other patients by two health assistants. The percent agreement between observers was calculated for each single nerve, and weighted kappa statistics were used to assess whether agreement was better than expected due to chance alone. Systematic differences between observers were evaluated using the Wilcoxon signed rank test. On sensory testing, inter-observer variability was found to be related to the training and experience of the observer, to the nerve tested, and to the neurological status of the patient. When tests were performed by physio-technicians, we observed 32% to 58% agreement with the NF test and 71% to 84% agreement with the BP test, measured on different scales. After weighting for the scale difference, the agreement seemed comparable with these methods but the differences in measurements with the BP test were found to be dependent upon the neurological status of the patient. The variability between observers differed according to the nerve tested, and there was some evidence of systematic differences between observers with both methods. When performed by the health assistants, agreement was between 34% and 46% with the NF and between 66% and 82% with the BP tests. After weighting for the scale difference, the agreement seemed comparable but the BP was not liable to the systematic differences seen in the NF results. These differences could be attributed to the differences in the experience of the workers with these tests. With the VMT, small variability between observers was found for all nerves tested, except the facial nerve, when performed by both the physio-technicians and by the health assistants (72% to 98% agreement).(ABSTRACT TRUNCATED AT 400 WORDS

Prevalence of human T cell lymphotropic virus (HTLV) types I and II and human immunodeficiency virus type 1 infections among persons with Hansen's disease in New York City.

One-hundred seven consecutive patients attending a New York Hansen's disease clinic from November 1990 through June 1991 were tested for retroviruses. This cohort included 58 patients diagnosed with Hansen's disease after the onset of the AIDS epidemic, 54 of whom immigrated to the United States before diagnosis of Hansen's disease (median, 7 years). The overall rate (1.9%) of human T cell lymphotropic virus (HTLV) type I infection was low. Two (3.6%) of 55 Caribbean-born patients had polymerase chain reaction (PCR)-documented HTLV-I infection, but this incidence was not higher than expected in persons without Hansen's disease. No patient had PCR-documented evidence of either HTLV-II or human immunodeficiency virus (HIV) type 1 infection. The low rate of HIV-1 among those studied was likely related to an absence of classic HIV risk behavior because about half of the cohort could have incubated Mycobacterium leprae for a prolonged period while infected with HIV-1.

[Presence of antibodies against Toxoplasma gondii in adolescents from the African continent]. / Presencia de anticuerpos anti-Toxoplasma gondii en jóvenes procedentes del Continente Africano.

It was determined the presence of antibodies anti-T. gondii in young, 13-16 year old, belonging to Republic Arab Saharaui; Popular Republic of Angola; Ethiopia and Republic of Ghana. From a total of 707 sera analyzed, the 71.43% of them showed the presence of specific antibodies. The prevalence of antibodies did not differ significantly (P > 0.05) between males and females in Angola and Republic Arab Saharaui. It was found a significant difference (P < 0.0001) among countries.

Brugia species in a man from western Ethiopia.

A case of human brugiasis in a student from Gambela, Ethiopia, is reported. Ten sheathed microfilariae showing the Brugia genus characteristics were recovered from 1 ml of blood.

Antibody response to Campylobacter pylori in diverse ethnic groups.

Antibody response to Campylobacter pylori was measured in ethnic groups of Vietnamese, El Salvadorean and Ethiopian origin. The results were compared with the previously reported antibody titres found in sera of culture positive and culture negative patients, patients suffering from duodenal ulcer, white Australian blood donors and Australian Aboriginals. While in Vietnamese the prevalence of serologically positive sera was found to be similar to the white Australian population, numbers of serologically positive sera in El Salvadorean and Ethiopian ethnic groups was found to be very high. The high incidence of serologically positive sera in the Ethiopians correlated with the reported high incidence of duodenal ulcer in this population.

Koro: computed tomography and brain electrical activity mapping in two patients.

In koro, the sensation of penile retraction is coupled with an intense fear that death will occur once the retraction is complete. Koro has been reported mainly in Southeast Asia, and it occurs in both epidemic and sporadic forms. Two cases, the first each in natives of Haiti and Ethiopia, are presented. Similarities between them and computed tomography and brain electrical activity mapping data are used to support the concept that sporadic koro may be a form of right temporoparietal or bitemporoparietal dysfunction similar to sexual epilepsy. The hypothesis is advanced that epidemic koro occurs in permissive cultures when groups of individuals imitate sporadic koro.