Vaccination of calves with Mycobacterium bovis Bacillus Calmette-Guerin reduces the frequency and severity of lesions of bovine tuberculosis under a natural transmission setting in Ethiopia.

Bovine tuberculosis (bTB) is highly prevalent in intensive dairy farms of the urban "milk-sheds" in Ethiopia, and vaccination could be a cost-effective disease control strategy. In the present study, the efficacy of Bacillus Calmette-Guerin (BCG) to protect against bTB was assessed in Holstein-Friesian calves in a natural transmission setting. Twenty-three 2-week-old calves were subcutaneously vaccinated with BCG Danish SSI strain 1331, and matched 26 calves were injected with placebo. Six weeks later, calves were introduced into a herd of M. bovis-infected animals (reactors) and kept in contact with them for 1 year. In vitro and in vivo immunological tests were performed to assess immune responses post-vaccination and during exposure. Successful vaccine uptake was confirmed by tuberculin skin test and IFN-γ responses in vaccinated calves. The kinetics of IFN-γ responses to early secretory antigen target 6 and culture filtrate protein 10 (ESAT6 and CFP10, respectively) and tuberculin skin test responses post-exposure suggested that the animals were infected early after being placed in contact with the infected herd as immunological signs of infection were measurable between 2 and 4 months post-initial exposure. Protection was determined by comparing gross and microscopic pathology and bacteriological burden between vaccinated and control calves. BCG vaccination reduced the proportions of tissues with visible pathology in vaccinates compared to control calves by 49% (p < .001) with 56%, 43%, 72%, and 38% reductions in the proportion of lesioned tisues in head, thoracic, abdominal lymph nodes, and lungs, respectively (p-values .029-.0001). In addition, the lesions were less severe grossly and microscopically in vaccinated calves than in non-vaccinated calves (p < .05). The reduction in the overall incidence rates of bTB was 23%, 28%, and 33% on the basis of the absence of gross pathology, M. bovis culture positivity, and histopathology, respectively, in vaccinated animals. In conclusion, BCG vaccination reduced the frequency and severity of the pathology of bTB significantly, which is likely to reduce onwards transmission of the disease.

Etiology of pneumonia, sepsis and meningitis in infants younger than three months of age in Ethiopia.

METHODS: Within a multicenter study coordinated by WHO, an investigation of the etiologic agents of pneumonia, sepsis and meningitis was performed among infants younger than 3 months of age seen at the Ethio-Swedish Children's Hospital in Addis Ababa for a period of 2 years. Of the 816 infants enrolled 405 had clinical indications for investigation. RESULTS: There were a total of 41 isolates from blood cultures from 40 infants. The study showed that the traditionally known acute respiratory infection pathogen Streptococcus pneumoniae was most common in this extended neonatal age group, found in 10 of 41 blood isolates. Streptococcus pyogenes was a common pathogen in this setting (9 of 41 blood isolates), whereas Salmonella group B was found in 5 of 41 isolates. Streptococcus agalactiae, which is a common pathogen in developed countries, was absent. A study of the susceptibility pattern of these organisms suggests that a combination of ampicillin with an aminoglycoside is adequate for initial treatment of these serious bacterial infections, but the combination is not optimal for the treatment of Salmonella infections. Among 202 infants on whom immunofluorescent antibody studies for viruses were performed based on nasopharyngeal aspirates, respiratory syncytial virus was found in 57 (28%) infants, and Chlamydia trachomatis was isolated in 32 (15.8%) of 203 infants.

Neonatal congenital hypothyroidism screening in Addis Ababa, Ethiopia.

OBJECTIVES: To determine the prevalence of congenital hypothyroidism, establish reference levels for thyroid stimulating hormone (TSH), and determine the cut-off points of TSH level for neonatal screening in congenital hypothyroidism. DESIGN: A cross-sectional study. SETTING: Ghandhi Memorial, Zewditu, Tikur Anbessa and St Paulo's referral hospitals in Addis Ababa, Ethiopia, from July 1996 to January 1997. SUBJECTS: Four thousand two hundred and six consecutive newborns. MAIN OUTCOME MEASURES: TSH and T4 values using standard TSH level estimation approach. RESULTS: The overall mean TSH value was 9.6 mIU/l with standard deviation of 7.8 mIU/l. Transient hypothyroidism occurred in 3.6% of the neonates. No true case of congenital hypothyroidism was identified. The mean(SD) sampling time was 12.8(6.7) hours and the recall rate 4.8%. Most neonates (98.6%) were screened at or less than 24 hours of age. Twins had lower mean TSH value of 7.9(SD=6.4) mIU/l than single neonates with 9.6(SD=7.8) mIU/l, while females had significantly lower mean TSH value of 9.4(SD=7.9) mIU/l than males of 9.8(SD=7.6) mIU/l. The mean TSH level decreased significantly as sampling time increases, the mean TSH level for neonates older than 24 hours is significantly lower than the mean TSH level for those with 24 hours old or less. No significant difference was found in the mean TSH levels in relation to maternal age, parity and gestational age. No significant correlation was found between TSH value and birth weight (r=0.02), height (r=0.03), and head circumference (r=0.02) of the neonates. The most appropriate TSH level cut-off point was found to be at 29.4 mIU/l. The reference range (the range between 2.5th and 97.5th percentiles) for serum thyrotrophin value was higher in the age range of 6 to 12 hours and then declined. CONCLUSION: This pilot study has highlighted important findings, however larger studies should be conducted to assess the magnitude and associated factors of congenital hypothyroidism because congenital hypothyroidism represents one of the most common preventable causes of mental retardation.

Heel pad thickness of adult Ethiopian patients in Tikur Anbessa Hospital, Addis Abeba.

One-hundred-twenty-five male and 113 female subjects attending the Tikur Anbessa Hospital Radiology Department in Addis Abeba from August 1991 to July 1992 were included in a study of heel pad thickness (HPT). Their age ranged from 10 to 65 years (mean 30.4 years) and body weight 21 to 86 kg (mean 55.7). Mean HPT for males was 21.4 mm (SD 1.6), range 17mm to 24mm, and for females 20.7 mm (SD 1.5), range 17mm to 24mm. Males had thicker heel pads than females and HPT was directly correlated with body weight in both sexes. The difference between mean male and female HPT was statistically significant (p < 0.001). As HPT is a reliable indicator of changes in soft tissue thickness in the body, these values can be used as a preliminary reference for Ethiopian patients until a more extensive study is made.

Perceptions and attitudes toward SLMTA amongst laboratory and hospital professionals in Ethiopia.

BACKGROUND: Strengthening Laboratory Management Toward Accreditation (SLMTA) is a competency-based management training programme. Assessing health professionals' views of SLMTA provides feedback to inform program planning, implementation and evaluation of SLMTA's training, communication and mentorship components. OBJECTIVES: To assess laboratory professionals' and hospital chief executive officers' (CEOs) perceptions and attitudes toward the SLMTA programme in Ethiopia. METHODS: A cross-sectional descriptive survey was conducted in March 2013 using a structured questionnaire to collect qualitative data from 72 laboratory professionals and hospital CEOs from 17 health facilities, representing all regions and two city administrations in Ethiopia. Focus groups were conducted with laboratory professionals and hospital administration to gain insight into the strengths and challenges of the SLMTA programme so as to guide future planning and implementation. RESULTS: Ethiopian laboratory professionals at all levels had a supportive attitude toward the SLMTA programme. They believed that SLMTA substantially improved laboratory services and acted as a catalyst for total healthcare reform and improvement. They also noted that the SLMTA programme achieved marked progress in laboratory supply chain, sample referral, instrument maintenance and data management systems. In contrast, nearly half of the participating hospital CEOs, especially those associated with low-scoring laboratories, were sceptical about the SLMTA programme, believing that the benefits of SLMTA were outweighed by the level of human resources and time commitment required. They also voiced concerns about the cost and sustainability of SLMTA. CONCLUSION: This study highlights the need for stronger engagement and advocacy with hospital administration and the importance of addressing concerns about the cost and sustainability of the SLMTA programme.

Laboratory system strengthening and quality improvement in Ethiopia.

BACKGROUND: In 2010, a National Laboratory Strategic Plan was set forth in Ethiopia to strengthen laboratory quality systems and set the stage for laboratory accreditation. As a result, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme was initiated in 45 Ethiopian laboratories. OBJECTIVES: This article discusses the implementation of the programme, the findings from the evaluation process and key challenges. METHODS: The 45 laboratories were divided into two consecutive cohorts and staff from each laboratory participated in SLMTA training and improvement projects. The average amount of supportive supervision conducted in the laboratories was 68 hours for cohort I and two hours for cohort II. Baseline and exit audits were conducted in 44 of the laboratories and percent compliance was determined using a checklist with scores divided into zero- to five-star rating levels. RESULTS: Improvements, ranging from < 1 to 51 percentage points, were noted in 42 laboratories, whilst decreases were recorded in two. The average scores at the baseline and exit audits were 40% and 58% for cohort I (p < 0.01); and 42% and 53% for cohort II (p < 0.01), respectively. The p-value for difference between cohorts was 0.07. At the exit audit, 61% of the first and 48% of the second cohort laboratories achieved an increase in star rating. Poor awareness, lack of harmonisation with other facility activities and the absence of a quality manual were challenges identified. CONCLUSION: Improvements resulting from SLMTA implementation are encouraging. Continuous advocacy at all levels of the health system is needed to ensure involvement of stakeholders and integration with other improvement initiatives and routine activities.

Anthropometric indicators of nutritional status, socioeconomic factors and mortality in hospitalized children in Addis Ababa.

The influence of some household and maternal variables on three anthropometric nutritional status indices of hospitalized children in Addis Ababa, Ethiopia, are examined. On admission, only 30% of these children can be classified as being of a normal overall nutritional status. There are no significant differences in weight-for-age of hospitalized children between those residing in Addis Ababa and those residing in the rural areas. Income and father's occupation appear to be the major household factors influencing the level of two of the three indices (weight-for-age and weight-for-height). Length of last closed birth interval and, to a lesser degree, maternal age appear to have significant effects on all three nutritional status indices. Upon admission to hospital, children who will in the end survive their hospital stay are on average nutritionally normal or in a mild state of malnutrition, whereas children who will die during their stay arrive in a moderate or severe state of malnutrition. The degree of malnutrition is positively related to the risk of mortality in respiratory disease patients.

PIP: The influence of some household and maternal variables on 3 anthropometric nutritional status indices of hospitalized children in Addis Ababa, Ethiopia, are examined. On admission, only 30% of these children can be classified as being of a normal overall nutritional status. There are no significant differences in weight-for-age of hospitalized children between those residing in Addis Ababa and those residing in the rural areas. Income and father's occupation appear to be the major household factors influencing the level of 2 of the 3 indices (weight-for-age and weight-for-height). Length of last closed birth interval and, to a lesser degree, maternal age appear to have significant effects on all 3 nutritional status indices. Upon admission to hospital, children who will in the end survive their hospital stay are on average nutritionally normal or in a mild state of malnutrition, whereas children who will die during their stay arrive in a moderate or severe state of malnutrition. The degree of malnutrition is positively related to the risk of mortality in respiratory disease patients. (Author's).