Association between domestic animal exposure and diarrhea prevalence in under- five children in low- and middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Diarrheal disease is still the leading cause of morbidity and mortality in children, despite significant progress in diarrhea interventions. Zoonotic transmission is the main cause of the emergence and re-emergence of diseases. Domestic animals are often close to humans, particularly in resource-poor countries. Despite evidence of environmental contamination, there have been limited studies conducted to examine the association between domestic animal exposure and diarrheal disease in low- and middle-income countries (LMIC). Therefore, this systematic review and meta-analysis examines the association between domestic animal exposure and diarrheal disease in children under five years of age in LMIC. METHODS: The search strategy followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for the reporting of systematic reviews. All appropriate databases were searched to find relevant articles. Research studies were selected for review if they reported an outcome variable that measured diarrhea and exposure variables of any domestic animals. A data extraction form was used to extract information from each study. The quality of the individual articles was assessed using the Joanna Briggs Institute (JBI's) critical appraisal tools. Publication bias was checked using a funnel plot, Egger's regression test, and Begg's test. The heterogeneity of studies was checked using the Galbraith plot and the I-squared test. A sensitivity analysis was conducted, and a meta-analysis was conducted using STATA 17. RESULTS: After reviewing 113 articles, 11 articles fulfilled the inclusion criteria hence considered for meta-analysis. The finding of these 11 studies revealed that study participants who had animal exposure had 1.95 higher odds of diarrhea as compared to participants who hadn't animal exposure (OR: 1.95, 95%CI: 1.25, 2.66). CONCLUSIONS AND RECOMMENDATIONS: This study reported that diarrheal disease was associated with study subjects who had domestic animal exposure. Therefore, more comprehensive research is needed on specific behaviors and interventions surrounding animal husbandry that may affect the transmission of pathogens between animals and humans; this would facilitate the design and implementation of measures to reduce animal exposure in the domestic environment.

HIV Stigma in Awi Zone, Northwest Ethiopia, and a Unique Community Association as a Potential Partner.

Indigenous institutions play a vital role in fighting HIV stigma by leveraging their cultural knowledge, leadership, and community connections. Understanding HIV/AIDS attitudes, information gaps, and stigma among members of indigenous institutions is critical for devising culturally relevant and successful interventions and preventative strategies. This study was conducted with the objective of assessing the levels of knowledge about HIV/AIDS and the various HIV/AIDS discriminatory attitudes and practices among members of the Awi Equestrian Association, an indigenous association in Awi Zone, Northwest Ethiopia, that plays major roles in the social, cultural, political, and economic activities of the community. The study is a cross-sectional study conducted from June through July 2022. Eight hundred and forty-six people in the study area were interviewed using a pilot-tested questionnaire. Multiple linear regression analysis was used to identify factors associated with the score level of HIV-related stigma. Forty-five percent of study participants did not have adequate knowledge of HIV/AIDS, and 67.4% had moderate to high discriminatory attitudes towards people living with HIV. HIV-stigmatizing practices were high, with 36% admitting to speaking badly about people living with HIV and 23% wanting their relative with HIV to seek treatment in another zone. In our study, low level of knowledge about HIV/AIDS (p < 0.001), older age (p < 0.05), and male sex (p < 0.05) were factors associated with higher levels of stigmatizing practices. In conclusion, HIV-related stigma is common in Awi Zone. The Awi Equestrian Association has become a unique potential partner for HIV control in the area in an effort to achieve United Nation AIDS target of 95-95-95.

Diagnostic performance of PfHRP2/pLDH malaria rapid diagnostic tests in elimination setting, northwest Ethiopia.

Accurate diagnosis of malaria is vital for the effectiveness of parasite clearance interventions in elimination settings. Thus, evaluating the diagnostic performance of rapid diagnostic tests (RDTs) used in malaria parasite clearance interventions in elimination settings is essential. Therefore, this study aimed to evaluate the diagnostic performance of rapid diagnostic tests recently used in detecting malaria parasites in northwest Ethiopia. A facility-based cross-sectional study was conducted from November 2020 to February 2021 comparing PfHRP2/pLDH CareStart malaria RDTs with light microscopy and polymerase chain reaction (PCR). Blood samples were collected from 310 febrile patients who attended the outpatient department and examined using CareStart RDTs, light microscopy, and PCR. Statistical analyses were performed using STATA/SE version 17.0. The sensitivity of PfHRP2/pLDH CareStart malaria RDTs, regardless of species, was 81.0% [95% CI, 75.3, 86.7] and 75.8% [95% CI, 69.6, 82.0] compared to light microscopy and PCR, while the specificity was 96.8% [95% CI, 93.7, 99.9] and 93.2% [95% CI, 88.6, 97.8], respectively. The false-negative rate of CareStart malaria RDTs in comparison with light microscopy and PCR was 19.0% and 24.2%, respectively. The level of agreement beyond chance between tests was substantial, RDT versus microscopy was 75.0% and RDT versus PCR was 65.1%. The diagnostic performance of PfHRP2/pLDH CareStart RDTs in detecting malaria parasites among febrile patients in the study area was below the recommended WHO standard. The limited diagnostic performance of RDTs in the malaria elimination area undoubtedly affects the impact of malaria parasite clearance interventions. Therefore, parasite clearance intervention like targeted mass drug administration with antimalarial drugs is recommended to back up the limited diagnostic performance of the RDT or replace the existing malaria RDTs with more sensitive, field-deployable, and affordable diagnostic tests.

Spatiotemporal variation of malaria incidence in parasite clearance interventions and non-intervention areas in the Amhara Regional State, Ethiopia.

BACKGROUND: In Ethiopia, malaria remains a major public health problem. To eliminate malaria, parasite clearance interventions were implemented in six kebeles (the lowest administrative unit) in the Amhara region. Understanding the spatiotemporal distribution of malaria is essential for targeting appropriate parasite clearance interventions to achieve the elimination goal. However, little is known about the spatiotemporal distribution of malaria incidence in the intervention and non-intervention areas. This study aimed to investigate the spatiotemporal distribution of community-based malaria in the intervention and non-intervention kebeles between 2013 and 2018 in the Amhara Regional State, Ethiopia. METHODS: Malaria data from 212 kebeles in eight districts were downloaded from the District Health Information System2 (DHIS2) database. We used Autoregressive integrated moving average (ARIMA) model to investigate seasonal variations; Anselin Local Moran's I statistical analysis to detect hotspot and cold spot clusters of malaria cases; and a discrete Poisson model using Kulldorff scan statistics to identify statistically significant clusters of malaria cases. RESULTS: The result showed that the reduction in the trend of malaria incidence was higher in the intervention areas compared to the non-intervention areas during the study period with a slope of -0.044 (-0.064, -0.023) and -0.038 (-0.051, -0.024), respectively. However, the difference was not statistically significant. The Global Moran's I statistics detected the presence of malaria clusters (z-score = 12.05; p<0.001); the Anselin Local Moran's I statistics identified hotspot malaria clusters at 21 locations in Gendawuha and Metema districts. A statistically significant spatial, temporal, and space-time cluster of malaria cases were detected. Most likely type of spatial clusters of malaria cases (LLR = 195501.5; p <0.001) were detected in all kebeles of Gendawuha and Metema districts. The temporal scan statistic identified three peak periods between September 2013 and November 2015 (LLR = 8727.5; p<0.001). Statistically significant most-likely type of space-time clusters of malaria cases (LLR = 97494.3; p<0.001) were detected at 22 locations from June 2014 to November 2016 in Metema district. CONCLUSION: There was a significant decline in malaria incidence in the intervention areas. There were statistically significant spatiotemporal variations of malaria in the study areas. Applying appropriate parasite clearance interventions is highly recommended for the better achievement of the elimination goal. A more rigorous evaluation of the impact of parasite clearance interventions is recommended.

Magnitude of risky sexual practice and associated factors among big construction site daily laborers in Bahir Dar city, Amhara Region, Ethiopia.

BACKGROUND: Young person's susceptibility to sexually transmitted infection has been consistently linked to intractable work places. In Ethiopia, different behavior related interventions had carried out to raise awareness of risky sexual behaviors and their consequences. However, there is still limited information on risky sexual practices. METHODS: A cross-sectional study was conducted among the big construction site daily laborers from April 1, 2019 to May 30, 2019. A pre-tested questionnaire was used for data collection, and data were entered into Epidata and transported to SPSS for analysis. Independent variables with p < 0.05 in the multivariate analysis were considered to have a statistically significant association with risky sexual practice. RESULT: Among 627 sample respondents, the magnitude of risky sexual practice was found to be 24.2%. Labor workers who had a history of an STIs (AOR = 4.29; 95% CI: 2.56, 7.19), those who enjoy in the nightclubs (AOR = 2.33; 95% CI: 1.34, 4.08), those who started sex by peer pressure (AOR = 3.42; 95% CI: 2.06, 5.68), substance users (AOR = 2.03; 95% CI: 1.08, 3.82), those who were unable to read and write (AOR = 3.65; 95% CI: 1.41, 9.67), living independently (AOR = 3.71; 95% CI: 1.78, 7.77) and living with relatives (AOR = 3.12; 95% CI: 1.06, 9.20) were statistically associated with risky sexual practice. CONCLUSION: The magnitude of risky sexual practice among big constriction daily laborers was high in Bahir Dar City likely to increase their vulnerability to HIV. The findings of this study show the need of targeted HIV prevention plan to give due attention for daily laborers who had a history of an STI, enjoy in the night clubs, peer pressure, substance users, educational status and living arrangement. The Amhara Education Bureau and the city education department have to design ways to deliver at least a high school education.

Age-appropriate vaccination coverage and its associated factors for pentavalent 1-3 and measles vaccine doses, in northeast Ethiopia: A community-based cross-sectional study.

BACKGROUND: In Ethiopia, there are limited studies on age-appropriate vaccinations that children received at the recommended specific ages. Therefore, we assessed age-appropriate vaccinations coverage and its associated factors among children 12 to 23 months of age in Menz Lalo district, northeast Ethiopia. METHODS: A community-based cross-sectional study was conducted in Menz Lalo district from March to April/2018 among 417 mothers/caregivers with children 12 to 23 months of age using simple random sampling technique. Data were collected using a pretested structured questionnaire. Information about children's vaccination status was collected from vaccination cards. Age-appropriate vaccination coverage was measured using World Health Organization vaccination schedule recommendation. Data was entered into Epi-Info7 software and exported to SPSS-20 for analysis. Four consecutive logistic regression models were performed to identify factors associated with age-inappropriate vaccinations. A P-value of ≤ 0.05 was considered to state statistically significant associations. RESULTS: Age-appropriate vaccination coverage was 39.1% (95% CI: 34.3 to 44) for pentavalent 1, 36.3% (95% CI: 31.6 to 41.5) for pentavalent 2, 30.3% (95% CI: 25.6 to 35) for pentavalent 3 and 26.4% (95% CI: 21.7 to 31) for measles vaccine doses. Age-inappropriate pentavalent 1-3 vaccinations was associated with being male sex (AOR: 0.47, 95% CI: 0.29-0.74), lack of telephone (AOR: 2.2, 95% CI: 1.4-3.6), lack of usual caretaker (AOR: 2.6, 95% CI: 1.3-5.2), unplanned pregnancy (AOR: 1.9, 95% CI: 1.1-3.5), missing pregnant women's conference (AOR: 2.7, 95% CI: 1.3-5.7), decreasing birth order (AOR: 0.34, 95% CI: 0.17-0.68) and insufficient knowledge (AOR: 2.7, 95% CI: 1.6-4.4). CONCLUSION: The proportions of age-appropriate vaccination coverage were low in the study area. Modifiable factors were associated with age-inappropriate vaccinations. Vaccination interventions should consider identified modifiable factors to improve age-appropriate vaccinations coverage.

Occupational exposure to blood and body fluids among health care professionals in bahir dar town, northwest ethiopia.

BACKGROUND: Health care professionals (HCPs) are at high risk of contracting blood-borne infections due to their occupational exposure to blood and body fluids (BBFs). The incidence of these infections among HCPs are higher in low income countries such as Ethiopia. The aim of the study was to investigate the extent of occupational exposure to BBFs and its associated factors among HCPs in Bahir Dar town, Ethiopia. METHODS: A cross-sectional study was used from October 1, 2012 to October 30, 2012. Three hundred and seventeen HCPs were included in the study using a simple random sampling technique. The data were collected using a structured questionnaire and analyzed using SPSS version 16. Bivariate and multivariate analyses were used to identify the factors related to exposure to BBFs. RESULTS: Two hundred and nine (65.9%) HCPs were exposed to BBFs in the past year, of which 29.0% were needlestick injuries. Work experience [adjusted odds ratio (AOR) 4.13, 95% confidence interval (CI) 1.56-10.91], inconsistent use of gloves (AOR 1.98, 95% CI 1.04-3.43), and not complying with standard precautions (AOR 1.80, 95% CI 1.00-3.22) were the factors associated with occupational exposure to BBFs. CONCLUSION: A high proportion of HCPs was exposed to BBFs in this study. Occupational exposure to BBFs was determined by the use of gloves and not complying with standard precautions. Ensuring the availability of gloves, training about standard precautions, and motivation of HCPs to implement standard precautions should be emphasized to avoid such exposures.