Ethiopian Journal of Translational Sciences

War and its implications for the tuberculosis program in the Amhara Region

Tue, 01 Oct 2024 00:00:00 +0000

Background: War is one of the most significant factors exacerbating tuberculosis (TB) epidemics, increasing both morbidity and mortality rates. Direct attacks on healthcare facilities and medics, displacement of millions of people, and challenges with access to and delivery of medicines disrupt patients' treatment. This study aimed to assess war and its implications for the TB control program in the Amhara region.

Methods: Retrospective data archived in the regional Health Management Information System (HMIS) database were extracted to understand the regional TB program in the prewar period and forecast the impact of war on the TB control program. Four years of secondary archived data (July 2019 to December 2022) were used to forecast TB incidence and treatment outcomes in war-affected zones in 2022. To validate the model, the results were compared with actual observed TB incidence data. Line graphs and bar charts were used to compare the incidence of TB across age and sex categories.

Results: The TB incidence rate in North Wollo, Waghimira, and North Gondar (war-affected zones) was 198.7, 169.7, and 142 per 100,000, respectively. Among females, the proportion of extrapulmonary TB (EPTB), clinically confirmed TB cases, and pulmonary TB cases were 49.3%, 26.6%, and 24.0%, respectively. In the region, 204 drug-resistant TB cases were notified. TB patients, including those with multidrug-resistant TB (MDR-TB), were left without care and were forced to flee to internally displaced persons (IDP) centers. Of the 116 drug-susceptible TB patients identified during the war, 85 (73.3%) were from IDP sites. According to the six months HMIS report, Zones had zero TB case notification. The TB control program was interrupted for nine months in war-affected zones and severely attenuated in other zones.

Conclusion: The incidence of TB in war-affected areas was high. Severe types of TB and under-diagnosed cases were more prevalent, which could lead to high TB transmission, reactivation, and drug resistance development in both war-affected and non-affected zones. Therefore, strengthening active and passive case finding, restoring diagnostic capacity, providing Bacillus Calmette-Guérin (BCG) vaccination, conducting rigorous TB screening and surveillance, and managing TB, including severe forms such as MDR-TB and Extensively drug-resistant tuberculosis (XDR-TB), are crucial measures to enhance the regional TB control program.

Violence against Healthcare during the War in the Amhara Region of Ethiopia

Tue, 01 Oct 2024 00:00:00 +0000

Background: Depriving health care through damaging the health facilities' infrastructure, supplies, warehouses, and transport, and targeting the health workforce during war is a serious violation of international humanitarian law. This survey was conducted to assess the damages and service interruptions to the health services in the Amhara region's war zones following the broke out of the war between Ethiopia's central government and the Tigray forces in late 2020.

Methods: The survey was carried out in six zones and one city administration of the Amhara region. Quantitative data on the extent of destruction were collected from 113 accessible hospitals and health centers using a semi-structured checklist. Furthermore, qualitative data were obtained from twenty-one local administrative heads of zonal health departments, district health offices, hospitals, and health centre administrators. The quantitative data were coded, cleaned, and analyzed using SPSS version 24 software. The transcribed qualitative data were translated, coded, and thematically analyzed.

Result: Deliberate destruction of buildings, electrical power supplies, and water sources was noted in 92%, 85%, and 64% of the health facilities respectively. Medical equipment, computers, and other devices were looted from 94% of the health facilities. In addition, 24 ambulances were damaged, and 34 were looted. Healthcare services were disrupted in the majority of health facilities. The healthcare workforces were compelled to evacuate, and experienced kidnappings, torture, and fatalities.

Conclusion: The war broke out in the northern part of Ethiopia deprived the healthcare service of the community. The health workforces were intentionally attacked, and many of the health facilities' infrastructure, ambulances, and medical equipment were looted and destroyed requiring urgent and collective efforts to restore the health service.

Influence of Mass Media on Institutional Delivery Service Utilization among Ethiopian Women: Insights from the 2016 Demographic and Health Survey

Adane Nigusie Weldeab, Amlaku Nigusie — Tue, 01 Oct 2024 00:00:00 +0000

Introduction: Globally, the rapid advancement of technology has significantly expanded the reach of mass media, exposing a large portion of the world's population to diverse information sources. Mass media encompass various technologies that distribute information, ideas, and opinions to broad and targeted audiences. In developing countries, including Ethiopia, the utilization of institutional delivery services remains very low.

Objective: This study aims to assess the influence of mass media on the utilization of institutional delivery services among women in Ethiopia, utilizing data from the 2016 EDHS.

Methods :The study used data from the published reports of Ethiopian Demographic and Health Surveys-2016.

Results: Nearly twenty-eight percent (27.7%) of the respondents were exposed to radio, followed by television (19.6%) and newspapers (7.1%). Multivariable logistic regression analyses showed that mothers exposed to mass media were more likely to utilize institutional delivery services (AOR 1.25; 95% CI 1.10, 1.42). Place of residence, specifically rural areas (AOR 0.20; 95% CI 0.16, 0.25), educational status (primary school: AOR 1.98; 95% CI 1.76, 2.24; secondary school: AOR 6.12; 95% CI 4.59, 8.17; higher education: AOR 8.21; 95% CI 4.72, 14.30), and wealth index (poorer: AOR 1.72; 95% CI 1.44, 2.06; middle: AOR 1.97; 95% CI 1.65, 2.36; richer: AOR 2.11; 95% CI 1.76, 2.54; richest: AOR 3.19; 95% CI 2.52, 4.03) were significantly associated with institutional delivery service utilization.

Conclusion: The study reveals that exposure to mass media significantly increases the likelihood of utilizing institutional delivery services among women in Ethiopia. Additionally, factors such as urban residency, higher educational attainment, and greater wealth are positively associated with higher rates of institutional delivery service utilization. These findings highlight the importance of mass media and socio-economic factors in improving maternal health service uptake.

Outcomes of Patients with Acute Chemical Poisoning in Public Referral Hospitals of Bahir Dar City, Ethiopia

Tue, 01 Oct 2024 00:00:00 +0000

Background: Acute chemical poisoning is a global public health concern. It is influenced by factors such as geographical differences, availability of chemical substances, occupation, and industrialization. Widespread pesticide use in developing countries increased its incidences. There is insufficient epidemiological data in the region to manage and intervene the problem. The study aims to assess the outcome of acute chemical poisoning cases in two public specialized hospitals of Bahir Dar city, Ethiopia from May 2022 to November 2023.

Method: A retrospective cross-sectional study was conducted at the Emergency departments of the two public hospitals in Bahir Dar City from May 2022 to November 2023 to assess the outcome of acute chemical poisoning cases. A total of 619 registered patients diagnosed with poisoning were included in the study. Socio-demographic data were collected from the medical records of acute poisoning patients using a data collection checklist. Descriptive analysis was performed using statistical tools in Statistical Package for Social Science (SPSS), and the results were presented through tables and graphs. Ethical approval was obtained from the Amhara National Regional State Public Health Institute Research Ethics Review Board (ARRERB), and cooperation letters to the hospitals were requested.

Results: There was a higher incidence of chemical poisoning in females than in males. Seventy percent of the cases were between 15-29 years of age. 86.16% of the chemical poisoning cases were attributed to Organophosphates and Metallo Phosphides. The most reported complaints 97.4% cases were vomiting, and abdominal pain. Chemical poisoning cases were primarily intentional accounting for 93.3% of the cases. Twelve percent of acute chemical poisoning cases were died. The study indicates a higher (32.10%) cases in Spring and fewer (18.01%) cases in Autumn.

Conclusion: Acute chemical poisoning is more common in females and youths aged 11-30 years, primarily due to organophosphorus chemicals, often resulting from intentional poisoning. Effective strategies are essential for safely storing and distributing highly toxic chemicals, especially to prevent children from accessing them.

Bacterial profile and antimicrobial susceptibility patterns of isolates from postoperative surgical site infections and hospital environment samples

Tue, 01 Oct 2024 00:00:00 +0000

Background: The occurrence of microorganisms especially antimicrobial-resistant bacteria in health facilities can cause infections among admitted patients. This increases the treatment costs, prolonged hospital stays, and significant morbidity and mortality for postoperative patients. Currently, there is insufficient evidence of surgical site infection and multidrug-resistant bacteria. Therefore, continuous surveillance is necessary to guide an appropriate therapy for surgical site infection and the rational use of antimicrobial agents. Thus, this study provides updated information on information about the bacteria, Multi-Drug Resistance bacteria species responsible for postoperative surgical site infection, and the etiologic agents in hospital environments.

Objectives: This study assesses bacterial profile and antimicrobial susceptibility patterns in samples collected from postoperative surgical site infections and the hospital environment at the University of Gondar Comprehensive Specialized Hospital, Gondar; Northwest Ethiopia.

Materials and methods: A cross-sectional study was conducted among patients with postoperative surgical site infections and hospital environment samples from February 1 to April 30, 2020. All postoperative patients suspected of having surgical site infections and hospital environments were included in the study. A total of 202 samples (52 from wounds and 150 from the environment) were examined. Socio-demographic characteristics were collected using a structured questionnaire. Swab samples were obtained and inoculated onto MacConkey agar, Mannitol salt agar, Blood agar plates, and Chocolate agar by rolling the swab over the agar surfaces. The inoculated plates were then incubated at 37 °C for 24 to 48 hours. Air culture samples from Blood agar plates were also incubated at 37 °C for 24 hours. Antimicrobial susceptibility testing was conducted using the disk diffusion method on Muller Hinton agar. Data were entered and analyzed using Statistical Package for the Social Sciences version 20. Descriptive statistics were employed to present the findings through words, percentages, and tables.

Results: Of 52 wound samples from surgical site infection, the most frequent isolates were S. aureus and Klebsiella species, each accounting for 11 cases (20%), followed by E. coli with 10 cases (18.2%). Among the S. aureus isolates, 63.6% were methicillin-resistant. The overall rate of multidrug resistance was 31 cases (56.4%). Regarding hospital environmental samples, of 150 samples, the most commonly identified isolates were coagulase-negative S. aureus with 57 cases (47.5%), followed by S. aureus with 35 cases (29.2%). The overall rate of multidrug resistance was 66 cases (55.0%).

Conclusion: Staphylococcus aureus, Klebsiella species, and E. coli were identified the most prevalent bacteria associated with postoperative surgical site infections, with hospital environments serving as potential reservoirs for these pathogens in the study area. High prevalence rates of methicillin-resistant and multidrug-resistant were observed among both clinical and hospital isolates in this study. However, Amikacin and Clindamycin demonstrated the highest effectiveness in inhibiting the in vitro growth of Gram-negative and Gram-positive bacterial isolates, respectively. Therefore, updating treatment guidelines based on hospital formularies and susceptibility patterns is crucial to prevent the further emergence and spread of multidrug-resistant bacterial pathogens. Additionally, infection prevention practices should be strengthened.

Health under Siege: The Far-Reaching Impact of Conflict on Health Services

Tue, 01 Oct 2024 00:00:00 +0000