Antimicrobial resistance patterns and virulence factors of enterococci isolates in hospitalized burn patients

Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review

BACKGROUND

COVID-19 is a pandemic caused by nCoV-2019, a new beta-coronavirus from Wuhan, China, that mainly affects the respiratory system and can be modulated by nutrition.

METHODS

This review aims to summarize the current literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We searched for relevant articles in various databases and selected those that met our inclusion criteria.

RESULTS

Some studies suggest that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may have a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is not consistent and conclusive, and more research is needed to clarify the mechanisms and the optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been mainly studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D.

CONCLUSION

This review highlights the potential of nutrition as a modifiable factor in the prevention and management of respiratory infections and suggests some directions for future research. However, it also acknowledges the limitations of the existing literature, such as the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet.

Maternal dietary diversity increases with women's high decision-making autonomy in Northwest Ethiopia, 2022

Background

Dietary diversification is one of several approaches for improving micronutrient levels in women of reproductive age. Therefore, this study aimed to assess the magnitude of minimum dietary diversity among pregnant women, explore the association between women's decision-making autonomy and dietary diversity, and identify other potential determinants of dietary diversity in Northwest Ethiopia.

Method

A community-based cross-sectional study of 621 pregnant women was conducted from November 2022 to December 2022. A cluster random sampling technique was employed. A binary logistic regression model was used to explore the association between dietary diversity and women's decision-making autonomy. Adjusted odds ratios with 95 % CIs were estimated to identify factors associated with the dietary diversity of pregnant women, and they were considered to be statistically significant at a P-value <0.05.

Results

The minimum dietary diversity among pregnant women was 22.4 %. The study revealed a significant association between dietary diversity and women's decision-making autonomy (AOR: 2.82, 95 % CI: 1.73, 4.59; p value: 0.001). Primary education and above (AOR = 4.0, CI: 2.1, 7.67), monthly income 1000-2000 ETB (AOR = 4.46, CI: 2.53, 7.87) and >2000 ETB (AOR = 6.05, CI: 3.16, 11.59), having nutritional information (AOR = 2.15, CI: 1.32, 3.51), being food secure (AOR = 2.63, CI:1.6, 4.34), morbidity status (AOR: 0.278, CI: 0.14, 0.56), ANC visits one time (AOR = 2.08, CI = 1.003, 4.33) and two or three times (AOR = 2.45, CI: 1.15, 5.24) were potential predictors of pregnant women's dietary diversity.

Conclusion

Maternal dietary diversity was significantly associated with women's decision-making autonomy. Thus, the government should strengthen women's empowerment, rights, access to education, and economic opportunities.

Determining the rate and reasons for specimen rejection among specimens referred for HIV viral load determination through referral linkage to Debre Tabor Comprehensive Specialized Hospital, north-central, Ethiopia,2023: Retrospective study

Background

The preanalytical phase encompasses the time between the clinician's test order to the sample being ready for analysis. Of all errors during the laboratory diagnostic process,70 % appeared in the pre-analytical phase. In clinical laboratories, it is crucial to ensure proper specimen collection and handling, which is essential to guarantee quality assessment, monitoring process standardization, improving performance, and ensuring patient safety. Despite this importance, no study has been conducted in the study area to investigate the rate and reasons for human immunodeficiency virus viral load sample rejection.

Objective

To determine the rate of human immunodeficiency virus viral load sample rejection (number of preanalytical errors) documented during the preanalytical phase and articulate possible causes for specimen rejection.

Material and methods

A retrospective study was conducted at Debre Tabor Comprehensive Specialized Hospital from January 1st to January 31, 2023. During the study period, 5950 samples were extracted from the human immunodeficiency virus viral load laboratory sample tracking log books, which were sent to the hospital for viral load testing between August 2021 to November 2022. The collected data were cleaned and entered into EPI data version 4.6 before transferred it to STATA version 14.0 for analysis. Descriptive statistics such as frequencies, percentages, and cross-tabulations were used to summarize the findings.

Results

The study found that improper sample handling was common during the preanalytical phase. According to the current study, 3.6 % of the sample was rejected at pre analytical stage. The most common reasons for specimen rejection were using inappropriate containers (64.0 %) uncentrifuged specimens (20.4 %); hemolyzed specimens (7.0 %); insufficient specimen volume (6.2 %); clotted specimens (1.9 %); and specimen labeling problems (0.5 %).

Conclusion

This study found that the most common preanalytical error was using an inappropriate sample collection container, followed by uncentrifuged samples, Therefore, it is recommended that mentorship programs be developed to educate staff on the preanalytical phase of laboratory testing, specifically on sample collection, storage, and transportation for HIV viral load testing. Additionally, the quality management system of laboratory processes should be strengthened to ensure accuracy and minimize errors.

Hotspot areas of risky sexual behaviour and associated factors in Ethiopia: Further spatial and mixed effect analysis of Ethiopian demographic health survey

INTRODUCTION

Sexual behaviour needs to take a central position in the heart of public health policy makers and researchers. This is important in view of its association with Sexually Transmitted Infections (STIs), including HIV. Though the prevalence of HIV/AIDS is declining in Ethiopia, the country is still one of the hardest hit in the continent of Africa. Hence, this study was aimed at identifying hot spot areas and associated factors of risky sexual behavior (RSB). This would be vital for more targeted interventions which can produce a sexually healthy community in Ethiopia.

METHODS

In this study, a cross-sectional survey study design was employed. A further analysis of the 2016 Ethiopia Demographic and Health Survey data was done on a total weighted sample of 10,518 women and men age 15-49 years. ArcGIS version 10.7 and Kuldorff's SaTScan version 9.6 software were used for spatial analysis. Global Moran's I statistic was employed to test the spatial autocorrelation, and Getis-Ord Gi* as well as Bernoulli-based purely spatial scan statistics were used to detect significant spatial clusters of RSB. Mixed effect multivariable logistic regression model was fitted to identify predictors and variables with a p-value ≤0.05 were considered as statistically significant.

RESULT

The study subjects who had RSB were found to account about 10.2% (95% CI: 9.64%, 10.81%) of the population, and spatial clustering of RSB was observed (Moran's I = 0.82, p-value = 0.001). Significant hot spot areas of RSB were observed in Gambela, Addis Ababa and Dire Dawa. The primary and secondary SaTScan clusters were detected in Addis Ababa (RR = 3.26, LLR = 111.59, P<0.01), and almost the entire Gambela (RR = 2.95, LLR = 56.45, P<0.01) respectively. Age, literacy level, smoking status, ever heard of HIV/AIDS, residence and region were found to be significant predictors of RSB.

CONCLUSION

In this study, spatial clustering of risky sexual behaviour was observed in Ethiopia, and hot spot clusters were detected in Addis Ababa, Dire Dawa and Gambela regions. Therefore, interventions which can mitigate RSB should be designed and implemented in the identified hot spot areas of Ethiopia. Interventions targeting the identified factors could be helpful in controlling the problem.

Visual impairment among diabetes patients in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been conducted to determine the prevalence of visual impairment and its associated factors among diabetes patients in Ethiopia, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of visual impairment and identify associated factors among diabetes patients.

METHODS

An extensive search of literature was done on PubMed, Google Scholar, and Web of Sciences databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to calculate the pooled prevalence of visual impairment.

RESULTS

A total of 34 eligible primary studies with a sample size of 11,884 participants were included in the final meta-analysis. The pooled prevalence of visual impairment was 21.73% (95% CI: 18.15, 25.30; I2 = 96.47%; P<0.001). Diabetes mellitus with a duration of diagnosis ≥10 years [AOR = 3.18, 95% CI: 1.85, 5.49], presence of co-morbid hypertension [AOR = 3.26, 95% CI: 1.93, 5.50], poor glycemic control [AOR = 4.30, 95% CI: 3.04, 6.06], age ≥56 years [AOR = 4.13, 95% CI: 2.27, 7.52], family history of diabetes mellitus [AOR = 4.18 (95% CI: 2.61, 6.69], obesity [AOR = 4.77, 95% CI: 3.00, 7.59], poor physical activity [AOR = 2.46, 95% CI: 1.75, 3.46], presence of visual symptoms [AOR = 4.28, 95% CI: 2.73, 6.69] and no history of eye exam [AOR = 2.30, 95% CI: 1.47, 3.57] were significantly associated with visual impairment.

CONCLUSIONS

The pooled prevalence of visual impairment was high in Ethiopia. Diabetes mellitus with a duration of diagnosis ≥10 years, presence of co-morbid hypertension, poor glycemic control, age ≥56 years, and family history of diabetes mellitus, obesity, poor physical activity, presence of visual symptoms, and no history of eye exam were independent predictors. Therefore, diabetic patients with these identified risks should be screened, and managed early to reduce the occurrence of visual impairment related to diabetes. Moreover, public health policy with educational programs and regular promotion of sight screening for all diabetes patients are needed.

Challenges and support experienced by family caregivers seeking antiretroviral therapy services for children living with HIV/AIDS: a phenomenological study in Ghana

BACKGROUND

Family caregivers of children living with HIV/AIDS in most cases are found to be overwhelmed and under-resourced, yet they are believed to be the primary source of support for children living with HIV/AIDS. Family caregivers experience different challenges that affect their children's antiretroviral therapy (ART) adherence.

AIM

This study explored the lived experiences of family caregivers of children living with HIV/AIDS who sought ART services for these children at the St Joseph's Hospital of Jirapa, Ghana.

METHOD

Using a qualitative phenomenology design and a semistructured in-depth interview guide and using purposive sampling, data were gathered from 13 family caregivers of children living with HIV/AIDS receiving ART treatment at St Joseph's Hospital, Jirapa following ethical approval. All interviews were audio-taped and transcribed verbatim. Reflexive thematic analysis was used to analyse the transcribed data.

FINDINGS

Six themes were generated: five challenges and one support. Family caregivers of children living with HIV/AIDS experienced: (1) Financial challenges, (2) Human-related challenges, (3) Challenges at HIV testing and counselling (HTC) centres, (4) Challenges with transportation, (5) Challenges in disclosing children's HIV status to them and (6) Support received from HTC and their family members.

CONCLUSION AND RECOMMENDATION

Family caregivers of children living with HIV/AIDS experience daunting challenges in their quest to care for their children. Governmental and non-governmental HIV/AIDS programme support should include small business skills training and acquisition including capital to help set up small-scale businesses for such caregivers to reduce their financial challenges. Access to ART at clinics closer to caregivers is also key to promoting adherence. Family and community support has been recognised as key to enhancing ART adherence. Education of caregivers on policy regarding disclosure of the HIV/AIDS status of children, the need to work to reduce the time spent by caregivers at HTC, and ensuring privacy by limiting access to HTCs to only caregivers and their children, are important to enhancing adherence.

Determinants of birth asphyxia among newborns in south Gondar Zone public hospitals, North West Ethiopia, 2021: A case control study

Introduction

Birth asphyxia is one of the leading causes of neonatal mortality, which accounts for around 24 % of overall neonatal mortality. Neonatal death usually results from preventable factors. Thus, this study has aimed to identify the determinant factors of birth asphyxia among newborns in South Gondar Zone public hospitals.

Methods

Institution based unmatched case control study and systematic random sampling technique was conducted in South Gondar zone public hospitals from March October 2021 to May 20/2021. A pretested interviewer administered questionnaire and a data retrieving checklist was used for data collection. Cases were selected if one of the following was present at birth: (gasping, no breathing, or breathing rate of below 30 per minute). Epidata version 4.6 software was used for data entry and bivariate logistic regression and multivariable logistic regression techniques were used for data analysis using SPSS version 23.

Result

In this study, Instrumental delivery (AOR = 3.19, 95%CI: 1.23-8.36), labor abnormality (AOR = 3.24, 95%CI: 1.31-8.03), cord prolapse (AOR = 7.06, 95%CI:2.25-22.50),APH (AOR = 4.68,95%CI:2.00-10.95) and preterm birth (AOR = 3.84,95%CI:1.32-11.20) were predictors of birth asphyxia.

Conclusion

Labor abnormality, ante-partum hemorrhage, cord prolapse, instrumental delivery and preterm birth were independent predictors of birth asphyxia.

Where the children play: Gender gaps in recess physical activity by age and playground area

Objective

Recess contributes meaningfully to physical activity (PA), but recess time has declined. The study's purpose was to report PA by age, gender, and playground feature to inform potential playground configurations more conducive to PA during recess.

Methods

Using the System for Observing Play and Leisure Activity in the Youth, kindergarten through 5th grade recesses were observed on at least four days at four schools in Little Rock, Arkansas, United States during May 2023. Target playground features were ball courts, grass, pavement, play structures, and swings. To provide inferential analysis, a comparison of conditional means across playground features, age, and gender was conducted using linear regression with robust standard errors clustered by school.

Results

3,356 playground scans (intercoder correlation = 0.93) were collected and aggregated by school, day, gender, age (grade), and target feature for a sample size of 292 observations. The gender gap was widest among 4-5th graders, 79 % (95 % CI: 72, 86) for males and 64 % (95 % CI: 58, 70) for females. Among females, PA was highest on swings [82 % (95 % CI: 77, 86)] and lowest on paved areas [56 % (95 % CI: 43, 69)]. Among males, it was highest on both swings [81 % (95 % CI: 75, 86)] and ball courts [83 % (95 % CI: 77, 89)] and lowest on grassy areas [64 % (95 % CI: 60, 67)].

Conclusion

Swings, courts, and play structures were associated with a higher proportion of children being engaged in PA. Research is needed to identify whether physical improvements to facilitate access to these features increase PA.

The association between economic uncertainty and suicide in Japan by age, sex, employment status, and population density: an observational study

Background

Suicide is one of the ten leading causes of death globally, and previous research has revealed a link between economic conditions and mental health. However, the literature has focused primarily on recessions and unemployment, i.e. actual economic developments, as opposed to uncertainty, which relates to economic developments that have not (yet) materialised. This study examines the differential association between economic uncertainty and suicide in Japan, depending on age, sex, employment status, and population density, in order to identify the groups that are affected the most.

Methods

Using monthly prefectural suicide mortality data from the Ministry of Health, Labour and Welfare and a monthly economic uncertainty index for the period 2009 to 2019, we employed a fixed effects panel data approach to examine the association between uncertainty and suicide by population group.

Findings

We found that a 1% increase in economic uncertainty is associated with a 0.061 increase in the monthly number of suicides per 100,000 people per prefecture, on average (coefficient: 6.08; 95% CI: 5.07-7.08), which constitutes a 3.62% increase. Self-employed people, as well as men in their 50s and unemployed men, experience the highest additional risk of suicide when uncertainty increases. The association was approximately three times stronger for males than for females, and a strong association was observed for self-employed males living in more densely-populated areas.

Interpretation

Uncertainty appears to relate to suicides for most groups, but self-employed people, males, and those living in more densely populated areas appear to be more at risk of suicide in periods of increased economic uncertainty. Our results provide an indication of which groups mental health services and prevention strategies can focus on in times of economic uncertainty.

Funding

None.

Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model

OBJECTIVE

To assess the time to initiation of antenatal care (ANC) and its predictors among pregnant women in Ethiopia.

DESIGN

Retrospective follow-up study using secondary data from the 2019 Ethiopian Mini-Demographic and Health Survey.

SETTING AND PARTICIPANTS

2933 women aged 15-49 years who had ANC visits during their current or most recent pregnancy within the 5 years prior to the survey were included in this study. Women who attended prenatal appointments but whose gestational age was unknown at the first prenatal visit were excluded from the study.

OUTCOME MEASURES

Participants were interviewed about the gestational age in months at which they made the first ANC visit. Multivariable mixed-effects survival regression was fitted to identify factors associated with the time to initiation of ANC.

RESULTS

In this study, the estimated mean survival time of pregnant women to initiate the first ANC visit in Ethiopia was found to be 6.8 months (95% CI: 6.68, 6.95). Women whose last birth was a caesarean section (adjusted acceleration factor (AAF)=0.75; 95% CI: 0.61, 0.93) and women with higher education (AAF)=0.69; 95% CI: 0.50, 0.95) had a shorter time to initiate ANC early in the first trimester of pregnancy. However, being grand multiparous (AAF=1.31; 95% CI: 1.05, 1.63), being previously in a union (AAF=1.47; 95% CI: 1.07, 2.00), having a home birth (AAF=1.35; 95% CI: 1.13, 1.61) and living in a rural area (AAF=1.25; 95% CI: 1.03, 1.52) were the impediments to early ANC initiation.

CONCLUSION

Women in this study area sought their initial ANC far later than what the WHO recommended. Therefore, healthcare providers should collaborate with community health workers to provide home-based care in order to encourage prompt ANC among hard-to-reach populations, such as rural residents and those giving birth at home.

Magnitude of Thrombocytopenia and Associated Factors among Pregnant Women Attending the Antenatal Care Service Unit of Wachemo University Nigist Ellen Mohammed Comprehensive Specialized Hospital Hosanna, Southern Ethiopia

Background

Thrombocytopenia is the second most common hematological disorder in pregnancy after anemia worldwide and affects 7-8% of all pregnancies. Pregnant women with thrombocytopenia have complications of excessive bleeding during or after childbirth, exudation at the cesarean section, and neonatal thrombocytopenia. Therefore, the main aim of this study was to assess the magnitude of thrombocytopenia and its associated factors among pregnant women attending the Antenatal Care Service Unit of Wachemo University Nigist Ellen Mohammed Comprehensive Specialized Hospital Hosanna, Southern Ethiopia.

Materials and Methods

A cross-sectional study was conducted from June 1 to August 30, 2022, involving 209 consecutive pregnant women who came to the hospital during the study period for antenatal care follow-up. Sociodemographic, reproductive, and other clinical data were collected using a structured questionnaire. A four-milliliter venous blood specimen was collected for complete blood analysis and peripheral blood smear. The data were analyzed by using SPSS version 25. Descriptive statistical analysis and bivariate and multivariate logistic regression analyses were performed. A P value ≤0.05 was considered to indicate statistical significance.

Results

The overall magnitude of thrombocytopenia among pregnant women was 14.8% (95% CI: 10, 19.6). The prevalence of mild, moderate, and severe thrombocytopenia was 77.4%, 16.1%, and 6.5%, respectively. Multivariate logistic regression revealed that rural residence (AOR = 2.6 and 95% CI = 1.02, 7.12), cigarette smoking (AOR = 8.4 and 95% CI = 1.86, 38), anemia (AOR = 8.3 and 95% CI = 2.7, 25.6), and alcohol consumption (AOR = 8.2 and 95% CI = 2.17-31) were significantly independent factors associated with the development of thrombocytopenia.

Conclusion

The magnitude of thrombocytopenia in this study was 14.8%. Rural residence, cigarette smoking, alcohol consumption, and anemia were significantly associated with thrombocytopenia. Therefore, the platelet count should be routinely determined during antenatal care visits for proper diagnosis and to minimize bleeding during and/or after childbirth.

Isolation and Identification of Pasteurella multocida and Mannheimia haemolytica from Pneumonic Small Ruminants and Their Antibiotic Susceptibility in Haramaya District, Eastern Ethiopia

Background

Pasteurella species are frequently encountered as serious diseases in small ruminants. It is the main cause of respiratory pasteurellosis in sheep and goats of all age groups.

Methods

The cross-sectional study was conducted from December 2022 to April 2023 in Haramaya district, eastern Ethiopia, to isolate and identify Pasteurella multocida and Mannheimia haemolytica and estimate their prevalence, associated risk factors, and antimicrobial sensitivity of isolates in small ruminants using a purposive sampling method. A total of 384 samples (156 nasal swabs from clinic cases and 228 lung swabs from abattoir cases) were collected. STATA 14 software was used to analyze the data. In addition, multivariable logistic regression analysis was performed to assess an association of risk factors.

Results

Out of the 384 samples examined, 164 were positive for pasteurellosis, resulting in a 42.70% prevalence. Similarly, 63 (38.4%) of the 164 positive results were from nasal swabs, while 101 (61.6%) came from lung samples. M. haemolytica accounted for 126 (76.82%) of the isolates, while P. multocida accounted for 38 (23.17%). Of the 63 nasal swab isolates, 33 (37%) were from goats and 30 (42.8%) were from sheep. And 17 (10.89%) and 46 (29.58%), respectively, were P. multocida and M. haemolytica. Of the 46 (40%) of the 101 (44.3%) isolates of the pneumonic lung, samples were from goats, while 55 (48.47%) were from sheep. In this study, the risk factors (species, age, and body condition score) were found to be significant (p < 0.05). Pasteurella isolates evaluated for antibiotic susceptibility were highly resistant to oxacillin (90.90%), followed by gentamycin (72.72%), and penicillin (63.63%). However, the isolates were highly sensitive to chloramphenicol (90.90%), followed by tetracycline (63.63%), and ampicillin (54.54%).

Conclusion

This study showed that M. haemolytica and P. multocida are the common causes of mannheimiosis and pasteurellosis in small ruminants, respectively, and isolates were resistant to commonly used antibiotics in the study area. Thus, an integrated vaccination strategy, antimicrobial resistance monitoring, and avoidance of stress-inducing factors are recommended.

Assessment of bacterial profile, antimicrobial susceptibility status, and associated factors of isolates among hospitalized patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia

BACKGROUND

Antimicrobial resistant bacteria among hospitalized patients are becoming a major public health threat worldwide, mainly in developing countries. Infections by these multidrug resistant pathogens cause high rate of mortality, prolong hospital stays, and affect individual and country economies in greater amounts. Thus, this study aimed to assess the bacterial profile, antimicrobial susceptibility status, and associated factors of isolates from hospitalized patients at the Dessie Comprehensive Specialized Hospital.

METHODOLOGY

This hospital-based cross-sectional study was conducted between February and April 2021. Consecutive sampling was used to select the study participants. All bacterial isolates were identified using standard bacteriological techniques. Antibiotic susceptibility testing was performed using disk diffusion technique. The data was analyzed using SPSS version 25. Descriptive statistics and logistic regression were used. A P-value of less than 0.05 was considered statistically significant.

RESULTS

Of 384 clinical samples (blood, urine, stool, wound, vaginal discharge, and ear discharge) processed 180 (46.9%) were culture positive. Overall, Escherichia coli was the predominant isolate (41; 22.8%), followed by Staphylococcus aureus (36; 20%). Most of the isolates were from blood (70; 38.9%). The level of overall drug resistance of the gram-negative bacteria isolates for ampicillin, tetracycline, and cotrimoxazole was (104; 88.1%), (79; 75.9%), and (78; 75.0%), respectively. The overall multidrug rate of isolates was 143 (79.4%). Variables such as history of invasive procedures, chronic underlying diseases, history of hospitalization, and habit of eating raw animal products were statistically significant for the acquisition of bacterial infection.

CONCLUSIONS AND RECOMMENDATION

E. Coli and S. aureus were the most common isolates. Most of the isolates were resistant to commonly prescribed antibiotics. And also, consumption of raw animal products, chronic underlying disease, previous hospitalization, history of invasive procedures, and educational status were associated with the acquisition of bacterial infections. Therefore, routine antimicrobial susceptibility testing, proper patient management, wise use of antibiotics in clinical settings and health education are recommended.

Prevalence of antimicrobial resistance, biofilm formation, efflux pump activity, and virulence capabilities in multi-drug-resistant Klebsiella pneumoniae isolated from freshwater fish farms

The present study aimed to determine the antibiotic resistance, underlying mechanisms, antibiotic residues, and virulence genes involved in 32 multi-drug-resistant Klebsiella pneumoniae isolates from freshwater fishes in Andhra Pradesh, India. Antibiogram studies revealed that all isolates were multi-drug-resistant, harbored tetA (96.8%), tetC (59.3%), tetD (71.9%), nfsA (59.3%), nfsB (53.1%), sul2 (68.7%), qnrC (43.7%), qnrD (50%), blaSHV (75%), blaTEM (68.7%), and blaCTX-M (93.7%) genes. Multiple antibiotic resistance index was calculated as 0.54. Sixteen isolates were confirmed to be hyper-virulent and harbored magA and rmpA genes. In total, 46.9, 31.2, and 21.9% of the isolates were categorized as strong, moderate, or weak biofilm formers, respectively. All isolates possessed an active efflux pump and harbored acrA, acrB, acrAB, and tolC genes in 94% of the isolates, followed by mdtK (56.2%). Porins such as ompK35 and ompK36 were detected in 59.3 and 62.5% of the isolates, respectively. Virulence genes fimH-1, mrkD, and entB were present in 84.3, 81.2, 87.5% of the isolates, respectively. These findings imply a potential threat that multi-drug-resistant bacterial pathogens could transmit to surrounding environments and humans through contaminated water and the aquaculture food chain.

Promiscuous, persistent and problematic: insights into current enterococcal genomics to guide therapeutic strategy

Vancomycin-resistant enterococci (VRE) are major opportunistic pathogens and the causative agents of serious diseases, such as urinary tract infections and endocarditis. VRE strains mainly include species of Enterococcus faecium and E. faecalis which can colonise the gastrointestinal tract (GIT) of patients and, following growth and persistence in the gut, can transfer to blood resulting in systemic dissemination in the body. Advancements in genomics have revealed that hospital-associated VRE strains are characterised by increased numbers of mobile genetic elements, higher numbers of antibiotic resistance genes and often lack active CRISPR-Cas systems. Additionally, comparative genomics have increased our understanding of dissemination routes among patients and healthcare workers. Since the efficiency of currently available antibiotics is rapidly declining, new measures to control infection and dissemination of these persistent pathogens are urgently needed. These approaches include combinatory administration of antibiotics, strengthening colonisation resistance of the gut microbiota to reduce VRE proliferation through commensals or probiotic bacteria, or switching to non-antibiotic bacterial killers, such as bacteriophages or bacteriocins. In this review, we discuss the current knowledge of the genomics of VRE isolates and state-of-the-art therapeutic advances against VRE infections.

Factors related to stunting in children under 2 years old in the Papua, Indonesia: Does the type of residence matter?

OBJECTIVES

To analyze factors related to stunting in Papua region.

METHODS

Secondary data from the 2021 Indonesian National Nutrition Status Survey were used in this study. Samples of 2,937 Papuan children under the age of two were gathered for the study. This study analyzed independent variables (type of residence, mother's age, marriage, mother's education, employment, wealth, child's age, gender, and early breastfeeding initiation (EBFI) with stunting. The relationship was analyzed using logistic regression tests.

RESULTS

Stunting is more common among children in Papua's rural areas than in urban (AOR 1.168, 95% CI, 1.128-1.209). Stunting is more common in children who mother do not work than in mothers who do (AOR 1.174, 95% CI, 1.142- 1.207). Stunting is more common in children aged 12-23 months compared to children <12 months (AOR 3.381, 95% CI, 3.291-3.474). Compared to girls, boys are more likely to become stunted (AOR 1.348, 95% CI, 1,314-1,383). Children under the age of two who do not experience EBFI are at higher risk than those who have (AOR 1.078, 95% CI, 1.050-1.106).

CONCLUSION

There are eight variables associated with stunting, namely residence, age of mother, mother's education, mother's occupation, economic status, child's age, gender, and EBFI. Prioritization of stunting interventions in Papua should be targeted at mothers who living in rural, having low education, and not doing early breastfeeding initiation.

Hirschsprung disease: a cost analysis study of the direct, indirect costs and financial coping strategies for the surgical management in Western Uganda

BACKGROUND

Surgical management of Hirschsprung disease (HD) in low- and middle-income countries is typically a staged procedure, necessitating multiple hospitalizations and clinic visits increasing family financial burden. Currently, there is limited information on the costs borne by caretakers of children with Hirschsprung disease seeking surgical intervention. This study seeks to measure the costs and economic burden of surgical treatment for Hirschsprung disease in western Uganda.

METHODS

A cross-sectional study using cost analysis was conducted among caretakers of patients who completed surgical treatment of HD between January 2017 and December 2021 at two hospitals in western Uganda. The average direct and indirect costs incurred by caretakers presenting at a public and private hospital were computed.

RESULTS

A total of 69 patients (M: F = 7:1) were enrolled in the study. The median age at diagnosis was 60.5 (IQR 3-151.25) days for children and two-staged pull-through procedure was the common surgery performed. The mean overall cost for treatment was US $960 (SD = $720), with the majority of costs coming from direct medical costs. Nearly half (48%) of participants resorted to distress financing to finance their child's surgical care. The overwhelming majority of patients (n = 64, 93%) incurred catastrophic expenditure from the total costs of surgery for HD, and 97% of participants fell below the international poverty line at the time treatment was completed.

CONCLUSION

Despite the availability of 'free care' from government hospital and non-profit services, this study found that surgical management of Hirschsprung disease imposed substantial cost burden on families with Hirschsprung disease patients.

Immediate postnatal care guidelines implementation and associated factors among healthcare providers in East Shewa zone public health facilities, Oromia, Ethiopia, 2022: a multicentre cross-sectional study

OBJECTIVES

Immediate postnatal care is a critical intervention to reduce maternal and neonatal morbidity and mortality; however, many women and newborns receive inadequate postnatal care timely and effectively during the first 24 hours following childbirth. Therefore, this study aimed to assess the immediate postnatal care guidelines implementation and its associated factors among healthcare providers in the East Shewa zone public health facilities, Oromia, Ethiopia.

DESIGN

Facility-based cross-sectional study was conducted from 13 September 2022 to 28 October 2022.

SETTING

The study was conducted in 6 hospitals and 19 health centres in the East Shewa zone.

PARTICIPANTS

All healthcare providers who work in the maternity ward of the East Shewa zone public health facilities were the source population while all healthcare providers who work in the maternity ward of the randomly selected East Shewa zone public health facilities were the study population. Healthcare providers who were assigned to the delivery and postnatal ward during data collection were included in the study. Healthcare providers, who are not on duty for annual, maternity, sick and study leave, were excluded from the study.

MEASURES

A structured self-administered questionnaire and observational checklist were used for data collection. The questionnaires were pretested and data were collected by the Kobo toolbox software. Data were analysed by using the SPSS V.25. Binary logistic regression (bivariate and multivariable) analyses were done to identify significantly associated variables, and finally, an adjusted OR (AOR) at a 95% CI was used to declare significant variables depending on a p<0.05.

RESULT

The study revealed that 196 healthcare providers with a response rate of 97.03% were included in this study. The overall proportion of healthcare providers who have a good implementation of immediate postnatal care guidelines was 44.4% (95% CI 37.3% to 51.6%). Providers who received basic emergency obstetrics and newborn care training (AOR 3.72, 95% CI 1.7 to 8.1), working in a tertiary-level hospital (AOR 3.85, 95% CI 1.3 to 11.2), and who had maternal and newborn care guidelines in their facility (AOR 3.2, 95% CI 1.5 to 6.6) were significantly associated factors with good implementation of immediate postnatal care guidelines.

CONCLUSIONS

Implementation of the immediate postnatal care guideline by healthcare providers in the maternity ward was found low as less than half of healthcare providers have good implementation. Receiving basic emergency obstetrics and newborn care training, having maternal and newborn care guidelines in their facility, and working in a tertiary-level hospital were significantly associated factors with good implementation of immediate postnatal care guidelines.

Magnitude and associated factors of low birth weight among term newborns delivered in Addis Ababa public hospitals, Ethiopia, 2021

Only 14% of births had information on birth weight available at the time of birth in Ethiopia. Hence, previous studies underestimate the magnitude and associated factors of low birth weight (LBW). As a result, the goal of this study is to fill those gaps in the previous studies. An institution-based cross-sectional study was employed. Binary logistic regression was used to identify the associated factors. In this study, the magnitude of LBW was 13.06%. History of chronic medical illness (AOR = 3; 95% CI: (1.02, 9.17)), haemoglobin level during pregnancy (AOR = 0.23; 95% CI: (0.10, 0.50)), iron/folic acid supplementation (AOR = 0.27; 95% CI: (0.10, 0.72)) and extra meal during pregnancy (AOR = 3.2; 95% CI: (1.52, 7.00)) were significantly associated with LBW. The magnitude of LBW in this study was comparable to the Ethiopian Demographic and Health Survey (EDHS) report from 2016. It is better to intervene in those identified factors in order to reduce LBW.Impact StatementWhat is already known on this subject? Low birth weight (LBW) accounts for 60-80% of all neonatal deaths each year. In developing countries like Ethiopia, LBW is a major public health concern. Almost half of the world's infants are not weighed at birth, a figure that is especially high in sub-Saharan Africa including Ethiopia.What do the results of this study add? Only 14% of births had information on birth weight available at the time of birth in Ethiopia. Hence, previous studies underestimate the magnitude and associated factors of LBW. To meet the Sustainable Development Goals (SDGs)-2030 targets for neonatal and child mortality, sufficient evidence on the magnitude of LBW and associated factors must be important in order to contribute to the development of timely interventions. A history of chronic medical illness, haemoglobin level, iron/folic acid supplementation and extra meal during pregnancy was associated with LBW.What are the implications of these findings for clinical practice and/or further research? The findings of this study will be useful in developing better health policies to prevent LBW as well as interventions that can target the identified factors.

Asymptomatic gastrointestinal carriage of multidrug-resistant carbapenemase-producing Enterobacteriaceae among children under five years in a Kenyan hospital

Objectives

Asymptomatic gastrointestinal carriage of carbapenem-resistant Enterobacteriaceae (CRE) is a threat to global health in developing countries with inadequate safe drinking water, poor hygiene, and weak antimicrobial stewardship; however, epidemiological data to guide CRE infection prevention and control is limited in these settings. We assessed asymptomatic CRE and carbapenem-producing Enterobacteriaceae (CPE) fecal carriage rates and associated risk factors among hospitalized children aged under 5 years.

Methods

We adopted a cross-sectional study at Mama Lucy Kibaki Hospital in Nairobi-City County, Kenya, between June and September 2022. We collected demographic and clinical characteristics using a structured questionnaire and clinical reports and analyzed stool/rectal swab samples by standard and automated bacteriological methods.

Results

Asymptomatic CRE and CPE fecal carriage rate was 2.25% (6/267), with six isolates recovered, predominated by Escherichia coli (33.33%) and Enterobacter cloacae subsp dissolvens (33.33%). Third-generation cephalosporin and ciprofloxacin resistance were highest in Citrobacter farmer and E. cloacae subsp cloacae. All CRE and CPE were multidrug-resistant, and except E. cloacae subsp cloacae, were 100% colistin-resistant.

Conclusions

Asymptomatic gastrointestinal carriage of multidrug-resistant-CRE among hospitalized children under 5 years, presents a substantial public health threat. This calls for continuous surveillance including molecular characterization of isolates, to inform infection prevention and antimicrobial stewardship adherence in line with local and global plans on AMR.

Factors associated with glycaemic control among patients with type 2 diabetes mellitus in Ho, Ghana: A cross-sectional study

Background

The purpose of this study was to assess the status of glycaemic control and associated factors among patients with type 2 diabetes mellitus patients.

Methods

This was a hospital-based cross-sectional descriptive study of 326 patients with type 2 diabetes at the Ho Municipal and Teaching Hospitals. The adequate sample size was calculated using Yamane formula N/1 + Ne2, with 95 % confidence interval, 5 % margin of error and 10 % non-response rate and a sample size of 326 was determined. Using the sampling frame of patients chart, systematic random sampling technique was used to select the study participants. Glycaemic level was assessed using fasting blood glucose (FBG) readings. A poor glycaemic control was when an average of three months blood glucose level was above 130 mg/dl (7 mm/L). Data was analysed using STATA version 15.0.

Results

Out of 310 patients who participated in the study, more than two-thirds (76.1 %) had poor glycaemic control. Patients who use combination of oral medication and insulin (AOR = 3.67, 95 % CI: 1.34-8.74), patients with diabetes for 16 years or more (AOR = 4.67, 95 % CI: 2.44-9.29), patients who did not practised diabetes self-care activities (AOR = 4.32, 95 % CI: 2.82-9.31) and patients with complications were (AOR = 2.47, 95%CI: 1.45-8.66) more likely to have poor glycaemic control. Age, employment, diabetes education, comorbidities, diabetes self-care activities, treatment type, complications, resident and duration of diabetes were significantly associated with poor glycaemic control.

Conclusion

Based on this findings, teaching and counselling provided by nurses, physicians, dietitians and pharmacists should focus on improving adherence to diabetes self-care activities to attain good glycaemic control.

Electromechanical therapy in diabetic foot ulcers patients: A systematic review and meta-analysis

Purpose

Diabetic foot ulcer (DFU) is one of the most devastating and troublesome consequences of diabetes. The current therapies are not always effective because of the complicated aetiology and interactions of local and systemic components in DFU. However, adjunctive therapy (electromechanical therapy) has become the latest modality in recent years, although there is a lack of significant research to support its utilization as a treatment standard. The purpose of this systematic research was to review the literature on the application of electromechanical therapies in the healing of DFUs.

Methods

For this systematic review, we searched PubMed, Medline, EmBase, the Cochrane library, and Google Scholar for the most current research (1990-2022) on electromechanical therapies for DFUs. We used the PICO method (where P is population, I is intervention, C is comparator/control, and O is outcome for our study) to establish research question with the terms [Electromechanical therapy OR Laser therapy OR photo therapy OR Ultrasound therapy OR Shockwave therapy] AND [diabetic foot ulcers OR diabetes] were used as search criteria. Searches were restricted to English language articles only. Whereas, Cochrane handbook of "Systematic Reviews of Interventions" with critical appraisal for medical and health sciences checklist for systematic review was used for risk of bias assessment. There were 39 publications in this study that were deemed to be acceptable. All the suitably selected studies include 1779 patients.

Results

The meta-analysis of 15 included research articles showed the overall effect was significant (P = 0.0002) thus supporting experimental groups have improvement in the DFUs healing in comparison to the control group.

Conclusion

This systematic review and meta-analysis revealed electromechanical treatments are significantly viable options for patients with DFUs. Electromechanical therapy can considerably reduce treatment ineffectiveness, accelerate healing, and minimize the time it takes for complete ulcer healing.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01240-2.

Potential of psychrotolerant rhizobacteria for the growth promotion of wheat (Triticum aestivum L.)

Wheat is the second most important staple crop grown and consumed worldwide. Temperature fluctuations especially the cold stress during the winter season reduces wheat growth and grain yield. Psychrotolerant plant growth-promoting rhizobacteria (PGPR) may improve plant stress-tolerance in addition to serve as biofertilizer. The present study aimed to isolate and identify PGPR, with the potential to tolerate cold stress for subsequent use in supporting wheat growth under cold stress. Ten psychrotolerant bacteria were isolated from the wheat rhizosphere at 4 °C and tested for their ability to grow at wide range of temperature ranging from -8 °C to 36 °C and multiple plant beneficial traits. All bacteria were able to grow at 4 °C to 32 °C temperature range and solubilized phosphorus except WR23 at 4 °C, whereas all the bacteria solubilized phosphorus at 28 °C. Seven bacteria produced indole-3-acetic acid at 4 °C, whereas all produced indole-3-acetic acid at 28 °C. Seven bacteria showed the ability to fix nitrogen at 4 °C, while all the bacteria fixed nitrogen at 28 °C. Only one bacterium showed the potential to produce cellulase at 4 °C, whereas four bacteria showed the potential to produce cellulase at 28 °C. Seven bacteria produced pectinase at 4 °C, while one bacterium produced pectinase at 28 °C. Only one bacterium solubilized the zinc at 4 °C, whereas six bacteria solubilized the zinc at 28 °C using ZnO as the primary zinc source. Five bacteria solubilized the zinc at 4 °C, while seven bacteria solubilized the zinc at 28 °C using ZnCO3 as the primary zinc source. All the bacteria produced biofilm at 4 °C and 28 °C. In general, we noticed behavior of higher production of plant growth-promoting substances at 28 °C, except pectinase assay. Overall, in vitro testing confirms that microbes perform their inherent properties efficiently at optimum temperatures rather than the low temperatures due to high metabolic rate. Five potential rhizobacteria were selected based on the in vitro testing and evaluated for plant growth-promoting potential on wheat under controlled conditions. WR22 and WR24 significantly improved wheat growth, specifically increasing plant dry weight by 42% and 58%, respectively. 16S rRNA sequence analysis of WR22 showed 99.78% similarity with Cupriavidus campinensis and WR24 showed 99.9% similarity with Enterobacter ludwigii. This is the first report highlighting the association of C. campinensis and E. ludwigii with wheat rhizosphere. These bacteria can serve as potential candidates for biofertilizer to mitigate the chilling effect and improve wheat production after field-testing.

Altered Topological Structure of the Brain White Matter in Maltreated Children through Topological Data Analysis

Childhood maltreatment may adversely affect brain development and consequently influence behavioral, emotional, and psychological patterns during adulthood. In this study, we propose an analytical pipeline for modeling the altered topological structure of brain white matter in maltreated and typically developing children. We perform topological data analysis (TDA) to assess the alteration in the global topology of the brain white-matter structural covariance network among children. We use persistent homology, an algebraic technique in TDA, to analyze topological features in the brain covariance networks constructed from structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). We develop a novel framework for statistical inference based on the Wasserstein distance to assess the significance of the observed topological differences. Using these methods in comparing maltreated children to a typically developing control group, we find that maltreatment may increase homogeneity in white matter structures and thus induce higher correlations in the structural covariance; this is reflected in the topological profile. Our findings strongly suggest that TDA can be a valuable framework to model altered topological structures of the brain. The MATLAB codes and processed data used in this study can be found at https://github.com/laplcebeltrami/maltreated.

Insecticide-treated net utilization and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

Background

Malaria is a major public health problem in many developing countries, particularly in sub-Saharan Africa. The pregnant woman, fetus, and newborn infant are all at risk from malaria during pregnancy. Hence, insecticide-treated bed net (ITN) use is the most effective and advisable method for preventing malaria during pregnancy. Studies on the prevalence of ITN utilization among pregnant women in Ethiopia are inconsistently reported and highly varied. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of ITN utilization and associated factors among pregnant women in Ethiopia.

Methods

A comprehensive search of databases such as PubMed, CINAHL, Web of Science, SCOPUS, Science Direct, Google, and Google Scholar was performed to find studies conducted in Ethiopia. All original observational studies that reported the prevalence of ITN utilization were identified and screened. The Newcastle-Ottawa scale tool was used to assess the quality of the studies. Data were extracted in Microsoft Excel 2010 format and analyzed using STATA Version 14. A random-effect meta-analysis model was utilized to estimate the pooled prevalence of ITN utilization. The statistical heterogeneity was checked using the I2 test and subgroup analysis. The publication bias was assessed using funnel plots and Egger's regression test. The size of the pooled effect of the factors influencing the use of ITNs was estimated using an odds ratio (OR) with a 95% confidence interval (CI), and a P-value <0.05 was considered statistically significant.

Results

Twenty-nine cross-sectional studies with 13,957 study participants were included in this meta-analysis. The overall pooled prevalence of ITN utilization among pregnant women in Ethiopia was 51% (95% CI: 43-60). A statistically significant heterogeneity was observed across studies (I2 = 99.09%; P < 0.001). Being literate [OR = 2.93 (95% CI: 2.14-4.01)], rural residence [OR = 1.76 (95% CI: 1.37-2.26)], and having knowledge of ITN [OR = 4.13 (95% CI: 1.57-10.81)] were factors significantly associated with ITN utilization among pregnant women.

Conclusion

The utilization of ITNs among pregnant women was substantially lower than the national target, alarmingly highlighting the need for urgent and effective interventions. Maternal education status, place of residence, and knowledge of ITNs were independent predictors of ITN utilization. Health policymakers and programmers should design and implement the most effective strategies to scale up the utilization of ITNs by pregnant women and reduce malaria-related morbidity during pregnancy.

Systematic Review Registration

CRD42022304432.

Loop mediated isothermal amplification as a molecular diagnostic assay: Application and evaluation for detection of Enterohaemorrhagic Escherichia coli (O157:H7)

Purpose

This study aimed at evaluating the performance of the Loop Mediated Isothermal Amplification (LAMP) diagnostic test, which targets the putative Fimbria protein-encoding gene (Z3276) for rapid and specific detection of locally isolated enterohemorrhagic Escherichia coli (EHEC) O157:H7.

Results

A total number of 40 locally available bacteria isolates and standard strains, among them 6 entrohemorrhagic (O157:H7) and 10 entropathogenic E. coli, 7 non diarrheic E. coli strains and 13 non entrohemorrhagic shiga toxic (stx) E. coli isolates as well as 4 pathogenic non E. coli species were used to optimize and evaluate the LAMP assay. The LAMP amplified DNA samples were visualized as turbid DNA both by naked eye and gel electrophoresis followed by staining. The assay had a sensitivity of 100% (6/6), a specificity of 97.05% (33/34), and an efficiency of 97.5% (39/40). The assay was also exhibited with 100% negative predicted value and 85.7% positive predicted value. The LAMP assay was also 10-fold more sensitive than the conventional PCR assay; sensitivity was determined by serial dilution. The results of LAMP and the PCR tests showed very high agreement (k = 0.97) in the detection of the bacteria studied.

Conclusion

Compared with the performance of PCR and SMAC, LAMP assay was better in terms of efficiency, rapidity and cost-effectiveness, which can be used as a point-care diagnostic test in resource-limited laboratories.

Postpartum depression and associated factor among mothers attending public health centers of Yeka sub city, addis ababa Ethiopia

Postpartum depression (PPD) is a major public health concern that affects both the mother's health and the development of the child.Postpartum depression is defined by the American Psychiatric Association (APA) as the development of a Major Depressive Episode (MDE) within four weeks of birth. The rate of postpartum depression statistics is lacking in developing countries. This indicates that the data can be much higher if diagnosed and reported.There for this study assessed the magnitude of postpartum depression and its associated factors among mothers attending selected public health center of Yeka sub city, Addis Ababa, Ethiopia.

Method and materials

An institutional-based cross-sectional approach was conducted from December 2021 to January 2022 among 454 postpartum women. A single population proportion equations was used to calculate the sample size for this investigation.A multi-stage sampling method was applied based on the health center they are attending.One of the eleven sub-cities in Addis Abeba, Ethiopia, was chosen for this procedure using a simple random selection technique. Furthermore, four health centers from the selected sub-city were chosen using simple random selection.For data collection, structured questioners were utilised.The Edinburgh Postnatal Depression Scale, also known as the EPDS, was used to assess participants' postpartum depression. The data was validated, coded, and entered into Epi-data before being exported to SPSS for analysis. Bivariable and multivariable logistic regression were used. P-values less than 0.05 were deemed statistically significant.

Result

The overall prevalence of postpartum depression was 23.8 % [95 % CI (20-27.8)].Being single [AOR = 7.4, 95 % CI (4.2-12.9)], having complications during pregnancy [AOR = 2.1, 95 % CI (1.16-3.82)], Bottle feeding immediately after birth [AOR = 0.3, 95 % CI (0.13-0.66)], and having low perceived psycho-social support [AOR = 3.5, 95 % CI (1.4-8.5)] were significantly associated with postpartum depression.

Conclusion and recommendation

The current study found that post postpartum depression is highly prevalent among women. As a result, we recommend that to have regular screening, follow up and mental health care in postnatal periods of pregnancy. Because the period following childbirth is stressful, especially for new mothers, emotional and psychosocial support should be provided both in the community and in health care settings. Keywords:Postpartum depression, Women, Edinburgh Postnatal Depression Scale (EPDS),Ethiopia.

Midwives' Voices on Early Initiation of Antenatal Care Following a Positive Gravindex Test: A Qualitative Study

Background

Early Antenatal Care (ANC) initiation is aimed at improving maternal and perinatal health outcomes through the identification of complications and determining the level of care needed. This study aimed to determine the voices of midwives on the provision of early initiation of ANC following positive gravindex.

Materials and Methods

The phenomenology approach underpinned the study. The participants included midwives providing ANC at health facilities under Tshino-Mutsha local area in May-December 2020. Nonprobability, purposive sampling was used to select four clinics and to sample 20 midwives. Semistructured face-to-face, in-depth interviews were conducted using an interview guide. Data saturation was reached at Participant 15; however, the researcher continued until Participant 20. Trustworthiness was ensured and ethical principles were adhered to. Data analysis was done using Tesch's open coding approach.

Results

Two themes and seven subthemes emerged, as challenges related to the provision of midwifery practice and to pregnant women. The seven subthemes were the shortage of resources, poor support of midwives, poor adherence to the available protocol for the provision of ANC, blaming of midwives by management and community, late ANC booking by pregnant women, denial of pregnancy by young women ignorance leading to a general resistance to ANC instructions, hence late booking.

Conclusions

It was concluded that shortage of human and material resources hindered the initiation of early ANC to detect, prevent, and manage the existing and potential causes of maternal and newborn mortality and morbidity.

Genome sequencing identifies coding and non-coding variants for non-syndromic hearing loss

Hearing loss (HL) is a common heterogeneous trait that involves variants in more than 200 genes. In this study, we utilized exome (ES) and genome sequencing (GS) to effectively identify the genetic cause of presumably non-syndromic HL in 322 families from South and West Asia and Latin America. Biallelic GJB2 variants were identified in 58 probands at the time of enrollment these probands were excluded. In addition, upon review of phenotypic findings, 38/322 probands were excluded based on syndromic findings at the time of ascertainment and no further evaluation was performed on those samples. We performed ES as a primary diagnostic tool on one or two affected individuals from 212/226 families. Via ES we detected a total of 78 variants in 30 genes and showed their co-segregation with HL in 71 affected families. Most of the variants were frameshift or missense and affected individuals were either homozygous or compound heterozygous in their respective families. We employed GS as a primary test on a subset of 14 families and a secondary tool on 22 families which were unsolved by ES. Although the cumulative detection rate of causal variants by ES and GS is 40% (89/226), GS alone has led to a molecular diagnosis in 7 of 14 families as the primary tool and 5 of 22 families as the secondary test. GS successfully identified variants present in deep intronic or complex regions not detectable by ES.

Utilization of preconception care and associated factors among pregnant mothers in Fiche Town, Central Ethiopia: a community-based cross-sectional study 2021

Introduction

Preconception care is an important preventive intervention for adverse pregnancy outcomes. It is recognized as a strategy to optimize women's health and pregnancy outcomes in Western countries. However, preconception care is underutilized in sub-Saharan Africa, like Ethiopia, where maternal mortality is high. Evidence is scarce in the study area about the prevalence and factors associated with preconception care utilization. Therefore this study aimed to assess the proportion of preconception care utilization and associated factors among pregnant mothers in Fiche town, central Ethiopia, 2021.

Method

A community-based cross-sectional study was done from May 10 to June 25, 2021. A systematic random sample technique was used to choose 393 pregnant women for the study. A structured, pre-tested, interviewer-administered questionnaire was used to collect data. The data were entered into Epi Data version 3.1 and then exported into SPSS version 25 for analysis. A Bivariable and multivariable logistic regression analysis was used to check for the association. Odds ratio along with 95% was used to describe the association. Finally, a significant association was declared at a p-value less than 0.05.

Results

388 respondents participated in this study, making the response rate 98.7%. Of total study participants only 84 (21.6%; 95% CI, 18, 25.8) utilized preconception care. The study found that diploma or higher level of education (AOR = 3.47, 95% CI: 1.27, 9.53), psychological and financial support from a partner (AOR = 3.86, 95% CI: 2.1, 7.10), joint discussion and plan with a partner (AOR = 3.32, 95% CI: 1.55, 7.13), history of chronic disease (AOR = 3.47, 95% CI: 1.67, 7.25), and good knowledge about preconception care (AOR = 2.42, 95% CI: 1.34, 4.38) were significantly associated with preconception care utilization.

Conclusions

Overall, less than a quarter of the pregnant mothers utilized preconception care, indicating that awareness is very low. Pregnant mothers who have a higher educational level, have good communication and support from their partners, have chronic health problems, and have good knowledge about preconception care were more likely to utilize the service. Preconception care is a better opportunity to intervene and maintain the mother in the continuum of care.

Assessment of magnitude and associated factors of attitude towards time management among health professionals working in public hospitals of Dessie City, Northeast Ethiopia

BACKGROUND

Good attitude towards to time management is the backbone to bring a change at individual and organizational levels in different sectors across the globe. But it has been ignored by different institutions, particularly in low and middle-income countries including Ethiopia. However, this can be alleviated if there are punctual, committed, and accessible health professionals that could translate the national aspirations and the desire of the community into reality. This study aims to determine the magnitude and associated factors of attitude towards time management among health professionals working in public hospitals of Dessie City, Northeast Ethiopia, METHODS: Institution-based cross-sectional study was conducted from March 24 -April 24, 2021 among 409 health professionals using a stratified sampling technique, Frequency and percentage were used to describe the study population. Multivariable logistic regression analysis was used to identify independent predictors. A p-value of < 0.05 with 95% CI were used to declare statistically significant associations.

RESULTS

The overall good time management attitude among sample was 67%(95%CI:66.77-67.22%). Satisfaction with organizational policy and strategy (AOR: 2.69, 95%CI: 1.42-5.09), satisfaction with supervisor support (AOR: 2.12, 95% CI: 1.19-3.77), and managers' good attitude towards time management (AOR: 2.00, 95%CI: 1.23-3.25) were significantly associated with good attitude towards time management among health professionals.

CONCLUSION

The attitude towards time management in public hospitals of Dessie City was low. Satisfaction with organizational policies and strategies, satisfaction with supervisor support, and managers' good attitude towards time management were delineated factors. This low attitude towards time management could affect the practice and it compromise the health service coverage and quality unless timely and appropriate interventions should be taken. Strengthening strategies aimed at maximizing job satisfaction and emphasizing an attitude towards time might have a substantial contribution.

Postpartum depression and associated factors in Afar Region, northeast Ethiopia

Background

To effectively address the burden of postpartum depression (PPD), it is crucial to gain a comprehensive understanding of its magnitude and the factors associated with it in the pastoral and hot region of the Afar Region. This will help identify the progress made thus far and highlight areas that require further attention to accelerate efforts toward reducing the impact of PPD. Notably, no previous study has examined the prevalence and associated factors of PPD specifically in pastoral communities within Ethiopia, including the Afar Region. Accordingly, we investigated the prevalence and associated factors of PPD among postpartum women in the Afar Region, Northeast Ethiopia.

Methods

An institution-based cross-sectional study was conducted in the Awsi Rasu Zone of Afar Regional State from June to July 2021. The study employed a systematic random sampling method to select a total of 302 postpartum mothers who had visited the Expanded Program of Immunisation (EPI) clinics in public health facilities within the Awsi Rasu Zone of the Afar Region. The measurement of PPD was performed using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable binary logistic regression modelling was used to investigate associations between sociodemographic, obstetric and health service, and psychosocial factors with PPD.

Results

The overall prevalence of PPD was 37.4% with a 95% confidence interval (CI) from 32.0% to 43.0%. Postpartum women who attained high school education were associated with a lower odds of PPD compared to those who did not attain formal schooling (adjusted odds ratio [AOR] = 0.31; 95% CI: 0.12, 0.82). Postpartum women with a family history of mental illness (AOR = 2.34; 95% CI: 1.24, 4.41), those who had trouble in infant feeding (AOR = 4.26; 95% CI: 2.32, 7.83), and those who experienced intimate partner violence (AOR = 3.09; 95% CI: 1.58, 6.04) were positively associated with PPD.

Conclusion

The results of our study revealed that the prevalence of PPD in the Awsi Rasu Zone of the Afar Region is higher than both the national and global averages. The findings also highlighted the need for targeted interventions addressing the needs of pastoral postpartum women who experience various stressors, such as feeding difficulties and intimate partner violence.

A cross-sectional study on the knowledge, attitude, and practice of pregnant women regarding medication use and restriction during pregnancy

Background

The use of medication during pregnancy is a complex issue that requires careful consideration to avoid potential harm to the developing fetus. Despite the existence of guidelines and restrictions on medication use during pregnancy, pregnant women in Nigeria often have limited access to information regarding drug use and may rely on their own judgment or the advice of non-professionals when making decisions about medication use.

Objectives

To assess Nigerian pregnant women's knowledge, attitude, and practice toward the use of drugs and restriction/contraindications in pregnancy.

Methods

A descriptive cross-sectional study was conducted among pregnant women who visited the Federal Medical Center, Umuahia, from January to February 2023. A self-administered questionnaire was answered by conveniently sampled participants. Data were collected about their sociodemographic characteristics, knowledge, attitude, and practice. Descriptive statistics and inferential statistics utilizing the Pearson's chi-Square test were used for data analysis. The level of significance was set at p < 0.05.

Results

One hundred and fifty-two pregnant women completed the questionnaire (60.8% response rate) and were mostly married (n = 148; 95.0%). Majority were between the age of 25 to 35 years (n = 107; 70.4%), had a university/bachelor's degree (n = 94; 61.8%), and were business women (n = 85; 56.0%). About 35.5% of the respondents had good knowledge of medication restrictions in pregnancy. The majority of the respondents had a positive attitude (n = 98; 64.5%) and good practice (n = 139; 91.4%).

Conclusion

The findings established that a substantial proportion of the women had a positive attitude and good practice of medication use and restrictions in pregnancy. However, the level of knowledge was surprisingly poor among the study group. There is a need to educate pregnant women on safe medication use and avoidance during pregnancy.

Socio-demographic and antenatal care-related factors associated with early post-partum family planning use in Ethiopia: evidence from Ethiopian Demographic and Health Survey 2016 data

Introduction

Initiation of family planning in the early post-partum period is a strategic move to reduce maternal, neonatal, and child mortality due to the negative consequences of short interbirth interval and the complications of unintended pregnancy. Antenatal care (ANC) is the noteworthy predictor of scaling up early initiation of post-partum family planning (PPFP) and preventing unintended pregnancy before menses resume. Despite the great role of ANC, information is scant about the effect of content, timing, and the number of ANC visits on the early initiation of PPFP in Ethiopia.

Objective

This study aimed to assess the association of ANC services with the early initiation of PPFP in Ethiopia.

Methods

The study was based on Ethiopian Demographic and Health Survey 2016 data, which was a cross-sectional survey from 18 January 2016 to 27 June 2016. A total weighted sample size of 2,920 post-partum women was included. A multilevel logistic regression model was used because of the hierarchical data, and variables with a p-value of ≤0.2 in the bivariable multilevel analysis were taken to multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval (CI) was used to declare both the direction and strength of the association, and variables with a p-value of <0.05 were considered as statistically significant for the outcome variable.

Results

The early initiation of PPFP was 20.4%. Women with at least four ANC visits [adjusted odds ratio (AOR) = 1.31; CI 1.12-2.32], women who started ANC within the first trimester (AOR = 1.25; CI 1.10-2.23), complete routine ANC (AOR = 1.11; CI 1.01-2.03), post-natal care (AOR = 1.45; CI 1.19-1.87), resumption of menses (AOR = 1.67; CI 1.18-1.93), urban residency (AOR = 2.14; CI 1.18-2.51), and high community women's education (AOR = 1.71; CI 1.51-2.11) were variables significantly associated with the early initiation of PPFP.

Conclusion

The early initiation of PPFP in Ethiopia was very low. Attention needs to be given to the quality of ANC, post-natal care, resumption of menses, residency, and community-level education of women to increase the prevalence of the early initiation of PPFP in Ethiopia. Therefore, the government should design a program targeting the quality of ANC in rural communities, considering women without menses and scaling up the education of women at the community level to the culture of the early initiation of PPFP in order to achieve reduced maternal, neonatal, and child mortality.

Five-times sit-to-stand test following anterior cruciate ligament surgery: a cross-sectional reliability study

Aims

Patients who have had anterior cruciate ligament reconstruction (ACL-R) should periodically have their muscle strength assessed. The five-times sit-to-stand test (FTSST) can evaluate the muscle strength and balance of the lower extremities. This study's primary purpose was to assess the validity and reliability of the FTSST in patients who have undergone ACL-R.

Material and Methods

Forty-three people who had undergone ACL-R surgery were included in the study. The study's primary outcome measure, the FTSST, was assessed by two different investigators. Secondary outcome measures were body balance, quadriceps muscle strength, Tegner activity score (TAS), and Lysholm score.

Results

The FTSST's test-retest and inter-rater reliability were both high (ICC: 0.99). The FTSST also showed a strong statistically significant correlation with all secondary outcome measures, including balance, quadriceps muscle strength, TAS, and Lysholm score (p<0.05).

Conclusions

According to the study results, the FTSST is a tool-free, simple method for assessing muscle strength and the body balance level, mobility level, and functional status of the knee in patients who have undergone ACL-R surgery.

Molecular Characterization of Enterococcus faecalis and Enterococcus faecium Isolated from a Meat Source in Shahrekord Local Markets, Iran

Enterococcus faecalis (E. faecalis) and E. faecium (E. faecium) are commensals of the gastrointestinal biota of humans and animals and are considered opportunistic pathogens. This study aimed to improve the knowledge about E. faecalis and E. faecium isolated from meat. To this end, 104 meat samples were collected from sheep, goats, cattle, and calves from Shahrekord local markets in Iran. Presumptive colonies of E. faecalis and E. faecium were isolated from the samples and subjected to identification tests. Antimicrobial susceptibility was determined using the Kirby-Bauer disc diffusion method, and polymerase chain reaction (PCR) was performed to detect some virulence genes. Furthermore, randomly amplified polymorphic DNA typing and repetitive element sequence-based PCR fingerprinting were used to show the clonal relatedness of the isolates. The results revealed that enterococci were present in 90 out of 104 samples. Specifically, E. faecalis and E. faecium were the commonly isolated species, with the predominance of E. faecalis, which exhibited high resistance to streptomycin (95%) but was susceptible to vancomycin (85.6%). Virulence genes detection showed that ccf and cpd genes were the most prevalent genes in both species. In addition, the molecular typing method indicated that the isolates belonged to separate subgroups. This study shows the contamination of meat products by potential pathogens and resistant enterococci. There is a need to implement regular surveillance to monitor the emergence of antimicrobial-resistant E. faecalis and E. faecium in food, particularly in meat production.

Children's Adherence to Antiretroviral Therapy and Associated Factors: Multicenter Cross-Sectional Study

Background

Poor adherence to antiretroviral therapy (ART) causes drug resistance, treatment failure and death. Studies conducted among children below 15 years were limited in Ethiopia in general and in the study area. Therefore, this study aimed to assess the status of children's adherence to ART and associated factors in the study area.

Methods

We conducted a facility-based cross-sectional study from April 1 to May 10, 2020 by including 282 children <15 years. All children who received ART for at least one month and attend ART clinic during data collection period were consecutively recruited. Face-to-face interview was conducted using a standardized questionnaire. Both bivariate and multivariate logistic regression were performed. Adherence and exposure variables (i.e., sociodemographic and reason for missing) were measured by the caregivers/children's report of a one-month recall of missed doses.

Results

Among 282 caregivers included with their children, 226 (80.2%) were females (mean age = 38.6 and SD = 12.35) and half (50%) of children were females. Two hundred forty six (87.2%) children were aged between 5-14 years (mean age = 8.5 and SD = 2.64), and 87.2% were adhered (≥95%) to ART in the month prior to the interview. Children whose caregivers were residing in urban were 3.3 (95% CI: 1.17, 9.63) times more adherent to ART than their counterparties. Children whose caregivers were biological parents were 2.37 (95% CI: 1.59, 3.3) times more adherent than children with non-biological parents. Children with knowledgeable caregivers about ART were 4.5 (95% CI: 1.79, 9.8) times more adherent to ART.

Conclusion and Recommendation

Children's adherence to ART in our study area was sub optimal. Biological caregivers, residing in urban and being knowledgeable about ART facilitate adherence to ART. Adherence counseling targeting non-biological parents and for those who come from rural areas were recommended.

A systematic review and meta-analysis on prevalence and antimicrobial resistance profile of Escherichia coli isolated from water in africa (2000-2021)

Water is essential for the survival of humans, animals and plants. Numerous research has been conducted on the prevalence and antibiotic resistance of Escherichia coli (E. coli) in water from various African countries, however, there is lack of comprehensive analysis of published literature. We conducted a systematic review and meta-analysis following the PRISMA guidelines where articles published in English language between January 2000 and March 2022 were searched from ScienceDirect, PubMed, Google Scholar, Scopus, African Journal Online (AJO), and Africa Index Medicus (AIM). Comprehensive Meta-Analysis (CMA) Ver 3.0 software was used to analyze the data. The pooled prevalence estimate (PPE) with 95% confidence interval was calculated using the random-effects model (CI). The overall PPE and antimicrobial resistance trends of E. coli isolated from water was screened from 4009 isolates which were isolated from 2586 samples. We extracted data from 17 studies including drinking water (n = 6), rivers (n = 5), wastewaters (n = 4) and wastewater/river (n = 1) which are all covering 27 countries in Africa with 3438 isolates. The PPE of E. coli in water was 71.7% (0.717; 95% CI: 0.562-0.833). The highest PPE antibiotic resistance was against penicillin followed by erythromycin, and ampicilin with resistance rates of 93.4%, 92.3%, and 69.4%, respectively. This systematic review provides critical evidence of E. coli consolidated prevalence and antibiotic resistance profiles, as well as regions where future studies and enhanced reporting could be beneficial in the African continent.

Antibiotic Susceptibility Patterns and Virulence-Associated Factors of Vancomycin-Resistant Enterococcal Isolates from Tertiary Care Hospitals

This study explored the prevalence of multi-drug resistance and virulence factors of enterococcal isolates obtained from various clinical specimens (n = 1575) including urine, blood, pus, tissue, catheter, vaginal wash, semen, and endotracheal secretions. Out of 862 enterococcal isolates, 388 (45%), 246 (29%), 120 (14%), and 108 (13%) were identified as Enterococcus faecalis, Enterococcus faecium, Enterococcus durans, and Enterococcus hirae, respectively, using standard morphological and biochemical methods. The antibiotic resistance profile of all these enterococcal isolates was checked using the disc diffusion technique. High-level resistance was observed for benzylpenicillin (70%) and vancomycin (43%) among E. faecalis and E. faecium isolates, respectively. This study also revealed the prevalence of 'multi-drug resistance (resistant to 3 antibiotic groups)' among the vancomycin-resistant enterococcal strains, and this was about 11% (n = 91). The virulence determinants associated with vancomycin resistance (VR) were determined phenotypically and genotypically. About 70 and 39% of E. faecalis and E. faecium isolates showed to be positive for all four virulence factors (gelatinase, protease, hemolysin, and biofilm). Among the several virulence genes, gelE was the most common virulence gene with a prevalence rate of 76 and 69% among E. faecalis and E. faecium isolates, respectively. More than 50% of VRE isolates harbored other virulence genes, such esp, asa, ace, and cylA. Similarly, the majority of the VR enterococcal isolates (n = 88/91) harbored vanA gene and none of them harbored vanB gene. These results disclose the importance of VR E. faecalis and E. faecium and the associated virulence factors involved in the persistence of infections in clinical settings.

Clinical characteristics and treatment outcomes of tuberculous tenosynovitis of the hand and wrist

Objective: Vietnam is endemic with tuberculosis (TB), which is highly prevalent in the community. TB tenosynovitis of the wrist and hand is uncommon. Because of its insidious progression and atypical presentations, it is often difficult to diagnose, leading to treatment delays. This study investigates the characteristics of clinical and subclinical signs and treatment outcomes of patients with TB tenosynovitis in Vietnam. Patients and Methods: This prospective longitudinal cross-sectional study included 25 TB tenosynovitis patients in the Rheumatology Clinic at University Medical Center Ho Chi Minh City. The diagnosis was made based on a tuberculous cyst in histopathological specimens. The data were collected through medical history, physical examination, and medical records, including demographics, signs, symptoms, condition duration, and related laboratory tests and imaging. The outcomes of all participants were assessed after 12 months of treatment. Results: The most common symptom of TB tenosynovitis was swelling of the hand and wrist, which was present in all patients. Its other symptoms included mild pain and numbness of the hand in 72% and 24% of patients, respectively. It can affect any site on the hand. Hand ultrasound findings included thickening of the synovial membrane (80%), peritendinous effusion (64%), and soft tissue swelling (88%). Most patients (18/22) had a good outcome after the treatment with anti-tubercular drugs. Conclusions: TB tenosynovitis progression is often insidious. Its most common symptoms are swelling of the hand and mild pain. Ultrasound is a useful tool to support the diagnosis. A histological examination confirms the diagnosis. Most cases respond and have a good outcome after 9-12 months of anti-tuberculosis treatment.

Complete childhood vaccination and associated factors among children aged 12-23 months in Dabat demographic and health survey site, Ethiopia, 2022

INTRODUCTION

Childhood immunization is one of the most cost-effective public health strategies to prevent children's mortality and morbidity from infectious diseases, but the Covid-19 pandemic and associated disruptions have strained health systems, and worldwide 25 million children missing out on vaccination in 2021. Of the 25 million, more than 60% of these children live in 10 countries including Ethiopia. Therefore, this study aimed to assess complete childhood vaccination coverage and associated factors in the Dabat district.

METHOD

A community-based cross-sectional study was conducted from December 10/2020 to January 10/2021Gregorian Calendar. The data for this study was extracted from information collected for the assessment of maternal, Neonatal, and Child Health and health services utilization in the Dabat demographic and health survey site. Vaccine-related data were collected using an interviewer-administered questionnaire. An adjusted odds ratio with a 95% confidence interval was used to identify the presence and the direction of the association.

RESULTS

Based on vaccination cards and mothers/caretakers' recall 30.9% (95%CI: 27.9-34.1%) of children aged 12-23 months in the Dabat district were completely immunized. Urban residency [AOR 1.813, 95% CI: (1.143, 2.878)], delivered in the health facility [AOR = 5.925, 95% CI: (3.680, 9.540)], ANC follow-up during their pregnancy [AOR 2.023, 95% CI: (1.352, 3.027)], rich wealth index [AOR = 2.392, 95% CI: (1.296, 4.415)], and parity [AOR 2.737, 95% CI: (1.664, 4.500)] were significantly associated with complete child vaccination.

RECOMMENDATION AND CONCLUSION

Complete vaccination coverage among children aged 12-23 months in the Dabat district was lower than the Global vaccine plan and Ethiopian ministry of health goal in 2020. Therefore, Health care providers and other stakeholders should mobilize the community to improve mothers' health-seeking behavior toward pregnancy follow-up and health facility delivery to improve childhood vaccination. Besides, expanding the service to remote areas are necessary to increase the immunization access.

Epidemiology of Bloodstream Infections and Antimicrobial Susceptibility Pattern in ICU and Non-ICU Wards: A Four-Year Retrospective Study in Isfahan, Iran

Background

Bloodstream infections (BSIs) are one of the causes of morbidity and mortality in hospitalised patients. This study evaluated BSI's incidence, trend, antimicrobial susceptibility patterns and mortality in AL Zahra Hospital in Isfahan, Iran.

Materials and Methods

This retrospective study was conducted in AL Zahra Hospital from March 2017 to March 2021. The Iranian nosocomial infection surveillance system was used for data gathering. The data included demographic and hospital data, type of bacteria, and antibiotic susceptibility findings and were analysed in SPSS-18 software.

Results

The incidence of BSIs was 1.67% and 0.47%, and the mortality was 30% and 15.2% in the intensive care unit (ICU) and non-ICU wards, respectively. In the ICU, the mortality was correlated with the use of the catheter, type of organism and year of study, but in non-ICU, correlated with age, gender, use of the catheter, ward, year of study and duration between the incidence of BSIs and discharging/death. Staphylococcus epidermidis, Acinetobacter spp. and Klebsiella spp. were the most frequent germs isolated in all wards. Vancomycin (63.6%) and Gentamycin (37.7%) for ICU and Vancomycin (55.6%) and Meropenem (53.3) for other wards were the most sensitive antibiotics.

Conclusion

Despite the few rate of BSI in the last four years in AL Zahra Hospital, our data showed that its incidence and mortality in the ICU ward are significantly more than in other hospital wards. We recommend prospective multicentre studies to know the total incidence of BSI, local risk factors and patterns of pathogens causing BSI.

Airflow obstruction and small airway dysfunction following pulmonary tuberculosis: a cross-sectional survey

OBJECTIVES

Pulmonary function impairment and chronic respiratory symptoms after tuberculosis are relatively common in low-income and middle-income countries. We aimed to estimate the impact of post-tuberculosis (post-TB) on pulmonary function.

METHODS

This large cross-sectional, population-based study included subjects aged 15 years or older with technically acceptable postbronchodilator spirometry measurements. Post-TB was diagnosed on the basis of radiological evidence and/or medical history. Airflow obstruction was defined as a postbronchodilator forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal of Global Lung Function Initiative (GLI) lung function equations. Small airway dysfunction was diagnosed if at least two of the following indicators were less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50% or FEF 75%.

RESULTS

In this population sample (N=8680, mean age: 40.1 years), 610 (7.0% (95% CI 6.5 to 7.6) participants were post-TB. Post-TB subjects had more frequent respiratory symptoms (46.8% vs 28.3%). Among post-TB subjects, 130 (21.3% (95% CI 18.1 to 24.8)) had airflow obstruction; OR of airflow obstruction was significantly associated with post-TB after adjustment for other confounding factors (OR 1.31, 95% CI 1.05 to 1.62). Post-TB was also associated with small airway dysfunction (OR 1.28, 95% CI1.07 to 1.53), which was present in 297 (48.9% (95% CI 33.9 to 53.0)) post-TB subjects.

CONCLUSIONS

Our findings support existing knowledge that post-TB is positively associated with pulmonary function impairment and make for frequent respiratory symptoms. Post-TB should be considered as a potentially important cause of airflow obstruction and respiratory symptoms in patients originating from countries with a high burden of tuberculosis.

Treatment outcomes and associated factors among patients with drug-sensitive tuberculosis on daily fixed-dose combination drugs: A cohort study from Ahmedabad, India

Background and Aim

The National Tuberculosis Elimination Program (NTEP) has been progressive in addressing the issues related to tuberculosis (TB) control in the country, with constant programmatic changes based on evidence available from operational research. Our objectives were 1. to assess the sociodemographic and clinical characteristics, and the treatment outcomes of patients on fixed-dose combination (FDC) daily regimen and 2. to assess the factors associated with unsuccessful treatment outcomes among patients with DS-TB.

Materials and Methods

A retrospective cohort study was conducted based on record review. The study population included all patients with drug-sensitive TB, registered and initiated on treatment under NTEP "new category" from January to June 2018 and under "previously treated category" from January to March 2018. Quantitative data downloaded from Nikshay in Excel format was imported.

Results

A total of 8301 patients with DS-TB registered under NTEP. Mean (standard deviation [SD]) age of DS-TB patients was 35.3 + 16.9 years, and 63.2% were in the age group of 15-44 years. Also, 60.1% were male, 2.5% were human immunodeficiency virus (HIV) positive, 65.3% were pulmonary TB cases, and 70.4% obtained treatment from public providers. Proportion of "successful" and "unsuccessful" outcomes was 87.9% and 12.1%, respectively, in the new treatment category and 78.3% and 21.7%, respectively, in the previously treated category. Among the patients classified under new category, the unsuccessful treatment outcome remained significantly high after adjustments with known confounders among patients aged 45-54 years (adjusted relative risks [aRR] 1.59, 95% confidence interval [CI] 1.31-1.93) and 55-64 years (aRR 1.67, 95% CI 1.36-2.05) compared to patients aged <15 years.

Conclusion

Unsuccessful treatment outcome was significantly high among patients aged 45-54 years. Various adherence mechanisms implemented can be evaluated for further upscaling and improving the program effectiveness.

Prevalence and associated factors of stress and anxiety among female employees of hawassa industrial park in sidama regional state, Ethiopia

BACKGROUND

Work-related stress and anxiety are emerging global public health problems causing serious social and economic consequences. Working women bear a heavy burden due to high social disparity, gender inequality, and an important responsibility to balance work and family life in undeveloped society.

OBJECTIVE

To assess the prevalence and associated factors of work related stress and anxiety among female employees of Hawassa industrial park in Sidama Region, Ethiopia, 2021.

METHODS

Institution-based cross-sectional study design was conducted among 417 female employees using structured interviewer-administered questionnaires and depression, Anxiety, and Stress scale (DASS) 21 items. A simple random sampling technique was used through the computer-generated random method. The outcome variables were work related stress and anxiety. Work related stress and anxiety were ascertained using the DASS 21( stress ≥ 15 &anxiety8 - 14). The associated factors assessed included sociodemographic, behavioral factor, job and organization related factors, past illness and social support related factors. Bivariate and multivariable logistic regression analyses were done. The strength of association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval and, the statistical significance of P-value < 0.05.

RESULT

The prevalence of work-related stress and anxiety were 59.3% [95% CI: (54.7, 63.9)] and 79.8% [95% CI: 75.5, 83.6)] respectively. Respondents with single marital status [AOR = 5.31, 95% CI: (1.68, 16.86)], having chronic illness [AOR = 4:00, 95% CI: (1.24, 12.9)], and current alcohol drinking [AOR = 12.5, 95% CI: (4.56, 34.2)] were significantly associated with stress. Likewise, being single in marital status [AOR = 1.99, 95% CI: (1.15, 3.46)], poor social support [AOR = 3.78, 95% CI: (1.53, 9.35)], overtime work [AOR = 2.31, 95% CI: (1.12, 4.74)], having work experience (3-4 years) [AOR = 4.71, 95% CI: (1.49, 14.84)], and fear of losing job [AOR = 1.72, 95% CI: (1.01, 2.93)] were significantly associated with anxiety.

CONCLUSION

The prevalence of work-related stress and anxiety was high in the study area. Marital status, alcohol drinking, and chronic illnesses were factors associated with work-related stress. In contrast the fear of losing a job, work experience, overtime work, and having poor social support were factors associated with anxiety.. The significant factors identified in this study can be targeted to reduce the occurrence of work related stress and anxiety among women through designing preventive programs and strategies which includes acknowledging the importance of mental health services for the welfare of the public, screening for work related stress and anxiety, counselling, and the provision of support for women as well as lifestyle modification.

Multisite Quality Improvement Initiative to Identify and Address Racial Disparities and Deficiencies in Delivering Equitable, Patient-Centered Care for Multiple Myeloma-Exploring the Differences between Academic and Community Oncology Centers

Treatment of multiple myeloma (MM) is complex; however, with equal access to care, clinical outcomes for Black patients match those in other patient groups. To reveal and begin to address clinical practice barriers to equitable, patient-centered MM care, this quality improvement (QI) initiative assessed patient electronic medical records (EMRs) and surveyed patients and providers at two large hospital systems and four community-based practices. For the educational intervention, providers participated in feedback-focused grand rounds sessions to reflect on system barriers and develop action plans to improve MM care. EMR reviews revealed infrequent documentation of cytogenetics and disease staging at community-based practices compared to large hospital systems. In surveys, providers from each care setting reported different challenges in MM care. Notably, the goals of treatment for patients and providers aligned at community clinics while providers and patients from large hospital systems had discordant perspectives. However, providers in community settings underreported race-associated barriers to care and identified different factors impacting treatment decision-making than Black patients. Relative to pre-session responses, providers were more likely to report high confidence after the educational sessions in aligning treatment decisions with guidelines and clinical evidence and shared decision-making (SDM). This QI study identified discordant perceptions among providers at large hospital systems and community-based practices in providing quality MM care. Provider education yielded increased confidence in and commitment to patient-centered care.

Biomarker prediction in autism spectrum disorder using a network-based approach

BACKGROUND

Autism is a neurodevelopmental disorder that is usually diagnosed in early childhood. Timely diagnosis and early initiation of treatments such as behavioral therapy are important in autistic people. Discovering critical genes and regulators in this disorder can lead to early diagnosis. Since the contribution of miRNAs along their targets can lead us to a better understanding of autism, we propose a framework containing two steps for gene and miRNA discovery.

METHODS

The first step, called the FA_gene algorithm, finds a small set of genes involved in autism. This algorithm uses the WGCNA package to construct a co-expression network for control samples and seek modules of genes that are not reproducible in the corresponding co-expression network for autistic samples. Then, the protein-protein interaction network is constructed for genes in the non-reproducible modules and a small set of genes that may have potential roles in autism is selected based on this network. The second step, named the DMN_miRNA algorithm, detects the minimum number of miRNAs related to autism. To do this, DMN_miRNA defines an extended Set Cover algorithm over the mRNA-miRNA network, consisting of the selected genes and corresponding miRNA regulators.

RESULTS

In the first step of the framework, the FA_gene algorithm finds a set of important genes; TP53, TNF, MAPK3, ACTB, TLR7, LCK, RAC2, EEF2, CAT, ZAP70, CD19, RPLP0, CDKN1A, CCL2, CDK4, CCL5, CTSD, CD4, RACK1, CD74; using co-expression and protein-protein interaction networks. In the second step, the DMN_miRNA algorithm extracts critical miRNAs, hsa-mir-155-5p, hsa-mir-17-5p, hsa-mir-181a-5p, hsa-mir-18a-5p, and hsa-mir-92a-1-5p, as signature regulators for autism using important genes and mRNA-miRNA network. The importance of these key genes and miRNAs is confirmed by previous studies and enrichment analysis.

CONCLUSION

This study suggests FA_gene and DMN_miRNA algorithms for biomarker discovery, which lead us to a list of important players in ASD with potential roles in the nervous system or neurological disorders that can be experimentally investigated as candidates for ASD diagnostic tests.

Asymptomatic nasopharyngeal bacterial carriage, multi-drug resistance pattern and associated factors among primary school children at Debre Berhan town, North Shewa, Ethiopia

BACKGROUND

Nasopharyngeal carriage of bacteria is the main source for transmission of pathogens across individuals and horizontal spread of organisms in the community. It is an important risk factor for the acquisition of community-acquired respiratory tract infection. It is the major public health problem among children. The asymptomatic carriage of nasopharyngeal bacteria is different globally, particularly in Africa, carriage is higher in children and decreases with increasing age, 63.2% in children less than 5 years, 42.6% in children 5-15 years, and 28.0% in adults older than 15 years.

OBJECTIVE

The aims of this study was to determine asymptomatic nasopharyngeal bacterial carriage, multi-drug resistance pattern and associated factors among primary school children at Debre Berhan town, North Shewa, Ethiopia.

METHODS

Institutional based cross-sectional study was conducted at Debre Berhan town primary schools from February 1 to April 30, 2021. Primarily, the schools were stratified into two strata, public and private primary schools. From a total of sixteen government and fourteen private primary schools, five government and five private schools were selected by using a simple random sampling technique. Socio-demographic variables and potential risk factors were assessed using a structured questionnaire. A total of 384 nasopharyngeal swab samples were collected using sterile swabs aseptically; and inoculated on Blood agar, Chocolate agar, MacConkey agar, and Mannitol salt agar. The colony was characterized to isolate bacteria, and bacterial identification was performed by Gram reaction, hemolysis patterns, colonial characteristics and pigmentation, catalase test, coagulase test, mannitol fermentation test, oxidase test, fermentation of carbohydrates, H₂S production, motility, formation of indole, triple sugar iron agar (TSI), citrate utilization, lysine decarboxylase or methyl red vogues proskur utilization, urea hydrolysis and satellitism tests. Antimicrobial sensitivity tests were performed by using modified Kirby-Bauer disk diffusion method. Data were entered into statistical package Epi data 4.0.0.6 and transferred to and analyzed using SPSS software version-23. P value of < 0.05 with Odds ratio (OR) and 95% confidence interval (CIs) was considered as statistically significant.

RESULTS

The overall prevalence of nasopharyngeal carriage of bacterial isolate was 35.7% (95% CI 30.7-40.7%). The predominant isolates were Staphylococcus aureus 54.5% followed by coagulase-negative Staphylococcus 35.8%, and Streptococcus pyogens 4.5%. Most bacterial isolates were susceptible to chloramphenicol, ciprofloxacin, gentamycin, nitrofurantoin, azithromycin, ciprofloxacin; and the overall multidrug resistance pattern of isolated bacteria was 62.03% out of 137 bacterial isolates. Numbers of rooms ≤ 2 per house [AOR = 5.88, 95%CI 1.26-27.57], having history of hospitalization [AOR = 4.08, 95%CI 1.45-11.53], passive smoking [AOR = 4.87, 95%CI 1.49-15.97], family size of > 5 members [AOR = 2.17, 95%CI 1.24-3.81], and number of students in the classroom [AOR = 2.35,95%CI 1.37-4.02] were statistically significant associated risk factors for nasopharyngeal bacteria carriage.

CONCLUSION

Asymptomatic nasopharyngeal bacteria carriage in children is alarming for community-acquired infection. The overall multidrug resistance was very high. The risk of the carriage was increased with having a history of passive smoking, being in large family size and number of students per class. Longitudinal follow-up studies would be helpful for better understanding the infection risk in bacterial pathogen carriers.

Early initiation of antenatal care and its associated factors among pregnant women attending antenatal care at public health centres in Bahir Dar Zuria zone, Northwest Ethiopia, 2021: a cross-sectional study

OBJECTIVES

This study aimed to assess the prevalence of, and factors associated with, early initiation of antenatal care (ANC) follow-up among pregnant women attending ANC services at Bahir Dar Zuria zone public health centres (HCs), Bahir Dar, Northwest Ethiopia.

DESIGN

An institution-based, cross-sectional study was conducted from 15 December 2020 to 1 March 2021. A systematic random sampling technique was applied to select the study participants.

SETTING

Five public HCs (Han HC, Shimbit HC, Dagmawi Minilik HC, Shumabo HC and Meshentie HC) in Bahir Dar Zuria zone.

PARTICIPANTS

Pregnant mothers who were attending their ANC service during the data collection period were enrolled in this study. A total of 592 mothers were interviewed for the study.

OUTCOME MEASURE

Early initiation of ANC services (within 16 weeks of gestation).

RESULTS

48.6% (95% CI 41.6% to 53.5%) of participants began their first ANC service before 16 weeks of gestation. Family size less than five (adjusted OR 2.0, 95% CI 1.25 to 3.25), urban residence (3.0, 1.48 to 6.17), secondary education (2.1, 1.3 to 3.6), college-level education and above (3.5, 1.8 to 6.8), primigravida (2.6, 1.65 to 4.14), planned pregnancy (3.5, 1.5 to 8.1) and knowledge about early initiation of ANC (1.7, 1.14 to 2.55) were significantly associated with early initiation of ANC.

CONCLUSION

A substantial number of participants had not received ANC services in a timely manner. Sociodemographic and obstetric characteristics of the respondents were associated with timely booking of ANC services. Dissemination of information about recommended time to initiate ANC services and efforts to improve women's educational status to increase knowledge about early initiation of ANC are needed in the region.