Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia

BACKGROUND

As countries reach the trachoma elimination threshold and cases of trachomatous inflammation follicular (TF) become rare, it becomes difficult to train survey graders to recognize clinical signs. We assess the use of photography as a grading tool, the efficiency of an in-country grading center and the comparability of field and photographic grading.

METHODS

During January-February 2017 surveys in Amhara, Ethiopia, field graders assessed TF, trachomatous inflammation intense (TI) and trachomatous scarring (TS). Photographs were taken from each conjunctiva and later graded at the Gondar Grading Center (GGC) at the University of Gondar in Amhara. Two trained ophthalmology residents graded each set of photographs and a third grader provided an adjudicating grade when needed.

RESULTS

A total of 4953 photographs of 2477 conjunctivae from 1241 participants in 10 communities were graded over 5 d at the GGC. Six examined participants were not photographed. Agreement between field and photographic grades were for TF: percent agreement (PA) 96.7%, κ=0.70 (95% confidence interval [CI] 0.64 to 0.77; for TI: PA 94.7%, κ=0.32 (95% CI 0.20 to 0.43); and for TS: PA 83.5%, κ=0.22 (95% CI 0.15 to 0.29).

CONCLUSIONS

Conjunctival photography may be a solution for programs near the elimination threshold where there are few available community cases for training field graders.

Surgical output within the Fast Track Initiative against trachoma in Amhara region, Ethiopia

INTRODUCTION

Trachomatous trichiasis (TT) is the advanced stage of trachoma where lashes touch the globe of the eye causing permanent damage. Without eyelid surgery, TT can lead to irreversible blindness. In 2015 the Ethiopian Ministry of Health launched the Fast Track Initiative with the aim of enhancing the provision of surgical services for TT. The aims of this study were to determine the productivity of individual surgeons during the 2017 Initiative, to compare this productivity with the Ministry's annual target indicator of ≥ 200 surgeries, and to assess the factors associated with surgical output.

METHODOLOGY

This retrospective cross-sectional study utilized programmatic data on surgical output from 140 surgeons active from January 2017 through December 2017 in the eastern half of Amhara region, Ethiopia. Data were collected from a surgery monitoring dataset, analyzed, and compared to the performance targets set by the Ministry.

RESULTS

The mean annual number of surgeries carried out per surgeon was 169 (standard deviation: 111) for a total of 23,616 surgeries. Among the 140 surgeons, 38% achieved the target set by the Ministry. Location of surgical training site and estimated surgical backlog were signficantly associated with a higher surgery output.

CONCLUSIONS

An increase in surgical output was observed compared to productivity prior to the Initiative, although the average annual output during the 2017 Fast Track Initiative was lower than the Ministry's target. Using data driven approaches to setting annual productivity goals should be considered, particularly in light of fewer remaining TT cases as a result of the successful Initiative.

Post menopausal vaginal bleeding due to vaginal wall leech infestation

A 50 year old para vi patient was referred to Mekelle Hospital on October 23, 1992 with post menopausal vaginal bleeding and haemorrhagic shock to rule out endometrial carcinoma. She was anaemic. Speculum examination revealed a darkish mass attached to the posterior vaginal fornix. The mass was instilled with about 5 ml (1%) Lidocaine, after which it detached itself and started movement. The mass was an aquatic leech. Previously, post menopausal vaginal bleeding due to leech infestation was not reported, and therefore, this has to be included in the differential diagnosis of abnormal vaginal bleeding. Emphasis should also be made to create awareness among professionals working in areas where leech infestation is prevalent.

The effect of varying doses of oral iodized oil in the prophylaxis of endemic goitre in elementary schools children

The effect of oral iodine supplementation on total goitre rate (%TGR) and urinary iodine excretion among school children 4 to 16 years of age was studied. In the first group (n = 57) 200mg oral iodized oil reduced %TGR from 31.6% to 17.5% and 33.3% to 24.6% in males and females respectively, while in the second group (n = 53), 400mg iodine reduced the %TGR from 34.0% to 20.8% in males and 35.9% to 24.5% in females after 13 months of intervention. This gave a relative indication that the 200mg is as effective as the 400mg in goitre reduction. In subsequent tests, the maximum urinary iodine excretion was obtained from the groups which received two doses of iodized oil 24 hours after the intervention. A significant (p = 0.003) greater increase in urinary iodine excretion was noted at 24 hours among both male and female children administered 400mg than among those who received 200mg. Measurements after 24 hours showed no significant difference between urinary iodine excretion of the two dose groups. These results suggest that: (i) 200mg is likely equally effective as 400mg for iodine deficiency disorders control and prevention among children and (ii) iodine could be administered annually rather than biannually.

Nutrient costing

For the purpose of computing changes in food cost over time as well as the planning of proper nutrition education and dietary counselling, the cost of important Ethiopian foods was collected in Addis Ababa markets for three and one-half years and computed for the amount of energy and protein yield per unit price. In general, cereals and legumes faired well in their contribution of these nutrients at low cost. Certain foods, such as vetch, sugar and marmalades were also found to contribute a significant amount of nutrients at low cost. Because of the neurotoxic content in vetch and the contribution of a single nutrient as an energy source in the case of the latter two, their utilization during meal planning is subject to careful consideration. Foods of animal origin are second to last in their nutrient contribution per cost although their nutrient density makes them important in consumer demand. Root crops and vegetables that are known for their bulk are at the bottom of the list of good nutrient contributors per cost.

Thiamin status in normal and malnourished children in Jamaica

Thiamin status has been measured using the erythrocyte transketolase (EC 2.2.1.1) assay in twenty-eight normal children and in twenty-five severely-malnourished children throughout the course of recovery. Subclinical thiamin deficiency was found in 7% of the normal children and 36% of the malnourished children on admission. There was no significant association between thiamin status and oedema, stunting or wasting, history of breast-feeding, pattern of weaning, age or sex. Five malnourished children, who died, all had a normal thiamin status on admission; however, two developed biochemical evidence of thiamin deficiency preterminally.