Efficiency of TB service provision in the public and private health sectors in Ethiopia

BACKGROUND: The Ethiopian Government has identified efficiency of TB services as a key priority in planning and budgeting. Understanding the magnitude and sources of inefficiencies is key to ensuring value for money and improved service provision, and a requirement from donors to justify resource needs. This study identifies the cost of providing a wide range of TB services in public and private facilities in Ethiopia.METHODS: Financial and economic unit costs were estimated from a health provider´s perspective, and collected retrospectively in 26 health facilities using both top-down (TD) and bottom-up (BU) costing approaches for each TB service output. Capacity inefficiency was assessed by investigating the variation between TD and BU unit costs where the factor was 2.0 or more.RESULTS: Overall, TD unit costs were two times higher than BU unit costs. There was some variation across facility ownership and level of care. Unit costs in urban facilities were on average 3.8 times higher than in rural facilities.CONCLUSION: We identified some substantial inefficiencies in staff, consumable and capital inputs. Addressing these inefficiencies and rearranging the TB service delivery modality would be important in ensuring the achievement of the country´s End TB strategy.

Complete Strain Mapping of Nanosheets of Tantalum Disulfide

Quasi-two-dimensional (quasi-2D) materials hold promise for future electronics because of their unique band structures that result in electronic and mechanical properties sensitive to crystal strains in all three dimensions. Quantifying crystal strain is a prerequisite to correlating it with the performance of the device and calls for high resolution but spatially resolved rapid characterization methods. Here, we show that using fly-scan nano X-ray diffraction, we can accomplish a tensile strain sensitivity below 0.001% with a spatial resolution of better than 80 nm over a spatial extent of 100 μm on quasi-2D flakes of 1T-TaS₂. Coherent diffraction patterns were collected from a ∼100 nm thick sheet of 1T-TaS₂ by scanning a 12 keV focused X-ray beam across and rotating the sample. We demonstrate that the strain distribution around micron- and submicron-sized "bubbles" that are present in the sample may be reconstructed from these images. The experiments use state-of-the-art synchrotron instrumentation and will allow rapid and nonintrusive strain mapping of thin-film samples and electronic devices based on quasi-2D materials.

Detailed Characterization of a Nanosecond-Lived Excited State: X-ray and Theoretical Investigation of the Quintet State in Photoexcited [Fe(terpy)2]2

Theoretical predictions show that depending on the populations of the Fe 3d _xy , 3d _xz , and 3d _yz orbitals two possible quintet states can exist for the high-spin state of the photoswitchable model system [Fe(terpy)₂]²⁺. The differences in the structure and molecular properties of these ⁵B₂ and ⁵E quintets are very small and pose a substantial challenge for experiments to resolve them. Yet for a better understanding of the physics of this system, which can lead to the design of novel molecules with enhanced photoswitching performance, it is vital to determine which high-spin state is reached in the transitions that follow the light excitation. The quintet state can be prepared with a short laser pulse and can be studied with cutting-edge time-resolved X-ray techniques. Here we report on the application of an extended set of X-ray spectroscopy and scattering techniques applied to investigate the quintet state of [Fe(terpy)₂]²⁺ 80 ps after light excitation. High-quality X-ray absorption, nonresonant emission, and resonant emission spectra as well as X-ray diffuse scattering data clearly reflect the formation of the high-spin state of the [Fe(terpy)₂]²⁺ molecule; moreover, extended X-ray absorption fine structure spectroscopy resolves the Fe-ligand bond-length variations with unprecedented bond-length accuracy in time-resolved experiments. With ab initio calculations we determine why, in contrast to most related systems, one configurational mode is insufficient for the description of the low-spin (LS)-high-spin (HS) transition. We identify the electronic structure origin of the differences between the two possible quintet modes, and finally, we unambiguously identify the formed quintet state as ⁵E, in agreement with our theoretical expectations.

Tracking chemical reactions with ultrafast X-ray spectroscopies and scattering

Ultrafast structural dynamics is an emerging field aiming to deliver a detailed understanding of the elementary steps in reacting chemical species, which involve changes in their nuclear, electronic and spin states. Such processes are vital ingredients in chemistry and biology, but also in technological applications, including efficient charge transport in solar energy converters and ultrafast switchable molecular magnets. In order to unravel the complex dynamic behavior in photoexcited molecules we have implemented a suite of ultrafast x-ray spectroscopic and scattering tools to zoom into both the electronic and nuclear structures, with the goal to ultimately deliver a molecular movie of ongoing chemical processes. In view of the many potential applications in chemical and biological dynamics it is desirable to increase the signal-to-noise (S/N) level of such experiments as well as to decrease the time resolution into the femtosecond time domain. We present our benchmark results using a versatile setup that permits simultaneous measurements of ultrafast x-ray absorption and emission spectroscopies combined with x-ray diffuse scattering. This combined scattering and spectroscopic approach has recently been established by us at different synchrotron [1-2] and XFEL [3] lightsources. We applied it to study different photochemical systems in liquid media, ranging from nascent radicals in solution to photocatalytic systems, with the goal to deliver a deeper understanding of the elementary steps in chemical reactivity.

Parasight-F dipstick antigen test in the diagnosis of falciparum malaria in Ethiopia

OBJECTIVE

To determine the shelf life, rapidity and diagnostic performance of ParaSight-F.

DESIGN

Prospective randomised study.

SETTINGS

Malaria diagnostic and treatment posts and health centres in central-southern part of the Ethiopian Rift Valley.

SUBJECTS

Three hundred and eighty two subjects randomly selected.

MAIN OUTCOME MEASURES

Double blind evaluation of the sensitivity, specificity and predictive values of PFT versus CBF.

RESULTS

The point prevalence was found to be 29.7% with species dominance of P. falciparum to P. vivax in the ratio of 4:1. The ParaSight-F test showed, considering P. falciparum only, a sensitivity of 92.5% and specificity of 93%. A remarkably high positive predictive value (PPV) of 82% as well as a negative predictive value (NPV) of 99% was obtained. Considering all species of Plasmodium, sensitivity was 78.6% and specificity 93%, with PPV and NPV of 82% and 91% respectively. Moreover, PFT was found to be rapid with a batch of ten-strips--a rack completed in 30 to 50 minutes, which was five to six times faster than CBF reading. In shelf-life studies, after one year of storage at room temperature, results were found similar to the original readings, indicating the stability and long durability of the test strips.

CONCLUSION

In their durability and high diagnostic performances, both the microscopic slide readings and PFT were found comparable and interchangeable, and advantage in endemic areas where laboratory facilities are not available. The rapidity of PFT may be of greater value during malaria epidemics. But during non-epidemic seasons, the inability of PFT not to detect all forms of malaria remains a draw back.

Cryptosporidiosis in children seen at the children's clinic of Yekatit 12 Hospital, Addis Ababa

The stools of 214 children under five years of age with diarrhoea were examined for Cryptosporidium oocysts using the Modified Ziehl Nelson Technique. Twelve (5.6%) of the children had Cryptosporidium oocysts in their faeces. All of these were above 6 months of age and were either partially or fully weaned. There were 15 exclusively breast fed children of whom 11 were less than 6 months of age. None of these cases had the evidence of Cryptosporidial infection. The present study indicates the importance of Cryptosporidium as a possible etiologic agent in patients with diarrhoeal diseases. However, a comprehensive investigation is needed in order to rule out other enteropathogens.

Hookworm infection among the Melka Sedi banana plantation residents, middle Awash Valley, Ethiopia

A study of intestinal parasites was done among the people who lived within the banana plantation zone of the Melka Sedi Agricultural Enterprise, Awash Valley, Ethiopia in April 1987. The methods of parasite detection were the Ritchie formal ether and the charcoal culture method for hookworm larvae species identification. From the total 633 population, 311 were examined at random of whom 60.8% were positive for one or more intestinal parasites. Eight parasites were encountered, Ascaris lumbricoides in 1.3%, Trichuris trichiura in 6.4%, Strongyloides stercoralis in 3.9%, hookworm in 53.1%, Taenia sp. in 3.5%, Schistosoma mansoni in 1.9%, Entamoeba histolytica in 0.6% and Hymenolepis sp. in 0.6%. Prevalence of hookworm infection was significantly higher than that of any of the other parasites (p less than 0.001). In the hookworm infected individuals there were more males than females, and the 25 to 34 year age group had significantly higher infection rates (p less than 0.05). The majority of those with hookworm were banana plantation workers. This communication emphasizes the basic guidelines for control and prevention of hookworm and other related faecal/soil-borne infections in this and similar agricultural settings.

Evaluation of the modified Baermann's method in the laboratory diagnosis of Strongyloides stercoralis

This study compares the modified Baermann's method with the formol-ether concentration and the direct/saline techniques in the diagnosis of Strongyloides stercoralis larvae in stool specimens. This study was conducted at Wonji-Shewa Sugar Estate located at about 110 kms. south east of Addis Abeba. Of the 718 randomly selected and examined stool specimens, 125 were found positive for Strongyloides stercoralis. Of these 98% were recovered by the modified Baermann's method, 23% by the formol-ether, and 22% by the direct saline techniques. The rate of recovery by the modified Baermann's method was significantly different (p less than 0.001) compared with those of the direct and the formol-ether concentration techniques. There was no difference (p greater than 0.1) between the direct saline and the formol-ether methods. The modified Baermann's method accounted for over 60% of the total positive findings. Furthermore, the sensitivity of the method excelled the other two techniques by four fold. Thus, the modified Baermann's method by the Merck and Sharp Dohme Company is effective, cheap and simple to use and hence recommended for routine use and epidemiological surveys.

A new suspected focus of Schistosoma haematobium in the Metema area, Gonder administrative region, north-west Ethiopia

Two cases of Schistosoma haematobium, one in a 10 year old boy who was born in Metema and had never left the area, and another from a Sudaness refugee, are reported. Further investigation is required to verify if S. haematobium has been imported from Sudan or is being transmitted in Metema.