Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study

BACKGROUND: The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent population-based studies reporting substantial levels of obstructive and restrictive lung function.OBJECTIVE: To characterise the common chronic respiratory diseases encountered in hospital outpatient clinics in three African countries.METHODS This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8 weeks) attending hospital outpatient departments in Ethiopia, Kenya and Sudan. Patients were assessed using a respiratory questionnaire, spirometry and chest radiography. The diagnoses of the reviewing clinicians were ascertained.RESULT: A total of 519 patients (209 Kenya, 170 Ethiopia, 140 Sudan) participated; the mean age was 45.2 years (SD 16.2); 53% were women, 83% had never smoked. Reviewing clinicians considered that 36% (95% CI 32-40) of patients had asthma, 25% (95% CI 21-29) had chronic bronchitis, 8% (95% CI 6-11) chronic obstructive pulmonary disease (COPD), 5% (95% CI 4-8) bronchiectasis and 4% (95% CI 3-6) post-TB lung disease. Spirometry consistent with COPD was present in 35% (95% CI 30-39). Restriction was evident in 38% (95% CI 33-43). There was evidence of sub-optimal diagnosis of asthma and COPD.CONCLUSION: In Ethiopia, Kenya and Sudan, asthma, COPD and chronic bronchitis account for the majority of diagnoses in non-TB patients with chronic respiratory symptoms. The suboptimal diagnosis of these conditions will require the widespread use of spirometry.

Chemical Composition, Antioxidant Potential, and Blood Glucose Lowering Effect of Aqueous Extract and Essential Oil of Thymus Serrulatus Hochst. Ex Benth

Thymus serrulatus, an endemic plant of Ethiopia, is traditionally used to cure various diseases and as a food ingredient. In the Ethiopian folk medicine, the decoction is orally taken as a remedy to treat diabetes and high blood pressure. The purpose of the present study was to evaluate the antioxidant and antihyperglycemic effects of the aqueous extract and of the essential oil of Thymus serrulatus. The chemical composition of the aqueous extract was determined by LC-MS and the essential oil was characterized by GC-MS analysis. Radical scavenging assays, namely scavenging of 2,2-diphenyl-1-picrylhydrazyl (DPPH•), hydroxyl (•OH), and nitric oxide (•NO), were used as a first approach to screen the potential antioxidant abilities of the samples. Alpha-amylase and α-glucosidase inhibitory studies were also employed to evaluate the in vitro antihyperglycemic potential of the plant. The in vivo blood glucose lowering effect of the extracts was assessed using hypoglycemic activity and the oral glucose tolerance test in normal and in streptozotocin induced diabetic mice. When compared to the aqueous extract, the essential oil showed superior radical scavenging activity, particularly for •NO, as well as greater inhibitory potency against α-amylase and α-glucosidase (IC50 = 0.01 mg/ml and 0.11 mg/ml, respectively). Both tested samples showed a statistically significant antihyperglycemic effect. The aqueous extract at 600 mg/kg exerted maximum antihyperglycemic activity (44.14%), followed by the essential oil (30.82%). Body weight and glucose tolerance parameters were also improved by the samples both in normal and diabetic mice. The findings of this study support the hypothesis that aqueous extract and essential oil of T. serrulatus are promising therapeutic agents.

Possible Tracheal Relaxant and Antimicrobial Effects of the Essential Oil of Ethiopian Thyme Species (Thymus serrulatus Hochst. ex Benth.): A Multiple Mechanistic Approach

The genus Thymus is traditionally used for the treatment of hyperactive airways complaints. The purpose of the current study is to investigate the potential tracheal relaxant effect and possible mechanism(s) of the essential oil of Thymus serrulatus (TS Oil) in isolated guinea pig tracheal tissues. The essential oil was obtained from the fresh erial parts of Thymus serrulatus, and its phyto-components were identified by GC-MS analysis. Guinea pig tracheal preparations were used for testing the tracheal relaxant effect of TS Oil with the determination of the mechanism(s) involved in this relaxation. GC-MS findings reveal that terpenes, fragrance constituents, saponins, and higher fatty acids are present in TS Oil. In isolated guinea pig trachea, TS Oil inhibited carbachol (CCh, 1 µM) and K⁺ (80 mM)-induced contractions in a pattern similar to that of dicyclomine. TS Oil, at 0.3 mg/ml, shifted parallel CCh-curves towards the right, followed by a non-parallel shift at higher concentration (1 mg/ml), thus suppressing maximum response in the same manner as produced by dicyclomine. Pretreatment of tissues with TS Oil (1 and 3 mg/ml) also produced a rightward shift of Ca⁺⁺ concentration-response curves (CRCs) in the same manner as caused by verapamil. Further, TS Oil at low concentrations (0.3 and 1 mg/ml) shifted isoprenaline-induced inhibitory CRCs towards the left and increased cAMP levels in isolated tracheal homogenates similar to papaverine, a phosphodiesterase (PDE) inhibitor. In the antimicrobial assay performed by the agar well diffusion method, TS Oil was found most active against Candida albicans and Staphylococcus aureus where the zone of inhibition measured was 28 mm. Additionally, there was little difference between standard strains of gram-positive and gram-negative bacteria. However, methicillin-resistant S. aureus (MRSA) showed a small zone of inhibition as compared to standard strains (22 mm). From these results, it can be concluded that the essential oil of T. serrulatus has the potential to produce antimicrobial effects while causing tracheal relaxation mediated possibly by anticholinergic effects, Ca⁺⁺ channel blockade, and PDE inhibition whereas additional mechanism(s) cannot be ruled out.

The burden and outcomes of COVID-19 among patients with co-morbid disease in Africa: protocol for a systematic review and meta-analysis

The coronavirus disease 2019 (COVID-19) outbreak is now a global public health concern and has had an enormous adverse impact in both developed and developing countries. In Africa, in August 2020, the total number of confirmed cases was 1 022 401 cases, with 704 704 recovered and 22 501 deaths. People with co-morbidities are at increased risk of complications and COVID-19-related death. Evidence on the burden and outcome among patients with co-morbid diseases has not been published in Africa, so this systematic review and meta-analysis aims to quantify these. Observational studies reporting on the burden and outcome of COVD-19 among patients with co-morbid diseases in Africa will be included and a search of online databases PubMed/MEDLINE, EMBASE, HINARI, Cochrane Library, World Health Organization COVID-19 database, Africa Wide Knowledge and Web of Science will be applied. Two independent authors will carry out data extraction and assess the risk of bias using a predetermined and structured method of data collection. Disagreements will be resolved by discussion after mutual consensus with a third reviewer who is an experienced researcher (AH) in meta-analysis studies. We will use random-effects to estimate the overall burden and outcome of COVID-19 among patients with co-morbid diseases in Africa. To assess possible publication bias, funnel plot test and Egger's test methods will be used. This systematic review and meta-analysis protocol will be reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis protocol guidelines. Results will be stratified by the African geographic region, diagnostic methods and co-morbidity. COVID-19 distribution data will be shown by interest variables such as residence/geographic region, diagnostic methods, type of co-morbidity and outcomes of co-morbidity. The findings of this review will notify health-care professionals about the burden and outcome of COVID-19 among patients with co-morbid diseases while providing evidence to bring about the requisite improvements in clinical practice for these patients.

Anti-inflammatory and anti-nociceptive property of Capparis tomentosa Lam. root extracts

ETHNOPHARMACOLOGICAL RELEVANCE

Capparis tomentosa Lam. root is one of the commonly used traditional medicines for the treatment of pain and inflammatory conditions by the Kunama ethnic group of Ethiopia. Yet, its ethnomedicinal claim has not been scientifically investigated.

AIM OF THE STUDY

This study aims to evaluate the anti-inflammatory and anti-nociception activities of root extracts of Capparis tomentosa Lam.

MATERIALS AND METHODS

The anti-inflammatory activity of the 70% ethanolic extracts and solvent fractions was determined using invitro hyaluronidase inhibition assay and in vivo carrageenan-induced paw edema in Swiss albino mice model. The anti-nociception effect was determined using the acetic acid-induced writhing model and tail immersion model in Swiss albino mice.

RESULTS

The root extract of Capparis tomentosa has exhibited significant hyaluronidase inhibition activity which was comparable with the reference drug, indomethacin. Significant inhibition of carrageenan-induced paw edema was observed in all the test sample treated mice compared to the negative control with the highest activity observed from butanol fraction which was equivalent to the effect of acetylsalicylic acid. All the root extract and solvent fractions have possessed a significant and dose-dependent abdominal writhing inhibition with the highest effect observed in the aqueous fraction. Additionally, the crude extract was found better in increasing the reaction latency of the mice to the hot water stimulus than the solvent fractions which were significant after 60-120 min compared to the distilled water treated group. The root extract and solvent fractions were also found safe at a single oral dose of 2 mg/g in Swiss albino mice.

CONCLUSION

The findings of the present study may partially support the folkloric use of Capparis tomentosa root for the treatment of pain and inflammation.

Visceral leishmaniasis in northern Ethiopia

BACKGROUND

Visceral leishmaniasis (VL) has been well documented by the Medecins sans Frontieres (MSF) VL treatment programmeme in the Tigray region of Ethiopia, but reports are limited from other facilities in this region where this disease continues to cause substantial morbidity and mortality.

OBJECTIVE

To describe the clinical manifestations and treatment outcomes of VL in a government hospital in Axum, Ethiopia.

DESIGN

Retrospective analysis of 111 patients treated for visceral leishmaniasis.

SETTING

Saint Mary's Hospital, Axum, Ethiopia.

SUBJECTS

One hundred and Eleven patients treated for visceral leishmaniasis in a government hospital in Axum, Ethiopia.

RESULTS

All patients were male and most reported travel history to Humera, a known endemic area. Patients presented with classic signs and symptoms, including fever, weight loss, splenomegaly and anaemia. Almost one third (15/53) of patients who underwent HIV testing had a positive result. Crude death rate at six months was 13.5 per 100 patients (95% CI: 6.7 - 20.3 per 100 patients). Presence of HIV and other co-infections were associated with increased risk of death.

CONCLUSIONS

Clinical manifestations and treatment outcomes in this setting were comparable to that of the MSF programmeme in Tigray, Ethiopia and highlight the importance of HIV testing for patients presenting with visceral leishmaniasis.

Impact assessment of a community-based animal health project in Dollo Ado and Dollo Bay districts, southern Ethiopia

Participatory methods were used to assess the impact of a community-based animal health worker (CAHW) project in two remote pastoralist districts of Ethiopia. The CAHW project had been operating for 3 years at the time of the assessment. Participatory methods were standardized and repeated with 10 groups of informants in the project area. The assessment showed significant reductions in disease impact for diseases handled by CAHWs compared with diseases not handled by CAHWs. In camels, there was significant reduction (p < 0.001) in the impact of mange, trypanosomosis, helminthosis, anthrax and non-specific respiratory disease. In cattle there was a signficant reduction (p < 0.001) in the impact of blackleg, anthrax and helminthosis. In sheep and goats there was a sign reduction (p < 0.001) in the impact of mange, helminthosis, contagious caprine pleuropneumonia, orf and non-specific diarrhoea. In order of importance, these reductions in disease impact were attributed to (1) increased use of modern veterinary services provided by CAHWs, (2) vaccination campaigns involving CAHWs, (3) good rainfall and availability of grazing and (4) decreased herd mobility. Decreased herd mobility was also associated with negative impact of tick infestation. Community-based animal health workers were considered to be highly accessible, available, affordable and trustworthy relative to other service providers. They were also perceived to be suppliers of a good quality service. Specific types of positive impact attributed to CAHW activities were increases in milk, meat, income and draught power.

Cryptococcosis in patients from Tikur Anbessa Hospital, Addis Ababa, Ethiopia

A study was done to investigate the occurrence of Cryptococcus neoformans infection in patients admitted to Tikur Anbessa Hospital. Cryptococcus neoformans is an important opportunistic fungal pathogen in immunocompromised patients. The study was done over a period of 18 months, from October 1998 to April 2000. During this period, a total of 1088 cerebrospinal fluid (CSF) specimens were sent to the bacteriology laboratory in Tikur Anbessa Hospital, out of which 275 were subjected for India ink examination. Out of these 19 (7%) were India ink positive. Additionally one lymph node aspirate was also India ink positive. All these specimens were culture positive for Cryptococcus neoformans. The medical records of these patients were retrospectively reviewed and all presenting clinical symptoms were recorded. In this group of patients with meningitis the most common presenting were fever and headache. In addition, at the time of admission, 75% of the patients had other opportunistic infections, such as oral candidiasis, herpes zoster and Pneumocystis carini pneumonia. The mortality rate was high even in patients with appropriate therapy. All the isolates were identified as C. neoformans var. neoformans. The variety gatti was not isolated in this study.

Seroprevalence of syphilis amongst pregnant women attending antenatal clinics in a rural hospital in north west Ethiopia

OBJECTIVE

To determine the seroprevalence of syphilis in pregnant women attending antenatal care clinics in a rural hospital in Ethiopia and describe their characteristics so that timely and effective care can be offered.

SUBJECTS

Pregnant women attending antenatal care clinics at a rural hospital.

METHODS

A cross sectional study was conducted at a rural hospital in north west Ethiopia in September 1994. Data were collected on socio demographic characteristics and past history of sexually transmitted diseases of antenatal care attenders from the records of the hospital. Sera from these pregnant women were examined for syphilis using the VDRL test. VDRL positivity was cross tabulated with socio demographic variables and past history of sexually transmitted diseases.

RESULTS

Two hundred and seventy pregnant women were included in the study. Median age of the respondents was 25.2 years. A substantial majority were orthodox Christians (97.4%) and married (92.6%). Town dwellers constituted 58.2% of the antenatal care attenders. Only 4.7% of the women started attending antenatal care clinics during the first trimester. Thirty seven women (13.7%) were found to be VDRL positive. Past history of sexually transmitted diseases was significantly associated with VDRL positivity (p < 0.05).

CONCLUSIONS

High VDRL positivity rate is observed in this study. Certain risk factors may be responsible for current and past episodes of sexually transmitted diseases. There is a need for improvement of antenatal care activities at different levels of health care. Appropriate strategies should be devised for prevention and control of sexually transmitted diseases in women of reproductive age groups and the general population.

A comparison of skin-test responses using antigen from Leishmania donovani and a lizard trypanosome

261 individuals were skin tested with leishmanin from Leishmania donovani and with an antigen from a lizard trypanosome isolated in an area endemic for kala-azar in Ethiopia. 83 of the 261 responded positively, with indurations of 5 mm or greater, to one antigen but negatively to the other, and 42 reacted positively to both. Among the Afar people of the Awash valley in north-eastern Ethiopia and the Nyangatom people of south-western Ethiopia, positive response to both antigens was high, though many individuals responded to one antigen but not the other. Both these groups live as cattle pasturalists, a predominantly male occupation, in areas where known vectors of kala-azar as well as lizard-feeding sandflies exist. Among the Anuak and Suri people, who live in areas of south-western Ethiopia infested with tsetse flies, the lizard trypanosome antigen gave a markedly higher skin test positivity than did the leishmanin antigen. This suggests that the lizard trypanosome may give artificially high results in other immunological tests of exposure to trypanosomiasis in areas where lizard trypanosomes and man-biting sandflies co-exist with mammalian trypanosomes transmitted by Glossina.

Kala-azar in Ethiopia: survey of south-west Ethiopia. The Leishmanin skin test and epidemiological studies

The Leishmanin skin test was performed on 1353 people in a kala-azar endemic region of south-west Ethiopia. Physical examinations were also carried out on 2723. Two of these individuals, both males, had active visceral leishmaniasis with Leishmania organisms demonstrated by spleen puncture. Two other males, including one member of the research team, had parasitologically proven cutaneous leishmaniasis. Because there was negligible migration and little movement of individuals outside of their tribal territories, the geographical distribution of skin test positivity and clinical findings could be determined and correlated with environmental parameters. The level of positive skin tests for the groups tested ranged from over 64% for the three tribes collectively inhabiting the lower regions of the Omo Valley (altitude approx. 500 m) to 6.4% for the Suri tribe, which lives at 1400 m. Skin test positivity was highest in areas of deeply fissuring montmorillonite soils and where Phlebotomus langeroni orientalis have been collected. Termite mounds of the pipe-organ type seemed to occur independently of the proportion of positive skin tests, possibly because alternative resting and breeding sites for sandflies were available in the cotton clay soil or because of the cultural patterns of the people. Almost always, males had a markedly higher prevalence of positive skin tests than did females. The degree of positivity was strongly correlated with increasing age, most positive conversions occurring in the ten to 20 year olds, the age at which males join cattle camps as part of their herding activities. Splenomegaly reached a prevalence of nearly 50% among the Hamar speaking people to the east of the Omo River, where the pattern of disease suggests malaria as the principal cause. Hepatomegaly, however, was highest in the lower Omo Basin among the Nyangatom, Dassanetch and Kerre, where hydatid disease was a major cause of liver enlargement, but seemed unrelated to the proportion of positive Leishmanin skin tests.

Schistosomiasis in Omo National Park of southwest Ethiopia

Schistosomiasis mansoni infection was found in more than 50 tourists who had visited Omo National Park, Ethiopia, and bathed and swum in the Mui River. A survey revealed Schistosoma mansoni infection in 41% of Park residents and in 33% of the neighboring Suri people. Eggs were found in stools and adult worms at autopsy of wild Papio anubis and Cercopithecus aethiops. Trematode larvae were found in 27% of Biomphalaria pfeifferi snails found in the Mui River. The source of the disease and the implications of its spread with the future development of the Omo Valley are discussed.

Kala-azar in Ethopia I: Leishmanin skin test in Setit Humera, a kala-azar endemic area in northwestern Ethopia

Leishmannin skin test surveys were carried out on 1057 farmers and non-farmers in the low-lying Setit Humera area of northwest Ethiopia, a region known to be endemic for kala-azar. The population of the Humera area is composed mainly of new migrants, and the mean time of residence for the entire population is only 4-4 years. The corresponding periods for the urban and farm-owning population are 6-3 years and migrant farm labourers 2-6 years. Most of the population comes from the highland provinces of Begemdir, Tigre, and Wollo, areas where kala-azar is virtually unknown except for two recent cases (Ashford et al., 1973b). 45-6% of farmers were skin test positive, but only 8-3% of non-farmers. Women in this area are only rarely involved in farming, hence there is a concommitant marked sex difference. The skin test results seem to be correlated with the results for sex, age, and occupation of known kala-azar patients. The percentage of skin test positivity increases with age and, particularly among farmers, with the length of time spent in the Humera lowlands. This correlation is lacking among non-farmers. The annual rate of infection to Leishmania sufficient to result in skin test conversion is around 7% per annum in agricultural workers in the Humera area, but less than 1% per annum in the non-farming population. The infection rate for farm workers to Leishmania prior to coming to Humera is around 2%, compared to less than 1% for the non-farmers. There appears (significant at 10%) to be a weak correlation between the induration of positive skin test and the length of time spent in Humera, suggesting that the degree of induration is related to the degree of exposure to Leishmania. The positive skin test in kala-azar endemic areas is probably the result of (a) nonpathogenic Leishmania species, (b) L. donovani of low virulence and/or (c) human host resistance to L. donovani.