Joint environmental and social benefits from diversified agriculture

Agricultural simplification continues to expand at the expense of more diverse forms of agriculture. This simplification, for example, in the form of intensively managed monocultures, poses a risk to keeping the world within safe and just Earth system boundaries. Here, we estimated how agricultural diversification simultaneously affects social and environmental outcomes. Drawing from 24 studies in 11 countries across 2655 farms, we show how five diversification strategies focusing on livestock, crops, soils, noncrop plantings, and water conservation benefit social (e.g., human well-being, yields, and food security) and environmental (e.g., biodiversity, ecosystem services, and reduced environmental externalities) outcomes. We found that applying multiple diversification strategies creates more positive outcomes than individual management strategies alone. To realize these benefits, well-designed policies are needed to incentivize the adoption of multiple diversification strategies in unison.

Agroecology Can Promote Climate Change Adaptation Outcomes Without Compromising Yield In Smallholder Systems

A critical question is whether agroecology can promote climate change mitigation and adaptation outcomes without compromising food security. We assessed the outcomes of smallholder agricultural systems and practices in low- and middle-income countries (LMICs) against 35 mitigation, adaptation, and yield indicators by reviewing 50 articles with 77 cases of agroecological treatments relative to a baseline of conventional practices. Crop yields were higher for 63% of cases reporting yields. Crop diversity, income diversity, net income, reduced income variability, nutrient regulation, and reduced pest infestation, indicators of adaptative capacity, were associated with 70% or more of cases. Limited information on climate change mitigation, such as greenhouse gas emissions and carbon sequestration impacts, was available. Overall, the evidence indicates that use of organic nutrient sources, diversifying systems with legumes and integrated pest management lead to climate change adaptation in multiple contexts. Landscape mosaics, biological control (e.g., enhancement of beneficial organisms) and field sanitation measures do not yet have sufficient evidence based on this review. Widespread adoption of agroecological practices and system transformations shows promise to contribute to climate change services and food security in LMICs. Gaps in adaptation and mitigation strategies and areas for policy and research interventions are finally discussed.

Dupuytren's contracture in Ethiopia

Dupuytren's contracture is believed to be rare in Africa. We have observed the disease in many patients coming to our hospital. This study aimed to provide information concerning the occurrence of the disease and risk factors in these patients. All 75 patients who were referred to the hospital during a 2-year period because of a hand problem that was diagnosed as Dupuytren's contracture were included. The demographic data of the patients and possible risk factors were recorded and compared with a control group. The male to female ratio was 18:1. The little and ring fingers were most commonly affected. A total of 43 had bilateral hand involvement. The condition affected only the left hand in one patient. Six men also had fibromatosis of the soles of the feet and three of the penis. There was a statistically significant association with hypertension and alcohol consumption, but not with diabetes mellitus. We conclude that there are more cases of Dupuytren's contracture in Ethiopia than previously thought.

LEVEL OF EVIDENCE

III.

Incidence of smear-positive tuberculosis in Dabat, northern Ethiopia

OBJECTIVE

To determine the incidence of smear-positive tuberculosis (TB) in Dabat District, northern Ethiopia.

METHODS

Using a population-based longitudinal design, a TB surveillance system was initiated among 46,165 residents at the Dabat Health and Demographic Surveillance System site. Trained field workers visited each household every third month and interviewed all individuals aged ≥14 years using a uniform questionnaire to detect suspected cases of TB (cough ≥15 days), at which time two sputum (spot-morning) samples were collected for smear microscopy.

RESULTS

A total of 281,820 person-months were observed during the 1-year period, which generated 74 smear-positive TB cases. The incidence of smear-positive TB was calculated at 311 per 100,000 person-years (95%CI 240-382). Higher rates were observed among females (incidence rate ratio [IRR] 2.08, 95%CI 1.24-3.52), persons with no schooling (IRR 2.74, 95%CI 1.11-6.78) and urban residents (IRR 2.39, 95%CI 1.39-4.12).

CONCLUSION

The incidence of smear-positive TB is high in Dabat District, suggesting a high risk of transmission in the communities. TB control programmes thus need to improve case-finding mechanisms at the community level in Ethiopia, with greater emphasis on risk groups.

The prevalence of suicidal ideation and attempts among individuals attending an adult psychiatry out-patient clinic in Gondar, Ethiopia

BACKGROUND

Suicide is a common problem worldwide and the magnitude is high especially in countries where mental illnesses are prevalent and psychiatric services are poor.

OBJECTIVE

To determine the prevalence of suicidal ideation and attempts among patients who attended the Psychiatry clinic of Gondar University Hospital.

METHODS

A cross sectional study was conducted from March-December 2006 involving a total of 474 patients. Data was collected using a pre tested structured questionnaire containing basic socio-demographic variables, psychiatric diagnosis, suicidal ideation, suicidal attempt, the methods of suicide attempt and ways of survival from the attempted suicide. It was administered by psychiatry nurses working in the clinic. The data was analyzed anonymously using SPSS software.

RESULTS

The commonest mental illness was Major Depressive Disorder (51.3%) followed by Psychosis (38%). Ninety one (19.2 %) patients attempted suicide at least once after the onset of the current mental illness and 307(64.8%) have suicidal ideation. The common method of suicidal attempt was hanging (45.1%) and 69.2% were at home. An association was found between suicidal ideation and attempt (OR=33.7; CI=8.2-138.8, p-value <0.01).

CONCLUSION

Suicidal ideation was common in psychiatric patients. It was also associated with suicidal attempt.

Field evaluation of a fast anti-Leishmania antibody detection assay in Ethiopia

A fast agglutination screening test (FAST) for the detection of Leishmania antibodies in human serum samples was evaluated under harsh field conditions in northern Ethiopia. Test performance was compared with a standard serological test, namely the direct agglutination test (DAT), and with parasitology. In total, 103 suspected cases were recruited for the study. Based on parasitological examination, 49 patients were confirmed of having visceral leishmaniasis (VL) and the other 54 suspected cases were parasitologically negative. Field evaluation of FAST was possible in blood samples of 89 patients. FAST had 4 false negative results and 13 false positive results. DAT had 2 false negative results and 20 false positive results. A good degree of agreement (86.9%) was observed between FAST and DAT (kappa value 0.73). In this field-based evalauation, the sensitivity and specificity of FAST were found to be 91.1% (95% CI 77.9-97.1) and 70.5% (95% CI 54.6-82.8), respectively, compared with 95.3% (95% CI 82.9-99.2) and 62.3% (95% CI 47.9-74.9) for DAT. FAST had a high predictive value of a negative test, demonstrating that FAST could be utilised to exclude rapidly non-VL patients from a large population of suspects with fever and splenomegaly in endemic areas.

Does one size fit all? Drug resistance and standard treatments: results of six tuberculosis programmes in former Soviet countries

SETTING

After the collapse of the Soviet Union, countries in the region faced a dramatic increase in tuberculosis cases and the emergence of drug resistance.

OBJECTIVE

To discuss the relevance of the DOTS strategy in settings with a high prevalence of drug resistance.

DESIGN

Retrospective analysis of one-year treatment outcomes of short-course chemotherapy (SCC) and results of drug susceptibility testing (DST) surveys of six programmes located in the former Soviet Union: Kemerovo prison, Russia; Abkhasia, Georgia; Nagorno-Karabagh, Azerbaijan; Karakalpakstan, Uzbekistan; Dashoguz Velayat, Turkmenistan; and South Kazakhstan Oblast, Kazakhstan. Results are reported for new and previously treated smear-positive patients.

RESULTS

Treatment outcomes of 3090 patients and DST results of 1383 patients were collected. Treatment success rates ranged between 87% and 61%, in Nagorno-Karabagh and Kemerovo, respectively, and failure rates between 7% and 23%. Any drug resistance ranged between 66% and 31% in the same programmes. MDR rates ranged between 28% in Karakalpakstan and Kemerovo prison and 4% in Nagorno-Karabagh.

CONCLUSION

These results show the limits of SCC in settings with a high prevalence of drug resistance. They demonstrate that adapting treatment according to resistance patterns, access to reliable culture, DST and good quality second-line drugs are necessary.

Cigarette smoking and khat chewing among university instructors in Ethiopia

OBJECTIVE

To assess the prevalence and risk factors of cigarette smoking and khat chewing.

DESIGN

College based cross sectional.

SETTING

Four colleges found in north west Ethiopia namely Gondar College of Medical Sciences, Gondar College of Teachers Education, Bahr Dar University Engineering Faculty, and Bahr Dar University Education Faculty.

SUBJECTS

All instructors in these colleges.

MAIN OUTCOME MEASURES

Prevalence of cigarette smoking and khat chewing.

RESULTS

Seventy six (42.0%) instructors were either lifetime smokers or lifetime khat chewers or both. The current prevalence rates of cigarette smoking and khat chewing were found to be 13.3% and 21.0%, respectively. The majority of the instructors started smoking (56.8%) and khat chewing (40.0%) while they were senior high school or first year college students. Most of the instructors (82.1%) knew that cigarette smoking is a risk factor for lung diseases including lung cancer. Statistically significant difference (p<0.05) was seen between the outcome variable and the independent variables faculty, religion, education status, income and family history of khat chewing.

CONCLUSION

The prevalence of cigarette smoking seemed to decrease among university instructors but the prevalence of khat chewing is almost the same as it was some years ago. Instructors knew the common health risks associated with cigarette smoking. The high schools and colleges should inform their students about the health and socioeconomic problems associated with cigarette smoking and khat chewing. Additionally, college students need counseling service on ways of coping with their problems.

The prevalence and characteristics of physical and sensory disabilities in Northern Ethiopia

PURPOSE

To identify disabilities and to determine their prevalence, age of onset and perceived cause in one urban and three rural areas in Northern Ethiopia.

METHOD

A community based cross-sectional study of households that were selected by systematic sampling. Trained enumerators identified individuals with physical disabilities or epilepsy who were 5 years of age or older.

RESULTS

The overall prevalence of disability in 4214 individuals was 4.9%. The more common forms were walking difficulty (1.7%), loss of vision in one or both eyes (1.5%), hand dysfunction (0.8%) and epilepsy (0.7%). Information provided by the interviewees revealed a pattern of early onset, with injury and infection prominent as perceived causes. The importance of injury and infections was confirmed by the findings in half the people with disability, who were examined by a surgeon.

CONCLUSIONS

Disability is a major public health problem and more facilities for rehabilitation and social support are needed. Measures that are needed to reduce the prevalence include health promotion, preventing injury, widening immunization coverage, better childhood nutrition and effective treatment for infection and injury. Further research should include younger children, cover a wider range of disability and use more sensitive means to detect hearing loss.

HIV infection in an Ethiopian prison

HIV-1 antibody was detected in 6.0 percent of prisoners in an Ethiopian prison. HIV-1 seropositivity was strongly associated with positive VDRL status (RR = 3.7) and recent admission to prison (RR = 3.5). Seropositive prisoners were more likely to have prostitute contacts. No correlation was found between seropositivity and number of sexual contacts, long-term sex partners, or dental extractions. HIV-1 infection in this area may be of recent origin and the high prevalence may reflect rates in the surrounding community.