The pattern and burden of in-patient neurologic diseases at a tertiary hospital in southern Ethiopia: A retrospective hospital-based study

Background: The burden of neurologic diseases is higher in developing countries where the number of neurologists is lowest. However, the pattern of neurologic admissions in Southern Ethiopia is not known. The objective of this study was to determine the pattern and burden of inpatient neurologic diseases at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Methods: The medical records of all cases admitted with neurologic diseases at Hawassa University Comprehensive Specialized Hospital over a 3-year period were reviewed. Results: Nine hundred and eighteen patients with mean age of 44 years (SD 18.7) and 1.7:1 male: female ratio were included in the study. Neurologic diseases accounted for 20% of all medical admissions. Non-infectious neurologic diseases were 69.2%. Stroke was the most common neurologic admission (51.5%) followed by infections of the nervous system (30.8%). The overall in-hospital mortality of neurologic diseases was 19.7%. Conclusion: The burden of inpatient neurologic diseases is high at Hawassa University comprehensive specialized Hospital. Non-infectious neurologic diseases are responsible for the majority of neurologic admissions. Stroke is the commonest cause of neurologic admission followed by infections of the nervous system.

Burden of podoconiosis in poor rural communities in Guliso woreda, western Ethiopia

Background. Podoconiosis is an environmental lymphoedema affecting people living and working barefoot on irritant red clay soil. Podoconiosis is relatively well described in southern Ethiopia, but remains neglected in other parts of the Ethiopian highlands. This study aimed to assess the burden of podoconiosis in rural communities in western Ethiopia. Methodology/Principal Findings. A cross-sectional study was conducted in Gulliso woreda (district), west Ethiopia. A household survey in the 26 rural kebeles (villages) of this district was conducted to identify podoconiosis patients and to measure disease prevalence. A more detailed study was done in six randomly selected kebeles to describe clinical features of the disease, patients’ experiences of foot hygiene, and shoe wearing practice. 1,935 cases of podoconiosis were registered, giving a prevalence of 2.8%. The prevalence was higher in those aged 15 – 64 years (5.2%) and in females than males (prevalence ratio 2.6:1). 90.3% of patients were in the 15 – 64 year age group. In the detailed study, 335 cases were interviewed and their feet assessed. The majority of patients were farmers, uneducated, and poor. Two-third of patients developed the disease before the age of thirty. Almost all patients (97.0%) had experienced adenolymphangitis (ALA - red, hot legs, swollen and painful groin) at least once during the previous year. Patients experienced an average of 5.5 ALA episodes annually, each of average 4.4 days, thus 24 working days were lost annually. The incidence of ALA in podoconiosis patients was higher than that reported for filariasis in other countries. Shoe wearing was limited mainly due to financial problems. Conclusions. We have documented high podoconiosis prevalence, frequent adenolymphangitis and high disease-related morbidity in west Ethiopia. Interventions must be developed to prevent, treat and control podoconiosis, one of the core neglected tropical diseases in Ethiopia

Giardiasis in Ethiopia

Abstract: A countrywide survey of giardiasis, using formal-ether concentration method, among school children and residents showed overall prevalence rates of 8.9% and 3.1 % , respectively. The corresponding rate for non-school children {5-19 years of age), however ,was 4.4% showing that the school children are ore significantly infected than their non-school counterparts {P < 0.005). There were no significant differences between overall male and female infection rates in both populations {P > 0.01 ). However, by age, children are more infected than adults in both populations. Infection rates did not vary with altitude. In this paper, the possible mode of transmission and factors influencing it are discussed. [Ethiop. J. Health Dev. 1995;9(2) :77-80

Schistosomiasis and intestinal helminthic infections in Delo Awraja, Bale administrative region south Ethiopia

Abstract: A cross-sectional survey of schistosomiasis, intestinal helminthic infections and the snail intermediate hosts of schistosomiasis was conducted in Delo Awraja, Bale Administrative Region, South Ethiopia. Of 15 accessible communities studied, the prevalence of intestinal schistosomiasis exceeded 5% in five of them, reaching 48% in Meda. No S. haematobium infection was found except two imported cases diagnosed at Melkaaman at a temporary shelter for refugees returning from Somalia. Uninfected snail hosts of S. mansoni were collected from few water bodies. Other intestinal helminth parasites were also highly prevalent and widespread, the dominant ones being Ascaris lumbricoides, hookworm species and Trichuris trichiura, infection rates reaching 84%, 67% and 64% respectively in some communities located at altitudes of 1500-1600 m.a.s.l. The apprehension that schistosomiasis may further spread with future development plans and the need for initiation of surveillance and/or control programmes for schistosomiasis in particular and intestinal helminthic infections in general are discussed. [Ethiop. J. Health Dev. 1997;11(3):183-188

Comparison of different Kato templates for quantitative faecal egg count of intestinal helminth parasites

IntroductionEstimating the intensity of infection is crucial for. estimating morbidity due to intestinal helminth parasites (1) .The intensity of infection of most intestinal helminth parasites is indirectly estimated by quantitative faecal egg count which, in turn, is used for estimating the worm burden (2). Along this line, the quantitative Kato's thick smear method is the most widely used because of its simplicity , low cost, adaptability to the field and adequate sensitivity (3). However , because of the various modifications that are available (50mg, 41.7mg and 20mg templates) comparison of results have been quite difficult. The modifications are based on variations in the thickness and diameter of the template which, in turn, determines the amount of the faecal matter delivered on the slide

Spatial distribution of podoconiosis in relation to environmental factors in Ethiopia: a historical review

BACKGROUND An up-to-date and reliable map of podoconiosis is needed to design geographically targeted and cost-effective intervention in Ethiopia. Identifying the ecological correlates of the distribution of podoconiosis is the first step for distribution and risk maps. The objective of this study was to investigate the spatial distribution and ecological correlates of podoconiosis using historical and contemporary survey data. METHODS Data on the observed prevalence of podoconiosis were abstracted from published and unpublished literature into a standardized database, according to strict inclusion and exclusion criteria. In total, 10 studies conducted between 1969 and 2012 were included, and data were available for 401,674 individuals older than 15 years of age from 229 locations. A range of high resolution environmental factors were investigated to determine their association with podoconiosis prevalence, using logistic regression. RESULTS The prevalence of podoconiosis in Ethiopia was estimated at 3.4% (95% CI 3.3%-3.4%) with marked regional variation. We identified significant associations between mean annual Land Surface Temperature (LST), mean annual precipitation, topography of the land and fine soil texture and high prevalence of podoconiosis. The derived maps indicate both widespread occurrence of podoconiosis and a marked variability in prevalence of podoconiosis, with prevalence typically highest at altitudes >1500 m above sea level (masl), with >1500 mm annual rainfall and mean annual LST of 19-21°C. No (or very little) podoconiosis occurred at altitudes 24°C. CONCLUSION Podoconiosis remains a public health problem in Ethiopia over considerable areas of the country, but exhibits marked geographical variation associated in part with key environmental factors. This is work in progress and the results presented here will be refined in future work

Transmission dynamics of Schistosoma mansoni in an irrigation setting in Ethiopia

Summary: The transmission dynamics of S. mansoni was studied in the Metehara Sugar Estate for 12 months. The prevalence of human infection ranged from 7.4% to 71.3% for 6 villages in the Estate. The infection rate was highest in the 10-14 years of age while the intensity reached peak in the 5-9 years. There were significant variations in the focality and seasonality of transmission. Biomphalaria pfeifferi which was persistent year round, was most abundant during the dry season. Absence of potable water supply and sanitary facilities, proximity to irrigation canals, and overcrowding are some of the most important factors influencing transmission of schistosomiasis in Metehara Sugar Estate. Mass chemotherapy and mollusciciding should be launched in Awash and Chore farm villages to control transmission, while treatment of children under 15 years is believed to control morbidity in other villages. [Ethiop. J. Health Dev. 1995 9(3): 146-158

Praziquantel in the control of Schistosoma mansoni infection in Jiga, Northwestern Ethiopia

Abstract: The curative efficacy and side effects of praziquantel were observed in patients with intestinal schistosomiasis in Jiga town, Northwestern Ethiopia. A total survey of the inhabitants (4861) was done and all those positive for S. man.soni and with no serious contraindications (1248) were treated with praziquantel, single oral dose of 40 mg per kg body weight. The drug has a cure rate of 89% , with a significant reduction in prevalence (P <0.001, OR: 3.58, CI:2. 77, 4.64) and a marked decrease in average intensity of infection (from 187 to 111 EPG). The most frequent (64.4% )' side effects were headache and dizziness, directly related to intensity of infection, and most often did not last more than 48 hours. Therefore, it is concluded that praziquantel is a safe and effective therapy for schistosomiasis and can be used as a key component in the control of the disease. [Ethiop. I. Health Dev. 1996;10(2):105-110

TRANSMISSION OF SCHISTOSOMA MANSONI IN THREE ECOLOGICAL SETTINGS IN ETHIOPIA

ABSTRACT: The epidemiological indices of Schistosome mansoni for three communities in Ethiopia; Jigga (northwest), Metahara sugar estate (southeast) and Lake Zway (central), each representing the three major transmission ecologies in the country, the stream, irrigation scheme and lake, respectively were studied and compared. A totals of 2897 people (913, 1614 and 370 from the stream, irrigation scheme and lake, respectively) was examined for S. mansoni ova by the Kato's smear method. The highest human prevalence (58% ) and intensity of infection (geometric mean of 450 EPG) were recorded for the lake ecology, whereas the irrigation scheme and stream showed moderate (218 EPG) and light (172 EPG) intensities of infection, despite fairly high disease prevalences of 20% and 41% respectively. Age-specific analysis of prevalence, intensity of infection and relative index of potential contamination (RIPC) indicated that children in their second decade of life to be most responsible. Nevertheless, the decline of all indices with increasing age was less obvious in the lake area than others. The disparity between prevalence and intensity of infection in the stream ecology, inter- ecological differences in the indices of infection and their implication in disease control tactics are discussed. [Ethiop. J. Health Dev. 1993;7(2):63-69

The burden of neglected tropical diseases in Ethiopia, and opportunities for integrated control and elimination

Background: Neglected tropical diseases (NTDs) are a group of chronic parasitic diseases and related conditions that are the most common diseases among the 2·7 billion people globally living on less than US$2 per day. In response to the growing challenge of NTDs, Ethiopia is preparing to launch a NTD Master Plan. The purpose of this review is to underscore the burden of NTDs in Ethiopia, highlight the state of current interventions, and suggest ways forward. Results: This review indicates that NTDs are significant public health problems in Ethiopia. From the analysis reported here, Ethiopia stands out for having the largest number of NTD cases following Nigeria and the Democratic Republic of Congo. Ethiopia is estimated to have the highest burden of trachoma, podoconiosis and cutaneous leishmaniasis in sub-Saharan Africa (SSA), the second highest burden in terms of ascariasis, leprosy and visceral leishmaniasis, and the third highest burden of hookworm. Infections such as schistosomiasis, trichuriasis, lymphatic filariasis and rabies are also common. A third of Ethiopians are infected with ascariasis, one quarter is infected with trichuriasis and one in eight Ethiopians lives with hookworm or is infected with trachoma. However, despite these high burdens of infection, the control of most NTDs in Ethiopia is in its infancy. In terms of NTD control achievements, Ethiopia reached the leprosy elimination target of 1 case/10,000 population in 1999. No cases of human African trypanosomiasis have been reported since 1984. Guinea worm eradication is in its final phase. The Onchocerciasis Control Program has been making steady progress since 2001. A national blindness survey was conducted in 2006 and the trachoma program has kicked off in some regions. Lymphatic Filariasis, podoconiosis and rabies mapping are underway. Conclusion: Ethiopia bears a significant burden of NTDs compared to other SSA countries. To achieve success in integrated control of NTDs, integrated mapping, rapid scale up of interventions and operational research into co implementation of intervention packages will be crucial