Caesarean childbirth and associated factors during Covid-19 pandemic at public hospitals in the Sidama region, Southern Ethiopia.

Background: The increasing number of caesarean births worldwide concerns pregnant women, obstetric service providers, and the country's economy. Unnecessary caesarean childbirth increases childbirth complications and the cost of health care in low-income countries, including Ethiopia. Objective: This study aims to assess caesarean birth and associated factors at the Sidama region public hospitals, Southern Ethiopia, 2020. Methods: An institution-based cross-sectional study was conducted among 484 women who gave birth at public hospitals in the Sidama region. A multi-stage sampling technique was employed. The data were collected from 1st to 30th of July 2020 by face-to-face interviews using a semi-structured questionnaire (see Table S1: see supplementary materials associated with this article on line), and the wealth index was analysed by principal component analysis. Backward logistic regression used an adjusted odds ratio and a 95% confidence interval to assess the strength and association between the caesarean section and its associated factors. A P-value of < 0.05 was used to declare statistical significance. Result: Caesarean childbirth in this study was 34.3%. In this study, partograph monitoring (AOR = 2.23, CI = 1.13, 4.38), previous caesarean birth (AOR = 3.21, CI = 1.28,8.17), having genital cutting/mutilation (AOR = 2.51, CI = 1.14,5.53), intermittent cardiotocography monitoring during childbirth (AOR = 2.3, CI = 1.14, 4.49), absence of companionship during delivery (AOR = 4.97, CI = 2.37, 10.43) and is not remembering the last normal menstrual period (AOR = 3.12, CI = 1.40,6.94) had increased the odds of caesarean birth. Conclusion: Studies show that the prevalence of caesarean has alarmingly increased in both developed and developing countries. However, the magnitude of caesarean section differs from country to country and in rural and urban areas; the magnitude of caesarean section in this study is much higher than the WHO recommends threshold. The local health bureau and obstetric care providers should pay attention to the caesarean section and need intervention in partograph plotting, companionship, cardiotocography, and female genital mutilation.

Community perception of school-based delivery of anthelmintics in Ghana and Tanzania.

This paper presents the results of an evaluation of community perception of two large-scale, government-run, school-based health programmes delivering anthelmintic drugs to primary school children, in Ghana (80 442 children in 577 schools) and Tanzania (110 000 children in 352 schools). Most teachers (96% in Ghana and 98% in Tanzania) were positive about their role in the programme, including administration of anthelmintic drugs, and parents and children fully accepted their taking on this role. The benefits of the programme were apparent to teachers, parents and children in terms of improved health and well-being of the children. Over 90% of parents in both Ghana and Tanzania indicated a willingness to pay for the continuation of drug treatment. The evaluation also highlighted areas that are critical to programme effectiveness, such as communication between schools and parents, the issue of collaboration between the health and education sectors, parents' perception of the importance of helminth infection as a serious and chronic health problem (compared with more acute and life threatening illnesses such as malaria), and who should pay for treatment of side-effects.

Escherichia coli O157:H7; an economic assessment of an outbreak.

BACKGROUND: The aim of the study was to assess the impact of an outbreak of Escherichia coli O157:H7 that occurred in 1994 in a rural community, with a population of approximately 107,000, to the west of Edinburgh. METHODS: The impact of the outbreak was assessed during the acute phase of the illness and in the subsequent 12 months. The method involved three surveys of confirmed cases using general practice notes, hospital records and interviews with cases. Key persons involved in the investigation and control of the outbreak were also interviewed. The impact of the illness on cases and their families was estimated and the resources used to treat cases and to control the outbreak were costed and long-term costs projected. RESULTS: There were 71 cases whose ages ranged from 7 months to 84 years. The mortality rate was 1.4 per hundred cases. There were 10 cases of haemolytic uraemic syndrome (HUS) and one case of thrombotic thrombocytopenia purpura (TTP). Two children were on long-term dialysis. Co-morbidity involving the immune system was associated with hospital admission. The illness lasted on average 6.9 weeks. Twenty-six per cent of cases reported symptoms 12 months later. The average cost per HUS case was 62,353 pound sterlings, the TTP case cost 21,422 pound sterlings, non-HUS and non-TTP cases cost 1,030 pound sterlings. The costs of investigating and controlling the outbreak were 171,848 pound sterlings. The costs of cases projected over 30 years were 11.9 million pound sterlings, or 168,032 pound sterlings per case. CONCLUSIONS: The impact on the health of cases was considerable and the costs were high. Every effort should be made to prevent the disease and to identify and control outbreaks quickly.

Should governments subsidize the use of insecticide-impregnated mosquito nets in Africa? Implications of a cost-effectiveness analysis.

Recent large-scale field trials show that mosquito nets impregnated with insecticide can substantially reduce all-cause mortality in children in malaria-endemic areas in Africa. This paper considers the cost-effectiveness of impregnated nets, initially from the perspective of a government programme which would distribute nets free of charge and organize and fund re-impregnation on an annual basis. The calculations show that with the reductions in all-cause mortality observed in the trials, complete government subsidy of nets through a vertical programme would represent an efficient use of scarce resources for most combinations of assumptions. However, alternative ways of financing and organizing the use of impregnated nets are also possible and may be more cost-effective than vertical delivery. Distribution of nets and insecticide might be less costly than required for a vertical programme by integrating delivery with other types of government health programmes, with private sector delivery systems for other types of products, or with government systems developed for other sectors such as agriculture. Further, not all the costs need to be met by governments, as costs could be shared with donors, NGOs and the beneficiaries. The major conclusion is that impregnated nets would save a large number of lives in malaria endemic areas, they are an efficient use of scare resources, and ways of encouraging their use need to be developed and tested.

Frequency and resistance patterns of bacterial isolates from surgical patients in a teaching hospital in Addis Ababa.

Specimens from surgical patients in a teaching hospital in Addis Ababa were processed for aerobic culture; 2654 isolates were tested for their sensitivities to 11 antibiotics using the Kirby-Bauer technique. Proteus, E. coli, S. aureus, Klebsiella and Pseudomonas comprised over 80% of the isolates. Only gentamicin, polymyxin B, kanamycin and trimethoprim-sulphamethoxazole were effective against the majority (over 70%) of the Gram-negative isolates. Over 85% of the S. aureus strains were susceptible to gentamicin, kanamycin, trimethoprim-sulphamethoxazole, cephalothin and lincomycin. All B-haemolytic streptococci were susceptible to penicillin and 77% to tetracycline. Between 70% and 90% of the Gram-negatives were multiple resistant, with greatly varied resistance patterns. A few types occurred more frequently. The findings of high rates of resistance to the many antibiotics underscore the need for a policy that should promote a more rational use of antibiotics.

Diagnostic value of the Widal test.

The usefulness of a single Widal test to diagnose typhoid fever in Ethiopia was investigated in three study groups both retrospectively and prospectively. These were blood culture proven typhoid and non-typhoid patients and healthy individuals. Salmonella typhi H and O titres greater than or equal to 1:160 occurred in respectively 82% and 58% of typhoid fever patients; only 4% of healthy individuals and 8% of non-typhoid patients had Widal titres greater than or equal to 1:80. In typhoid fever, the H titre is elevated earlier and more frequently than the O titre. Antibody rise is maximal during the second week of illness. Antibiotic treatment did not affect the rise of antibody titre in typhoid fever. A single Widal test in an unvaccinated Ethiopian patient showing H and/or O titres greater than or equal to 1:160 and typhoid-like symptoms is strongly suggestive of typhoid fever. It also appears that H titre is more useful than O titre. More false positives are found than false negatives. Under these circumstances, the clinical picture is the decisive factor in making a diagnosis of typhoid.