Blinded rechecking of sputum smear microscopy performance in public health facilities in Tigray region, Northern Ethiopia: Retrospective cross sectional study.

INTRODUCTION: Tuberculosis disease is the leading cause of death worldwide along with HIV/AIDS. Sputum smear microscopy plays an essential role for initial TB diagnosis and treatment follow up. But, misdiagnosis of sputum smear microscopy revealed a high economical crisis and missing of active TB cases. This study was aimed to determine blinded rechecking of sputum smear microscopy performance in public health facilities in Tigray region, Northern Ethiopia. MATERIALS AND METHODS: A cross sectional retrospective study was conducted from January, 2017 to December, 2018 year. Data was collected retrospectively using electronic and paper based in Tigray health research institute. The data was analyzed using the SPSS version 25 software. The sensitivity, specificity, positive predictive value, and negative predictive value of the smear readings were calculated using 2X2 contingency table. The reading agreement between the microscopic center and reference center was determined using kappa statistics. RESULTS: A total of 23,456 blinded rechecked smear results were reviewed. In average, the performances of sputum smear quality were 61%, 68%, 64%, 66%, 62% and 75% for specimen quality, staining quality, smear size, smear thickness, smear evenness and smear cleanliness respectively. Of the total error (0.48%) reported, 0.25%, 0.19% and 0.085% were false positive, false negative and quantification errors respectively. The concordance rate of health facilities for smear reading was increased to 90% by the end of 2018. Overall, the sensitivity, specificity, PPV, and NPV of the smear readings were 95%, 99.7%, 93% and 99.8% respectively. Likewise, the smear reading agreement was also perfect with kappa value, 0.87. CONCLUSION: The overall performance of public health facilities for blinded rechecking of smear microscopy was satisfactory. But, the high false positive and false negative errors found calls for continuous evaluation and monitoring of the health facilities by reference center.

Knowledge, attitude, and practice about epilepsy among teachers at Ethio-National School, Addis Ababa, Ethiopia.

BACKGROUND: Epilepsy is one of the most common serious chronic brain disorders and is poorly understood by the public and has been associated with numerous misconceptions and beliefs. This, coupled with its dramatic clinical manifestations, has resulted in a strong social stigma. Since teachers have a key role in society as educators, the purpose of this study was to find out the knowledge, attitude, and practice towards epilepsy among school teachers. METHODS: A cross-sectional study design was used to assess the knowledge, attitude, and practice of 135 teachers about epilepsy using a semi-structured, self-administered questionnaire. Data were entered into IBM SPSS version 20.0 and analyzed. Descriptive statistics including frequencies, means, and standard deviations were used to describe the data. Associations were computed using a chi-square test and p-value<0.05 was considered significant. RESULTS: Nearly all teachers 122 (96.3 %) were aware of epilepsy. Only 41% of the respondents had good knowledge about epilepsy whereas 26.8% and 32.3% had fair and poor knowledge about the disease, respectively. About 74% of them had a positive attitude about epilepsy. Only 60.3% of the respondents had proper first aid training. Literacy status and years of experience were not significantly associated with the level of knowledge about epilepsy. CONCLUSION: A significant proportion of teachers had deficits in terms of general knowledge, attitude, and the appropriate management of epilepsy in the classroom. Therefore, it is important to train and update teachers on epilepsy by the responsible health authorities.

The pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestation in Ethiopia: a retrospective study.

BACKGROUND: Even though the prevalence of HIV infection among the adult population in Ethiopia was estimated to be 2.2% in 2008, the studies on the pattern of neurological manifestations are rare. The aim of this retrospective study was to assess the pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestations. METHODS: Medical records of 347 patients (age ≥13 years) admitted to Tikur Anbesa Hospital from September 2002 to August 2009 were reviewed and demographic and clinical data were collected. RESULTS: Data from 347 patients were analysed. The mean age was 34.6 years. The diagnosis of HIV was made before current admission in 33.7% and 15.6% were on antiretroviral therapy (ART). Causes of neurological manifestation were: cerebral toxoplasmosis (36.6%), tuberculous meningitis (22.5%), cryptococcal meningitis (22.2%) and bacterial meningitis (6.9%). HIV-encephalopathy, primary central nervous system (CNS) lymphoma and progressive multifocal leukoencephalopathy were rare in our patients. CD4 count was done in 64.6% and 89.7% had count below 200/mm3[mean = 95.8, median = 57] and 95.7% were stage IV. Neuroimaging was done in 38% and 56.8% had mass lesion. The overall mortality was 45% and the case-fatality rates were: tuberculous meningitis (53.8%), cryptococcal meningitis (48.1%), cerebral toxoplasmosiss (44.1%) and bacterial meningitis (33.3%). Change in sensorium and seizure were predictors of mortality. CONCLUSIONS: CNS opportunistic infections were the major causes of neurological manifestations of HIV/AIDS and were associated with high mortality and morbidity. Almost all patients had advanced HIV disease at presentation. Early diagnosis of HIV, prophylaxis and treatment of opportunistic infections, timely ART, and improving laboratory services are recommended. Mortality was related to change in sensorium and seizure.