Predicting the long-term impact of rotavirus vaccination in 112 countries from 2006 to 2034: A transmission modeling analysis.

Rotavirus vaccination has been shown to reduce rotavirus burden in many countries, but the long-term magnitude of vaccine impacts is unclear, particularly in low-income countries. We use a transmission model to estimate the long-term impact of rotavirus vaccination on deaths and disability adjusted life years (DALYs) from 2006 to 2034 for 112 low- and middle-income countries. We also explore the predicted effectiveness of a one- vs two- dose series and the relative contribution of direct vs indirect effects to overall impacts. To validate the model, we compare predicted percent reductions in severe rotavirus cases with the percent reduction in rotavirus positivity among gastroenteritis hospital admissions for 10 countries with pre- and post-vaccine introduction data. We estimate that vaccination would reduce deaths from rotavirus by 49.1 % (95 % UI: 46.6-54.3 %) by 2034 under realistic coverage scenarios, compared to a scenario without vaccination. Most of this benefit is due to direct benefit to vaccinated individuals (explaining 69-97 % of the overall impact), but indirect protection also appears to enhance impacts. We find that a one-dose schedule would only be about 57 % as effective as a two-dose schedule 12 years after vaccine introduction. Our model closely reproduced observed reductions in rotavirus positivity in the first few years after vaccine introduction in select countries. Rotavirus vaccination is likely to have a substantial impact on rotavirus gastroenteritis and its mortality burden. To sustain this benefit, the complete series of doses is needed.

Milk production, quality, and consumption in Jimma (Ethiopia): Facts and producers', retailers', and consumers' perspectives.

Four studies were performed to quantify milk production, quality and consumption in the town Jimma, Ethiopia. First, 47 dairy farmers and 44 milk retailers were interviewed to gain more insights in dairy farming and marketing, and associated constraints. Second, bulk milk samples (n=188) were collected for 4 consecutive weeks to investigate milk quality [Total Bacterial Counts (TBC), Coliform Counts (CC), Somatic Cell Counts (SCC), and antimicrobial residues]. Third, (bulk) milk samples from 32 farms, 46 milk retailers and the 3 local milk collection centers were collected to determine the presence of oxacillin susceptible-and oxacillin resistant Staphylococcus aureus. Fourth, 208 adult inhabitants were interviewed to gain more insight in milk consumption and associated concerns of consumers. The average dairy farm included in the studies consisted of 5 lactating cows, produced 43 liters of milk per day and was owned by male, literate adults. Milk was sold to retailers (71% of the production) and directly to customers (25%) without any quality control, whereas 4% was self-consumed. Shortage of animal nutrition and adulteration of the milk were the main constraints for farmers and retailers, respectively. The median TBC, CC and SCC were 122,500CFU/mL, 1,005CFU/mL and 609,500cells/mL, respectively. Antimicrobial residues were detected in 20% of all samples. In general, the milk quality was considered to be poor (TBC>10,000CFU/mL, and/or CC>100CFU/mL, and/or SCC>400,000cells/mL and/or presence of antimicrobial residues) in 97% of all samples. S. aureus was isolated from 12 (38%), 13 (33%), and 2 out of 3 of the milk samples originating from the dairy farms, the milk retailers, and the milk collection centers, respectively. Seven (26%) of the isolates were resistant to oxacillin suggesting the presence of MRSA (Lee, 2003). Local milk is occasionally consumed by adults but more frequently by children. Adults mainly drink spontaneously fermented milk (57% of 105 interviewees consuming local milk) whereas most milk for children is boiled (86% of 110 households with children consuming local milk). Most consumers are concerned about adulteration and milk borne diseases but not about antimicrobial residues. Educated consumers (secondary school or higher) were more likely to boil milk for own consumption, to be concerned about antimicrobial residues in milk, to be concerned about milk borne diseases and to be willing to pay more for milk with proven good quality compared to poorly educated consumers. We conclude that milk quality incentives should be introduced in Jimma, and investments should be made in knowledge transfer, training, milk collection systems and a central milk quality lab.

Ambulatory care for multidrug-resistant tuberculosis: lessons learned in Addis Ababa, Ethiopia.

SETTING: Ethiopia is one of the high multidrug-resistant tuberculosis (MDR-TB) burden countries. Efforts by the National TB Programme to control MDR-TB include expanding ambulatory care. OBJECTIVE: To investigate the opportunities and challenges faced by treatment follow-up health centres (TFCs) when managing MDR-TB patients, with greater focus on recording, TB infection control (IC) and supervision practices. METHODS: A facility-based cross-sectional study was conducted by reviewing the records of all MDR-TB cases in all 25 TFCs in Addis Ababa, Ethiopia. The TB focal point, pharmacy and laboratory heads were also interviewed. RESULT: A total of 221 MDR-TB patients were registered; 157 (71%) patients had been referred from one of the two treatment initiating centres. While some TFCs oversaw up to 41 patients, others had just one patient. The majority of the TFCs (n = 21, 84%) followed standardised TB IC procedures. Poor documentation of patient information was observed at all sites; for example, human immunodeficiency virus and current treatment status was not indicated for respectively 86 (38%) and 41 (18%) patients. CONCLUSION: The study revealed that infection prevention practices were largely adhered to. Documentation of patient-related information was a major challenge, and regular supervision of the TFCs should be emphasised. Record keeping is critical.

Contexte : L'Ethiopie est l'un des pays durement frappés par la tuberculose multirésistante (TB-MDR). Les efforts du programme national de lutte contre la TB pour contrôler la TB-MDR incluent l'expansion des soins ambulatoires.Objectif : Etudier les opportunités et les défis affrontés par les centres de santé qui suivent le traitement des patients (TFC) dans la prise en charge de patients atteints de TB-MDR avec un accent sur la tenue des dossiers, la lutte contre l'infection tuberculeuse et les pratiques de supervision.Méthodes : Une étude transversale a été réalisée dans des centres de santé grâce à une revue des dossiers de tous les cas de TB-MDR dans les 25 TFC à Addis Ababa, Ethiopie. Le point focal TB, le chef de service de la pharmacie et du laboratoire ont également été interviewés.Résultats: Un total de 221 patients TB-MDR ont été inscrits ; 157 (71%) patients ont été transférés de l'un des deux centres de mise en route du traitement. Si certains TFC ont suivi jusqu'à 41 patients, d'autres n'ont vu qu'un patient. La majorité des TFC (n = 21, 84%) ont suivi les procédures standardisées de lutte contre l'infection TB. Dans tous les sites, on a observé une documentation insuffisante des informations relatives aux patients. Le statut à l'égard du virus de l'immunodéficience humaine et le traitement en cours n'étaient, par exemple, pas indiqués pour 86 (38%) et 41 (18%) patients, respectivement.Conclusion : L'étude a révélé que les pratiques de prévention de l'infection étaient largement observées. Le principal défi résidait en la documentation des informations relatives aux patients ; la supervision régulière des TFC devrait également être renforcée. La bonne tenue des dossiers est cruciale.

Marco de referencia: Etiopía es uno de los países con alta carga de morbilidad por tuberculosis multidrogorresistente (TB-MDR). Entre las iniciativas del programa nacional contra la TB, encaminadas a luchar contra este tipo de TB, se encuentra la ampliación de la prestación de atención ambulatoria.Objetivo: Investigar las oportunidades que encuentran y los obstáculos que afrontan los centros donde se practica el seguimiento terapéutico de los pacientes con TB-MDR, con un interés especial en las prácticas de registro, iniciación del control de la infección tuberculosa y supervisión del tratamiento.Métodos: Se llevó a cabo un estudio transversal de los centros de atención sanitaria (TFC) mediante el examen de las historias clínicas de todos los casos de TB-MDR en los 25 centros de seguimiento terapéutico de Addis Abeba, Etiopía. Se practicaron además entrevistas en el centro de coordinación de la TB, en las farmacias y a los directores de laboratorio.Resultados: Se registraron 221 pacientes con diagnóstico de TB-MDR. Ciento cincuenta y siete pacientes habían sido transferidos de uno de los dos centros de iniciación del tratamiento antituberculoso (TIC) de la ciudad. Algunos de los TFC supervisaban 41 pacientes, pero otros practicaban el seguimiento de un solo paciente. En la mayoría de los TFC se cumplía con los procedimientos normalizados de control de la infección tuberculosa (n = 251, 84%). En todos los centros se observó una documentación deficiente de la información sobre los pacientes; por ejemplo, en 86 casos no se indicó su situación frente al virus de la inmunodeficiencia humana (38%) y en 41 casos no existía información sobre el estado del tratamiento antituberculoso en el momento de la recogida de los datos (18%).Conclusión: El presente estudio reveló una alta tasa de cumplimiento de las prácticas de prevención de la infección tuberculosa en los centros participantes. Un escollo importante que se observó fue la deficiencia en la documentación de la información sobre los pacientes. Se debe reforzar la supervisión periódica de los TFC y es primordial mantener al día los registros clínicos.

Observations on the clinical examination of the camel (Camelus dromedarius) in the field.

Camels usually inhabit remote areas, where diagnostic facilities and laboratories are very scarce. The species differences between the camel and other domestic animals necessitate some specific examination techniques. The objective of this study was to describe the clinical examination methods and sources of common errors that require special consideration in the camel. Young camels are examined in the standing position, while adults require restraint. Restraining procedures, both standing and in sternal recumbency, are described. New equipment and a crush were designed. The body temperature of the camels examined fluctuated from 35.7 to 38.9 degrees C, being lowest in the morning and highest in the afternoon; high temperature in the morning is indicative of fever, while high afternoon temperatures could be hyperthermia. It was difficult to take the pulse rate for routine procedures. The heart rate ranged from 35 to 50 per min; there was no difference between the heart rate in the morning and in the afternoon. The mean respiratory rate was 11 per min and respiration was of thoracol-lumbar type. The mucous membranes of the eye were an important site for appreciating signs of discoloration, while those of the mouth, rectum and vagina were unsuitable. The left flank was the best site for determining the rate of rumen contractions, which was 3+/-1.2 every 5 min, as determined by auscultation; counting the contractions by the application of the fist was difficult. The palpable external lymph nodes were the parotid, maxillary, prescapular, inferior cervical, thoracic, cubital, ilial and popiteal; they are large and can be seen on inspection in healthy animals, so that was not indicative of disease. A list of diagnostic indicators for the rapid diagnosis of ten endemic camel diseases was generated from the empirical signs.

Recent evidence of animal exploitation in the Axumite epoch, 1st-5th centuries AD.

This study reports evidence of animal exploitation during the Axumite era based on a survey of architectural features, rock art and artefacts recovered from the archaeological site at Axum, northern Ethiopia. Animals and agricultural tools were identified from materials not previously examined. Pottery, rock art and animal remains revealed a range of zoological species. Agricultural implements and sacrificial vessels also provided indirect evidence of animal exploitation. It is concluded that, in addition to plough-based agriculture, the hunting of large wild animals, such as elephants and lions, and the exploitation of domestic cattle, small ruminants and poultry were part of the Axumite subsistence regime. Although it is difficult to reconstruct an overall subsistence pattern based on this study alone, the physical and biological evidence suggests that the Axumites practised combined cultivation and animal herding. Further investigation is required to study the types and breeds of animals and their distribution in time and space.

A study on the productivity and diseases of camels in eastern Ethiopia.

A study concerning performance traits of the Ethiopian camel indicated that, in the camel herds examined, there was one active bull camel for 25 females. The bull camel was 5 years old at puberty; it reached rutting vigour at the age of 9 years, the number of mountings per day was 8 during the breeding season, and the reproduction span was 10 years. The female camel reached puberty at 4 years of age; the age at first calving was 5 years, and the lactation period was one year; the calving interval was 2 years, the calving rate was 50%, and the reproduction span was 10-15 years. The survival rate of the newborn calves was 50%. The average milk yield was 2.5 L per day; the price of camel's milk was higher than that of cow's milk at US$0.5. Adult camels weighed around 500 kg; the dressing-out percentage was 52%. Mutton was preferred to camel meat, which came second in popularity, costing US$2/kg. Owing to their poor reproductive performance, camels are not efficient for producing meat. The camels worked for 16 h per day, covering 60 km. Animal health problems encountered were trypanosomosis, camel pox, camel pustular dermatitis, camel cephalopsis, dermatomycosis, mange mite, tick infestation and balantidiosis, most of which mainly affected the young animals.

The effect of diazepam on human gastric secretion.

Human basal gastric secretion is markedly reduced after oral administration of 10 mg diazepam. This effect lasts for five hours.Gastric nocturnal secretion, collected five hours after the last meal, reveals a decline towards the morning hours with an average of 25% in placebo-treated patients. A comparison between placebo and diazepam reveals a significantly greater decrease of 47% in volume after giving parenterally 10 mg diazepam without noticeable side effects.