Policy Brief
mHealth intervention for better maternal and neonatal health in pastoralist communities
Background
The World Health Organization (WHO) estimated the global maternal and neonatal mortality to be 295, 000 maternal and 2.5 neonatal million in 20171. Ninety percent of the global maternal and neonatal mortality occurs in Sub-Saharan Africa2. A delay due to longer distance to health facilities, poor infrastructure, poor health system, poverty, cultural beliefs and practices, and lack of education has significantly contributed to higher maternal and neonatal mortality in low-income setting3. In Ethiopia, maternal and infant mortality are 400 and 60 per 100, 000 live births4, respectively. Pastoralist communities in Ethiopia are at higher risk because their nomadic way of life and remoteness makes it challenging for them to access the existing primary health care services5.
Leprosy Patients Remained hidden and Undiagnosed: Call for Action
Background
Leprosy or Hansen’s disease is a curable, chronic infectious disease that remains the leading cause of physical disability. Ethiopia is one of the 23 global priority countries reporting > 1000 cases annually. The country stands 6th in the world and 1st in Africa. The Ministry of Health (MOH), Ethiopia, has devised a strategy to address challenges imposed by leprosy following WHO 2016-2020 strategic plan which emphasizes Active case detection and contact tracing as one strategy to reduce transmission.
The integration of leprosy management into the General Health Service (GHS) has brought the service closer to the community. However, lack of experience in leprosy management among health care workers (Lema et al., 2023, Urgessa et al., 2021,Abeje et al., 2016)
Early Childhood Development (ECD) Program
Summary
Early Childhood Development (ECD) is crucial for a child’s lifelong well-being. Despite its
importance, many children in low- and middle-income countries (LMICs), including Ethiopia, face
challenges in achieving optimal development. Significant gaps remain in ECD services and
majority of Ethiopian children were deprived of basic health care and lacked proper nutrition.
Particularly, children from rural areas and low-income households are particularly vulnerable to
developmental delays and stunting; mainly due to poverty and limited capacity to provide quality
ECD services.
Like other regional state in Ethiopia, children from Dire Dawa city administration still lack basic
needs and services where nearly 26% of them are deprived in at least one of the five dimensions
of childhood developmental milestones. Similarly, prevalence of stunting in children under five
years old increased from 36% in 2011 to 40% in 2016, but it declined to 25% in 2019.
Early Childhood Development Program at Oromia Regional State of Ethiopia
Summary
Early Childhood Development (ECD) is crucial for a child’s lifelong well-being. Despite its importance, many children in low- and middle-income countries (LMICs), including Ethiopia, face challenges in achieving optimal development. Significant gaps remain in ECD services and majority of Ethiopian children were deprived of basic health care and lacked proper nutrition. Partic larly, children from rural areas and low-income households are particularly vulnerable to developmental delays and stunting; mainly due to poverty and limited capacity to provide quality ECD services. Considering that Ethiopia has been implementing integrated initiatives to ensure the holistic development of children. Similarly, Oromia Regional Sate recently designed a multisectoral ECD program and strategy towards the implementation of concerted approaches used to establish and increase equitable access to quality ECD services.
Sepsis: emerging pathogens and antimicrobial resistance in Ethiopian
Executive Summary
Sepsis caused by multidrug-resistant bacteria is a global public health problem mainly in low income countries however its burden in Ethiopia is undetermined. A multicenter study between October 2019 and September 2020 at four hospitals located in the central (Tikur Anbessa and Yekatit 12), southern (Hawassa), and northern (Dessie) parts of Ethiopia was conducted. A total of 1,416 patients clinically investigated for sepsis were enrolled and blood cultures performed. Positive cultures were characterized using the conventional method and MALDI-TOF (Matrix Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF). The antimicrobial resistance pattern was determined using disc diffusion. Of all blood cultures performed, 40.6% yielded growth. Klebsiella pneumoniae (26.1%), Klebsiella variicola (18.1%), and E. coli (12.4%) were the most frequent pathogens. Most K. variicola were detected at Dessie (61%) and Hawassa (36.4%). Almost all Pantoea dispersa (95.2%) were isolated at Dessie.
The presence of Anopheles stephensi in Ethiopia findings for action
Summary
Anopheles stephensi (An. stephensi), a major and efficient vector of urban malaria in Asia, was first detected in Ethiopia in 2016. Surveillance in subsequent years has shown its spread to more sites in Ethiopia and throughout the Horn of Africa. After the 2019 expert committee meeting, the World Health Organization (WHO) surfaced its concern that the spread of An. stephensi is a growing threat for malaria control programs in the region. For instance, Djibouti, where An. stephensi was first detected in Africa (2012), has seen a drastic increase in malaria cases in recent years.
To maintain the progress towards malaria elimination, this is a critical time to take informed and stepwise actions to limit the impact of An. stephensi in Ethiopia.
Affordable and easily scalable serological assay for COVID-19 testing developed in Ethiopia
Background
Enhancing the diagnosis of SARS-CoV-2 infection is one of the strategies for controlling COVID-19 pandemic globally. To achieve this strategy, health care systems adopted different molecular and serology-based tests. A molecular method, qRT-PCR, has been the gold standard diagnostic approach as it detects the infecting virus itself. On the other hand, serology-based tests measure antibodies (IgM/IgG) from blood that are produced as a result of SARS-CoV-2 infection, so it is a proxy biomarker for COVID-19 disease. Serology-based diagnostics (either in an ELISA or lateral flow assay (LFA) platform) have been suggested to be used for different purposes including contact tracing, estimating exposure to the virus among high-risk groups and used as a key index for evaluating the effectiveness of a vaccine. In resource limited countries, such data generated from high quantity serology-based tests provide valuable information regarding the spread of SARS-CoV-2 especially among health care workers and high-risk groups. More importantly, policymakers can use this information to prioritize control measures to mobilize limited resources to break the spread of the pandemic and avoid
second and third waves.
Neisseria meningitidis serogroup X (a New serogroup) and W135 are detected in Ethiopian bacterial meningitis patients
Background
The population living in countries of the meningitis belt of Africa stretching from Senegal in the west to Ethiopia in the east are facing frequent epidemics of meningitis. The first report on the outbreak of meningitis in Africa was documented in 1840 (1). Major epidemics of meningitis were reported earlier in African countries such as Nigeria and Ghana in 1905-1908 and in Ethiopia in 1901 and 1935 (2). Since 1935, no single decade has passed without occurrence of meningitis epidemic in Ethiopia,and the most recent epidemics occurred in 2000 and 2003 (3,4,5). In the past two decades, the dominant meningococcal serogroup causing the disease in the meningitis belt countries was mainly serogroup A (4, 6, 7), followed by serogroup C (8, 3). However, the presence of other serogroups wasreported from meningitis belt countries in later years (3).surveillance is suggested to predict receptive areas at risk of malaria outbreaks in low transmission settings. The aim of this policy brief is to foster dialogue and decisions that are practiced by the best available evidence in the malaria prevention and control endeavors.
Detection of the exposure to malaria parasites as a viable means for malaria elimination: Evidence from serological assay
Summary
Ethiopia has realized a sustained decline in malaria burden comparing to most malaria endemic countries. Nevertheless, there is a need to foster dialogue and decisions that are practiced by the best available evidence in the malaria prevention and control endeavors.
A combination of methods including microscopy, molecular assays and serology were used to examine the current burden of malaria and history of malaria transmission among 1,144 samples, 46 – 128 per village, in Babile district, Ethiopia.
The study supported that Serology can be adapted as an alternative tool to monitor malaria elimination effort of the malaria program with relatively less technical demand. Thus, district-based serological surveillance is suggested to predict receptive areas at risk of malaria outbreaks in low transmission settings. The aim of this policy brief is to foster dialogue and decisions that are practiced by the best available evidence in the malaria prevention and control endeavors.
Look-see Neglected Tropical Diseases: Shout for Podoconiosis
Summary
Podoconiosis is a non-filarial elephantiasis that is caused by exposure of bare feet to volcanic derived soil particles. Podoconiosis is common in Ethiopia with more than 345 endemic disease-related districts. In areas with irritant soil, the prevalence of podoconiosis is about 5%. Podoconiosis is a disease with simple and cheap intervention but affecting a prosperous age group that has a socio-economic significance.
Most of the support for disease management has been provided by Non-Governmental Organizations (NGO), with no government supported care service. NGOs have not had consistent funding; hence podoconiosis care is often insufficient. Podoconiosis care integration, including rehabilitation centers should ultimately be integrated with other governmental health services, particularly in high burden regions of the country. As a major first step, we propose the organization of a stakeholder meeting among policy makers, NGO and other relevant associations, and experience researchers and health care providers to discuss the best way forward.
Flow cytometry for the diagnosis of acute leukemia in Ethiopia
Summary
Flow cytometric phenotypic has become one of the principal means of diagnosing acute leukemia, and is routine in many western settings to guide patient management. The Armauer Hansen Research Institute has over 30 years of experience in flow cytometry, and has conducted several research pilot studies into its use for leukemia diagnosis in the Ethiopian setting. Our findings confirm results of many previous clinical studies and have demonstrated the feasibility of this approach for many patients and the hematologists and pathologists at Black Lion hospital are enthusiastic about its application; however, the cost and technical and interpretative skill required is not trivial.
We propose a two-phase plan of implementation of flow cytometry phenotyping. The first phase will last two years and focus on intensive training and gradual roll out with comprehensive monitoring at Black Lion hospital. After review of strengths and weakness of the program, a second phase will be entertained, in which appropriate modifications will be introduced, including expansion of involved sites to peripheral oncology centers and upgrade of flow cytometers.
Issue Brief
Integrating physical and psychosocial care for people with podoconiosis, lymphatic filariasis and leprosy in Ethiopia: EnDPoINT project
Background
Podoconiosis, lymphatic filariasis (LF), and leprosy are classified as neglected tropical diseases (NTDs) that lead to lower limb lymphoedema. These diseases normally affect impoverished and geographically isolated communities in tropical and subtropical regions, where access to healthcare is limited [1, 2]. In Ethiopia, nearly half of the districts are endemic to one or more of these diseases, impacting over a million individuals who suffer from lower limb lymphoedema [3, 4].
The consequences of these diseases extends beyond physical symptoms and have a significant negative impact on affected individuals and communities. They result in disability, mental distress, depression, stigma, and a decline in economic productivity [5-7].
Curb pneumonia deaths with Low cost locally made oxygen device (BCPAP)
Background
Pneumonia remains leading infectious cause of death among children under the age of five, resulting in a staggering 740,000 deaths globally in 2019. In Ethiopia, pneumonia accounts for 18% of all deaths in this age group. Hypoxemia, a common consequence of pneumonia, significantly increases the risk of mortality in affected children, with five fold higher risk compared to those without hypoxemia. The utilization of low-cost, locally made bubble continuous positive airway pressure (bCPAP) offers an inexpensive (<2USD) method for providing oxygen support and has the potential to substantially reduce mortality in children with severe pneumonia and hypoxemia.
Attention To Comprehensive and Pastoralist-Specific Pain Management
Background
Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage [1]. Pain relief as a global health priority is not receiving the necessary attention from interna tional health funders and organiza tions [2, 3]. Pain management is one of the most neglected areas of care in developing countries and is often poorly managed. Pain conditions such as lower back pain are prevalent in 39% of people on the African continent[4]. This is more than twice as high compared with global estimates (Hoy et al. 2012).
In Ethiopia, the prevalence of musculoskeletal pain was 19.7%, and low back pain was 54% [5]. The prevalence of inadequately managed pain is as high as 80% among adult hospitalized patients[6]. This is due to fundamental barriers to pain manage ment, such as a lack of validated pain assessment tools, insufficient pain education of health professionals, or difficulty in accessing pain medication [7].