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The coronavirus disease 2019 (COVID-19) pandemic has provided a great lesson for the globe about the necessity and significance of pandemics-related preparedness in all settings. Public health emergency operation centers play critical roles in preparing for and responding to public health events and emergencies by coordinating and pooling resources. In this article, we aimed to share lessons learnt from the public health response to the louse-borne relapsing fever (LBRF) outbreak coordinated by the emergency operation center established to respond to the COVID-19 pandemic in Jimma, Ethiopia.
After the major waves of COVID-19 outbreaks in Ethiopia were over, Jimma University Medical Center (JUMC) reported clusters of louse-borne relapsing fever cases from Jimma Main Prison. Accordingly, Jimma Emergency Operation Center (JEOC) established for the COVID-19 pandemic was immediately alerted and effectively coordinated the overall response.
As a result, the outbreak was contained within the prison without spreading to the community and the outbreak ended within a shorter period compared to previous LBRF outbreaks in Ethiopia. This indicates the necessity of establishing and sustaining public health emergency operation centers to prepare for and combat potential future public health emergencies.
Surgical site infections (SSIs) greatly burden healthcare systems around the world, particularly in low- and middle-income countries. We sought to employ the Systems Engineering Initiative for Patient Safety (SEIPS) model to better characterize SSI prevention practices and factors affecting adherence to prevention guidelines at Jimma University Medical Center (JUMC).
Our cross-sectional study consisted of semistructured interviews designed to elicit perceptions of and barriers and facilitators to SSI prevention among surgical staff and observations of current preoperative, perioperative, and postoperative SSI prevention practices in surgical cases. Interviews were recorded, manually transcribed, and thematically coded within the SEIPS framework. Trained observers recorded compliance with the World Health Organization’s SSI prevention recommendations.
A tertiary-care hospital in Jimma, Ethiopia.
Surgical nurses, surgeons, and anesthetists at JUMC.
Within 16 individual and group interviews, participants cited multiple barriers to SSI prevention including shortages of water and antiseptic materials, lack of clear SSI guidelines and training, minimal Infection Prevention Control (IPC) interaction with surgical staff, and poor SSI tracking. Observations from nineteen surgical cases revealed high compliance with antibiotic prophylaxis (94.7%), hand scrubbing (100%), sterile gloves and instrument use (100%), incision site sterilization (100%), and use of surgical safety checklist (94.7%) but lower compliance with preoperative bathing (26.3%), MRSA screening (0%), and pre- and postoperative glucose (0%, 10.5%) and temperature (57.9%, 47.3%) monitoring.
Utilizing the SEIPS model helped identify institution-specific barriers and facilitators that can inform targeted interventions to increase compliance with currently underperformed SSI prevention practices at JUMC.
Liben Lark Heteromirafra archeri is a ‘Critically Endangered’ species threatened by the loss and degradation of grassland at the Liben Plain, southern Ethiopia, one of only two known sites for the species. We use field data from nine visits between 2007 and 2019 and satellite imagery to quantify changes over time in the species’ abundance and in the extent and quality of its habitat. We estimate that the population fell from around 279 singing males (95% CL: 182–436) in 2007 to around 51 (14–144) in 2013, after which too few birds were recorded to estimate population size. Arable cultivation first appeared on the plain in the early 1990s and by 2019 more than a third of the plain had been converted to crops. Cultivation was initially confined to the fertile black soils but from 2008 began to spread into the less fertile red soils that cover most of the plain. Liben Larks strongly avoided areas with extensive bare ground or trees and bushes, but the extent of these did not change significantly over the survey period. A plausible explanation for the species’ decline is that grassland degradation, caused before 2007 by continuous high-pressure grazing by livestock, reduced its rates of reproduction or survival to a level that could not support its previous population. Since 2015, communal kalos (grazing exclosures) have been established to generate forage and other resources in the hope of also providing breeding habitat for Liben Larks. Grass height and density within four grassland kalos in 2018 greatly exceeded that in the surrounding grassland, indicating that the plain retains the potential to recover rapidly if appropriately managed. Improvement of grassland structure through the restitution of traditional and sustainable rangeland management regimes and the reversion of cereal agriculture to grassland are urgently needed to avert the species’ extinction.
Low vitamin D level in HIV-positive persons has been associated with disease progression. We compared the levels of serum 25-hydroxyvitamin D (25(OH)D) in HIV-positive and HIV-negative persons, and investigated the role of nutritional supplementation and antiretroviral treatment (ART) on serum 25(OH)D levels. A randomised nutritional supplementation trial was conducted at Jimma University Specialized Hospital, Ethiopia. The trial compared 200 g/d of lipid-based nutrient supplement (LNS) with no supplementation during the first 3 months of ART. The supplement provided twice the recommended daily allowance of vitamin D (10 μg/200 g). The level of serum 25(OH)D before nutritional intervention and ART initiation was compared with serum 25(OH)D of HIV-negative individuals. A total of 348 HIV-positive and 100 HIV-negative persons were recruited. The median baseline serum 25(OH)D level was higher in HIV-positive than in HIV-negative persons (42·5 v. 35·3 nmol/l, P<0·001). In all, 282 HIV-positive persons with BMI>17 kg/m2 were randomised to either LNS supplementation (n 189) or no supplementation (n 93) during the first 3 months of ART. The supplemented group had a 4·1 (95 % CI 1·7, 6·4) nmol/l increase in serum 25(OH)D, whereas the non-supplemented group had a 10·8 (95 % CI 7·8, 13·9) nmol/l decrease in serum 25(OH)D level after 3 months of ART. Nutritional supplementation that contained vitamin D prevented a reduction in serum 25(OH)D levels in HIV-positive persons initiating ART. Vitamin D replenishment may be needed to prevent reduction in serum 25(OH)D levels during ART.
We show that any n-vertex complete graph with edges coloured with three colours contains a set of at most four vertices such that the number of the neighbours of these vertices in one of the colours is at least 2n/3. The previous best value, proved by Erdős, Faudree, Gould, Gyárfás, Rousseau and Schelp in 1989, is 22. It is conjectured that three vertices suffice.
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