Desire for fertility and associated factors among people living with HIV/AIDS (PLWHA) in selected antiretroviral therapy (ART) clinics of Horro Guduru Wollega Zone, North West Oromia, Ethiopia- A cross sectional study

Background: Most recently fertility issues in HIV positive men and women are becoming increasingly important. Because of ART access and its good life effect, it is expected that the need and desire to get married, to have children and to have sexual partners for PLWHA would change with the regard to reproductive health. In Ethiopia HIV positive individuals may or may not have desire to have children. And the extent of this desire and how it varies by individual, health and demographic characteristics is not well known.

Objective: the aim of the study was to assess desire for fertility and associated factors among PLWHA in selected ART clinics of Horro Guduru Wollega Zone, Oromia National Regional State, Ethiopia.

Methods: A cross-sectional, institutional-based study that employed quantitative and qualitative in-depth interviews was conducted. Three hundred twenty one study subjects were selected using systematic random sampling technique and the data was collected using interviewer administered structured questionnaire. Data entry and analysis were performed using EPI Info version 3.5.1 and SPSS version 16. P-value <0.05 was taken as statistically significant and logistic regression was used to control potential confounding factors.

Results: Seventy three (57.9%) of the males and seventy six (39%) of the females desired to have children, giving a total of 149(46.4%) of all study participants. PLWHA who desired children were younger (AOR:3.3, 95%CI: 1.3-8.9), married (AOR: 5.8, 95%CI: 2.7-12.8), had no children (AOR: 75, 95%CI: 20.1-273.3) and males (AOR; 1.9, 95%CI: 1.02-3.62) compared with their counter parts. The major reason for those people who did not desire children were having desired number of children 80 (46.5%) followed by fear of HIV transmission to child reported by 42 (24.4%) of them.

Conclusion: A considerable number of PLWHA wants to have a child currently or in the near future. Many variables like socio demography, partner related, number of alive children and HIV related disease condition were significantly associated with fertility desire.

Retinopathy in type 1 diabetes mellitus: Major differences between rural and urban dwellers in northwest Ethiopia

Aim: To audit levels of diabetes-related eye disease in Type 1 diabetes mellitus (T1DM) patients in northwest Ethiopia. In particular to establish whether, despite identical clinical goals, major differences between the physically demanding life-style of rural subsistence farmers and the sedentary life-style of urban dwellers would influence the prevalence of diabetes-related eye complications. 

Methods: A robust infrastructure for chronic disease management that comprehensively includes all rural dwellers was a pre-requisite for the investigation. A total of 544 T1DM were examined, representing 80% of all T1DM patients under regular review at both the urban and rural clinics and representative of patient age and gender (62.1% male, 37.9% female) of T1DM patients from this region; all were supervised by the same clinical team. Eye examinations were performed for visual acuity, cataract and retinal changes (retinal photography). HbA1c levels and the presence or absence of hypertension were recorded. 

Results/conclusions: Urban and rural groups had similar prevalences of severe visual impairment/blindness (7.0% urban, 5.2% rural) and cataract (7.3% urban, 7.1% rural). By contrast, urban dwellers had a significantly higher prevalence of retinopathy compared to rural patients, 16.1% and 5.0%, respectively (OR 2.9, p <. 0.02, after adjustment for duration, age, gender and hypertension). There was a 3-fold greater prevalence of hypertension in urban patients, whereas HbA1c levels were similar in the two groups. Since diabetic retinopathy is closely associated with microvascular disease and endothelial dysfunction, the possible influences of hypertension to increase and of sustained physical activity to reduce endothelial dysfunction are discussed.

The distribution of Fasciola hepatica and Fasciola gigantica within southern Tanzania - constraints associated with the intermediate host

In East Africa, Fasciola gigantica is generally the causative agent of fasciolosis but there have been reports of F. hepatica in cattle from highland regions of Kenya, Ethiopia, Uganda and Zaire. The topography of the Southern Highlands of Tanzania provides an environment where the climatic conditions exist for the sustenance of lymnaeid species capable of Supporting both Fasciola hepatica and F. gigantica. Theoretically this would allow interaction between fasciolid species and the possible creation of hybrids. In this report we present molecular data confirming the existence of the snail, Lymnaea truncatula, at high altitude on the Kitulo Plateau of the Southern Highlands, Tanzania, along with morphometric and molecular data confirming the presence of F. hepatica in the corresponding area. At lower altitudes, where climatic conditions were unfavourable for the existence of L. truncatula, the presence of its sister species L. natalensis was confirmed by molecular data along with its preferred fasciolid parasite, F. gigantica. Analysis based on a 618 bp sequence of the 28S rRNA gene did not reveal the presence of hybrid fasciolids in our fluke samples.

maternal health as a human right’s issue.

In September 2010, just days before a crucial UN summit to review progress on the MDGs, chair of the RCM board for Northern Ireland Shona Hamilton participated in Amnesty International’s conference on poverty, health and human rights, held at Stormont. She provided great personal insight into the daily lives of women in some of the world’s poorest regions and the role midwives can play in addressing the disproportionate impact of poverty on women. She was accompanied by midwifery teaching fellow at Queen’s University Shirley Stronge who has experience of working in Malawi and Ethiopia.

Seven key actions to eradicate rheumatic heart disease in Africa: the Addis Ababa communiqué

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a 'roadmap' of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) decentralise technical expertise and technology for diagnosing and managing ARF and RHD (including ultrasound of the heart), (5) establish national and regional centres of excellence for essential cardiac surgery for the treatment of affected patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes within NCD control programmes of affected countries, and (7) foster international partnerships with multinational organisations for resource mobilisation, monitoring and evaluation of the programme to end RHD in Africa. This Addis Ababa communiqué has since been endorsed by African Union heads of state, and plans are underway to implement the roadmap in order to end ARF and RHD in Africa in our lifetime.

L'Asse Tripartito Italia-Germania- Giappone e la Cina

Germany, Italy and Japan were engaged in China from the turn of the 20th century to WWII. However, they formed an anti-Chinese alliance only at the final stage of their presence there, when Japan assumed an undisputed role of leader in the region. Despite its alliance with the Axis powers, Japan never implemented racial laws against the Jews in China. All of them took part in the Boxer Upraising suppression and received as a consequence extraterritorial rights and concessions. Moreover, Japan won the war against China in 1895 and transformed itself from a tributary country of China into an imperialistic power. It took possession of Taiwan and in the 1930s established a puppet government in Manchuria.Germany followed different route obtaining as indemnity for the murders of two missionaries the control of the Shandong province, which was later expanded thanks to the anti-Boxer coalition's victory. However, Germany lost all possessions when China entered WWI. The issue of Shandong was finally resolved at the Conference for Disarmament hold in Washington in 1921-2. Japan failed to gain ex-Germany territories. Finally, Italy arrived in the Far East at the turn of the century but was not very interested in the oriental colonialism to the same extent it was interested in Africa. Tianjin was its only concession in China, and it took almost a decade before a subvention to arrive from the Italian government for its development.In the 1920s and 1930s Germany and Italy engaged in successful diplomatic, commercial and military relationships with China. In fact, both were considered China's partners thanks to their experts at the service of the Chinese government. On the other hand, Japan position was opposite to them, because of its plans of aggression towards China which was to be transformed into “the natural extension” of the mainland. In 1935 Italy declared war on Ethiopia and abandoned the seat at the League of Nations. China interpreted the Italian aggression as the endorsement of Japan's politics towards China in Manchuria, and the relations between the two countries were broken off. After that Italy supported Wang Jingwei's puppet government during the Japanese occupation of China. Germany followed the same path in 1937, when it was evident that the Japanese were playing the leading role in the region, and decided to ally with Wang Jingwei too. Both Italy and Germany decided also to recognise the Manzhuguo and established diplomatic relations, definitively turning their backs on the old Chinese ally.The Rome-Berlin-Tokyo Axis sealed the alliance among the three countries, and it confirmed Japan as the leading power in the region. Nevertheless Japan did not apply the racial law against the Jews in China.