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Weyinshet Gossa,1,2 Dawit Wondimagegn,3 Demeke Mekonnen,4 Wondwossen Eshetu,5 Zerihun Abebe,6 Michael D Fetters2 1Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; 2Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA; 3Department of Psychiatry, Addis Ababa University, Addis Ababa, 4Department of Pediatrics, Jimma University, Jimma, 5Federal Ministry of Health, 6St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia Abstract: As a very low-income country, Ethiopia faces significant development challenges, though there is great aspiration to dramatically improve health care in the country. Family medicine has recently been recognized through national policy as one potential contributor in addressing Ethiopia's health care challenges. Family medicine is a new specialty in Ethiopia emerging in the context of family medicine development in Sub-Saharan Africa. The Addis Ababa University family medicine residency program started in 2013 and is the first and the only family medicine program in the country as of March 2016. Stakeholders on the ground feel that family medicine is off to a good start and have great enthusiasm and optimism for its success. While the Ministry of Health has a vision for the development of family medicine and a plan for rapid upscaling of family medicine across the country, significant challenges remain. Continuing discussion about the potential roles of family medicine specialists in Ethiopia and policy-level strategic planning to place family medicine at the core of primary health care delivery in the country is needed. In addition, the health care-tier system needs to be restructured to include the family medicine specialists along with appropriately equipped health care facilities for training and practice. Key stakeholders are optimistic that family medicine expansion can be successful in Ethiopia through a coordinated effort by the Ministry of Health and collaboration between institutions within the country, other Sub-Saharan African countries, and international partners supportive of establishing family medicine in Ethiopia. Keywords: primary health care, ethnography, residency program, Sub-Saharan Africa

Background: Increasing evidence suggests that methicillin-resistant Staphylococcus aureus (MRSA) infections are becoming more prevalent throughout the human immunodeficiency virus (HIV) infected community. However, there is scarcity of data about the prevalence of MRSA among HIV positive pediatric patients in the study area. Objectives: To determine the prevalence and types of MRSA among S. aureus isolates of HIV positive pediatric patients in the Amhara National Regional State, Northwest Ethiopia. Methods: Pediatric patients who attended the clinic from December 2013 to April 2014 were included in the study. Genotype MRSA VER 3.0 was used for characterization of S. aureus isolates. This detected methicillin-resistance-mediating mecA and mecC genes and the bicomponent cytotoxic virulence factor Panton–Valentine leukocidin (PVL). Data were analyzed using SPSS version 20. Results: Among 126 S. aureus isolates, 37.3% and 11.9% were mecA and Panton–Valentine leukocidin gene positive, respectively. Patients of FHRH (P = 0.04) and DRH (P = 0.02) have statistical significance for mecA gene. Panton–Valentine leukocidin gene positive strains were about 97% less likelihood to be mecA gene positive (P = 0.001). Conclusion: A high prevalence of pathogenic MRSA strains among HIV positive pediatric patients was observed. Most of the MRSA types were hospital acquired. Hence, strict hygienic approaches by healthcare workers in hospitals should be implemented. In addition, screening and treatment of MRSA for HIV positive pediatric patients is recommended. [Ethiop. J. Health Dev. 2018;32(3):00-000] Key words: MRSA, pediatrics, HIV, Ethiopia

Water and nutrition are linked in multiple ways, but few of these interlinkages are well understood. What is, for example, the exact relationship between water pollution and health or between water resource management and nutrition? Even less is known about the interactions across these various linkages. The importance of better understanding these connections has been highlighted as we pursue the United Nations Sustainable Development Goals (SDGs), which challenge mankind to meet both water security as well as food and nutrition security goals, while also improving water-based ecosystems. It has become increasingly clear that progress toward these goals can only be achieved if measures in the food and nutrition space (SDG 2) do not constrain progress on water (SDG 6) and if measures undertaken to support targets under one of these SGDs also support the outcomes of the other. This paper provides an overview of water–nutrition linkages as reflected in the SDGs, and it identifies key gaps in these linkages and suggests a way forward to support the achievement of both water and nutrition goals and targets., Colombo, Sri Lanka: International Water Management Institute (IWMI). CGIAR Research Program on Water, Land and Ecosystems (WLE) Washington, DC, USA: The World Bank

The study examined the production technologies and productive performance of smallholder beef production systems to determine the levels of technical inefficiency in the agricultural districts of Botswana. The analysis draws on data from 26 districts of Botswana for the period of 2006-2014 to estimate latent class stochastic frontiers in which the technological class to which the agricultural district belongs is determined within the model. To enable efficiency comparisons between agricultural districts across these technological classes, a meta-frontier that encompasses all the class frontiers is estimated. Components of efficiency drivers are embedded in this estimation to explain agricultural districts technical inefficiency with respect to their respective class frontiers. Results show that beef production efficiency is positively associated with the rate of formal education and negatively related with an increase in proportion of exotic breeds, high mortality and low offtake rates, indicating the presence of considerable scope for animal husbandry improvement. The mean technical efficiency scores for beef production between 2006 and 2014 for agricultural districts in class one is 18 % whereas it is 13 % for agricultural districts in class two, implying high potential to improve beef production using the same level of agricultural inputs through efficiency-enhancing investments. Acknowledgement

During the last several years, a series of important policy changes affecting genetic resource conservation, use, and exchange have entered into force. These policy changes will likely affect investment choices made by the international research-for-development community - choices that influence scientific collaboration and cooperation nationally, regionally and internationally. Specifically, these policy changes may introduce new institutional constraints on the use of genetic resources, with potentially long-lasting influence on research priority-setting and collaboration strategies. This paper provides a novel characterization of the changing landscape governing international germplasm exchanges. Emphasis is placed on culling evidence from historical trends, networks, and econometric analysis to better understand how national regulatory changes associated with the Convention on Biological Diversity (CBD) of 1993 and the International Treaty on Plant Genetic Resources for Food and Agriculture (ITPGRFA) of 2004 affected the movement of genetic resources and lessons to be drawn to understand the potential effects of the Nagoya Protocol which entered into force beginning 2014. Acknowledgement : This paper was prepared with generous funding from the U.S. Agency for International Development and the CGIAR Research Program on Policies, Institutions, and Markets. The authors thank Jennifer Long, M. Lisa Wilson, Eric Welch, Selim Louafi, Federica Fusi, and Fatima Zaidi for their insightful comments. This paper is dedicated to the memory of Eduardo Magalhaes, our colleague and friend. Any and all errors are the sole responsibility of the authors.

Background: Despite improved antimicrobial therapy and multiple options for drainage of infected pleural space, thoracic empyema (TE) continues to cause significant morbidity and mortality. The objectives of this study were to assess the causes and treatment outcome of patients with thoracic empyema.Methods: Patients aged ≥ 13year with TE who were admitted to Gondar University Teaching Hospital, Northwest Ethiopia, from Nov 1999 to Dec 2007 were included. Retrospectively, medical records were reviewed and demographic and clinical data were collected.Results: Records of 81 patients were analyzed; majority (82%) were below the age 50 year. The mean duration of symptoms prior to presentation and hospital stay was 97.4 and 38days, respectively. HIV/AIDS was detected in 60%. Causes of empyema were pulmonary tuberculosis (56%), pneumonia (36%) and lung abscess (7%). Closed chest tube was inserted in 86% of cases and was successful in 93% of them. Case-fatality was 12% and poor outcome occurred in 26%.Conclusions: Early identification of TE and aggressive management with antibiotics or antituberculosis, drainage with chest tube, and surgical treatment when closed tube drainage fails is recommended to improve the high mortality and morbidity.

The non-proteinogenic amino acid γ-aminobutyric acid (GABA) is present in all organisms analyzed so far. In invertebrates GABA acts as a neurotransmitter; in plants different functions are under discussion. Among others, its involvement in abiotic stress reactions and as a defensive compound against feeding insects is suggested. GABA is synthesized from glutamate by glutamate decarboxylases and degraded by GABA-transaminases. Here, in Arabidopsis thaliana, gad1/2 double mutants showing reduced GABA concentrations as well as GABA-enriched triple mutants (gad1/2 x pop2-5) were generated and employed for a systematic study of GABA induction, accumulation and related effects in Arabidopsis leaves upon herbivory. The results demonstrate that GABA accumulation is stimulated by insect feeding-like wounding by a robotic caterpillar, MecWorm, as well as by real insect (Spodoptera littoralis) herbivory. Higher GABA levels in both plant tissue and artificial dietary supplements in turn affect the performance of feeding larvae. GABA enrichment occurs not only in the challenged but also in adjacent leaf. This induced response is neither dependent on herbivore defense-related phytohormones, jasmonates, nor is jasmonate induction dependent on the presence of GABA. Thus, in Arabidopsis the rapid accumulation of GABA very likely represents a general, direct and systemic defense reaction against insect herbivores.

This paper presents a case of a 7 year-old child who presented with a 14-days history of blood stained saliva and shortness of breath of 3 days with signs of upper airway obstruction. Laryngoscopy revealed a blackish living foreign body in the proximal trachea. Under general anesthesia the leech was removed by applying forceps. I conclude that a high index of suspicion of leech infestation is required when faced with a child presenting with unexplained bleeding per mouth and signs of upper airway obstruction.KEY WORDS: Leech, Foreign body, Trachea, upper airway obstruction.

Suicide is a common problem worldwide and the magnitude is high especially in countries where mental illnesses are prevalent and psychiatric services are poor.To determine the prevalence of suicidal ideation and attempts among patients who attended the Psychiatry clinic of Gondar University Hospital.A cross sectional study was conducted from March-December 2006 involving a total of 474 patients. Data was collected using a pre tested structured questionnaire containing basic socio-demographic variables, psychiatric diagnosis, suicidal ideation, suicidal attempt, the methods of suicide attempt and ways of survival from the attempted suicide. It was administered by psychiatry nurses working in the clinic. The data was analyzed anonymously using SPSS software.The commonest mental illness was Major Depressive Disorder (51.3%) followed by Psychosis (38%). Ninety one (19.2 %) patients attempted suicide at least once after the onset of the current mental illness and 307(64.8%) have suicidal ideation. The common method of suicidal attempt was hanging (45.1%) and 69.2% were at home. An association was found between suicidal ideation and attempt (OR=33.7; CI=8.2-138.8, p-value0.01).Suicidal ideation was common in psychiatric patients. It was also associated with suicidal attempt.

Background: The World Health Organization endorsed GeneXpert MTB/RIF (Xpert) assay for the diagnosis of tuberculosis (TB) and multidrug resistant tuberculosis (MDR-TB) in 2010. However, the practice of using this novel diagnostic method is still limited in a high TB and human immunodeficiency virus (HIV) burden settings, including Ethiopia. Therefore, we conducted this study aimed at describing the first implementation status of Xpert assay in the diagnosis of TB and MDR-TB at Felege Hiwot Referral Hospital (FHRH) and Debre Tabor General Hospital (DTGH), Northwest Ethiopia.Methods: We analyzed the records of 1922 (FHRH=544 and DTGH=1378) presumptive TB patients diagnosed using Xpert test from 1 November 2015 to 30 April 2016 at FHRH and DTGH, Northwest Ethiopia. All patients who had registered data on their sex, age, HIV status, presumptive MDR-TB status and Xpert results were included for analysis. Data were retrieved directly from GeneXpert result registration log book using data extraction sheet. Data were entered, cleaned, and analyzed using SPSS statistical software package; p < 0.05 was considered to be significant.Results: Overall Xpert assay properly diagnosed 14.6% of the cases (258/1922). Among these, rifampicin (RIF) resistance was detected at 9.3% (24/258). In the studied settings, clinical data showed that 81.0% (1556/1922) of the cases were MDR- TB. Among the study subjects, 888 (46.2 %) of them were HIV positive. However, TB-HIV co-infection rate was at 41.9% (108/258). Of the total patients registered, 1005 (52.3%) of whom were males. The mean age of patients was 31.1 years with SD of 17.5. Significant predictors of the Xpert test were: age (p=0.000), sex (p=0.009), HIV status (p=0.003) and presumptive MDR-TB (p=0.000).Conclusions: In the studied areas, large proportion of clinically TB suspected patients were wrongly diagnosed with MDR-TB. Therefore, the use of Xpert assay in health settings with no culture facility will decrease the unnecessary use of anti-TB drugs and improve rapid TB, and MDR-TB detection and proper management of the cases. [Ethiop. J. Health Dev. 2016;30(2):60-65]Keywords: TB, GeneXpert, MTB/RIF assay, Northwest Ethiopia

Background: Bedbug is a wingless human blood-sucking bug that generally infests houses and beds. Bedbug infestation is prevalent across the country. Despite its prevalence, however, there is scarce information on the epidemiological, psychological, social and public health impacts of the infestation. This lack may arise from the absence of sufficient research in the area. The impetus for this study arose from this recognition. This study therefore assessed the extent of bedbug infestation in five towns in Amhara Regional State, Ethiopia, and its impact on public health in the areas considered in this study.Methods: A community-based cross sectional study was conducted in five towns of Amhara Regional State from 1 March 2015 to 30 June 2016. Bedbug inspection was done following the Michigan manual for prevention and control of bedbug recommendation. The presence of a living or dead bedbugs, their eggs, their skin discarded in shedding, and their fecal stains or droppings were taken as an infestation. In addition, data from households were collected using pretested, structured and interviewer-administered questionnaire. The data were analyzed using SPSS version 20. Both bivariate and multivariate logistic regressions were computed to identify associated factors.Results: From the 203 residential institutions surveyed, evidence of prevalence of bedbugs was located in 75.9% (154) houses. From among the infested residents, 87%, 83.1%, and 71.4% had faced one or more psychological, social and health impacts, respectively. Residential institutions in Bahir Dar town administration were 3.4 times more likely to be infested by bedbug than those in Amanuel town (AOR: 3.4; 95% CI: 1-11). The chances that residents of Kobo town administration had to be infested by bedbug were 41 times more than that of the residents in Amanuel town (AOR: 41; 95%CI: 8-206). However, no statistically significant difference was observed between the rates of bedbug infestation and the type of residential institutions.Conclusions: Bedbug infestation was found to be a major public health problem in Bahir Dar, Woreta and Kobo towns. A significant psychological, social and health impact was observed in the communities. Thus, aggressive public health promotion campaigns against bedbug are recommended to empower the communities and equip them with preventive strategies. Moreover, an effective pest management strategy also needs to be made a priority health agenda, in the particular areas of study. A larger study is recommended to assess more in-depth impacts of bedbug infestation on public health [Ethiop. J. Health Dev. 2017;31(4):251-258]Keywords: Bedbug infestation, Ethiopia