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Esayas Kebede Gudina,1 Zeleke Mekonnen,2 Daniel Yilma1 1Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia; 2School of Medical Laboratory Sciences, Jimma University Institute of Health, Jimma, EthiopiaCorrespondence: Esayas Kebede Gudina, Department of Internal Medicine, Jimma University Institute of Health, P. O.Box 5058, Jimma, Ethiopia, Email esayas.gudina@ju.edu.etAbstract: The world has come a long way in the fight against the COVID-19 pandemic by averting the initially feared humanitarian crisis and by producing effective vaccines in a record time. Paradoxically, more new daily cases are being reported today than when there was not any effective vaccine around. The success against the pandemic so far is dented by inadequate vaccine supply in most low-income countries and widespread vaccine hesitancy. By the end of 2021, only half of WHO Member States have reached the target of immunizing 40% of their populations, while only less than 10% of the population in low-income countries have received at least one dose of the vaccine. This happened while more than nine billion doses of the vaccines were administered globally, predominantly in rich countries. On the backdrop of these man-made factors, the evolution of highly mutated variants of the virus is causing more uncertainties than the pre-vaccine time. If the vaccine inequities and hesitancy are not properly addressed, we are likely to enter into the vicious cycle of inequitable vaccine distribution leading to low vaccination rates in most low-income countries where the majority of the world population resides. This will ultimately enhance sustained transmission of the virus, leading to evolution of new variants of concern. As the highly mutated variants are likely to infect both vaccinated and unvaccinated individuals, it will inevitably lead to major doubts in the effectiveness and acceptance of the vaccines. In this review, we present how this vicious cycle may prolong the pandemic and discuss the importance of concerted global action to tackle it.Keywords: COVID-19, SARS-CoV-2, variants of concern, vaccine hesitancy, vaccine scepticism, vaccine inequity

Shiferaw Woyesa,1 Aklilu Mamo,1 Zeleke Mekonnen,1 Gemeda Abebe,1 Esayas Kebede Gudina,2 Tesfaye Milkesa3 1School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia; 2Department of Internal Medicine, Jimma University, Jimma, Ethiopia; 3Ambo University Hospital, Ambo, EthiopiaCorrespondence: Shiferaw Woyesa Email bekeleshiferaw@yahoo.comBackground: Lipoproteins are complexes of lipids and proteins that are essential for the transport of cholesterol, triglycerides, and fat-soluble vitamins. The linkage between chronic diseases like diabetes mellitus and HIV infection increases the complication of the diseases and worsens the clinical outcome of the patients.Purpose: To assess and compare lipid and lipoprotein profiles among HIV-infected and non-infected diabetic patients, and to identify independent predictor variables for abnormal lipid and lipoprotein profiles.Patients and Methods: A comparative cross-sectional study design was used to carry out the research, and a convenient sampling technique was used to include 96 adult diabetic patients (48 HIV-infected and 48 non-infected diabetics). Socio-demographic and clinical data were collected by interviewer-administered questionnaire. Five milliliter blood sample was collected and processed for lipid and lipoprotein profile measurement. Multivariate and bivariate logistic regressions were used to identify independent predictor variables for abnormal lipid and lipoprotein profiles.Results: The prevalence of diabetic dyslipidemia was 41.7% and 37.5% in HIV-infected and non-infected diabetic patients, respectively. Hypercholesterolemia was more commonly detected among HIV-infected diabetic patients than non-HIV-infected, 25.0% versus 18.8%, respectively. Similarly, hypertriglyceridemia was more commonly observed in HIV-infected (31.3%) than non-infected diabetic patients (20.8%). About 25.0% HIV-infected diabetic patients had combined hyperlipidemia (hypercholesterolemia plus hypertriglyceridemia); and about 4.2% had hypoalphalipoproteinemia or isolated low HDL-C. Being female and long duration of diabetes mellitus were independent predictor variables for abnormal lipid and lipoprotein profiles in HIV-infected patients. Similarly, being female and high blood pressure were independent predictor variables in non-HIV-infected diabetic patients.Conclusion: High prevalence lipid and lipoprotein abnormalities were detected in HIV-infected diabetic patients even though the abnormalities were also common in non-HIV co-morbid diabetic patients. Hence, proactive screening and treatment of blood glucose, lipid, and lipoprotein abnormalities are critically important and should be part of comprehensive HIV care.Keywords: diabetes mellitus, hypertriglyceridemia, lipoproteins, hypercholesterolemia, HIV-infection

Tsegaye Melaku,1 Mulatu Gashaw,2 Legese Chelkeba,3 Melkamu Berhane,4 Sisay Bekele,5 Gemechu Lemi,6 Tekle Wakjira,7 Getnet Tesfaw,2 Zeleke Mekonnen,2 Solomon Ali,8 Arne Kroidl,9,10 Andreas Wieser,9,10 Guenter Froeschl,9,10 Esayas Kebede Gudina11 1School of Pharmacy, Jimma University, Jimma, Ethiopia; 2School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia; 3Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia; 4Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia; 5Department of Ophthalmology, Jimma University, Jimma, Ethiopia; 6Department of Surgery, Jimma University, Jimma, Ethiopia; 7Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia; 8Department of Microbiology, Immunology and Parasitology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 9Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany; 10German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany; 11Department of Internal Medicine, Jimma University, Jimma, EthiopiaCorrespondence: Tsegaye MelakuSchool of Pharmacy, Jimma University, Jimma, EthiopiaTel +251 913765609Email tsegayemlk@yahoo.comIntroduction: Inappropriate antibiotic use is a major public health concern and driver of antibiotic resistance. Excessive exposure to antibiotics results in the emergence and spread of drug-resistant microorganisms. This study aimed to measure the volume of antibiotic consumption at the outpatient settings in a tertiary-care teaching hospital in Ethiopia.Methods: A cross-sectional study was undertaken from February 01, 2019 to March 31, 2019 at Jimma Medical Center in southwest Ethiopia. Antibiotics use was analyzed using Anatomical Therapeutic Chemical Classification and Defined Daily Dose (DDD) system. Antibiotic use was calculated as DDD per 100 outpatients per day. Antibiotics were classified based on World Health Organization “AWaRe” classification scheme as “Access”, “Watch” and “Reserve” group antibiotics and measured their consumption intensity.Results: A total of 496 adult patients were included in the study. The mean (SD) age of participants was 33.07 (14.05) years. The total amount of antibiotics consumed was 5.31 DDD/100 outpatients per day. Ciprofloxacin was the most commonly [122 (21.12%)] prescribed antibiotics with DDD/100 outpatients per day value of 1.13, followed by amoxicillin [68 (11.76%)] with DDD/100 outpatients per day value of 0.44, and azithromycin [61 (10.55%)] with DDD/100 outpatients per day value of 0.51. On antibiotic consumption index, antibiotics in the “Watch” group had 2.10 DDD/100 outpatients per day.Conclusion: There was high consumption of antibiotics in the study setting. Based on the use control criteria, half of the antibiotics used were in the “Watch” group. The high level of consumptions of antibiotics, such as ciprofloxacin, norfloxacin, and azithromycin, in particular, requires further scrutiny and calls for an urgent implementation of an antibiotic stewardship program at the hospital.Keywords: antibiotics, antibiotics consumption, antibiotic resistance, defined daily dose, Ethiopia

Tsegaye Melaku,1 Legese Chelkeba,1 Zeleke Mekonnen,2 Kabaye Kumela1 1Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia; 2School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, EthiopiaCorrespondence: Tsegaye MelakuJimma University, Jimma, EthiopiaTel +251 913765609Email tsegayemlk@yahoo.comBackground: Antiretroviral therapy has decreased human immunodeficiency virus related mortality. However, the incidence of diabetes mellitus is increasing among people living with human immunodeficiency virus and adds complexity to the standards of care.Objective: The study was aimed to determine the glycemic control and delivery of clinical care among people living with diabetes and human immunodeficincy virus in Ethiopia.Methods: A comparative prospective cohort study was conducted among patients living with diabetes at follow-up clinics of Jimma Medical Center in two study arms. The first arm was people living with diabetes and human immunodeficiency virus. The second arm was human immunodeficiency virus negative patients living with diabetes. The expanded English version of the summary of diabetes self-care activities scale was used to measure self-care behaviors. In order to identify the predictors of glycemic control, multivariable Cox regression analysis was used. Statistical significance at p-value ≤ 0.05 was considered.Results: A total of 297 eligible participants were followed for one year, with a mean age of 44.35± 12.55 years. Males accounted for 55.9%. After one year of follow-up, 61.9% of diabetes people living with human immunodeficiency virus, and 49% of human immunodeficiency virus-negative patients with diabetes poorly met blood glucose target (p=0.037). Female gender [AHR: 2.72; 95% CI (1.21– 5.72)], age > 31 years [AHR: 2.48; 95% CI (1.34– 11.01)], increased waist circumference [AHR: 3.64; 95% CI (2.57– 16.12)], overweight [AHR: 3.63; 95% CI (1.65– 22.42)], chronic disease comorbidity [AHR: 2.02; 95% CI (1.44– 2.84)], human immunodeficiency virus infection [AHR: 3.47; 95% CI (2.03– 23.75)], living longer with diabetes (> 5 years) [AHR: 3.67; 95% CI (3.26– 4.14)] showed a higher risk of blood sugar control failure and were independent predictors of uncontrolled glycemia. Tuberculosis infection increased the risk of uncontrolled blood sugar among people living with diabetes and human immunodeficency virus[AHR:3.82;95% CI(2.86-5.84].Conclusion: Significant gaps were observed in achieving the recommended glycemic target and involvement of patients on self-care care behavior in the study area. The co-occurrence of tuberculosis, human immunodeficiency virus, and diabetes is triple trouble needing special attention in their management. It is high time to leverage the clinical care of the looming co-epidemics through chronic comprehensive care clinic.Keywords: human immunodeficiency virus, glycemic control, treatment outcome, self-care behavior

Binyam Gintamo,1 Mohammed Azhar Khan,1 Henok Gulilat,1 Zeleke Mekonnen,2 Rakesh Kumar Shukla,1 Tabarak Malik3 1Department of Biotechnology, Faculty of Applied Sciences and Biotechnology, Shoolini University, Bajhol, HP, India; 2School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia; 3Department of Biochemistry, College of Medicine & Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Tabarak Malik Email malikitrc@gmail.comBackground: Integrated Management of Neonatal and Childhood Illnesses (IMNCI) is one of the child health programs and it provides an integrated approach and focuses on the well-being of the whole child. Globally, nearly nine million children pass away every year with preventable and treatable conditions. IMNCI program is provided by the health facilities to aid children under five years of age from illness. This study is aimed at assessing the implementation of the IMNCI program in public health centers of Soro District, Hadiya Zone, Southern Ethiopia.Methods: The implementation of the IMNCI program was studied using a facility-based cross-sectional study design integrating both qualitative and quantitative data collected from 9 public health centers in Soro district, Hadiya Zone, Southern Ethiopia. A total of 390 (92%) caregivers were included in the study by the proportion of under-five outpatient coverage from each public health center. Data were collected through face to face interviewer-administered questionnaires, document review checklist, observation checklist, and in-depth interview guide.Results: Based on agreed criteria resources’ availability was 80.11% and judged as fair. Less than 50% of health centers (HCs) had cotrimoxazole and gentamycin. The compliance of health workers was 85.5% and judged as good. Below 85% of prescribed drugs were given correctly for the classified disease. Counseling on medication and follow updates were given for less than 80% of caretakers. The overall satisfaction of clients on IMNCI was 79.5% according to the judging criteria. The caretakers who took less than 30 minutes to reach the health center on foot (AOR=7.7, 95% CI [3.787– 15.593]), caretakers who waited for less than 30 minutes to see the health care provider (AOR=2, 95% CI [1.00– 3.77]), the caretakers who found prescribed drugs in HCs pharmacy (AOR = 3.7,95% CI [1.91– 7.34]), the caretakers who have less than four family size (AOR=2, 95% [1.109– 4.061]) were more satisfied in IMNCI services, whereas, caregivers who measured the weight of child were negatively associated with satisfaction (AOR= 0.24, 95% CI [0.13– 0.45]).Conclusion: This study found that the overall implementation of the Integrated Management of Neonatal and Childhood Illnesses was good. All health centers had trained health workers, ORS, paracetamol, vitamin A, chart booklet, and IMNCI guidelines were available; however, cotrimoxazole, gentamycin, ampicillin, and mebendazole were less abundant drugs in health centers. Further, a large-scale study is required to be conducted in future in other districts to ensure proper implementation of the IMNCI program in Ethiopia.Keywords: IMNCI, healthcare provider, practice, Hadiya zone, southern Ethiopia

In this paper we have investigated the effects of geomagnetic storm on the variation of interplanetary magnetic field (IMF Bz), disturbance storm time (Dst), solar wind speed and total electron content (TEC) over Ethiopian ionosphere. A total of 17 geomagnetic storms have analysed by using ground based Global Positioning System (GPS) stations at Bahir Dar (11° N, 38° E), Debark(4.32° N, 109.48° E), Armi (3.03° N, 109.29° E), Nazret (8.57° N, 39.29° E), Robe(7.60° N, 40°E), Assosa (1.14° N, 106.16° E), and Ambo(8.59° N, 37.51° E) from the years 2010 to 2013. The results have revealed that there is a mixed effect of geomagnetic storm on the variation of interplanetary magnetic field (IMF Bz), disturbance storm time (Dst), solar wind speed and total electron content (TEC), however, most of the effects were positive and might be attributed to the prompt penetration electric fields (PPEFs) and disturbed dynamo fields. [ABSTRACT FROM AUTHOR]

Model projections of future CO2 and CH4 exchange in Arctic tundra diverge widely. Here we used ecosys to examine how climate change will affect CO2 and CH4 exchange in troughs, rims, and centers of a coastal polygonal tundra landscape at Barrow, AK. The model was shown to simulate diurnal and seasonal variation in CO2 and CH4 fluxes associated with those in air and soil temperatures (Ta and Ts) and soil water contents (θ) under current climate in 2014 and 2015. During RCP 8.5 climate change from 2015 to 2085, rising Ta, atmospheric CO2 concentrations (Ca), and precipitation (P) increased net primary productivity (NPP) from 50-150 g C m-2 y-1, consistent with current biometric estimates, to 200--250 g C m-2 y-1. Concurrent increases in heterotrophic respiration (Rh) were slightly smaller, so that net CO2 exchange rose from values of -25 (net emission) to +50 (net uptake) g C m-2 y-1 to ones of -10 to +65 g C m-2 y-1. Increases in net CO2 uptake were largely offset by increases in CH4 emissions from 0-6 to 1-20 g C m-2 y-1, reducing gains in net ecosystem productivity. These increases in net CO2 uptake and CH4 emissions were modeled with hydrological boundary conditions that were assumed not to change with climate. Both these increases were smaller if boundary conditions were gradually altered to increase landscape drainage during model runs with climate change. [ABSTRACT FROM AUTHOR]

Abstract: Microtopographic variation that develops among features (troughs, rims, and centers) within polygonal landforms of coastal arctic tundra strongly affects movement of surface water and snow and thereby affects soil water contents (θ) and active layer depth (ALD). Spatial variation in ALD among these features may exceed interannual variation in ALD caused by changes in climate and so needs to be represented in projections of changes in arctic ALD. In this study, increases in near‐surface θ with decreasing surface elevation among polygon features at the Barrow Experimental Observatory (BEO) were modeled from topographic effects on redistribution of surface water and snow and from lateral water exchange with a subsurface water table during a model run from 1981 to 2015. These increases in θ caused increases in thermal conductivity that in turn caused increases in soil heat fluxes and hence in ALD of up to 15 cm with lower versus higher surface elevation which were consistent with increases measured at BEO. The modeled effects of θ caused interannual variation in maximum ALD that compared well with measurements from 1985 to 2015 at the Barrow Circumpolar Active Layer Monitoring (CALM) site (R2 = 0.61, RMSE = 0.03 m). For higher polygon features, interannual variation in ALD was more closely associated with annual precipitation than mean annual temperature, indicating that soil wetting from increases in precipitation may hasten permafrost degradation beyond that caused by soil warming from increases in air temperature. This degradation may be more rapid if increases in precipitation cause sustained wetting in higher features. [ABSTRACT FROM AUTHOR]

Abstract: Differences of surface elevation in arctic polygonal landforms cause spatial variation in soil water contents (θ), active layer depths (ALD), and thereby in CO2 and CH4 exchange. Here we test hypotheses in ecosys for topographic controls on CO2 and CH4 exchange in trough, rim, and center features of low‐ and flat‐centered polygons (LCP and FCP) against chamber and eddy covariance (EC) measurements during 2013 at Barrow, Alaska. Larger CO2 influxes and CH4 effluxes were measured with chambers and modeled with ecosys in LCPs than in FCPs and in lower features (troughs) than in higher (rims) within LCPs and FCPs. Spatially aggregated CO2 and CH4 fluxes from ecosys were significantly correlated with EC flux measurements. Lower features were modeled as C sinks (52–56 g C m−2 yr−1) and CH4 sources (4–6 g C m−2 yr−1), and higher features as near C neutral (−2–15 g C m−2 yr−1) and CH4 neutral (0.0–0.1 g C m−2 yr−1). Much of the spatial and temporal variations in CO2 and CH4 fluxes were modeled from topographic effects on water and snow movement and thereby on θ, ALD, and soil O2 concentrations. Model results forced with meteorological data from 1981 to 2015 indicated increasing net primary productivity in higher features and CH4 emissions in some lower and higher features since 2008, attributed mostly to recent rises in precipitation. Small‐scale variation in surface elevation causes large spatial variation of greenhouse gas (GHG) exchanges and therefore should be considered in estimates of GHG exchange in polygonal landscapes. [ABSTRACT FROM AUTHOR]