Biomedical subjects

Alemayehu Worku

Publications and source records attributed to Alemayehu Worku.

7 recordsLinked to original sources

PubMed2006

Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia.

BACKGROUND: Trichiasis recurrence following surgery is a serious problem for trachoma programs. OBJECTIVE: To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient. DESIGN: A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms: single-dose (1 g) oral azithromycin alone, single-dose azithromycin for household members (20 mg/kg up to 1 g) plus the patient, or topical tetracycline (twice per day for 6 weeks). MAIN OUTCOME MEASURES: Trichiasis recurrence within 1 year following surgery. RESULTS: The combined azithromycin groups had significantly fewer recurrences, 6.9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 person-years (P = .047). There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years (P = .19). CONCLUSIONS: In trachoma-endemic areas, a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Administration, Oral↗

PubMed2005

Potential for medical transmission of HIV in Ethiopia.

The potential medical transmission of HIV through unsafe medical injections was evaluated in 16 rural health institutions in Ethiopia. Most institutions reported re-using disposable needle/syringes, and 12% of observed injections were given with used, disposable syringes prepared for re-use. Analysis of used needle flushes showed no HIV RNA; however, the sensitivity of our method was limited. Despite the re-use of disposable needles, medical injection practices are not likely to contribute significantly to HIV transmission in this region.

Adolescent↗

PubMed2005

Active trachoma in children in central Ethiopia: association with altitude.

A cross-sectional study was conducted in the dry month of February 2000 in the Gurage Zone of Ethiopia (population over 1.5 million) to determine the magnitude of trachoma and blindness. A multistage cluster sampling was applied to identify the study subjects. Pre-school children (1-6 years) were examined for active trachoma by trained ophthalmic nurses. The prevalence of active trachoma in the 1-6-year-old age group was 56.5%, ranging from 5.7% (altitude > 3000 m) to 73.4% (altitude less than 2000 m) (P < 0.001). Active trachoma was more common in male children than in female children and peaked in the 3-year-old age group (63.2%), declining with age. The distance to a source of water for 45% of these households was only 15 min. Only 6% of the households had latrines. Confirmation of the association between active disease and altitude may assist with mapping of trachoma in Ethiopia and elsewhere. It is possible that fly density, higher in villages at low altitudes, contributed to the differences seen.

Age Distribution↗

PubMed2004

Surgery for trichiasis by ophthalmologists versus integrated eye care workers: a randomized trial.

OBJECTIVE: To study the outcome of bilamellar tarsal rotation (BTR) trichiasis surgery performed by ophthalmologists versus that done by integrated eye care workers (IECWs). DESIGN: Randomized prospective interventional trial. PARTICIPANTS: Nine hundred eighty-two patients with various degrees of trachomatous trichiasis in central Ethiopia. METHODS: Trachomatous trichiasis patients in 3 woredas (districts) in central Ethiopia were enrolled. Trichiasis severity was graded. Patients were randomly assigned to surgery by 2 ophthalmologists and 2 IECWs. On the seventh day postoperatively, patients were evaluated for undercorrection or other complications. If trichiasis was present, it was considered a failure of surgery (technical failure), and patients were excluded from the follow-up study, but repeat surgery was performed. Those patients with good correction at the seventh day were examined again on the third and sixth months. Further follow-up evaluation is planned for the first, second, and third years postoperatively. MAIN OUTCOME MEASURES: Recurrence rate, recurrence difference in the various grades, and difference between surgeries done by ophthalmic surgeons and those done by IECWs. RESULTS: In the third month of follow-up, it was possible to locate 713 (73.0%) of the operated patients. Eighty-one of 713 (11.4%) individuals and 94 of 1286 (5.4%) operated lids developed recurrent trichiasis in this period. There was a linear trend of recurrence with grading (severity) at baseline (chi(2) = 22.017, P<0.001), but there was no difference in recurrence by age (chi(2) =1.53, P = 0.9 at the third month; chi(2) = 1.43, P = 0.9 at the sixth month). There was also no difference with regard to gender (0.38 < odds ratio < 1.14, P = 0.1). The recurrence observed in the group of individuals operated on by ophthalmologists at the 3-month follow-up was 47 (12.1%) lids, and the recurrence observed in the group operated on by the IECWs was 34 (9.9%) lids, with no statistically significant difference (chi(2) =1.38, P = 0.24, 95% confidence interval [CI], -18% to 74%). At the 6-month follow-up, 43 (6.2%) persons had recurrence (95% CI, 4.4%-8%). There was no statistically significant difference between the 2 groups of surgeons at the 6-month point of follow-up examination (chi(2) = 4.46, P = 0.2). The overall recurrence was 124 (14.3%) lids within the first 6 months. CONCLUSION: Recurrent trichiasis is common, especially in cases where the degree of trichiasis is severe at baseline. This suggests that these patients may need surgical overcorrection to decrease the recurrence rate. The outcome of BTR surgery done by IECWs is similar to that of the ophthalmic surgeons. Because of these findings, we recommend that training of IECWs in trichiasis surgery may help to ameliorate the effects of the eye care worker shortage in developing countries.

Adolescent↗

PubMed2004

Trichiasis among close relatives, central Ethiopia.

Active trachoma is known to cluster in close contacts, such as mother and child and between siblings, but we do not know the pattern for trichiasis. This cross-sectional study was conducted to determine if there is as much trichiasis as active trachoma within families having close contact. This information will be helpful in designing intervention strategies. Trichiasis patients that presented for surgery were interviewed for the presence or absence of trichiasis in the current nuclear family, their parent/s, brother/s, sister/s, aunt/s or uncle/s. Of the 739 trichiasis patients interviewed, 78% were women. Fourteen percent of trichiasis cases had at least one nuclear family member with the same condition, and 20.0% had other relative/s (parent/s, brother/ s, sister/s, aunt/s or uncle/s) with trichiasis. Trichiasis increases in parallel with the increase in family size of the index case (c2 for trend = 70.6; P < 0.001). Sixty-nine percent of affected nuclear family members of the index cases were female members. In the relative with trichiasis, 92.8% of cases were parents, sisters and brothers of the index cases. Out of these, the majority (70%) were mothers and sisters. The chance of a female trichiasis patient having another relative with trichiasis is 70%. The chance of the mother/sister/s of a male trichiasis patient being trichiasis patients themselves is 80%, while that of the father/brother/s is 20% (c2=21.88; P < 0.001). If a female has trichiasis there is a 70% chance of her mother/sister/s, and 30% chance of the father/ brother/s (c2 = 27.52; P <0.001) also being trichiasis patients.

Adult↗

PubMed2003

Modified grading system for upper eyelid trachomatous trichiasis.

AIM: This study was conducted to determine the level of inter-observer agreement in the modified grading scheme for trichiasis of the upper eyelid. METHODS: A grading system that covers the entire spectrum of trachomatous trichiasis, extending from the simple to the severe forms, was initially developed by the first and second authors and field-tested. The grading scheme recognizes three levels of severity, based on deviation of the lid margin (TT1, TT2 and TT3); and four anatomical locations indicating where the eyelashes touch the globe in TT1 (nasal, central, temporal, or combined). The grading of trichiasis patients was then conducted on the basis of the modified grading scheme. RESULTS: The inter-observer agreement between the grades of simple trichiasis (TT1) and entropion (TT2) using Cronbach's alpha was 0.84, and the agreement within each sub-grade was 0.86. The weighted Kappa value was 0.68 (95% CI 0.57-0.79) for the main grades and 0.49 (95% CI 0.23-0.79) for the sub-grades. CONCLUSIONS: The inter-observer agreement was very reliable and could easily be attained by all levels of ophthalmic professionals. As the grading follows the natural progression of trichiasis from the simple to the severe forms in relation to the anatomical site involved, it helps to determine the degree of correction and how far to extend the surgical incision.

Eyelashes↗

PubMed2003

Overall HIV-1 prevalence in pregnant women over-estimates HIV-1 in the predominantly rural population of Afar Region.

The appropriateness of sentinel sero-surveillance based upon ante-natal clinic (ANC) attendees to estimate HIV-1 prevalence in the general population has been questioned. In Ethiopia, where the population is heterogeneous and where economic and practical barriers to ANC attendance exist, problems of extrapolation may be exacerbated. We planned an unlinked anonymous sero-survey which included data on basic population characteristics to investigate whether sero-surveillance data from ANCs in Afar Region might be taken to represent the situation among the general population of the Region. 371 pregnant women attending Dubti Hospital and Assayta Health Centre were tested for HIV-1 (using a single ELISA test) and active syphilis (RPR test). Socio-demographic characteristics were collected for each woman. Of the women tested, 278 (75%) were 28 years of age or younger. Two hundred eighty (76%) were urban residents and 237 (64%) described themselves as being of Amhara ethnicity. Overall, 73 (19.7%) were HIV-1 positive, but prevalence was three times higher among the 237 women of Amhara ethnicity compared to the 112 of Afar ethnicity (24.9% vs 8.0%, p < 0.001), and almost three times higher for urban compared to rural residents (23.2% vs 8.8%, p < 0.001). Positive RPR results were strongly associated with HIV-1 infection (OR 3.37, 95% CI 1.47-7.71). According to the Demographic and Health Survey (DHS) 2000, only 4.5% of the population of Afar Region is of Amhara ethnicity, and 7.8% urban residents. We have demonstrated that basing ANC sero-surveillance in urban areas of Afar Region over-samples urban residents of Amhara ethnicity and yields a major over-estimation of overall HIV-1 prevalence for the Region. Reliable estimation of HIV-1 prevalence in Afar Region will require more flexible strategies that permit sampling of rural Afar residents.

AIDS Serodiagnosis↗