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In almost all lower and lower middle-income countries, the healthcare system is structured in the customary model of in-person or face to face model of care. With the current global COVID-19 pandemics, the usual health care service has been significantly altered in many aspects. Given the fragile health system and high number of immunocompromised populations in lower and lower-middle income countries, the economic impacts of COVID-19 are anticipated to be worse. In such scenarios, technological solutions like, Telemedicine which is defined as the delivery of healthcare service remotely using telecommunication technologies for exchange of medical information, diagnosis, consultation and treatment is critical. The aim of this study was to assess healthcare providers' acceptance and preferred modality of telemedicine and factors thereof among health professionals working in Ethiopia. A multi-centric online survey was conducted via social media platforms such as telegram channels, Facebook groups/pages and email during Jul 1- Sep 21, 2020. The questionnaire was adopted from previously validated model in low income setting. Internal consistency of items was assessed using Cronbach alpha (α), composite reliability (CR) and average variance extracted (AVE) to evaluate both discriminant and convergent validity of constructs. The extent of relationship among variables were evaluated by Structural equation modeling (SEM) using SPSS Amos version 23. From the expected 423 responses, 319 (75.4%) participants responded to the survey questionnaire during the data collection period. The majority of participants were male (78.1%), age <30 (76.8%) and had less than five years of work experience (78.1%). The structural model result confirmed the hypothesis \"self-efficacy has a significant positive effect on effort expectancy\" with a standardized coefficient estimate (β) of 0.76 and p-value <0.001. The result also indicated that self-efficacy, effort expectancy, performance expectancy, facilitating conditions and social influence have a significant direct effect on user's attitude toward using telemedicine. User's behavioral intention to use telemedicine was also influenced by effort expectancy and attitude. The model also ruled out that performance expectancy, facilitating conditions and social influence does not directly influence user's intention to use telemedicine. The squared multiple correlations (r2) value indicated that 57.1% of the variance in attitude toward using telemedicine and 63.6% of the variance in behavioral intention to use telemedicine is explained by the current structural model. This study found that effort expectancy and attitude were significantly predictors of healthcare professionals' acceptance of telemedicine. Attitude toward using telemedicine systems was also highly influenced by performance expectancy, self-efficacy and facilitating conditions. effort expectancy and attitude were also significant mediators in predicting users' acceptance of telemedicine. In addition, mHealth approach was the most preferred modality of telemedicine and this opens an opportunity to integrate telemedicine systems in the health system during and post pandemic health services in low-income countries.

Atrial fibrillation is the most common sustained cardiac rhythm disorder with substantial mortality and morbidity from stroke, thromboembolism, heart failure, and impaired quality of life. This study aimed to investigate the emergency presentation, treatment outcome and associated risk factors of atrial fibrillation patients admitted to three tertiary hospitals in Addis Ababa. A cross-sectional study was conducted in the adult emergency room of three tertiary hospitals in Addis Ababa. All atrial fibrillation patients admitted to these hospitals from August 15, 2021, to August 15, 2022, fulfilling inclusion criteria were included in the study. Data was collected by reviewing medical records in the form of a structured data abstraction form and analyzed by SPSS. A total of 133 chart records were reviewed and the mean (±SD) age of study participants was 54.82 ± 20.49 years and ranged between 18-85 years of age. The majority of the patients, 47 (35.3%) were aged between 18-40 years. Nearly more than half of the patients 69 (51.9%) were females and two third [91 (68.4%)] of the patients were from Addis Ababa. Patients of the age group 40-59 with atrial fibrillation have an 82% lower chance of developing stroke than those in the age group >60 years and patients with underlying cardiovascular diseases have seven times higher odds of having a stroke compared to those without underlying cardiac diseases. Male patients with atrial fibrillation had 2.15 times higher odds of staying for > 24 hours at the emergency department compared to female patients. The odds of a > 24-hour stay in the ER significantly increased by 2.7 times as the patient became unstable compared to stable patients. Males and those with unstable atrial fibrillation have a higher chance of staying more than 24 hours in the emergency room. According to the study, patients who were more than 60 years of age with underlying cardiovascular diseases had a higher likelihood of developing ischemic stroke.

Background Anopheles mosquitoes are of great importance to human health. A number of studies have shown that midgut and salivary gland microflora have an impact on malaria parasite burden through colonization mechanisms, involving either direct Plasmodium microbiota interaction or bacterial-mediated induction of mosquito immune response. The objective of this study was to isolate and identify the microflora from the midgut and salivary glands of Anopheles species. Methods A total of 20 pools (ten per pool) from insectary-reared and 56 pools (five per pool) of field-collected Anopheles mosquitoes were anesthetized by chloroform and dissected. 70% of ethanol was used for surface sterilization of mosquitoes and laboratory equipment, followed by rinsing Anopheles mosquitoes four times with 1X PBS. Each pool of dissected midgut and salivary gland sample was transferred in 1X PBS and squashed, incubated in the water bath and enriched in tryptic soya broth for 24 h at 35 ± 2 °C. As a control, the PBS solutions used to rinse the mosquitoes were also incubated in tryptic soya broth in the same conditions as the sample. After enrichment, a loopful of each sample was taken and inoculated on Blood, Chocolate, MacConkey, and Sabouraud Dextrose agar. Finally, the microbiota was isolated by colony characteristics, biochemical tests, and automated VITEK 2 Compact Analyzer. Results From all field and laboratory mosquitoes, Pseudomonas was found to be the dominant microbiota identified from all species of Anopheles mosquitoes. Acinetobacter and Klebsiellapneumonia and other families of gram-positive and gram-negative bacteria were identified. Conclusions A number of bacteria were isolated and identified. This is the first report on isolation and identification of microbiota from midgut and salivary glands of Anopheles species in Ethiopia. It can be used as a baseline for studying the relationship between microbiota and mosquitoes, and for the development of a new malaria biological control.

Naturally acquired antibodies may reduce the transmission of Plasmodium gametocytes to mosquitoes. Here, we investigated associations between antibody prevalence and P. vivax infectivity to mosquitoes. A total of 368 microscopy confirmed P. vivax symptomatic patients were passively recruited from health centers in Ethiopia and supplemented with 56 observations from asymptomatic P. vivax parasite carriers. Direct membrane feeding assays (DMFA) were performed to assess mosquito infectivity; for selected feeds these experiments were also performed after replacing autologous plasma with malaria naïve control serum (n=61). The prevalence of antibodies against 6 sexual stage antigens (Pvs47, Pvs48/45, Pvs230, PvsHAP2, Pvs25 and PvCelTOS) and an array of asexual antigens was determined by ELISA and multiplexed bead-based assays. Gametocyte (ρ< 0.42; p = 0.0001) and parasite (ρ = 0.21; p = 0.0001) densities were positively associated with mosquito infection rates. Antibodies against Pvs47, Pvs230 and Pvs25 were associated with 23 and 34% reductions in mosquito infection rates (p<0.0001), respectively. Individuals who showed evidence of transmission blockade in serum-replacement DMFAs (n=8) were significantly more likely to have PvsHAP2 or Pvs47 antibodies. Further studies may demonstrate causality for the observed associations, improve our understanding of the natural transmission of P. vivax and support vaccine development.

Anthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region. Following reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR). In Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR. We report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage.