In the epidemiologic modeling of diseases, the epidemiologic problem oriented approach (EPOA) methodology facilitates the development of systematic and structured knowledge bases, which are crucial for development of models. A detailed understanding of the epidemiology of a given disease provides the essential framework for model development and enables the laying out of the comprehensive and fundamental structures for the models.To develop such a knowledge base for developing HIV/AIDS models.The EPOA methodology was utilized to develop the knowledge base for HIV/AIDS; it is composed of six pillars within two triads: the Problem Identification/Characterization and the Problem Management/Solution/Mitigation Triads, interlinked by the diagnostic procedure.Using information from various sources, the triads are decomposed into their respective pillar variables and parameters. The agent pillar identifies the causative agent (HIV) and its characteristics. The host pillar identifies and characterizes the host (human). The environment pillar characterizes the physical, biological and socioeconomic environments for both the host and agent. The therapeutics/treatment pillar considers the treatment options for HIV/AIDS. The prevention/control pillar considers prevention and control measures. The health maintenance/health promotion pillar considers measures for the health maintenance of the population.Models for HIV/AIDS can be conceptual, in vivo or in vitro, systems analysis, mathematical, or computational just to name a few. The knowledge base developed using the EPOA methodology provides a well-organized structured source of information, which is used in the variable and parameter estimations as well as analysis (biological, mathematical, statistical and computer simulations), which are crucial in epidemiologic modeling of HIV/AIDS. EPOA methodology has become an important tool in the development of models that can enlighten decision making in public health.
Epidemiologic research involves the study of a complex set of host, environmental and causative agent factors as they interact to impact health and diseases in any population. The most advanced of these efforts have focused on micro (cellular) or macro (human) population level studies but lacked the integrative framework as presented in this article. Modeling the cumulative impact of HIV/AIDS at the cellular, molecular, and individual behaviors at the population-level can be complex. The main objective of our research is to develop a macro-micro level computational epidemiologic model that integrates the dynamic interplay of HIV/AIDS at the cellular and molecular level (micro-epidemiologic modeling), and the dynamic interplay of multifactorial determinants: biomedical, behavioral, and socioeconomic factors at the human population level (macro-epidemiologic modeling).The computational epidemiologic model was constructed using systems dynamics modeling methodology. The dynamics of the relationships was described by means of ordinary/partial differential equations. All state equations in the model were approximated using the Runge-Kutta 4th order numerical approximation method.Computational tools and mathematical approaches that integrate models from micro to macro levels in a seamless fashion have been developed to study the population-level effects of various intervention strategies on HIV/AIDS. The critical variables that facilitate transmission of HIV and intracellular interactions and molecular kinetics were examined to assess different interventions strategies. Such multilevel models are essential if we are to develop quantitative, predictive models of complex biological systems such as HIV/AIDS.
Bovine Tuberculosis (BTB) is a widespread and endemic disease of cattle in Ethiopia posing a significant threat to public health. Regular surveillance by skin test, bacteriology and molecular methods is not feasible due to lack of resource. Thus, routine abattoir (RA) inspection will continue to play a key role for national surveillance. We evaluated efficiency of RA inspection for diagnosis of Mycobacterium bovis infection and discussed its public health implications in light of a high risk of human exposure. The study was conducted in five abattoirs: Addis Ababa, Adama, Hawassa, Yabello and Melge-Wondo abattoirs. The efficiency of routine abattoir (RA) inspection was validated in comparison to detailed abattoir (DA) inspection, followed by culture and microscopy (CM) and region of difference (RD) deletion analysis. Diagnostic accuracies (with corresponding measures of statistical uncertainty) were determined by computing test property statistics (sensitivity and specificity) and likelihood estimations using web-based SISA diagnostic statistics software. Post-test probability of detecting TB infected carcasses was estimated using nomograms. Agreement between RA and DA inspections was measured using kappa statistics. The study was conducted and reported in accordance with standards for reporting of diagnostic accuracy (STARD) requirements. Both routine and detailed meat inspection protocols were performed on a subpopulation of 3322 cattle selected randomly from among 78,269 cattle slaughtered during the study period. Three hundred thirty seven carcasses identified through detailed meat inspection protocols were subjected to culture and microscopy; of the 337, a subset of 105 specimens for culture and microscopy were subjected to further molecular testing. There was a substantial agreement between RA and DA inspections in Addis Ababa (Kappa = 0.7) and Melge-Wondo abattoirs (Kappa = 0.67). In Adama, Hawassa and Yabello abattoirs, the agreement was however poor (Kappa ≤ 0.2). RA inspection was able to detect only 117 of the total 3322 carcasses inspected (3.5%). The sensitivity (Sn) and specificity (Sp) of RA inspection were 28.2% (95/337) [95%CI: 23.4-33.0] and 99.3% (2963/2985) [95%CI: 99.0-99.6], respectively, when DA inspection was considered as reference test. When culture and microscopy (CM) was considered as reference test, the Sn and Sp of RA were 55.2% (58/105) [95%CI: 45.7-64.7] and 84.1% (195/232) [95%CI: 79.3-88.8]. RA inspection failed to detect 71.8% (242/337) and 44.8% (47/105) of TB infected carcasses as judged by DA inspection and CM, respectively. On the other hand, a much higher sensitivity of DA was obtained when CM and RD deletion analysis were considered as reference tests (96.3% (105/109) and 100.0% (24/24), respectively). The study results indicate that meat inspection protocols currently utilized in abattoirs are insufficient to detect the majority of TB lesions at the gross level. DA inspection protocols were demonstrated to improve the detection level by approximately 3-fold. The failure of current inspection techniques to detect approximately 70% of carcasses presented with grossly-visible lesions of TB at the slaughter-plants indicates the magnitude of meat-borne zoonotic TB as an on-going risk to public health. Standardization of abattoir inspection protocols (in line with international sanitary requirements), enhanced training and proficiency testing of meat inspections, and raising public awareness are recommended as essential and cost-effective interventions to improve meat inspection service in Ethiopia, with subsequent protection of consumers' health.
PURPOSE:African-American (AA) women living in four Black Belt Counties (BBC) of Alabama; consisting of Barbour, Macon, Green and Wilcox are known to have lower mammogram utilization and breast self-exam rates when compared to their white female counterparts.The influence of socioeconomic and demographic factors on these disparities has not been clearly defined so far.Our study was designed to determine whether these observed disparities can be predicted with the socioeconomic and other demographic attributes.METHODS: Health Disparity Questionnaires data (n = 516) for BBC of Alabama was analyzed using a logistic regression model to examine the association of breast cancer screening rates and breast self-exam with income, the level of education, family doctor, type of health insurance, obesity, and age.RESULTS: Income, education, family doctor, age and health insurance were independent predictors for the low utilization rate of mammography and breast self-exam (BSE).CONCLUSION: Improving socioeconomic conditions such as level of education and availability of health care are essential to increase the rates of breast cancer screening test and breast self-exam in the BBC of Alabama.
Bovine Tuberculosis (BTB) is a widespread and endemic disease of cattle in Ethiopia. Information relating to genotypic characteristics of Mycobacterium bovis strains affecting the cattle population in Ethiopia is limited. We carried out molecular characterization of M. bovis strains isolated from BTB infected cattle using the spoligotyping technique. The relationship between distribution of spoligotypes and recorded variables was also investigated. A new approach that can numerically reflect the degree of genetic polymorphism in a M. bovis population was also developed. The study was conducted from July 2006 to January 2007 in cattle slaughtered at five representative abattoirs in Ethiopia. Forty-five M. bovis isolates were obtained from 406 pathologic tissue specimens collected from 337 carcasses with lesions compatible with BTB. Twelve spoligotypes were identified from 34 distinct strains; with SB1176 as a dominant spoligotype (41.2% of the isolates) followed by SB0133 (14.7%). Comparison of spoligotypes with an M. bovis global database http://www.mbovis.org revealed six new spoligotypes which were subsequently registered in the database with international identification codes of SB1517, SB1518, SB1519, SB1520, SB1521 and SB1522. The majority of strains were obtained from cattle slaughtered at Addis Ababa abattoir. On the basis of the Spoligotype Evolutionary Index, SEI (a numeric expression approach to make standardized comparison of spoligotype evolution), M. bovis isolates from Ethiopia were relatively more heterogeneous (SEI = 3.2) compared to isolates from other countries. This might be attributed to extensive livestock movement linked to trading or seasonal migration, high degree of livestock mingling, and also diversities of the country's agricultural and livestock ecosystems, in addition to lack of disease control measures that led to high infection prevalence. Multiple spoligotype infection was recorded in nine (50%) of infected carcasses and this may indicate the prevailing high degree of super infection. This study provided molecular evidence for the widespread distribution of M. bovis in the cattle population in Ethiopia. It also demonstrated a relatively high degree of genetic polymorphism of the isolates. Further molecular investigation of M. bovis strains in humans and other domestic animals is recommended in order to elucidate the zoonotic importance as well as reservoirs and pattern of transmission among various hosts.
The majority of cattle in Uganda are located in the "cattle corridor," an area stretching from the northeast to the southwest of the country. Bovine tuberculosis (BTB) was first recorded in Uganda in 1917 and has been present in cattle since that time. In Uganda, BTB is most commonly encountered during routine meat inspection. The use of PCR has provided insights into the interspecies transmission and epidemiology of Mycobacterium bovis. Uganda is ranked 19th among the countries with the highest burden of human tuberculosis (TB). Postmortem inspection followed by bacteriological examination of suspected lesions is an important tool to confirm the presence of BTB in animals. This chapter discusses studies that have identified several risk factors associated with BTB in cattle. BTB control programs in Uganda and other developing countries are fraught with many challenges and constraints, and are unlikely to achieve major advances unless current approaches are drastically changed.
As part of a poverty reduction strategy, Ethiopia has embarked on increasing milk production through smallholder and other dairy schemes. Introduction of improved breeds such as Holstein-Friesian and intensification of animal husbandry are the centerpieces of such strategy. In the absence of appropriate disease surveillance and food safety standards, intensive animal husbandry can increase the risk of zoonoses. Due to close contact between animals and their owners, the significance of zoonotic TB had been noted. We summarized the fragmentary evidence from literature on status of bovine TB research in Ethiopia. Since accumulation of data is valueless unless it led to practicable control measures, the review put into perspective locally adapted protocols for future control of the disease.
4 Abstract: The study was conducted to determine prevalence of bovine mastitis, identify predominant bacteria responsible for mastitis infection and assess potential risk factors associated with the disease. A total of 460 lactating Boran breed cows from both pastoral and agro-pastoral set up of the district were included in the study. California Mastitis Test (CMT), clinical examination of udder and teats and bacteriological examination were employed during the study period. The overall prevalence of mastitis at a cow level was 59.1% (272/460), from which 21.1% (97/460) and 38.0% (175/460) were clinical and subclinical, respectively. The quarter level prevalence of the disease was also 38.7% (712/1840) from which 13.4% (246/1840) and 25.3% (466/1840) were clinical and subclinical form, respectively. Among the cause of bovine mastitis in the study area Staphylococcus species, Streptococcus species and E. coli were leading infectious causes with relative percentage of 29.2%, 22.5% and 11.4%, respectively. All the potential risk factors considered in this study namely, parity ( ² = 83.6, p = 0.00001), age ( ²= 16.4, p = 0.0003) and stage of lactation ( ² = 14.1, p = 0.0009) showed very highly significant effects on prevalence of mastitis in the present study. Thus, high prevalence was observed in older cows >10 years and cows with parity >7 calves. In general, management practices and hygiene of dairy environment in all studied pastoral associations were very poor. Adequate sanitation of dairy environment, proper attention to health of mammary gland, regular screening tests and awareness of the people of the area about the disease should get emphases as control strategies and antimicrobial sensitivity tests for the isolated bacterial species were recommended for further study.
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