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Background: Providing medical care for non-communicable diseases (NCDs) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). The reasons for this are poorly understood.Objective: To investigate LTFU among patients with two different but common NCDs who attended rural Ethiopian health centres.Method: The study was based in five health centres in southern Ethiopia with established NCD clinics run by nurses and health officers. Patients with epilepsy or hypertension who were lost to follow-up and non-LTFU comparison patients were identified and traced; a questionnaire was administered enquiring about the reasons for LTFU.Results: Of the 147 LTFU patients successfully located, 62 had died, moved away or were attending other medical facilities. The remaining 85 patients were compared with 211 non-LFTU patients. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments, together with a misunderstanding of the nature of NCD management.Conclusions: The delivery of affordable care closer to the patients' homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.

Background : Providing health care for patients with hypertension has been difficult in rural areas of sub-Saharan Africa because of lack of medical staff and facilities. The use of non-physician healthcare workers offers a possible solution, but little is known about the feasibility and clinical response to treatment. Methods : We carried out a descriptive, retrospective review of the records of a sequential sample of 249 hypertensive patients aged 52.3 (SD 12.7) years from eight health centres in a rural area of southern Ethiopia where nurses and health officers had been previously trained to diagnose, treat and manage non-communicable diseases including hypertension. The study evaluated the changes in systolic and diastolic blood pressures following treatment over a 30 month period. Results : The mean systolic blood pressure on admission was 156.1(SD 21.1) mm Hg and the mean diastolic pressure 95.7(SD 12.7) mm Hg. Of the 249 subjects, 105(42.1%) defaulted from clinic follow-up during the period of the study. More than half (53.8%) were controlled on monotherapy with a thiazide diuretic, the remainder required combination therapy. Significant declines in systolic and diastolic blood pressure were achieved in each blood pressure group with the exception of the lowest pressure groups. Conclusion : Our study demonstrates that nurses and heath officers working in remote rural health centres can obtain worthwhile reductions in blood pressure in patients with hypertension. Moreover, this could often be achieved with a single, inexpensive diuretic, hydrochlorthiazide, although combination therapy was sometimes required. [Ethiop. J. Health Dev. 2018; 32(2):104-109] Key words : Hypertension, blood pressure, task-shifting, delivery of health care, nurses, Ethiopia.

Proposed changes to junior doctors' contracts working within the NHS have been met with fierce opposition, attracting widespread media coverage in recent weeks. Heavy criticism of the changes has led to a stall in negotiations and threats of possible industrial action led by the British Medical Association.1British Medical AssociationJunior doctor contract. 10 reasons why we are not re-entering negotiations.http://bma.org.uk/working-for-change/in-depth-junior-and-consultant-contract/ddrb-recommendations-analysis-for-juniors/10-reasons-for-not-reentering-2015-junior-contract-negotiationsGoogle Scholar Several Royal Colleges have also called on the government to reassess its position, citing longer working hours and reducing pay as detrimental to staff morale and patient safety.2Letter from medical Royal College presidents to Jeremy HuntThe Guardian.http://www.theguardian.com/society/2015/sep/24/letter-from-medical-royal-college-presidents-to-jeremy-hunt-in-fullGoogle Scholar Most of the reaction has centred on the physical and financial effects this proposal will have on junior doctors, although there has been limited emphasis on the wider long-term effects and unintended consequences that will prevent the NHS meeting the demands of patients in the future. The proposed contract penalises clinicians who take time out of their training to pursue their interests in research or elsewhere, as they will no longer receive annual wage increments on returning to clinical practice.3Bagenal J Moberly T Godlee F Problems with the new junior doctor contract.BMJ. 2015; 351: h5077Crossref PubMed Scopus (7) Google Scholar Alternative career routes will become increasingly undesirable given the pressure to complete protracted specialty training programmes even faster. This approach will deter clinicians from engaging in cutting-edge research to pioneer new treatments which is necessary to maintain the NHS' reputation as a world-class health system. Doctors who embark on leadership pathways might also be affected despite the growing need for clinical leaders, as set out in the NHS Five Year Forward View.4The LancetFuture plans for the NHS.Lancet. 2014; 384: 1549Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Furthermore, removing pay protection for women on maternity leave could potentially widen gender inequalities and discourage female students from embarking on a career in medicine, exacerbating staff shortages in the future. The changes will also have serious implications to global health and surgery. Junior doctors often travel abroad to not only develop their clinical skills but also contribute as global citizens committed to realising the new Sustainable Development Goals. Such cross-cultural professional experience enables them to give back much more to the NHS when they return and also cogently expresses the government's commitment to the developing world. In conclusion, the junior doctor contract in its proposed form will create a homogeneous workforce that will be insular and stagnant. Our workforce must be diverse, multitalented and multifaceted to meet the complex needs of the future. We declare no competing interests.

Journal Article Ann Crichton-Harris, Poison in Small Measure: Dr Christopherson and the Cure of Bilharzia Get access Ann Crichton-Harris, Poison in Small Measure: Dr Christopherson and the Cure of Bilharzia, Leiden: Brill, 2009. Pp xx + 428. $99. ISBN 978 90 04 37541 9. Eldryd Parry Eldryd Parry London School of Hygiene and Tropical Medicine Eldryd@thet.org Search for other works by this author on: Oxford Academic PubMed Google Scholar Social History of Medicine, Volume 23, Issue 3, December 2010, Pages 696–697, https://doi.org/10.1093/shm/hkq078 Published: 02 November 2010

Background/Objectives: Most insulin-requiring diabetes patients in Ethiopia have an atypical form of the disease, which resembles previous descriptions of malnutrition-related diabetes. As so little is known about its aetiology, we have carried out a case–control study to evaluate its social and nutritional determinants. Subjects/Methods: Men and women with insulin-requiring diabetes ( n =107), aged 18–40 years, were recruited in two centres, Gondar and Jimma, 750 km northwest and 330 km southwest of the capital, Addis Ababa, respectively. Controls of similar age and sex ( n =110) were recruited from patients attending other hospital clinics. Results: Diabetes was strongly associated with subsistence farming, odds ratio=3.5 (95% confidence interval: 1.5–7.8) and illiteracy/low levels of education, odds ratio=4.0 (2.0–8.0). Diabetes was also linked with a history of childhood malnutrition, odds ratio=5.5 (1.0–29.0) the mother's death during childhood, odds ratio=3.9 (1.0–14.8), and markers of poverty including poorer access to sanitation ( P =0.004), clean water ( P =0.009), greater overcrowding ( P =0.04), increased distance from the clinic ( P =0.01) and having fewer possessions ( P =0.01). Compared with controls, people with diabetes had low mid upper arm circumference, body mass index (BMI) and fat/lean body mass ( P <0.01). In addition, men with the disease tended to be shorter, were lighter ( P =0.001), with reduced sitting height ( P =0.015) and reduced biacromial ( P =0.003) and bitrochanteric ( P =0.008) diameters. Conclusions: Insulin-requiring diabetes in Ethiopia is strongly linked with poor education and markers of poverty. Men with the disease have associated disproportionate skeletal growth. These findings point towards a nutritional aetiology for this condition although the nature of the nutritional deficiency and its timing during growth and development remains obscure.

Rheumatic fever (RF) and rheumatic heart disease (RHD) are a major public health concern for many developing countries (1, 2, 3). While epidemiological trends of RF and RHD have progressively declined in economically developed countries over the past 50 years, they continue to increase at a striking rate in the developing world (4). Linked to poverty and poor access to health care facilities, estimates suggest that roughly 50% of cardiac patients in less developed countries have RF or RHD(5). To limit the progression of the disease, the World Health Organization recommends that patients take monthly treatment of penicillin (5). However, adherence to monthly treatment is not easy for poor populations who struggle to meet the costs and constraints required to seek treatment. In Ethiopia, RF/RHD are the major cause of cardiac pathology (6). Rates continue to increase as a result of minimal diagnostic assessments and low attendance for monthly follow-up treatment; issues which are further exacerbated in rural areas (5). To improve health service provision, this study sought to identify the factors that influence RF and RHD patients‟ decision to seek treatment in Jimma, Ethiopia. The principles of grounded theory were used to heighten the understanding of patient treatment seeking in this context. It is intended that these results will provide an in-depth understanding of patient needs and experiences related to seeking treatment and guide the improvement of health care services for RF/RHD patients in rural areas.

We evaluated the incidence of insulin-requiring diabetes in a rural area of sub-Saharan Africa.

The pathologist Jack N. P. Davies identified endomyocardial fibrosis in Uganda in 1947. Since that time, reports of this restrictive cardiomyopathy have come from other parts of tropical Africa, South Asia, and South America. In Kampala, the disease accounts for 20% of heart disease patients referred for echocardiography. We conducted a systematic review of research on the epidemiology and etiology of endomyocardial fibrosis. We relied primarily on articles in the MEDLINE database with either "endomyocardial fibrosis" or "endomyocardial sclerosis" in the title. The volume of publications on endomyocardial fibrosis has declined since the 1980s. Despite several hypotheses regarding cause, no account of the etiology of this disease has yet fully explained its unique geographical distribution.