Bacterial contamination and antibiogram of isolates from health care workers’ fomites at Felege Hiwot Referral Hospital, northwest Ethiopia

Background: Health care workers’ fomites are highly predisposed to bacterial contamination in the health care setting and are potential sources of hospital-acquired infections. However, there is scarcity of data on the status of bacterial contamination and antibiogram of isolates from HCWs’ fomites in Ethiopia. This study determined the bacterial contamination and antibiogram of isolates from health care workers’ fomites at Felege Hiwot Referral Hospital, Ethiopia.Methods: A cross-sectional study was conducted from February to April 2017 in different wards of the hospital. From 422 health care workers’ fomites, surface samples were swabbed using a simple-rinse method. Data from participants were collected by face-to-face interviews using a structured questionnaire. Bacterial colonies were counted and species were identified using standard bacteriological techniques. Drug susceptibility testing was performed using a disk diffusion technique. Chi-square test was computed to ascertain the association between variables. Regression analysis was computed to identify the independent risk factors.Results: Overall, 243 (57.6%) fomites were contaminated with aerobic bacteria. Working in medical (AOR=5.2, 95% CI=1.85-14.8) and gynecology (AOR=3.1, 95% CI=1.5-6.43) wards and intensive care units (AOR=16, 95% CI=2.1-17.9), and poor laundering of HCWs’ uniforms (AOR=1.3, 95% CI=1.34-3.72), were significantly associated with bacterial contamination. Staphylococcus aureus (19.2%) was the predominant pathogen, followed by Klebsiella pneumoniae (6.4%). The proportion of K. pneumoniae (P<0.001) and E. coli (P=0.014) was significantly highest in mobile phones and white coats, respectively. S. aureus isolates were resistant to penicillin (82.7%) and co-trimoxazole (53.1%). K. pneumoniae isolates were 100% resistant to ampicillin. E. coli isolates were 87.5% resistant to co-trimoxazole. Overall, 204 (88.3%) of the isolates were multidrug-resistant. The overall multidrug-resistant rates among S. aureus, K. pneumoniae and E. coli isolates were 88.9%, 92.6% and 100%, respectively.Conclusions: Bacterial contamination of health care workers’ fomites is a major health care problem in the study area. Multidrug-resistant isolates are alarmingly high in pathogenic bacteria. Therefore, hospital HCWs need to implement proper handling of fomites to reduce contamination and the spread of drug-resistant pathogens. [Ethiop.J. Health Dev. 2019; 33(2):128-141]Keywords: Health care workers, bacterial contamination, antibiogram, fomites, health-care associate infections, Ethiopi

Evaluation of the efficacy of bleach routinely used in health facilities against Mycobacterium tuberculosis isolates in Ethiopia

Introduction: In Ethiopia, the most widely used disinfectant is 5% Hypochlorites. However, Ethiopian national health safety and infection prevention guideline recommendation on the use of bleach is not consistent and varying from 0.1%-4%. The purpose of this study was therefore to assess the effective time-concentration relationship of sodium hypochlorite against Mycobacterium tuberculosis complex isolates in the absence of any organic load. Methods: This experimental study was conducted in Bahir Dar Regional laboratory from February-June 2013. Test suspensions of 1.5 X 108 CFU/ml prepared using normal saline containing 0.5% tween 80. From 5% stock, 0.1%, 0.5%, 1% and 2% bleach was prepared. A 1ml of test strain suspension and 1ml of bleach mixed and allowed to stand until the specified time achieved, neutralized by 48 ml phosphate buffer. 100<l from the diluted sediment were spread on two L-J mediums and incubated at 37°C for 8 weeks. Results: When 0. 1% bleach was used for 10 min, majority 11/20 of isolates showed 3 x 103 CFU/ml growth (ME=4.4) which was inefficient. However, when the time increased, the log10 reduction was acceptable, ME >5 and it was effective. The bleach solution containing 0.5% and above was effective in all respective times. In this study, there is no difference observed in the tuberculocidal activity of bleach against resistant and sensitive strains. Conclusion: Our study showed that in the absence of any organic load, 0.1% bleaches over 15 min and 0.5 % bleaches over 10 min was found to be tuberculocidal.Pan African Medical Journal 2015; 2

Risky sexual behaviour and associated factors among students of Debre Tabor University, Northwest Ethiopia: a cross-sectional study

Introduction: Youth are the foundation of any society. Neglecting their sexual and reproductive health leads to high social and economic crisis. However, there is limited information on the sexual and reproductive health aspects of University students in Ethiopia. Thus, the aim of this study was to assess risky sexual behaviours and associated factors among students of Debre Tabor University.Methods and materials: A cross-sectional survey was conducted between 1February and 30 March 2014 using self-administered structured questionnaire to collect data on socio-demographic, sexual and associated risk behaviours among 394 University students. Descriptive and stepwise logistic regression model was carried out using SPSS version 21. A p value of < 0.05 and 95% CI was considered to test statistical significance.Results: A total of 394 students were enrolled in the study. Among these, 347 (88.1%) provided complete responses. About 97 (28.4%) study participants had sexual experience at the mean age of 18.9 years (SD 1.9 years). Out of these, 59 (62.1%) had sexual contact with their regular friends. Female students under the age of 18 were less likely to start sexual intercourse compared with males [AOR=0.2, 95%CI (0.7-0.9)]. Students who had symptoms of sexually transmitted infection (STI) were 16 times more likely to have early sexual contact compared to those students who had no symptoms [AOR = 16.4, 95% CI (1.4-193]. Not using condom at the first [AOR= 3.2 95%CI (1.2-10.5)] and last [AOR= 3.8, 95%CI (1.2-13.6)] sexual engagement were significant predictors of having multiple sexual partners.Conclusions: This study revealed risky sexual behaviours among Debre Tabor University students. Thus, continuous and intensified public health strategies on health education and reproductive health services are required to address the sexual and reproductive health needs of the students.Key words: Risky sexual behaviours, University students, Debre Tabo

Magnitude and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy among people living with HIV/AIDS in Northwest Ethiopia: a cross - sectional study

<p>Abstract</p> <p>Background</p> <p>Adequate antiretroviral drug potency is essential for obtaining therapeutic benefit, however, the behavioral aspects of proper adherence and readiness to medication, often determine therapeutic outcome. Therefore, this study aimed to assess the level and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy (HAART) among people living with HIV/AIDS (PLWHA) at Gondar University Teaching Hospital and Felege Hiwot Hospital in Northwest Ethiopia.</p> <p>Methods</p> <p>A cross-sectional study was conducted between July and September 2008 using structured interviewer-administered questionnaire. All consecutive adult outpatients who were receiving antiretroviral treatment for at least three months, seen at both hospitals during the study period and able to give informed consent were included in the study. Multivariate logistic regression was used to determine factors associated with nonadherence and nonreadiness.</p> <p>Results</p> <p>A total of 504 study subjects were included in this study. The prevalence rates of nonadherence and nonreadiness to HAART were 87 (17.3%) and 70 (13.9%) respectively. Multivariate logistic regression analysis revealed that medication adverse effects, nonreadiness to HAART, contact with psychiatric care service and having no goal had statistically significant association with nonadherence. Moreover, unwillingness to disclose HIV status was significantly associated with nonreadiness to HAART.</p> <p>Conclusions</p> <p>In this study the level of nonadherence and nonreadiness to HAART seems to be encouraging. Several factors associated with nonadherance and nonreadiness to HAART were identified. Efforts to minimize nonadherence and nonreadiness to HAART should be integrated in to regular clinical follow up of patients.</p

Survival of patients in the intensive care units of referral hospitals in Amhara Region: A prospective cohort study

Background: An intensive care unit (ICU) is a place where critically ill patients are managed using life-saving interventions. Evidence regarding ICUs like average days of stay, and what caused the patients to delay in the ward were scarce in resource-limited settings such as Ethiopia. The objectives of this study were to assess the survival of patients in ICUs, the incidence density for discharge with prognosis, and the determinants of ICU stay in five referral hospitals in Amhara Region. Methods and materials: To implement the prospective cohort study design, baseline data were recorded from patients’ charts at the time of admission to the ICUs of the five referral hospitals. Patients’ status was followed every day for a maximum of nine days. Interviews and chart reviews were used to collect the data. A Kaplan–Meier curve was used to estimate the time of patients’ discharge from the ICU. A Cox proportional hazard model (Weibull) was used to identify the predictors of ICU stay. Results: A total of 2,789 patients were included; the incidence density of discharge with prognosis was 1,962/12,448 person days. The length of ICU stay was determined by patient-to-nurse ratio (AHR = 0.59 [95% CI: 0.56-0.64]), chronic illness (AHR = 0.93 [95% CI: 0.88-0.98]), hemoglobin concentration (AHR = 1.09 [95% CI: 1.05-1.14]), ICU area-to-bed ratio (AHR = 1.14 [95% CI: 1.06-1.22]), nosocomial infection (AHR = 0.47 [95% CI: 0.37-0.59]), tracheotomy (AHR = &nbsp;1.12 [95% CI: 1.01-1.24]), time of admission (AHR = 0.83 [95% CI: 0.75-0.93]), and formal education (AHR = 0.72 [95% CI: 0.64-0.80]). Conclusions and recommendations: Decision makers in Ethiopia should give high priority to ICU infrastructure and to increasing the number of nurses in ICU wards. [Ethiop. J. Health Dev. 2020; 34(1):30-34] Key words: Critical care, Intensive care, predictors, resource-limited settin

The epidemiology of smear positive pulmonary tuberculosis at Felege Hiwot Referral Hospital, Northwest Ethiopia: A five year retrospective study

Background: Globally, tuberculosis (TB) continues to cause considerable morbidity and mortality. Ethiopia is among the 22 high TB burden countries reported. Currently, data regarding the magnitude of TB and associated factors have been released at different health facilities as part of service auditing. However, such data are not universally available that this study was carried out to determine the prevalence of smear positive tuberculosis and its associated risk factors at FelegeHiwot Referral Hospital (FHRH) over a period of five years.Methods: We analyzed all the records of 12,442 presumptive TB patients registered at FHRH from 2011 to 2015. Data on patient’s sex, age, residential address and sputum smear microscopy results were extracted from laboratory registration logbook. All data were entered, cleaned and analyzed using SPSS version 22 for windows. The proportion and trend of smear positive TB over the five years period was calculated and the overall prevalence of TB in these years was determined. Logistic regression model was used to analyze the association between TB positivity and potential associated variables; p &lt; 0.05 was considered to be significant.Results: TB suspected patients were found to be characterized as male 7052 (56.7%), within the age group of 15-29 years of age 4105 (33.0%) and were from rural settings7841 (63.0). The number of presumptive TB patients visiting FHRH over the five years period was quite variable. However, the prevalence of smear positive TB in each year was almost consistent, ranging from 4.2% to 6.5%. The prevalence of smear positive TB among new and follow up patients was at 5.2% and 4.5%, respectively. The proportion of overall burden of smear positive pulmonary TB was estimated at 5.2% and was found significantly associated with age group between 15-29 (AOR: 0.45, 95% CI, 0.23-0.77), 30-44 (AOR:0.22, 95% CI, 0.15-0.32) and 45-59 (AOR:0.38, 95% CI, 0.26-0.56).Conclusions: In the studied area high prevalence of smear positive TB was documented over the five years period; which implies inconsistent measures being taken to reduce the burden of the disease. Hence, interventions to decrease prevalence of TB and thereby its impacts need to be evaluated and strengthened. [Ethiop. J. Health Dev. 2017;31(3):155-160]Keywords: TB, Trend, Felege Hiwot Referral Hospita

Tuberculosis Lymphadenitis and Human Immunodeficiency Virus Co-infections among Lymphadenitis Patients in Northwest Ethiopia

BACKGROUND: Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in NorthwestEthiopia.METHODS: Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P&lt;0. 05.RESULTS: A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007).CONCLUSION: Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision

Drug resistance patterns of bacterial isolates from infected wounds at Bahir Dar Regional Health Research Laboratory Center, Northwest Ethiopia

Background: An increased antibiotic resistance of bacterial isolates from wound infections is a major therapeutic challenge. The aim of this study was to identify bacterial isolates associated with wound infection and to determine their current antimicrobial susceptibility profile.Methods: This is a retrospective cross-sectional study in which we analyzed the records of 380 wound swab culture results that have been processed at Bahir Dar Regional Health Research Laboratory Center in the period of 1 January 2013 to 30 December 2015. Swabs from different wound types were collected aseptically and analyzed using standard bacteriological procedures. Antimicrobial susceptibility testing was performed using disc diffusion technique as per the standard protocol. Demographic and bacteriological data were collected using a data extraction sheet. The data were cleaned, entered and analyzed using SPSS version 22.Results: The overall bacterial isolation rate was at 61.6% (234/380). More than half 123 (52.6%) of the isolates were gram positive and 111 (47.4%) were gram negatives. The predominant isolates were S. aureus at 100 (42.7%) followed by E. coli, 33 (14.1%), P. aeruginosa, 26 (11.1%) and S. pyogenes, at 23 (9.8%). The proportion of multidrug resistant (MDR) bacterial pathogens was at 54.3%. Out of these, 35 (15.1%) of the isolates were resistant to more than five drugs. The highest resistance rate at (85.9%) was documented for ampicillin by gram-negative isolates. Whereas the highest resistance rate among gram positive isolates was against erythromycin (31.1%). The resistance rate of S. aureus for penicillin was at 69.7%.Conclusions: High frequency of mono and multi-drug resistant bacterial pathogens were documented. Thus, an alternative method to the causative agent and antimicrobial susceptibility testing surveillance in areas where there is no culture facility is needed to assist health professionals for the selection of appropriate antibiotics. [Ethiop. J. Health Dev. 2016;30(3):112-117]Keywords: Wound infection, bacterial isolates, and antimicrobial susceptibility profil

Mycobacterium tuberculosis Affects Protein and Lipid Content of Circulating Exosomes in Infected Patients Depending on Tuberculosis Disease State

Tuberculosis (TB), which is caused by the bacterium Mycobacterium tuberculosis (Mtb), is still one of the deadliest infectious diseases. Understanding how the host and pathogen interact in active TB will have a significant impact on global TB control efforts. Exosomes are increasingly recognized as a means of cell-to-cell contact and exchange of soluble mediators. In the case of TB, exosomes are released from the bacillus and infected cells. In the present study, a comprehensive lipidomics and proteomics analysis of size exclusion chromatography-isolated plasma-derived exosomes from patients with TB lymphadenitis (TBL) and treated as well as untreated pulmonary TB (PTB) was performed to elucidate the possibility to utilize exosomes in diagnostics and knowledge building. According to our findings, exosome-derived lipids and proteins originate from both the host and Mtb in the plasma of active TB patients. Exosomes from all patients are mostly composed of sphingomyelins (SM), phosphatidylcholines, phosphatidylinositols, free fatty acids, triacylglycerols (TAG), and cholesterylesters. Relative proportions of, e.g., SMs and TAGs, vary depending on the disease or treatment state and could be linked to Mtb pathogenesis and dormancy. We identified three proteins of Mtb origin: DNA-directed RNA polymerase subunit beta (RpoC), Diacyglycerol O-acyltransferase (Rv2285), and Formate hydrogenase (HycE), the latter of which was discovered to be differently expressed in TBL patients. Furthermore, we discovered that Mtb infection alters the host protein composition of circulating exosomes, significantly affecting a total of 37 proteins. All TB patients had low levels of apolipoproteins, as well as the antibacterial proteins cathelicidin, Scavenger Receptor Cysteine Rich Family Member (SSC5D), and Ficolin 3 (FCN3). When compared to healthy controls, the protein profiles of PTB and TBL were substantially linked, with 14 proteins being coregulated. However, adhesion proteins (integrins, Intercellular adhesion molecule 2 (ICAM2), CD151, Proteoglycan 4 (PRG4)) were shown to be more prevalent in PTB patients, while immunoglobulins, Complement component 1r (C1R), and Glutamate receptor-interacting protein 1 (GRIP1) were found to be more abundant in TBL patients, respectively. This study could confirm findings from previous reports and uncover novel molecular profiles not previously in focus of TB research. However, we applied a minimally invasive sampling and analysis of circulating exosomes in TB patients. Based on the findings given here, future studies into host–pathogen interactions could pave the way for the development of new vaccines and therapies

Health impacts of bedbug infestation: A case of five towns in Amhara Region, Ethiopia

Background: Bedbug is a wingless human blood-sucking bug that generally infests houses and beds. Bedbug infestation is prevalent across the country. Despite its prevalence, however, there is scarce information on the epidemiological, psychological, social and public health impacts of the infestation. This lack may arise from the absence of sufficient research in the area. The impetus for this study arose from this recognition. This study therefore assessed the extent of bedbug infestation in five towns in Amhara Regional State, Ethiopia, and its impact on public health in the areas considered in this study.Methods: A community-based cross sectional study was conducted in five towns of Amhara Regional State from 1 March 2015 to 30 June 2016. Bedbug inspection was done following the Michigan manual for prevention and control of bedbug recommendation. The presence of a living or dead bedbugs, their eggs, their skin discarded in shedding, and their fecal stains or droppings were taken as an infestation. In addition, data from households were collected using pretested, structured and interviewer-administered questionnaire. The data were analyzed using SPSS version 20. Both bivariate and multivariate logistic regressions were computed to identify associated factors.Results: From the 203 residential institutions surveyed, evidence of prevalence of bedbugs was located in 75.9% (154) houses. From among the infested residents, 87%, 83.1%, and 71.4% had faced one or more psychological, social and health impacts, respectively. Residential institutions in Bahir Dar town administration were 3.4 times more likely to be infested by bedbug than those in Amanuel town (AOR: 3.4; 95% CI: 1-11). The chances that residents of Kobo town administration had to be infested by bedbug were 41 times more than that of the residents in Amanuel town (AOR: 41; 95%CI: 8-206). However, no statistically significant difference was observed between the rates of bedbug infestation and the type of residential institutions.Conclusions: Bedbug infestation was found to be a major public health problem in Bahir Dar, Woreta and Kobo towns. A significant psychological, social and health impact was observed in the communities. Thus, aggressive public health promotion campaigns against bedbug are recommended to empower the communities and equip them with preventive strategies. Moreover, an effective pest management strategy also needs to be made a priority health agenda, in the particular areas of study. A larger study is recommended to assess more in-depth impacts of bedbug infestation on public health [Ethiop. J. Health Dev. 2017;31(4):251-258]Keywords: Bedbug infestation, Ethiopi