Diarrhoea-associated parasitic infectious agents in AIDS patients within selected Addis Ababa Hospitals

Abstract: The aim of the study was to determine the prevalence of gastrointestinal parasites in Acquired Immunodeficiency Syndrome (AIDS) patients with chronic diarrhea. This prevalence was compared with two control groups: Human Immunodeficiency Virus (HIV) seronegative diarrheal patients and HIV seropositive individuals without diarrhoea. Stool specimens from clinically diagnosed hospitalized AIDS patients in some hospitals in Addis Ababa were screened for parasite infection. Of 147 AIDS patients with chronic diarrhoea, 74 (50.3%) were infected with one kind or more of parasites. Out of 56 non-AIDS (seronegative) diarrhoeal patients, 41.1% (23/56) and out of the 43 non-diarrhoeal (seropositive) patients, 41.9% (18/43) were infected by a variety of intestinal protozoa and helminths. The parasites detected in AIDS patients were Cryptosporidium spp, Isospora spp, Blastocystis spp, Ascaris lumbricoides, Giardia lamblia, Strongyloides stercoralis, Taenia spp, Trichuris trichiura, Entamoeba histolytica, and Hook worm spp. Among the intestinal parasites, Cryptosporidium spp was exclusively associated with AIDS patients. The high proportion of the study subjects who had diarrhoea in the absence of identifiable parasitic infections suggests that other infectious agents (eg. Bacteria and Virus) or mechanisms other than infectious agents, are responsible for the diarrhoea. [Ethiop. J. Health Dev. 1999;13(3):169-173

Evaluation of five commercial assays for detecting HIV 1 & 2 antibodies, Addis Ababa

Abstract: The major operational characteristics of five commercially available assays for the detection of antibodies to Human Immunodeficiency Virus (HIV1 & 2) were evaluated. Four Enzyme Linked Immuno-sorbent assays (ELISAs) and one simple immuno-dot assay with visual reading, were assessed using a panel of 265 sera (18.8% hospital suspected patients, 18.8% commercial sex-workers (CSW), 31.5% blood donor sample (BDS), and 30.9% of them were scholarship winners (SSW)). Sensitivity, specificity, positive predictive value, test efficiency, delta (δ) values (for the four ELISAs) were determined. All the assays had higher sensitivities (98.7100%), specificities (97.2-99.1%), and test efficiencies (98.1-99.6%). Higher positive and negative delta (δ+,δ -) values, +1.17 and –0.99, were observed for ICE*HIV 1-0-2 and Vironostika Uniform II PLUS O, respectively. HIV-SPOT HIV 1 & 2 showed highest value of ease of performance and suitability for small blood bank collection centers. Results of this study showed that the test efficiency, sensitivity, and specificity of the test kits were excellent as compared to the reference test. Further studies on cost-effectiveness and evaluation of newly arrived test kits before use at different levels are recommended. [Ethiop. J. Health Dev. 1999;13(3):175-180

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Development of a Nucleic Acid Sequence-Based Amplification Assay That Uses gag-Based Molecular Beacons To Distinguish between Human Immunodeficiency Virus Type 1 Subtype C and C′ Infections in Ethiopia

A gag-based molecular beacon assay utilizing real-time nucleic acid sequence-based amplification technology has been developed to differentiate between the two genetic subclusters of human immunodeficiency virus type 1 (HIV-1) subtype C (C and C′) circulating in Ethiopia. Of 41 samples, 36 could be classified as C or C′ by sequencing of the gag gene. All 36 isolates were correctly identified by the gag beacon test. Three isolates with genomes that were recombinant in gag were unambiguously typed as belonging to the C′ subcluster. Further analysis revealed that these contained the most sequence homology with a reference subcluster C′ sequence in the target region of the beacon and hence were correct for the analyzed region. For one sample, sequencing and gag molecular beacon results did not match, while another isolate could not be detected at all by the beacon assay. Overall, high levels of sensitivity and specificity were achieved for both beacons (90.5% sensitivity and 100% specificity for the C beacon and 100% sensitivity and 95.2% specificity for the C′ beacon). The availability of a diagnostic test which can quickly and reliably discriminate between C and C′ HIV-1 infections in Ethiopia is an important first step toward studying their respective biological characteristics. As the assay is specific to the Ethiopian HIV-1 subtype C epidemic, it will contribute to characterizing the circulating viruses in this population, thereby generating the information necessary for the development of a potential efficacious HIV-1 vaccine appropriate for the Ethiopian context