Microbiological assessment of drinking water with reference to diarrheagenic bacterial pathogens in Shashemane Rural District, Ethiopia

Fecal contamination of drinking water is a major problem in rural communities of Ethiopia, where surface water sources like rivers, wells, and lakes are used for drinking. In spite of these problems, few data exist on the microbiological safety of water sources in these settings. Therefore, the aim of this study was to investigate the microbiological safety of drinking water from the sources and households in selected communities of Shashemane rural district, Ethiopia. A descriptive analytic study was used to examine the bacteriological quality of drinking water from sources and household containers. Data on water collection and storage practices were collected using structured questionnaires. Water samples were collected according to the WHO Guidelines for drinking water quality assessment from surface and ground water sources which are used directly for drinking purpose in the community. Water samples were examined for total coliforms and fecal coliforms using the most probable number methods. The detection of Escherichia coli, Salmonella, Shigella, and Vibrio cholerae were assessed by biochemical tests. Total coliforms were detected in higher proportion in all water source samples. Fecal coliform contamination was detected in all water sources, except in hand pipes. E. coli, Salmonella and Shigella species were detected in water samples from river and wells. Total coliforms, fecal coliforms, E. coli and Salmonella spp. were also detected in water samples from households. The bacteriological load of the sampled water from source and households was found to be higher than the maximum value set for drinking water. Therefore, enabling the community access to potable water through encouraging construction of toilets, creating proper domestic and animal waste disposal system and rendering health education and sanitation practices for the community is recommended

Microbiological assessment of drinking water with reference to diarrheagenic bacterial pathogens in Shashemane Rural District, Ethiopia

Fecal contamination of drinking water is a major problem in rural communities of Ethiopia, where surface water sources like rivers, wells, and lakes are used for drinking. In spite of these problems, few data exist on the microbiological safety of water sources in these settings. Therefore, the aim of this study was to investigate the microbiological safety of drinking water from the sources and households in selected communities of Shashemane rural district, Ethiopia. A descriptive analytic study was used to examine the bacteriological quality of drinking water from sources and household containers. Data on water collection and storage practices were collected using structured questionnaires. Water samples were collected according to the WHO Guidelines for drinking water quality assessment from surface and ground water sources which are used directly for drinking purpose in the community. Water samples were examined for total coliforms and fecal coliforms using the most probable number methods. The detection of Escherichia coli, Salmonella, Shigella, and Vibrio cholerae were assessed by biochemical tests. Total coliforms were detected in higher proportion in all water source samples. Fecal coliform contamination was detected in all water sources, except in hand pipes. E. coli, Salmonella and Shigella species were detected in water samples from river and wells. Total coliforms, fecal coliforms, E. coli and Salmonella spp. were also detected in water samples from households. The bacteriological load of the sampled water from source and households was found to be higher than the maximum value set for drinking water. Therefore, enabling the community access to potable water through encouraging construction of toilets, creating proper domestic and animal waste disposal system and rendering health education and sanitation practices for the community is recommended

New Insight into the Pathogenesis of Erythema Nodosum Leprosum: The Role of Activated Memory T-Cells.

Memory T-cells, particularly, effector memory T cells are implicated in the pathogenesis of inflammatory diseases and may contribute to tissue injury and disease progression. Although erythema nodosum leprosum (ENL) is an inflammatory complication of leprosy, the role of memory T cell subsets has never been studied in this patient group. The aim of this study was at investigate the kinetics of memory T cell subsets in patients with ENL before and after prednisolone treatment. A case-control study design was used to recruit 35 untreated patients with ENL and 25 non-reactional lepromatous leprosy (LL) patient controls at ALERT Hospital, Ethiopia. Venous blood samples were obtained before, during, and after treatment from each patient. Peripheral blood mononuclear cells (PBMCs) were isolated and used for immunophenotyping of T cell activation and memory T-cell subsets by flow cytometry. The kinetics of these immune cells in patients with ENL before and after treatment were compared with LL patient controls as well as within ENL cases at different time points. The median percentage of CD3+, CD4+, and CD8+ T-cells expressing activated T-cells were significantly higher in the PBMCs from patients with ENL than from LL patient controls before treatment. The median percentage of central and activated memory T-cells was significantly increased in patients with ENL compared to LL patient controls before treatment. Interestingly, patients with ENL had a lower percentage of naïve T cells (27.7%) compared to LL patient controls (59.5%) (P < 0.0001) before treatment. However, after prednisolone treatment, patients with ENL had a higher median percentage of naïve T-cells (43.0%) than LL controls (33.0%) (P < 0.001). The median percentage of activated T-cells (effector memory and effector T-cells) was significantly increased in patients with ENL (59.2%) before treatment compared to after treatment with prednisolone (33.9%) (P < 0.005). This is the first work which has shown T-cell activation and the different subsets of memory T cells in untreated patients with ENL. Consequently, this study delineates the role of T-cell activation in the pathogenesis of ENL reaction and challenges the long-standing dogma of immune complex as a sole etiology of ENL reaction

The Microbiology of Teff (Eragrostis Tef) Enjera

Enjera, an indigenous Ethiopian pancake is the one of the staple foods of Ethiopians. There is few information available concerning the succession and activities of microflora of its fermentation. Therefore this study was carried out to assess the microbiology of teff enjera. A total of 34 samples from “kuncho” and “Magna” enjera batter were collected during 96 hr fermentation at 6 hr intervals.“Kuncho” and “Magna” were bought from Debrezeit Agriculture Research Center and from Hawassa open market, respectively. Samples were analysed for changes in pH, titratable acidity (TA) and microbial count. The pH decreased with increasing TA during “kuncho” and “Magna” teff enjera batter fermentation. Total aerobic mesophilic count, LAB and yeast increasedby about 3 log cycles until 48 hr fermentation, while Enterobacteriaceae were reduced below detectable levels after 18 hr due to the low pH of the teff batter. Generally, the pH, TA and microbial count of enjera from the two cultivars of teff batter were not different

The Effects of Prednisolone Treatment on Cytokine Expression in Patients with Erythema Nodosum Leprosum Reactions.

Erythema nodosum leprosum (ENL) is a systemic inflammatory complication occurring mainly in patients with lepromatous leprosy (LL) and borderline lepromatous leprosy. Prednisolone is widely used for treatment of ENL reactions but clinical improvement varies. However, there is little good in vivo data as to the effect of prednisolone treatment on the pro-inflammatory cytokines in patients with ENL reactions. As a result, treatment and management of reactional and post-reactional episodes of ENL often pose a therapeutic challenge. We investigated the effect of prednisolone treatment on the inflammatory cytokines TNF, IFN-γ, IL-1β, IL-6, and IL-17 and the regulatory cytokines IL-10 and TGF-β in the skin lesion and blood of patients with ENL and compared with non-reactional LL patient controls. A case-control study was employed to recruit 30 patients with ENL and 30 non-reactional LL patient controls at ALERT Hospital, Ethiopia. Blood and skin biopsy samples were obtained from each patient before and after prednisolone treatment. Peripheral blood mononuclear cells from patients with ENL cases and LL controls were cultured with M. leprae whole-cell sonicates (MLWCS), phytohemagglutinin or no stimulation for 6 days. The supernatants were assessed with the enzyme-linked immunosorbent assay for inflammatory and regulatory cytokines. For cytokine gene expression, mRNA was isolated from whole blood and skin lesions and then reverse transcribed into cDNA. The mRNA gene expression was quantified on a Light Cycler using real-time PCR assays specific to TNF, IFN-γ, IL-β, TGF-β, IL-17A, IL-6, IL-8, and IL-10. The ex vivo production of the cytokines: TNF, IFN-γ, IL-1β, and IL-17A was significantly increased in untreated patients with ENL. However, IL-10 production was significantly lower in untreated patients with ENL and significantly increased after treatment. The ex vivo production of IL-6 and IL-8 in patients with ENL did not show statistically significant differences before and after prednisolone treatment. The mRNA expression in blood and skin lesion for TNF, IFN-γ, IL-1β, IL-6, and IL-17A significantly reduced in patients with ENL after treatment, while mRNA expression for IL-10 and TGF-β was significantly increased both in blood and skin lesion after treatment. This is the first study examining the effect of prednisolone on the kinetics of inflammatory and regulatory cytokines in patients with ENL reactions before and after prednisolone treatment. Our findings suggest that prednisolone modulates the pro-inflammatory cytokines studied here either directly or through suppression of the immune cells producing these inflammatory cytokines

Knowledge and self-care practice of leprosy patients at ALERT Hospital, Ethiopia

Summary Introduction: In addition to multi-drug treatment, patient self-care practice is crucial for the successful treatment of the disease. This study assessed the knowledge and self-care practices of leprosy patients at ALERT leprosy referral hospital in Ethiopia. Methods: A total of 424 leprosy patients were interviewed using pre-tested structured questionnaires. The questionnaires included core points such as sociodemographic characteristics, knowledge of leprosy and self-care practices. Bloom’s cut off point was used to describe the knowledge and self-care practices of the respondents and statistical significance was assessed at 95% confidence interval with 5% of level of significance. Results: The knowledge score of the respondents was poor for 276 (65·1%) and good for 148 (34·9%). The level of knowledge varied significantly with respect to age group (p , 0·01), sex (p , 0·01), marital status (p ¼ 0·003), educational status (p , 0·01) and income (p , 0·01). About 77·4% of interviewed patients had poor self-care practices and only 22·6 of patients had a good self-care practice score (p , 0·01). Age (p ¼ 0·002), previous disability due to leprosy (p , 0·01), knowledge of leprosy (p ¼ 0·038) and income (P ¼ 0·028), were significantly associated with poor selfcare practice. Conclusion: Although leprosy treatment, disability prevention and rehabilitation programs have been run in the country for decades, poor leprosy self-care practice and poor leprosy knowledge has been confirmed in this study. Therefore, the leprosy program should re-visit its strategy and mode of delivery to improve the leprosy knowledge and leprosy self-care practices of patients

Increased activated memory B-cells in the peripheral blood of patients with erythema nodosum leprosum reactions.

B-cells, in addition to antibody secretion, have emerged increasingly as effector and immunoregulatory cells in several chronic inflammatory diseases. Although Erythema Nodosum Leprosum (ENL) is an inflammatory complication of leprosy, the role of B- cell subsets has never been studied in this patient group. Therefore, it would be interesting to examine the contribution of B-cells in the pathogenesis of ENL. A case-control study design was used to recruit 30 untreated patients with ENL and 30 non-reactional lepromatous leprosy (LL) patient controls at ALERT Hospital, Ethiopia. Peripheral blood samples were obtained before, during and after treatment from each patient. Peripheral blood mononuclear cells (PBMCs) were isolated and used for immunophenotyping of B- cell subsets by flow cytometry. The kinetics of B-cells in patients with ENL before, during and after Prednisolone treatment of ENL was compared with LL patient controls as well as within ENL group. Total B-cells, mature B-cells and resting memory B-cells were not significantly different between patients with ENL reactions and LL controls before treatment. Interestingly, while the percentage of naive B-cells was significantly lower in untreated ENL patients than in LL patient controls, the percentage of activated memory B-cells was significantly higher in these untreated ENL patients than in LL controls. On the other hand, the percentage of tissue-like memory B-cells was considerably low in untreated ENL patients compared to LL controls. It appears that the lower frequency of tissue-like memory B-cells in untreated ENL could promote the B-cell/T-cell interaction in these patients through downregulation of inhibitory molecules unlike in LL patients. Conversely, the increased production of activated memory B-cells in ENL patients could imply the scale up of immune activation through antigen presentation to T-cells. However, the generation and differential function of these memory B-cells need further investigation. The finding of increased percentage of activated memory B-cells in untreated patients with ENL reactions suggests the association of these cells with the ENL pathology. The mechanism by which inflammatory reactions like ENL affecting these memory cells and contributing to the disease pathology is an interesting area to be explored for and could lead to the development of novel and highly efficacious drug for ENL treatment

Performance of general health workers in leprosy control activities at public health facilities in Amhara and Oromia States, Ethiopia.

BACKGROUND: Leprosy is a chronic infectious disease of public health importance and one of the leading causes of permanent physical disability. Nevertheless, the drop in prevalence following multidrug therapy has resulted in the neglect of leprosy. The annual incidence of leprosy has remained the same in Ethiopia since decades with more than 76% of the reported new cases coming from Oromia and Amhara Regional States. This study was aimed to assess the knowledge, attitude and skill of general health workers in leprosy control activities at public health facilities in Oromia and Amhara Regional States. METHODS: A cross-sectional study was conducted from September 2011 to February 2012 at different public health facilities in selected eight zones in Oromia and Amhara Regional States. A multistage sampling method was used to obtain representative samples. High and low endemic zones for leprosy were included in the study in both regional states. Data were collected from general health workers through a structured self-administered questionnaire and at on-site assessment of their performance. Baseline socio-demographic data, health workers' attitude towards leprosy and their knowledge and skill in the management of leprosy were assessed. Bloom's cut off point was used to describe the knowledge and practical skills of the respondents while Likert's scale was used for attitude assessment. RESULT: A total of 601 general health workers responsible for leprosy control activities at public health facilities were included in knowledge and attitude assessment and 83 of them were subjected to practical evaluation, with on-site observation of how they handle leprosy patients. These included medical doctors (4%), health officers and nurses with Bachelor degree in Science (27%), clinical nurses with diploma (66%) and health assistants (2.8%). The median age of the respondents was 26.0 years and females made up of 45%. Generally the knowledge and skills of the respondents were found to be poor while attitude towards leprosy was positive for the majority of the respondents. The result showed that 519 (86.3%) had poor knowledge. Overall 155 (25.8%) of the respondents had positive attitude towards leprosy while 205 (34.1%) had intermediate (mixed) attitude and 241 (40.1%) had negative attitude to the disease. Among 83 respondents assessed for diagnosis of leprosy only 15(18.0%) diagnosed leprosy correctly. Variation in knowledge and attitude indicated a significant difference (p < 0.05) among different health institutions, professions, gender, in-service training and years of experience. CONCLUSION: The current finding underlines that although leprosy control activities are integrated to the general health services in the country, the knowledge and skills of leprosy diagnosis, treatment and management by health workers was unsatisfactory. Hence, attention should be given to develop training strategies that can improve health worker knowledge and promote better leprosy management at public health facilities. This could be achieved through pre-service and in-service training and giving adequate emphasis to leprosy related practical work and continuous follow- up

Clinico-pathological features of erythema nodosum leprosum: A case-control study at ALERT hospital, Ethiopia.

BACKGROUND: Leprosy reactions are a significant cause of morbidity in leprosy population. Erythema nodosum leprosum (ENL) is an immunological complication affecting approximately 50% of patients with lepromatous leprosy (LL) and 10% of borderline lepromatous (BL) leprosy. ENL is associated with clinical features such as skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. ENL is treated mainly with corticosteroids and corticosteroids are often required for extended periods of time which may lead to serious adverse effects. High mortality rate and increased morbidity associated with corticosteroid treatment of ENL has been reported. For improved and evidence-based treatment of ENL, documenting the systems affected by ENL is important. We report here the clinical features of ENL in a cohort of patients with acute ENL who were recruited for a clinico-pathological study before and after prednisolone treatment. MATERIALS AND METHODS: A case-control study was performed at ALERT hospital, Ethiopia. Forty-six LL patients with ENL and 31 non-reactional LL matched controls were enrolled to the study and followed for 28 weeks. Clinical features were systematically documented at three visits (before, during and after predinsolone treatment of ENL cases) using a specifically designed form. Skin biopsy samples were obtained from each patient before and after treatment and used for histopathological investigations to supplement the clinical data. RESULTS: Pain was the most common symptom reported (98%) by patients with ENL. Eighty percent of them had reported skin pain and more than 70% had nerve and joint pain at enrolment. About 40% of the patients developed chronic ENL. Most individuals 95.7% had nodular skin lesions. Over half of patients with ENL had old nerve function impairment (NFI) while 13% had new NFI at enrolment. Facial and limb oedema were present in 60% patients. Regarding pathological findings before treatment, dermal neutrophilic infiltration was noted in 58.8% of patients with ENL compared to 14.3% in LL controls. Only 14.7% patients with ENL had evidence of vasculitis at enrolment. CONCLUSION: In our study, painful nodular skin lesions were present in all ENL patients. Only 58% patients had dermal polymorphonuclear cell infiltration showing that not all clinically confirmed ENL cases have neutrophilic infiltration in lesions. Very few patients had histological evidence of vasculitis. Many patients developed chronic ENL and these patients require inpatient corticosteroid treatment for extended periods which challenges the health service facility in resource poor settings, as well as the patient's quality of life