The prevalence and antimicrobial responses of Shigella isolates in HIV-1 infected and uninfected adult diarrhoea patients in north west Ethiopia

Background: Shigella is one of the diarrhoea causing organisms found in HIV positive patients. But so far, the pattern of diarrhoeal agents caused by Shigella in AIDS patients has not been determined. Objective: This study is thus aimed at determining the prevalence, antimicrobial susceptibility and resistance of Shigella isolates in HIV positive subjects. Methods: All stool samples taken from the subjects of this study were plated on the MacConkey agar and incubated at 35-37oC for 24 or 48 hrs. Biochemical and antimicrobial sensitivity testing were carried out by using the standard methods. Results: Out of the 391 subjects included in the study, 199(63.8%) HIV seropositive and 113 seronegative patients had acute and chronic diarrhoea while 79 were HIV seropositive without diarrhoea. Of the 27 (8.7) Shigella isolates taken from the diarrhea patients, 11 (3.5%) were from HIV positive subjects. All Shigella isolates were found to be sensitive against norfloxacin (100%), gentamicin (97%), polymyxin B (97%) and kanamycin (93%). The most frequent resistance observed was to chloramphenicol (62%), tetracycline (86%) and ampicillin (100%). The frequency of resistance of Amp, Sex, Ch, TTc was found to be very high when compared with other patterns of resistance. Conclusion: The high proportion of HIV seropositive patients who had diarrhea in the absence of identified Shigella strains strongly indicates the existence of other diarrhoeagenic agents or mechanisms. Detailed investigation is important to get comprehensive information for better treatment of diarrhoea in HIV /AIDS patients. According to this finding, norfloxacin, gentamicin, polymyxin B, kanamycin and nalidixic acid might be used as drugs of choice for empirical treatment. On the other hand, amplicilin, tetracycline and chloramphenicol may not be used as the drugs of choice for the treatment of Shigella infection unless culture and sensitivity tests are done prior to treatment. The Ethiopian Journal of Health Development Vol. 20 (2) 2006: 99-10

Brief Communication: Comparison of formol-acetone concentration method with that of the direct iodine preparation and formol-ether concentration methods for examination of stool parasites

Background: Formol-ether concentration technique is taken as a gold standard method to detect most intestinal parasites; however, because of its low safety and hazardous impact a need for better technique has a paramount importance.Objective: To evaluate a formol- acetone concentration method in comparison with the conventional direct iodine preparation and formol- ether concentration methods in detecting intestinal parasites.Methods: A total of 382 stool samples were collected from Tseda elementary school children, in 2006. Samples were processed and examined using formol-acetone concentration, the direct iodine stained smear, and formol-ether concentration methods.Results: Formol-ether detected 79.1% of parasites followed by formol-acetone (73.6%) and direct iodine preparation (50.3%). Statistical (P< 0.05) difference was observed for the detection of over all positivity of any parasites between the two concentration methods. However, the sensitivity, specificity, and positive predicative value of formol-acetone were 88.1%, 81.3%, and 94.7%, respectively respective to formol-ether method. Almost similar detection ability was also observed by the two concentration methods for A. lumbricoids, H. nana, T. trichuira, and S. stercoralis. However, there was difference in the detection rate of hookworm and S. mansoni.Conclusions: for safety and hazard free laboratory set up, this new method might be used as an alternative choice for formol-ether concentration method. [Ethiop. J. Health Dev. 2010;24(2):148-151

Brief communication: Low prevalence of HIV infection, and knowledge, attitude and practice on HIV/AIDS among high school students in Gondar, Northwest Ethiopia

HIV/AIDS is a major public health problem in Ethiopia. Therefore, a school based cross-sectional study was conducted in Gondar; Northwest Ethiopia to determine the seroprevalence of HIV infection and to assess Knowledge, attitude and practice related to HIV/AIDS. A total of 565 students were included in the study. The seroprevalence of HIV infection was 1.1%. Sexual contact with commercial sex worker or non-regular partner was reported by 16.7% of the students. Only 58.5% of those who practice sex used condoms. History of sexually transmitted diseases was reported by 10.7% of the sexually active students. The majority (96.6%) reported unprotected sex, unsafe blood transfusion, contaminated needles and mother to child transmissions as common ways of HIV transmission. Abstinence, faithfulness to one\'s partner and use of condom as means to prevent transmission of HIV was responded by 84.1%, 60.4% and 41.8% of the students, respectively. Over 82% demanded screening for HIV as a precondition for marriage and 97.2% agreed to have a VCT service. The findings of the study indicate that the prevalence of HIV infection is low among high school students in Gondar. The students had adequate knowledge about HIV/AIDS and VCT despite the risky practices. Continued health education is needed to bring behavioral changes.The Ethiopian Journal of Health Development Vol. 21 (2) 2007: pp. 179-18

Podoconiosis and soil-transmitted helminths (STHs): double burden of neglected tropical diseases in Wolaita zone, rural southern Ethiopia

Background Both podoconiosis and soil-transmitted helminth (STH) infections occur among barefoot people in areas of extreme poverty; however, their co-morbidity has not previously been investigated. We explored the overlap of STH infection and podoconiosis in Southern Ethiopia and quantified their separate and combined effects on prevalent anemia and hemoglobin levels in podoconiosis patients and health controls from the same area. Methods and Principal Findings A two-part comparative cross-sectional study was conducted in Wolaita zone, southern Ethiopia. Data were collected from adult patients presenting with clinically confirmed podoconiosis, and unmatched adult neighborhood controls living in the same administrative area. Information on demographic and selected lifestyle factors was collected using interviewer-administered questionnaires. Stool samples were collected and examined qualitatively using the modified formalin-ether sedimentation method. Hemoglobin level was determined using two different methods: hemoglobinometer and automated hematology analyzer. A total of 913 study subjects (677 podoconiosis patients and 236 controls) participated. The prevalence of any STH infection was 47.6% among patients and 33.1% among controls (p<0.001). The prevalence of both hookworm and Trichuris trichiura infections was significantly higher in podoconiosis patients than in controls (AOR 1.74, 95% CI 1.25 to2.42, AOR 6.53, 95% CI 2.34 to 18.22, respectively). Not wearing shoes and being a farmer remained significant independent predictors of infection with any STH. There was a significant interaction between STH infection and podoconiosis on reduction of hemoglobin level (interaction p value = 0.002). Conclusions Prevalence of any STH and hookworm infection was higher among podoconiosis patients than among controls. A significant reduction in hemoglobin level was observed among podoconiosis patients co-infected with hookworm and ‘non-hookworm STH’. Promotion of consistent shoe-wearing practices may have double advantages in controlling both podoconiosis and hookworm infection in the study area

Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia.</p> <p>Methods</p> <p>In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography.</p> <p>Results</p> <p>After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002).</p> <p>Conclusion</p> <p>The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.</p

Importance of Ethnicity, CYP2B6 and ABCB1 Genotype for Efavirenz Pharmacokinetics and Treatment Outcomes: A Parallel-group Prospective Cohort Study in two sub-Saharan Africa Populations.

We evaluated the importance of ethnicity and pharmacogenetic variations in determining efavirenz pharmacokinetics, auto-induction and immunological outcomes in two African populations. ART naïve HIV patients from Ethiopia (n = 285) and Tanzania (n = 209) were prospectively enrolled in parallel to start efavirenz based HAART. CD4+ cell counts were determined at baseline, 12, 24 and 48 weeks. Plasma and intracellular efavirenz and 8-hydroxyefvairenz concentrations were determined at week 4 and 16. Genotyping for common functional CYP2B6, CYP3A5, ABCB1, UGT2B7 and SLCO1B1 variant alleles were done. Patient country, CYP2B6*6 and ABCB1 c.4036A>G (rs3842A>G) genotype were significant predictors of plasma and intracellular efavirenz concentration. CYP2B6*6 and ABCB1 c.4036A>G (rs3842) genotype were significantly associated with higher plasma efavirenz concentration and their allele frequencies were significantly higher in Tanzanians than Ethiopians. Tanzanians displayed significantly higher efavirenz plasma concentration at week 4 (p<0.0002) and week 16 (p = 0.006) compared to Ethiopians. Efavirenz plasma concentrations remained significantly higher in Tanzanians even after controlling for the effect of CYP2B6*6 and ABCB1 c.4036A>G genotype. Within country analyses indicated a significant decrease in the mean plasma efavirenz concentration by week 16 compared to week 4 in Tanzanians (p = 0.006), whereas no significant differences in plasma concentration over time was observed in Ethiopians (p = 0.84). Intracellular efavirenz concentration and patient country were significant predictors of CD4 gain during HAART. We report substantial differences in efavirenz pharmacokinetics, extent of auto-induction and immunologic recovery between Ethiopian and Tanzanian HIV patients, partly but not solely, due to pharmacogenetic variations. The observed inter-ethnic variations in efavirenz plasma exposure may possibly result in varying clinical treatment outcome or adverse event profiles between populations

Treatment of Helminth Co-Infection in Individuals with HIV-1: A Systematic Review of the Literature

Many people living in areas of the world most affected by the HIV/AIDS pandemic are also exposed to other common infections. Parasitic infections with helminths (intestinal worms) are common in Africa and affect over half of the population in some areas. There are plausible biological reasons why treating helminth infections in people with HIV may slow down the progression of HIV to AIDS. Thus, treating people with HIV for helminths in areas with a high prevalence of both HIV and helminth infections may be a feasible strategy to help people with HIV delay progression of their disease or initiation of antiretroviral therapy. After a comprehensive review of the available literature, we conclude that there is not enough evidence to determine whether treating helminth infections in people with HIV is beneficial

Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: a ten-year retrospective study

<p>Abstract</p> <p>Background</p> <p>Many DOTS experiences in developing countries have been reported. However, experience in a rural hospital and information on the differences between children and adults are limited. We described the epidemiology and treatment outcome of adult and childhood tuberculosis (TB) cases, and identified risk factors associated with defaulting and dying during TB treatment in a rural hospital over a 10-year period (1998 to 2007).</p> <p>Methods</p> <p>Retrospective data collection using TB registers and treatment cards in a rural private mission hospital. Information was collected on number of cases, type of TB and treatment outcomes using standardised definitions.</p> <p>Results</p> <p>2225 patients were registered, 46.3% of whom were children. A total of 646 patients had smear-positive pulmonary TB (PTB), [132 (20.4%) children]; 816 had smear-negative PTB [556 (68.2%) children], and 763 extra-PTB (EPTB) [341 (44.8%) children]. The percentage of treatment defaulters was higher in paediatric (13.9%) than in adult patients (9.3%) (p = 0.001). The default rate declined from 16.8% to 3.5%, and was independently positively associated with TB meningitis (AOR: 2.8; 95% CI: 1.2-6.6) and negatively associated with smear-positive PTB (AOR: 0.6; 95% CI: 0.4-0.8). The mortality rate was 5.3% and the greatest mortality was associated with adult TB (AOR: 1.7; 95% CI: 1.1-2.5), TB meningitis (AOR: 3.6; 95% CI:1.2-10.9), and HIV infection (AOR: 4.3; 95% CI: 1.9-9.4). Decreased mortality was associated with TB lymphadenitis (AOR: 0.24; 95% CI: 0.11-0.57).</p> <p>Conclusion</p> <p>(1) The registration of TB cases can be useful to understand the epidemiology of TB in local health facilities. (2) The defaulter and mortality rate of childhood TB is different to that of adult TB. (3) The rate of defaulting from treatment has declined over time.</p

An ethnobotanical study of medicinal plants used by local people in the lowlands of Konta Special Woreda, southern nations, nationalities and peoples regional state, Ethiopia

<p>Abstract</p> <p>Background</p> <p>Research was carried out in Konta Special Woreda (District); it is a remote area with lack of infrastructure like road to make any research activities in the area. Therefore, this research was conducted to investigate medicinal plants of the Konta people and to document the local knowledge before environmental and cultural changes deplete the resources.</p> <p>Methods</p> <p>The information was collected between October 2006 and February 2007. Interview-based field study constituted the main data collection method in which the gathering, preparation, use, previous and current status and cultivation practices were systematically investigated. The abundance, taxonomic diversity and distribution of medicinal plants were studied using ecological approach.</p> <p>Results</p> <p>A total of 120 species, grouped within 100 genera and 47 families that are used in traditional medical practices were identified and studied. The Fabaceae and Lamiaceae were the most commonly reported medicinal plants with 16 (13.3%) and 14 (12%) species, respectively. 25.4% of the total medicinal plants are collected from homegardens and the rest (74.6%) are collected from wild habitats. Of the total number of medicinal plants, 108 species (90%) were used to treat human ailments, 6 (5%) for livestock diseases and the remaining 6 (5%) were used to treat both human and livestock health problems. The major threats to medicinal plants reported include harvesting medicinal plants for firewood (24.8%) followed by fire (22.3%) and construction (19%). Of the four plant communities identified in the wild, more medicinal plant species (34) were found in community type-4 (<it>Hyparrhenia cymbaria</it>-<it>Erythrina abyssinica </it>community), which accounted for 61.8%.</p> <p>Conclusion</p> <p>Konta Special Woreda is an important area for medicinal plants and associated local knowledge; the natural vegetation being the most important reservoir for the majority of the medicinal plants. Environmental and cultural changes are in the process of threatening the resources and this signals the need for serious efforts to create public awareness so that measures are taken to conserve the medicinal plants in the natural ecosystems and other suitable environments.</p