Seroepidemiological investigations on typhus in Mekele, Dessie and the nearby towns

Abstract: A seroepidemiological study on typhus was conducted in Dessie, Mekele and the nearby towns. A total of 792 serum specimens were collected from patients with acute febrile illness who came to seek treatment in hospitals, health centres and malaria control centres. Also, 246 blood specimens were collected from apparently healthy individuals who donated blood to the blood banks of Dessie and Mekele. The specimen collection was performed during the rainy (July 31 - Sept. 3, 1993) and during the dry (May 21 - June 21, 1994) seasons. All specimens were tested by the WeilFelix test and the Enzyme Linked Immunosorbent Assay (ELISA) for IgM antibodies specific to Rickettsia prowazekii. The disease prevalence was significantly higher during the rainy season than the dry season. A Weil-Felix test positivity of 5.3% and 13.5% in Mekele (OR=2.78, P<0.05); 6% and 18.7% in Dessie (OR=3.36, P<0.0001) were obtained for the dry and the rainy seasons, respectively. Using the IgM ELISA: the rates for Mekele of 8.7% and 31.1% (OR=4.75, P<0.001) and for Dessie, 21.6% and 28.4% (OR=1.44, P>0.05) were found during the dry and rainy seasons, respectively. Among the various occupational groups, higher prevalence was observed in the student population (up to 36%). A general prevalence which ragned from 6% to 9% and 10% to 22% was observed in blood donors from the two towns by the Weil-Felix test and IgM ELISA respectively. The seroprevalence observed in the various groups, the seasonality of the disease as well as the importance of laboratory diagnostic methods have been discussed in relation to possible future outbreaks of epidemic typhus. [Ethiop. J. Health Dev. 1998;12(1):9-16

COMPARISON OF TWO GENERATIONS OF WELLCOZYME KITS

ABSTRACT: A study to compare the specificity of two generations of Wellcozyme kits was performed using sera obtained from three different groups with different prevalence rates of HIV-1 infection, namely, females with multi-partner sexual contacts (MPSC) with an average HIV prevalence of 20% representing the high risk group, specimens from patients who have been suspected to have been infected with HIV based on clinical diagnosis, and scholarship winners with a prevalence rate of 3.4%. ELISA was performed on 1000 samples from each of the first two groups and 377 samples from the third group using both generation of kits. The percentage of false positivity using the first generation kit was 16.3% (33/202), 5.1% (14/271),36% (9/39) and using the second generation kit, 7.94% (12/151), 0.25% (1/399) and 5.8% (1/19) in MPSC females, suspected AIDS patients and scholarship students respectively. ELISA false positivity was highest in the group with a low HIV sero-prevalence rate. The result of the study, in relation to the specificity of the kits, is presented. Students who have won scholarships to countries that require HIV testing

Parasito-haematological features of acute Plasmodium falciparum and P. vivax malaria patients with and without HIV co-infection at Wonji Sugar Estate, Ethiopia

No Abstract.Ethiopian Journal of Health Development Vol. 19 (2) 2005: 132-13

Age- and sex-specific HIV-1 prevalence in the urban community setting of Addis Ababa, Ethiopia

Objective: To estimate the age and sex-specific prevalence of HIV infection in th

Prevalence and Incidence of, and Risk Factors for, HIV-1 Infection Among Factory Workers in Ethiopia, 1997-2001

The study was conducted to determine the prevalence, incidence, and risk factors for HIV infection among factory workers at two sites in Ethiopia. During February 1997-December 2001, a structured questionnaire was used for obtaining information on sociodemographics, sexual behaviour, and reported sexually transmitted infections (STIs) from a cohort of 1,679 individuals. Serum samples were screened for antibodies against HIV, Treponema pallidum haemaglutination (TPHA), and herpes simplex virus type 2 (HSV-2). The overall baseline prevalence of HIV was 9.4%--8.5% among males and 12.4% among females. For both the sexes, the factors independently associated with an increased risk of HIV infection were widowhood and having had antibodies against TPHA and HSV-2. The risk factors specific for males were being orthodox Christian, having had a higher lifetime number of sexual partners, and genital discharge in the past five years. The risk factors for females, included low income, one or more rape(s) over lifetime, and casual sex in the last year. The overall incidence of HIV infection was 0.4 per 100 person-years. The highest rate of incidence was observed among young women aged less than 30 years (1 per 100 person-years). The study confirmed that high-risk sexual behaviour and STIs play major roles in the spread of HIV infection in the Ethiopians of both the sexes, but the factors, such as rape and low economic status, make women more vulnerable than me

Tuberculin Skin Test Conversion and Reactivity Rates among Adults with and without Human Immunodeficiency Virus in Urban Settings in Ethiopia

To investigate whether low CD4(+) T-cell counts in healthy and human immunodeficiency virus (HIV)-infected Ethiopians influence tuberculosis (TB) immunological memory, tuberculin skin test (TST) conversion and reactivity rates were investigated among adults with and without HIV infection in urban settings in Ethiopia. Reaction to the TST was analyzed with purified protein derivative by the Mantoux technique. A total of 1,286 individuals with TST results of ≥5-mm (n = 851) and ≤4-mm (n = 435) induration diameters were included. Individuals with ≤4-mm induration sizes were followed up for 21.4 ± 9.5 months (mean ± standard deviation) to observe skin test conversion. The overall TST reactivity (≥5-mm induration diameter) was 66.2% (n = 851). Reactivity was significantly lower among HIV-positive persons (40.5%) than among HIV-negative persons (68.7%) (P < 0.001). Of the above persons, 32 incident TB patients were checked for their TST status 13.05 ± 11.1 months before diagnosis and reactivity was found among 22 (68.7%) of them. Of the TST-negative persons with 0- to 4-mm indurations who were followed up for 3 years, the conversion rate to positivity was 17.9/100 person-years of observation (PYO) (14.4/100 PYO and 18.3/100 PYO in HIV-positive and -negative persons, respectively). Despite lower absolute CD4(+) T-cell numbers in Ethiopians, higher TST conversion and reactivity rates show the presence of a higher rate of latent TB infection and/or transmission. The lower TST positivity rate before a diagnosis of TB disease showed the lower sensitivity of the test. This indicates the need for other sensitive and specific diagnostic and screening methods to detect TB infection, particularly among HIV-positive persons, so that they can be given prophylactic isoniazid therapy

Human leptospirosis, in Ethiopia: a pilot study in Wonji

Background: Although there is no documented information so far concerning the occurrence of leptospirosis in humans in Ethiopia, climatologic, socioeconomic and cultural factors are highly favourable for the occurrence and spread of the disease in humans in the country. Objective: The objective of this study is therefore to obtain an estimate of the occurrence of leptospirosis in humans in Ethiopia. Method: Serum samples were collected from a total of 59 febrile patients attending the out patient department of Wonji Hospital, Shoa and Wonji Polyclinics. The samples were tested by Dri-Dot method for the presence of leptospirosis antibodies. The inclusion criteria for the patients were patients that are negative for malaria, whose chief complaint was not diarrhoeal disease and who have an axillary temperature of 37.5 0C and more. Results: The study showed that 47.46% of the patients were positive for leptospirosis. The occurrence of the disease was more common in males than females. Conclusions: This pilot study sufficiently demonstrated the occurrence of human leptospirosis. This is the first report on the presence of human leptospirosis in Ethiopia. Therefore, it is strongly recommended that further wider scale study should be conducted to estimate the actual prevalence of the disease and to identify the specific serovars of leptospires present in the country. [Ethiop.J.Health Dev. 2004;18(1):48-51

Behavioural survey for HIV/AIDS infection in Asosa, among the general population and commercial sex workers

Background: Assessment of high-risk behavior for HIV/AIDS transmission is rare in emerging regions of Ethiopia. Objective: To assess high-risk behaviors and factors for voluntary counseling and testing. Examination of the situation has been undertaken. Methods: A cross-sectional behavioral survey was done in Asosa Town on randomly selected adults and all female sex workers. Results: From 631 sexually active adults, 527 (84.6%) had sexual intercourse in last the 12months, 67(12.7%) sex in exchange with money and 88(16.7%) with their non-regular non-commercial partner. Ever use of condom among the general population and female sex workers was found in 168(26.6%) and 185(88.5%) respectively. More than one third of the respondents among the general population knew a person who died of HIV /AIDS and 47.6 % of the respondents lost a close relative due to the same cause. Among the general population, 421(47.6%) were aware of being engaged in high-risk practices, which expose them to HIV/AIDS. Multi variate analysis revealed female [OR= 1.5, 95%CI=1.02-2.10] and individuals who had a positive attitude to take VCT test [OR=1.60: 95% CI=1.2-2.2] felt themselves more at risk. Conclusion: High-risk behavior, low levels of condom use and knowledge about the epidemic have been found in Asosa. Behavioral change communication has to be implemented to reduce those risky behavior and scale up condom use. [Ethiop.J.Health Dev. 2004;18(2):75-81

The status of HIV screening laboratories in Ethiopia: achievements, problems encountered and possible solutions

Objectives: To know the status of HIV screening laboratories in different parts of the country, to identify the major problems encountered and to suggest and recommend possible solutions to the policy makers at different levels. Materials and methods: Forty-two out of 74 government and non-government owned HIV screening laboratories were supervised in December 2001. A cross sectional study using a detailed questionnaire and an on-site observation /supervision to assess the technical issues, safety procedures, laboratory management and other related issues to quality assurance was conducted. These laboratories were selected randomly and at least one laboratory from each region has been included. Results: Most laboratories, 27(64.3%) were capable of performing ELISA and Rapid tests. Majority of them (62%) do not follow a specific testing algorithm, only in 50% were confirmatory tests performed, while 21% send their specimen to the regional laboratories and the remaining 29% do not confirm their results at all. In only 29% of them were safety guidelines practiced. In 58.4% and 54.7% of them, there was a shortage of reagents and protective materials, respectively. Problems related to maintenance, weak referral system, poor laboratory management, lack of follow-up resulting in delay of issuing results to clients were identified. Recommendations: It is suggested that the problems of regional laboratories should be alleviated through collaborative approach among different stakeholders and there is a need to encourage them to fully participate in NEQUAS. Strengthening in equipment and trained human resource, and close follow-up of Regional Laboratories, timely ordering of supplies and reagents, continuous training programs on HIV screening methods, quality assurance and maintenance were recommended. [Ethiop.J.Health Dev. 2002;16(2):209-215

Laboratory services in hospitals and regional laboratories in Ethiopia

Background: Laboratory service facility in health institutions in Ethiopia of is very weak and limited. This can be explained by lack of properly designed laboratory rooms, shortage of equipment and supplies, poor maintenance system and lack of close follow-up and supervision. Objective: To assess the laboratory service at a Hospital and Regional levels, and to come up with some recommendations that may help for the improvement of the service in the country. Methods: Thirty-four health institutions with laboratory service (28 Hospitals and 6 Regional Referral laboratories) were assessed from 9 Regional and 2 Administrative states of the country. A pre-tested well-structured questionnaire was administered. Site supervision on the general conditions of the laboratories was also made. Results: Almost all the health institutions reported shortage of common supplies and reagents. Common and simple tests were not even done due to severe reagent shortages. Majority of the health institutions reported problems related to maintenance. Weak referral system and absence of quality assurance network were also observed. Recommendations: Planning together with laboratory professionals and/or budgeting the laboratory service separately and close follow-up for the proper utilization were suggested to alleviate the problems related to shortage of supplies and reagents. Establishing national quality assurance network, addressing problems related to maintenance, equipping the laboratories would help the laboratories to meet the need of the service users in the sector. [Ethiop.J.Health Dev. 2004;18(1):43-47