Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center, A Tertiary Hospital in Ethiopia

BACKGROUND፡ Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia.METHODS: A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization’s case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected.RESULTS: Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%;164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria.CONCLUSION: Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia

Impact of Parental Migration on Education and Behavioural Outcomes of Children Left Behind in Southern Wollo

The migration of parents is believed to be for the sake of children and families left behind. However, its impact on children left behind has been overlooked in Southern Wollo, Ethioipia. The impact of parental migration on the education and behavioral outcomes of children left behind has to be investigated in the migration-prone area. The objective of this study was to examine the impact of the migration of parent(s) on the education and behavioral outcomes of children left behind. A total of 622 children of migrating parents and children living with both parents were selected for this study. Data were gathered by using a strength and difficulty questionnaire (SDQ) from children of non-migrating parents and children whose either one or both parents migrated abroad in two weredas of southern Wollo, Ethiopia through the use of a stratified sampling method. Morover18 teachers were selected for an interview and focus group discussion to explore their perception of the influence of migration on the education and literacy of children. The results found that the mean score of LBC with parental migration was 15.86 (SD= 3.18) as compared to children living with intact families with a mean score of 12.06 (SD=3.20). The results of the study demonstrated that a significant mean difference was found between children of migrating parents and children living with both parents (F(1,620)= 219.25, p.01). Interview and FGD results also demonstrated that children experienced isolation, longing, sadness, and lack of motivation in schooling following their parents’ migration. To mitigate the problem families, government, and non-government organizations that have a stake in children's well-being and education that can be affected by migration should discharge their responsibilities accordingly. It is necessary to look at the hidden costs of parental migration on children left behind

Isolation of Extended-Spectrum β-lactamase- (ESBL-) Producing Escherichia coli and Klebsiella pneumoniae from Patients with Community-Onset Urinary Tract Infections in Jimma University Specialized Hospital, Southwest Ethiopia

Background. Klebsiella pneumoniae and Escherichia coli are the major extended-spectrum β-lactamase- (ESBL-) producing organisms increasingly isolated as causes of complicated urinary tract infections and remain an important cause of failure of therapy with cephalosporins and have serious infection control consequence. Objective. To assess the prevalence and antibiotics resistance patterns of ESBL-producing Escherichia coli and Klebsiella pneumoniae from community-onset urinary tract infections in Jimma University Specialized hospital, Southwest Ethiopia, 2016. Methodology. A hospital-based cross-sectional study was conducted, and a total of 342 urine samples were cultured on MacConkey agar for the detection of etiologic agents. Double-disk synergy (DDS) methods were used for detection of ESBL-producing strains. A disc of amoxicillin + clavulanic acid (20/10 µg) was placed in the center of the Mueller–Hinton agar plate, and cefotaxime (30 µg) and ceftazidime (30 µg) were placed at a distance of 20 mm (center to center) from the amoxicillin + clavulanic acid disc. Enhanced inhibition zone of any of the cephalosporin discs on the side facing amoxicillin + clavulanic acid was considered as ESBL producer. Results. In the current study, ESBL-producing phenotypes were detected in 23% (n = 17) of urinary isolates, of which Escherichia coli accounts for 76.5% (n = 13) and K. pneumoniae for 23.5% (n = 4). ESBL-producing phenotypes showed high resistance to cefotaxime (100%), ceftriaxone (100%), and ceftazidime (70.6%), while both ESBL-producing and non-ESBL-producing isolates showed low resistance to amikacin (9.5%), and no resistance was seen with imipenem. In the risk factors analysis, previous antibiotic use more than two cycles in the previous year (odds ratio (OR), 6.238; 95% confidence interval (CI), 1.257–30.957; p = 0.025) and recurrent UTI more than two cycles in the last 6 months or more than three cycles in the last year (OR, 7.356; 95% CI, 1.429–37.867; p = 0.017) were found to be significantly associated with the ESBL-producing groups. Conclusion. Extended-spectrum β-lactamases- (ESBL-)producing strain was detected in urinary tract isolates. The occurrence of multidrug resistance to the third-generation cephalosporins, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracyclines is more common among ESBL producers. Thus, detecting and reporting of ESBL-producing organisms have paramount importance in the clinical decision-making

Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia.

BACKGROUND:Tuberculosis (TB) is among the leading causes of morbidity and mortality worldwide. More than 70% of the deaths of TB patients occur during the first two months of TB treatment. The major risk factors that increase early death of TB patients are being positive for human immunodeficiency virus (HIV), being of old age, being underweight or undergoing re-treatment. OBJECTIVE:To assess the time of reported deaths and associated factors in a cohort of patients with TB during TB treatment. METHODS:An institution-based retrospective cohort study was analyzed in Dangila Woreda, Northwest Ethiopia from March 1st through March 30, 2014. All TB patients registered in the direct observed treatment (DOTs) clinic from 2008-2012 were included in the study. Data were entered into EpiData and exported to SPSS for analysis. The survival probability was analyzed by the Kaplan Meier method and Cox regression analysis was applied to investigate factors associated with death during TB treatment. RESULTS:From a total of 872 cases registered in TB registry log book, 810 were used for the analysis of which 60 (7.4%) died during the treatment. The overall mortality rate was 12.8/1000 person months of observation. A majority of TB deaths 34 (56.7%) occurred during the intensive phase of the treatment, and the median time of death was at two months of the treatment. Age, HIV status and baseline body weight were independent predictors of death during TB treatment. CONCLUSIONS:Most deaths occurred in the first two months of TB treatment. Old age, TB/HIV co-infection and a baseline body weight of <35 kg increased the mortality during TB treatment. Therefore, a special follow up of TB patients during the intensive phase, of older patients and of TB/HIV co-infected cases, as well as nutritionally supplementing for underweight patients may be important to consider as interventions to reduce deaths during TB treatment

Prevalence of group A β-haemolytic Streptococcus among children with pharyngitis in Jimma town, Southwest Ethiopia

Background: Group A Streptococcus (GAS) is an important cause of morbidity and mortality among children and responsible for 20–30% of bacterial pharyngitis. Objective: Determining prevalence, antimicrobial susceptibility pattern and clinical predictors of GAS among children with pharyngitis. Method: A cross sectional study was conducted on 355 children with pharyngitis attended in Health Centers of Jimma town from May 8 to December 31, 2013. Demographic and clinical data were collected by questionnaire. Throat swabs were collected and processed with the standard microbiological techniques to isolate GAS. The disc diffusion method was used for antimicrobial susceptibility testing. Descriptive statistics and multivariate logistic regression analysis were done by SPSS version 20. Results: Females accounted for 57.7% of 355 children with pharyngitis. Sixty-six percent of the children were 5–9 years old giving mean ± SD age of 8.5 ± 2.7 years. The prevalence of GAS was 11.3%. All isolates of GAS were susceptible to penicillin and erythromycin. However, 52.5% were resistant to tetracycline. Absence of cough, tonsillar swelling or exudate and temperature >38 °C were found to be independent predictors for GAS infection among children with pharyngitis (P < 0.05). Conclusion: In this study the prevalence of GAS was relatively low. However, the seasonality of GAS infection might underestimate the prevalence, so that large-scale prospective study in the entire season and in various settings is required. In addition, the clinical variables that are predictor of GAS pharyngitis can be considered for the diagnosis of GAS pharyngitis with further evaluation of its reproducibility in different settings

Survival curve of TB patients treated under DOTs program by socio-demographic and clinical characteristics in Dangila Woreda, Northwest Ethiopia, 2008–2012.

<p>A) Age of the patients, B) Weight of the Patients, C) HIV status.</p

Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Objectives: Children with severe acute malnutrition (SAM) are treated with empiric amoxicillin or penicillin and gentamicin because of the high risk of severe infections. Experts have suggested, based on available evidence, adding metronidazole to cover anaerobic bacteraemia and diarrhoea caused by Giardia duodenalis or Clostridium difficile. The objective of this study was to assess the importance of these infections in children with SAM. Methods: Children from 6 months to 15 years with SAM were enrolled and followed clinically. Aerobic and, when patient weight permitted, anaerobic blood cultures were done using Bactec® system, and isolates identified with matrix-assisted laser desorption ionization–time of flight mass spectrometry. Stool samples were tested for C. difficile, G. duodenalis and Entamoeba histolytica by PCR. Results: A total of 334 children were enrolled and 174 out of 331 (53%) for which data on this was available had diarrhoea. Of 273 patients tested by blood culture, 11 had bacteraemia (4.0%, 95% CI 2.3–7.1%) but none with strict anaerobic bacteria (0/153, 95% CI 0–2.4%). There was no difference in the prevalence of C. difficile between children with (5/128, 4%) and without (7/87, 8%) diarrhoea (OR 0.47, 95% CI 0.14–1.53), and no difference in the prevalence of Giardia between these groups (78/138, 60% vs. 46/87, 53%; OR 1.34, 95% CI 0.77–2.32). Children with C. difficile had higher mortality than those without this infection (3/11, 27%, vs. 7/186, 4%; OR 43, 95% CI 3.9–483). Conclusion: Our results do not provide support for empiric metronidazole to cover for anaerobic bacteraemia. Trials evaluating the effect of empiric treatment and its effect on G. duodenalis and C. difficile are warranted

Critical evaluation of the appetite test for children with severe acute malnutrition

OBJECTIVES: The appetite test is used to risk-stratify for children with severe acute malnutrition (SAM) in in-patient or out-patient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome. METHODS: We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models. RESULTS: Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6·6% higher weight gain per day (95% CI 2·6, 10·8) adjusted for type of treatment, oedema, duration of follow up, and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3·5%, 95%CI -0·25, 7·0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure. CONCLUSIONS: Our findings question the use of the appetite test to identify children who need in-patient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings

New molecular tools for meningitis diagnostics in Ethiopia – a necessary step towards improving antimicrobial prescription

Background Meningitis remains a top cause of premature death and loss of disability-adjusted life years in low-income countries. In resource-limited settings, proper laboratory diagnostics are often scarce and knowledge about national and local epidemiology is limited. Misdiagnosis, incorrect treatment and overuse of antibiotics are potential consequences, especially for viral meningitis. Methods A prospective study was conducted over three months in a teaching hospital in Ethiopia with limited laboratory resources. Cerebrospinal fluid (CSF) samples from patients with suspected meningitis were analysed using a multiplex PCR-based system (FilmArray, BioFire), in addition to basic routine testing with microscopy and culture. Clinical data, as well as information on treatment and outcome were collected. Results Two hundred and eighteen patients were included; 117 (54%) neonates (0–29 days), 63 (29%) paediatrics (1 month-15 years) and 38 (17%) adults (≥16 years). Of 218 CSF samples, 21 (10%) were PCR positive; 4% in neonates, 14% in paediatrics and 18% in adults. Virus was detected in 57% of the PCR positive samples, bacteria in 33% and fungi in 10%. All CSF samples that were PCR positive for a bacterial agent had a white cell count ≥75 cells/mm3 and/or turbid appearance. The majority (90%) of patients received more than one antibiotic for treatment of the meningitis episode. There was no difference in the mean number of different antibiotics received or in the cumulative number of days with antibiotic treatment between patients with a microorganism detected in CSF and those without. Conclusions A rapid molecular diagnostic system was successfully implemented in an Ethiopian setting without previous experience of molecular diagnostics. Viral meningitis was diagnosed for the first time in routine clinical practice in Ethiopia, and viral agents were the most commonly detected microorganisms in CSF. This study illustrates the potential of rapid diagnostic tests for reducing antibiotic usage in suspected meningitis cases. However, the cost of consumables for the molecular diagnostic system used in this study limits its use in low-income countries