Anemia among HIV infected individuals taking art with and without zidovudine at Addis Ababa, Ethiopia

Background: Hematological complications such as Zidovudine(ZDV) associated anemia are among the commonly reported adverse drug reactions of Antiretroviral Therapy(ART). Little is known about ZDV associated anemia in developing countries like Ethiopia.Methods: Comparative retrospective cohort study was conducted at the ART Clinic of St. Paul Hospital Millennium Medical College from February 2011 to December 2012 to characterize anemia among HIV/AIDS patients initiated with ZDV and non-ZDV containing ART regimens. In each group, 197 HIV infected adults who had complete medical records were included. Medical records of participants were reviewed using pre-tested data collection format. Data were analyzed using SPSS version 19 for windows. For all statistical significance tests, the cut-off value was P<0.05.Results: Among ZDV group, anemia prevalence was 20.8 % (41/197), 33.5%(66 /197) and 13%(19/146) at baseline, six and twelve months of ART follow-up, respectively.On the other hand in non-ZDV group, anemia was present among 44.2% (87/197), 18.3% (36/197) and 12.4% (25 /202) of participants at baseline, six and twelve months of ART follow-up, respectively. After six months of follow-up, ZDV associated anemia was present among 32.7% (51/156) of the participants, and 43.1% of them were severe while about 45.2% were macrocytic type. Zidovudine group participants were 3.34 times more likely to develop severe anemia than non-ZDV group, P< 0.001.Conclusion: The prevalence, severity and characteristics of anemia were different between ZDV and non-ZDV group participants at different follow-up periods of ART. Zidovudine had significant contribution to severe anemia incidence after six months of ART; thus, hemoglobin level monitoring with red cell indices is suggested for improved detection of zidovudine associated anemia.Keywords: Anemia, Zidovudine, HIV/AIDS, ART, Ethiopi

Biochemical and immuno-hematological test availability during the COVID-19 pandemic: The case of private diagnostic laboratories in Addis Ababa, Ethiopia

AbstractBackground: Since the emergence of COVID-19 (SARS-CoV-2) in China, in December 2019, the pandemic has continued to be a major public health threat. According to the World Health Organization, on March 02, 2021, there were113,989,973 confirmed cases of COVID-19 globally, and 2,531,542 reported deaths. In Ethiopia on the same period, there were159,072 confirmed cases and 2,365 reported deaths. Efforts have been made in Ethiopia to make COVID-19 Biochemical and immuno-hematological tests available; however, the role of private diagnostic laboratories with this perspective has not been assessed. This study aims to address the role of private diagnostic laboratories as service providers of various laboratory tests that can help with the management of COVID-19 patients. Materials and methods: A cross-sectional survey was carried out with seven standalone laboratories in Addis Ababa. A questionnaire and observation checklists – adopted from the World Health Organization, were used to prepare a structured questionnaire and on-site evaluations of the availability of biochemical and immuno-hematological tests in the city. The data collection tool also assessed whether the diagnostic laboratories had back-up instruments for common biochemical and immuno-hematological tests. The data entry and analysis were conducted using SPSS software version 20. Results: Among the 7 private diagnostic laboratories participated in this study majority of them have professionals who are males (N=20/33, 60.6%). Most of the laboratory professionals in the private laboratories had Bachelor of Science degrees in medical laboratory sciences (15/33, 45.5%). Almost all of them provide organ function tests including liver and renal functions. However, some important tests like D-dimer were not available. All the laboratories claimed that they had adequate stock for conducting hematological tests, although none had GeneXpert® MTB/RIF assays for detection Mycobacterium tuberculosis and testing for rifampin resistance. Conclusions: Private diagnostic laboratories that offer clients most clinical chemistry, hematological and immuno-hematological tests are to be welcomed, particularly during the COVID-19 pandemic, when public health diagnostic laboratories could be overburdened, and the stock of reagents might be low or unavailable. There should be a means to strengthen public-private partnerships and both patients and clinicians could benefit a lot by availing diagnostics as needed. Further detailed study is required to understand the role of private diagnostic laboratories during outbreaks and pandemics situation. [Ethiop. J. Health Dev. 2021; 35(1):3-8] Key words: Private laboratory, biochemical tests, hematological tests, COVID-1

Socio-demographic and Haematological Determinants of Breast Cancer in a Tertiary Health Care and Teaching Hospital in Addis Ababa, Ethiopia

AbstractBackground: Breast cancer is the major cause of cancer deaths among women globally. Socio-demographic and haematological characteristics are among the determinants of breast cancer, and these characteristics are supposed to be monitored during early diagnosis and treatment of cases.Objective: The objective of this study was to assess socio-demographic and haematological profile of patients with breast cancer at Tikur Anbessa Specialized Hospital.Methods: Case controlled study was conducted among 230 cases and 230 controls from May 2018 to June 2019. Descriptive analysis was made to assess socio-demographic characteristics and independent sample t- test was performed to compare the mean haematological parameters.Results: The mean age was 42.8 + 12.1 years and 39.3 + 11.1 years for cases and controls, respectively. About 43.5% of the cases and 14.8% of the controls were not able to read and write. About 76.1% of the cases and 67.4% of the controls were married. The mean values of Haemoglobin, Red Blood cell, Packed Cell Volume for the cases were 13.1 + 1.6g/dl; 4.6 + 0.54x1012/L; and 38.7 + 4.5 %, respectively. These were significantly lower than those of the controls (14.0 + 1.3g/dl, 4.8 + 0.47 x 1012/L, 40.5 + 3.5%, respectively). Mean platelet count was higher among the cases, whereas total White Blood cell count was almost similar.Conclusion and recommendations: Majority of the cases were less than 40 years of age and were not able to read and write. Most of the RBC parameters of cases were significantly lower than the controls. Therefore, attention should be given for exposed groups and those with the designated haematological abnormalities. [Ethiop. J. Health Dev. 2021; 35(2):125-132]Keywords: Breast cancer, Haematological parameters, Socio-demographic factors, Ethiopi

Establishing reference intervals for common hematology test parameters from apparently healthy geriatrics in Asella town, Southeast Ethiopia, 2020: a community-based cross-sectional study

BackgroundReference intervals are an important method tool for identifying abnormal laboratory test results. Complete blood count reference values are useful to interpret complete blood count (CBC) results and make clinical decisions, but these values have not been established for geriatrics in Asella town. Therefore, this study aimed to establish reference intervals (RIs) for complete blood count (CBC) parameters from geriatric participants/subjects in Asella town, Southeast Ethiopia.MethodsA community-based cross-sectional study was conducted from December 2019 to May 2020. An interviewer-administered questionnaire was used to collect data on sociodemography and other characteristics from 342 eligible geriatric participants. Weight, height, and vital signs were measured, and 8 mL of blood sample was collected. Screening tests such as HIV, HBsAg, HCV, syphilis, stool examination, and urinalysis were performed. The hematological parameter was measured using a Sysmex kx-21 hematology analyzer. The data were analyzed using SPSS version 21 software. The non-parametric independent Kruskal–Wallis test and Wilcoxon rank-sum test (Mann–Whitney U test) were used to compare the parameters between age groups and genders. The 97.5 and 2.5th percentile were the upper and lower reference limit for the population.ResultsAccording to the study’s findings, the reference intervals of red blood cell, white blood cell, platelet count, hemoglobin (HGB), and hematocrit (HCT) in male geriatrics were 3.8–5.85 × 1012/L, 3.1–9.66 × 109/L, 115.8–353 × 109/L, 12.4–17.76 g/dL, and 35.06–50.2%, respectively. The respective values for women were 3.94–5.48 × 1012/L, 3.13–8.4 × 109/L, 137.5–406 × 109/L, 12.5–16.4 g/dL, and 36.09–48.2%. Most of the hematological parameters showed significant differences between the two genders (p value <0.05).ConclusionAccurate gender and age-specific reference intervals are crucial in managing patient health. The current study offers essential CBC hematological parameters that can assist clinicians in interpreting laboratory results and can improve healthcare quality in the geriatric population. Therefore, it is more relevant to use the current RIs in the geriatric set-up

Increased cell division but not thymic dysfunction rapidly affects the T-cell receptor excision circle content of the naive T cell population in HIV-1 infection

Recent thymic emigrants can be identified by T cell receptor excision circles (TRECs) formed during T-cell receptor rearrangement. Decreasing numbers of TRECs have been observed with aging and in human immunodeficiency virus (HIV)-1 infected individuals, suggesting for thymic impairment. Here, we show that in healthy individuals, declining thymic output will affect the TREC content only when accompanied by naive T-cell division. The rapid decline in TRECs observed during HIV-1 infection and the increase following HAART are better explained not by thymic impairment, but by changes in peripheral T-cell division rates. Our data indicate that TREC content in healthy individuals is only indirectly related to thymic output, and in HIV-1 infection is mainly affected by immune activation

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

Effect of Helicobacter pylori infection on growth trajectories in young Ethiopian children: a longitudinal study

Background: Helicobacter pylori infection has been associated with early childhood growth impairment in high- and middle-income countries; however, few studies have examined this relationship within low-income countries or have used a longitudinal design. The possible effects of H. pylori infection on growth trajectories were examined in a cohort of young Ethiopian children. Methods: In 2011/12, 856 children (85.1% of the 1006 original singletons in a population-based birth cohort) were followed up at age 6.5 years. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Height and weight were measured twice, and the average of the two measurements was used. Exposure to H. pylori infection was assessed using a rapid H. pylori stool antigen test. The independent associations of positive H. pylori infection status (measured at ages 3 and 6.5 years) with baseline height and weight (age 3 years) and height and weight growth trajectory (from age 3 to 6.5 years) were modelled using hierarchical linear models. Results: At baseline (age 3 years), the children's mean height was 85.7 cm and their mean weight was 11.9 kg. They gained height at a mean rate of 8.7 cm/year, and weight at a mean rate of 1.76 kg/year. H. pylori infection was associated with lower baseline measurements and linear height trajectory (β = −0.74 cm and −0.79 cm/year, respectively), after controlling for demographics and markers of socio-economic status. However, the positive coefficient was associated with quadratic growth in height among H. pylori-infected children (β = 0.28, 95% confidence interval 0.07 to 0.49, p < 0.01), and indicated an increase in height trajectory as the child increased in age. A non-significant difference in baseline and trajectory of weight was observed between H. pylori-infected and non-infected children. Conclusions: These findings add to the growing body of evidence supporting that H. pylori infection is inversely associated with childhood growth trajectory, after controlling for a range of factors associated with reduced growth and H. pylori status. Further follow-up will be important to confirm possible catch-up in height trajectory among H. pylori-infected children as they grow older

Effect of early and current Helicobacter pylori infection on the risk of anaemia in 6.5-year-old Ethiopian children

Background: Epidemiological and clinical studies in high income countries have suggested that Helicobacter pylori (H. pylori) may cause anaemia, but evidence is lacking from low income countries.We examined associations between H. pylori infection in early childhood and anaemia at the age of 6.5 years in an Ethiopian birth cohort. Methods: In 2011/12, 856 children (85.1 % of the 1006 original singletons in a population-based birth cohort) were followed up at age six and half. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Haemoglobin level and red cell indices were examined using an automated haematological analyzer (Cell Dyn 1800, Abbott, USA), and stool samples analyzed for H. pylori antigen. The independent effects of H. pylori infection (measured at age 3.5 and 6.5 years) on anaemia, haemoglobin level, and red cell indices (measured at age 6.5 years) were determined using multiple logistic and linear regression. Results: The prevalence of anemia was 34.8 % (257/739), and the mean (SD) haemoglobin concentration was 11.8 (1.1) gm/dl. Current H. pylori infection at age 6.5 years was positively, though not significantly related to prevalence of anaemia (adjusted OR, 95 % CI, 1.15; 0.69, 1.93, p = 0.59). Any H. pylori infection up to age 6.5 years was significantly associated with an increased risk of anaemia at age 6.5 (adjusted OR, 95 % CI, 1.68; 1.22, 2.32, p = 0.01). A significant reduction in haemoglobin concentration and red cell indices was also observed among children who had any H. pylori infection up to age 6.5 (Hb adjusted β = −0.19, 95 % CI, −0.35 to −0.03, p = 0.01; MCV adjusted β = −2.22, 95 % CI, −3.43 to −1.01, p = 0.01; MCH adjusted β = −0.63, 95 % CI, −1.15 to - 0.12, p = 0.01; and MCHC adjusted β = −0.67, 95 % CI, −1.21 to −0.14, p = 0.01), respectively. Conclusion: This study provides further evidence from a low income country that any H. pylori infection up to age 6.5 is associated with higher prevalence of anaemia, and reduction of haemoglobin level and red cell indices at age 6.5

Types of anaemia due to hookworm infection among the populations of Wolisso

Abstract: A community-based cross-sectional study to investigate the association between hookworm infection and anaemia was carried out on 227 apparently healthy individuals living around Wolisso. Of these subjects, 155 were positive and 72 were negative for hookworm infections. It was found out that 32 (20.6%) of the hookworm positvie and 4 (5.6%) of the hookworm negative individuals were anaemic. Chi-square analysis showed hookworm infection was significantly associated with low haemoglobin (Hb), low transferrin saturation (TS) and low ferritin levels. Intensity of infection as expressed in eggs per gram of faeces showed a highly significant negative association with TS and serum ferritin levels (p&lt;0.001) but not with Hb levels. The degree of anaemia could be considered as mild, however, the light hookworm infection could possibly lead to iron deficiency anaemia. When multiple criteria involving elevated mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and macrocytic blood picture were taken as suggestive of a macrocytic type of anaemia, 20 (13.0%) of the hookworm positive and 4 (5.6%) of the hookworm negative individuals fell into this category. However, the association between parameters suggestive of macrocytic anaemia and hookworm infection was not strong. [Ethiop. J. Health Dev. 1999;13(1):33-39