Methicillin-resistant Staphylococcus aureus with genotyping method among human immunodeficiency virus positive pediatric patients in Northwest Ethiopia: A cross-sectional study design

Abstract Background: Increasing evidence suggests that methicillin-resistant Staphylococcus aureus (MRSA) infections are becoming more prevalent throughout the human immunodeficiency virus (HIV) infected community. However, there is scarcity of data about the prevalence of MRSA among HIV positive pediatric patients in the study area. Objectives: To determine the prevalence and types of MRSA among S. aureus isolates of HIV positive pediatric patients in the Amhara National Regional State, Northwest Ethiopia. Methods: Pediatric patients who attended the clinic from December 2013 to April 2014 were included in the study. Genotype MRSA VER 3.0 was used for characterization of S. aureus isolates. This detected methicillin-resistance-mediating mecA and mecC genes and the bicomponent cytotoxic virulence factor Panton–Valentine leukocidin (PVL). Data were analyzed using SPSS version 20. Results: Among 126 S. aureus isolates, 37.3% and 11.9% were mecA and Panton–Valentine leukocidin gene positive, respectively. Patients of FHRH (P = 0.04) and DRH (P = 0.02) have statistical significance for mecA gene. Panton–Valentine leukocidin gene positive strains were about 97% less likelihood to be mecA gene positive (P = 0.001). Conclusion: A high prevalence of pathogenic MRSA strains among HIV positive pediatric patients was observed. Most of the MRSA types were hospital acquired. Hence, strict hygienic approaches by healthcare workers in hospitals should be implemented. In addition, screening and treatment of MRSA for HIV positive pediatric patients is recommended. [Ethiop. J. Health Dev. 2018;32(3):00-000] Key words: MRSA, pediatrics, HIV, Ethiopi

Rubella virus sero-prevalence and associated factors among non-vaccinated pregnant women in Northwest Ethiopia

Abstract Background: Rubella virus infection during pregnancy is associated with adverse fetal outcomes and reproductive failures. In Ethiopia, little is known about the extent of the disease and rubella vaccination is not widely available. The main aim of this study was to assess the sero-prevalence of the rubella virus infection and its associated risk factors among pregnant women. Methods: An institution based cross-sectional study was conducted in the antenatal clinics of Debre Markos and Debre Tabor hospitals of Amhara Region, Northwest Ethiopia from March to June2015. Study participants were recruited until the calculated sample size was achieved at both hospitals. Data on socio-demographic and factors associated with rubella virus infection were collected through a structured questionnaire. A 5ml blood sample was also collected from all study participants and tested for Immunoglobulin (Ig) G and IgM antibodies against rubella virus infection using enzyme immune assay (EIA) test at the Amhara Regional Health Research Laboratory Center, Bahir Dar. Data were analyzed using SPSS version 21 and frequencies, chi-square tests and Odds ratio were computed using a p value < 0.05 as a level of significance. Result: A total of 401 pregnant mothers were screened for rubella virus infection. The mean age of the study participants was 26.4 year (SD= 5.4) and the overall sero-prevalence of rubella anti-IgG was 46.4%. In connection, the sero-prevalence of anti-IgM among anti-IgG sero-positive cases was 3.2%. Pregnant women at first trimester (OR=2.49, 95% CI= 1.14-5.42) and HIV sero-status (OR= 0.33, 95% CI= 0.15-0.76) were factors found to be significantly associated with rubella anti-IgG sero-prevalence (p<0.05). Conclusion: The sero-prevalence of rubella virus infection among pregnant women was considered to be low, showing the high risk of a new infection. In addition to a comprehensive surveillance approach and efforts to determine rubella susceptibility profile among school-aged girls and women of childbearing age, it is also important to consider rubella vaccine in a national vaccination program. [Ethiop. J. Health Dev. 2018;32(3):00-000] Keywords: Rubella virus, unvaccinated, sero-prevalence, pregnant women, risk factors, Ethiopi

Tuberculosis Lymphadenitis and Human Immunodeficiency Virus Co-infections among Lymphadenitis Patients in Northwest Ethiopia

BACKGROUND: Tuberculosis and human immunodeficiency virus (HIV) are among the major health problems in Ethiopia. This study assessed the proportion of tuberculosis lymphadenitis (TBLN), HIV infection and their co-infection among TBLN presumptive individuals at the selected hospitals in NorthwestEthiopia.METHODS: Institution based cross sectional study was carried out. Data on demographic and clinical variables were collected with standardized questionnaire. Microbiological culture was done on specimen obtained by fine needle aspirates. The HIV status was determined by rapid anti-HIV antibody test. Data was entered and scrutinized using SPSS version 20 statistical packages. A stepwise logistic regression model was used. The result was considered as statistically significant at P<0. 05.RESULTS: A total of 381 lymphadenitis patients were included in the study. The overall prevalence of TBLN and HIV were at 250(65.6%) and 9(2.4%), respectively and their co-infection was at 6(2.4%). Based on the cytological examination, 301(79.0%) of them were diagnosed as TBLN. The age group, (P=0.01) and residency, (P=0.01) were found significantly associated with TBLN. Similarly, unsafe sex was also statistically significant for HIV infection (P=0.007).CONCLUSION: Tuberculosis lymphadenitis is the leading cause of TB and lymphadenitis in the region. However, TBLN-HIV coinfection was promisingly low. High rate of discrepancy was noticed between cytological and culture results. Hence, the TBLN diagnostic criteria shall pursue revision

Health impacts of bedbug infestation: A case of five towns in Amhara Region, Ethiopia

Background: Bedbug is a wingless human blood-sucking bug that generally infests houses and beds. Bedbug infestation is prevalent across the country. Despite its prevalence, however, there is scarce information on the epidemiological, psychological, social and public health impacts of the infestation. This lack may arise from the absence of sufficient research in the area. The impetus for this study arose from this recognition. This study therefore assessed the extent of bedbug infestation in five towns in Amhara Regional State, Ethiopia, and its impact on public health in the areas considered in this study.Methods: A community-based cross sectional study was conducted in five towns of Amhara Regional State from 1 March 2015 to 30 June 2016. Bedbug inspection was done following the Michigan manual for prevention and control of bedbug recommendation. The presence of a living or dead bedbugs, their eggs, their skin discarded in shedding, and their fecal stains or droppings were taken as an infestation. In addition, data from households were collected using pretested, structured and interviewer-administered questionnaire. The data were analyzed using SPSS version 20. Both bivariate and multivariate logistic regressions were computed to identify associated factors.Results: From the 203 residential institutions surveyed, evidence of prevalence of bedbugs was located in 75.9% (154) houses. From among the infested residents, 87%, 83.1%, and 71.4% had faced one or more psychological, social and health impacts, respectively. Residential institutions in Bahir Dar town administration were 3.4 times more likely to be infested by bedbug than those in Amanuel town (AOR: 3.4; 95% CI: 1-11). The chances that residents of Kobo town administration had to be infested by bedbug were 41 times more than that of the residents in Amanuel town (AOR: 41; 95%CI: 8-206). However, no statistically significant difference was observed between the rates of bedbug infestation and the type of residential institutions.Conclusions: Bedbug infestation was found to be a major public health problem in Bahir Dar, Woreta and Kobo towns. A significant psychological, social and health impact was observed in the communities. Thus, aggressive public health promotion campaigns against bedbug are recommended to empower the communities and equip them with preventive strategies. Moreover, an effective pest management strategy also needs to be made a priority health agenda, in the particular areas of study. A larger study is recommended to assess more in-depth impacts of bedbug infestation on public health [Ethiop. J. Health Dev. 2017;31(4):251-258]Keywords: Bedbug infestation, Ethiopi

Xpert MTB/RIF assay for the diagnosis of Mycobacterium tuberculosis and its Rifampicin resistance at Felege Hiwot and Debre Tabor Hospitals, Northwest Ethiopia: A preliminary implementation research

Background: The World Health Organization endorsed GeneXpert MTB/RIF (Xpert) assay for the diagnosis of tuberculosis (TB) and multidrug resistant tuberculosis (MDR-TB) in 2010. However, the practice of using this novel diagnostic method is still limited in a high TB and human immunodeficiency virus (HIV) burden settings, including Ethiopia. Therefore, we conducted this study aimed at describing the first implementation status of Xpert assay in the diagnosis of TB and MDR-TB at Felege Hiwot Referral Hospital (FHRH) and Debre Tabor General Hospital (DTGH), Northwest Ethiopia.Methods: We analyzed the records of 1922 (FHRH=544 and DTGH=1378) presumptive TB patients diagnosed using Xpert test from 1 November 2015 to 30 April 2016 at FHRH and DTGH, Northwest Ethiopia. All patients who had registered data on their sex, age, HIV status, presumptive MDR-TB status and Xpert results were included for analysis. Data were retrieved directly from GeneXpert result registration log book using data extraction sheet. Data were entered, cleaned, and analyzed using SPSS statistical software package; p < 0.05 was considered to be significant.Results: Overall Xpert assay properly diagnosed 14.6% of the cases (258/1922). Among these, rifampicin (RIF) resistance was detected at 9.3% (24/258). In the studied settings, clinical data showed that 81.0% (1556/1922) of the cases were MDR- TB. Among the study subjects, 888 (46.2 %) of them were HIV positive. However, TB-HIV co-infection rate was at 41.9% (108/258). Of the total patients registered, 1005 (52.3%) of whom were males. The mean age of patients was 31.1 years with SD of 17.5. Significant predictors of the Xpert test were: age (p=0.000), sex (p=0.009), HIV status (p=0.003) and presumptive MDR-TB (p=0.000).Conclusions: In the studied areas, large proportion of clinically TB suspected patients were wrongly diagnosed with MDR-TB. Therefore, the use of Xpert assay in health settings with no culture facility will decrease the unnecessary use of anti-TB drugs and improve rapid TB, and MDR-TB detection and proper management of the cases. [Ethiop. J. Health Dev. 2016;30(2):60-65]Keywords: TB, GeneXpert, MTB/RIF assay, Northwest Ethiopi

BURDEN AND DETERMINANT FACTORS OF ANEMIA AMONG ELEMENTARY SCHOOL CHILDREN IN NORTHWEST ETHIOPIA: A COMPARATIVE CROSS SECTIONAL STUDY

Background: Anemia is an indicator of both poor nutrition and health. In low-income countries like Ethiopia, the prevalence of anemia remains high due to several determinant factors. There is a lack of regular surveillance system to determine the magnitude of anemia among school age children. The aim of this study was to determine the burden and determinant factors of anemia among school children. Materials and Methods: A comparative cross-sectional study was conducted from March 2014 to May 2014 among elementary school children in Northwest Ethiopia. Multi stage and simple random sampling techniques were used to select the schools and the study subjects. Standard questionnaire was employed to assess the socioeconomic status of study participants. Intestinal parasitosis infections and hemoglobin level were determined by formula ether concentration technique and automated hematology analyzer, respectively. Descriptive statistics were used to determine the burden of anemia. Stepwise logistic regression was used to identify the determinants of anemia. Results: Among 2,372 elementary school children, the prevalence of anemia was 7.6% (95 % CI: 7% - 9%). The mean hemoglobin level was 11.6 g/dl ranging from 10 g/dl to 13g/dl. The magnitude of hookworm infection was 530 (22.3%). In multivariate analysis anemia was found associated with residence, source of water, availability of latrine, maternal education, family size and hookworm infection. Conclusion: Anemia still remains as a major public health problem among the school children in the study area. Residence, source of water, availability of latrine, maternal education, family size and hookworm infection are also the major determinant factors for the high prevalence of anemia. Therefore, health education, iron supplement and deworming should be given to school age children

Additional file 1: of Spoligotyping based genetic diversity of Mycobacterium tuberculosis in Ethiopia: a systematic review

Description of M. tuberculosis shared types reported for TB strains isolated in Ethiopia from nine regional states and two city administrations (n = 2596). a In the SITVIT2 database, the spoligo international type (SIT) numbers designate spoligotypes shared by two or more patient isolates. In contrast, “orphan” designates patterns reported for a single isolate. b Clade designations according to STVIT2 database: Beijing clade, East African-Indian (EAI) clade and 9 sub-lineages, Haarlem (H) clade and 3 sub-lineages, Latin American-Mediterranean (LAM) clade and 12 sub-lineages, the ancestral “Manu” family and 3 sub-lineages, the S clade, the IS6110-low-binding X clade and 3 sub-lineages, and an ill-defined T clade with 5 sub-lineages, U: Unknown patterns, ** Belongs to new Ethiopian L7. c AA: Addis Ababa; AM: Amhara; AF: Afar; BG: Benishangul Gumz; DD: Dire Dawa; GM: Gambela; HR: Harari; OR: Oromia; SNNPR: South Nation and Nationalities Peoples Region; SM: Ethiopian Somali; TG: Tigray dHigh clustering rate reported. (DOCX 58 kb

Intestinal Parasitic Infections and Nutritional Status among Primary School Children in Delo-mena District, South Eastern Ethiopia

Background: Although there are efforts being underway to control and prevent intestinal parasitic infections (IPIs) in Ethiopia, they are still endemic and responsible for significant morbidity. The aim of this study was to evaluate the prevalence of IPIs and their association with nutritional status among primary school children of Delo-Mena district, South Eastern Ethiopia. Methods: A cross-sectional study was conducted from April to May 2013. Demographic data was obtained, and IPIs was investigated in a single-stool sample by both direct stool examination and formol-ether concentration techniques. Anthropometric measurements were taken to calculate height for-age (HAZ), BMI-for-age (BAZ) and weight-for-age (WAZ) for the determination of stunting, thinness and underweight, respectively using WHO AntroPlus software. SPSS version 20 was used for statistical analysis and p value less than 0.05 was considered significant. Results: Among 492 children studied (51% boys, aged 6–18 years, mean 10.93 +2.4) an overall IPIs prevalence of 26.6% was found. The prevalence of S. mansoni, E. histolytica/dispar, H. nana, A. lumbricoides, G. lambilia, T. trichiura, S. stercolaris, E. vermicularis, Hookworms and Taenia spp were 9.6%, 7.7%, 5.3%, 3.7%, 2.0%, 1.6%, 1.4%, 1.2%, 0.8% and 0.2% respectively. Stunting and underweightedness were observed in 4.5% and 13.6% of children and associated with IPIs (P<0.001) and (P=0.001), respectively. Conclusion: IPIs and its associated malnutrition remain a public health concern in Delo-Mena district. Therefore, the overall health promotion activities coupled with snail control and de-worming to the students is crucial. Additionally, initiatives aimed at improving the nutritional status of school children are also important