Fungal infection knowledge gap in Ethiopia

Fungal infections are associated with morbidity and mortality especially in in patients with underlying medical conditions. With the increasing number of immune-compromised patients, the burden of invasive fungal infections became widespread.In any country, data on fungal infection is important to design appropriate programs as well as to plan and implement further studies. A review of literature on fungal infections in Ethiopia shows that there is paucity of evidences on this problem and existing ones focused mainly on superficial and mucosal fungal infections while there is almost none on an invasive or systemic infection [Ethiop. J. Health Dev. 2017;31(2):124-126].Keywords: fungal infections, Ethiopi

Women’s Health Research Working Group: A Mentorship Model to Increase Women’s Participation in Research

AbstractBackground: Female academia makes up only a fifth of all faculty at Addis Ababa University, where only a few are actively engaged in research. With a belief that dedicated mentorship could bring positive change in research participation, a female-to-female mentorship group was established at the College of Health Sciences. Objective: This study aimed to assess the effectiveness of mentorship in improving the research participation of young female academia from August 2016-April 2019. Methods: The implementation was instituted by establishing a female-only research working group to enhance the participation of young female faculty members who were newly employed in a relatively large number. The main interventions were the coupling of mentors and mentees based on their respective research areas for two hours’ weekly lunchtime and providing need-based training and life skill talks by exemplary women. We used a desk review and written testimonies of the Group to evaluate the effectiveness of the intervention. Results: Young academics of the Group started to author scientific articles while the mentors had increased their publication track. The Group won a competitive three-year research grant. from Addis Ababa University. Its visibility due to its research output has helped to attract more members and encouraged the establishment of other sister groups in the University. The Group has also received the best female research group award from the Ministry of Science and Higher Education. Conclusion: Female-to-female mentorship had helped researchers in their early careers to publish and won grants. This could be an exemplary intervention which only requires a commitment of staff time. [Ethiop. J. Health Dev. 2021; 35(SI-2):08-14]Keywords: Female faculty, Implementation research, Mentorship, Research working grou

Why has Africa reported relatively few COVID-19 cases so far? A web-based survey

Abstract Background: Africa’s first COVID-19 case was identified in Egypt on 14 February 2020. Since then, almost all African countries have reported cases. The pandemic is transitioning to more widespread community transmission in most African countries, underscoring the need to further scale-up COVID-19 testing with a much wider geographic coverage. In Africa, the expected devastation caused by COVID-19 has been ‘delayed’ compared to some European countries and the USA. The reason behind this is not well understood. The aim of this Google survey was to collect speculations about the phenomena in Ethiopia, in particular. Methods: This web-based survey used Google Forms to collect data from 28 April to 13 May 2020. Participants from the general public with different expertise were invited via email to take part in the survey. Participants’ voluntarism to fill in the form, and their age, sex and educational status, were recorded. In addition, they were asked whether they worried about COVID-19 and the role of lockdowns to minimize the transmission rate of the disease in Africa. Multiple suggestions about the possible reasons behind the relative low number of COVID-19 case and fatalities were recorded, and the collected data were summarized using a Microsoft Excel spreadsheet. Results: A total of 102 participants took part in the web-based survey. Respectively, 92.1% and 64.4% of the participants worried about COVID-19 in Africa and believed that lockdowns could contain the disease in Africa. As for the question why, Africa still has a low number of COVID-19 cases and fatalities compared to other continents, participants reported the following points as the main factors: poor COVID-19 screening practice in the continent (71.3%); God is saving Africa (33.7%); Africans are immune to the virus (18.8%); and poor connection to the rest of the world (18.8%). Conclusions: There is a big concern about COVID-19 in Africa. Timely and accurate epidemiological data is one of the most important tools to inform and drive the COVID-19 response on the continent. Until researchers know exactly what is going on with COVID-19 in Africa, its member states need to keep on measuring and testing. [Ethiop. J. Health Dev. 2020; 34(4):313-316] Key words: COVID-19, SARS-CoV-2, Afric

Polyclonal spread of blaCTX-M-15 through high-risk clones of Escherichia coli at a tertiary hospital in Ethiopia

Objectives: The burden of antimicrobial resistance and spread of epidemic clones are rarely reported from low-income countries. We aimed to investigate the genome-based epidemiology of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) at a tertiary hospital in Jimma, Ethiopia. Methods: Bacteria were isolated from clinical specimens at Jimma Medical Center and subjected to species identification (MALDI-TOF), antimicrobial susceptibility testing (disk diffusion) and whole-genome sequencing (Illumina, HiSeq2500). Genomic data analysis was performed using EnteroBase and Center for Genomic Epidemiology bioinformatics pipelines. A maximum likelihood tree was generated using FastTree/2.1.8 based on single nucleotide polymorphisms (SNPs) in shared genomic regions to identify transmission clusters. Results: Escherichia coli isolates (n = 261) were collected from 1087 single non-duplicate clinical specimens over a 5-month period in 2016. The prevalence of ESBL-EC was 54.8% (143/261), 96% of which were resistant to multiple antibiotic classes. The blaCTX-M-15 ESBL gene was present in 88.4.% of isolates (122/138). Genes conferring resistance to aminoglycosides and ciprofloxacin [aac(6′)-Ib-cr, 62.3% (86/138)], phenicols [catB3, 56.5% (78/138)], sulfonamides [sul1, 68.1% (94/138), trimethoprim [dfrA17, 58.0% (80/138)] and macrolides [mph(A), 67.4% (93/138) were detected. The most prevalent sequence types were ST410 (23%), ST648 (17%), ST131 (10%) and ST167 (7%). Isolates of the same sequence type collected from different units of the hospital were highly similar in the SNP analysis. Conclusion: A high prevalence of ESBLs and dissemination of blaCTX-M-15 through multiple high-risk E. coli clones was detected. Nosocomial spread of multidrug-resistant ESBL-EC within the hospital puts vulnerable patients at risk of difficult-to-treat infections

High prevalence of bla(CTX-M-15) and nosocomial transmission of hypervirulent epidemic clones of Klebsiella pneumoniae at a tertiary hospital in Ethiopia

Background: Genomic epidemiology of antibiotic resistance is not sufficiently studied in low-income countries. Objectives: To determine prevalence of ESBL production, and resistome and virulome profiles, of Klebsiella pneumoniae isolated at Jimma Medical Center, Ethiopia. Methods: Strains isolated from patients with suspected infections between June and November 2016 were characterized by MALDI-TOF for species identification and disc diffusion for antimicrobial susceptibility testing. All K. pneumoniae isolates were characterized by double disc diffusion for ESBL production and all ESBL-producing strains (ESBL-KP) were subjected to WGS on the Illumina (HiSeq 2500) platform. DNA was extracted by automated systems (MagNA Pure 96). Genome assembly was performed using SPAdes (v. 3.9) and draft genomes were used for analysing molecular features of the strains. Maximum likelihood trees were generated using FastTree/2.1.8 based on SNPs in shared genomic regions to identify transmission clusters. Results: Of the 146 K. pneumoniae strains isolated, 76% were ESBL-KP; 93% of the ESBL-KP strains showed resistance to multiple antimicrobial classes. bla(CTX-M-15) (84.4%) was the most prevalent ESBL gene. Resistance genes for aminoglycosides and/or fluoroquinolones [aac(6)-Ib-cr (65.1%)], phenicols [catB3 (28.4%)], sulphonamides [sul1 (61.2%) and sul2 (60.5%)], trimethoprim [dfrA27 (32.1%)], macrolides [mph(A) (12.8%)] and rifampicin [arr2/arr3 (39.4%)] were prevalent. Plasmids of the IncF and IncR families were prevalent among ST218, ST147, ST15 and ST39. KL64 and KL57 capsular types and O1 and O2 LPSs were prevalent. A high-risk clone, ST218-KL57 encoding rmpA1/rmpA2 and iutA, was detected. Phylogenetic analysis showed a cluster of clonally related strains from different units of the hospital. Conclusions: Prevalence of ESBL-KP was high and bla(CTX-M-15) was the predominant ESBL gene. ESBL genes had spread through both clonal and polyclonal expansion of high-risk and hypervirulent clones. Nosocomial transmission of MDR strains between different units of the hospital was observed

Population-based Screening for Pulmonary Tuberculosis utilizing Community Health Workers in Ethiopia

Objective To evaluate the utility of a volunteer health development army in conducting population screening for active TB in a rural community in Southern Ethiopia. Methods A population-based cross-sectional survey was conducted in sixKebeles (the lowest administrative units).Volunteer women community workers led a symptom screening program to identify adults ≥15 years with TB in the community. Individuals with cough ≥ 2 weeks had spot and morning sputum samples and were examined using AFB smear microscopy, culture and Xpert MTB/RIF. Results All 24,517 adults in the study area had a symptom screen performed; 544 (2.2%) had cough ≥ 2 weeks. Among a positive symptom screen, 13 (2.4%) had a positive sputum AFB smear microscopy, 13 (2.4%) a positive culture and 32 (5.8%) a positive Xpert MTB/RIF test. Overall, 34 TB cases (6%) were identified by culture and/or Xpert which corresponds to a prevalence of 139 per 100,000 persons. Conclusion We demonstrate the capability of community health workers (volunteer and paid) to rapidly conduct a large-scale population TB screening evaluation and highlight the high yield of such a program to detect previously undiagnosed cases when combined with Xpert MTB/RIF testing. This could be a model to implement in other similar settings

Robust barcoding and identification of Mycobacterium tuberculosis lineages for epidemiological and clinical studies.

BACKGROUND: Tuberculosis, caused by bacteria in the Mycobacterium tuberculosis complex (MTBC), is a major global public health burden. Strain-specific genomic diversity in the known lineages of MTBC is an important factor in pathogenesis that may affect virulence, transmissibility, host response and emergence of drug resistance. Fast and accurate tracking of MTBC strains is therefore crucial for infection control, and our previous work developed a 62-single nucleotide polymorphism (SNP) barcode to inform on the phylogenetic identity of 7 human lineages and 64 sub-lineages. METHODS: To update this barcode, we analysed whole genome sequencing data from 35,298 MTBC isolates (~ 1 million SNPs) covering 9 main lineages and 3 similar animal-related species (M. tuberculosis var. bovis, M. tuberculosis var. caprae and M. tuberculosis var. orygis). The data was partitioned into training (N = 17,903, 50.7%) and test (N = 17,395, 49.3%) sets and were analysed using an integrated phylogenetic tree and population differentiation (FST) statistical approach. RESULTS: By constructing a phylogenetic tree on the training MTBC isolates, we characterised 90 lineages or sub-lineages or species, of which 30 are new, and identified 421 robust barcoding mutations, of which a minimal set of 90 was selected that included 20 markers from the 62-SNP barcode. The barcoding SNPs (90 and 421) discriminated perfectly the 86 MTBC isolate (sub-)lineages in the test set and could accurately reconstruct the clades across the combined 35k samples. CONCLUSIONS: The validated 90 SNPs can be used for the rapid diagnosis and tracking of MTBC strains to assist public health surveillance and control. To facilitate this, the SNP markers have now been incorporated into the TB-Profiler informatics platform ( https://github.com/jodyphelan/TBProfiler )

Serum level of high sensitive C-reactive protein and IL − 6 markers in patients with treatment-resistant schizophrenia in Ethiopia: a comparative study

Background Accumulating evidence indicates that schizophrenia is accompanied by significant activation of the immune system; however, there is limited data from low and middle-income countries (LMIC). Inflammatory markers may be more relevant in LMIC settings where infectious conditions are more prevalent and may thus play some role in the causation and maintenance of schizophrenia. The aim of this study was to assess the level of inflammatory markers high sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6) in patients with schizophrenia. Materials and methods The study population consisted of a total of 132 study participants; 82 participants with schizophrenia and 50 controls. hsCRP and IL-6 were measured using Cobas Integra 400 Plus and Cobas e 411 analysers respectively. Results The levels of hsCRP and IL-6 were significantly increased among participants with schizophrenia compared to controls: hsCRP mean value 2.87 ± 5.6 vs 0.67 ± 0.6 mg/L; IL-6 mean value 6.63 ± 5.6 vs 3.37 ± 4.0 pg/ml. Controlling for potential confounders (age, sex and body mass index), having a diagnosis of schizophrenia remained significantly associated with increased hsCRP and IL-6. Conclusion The results confirm that inflammatory processes may have a role in the pathophysiology of schizophrenia regardless of setting. Despite failure of some interventions with anti-inflammatory properties, interventions to reduce inflammation are still worth pursuing

Gene drives for schistosomiasis transmission control.

Schistosomiasis is one of the most important and widespread neglected tropical diseases (NTD), with over 200 million people infected in more than 70 countries; the disease has nearly 800 million people at risk in endemic areas. Although mass drug administration is a cost-effective approach to reduce occurrence, extent, and severity of the disease, it does not provide protection to subsequent reinfection. Interventions that target the parasites' intermediate snail hosts are a crucial part of the integrated strategy required to move toward disease elimination. The recent revolution in gene drive technology naturally leads to questions about whether gene drives could be used to efficiently spread schistosome resistance traits in a population of snails and whether gene drives have the potential to contribute to reduced disease transmission in the long run. Responsible implementation of gene drives will require solutions to complex challenges spanning multiple disciplines, from biology to policy. This Review Article presents collected perspectives from practitioners of global health, genome engineering, epidemiology, and snail/schistosome biology and outlines strategies for responsible gene drive technology development, impact measurements of gene drives for schistosomiasis control, and gene drive governance. Success in this arena is a function of many factors, including gene-editing specificity and efficiency, the level of resistance conferred by the gene drive, how fast gene drives may spread in a metapopulation over a complex landscape, ecological sustainability, social equity, and, ultimately, the reduction of infection prevalence in humans. With combined efforts from across the broad global health community, gene drives for schistosomiasis control could fortify our defenses against this devastating disease in the future

Conceptualising centres of excellence: a scoping review of global evidence

Objective- Globally, interest in excellence has grown exponentially, with public and private institutions shifting their attention from meeting targets to achieving excellence. Centres of Excellence (CoEs) are standing at the forefront of healthcare, research and innovations responding to the world’s most complex problems. However, their potential is hindered by conceptual ambiguity. We conducted a global synthesis of the evidence to conceptualise CoEs. Design- Scoping review, following Arksey and O’Malley’s framework and methodological enhancement by Levac et al and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Data sources- PubMed, Scopus, CINAHL, Google Scholar and the Google engine until 1 January 2021. Eligibility- Articles that describe CoE as the main theme. Results- The search resulted in 52 161 potential publications, with 78 articles met the eligibility criteria. The 78 articles were from 33 countries, of which 35 were from the USA, 3 each from Nigeria, South Africa, Spain and India, and 2 each from Ethiopia, Canada, Russia, Colombia, Sweden, Greece and Peru. The rest 17 were from various countries. The articles involved six thematic areas—healthcare, education, research, industry, information technology and general concepts on CoE. The analysis documented success stories of using the brand ‘CoE’—an influential brand to stimulate best practices. We identified 12 essential foundations of CoE—specialised expertise; infrastructure; innovation; high-impact research; quality service; accreditation or standards; leadership; organisational structure; strategy; collaboration and partnership; sustainable funding or financial mechanisms; and entrepreneurship. Conclusions- CoEs have significant scientific, political, economic and social impacts. However, there are inconsistent use and self-designation of the brand without approval by an independent, external process of evaluation and with high ambiguity between ‘CoEs’ and the ordinary ‘institutions’ or ‘centres’. A comprehensive framework is needed to guide and inspire an institution as a CoE and to help government and funding institutions shape and oversee CoEs