Laboratory services in health centres within Amhara region, North Ethiopia

Objective: To identify current problems in laboratory services and elicit suggestions from the technicians aimed at improving the services in health centres within Amhara region, north Ethiopia. Design: Cross-sectional study using a pre-tested questionnaire. Settings: Twenty seven health centres in Amhara region, north Ethiopia. Participants: Twenty seven laboratory technicians. Results: Physical facilities were seriosly lacking, consisting of only one room in 85.2%  of the health centres. Supply of electricity was never continuous. Whereas virtually all the health centres had up to five medical doctors each, laboratory manpower was grossly below the ideal requirement. Over half of the health centres had only one technician each, resulting into heavy workload. Laboratory reagents were insufficient, equipment lacking, and maintenance and repair were not accorded adequate attention. Eighty different tests were offered by the health centres in various combinations. Twenty categories of suggestions were advanced by the respondents. Conclusion: There is a great shortage of manpower, equipment, chemicals and other supplies to provide adequate laboratory services in the health centres within the region. Consequently, the laboratories are functioning below capacity.East African Medical Journal, May 1999, 239-24

Campylobacter enteritis among children in Dembia District, Northwest Ethiopia

Objective: To estimate the magnitude of Campylobacter enteritis in children below fifteen years of age.Design: A cross-sectional survey.Setting: Seven villages found in the outskirts of Kolla Diba town were covered. The town is located 35 kilometres away from Gondar teaching hospital.Participants: Stool specimens were collected from 153 children under fifteen years of age. Caretakers of the children were interviewed using a structured questionnaire.Main outcome measures: Culture result for Campylobacter, culture and biochemical test results for Salmonella and Shigella and direct microscopy results for parasites or ova measures.Results: The prevalence of Campylobacter species was 16/153 (10.5%) and the frequency of isolation was twice as much as Salmonella or Shigella species (5.2% each). Contact with cats and diarrhoea-sick person in the household was associated with isolation of Campylobacter species.Conclusion: Based on the finding and the evidence accumulated, clinical health professionals need to consider Campylobacter species as one of the major causes of diarrhoea in children

The prevalence and antimicrobial responses of Shigella isolates in HIV-1 infected and uninfected adult diarrhoea patients in north west Ethiopia

Background: Shigella is one of the diarrhoea causing organisms found in HIV positive patients. But so far, the pattern of diarrhoeal agents caused by Shigella in AIDS patients has not been determined. Objective: This study is thus aimed at determining the prevalence, antimicrobial susceptibility and resistance of Shigella isolates in HIV positive subjects. Methods: All stool samples taken from the subjects of this study were plated on the MacConkey agar and incubated at 35-37oC for 24 or 48 hrs. Biochemical and antimicrobial sensitivity testing were carried out by using the standard methods. Results: Out of the 391 subjects included in the study, 199(63.8%) HIV seropositive and 113 seronegative patients had acute and chronic diarrhoea while 79 were HIV seropositive without diarrhoea. Of the 27 (8.7) Shigella isolates taken from the diarrhea patients, 11 (3.5%) were from HIV positive subjects. All Shigella isolates were found to be sensitive against norfloxacin (100%), gentamicin (97%), polymyxin B (97%) and kanamycin (93%). The most frequent resistance observed was to chloramphenicol (62%), tetracycline (86%) and ampicillin (100%). The frequency of resistance of Amp, Sex, Ch, TTc was found to be very high when compared with other patterns of resistance. Conclusion: The high proportion of HIV seropositive patients who had diarrhea in the absence of identified Shigella strains strongly indicates the existence of other diarrhoeagenic agents or mechanisms. Detailed investigation is important to get comprehensive information for better treatment of diarrhoea in HIV /AIDS patients. According to this finding, norfloxacin, gentamicin, polymyxin B, kanamycin and nalidixic acid might be used as drugs of choice for empirical treatment. On the other hand, amplicilin, tetracycline and chloramphenicol may not be used as the drugs of choice for the treatment of Shigella infection unless culture and sensitivity tests are done prior to treatment. The Ethiopian Journal of Health Development Vol. 20 (2) 2006: 99-10

Perspectives of Protocol Based Breaking Bad News among Medical Patients and Physicians in a Teaching Hospital, Ethiopia

BACKGROUND፡ Discussing potentially bad outcomes is a standard communication task in clinical care. Physicians’ awareness on ways to communicate bad news is considered low. SPIKES protocol is the most popular strategy used by physicians, but its practice and patients' perception are not known. This study attempted to fill the knowledge gap on protocol implementation, patient preference and physician effects.METHODS: Hospital-based descriptive cross-sectional study was conducted at SPHMMC from May 1 to June 30 using structured interviews administered to patients and physicians. Three hundred and sixty patients and 111 physicians were included. Assessment of SPIKES performance, patient satisfaction, patient preference, and physician awareness, attitude and effects were studied.RESULTS: Performance of SPIKES protocol was setting (74.5%), perception (51.1%), invitation (56.3%), knowledge (15.9%), emotion (22.3%) and summary (10.1%). Only 30.6% of the patients were entirely satisfied with the interaction, and 19.2% with knowledge attained. Patient satisfaction was associated with physician asking how much information they like (P=0.025). Patient desire and report showed variation. Eighty-two percent of the physicians were not aware of the protocol, and 83.8% had no training. Half of the physicians feel depressed after disclosure.CONCLUSIONS: Patient satisfaction with communication process and knowledge is poor, as is performance of SPIKES components. Satisfaction is related to being asked how much patients want to know. Patients’ desires on how to be told news is different from how it is done. Breaking bad news increases feeling of depression. Awareness and training on the protocol are deficient; medical schools should incorporate it into their studies and implement proper follow-up.&nbsp

Brief Communication: Comparison of formol-acetone concentration method with that of the direct iodine preparation and formol-ether concentration methods for examination of stool parasites

Background: Formol-ether concentration technique is taken as a gold standard method to detect most intestinal parasites; however, because of its low safety and hazardous impact a need for better technique has a paramount importance.Objective: To evaluate a formol- acetone concentration method in comparison with the conventional direct iodine preparation and formol- ether concentration methods in detecting intestinal parasites.Methods: A total of 382 stool samples were collected from Tseda elementary school children, in 2006. Samples were processed and examined using formol-acetone concentration, the direct iodine stained smear, and formol-ether concentration methods.Results: Formol-ether detected 79.1% of parasites followed by formol-acetone (73.6%) and direct iodine preparation (50.3%). Statistical (P< 0.05) difference was observed for the detection of over all positivity of any parasites between the two concentration methods. However, the sensitivity, specificity, and positive predicative value of formol-acetone were 88.1%, 81.3%, and 94.7%, respectively respective to formol-ether method. Almost similar detection ability was also observed by the two concentration methods for A. lumbricoids, H. nana, T. trichuira, and S. stercoralis. However, there was difference in the detection rate of hookworm and S. mansoni.Conclusions: for safety and hazard free laboratory set up, this new method might be used as an alternative choice for formol-ether concentration method. [Ethiop. J. Health Dev. 2010;24(2):148-151

Brief communication: Low prevalence of HIV infection, and knowledge, attitude and practice on HIV/AIDS among high school students in Gondar, Northwest Ethiopia

HIV/AIDS is a major public health problem in Ethiopia. Therefore, a school based cross-sectional study was conducted in Gondar; Northwest Ethiopia to determine the seroprevalence of HIV infection and to assess Knowledge, attitude and practice related to HIV/AIDS. A total of 565 students were included in the study. The seroprevalence of HIV infection was 1.1%. Sexual contact with commercial sex worker or non-regular partner was reported by 16.7% of the students. Only 58.5% of those who practice sex used condoms. History of sexually transmitted diseases was reported by 10.7% of the sexually active students. The majority (96.6%) reported unprotected sex, unsafe blood transfusion, contaminated needles and mother to child transmissions as common ways of HIV transmission. Abstinence, faithfulness to one\'s partner and use of condom as means to prevent transmission of HIV was responded by 84.1%, 60.4% and 41.8% of the students, respectively. Over 82% demanded screening for HIV as a precondition for marriage and 97.2% agreed to have a VCT service. The findings of the study indicate that the prevalence of HIV infection is low among high school students in Gondar. The students had adequate knowledge about HIV/AIDS and VCT despite the risky practices. Continued health education is needed to bring behavioral changes.The Ethiopian Journal of Health Development Vol. 21 (2) 2007: pp. 179-18

Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia.</p> <p>Methods</p> <p>In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography.</p> <p>Results</p> <p>After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002).</p> <p>Conclusion</p> <p>The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.</p

High prevalence of syphilis among demobilized child soldiers in Eastern Congo: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Syphilis, a known major public health issue for soldiers during periods of conflict, is exacerbated in the Democratic Republic of Congo due to widespread sexual violence. However, there has been no previous study to determine the extent of this problem. Therefore, we determined the prevalence of syphilis among young demobilized soldiers.</p> <p>Methods</p> <p>Screening of syphilis using the rapid plasma reagin test and the <it>Treponema pallidum </it>hemagglutination assay was conducted in three transit sites of soldier reintegration in 2005. The Fisher Exact probability test was used to compare results.</p> <p>Results</p> <p>The prevalence of syphilis was found to be 3.4%, with almost equal distribution in respect to sex, location.</p> <p>Conclusion</p> <p>Syphilis continues to be highly prevalent in demobilized child soldiers in Eastern Congo. Syphilis screening tests are recommended.</p

Importance of Ethnicity, CYP2B6 and ABCB1 Genotype for Efavirenz Pharmacokinetics and Treatment Outcomes: A Parallel-group Prospective Cohort Study in two sub-Saharan Africa Populations.

We evaluated the importance of ethnicity and pharmacogenetic variations in determining efavirenz pharmacokinetics, auto-induction and immunological outcomes in two African populations. ART naïve HIV patients from Ethiopia (n = 285) and Tanzania (n = 209) were prospectively enrolled in parallel to start efavirenz based HAART. CD4+ cell counts were determined at baseline, 12, 24 and 48 weeks. Plasma and intracellular efavirenz and 8-hydroxyefvairenz concentrations were determined at week 4 and 16. Genotyping for common functional CYP2B6, CYP3A5, ABCB1, UGT2B7 and SLCO1B1 variant alleles were done. Patient country, CYP2B6*6 and ABCB1 c.4036A>G (rs3842A>G) genotype were significant predictors of plasma and intracellular efavirenz concentration. CYP2B6*6 and ABCB1 c.4036A>G (rs3842) genotype were significantly associated with higher plasma efavirenz concentration and their allele frequencies were significantly higher in Tanzanians than Ethiopians. Tanzanians displayed significantly higher efavirenz plasma concentration at week 4 (p<0.0002) and week 16 (p = 0.006) compared to Ethiopians. Efavirenz plasma concentrations remained significantly higher in Tanzanians even after controlling for the effect of CYP2B6*6 and ABCB1 c.4036A>G genotype. Within country analyses indicated a significant decrease in the mean plasma efavirenz concentration by week 16 compared to week 4 in Tanzanians (p = 0.006), whereas no significant differences in plasma concentration over time was observed in Ethiopians (p = 0.84). Intracellular efavirenz concentration and patient country were significant predictors of CD4 gain during HAART. We report substantial differences in efavirenz pharmacokinetics, extent of auto-induction and immunologic recovery between Ethiopian and Tanzanian HIV patients, partly but not solely, due to pharmacogenetic variations. The observed inter-ethnic variations in efavirenz plasma exposure may possibly result in varying clinical treatment outcome or adverse event profiles between populations