Comparative studies on two culture methods for hookworm species identification

Abstract: Ninety stool specimens obtained from patients referred to the National Research Institute of Health and found to reveal hookworm ova were cultured using the Test Tube Filter Paper and the Charcoal methods with a view to recover and identify the third stage larvae. Infective larvae were harvested in a total of 88(97.8%) specimens, 79(87.8%) of which were detected by both methods. Only 5(5.6%) and 4(4.4%) were exclusively detected by the Test Tube and Charcoal methods, respectively. Except in one specimen where filariforms of both species (Necator americanus and Ancylostoma duodenale) were encountered, N.americanus was dominant. Both methods exhibited no significant difference (P > 0.05) in the development capacity of third stage larvae. The importance of culturing hookworm species in relation to the understanding of species dominance and the merits and demerits of both methods are discussed.[Ethiop. J. Health Dev.1995;9(3):189-191

HOOKWORM SPECIES DISTRIBUTION AMONG SCHOOL CHILDREN IN ASENDABO TOWN, JIMMA ZONE, SOUTH WEST ETHIOPIA

No abstract - Available on PD

Observation of blood microfilariae during human trypanosomiasis survey in Gambella, south west Ethiopia

Abstract: While conducting a survey on sleeping sickness during 1989-92 in Gambella, South western Ethiopia, microfilariae of Mansonella perstans were detected in the blood of the indigenous population, the Anuaks (1%), and the refugees from Southern Sudan (4.1%). No blood microfilarial infection was detected in resettlers, who arrived in the area from drought affected regions of the country during the 1985/86 resettlement program. Among the diagnostic methods applied, nearly twice more microfilaraemic cases (4.1%) were detected by the Miniature Anion Exchange Centrifugation Technique (M-AECT) while only (1.9%) were detectable by Microhaematocrit Buffy Coat Technique (MHBCT) among the refugees. Using the conventional blood film methods (thin and thick smears) only fewer positive cases (1.0%) were detected compared to the above two techniques. Besides a known standard diagnostic methods for blood filariasis, however, the MHBCT seems preferable as field diagnostic technique. Because it is more rapid, simple to operate and does not necessitate as much advanced preparation and sterile condition as M-AECT, and could be a potential diagnostic tool for blood microfilariae. There is a significant difference (P<0.01) in age groups 15-30 years among Anuaks and refugees. There is no significant difference (P>0.01) in other age groups and sexes among Anuaks and refugees. However, there is a significant difference (P<0.01) in over all positivity among Anuaks and refugees. [Ethiop. J. Health Dev. 1997;11(1):1-5

Paracheck-PF® test Versus Microscopy in the Diagnosis of Falciparum Malaria in Arbaminch

Background: Malaria is a major cause of morbidity and mortality in Ethiopia. Rapid diagnostic tests such as Paracheck Pf are the major tools for falciparum malaria diagnosis as an alternative to microscopy in peripheral health facilities. The objective of this study was to evaluate the sensitivity and specificity of Paracheck Pf against microscopy for diagnosis of P.falciparum infection and observe the persistence of the antigen for an elongated period.Methods: Cross sectional study was undertaken in Arbaminch Zuria at Shele health center from October 2008 to January 2009. Paracheck-Pf versus microscopy comparison was done in conjunction with an artemisinin-based combination therapy efficacy monitoring for a period of 28 days. Standard microscopic procedures were done by experienced laboratory technicians and paracheck-Pf was performed in accordance with the manufacturer’s instruction.Results: out of 1293 examined blood films, 400(31%) were found to be malaria positive. Considering microscopy as the gold standard, paracheck-pf showed sensitivity of 94.1 %( 95%CI: 89.9-98.3%) and specificity of 80.0% (95%CI: 67.6-92.4%). The positive and negative predictive values were 93.3 %( 95%CI: 88.8-97.8%) and 82.1% (95%CI: 70-94.1%), respectively. Comparing microscopy results 98.7 % (79/80), 60% (48/80), 48.1% (37/77), and 44.6 %( 33/74) were also found to be positive by paracheck-pf at days7, 14, 21, and 28, respectively. Conclusion: Paracheck Pf® has a comparable diagnostic performance in detecting P. falciparum infections through the persistence of frequent false positivity is a limitation. Thus, this diagnostic test is not appropriate for monitoring of treatment effect. Keywords: P. falciparum, Paracheck-Pf®, RDT, microscopy.Ethiop J Health Sci. Vol. 22, No. 2 July 201

The human trypanosomiasis situation in Gambella, south western Ethiopia

Abstract: Surveillance of human trypanosomiasis was carried out in Gambella, an endemic region of South Western Ethiopia. The study was conducted in March 1993, October 1993 and April 1994 with the major objective of investigation of the sleeping sickness infection and its vector status in the area. In the present survey no parasitologically confirmed case was detected. The main vectors of the disease, Glossina pallidipes and G. tachinoides in wooded savanna and forest area and G. fuscipes in riverain vegetation, were commonly encountered. Eventhough there were no parasitologically proven cases of sleeping sickness infection due to prolonged combined effect of ecological, climatic and human interference, the presence of potential vectors, Glossina species specially along the major river banks, ecological rehabilitation of the area to its previous conditions and the invasion of the game animals might give way to the reappearance of the parasite, T. b. rhodesiense. Thus, regular active surveillance of the endemic region is of great importance to control the disease at an early stage before the appearance of epidemics which could be more costly financially as well as in human life. Specific ecological requirements and feeding habits of Glossina species, specially of G. morsitans, which was not found in this survey, need further investigation. A comprehensive study on community awareness about sleeping sickness and its vector is also recommended to support future control measures. [Ethiop. J. Health Dev. 1997;11(1):23-28

MASS TREATMENT OF ONCHOCERCIASIS WITH IVERMECT AT BEBEKA COFFEE PLANTATION IN ETHIOPIA

ABSTRACT: A longitudinal study of mass treatment of onchocerciasis with ivermectin is going on at Bebeka Coffee Plantation in Ethiopia. In this paper we report findings of a pilot study conducted at the initial stage of the project to assess safety and feasibility of launching mass-therapy using this drug. Of 2083 persons examined between 23 and 30 April 1990, in two sub-localities, Berhane and Olme, in Bebeka Coffee Plantation, 826 (39.7%) persons were diagnosed as cases of onchocerciasis by clinical and skin snip examinations. Ivermectin was then administered to 640 persons eligible for treatment. Following treatment no severe adverse reactions were observed and only 51 cases, (8%), sought treatment for mild to moderate mazzoti type reactions and 7 of them (1%) had temporary incapacitation. In addition, 27 cases were systematically selected, among those treated on the first and second day, and examined daily for 4 days and pattern of adverse responses were noted. Over all therapy was well accepted

Assessment of the infection rate of onchocerciasis in the resettled and indigenous communities of Asossa, Western Ethiopia

Abstract: An attempt was made to determine the infection rate of onchocerciasis in the resettled and indigenous communities of Asossa. A total of 931 persons consisting of 548 settlers and 383 indigenous population, aged five years and over were examined parasitologically for the presence of Onchocerca microfilaria in a skin snip, and 11.1% of the resettled population and 31.3% of the indigenous population were found infected with the parasite. The total mean number of microfilariae per mg of skin snip at the buttock was 15.3. The clinical manifestations recorded include skin atrophy, skin depigmentation, pruritus and presence of nodules at a rate of 15.5%, 20.4%,44.8%, and 1.7%, respectively, among the positives. No visual impairment difference between the positives and negatives was seen and blindness due to onchocerciasis was not detected. Blackfly collection and identification around the near-by rivers indicated the presence of the anthropophilic vector Simulium damnosum s.l. The results recorded for the resettled communities clearly indicated disease propagation in the resettled population who came from areas of the country non-endemic for onchocerciasis in 1984. [Ethiop. I. Health Dev. 1996;10(2):89-95

Shrinking the lymphatic filariasis map of Ethiopia: reassessing the population at risk through nationwide mapping

BACKGROUND Mapping of lymphatic filariasis (LF) is essential for the delineation of endemic implementation units and determining the population at risk that will be targeted for mass drug administration (MDA). Prior to the current study, only 116 of the 832 woredas (districts) in Ethiopia had been mapped for LF. The aim of this study was to perform a nationwide mapping exercise to determine the number of people that should be targeted for MDA in 2016 when national coverage was anticipated. METHODOLOGY/PRINCIPAL FINDING A two-stage cluster purposive sampling was used to conduct a community-based cross-sectional survey for an integrated mapping of LF and podoconiosis, in seven regional states and two city administrations. Two communities in each woreda were purposely selected using the World Health Organization (WHO) mapping strategy for LF based on sampling 100 individuals per community and two purposely selected communities per woreda. Overall, 130 166 people were examined in 1315 communities in 658 woredas. In total, 140 people were found to be positive for circulating LF antigen by immunochromatographic card test (ICT) in 89 communities. Based on WHO guidelines, 75 of the 658 woredas surveyed in the nine regions were found to be endemic for LF with a 2016 projected population of 9 267 410 residing in areas of active disease transmission. Combining these results with other data it is estimated that 11 580 010 people in 112 woredas will be exposed to infection in 2016. CONCLUSIONS We have conducted nationwide mapping of LF in Ethiopia and demonstrated that the number of people living in LF endemic areas is 60% lower than current estimates. We also showed that integrated mapping of multiple NTDs is feasible and cost effective and if properly planned, can be quickly achieved at national scale

Magnitude of Antiretroviral Drug toxicity in adult HIV patients in Ethiopia: A cohort study at seven teaching hospitals

Background: The introduction of antiretroviral therapy (ART) has resulted in significant mortality reduction and improvement in the quality of life. However, this has come at a cost of increased drug toxicity. The objective of this study was to assess the patterns and predictors of ART toxicity in adult HIV patients in Ethiopia.Methods: This is a prospective cohort study conducted at seven teaching hospitals between September 2009 and December 2013 involving 3921 HIV patients on ART. Adverse drug reactions (ADR) due to ART were identified based on clinical assessment and/or laboratory parameters. Multivariable random effects Poisson regression analysis was used to identify factors independently associated with toxicity.Result: ADR due to ART drugs was reported in 867 (22.1 %) of the participants; 374 (9.5%) had severe forms. About 87% of reported toxicities were limited to three organ systems – the skin, nervous system and blood. The overall incidence of ADR was 9 per 100 person years. About a third of toxicities occurred during the first six months after ART initiation with the incidence rate of 22.4 per 100 person years. Concomitant anti-tuberculosis treatment was the strongest independent predictor of toxicity.Conclusion: ADR was found to be highly prevalent in HIV patients on ART at tertiary hospitals in Ethiopia. Most of these conditions occurred early after ART initiation and in those with concomitant anti-tuberculosis treatment. Thus, routine monitoring of patients on ART should be strengthened with particular emphasis in the first 6 months. Strategies should also be devised to replace older and more toxic agents with newer and safer drugs available.Key words: HIV, ART, adverse drug reaction, incidence rate, ACM, Ethiopi

Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia

Problem Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require the similar provision of care, but in 2012 the Ethiopian health system did not integrate the morbidity management. Approach To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers did integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system. Local setting In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services. Relevant changes To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts. Lessons learnt In Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic