Efficacy and safety of chloroquine plus primaquine for the treatment of Plasmodium vivax malaria in Hamusit site, Northwestern Ethiopia.

BACKGROUND: Plasmodium vivax malaria is still an important public health problem in Ethiopia. Unlike Plasmodium falciparum, P. vivax has a dormant liver stage (hypnozoite) that can be a risk of recurrent vivax malaria unless treated by radical cure with primaquine. Drug resistance to chloroquine is threatening malaria control and elimination efforts. This study assessed the therapeutic efficacy and safety of chloroquine plus 14 days of primaquine on P. vivax infection based on parasitological, clinical, and haematological parameters. METHODS: A single-arm in vivo prospective therapeutic efficacy study was conducted to assess the clinical and parasitological response to the first-line treatment of P. vivax in Ethiopia, chloroquine plus 14 days low dose of (0.25 mg/kg/day) primaquine between December 2022 and March 2023 at Hamusit Health Centre using the standard World Health Organization (WHO) protocol. A total of 100 study participants with P. vivax mono-infection who were over 6 months old were enrolled and monitored for adequate clinical and parasitological responses for 42 days. The WHO double-entry Excel sheet and SPSS v.25 software were used for Kaplan-Meier survival analysis, and a paired t-test was used for analysis of haemoglobin improvements between follow up days. RESULTS: A total of 100 patients were enrolled among those, 96% cases were rural residents, 93% had previous malaria exposure, and predominant age group was 5-15 years (61%). 92.6% (95% CI 85.1-96.4%) of enrolled patients were adequate clinical and parasitological response, and 7.4% (95% CI 3.6-14.9%) recurrences were observed among treated patients. The fever and parasite clearance rate on day 3 were 98% and 94%, respectively. The baseline haemoglobin levels improved significantly compared to those days 14 and 42 (p < 0.001). No serious adverse event was observed during the study period. CONCLUSIONS: In this study, co-administration of chloroquine with primaquine was efficacious and well-tolerated with fast resolution of fever and high parasites clearance rate. However, the 7.4% failure is reported is alarming that warrant further monitoring of the therapeutic efficacy study of P. vivax.

Anopheles gambiae s.l (Diptera: Culicidae) seasonal abundance, abdominal status and parity rates in Metema-Armachiho lowland, Northwest Ethiopia.

BACKGROUND: Malaria is a life threating vector borne disease caused by different Plasmodium parasites. Metema and Armachiho are two of the top five malaria endemic areas among the districts of Amhara region in Ethiopia. Transmission pattern is seasonal and migrant laborers who visit these areas for employment in mechanized agriculture are highly affected. The aim of this study was to investigate seasonal abundance, abdominal status and parity rate of An.gambiae s.l in Metema-Armachiho lowlands, Northwest Ethiopia. METHOD: A 1 year longitudinal entomological study was conducted in Metema-Armachiho lowlands from June 2016-May 2017. Mosquitoes were collected using CDC-light traps in indoor and outdoor sites for four consecutive days in each month. A total of eight standard battery operated CDC-light traps were used to collect mosquitoes. Female mosquitoes were classed as unfed, fed or gravid under a dissecting microscope. The ovaries of all unfed An.gambiae s.l mosquitoes were examined for evidence of parity. Data were entered and analyzed using SPSS-20 software. Chi-square test was applied to show significant difference between variables. P-value< 0.05 was taken as statistically significant. RESULTS: Of the total 1253 mosquitoes collected, 713 (552 female, 161 male) were culex and 540 (501 female, 39 male) were An.gambiae s.l. About 50.9% were collected in June-August 2016, 21.7% in September-November 2016, 12.0% in December 2016-February 2017 and 15.4% in March to May 2017. Of the total, 57.2 and 42.8% of the An.gambiae s.l were collected from indoor and outdoor sites respectively. Of the total females collected, 76.8% were unfed; of which 69.4% were parous. Significantly higher number of female An.gambiae s.l were collected in indoor and there was significant difference in abdominal status of An.gambiae s.l mosquitoes collected in different season (P < 0.05). CONCLUSIONS: Highest number of An.gambiae s.l was observed from June-August followed by September-November. The parity rate of An.gambiae s.l was high and there was significant difference in abdominal status of An.gambiae s.l collected in different season.

Malaria-visceral leishmaniasis co-infection and associated factors among migrant laborers in West Armachiho district, North West Ethiopia: community based cross-sectional study.

BACKGROUND: Malaria and leishmaniasis are the two largest parasitic killers in the world. Due togeographical overlap of these diseases, malaria-visceral leishmaniasis co-infections occur in large populations and exist in different areas even if they have been poorly investigated. The aim of this study was to determine malaria-visceral leishmaniasis co-infection and their associated factors among migrant laborers. METHODS: Community based cross-sectional study was conducted from October-December 2016 on migrant laborers who are residents of rural agricultural camp in West Armachiho district and involved in sesame and sorghum harvesting. Standardized questionnaire was used to collect socio-demographic data and risk factors. Capillary blood was collected for giemsa stained blood film examination to detect and identify Plasmodium parasites. Recombinant kinensin (rk39) antigen test was performed to detect anti-leishmania donovani antibody. Data was coded, entered, checked for completeness and analyzed using SPSS version-20 statistical software. Chi-square test was applied to show a significant association between variables. P-value < 0.05 was considered as statistically significant. RESULTS: A total of 178 migrant laborers were included in this study. Of these, 74.2% belong to the age group 15-29; 61.2% come from lowland areas and 51.6% visit the area more than four times. Seroprevalence of visceral leishmaniasis was 9.6% (17/178); and 22.4% (40/178) of tested migrant laborers were found malaria infected. The overall prevalence of malaria-visceral leishmaniasis co-infection was 2.8%. Of the total migrant laborer, 47.8% used bed nets, of them 1.2% were malaria-visceral leishmaniasis co-infected; 72.5% used outdoor sites as usual sleeping site, among them 3.1% were malaria-visceral leishmaniasis co-infected; 60.1% were migrants, of which 2.8% were malaria-visceral leishmaniasis co-infected. All variables were not significantly associated with malaria-visceral leishmaniasis co-infection (P > 0.05). CONCLUSIONS: Prevalence of malaria-visceral leishmaniasis co-infection was low and it is not significantly associated with residence, number of visits, bed net utilization and outdoor sleeping habit even if both diseases are prevalent in the study area.

Prevalence of Plasmodium and Soil-Transmitted Helminth Coinfection and Associated Factors among Malaria-Suspected Patients Attending Shewa Robit Health Center, North-Central Ethiopia.

Plasmodium and soil-transmitted helminth (STH) coinfection is a major public health problem in developing countries. Its prevalence and associated factors are poorly addressed in the available research. Therefore, this study aimed to assess Plasmodium-STH coinfection prevalence and associated factors among malaria-suspected patients attending Shewa Robit Health Center, north-central Ethiopia. A cross-sectional study was conducted among 379 malaria-suspected patients attending Shewa Robit Health Center from April to May 2023. Stool and blood samples were collected from each participant. Plasmodium and STHs were detected from blood and stool samples by using blood film and the Kato-Katz method, respectively. Data were entered into Epi Info version 7 and analyzed by SPSS version 26. Descriptive statistics were used to compute Plasmodium-STH coinfection. Logistic regression was used to identify associated factors. Variables with a P-value <0.05 were considered statistically significant. Among the study participants, 27.9%, 20.3%, and 13.4% were positive for Plasmodium, STHs, and Plasmodium-STH coinfection, respectively. The prevalence of Plasmodium-Ascaris lumbricoides coinfection was high (7.6%). Unavailability of insecticide-treated bed nets (ITNs), improper use of ITNs, absence of indoor residual spraying, presence of stagnant water, and previous malaria infection were significantly associated (P <0.01) with Plasmodium infection. Being illiterate, using an unimproved latrine, having an untrimmed fingernail, and practicing open defecation were also significantly associated (P <0.03), with STH infection. Being male, illiterate, and living in rural areas were significantly associated (P <0.03) with Plasmodium-STH coinfection. The prevalence of Plasmodium-STH coinfection was high in malaria-endemic areas. Therefore, malaria-suspected cases should be checked for STH infection.

High Prevalence of Hookworm Species and Associated Factors among Soil-Transmitted Helminth-Infected Household Contacts in Burie Zuria District, Northwest Ethiopia: A Community-Based Cross-Sectional Study.

Background: Soil-transmitted helminths (STHs) are parasitic worms that are widely distributed in the tropical and subtropical regions. In Ethiopia, one of the tropical countries, STH infections are high and cause a huge burden. Several STH species show a pattern of household clustering with regard to prevalence and intensity. However, there is a scarcity of data on the status of STH infection among family contacts of STH-infected individuals in Ethiopia in general and in the study area in particular. Objective: This study is aimed at assessing the prevalence of soil-transmitted helminths and associated factors among STH-infected household contacts in Burie Zuria district, northwest Ethiopia. Method: A community-based cross-sectional study was conducted among 422 study participants from March to May 2021. Study participants were traced to their residences by following STH-infected patients. A convenient sampling technique was used to recruit the study participants. The stool samples were processed using duplicate Kato-Katz thick smears and a modified Ritchie's technique. The data were entered and analyzed using the Statistical Package for Social Sciences, version 26 of the software package. A P value <0.05 was considered a statistically significant association. Results: The overall prevalence of STHs was 36.5% (95% CI: 31.7%-41.5%). Two STHs, namely hookworm species (33.2%, 140/422) at (95% CI: 28.9%-37.8%) and Ascaris lumbricoides (4.3%, 18/422) at (95% CI: 2.7%-6.6%), were identified, with a double infection of 2.6% (4/154) at (95% CI: 1.0%-6.5%). Almost the majority (96.9%) of hookworm species and all Ascaris lumbricoides infections were categorized under a light intensity of infection. Family size >5 (AOR = 1.74; 95% CI: 1.15-2.60; P = 0.008) and lack of latrine facility (AOR = 1.86; 95% CI: 1.17-2.90; P = 0.02) were significantly associated with STH infections. Conclusion: A high prevalence of hookworms was found in the study area, where the majority of the study participants were adults. This finding may provide a basis for revising the school-based deworming programs that exclude the adult population. Public health interventions like accessing latrines, health education, and deworming programs should be regularly implemented for all age groups in the areas.

Soil Contamination and Infection of School Children by Soil-Transmitted Helminths and Associated Factors at Kola Diba Primary School, Northwest Ethiopia: An Institution-Based Cross-Sectional Study.

Background: Soil-transmitted helminths (STHs) are among the most prevalent parasitic worms infecting humans worldwide. They are still a major public health concern in the developing world, school-age children being the most affected segment of the population. Soil polluted with parasite ova and/or infective larvae is a source of human parasitic infections. There is a substantial shift in the notion of sanitation in many countries, and control of STHs contamination in the environment is becoming an emerging topic of research. However, data are scarce on the extent of soil contamination with STHs in Ethiopia in general and the study area in particular. Objective: This study aimed to determine the prevalence of STHs in soil, and school children and associated factors at Kola Diba primary school, Northwest Ethiopia. Methods: A school-based cross-sectional study was conducted in 2020 at Kola Diba primary school. A systematic random sampling technique was used to select 400 participants. About 150 soil samples were collected. A structured Amharic version questionnaire was used to collect data on sociodemographic variables and the factors associated with STH infection. Two grams of stool specimen was processed using the Kato-Katz technique. Data were entered and analyzed using STATA version 14.1. Binary and multiple logistic regressions were performed, and P < 0.05 was considered statistically significant. Result: The overall prevalence of soil-transmitted helminths was 50.0% with Ascaris lumbricoides (26.2%), hookworm species (16.5%), and Trichuris trichiura (3.5%). The overall soil contamination rate was 13.3% with A. lumbricoides (9.3%) and T. trichiura (4.0%). No habit of handwashing after toilet (AOR; 2.2, 95%CI: 1.3-3.6, P value = 0.002), no habit of regular shoe-wearing (AOR; 3.7, 95%CI: 2.1-6.2, P value <0.001), untrimmed fingernail status (AOR; 4.3, 95%CI: 2.6-7.1, P value <0.001), and playing with soil (AOR; 3.5, 95%CI: 2.2-5.7, P value <0.001) were significantly associated with STHs infection. Conclusion: The prevalence of STHs remains high among primary school children, with a considerable soil contamination rate. No habit of handwashing after defecation, untrimmed fingernail status, and no habit of regular shoe-wearing and playing with soil were significantly associated with the STHs infections.

Medicinal Plants Utilized for the Treatment of Gastrointestinal Parasitosis in Ethiopia.

Background: Nonhygienic living conditions give rise to parasitic infections. Intestinal parasitosis is a serious public health problem in Ethiopia. It is more common in the poor part of the population with low-income, poor personal, and environmental sanitation and limited clean water supply. This review is aimed at providing an overview of the medicinal plants used for the treatment of gastrointestinal parasitosis in Ethiopia. Methods: International databases (PubMed, Google Scholar, Scopus, and Web of Science) were systematically searched to access published original articles on medicinal plants used to treat gastrointestinal parasitosis without restriction on the year of publication and methodology. The validity of articles was checked before inclusion in the review by undertaking critical appraisal using tools adapted from JBI Critical Appraisal Checklist. The details of medicinal plants were extracted from the included studies using a standardized data extraction format in excel spreadsheet and analyzed using descriptive statistics to calculate frequency and percentage. Results: A search for published articles produced a total of 205 papers, of which 23 met the inclusion criteria. Of the 85 medicinal plants identified, the majority (40.2%) were shrubs, and the common plant part used was leaf (28.2%). Family Asteraceae has the highest number of plant species. The majority of the plant remedies were given orally (96.9%). Taeniasis comprises the highest percentage of intestinal parasitosis treated followed by ascariasis. Conclusion: Numerous plants have been utilized to treat gastrointestinal parasitosis. Information obtained from this review could serve as a guide to discover novel antiparasitic agents. Therefore, it is advisable for researchers to properly identify, document, conserve, and conduct safety and efficacy studies on such claimed medicinal plants.

Prevalence and Associated Risk Factors of Intestinal Parasites among Diarrheic Under-Five Children Attending Bahir Dar and Han Health Centers, Northwest Ethiopia: A Cross-Sectional Study.

Background: Intestinal parasitic infection is one of the major public health problems in developing countries including Ethiopia. The problem is highly pronounced in children under five years of age who are not able to adhere to prevention and control precautions. Objective: To assess the prevalence of intestinal parasitic infections (IPIs) and associated factors among diarrheic children under five years of age attending Bahir Dar and Han Health Centers, Bahir Dar, Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted among diarrheic children less than five years of age at Bahir Dar and Han Health Centers, Northwest Ethiopia, 2020. A total of 221 diarrheic children less than five years of age were recruited using the convenience sampling technique. Data were collected using a pretested structured Amharic version questionnaire after obtaining informed consent from children's parents or guardians. Approximately 1 mL of fresh fecal specimen was collected and subjected to direct saline wet mount microscopy. All data were entered into Epi Info version 7 and transferred to SPSS statistical software version 20 for analysis. Logistic regression was employed to assess risk factors associated with increased prevalence of intestinal parasitic infection in diarrheic children under five years of age, and a P value < 0.05 was taken as statistically significant. Results: The overall prevalence of intestinal parasites was 19% (95%CI = 14-24.6). The most prevalent intestinal parasites were Entamoeba histolytica/Entamoeba dispar (24 (10.86%)), Giardia lamblia (12 (5.43%)), and Ascaris lumbricoides (2 (0.9%)). Children's mother/guardian washed their hands sometimes after the toilet (AOR = 2.98, 95% CI: 1.09-8.18), children who always eat unwashed fruits and vegetables (AOR = 4.63, 95% CI: 1.09-19.75), and children's mother/guardian who had no knowledge about the mode of transmission (AOR = 4.03, 95% CI: 1.04-15.64) were risk factors significantly associated with increased intestinal parasitic infections. Conclusion: The prevalence of intestinal parasitic infections was found low compared to the population prevalence reported by WHO. However, strengthening health education about food and personal hygiene of both children and their mothers/guardians is crucial to limit the transmission of IPIs.

Prevalence and Intensity of Soil-Transmitted Helminths and Associated Factors among Adolescents and Adults in Bibugn Woreda, Northwest Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: Soil-transmitted helminths are a common public health problem in Ethiopia, affecting all age groups. However, epidemiological studies and interventions primarily target school-age children, despite the fact that 44.6 million adults live in endemic areas. Hence, data on the prevalence and intensity of soil-transmitted helminths infections and associated factors among adolescents and adults helps to expand interventions. OBJECTIVE: The aim of the study was to assess the prevalence and intensity of soil-transmitted helminths and associated factors among adolescents and adults in Bibugn Woreda, East Gojjam, Northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted in Bibugn Woreda from February to September 2021. Using multistage proportionate sampling technique, 641 adolescents and adults were enrolled in this study. Data on sociodemographic characteristics and factors associated with helminthic infections was collected using structured questionnaire prepared in Amharic and administered through face-to-face interview. Parasite detection in stool samples was performed using modified formol-ether concentration and Kato-Katz techniques following standard protocols. Data was entered and analyzed using Statistical Package for the Social Sciences software version 25. Multivariable logistic regression was used to assess factors associated with soil-transmitted helminths infections. P value <0.05 was considered as statistically significant. RESULTS: The overall prevalence of soil-transmitted helminths infection was 20.9% (134/641). The most detected parasite was Ascaris lumbricoides (12.5%), followed by hookworm species (7.5%) and Trichuris trichiura (1.1%). Fecal egg counts revealed that 96.5% (112/116) of the infections were with light parasite intensity, while 3.5% (4/116) were with moderate parasite intensity. Family size >5 (AOR = 1.866; 95% CI: 1.221-2.853; P=0.004), absence of latrine (AOR = 3.675; 95% CI: 1.599-8.449; P=0.002), and no habit of hand washing before meal (AOR = 2.622; 95% CI: 1.073-6.405; P=0.034) were significantly associated with soil-transmitted helminths infections. CONCLUSION: There was moderate prevalence of soil-transmitted helminths among adolescents and adults with predominance of A. lumbricoides. Family size greater than five, absence of latrine, and no hand washing habit before meal predisposed adolescents and adults for soil-transmitted helminths. The existing school-based interventions should expand to address adolescents and adults.

Prevalence of intestinal parasites and associated factors among children from child centres in Bahir Dar city, northwest Ethiopia.

Data concerning the burden of parasites among populations living in overcrowded circumstances have paramount importance for the success of interventions aimed at eliminating such disease. A cross-sectional study was therefore conducted from February to May 2019 among 217 children at child centres in Bahir Dar city. Data were collected using a structured questionnaire and stool samples were processed for parasitological investigation.A total of 53 (24.4%) children were infected with at least a single species of intestinal parasite. Giardia lamblia (7.8%) was the most frequent, followed by Hymenolepis nana (6%). Children with untrimmed fingernails (adjusted odds ratio [AOR] = 2.422, P = 0.027) were significantly more prone to infection. Similarly, children with no habit of hand washing after soil contact (AOR = 2.752, P = 0.014) or after defecation (AOR = 3.087, P = 0.026) were significantly associated with parasitic infection. The prevalence of intestinal parasites at child centres in Bahir Dar is of public health importance; therefore, control programmes should target these children.

Seroprevalence of Asymptomatic Leishmania donovani among Laborers and Associated Risk Factors in Agricultural Camps of West Armachiho District, Northwest Ethiopia: A Cross-Sectional Study.

BACKGROUND: Visceral leishmaniasis (VL, also called kala-azar) is a public health problem in Ethiopia, especially in sesame and sorghum growing areas. Compared to other populations, labor migrants are the most exposed. Knowing the seroprevalence of Leishmania donovani and associated risk factors is essential to design appropriate control measures. The main aim of this study was to assess the seroprevalence of asymptomatic L. donovani among laborers and associated risk factors in agricultural camps of West Armachiho district, Northwest Ethiopia. Therefore, this study was conducted to know the seroprevalence and associated risk factors of L. donovani infection. METHOD: A cross-sectional study was conducted among 185 laborers from October to December 2017. A simple random sampling technique was used to select study participants from selected agricultural camps. After obtaining written informed consent, data were collected using a structured pretested Amharic version questionnaire using the interview technique. A single finger prick blood sample was collected from the study participants and the blood samples were subjected to the serological diagnostic method using the rk39 kit. The multivariable logistic regression model was used to identify risk factors associated with L. donovani infection. RESULT: Among 185 participants examined using rk39, 14 (7.6%) were seroreactive for L. donovani. Leishmania donovani infection had a statistically significant association with sleeping under Balanites trees (AOR: 4.36, 95%CI: 1.186-16.06), presence of domestic animals near sleeping place (AOR: 4.68, 95% CI: 1.25-17.56), and lack of knowledge about VL transmission (AOR: 3.79, 95% CI: 1.07-13.47). CONCLUSION: Seroprevalence of asymptomatic L. donovani among laborers in agricultural camps of West Armachiho was low. Prevention measures and health education about risk factors that expose to L. donovani infection for the laborers are essential to prevent the spread of the disease.