Prevalence of G6PD deficiency and distribution of its genetic variants among malaria-suspected patients visiting Metehara health centre, Eastern Ethiopia.

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) is cytosolic enzyme, which has a vital role for the integrity and functioning of red blood cells. Lower activity of this enzyme leads to the occurrence of acute haemolytic anaemia after exposure to oxidative stressors like primaquine. Primaquine is an important drug for the radical cure of Plasmodium vivax and blocking transmission of Plasmodium falciparum, and thereby enhancing malaria elimination. However, there is a need to identify G6PD deficient individuals and administer the drug with caution due to its haemolytic side effects. The main objective of this study is to determine the prevalence of G6PD deficiency among malaria-suspected individuals. METHODS: A facility-based cross-sectional study was conducted from September 2020 to September 2021 in Metehara Health Centre, Eastern Ethiopia. A structured questionnaire was used to collect the socio-demographic and clinical information of the study participants. Capillary and venous blood samples were collected based on standard procedures for onsite screening, dried blood spot preparation, and malaria microscopy. The G6PD enzyme activity was measured by careSTART™ G6PD biosensor analyzer. Data was entered and analysed by SPSS. RESULTS: A total of 498 study participants were included in the study, of which 62% (309) were males. The overall prevalence of G6PD deficiency based on the biosensor screening was 3.6% (18/498), of which 2.9% and 4.8% were males and females, respectively. Eleven of the G6PD deficient samples had mutations confirmed by G6PD gene sequencing analysis. Mutations were detected in G267 + 119C/T, A376T, and ChrX:154535443. A significant association was found in sex and history of previous malaria infection with G6PD deficiency. CONCLUSIONS: The study showed that the G6PD deficient phenotype exists in Metehara even if the prevalence is not very high. G267 + 119C/T mutation is the predominant G6PD variant in this area. Therefore, malaria patient treatment using primaquine should be monitored closely for any adverse effects.

Commonly Consumed Vegetables as a Potential Source of Multidrug-Resistant and ß-Lactamase-Producing Bacteria in Debre Berhan Town, Ethiopia.

Background: Recently, antibiotic resistance of bacteria contained in foods such as vegetables has become a public health problem. In Ethiopia, the diversity of bacterial contamination and level of antibiotic resistance in vegetables are poorly understood. Local analysis of vegetable contamination and its contribution to the spread of antibiotic resistance are therefore essential for One Health interventions. Therefore, the aim of this study was to investigate the level of bacterial contamination of commonly consumed vegetables and their antimicrobial resistance patterns. Methods: A cross-sectional research was conducted in Debre Berhan town from February to August 2022. Questionnaires were used to collect data on sociodemographic variables, hygiene practices, and market hygiene. Six carefully selected vegetables (30 each, 180 in total) were purchased at a local market. Bacterial isolation and identification, multidrug-resistant (MDR) screening and confirmation, extended-spectrum ß-lactamase (ESBL) screening and confirmation, and antibiotic susceptibility tests were performed using standard operating procedure. The data were analysed statistically using SPSS software version 25. Results: The contamination rate of vegetables was 119 (66.1%). Of the 176 bacteria isolates, E. coli (26.1%; 46/176), S. aureus (18.8%; 176), S. epidermidis (10.8%; 19/176), Klebsiella spp. (9.1%; 16/179) and Acinetobacter spp. (6.8%; 12/176) were the most frequently detected isolates. Of the 180 samples tested, (66.1%; 119/180) were contaminated with at least one type of bacteria. Lettuce (22.7%; 40/176), spinach (18.6%; 33/176), and cabbage (19.2%; 32/176) were the most contaminated vegetables. Of the 176 bacteria isolates, (64.8%; 114/176) were MDR, and (18.5%; 23/124) isolates were ESBL producers. The kind of vegetables, vendor/seller finger-nail status, medium of display, market type, and not cleaned before to display were all significantly associated with bacterial contamination. Conclusion: This study found that commonly consumed vegetables are contaminated with antibiotic-resistant bacteria. Vegetables were also notable for the incidence of multidrug-resistant, extended ß-lactamase-resistant, and methicillin-resistant bacterial isolates. Therefore, we urge local health authorities to develop and implement effective control strategies to reduce vegetable contamination.

Parasitic Contamination and Microbiological Quality of Commonly Consumed Fresh Vegetables Marketed in Debre Berhan Town, Ethiopia.

Parasitic and microbial contamination and the pattern of occurrence of the parasite species depends on weather conditions, socio-cultural conditions, sampling season, analyzed vegetable products, and other factors. Therefore, local assessment of vegetable contamination is crucial for targeted and effective interventions. A cross-sectional study was conducted from February to August 2022. A questionnaire was used to assess factors associated with parasite contamination of vegetables during the marketing period. The selected vegetables were purchased and processed for parasite and microbial analysis using standard methods. Finally, all data were summarized and analyzed using SPSS software version 25. A total of 180 vegetable samples were purchased from 180 vendors. This study identified a total of 129 parasites from 180 vegetable samples, with an overall contamination rate of (75; 41.7%). Both protozoa (41; 31.8%) and helminthes (88; 68.2%) were identified from vegetables. Contamination with more than one parasite species was (38; 21.1%). The kind of produce, finger nail status of vendors/sellers, the medium of the display, the type of market and not washed prior to display were significantly associated with parasite contamination. The results also showed that vegetable microbial load for total heterotrophic count, total coliform count, fecal coliform count, yeast count, and mold count was higher in the afternoon than in the morning. To decrease risks to public health, local health authorities and/or market inspectors should establish and implement strategies to reduce contamination such as encouraging specific display medium and washing of vegetables prior to display.

High Levels of Multidrug-Resistant and Beta-Lactamase-Producing Bacteria in Meat and Meat Contact Surfaces, Debre Berhan Town, Ethiopia.

Background: Over the years, microbial contamination caused by foodborne bacteria has led to a significant number of food recalls, particularly for meat items that have been related to outbreaks of deadly diseases. Animals often carry Salmonella and Escherichia coli bacteria in their intestines, and these bacteria contaminate raw meat during slaughter. In addition, pathogens such as Staphylococcus aureus can contaminate meat processing equipment and utensils and spread to raw meat. Methods: A cross-sectional study was undertaken between 30 February and 15 March 2022. Sanitary conditions of abattoir and butchers and food handlers' hygienic practices were assessed using a structured questionnaire. An equal number of meat, swabs from carcasses, knife, weighing balance and cutting board samples (24 each, 120 total) were collected from abattoir and butcher shops. The collected samples were processed for bacterial isolation, antimicrobial susceptibility testing, MDR screening and confirmation, and ESBL screening and confirmation. Finally, SPSS software version 25 was used to compile and analyze the data. Descriptive data from surveys and laboratory procedures were cross-tabulated and summarized using statistical tables and figure. Results: A total of 76 bacteria were isolated from 120 samples. Of all bacteria isolated, S. aureus 16 (21.1%). E. coli 13 (17.1%), and S. epidermidis 12 (15.8%) were the most prevalent. The rate of bacterial contamination was high in meat 18 (23.7%), carcasses 15 (19.7%) and weighing balance 15 (19.7%), respectively. Among the isolates, 18 (23.7%) were resistant for eight and more antibiotics. While, 17 (22.4%), 7(9.2%) and 4(5.3%) of the isolates were resistant for two and three, four and five, and six and seven antibiotics, respectively. Of bacteria isolated, 51/76 (67.1%) were MDR, 23/48 (47.9%) were screened for ESBL production and 13/48 (27.1%) isolates were confirmed as ESBL producer. Conclusion: Multidrug-resistant bacterial contamination was common in meat and meat contact surfaces, which was exacerbated by inadequate sanitation and hygiene practices.

Pathogenic Bacteria and Their Antibiotic Resistance Patterns in Milk, Yoghurt and Milk Contact Surfaces in Debre Berhan Town, Ethiopia.

Background: Bacterial contamination of milk is a primary culprit for causing foodborne illnesses, presenting a significant health hazard for millions of individuals around the globe. The level and variety of microorganisms present in raw milk determine its degree of contamination and the potential health risks it poses. Methods: A cross-sectional survey was conducted from February to August. A questionnaire was used to collect data on socio-demographic characteristics and hygiene practices from milk distributors and traders. Raw milk, yoghurt, swabs from milk containers and drinking cups were collected and processed for bacterial isolation and identification, antibiotic susceptibility testing, MDR screening and confirmation, ESBL screening and confirmation. Finally, all data were pooled and analyzed using SPSS software version 25. Results: A total of 120 samples of fresh milk, yogurt and cotton swabs from milk containers and cups were collected. A total of 80 bacterial isolates were isolated from 120 samples. Among the bacteria isolated, S. aureus 17 (21.3%), E. coli 17 (21.3%), S. epidermidis 14 (17.5%), Klebsiella spp. 9 (11.3%) and Salmonella spp. 7 (8.8%) were detected most often. High rate of contamination was observed in fresh milk 23 (28.8%) and yogurt 23 (28.8%). All isolates were resistant to at least one antibiotic tested. Comparatively, high rates of resistance were observed in all isolates to the most commonly prescribed antibiotics in Ethiopia. However, lower rates of resistance have been observed for recently introduced antibiotics in Ethiopia. Of the isolates, 20 (25.0%) were resistant to eight or more antibiotics. While 16 (20.0%), 12 (15.0%), 9 (11.3%) isolates were resistant to two, three and five antibiotics, respectively. Of the bacteria isolated, 52/80 (65.0%) were MDR, 25/49 (51.0%) were screened for ESBL production, and 20/49 (40.8%) isolates were confirmed as ESBL producer. Conclusion: This study showed a high rate of bacterial isolates along with MDR and ESBL-producing strains in raw milk, yoghurt, milk container swabs and drinking cup swab samples, associated with poor hygiene and sanitation practices.

Foodborne Pathogens and Antimicrobial Resistance in Ethiopia: An Urgent Call for Action on "One Health".

Foodborne pathogens are the most common cause of foodborne disease worldwide. They contaminate food at all stages of the food chain, at the agricultural production level (soil and irrigation), from animal sources or at the time of preparation by food handlers. Therefore, food security is a critical issue that affects everyone in the world. Current studies indicate that the problem is more severe in low-income countries like Ethiopia. The majority of studies in Ethiopia have been conducted partially on human, animal or environmental samples with conventional culture-based diagnostic methods. Therefore, this review was conducted to gather information on the main foodborne pathogens and identify gaps in their traceability. Clinically important foodborne pathogens in Ethiopia include (A. lubmbricoids, Toxocara spp., H. nana. E. histolytica/dispar, G. intestinalis, H. diminuta and C. belli), bacteria (Salmonella spp, E. coli O157:H7, B. anthracis, Yersinia, C. perfringens, Klebsiella spp. M. paratuberculosis, and L. monocytogenes), and viruses like (rotaviruses, enteroviruses and astroviruses, hepatitis E virus). In Ethiopia, all isolated foodborne bacterial pathogens showed high rates of antimicrobial resistance (AMR). In particular, the most studied foodborne pathogens, Staphylococcus spp., Salmonella spp., and E. coli from specific sources, showing high levels of resistance to most of the antibiotics prescribed in Ethiopia. The occurrence and persistence of AMR in food is one of the main factors causing the spread of antimicrobial resistance in different compartments, humans, animals and the environment. Therefore, strategies of coordination and struggle from a One Health perspective is an urgent strategy to control antibiotic resistance in order to achieve better outcomes for human and animal health.