Baseline survey for malaria prevalence in Khyber Pakhtunkhwa Province, Pakistan.

BACKGROUND: Plasmodium falciparum and P. vivax are prevalent in Pakistan. Data on the epidemiology of Plasmodium infections in Khyber Pakhtunkhwa province are lacking. AIMS: This study aimed to: 1) determine the malaria prevalence in three districts of Khyber Pakhtunkhwa province with endemic malaria (Bannu, Dera Ismail Khan and Lakki Marwat); 2) determine household ownership of long-lasing insecticidal bed nets in the districts; and 3) assess malaria services in health facilities in the districts, in order to provide baseline information for malaria control in these areas. METHODS: A cross-sectional study was conducted. In total, 31 041 individuals were selected for the malaria prevalence survey, 864 households for the insecticidal net ownership survey and 98 health facilities for malaria services. Rapid diagnostic tests were used to test for malaria. RESULTS: Overall, 4297 (13.8%) people tested positive for malaria. The prevalence of P. vivax, P. falciparum and mixed infection was 92.4%, 4.7% and 2.9%, respectively. The prevalence of malaria infection differed significantly between districts (P < 0.05). Prevalence was higher in people over 14 years and in women for P. vivax and P. falciparum malaria (P < 0.05). Only 44.1% of households owned one or more insecticidal nets. The most common drugs used to treat malaria were primaquine (62.5% of cases) and chloroquine (36.1%). CONCLUSIONS: The prevalence of malaria infection was high in the three districts. Malaria services in the health facilities were weak. Household ownership of long-lasing insecticidal nets was low. Malaria control or elimination strategies should be strengthened in these districts.

Genotyping and sero-virological characterization of hepatitis B virus (HBV) in blood donors, Southern Ethiopia.

Hepatitis B virus (HBV) prevalence is highest in Sub-Saharan Africa including Ethiopia. HBV genotypes have distinct geographic distributions and play a role in course of infection and treatment management. However, in Ethiopia there is paucity of information about distribution of HBV genotypes. This study was done to determine genotype, mutation and sero-virological profiles of HBV isolates in Southern Ethiopia. Cross-sectional, laboratory based study was conducted on 103HBsAg sero-positive samples from a total of 2,237 screened blood donors. HBV serological markers and biochemical assays were done. Serum viral load was measured using quantitative real-time PCR. Partial HBV S-gene was amplified with nested PCR and sequenced. Bioinformatics tools were utilized to determine genotypes, serotypes and mutations. Of 103 HBsAg reactive serum samples, 14.6% and 70.9% were sero-positive for HBeAg and HBeAb, respectively. Ninety-eight samples gave detectable viral load with a median of 3.46(2.62-4.82) log IU/ml. HBeAg sero-positive donors carried elevated levels of viral load. Eighty five isolates were successfully amplified, sequenced and genotyped into 58 (68.2%) genotype A (HBV/A) and 27 (31.8%) genotype D (HBV/D). HBV serotypes found were adw2 (74.1%), ayw2 (24.7%), and ayw3 (1.2%). In twenty-four (28.2%) samples mutations in the major hydrophilic region (MHR) were observed. Donors infected with HBV/A had higher viral load and more frequent MHR mutation than HBV/D infected donors. This study illustrated distribution of HBV genotype A and D among blood donors in southern Ethiopia. It also demonstrated occurrence HBV variants that may influence clinical aspects of HBV infection. The study contributes in narrowing the existing gap of HBV molecular study in Ethiopia.

Prevalence of Toxoplasma gondii infection in HIV-infected patients and food animals and direct genotyping of T. gondii isolates, Southern Ghana.

Toxoplasma gondii is of public health and veterinary importance causing severe diseases in immunocompromised individuals including HIV/AIDS patients and in congenital cases and animals. There is limited information on the epidemiology of T. gondii infection in humans, particularly HIV patients and food animals and the parasite genotypes in Ghana. A total of 394 HIV-infected patients from three hospitals were screened for T. gondii anti-IgG and IgM using ELISA. DNAs from blood samples of seropositve participants and 95 brain tissues of food animals were PCR assayed to detect Toxoplasma gra6. DNA positive samples were genotyped using multilocus nested polymerase chain reaction restriction fragment length polymorphism at 10 loci: sag1, alt.sag2, sag3, btub, gra6, l358, c22-8, c29-2, pk1, and apico. The overall seroprevalence was 74.37% (293/394). Toxoplasma DNAs were detected in 3.07% of the seropositive participants and 9.47% of the animals. Six of the human DNA positive samples were partly typed at sag3: 33.33, 50, and 16.67% isolates had type I, II, and III alleles, respectively. All nine isolates from food animals typed at nine loci except apico were atypical: six isolates were identical to ToxoDB #41 and #145, and one was identical to TgCkBrRj2 all identified in Brazil. The genotype of two isolates has not been reported previously and was named as TgCtGh1. T. gondii seroprevalence is high among the HIV-infected individuals with T. gondii circulating in Ghana being genetically diverse.

Syphilis among people with HIV infection in southern Ethiopia: sero-prevalence and risk factors.

BACKGROUND: Syphilis facilitates both HIV (human immunodeficiency virus) transmission and acquisition, reflecting the complex interplay between the two infections. Scarce information exists regarding syphilis epidemiology in Ethiopian context. Thus, this study determined the sero-prevalence of syphilis and associated risk factors in people with HIV infection. METHODS: A cross-sectional study was conducted at Hawassa Referral Hospital, southern Ethiopia from January to May, 2014. A consecutive 993 HIV-infected participants were studied; but individuals under 15 years of age or treated for syphilis or those with a CD4+ T-cell count below 50 cells/µl were excluded. Structured questionnaires were used to collect data on socio-demography and potential risk factors for syphilis. Moreover, blood samples were collected from all participants and screened for syphilis using rapid plasma reagin (RPR) test, and those found sero-positive were confirmed using treponema pallidum haemagglutination assay (TPHA). RESULTS: The sero-prevalence of syphilis was found to be 7.3% (95% CI 5.7- 9%). The rate of infection was significantly higher among participants who were ART (antiretroviral therapy) naive (odds ratio (OR) = 2.2; 95% CI 1.22 - 4.1), men (OR = 2.2; 95% CI 1.22 - 3.87), older than 50 years of age (OR = 3.9; 95% CI 1.45 - 6.94), had only primary school level education (OR = 7.8; 95% CI 2.63 - 23.2) and had a history of blood transfusion (OR = 3.9; 95% CI 1.5 - 10.4). CONCLUSION: The high prevalence of syphilis among HIV-infected population warrants integrating syphilis screening with HIV care to limit the clinical consequences of untreated syphilis as well as its adverse impact on HIV transmission.

Prevalence of dyslipidemia among HIV-infected patients using first-line highly active antiretroviral therapy in Southern Ethiopia: a cross-sectional comparative group study.

BACKGROUND: Data on lipid profile abnormalities among patients receiving highly active antiretroviral treatment in Ethiopia are very limited. The aim of this study was to determine the prevalence of dyslipidemia and characteristics of lipid profiles among patients living with human immunodeficiency virus (HIV) using first-line highly active antiretroviral therapy (HAART) in Southern Ethiopia. METHODS: This cross sectional comparative group study was conducted between March and May 2012, and included 113 HIV infected patients treated for a minimum of one year with first-line HAART regimens that included Efavirenz and Nevirapine (HAART group) and others 113 who had never received HAART (pre-HAART group). Serum lipid profiles were determined after overnight fasting and dyslipidemia was assessed according to the United State National Cholesterol Education program-III guideline. For statistical analysis Chi-square, student's t-test, and logistic regression were used using Statistical Package for Social Sciences (SPSS) Version 20. RESULT: Ninety-three (82.3%) of HAART and 87 (76.9%) pre-HAART patients had at least one laboratory abnormality, which is compatible with a diagnosis of dyslipidemia. Total cholesterol ≥ 200 mg/dl occurred in 43.4% of HAART and 15.9% pre-HAART patients (p=<0.0001), whereas HDL-cholesterol below 40 mg/dl occurred in 43.4% and in 63.7% respectively, (p=0.002). The LDL-cholesterol ≥ 130 mg/dl occurred in 33.6% of HAART and 15% pre-HAART patients (p=0.001), while triglycerides ≥ 150 mg/dl occurred in 55.8% and 31.0% respectively, (p=0.001). Receiving of HAART was significantly and positively associated with raised total cholesterol, LDL-cholesterol, and triglycerides. The adjusted odds ratio (95% CI) of HAART-treated vs. pre-HAART was 3.80 (1.34-6.55) for total cholesterol ≥ 200 mg/dl; 2.64 (1.31-5.32) for LDL- cholesterol ≥ 130 mg/dl and 2.50 (1.41-4.42) for triglycerides ≥150 mg/dl. CONCLUSION: Use of first-line antiretroviral therapy regimens that contain Efavirenz and Nevirapine were associated with raised total cholesterol, LDL-cholesterol, and triglycerides, an established atherogenic lipid profiles. Lipid profiles should be performed at baseline before commencement of antiretroviral therapy and then periodically through treatment follow-up to monitor any rising trends.