Establishing reference intervals for common hematology test parameters from apparently healthy geriatrics in Asella town, Southeast Ethiopia, 2020: a community-based cross-sectional study.

Background: Reference intervals are an important method tool for identifying abnormal laboratory test results. Complete blood count reference values are useful to interpret complete blood count (CBC) results and make clinical decisions, but these values have not been established for geriatrics in Asella town. Therefore, this study aimed to establish reference intervals (RIs) for complete blood count (CBC) parameters from geriatric participants/subjects in Asella town, Southeast Ethiopia. Methods: A community-based cross-sectional study was conducted from December 2019 to May 2020. An interviewer-administered questionnaire was used to collect data on sociodemography and other characteristics from 342 eligible geriatric participants. Weight, height, and vital signs were measured, and 8 mL of blood sample was collected. Screening tests such as HIV, HBsAg, HCV, syphilis, stool examination, and urinalysis were performed. The hematological parameter was measured using a Sysmex kx-21 hematology analyzer. The data were analyzed using SPSS version 21 software. The non-parametric independent Kruskal-Wallis test and Wilcoxon rank-sum test (Mann-Whitney U test) were used to compare the parameters between age groups and genders. The 97.5 and 2.5th percentile were the upper and lower reference limit for the population. Results: According to the study's findings, the reference intervals of red blood cell, white blood cell, platelet count, hemoglobin (HGB), and hematocrit (HCT) in male geriatrics were 3.8-5.85 × 1012/L, 3.1-9.66 × 109/L, 115.8-353 × 109/L, 12.4-17.76 g/dL, and 35.06-50.2%, respectively. The respective values for women were 3.94-5.48 × 1012/L, 3.13-8.4 × 109/L, 137.5-406 × 109/L, 12.5-16.4 g/dL, and 36.09-48.2%. Most of the hematological parameters showed significant differences between the two genders (p value <0.05). Conclusion: Accurate gender and age-specific reference intervals are crucial in managing patient health. The current study offers essential CBC hematological parameters that can assist clinicians in interpreting laboratory results and can improve healthcare quality in the geriatric population. Therefore, it is more relevant to use the current RIs in the geriatric set-up.

Helicobacter pylori (H. pylori) risk factor analysis and prevalence prediction: a machine learning-based approach.

BACKGROUND: Although previous epidemiological studies have examined the potential risk factors that increase the likelihood of acquiring Helicobacter pylori infections, most of these analyses have utilized conventional statistical models, including logistic regression, and have not benefited from advanced machine learning techniques. OBJECTIVE: We examined H. pylori infection risk factors among school children using machine learning algorithms to identify important risk factors as well as to determine whether machine learning can be used to predict H. pylori infection status. METHODS: We applied feature selection and classification algorithms to data from a school-based cross-sectional survey in Ethiopia. The data set included 954 school children with 27 sociodemographic and lifestyle variables. We conducted five runs of tenfold cross-validation on the data. We combined the results of these runs for each combination of feature selection (e.g., Information Gain) and classification (e.g., Support Vector Machines) algorithms. RESULTS: The XGBoost classifier had the highest accuracy in predicting H. pylori infection status with an accuracy of 77%-a 13% improvement from the baseline accuracy of guessing the most frequent class (64% of the samples were H. Pylori negative.) K-Nearest Neighbors showed the worst performance across all classifiers. A similar performance was observed using the F1-score and area under the receiver operating curve (AUROC) classifier evaluation metrics. Among all features, place of residence (with urban residence increasing risk) was the most common risk factor for H. pylori infection, regardless of the feature selection method choice. Additionally, our machine learning algorithms identified other important risk factors for H. pylori infection, such as; electricity usage in the home, toilet type, and waste disposal location. Using a 75% cutoff for robustness, machine learning identified five of the eight significant features found by traditional multivariate logistic regression. However, when a lower robustness threshold is used, machine learning approaches identified more H. pylori risk factors than multivariate logistic regression and suggested risk factors not detected by logistic regression. CONCLUSION: This study provides evidence that machine learning approaches are positioned to uncover H. pylori infection risk factors and predict H. pylori infection status. These approaches identify similar risk factors and predict infection with comparable accuracy to logistic regression, thus they could be used as an alternative method.

Machine learning-based risk factor analysis and prevalence prediction of intestinal parasitic infections using epidemiological survey data.

BACKGROUND: Previous epidemiological studies have examined the prevalence and risk factors for a variety of parasitic illnesses, including protozoan and soil-transmitted helminth (STH, e.g., hookworms and roundworms) infections. Despite advancements in machine learning for data analysis, the majority of these studies use traditional logistic regression to identify significant risk factors. METHODS: In this study, we used data from a survey of 54 risk factors for intestinal parasitosis in 954 Ethiopian school children. We investigated whether machine learning approaches can supplement traditional logistic regression in identifying intestinal parasite infection risk factors. We used feature selection methods such as InfoGain (IG), ReliefF (ReF), Joint Mutual Information (JMI), and Minimum Redundancy Maximum Relevance (MRMR). Additionally, we predicted children's parasitic infection status using classifiers such as Logistic Regression (LR), Support Vector Machines (SVM), Random Forests (RF) and XGBoost (XGB), and compared their accuracy and area under the receiver operating characteristic curve (AUROC) scores. For optimal model training, we performed tenfold cross-validation and tuned the classifier hyperparameters. We balanced our dataset using the Synthetic Minority Oversampling (SMOTE) method. Additionally, we used association rule learning to establish a link between risk factors and parasitic infections. KEY FINDINGS: Our study demonstrated that machine learning could be used in conjunction with logistic regression. Using machine learning, we developed models that accurately predicted four parasitic infections: any parasitic infection at 79.9% accuracy, helminth infection at 84.9%, any STH infection at 95.9%, and protozoan infection at 94.2%. The Random Forests (RF) and Support Vector Machines (SVM) classifiers achieved the highest accuracy when top 20 risk factors were considered using Joint Mutual Information (JMI) or all features were used. The best predictors of infection were socioeconomic, demographic, and hematological characteristics. CONCLUSIONS: We demonstrated that feature selection and association rule learning are useful strategies for detecting risk factors for parasite infection. Additionally, we showed that advanced classifiers might be utilized to predict children's parasitic infection status. When combined with standard logistic regression models, machine learning techniques can identify novel risk factors and predict infection risk.

Magnitude of Anemia and Undernutrition Among Primary School Children in a Setting of Mass Deworming in Central Ethiopia.

Background: Undernutrition and anemia in children continue to be a public health problem in developing countries. Besides, intestinal parasitic infection among school children is common in developing countries. World Health Organization (WHO) recommends periodic deworming of children who live in endemic areas. The aim of this study was to determine the magnitude of anemia and undernutrition among school children in a setting of mass deworming. Methods: A cross-sectional study was conducted among 510 school children aged 5-14 years from three randomly selected governmental schools in Sululta town, central Ethiopia. Socio-demographic variables were assessed using interviewer administered structured questionnaire. Anthropometric data were obtained and analyzed using WHO Anthroplusv1.0.4. Venous blood samples were collected using EDTA vacutainers. Hemoglobin level was determined by Sysmex KX-21N automated hematology analyzer and stool samples were processed using direct wet mount, formol-ether concentration and Kato-Katz methods. Data were entered and analyzed using SPSS version 21. Logistic regression analysis was performed to determine the association of anemia and undernutrition with the independent variables. Results: The overall magnitude of anemia was 3.7%. Among anemic individuals, 84.2% and 15.8% of participants had mild and moderate anemia, respectively. The magnitude of stunting and thinness was 16.9% and 10.8%, respectively. Of them, 18.6% of stunting and 14.5% of thinness were severe. Of factors related to undernutrition, children from large families (≥5) were less likely to be stunted (AOR=0.38, 95% CI=0.2-0.7, P=0.002) compared to small families. Conclusion: The magnitude of anemia in the study area was considered as an insignificant public health problem and none of the socio-demographic variables of participants were significantly associated with anemia and likewise with undernutrition except for family size. Further studies are required to clearly understand the impact of mass deworming on the magnitude of anemia and undernutrition.

A comparative study of hematological parameters between hypertensive and normotensive individuals in Harar, eastern Ethiopia.

BACKGROUND: Hypertension is the major public health concern; leading to cardiovascular disease. It is associated with alteration in hematological parameters which may lead to end-organ damage. Thus, this study aimed to compare hematological parameters between hypertensive and normotensive adult groups in Harar, eastern Ethiopia. METHODS: A comparative cross-sectional study was conducted from January to March, 2020 at Jugel and Hiwotfana Specialized University hospital, Harar, eastern Ethiopia. Convenient sampling technique was used to recruit 102 hypertensive patients from the two hospitals and 102 apparently healthy blood donors. Participant's socio-demographic and clinical information were collected using pre-tested structured questionnaire. Blood sample were collected and analyzed by Beckman Coulter DxH 500 analyzer for complete blood count. The data were entered and analyzed using SPSS version 23. Independent t-test and Mann Whitney u-test was used for comparison between groups. Spearman's correlation was used for correlation test. P values less than 0.05 was considered as statistically significant. RESULT: 102 hypertensive and 102 healthy controls were enrolled in this study. The median ± IQR value of white blood cell (WBC) count, hemoglobin (Hgb), hematocrit (HCT), red cell distribution width (RDW) and mean platelet volume (MPV) were significantly higher in hypertensive group compared to apparently healthy control group. Additionally, RBC (red blood cell) count, HCT and RDW showed statistically significant positive correlations with systolic and diastolic blood pressure. WBC count and RDW were significantly and positively correlated with body mass index (BMI). Platelet (PLT) count had a significant but negative correlation (r = -0.219, P = 0.027) with duration of hypertension illness while MPV showed positive and significant correlation (r = 0.255, P = 0.010). CONCLUSION: The median values of WBC, Hgb, HCT, RDW and MPV were significantly higher in hypertensive patient compared to apparently healthy individuals. Hence, it is important to assess hematological parameters for hypertensive individuals which may help to prevent complications associated with hematological aberrations. However, further studies are required to understand hypertensive associated changes in hematological parameters.

Blood coagulation parameter abnormalities in hospitalized patients with confirmed COVID-19 in Ethiopia.

BACKGROUND: Coagulopathy and thromboembolic events are among the complications of Corona Virus disease 2019 (COVID-19). Abnormal coagulation parameters in COVID-19 patients are important prognostic factors of disease severity. The aim of this study was to analyze coagulation profiles of hospitalized COVID-19 patients in Addis Ababa, Ethiopia. METHODS: This prospective cross-sectional study was conducted among 455 Covid-19 patients admitted at Millennium COVID-19 care and treatment center, Addis Ababa, Ethiopia from July 1- October 23, 2020. Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT) and International normalized ratio (INR) were determined on HUMACLOT DUE PLUS® coagulation analyzer (Wiesbaden, Germany). In all statistical analysis of results, p<0.05 was defined as statistically significant. RESULT: A prolonged prothrombin time was found in 46.8% of study participants with COVID-19 and a prolonged prothrombin time and elevated INR in 53.3% of study subjects with severe and 51% of critically COVID patients. Thrombocytopenia was detected in 22.1% of COVID-19 patients. 50.5% and 51.3% of COVID-19 patients older than 55 years had thrombocytopenia and prolonged APTT respectively. CONCLUSION: In this study, prolonged prothrombin time and elevated INR were detected in more than 50% of severe and critical COVID-19 patients. Thrombocytopenia and prolonged APTT were dominant in COVID-19 patients older than 55 years. Thus, we recommend emphasis to be given for monitoring of platelet count, PT, APTT and INR in hospitalized and admitted COVID-19 patients.

Intestinal helminthic infection and allergic disorders among school children enrolled in mass deworming program, Sululta, Ethiopia.

BACKGROUND: Intestinal helminths have been proposed to have a protective role against allergic sensitization and atopic diseases. However, consistent data demonstrating this are lacking in Sub-Saharan countries. We aimed to assess the association between intestinal helminths and allergic disorders among school children enrolled in mass deworming program in Sululta, Ethiopia. METHODS: A cross sectional study was conducted among 526 school children aged 5 to 14 years old from primary government schools in Sululta district, Ethiopia. An interviewer-led questionnaire administered to parents provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were collected using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire 6 months following deworming treatments. Atopy was defined as a positive skin prick test reaction to one or both dust mite (Dermatophagoides) and German cockroach (Blatella germanica) allergens. Fresh stool samples were collected, processed, and examined by direct wet mount, Kato-Katz technique, and formol-ether concentration technique. Multivariate logistic regressions were used to assess the association between allergic disorder and helminths infection. RESULTS: Of the total 526 school children, 58.2% were females. Overall, 24% (126/526) had allergic symptoms, 5.1% (27/526) had atopy, and 16.9% (89/526) had intestinal helminths. There was no association between helminthic infection and self-reported allergic symptoms (P = 0.317), but Ascaris lumbricoides infection was positively associated with atopy (AOR = 4.307, 95% CI 1.143-16.222, P = 0.031). Atopy was related to increased allergy symptoms (AOR = 2.787, 95% CI 1.253-6.197, P = 0.012), and family history of allergy was associated with increased childhood allergy (AOR = 2.753, 95% CI 1.565-4.841, P = 0.001). Deworming in the past 6 months showed a reduced odd of self-reported allergic symptoms (AOR = 0.581, 95% CI 0.366-0.954, P = 0.034). CONCLUSION: While no significant association between self-reported allergy and helminths was found in this study, this may have been due to the low prevalence and intensity of helminthic infection in the sample. There was a positive association between Ascaris lumbricoides and atopy. To further examine the underlying mechanism behind this positive association, a longitudinal study is needed.

The Magnitude of Hematological Abnormalities Among COVID-19 Patients in Addis Ababa, Ethiopia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a systemic infection with cardiovascular, pulmonary, gastrointestinal, neurological, and hematological manifestations. Abnormal hematological findings are thought to have a role in early risk stratification and prognostication of COVID-19 patients. However, the data on hematological abnormalities associated with the disease among Ethiopian COVID-19 patients are limited. OBJECTIVE: To determine the magnitude of hematological abnormalities among COVID-19 patients admitted at Millennium COVID-19 referral treatment center, Addis Ababa, Ethiopia. METHODS: A prospective cross-sectional study was conducted among COVID-19 patients admitted to Millennium COVID-19 referral treatment center from May to July, 2020. A total of 334 COVID-19 patients were included using convenience sampling. Socio-demographic data and disease severity status of admitted patients were recorded. Three milliliters of venous blood was collected and analyzed by Beckman Coulter DXH-600 automated analyzer to determine complete blood count (CBC). The data were entered and analyzed using SPSS version 23 software. Association of age, sex, and disease severity with hematological abnormalities was analyzed using binary logistic regression. An odds ratio and 95% confidence interval were used to measure the strength of association. P-value <0.05 was considered as statistically significant. RESULTS: Of 334 admitted COVID-19 patients, the majority were males (62.3%) and 69.8% had moderate disease conditions. The overall magnitude of any cytopenia and pancytopenia was 41% and 1.8%, respectively. The magnitude of anemia, thrombocytopenia, and leukopenia was 24.9%, 21.6%, and 5.4%, respectively. Lymphopenia (72.2%) was the most common hematological abnormality. COVID-19 patients with severe and critical disease were more likely to develop anemia, leukocytosis, neutrophilia, and combined neutrophilia-lymphopenia than those with moderate disease condition, with a significant association. CONCLUSION: Lymphopenia was the most common hematological abnormality observed among COVID-19 patients. Hematological abnormalities such as anemia, leukocytosis, neutrophilia, and combined neutrophilia-lymphopenia were significantly associated with disease severity. Monitoring and evaluation of hematological parameters could provide prognostic insight into the management and risk stratification of COVID-19 patients. However, further studies are required to fully understand the utility of hematological parameters for the prognosis of COVID-19 disease.

Increased Prevalence of Cestode Infection Associated with History of Deworming among Primary School Children in Ethiopia.

Mass deworming of school-aged children with anthelmintics has been recognized as an effective approach for reducing the burden of soil-transmitted helminth (STH) infections. However, the consequences of this intervention on nontargeted parasite populations sharing the same gastrointestinal niche are unclear. We conducted a cross-sectional survey among three primary schools in Sululta town, Ethiopia, to examine the association between students' histories of deworming treatment in the past 6 months and the prevalence of cestode and protozoan infections. An interviewer-led questionnaire administered to parents provided information on sociodemographic factors, and deworming status was ascertained from school records. Stool samples were collected from 525 children for microscopic examination. The independent associations of "any cestode" (positive either for Hymenolepis nana or Taenia spp. eggs) and "any protozoan" (positive either for Giardia lamblia or Entamoeba histolytica/Entamoeba dispar) with history of deworming were examined using logistic regression. Overall, 25.9% of children were infected with at least one intestinal parasite of which H. nana was the most common. In multivariate analyses, deworming in the past 6 months was positively associated with increased odds of both "any protozoan" and "any cestode" infections; the latter reached statistical significance (AOR = 1.83, 95% CI: 0.69-4.86, P = 0.220, AOR = 3.82, 95% CI: 1.17-12.73, P = 0.029, respectively). If this observed association is causal, a greater understanding of interspecies interactions within the gastrointestinal niche may elucidate possible consequences of mass deworming treatments against STHs on coexisting nontargeted parasites.

Association between infection with Helicobacter pylori and platelet indices among school-aged children in central Ethiopia: a cross-sectional study.

OBJECTIVE: Previous clinical studies in adults from developed countries have implicated Helicobacter pylori infections in the development of thrombocytopenia. However, studies in children, particularly those from low-income countries, are unusually scarce. We examined the association between H. pylori infection and platelet indices in young Ethiopian school children. DESIGN: Cross-sectional study SETTING: This study was conducted in five elementary schools located in central Ethiopia. PARTICIPANTS: Blood and stool samples were collected from 971 children across five elementary schools in Ethiopia. H. pylori infection was diagnosed using stool antigen and serum antibody tests, and haematological parameters were measured using an automated haematological analyser. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. The independent effects of H. pylori infection on platelet indices were determined using multivariate linear and logistic regressions. STUDY OUTCOMES: H. pylori-infected children had a lower average platelet count and mean platelet volume than uninfected after adjusting the potential confounders (adjusted mean difference: -20.80×109/L; 95% CI -33.51 to -8.09×109, p=0.001 and adjusted mean difference: -0.236 fL; 95% CI -0.408 to -0.065, p=0.007, respectively). Additionally, H. pylori-infected children had lower red blood cell counts (adjusted mean difference: -0.118×1012/L; 95% CI -0.200 to -0.036, p=0.005) compared with non-infected. CONCLUSION: Our study from a developing country provides further support for an association between H. pylori infections and reduced platelet indices in young Ethiopian school children, after controlling for potential confounders. Further research is needed, particularly longitudinal studies, to establish causality.

Allergy-related disorders (ARDs) among Ethiopian primary school-aged children: Prevalence and associated risk factors.

BACKGROUND: There has been a noticeable increase in the prevalence of allergy-related disorders (ARDs) in the modern era. Urbanization is believed to be a major environmental risk factor for the onset of ARDs but data from low- to middle-income countries is limited. OBJECTIVE: Our purpose was to assess the prevalence of ARDs and atopy among a population of rural Ethiopian school children and identify environmental and lifestyle factors associated with such disorders. METHODS: We performed a cross-sectional study on 541 school-children. An interviewer-led questionnaire administered to the mothers of each participant provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were based on the International Study of Asthma and Allergies in Children (ISAAC) core allergy and environmental questionnaire. Skin prick test for common allergens German cockroach (Blattella germanica) and dust mite (Dermatophagoides) was performed to define atopy. Multiple logistic regression analyses were performed to determine the odds ratio between ARDs and atopy with specific environmental and lifestyle habits. RESULTS: 541 children responded to the survey questions: the majority of participants were female (60.3%) and aged 10-15 years-old. The prevalence of any ARD was 27%, while the rates of ever-having eczema, rhinitis, and wheeze was found to be 16.8%, 9.6%, and 8.6% respectively. Only 3.6% (19 school-children) tested positive for any skin sensitization. Analysis of associated factors for ARDs found that a family history of allergic disorders (AOR: 2.80; p-value<0.01), use of insecticides (AOR: 2.05; p-value<0.01), and wearing open-toed shoes (AOR: 2.19; p-value = 0.02) were all significantly associated factors. Insecticide use, river-bathing, and infection with intestinal parasites were found to be significantly associated factors for atopy. Other potential risk factors such as frequent use of soap, bacterial infection, and household crowding had no statistical significance. CONCLUSION: Our study suggests that the prevalence of skin sensitization and ARDs in rural populations of developing countries is still relatively low. We identified several possible risk factors for further investigation. Overall, the significance of identified risk factors appears to indicate that genetic predisposition and exposure to environmental pollution are more important to the etiology of ARDs and atopy than specific lifestyle behaviors.