Vertical Transmission, Risk Factors, and Antimicrobial Resistance Patterns of Group B Streptococcus among Mothers and Their Neonates in Southern Ethiopia.

Background: Group B Streptococcus (GBS) contributes to maternal and neonatal morbidity and mortality by increasing intrauterine infection or vertical transmission at the time of birth. Despite many efforts to reduce the potential risk of vertical transmission, GBS remains the main cause of serious disease (neonatal sepsis, meningitis, and/or pneumonia) in vulnerable newborns during the first week of life. This study aimed to assess vertical transmission, risk factors, and antimicrobial resistance patterns of GBS among pregnant women and their neonates. Methods: A facility-based cross-sectional study was conducted among mothers and their neonates from February to May 2021. A total of 201 pregnant women with their neonates participated in this study. A well-designed questionnaire was used to collect sociodemographic and clinical data. A vaginal swab from mother before delivery and neonatal nasal and ear canal swab samples were taken as soon as after delivery within 30 minutes. Vaginal swabs, neonatal ear canal, and nasal swabs were placed into Todd-Hewitt broth and incubated at 37°C for 18-24 hours at 35-37°C in 5% CO2 conditions and then subcultured on 5% sheep blood agar for 18-48 hours. Presumptive identification of GBS was made by morphology, Gram stain, catalase, and hemolytic activity on sheep blood agar plates. CAMP and bacitracin susceptibility tests were used as confirmatory tests for GBS. Data were analyzed using SPSS version 21. P value ≤0.05 was considered statistically significant. Results: Vertical transmission rates of GBS (mother to neonates) were 11.9%. The prevalence of GBS among pregnant women and newborns was 24/201 (11.9%) (95% CI = 7.5-16.9) and 11/201 (5.5%) (95% CI = 2.5-9.0), respectively. The history of prolonged rupture of membranes (AOR = 3.5, CI = 2.2-18.8) and urinary tract infection (AOR = 2.9, CI = 1.7-16.3) were associated factors for maternal GBS colonization. Gestational age of <37 weeks (p=0.008), low birth weight of <2.5 kg (p=0.001), and maternal history of vaginal discharge (p=0.048) were associated factors for neonatal GBS colonization. Low antibiotic resistance was observed for erythromycin 8.6%, clindamycin 5.7%, and chloramphenicol 2.9%. Conclusion: In this study, high vertical transmission (mother to neonates) rate was observed. The prevalence of vaginal GBS colonization of women at delivery was 11.9% and significantly associated with the history of prolonged rupture of membranes and urinary tract infections. Gestational age of <37 weeks, low birth weight of <2.5 kg, and maternal history of vaginal discharge were associated with neonatal GBS colonization. Hence, there is a need for antenatal culture-based GBS screening, risk factor-based interventions, and regular follow-up of drug resistance patterns for proper treatment and management of GBS.

Bacteriological Profiles, Antimicrobial Susceptibility Patterns, and Associated Factors in Patients Undergoing Orthopedic Surgery with Suspicion of Surgical Site Infection at Arba Minch General Hospital in Southern Ethiopia.

Background: In the thoughts of all orthopedicians, the emergence of drug-resistant and biofilm-forming bacterial infections at orthopedic surgical sites is the most feared problem. Thus, this study aimed to determine the bacteriological profiles, antimicrobial susceptibility patterns, and biofilm forming ability of isolates, as well as factors associated with orthopedic surgical site infections (OSSIs). Methods: An institution-based cross-sectional study was conducted from March 1st, 2021, to February 30th, 2022 at Arba Minch General Hospital. About 245 suspected orthopedic patients with surgical site infection were enrolled and structured questionnaires were used to collect the required information. Wound swabs or pus aspirates were aseptically collected. The frequency and type of bacterial pathogen(s), antimicrobial susceptibility pattern, and biofilm formation were used to determine and characterize the magnitude of OSSIs. SPSS version 25 was used to analyze factors associated with OSSIs. Results: The overall magnitude of symptomatic OSSIs was 29.4% (72/245). External fixation [AOR = 4.761, 95% CI: (1.108-20.457)], implant use [AOR = 3.470, 95% CI: (1.460-8.246)], length of time for surgery [AOR = 3.225, 95% CI: (1.545-6.731)], and post-operative hospitalization [AOR = 4.099, 95% CI: (2.026-8.293)] were all statistically significant. Staphylococcus aureus was the most frequently isolated bacteria, accounting for 76%. Methicillin-resistant was observed in 57.9% and 40% of isolated S. aureus (MRSA) and coagulase-negative staphylococci (CoNS), respectively. One-third of the isolated E. faecium was vancomycin-resistant (VRE). Overall, 67.1% (51/76) of isolates were multidrug-resistant (MDR). About 27.6% (21/76) of isolates were found to be strong biofilm producers. Conclusion: OSSIs were shown to be caused by a significant number of drug-resistant and biofilm-producing bacterial isolates. To mitigate the problem, aseptic surgical practice and conventional wound management, as well as constant observation of antimicrobial resistant patterns, should be followed.

Factors associated with diabetic retinopathy screening and regular eye checkup practice among diabetic patients attending Felege Hiwot Specialized Hospital.

AIM: To identify associated factors of diabetic retinopathy (DR) screening and ey e check-up practice among diabetes mellitus (DM) patients attending Felege Hiwot Specialized Hospital. METHODS: An institution-based cross-sectional study was applied from October 4, 2019 to January 12, 2020 at Felege Hiwot Specialized Hospital. A systematic random sampling technique was used to recruit participants and an interviewer-administered questionnaire was employed to collect the data. The collected data were entered into Epi Info version 7 and transposed to SPSS version 24 for statistical analysis. Descriptive statistics were executed and associated factors were identified using binary logistic regression. The strength of association between the independent and the outcome variable was determined using an adjusted odds ratio (AOR) with 95% confidence interval (CI). RESULTS: Four hundred and six participants partake with a response rate of 95.7% and a mean age of 47±11.5y. The magnitude of DR screening was 308 (75.9%, 95%CI: 71.5%, 79.8%). Higher educational level (AOR=3.25; 95%CI: 1.40, 8.78), good knowledge of DR (AOR=2.50; 95%CI: 1.55, 4.46), and family history of DM (AOR=2.15; 95%CI: 1.41, 3.85) were significantly associated with DR screening. On the other side, rural residence [AOR=3.11 (1.89, 5.02)] and undesirable attitudes toward DR [AOR=5.65 (3.14, 8.76)] were significantly associated with poor regular eye checkup practice. CONCLUSION: Most of the participants are screened for DR. Higher education, family history, and good knowledge are associated with DR screening. In addition, rural residence and undesirable attitudes toward DR are associated with regular eye checkup practice.

Assessment of the Bacteriological Profile and Antibiotic Susceptibility Patterns of Wastewater in Health Facilities of Ethiopia.

BACKGROUND: Antimicrobials used for the treatment and prevention of bacterial infections are mainly released nonmetabolized into the aquatic environment via wastewater. Sometimes, unused therapeutic drugs are released down the drains that could act as selective pressure for the development of resistance. The aim of this study was to assess the bacteriological profile of wastewater in health facilities and determine antibiotic susceptibility patterns of bacterial isolates. METHODS: A cross-sectional study was conducted from October 1 to December 26, 2020, in health facility wastewater. A total of 128 samples were collected from health facilities for bacteriological analysis and antimicrobial susceptibility testing. RESULT: A total of 128 samples were processed, and 81 bacterial isolates were recovered. The most common bacterial isolates were S. aureus (16/81 (19.8%)) followed by Klebsiella spp. (15/81 (18.5%)), E. coli (13/81 (16%)), P. aeruginosa (10/81 (12.3%)), Enterobacter spp. (8/81 (9.9%)), Citrobacter spp. (7/81 (8.6%)), coagulase-negative Staphylococcus (5/81 (6.2%)), Salmonella spp. (5/81 (6.2%)), and Shigella spp. (2/81 (2.5%)). A majority of isolates were resistant to ampicillin (62/81 (76.5%)). Only few isolates were resistant to ciprofloxacin (11/81 (13.6%)), chloramphenicol (13/81 (16%)), and kanamycin (8/54 (14.8%)). A majority of bacterial isolates (57/81 (70.4%)) were multidrug resistant (MDR). CONCLUSION: Wastewater from the health facilities contains antibiotic-resistant including multidrug-resistant bacteria. Therefore, health facility wastewater should be treated by appropriate wastewater treatment before being released into the environment.

Catheter-Associated Urinary Tract Infection: Incidence, Associated Factors and Drug Resistance Patterns of Bacterial Isolates in Southern Ethiopia.

INTRODUCTION: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection and a leading cause of morbidity. The aim of this study was to determine the prevalence, associated factors and antibiogram of the bacterial isolates among CAUTIs patients. METHODS: A facility-based, cross-sectional study was conducted from March to December 2019 at Arba Minch General Hospital, Southern Ethiopia. Clinical and socio-demographic data were obtained using a questionnaire. Clean catch midstream urine samples were collected and inoculated onto blood agar, MacConkey agar, and cysteine lactose electrolyte deficient agar (CLED). The inoculated culture media were incubated in an aerobic atmosphere at 37°C for 24 h. After overnight incubation, the bacterial growth on the respective media was inspected visually and graded for the presence of significant bacteriuria. A significant bacteriuria was considered, if pure culture at a concentration of ≥105 colony forming unit (CFU)/mL. All isolates were further identified using colony morphology and biochemical tests. Antimicrobial sensitivity was determined by modified Kirby-Bauer disc diffusion method. Data were analyzed using SPSS version 25. P-value less than 0.05 was used as statistical significance. RESULTS: The overall incidence of symptomatic CAUTIs was 39/231 (16.8%). Independent predictors of CAUTIs were prolonged (≥7 days) catheterization (AOR = 3.6, 95% CI = 1.0-12.2), diabetes mellitus (AOR = 5.3, 95% CI = 1.4-19.6) and insertion of catheter in surgical ward (AOR = 3.6, 95% CI = 1.08-12.28). The most common bacterial isolates were E. coli 17/42 (40.5%), Klebsiella species 9/42 (21.4%) and Enterococcus species 5/42 (11.9%). High (>80%) drug resistance was observed against cotrimoxazole, cefoxitin and tetracycline. Ciprofloxacin and nitrofurantoin were the most active drugs. The overall prevalence of MDR among isolates was 37/42 (88.1%). Most bacterial isolates 30/42 (71.4%) were biofilm producers. CONCLUSION: High levels of drug resistance were observed to commonly used antibiotics. In our study, biofilm-producing bacterial isolates were the predominant cause of CAUTIs. Therefore, continuous surveillance of antimicrobial resistance patterns is necessary to help physicians in treatment and management of CAUTIs.

Integrated community based human and animal syndromic surveillance in Adadle district of the Somali region of Ethiopia.

The economy of Ethiopia largely depends on agriculture and roughly 80% of the households have direct contact with domestic animals which make the community vulnerable to zoonotic diseases, especially in pastoral areas like the Somali Regional State (SRS) of Ethiopia. However, in addition to low reporting rates, especially in livestock, there is also lack of coordination between public health and animal health surveillance and there is no linkage between public health system and animal health system and mechanism or structure for sharing information on zoonotic diseases in SRS. In view of these challenges, a small scale study was conducted to evaluate the feasibility of mobile communication in the early detection of human and animal syndromes in remote pastoral areas including where there are no human and animal health facilities by engaging local communities in the diseases surveillance. METHOD: A small scale study, testing a community based human and animal syndromic surveillance was conducted from August 2017 to February 2018 in 20 villages in four Kebeles of Adadle district in the SRS with an estimated 1390 households and 112,850 livestock. The selected community leaders were trained on disease surveillance and detection. The communication was done by direct calls. Two dollars per month were provided to the village leaders recruited for the surveillance. RESULTS: A total of 904 and 671 human and animal syndrome cases were reported in seven months of the study period. In addition to syndromes, suspected anthrax, sheep and goat pox (SGP), rabies, salmonellosis and mass abortion outbreaks were reported in animals. In humans, suspected cholera and chicken pox outbreaks were reported. Furthermore, tuberculosis and malaria cases were also confirmed in the study villages. In humans, gastrointestinal tract (GIT) disorder was the most common syndrome observed, which constituted (42.8%) of all syndromes, followed by respiratory disorder (37.8%) and febrile illness (15.5%). In livestock, cattle contributed (40.8%) of all cases of illness, while sheep, goats and camels contributed 24.1%, 18% and 17% of the cases respectively. Responses were organized for emergency treatment and vaccination campaigns against certain suspected disease outbreaks and emergencies such as SGP and cholera. CONCLUSION: This study suggests that engaging and empowering the village local leaders in disease surveillance in pastoral setting areas, including where there are no human and animal health facilities, coupled with mobile technologies (non-smart phone), would improve early detection and response to human and animal health events including zoonotic emergencies, and consequently improve the reporting rate at district, regional and national level. However, the collaboration between sectors (human health and animals health) and the capacity to respond to zoonotic diseases and etiological identification are crucial elements for effective integrated human and animals disease surveillance and response.