Sero-prevalence of visceral leishmaniasis and its associated factors among asymptomatic individuals visiting Denan health center, southeastern Ethiopia.

BACKGROUND: In the Somali region of Ethiopia, visceral leishmaniasis (VL) is a public health concern. However, VL epidemiology and sand fly vectors have not been well studied in various areas of the regional state, including Denan district. Therefore, this study was conducted to determine the sero-prevalence, associated factors, and distribution of sand fly vectors of VL in Denan district, south-eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted from April to September 2021 among VL patients with classic signs and symptoms visiting Denan Health Center in south-eastern Ethiopia. Using a convenience sampling method, 187 blood samples were collected from individuals who visited Denan Health Center during the study period. Blood samples were subjected to Direct Agglutination Test for the detection of antibodies to VL. A pre-tested structured questionnaire was also used to gather information on risk factors and other characteristics of knowledge and attitude assessment. Sand flies were also collected from indoor, peri-domestic, mixed forest, and termite mounds using light and sticky traps to determine the fauna and abundance. RESULTS: The overall sero-prevalence rate was 9.63% (18/187). The sero-prevalence was significantly associated with outdoor sleeping (OR = 2.82), the presence of damp floors (OR = 7.76), and sleeping outdoor near animals (OR = 3.22). Around 53.48% of the study participants had previously heard about VL. Study participants practiced different VL control methods, including bed nets (42%), insecticide spraying (32%), smoking plant parts (14%), and environmental cleaning (8%). In total, 823 sand fly specimens, comprising 12 species in two genera (Phlebotomus and Sergentomyia), were trapped and identified. The most abundant species was Sergentomyia clydei (50.18%), followed by Phlebotomus orientalis (11.42%). Also, a higher proportion of P. orientalis was found in termite mounds (65.43%), followed by mixed forest (37.8%) and peri-domestic (20.83%) habitats. CONCLUSION: The study demonstrated a 9.63% sero-positivity of VL and a remarkable gap in knowledge, attitude, and practices towards VL. P. orientalis was also detected, which could be a probable vector in this area. Thus, public education should be prioritized to improve the community's awareness of VL and its public health impact. In addition, detailed epidemiological and entomological studies are recommended.

Laboratory-based efficacy evaluation of Bacillus thuringiensis var. israelensis and temephos larvicides against larvae of Anopheles stephensi in ethiopia.

BACKGROUND: Malaria, transmitted by the bite of infective female Anopheles mosquitoes, remains a global public health problem. The presence of an invasive Anopheles stephensi, capable of transmitting Plasmodium vivax and Plasmodium falciparum parasites was first reported in Ethiopia in 2016. The ecology of An. stephensi is different from that of Anopheles arabiensis, the primary Ethiopian malaria vector, and this suggests that alternative control strategies may be necessary. Larviciding may be an effective alternative strategy, but there is limited information on the susceptibility of Ethiopian An. stephensi to common larvicides. This study aimed to evaluate the efficacy of temephos and Bacillus thuringiensis var. israelensis (Bti) larvicides against larvae of invasive An. stephensi. METHODS: The diagnostic doses of two larvicides, temephos (0.25 ml/l) and Bti (0.05 mg/l) were tested in the laboratory against the immature stages (late third to early fourth stages larvae) of An. stephensi collected from the field and reared in a bio-secure insectary. Larvae were collected from two sites (Haro Adi and Awash Subuh Kilo). For each site, three hundred larvae were tested against each insecticide (as well as an untreated control), in batches of 25. The data from all replicates were pooled and descriptive statistics prepared. RESULTS: The mortality of larvae exposed to temephos was 100% for both sites. Mortality to Bti was 99.7% at Awash and 100% at Haro Adi site. CONCLUSIONS: Larvae of An. stephensi are susceptible to temephos and Bti larvicides suggesting that larviciding with these insecticides through vector control programmes may be effective against An. stephensi in these localities.

Low awareness and common misconceptions about schistosomiasis in endemic lowland areas in Western Ethiopia: a mixed-methods study.

BACKGROUND: Understanding the health behavior of the target population is crucial for sustainable schistosomiasis control. The aim of this study was to assess schistosomiasis related levels of knowledge, attitude, and practices of communities in lowland areas of western Ethiopia, where schistosomiasis is endemic. METHODS: A community-based multilevel triangulation mixed-methods design was conducted in three schistosomiasis endemic villages in the Abbey and Didessa valleys of the Benishangul Gumuz Region of Western Ethiopia, where mass drug administration (MDA) was done 30 years back and again the last 5 years. A structured survey questionnaire, in-depth interviews, focused group discussions, and observation was conducted to assess levels of knowledge, attitude, and practices related to schistosomiasis in the communities. RESULTS: Among the survey participants, 13% reported having heard of schistosomiasis, locally called Pecka (meaning worm). The majority of this 13% believe that schistosomiasis is caused by the biting of the worm Pecka, while others say drinking dirty water is the cause of infection, or they didn't know what the cause is. A majority of respondents answered "I don't know" to most of the questions about established knowledge of schistosomiasis. Male participants and students were more aware of schistosomiasis than their counterparts, and awareness increased with the educational level. Only one participant perceived that schistosomiasis was a serious disease. There were negative attitudes and misconceptions about the drug used in the mass treatment and many complaints were raised related to the size of the tablet and its side effects. There was no local budget and specific plan to prevent and control the disease. Local health personnel had insufficient knowledge about schistosomiasis, and the diagnosis and treatment capacities of local health institutions were poor. CONCLUSION: In the current research area, schistosomiasis prevention and control recommendations should be redesigned to change the knowledge, attitudes, and practices of the community and local health workers. It is also necessary to have the local budget and trained manpower in order to diagnose and treat schistosomiasis locally. There is a great need to have a safer Praziquantel pediatric formulation.

High helminthic co-infection in tuberculosis patients with undernutritional status in northeastern Ethiopia.

BACKGROUND: Tuberculosis and parasitosis are the widely distributed diseases in Ethiopia with the leading cause of mortality and morbidity, respectively. There has been no information on the status of co-infections of tuberculosis and parasitosis in Oromia Zone of Amhara Region and South Wollo, Ethiopia. Hence, this study primarily focuses on determining the status of tuberculosis and parasitosis co-infections and associated factors. METHODS: The study was conducted in Oromia Special Zone of the Amhara Regional State and South Wollo Zone, northeastern Ethiopia from April 2015 to January 2017. Tuberculosis cases confirmed by health personnel at the health institutions were the source of the study sample. In a cross-sectional study 384 smear positive pulmonary and extra-pulmonary tuberculosis cases were recruited. Faecal specimens provided by the study participants were examined for parasitic co-infections using direct saline microscopic test, Kato-Katz and concentration techniques. Nutritional status was determined using body mass index and mid-upper arm circumferences. Data were analyzed using descriptive statistical methods and Pearson chi-square. RESULTS: Tuberculosis and parasitosis co-infection prevalence was 10.8%, and the proportion of intestinal helminths accounted for 9.7% while intestinal protozoa accounted for 1.9%. Cases with single parasitic infection was 89.3% among co-infected individuals. Co-infection of both disease was not significantly associated with gender and age (P > 0.05). The prevalence of undernutrition was 58.6% as determined using body mass index and 73.0% as determined using mid-upper arm circumference with no significant association with gender. Among all forms of tuberculosis cases (384) screened for the study, the bacterial positivity was relatively more common in males (55.5%) than females (44.5%). Tuberculosis lymphadenitis was found to be the most prevalent (85.9%) form of extra-pulmonary tuberculosis with cervical adenopathy (75.3%) being the commonly existing disease. CONCLUSIONS: The rate of helminthic co-infection is predominantly high than that of intestinal protozoa. Single parasitic co-infection was more common than double or multiple co-infections. Both body mass index and mid-upper arm circumference anthropometric parameters revealed greater risk of undernutrition in tuberculosis patients. Thus, screening and prompt treatment of parasites in tuberculosis patients and a support of nutritional supplementation for malnourished tuberculosis patients should be further studied which might enhance the disease treatment and minimize the risk of its complexity.

Prevalence of urinary schistosomiasis and associated risk factors among Abobo Primary School children in Gambella Regional State, southwestern Ethiopia: a cross sectional study.

BACKGROUND: In Ethiopia, urinary schistosomiasis caused by Schistosoma haematobium has been known to be endemic in several lowland areas of the country where it causes considerable public health problems, mainly among school-age children. However, information on recent magnitude and risk factors of the disease is lacking, particularly for Gambella area. Therefore, this study aimed to assess the prevalence of urinary schistosomiasis and associated risk factors among Abobo Primary School children in Gambella, southwestern Ethiopia. METHODS: A cross-sectional study involving 304 school children was conducted in Abobo Primary School, Gambella Regional State, southwestern Ethiopia, from February to June 2014. Ten ml of urine sample was collected from each study participant and processed for microscopic examination by the urine filtration method; egg load for positive individuals was determined per 10 ml of urine. Data on socio-demographic characteristics and risk factors were collected using an interview-based questionnaire. The data were entered into and analyzed with SPSS version 20. Logistic regression and odds ratio were used to measure association and strength between variables, respectively. P-value < 0.05 at 95% CI was considered as statistically significant. RESULTS: The prevalence of urinary schistosomiasis was 35.9% (109/ 304) with a mean egg intensity of 8.76 per 10 ml of urine. Being male [AOR (95%CI) = 2.15(1.31, 3.52)], having father as a farmer [AOR (95%CI) = 1.96(1.19, 3.22)] and children living apart from parents [AOR (95% CI): 3.09 (1.14, 8.4)] were significantly associated with urinary schistosomiasis. CONCLUSION: The present study area in Gambella Regional State, southwestern Ethiopia, represents moderate-risk community for urinary schistosomiasis. Sex, father's occupation and living apart from parents were found to be associated with infection. Treatment of all school-age children and fishermen is required once every 2 years until the prevalence of infection falls below the level of public health importance. It is also recommended to complement praziquantel treatment with supplementary measures such as provision of sanitation facilities and health education.

A new focus of schistosomiasis mansoni in Hayk town, northeastern Ethiopia.

BACKGROUND: The endemicity of human schistosomiasis has long been established in Ethiopia, and new foci have also been continuously reported.The objective of this study was to determine the transmission and magnitude of schistosomiasis in Hayk area, northeastern Ethiopia. METHODS: A cross sectional parasitological survey involving 384 school children was conducted for intestinal schistosomiasis between January and March 2010 in two primary schools in Hayk area, northeastern Ethiopia. The stool samples were processed for microscopic examination using Kato-Katz technique. Malacological survey and observation on human water contact activities were also carried out. Snails were checked for schistosome infection by shedding and lab-bred mice were exposed to the cercariae shed from Biomphalaria pfeifferi en masse. Adult Schistosoma mansoni worms were harvested from the mice after 45 days of exposure to the schistosome cercariae. RESULTS: The overall prevalence and intensity of intestinal schistosomiasis among school children in Hayk Number 1 and Hayk Number 2 Primary Schools was found to be 45% and 161 epg, respectively. The prevalence of infection had relationship with age and sex. Males were more infected than females. Children in the age group 15-19 years had the highest infection rate, followed by 10-14 and 5-9 years age group. Schistosome infection in Biomphalaria pfeifferi was 3.2%. Schistosome infection was also established in laboratory-bred mice and adult Schistosoma mansoni worms were harvested. CONCLUSION: The observed intestinal schistosomiasis with prevalence of 45% among young children, collection of schistosome infected Biomphalaria pfeifferi, and the establishment of lab infection in mice showed that transmission of intestinal schistosomiasis is taking place in the area. Preventive chemotherapy with praziquantel should be immediately put in place to reduce morbidity and interrupt transmission of schistosomiasis in the area.

Efficacy of Praziquantel against Schistosoma haematobium in Dulshatalo village, western Ethiopia.

BACKGROUND: Praziquantel (PZQ) is the drug of choice for treatment of all human schistosomes. It is used in population based targeted or mass deworming strategies in several countries. The effect of PZQ on S. hematobium has not been studied in Ethiopia. The objective of this study was to determine the efficacy of PZQ against S. haematobium in Dulshatalo village, western Ethiopia. METHODS: A prospective study was conducted from October to December, 2007. Urine samples from 341 residents were collected and screened for haematuria and proteinuria using urinalysis dipstick. S. haematobium eggs were detected and quantified using filtration techniques. The participants who were positive for haematuria were treated with a standard dose of PZQ (40 mg/kg). Data on pre and 24 hours post treatment symptoms were collected via questionnaire. Urine samples were also collected 7 weeks after treatment and examined to assess the cure and the egg reduction rates. RESULTS: The prevalence of S. haematobium among the study participants was 57.8% (197/341). Haematuria was detected in 234 (68.6%) of the study participants. For PZQ efficacy asessment, 152 of the treated participants were considered. The presence of S. haemetaobium eggs showed statistically significant association (p < 0.05) with haematuria and proteinuria. Seven weeks post treatment, the extent of haematuria and proteinuria decreased from 100% to 40.8% and 94.07% to 48.7%, respectively. The cure and the parasitological egg reduction rates seven weeks post treatment were 86% and 85%, respectively. Post treatment symptoms revealed a wide range of side effects including straining, abdominal pain, nausea and headache. CONCLUSIONS: There were marked cure and egg reduction rates, together with mild and short lived side effects of PZQ for treatment of S. haematobium, in this study.

Efficacy and side effects of praziquantel in the treatment for Schistosoma mansoni infection in school children in Senbete Town, northeastern Ethiopia.

OBJECTIVE: To assess the efficacy and side effects of praziquantel in the treatment for Schistosoma mansoni infection in school children in Senbete Town, northeastern Ethiopia. METHODS: A single stool specimen was collected from 342 school children and examined for S. mansoni ova using Kato-Katz technique (single slide) and formol-ether concentration technique. Positive individuals were treated with a single oral dose of praziquantel at 40 mg/kg body weight. Egg reduction and cure rates were assessed 4 weeks post-treatment. Structured questionnaires were also used to collect pre-treatment and 24-h post-treatment signs and symptoms to assess side effects of the drug. RESULTS: Praziquantel reduced the egg rate by 79.46% and achieved a cure rate of 82.89% 4 weeks post-treatment. 86.67% of the children presented at least one transient drug-related sign and symptom 24-h post-treatment. CONCLUSION: Praziquantel demonstrated sufficient efficacy against S. mansoni in Senbete Town, northeastern Ethiopia. Mild and transient signs and symptoms associated with therapy disappeared within 24 h without specific treatment.

Evaluation of urine-circulating cathodic antigen (Urine-CCA) cassette test for the detection of Schistosoma mansoni infection in areas of moderate prevalence in Ethiopia.

OBJECTIVE: To evaluate the diagnostic performance of antigen detecting urine-CCA cassette test for the detection of Schistosoma mansoni infection in areas of moderate prevalence in Ethiopia. METHODS: Stool specimens were collected from 620 schoolchildren on three consecutive days. The samples were microscopically examined using double Kato slides; midstream urine specimens were also collected for three consecutive days and tested for S. mansoni. The sensitivity of the urine-CCA cassette test was determined using combined results of six Kato-Katz thick smears and three urine-CCA cassette tests as gold standard. The specificity of the urine-CCA cassette test was evaluated in an area where schistosomiasis is not endemic. RESULTS: Prevalence of S. mansoni infection as determined by single urine-CCA cassette test was 65.9%, by single Kato-Katz smear 37.3% and by six Kato-Katz thick smears 53.1% (P < 0.001). A single urine-CCA cassette test was significantly (P < 0.001) more sensitive (89.1%), had a lower negative predictive value (78.2%), was more accurate (92.6%) and agreed better with the gold standard (k = 0.83) than one or six Kato-Katz thick smears. However, both the Kato-Katz and urine-CCA cassette test showed 100% specificity in endemic settings. CONCLUSIONS: In moderate and high prevalence areas, urine-CCA cassette test is more sensitive than the Kato-Katz method and can be used for screening and mapping of S. mansoni infection.

Efficacy and side effects of praziquantel in the treatment of Schistosomiasis mansoni in schoolchildren in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia.

OBJECTIVE: To evaluate the efficacy and side effects of praziquantel (PZQ) in the treatment of schistosomiasis in Ethiopia. METHODS: In a cross-sectional study, stool specimens were collected from randomly selected 299 school children in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia, in April 2010. Stool specimens were examined using a single Kato-Katz thick smear for Schistosoma mansoni (S. mansoni) ova. Children who were found positive for S. mansoni were treated with a single oral dose of PZQ at 40 mg/kg bw and interviewed for treatment-related symptoms 24 hours after drug administration. Four weeks post-treatment, stool specimens were collected from the same children and examined following the same procedure as in the pre-treatment. Drug efficacy was determined based on cure and egg reduction rates. RESULTS: Pre-treatment prevalence of S. mansoni infection was 74.9% with geometric mean egg count of 268. The evaluated generic PZQ produced an overall cure rate of 73.6% (P<0.000 1, OR: 8.33, CI: 5.3-13.1) and egg reduction rate of 68.2% (P=0.03, F=0.64). The cure rate showed significant association with age (χ(2)=11, P=0.004), the highest rate being observed in the 15-22 age group. 83% of S. mansoni infected children showed various treatment-related symptoms, the most frequent being headache, nausea, and abdominal pain. These symptoms were associated with age (P<0.001) and pre-treatment intensity of infection (P<0.05). CONCLUSIONS: The present observations revealed relatively lower cure and egg reduction rates of the PZQ evaluated as compared to previous reports for other PZQ brands in Ethiopia. Hence, in depth studies are recommended to clarify whether the present relatively lower cure rate is the actual cure rate of the praziquantel evaluated, treatment failure, or reduced susceptibility of the parasite. Treatment-related side effects observed were transient and tolerable.

Cockroaches as carriers of human intestinal parasites in two localities in Ethiopia.

A study was undertaken to assess the role of cockroaches as potential carriers of human intestinal parasites in Addis Ababa and Ziway, Ethiopia. A total of 6480 cockroaches were trapped from the two localities from October 2006 to March 2007. All the cockroaches trapped in Addis Ababa (n=2240) and almost 50% (2100/4240) of those trapped in Ziway were identified as Blattella germanica. The rest of the cockroaches trapped in Ziway were identified as Periplaneta brunnea (24.52%), Pycnoscelus surinamensis (16.03%) and Supella longipalpa (9.90%). Microscopic examination of the external body washes of pooled cockroaches and individual gut contents revealed that cockroaches are carriers of Entamoeba coli and Entamoeba histolytica/dispar cysts as well as Enterobius vermicularis, Trichuris trichiura, Taenia spp. and Ascaris lumbricoides ova. Besides their role as a nuisance, the present study further confirms that cockroaches serve as carriers of human intestinal parasites. The possible association of cockroaches with allergic conditions such as asthma is also discussed. Hence, appropriate control measures should be taken particularly to make hotels and residential areas free of cockroaches as they represent a health risk.

Field-based evaluation of a reagent strip test for diagnosis of Schistosoma mansoni by detecting circulating cathodic antigen in urine before and after chemotherapy.

The sensitivity of a reagent strip test for the diagnosis of schistosomiasis by detecting circulating cathodic antigen (CCA) in urine was evaluated under field conditions using 251 stool and urine samples collected from a Schistosoma mansoni-endemic area of Ethiopia. The specificity of the test was evaluated in an area where schistosomiasis is not endemic. Stool samples were examined microscopically using duplicate Kato slides and formol-ether concentration methods. The effectiveness of the test in monitoring efficacy was also evaluated following chemotherapy. The results revealed that detection of CCA in urine using the one-step reagent strip test was superior to the stool examination methods (P<0.05) in indicating the prevalence of the disease. Assuming the combination of parasitological test results as the gold standard, the sensitivity and specificity of the test were 82.1% and 75.9%, respectively. The results of egg counts suggested the potential use of urine CCA in indicating the intensity of infection as an alternative to parasitological methods. The sensitivity and specificity of the test were 75% and 73.7%, respectively, following chemotherapy. Diagnosis of S. mansoni infection in urine using reagent strips would provide information on the prevalence of the disease, although further study is needed to improve its sensitivity and specificity.

Zoonotic intestinal parasites in Papio anubis (baboon) and Cercopithecus aethiops (vervet) from four localities in Ethiopia.

A total of 59 faecal samples from ranging Papio anubis (baboons) and another 41 from Cercopithecus aethiops (vervet) from the Rift Valley areas of Ethiopia were microscopically examined to determine the prevalence and species of major gastro-intestinal parasites of zoonotic importance. Faecal smears were prepared from fresh faecal samples, stained using modified Ziehl-Neelsen method and microscopically examined. About 3 gm of the dropping was also preserved separately in clean and properly labelled containers containing 10% formalin. The specimens were microscopically examined after formalin-ether concentration for ova, larvae, cysts and oocyst of intestinal parasites. The results of microscopic examination of faecal samples of baboons demonstrated the presence of Trichuris sp. (27.1%), Strongyloides sp. (37.3%), Trichostrongylus sp. (8.5%), Oesophagostomum sp. (10.2%), Schistosoma mansoni (20.3%), Entamoeba coli (83.1%), Entamoeba histolytica/dispar (16.9%), Blastocystis hominis (3.3%), Cyclospora sp. (13.3%) and Cryptosporidium sp. (11.9%). Likewise, the results of microscopic examination of faecal samples of vervets demonstrated the presence of Trichuris sp. (36.6%), Oesophagostomum sp. (4.9%), E. coli (61.0%), E. histolytica/dispar (24.4%), B. hominis (34.2%), Cyclospora sp. (22.0%) and Cryptosporidium sp. (29.3%). The presence of parasitic protozoa and helminths in baboons and vervets in the study areas is a high risk to human welfare because these non-human primates use the same water sources as humans and range freely in human habitats. An implication of such parasitic infection for the control programme is discussed.