High burden of nosocomial infections caused by multi-drug resistant pathogens in pediatric patients at hawassa university comprehensive specialized hospital

Background: Pediatric patients are at increased risk of nosocomial infections with multi-drug resistant pathogens which are more prevalent in the hospital environment. The aim of this study was to determine the prevalence of nosocomial infections, antibiotic resistance pattern of bacterial isolates and associated factors in pediatric patients. Methods: This was a cross-sectional study conducted from March to August, 2016. Data included sociodemographic and clinical variables in patients clinically suspected of having nosocomial infections and collected using a structured questionnaire. Bacterial identification and antimicrobial susceptibility test was done with standard microbiological methods. Data were analyzed with SPSS version 20 and p value < 0.05 was considered to be statistically significant. Results: Out of 939 children admitted to the hospital, 384 patients (40.9%) were clinically suspected and had 462 nosocomial infections. Blood stream infection was the most common site of nosocomial infections. Culture confirmed nosocomial infections were reported in 82 patients (21.4%; 95% CI, 17.2-25.8%) with 88 isolates. Among the most frequently isolated bacteria, 21 (23.9%) were Klebsiella spp, and 16 (18.2%) were S. aureus, 62.5% of which were methicillin resistant. Among all bacterial pathogens, 88.9% were multi-drug resistant. Extremely high (97.9%) multi-drug resistance was associated with Gram negative bacteria. Among these, all isolates, except E. coli, were 100% multi-drug resistant. Long hospital stay and malnutrition were significantly associated with nosocomial infections. Conclusion: The high prevalence of nosocomial infections with multi-drug resistant bacteria suggests the need for proper implementation of the nosocomial infections prevention and control measures

Seroprevalence of Hepatitis B virus infection and associated factors among mothers in gondar, North-West Ethiopia: a population based study

Background: Hepatitis B virus (HBV) is the main cause of serious liver infection. Factors that increase the risk of HBV infection include contact during child birth and different horizontal means of transmission, such as unprotected sexual exposure with an infected person and having direct contact with the blood of an infected person. Objectives: The main aim of this study is to determine seroprevalence of HBV infection and associated risk factors among mothers in Gondar, Northwest Ethiopia. Methods: A community based cross-sectional study was conducted on mothers in Gondar from March to November 2016. Study participants were selected using a multistage cluster random sampling technique and a total of 419 mothers were included. Sociodemographic data and exposure to associated factors (hospital admission, history of circumcision, history of contact with jaundiced family and history of abortion) were collected through a structured questionnaire. Five milliliters of blood were collected from each study participant. Serum level hepatitis B surface antigen (HBsAg) and anti-HBc were detected using sandwich and indirect ELISA, respectively. The data were entered with Epi Info 7 and analyzed using SPSS version 20. To declare the presence of association, odds ratio with 95% confidence interval and p-value <0.05 were considered statistically significant. Result: A total of 419 mothers with the median age of 29 (20-58) years old were enrolled. The sero-prevalence of HBsAg and anti-HBc was 3.8% and 36.0%, respectively. Statistically significant association with HBV infection was observed for age (AOR= 6.960, 96% CI, 2.047-23.659, P= 0.002), history of hospital admission (AOR= 3.279, 95% CI, 1.054-10.195, P= 0.04), history of circumcision (AOR= 4.394, 95% CI, 1.463-13.198, P= 0.008), history of contact with jaundiced family (AOR= 3.877, 95% CI, 1.274-11.795, P= 0.017) and history of abortion (AOR= 4.867, 95% CI, 1.438-16.473, P= 0.011). Conclusions and recommendations: An intermediate seroprevalence of HBV infection, which is an important public health problem in the area, was detected. Therefore, implementing strategies for routine screening and care of mothers for hepatitis B virus would be important. Further, health education on modes of transmission and precautions and immunization of HBV has to be strengthened

Prevalence and associated risk factors of Hepatitis B and C virus infections among mothers in Jimma, South West Ethiopia: a community-based study

Background: Viral hepatitis affects over 400 million people globally with 6 to 10 million people newly infected each year. Viral hepatitis infectious agents such as hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the greatest threats to the liver and can cause liver cancer. One of the most important modes of transmission of these viruses is a vertical transmission from mother to child. The aim of this study is to assess the prevalence of HBV and HCV infection as well as its associated risk factors among mothers in Jimma. Methods: A community-based cross-sectional study was conducted among 455 mothers in Jimma from June to December 2016. Simple random sampling was employed to recruit study participants and informed consent was obtained. From each mother, about 5ml of blood was collected and tested for HBsAg, anti-HBc, and HCVAg/Ab using ELISA. Chi-square and logistic regression tests were used to assess statistically significant associations between dependent and independent variables. P-values less than 0.05 were considered statistically significant. Result: HBsAg, anti-HBc and HCVAg/Ab prevalence was 5.7%, 30.5% and 2.5%, respectively. Multivariate logis-ic regression analysis showed that history of hospital admission (AOR = 3.098; P <0.040) and abortion (AOR = 15.514, P <0.001) remained independent predictors of HBsAg seropositivity. Conclusion: Hospital admission and abortion are the major risk factors for hepatitis B and C virus infection among mothers. Awareness creation for adult HBV vaccine and health education on modes of transmission should be promoted and strengthened

Seroprevalence of Hepatitis B virus surface antigen, anti-hepatitis C virus antibody and their associated factors among mothers living in Harar, Eastern Ethiopia

Background: Hepatitis B virus (HBV) and Hepatitis C Virus (HCV) infections are major causes of acute and chronic liver disease and infection by these viruses during pregnancy is associated with maternal, fetal and neonatal health complications. Understanding the epidemiology of these viruses could be valuable to take appropriate preventive measures. Objective: This study aims to determine the seroprevalence and associated factors of HBV and HCV infection among mothers living in Harar, Ethiopia. Materials and Methods: A cross-sectional study was conducted among 461 mothers living in Harar, Eastern Ethiopia from March 1 ­May 30, 2017. The systematic random sampling method was used to select the study participants. Sociodemographic information was collected through face-to-face interviews using pretested structured questionnaires. Five millilitres of venous blood was collected from each study subject and HBsAg and anti-HCV levels in sera were tested using a sandwich third generation Enzyme-Linked Immunosorbent Assay (ELISA). Data was analysed by using Statistical Package for Social Sciences (SPSS) version 20. Result: The seroprevalence rates for HBV and HCV infection were 5.9% and 1.1%, respectively. None of the mothers were co-infected with HBV and HCV. Among the potential risk factors, previous history of abortion (AOR =3.7 95%, CI 1.4-9.6) and multiple sexual exposures (AOR =10.6, 95% CI 4.0-27.9) were significant predictors of HBV infection. Conclusion: This study determined that the prevalence of HBV and HCV infection among mothers was 5.9% and 1.1% respectively. History of abortion and history of multiple sexual partners were significantly associated with HBV infection. Health education programs on the mode of HBV and HCV transmission, high-risk behaviours and methods of preventions are recommended to raise awareness and reduce the spread of infection

Determining seroprevalence of Hepatitis B and C virus infections and associated risk factors among apparently healthy mothers in Addis Ababa, Ethiopia

Introduction: Viral hepatitis is a global public health problem affecting millions of people every year, causing disability and death. Hepatitis B (HBV) and hepatitis C (HCV) viruses spread horizontally, mainly through sexual contact and contaminated needles, and vertically. Both cause considerable morbidity and mortality worldwide. Maternal infection is a risk factor for vertical transmission. Objective: To determine the sero-prevalence of HBsAg and anti-HCV antibody among non-pregnant, apparently healthy mothers and to identify potential risk factors associated with HBV or HCV infection. Methods: A community based cross sectional study was conducted on 454 apparently healthy women, in Addis Ababa, Ethiopia from May 2016 to June 2017. A systematic random sampling method was used to recruit participants. Result: A total of 454 mothers were enrolled. Sero-prevalence of HBsAg and HCV was found to be 3.7% and 2.0%, respectively. HBc antibody was detected in 36.3% of the mothers. None of the participants were co-infected with both viruses. Previous history of liver disease, history of jaundice, HIV infection, and family history of liver disease were significantly associated with HBV infection. Marital status, caring for hepatitis patients, and a history of liver disease were factors significantly associated with HCV infection. Conclusion: Apparently healthy mothers in Addis Ababa had intermediate level of endemicity for hepatitis B and C infections Routine screening and vaccination of high risk reproductive mothers against HBV is advisable. Emphasis should be given to health education and promotion of infection control practices. Population based studies are strongly recommended to help monitor disease transmission patterns and to design evidence-based interventions against the spread of hepatitis infections in Ethiopia

Immune protection of Hepatitis B vaccine among children living in gondar, Northwest Ethiopia

Background: Hepatitis B virus infection is a worldwide health problem and highly endemic in developing countries including Ethiopia. Hepatitis B vaccine is included in the routine Expanded Program on Immunization since 2007 in Ethiopia. Objective: The aim of this study is to assess the seroprotection level of hepatitis B vaccination among children who have received the vaccine. Methods: A cross-sectional study was conducted on children attending kindergarten and elementary school in Gondar. A pretested structured questionnaire was used to collect the sociodemographic data. Blood samples were collected and serum separated to measure anti-HBs, anti-HBc, and HBsAg levels. Data were analyzed using SPSS statistical software version 21. Binary logistic regression analysis was done. P-value less than 0.05 was considered as statistically significant. Results: Out of 431 children screened, 27 were excluded from analysis because they were positive for anti-HBc (27/431, 6.3%) and/or for HBsAg (18/431 or 4.2%). Out of the rest 404 children, 130 (32.2%) had anti-HBs titers >10 mIU/ml (seroprotected), while 274 (68.8%) had anti-HBs titers <10 mIU/ml (non-protected). Among 130 sero-protected children, 99 (76.2%) were hypo-responders (antibody titer 10-100 mIU/ml) and 31 (23.8%) were good responders (antibody titer >100 mIU/ml). In multivariate analysis, children of age 6 and 8 years old were 2.4 times (AOR: 2.436, 95% CI 1.049-5.654) (P=0.038) and 3.3 times (AOR: 3.397, 95% CI1.306-8.837) (p=0.012) better responders compared to 9 years old children, respectively. Moreover, children whose mothers had no previous history of hepatitis were 2.0 times (AOR: 2.009, 95% CI 1.101-3.665) (P= 0.023) better responders compared to their counterparts. Conclusion: The seroprotection level among vaccinated children in Gondar was surprisingly low. Age and children from mothers with a history of hepatitis B infection were associated with seroprotection. The preliminary findings obtained in this study call for a thorough assessment of the effectiveness of the current hepatitis B vaccination program in this study region

Seroprevalence of Hepatitis B virus infection and seroprotection of Hepatitis B vaccine among children in Jimma Town, South-West Ethiopia

Background: Hepatitis B virus is the leading cause of viral hepatitis and about 240 million people worldwide are chronic carriers. The virus is reported to be widely prevalent in Ethiopia and routine vaccination of children has been initiated in the country recently. We assessed the seroprevalence of HBV infection and seroprotection of HBV vaccine among children in Jimma. Methods: A community-based cross-sectional study was conducted among 900 children who were 5-9 years of age between June and December 2016. A simple random sampling technique was employed to recruit study participants by proportional allocation into different Kebeles of Jimma. Data were collected using pretested questionnaire.3-5ml of blood sample was collected from each child and it was tested for HBsAg, anti-HBc, and anti-HBs using ELISA (Bio-rad, Monolisa, Lacquote, France). Data were analyzed using chi-square and logistic regression analysis. Result: HBsAg and anti-HBc prevalence among all participants was 3.5% and 3.8%, respectively. The prevalence of HBsAg among vaccinated and non-vaccinated children was 2.1% and 7.0% whereas anti-HBc positivity was 1.1% and 6.2%, respectively. It was also found that 58.4% of vaccinated children maintained a protective level of HB surface antibodies which is defined as ≥ 10 mIU/ml anti-HBs. While 1.8%(4/222) vaccinated children with protective anti-HBs levels were positive for hepatitis B core antibody, none of the vaccinated children with non-protective anti-HBs levels were positive for hepatitis B core antibody. Multi-variable logistic regression revealed that lack of vaccination (AOR =2.788, P < 0.029), children who were born at home (AOR= 3.211, P < 0.009), and children who had a history of hospital admission (AOR= 7.122, P <0.001) were more likely to be HBV surface antigen positive. Conclusion: The seroprevalence of hepatitis B infection is high among children who have not received HBV vaccination. Hepatitis B vaccine has contributed to the reduction of the infection in this endemic area, though further efforts are required to improve timely vaccination and its coverage. The prevalence of protective anti-HBs is low among fully vaccinated children, hence, it is better to include the monovalent birth dose of the vaccine and conduct further studies to evaluate underlining causes for the waning of serum anti-HBs level

Serum level of anti-hepatitis B surface antigen and hbv associated factors among vaccinated and unvaccinated children in Harar, Eastern Ethiopia: a community - based study

Background: Hepatitis B virus infection is a major global health problem which is known to be the main cause of liver failure, cirrhosis, and hepatocellular carcinoma. Production of anti-HBs which is stimulated by HBV vaccine, provides protection against HBV infection. However, not all vaccinated children develop protective or durable levels of antibody against HBsAg. Therefore, testing for anti-HBs levels after HBV vaccination is important. Objective: The main objective of this study was to assess serum level of antibody against hepatitis B surface antigen among vaccinated and unvaccinated children in Harar, Eastern Ethiopia. Method: A community-based comparative cross-sectional study design was used. 540 children within the ages of 5-8 years (284 vaccinated and 256 unvaccinated) were enrolled in the study using simple random sampling in selected kebeles. Three to five milliliters of blood was collected from each study participant. Serum was separated and anti-HBsAg level was determined using ELISA. A pretested, structured questionnaire was used to collect socio-demographic and HBV associated factors exposure information of the study participants and their parents. Data entry and statistical analysis were done using SPSS statistical software version 21. Logistic regressions with 95% CI were used to identify independent predictors of anti-HBs. A p-value of less than 0.05 was considered statistically significant. Results: The overall seroprotection rate detected in this study was 95.4% among vaccinated children, whereas it was only 6.2% among unvaccinated children. 3.1% of unvaccinated children were positive for HBsAg, indicating chronic disease, whereas 1.1% of vaccinated children were HBsAg+. Anti-HBs levels declined from 414 U/ml at 5 years after vaccination to 105 U/ml after 8 years. Conclusion and Recommendation: Protective levels of anti-HBs were detected in 95.4% of vaccinated children suggesting that there is no need for a further booster dose for these children

Antibody response against Hepatitis B virus after vaccination and seroprevalence of HBV in children in Addis Ababa, Ethiopia

Background: Around two billion people have been infected with HBV worldwide, and more than 240 million are chronic carriers. Vaccine introduction for HBV in children was officially launched by the WHO in 1980. Since then the vaccine response level has been determined in different countries. Since the introduction of the vaccine in Ethiopia in 2007, few studies have been conducted to assess the antibody response against the HBV vaccine. Objectives: The aim of this study is to determine antibody response against HBV after hepatitis B vaccination and assess the seroprevalence of HBV in children in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted using a multistage probability sampling technique. Four hundred and fifty children between the ages of 5 and 8 living in Addis Ababa were enrolled. Socio-demographic characteristics were obtained through a structured questionnaire and three to four ml of blood was collected from each child. ELISA was performed to determine antibody levels against HBV. Results:The mean age was 7+1 (SD) years. Anti-HBs were detected in 54.3% (208/450) of children with a slightly higher proportion of protective level in females 98 (54.7%) than males 110 (53.9%). The overall vaccine coverage in our study was 85.1 %. The proportion of children with a protective level (>10 mIU/ml anti-HBs antibody) declined as the age of the child increased: 52.6%, 60%, 43.5% and 37.1% at the age of 5, 6, 7 and 8 years, respectively. Seroprevalence of HBsAg was 0.4%, whereas seroprevalence of anti-HBc was 5.6%. Age was negatively correlated with the response level (p=0.001), whereas sex and history of HBV infection had no significant association. Age was also significantly associated with seroprevalence of anti-HBc (p=0.003). Conclusion: The HBV vaccine coverage in children was high but antibody response against the vaccine appears low. Seroprevalence of the virus was also low. The low response level to the vaccine should be a concern and revaccination or booster doses should be considered for non-responding children. Further studies should also be undertaken

Estudios de susceptibilidad de cepas de Leishmania aethiopica frente a alcaloides de Galipea longiflora (Evanta) / Susceptibility studies on Leishmania aethiopica strains against total alkaloids from Galipea longiflora (Evanta)

El Instituto de Investigaciones Fármaco Bioquímicas (IIFB), de la Facultad de Ciencias Farmacéuticas y Bioquímicas, de la UMSA, desarrolla trabajos sobre la actividad leishmanicida, de los alcaloides totales (CAT) obtenidos de la corteza de la especie medicinal amazónica conocida como Evanta (Galipea longiflora) por los Pueblos Tacana, Tsimane y Mosetene. Como parte de las actividades del Proyecto UMSA-ASDI Biomoleculas de interés medicinal e industrial (antiparasitarios) hemos podido contar con la estadía, en el IIFB, de un investigador del Armauer Hansen Research Institute (AHRI) de Etiopia, lo que nos ha permitido desarrollar evaluaciones de CAT, Miltefocine y Amfotericina B, frente a cepas de Leishmania aethiopica, agente causante de las diversa formas de Leishmaniais cutánea en Etiopía. Un total de seis cepas, de L. aethiopica, fueron adaptadas a condiciones in vitro y mostraron un comportamiento homogéneo frente a CAT, cinco de estas cepas mostraron un valor promedio de IC50 = 8,68 ±1,56 mg/mL, valor algo inferior a los calculados para nuestras cepas de referencia, L. amazonensis y L. braziliensis con IC50 = 11,73 ± 4,32 mg/mL y IC50 = 12,28 ±- 2,95 mg/mL, respectivamente. Excepto por una cepa de L. aethiopica que mostro valores consistentemente más elevados que el resto con IC50= 14,37 ± 3,58 mg/mL. Como consecuencia de esta interacción científica, la Universidad Mayor de San Andrés (UMSA) ha firmado un Memorandum de Entendimiento para el desarrollo de investigaciones conjuntas, con el Armauer Hansen Research Institute (AHRI), dependiente del Ministerio de Salud de Etiopia y explorar la posibilidad de que nuestra experiencia de validación clínica con Evanta en el tratamiento de leishmaiasis cutánea, en Bolivia, podría ser replicada en Etiopía, donde se reportan entre 20,000 a 30,000 nuevos casos de Leismaniasis por año.

The Instituto de Investigaciones Fármaco Bioquímicas (IIFB), at the Faculty of Pharmaceutical and Biochemical Sciences, from UMSA, carry out work related to the leishmanicidal activity of the total alkaloids (CAT) obtained from the bark of the Amazonian medicinal species known as Evanta (Galipea longiflora) by the Tacana, Tsimane y Mosetene people. As part of the activities develop by the UMSA-ASDI Project Biomolecules of medicinal and industrial Interest (antiparasitic) we had a visit, in our laboratories at IIFB, of a researcher from The Armauer Hansen Research Institute (AHRI) from Ethiopia, during his stay we were able to carry out evaluations of CAT, Miltefocine and Anphotericin B, against strains of L. aethiopica, causative agent of the different manifestations of cutaneous leishmaniasis in Ethiopia. A total of six strains of L. aethiopica, were adapted to in vitro a conditions, at IIFB; and did show homogenous behavior against CAT. Five of the strains, showed an average calculated value for IC50 = 8.68 ±1.56 mg/mL, a value somewhat lower to the calculated for the reference strains L. amazonensis and L. braziliensis with IC50 = 11.73 ± 4.32 mg/mL and IC50 = 12.28 +/- 2.95 mg/mL, respectively. Except for one strain that showed values somewhat higher, to the other strains, consistently through our studies, with IC50 = 14.37 ± 3.58 mg/mL. As a consequence of our scientific interaction, the Universidad Mayor de San Andrés (UMSA) has signed a Memorandum of Understanding for the development of joint research with the Armauer Hansen Research Institute (AHRI) that belongs to the Ministry of Health in Ethiopia, and explore the possibilities to replicate the Bolivian clinical validation experience of Evanta in the treatment of cutaneous leishmaniasis, in Ethiopia where the annual incidence is estimated to be between 20, 000 to 30, 0000.

Latent tuberculosis among adult Ethiopian patients at chest clinic, Tikuranbessa specialized hospital, Addis Ababa, Ethiopia

Background: One-third of the world population is infected with mycobacterium tuberculosis. Most people exposed to mycobacterium tuberculosis showed no evidence of active disease. About 5-10% of latent tuberculosis infection without HIV will progress to developed active tuberculosis in their lifetimes. This study was conducted to determine the magnitude of Latent TB among the adult population at a teaching and referral Hospital in Ethiopia.Methods: This study was conducted at the Chest clinic of Tikur Anbessa Specialized Hospital during 2010-2013.The study was a cross-sectional study conducted among healthy adults after informed consent was obtained from each individual. Tuberculin skin test and Interferon Gamma whole blood assay (Quantiferon-Tuberculosis-Gold) was performed using Enzyme linked Immuno-sorbent Assay. Average CD4, CD8, CD3 and CD4:CD8 ratio was determined for all study participants. Results:From a total of 70 healthy adults tested for latent tuberculosis infection using Quantiferon Gold,45(64%) tested positive and 25 (36%) were negative for latent tuberculosis infection. From the sixty six healthy individuals who were tested using tuberculin skin test for latent tuberculosis infection, 42 (62%) individuals were Tuberculin skin test positive and 25 (38%) individuals were Tuberculin skin test negative. Average CD4, CD8, CD3 and CD4:CD8 ratio was 748, 598, 1401 and 1.4, respectively. Conclusions: The magnitude of latent tuberculosis infection was high in this study, which reflects existing high prevalence of tuberculosis.Tuberculin skin test and Quantiferon-Tuberculosis-Goldassay show similar efficacy for the diagnosis of latent tuberculosis infection in healthy Ethiopian adults. The absolute CD4 T-cell counts of healthy HIV-negative Ethiopian's are considerably lower than other countries

Mycobacterium leprae virulence-associated peptides are indicators of exposure to M: leprae in Brazil, Ethiopia and Nepal

Silent transmission of Mycobacterium leprae, as evidenced by stable leprosy incidence rates in various countries, remains a health challenge despite the implementation of multidrug therapy worldwide. Therefore, the development of tools for the early diagnosis of M. leprae infection should be emphasised in leprosy research. As part of the continuing effort to identify antigens that have diagnostic potential, unique M. leprae peptides derived from predicted virulence-associated proteins (group IV.A) were identified using advanced genome pattern programs and bioinformatics. Based on human leukocyte antigen (HLA)-binding motifs, we selected 21 peptides that were predicted to be promiscuous HLA-class I T-cell epitopes and eight peptides that were predicted to be HLA-class II restricted T-cell epitopes for field-testing in Brazil, Ethiopia and Nepal. High levels of interferon (IFN)-γ were induced when peripheral blood mononuclear cells (PBMCs) from tuberculoid/borderline tuberculoid leprosy patients located in Brazil and Ethiopia were stimulated with the ML2055 p35 peptide. PBMCs that were isolated from healthy endemic controls living in areas with high leprosy prevalence (EChigh) in Ethiopia also responded to the ML2055 p35 peptide. The Brazilian EChigh group recognised the ML1358 p20 and ML1358 p24 peptides. None of the peptides were recognised by PBMCs from healthy controls living in non-endemic region. In Nepal, mixtures of these peptides induced the production of IFN-γ by the PBMCs of leprosy patients and EChigh. Therefore, the M. leprae virulence-associated peptides identified in this study may be useful for identifying exposure to M. leprae in population with differing HLA polymorphisms.