Prevalence of Salmonella Typhi, its associated factors and antimicrobial susceptibility profile among patients attending Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.

INTRODUCTION: Salmonella Typhi infections cause significant morbidity and mortality worldwide, especially in developing countries including Ethiopia. This study aimed to determine the prevalence of Salmonella Typhi, its associated factors and antibiotic susceptibility profile among suspected typhoid patients. METHODS: A cross-sectional study was conducted on 270 typhoid fever suspected patients at Hawassa University Comprehensive Specialized Hospital from June 2022 to September 2022. Data were collected using questionnaires by face-to-face interview. Stool samples for microbiological culture, blood samples for S. Typhi IgM/Entero-check WB rapid test and isolates for antimicrobial susceptibility tests were used through standard procedures and according to the reagents manufactures' instructions. Hygiene implementation of patients was also assessed using interview. Sociodemographic and clinical characteristics of the patient's were considered. Descriptive statistics were used to summarize the data, and logistic regression model analysis was performed to assess associations between S. Typhi infection and the associated sociodemographic and clinical factors. RESULTS: The prevalence of S. Typhi IgM/Entero-check WB rapid test and stool culture results were 3.3%; (95% CI: 1.5-5.6) and 3.7%; (95% CI: 1.9-6.3) respectively. Not washing hands after latrine [AOR = 0.85, 95% CI (0.15-4.79), p = 0.05] is not significant but, not washing hands before meal [AOR = 0.053, 95% CI (0.08-0.36), p = 0.03], eating raw vegetables [AOR = 0.024, 95% CI (0.001-0.48), p = 0.015] and drinking water from a stream [AOR = 0.12, 95% CI (0.19-0.70), p = 0.001] were significantly associated with S. Typhi infection, but in terms of AOR, all are preventive. Susceptibility of isolates was 9/10 (90%), 8/10 (80%), and 8/10 (80%) to ciprofloxacin, ceftriaxone, and chloramphenicol, respectively. The majorities 100% and 80% of the isolates were resistant to ampicillin and cotrimoxazole, respectively. About 40% of the isolates were MDR. CONCLUSION: The prevalence of Salmonella Typhi with MDR has been observed. Therefore, health programmers and stakeholders should make efforts to improve the habit of sanitation, strengthen the capacity of laboratory diagnostic methods and increase awareness of the misprescription and misuse of antibiotics to reduce the impact of MDR bacteria.

Bacterial Profile and Antibiotic Susceptibility Pattern of Urinary Tract Infection among Pregnant Women Attending Antenatal Care at a Tertiary Care Hospital in Southern Ethiopia.

BACKGROUND: Urinary tract infection is one of the most common bacterial infections encountered in pregnant women with significant morbidity. This study aimed to determine the bacterial profile and its antimicrobial susceptibility pattern of urinary tract infection among pregnant women attending antenatal care (ANC) at a Hawassa University Comprehensive Specialized Hospital (HUCSH), Southern Ethiopia. METHOD: A cross-sectional study was conducted in which consecutive pregnant women enrolled in the study from March to June 2019. The structured questionnaire used to collect sociodemographic and clinical data in a face-to-face interview. Midstream urine was collected from pregnant women using sterile containers. Culture and sensitivity were performed using a standard operating procedure of the microbiology laboratory. Data entry and analysis were conducted using the statistical package for social sciences (SPSS) version 20. Descriptive and logistic regression was used to conduct the output of the data. The odds ratio at 95% confidence interval was considered as a statistically significant association with a p value <0.05. RESULT: The overall magnitude of urinary tract infection in this study was 7.8% (4.7-10.8%). Escherichia coli was found to be the most frequently isolated (47.8%), followed by Klebsiella pneumoniae (17.4%), Staphylococcus aureus (8.7%), Klebsiella ozaenae, Klebsiella rhinoscleromatis, Citrobacter spp., Salmonella group A, Staphylococcus saprophyticus, and Enterobacter cloacae each (4.3%). Gram-negative bacteria were sensitive to 78.3%, 91.3%, and 100% of ciprofloxacin, gentamicin, and nitrofurantoin, respectively. Gram-positive bacteria were sensitive to clindamycin (100%), gentamicin (100%), and nitrofurantoin (100%) and fully resistant to ceftriaxone (100%) and cefuroxime (100%). There is no statistically significant association (p < 0.05) between the risk factor of urinary tract infection and UTI. CONCLUSION: The overall prevalence of urinary tract infection among pregnant women attending antenatal care was 7.8%. Escherichia coli were the dominant isolate followed by Klebsiella pneumoniae. Gram-negative isolates are highly sensitive to ciprofloxacin, gentamicin, nitrofurantoin, and ceftriaxone and Gram-positive isolates to gentamicin, clindamycin, and nitrofurantoin. Most of the bacteria are resistant to cotrimoxazole and cefuroxime. There is no statistically significantly associated variable. Screening for the presence of urinary tract infection during pregnancy will improve the quality of antenatal care further reducing complication. The above antibiotics can be prescribed based on the side effect to pregnant women in case empirical treatment is mandatory in the study area.

The burden of antimicrobial resistance at tertiary care hospital, southern Ethiopia: a three years' retrospective study.

BACKGROUND: Antibiotic resistance is a worldwide problem that crosses international boundaries and spread between continents easily. Hence, information on the existence of the causative microorganisms and their susceptibility to commonly used antibiotics are essential to enhance therapeutic outcome. METHOD: A cross-sectional study was conducted retrospectively at Hawassa University Comprehensive Specialized Hospital. The culture and antibiotic sensitivity data of the isolates were collected from the record books of the microbiology unit for the study period after official permission obtained from the institutional review board. The data entered and analyzed using statistical package for social science software version 20. RESULT: A total of 693 bacteria were retrieved, of these 435(62.77%) were gram-negative and the rest 258(37.23%) were gram-positive. Most of the isolates were from a urine sample. Among gram positives isolates, S. aureus and from gram negatives Klebsiella spp are the most recurrent isolate. Almost a remarkable resistance was observed to most of the antibiotics mainly, penicillin G (81.8%) and cotrimoxazole (81.1%), for gram-positive bacteria. The gram-negative bacteria also show resistance to ampicillin (92.5%), tetracycline (85%) and cotrimoxazole (93.1%). CONCLUSIONS: Nearly all isolate show substantial rates of resistance to most of the antibiotic that is frequently used in the study area. As already known we want to emphases on the importance of performing continuous monitoring of drug susceptibility to help the empirical treatment of bacterial agents to a health professional in the region. In addition, this data might help policymakers to control of antibiotics resistance.

Hygienic Practices of Vendors and Their Contribution to Coliform, Salmonella, and Shigella Bacteria of Raw Milk at Asella Town, Oromia, Ethiopia.

Background: Coliform, Salmonella, and Shigella are among the most encountered bacteria in raw milk. This study is aimed at determining the extent of coliform, Salmonella, and Shigella bacteria in raw milk and vendor hygiene practices at Asella town, Oromia Regional State, Ethiopia, from March 1 to 30, 2022. Methods: In this study, 210 milk vendors were included; each vendor provided a 50 ml sample of raw milk. Bacteria were isolated and identified using standard bacteriological techniques. Data were entered and analyzed using EPI info version 7 and SPSS version 22, respectively. A binary logistic regression model was applied to determine the factors associated with bacterial contamination of raw milk. Results: The total contamination percentage of raw milk was 50 (23.8%) (95% CI: 18.1-29.5%). The predominant bacteria identified were coliform 43 (20.5%) followed by Salmonella species 7 (3.3%). Among coliforms, the predominant bacteria were Citrobacter species 15 (34.9%) followed by Enterobacter species 11 (25.6%), Escherichia coli and Serratia species each 6 (14%), and Klebsiella species 5 (11.6%). However, no Shigella was isolated in this study. Not having the habit of washing cow teats (p < 0.0001), the habit of washing teats with tap water (p < 0.0001), not having separate cloth during milking (p < 0.0001), not having a practice of testing milk for bacterial contamination (p = 0.027), and not having separate vending environment (p = 0.039) were significantly associated with bacterial contamination of raw milk. Conclusions: The percentage of bacterial contamination of milk was found to be high. Participants without a habit of washing cow teats, a habit of washing milk utensils with only tap water, and not having separate vending environments were associated factors for bacterial contamination of raw milk. Milk vendors are advised to develop the habit of washing teats before milking, avoid washing teat/milk utensils only with tap water, and have a separate vending environment.

Dermatophytosis and its risk factors among children visiting dermatology clinic in Hawassa Sidama, Ethiopia.

Dermatophytosis represents one of the common fungal diseases that attack the skin, hair and nail of human beings worldwide. It causes chronic morbidity in children and the condition is more common, in developing countries. The study aimed to determine dermatophytosis and its associated factors among children in Hawassa Sidama, Ethiopia April 2021-October 2021. A cross-sectional study was conducted on children suspected of cutaneous fungal infections. Data were surveyed based on a semi-structured questionnaire. Standard laboratory methods were used to identify the dermatophytes. The data entry and analysis were conducted with SPSS version 26. The Chi-square test was used to check the predictor and a p-value < 0.05 was taken as a significant value. A total of 83 study subjects included in the study in which all 83 (100%) patients were positive for fungal elements (hyphae/and spores) in microscopy, of this 81 (97.6%) yielded growth on culture. Hair scalps 75 (90.4%) were the dominant among the case. Trichophyton 52 (62.6%) was the dominant aetiology followed by Microsporum 22 (26.6%). Intervention measures to tackle dermatophytosis should emphasis on tinea capitis among 6-10 years old children with history of recent migration by raising awareness of communities through health extension programs.

The association of aspartate transaminase-to-alanine transaminase ratio and metabolic syndrome among HIV patients in Sidama Region, South Ethiopia.

Objective: Studies on the association of the aspartate transaminase-to-alanine transaminase ratio with the metabolic syndrome and its components among HIV patients were scarce. This study aims to determine the association between the aspartate transaminase-to-alanine transaminase ratio and the metabolic syndrome and its components in adult HIV patients on highly active antiretroviral therapy. Methods: This was a cross-sectional study conducted on 302 HIV patients from January 15 to June 30, 2021. Sociodemographic, clinical, and anthropometric data were collected using a structured questionnaire. The patient's medical records were reviewed. Biochemical analysis was performed after 5 ml of venous blood was collected from each study participant. Metabolic syndrome was defined by the third report of the national cholesterol education program-adult treatment panel. Logistic regression was done to assess the association of MetS with the independent variables, and correlation analysis was performed to see the correlation of MetS components with the aspartate aminotransferase-to-alanine aminotransferase ratio. Result: 302 HIV-positive patients on highly active antiretroviral therapy were included in this study, and 54.6% were female. The median and interquartile range of the age of the study participants were 41 (35-50) years. The prevalence of metabolic syndrome was 29.5% (confidence interval = 24.5-35.1). Chronic illness (Adjusted odds ratio = 4.8, confidence interval = 2.2-10.9) and aspartate aminotransferase-to-alanine aminotransferase ratio (adjusted odds ratio = 2.5, confidence interval = 1.4-4.4) were significantly associated with Metabolic syndrome among the study participants. The aspartate aminotransferase-to-alanine aminotransferase ratio was significantly correlated with blood pressure. Conclusion: This study found the existence of a significant association between the aspartate aminotransferase-to-alanine aminotransferase ratio and metabolic syndrome among HIV patients.

Methicillin-resistant Staphylococcus aureus antibiotic susceptibility profile and associated factors among hospitalized patients at Hawassa University Comprehensive Specialized Hospital, Ethiopia.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital-acquired infection, which is difficult to treat because of antibiotic resistance. There is scant data on MRSA from southern parts of Ethiopia. Objective: The aim of this study was to determine the prevalence of MRSA nasal carriage, antibiotic susceptibility profiles, and associated factors among hospitalized patients attending Hawassa University Comprehensive Specialized Hospital (HUCSH), Hawassa, Ethiopia. Methods: A hospital-based cross-sectional study was conducted from December 11, 2019 to February 15, 2020. Background and clinical data were captured by an interviewer-administered questionnaire. Nasal swabs were collected aseptically and inoculated onto mannitol salt agar and sheep blood agar, which was incubated for 24 hours at 37°C. S. aureus was confirmed using standard bacteriological methods. MRSA was identified using the cefoxitin Kirby-Bauer disk diffusion method. Results: Of the 280 included hospitalized patients, 38 (13.6%) were colonized with S. aureus. The prevalence of MRSA carriage was 9.3% (95% CI 6.1‒12.2). Twenty-six (68.4%) of the S. aureus isolates were methicillin resistant. Participants with a monthly income > 4000 Ethiopian Birr were four times more likely to be colonized with MRSA (p = 0.022). A high proportion of patients with a history of admission to the surgical ward was colonized with MRSA. Over 10% of MRSA isolates were resistant to all antibiotics except clindamycin and erythromycin. Of the 26 MRSA isolates, 88.5% showed multidrug resistance. Conclusions: The prevalence of MRSA was relatively high among hospitalized patients at HUCSH. Factors such as weight and monthly income were significantly associated with the occurrence of MRSA.

Prevalence, determinants, and antimicrobial susceptibility patterns of Campylobacter infection among under-five children with diarrhea at Governmental Hospitals in Hawassa city, Sidama, Ethiopia. A cross-sectional study.

BACKGROUND: Campylobacteriosis, is a zoonotic bacterial disease observed with a rising worldwide. It is becoming the most commonly recognized cause of bacterial gastroenteritis in under-five mortality in recent years. This study was done to determine the prevalence and determinants of Campylobacter infection among under-fives with acute watery diarrhea. METHODS: This institutional-based cross-sectional study was conducted at governmental and private health institutions in Hawassa city. All outpatient under-five children who met the inclusion criteria from April 2021 to August 2021 were enrolled in this study. Demographic and clinical data were obtained using a standardized data collection tool. Stool samples were collected from each participant with a sterile container and inoculated on a campylobacter agar media. The isolates were identified by using biochemical tests and a disc diffusion technique was performed to determine the antimicrobial sensitivity patterns of the isolates. Data were entered and analyzed using SPSS version 21. Descriptive and Logistic regression analysis was applied to determine the determinants of Campylobacter infection. P-value < 0.05 was considered statistically significant. RESULTS: A total of 235 under-five children were enrolled in this study with a 100% response rate. Of these 130 (55.3%) and 105(44.7%) were males and females respectively with the age range of 2 months to 60 months with the mean age of 25 months. The majority of the 150 (63.2%) were rural residents. Of 235 under-fives with acute watery diarrhea, 16 (6.8%) patients were found to have Campylobacter infection with (95% CI, 3.8-10.2%). Consumption of pasteurized milk (AOR: 0.12; 95% CI 0.02-0.75, P<0.05), presence of domestic animals like cats, hens, and cows (AOR: 0.09: 95% CI 0.01-0.67, P<0.05), absence of handwashing practice before food preparation (AOR: 3.63, 95% CI 1.15-11.46, P<0.05) showed significant association with campylobacter infection. The antimicrobial susceptibility patterns of the isolated bacteria were 100% sensitivity to Azithromycin, Chloramphenicol, and Gentamicin, however; it was 100% resistant to Cephalothin. The associations of socio-demographic, environmental, and behavioral factors were compared and consumption of unpasteurized milk, the presence of domestic animal like the cat was significantly associated. CONCLUSION: Campylobacter infection showed a comparatively low prevalence in under-fives with acute watery diarrhea. In this study contact with cats, consumption of unpasteurized milk were associated with Campylobacter infection. The treatment approach of Campylobacter infection must consider the sensitivity profile of antibiotics as indicated in the study. We, therefore, recommend further studies to determine the species responsible for Campylobacter infection with other co-morbidities and the susceptibility pattern for each species to indicate appropriate antibiotic therapy.

Prevalence of multidrug-resistant bacteria in Ethiopia: a systematic review and meta-analysis.

OBJECTIVES: Multidrug-resistant (MDR) bacteria are a significant public-health threat worldwide, especially in low- and middle-income countries. Comprehensive data are important to understand the magnitude of multidrug resistance (MDR), however these are not available in Ethiopia. METHODS: Five electronic databases and grey literature of Addis Ababa University Repository were searched for data regarding the prevalence of MDR bacteria in Ethiopia. OpenMetaAnalyst R1.3 was used for analysis using a random-effects model to determine the effect size. Heterogeneity among articles was checked using the inconsistency index (I2). Funnel plot was used to check for publication bias. The quality of each article was checked using the Newcastle-Ottawa checklist adapted for cross-sectional studies. RESULTS: Through database searching, 2094 articles were identified, of which 37 fulfilled the study inclusion criteria. This review comprises 6856 bacteria, of which 4949 isolates were MDR. The overall pooled prevalence of MDR was 70.5% (95% CI 64.9-76.1%), with considerable heterogeneity (I2 = 97.48%, P < 0.001). Funnel plot revealed no publication bias. Sidama (81.7%) had the highest MDR and Tigray (51.1%) the lowest. The greatest source of MDR was from multiple sites of infection (MSI) (76.8%); the least was from bloodstream infections (62.9%). MDR was higher in studies conducted on hospital-acquired infections (72.1%) compared with both hospital- and community-acquired infections (69.8%). CONCLUSION: Our study indicates a high prevalence of MDR in Ethiopia. Sidama region, MSI and hospital-acquired infections showed the highest MDR in subgroup analysis. Regional hospitals should implement infection prevention and proper use of antibiotics in the community.

Magnitude, risk factors and antimicrobial susceptibility pattern of Shigella and Salmonella, among children with diarrhea in Southern Ethiopia: A Cross-sectional Study.

OBJECTIVE: This study was aimed at identifying Shigella and Salmonella infection, their antibiotic susceptibility pattern and associated risk factors among children with diarrhea who attended Alamura Health Center. METHOD: A facility-based cross-sectional study was conducted on 263 children aged below 14 years with diarrhea. A structured questionnaire was used to collect socio-demographic and clinical data after obtaining the necessary consent from their parents or caretakers. The culture and sensitivity tests were performed using the standard operating procedure of the microbiology laboratory. RESULTS: Accordingly, 20/263 (7.6%), 95% confidence interval: 4.4%-11.4% Shigella and 1/263 (0.38%), 95% confidence interval: 0.0%-1.1% Salmonella were isolated. Shigella dysenteriae was dominant 11 (4.2%), followed by Shigella spp. 9 (3.42%) and Salmonella typ 1 (0.38%). The isolates showed 71.4% overall resistance to ampicillin and 61.9% for augmentin and tetracycline, whereas 95.2% of the isolates were sensitive to ciprofloxacin, 85.9% to ceftriaxone and ceftazidime, 81% to gentamycin, 76.2% to chloramphenicol, 66.7% to cefuroxime and 52.4% to cotrimoxazole. The habit of washing hands after toilet use for a while (adjusted odds ratio: 235.1, 95% confidence interval: 20.9-2643.3, p < 0.000) and storing cooked food in an open container for later use (adjusted odds ratio: 36.44, 95% confidence interval: 5.82-228.06, p < 0.000) showed a statistically significant association. CONCLUSION: High level of Shigella and single Salmonella was isolated. Ampicillin, augmentin and tetracycline were resistant and ciprofloxacin, ceftriaxone, ceftazidime, gentamycin, chloramphenicol, cefuroxime and cotrimoxazole were relatively sensitive. Hand-washing after defecation for some time and storing of foods for later use in an open container were statistically associated. Therefore, to alleviate this infection, the concerned body should focus on imparting health education for hand-wash after defecation and storing food in a closed container for later use is mandatory.

Major bacterial isolate and antibiotic resistance from routine clinical samples in Southern Ethiopia.

Currently, antibiotic-resistant bacterial infections are a challenge for the health care system. Although physicians demand timely drug resistance data to guide empirical treatment, local data is rather scarce. Hence, this study performed a retrospective analysis of microbiological findings at the Hawassa public hospital. Secondary data were retrieved to assess the prevalence and level of drug resistance for the most common bacterial isolates from clinical samples processed at Hawassa University Comprehensive Specialized Hospital. Out of 1085 clinical samples processed in the microbiology laboratory, the prevalence of bacterial infection was 32.6%. Bacterial bloodstream infection was higher in children than in adults (OR, 4; 95% CI 1.8-14.6; p = 0.005). E. coli and K. pneumoniae were the commonest bacterial isolate both in children (36.8%, 26.3%) and in adults (33.3%, 26.7%) from the urine sample while, the leading bacteria identified from the CSF sample was P. aeruginosa, 37% in children and 43% in adult. In this study, all identified bacterial isolates were multi-drug resistant (MDR) ranging from 50 to 91%. The highest proportion of MDR was S. aureus 91.1 followed by K. pneumoniae 87.6%. Since the nationwide investigation of bacterial isolate, and drug resistance is rare in Ethiopia, a report from such type of local surveillance is highly useful to guide empirical therapy by providing awareness on the level resistance of isolates.

Phenotypic Detection of Carbapenem-Resistant Gram-Negative Bacilli from a Clinical Specimen in Sidama, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Carbapenem-resistant gram-negative bacteria are an emergent source of both community-acquired and healthcare-associated infection that poses a substantial hazard to public health. This study aimed to conclude the magnitude of carbapenem resistance gram-negative bacteria from a clinical specimen at Hawassa University Comprehensive Specialized Hospital. METHODS: A hospital-based cross-sectional study was accompanied from February 13 to June 7, 2020, in which consecutive patients with 103 gram-negative bacteria were encompassed. The isolates included were 54 urine, 17 blood, 17 pusses, 4 cerebrospinal fluid (CSF), 3 aspirates, 3 effusions, 2 stools, 2 ear discharges, and 1 nasal swab. A semi-structured questionnaire was used to gather socio-demographic data from the attendant and clinical data from the patient's chart. Patients admitted in any wards and visited outpatients department were included for the study if gram-negative bacteria was identified for those who accepted the consent. A routine manual culture, Gram's staining and biochemical tests used to identify the bacteria. Antibiotic susceptibility was determined for twelve antibiotics including cotrimoxazole, ceftazidime, meropenem, gentamycin, chloramphenicol, ampicillin, ciprofloxacin, cefotaxime, cefuroxime, nitrofurantoin, piperacillin-tazobactam, and amikacin using the Kirby-Bauer disc diffusion method. Modified carbapenem inactivation (mCIM) method was used to determine carbapenem resistance using meropenem disk as per the recommendation of Clinical and Laboratory Standards Institute guideline. Statistical package for social science software version 21 was used for data entry and analysis. The odds ratio at 95% confidence interval (CI) and p-value <0.05 were taken as a statistically significant association. RESULTS: Generally, 111 gram-negative bacteria were identified from 103 patients. Of 111 isolates, thirteen isolates (nine resistance and four intermediates) were identified in disk diffusion testing for meropenem. Of this, 10 isolates were carbapenemases producer with the overall rates of 9% in the Modified carbapenem inactivation method (mCIM). Pseudomonas spp. 3 (30.0%), E. coli, K. pneumonia, Acinetobacter spp. each two (20.0%), and K. oxytoca 1 (10.0%) were identified as carbapenemases positive. The rates of the multidrug, extensive, pan drug were 86.5, 43.3, and 1.8, respectively. Ampicillin 94 (97.9%), followed by cefuroxime 52 (91.2%), cefotaxime 94 (88.7%), cotrimoxazole 58 (88.1%), ceftazidime 40 (83.3%), ciprofloxacin 47 (77.1%), nitrofurantoin 35 (70.0%), gentamycin 71 (65.7%), with high level of resistance. However, piperacillin-tazobactam 41 (48.8%), chloramphenicol 25 (47.2%), meropenem 13 (11.7%), and amikacin 9 (8.5%) were with low rates of resistance. In this study, there were no variables statically associated with carbapenem resistance that is p > 0.05. CONCLUSION: Our study showed that carbapenem-resistant gram-negative bacilli are 9% in the study area. Our finding signposts that ampicillin, cefuroxime, cefotaxime, cotrimoxazole, ceftazidime, ciprofloxacin, nitrofurantoin, and gentamycin with a high rate of resistance >50%. However, piperacillin-tazobactam, chloramphenicol, meropenem, and amikacin were at low rates of resistance. Therefore, a measure should be taken to contain carbapenem resistance gram-negative bacteria in the study area. Further, study with better method needs to be conducted to conclude the real scenario of carbapenem resistance.

Prevalence of vancomycin-resistant enterococcus in Africa in one health approach: a systematic review and meta-analysis.

Vancomycin-resistant enterococci are a global challenge currently as reported by the World Health Organization. It is also important to recognize that combating antimicrobial resistance needs to recognize the interconnections between people, animals, plants and their shared environment in creating public health, the so-called One Health approach. Although the presence of VRE has been described in many regions of the world, there is a lack of comprehensive data indicating their prevalence of in Africa. Therefore, this study aimed to aggregate the result of studies describing VRE reported across multiple regions in Africa. A literature search was conducted on PubMed, Google scholar, and Hinari with the term "Vancomycin resistance enterococcus in Africa" on August 1-3, 2019. All available articles were downloaded to "Endnote version 7.1" then to Microsoft Word 2013. Articles determined to meet our criteria for the review was extracted to Microsoft Excel 2013. Those articles that reported the prevalence of vancomycin resistance Enterococcus obtained from all sample types and published from 2010 to 2019 in the English language were included for the review. A meta-analysis was conducted with OpenMetaAnalyst version R.3.1.0 software. The effect size was determined using a binary random effect model and statically significant considered when p < 0.05. Heterogeneity determined with the inconsistency index. A leave one out analysis used to perform the sensitivity analysis. There were 151 articles identified from the database searches; of this, 36 articles included after extensive review with two independent authors. Out of 4073 samples collected, 1488 isolates identified with an overall pooled prevalence of VRE 26.8% (95% CI; 10.7-43.0%) in Africa with a one-health perspective. The analysis showed that considerable heterogeneity among the studies (I2 = 99.97%; p < 0.001). Subgroup analysis in-country, African region, laboratory method, year of publication, and sample source showed that a high prevalence was identified from South Africa (74.8%), South African regions (74.8%), PCR (959.2%), 2010-2015 years (30.3%) and environmental (52.2%), respectively. This meta-analysis indicates that there was a high-pooled prevalence of vancomycin-resistant enterococci in African. A lot should be done to prevent and control the transmission of vancomycin resistance enterococci to a human being from the environment in the continent.

Magnitude of Cryptococcosis among HIV patients in sub-Saharan Africa countries: a systematic review and meta-analysis.

BACKGROUND: Cryptococcus is encapsulated opportunistic yeast that causes life threatening meningoencephalitis of patients with human immunodeficiency virus (HIV). The magnitude of Cryptococcosis among HIV patients varies from 1-10% in Western countries as opposed to almost a one third of HIV-infected individuals in sub-Saharan Africa where it is associated with high mortality. METHODOLOGY: By using key terms "Cryptococcosis among HIV patients in sub-saharan Africa countries", articles that published in different journals from 2010-2017 searched on Pub-Med and Google scholar database. Those freely accessible and included the prevalence of Cryptococcosis in the result section, their PDF file was downloaded and the result extracted manually and presented in table. Articles that did not report the prevalence of Cryptococcosis, with a study design otherthan cross sectional, or a sample size less than 100, and those duplicated in the same study area and period by the same authors were excluded. The article selection followed the PRISMA guidelines and meta- analysis was performed using OpenMeta(analyst). RESULTS: The overall pooled magnitude of Cryptococcosis among HIV patients in sub saharan African countries was 8.3% (95%CI 6.1-10.5%). The highest prevalence was from Uganda (19%) and the least was from Ethiopia at 1.6%. There was 87.2 % of substantial heterogeneity among the studies with p-value<0.001. The symmetry ofthe forest plot showed that there was little publication bias. The most commonly used method for diagnosis of Cryptococcosis was lateral flow assay and latex agglutination test and culture was the least method employed. CONCLUSION: The overall pooled magnitude of Cryptococcosisis high among HIV patients in sub-Saharan African countries. The studies showed substantial heterogeneity, and little publication bias. Most of the studies relied on LFA & LA that showed the scarcity of facilities for fungal culture. Therefore, paying attention to screening HIV patients; those with signs and symptoms of meningitis may help to reduce the loss of HIV patients.

Soil-Transmitted Helminths And Other Intestinal Parasites Among Schoolchildren In Southern Ethiopia.

BACKGROUND: Intestinal parasitic infections are the neglected tropical diseases that have a devastating effect and leads to malnutrition, morbidity and mortality in schoolchildren. The aim of this study was to determine the presence of soil-transmitted and other intestinal parasites among schoolchildren in southern Ethiopia. METHODS: A cross-sectional study was conducted in Gara Riketa primary school children at Hawassa Tula Sub-City, Southern Ethiopia from March 1 to April 20, 2017. The parent of participating children was interviewed with a structured questionnaire to collect the sociodemographic and risk factors data. Well-trained laboratory technicians were involved in the stool examination through direct and concentration methods. The data were entered and analyzed using SPSS version 20. ORs at 95% CI were considered as a statistically significant association with a p-value < 0.05. RESULTS: Out of 384 schoolchildren enrolled for the study, 260 (67.7%) were infected with one or more intestinal parasites. The predominantly identified parasite was Ascaris lumbricoides 146 (38.0%) followed by hookworms 12 (3.1%). The study showed that intestinal parasitic infections have a statistically significant association with being in 4th grade, the mother´s educational status (grade 9-12), having cut nails and washing hands before eating. CONCLUSION: The rates of soil-transmitted helminths and other intestinal parasitic infections were very high in Gara Riketa primary school children. Based on the statistical analysis, hygiene and nail clipping are important habits to prevent infection with intestinal parasites.

Cryptosporidiosis And Other Intestinal Parasitic Infections And Concomitant Threats Among HIV-Infected Children In Southern Ethiopia Receiving First-Line Antiretroviral Therapy.

BACKGROUND: Children infected with human immunodeficiency virus (HIV) are at high risk of acquiring intestinal parasitic infections. This study aimed to determine the magnitude of Cryptosporidium and other intestinal parasitic infections and concomitant threats among HIV-infected children. METHODS: A hospital-based cross-sectional study was carried out at three antiretroviral therapy clinics in southern Ethiopia from February 2016 to June 2017 in 384 HIV positive children. Socio-demographic and clinical data were collected using structured questionnaires. Direct stool microscopic examination and modified Zeihl-Neelsen staining technique to identify parasites. Chi-square test was conducted to determine the real predictors of the infection. Significant association was considered when p-value <0.05 at 95% CI. RESULTS: The overall magnitude of intestinal parasitic infections among the study population was 16.9% (95% CI: 13.0-20.8%). The most predominant parasitic infections were Cryptosporidium spp. (9.6%) and the least was Taenia spp. (0.78%). Diarrheal status (χ 2=7.653, df=2, p=0.022) was detected to be the only significant associated variable. CONCLUSION: Cryptosporidium infection was found to be the most common intestinal parasitosis among HIV-infected children. Routine screening service for Cryptosporidium and other intestinal parasites is important in the clinical management of HIV-infected children.