Comprehensive analysis of differentially expressed mRNA profiles in chicken jejunum and cecum following Eimeria maxima infection.

Coccidiosis, a protozoan disease that substantially impacts poultry production, is characterized by an intracellular parasite. The study utilized 48 one-day-old Horro chickens, randomly divided into the infected (I) and control (C) groups. The challenge group of chickens were administered Eimeria maxima oocysts via oral gavage at 21-days-old, and each chicken received 2 mL containing 7×104 sporulated oocysts. The total RNAs of chicken jejunum and cecum tissues were isolated from three samples, each from I and C groups. Our study aimed to understand the host immune-parasite interactions and compare immune response mRNA profiles in chicken jejunum and cecum tissues at 4 and 7 days postinfection with Eimeria maxima. The results showed that 823 up- and 737 down-regulated differentially expressed mRNAs (DEmRNAs) in jejunum at 4 d infection and control (J4I vs. J4C), and 710 up- and 368 down-regulated DEmRNAs in jejunum at 7 days infection and control (J7I vs. J7C) were identified. In addition, DEmRNAs in cecum tissue, 1424 up- and 1930 down-regulated genes in cecum at 4 days infection and control (C4I vs. C4C), and 77 up- and 191 down-regulated genes in cecum at 7 days infection and control (C7I vs. C7C) were detected. The crucial DEmRNAs, including SLC7A5, IL1R2, GLDC, ITGB6, ADAMTS4, IL1RAP, TNFRSF11B, IMPG2, WNT9A, and FOXF1, played pivotal roles in the immune response during Eimeria maxima infection of chicken jejunum. In addition, the potential detection of FSTL3, RBP7, CCL20, DPP4, PRKG2, TFPI2, and CDKN1A in the cecum during the host immune response against Eimeria maxima infection is particularly noteworthy. Furthermore, our functional enrichment analysis revealed the primary involvement of DEmRNAs in small molecule metabolic process, immune response function, inflammatory response, and toll-like receptor 10 signaling pathway in the jejunum at 4 and 7 days postinfection. Similarly, in the cecum, DEmRNAs at 4 and 7 days postinfection were enriched in processes related to oxidative stress response and immune responses. Our findings provide new insights and contribute significantly to the field of poultry production and parasitology.

Phenotypic and genomic characterisation of performance of tropically adapted chickens raised in smallholder farm conditions in Ethiopia.

Background: In sub-Saharan Africa, 80% of poultry production is on smallholder village farms, where chickens are typically reared outdoors in free-ranging conditions. There is limited knowledge on chickens' phenotypic characteristics and genetics under these conditions. Objective: The present is a large-scale study set out to phenotypically characterise the performance of tropically adapted commercial chickens in typical smallholder farm conditions, and to examine the genetic profile of chicken phenotypes associated with growth, meat production, immunity, and survival. Methods: A total of 2,573 T451A dual-purpose Sasso chickens kept outdoors in emulated free-ranging conditions at the poultry facility of the International Livestock Research Institute in Addis Ababa, Ethiopia, were included in the study. The chickens were raised in five equally sized batches and were individually monitored and phenotyped from the age of 56 days for 8 weeks. Individual chicken data collected included weekly body weight, growth rate, body and breast meat weight at slaughter, Newcastle Disease Virus (NDV) titres and intestinal Immunoglobulin A (IgA) levels recorded at the beginning and the end of the period of study, and survival rate during the same period. Genotyping by sequencing was performed on all chickens using a low-coverage and imputation approach. Chicken phenotypes and genotypes were combined in genomic association analyses. Results: We discovered that the chickens were phenotypically diverse, with extensive variance levels observed in all traits. Batch number and sex of the chicken significantly affected the studied phenotypes. Following quality assurance, genotypes consisted of 2.9 million Single Nucleotide Polymorphism markers that were used in the genomic analyses. Results revealed a largely polygenic mode of genetic control of all phenotypic traits. Nevertheless, 15 distinct markers were identified that were significantly associated with growth, carcass traits, NDV titres, IgA levels, and chicken survival. These markers were located in regions harbouring relevant annotated genes. Conclusion: Results suggest that performance of chickens raised under smallholder farm conditions is amenable to genetic improvement and may inform selective breeding programmes for enhanced chicken productivity in sub-Saharan Africa.

Role of RNA Splicing Mutations in Diffuse Large B Cell Lymphoma.

Ribonucleic acid splicing is a crucial process to create a mature mRNA molecule by removing introns and ligating exons. This is a highly regulated process, but any alteration in splicing factors, splicing sites, or auxiliary components affects the final products of the gene. In diffuse large B-cell lymphoma, splicing mutations such as mutant splice sites, aberrant alternative splicing, exon skipping, and intron retention are detected. The alteration affects tumor suppression, DNA repair, cell cycle, cell differentiation, cell proliferation, and apoptosis. As a result, malignant transformation, cancer progression, and metastasis occurred in B cells at the germinal center. B-cell lymphoma 7 protein family member A (BCL7A), cluster of differentiation 79B (CD79B), myeloid differentiation primary response gene 88 (MYD88), tumor protein P53 (TP53), signal transducer and activator of transcription (STAT), serum- and glucose-regulated kinase 1 (SGK1), Pou class 2 associating factor 1 (POU2AF1), and neurogenic locus notch homolog protein 1 (NOTCH) are the most common genes affected by splicing mutations in diffuse large B cell lymphoma.

Yolk Fatty Acid Content, Lipid Health Indices, and Oxidative Stability in Eggs of Slow-Growing Sasso Chickens Fed on Flaxseed Supplemented with Plant Polyphenol Extracts.

Previous attempts to increase the level of flaxseed in hens' diet for the production of n-3 polyunsaturated fatty acids (n-3 PUFAs)-enriched eggs have been commonly associated with undesirable effects on production efficiency, lipid health indices, and oxidative stability of eggs, requiring adequate research attention. This study investigated the effects of feeding a moderate level of flaxseed (FS) and plant polyphenol extracts (PPEs) on fatty acid content, oxidative stability, and lipid health indices in eggs of slow-growing Sasso T451A laying hens. One hundred and five hens were assigned to five groups (seven replicates of three) and fed on FS (75 g flaxseed and no antioxidants), VE8 (75 g flaxseed and 800 mg vitamin E), TS8 (75 g flaxseed and 800 mg Thymus schimperi), DA8 (75 g flaxseed and 800 mg Dodonaea angustifolia), and CD8 (75 g flaxseed and 800 mg Curcuma domestica) extract per kg diets. The egg yolk content of eicosapentaenoic acid (EPA, C20:5 n-3) in the DA8, TS8, and CD8 diets and docosahexaenoic acid (DHA, C22:6 n-3) in TS8 and CD8 diets significantly (p < 0.05) increased compared with the FS diet. The FS diet significantly increased the malondialdehyde (MDA) content in egg yolks, whereas the TS8 diet decreased it by 67% (p < 0.05). Little difference was observed in yolk fatty acid content between cooked and raw eggs. Production of n-3 PUFA-enriched eggs with favorable lipid health indices was possible through inclusion of PPEs extracted from local plant species grown in Ethiopia and a moderate dose of flaxseed in the diet of laying hens.

Influence of Eimeria maxima coccidia infection on gut microbiome diversity and composition of the jejunum and cecum of indigenous chicken.

Coccidiosis is an economically significant protozoan disease and an intracellular parasite that significantly impacts poultry production. The gastrointestinal tract microbiota plays a central role in host health and metabolism, and these microbes enhance chickens' immune systems and nutrient absorption. In this study, we analyzed the abundance and diversity of microbiota of the jejunum and cecum of a dual-purpose indigenous Horro chicken following Eimeria maxima infection. We compared microbial abundance, composition, and diversity at the 4- and 7- days post-infection using 16S rRNA gene sequencing. We obtained, on average, 147,742 and 132,986 high-quality sequences per sample for jejunum and cecum content, respectively. Firmicutes, Proteobacteria, Campilobacterota and Bacteroidota were the major microbial phylum detected in the jejunum content. Firmicutes were the dominant phylum for 4- and 7-days jejunum control groups accounting for (>60% of the sequences). In the infected group Campilobacterota was the dominant phylum in the jejunum (> 24% of sequences) at 4-and 7-days post-infection groups, while Proteobacteria was predominant at 4- and 7-days post-infection of the cecum (> 40% of the sequences). The microbial genus Lactobacillus and Helicobacter were found in the jejunum, while Alistipes, Barnesiella and Faecalibacterium were detected in the cecum. In the jejunum, Helicobacter was dominant at 4 -and-7 days post-infection (≥24%), and Lactobacillus was dominant at 4 -and 7- days in the control group (> 50%). In 4- and 7-days post-infection, Alistipes genus was the more prevalent (> 38%) in the cecum. Thus, clear differences were observed in the bacterial microbiota distribution and abundance between the jejunum and cecum, as well as between infected and control groups for both tissues. The results indicate that chicken intestinal microbial imbalance (dysbiosis) is associated with Eimeria parasite infection and will likely affect the host-microbial non-pathogenic and pathogenic molecular interactions.

In Vitro Antioxidant Activities of Plant Polyphenol Extracts and Their Combined Effect with Flaxseed on Raw and Cooked Breast Muscle Fatty Acid Content, Lipid Health Indices and Oxidative Stability in Slow-Growing Sasso Chickens.

Adding flaxseed was found to decrease oxidative stability in feed and increase the antioxidant needs of chicken. This has also been associated with a decrease in the nutritional value and oxidative stability of meat if sufficient dietary antioxidants are not included. Furthermore, dietary flaxseed has been explored in fast-growing chickens as such studies are limited with slow-growing chickens. Thus, this study aimed to evaluate the effects of feeding plant polyphenol extracts as an antioxidant alongside flaxseed on fatty acid content, oxidative stability, and lipid health indices in breast muscle of slow-growing Sasso T451A dual-purpose chicken. A total of 126 chickens assigned to six groups (seven replicates of three) were fed on NC (control and no antioxidants), FS (75 g flaxseed and no antioxidants), VE8 (75 g flaxseed and 800 mg vitamin E), TS8 (75 g flaxseed and 800 mg Thymus schimperi), DA8 (75 g flaxseed and 800 mg Dodonaea angustifolia) and CD8 (75 g flaxseed and 800 mg Curcuma domestica) extract per kg diet. Feeding on CD8 and VE8 in raw and TS8, CD8 and VE8 diets in cooked breast muscle increased (p < 0.05) the C22:6n − 3 (DHA) and C20:5n − 3 (EPA) contents compared to the FS diet. Feeding FS increased (p < 0.05) the malondialdehyde (MDA) content in breast muscle, whereas TS8 in cooked and raw and CD8 and DA8 diets in raw breast muscle decreased it (p < 0.05). No added benefit was observed in feeding VE8 over plant extracts in terms of improving fatty acid composition and lipid health indices and reducing lipid oxidation in breast meat.

Seroprevalence of Hepatitis C Viral Infection in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Hepatitis C virus is a highly genetically heterogenous bloodborne pathogen that is responsible for acute and chronic hepatitis. Globally, an estimated 71 million population is chronically infected with this virus from which 399,000 people die every year. Its prevalence is high in Ethiopia and varies from region to region, even among different studies within a region. METHODS: Electronic databases, including Science Direct, Medline, HINARI, African Journals Online, TRIP database, African Index Medicus, and Directory of Open Access Journals, searched from 2010 to 2020 and published articles were included. Due to evidence of considerable heterogeneity, the pooled prevalence of anti-HCV was analyzed using the random-effects model. The possible sources of heterogeneity were analyzed through subgroup analysis, sensitivity analysis, and meta-regression. Funnel plots and Egger's test statistics were used to determine the presence of publication bias. RESULTS: The analysis of 56 articles showed that the prevalence of anti-HCV in Ethiopia ranged from 0% to 22%. The pooled prevalence estimated was 2% (95% CI 2.0-3.0), and the meta-regression statistics indicated that the diagnostic method (p=0.037), study group (p=0.005), and level of bias (p=0.035) showed statistically significant association with the outcome variable. The sensitivity analysis claims no influence on the overall effect estimate while removing a single study from the analysis at a time. Egger's test statistics (p ≤ 0.001) declare the presence of publication bias that is handled using time and fill analysis. CONCLUSIONS: The pooled prevalence of anti-HCV in Ethiopia was high. Predictor variables, including the diagnostic method, study group, and level of bias, showed a statistically significant relationship with the outcome variable. Strengthening the scope of existing prevention and control programs and implementing novel approaches, including screen-and-treat, could significantly help to tackle this critical public health issue. The study provides a current estimate which is valuable for policymakers and other responsible bodies.

Laboratory Quality Management System and Quality Indicators Implementation Status as Perceived by Laboratory Professionals in Preparation for the Accreditation Process from Selected Government Hospitals of Ethiopia.

BACKGROUND: The aim was to produce quality results that clinical laboratories need to implement and maintain continuous quality improvement systems. In recent years, health organizations have increasingly prioritized the quality of laboratory services by implementing quality management systems (QMSs) and building quality improvement activities. Efforts to strengthen laboratory systems in the African region have received increased attention in recent years. Assessing the implementation levels of laboratory quality management system components is important to identify the gaps that need further improvements. METHODS: A cross-sectional study design was used between March and May 2017 in selected government hospitals of Ethiopia, and sample size was determined using a finite population formula, and a proportional sampling technique was employed; a sample size of 184 (62%) was calculated from 295 laboratory professionals. RESULTS: All respondents were informed about the laboratory's experience in the quality management system implementation; of those, only 138 (79%) engaged in the implementation process. From the 18 selected laboratory quality management components, 5 were observed to have the list implementation status, which are: (1) Performance of internal quality control for all tests, (2) Development and communication of a quality manual for all tests, (3) Adequacy of storage space for the supplies, (4) Development of an action plan based on internal audit, and (5) monitoring of environmental conditions. Running quality controls for all types of tests became a headache in almost all laboratories. From 12 selected quality indicators studied in this research, the 5 indicators with either poor or very poor performance outcome were: control of documents 136 (77.7%), control of records 123 (70.3%), development of manuals and policies 122 (69.7%), development of process and procedures 120 (68.6%), and internal communication 114 (65.1%). CONCLUSIONS: This research indicated the top 3 LQMS components with either poor or very poor implementation status: (1) Performance of internal quality controls for all tests, (2) Development and communication of quality manuals for all tests, (3) Adequacy of storage space for the supplies. Of the quality indicators studied, control of documents was perceived to have poor performance outcome by 136 (77.7%) of study participants.

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.

Assessment of Quality of Medical Laboratory Services Provision and Associated Factors in Public Health Facilities at Gondar Town, Amhara Regional State, Northwest Ethiopia.

BACKGROUND: A quality medical laboratory service is an important part of the health care system. In developing countries like Ethiopia, the laboratory quality system remains weak due to several factors. Therefore, assessing the factors affecting quality of medical laboratory service is highly important in order to improve service quality. OBJECTIVE: Assessment of factors affecting the quality of medical laboratory service in Gondar town public health facilities, Amhara regional state, Northwest Ethiopia, 2018. METHODS: An institution based cross-sectional study was conducted at Gondar town governmental health facilities from March to April 2018. A pretested, self-administered, semi-structured questionnaire and checklist was used to collect the socio-demographic information of the study participants and to assess factors affecting the provision of quality medical laboratory services. Data were checked for completeness, entered, and analyzed using SPSS version 20 (IBM Corporation, Armonk, NY, USA). Data were reported in tables and figures. The strength of association between the dependent and independent variables was assessed by the chi-square test. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 103 medical laboratory professionals participated in the study. Of these, 62 (60.2%) were males. The majority of the study participants, 63 (61.2%), were laboratory technologists. Of these participants, 72 (69.9%) did not attend laboratory refresher training and 93 (90.3%) of participants were not satisfied with their salary. Sixty-three (61.2%) of the participants reported that their laboratory did not provide quality laboratory service. Lack of quality and adequate equipment, non-adherence to standard operating procedures, no continuing professional development, unavailability of adequate supplies and reagents, no customer service management, no regular internal and external quality assessment activity, no diagnostic service for all requested tests, no result verification, and laboratory safety were the major factors significantly associated with poor quality laboratory service (p < 0.05). CONCLUSIONS: A high proportion of the study participants reported that their laboratory did not provide quality laboratory services. The shortage of adequate equipment, reagents, and lack of motivation and employees' recognitions are the major factors that affect the quality of laboratory services.

How Does ISO 15189 Laboratory Accreditation Support the Delivery of Healthcare in Ethiopia? A Systematic Review.

BACKGROUND: Assessing quality by considering input, process and output level quality variables is important to ensure improved quality services. Designing and execution of an effective quality management system are aimed for the purpose of quality improvement, error reduction and associated risks. Therefore, this review is designed to assess the value of accreditation on the performance of healthcare institutions in ensuring quality improvement interventions. Moreover, this review presents important concepts of accreditation and the aspects of quality. METHODS: Published articles were downloaded using EndNote® application software program from PubMed (NML) database, Web of Sciences (TS) and Google Scholar. From a total of 883 downloaded full-text published materials, only 28 journals and 1 report issued from 2010 to 2017 were used for the development of this review. RESULT: The overall quality of healthcare services in developing countries was error-prone and suffered from limitations. These could be associated with wrong interventions and increased risks. Accreditation schemes have been implemented to provide quality care and ensure safety. CONCLUSION: Evaluation feedback induces interventions aimed at quality improvement and ensures better management systems, good process design, wise resource utilization, meeting patients' need and increased satisfaction. Hence, stakeholders must be engaged in the provision of improve quality patient care and reduce associated risks. Hence, giving special quality improvement attention helps to improve quality healthcare services.

Knowledge, attitude, and practice of waste handlers about medical waste management in Debre Markos town healthcare facilities, northwest Ethiopia.

OBJECTIVE: Medical waste is a total waste stream which is generated from the healthcare facilities during the healthcare delivery process. It can contain potentially hazardous substances for the human being and the environment. Waste handlers play a significant role for its proper management and they need to have adequate knowledge, attitude, and practices. The study aimed to evaluate the knowledge, attitude, and practices of waste handlers regarding medical waste management in Debre Markos town healthcare facilities, northwest Ethiopia. RESULTS: A total of 55 medical waste handlers were studied from 12 healthcare facilities. Among this, 25 (45.4%) were diploma and certificate holders. The majority (69.1%) of the study participants were not provided with proper training. There was a lack of personal protective devices and waste management equipment supply. Regarding knowledge, attitude, and practices, 25 (45.5%), 43 (78.2%), and 44 (80%) of the study participants had adequate knowledge, favorable attitude, and adequate practice scores, respectively. There was high (30.9%) prevalence of needlestick and sharps injuries. Healthcare facilities should provide periodic training and adequate supplies for the waste handlers. Further study should be conducted on a large scale by including different levels of health facilities and regions of the country.

Plasmodium falciparum and Plasmodium vivax Prevalence in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Malaria is a protozoan disease caused by the Plasmodium species. Among the five Plasmodium species. Among the five Plasmodium falciparum and Plasmodium vivax malaria are by far the most predominant and widely distributed in Ethiopia. Malaria is one of the leading causes of morbidity and mortality globally, particularly in the sub-Saharan countries including Ethiopia. It is also a major obstacle to socio-economic development in the country. METHODS: Articles were searched from PubMed, Google Scholar, and Science Direct databases. The pooled prevalence estimates were analyzed using the DerSimonian-Laird random-effects model and the possible sources of heterogeneity were evaluated through subgroup analysis, metaregression, and sensitivity analysis. Publication bias was analyzed using funnel plots and Egger's test statistics. The data management and analysis were done using STATA 15.1 version software. RESULTS: Among 922 studies initially identified, thirty-five full-text articles fulfilled the inclusion criteria and included in the study. The combined, Plasmodium falciparum and Plasmodium vivax malaria are by far the most predominant and widely. CONCLUSIONS: This systematic review and meta-analysis showed a high malaria prevalence in Ethiopia. Therefore, previous prevention and control measures should be revised and/or strengthened as appropriate and new strategies should be implemented. In addition, technical, financial and material support, and coordination of the regional capacity building and logistics should be adequately implemented.

How does ISO 15189 laboratory accreditation support the delivery of healthcare in Ethiopia? a systematic review

BACKGROUND: Assessing quality by considering input, process and output level quality variables is important to ensure improved quality services. Designing and execution of an effective quality management system are aimed for the purpose of quality improvement, error reduction and associated risks. Therefore, this review is designed to assess the value of accreditation on the performance of healthcare institutions in ensuring quality improvement interventions. Moreover, this review presents important concepts of accreditation and the aspects of quality. METHODS: Published articles were downloaded using EndNote® application software program from PubMed (NML) database, Web of Sciences (TS) and Google Scholar. From a total of 883 downloaded full-text published materials, only 28 journals and 1 report issued from 2010 to 2017 were used for the development of this review. RESULT: The overall quality of healthcare services in developing countries was error-prone and suffered from limitations. These could be associated with wrong interventions and increased risks. Accreditation schemes have been implemented to provide quality care and ensure safety. CONCLUSION: Evaluation feedback induces interventions aimed at quality improvement and ensures better management systems, good process design, wise resource utilization, meeting patients' need and increased satisfaction. Hence, stakeholders must be engaged in the provision of improve quality patient care and reduce associated risks. Hence, giving special quality improvement attention helps to improve quality healthcare services

Prevalence and risk factors of tungiasis among children of Wensho district, southern Ethiopia.

BACKGROUND: Tungiasis is an ectoparasitic infestation, which still has public health importance in deprived populations of developing countries. Data on the prevalence and risk factors of tungiasis is rare in Ethiopia. Hence, this study was designed to determine the prevalence and risk factors of tungiasis among children in Wensho district, southern Ethiopia. METHODS: From February to May 2016, we conducted a community-based cross-sectional study on 366 children 5-14 years old. Data about the presence and severity of tungiasis were obtained through inspection and data on risk factors were collected through interviews of parents/guardians of the children using structured questionnaire and through observation of the housing environment using structured checklist. RESULTS: Two hundred fifteen (58.7%, 95% confidence interval [CI]: 53.7%, 63.8%) of the 366 children were infested with Tunga penetrans. Most lesions were localized in the feet and the distribution of the disease by sex was similar (57.4% among males and 60.3% among females). Children of illiterate mothers (adjusted odds ratio [AOR]: 3.62, 95% CI: 1.35, 9.73) and children whose mothers have attended only primary education (AOR: 2.72, 95% CI: 1.06, 6.97), children from cat owning households (AOR: 4.95, 95% CI: 1.19, 20.60) and children who occasionally use footwear (AOR: 7.42, 95% CI: 4.29, 12.83) and those who never use footwear (AOR: 12.55, 95% CI: 3.38, 46.58) had a significantly higher odds of tungiasis infestation. CONCLUSION: Tungiasis is an important public health problem with considerable morbidity among children in Wensho. Hence, implementation of tungiasis prevention strategies such as promoting shoes wearing, provision of health education, fumigating the residential houses and applying insecticides on pets are recommended.

Survey-Defined and Interview-Elicited Challenges That Faced Ethiopian Government Hospital Laboratories as They Applied ISO 15189 Accreditation Standards in Resource-Constrained Settings in 2017.

OBJECTIVES: The World Health Organization African Regional Office recommends ISO 15189 standards to improve performance quality in sub-Saharan African laboratories. We specify challenges Ethiopian laboratorians encountered applying ISO 15189 standards. METHODS: From a structured survey at 12 Ethiopian government hospitals, 175 laboratory staff replied; all were aware of the ISO standards and 138 had been involved in the ISO 15189 inspection process. In addition, 11 laboratory heads, 10 quality officers, and three medical directors were interviewed in depth. RESULTS: Half or more respondents identified six challenges obstructing accreditation to a "large" or "very large" degree: (1) low management support, (2) inadequate training, (3) insufficient infrastructure, (4) excessive documentation, (5) little mentorship, and (6) increased accreditation-related workload. Interviewees added (7) poor equipment, (8) unavailable/poor-quality reagents, and (9) high staff turnover. CONCLUSIONS: The survey and interviews specified nine major challenges for Ethiopian government hospital laboratories that seriously obstruct meeting ISO 15189 demands.

Cryptosporidiosis and Isosporiasis among HIV-positive individuals in south Ethiopia: a cross sectional study.

BACKGROUND: Cryptosporidium spp and I. belli are intestinal opportunistic infections associated with HIV/AIDS. A decline in the incidence of these opportunistic infections due to HAART was reported. We aim to investigate these parasites among HAART naïve and experienced HIV patients in south Ethiopia. METHODS: A cross sectional study was carried out among 268 HIV- positive patients between January and September, 2007. Interview with questionnaires and document reviews were used to collect data. Stool samples were obtained from each patient and parasites were examined by direct, formol-ether and modified Ziehl-Neelsen stain for Cryptosporidium spp and I. belli. Univariate and multivariate analysis were carried out. Level of significance was set at p-value of 0.05. RESULTS: A total of 268 patients participated in the study. The mean age was 34.0 (±1 SD of 8.34) years. Females constituted 53.4% (143) of the study participants. Half of the study participants were on HAART; majorities (85.8%) of such patients were within the first year of treatment. The prevalence of Cryptosporidium spp was 34.3% (92/268) and I. belli was 1.5% (4/268). Dual infection was detected in two patients (0.75%). The crude analysis revealed significant reduction in the odds of Cryptosporidium spp infection among patients who have started HAART (crude OR = 0.59, 95% CI 0.35, 0.98). The adjusted analysis remained in the same direction but has lost significance (Adj OR 0.65, 95%CI 0.35, 1.24). No differences in the risk of developing infection with Cryptosporidium spp were observed between groups based on most recent CD4 counts, sex, duration on HAART and age (p > 0.05 for all variables). Patients with Cryptosporidium spp were more likely to report vomiting [Adj OR 2.34 (95% CI 1.22, 5.41)], weight loss [Adj OR 2.10 (95% CI 1.15, 3.81)] and chronic diarrhea [Adj OR 3.35 (95%CI 1.05, 10.63)]. CONCLUSION: There is high burden of infection with Cryptosporidium spp among HIV infected individuals in southern Ethiopia but that of I. belli is low. We recommend considering infection with Cryptosporidium spp in HIV infected people with chronic diarrhea, weight loss and vomiting for HAART naïve patients and/or for patients who are within the first year of starting HAART.

Intestinal Protozoal Parasites in Diarrheal Children and Associated Risk Factors at Yirgalem Hospital, Ethiopia: A Case-Control Study.

Aim. A case-control study was conducted to determine the prevalence of G. lamblia, Cryptosporidium, spp and E. histolytica/dispar in diarrheal children at Yirgalem Hospital from February 2011 to August. Subjects and Methods. A total of 230 children participated in the study of which 115 (50%) were cases and 115 (50%) were controls. A single stool sample was collected and examined by direct saline wet mount, formol-ether concentration, and modified Ziehl-Neelsen. Results. Eighty-four (36.52%) were positive for at least one intestinal parasites (57 (49.56%) from diarrheal children and 27 (23.47%) out of nondiarrheal children). The prevalence of G. lamblia, Cryptosporidium spp, and E. histolytica/dispar was 15.65%, 9.56%, and 4.35% in children with diarrhea and 1.74%, 5.21%, and 1.74% in those without it, respectively. Cryptosporidium spp and E. histolytica/dispar revealed higher infection in males (10.81% and 5.4%, resp.) than in females (7.32% and 2.43%, resp.). G. lamblia infection was higher in females (29.27%) than in males (8.11%). Cryptosporidium spp infection was higher in the age groups of ≤4 years old (53.84%). Significant difference was seen between 10 and 13 (7.69%) years old. Higher prevalence of E. histolytica/dispar was found in 5-9 years (85.71%) than ≤4 years old (14.28%). Conclusion. Cryptosporidium spp, E. histolytica/dispar, and G. lamblia were higher in children with diarrhea than in those without it.