Vitamin D deficiency among newly diagnosed tuberculosis patients and their household contacts: a comparative cross-sectional study.

BACKGROUND: Recent studies suggest that the incidence and severity of tuberculosis is associated with low levels of vitamin D. Even though individuals living in Ethiopia have a high exposure to sunlight which is a source of vitamin D, tuberculosis is still one of the major causes of morbidity and mortality in the country. Therefore, this study aimed to determine the prevalence and associated factors of vitamin D deficiency in newly diagnosed tuberculosis patients, household contacts and community controls in Gondar, Ethiopia. METHODS: A comparative cross-sectional study design was conducted. Blood samples were collected from newly diagnosed smear positive pulmonary TB patients, their household contacts and community controls. Serum 25(OH)-vitamin D3 was determined by an Enzyme Linked Immunosorbent Assay. A serum level of 25(OH)-vitamin D3 below < 50 nmol/L was defined as vitamin D deficiency and <25 nmol/L as severe vitamin D deficiency. RESULTS: A total of 126 newly diagnosed smear positive TB patients, 57 house hold contacts and 70 apparently community controls were included in the study. The mean ± SD age (years) of TB patients, house hold contacts and community controls was 29.8 ± 11.9, 24.3 ± 14.7 and 27.3 ± 7.6 respectively. Ninety out of 126 (71.4%) TB patients were underweight with a BMI of < 18.5 kg/m2. The mean 25(OH)-vitamin D3 level of TB patients (30.1 ± 19.3 nmol/L) was significantly lower than community controls (38.5 ± 20.9 nmol/L, P = 0.005 and household contacts (37.7 ± 12.8 nmol/L, P =0.031).). The prevalence of vitamin D deficiency was higher in TB patients (83.3%) than in community controls (67.1%, P = 0.009). The prevalence of vitamin D deficiency was also found higher in household contacts (80.7%). Severe vitamin D deficiency was observed in 53%(67/126), 30% (21/70), 19.3%(11/57) of TB patients, community controls and household contacts respectively. Low BMI (AOR = 2.13; 95%CI: 1.02, 3.28) and being positive for tuberculosis (AOR = 1.93; 95%CI: 1.06, 2.86) were significant predictors of severe vitamin D deficiency. CONCLUSION: High prevalence of vitamin D deficiency was found among newly diagnosed TB patients and in their household contacts. The present study warrants further studies to determine the role of vitamin D supplementation in the prevention and treatment of tuberculosis in Ethiopia.

Assessment of knowledge, attitudes and practices toward prevention of hepatitis B virus infection among students of medicine and health sciences in Northwest Ethiopia.

BACKGROUND: Hepatitis B virus (HBV) infection in the health setting is a global public health problem. The risk of occupational exposure to HBV among health care workers is a major concern, especially among students in health professions. In Ethiopia, very little is known about the knowledge, attitude, and practices (KAP) of trainees in the health professions towards occupational risk of HBV. Thus, the aim of this study was to assess the level of KAP of medicine and health Sciences students in Northwest Ethiopia towards occupational risk of HBV infection. METHODS: A cross-sectional study was conducted from February 2015 to June 2015. A total of 246 students of health care professions were included into the study using a systematic random sampling technique. Data were collected using self-administered structured questionnaire and analysed by using SPSS version 20. RESULTS: Majority of the study participants, (>80 %) had an adequate knowledge on risk factors for HBV, its mode of transmissions, and preventions. Two hundred of 246 (83.3 %) participants had positive attitude towards following infection control guidelines, and 201 (81.7 %) respondents believe that all HCWs should take HBV vaccine. However, only 5 (2 %) students had completed the three doses schedule of HBV vaccination. Whereas, a significant number of students, 66 (26.8 %), had been exposed to blood/body fluid via needle stick injury at least once since they started their training in the health facility. CONCLUSIONS: Our study found that trainees in health profession are at a very high risk of contracting HBV infection during their training owing to the low HBV vaccine uptake rate and high rate of accidental exposure to blood. Thus, we recommend that all students in the health profession should be vaccinated prior to their entry into professional practices.

Successful Treatment of Human Visceral Leishmaniasis Restores Antigen-Specific IFN-γ, but not IL-10 Production.

One of the key immunological characteristics of active visceral leishmaniasis (VL) is a profound immunosuppression and impaired production of Interferon-γ (IFN-γ). However, recent studies from Bihar in India showed using a whole blood assay, that whole blood cells have maintained the capacity to produce IFN-γ. Here we tested the hypothesis that a population of low-density granulocytes (LDG) might contribute to T cell responses hyporesponsiveness via the release of arginase. Our results show that this population is affected by the anticoagulant used to collect blood: the frequency of LDGs is significantly lower when the blood is collected with heparin as compared to EDTA; however, the anticoagulant does not impact on the levels of arginase released. Next, we assessed the capacity of whole blood cells from patients with active VL to produce IFN-γ and IL-10 in response to antigen-specific and polyclonal activation. Our results show that whole blood cells produce low or levels below detection limit of IFN-γ and IL-10, however, after successful treatment of VL patients, these cells gradually regain their capacity to produce IFN-γ, but not IL-10, in response to activation. These results suggest that in contrast to VL patients from Bihar, India, whole blood cells from VL patients from Gondar, Ethiopia, have lost their ability to produce IFN-γ during active VL and that active disease is not associated with sustained levels of IL-10 production following stimulation.

Characterization of mycobacterium isolates from pulmomary tuberculosis suspected cases visiting Tuberculosis Reference Laboratory at Ethiopian Health and Nutrition Research Institute, Addis Ababa Ethiopia: a cross sectional study.

OBJECTIVE: To characterize mycobacterium isolates from pulmomary tuberculosis suspected cases visiting National Tuberculosis Reference Laboratory at Ethiopian Health and Nutrition Research Institute, for diagnosis of pulmonary tuberculosis from January 4 to February 22, 2010 with total samples of 263. METHODS: Sputum specimens were collected and processed; the deposits were cultured. For culturing Lowenstein Jensen medium (LJ) and Mycobacteria Growth Indicator Tube (BACTEC MGIT 960) were used. Capilia Neo was used for detecting NTM isolates from isolates of BACTEC MGIT 960. In Armauer Hansen Research Institute, Addis Ababa Ethiopia, Deletion typing PCR method for species identification (from confirmed Mycobacterium tuberculosis complex (MTBC) isolates by Capilia Neo) was done. RESULTS: Out of 263 enrolled in the study, 124 and 117 of them were positive for mycobacterium growth by BACTEC MGIT 960 and LJ culture method, respectively. From BACTEC MGIT 960 positive media of 124 isolates, 117 were randomly taken to perform Capilia TB Neo test. From these 7 (6%) of them were found to be NTM and 110 (94%) were MTBC. From these 110 MTBC isolates, 81 of them were randomly taken and run by the deletion typing RD9 PCR method of molecular technique. Out of these 78 (96.3%) were found to be species of Mycobacterium tuberculosis and 3 (3.7%) were found to be not in the MTBC. Regarding the types of methods of culture media, Mycobacteria Growth Indicator Tube (BACTEC MGIT 960) method was found to have excellent agreement (with kappa value of 0.78) with the routine method of LJ. CONCLUSIONS: Pulmonary tuberculosis suspected cases visiting the National Tuberculosis Reference Laboratory at EHNRI that were confirmed to be pulmonary tuberculosis are caused by the species of Mycobacterium tuberculosis, hence treatment regimen including pyrazinamide can be applied to the patients as the first choice in the study area in Addis Ababa, Ethiopia. There is indication of the presence of NTM in patients visiting the tuberculosis reference laboratory and this is important because NTM is known to cause pulmonary disease similar with sign and symptom of pulmonary tuberculosis but different in treatment. BACTEC MGIT 960 has excellent agreement with LJ media but it has high tendency of having high contamination rate unless a better decontamination method is designed.

Prevalence of smear positive pulmonary tuberculosis in Gondar prisoners, North West Ethiopia.

OBJECTIVE: To assess the prevalence and risk factors of smear positive pulmonary tuberculosis among Gondar town prisoners, North West Ethiopia. METHODS: A cross sectional study was conducted from February to July, 2008 in Gondar Prison. Prisoners with cough duration of more than two weeks were involved in the study by giving three sputum samples and filling the questionnaires prepared for risk factor assessment. Acid fast staining technique was employed to detect the presence of the Mycobacterium tuberculosis bacilli in the sputum samples. Data was analyzed using SPSS version13 computer software and presented in table. Chi-square test was used to assess associations and a P-value less than 0.05 was taken as significant. RESULTS: A total of 384 prisoners, 349 male and 35 females, with a mean age of 33.3 years were involved in the study. The prevalence of smear positive pulmonary tuberculosis among those prisoners with cough duration of more than two weeks was 8.59%. Only the length of imprisonment had a significant association (χ (2)= 18.82, P-value<0.0001) with the prevalence of tuberculosis. CONCLUSIONS: This study indicated that tuberculosis among prisoners with cough duration of more than two weeks in Gondar prison is very high. Therefore Periodic screening of the prisoners and screening of newly introduced prisoners should be practiced so as to minimize the burden of tuberculosis in prisoners.

Establishment of Normal Reference Intervals for CD3(+), CD4(+), CD8(+), and CD4(+) to CD8(+) Ratio of T Lymphocytes in HIV Negative Adults from University of Gondar Hospital, North West Ethiopia.

Background. Reference values for the CD3(+), CD4(+), CD8(+), and CD4(+) to CD8(+) ratio T lymphocyte subsets are adopted from textbooks. But for appropriate diagnosis, treatment, and follow-up of patients, correct interpretations of the laboratory results from normal reference interval are mandatory. This study was, therefore, planned to establish normal reference interval for T lymphocytes subset count and CD4(+) to CD8(+) ratio. Methods. A cross-sectional study was conducted on apparently healthy adult individuals who visited voluntary counseling and HIV testing clinic Gondar University Hospital from April to May, 2013. Whole blood was analyzed using fluorescence-activated cell sorting (BD FACS, San Jose, CA) machine to enumerate the T-cell subpopulations. Results. Out of the total 320 study participants, 161 (50.3%) were men and 159 (49.7%) were women. The normal reference intervals were (655-2,823 cells/µL), (321-1,389 cells/µL), and (220-1,664 cells/µL) for CD3(+), CD4(+), and CD8(+) T lymphocyte subsets, respectively, and CD4(+) to CD8(+) ratio was 0.5-2.5. Conclusion. The overall CD3(+) T lymphocytes reference interval in the current study was wide; low CD4(+) T lymphocytes, CD4 to CD8 ratio, and high CD8(+) T lymphocytes values were observed.

Prevalence and types of thyroid malignancies among thyroid enlarged patients in Gondar, Northwest Ethiopia: a three years institution based retrospective study.

BACKGROUND: Thyroid carcinoma is the leading cause of death among endocrine cancers second to carcinoma of the ovary. Now a day, the incidence of thyroid malignancy is increasing more rapidly than any other malignancy. But data on the prevalence of thyroid malignancy among thyroid enlarged patients were very limited in the study area. Therefore, this study was aimed to determine the prevalence of thyroid malignancies among thyroid enlarged patients. METHODS: Data of 846 thyroid enlarged patients registered from January 2010 to February 2013 were collected from fine needle aspirate cytology and histology (for inconclusive and the neoplastic cases) log books. It was entered and analyzed using SPSS version 20. Odds ratio was calculated to assess the presence and strength of association between the outcome variable and the explanatory variables. P-values less than 0.05 were considered statistically significant. RESULTS: Among the 846 thyroid enlarged patients, 62(7.3%) were confirmed to have malignancy. Among malignancies papillary thyroid carcinoma was the leading, 28 (45.2%), followed by follicular thyroid carcinoma, 18 (29%), and the least type of thyroid malignancies were medullary thyroid carcinoma and hurtle cell carcinoma, each accounts 1 (1.6%). Severe form of thyroid malignancy, undifferentiated thyroid carcinoma, was also accounted significant proportion, 12.9%. Older patients having an age of greater than 60 years and patients with solitary thyroid enlargement were more affected by malignancy compared to the reference age group, 11-20 years and diffused type of enlargement respectively (AOR: 10.96 (3.15-38.1; AOR: 8.82 (3.49-22.32) respectively). CONCLUSIONS: The prevalence of thyroid malignancy was significantly high and the leading type of malignancy was papillary thyroid carcinoma followed by follicular thyroid carcinoma. Thyroid malignancy was found to have statistically significant association with type of enlargement and age.

Current status of soil transmitted helminths and Schistosoma mansoni infection among children in two primary schools in North Gondar, Northwest Ethiopia: a cross sectional study.

BACKGROUND: School age children are one of the groups at high risk for intestinal parasitic infections especially in developing countries like Ethiopia as the supply of good quality drinking water and latrine coverage are poor. Though there are previous data on the prevalence of soil transmitted helminths (STHs) and Schistosoma mansoni infection among these high risk groups current status in the study area is unknown. Therefore, the aim of this study was to determine the current prevalence and associated risk factors of STHs and S. mansoni infections among school children. METHODS: A cross-sectional study was carried out in Gorgora and Chuahit towns, North Gondar Zone, North West Ethiopia from January 20 to February 25, 2012 involving 261 school children. A pre-tested and structured questionnaire was used to collect socio-demographic data and possible risk factors. Stool samples were collected and examined for intestinal parasites using Kato Katz method. Chi-square test was used to see if there is association between sociodemographic factors and other risk factors for STH and S. mansoni infection and odds ratio with 95% CI was computed as measures of association. P < 0.05 was taken as statistically significant. RESULTS: Out of the 261 study participants, 174 (66.7%) were infected with one or more species of intestinal parasites. Ascaris lumbricoides was the predominant isolates (39.8%) followed by Trichuris trichiura (6.1%) and Hookworms (4.9%). Schistosoma mansoni was detected in 33.7% of the children. Among infected individuals, 9.5% were coinfected by S. mansoni and A. lumbricoides and 1.5% with S. mansoni and T. trichiura. Swimming habit (OR: 2.536, 95% CI: 1.122, 5.737, P = 0.022) was significantly associated with S. mansoni infection. CONCLUSION: The prevalence of STH and S. mansoni was high among school children. This should call for implementation of an integrated strategy to reduce morbidity and control of transmission of STH and S. mansoni.

Seroprevalence and trend of Helicobacter pylori infection in Gondar University Hospital among dyspeptic patients, Gondar, North West Ethiopia.

BACKGROUND: The growing attention given to H. pylori is not surprising since this pathogen colonizes more than at least half of the world's inhabitants. In Ethiopia particularly in Gondar, there is no current study conducted about seroprevalence and trend of the prevalence of H. pylori. Therefore the aim of this study was to determine the seroprevalence and its trend of the H. pylori in three consecutive years in North Gondar, North West Ethiopia. FINDINGS: Retrospective study was conducted using data collected from log book of serology laboratory of Gondar University Hospital. We collected data from January 2009 to December 2011 and 1388 subjects were included whose data were registered completely.Among all of the study subjects, 912 (65.7%) were found to be seropositive. The prevalence in male was 449/679 (66.1%) and in females it was 463/709 (65.3%). The prevalence of H.pylori infection was significantly higher (77.0%) in patients whose age is greater than 60 years and the lowest positive age group was between 0-20 in which only 59.1% were positive (X2 =14.15,p=0.0146). The seroprevalence was 86.5% in 2009 and it decreased to 51.8% in 2010. But the seroprevalence increased to 61.3% in 2011. CONCLUSION: This study showed high seroprevalence of H. pylori among the dyspeptic patients in GUH. The trend of the seroprevalence was varied from year to year in the three consecutive years. In general it showed that the seroprevalence has started increasing.

Bacterial profile and antimicrobial susceptibility pattern in septicemia suspected patients attending Gondar University Hospital, Northwest Ethiopia.

BACKGROUND: Bacterial blood stream infection constitutes a significant public health problem and it is an important cause of morbidity and mortality in hospitalized patients. The aim of this study was to assess the prevalence of bacterial isolates from septicemia suspected patients and their antimicrobial susceptibility pattern in Gondar University Hospital. METHODS: This laboratory based retrospective study of 390 blood culture and susceptibility tests was conducted in Bacteriology Laboratory of the University of Gondar Teaching Hospital. The samples were collected and processed following standard microbiological techniques as part of the routine clinical management of the patient. Antibiotic susceptibility testing was done on pure culture isolates employing disc-diffusion method for the commonly used antibiotics. The data were analyzed by using SPSS version 16 and the results were summarized by using tables and graphs. RESULTS: Out of 390 blood culture results, 71 (18.2%) were culture positive. The predominant bacteria isolated from blood culture were Coagulase negative staphylococci 30 (42.3%), followed by S. aureus 17 (23.9%) and Klebiesella spp 9 (12.9%), E. coli 5 (7.0%), Pseudomonas aeroginosa 4 (5.6%) and Salmonella spp. 3 (4.2%). The gram positive and gram negative bacteria constituted 49 (69%) and 22 (31%) of the culture isolates; respectively. The isolates showed high rates of resistance to most antibiotics tested. The range of resistance for Gram positive and Gram negative were from 23.5% - 58.8%, and 20%- 100% respectively. CONCLUSIONS: In the present study most of the pathogens isolated from blood culture showed high rate of resistance to most commonly used antibiotics used to treat bacterial infections. Therefore, rational use of antibiotics should be practiced.

Assessment of knowledge, attitude and practice towards post exposure prophylaxis for HIV among health care workers in Gondar, North West Ethiopia.

BACKGROUND: HIV/AIDS infection in health care facility has become a major health problem. Especially in resource poor setting health care workers are managing huge number of HIV infected patients that made them to be more exposed to HIV infection. This situation makes the use of post exposure prophylaxis for HIV very important. Therefore the aim of the study was to assess knowledge, attitude and practice of health care workers towards post exposure prophylaxis for HIV. METHODS: Cross-sectional study was conducted among 195 health care workers from February 15 to June 20, 2012. Data was collected using self-administered questionnaire and entered and analyzed using SPSS-20 version. Results were summarized in percentages and presented in tables. RESULTS: Significant proportions of respondents, 72 (36.9%), were found to have inadequate knowledge about post exposure prophylaxis for HIV. However the majority of respondent 147 (75.4%) had good attitude toward the PEP and significant number of the respondents, 66 (33.8%), had been exposed to blood, body fluids, needles or sharp objects once or more times while giving care for patients. Among these exposed, 49 (74.2%) took PEP but the rest 17 (25.7%) didn't take PEP. From these exposed respondents that took PEP, 23 (46.9%) correctly started taking of PEP at exact initiation time, but the rest started after the recommended initiation time. Among those who took PEP, 39 (79 .6%) completed taking the drug, however 10 (20.4%) didn't complete the PEP regimen. CONCLUSION: As a conclusion, significant proportion of study subjects had less knowledge and practice even though the majority of respondents had favorable attitude towards PEP. Therefore, a formal training for all HCWs regarding PEP for HIV and also establishing a 24 hour accessible formal PEP centre with proper guideline is recommended.

Knowledge, attitude and practices related to visceral leishmaniasis among residents in Addis Zemen town, South Gondar, Northwest Ethiopia.

BACKGROUND: Visceral leishmaniasis (VL), commonly known as kala-azar is a systemic disease caused by parasitic protozoan species of genus Leishmania and transmitted by species of Phlebotomus (sand flies). It is a poverty-related disease and associated with malnutrition, displacement, poor housing, weakness of the immune system and lack of resources. For the success of prevention and control programs of any disease, the most important prerequisite is community participation. Therefore, this study was aimed to assess the knowledge, attitude and practice of residents towards VL in Addis Zemen town, south Gondar, Northwest Ethiopia. METHODS: Community based cross-sectional study was conducted among residents in Addis Zemen town from February to March 2012. A total of 346 households were selected by using simple random sampling techniques from three kebeles in the town. Data was collected using structured Questionnaire. For knowledge, attitude and practice variables each right response was given a score of 1 while a wrong or unsure response was scored 0. Data were double entered and analyzed using SPSS-15 statistical software. The frequency distribution of both dependent and independent variables were worked out. RESULTS: From a total of 346 study participants (136 males and 210 females), 87.6% heard of the disease kala-azar. From participants who heard about kala-azar 93.5% males and 86.7% females had awareness about the disease. The majority (95.7%) of participants had favourable attitude towards the treatment of kala-azar whereas 14.8% didn't use anything to prevent it. More than half of the respondents (68.6%) did practice proper methods for the prevention and control of kala-azar in the study area. CONCLUSION: In general our findings showed that the residents had good awareness and favourable attitude about the disease, but their overall practice about prevention and control of the disease was low. Therefore, our investigation call for continued and strengthened behavioral change communication and social mobilization related activities.

Effect of malaria on HIV/AIDS transmission and progression.

Malaria and HIV are among the two most important global health problems of developing countries. They cause more than 4 million deaths a year. These two infections interact bidirectionally and synergistically with each other. HIV infection increases the risk of an increase in the severity of malaria infection and burdens of malaria, which in turn facilitates the rate of malaria transmission. Malaria infection is also associated with strong CD4+ cell activation and up-regulation of proinflammatory cytokines and it provides an ideal microenvironment for the spread of the virus among the CD4+ cells and for rapid HIV-1 replication. Additionally, malaria increases blood viral burden by different mechanisms. Therefore, high concentrations of HIV-1 RNA in the blood are predictive of disease progression, and correlate with the risk of blood-borne, vertical, and sexual transmission of the virus. Therefore, this article aims to review information about HIV malaria interactions, the effect of malaria on HIV transmission and progression and the implications related to prevention and treatment of coinfection.

Soil transmitted helminths and schistosoma mansoni infections among school children in Zarima town, northwest Ethiopia.

BACKGROUND: In Ethiopia, because of low quality drinking water supply and latrine coverage, helminths infections are the second most predominant causes of outpatient morbidity. Indeed, there is a scarcity of information on the prevalence of soil transmitted helminths and Schistosomiasis in Ethiopia, special in study area. Therefore, the aim of this study was to determine the prevalence and associated risk factors of soil transmitted helminths and intestinal Schistosomiasis. METHODS: Cross-sectional study was conducted among 319 school children of Zarima town from April 1 to May 25, 2009. A pre-tested structured questionnaire was used to collect socio-demographic data and possible risk factors exposure. Early morning stool samples were collected and a Kato Katz semi concentration technique was used to examine and count parasitic load by compound light microscope. Data entry and analysis was done using SPSS-15 version and p-value < 0.05 considered statistically significant. RESULTS: Out of 319 study subjects, 263 (82.4%) of the study participants infected with one or more parasites. From soil transmitted helminths, Ascaris lumbricoides was the predominant isolate (22%) followed by Hookworms (19%) and Trichuris trichiura (2.5%). Schistosoma mansoni was also isolated in 37.9% of the study participants. Hookworm and S. mansoni infections showed statistically significant associations with shoe wearing and swimming habit of school children, respectively. CONCLUSION: Prevalence of soil transmitted helminths (STH) and S.mansoni was high and the diseases were still major health problem in the study area which alerts public health intervention as soon as possible.