Pertussis among patients with clinically compatible illness in the Amhara Regional State, Ethiopia.

BACKGROUND: Pertussis is an acute respiratory tract disease caused by Bordetella pertussis. In 2014, 24.1 million pertussis cases, resulting in 160,700 deaths, were estimated to have occurred worldwide. This study aimed to determine the epidemiology of pertussis among patients with clinically compatible illness who visited selected hospitals in the Amhara Regional State of Ethiopia. METHODS: A cross-sectional study design was used to review pertussis patients with clinically compatible illness. Nasopharyngeal swabs were collected from 515 patients from July 2018 through February 2019. DNA was extracted from all nasopharyngeal swabs and samples were analyzed using real-time (RT-) PCR. Crude and adjusted odds ratios with corresponding 95% confidence intervals were estimated using bivariable and multivariable logistic regression analysis, respectively. RESULTS: The overall prevalence of Bordetella species among the study participants was 156 of 515 (30.3%) [95% CI = 26.4-34.6] as determined by Bordetella RT-PCR, including: 65 (41.7%) B. pertussis, 89 (57.1%) indeterminate B. pertussis, one (0.6%) Bordetella holmesii and one (0.6%) Bordetella parapertussis. CONCLUSIONS: This study found that pertussis is potentially endemic and a common health problem among patients visiting health institutions in the Amhara Regional State of Ethiopia. More data regarding pertussis in Ethiopia could inform development of effective prevention strategies.

Erratum to "Assessment of Pertussis Vaccine Protective Effectiveness in Children in the Amhara Regional State, Ethiopia".

[This corrects the article DOI: 10.1155/2020/8845835.].

Assessment of Pertussis Vaccine Protective Effectiveness in Children in the Amhara Regional State, Ethiopia.

BACKGROUND: Bordetella pertussis is a human pathogen which causes pertussis, or whooping cough. The diphtheria-tetanus-pertussis immunization has significantly reduced the morbidity and mortality of pertussis globally. However, higher prevalence and resurgence of pertussis cases among both vaccinated and unvaccinated people has raised questions on the effectiveness of pertussis vaccine over time. Therefore, the objective of this study was to assess the protective effectiveness of pertussis vaccine in the Amhara Regional State, Ethiopia. METHODS: A nested matched case-control study design approach was used with vaccinated individuals as cases and unvaccinated individuals as controls. The study was conducted from July 2018 to February 2019. Real-time (RT-) PCR assay was done to ascertain the presence of pertussis among clinically suspected patients. Bivariable and multivariable logistic regression analyses were computed to estimate the crude and adjusted odds ratios (ORs), respectively. Vaccine effectiveness was calculated as (1 - OR) × 100. Adjusted OR with 95% CI and a P value <0.05 were used to assess statistical significance. RESULTS: A total of 112 vaccinated and 223 unvaccinated controls were enrolled for the study. Of the total participants, 173/335 (51.6%) were males. The prevalence of pertussis among vaccinated was 35/112 (31.3%), whereas it was 84/223 (37.7%) among the control group. The adjusted matched vaccine protective effectiveness against B. pertussis infection following three doses of whole-cell vaccine was 25% among children aged between 6 and 9 years. Adjusted estimates of vaccine protective effectiveness for participants who had complete vaccination, stratified by time since last vaccination, were 50% at 6 years, 34% at 7 years, and 2% at 8-9 years since last vaccination. CONCLUSION: Despite the availability and good coverage of childhood vaccination, the effectiveness of pertussis vaccine was found to be low in the Amhara region, Ethiopia. Moreover, we observed declining trends in the protective effectiveness of the vaccine after 6 years of vaccination. Thus, by considering the waning nature of immune response which is induced by whole-cell vaccine during early life, booster dose is highly recommended to optimize pertussis prevention and control strategies.

Antiretroviral treatment failure and associated factors among HIV patients on first-line antiretroviral treatment in Sekota, northeast Ethiopia.

BACKGROUND: Antiretroviral treatment has played a pivotal role in the reduction of HIV/AIDS-related morbidity and mortality. However, treatment options can be impaired by the development of antiretroviral treatment failure. Regular monitoring of the Human Immunodeficiency Virus treatment outcome via viral load tests is the key approach. There is a scarcity of information about HIV treatment failure and risk factors in the study area. Therefore, the study was aimed to assess antiretroviral treatment failure and associated factors among patients on first-line antiretroviral treatment at Tefera Hailu Memorial Hospital, Sekota, northeast Ethiopia. METHODS: A hospital-based cross-sectional study was conducted on 295 patients on first-line antiretroviral treatment from Nov. 2018 to Apr. 2019. Socio-demographic and clinical variables were collected using a pretested questionnaire, and blood specimen was collected for PCR viral load and CD4 + cell count estimation. Data were entered into Epi-Info and exported to SPSS for analysis. A binary logistic regression model was used to identify associated factors, and P value < 0.05 was considered as statistically significant. RESULTS: Of the 295 subjects on first-line ART, 49 (16.6%) and 18 (6.1%) experienced virological and immunological failures, respectively. The failure of the former was associated with poor adherence (AOR: 6.367, P < 0.001), CD4 + count < 500 cells/µL (AOR: 4.78, P = 0.031) and shorter (6-24 months) duration on ART (AOR: 0.48, P = 0.048), while poor treatment adherence (AOR: 11.51, P = 0.012) and drug interruption (AOR: 6.374, P = 0.039) were the independent risk factors for latter. Immunological tests to predict virological failures showed as sensitivity, specificity, PPV, and NPV were 20.4%, 96.7%, 55.5%, and 86.0%, respectively. CONCLUSIONS: The rate of ART failure was considerably high. Poor adherence, low CD4 + count, prolonged ART, and drug interruption were found to be the most predictor variables for virological and immunological failures. The discrimination power of the immunological parameter was low in comparison to virological measurements as standard methods. Therefore, the study highlighted the need for more attention and efforts to curb associated factors and maximize virological tests for monitoring treatment failures.

Prevalence and associated factors of intestinal parasitic infections among patients attending Shahura Health Center, Northwest Ethiopia.

OBJECTIVE: Parasitic infections are the commonest infections affecting 3.5 billion people leading 450 million illnesses. Parasites are major public health problems in developing countries. This study was aimed to assess the prevalence and associated factors of parasitic infections among patients. A cross sectional study was conducted on 364 patients, attending Shahura Health Center, Northwest Ethiopia. Stool specimens were collected and examined using formol-ether concentration technique. Socio-demographic data collected using questionnaire. Binary and multivariable logistic regression analyses were conducted to calculate the strength of association between variables. RESULT: The overall prevalence of intestinal parasitosis was 56.9%. The most prevalent parasite was Entamoeba histolytica/dispar 32.4% followed by Hookworm species 11.8% and Giardia lamblia 7.4% singly or mixed with other parasites. Furthermore, double and triple parasitic infections were observed in 3% and 1.4% patients respectively. Being male in gender (P = 0.049), age group interval between 1 and 20 years of old (P = 0.012), having stomach pain (P = 0.032) and having diarrhea (P = 0.007) were found to be significantly associated with parasitic infection. In conclusion, prevalence of parasitic infection in the area is high. Therefore, ensuring provision of clean potable water and minimizing the contamination of vegetables are recommended.

Bacterial profile, antibiotic susceptibility pattern and associated factors among pregnant women with Urinary Tract Infection in Goba and Sinana Woredas, Bale Zone, Southeast Ethiopia.

OBJECTIVE: Urinary tract infection (UTI) is one of the commonest infections affecting millions worldwide, especially pregnant women. It can lead to poor maternal and perinatal outcomes. Untreated UTI can be associated with serious obstetric complications. So the objective of present study was to determine the bacterial profile, antibiotic susceptibility pattern and associated factors of UTI among pregnant women in Goba and Sinana Woredas, Bale Zone, Southeast Ethiopia. RESULTS: The overall prevalence of UTI was 44/169 (26%) with 18/51 (35.3%) in symptomatic and 26/118 (22%) in asymptomatic pregnant women, respectively. Of the 44 bacterial isolates, E. coli 12/44 (27.3%), K. pneumonia 9/44 (20.5%) and S. marcescens 4/44 (9.1%) were the commonest bacterial pathogens. C. freundii 3/44 (6.8%), M. morganii 3/44 (6.8%), P. aeruginosa 3/44 (6.8%) and S. enteritidis 3/44 (6.8%) isolates were the moderately identified bacterial species. K. oxytoca 1/44 (2.3%) was the least common bacterium to be detected. The antibiotic susceptibility pattern showed that 90.9%, 88.6% and 86.3% of the isolates were sensitive to amoxicillin/clavulanic acid, gentamycin and norfloxacin, respectively. Significant bacteriuria was associated with low educational status (p = 0.024; AOR = 6.617; CI = 1.87-9.94) and kidney problems (p = 0.018; AOR = 0.286; CI = 1.19-2.81).

Prevalence and antibiotic susceptibility patterns of Shigella and Salmonella among children aged below five years with Diarrhoea attending Nigist Eleni Mohammed memorial hospital, South Ethiopia.

BACKGROUND: Diarrhoeal disease is the second leading cause of death among children aged below 5 years. Even though, both preventable and treatable diseases, globally there are nearly 1.7 billion cases of childhood diarrhoeal disease and responsible for killing around 525,000 children every year. Shigella and Salmonella species were the leading cause of etiologic agents for diarrhoea associated deaths. The aim of this study was to determine the prevalence and antibiotic susceptibility patterns of Shigella and Salmonella isolated from children aged below 5 years with diarrhoea attending Nigist Eleni Mohammed Memorial Hospital, Hossana, South Ethiopia. METHODS: A cross sectional study was conducted from June 02 to September 24, 2017. Two hundred four children aged below 5 years with diarrhoea were enrolled consecutively using convenience sampling technique. Stool specimens were processed in accordance with the standard bacteriological methods and antibiotic susceptibility pattern of the isolates was determined using disc diffusion method. Data were analyzed using SPSS version 20. RESULTS: Out of the 204 children aged below 5 years with diarrhoeal disease 19/204 (9.3%, [95%CI, 5.7-13.7%]) of them were positive for bacterial growth, of which 17/204(8.3%) were Shigella species and 2/204(1%) were Salmonella species. Both Shigella and Salmonella isolates were 100% susceptible to norfloxacin, nalidixic acid and kanamycin. However, isolates of Shigella showed 100, 76.5 and 64.7% resistance to ampicillin, gentamicin and cotrimoxazole respectively while Salmonella species were highly resistant to ampicillin and gentamicin (100% each). CONCLUSIONS: Salmonella and Shigella species is prevalent in the current study area. Among the tested antibiotics, norfloxacin, nalidixic acid and kanamycin were found to be most effective for both isolates. Both species are developing resistance to the commonly prescribed antibiotic. Therefore, culture based bacterial species identification and antimicrobial susceptibility testing services are strongly recommended to avoid empirical treatment in the study area.

Intestinal Parasitic Infections and Nutritional Status among Primary School Children in Delo-mena District, South Eastern Ethiopia.

BACKGROUND: Although there are efforts being underway to control and prevent intestinal parasitic infections (IPIs) in Ethiopia, they are still endemic and responsible for significant morbidity. The aim of this study was to evaluate the prevalence of IPIs and their association with nutritional status among primary school children of Delo-Mena district, South Eastern Ethiopia. METHODS: A cross-sectional study was conducted from April to May 2013. Demographic data was obtained, and IPIs was investigated in a single-stool sample by both direct stool examination and formol-ether concentration techniques. Anthropometric measurements were taken to calculate height for-age (HAZ), BMI-for-age (BAZ) and weight-for-age (WAZ) for the determination of stunting, thinness and underweight, respectively using WHO AntroPlus software. SPSS version 20 was used for statistical analysis and p value less than 0.05 was considered significant. RESULTS: Among 492 children studied (51% boys, aged 6-18 years, mean 10.93 +2.4) an overall IPIs prevalence of 26.6% was found. The prevalence of S. mansoni, E. histolytica/dispar, H. nana, A. lumbricoides, G. lambilia, T. trichiura, S. stercolaris, E. vermicularis, Hookworms and Taenia spp were 9.6%, 7.7%, 5.3%, 3.7%, 2.0%, 1.6%, 1.4%, 1.2%, 0.8% and 0.2% respectively. Stunting and underweightedness were observed in 4.5% and 13.6% of children and associated with IPIs (P<0.001) and (P=0.001), respectively. CONCLUSION: IPIs and its associated malnutrition remain a public health concern in Delo-Mena district. Therefore, the overall health promotion activities coupled with snail control and de-worming to the students is crucial. Additionally, initiatives aimed at improving the nutritional status of school children are also important.

Prevalence and its associated risk factors of intestinal parasitic infections among Yadot primary school children of South Eastern Ethiopia: a cross-sectional study.

BACKGROUND: Intestinal parasitic infections are posing significant morbidity worldwide. In Ethiopia, due to poor socio-economic status, intestinal parasitic infections are highly prevalent. The main aim of this study was to determine the prevalence of intestinal parasites and its associated risk factors among Yadot primary school children which is found in South-Eastern part of Ethiopia, in the district called Delo-Mena. METHODS: Institution based cross-sectional study was employed from March to April 2013. In this study, a total of 340 students were selected using simple random sampling, and data on socio-demographic characteristics and factors associated with the prevalence of intestinal parasites as well as stool samples were collected and processed accordingly. Statistical analysis was done using SPSS version 16, and binary and multivariate logistic regression analysis were conducted to measure the strength of association between dependent and independent variables. RESULTS: The overall prevalence of intestinal parasites was 26.2%. Poly-parasitism was detected in 6.2% of the students. Consistently, students who were infected with single, double, triple and quadruple parasites were 20%, 4.7%, 1.2% and 0.3% respectively. In line with this, the most prevalent parasites were Schistosoma mansoni 12.6%, followed by Entamoeba histolytica/dispar 5%, Ascaris lumbricoides 4.7%, and Hymenolepis nana 4.4%. Regarding the risk factors for the infections, not knowing why they wash their hands before meal [(AOR=0.20, 95% CI=0.10-0.40), p<0.001], water contact activities [(AOR=2.28, 95% CI=1.19-4.34), p=0.012], not wearing protective shoe [(AOR=0.27, 95% CI=0.15-0.51), p<0.001] were factors significantly associated with intestinal parasitic infections. CONCLUSION: Intestinal parasitic infections were found to be highly prevalent among Yadot primary school children. Hence, health education, improving sanitation, provision of safe drinking water, increasing latrine use, snail control and deworming to the students are crucial.

Prevalence of hepatitis B and C virus infections among patients with chronic hepatitis at Bereka Medical Center, Southeast Ethiopia: a retrospective study.

BACKGROUND: Viral hepatitis exists throughout the world and is a major global public health problem affecting millions of people. Hepatitis B (HBV) and hepatitis C (HCV) virus are the commonest causes of inflammation of the liver leading to chronic liver disease, cirrhosis, hepatocellular carcinoma and even fulminant hepatitis. The objective of this retrospective study was to determine the prevalence of infections with HBV and HCV among patients with chronic hepatitis who visited Bereka Medical Center, southeast Ethiopia. METHODS: Institution based retrospective study design was employed. HBV and HCV test records of all patients with chronic hepatitis who visited Bereka Medical Center from Nov. 2012 to Nov. 2013. A total of 578 (358 for HBV and 220 for HCV) patients with chronic hepatitis screened and the results of all patients were included. All sera were screened using commercially available rapid test kits. Test results were shown in percent and prevalence rates. RESULTS: The overall prevalence of HBV and HCV among chronic hepatitis patients were 22.3% and 3.6% respectively. Prevalence of HBV and HCV among males from the total HBV and HCV screened was 52/358 (14.5%) and 6/220 (2.7%) respectively. 64/80 (80%) of HBV sero-positives were found in between 16 to 45 years of age. Of those 64 HBV sero-positive patients, 42/64 (65.6%) were found 16-30 age interval. Furthermore, of those HCV infected, 6/8 (75%) of them fall under 16-30 years of age. 6/8 (75%) of HCV infected patients were males. CONCLUSION: The present study has shown that HBV was highly prevalent among patients who visited the clinic. Males were more susceptible than female patients. 3.6% HCV prevalence was also high. Mass immunization of HBV is recommended to halt HBV infection.

Impact of hepatitis C virus co-infection on HIV patients before and after highly active antiretroviral therapy: an immunological and clinical chemistry observation, Addis Ababa, Ethiopia.

BACKGROUND: Hepatitis C virus (HCV) is an RNA virus which has been known to cause acute and chronic necro-inflammatory disease of the liver. It is the leading cause of end-stage liver disease and hepatocellular carcinoma. HIV is known to have a negative impact on the natural disease outcome and immune response of HCV infection, whereas the reverse remains unclear. We evaluated the impact of HCV co-infection on recovery of CD4+ and CD8+ T-cells and liver enzyme levels before and after initiation of highly active antiretroviral therapy (HAART) in HIV/HCV co-infected patients. METHODS: A hospital-based, observational, prospective cohort study design was used for this study. Pre-antiretroviral treatment (Pre-ART) and under HAART HIV mono-infected and HCV/HIV co-infected individuals who are under regular follow-up were recruited for this study. 387 blood samples were collected from volunteer, known HIV positive Ethiopian patients and screened for HCV. Twenty five HCV/HIV co-infected patients were prospectively followed for four years. CD4+ and CD8+ T-cells and liver enzyme levels were determined annually for each of the participant. RESULTS: The prevalence of HCV/HIV co-infection in this study was 6.5%. Both HCV/HIV co-infected and HIV mono-infected under HAART groups showed CD4+ recovery (343 Vs 426; P < 0.004, OR = 4.97, 95% CI = 2.41 to 10.27) respectively; but, the recovery rate was higher in mono-infected (80 Vs 426) than co-infected group (148 Vs 343). The recovery and/or decline pattern of CD8+ T-cells was the same with that of CD4+. In 75% of co-infected groups, the mean alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were above the upper limit of normal reference range. Analyses restricted to individuals who initiated HAART and pre-ART showed similar results. CONCLUSION: We found that CD4+ T-cell recovery was negatively affected by the presence of ongoing HCV replication in under HAART co-infected individuals and fast decline of CD4+ T-cells in pre-ART patients. It was also associated with increased ALT and AST enzyme levels in both HAART initiated and treatment naïve co-infected patients.