Contribution of Aflatoxin B1 Exposure to Liver Cirrhosis in Eastern Ethiopia: A Case-Control Study.

Background: Liver cirrhosis is a global health problem due to a large number of disability-associated life years and mortality. However, evidence is scarce on its causes in Eastern-Ethiopia, a place where there is a high prevalence of liver cirrhosis of unknown etiology. This study attempted to identify the risk factors related to liver cirrhosis in the area. Methods: A case-control study was conducted at a tertiary care hospital from January 2020 to July 2021. Following diagnoses using an ultrasound-based cirrhosis scale, a total of 127 cases were identified and compared with 253 control patients. A structured questionnaire and data abstraction form were used to collect demographic, lifestyle, and clinical information. A blood sample was also taken from each participant for clinical chemistry, hepatitis B virus (HBV), and hepatitis C virus tests as well as for an aflatoxin B1 (AFB1) albumin adduct (AF-alb) assay. Binary logistic regression analysis was used to determine predictors of liver cirrhosis. Results: AF-alb levels were detected in 75% of the cases and 64% of the controls, with a median (IQR) level of 11 pg/mg (5.5-25) and 7.0 pg/mg (4.3-20.5), respectively (p<0.05). Moreover, the number of subjects with high AF-alb levels (≥8.6 pg/mg) was greater in cases (45%, p<0.05)) than controls (28%). Age ≥55 years (adjusted odds ratio (AOR)=0.4; 95% CI: 0.2, 0.8), being a farmer (AOR= 3.0; 95% CI: 1.5, 6.0), family history of liver disease (AOR= 2.9; 95% CI: 1.1, 7.9), HBV seropositivity (AOR=4.0; 95% CI: 1.9, 8.8), and exposure to high levels of AF-alb (AOR=2.0; 95% CI: 1.1, 3.7) were significantly associated with liver cirrhosis. Conclusion: This study found a strong link between AFB1 exposure and liver cirrhosis. Mitigation of aflatoxin exposure and a better understanding of additional environmental risk factors like pesticides may be necessary to reduce the disease burden in Ethiopia.

Causes of stillbirth and death among children younger than 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study.

BACKGROUND: Child mortality is high in Ethiopia, but reliable data on the causes of death are scarce. We aimed to gather data for the contributory causes of stillbirth and child deaths in eastern Ethiopia. METHODS: In this population-based post-mortem study, we established a death-notification system in health facilities and in the community in Kersa (rural), Haramaya (rural) and Harar (urban) in eastern Ethiopia, at a new site of the Child Health and Mortality Prevention Surveillance (CHAMPS) network. We collected ante-mortem data, did verbal autopsies, and collected post-mortem samples via minimally invasive tissue sampling from stillbirths (weighing at least 1000 g or with an estimated gestational age of at least 28 weeks) and children who died younger than 5 years. Children-or their mothers, in the case of stillbirths and deaths in children younger than 6 months-had to have lived in the catchment area for the past 6 months to be included. Molecular, microbiological, and histopathological analyses were done in collected samples. Cause of death was established by an expert panel on the basis of these data and classified as underlying, comorbid, or immediate separately for stillbirths, neonatal deaths (deaths aged 0-27 days), and child deaths (aged 28 days to <5 years). FINDINGS: Between Feb 4, 2019, and Feb 3, 2021, 312 deaths were eligible for inclusion, and the families gave consent in 195 (63%) cases. Cause of death was established in 193 (99%) cases. Among 114 stillbirths, the underlying cause of death was perinatal asphyxia or hypoxia in 60 (53%) and birth defects in 24 (21%). Among 59 neonatal deaths, the most common underlying cause was perinatal asphyxia or hypoxia (17 [29%]) and the most common immediate cause of death was neonatal sepsis, which occurred in 27 (60%). Among 20 deaths in children aged 28 days to 59 months, malnutrition was the leading underlying cause (15 [75%]) and infections were common immediate and comorbid causes. Pathogens were identified in 19 (95%) child deaths, most commonly Klebsiella pneumoniae and Streptococcus pneumoniae. INTERPRETATION: Perinatal asphyxia or hypoxia, infections, and birth defects accounted for most stillbirths and child deaths. Most deaths could have been prevented with feasible interventions, such as improved maternity services, folate supplementation, and improved vaccine uptake. FUNDING: Bill & Melinda Gates Foundation.

Evaluation of the performance of Abbott Panbio™ COVID-19 antigen rapid diagnostic test for the detection of severe acute respiratory syndrome coronavirus 2 at Harar, Eastern Ethiopia.

Background: Rapid antigen tests can help in the effective isolation of symptomatic cases and the systematic tracing of close contacts. However, their reliability must be validated before implementing them widely. Methods: A cross-sectional study was conducted on 236 COVID-19-suspected patients visiting four different health institutions in Harari Regional State, Harar, Eastern Ethiopia, from June to July 2021. Two nasopharyngeal samples were collected and processed by the Panbio™ Ag-RDT kit and qRT-PCR. The collected data were analyzed using SPSS version 25.0. Results: The Panbio tests had a sensitivity of 77.5% (95% CI: 61.6-89.2%) and a specificity of 98.5% (95% CI: 95.6-99.7%). It also had a positive predictive value of 91.2% (95% CI: 76.9-96.9%), a negative predictive value of 95.5% (95% CI: 92.3-97.4%), and a kappa of 0.81 (95% CI: 0.7-0.9). The test had a sensitivity of 94.4%, 100%, 100%, and 90% in the samples collected from patients within the 1-5 days post-onset of COVID-19 signs and symptoms, of age group ≤18 years old, with cycle threshold values of <20, and with household contact, respectively. Conclusion: This test can be used as point-of-care testing for the diagnosis of symptomatic patients with short clinical courses and contact with patients in households.

Loss to follow-up tuberculosis treatment and associated factors among adults attending at public health facilities in Warder District, Somali Regional State, Eastern Ethiopia.

Background: Tuberculosis is a major public health problem worldwide, particularly in resource-limited countries. Loss of follow-up during treatment is one of the major obstacles in the fight against tuberculosis, which has serious implications for patients, their families, communities, and health service providers. Purpose: To assess the magnitude of the loss to follow-up tuberculosis treatment and associated factors among adults attending public health facilities in Warder District, Somali Regional State, eastern Ethiopia from November 02-17, 2021. Methods: A 5-year (from 1 January 2016 to 31 December 2020) retrospective study was conducted on 589 adult tuberculosis treatment records. Data were collected using a structured data extraction format. Data were analyzed using STATA version 14.0 statistical package. Variables with P < 0.05 in the multivariate logistic regression analysis were considered statistically significant. Results: A total of 98 (16.6%) TB patients failed to follow up with their treatment. Age between 55 and 64 years (AOR = 4.4, 95% CI: 1.9-9.9), being male (AOR = 1.8, 95% CI: 1.1-2.9), living more than 10 km away from a public health facility (AOR = 4.9, 95% CI:2.5-9.4), and having a history of tuberculosis treatment (AOR = 2.3, 95% CI: 1.2-4.4) were associated with a higher likelihood of not following up, while having a positive initial smear result (AOR = 0.48, 95% CI: 0.24-0.96) was associated with a lower probability of not following up. Conclusion: One out of six patients was lost to follow-up after initiating their tuberculosis treatment. Hence, improving the accessibility of public health facilities with a special focus on older adults, male patients, smear-negative patients, and retreatment cases is highly warranted among TB patients.

Prevalence of hepatitis B infection and its associated factors among pregnant mothers attending antenatal care at public hospitals at Hararghe, Eastern Ethiopia.

Background: Hepatitis B infection is one of the world's most serious public health problems, causing significant morbidity and mortality. More than 2 billion individuals around the world have been infected with the hepatitis B virus (HBV), and approximately 400 million people are chronically infected with the virus, with more than a million dying each year from hepatitis B virus-related liver disease. A newborn infant whose mother is positive for both HBsAg and HBeAg has a 90% chance of developing chronic infection by the age of 6. Its infectivity is a 100 times that of the human immunodeficiency virus, but it receives little attention in public health. Therefore, this study was conducted to assess the prevalence of hepatitis B infection and its associated factors among pregnant mothers attending antenatal care at public hospitals in west Hararghe, eastern Ethiopia 2020. Method: This institution-based cross-sectional study was conducted on 300 pregnant mothers selected by systematic random sampling from September to December 2020. Data were collected by face-to-face interview using a pretested structured questionnaire. A blood sample was collected and tested for hepatitis B surface antigen using the enzyme-linked immunosorbent assay test method. Data were entered into EpiData version 3.1 and exported to Statistical Package for the Social Science version 22 for analysis. Bivariate and multivariable logistic regressions were used to assess the association between outcome and predictor variables. P-value <0.05 was considered to be statistically significant. Results: The overall seroprevalence of hepatitis B virus infection was 8% [95% confidence interval (CI): 5.3-11.0] among pregnant mothers. History of tonsillectomy [adjusted odd ratio (AOR) = 5.7; 95% CI: 1.3-23.9], tattoo (AOR = 4.3; 95% CI: 1.1, 17.0), having multiple sexual partners (AOR = 10.8; 95% CI: 2.5, 45.9), and history of contact with jaundiced patients (AOR = 5.6; 95% CI: 1.2, 25.7) were factors associated with the seroprevalence of hepatitis B virus infection among pregnant mothers. Conclusion: The hepatitis B virus was highly prevalent. A history of tonsillectomy, tattooing, having multiple partners, and contact with jaundiced patients were factors associated with hepatitis B virus infection. To reduce HBV transmissions, the government should increase HBV vaccination coverage. All newborns should receive the hepatitis B vaccine as soon as possible after birth. It is also recommended that all pregnant women have HBsAg testing and antiviral prophylaxis to reduce the risk of transmission from mother to child. Hospitals, districts, regional health bureaus, and medical professionals should also educate pregnant women about hepatitis B virus transmission and prevention, both in the hospital and in the community, with a focus on modifiable risk factors.

Bacterial Profile of External Ocular Infections, Its Associated Factors, and Antimicrobial Susceptibility Pattern among Patients Attending Karamara Hospital, Jigjiga, Eastern Ethiopia.

Background: External ocular infection is a global public health problem. Frequently, bacteria cause an ocular infection that ranges from morbidity to loss of vision. The increasing bacterial resistance in ocular infections leads to the risk of treatment failure with possibly serious consequences. Objective: The study aimed to assess the bacterial profile of external ocular infections, their associated factors, and antimicrobial susceptibility pattern among patients admitted to Karamara hospital, Jigjiga, Eastern Ethiopia. Method: Institutional-basedcross-sectional study was conducted on 288 conveniently selected patients among patients admitted to Karamara hospital from May 1 to June 30, 2020. Data were collected using a structured questionnaire. The ocular sample was collected and cultured in the appropriate culture media and identified using a series of biochemical tests. Antimicrobial susceptibility testing of isolates was performed by using the disk diffusion method. Data were double entered onto EpiData version 3.1 then exported to SPSS version 20 and analyzed to calculate descriptive frequency and odds ratio, and p value ≤0.05 was taken as the significant value. Result: The prevalence of bacterial infection in external ocular samples was 62.2% (95% CI: 56.6%, 68.4%). Out of the 179 isolates, the majority of the bacterial isolates (87.7%) were Gram-positive. Staphylococcus aureus (53.1%) was the predominant isolate. Using soap for washing the face (AOR = 0.43; 95% CI: 0.29, 0.95), having diabetes mellitus (AOR = 3.11; 95% CI: 1.45, 6.75), and history of hospitalization (AOR = 2.82; 95% CI: 1.44, 5.54) were significantly associated with external ocular infection. Most (95.5%) of the Gram-positive bacteria showed resistance to penicillin, but they were susceptible to vancomycin, clindamycin, and ciprofloxacin. Conclusion: The study showed a high prevalence of bacterial infections with the predominant isolate was S. aureus. Penicillin-resistant bacteria were identified among Gram-positive bacterial isolates. Soap usage, hospitalization, and diabetes mellitus were associated with the infection. Antibiotics that were susceptible to the specific bacteria should be used as a drug of choice and using soap for washing the face is advisable to protect against external ocular infection.

Blood donation practice and its predictors among undergraduate college students in Harari Regional State, Eastern Ethiopia.

Objectives: The main objective of this study was to assess blood donation practice and its associated factors among undergraduate college students in Harari Region, Eastern Ethiopia. Methods: An institutional-based cross-sectional study was employed among 518 college students selected by using a simple random sampling technique. Data was collected using pretested structured self-administered questionnaire. The collected data was entered into Epi-data 3.41 and exported to Statistical Package for Social Science version 22 for analysis. Bivariate and multivariable logistic regressions were utilized to identify factors associated with blood donation practice. p-Values of 0.05 or less was used to declare statistical significance. Results: In this study, the overall blood donation practice was 35.7% (95% confidence interval: 31.6, 39.8). Students studying health sciences were more likely than non-health sciences students (53.5%) to donate blood. Having positive knowledge about blood donation (adjusted odds ratio = 4.17; 95% confidence interval: 2.50, 6.92), being male (adjusted odds ratio = 0.57; 95% confidence interval: 0.38, 0.87), being student of midwifery department (adjusted odds ratio = 2.16; 95% confidence interval: 1.07, 4.36) and nursing department (adjusted odds ratio = 2.42; 95% confidence interval: 1.18, 4.98) were significantly associated with blood donation practice. Conclusion: Practice of blood donation among college students in the study is relatively low. Knowledge about blood donation, male sex and being a nursing and midwifery student were independently associated with blood donation practice. Therefore, the Regional Health Bureau and Blood Bank in collaboration with college administrators should design and implement appropriate strategies to improve blood donation practice.

Magnitude, associated factors, and antimicrobial susceptibility pattern of bacterial isolates among adult dental caries patients attending Hiwot Fana comprehensive specialized university hospital, Harar, Eastern Ethiopia.

BACKGROUND: Dental caries is defined as a dynamic diet microbial disease of teeth, which results in localized dissolution and destruction of the mineralized tissues of the teeth. Dental caries develops when there is a susceptible tooth exposed to pathogenic bacteria in the presence of substrate. Under these conditions, the bacteria metabolize substrate to form acid, which decalcifies teeth. Dental caries is among the top oral health problem in both developing and developed nations affecting around 20-50% of the population globally. OBJECTIVE: This study was conducted to assess the magnitude, associated factors, and antimicrobial susceptibility pattern of bacterial isolates among adult dental caries patients visiting Hiwot Fana specialized university hospital dental clinic from April 23 to-June 23, 2021. METHODS: An institutional-based cross-sectional study was conducted among 290 study participants. Convenient sampling techniques were used to select the study participants. Data was entered into Epi-info version 7.2.4.0 and exported to Statistical Package for the Social Sciences version 20 for analysis. The result was explained by using summary measures of texts, tables, and graphs after analysis by using bivariate and multivariate logistic regression. Statistical significance was defined at a p-value of less than 0.05. RESULT: The overall magnitude of bacteria among dental caries patients was 68.3%. S mutans 74(37.4%) and Lactobacillus spp 58(29.3%) were the most predominant isolated bacteria. Lack of teeth brushing (AOR: 2.8, 95% CI:1.6, 4.6), the habit of chewing khat always (AOR:4.8, 95%CI:2.10,8.80), the habit of chewing khat sometimes (AOR: 3.8: 95% CI: 2.520,9.48) and consumption of soft drinks (AOR: 1.9, 95% CI:1.2,3.1) were significantly associated with bacterial dental caries. Almost, all bacterial isolates were susceptible to ceftriaxone and ciprofloxacin compared to Amoxicillin, Azithromycin, chloramphenicol, clindamycin, doxycycline, erythromycin, gentamycin, penicillin, tetracycline, vancomycin and tobramycin. CONCLUSION: Teeth brushing habit, consumption of soft drink and a habit of chewing khat affects dental health and they are associated with bacterial dental caries. Harari regional health bureau better to focus by giving health education to the community about dental caries based on identified associated factors with dental caries.

Incidence and predictors of treatment interruption among patients on anti-tuberculosis treatment in Nekemte public healthcare facilities, Oromia, Western Ethiopia.

Introduction: Tuberculosis treatment interruption increases the risk of poor treatment outcomes and the occurrence of drug resistant Tuberculosis. However, data on the incidence and predictors of tuberculosis treatment interruption are still scarce in Ethiopia, as well as in the study area. Therefore, this study aimed to assess the incidence and predictors of treatment interruption among patients on tuberculosis treatment in Nekemte public healthcare facilities, Oromia region, Western Ethiopia, from July 1, 2017, to June 30, 2021. Methods: A retrospective cohort study design was conducted among 800 patients enrolled in anti-tuberculosis treatment during the study period. Data were collected from patient cards who were enrolled in treatment from July 1, 2017 to June 30, 2021. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A multivariable Cox regression model with a 95% confidence interval (CI) and adjusted hazard ratio (AHR) was used to identify the significant predictors at a p value < 0.05. Finally, the log likelihood ratio, and a Cox-Snell residual graph was used to check the adequacy of the model. Results: A total of 800 patients were followed for a median time of 2.3 (95% CI: 2.20-2.36) months, and with a maximum follow-up time of 11.7 months. The overall incidence rate of treatment interruption was 27.4 per 1000 (95% CI: 22.8-32.8) person-month observations. Age 18-34 years (AHR = 1.8, 95% CI: 1.02-3.18), male (AHR = 1.63, 95% CI: 1.1-2.42), rural residence (AHR = 3, 95% CI: 1.98-4.64), presence of comorbidity (AHR = 10, 95% CI: 5.47-18.27) and lack of treatment supporters on the treatment follow-up (AHR = 2.82, 95% CI: 1.9-4.41) were found to be significant predictors of treatment interruption. Conclusion: A high incidence rate of interruption was observed among TB patients in public health facilities in Nekemte town. Health facilities should provide supportive care for patients with co-morbidities and consider interventions that target middle-aged patients from rural areas that reduce treatment interruptions.

Treatment outcome of pediatric tuberculosis in eastern Ethiopia.

Background: Children are more vulnerable to developing active Mycobacterium tuberculosis infection which causes significant morbidity and mortality. However, the contribution of childhood tuberculosis and its treatment outcomes have not been well documented, and no research has been conducted in eastern Ethiopia. Objective: This study aimed to assess the treatment outcome and its predictors of pediatric tuberculosis in eastern Ethiopia from September 1, 2017 to January 30, 2018. Methods: A retrospective study was conducted in eight selected hospitals in eastern Ethiopia. Data on 2002 children with tuberculosis was extracted by using the standard checklist of the national tuberculosis treatment format. Treatment outcomes were determined according to the standard definitions of the National Tuberculosis and Leprosy Control Programme. Data were entered into Epi Data software version 3.1 and exported to Statistical Package for Social Science (SPSS) version 20 for analysis. Bivariable and multivariable regression analyses were carried out to examine the associations between dependent and independent variables. A P-value of <0.05 was considered statistically significant. Result: The overall successful treatment rate was 1,774 (88.6%) [95% confidence interval (CI): (80.59-97.40)]. A total of 125 (6.2%), 1,648 (82.3%), 59 (2.9%), and 19 (0.9%) children with tuberculosis (TB) were cured, completed, defaulted, and died, respectively. A high number of defaulters and deaths were reported in the age group <10 years. More children with smear-positive pulmonary TB (74.4%) were cured, while smear-negative tuberculosis had higher treatment completion rates. Being male in sex (adjusted odds ratio (AOR): 0.71, 95% CI: 0.53, 0.96) and those with human immunodeficiency virus (HIV) positive sero status (AOR: 0.51, 95% CI: 0.29, 0.90) had a lower chance of a successful treatment outcome. Conclusion: In this study, thee treatment success rate was higher than the recent World Health Organization report. Those males and HIV seropositive status were less likely to have a successful treatment outcome. Therefore, efforts should be made by each health institution in eastern Ethiopia by giving emphasis on male and HIV-positive individuals.

Assessment of Milk Contamination, Associated Risk Factors, and Drug Sensitivity Patterns among Isolated Bacteria from Raw Milk of Borena Zone, Ethiopia.

Background: The contamination of raw milk depends on the number and type of organisms that can cause health risks, which can be judged by the presence of microorganisms and bacterial pathogens. This study evaluated bacterial contamination, the risk factor, and drug sensitivity patterns. Methods: A cross-sectional study was carried out on conveniently selected 95 milk producers. Data were collected using the structured pretest questionnaire and the observation control list. Subsequently, 15 to 20 ml of milk samples were taken for laboratory analysis. The milk samples have been diluted and continuously inoculated on the number of standard plates and the blue Eosin methylene germs for the total number of bacteria and coliforms counted. Biochemical and drug sensitivity tests have been done. The version 21 Statistical Package for the Social Sciences was used for analysis. Analysis of the associated factors using binary logistical regression analysis and a P value less than 0.05 was considered to be statistically significant. Results: The total bacteria (TBC) and coliform count (CC) average with the standard deviation were 7.57 ± 0.83 log10 and 6.54 ± 1.53 log10 CFU/mL, respectively. The prevalence of raw milk contaminated with TBC and TCC was 84 (88.4%) and 75 (78.9%), respectively. Lack of handwash practice before milking (AOR = 2.4 [95% CI: 0.35-16.4]) and using unclean milk containers (AOR = 7.47 [95% CI: 0.0023-28.64]) were found to be significantly associated with bacterial contamination of raw milk. The bacteria isolated were E. coli (30.7%), Staphylococcus aureus (16.7%), and Salmonella spp. (1.2%). Among isolated bacteria, 76.3% were extensive drug resistant, 13.2% were multidrug resistant, and 2.6% were resistant to all drugs tested in the current study. Conclusion: Guaranteed appropriate hygiene exercise during time of milking and clean containers reduced milk contamination. Doctors should consider resistance to drugs during the treatment of patients with milk disease.

Bacteriological Quality and Antimicrobial Susceptibility Patterns Among Raw Milk Producers and Vendors in Gomole District, Borena Zone, Southern Ethiopia.

Background and Aim: Milk consumption plays a great role in the nutrition of consumers and the income of producers as well as vendors, but their bacteriological quality causes loss of those benefits. Hence, the aim of this study was to determine the bacteriological quality, associated factors and antimicrobial susceptibility pattern among raw milk of producers and vendors in Gomole district, Borena zone, South Ethiopia, from March 1 to April 30, 2019. Methods: A cross-sectional study was conducted on 130 purposively selected study participants. Pretested structured questionnaires and observation checklists were used to collect data. Then, 15 to 20 mL of milk samples were collected from producers and vendors for laboratory analysis. Standard plate count agar and eosin methylene blue agar were used for total bacterial count and total coliform count, respectively. Bacterial isolation from poor-quality milk was performed with biochemical tests and antimicrobial susceptibility tests using Kirby Bauer's disk diffusion method. After completeness checking, the data were analyzed by Statistical Package for the Social Sciences version 21. Chi-square (χ 2) was used to analyze association factors, and a p value <0.05 was considered statistically significant. Results: The overall means ± standard deviation of the total bacterial count (TBC) and total coliform count (TCC) were 7.75 ± 0.882 and 6.69 ± 1.545 log10 CFU/mL, respectively. The mean TBC was significantly different between producers' and vendors' milks t = 2.1 (P < 0.001). The proportions of raw milk TBC and TCC of poor quality were 90% and 80%, respectively. Poor hand washing practices before milking, water source and cleanliness of milk containers were associated with poor milk quality. The isolated bacteria were E. coli (30.8%), S. aureus (17.9%) and Salmonella spp. Out of the bacterial isolates, 80.4% were extensive drug resistant, 14.3% were multidrug resistant, and 5.4% were resistant against all antimicrobials used in this study. Conclusion: Ensuring proper hygienic practices during milking, storage and transportation to reduce milk contamination.

High seroprevalence of anti-SARS-CoV-2 antibodies among Ethiopian healthcare workers.

BACKGROUND: COVID-19 pandemic has a devastating impact on the economies and health care system of sub-Saharan Africa. Healthcare workers (HWs), the main actors of the health system, are at higher risk because of their occupation. Serology-based estimates of SARS-CoV-2 infection among HWs represent a measure of HWs' exposure to the virus and could be used as a guide to the prevalence of SARS-CoV-2 in the community and valuable in combating COVID-19. This information is currently lacking in Ethiopia and other African countries. This study aimed to develop an in-house antibody testing assay, assess the prevalence of SARS-CoV-2 antibodies among Ethiopian high-risk frontline HWs. METHODS: We developed and validated an in-house Enzyme-Linked Immunosorbent Assay (ELISA) for specific detection of anti-SARS-CoV-2 receptor binding domain immunoglobin G (IgG) antibodies. We then used this assay to assess the seroprevalence among HWs in five public hospitals located in different geographic regions of Ethiopia. From consenting HWs, blood samples were collected between December 2020 and February 2021, the period between the two peaks of COVID-19 in Ethiopia. Socio-demographic and clinical data were collected using questionnaire-based interviews. Descriptive statistics and bivariate and multivariate logistic regression were used to determine the overall and post-stratified seroprevalence and the association between seropositivity and potential risk factors. RESULTS: Our successfully developed in-house assay sensitivity was 100% in serum samples collected 2- weeks after the first onset of symptoms whereas its specificity in pre-COVID-19 pandemic sera was 97.7%. Using this assay, we analyzed a total of 1997 sera collected from HWs. Of 1997 HWs who provided a blood sample, and demographic and clinical data, 51.7% were females, 74.0% had no symptoms compatible with COVID-19, and 29.0% had a history of contact with suspected or confirmed patients with SARS-CoV-2 infection. The overall seroprevalence was 39.6%. The lowest (24.5%) and the highest (48.0%) seroprevalence rates were found in Hiwot Fana Specialized Hospital in Harar and ALERT Hospital in Addis Ababa, respectively. Of the 821 seropositive HWs, 224(27.3%) of them had a history of symptoms consistent with COVID-19 while 436 (> 53%) of them had no contact with COVID-19 cases as well as no history of COVID-19 like symptoms. A history of close contact with suspected/confirmed COVID-19 cases is associated with seropositivity (Adjusted Odds Ratio (AOR) = 1.4, 95% CI 1.1-1.8; p = 0.015). CONCLUSION: High SARS-CoV-2 seroprevalence levels were observed in the five Ethiopian hospitals. These findings highlight the significant burden of asymptomatic infection in Ethiopia and may reflect the scale of transmission in the general population.

Seroprevalence of anti-SARS-CoV-2 antibodies in women attending antenatal care in eastern Ethiopia: a facility-based surveillance.

OBJECTIVE: We conducted serosurveillance of anti-SARS-CoV-2 antibodies among pregnant women attending their first antenatal care. SETTING: The surveillance was set in one referral hospital in Harar, one district hospital and one health centre located in Haramaya district in rural eastern Ethiopia. PARTICIPANTS: We collected questionnaire data and a blood sample from 3312 pregnant women between 1 April 2020 and 31 March 2021. We selected 1447 blood samples at random and assayed these for anti-SARS-CoV-2 antibodies at Hararghe Health Research laboratory using WANTAI SARS-CoV-2 Rapid Test for total immunoglobulin. OUTCOME: We assayed for anti-SARS-CoV-2 antibodies and temporal trends in seroprevalence were analysed with a χ2 test for trend and multivariable binomial regression. RESULTS: Among 1447 sera tested, 83 were positive for anti-SARS-CoV-2 antibodies giving a crude seroprevalence of 5.7% (95% CI 4.6% to 7.0%). Of 160 samples tested in April-May 2020, none was seropositive; the first seropositive sample was identified in June and seroprevalence rose steadily thereafter (χ2 test for trend, p=0.003) reaching a peak of 11.8% in February 2021. In the multivariable model, seroprevalence was approximately 3% higher in first-trimester mothers compared with later presentations, and rose by 0.75% (95% CI 0.31% to 1.20%) per month of calendar time. CONCLUSIONS: This clinical convenience sample illustrates the dynamic of the SARS-CoV-2 epidemic in pregnant women in eastern Ethiopia; infection was rare before June 2020 but it spread in a linear fashion thereafter, rather than following intermittent waves, and reached 10% by the beginning of 2021. After 1 year of surveillance, most pregnant mothers remained susceptible.

COVID-19 Testing Experience in a Resource-Limited Setting: The Use of Existing Facilities in Public Health Emergency Management.

Introduction: Coronavirus disease 2019 (COVID-19) is a public health emergency with little testing and treatment experiences at its occurrence. Diagnostic and treatment rapidly changed in the world including Ethiopia. Haramaya University has strived to change its diagnostic capacity using existing facilities in response to the national call to the pandemic. Objective: This summary aims to detail experiences of setting up COVID-19 testing in Haramaya University laboratories, Eastern Ethiopia. Methods: Desktop exercise was conducted to understand the start-up and implementations of COVID-19 testing in two Haramaya University laboratories, Hararghe Health Research Partnership and Campylobacter Genomics and Environmental Enteric Dysfunction laboratories. Communication, formats, guidelines, and standards were reviewed and summarized. Discussion with those involved in the start-up and implementation of the testing were also held. Ideas were summarized to learn the experiences the COVID-19 testing exercises. Lesson Learned: This is a huge experience for Haramaya University to participate in the national call to increase the testing platform in the management of COVID19. Close work relationship with the public health authorities at all levels demonstrated the university's commitment to public service. The university has used the opportunity to advance its molecular testing capability by training its staff and students. The University has also contributed to the capacity development for laboratories in the surrounding areas of Harar, Somali, Oromia, and Dire Dawa. The pandemic has been an opportunity in harnessing existing resource for the benefit of the public during such times of dire needs to provide critical public health laboratory interventions.

High Seroprevalence of Anti-SARS-CoV-2 Antibodies Among Ethiopian Healthcare Workers.

Background COVID-19 pandemic has a devastating impact on the economies and health care system of sub-Saharan Africa. Healthcare workers (HWs), the main actors of the health system, are at higher-risk because of their occupation. Serology-based estimates of SARS-CoV-2 infection among HWs represent a measure of HWs’ exposure to the virus and a guide to the prevalence of SARS-CoV-2 in the community. This information is currently lacking in Ethiopia and other African countries. This study aimed to develop an in-house antibody testing assay, assess the prevalence of SARS-CoV-2 antibodies among Ethiopian high-risk frontline HWs. Methods A cross-sectional seroprevalence study was conducted among HWs in five public hospitals located in different geographic regions of Ethiopia. Socio-demographic and clinical data were collected using questionnaire-based interviews. From consenting HWs, blood samples were collected between December 2020 and February 2021, the period between the two peaks of COVID-19 in Ethiopia. The collected sera were tested using an in-house immunoglobin G (IgG) enzyme-linked immunosorbent assay (ELISA) for SARS-CoV-2 specific antibodies on sera collected from HWs. Results Of 1,997 HWs who provided a blood sample, demographic and clinical data, 50.5% were female, 74.0% had no symptoms compatible with COVID-19, and 29.0% had history of contact with suspected or confirmed patient with SARS-CoV-2 infection. The overall seroprevalence was 39.6%. The lowest (24.5%) and the highest (48.0%) seroprevalence rates were found in Hiwot Fana Specialized Hospital in Harar and ALERT Hospital in Addis Ababa, respectively. Of the 821 seropositive HWs, 224(27.3%) had history of symptoms consistent with COVID-19. A history of close contact with suspected/confirmed COVID-19 cases was strongly associated with seropositivity (Adjusted odds Ratio (AOR) =1.4, 95% CI 1.1-1.8; p=0.015). Conclusion High SARS-CoV-2 seroprevalence levels were observed in the five Ethiopian hospitals. These findings highlight the significant burden of asymptomatic infection in Ethiopia, and may reflect the scale of transmission in the general population.

Asymptomatic Bacteriuria among Pregnant Women Attending Antenatal Care at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: Magnitude, Associated Factors, and Antimicrobial Susceptibility Pattern.

BACKGROUND: Asymptomatic bacteriuria is one of the major risk factors for the development of urinary tract infections during pregnancy which accounts for about 70% of the cases. However, there is no guideline which recommends routine screening of pregnant women for asymptomatic bacteriuria in most of developing countries including Ethiopia. Thus, the aim of this study was to determine the magnitude, associated factors, and antimicrobial susceptibility pattern of asymptomatic bacteriuria among pregnant women. METHODS: A cross-sectional study was conducted from March to April 2019. Data were collected through face-to-face interview and analyzed using Statistical Package for Social Science version 22. A test of association was performed using logistic regression and P value less than 0.05 was considered statistically significant. RESULTS: The overall prevalence of asymptomatic bacteriuria was 19.9%. Direction of wiping after genital wash, postcoital urination, and catheterization were factors significantly associated with asymptomatic bacteriuria. Most of the isolated Gram positive were highly sensitive to Ceftriaxone (90.9%). Coagulase-negative staphylococci showed higher sensitivity to Augmentin (75.0) and Ceftriaxone (87.5%), whereas they showed resistance to Clindamycin (68.7%) and Ampicillin (62.5%). Gram-negative bacteria isolates showed higher sensitivity to Ceftriaxone (88.2%), Gentamycin (67.5%), and Augmentin (64.7%), while they showed resistance to Ampicillin (70.5%) and Clindamycin (50.0%). CONCLUSION: The overall prevalence of asymptomatic bacteriuria among pregnant women in this study was high. Direction of wiping after genital wash, catheterization, and postcoital urination increases the odds of asymptomatic bacteriuria. Therefore, health education on the predisposing factors is strongly recommended.

Bacterial otitis media in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Otitis media is inflammation of the middle ear, comprising a spectrum of diseases. It is the commonest episode of infection in children, which often occurs after an acute upper respiratory tract infection. Otitis media is ranked as the second most important cause of hearing loss and the fifth global burden of disease with a higher incidence in developing worlds like Sub-Saharan Africa and South Asia. Therefore, this systematic review is aimed to quantitatively estimate the current status of bacterial otitis media, bacterial etiology and their susceptibility profile in sub-Saharan Africa. METHODS: A literature search was conducted from major databases and indexing services including EMBASE (Ovid interface), PubMed/MEDLINE, Google Scholar, ScienceDirect, Cochrane Library, WHO African Index-Medicus and others. All studies (published and unpublished) addressing the prevalence of otitis media and clinical isolates conducted in sub-Saharan Africa were included. Format prepared in Microsoft Excel was used to extract the data and data was exported to Stata version 15 software for the analyses. Der-Simonian-Laird random-effects model at a 95% confidence level was used for pooled estimation of outcomes. The degree of heterogeneity was presented with I2 statistics. Publication bias was presented with funnel plots of standard error supplemented by Begg's and Egger's tests. The study protocol is registered on PROSPERO with reference number ID: CRD42018102485 and the published methodology is available from http://www.crd.york.ac.uk/CRD42018102485. RESULTS: A total of 33 studies with 6034 patients were included in this study. All studies have collected ear swab/discharge samples for bacterial isolation. The pooled isolation rate of bacterial agents from the CSOM subgroup was 98%, patients with otitis media subgroup 87% and pediatric otitis media 86%. A univariate meta-regression analysis indicated the type of otitis media was a possible source of heterogeneity (p-value = 0.001). The commonest isolates were P. aeruginosa (23-25%), S. aureus (18-27%), Proteus species (11-19%) and Klebsiella species. High level of resistance was observed against Ampicillin, Amoxicillin-clavulanate, Cotrimoxazole, Amoxicillin, and Cefuroxime. CONCLUSION: The analysis revealed that bacterial pathogens like P. aeruginosa and S. aureus are majorly responsible for otitis media in sub-Saharan Africa. The isolates have a high level of resistance to commonly used drugs for the management of otitis media.

Magnitude and causes of first-line antiretroviral therapy regimen changes among HIV patients in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Antiretroviral therapy (ART) has markedly decreased the morbidity and mortality due to HIV/AIDS. ART regimen change is a major challenge for the sustainability of human immunodeficiency virus (HIV) treatment program. This is found to be a major concern among HIV/AIDS patients in a resource-limited setting, where treatment options are limited. OBJECTIVES: The aim of this review is to generate the best available evidence regarding the magnitude of first-line antiretroviral therapy regimen change and the causes for regimen change among HIV patients on ART in Ethiopia. METHODS: The reviewed studies were accessed through electronic web-based search strategy from PubMed Medline, EMBASE, Hinari, Springer link and Google Scholar. Data were extracted using Microsoft Excel and exported to Stata software version 13 for analyses. The overall pooled estimation of outcomes was calculated using a random-effect model of DerSimonian-Laird method at 95% confidence level. Heterogeneity of studies was determined using I2 statistics. For the magnitude of regimen change, the presence of publication bias was evaluated using the Begg's and Egger's tests. The protocol of this systematic review and meta-analysis was registered in the Prospero database with reference number ID: CRD42018099742. The published methodology is available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=99742 . RESULTS: A total of 22 studies published between the years 2012 and 2018 were included. Out of 22 articles, 14 articles reported the magnitude of regimen change and consisted of 13,668 HIV patients. The estimated national pooled magnitude of regimen change was 37% (95% CI: 34, 44%; Range: 15.1-63.8%) with degree of heterogeneity (I2), 98.7%; p-value < 0.001. Seventeen articles were used to identify the causes for first-line antiretroviral therapy regimen change. The major causes identified were toxicity, 58% (95% CI: 46, 69%; Range: 14.4-88.5%); TB co-morbidity, 12% (95% CI: 8, 16%; Range: 0.8-31.7%); treatment failure, 7% (95% CI: 5, 9%; Range: 0.4-24.4%); and pregnancy, 5% (95% CI: 4, 7%; Range: 0.6-11.9%). CONCLUSIONS: The original first-line regimen was changed in one-third of HIV patients on ART in Ethiopia. Toxicity of the drugs, TB co-morbidity, treatment failure, and pregnancy were the main causes for the change of the first-line regimen among HIV patients on antiretroviral therapy.

Cardiovascular diseases risk factors among adult diabetic patients in eastern Ethiopia.

OBJECTIVE: The aim of this study was to determine the magnitude of cardiovascular disease risk factors among adult diabetic patients at Hiwot Fana Specialized University Hospital and Jugal Hospital, eastern Ethiopia. METHODS: An institutional based cross sectional study was conducted on a total of 416 study participants (age ≥18 years) from February to March 2017. Data were collected using: structured questionnaires, measurements of weight, height, and blood pressure, and laboratory examination of blood lipids (total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein cholesterol) and fasting blood glucose. Data were analyzed using SPSS version 16.0 software packages. The association of cardiovascular disease risk factors with diabetes type, age, and sex was assessed by chi-square test. RESULT: The mean age of study participants was 52 years and 44% were male. Dyslipidemia (90.6%), physical inactivity (76%), and hypertension (62.7%) were the most common cardiovascular disease risks factors identified among diabetic patients. It was also observed that 68.5% of the study participants had uncontrolled blood glucose level. Hypertension was significant in patients over 65 compared to those ≤65 years of age (p < 0.023). Females were considered to be significantly physically inactive compared to males (p < 0.001). CONCLUSION: Dyslipidemia is the most common risk factor of CVD in individuals with Types 1 and 2 diabetes mellitus. Identification and treatment of lipid abnormalities is very important. Controlling hypertension among older patients and lifestyle modification among female diabetic patients are also recommended.