War related disruption of clinical tuberculosis services in Tigray, Ethiopia during the recent regional conflict: a mixed sequential method study.

BACKGROUND: More than 70% of the health facilities in Tigray, northern Ethiopia, have been totally or partially destroyed by the recent war in the region. Diagnosis and management of tuberculosis were among many health services that suffered. In this study we assess the status of tuberculosis care in health facilities of Tigray during the recent war and compare it with the immediate pre-war state. METHODS: Using sequential mixed method, we analyzed and compared the availability of diagnostic services in 69 health facilities and the utilization of tuberculosis care in 50 of them immediately before the war (September-October 2020) and during the war (November-July 2021). TB focal persons in each selected health facility were interviewed to evaluate the status of diagnostic services. Patient service utilization was assessed using health facility registrations. We also compared the average monthly case detection rate of multidrug resistant tuberculosis in the region before and during the war. We computed summary statistics and performed comparisons using t-tests. Finally, existing challenges related to tuberculosis care in the region were explored via in-depth interviews. Two investigators openly coded and analyzed the qualitative data independently via thematic analysis. RESULTS: Among the 69 health facilities randomly selected, the registers of 19 facilities were destroyed by the war; data from the remaining 50 facilities were included in the TB service utilization analysis. In the first month of the war (November 2021) the number of tuberculosis patients visiting health facilities fell 34%. Subsequently the visitation rate improved steadily, but not to pre-war rates. This reduction was significant in northwest, central and eastern zones. Tuberculosis care in rural areas was hit hardest. Prior to the war 60% of tuberculosis patients were served in rural clinics; this number dropped to an average of 17% during the war. Health facilities were systematically looted. Of the 69 institutions assessed, over 69% of the microscopes in health centers, 87.5% of the microscopes in primary hospitals, and 68% of the microscopes in general hospitals were stolen or damaged. Two GeneXpert nucleic acid amplification machines were also taken from general hospitals. Regarding drug resistant TB, the average number of multidrug resistant tuberculosis (MDR TB) cases detected per month was reduced by 41% during the war with p-value < 0.001. In-depth interviews with eight health care workers indicated that the main factors affecting tuberculosis care in the area were lack of security, health facility destruction, theft of essential equipment, and drug supply disruption. CONCLUSION AND RECOMMENDATION: Many tuberculosis patients failed to visit health facilities during the war. There was substantial physical damage to health care facilities and systematic looting of diagnostic equipment. Restoring basic public services and revitalizing clinical care for tuberculosis need urgent consideration.

Prevalence of Smear-Positive, Rifampicin-Resistant Mycobacterium tuberculosis and Related Factors Among Residents with Cough in Northern Ethiopian Refugee Health Facilities.

Purpose: To ascertain the prevalence of Mycobacterium tuberculosis (M.tb) among refugees suspected of tuberculosis (TB) and related risk factors, including smear-positive and Rifampicin-resistant M.tb. Methods: A cross-sectional study was conducted between January 2020 and May 2020 among 384 refugees in four refugee camps in Northwest Tigray, Ethiopia. Socio-demographic and clinical data were collected from refugees with a history of cough for more than two weeks prospectively. Spot-spot sputum samples were collected and transported in an ice box to the Shire Suhul Hospital Microbiology laboratory; and then examined using a Fluorescent Microscope. All smear-positive samples were further processed by GeneXpert to detect Rifampicin-resistant MTB. Data were analyzed using SPSS version 21 and a p-value <0.05 was considered statistically significant. Results: The overall prevalence of smear-positive PTB infection was 5.5% (21/384), but No TB case was resistant to Rifampicin detected by GeneXpert MTB/RIF assay. About 70% of the smear-positive pulmonary TB identified were females. Five (23.8%) of the smear-positive pulmonary tuberculosis cases were co-infected by HIV. Sharing of drink and food materials (AOR = 4.36, 95% CI = 1.19-15.89), active TB contact (AOR 7.24, 95% CI = 1.62-32.125), BMI (AOR = 5.23, 95% CI = 1.28-21.29), opening window practice (AOR = 4.32, 95% CI = 1.02-18.30) and HIV status (AOR = 9.36, 95% CI = 1.64-53.35) were statistically significant predisposing factors. Conclusion: The prevalence of smear-positive pulmonary TB among northwest Tigray refugee camps was still high. The prevalence of TB/HIV co-infection was also high. Minimizing close contact with active TB cases, reducing malnutrition, rapid TB/HIV screening, and establishing a ventilation system can reduce the transmission of TB among refugees.

Seroprevalence and Associated Factors of Hepatitis B and Hepatitis C Viral Infections Among Prisoners in Tigrai, Northern Ethiopia.

Background: Hepatitis B and C viruses are important health and socioeconomic problem across the globe, with a remarkable number of diseases and deaths in sub-Saharan African countries. The burden of hepatitis is unknown in the prison settings of Tigrai. Therefore, we aimed to describe the seroprevalence and associated factors of hepatitis B and C viruses among prisoners in Tigrai, Ethiopia. Methods: A cross-sectional study was carried out from February 2020 to May 2020 at the prison facilities of Tigrai. Demographics and associated factors were collected from 315 prisoners prospectively. Five milliliters of blood was collected and tested using rapid tests kits of HBsAg (Zhejiang orient Gene Biotech Co., Ltd., China) and HCV antibodies (Volkan Kozmetik Sanayi Ve Ticaret Ltd. STI, Turkey). Positive samples were confirmed using enzyme-linked immunosorbent assay (ELISA) (Beijing Wantai Biological Pharmacy Enterprise Co. Ltd). Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20 and p<0.05 was considered statistically significant. Results: The overall seroprevalence of HBV and HCV were 25 (7.9%) and 1 (0.3%), respectively. The majority of hepatitis B viral infections were identified from the age groups of 18-25 years (10.7%) and unmarried prisoners (11.8%). Prisoners greater than 100 per cell (AOR=3.95, 95% CI=1.15-13.6, p=0.029) and with a history of alcohol consumption (AOR=3.01, 95% CI=1.17-7.74, p=0.022) were significantly associated with HBV infections. Conclusion: The seroprevalence of HBV among prisoners was nearly high or borderline (7.9%) with a very low HCV prevalence (0.3%). HBV was most prevalent among young adults, those housed with a large number of prisoners per cell, and those who had a history of alcohol consumption. This study recommends that there should be prison-focused intervention, including regular health education, with the emphasis on the mode of transmission and introducing HBV screening policy for prisoners, especially when they enter the prison.

Prognostic Value of C-Reactive Protein in SARS-CoV-2 Infection: A Simplified Biomarker of COVID-19 Severity in Northern Ethiopia.

Purpose: To evaluate the role of C-reactive protein (CRP) in predicting severe COVID-19 patients. Methods: A prospective observational cohort study was conducted from July 15 to October 28, 2020, at Kuyha COVID-19 isolation and treatment center hospital, Mekelle City, Northern Ethiopia. A total of 670 blood samples were collected serially. SARS-CoV-2 infection was confirmed by RT-PCR from nasopharyngeal swabs and CRP concentration was determined using Cobas Integra 400 Plus (Roche). Data were analyzed using STATA version 14. P-value <0.05 was considered statistically significant. Results: Overall, COVID-19 patients had significantly elevated CRP at baseline when compared to PCR-negative controls [median 11.1 (IQR: 2.0-127.8) mg/L vs 0.9 (IQR: 0.5-1.9) mg/L; p=0.0004)]. Those with severe COVID-19 clinical presentation had significantly higher median CRP levels compared to those with non-severe cases [166.1 (IQR: 48.6-332.5) mg/L vs 2.4 (IQR: 1.2-7.6) mg/L; p<0.00001)]. Moreover, COVID-19 patients exhibited higher median CRP levels at baseline [58 (IQR: 2.0-127.8) mg/L] that decreased significantly to 2.4 (IQR: 1.4-3.9) mg/L after 40 days after symptom onset (p<0.0001). Performance of CRP levels determined using ROC analysis distinguished severe from non-severe COVID-19 patients, with an AUC value of 0.83 (95% CI: 0.73-0.91; p=0.001; 77.4% sensitivity and 89.4% specificity). In multivariable analysis, CRP levels above 30 mg/L were significantly associated with an increased risk of developing severe COVID-19 for those who have higher ages and comorbidities (ARR 3.99, 95% CI: 1.35-11.82; p=0.013). Conclusion: CRP was found to be an independent determinant factor for severe COVID-19 patients. Therefore, CRP levels in COVID-19 patients in African settings may provide a simple, prompt, and inexpensive assessment of the severity status at baseline and monitoring of treatment outcomes.

Prevalence and Clindamycin Resistance Profile of Staphylococcus aureus and Associated Factors among Patients Attending the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia.

Clindamycin can serve as an alternative treatment for staphylococcal infections. Routine susceptibility tests may fail to determine inducible type clindamycin resistance and can be a source of failure in clinical therapeutics. Therefore, this study aimed to determine Staphylococcus aureus (S. aureus) prevalence, inducible clindamycin resistance pattern, and associated factors among patients attending the University of Gondar Comprehensive Specialized Hospital, Gondar, northwest Ethiopia. Methods. A cross-sectional study was conducted from January to April 2018. Clinical samples were inoculated on appropriate culture media. Standard bacteriological tests, including Gram stain, catalase, and coagulase tests, identified the presence of S. aureus. The antimicrobial susceptibility tests and the D-test were performed by using the Kirby-Bauer disk diffusion technique on the Mueller-Hinton agar. The D-test was performed using clindamycin (CLI) 2 ug and erythromycin (ERY) 15 ug disks located approximately 15 mm apart, and the cefoxitin susceptibility test was used to characterize methicillin-resistant S. aureus (MRSA). The association between S. aureus infection and different variables was assessed using bivariate and multivariate analysis. A P value <0.05 was considered statistically significant. Result. Of 388 study participants, the overall prevalence of S. aureus was 17% (66/388). Of these, the inducible type of clindamycin resistance was 25.8% (17/66) and 21.2% (14/66) were MRSA. All isolates were susceptible to chloramphenicol and resistant to tetracycline. A family size of 4-6 (AOR = 2.627, 95% CI (1.030-6.702)) and >7 (AOR = 3.892, 95% CI (1.169-12.959)), inpatient study participants (AOR = 3.198, 95% CI (1.197-8.070)), illness in the previous 4 weeks (AOR = 2.116, 95% CI (1.080-4.145)), and a history of chronic disease (AOR = 0.265, 95% CI (0.094-0.750)) were likely to have S. aureus infection. Conclusion. This study shows a considerable high magnitude of MRSA and inducible clindamycin resistance S. aureus isolates. To rule out clindamycin susceptibility testing, the D-test should be routinely performed.

Longitudinal profile of antibody response to SARS-CoV-2 in patients with COVID-19 in a setting from Sub-Saharan Africa: A prospective longitudinal study.

BACKGROUND: Serological testing for SARS-CoV-2 plays an important role for epidemiological studies, in aiding the diagnosis of COVID-19, and assess vaccine responses. Little is known on dynamics of SARS-CoV-2 serology in African settings. Here, we aimed to characterize the longitudinal antibody response profile to SARS-CoV-2 in Ethiopia. METHODS: In this prospective study, a total of 102 PCR-confirmed COVID-19 patients were enrolled. We obtained 802 plasma samples collected serially. SARS-CoV-2 antibodies were determined using four lateral flow immune-assays (LFIAs), and an electrochemiluminescent immunoassay. We determined longitudinal antibody response to SARS-CoV-2 as well as seroconversion dynamics. RESULTS: Serological positivity rate ranged between 12%-91%, depending on timing after symptom onset. There was no difference in positivity rate between severe and non-severe COVID-19 cases. The specificity ranged between 90%-97%. Agreement between different assays ranged between 84%-92%. The estimated positive predictive value (PPV) for IgM or IgG in a scenario with seroprevalence at 5% varies from 33% to 58%. Nonetheless, when the population seroprevalence increases to 25% and 50%, there is a corresponding increases in the estimated PPVs. The estimated negative-predictive value (NPV) in a low seroprevalence scenario (5%) is high (>99%). However, the estimated NPV in a high seroprevalence scenario (50%) for IgM or IgG is reduced significantly to 80% to 85%. Overall, 28/102 (27.5%) seroconverted by one or more assays tested, within a median time of 11 (IQR: 9-15) days post symptom onset. The median seroconversion time among symptomatic cases tended to be shorter when compared to asymptomatic patients [9 (IQR: 6-11) vs. 15 (IQR: 13-21) days; p = 0.002]. Overall, seroconversion reached 100% 5.5 weeks after the onset of symptoms. Notably, of the remaining 74 COVID-19 patients included in the cohort, 64 (62.8%) were positive for antibody at the time of enrollment, and 10 (9.8%) patients failed to mount a detectable antibody response by any of the assays tested during follow-up. CONCLUSIONS: Longitudinal assessment of antibody response in African COVID-19 patients revealed heterogeneous responses. This underscores the need for a comprehensive evaluation of seroassays before implementation. Factors associated with failure to seroconvert needs further research.

Antimicrobial resistance profiles and associated factors of Acinetobacter and Pseudomonas aeruginosa nosocomial infection among patients admitted at Dessie comprehensive specialized Hospital, North-East Ethiopia. A cross-sectional study.

INTRODUCTION: Hospital admitted patients are at increased risk of nosocomial infections (NIs) with multi-drug resistant (MDR) pathogens which are prevalent in the hospital environment. Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) are common causes of NIs worldwide. The objective of this study is to determine antimicrobial resistance profiles and associated factors of Acinetobacter spp and P. aeruginosa NIs among hospitalized patients. METHODS: A cross-sectional study was conducted at Dessie comprehensive specialized hospital, North-East Ethiopia, from February 1 to April 30, 2020. A total of 254 patients who were suspected of the bloodstream, urinary tract, or surgical site nosocomial infections were enrolled consecutively. Socio-demographic and other variables of interest were collected using a structured questionnaire. Specimens were collected and processed following standard microbiological procedures. Antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Data were analyzed with SPSS version 23 and p-value < 0.05 was considered statistically significant. RESULTS: Overall, 13% of patients had nosocomial Acinetobacter spp and/or P. aeruginosa infections. The culture positivity rate was 16(6.3%) for Acinetobacter spp and 18(7.1%) for P. aeruginosa. Patients admitted in the surgical ward (Adjusted odds ratio (AOR):10.66;95% confidence interval (CI):1.22-93.23), pediatric ward (AOR:14.37;95%CI:1.4-148.5), intensive care unit (AOR:41.93;95%CI:4.7-374.7) and orthopedics (AOR:52.21;95%CI:7.5-365) were significantly at risk to develop NIs compared to patients admitted in the medical ward. Patients who took more than two antimicrobial types at admission were 94% (AOR:0.06; 95% CI:0.004-0.84) times more protected from NIs compared to those who did not take any antimicrobial. About 81% of Acinetobacter spp and 83% of P. aeruginosa isolates were MDR. Amikacin and meropenem showed promising activity against Acinetobacter spp and P. aeruginosa isolates. CONCLUSION: The high prevalence of MDR Acinetobacter spp and P. aeruginosa nosocomial isolates enforce treating of patients with NIs based on antimicrobial susceptibility testing results.

Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. Evidence from Africa indicates that significantly less COVID-19 patients suffer from serious symptoms than in the industrialized world. We and others previously postulated a partial explanation for this phenomenon, being a different, more activated immune system due to parasite infections. Here, we aimed to test this hypothesis by investigating a potential correlation of co-infection with parasites with COVID-19 severity in an endemic area in Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites, between July 2020 and March 2021. The primary outcome was the proportion of patients with severe COVID-19. Ordinal logistic regression models were used to estimate the association between parasite infection, and COVID-19 severity. Models were adjusted for sex, age, residence, education level, occupation, body mass index, and comorbidities. Findings: 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37.8%) had intestinal parasitic infection. Only 27/255 (10.6%) severe COVID-19 patients were co-infected with intestinal parasites, while 257/496 (51.8%) non-severe COVID-19 patients were parasite positive (p<0.0001). Patients co-infected with parasites had lower odds of developing severe COVID-19, with an adjusted odds ratio (aOR) of 0.23 (95% CI 0.17-0.30; p<0.0001) for all parasites, aOR 0.37 ([95% CI 0.26-0.51]; p<0.0001) for protozoa, and aOR 0.26 ([95% CI 0.19-0.35]; p<0.0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolepis nana, Schistosoma mansoni, and Trichuris trichiura implied lower probability of developing severe COVID-19. There were 11 deaths (1.5%), and all were among patients without parasites (p = 0.009). Interpretation: Parasite co-infection is associated with a reduced risk of severe COVID-19 in African patients. Parasite-driven immunomodulatory responses may mute hyper-inflammation associated with severe COVID-19. Funding: European and Developing Countries Clinical Trials Partnership (EDCTP) - European Union, and Joep Lange Institute (JLI), The Netherlands. Trial registration: Clinicaltrials.gov: NCT04473365.

Clinical features and risk factors associated with morbidity and mortality among patients with COVID-19 in northern Ethiopia.

OBJECTIVE: To describe the clinical features and assess the determinants of severity and in-hospital mortality of patients with coronavirus disease 2019 (COVID-19) from a unique setting in Ethiopia. METHODS: Consecutive patients admitted to a COVID-19 isolation and treatment centre were included in this study. The overall clinical spectrum of COVID-19, and factors associated with risk of severe COVID-19 and in-hospital mortality were analysed. RESULTS: Of 2617 quarantined patients, three-quarters (n = 1935, 74%) were asymptomatic and only 114 (4.4%) presented with severe COVID-19. Common characteristics among the 682 symptomatic patients were cough (n = 354, 50.6%), myalgia (n = 212, 31.1%), headache (n = 196, 28.7%), fever (n = 161, 23.6%), dyspnoea (n = 111, 16.3%), anosmia and/or dysgeusia (n = 90, 13.2%), sore throat (n = 87, 12.8%) and chest pain (n = 77, 11.3%). Factors associated with severe COVID-19 were older age [adjusted relative risk (aRR) 1.78, 95% confidence interval (CI) 1.61-1.97; P < 0.0001], diabetes (aRR 2.00, 95% CI 1.20-3.32; P = 0.007), cardiovascular disease (aRR 2.53, 95% CI 1.53-4.17; P < 0.0001), malignancy (aRR 4.57, 95% CI 1.62-12.87; P = 0.004), surgery/trauma (aRR 23.98, 95% CI 10.35-55.57; P < 0.0001) and human immunodeficiency virus infection (aRR 4.24, 95% CI 1.55-11.61; P = 005). Factors associated with risk of in-hospital mortality included older age (aRR 2.37, 95% CI 1.90-2.95; P < 0.001), malignancy (aRR 6.73, 95% CI 1.50-30.16; P = 0.013) and surgery/trauma (aRR 59.52, 95% CI 12.90-274.68; P < 0.0001). CONCLUSIONS: A significant proportion of cases of COVID-19 were asymptomatic, and key comorbid conditions increased the risk of severe COVID-19 and in-hospital mortality. These findings could help in the design of appropriate management strategies for patients.

Knowledge, Attitude, and Practice towards Hepatitis B Virus among Pregnant Women Attending Antenatal Care at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: Hepatitis B virus (HBV) infection remains a serious public health concern worldwide. Mother-to-child transmission (MTCT) is the major mode in endemic areas, including Ethiopia, where little is known about pregnant women's knowledge, attitudes, and practice towards HBV infection and MTCT. Therefore, the study is aimed at determining the knowledge, attitude, and practice towards HBV among pregnant women attending antenatal care. METHOD: A cross-sectional study was conducted from February to April 2018, at the University of Gondar Comprehensive Specialized Hospital. A total of 354 pregnant women were selected by systematic random sampling and included in this study. KAP of participants on HBV MTCT was assessed using a structured questionnaire. Data was analyzed using SPSS version 22 software. RESULT: The total response rate was 100% (354/354). Out of the 354 participants, 73.4% were within the poor knowledge. Only 18.9% of the respondents know HBV can be transmitted from mother to child during pregnancy. Less than half (43.8) of the participants think that they will never be infected with HBV, and 47.7% of them go to traditional healers when they have symptoms of HBV. Majority of the respondents (85.87%) had never screened for HBV, and only 28.5% of the participants believed that hepatitis B can cause liver cancer. In multivariable analysis, residence, income, and educational level were associated with mean score knowledge and attitude. CONCLUSIONS: Knowledge about HBV among pregnant women was found to be poor, and their attitude and practice were also limited. Therefore, extensive health education program should be given to the pregnant women to increase their awareness towards HBV infection. All pregnant women should be screened for HBV as part of ANC follow-up.

Intestinal parasites among HIV/AIDS patients attending University of Gondar Hospital, Northwest Ethiopia

Background: Opportunistic intestinal parasitic infections are the major public health problem among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. In the absence of anti-retroviral therapy (ART), HIV/AIDS patients in developing countries such as Ethiopia continue to suffer from the consequences of intestinal parasites. This study aimed to determine the prevalence of opportunistic and other intestinal parasites among on-ART HIV/AIDS patients. Methods: A comparative cross-sectional study was conducted from December 2015 to January2016 among pre-ART and on-ART adult HIV/AIDS patients at University of Gondar Hospital, northwest Ethiopia. A pre-tested structured questionnaire was used to collect data on socio-demographic and associated risk factors. Systematic random sampling was used to select the study participants. Stool samples were collected and processed using a direct, wet-mount, formol-ether concentration technique and modified Ziehl-Neelsen staining technique. The CD4 counts were estimated by using the BD FACS Count system. Data were entered and analyzed using SPSS 20 software. Results: A total of 150 study participants (48ARTnaïve and102 on ART) were included in the study. The overall prevalence of intestinal parasitic infections was 45.3% ­ 25.3% in pre-ART patients and 20% in on-ART patients. Two thirds (8/12) of opportunistic parasitic infections were found in the ART-naïve patients and significantly associated with CD4 counts <200 cells/mm3. Those who have no toilet [AOR=5.21, 95% CI: 1.82, 16.03], source of water from stream [AOR = 2.8; 95% CI: 1.05, 7.72], who have diarrhea [AOR = 11.38; 95% CI: 4.69, 15.61], WHO stage III [AOR =5.3; 95% CI: 2.47, 11.56] and ART status [AOR = 4.2; 95% CI: 2.02, 8.77] were significantly associated with the prevalence of intestinal parasites. Key words: Opportunistic intestinal parasites, CD4 T-cells, Anti-retroviral therapy, diarrhea, Gondar

Vancomycin-Resistant Enterococci and Its Associated Risk Factors among HIV-Positive and -Negative Clients Attending Dessie Referral Hospital, Northeast Ethiopia.

BACKGROUND: Enterococci are becoming the most important public health concern and emerging as multidrug-resistant organisms around the world including Africa particularly in Ethiopia where there is a lack of availability of effective antimicrobial drugs. However, there is a paucity of data on the prevalence and associated risk factors of vancomycin-resistant enterococci in Ethiopia. OBJECTIVE: This study was aimed to assess the prevalence of vancomycin-resistant enterococci and its associated risk factors among HIV-positive and -negative clients. METHODS: A comparative cross-sectional study was conducted from February to May, 2017, on 300 participants at Dessie Referral Hospital. Data were gathered using a pretested structured questionnaire, stool samples were collected and inoculated on to bile esculin agar, and presumptive colonies were inoculated in brain-heart infusion broth containing 6.5% NaCl for selective identification of enterococci. Antibiotic susceptibility tests were done using the Kirby-Bauer disk diffusion method. Data were analyzed using SPSS version 22 software package. RESULTS: A total of 300 study participants were enrolled in this study, of which 57.7% were females with a mean age of 34.4, a range of 19-73 years. The overall prevalence of enterococci was 37.3%. The prevalence of VRE was 6.3%. From all isolates, the prevalence of VRE among HIV-positive and -negative clients was 5.9% and 7.4%, respectively. Resistance gentamicin, ampicillin, penicillin, and erythromycin was 37.5%, 34.8%, 34.8%, and 22.3%, respectively. Prevalence of multidrug resistance was (29.5%). Being low in hemoglobin content was significantly associated with VRE. CONCLUSION: The high prevalence of VRE and multidrug-resistant enterococci in this study signals the emergence of VRE. Detection of VRE in this study indicates decreased antibiotic treatment options of multidrug-resistant enterococci. Therefore, there should be a need to perform continuous surveillance, rational use of antibiotics, and more detailed study using phenotypic and genotypic methods.

HIV and Malaria Infections and Associated Risk Factors Among Febrile Illness Patients in Northwest Ethiopia.

OBJECTIVE: Malaria and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) are the major medical challenges of priority faced by the sub-Saharan African countries in general and Ethiopia in particular. Thus, the aim of this study was to determine the prevalence and associated risk factors of HIV and malaria infections among febrile illness patients. METHODS: A cross-sectional study was conducted from November 1, 2014 to May 30, 2015 at Kolla-Diba Health Center, Northwest Ethiopia. After obtaining informed consent, blood samples were collected from each febrile patient for the laboratory determination of HIV and malaria infections. Sociodemographic data and other associated factors for HIV and malaria infections were collected using a structured questionnaire. RESULTS: Of the total of 384 febrile illness patients, 23.7% (91/384) were positive for Plasmodium species. Of these, the most prevalent was P. falciparum, 56.0% (51/91), followed by Plasmodium vivax infection, 38.5% (35/91). In this study, 13.8% (53/384) of the participants were positive for HIV. Furthermore, 3.13% (12/91) of the participants were coinfected with HIV and malaria. According to the findings of the present study, genital ulcer patients and those who do not use bed net were significantly associated with HIV and malaria infections, respectively. CONCLUSION: Malaria and HIV are still common challenges independently occurring in the study area. The coexistence of the two diseases cannot be underestimated. Hence, health professionals should strengthen the provider initiative counseling and testing (PICT) program as a means of HIV/AIDS prevention and control strategy. Furthermore, approaching the febrile illness patients for both malaria and HIV diagnoses may help in having a joint HIV and malaria prevention and control strategy.

Utilization and Associated Factors of Modern Contraceptives During Extended Postpartum Period among Women Who Gave Birth in the Last 12 Months in Gondar Town, Northwest Ethiopia.

BACKGROUND: The postpartum period is a critical period for addressing widespread unmet needs in family planning and for reducing the risks of closely spaced pregnancies. However, many women do not realize that they are at risk for pregnancy during this period. Therefore, the aim of this study was to assess utilization and associated factors of modern contraceptives during extended post-partum period. METHODS: Institutional based cross-sectional study was conducted from March to April, 2015 in six health institutions among women who gave birth in the last 12 months prior to the study period in Gondar Town, Northwest Ethiopia. A systematic random sampling technique was used to select the study participants. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression models were fitted to identify the determinants of postpartum modern contraceptive use. Adjusted odds ratios with 95% confidence intervals were calculated, and p-values <0.05 were considered to indicate statistical significance. RESULT: Of the total 404 participants, 45.8% mothers used modern contraceptives during postpartum period. Injectable contraceptive was the most frequently used method. Menstruating [AOR =3.84, 95% CI: (2.33, 6.35)], resumption of sex [AOR= 3.17, 95% CI: (1.80, 5.58)], 37-51 weeks of postpartum period [AOR= 2.48, 95% CI: (1.11, 5.55)], husband approval of contraceptive [AOR= 2.10, 95% CI: (1.16, 3.82)] and current knowledge on FP [AOR= 5.01, 95% CI: (2.23, 11.24)] were factors affecting contraceptive use in postpartum period. CONCLUSION: Utilization of modern contraceptive during the postpartum period was significantly decreased placing women at risk for a pregnancy in the extended postpartum period. Menstruating, resumption of sex, variation on postpartum period and husband approval of contraceptive were factors associated with contraceptive use. Strengthening FP counseling service at the ANC clinic and postnatal care would improve contraceptive use during the postpartum period.

Diarrhea Prevalence and Sociodemographic Factors among Under-Five Children in Rural Areas of North Gondar Zone, Northwest Ethiopia.

BACKGROUND: Diarrheal disease remains one of the principal causes of morbidity and mortality in infants and children in developing countries, including Ethiopia. Risk factors for diarrhea vary by settings and have important implications for developing intervention strategies to reduce the burden of the disease. Thus, the aim of this study was to assess diarrhea prevalence and sociodemographic factors among under-five children in rural areas of North Gondar Zone. METHODS: A community-based cross-sectional study was conducted from April to June 2016 among 736 randomly selected households with one child under five years old. A structured questionnaire was used for collecting information on sociodemographic characteristics and diarrheal occurrence. Data was analyzed using SPSS version 20. The bivariate and multivariable logistic regression analysis were used to determine the association between risk factors and diarrheal occurrence, and a p value < 0.05 was taken as statistically significant. RESULTS: A total of 736 under-five children and their respondents were enrolled during the study period. Almost all respondents were biological mothers 96.4% (709/736), married 94.2% (693/736), and house wives 86% (632/736). The overall prevalence of diarrheal disease among under-five children was 22.1% (163/743). Of these, children with age group of less than one year old, 7.7 % (57/736), were commonly infected with diarrheal diseases. Children less than or equal to one year [AOR=1.82, 95% CI= (1.39, 4.63)], guardians [AOR=4.37, 95% CI= (1.73, 11.1)], and children with no breast feeding practice [AOR=3.13, 95% CI= (1.62, 6.03)] were the major risk factors for the occurrence of diarrhea. CONCLUSION: Childhood diarrhea remains an important health concern in the study area. Occurrence of diarrhea was statistically associated with child age less than or equal to one year, educational status of mother/guardians, and breast feeding. To minimize the magnitude childhood diarrhea, various designing and implementing strategies, such as health education, child care, breast feeding, and weaning practice, integrated with the existing national health extension are quite essential.

Asymptomatic bacteriuria and antimicrobial susceptibility pattern of the isolates among pregnant women attending Dessie referral hospital, Northeast Ethiopia: A hospital-based cross-sectional study.

OBJECTIVE: The aim of the current study was to find out the prevalence of asymptomatic bacteriuria, antimicrobial susceptibility pattern of the isolates and related risk factors among pregnant women. MATERIAL AND METHODS: A hospital-based cross-sectional study was carried out from February 2017 to May 2017 among asymptomatic pregnant mothers attending Dessie Referral Hospital, Northeast Ethiopia. About 10-15 mL of freshly voided midstream urine samples were collected from each study participants, and analyzed at Dessie regional research microbiology laboratory with conventional antibiotic susceptibility, and biochemical tests. Isolates were tested against commonly used antimicrobials using Kirby Bauer disc diffusion method. Data were analyzed by SPSS version 20 software and in all cases, p-values below 0.05 was considered as statistically significant. RESULTS: Overall, 358 pregnant women were included in the study with a mean age of 26.5±4.6 years (range, 19-43 yrs). The overall prevalence of asymptomatic bacteriuria was 56% (15.6%). Isolated microorganisms were mainly Escherichia coli and Staphylococcus aureus (for each, n=18; 31%). Escherichia coli and Staphylococcus aureus were resistant to ampicillin (66.7%), and penicillin (94.44%). The prevalence of multidrug- resistant isolates was 72.4%. History of catheterization [AOR=2.28, 95% CI=(1.03-5.06)] and anemia [AOR=4.98, 95% CI=(2.395-10.34) were statistically significant regarding the prevalence of asymptomatic bacteriuria. CONCLUSION: The overall prevalence of asymptomatic bacteriuria among pregnant women in the study area was high. The presence of asymptomatic bacteriuria and their antibiotic susceptibility test results should be taken into consideration during the management of pregnant women who are visiting antenatal care clinic.

Bacterial Isolates and Their Antimicrobial Susceptibility Patterns of Wound Infections among Inpatients and Outpatients Attending the University of Gondar Referral Hospital, Northwest Ethiopia.

Background. The widespread uses of antibiotics, together with the length of time over which they have been available, have led to the emergence of resistant bacterial pathogens contributing to morbidity and mortality. This study was aimed to assess bacterial isolates and their drug susceptibility patterns from inpatients and outpatients with pus and/or wound discharge. Methods. A cross-sectional study was conducted at the University of Gondar Referral Hospital from March to May, 2014. Wound swab samples were collected from each study participant and inoculated into appropriate media. The bacterial pathogens were identified using standard microbiological methods. Antimicrobial susceptibility tests were performed using disk diffusion technique following Kirby-Bauer method. Results. A total of 137 study subjects were included in the study with bacterial isolation rate of 115 (83.9%). Of all, 81 (59.1%) were males. Seventy-seven (57%) of the isolates were Gram-negative and 59 (43%) were Gram-positive. From the total isolates, Staphylococcus aureus was the most predominant isolate 39/115 (34%) followed by Klebsiella species (13%), coagulase negative staphylococci spp. (12%) and Pseudomonas aeruginosa. Gram-positive isolates were resistant to ampicillin (86.4%), amoxicillin (83%), penicillin (81.3%), oxacillin (74.6%), and tetracycline (59.4%), while Gram-negative isolates were resistant to amoxicillin (97.4%), ampicillin (94.8%), tetracycline (72.7%), trimethoprim/sulfamethoxazole (66%), and chloramphenicol (54.5%). Conclusion. High prevalence of bacterial isolates was found, Staphylococcus aureus being the most dominant. High rates of multiple drug resistance pathogens to the commonly used antimicrobial agents were isolated. Therefore, concerned bodies should properly monitor the choice of antibiotics to be used as prophylaxis and empiric treatment in the study area.

Smear positive pulmonary tuberculosis and HIV co-infection in prison settings of North Gondar Zone, Northwest Ethiopia.

BACKGROUND: In correctional settings tuberculosis is a public health concern. The incarcerated population is at greater risk for tuberculosis (TB) than the general population. The aim of this study was to determine the prevalence of smear positive pulmonary tuberculosis (PTB) and associated risk factors in prison settings. METHODS: A cross-sectional study was conducted among prisoners of North Gondar zone where all inmates with a history of cough for ≥ 2 weeks were included. Socio-demographic characteristics and potential risk factors were assessed using a structured questionnaire. Spot-morning-spot sputum samples were collected, smears were prepared and stained with Auramine O stain and examined through light emitting diode- fluorescence microscope. All samples positive for acid-fast bacilli were further examined by GeneXpert MTB/RIF assay. Data was analyzed using SPSS version 20 and a P-value < 0.05 was taken as statistically significant. The multivariable logistic regression analysis was used to determine the association between risk factors and prison tuberculosis. RESULTS: A total of 282 prison inmates suspected of PTB were enrolled in the study. The overall prevalence of smear positive PTB infection was 5.3 % (15/282), but none of the smear positive TB cases were resistant to rifampicin. The prevalence of HIV infection among TB suspected prisoners and smear positive PTB cases was 6 and 27 %, respectively. Moreover, smear positive PTB disease was significantly associated with smoking status, malnutrition, number of prison inmates per cell, poor cell ventilation, and a history of contact with TB patients. CONCLUSION: The prevalence of smear positive pulmonary tuberculosis among north Gondar prison inmates was still high although lower than previous reports. There was a high prevalence of HIV among smear positive PTB cases. Reducing the burden of prison inmates in a particular cell, preventing malnutrition, establishing ventilation system can possibly minimize the transmission of tuberculosis among prisoners.

Occurrence of Potential Bacterial Pathogens and Their Antimicrobial Susceptibility Patterns Isolated from Herbal Medicinal Products Sold in Different Markets of Gondar Town, Northwest Ethiopia.

Background. The World Health Organization estimates that about 80% of the world's population uses herbal medicine to treat various illnesses as means of primary healthcare. However, during preparation, herbal plants may be exposed to contamination by potential pathogens, and this may lead to infections. The aim of this study was to determine bacterial contamination of herbal medicinal products and to assess the antibiotic susceptibility pattern of the isolated bacteria. Methods. A cross-sectional study was conducted from January 1 to May 25, 2013, at Gondar Town. A total of 55 samples used as oral, local, and intranasal routes of administration were collected from the herbalists. Results. In the present study the total aerobic bacterial count ranges from zero to 2.41 × 10(9) CFU/g with mean count of 1.99 × 10(8) CFU/g or mL while the total coliform count showed an average of 1.05 × 10(8) CFU/g or mL with a range of zero to 2.1 × 10(9) CFU/g. The most common bacteria isolated were Bacillus spp. followed by Enterobacter spp., Shigella dysenteriae, and Salmonella spp. Multiple drug resistance was not uncommon and it was found that 125 (83.4%) of the isolates were resistant to two or more antibiotics. Conclusion. Herbal medicinal preparations were highly contaminated with pathogenic microorganisms with high microbial load. Most of the isolates have multiple drug resistance. Using those contaminated herbal medicines may lead to infection of other health related risks. Therefore, this warrants urgent training of herbalists and management scale-up for quality and safety of medicinal plants.

Urinary tract infection among obstetric fistula patients at Gondar University Hospital, northwest Ethiopia.

BACKGROUND: Many women die from complications related to pregnancy and childbirth. In developing countries particularly in sub-Saharan Africa and Asia, where access to emergency obstetrical care is often limited, obstetric fistula usually occurs as a result of prolonged obstructed labour. Obstetric fistula patients have many social and health related problems like urinary tract infections (UTIs). Despite this reality there was limited data on prevalence UTIs on those patients in Ethiopia. Therefore, the aim of this study was to determine the prevalence, drug susceptibility pattern and associated risk factors of UTI among obstetric fistula patients at Gondar University Hospital, Northwest Ethiopia. METHODS: A cross sectional study was conducted from January to May, 2013 at Gondar University Hospital. From each post repair obstetric fistula patients, socio-demographic and UTIs associated risk factors were collected by using a structured questionnaire. After the removal of their catheters, the mid-stream urine was collected and cultured on CLED. After overnight incubation, significant bacteriuria was sub-cultured on Blood Agar Plate (BAP) and MacConkey (MAC). The bacterial species were identified by series of biochemical tests. Antibiotic susceptibility test was done by disc diffusion method. Data was entered and analyzed by using SPSS version 20. RESULTS: A total of 53 post repair obstetric fistula patients were included for the determination of bacterial isolate and 28 (52.8%) of them had significant bacteriuria. Majority of the bacterial isolates, 26 (92.9%), were gram negative bacteria and the predominant ones were Citrobacter 13 (24.5%) and E. coli 6 (11.3%). Enterobacter, E.coli and Proteus mirabilis were 100% resistant to tetracycline. Enterobacter, Proteus mirabilis, Klebsella pneumonia, Klebsella ozenae and Staphylococcus aureus were also 100% resistant to ceftriaxone. CONCLUSION: The prevalence of bacterial isolates in obstetric fistula patients was high and majority of the isolates were gram negative bacteria. Even thought the predominant bacterial isolates were Citrobacter and E. coli, all of the bacterial isolates had multiple antibiotic resistance patterns which alert health profession to look better treatment for these patients.