Bacterial profiles, antibiotic susceptibility patterns, and associated factors of symptomatic urinary tract infections among symptomatic university students at Haramaya University, Eastern Ethiopia: Cross-sectional study.

Urinary tract infection (UTI) is a highly prevalent infection that can affect individuals of all ages, posing a significant risk to global health in terms of both morbidity and mortality. The emergence of multidrug-resistant bacteria adds to the complexity of this public health issue. There is limited data on the current study area. Therefore, this study aimed to determine the bacterial profiles, antibiotic susceptibility patterns, and associated factors of UTIs among symptomatic university students at Haramaya University, Eastern Ethiopia from May 10 to June 15, 2021. A cross-sectional study was conducted among 281 Haramaya University students. A systematic random sampling technique was used to select the study participants. Data were collected using a self-administered questionnaire. Ten to 15 mL of midstream urine samples were collected aseptically from patients. Standard microbiological techniques were used for bacterial identifications and drug susceptibility testing. The association between dependent and independent variables was determined by the logistics regression model. Variables with a P-value of <.05 were considered statistically significant. The overall prevalence of UTI among university students was 18.1% (95% confidence interval [CI]: 13.5-23.1). The most frequently isolated bacteria were Escherichia coli (33.3%) and Staphylococcus epidermidis (29.4%). Gram-negative bacteria demonstrated high resistance against ceftazidime (100%), penicillin (96%), ampicillin (92%), and tetracycline (71%). Similarly, gram-positive bacteria exhibited significant resistance to ceftazidime (100%) and ampicillin (81%). Multidrug-resistant isolates constituted an overall prevalence of 35 (68.6%) (95% CI: 63.6-73.6). Furthermore, year of study (adjusted odds ratios [AOR] = 2.66; 95% CI: 1.23-5.76), history of UTI (AOR = 2.57; 95% CI: 1.10-6.00), and sexual activity (AOR = 0.08; 95% CI: 0.02-0.39) were identified as factors. In this study, university students exhibited a higher prevalence of UTI compared to previous studies conducted in Africa. The most commonly identified bacteria causing UTIs were E coli, followed by S epidermidis. Factors such as the year of the study, presence of flank pain, history of previous UTIs, and frequency of sexual activity were found to be associated with UTIs. All the isolates have acquired resistance to the majority of commonly prescribed antibiotics. It is crucial to regularly monitor UTIs and the proliferation of antibiotic-resistant bacteria among university students.

Population structure and distribution of geladas (Theropithicus gelada, Ruppell 1835) in Kotu forest, Northern Ethiopia.

Endemic gelada populations outside protected areas are less investigated, and population census data are not available. As a result, a study was conducted to investigate the population size, structure, and distribution of geladas in Kotu forest and associated grasslands, in northern Ethiopia. The study area was stratified into five dominant habitat types namely, grassland, wooded grassland, plantation forest, natural forest, and bushland based on dominant vegetation type. Each habitat type was further divided into blocks, and a total counting technique was used to count the individuals of gelada. The total mean population size of gelada in Kotu forest was 229 ± 6.11. The mean ratio of male to female was 1:1.178. The gelada age composition comprised is as follows: 113 (49.34%) adults, 77 (33.62%) sub-adults, and 39 (17.03%) juveniles. The mean number of group one-male unit ranged from 1.5 ± 0.2 in the plantation forest to 4.5 ± 0.7 in the grassland habitat. On the other hand, all-male unit social system group was recorded only from grassland (1.5) and plantation forest (1) habitats. The average band size (number of individuals per band) was 45.0 ± 2.53. The largest number of geladas was recorded from grassland habitat 68 (29.87%), and the lowest was recorded from plantation forest habitat 34 (14.74%). Even though, the sex ratio was female biased, the proportion of juveniles to other age classes was very low compared with geladas in relatively well-protected areas, indicating negative consequences for the future viability of the gelada populations in the area. Geladas were widely distributed over open grassland habitat. Therefore, for sustainable conservation of the geladas in the area, there is a need for integrated management of the area with special attention on the conservation of the grassland habitat.

Daily Activity Pattern of Geladas (Theropithecus gelada, Ruppell 1835) in Kotu Forest, Northern Ethiopia.

Gelada (Theropithecus gelada) is one of the endemic primates of Ethiopia. The ecology of meta populations of geladas outside protected areas is less studied, and their population status is uncertain. As a result, we conducted a study to investigate the daily activity pattern of gelada in Kotu forest and associated grasslands in northern Ethiopia from August 2017 to February 2018 covering both wet and dry seasons. The instantaneous scan sampling method was employed to collect behavioral data. The activity pattern of three selected focal groups of geladas was studied, and predominant behavioral activities were scanned in 15 minutes intervals from dawn 7:00 h to dusk at 18:00 h. Feeding comprised 61.65% of the total scan, followed by moving 18.49%. Feeding activity was more frequent during the dry season (about 65%) than in the wet season (58.20%). On the other hand, moving activity was more frequent during the dry season (about 22%) than in the wet season (about 14%). The daily activity pattern of gelada showed a feeding peak early in the morning and in the late afternoon. The time allocated by geladas for feeding and moving in the study area is higher than other activities. Therefore, there is a need for further in-depth research on diet availability and quality to justify why geladas allocate more time for feeding and moving nexus for conservation interventions.

Bacterial Vaginosis and Associated Factors Among Pregnant Women Attending Antenatal Care in Harar City, Eastern Ethiopia.

Background: Bacterial vaginosis is one of the most common causes of abnormal vaginal discharge in women of reproductive age, especially pregnant women. It is characterized by the decrement of lactobacilli and increasing proliferation of diverse anaerobic bacteria. The prevalence of bacterial vaginosis and contributing factors vary between countries, within the same country, and among different populations. Objective: The purpose of this study was to determine the prevalence of bacterial vaginosis and associated factors among pregnant women attending antenatal care from May 5-July 15, 2021 in health-care facilities found in Harar town, eastern Ethiopia. Methods and Materials: An institutional-based cross-sectional study was conducted among 248 pregnant women attending antenatal care through systematic random sampling. Data were collected using a structured questionnaire and two vaginal swabs were collected using sterile swabs and transported to the microbiology laboratory. Samples were analyzed using Amsel's criteria or using Nugent scoring criteria and culture. Data were entered into EpiData version 3.1 and transferred to SPSS version 25 for analysis. Binary logistic regression was used to identify variables associated with bacterial vaginosis. P-value <0.05 was considered statistically significant. Results: Altogether 248 pregnant women were included in the study. Overall, 21.4% (95% CI: 16, 27) of study participants had bacterial vaginosis. History of sexually transmitted infection (AOR = 6.0, 95% CI: 1.94, 19.07; P = 0.002), history of spontaneous abortion (AOR = 5.8, 95% CI: 1.55, 22.02; P = 0.009), multiple sex partners (AOR = 8.6, 95% CI: 2.93, 25.79; P = 0.000) and having vaginal discharge (AOR = 5.5, 95% CI: 2.48, 12.41; P = 0.000) were significantly associated with bacterial vaginosis. Conclusion: The prevalence of bacterial vaginosis is higher among symptomatic pregnant women and associated with a history of sexually transmitted infection, vaginal discharge, multiple sexual partners and spontaneous abortion.

Health status of street children and reasons for being forced to live on the streets in Harar, Eastern Ethiopia. Using mixed methods.

INTRODUCTION: In Ethiopia, more than four million children are anticipated to live under particularly difficult circumstances. Street children are subject to violence, a lack of health care, and a lack of education. Which denies them the right to live in a secure environment and exposes them to different health problems. Currently, little is known about the prevalence of Streetism, including health conditions. Therefore, this study was aimed to assess the health status of street children and determinants of Streetism. METHODS: Mixed methods (sequential) were employed from February 1 to 28, 2021. Quantitative cross-sectional study design and phenomenological qualitative designs were applied. Overall, 220 street children were involved in the study. The most common reason that forced the children to resort to a street way of life is to look for a job and quarreled with parents. The data were collected using interviews methods. Chi-square test and multiple binary logistic regression were applied to examine the variations among variables with the health status of street children. Qualitative data were analyzed using the thematic analysis technique. RESULTS: The study included a total of 220 street children. As to the quantitative study, the majority of study participants (92.73%) drank alcohol regularly. Depression (39.22%) and peer pressure (43.14%) were the most common initiation causes of drinking alcohol. According to a qualitative study report, "Street children are mostly affected by the communicable disease" and… They are addicted to substances like benzene" which had a profound effect on their health." Furthermore, the study discovered a statistically significant association between respondents' health status and sociodemographic characteristics (age and educational status), job presence, and drug use. CONCLUSION: This study identified the factors that drove street children to live on the streets, such as the inability to find work and disagreements with their parents. The majority of the street children were affected by preventable and treatable diseases. Unfortunately, almost all street children reported drinking alcohol, which exposed them to a variety of health problems. In general, the study discovered that street children require immediate attention. Decision-makers and academicians should collaborate to develop a plan for these children's health and social interventions.

Urinary tract infection, antimicrobial susceptibility pattern of isolates, and associated factors among women with a post-fistula at public health facilities, Harar, eastern Ethiopia: A cross-sectional study.

INTRODUCTION: Urinary tract infection remains one of the major public health problems among post-fistula patients worldwide, particularly in sub-Saharan Africa. Besides, antimicrobial resistance impedes the effective infection prevention and treatment of ever-increasing bacteria. There was a paucity of data on urinary tract infections and the antimicrobial susceptibility profile of bacteria among post-fistula patients. OBJECTIVE: To determine the prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among women with post-fistula attending public health facilities, Harar, eastern Ethiopia. METHODS: An institutional-based cross-sectional study was conducted among 146 consecutively enrolled women with post-fistula from February 2017 to December 2018. Risk factors were collected using a structured questionnaire. The midstream urine was collected, cultured and bacteria species were identified by using standard culture methods. Antimicrobial susceptibility testing was done by the disk diffusion technique. The association between independent and outcome variables was computed by using logistic regression analysis. A p-value < 0.05 was considered statistically significant. RESULTS: The prevalence of urinary tract infections was 28.8% (95% confidence interval: 23.4, 33.6). Escherichia coli (19.1%), Pseudomonas aeruginosa (14.3%), and Proteus species (11.9%) were the commonest isolates. E. coli showed (75%) resistance to trimethoprim-sulfamethoxazole, amoxicillin (62.5%), and ciprofloxacin (62.5%). Staphylococcus aureus was shown 80% resistance to amoxicillin and erythromycin. Giving birth to a single baby (adjusted odds ratio: 0.3, 95% confidence interval: 0.1, 0.8), illness by a fistula for less than 3 years (adjusted odds ratio: 0.2, 95% confidence interval: 0.1, 0.6), and lack of a previous history of catheterization (adjusted odds ratio: 0.3, 95% confidence interval: 0.1, 0.9) decrease the odds of having urinary tract infections. CONCLUSION: Gram-negative organisms were the commonest cause of urinary tract infections in women with post-fistula. E. coli and P. aeruginosa showed higher resistance to most antimicrobials in the panels. Fistula patients need to be screened for urinary tract infections before antimicrobial treatment is indicated.

Sero-Prevalence of HBV and its Associated Factors Among Healthcare Providers in Public Health Facilities in Eastern Ethiopia.

BACKGROUND: Healthcare providers are in high occupational risk of Hepatitis B virus infection than that of the general population because of the high risk of occupational exposure to patients' body fluids and accidental sharp injuries. There are no large facility-based studies conducted on the prevalence of HBV infection and its associated factors among health care providers in eastern Ethiopia. OBJECTIVE: This study aimed at investigating the seroprevalence of Hepatitis B Virus and its associated factors among the healthcare providers in public health facilities in eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among 438 randomly selected healthcare providers in eastern Ethiopia from March to June 2018. Pretested structured questionnaire was used to collect data on socio-demographic characteristics and other risk factors. In addition, a 2.5 ml blood was collected and the serum was analyzed for Hepatitis B surface antigen using the Instant Hepatitis B surface antigen kit. Data were entered using Epidata version 3.1 and analyzed using SPSS statistical packages version 22. Descriptive summary measures were used. Bivariate and multivariable logistic regression was conducted at 95% CI. An association at P-value <.05 was considered statistically significant. RESULTS: A total of 438 (92.02% response rate) health care providers have participated in this study. The prevalence of hepatitis B virus infection was 9.6%. There were no significant differences in the HBV infection rates among healthcare providers with respect to socio-demographic characteristics (P-value >.05). After adjusting for some variables, the following variables remained statistically significantly associated with HBsAg positive result in the multivariable analysis: exposure to body fluids (AOR = 3.0; 95% CI [1.25, 7.05]), history of needle stick injury (AOR = 4.70; 95% CI [2.10, 10.55]), history of operation/surgery (AOR = 4.88, 95% CI [1.43, 16.62]), history of multiple sexual partner (AOR = 7.48; 95% CI [2.08, 26.96]), and being unvaccinated (AOR = 6.09; 95% CI [2.75, 13.51]). CONCLUSION: This study showed a high prevalence of HBV infection among health care providers in eastern Ethiopia. This is significant because health professionals may be at increased risk of chronic complications and may also be source of infection for their clients and general population during their healthcare practice. Management commitment that should focus on occupational safety and health promotions is necessary.

Perceived Self Efficacy in Implementing COVID-19 Preventive Measures Among Residents of Harari Regional State, Eastern Ethiopia: A Community-Based Cross-Sectional Study.

Background: The COVID-19 outbreak has now become a major international public health concern and a major challenge for the entire world. Poor adherence to COVID-19 prevention measures continues to be a challenge in managing COVID-19 pandemics, including in Ethiopia. As a result, the current study sought to identify the determinants of community adherence to COVID-19 preventive measures among the adult population of Harari Regional State in Eastern Ethiopia. Methods: A community-based cross-sectional study was conducted in Harari Regional State, Eastern Ethiopia from January 5 to 30, 2021. All adults above the age of 18 who lived in Harari Regional State's selected kebeles were eligible to participate in the study. A systematic random sampling method was used to select the study participants. The study included a total of 1,320 participants. Pre-tested, structured, and self-administered questionnaires were used to collect data, which was then analyzed using STATA version 16 software. The consent was obtained from each individual and concerned body. Binary logistic regression was used to find the correlation between community adherence to COVID-19 preventive measures and sociodemographic, knowledge, self-efficacy, and risk perception. A P-value of 0.05 was used as the statistical significance cut-off point. Results: One thousand two hundred fifty-five (1,255) people took the survey, yielding a 95.1 % response rate. Adherence to COVID-19 preventive measures resulted in a mean cumulative score of 29.8. Six hundred eight (48.5%) of the participants had good adherence to COVID-19 preventive measures, whereas 647 (51.5%) did not. The researchers also discovered a statistically significant link between participants' residence, educational status, risk perception, income, and adherence to COVID-19 preventive measures. Conclusion: Appropriate implementation of COVID-19 preventive measures among community members is required to manage or control pandemics and reduce health-related consequences associated with COVID-19 pandemics. The current study, on the other hand, discovered that nearly half of the study participants had poor adherence. As a result, in order to manage this pandemic, the relevant organizations, including the government and non-governmental organizations, must take appropriate and timely measures.

Magnitude of Surgical Site Infections, Bacterial Etiologies, Associated Factors and Antimicrobial Susceptibility Patterns of Isolates Among Post-Operative Patients in Harari Region Public Hospitals, Harar, Eastern Ethiopia.

BACKGROUND: Surgical site infections (SSIs) are infections that occur one month after a surgical operation or one year after implant surgery and a surgical procedure, either at the injury site or near the injury site. Surgical site infections are still a major global problem, especially in developing countries, where they cause increased morbidity and mortality. There is a dearth of information regarding SSIs in the eastern Ethiopia, particularly in this study area. OBJECTIVE: This study aimed to assess the prevalence of SSIs, bacterial etiologies, associated factors, and antimicrobial susceptibility patterns of isolates among post-operated patients admitted to public hospitals in the Harari Region, eastern Ethiopia. METHODS: A cross-sectional study was conducted among 306 patients who had undergone surgery. A pre-tested structured questionnaire was used for assessing the sociodemographic and clinical factors. Following standard microbiological techniques, wound swabs and pus specimens were collected and transported to Harar Health Research and Regional Laboratory for isolation, identification of bacteria, and antibiotic susceptibility test. Data were double entered onto Epi Data version 3.5.1 software and transferred to Statistical Package for the Social Sciences version 20.0 for analysis. P-value < 0.05 was declared as statistical significant. RESULTS: In this study, the overall prevalence of surgical site infection was 11.8% (95% CI: 8.3-15.4%) and Staphylococcus aureus (30.3%) was the most frequent isolate. Both S. aureus and coagulase negative Staphylococci were 100% resistant to penicillin. Wound with drain (AOR = 24.538; 95% CI: 10.053-59.898), being diabetic patient (AOR = 7.457, 95% CI 2.893-19.221), age >60 years (AOR = 4.139, 95% CI 1.278-13.40), surgical procedure duration of more than 2 hours (AOR = 0.159, 95% CI 0.040, 0.630), being alcohol drinker (AOR = 2.58, 95% CI 1.091-6.102) and having dirty surgical wound (AOR = 9.026; 95% CI: 3.503-23.255) were factors significantly associated with SSIs. CONCLUSION: In this study, single and multiple drug resistance to the commonly used antibiotics was high. Therefore, intensifying the implementation of infection prevention and patient safety measures and identifying an etiological cause may minimize the burden.

Community risk perception and health-seeking behavior in the era of COVID-19 among adult residents of Harari regional state, eastern Ethiopia.

BACKGROUND: COVID-19 brought significant challenges to public health. It changed the view of global health and safety, trust in the healthcare system, and clients' willingness to seek healthcare. To contain the course of the COVID-19 pandemic and its detrimental effects, understanding peoples' health behavior, especially healthcare-seeking, and determining the community risk perception is very important. Thus, this study aimed to determine the health-seeking behavior, community's risk perception to COVID-19 pandemics, and factors influencing the community risk perception in Harari regional state, Ethiopia. METHODS: Community-based cross-sectional study was conducted from 5 to 30 February 2021. A total of 1320 adult (>18 years) participants were selected using systematic random sampling. The data were collected using an online kobo collect toolbox and analyzed using descriptive statistical tests. Chi-square test and multiple binary logistic regression were applied to examine the difference between variables. A p-value < 0.05 was considered to be of statistical significance. RESULTS: The study included 1296 respondents >18 years old. The overall prevalence of willingness to seek healthcare in the study area was 35.6% (95% CI: 33%-38.3.0%). The mean cumulative score of risk perception was 30.5 (SD ± 7.25) with the minimum and maximum score of 13 and 63, respectively. A total of 656 (50.6%) of the participants had low-risk perceptions concerning COVID-19. The study found a statistically significant association between risk perception and sociodemographic characteristics (age, educational status, and income), and knowledge of the respondents. CONCLUSION: The overall prevalence of willingness to seek healthcare was 35.6%. Healthcare intervention aimed to contain the COVID-19 pandemic should consider the factors associated with the study area. Similarly, the study found a low-risk perception among the community that needs critical action to manage the COVID-19 pandemic and to protect the community as a whole. Thus, it is necessary to improve community risk perception through health education.

Hepatitis B virus infection and associated risk factors among medical students in eastern Ethiopia.

BACKGROUND: Hepatitis B virus (HBV) is a highly contagious pathogen that has become a severe public health problem and a major cause of morbidity and mortality, particularly in developing countries. Medical students are at high occupational risk during their training. However, no facility-based studies were found among medical students in eastern Ethiopia. Thus, this study aimed to investigate the seroprevalence of Hepatitis B Virus and associated factors among medical students in eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among 407 randomly selected medical students from March to June 2018. A pretested and structured questionnaire was used to collect data on socio-demographic characteristics and other risk factors. A 5ml blood was collected, and the serum was analyzed for Hepatitis B surface antigen (HBsAg) using the Instant Hepatitis B surface antigen kit. Data were entered using Epidata version 3.1 and analyzed using SPSS statistical packages version 22. Outcome and explanatory variables were described using descriptive summary measures. Binary and multivariable logistic regression was conducted at 95% CI and an association at P-value < 0.05 was declared statistically significant. RESULTS: The seroprevalence of hepatitis B virus surface antigen was 11.5% (95%CI = 8.6, 14.7). Poor knowledge of universal precaution guideline (AOR = 2.58; 95% CI = [1.35-4.93]), history of needle stick injury (AOR = 2.11; 95% CI = [1.07-4.18]) and never been vaccinated for HBV (AOR = 2.34; 95% CI = [1.17-4.69]) were found statistically significantly associated with HBsAg positivity after multivariate analysis. CONCLUSION: Hepatitis B virus infection rate is high among health care trainees in eastern Ethiopia. Improvement at health care practice centers safety through training on universal precaution guidelines, and scaling up HBV vaccination is mandatory.

Prevalence and antimicrobial resistance patterns of Salmonella isolates in human stools and animal origin foods in Ethiopia: A systematic review and meta-analysis.

OBJECTIVE: Foodborne diseases caused by non-typhoid Salmonella and the emergence of antimicrobial resistance remain as a public health challenge, especially in developing countries. The current study aimed to estimate the pooled prevalence and the antimicrobial resistance patterns of non-typhoid Salmonella in Ethiopia. METHODS: Literature search was conducted from major electronic databases and indexing services. Both published and unpublished studies addressing the prevalence and antimicrobial resistance profiles of Salmonella in Ethiopia from 2010 to 2020 and those studies reported sample size and the numbers of isolates/number of positive samples were included in the study. Data were extracted using format prepared in Microsoft Excel. The identified data were exported to EndNote to remove duplicated studies, then after the remained articles were screened using title, abstract, and full text to identify studies that meet the inclusion criteria and finally appraised for methodological validity using JBI guideline. The pooled prevalence of Salmonella and its drug resistance pattern was computed by a random-effects model. I2 test statistic was used to test heterogeneity across studies. The presence of publication bias was evaluated using the Begg's and Egger's tests. RESULTS: A total of 49 eligible articles, 33 of them on human stools, 15 of them on animal origin foods, and one both on human stools and animal origin foods, were included in the study. The pooled prevalence of Salmonella among human stools and animal origin foods in Ethiopia was 4.8% (95% CI: 3.9, 5.9) and 7.7% (95% CI: 5.6, 10.4), respectively. The subgroup analysis detected high pooled prevalence, 7.6% (95% CI: 5.3, 10.7) among outpatients and low, 3.7% (95% CI: 2.6, 5.1) in food handlers. The pooled resistant level of Salmonella was 80.6% (95% CI 72.6, 86.7) for ampicillin and 63.5% (95% CI 53.7, 72.4) for tetracycline. Low pooled resistance pattern was reported in ciprofloxacin, 8.7% (95% CI 5.6, 13.3) and ceftriaxone 12.2% (95% CI 7.9, 18.3). There was some sort of publication bias. CONCLUSION: High pooled prevalence of Salmonella among human stools and animal origin foods which were 4.8% and 7.7% respectively, and high Salmonella resistance, >72% to ampicillin and tetracycline were detected in Ethiopia. Antimicrobial stewardship efforts and infection control strategies are required to mitigate this major public health concern.

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.

Prevalence, Antimicrobial Susceptibility Pattern, and Associated Factors of Urinary Tract Infections among Pregnant and Nonpregnant Women at Public Health Facilities, Harar, Eastern Ethiopia: A Comparative Cross-Sectional Study.

BACKGROUND: Urinary tract infection is one of the most common health problems worldwide, afflicting many women in reproductive age, especially in developing countries. Increased risk of infection has been attributed to pregnancy and antimicrobial resistance. OBJECTIVE: To compare the prevalence, antimicrobial susceptibility pattern of the bacteria and associated factors of urinary tract infections among pregnant and nonpregnant women attending public health facilities, Harar, Eastern Ethiopia. METHODS: A health facility-based comparative cross-sectional study was conducted among 651 randomly selected women from public health facilities, Harar, Eastern Ethiopia, between February 2017 and December 2017. Pertinent data were collected through a face-to-face interview using a structured questionnaire. The midstream urine specimen was collected and cultured on cysteine-lactose-electrolyte-deficient agar and blood agar. Pure isolates were tested against the ten most prescribed antimicrobials using the Kirby-Bauer disk diffusion method. Data were entered and analysed using Statistical Program for Social Sciences version 21. A p value <0.05 was considered statistically significant. RESULTS: The overall prevalence of significant bacteriuria was 23% (95% CI: 13.6, 26.8). The higher proportion of bacteria were isolated from pregnant women (14.1%) compared to nonpregnant women (8.9%). Escherichia coli (28.8%) and Streptococcus aureus (14.3%) were the most common isolates. E. coli was resistant to amoxicillin (83.3%), trimethoprim-sulfamethoxazole (78.6%), and ciprofloxacin (81%), whereas S. aureus was resistant to chloramphenicol (81%), erythromycin (81%), and amoxicillin (76.2%). Current symptoms, and history of catheterization increase the likelihood of urinary tract infections. CONCLUSION: Pregnant women were more likely infected with bacterial pathogens than nonpregnant women. Current symptoms, and catheterization increase the odds of urinary tract infections. More than half of the isolates were resistant to the commonly prescribed antimicrobials. Regular assessment of urinary tract infections and antimicrobial resistance are recommended to provide effective therapy and thereby prevent urinary tract complications.

Are Invasive Procedures and a Longer Hospital Stay Increasing the Risk of Healthcare-Associated Infections among the Admitted Patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia?

BACKGROUND: Healthcare-associated infection is a major public health problem, in terms of mortality, morbidity, and costs. Majorities of the cause of these infections were preventable. Understanding the potential risk factors is important to reduce the impact of these avoidable infections. The study was aimed to identify factors associated with healthcare-associated infections among patients admitted at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. METHODS: A cross-sectional study was carried out among 433 patients over a period of five months at Hiwot Fana Specialized University Hospital. Sociodemographic and clinical data were obtained from a patient admitted for 48 hours and above in the four wards (surgical, medical, obstetrics/gynecology, and pediatrics) using a structured questionnaire. A multivariate logistic regression model was applied to identify predictors of healthcare-associated infections. A p value <0.05 was considered statistically significant. RESULTS: Fifty-four (13.7%) patients had a history of a previous admission. The median length of hospital stay was 6.1 days. Forty-six (11.7%) participants reported comorbid conditions. Ninety-six (24.4%) participants underwent surgical procedures. The overall prevalence of healthcare-associated infection was 29 (7.4%, 95% CI: 5.2-10.6). Cigarette smoking (AOR: 5.18, 95% CI: 2.15-20.47), staying in the hospital for more than 4 days (AOR: 4.29, 95% CI: 2.31-6.15), and undergoing invasive procedures (AOR: 3.58, 95% CI: 1.11-7.52) increase the odds of acquiring healthcare-associated infections. CONCLUSION: The cumulative prevalence of healthcare-associated infections in this study was comparable with similar studies conducted in developing countries. Cigarette smoking, staying in the hospital for more than 4 days, and undergoing invasive procedures increase the odds of healthcare-associated infections. These factors should be considered in the infection prevention and control program of the hospital.

Breast cancer screening practice and its associated factors among women in Kersa District, Eastern Ethiopia.

INTRODUCTION: Breast cancer is one of the most common cancers and cause of death among women globally. Mortality due to breast cancer was higher in lower (LMICs) and middle-income countries than high income countries (HICs) mostly due to lack of timely detection and treatment. There was limited evidence related to breast cancer screening practice among women in Eastern Ethiopia. Therefore, the aim of this study was to assess breast cancer screening practice and its associated factors among women in this area. METHODS: A community based descriptive cross-sectional study design was conducted among 422 randomly selected women in Kersa district, Eastern Ethiopia using systematic sampling. Data were collected using pretested interviewer administered questionnaire. Logistic regression was used to analyse the association between the dependent and independent variables. RESULTS: The overall breast cancer screening practice among women was 6.9%. Women with the age of 26 years and above were 2.3 times more likely to have breast cancer screening practice as compared to women with age of 20-25 years (AOR=2.3; 95% CI: 1.4, 3.7), and women who had good knowledge on breast cancer risk factors were 3.4 times more likely to had breast cancer screening as compared to their counterpart (AOR=3.4; 95% CI: 1.3, 9.4). The women who had ever heard about breast cancer screening were 2.8 times more likely to have breast cancer screening as compared to those who had never heard about breast cancer screening (AOR=2.8; 95% CI: 1.2, 6.5). CONCLUSION: The overall breast cancer screening practice was very low among women in the study area. Age and women's knowledge towards breast cancer risk factors and breast cancer screening information were identified as important factors for breast cancer screening practice.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

Effect of chlorhexidine cord application on prevention of neonatal sepsis in developing countries: Systematic review and meta-analysis.

OBJECTIVE: The aim of this review was to identify the pooled effect of chlorhexidine cord application on prevention of neonatal sepsis in developing countries. METHODS: We have conducted systemic review and meta-analysis. Articles were searched from electronic databases such as PubMed, EMBASE, CINHAL, Cochrane central register of controlled trials (CENTRAL), and other sources such as direct Google search, Google Scholar, and POPline. Only randomized controlled trial studies were considered for this review. The effect of chlorhexidine cord application on prevention of neonatal sepsis and mortality was assessed as compared to dry cord care. RESULTS: Five studies from developing countries were included in the review with a total of 129,293 participants. Pooled result of meta-analysis showed that chlorhexidine cord application reduces neonatal sepsis by 32% as compared to dry cord care (relative risk [RR] 0.68, 95% confidence interval [CI] 0.57-0.81, random effect model, I2 =93%). It also indicated that chlorhexidine cord application reduces severe sepsis by 77% (RR 0.23, 95% CI 0.11-0.48, random effect model, I2 = 63%) and neonatal mortality reduction by 13 % as compared to dry cord care (RR 0.87, 95% CI 0.79-0.97, random effect model, I2 = 0%). CONCLUSIONS: Chlorhexidine cord application significantly reduces neonatal sepsis and mortality in developing countries. Therefore, we stress the importance of including chlorhexidine cord application into the essential newborn care in the setting with high burden of neonatal mortality. The review protocol was registered at PROSPERO with registration number CRD 42018089204.

Bacterial Nosocomial Infections and Antimicrobial Susceptibility Pattern among Patients Admitted at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Nosocomial infections remain a major cause of mortality and morbidity worldwide. Despite the highly specialized interventions and policies, the rate of infection is still high due to the emergence of antimicrobial-resistant bacteria. This study described the prevalence of bacterial nosocomial infections and antimicrobial susceptibility pattern of isolates among patients admitted at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. A hospital-based cross-sectional study was conducted among 394 nosocomial infection-suspected patients from March 2017 to July 2017. Data were collected using a structured questionnaire. Specimens from the respective site of infections were collected and examined for the presence of pathogenic bacteria and their antimicrobial susceptibility using standard culture and serological tests. Data were summarized using descriptive statistics. The prevalence of culture-confirmed bacterial nosocomial infection was 6.9% (95% CI: 4.3-7.9). Staphylococcus aureus (18.5%) was the most common isolate followed by Escherichia coli (16.7%). S. aureus showed 80% resistance to chloramphenicol and erythromycin, and 70% to cephalexin and tetracycline, respectively. A methicillin-resistant S. aureus made up 88.9% of all S. aureus isolates. Pseudomonas aeruginosa showed 83.7% resistance to each of ceftazidime and cephalexin, and 66.7% to chloramphenicol. The most common multidrug-resistant isolates were P. aeruginosa (30.4%) and S. aureus (21.7%). The prevalence of nosocomial infections in this study was comparable with other findings; however, the high rates of antimicrobial resistant isolates represent a substantial threat to the patients, communities, health care providers, and modern medical practices. Bacterial nosocomial infection treatment should be supported by culture isolation and antimicrobial susceptibility testing.

Intensified tuberculosis case finding, implementation of isoniazid preventive therapy and associated factors among people living with human immunodeficiency virus at public health facilities of Harari Region, Eastern Ethiopia: A cross-sectional study.

OBJECTIVE: Globally, the number of people living with human immunodeficiency virus (PLHIV) particularly in sub-Saharan Africa is growing. This has been resulted in increased number of tuberculosis (TB) new cases. To control burden of TB among PLHIV, a number of collaborative TB/HIV activities were recommended. However, data about collaborative TB/HIV services in the study area is scarce. The objective of this study is to assess intensified TB case finding, implementation of isoniazid preventive therapy (IPT) and associated factors among PLHIV. METHODS: A facility based cross-sectional study design was employed among 419 randomly selected PLHIV from public health facilities of Harari region. Systematic sampling method was used to obtain sample from each health facilities. Interviewer-administered questionnaire was used to collect data. Data were entered into EpiData and analyzed by SPSS statistical software. Multivariate logistic regression analysis was conducted to determine the presence of association between variables using odds ratio with 95% confidence interval and association was declared significant at P ≤ 0.05. RESULTS: One hundred fifteen (75.2%) of the respondents reported that they offered screening for TB during their HIV chronic cares and 94 (29.8%) of them were found to be positive for active TB. Female sex [AOR 2.51; 95%CI (1.52, 6.14)], educated patients [AOR 0.52; 95%CI (0.21, 0.83)], CD4 count greater than 350 cells/dl3 [AOR 0.62; 95%CI(0.22,0.82)], Antiretroviral Therapy (ART) initiation [AOR 0.50; 95%CI (0.35, 0.88)] and missing dose of ART [AOR 2.57; 95%CI (1.21, 5.32)] were significantly associated with TB infection. Nearly four-fifth (78.7 %) of the study participants were provided IPT. CONCLUSIONS: Screening of TB among PLHIV and implementation of IPT in the region is lower when compared to the findings of other studies conducted in different parts of the country and needs to be improved through implementation of national and international guidelines.