The COVID-19 Severity and Its Association with Intestinal Parasite Coinfection and Urine Biochemical Parameters among COVID-19-Confirmed Patients Admitted to Debre Markos University COVID-19 Center, Northwest Ethiopia.

Background: Though most people with COVID-19 disease show asymptomatic to mild illness, a substantial number of patients are at high risk of developing severe disease and adverse outcomes with long COVID-19 and death. Even though some studies showed that previously existing infections with parasites amend the host's body defenses to increase resistance to infection with SARS-CoV-2, there is limited data in Ethiopia. Objectives: This study is aimed at determining the COVID-19 disease severity and its association with intestinal parasite coinfection and urine biochemical parameters among COVID-19-confirmed patients admitted at Debre Markos University COVID-19 Center, 2021. Methods: A prospective cohort study was conducted on 136 RT-qPCR-confirmed COVID-19 patients admitted at Debre Markos University COVID-19 Center from January 1 to March 30, 2021. Sociodemographic and clinical data were collected by using standardized data collection forms. A urine biochemical test was performed using a dry urine dipstick kit and stool examination using direct wet mount microscopic examination and formalin-ether concentration method. The chi-square test, Fisher exact test, and ordinal logistic regression analysis were computed to assess association with outcome variables using Statistical Package for Social Science software (version 24). Result: A total of 136 COVID-19-confirmed patients participated in this study. The median age of the participants was 48 years. The majority (86 (62.5%)) of them were male in sex. Of the 136 cases, 39 (28.7%) had died. Among the 136 patients, 22 (16.2%) were coinfected with intestinal parasites. COVID-19 patients who have intestinal parasite coinfection had lower odds of developing clinically severe COVID-19 compared to noninfected (AOR = 0.37; 95% CI = 0.147-0.944; P = 0.037). The majority (104 (76.5%)) of them have abnormal urine biochemical results. From the abnormal urine biochemical tests observed, the urine blood, glucose, and ketone tests were positive for 54 (39.7%), 36 (26.5%), and 30 (21.1%) patients, respectively. Among the 31 critical COVID-19 patients, 25 (80.6%) showed abnormal urine biochemical parameters. Age and comorbidity were significantly associated with COVID-19 severity (P < 0.05). Conclusion: Patients with old age and comorbidity had an increased risk of developing severe COVID-19 disease. Patients having SARS-CoV-2 and intestinal parasitic coinfections demonstrated mild COVID-19 disease severity. Abnormal urine biochemical results were common among critical COVID-19 patients. Thus, advanced study on the effect of the interaction among intestinal parasites on COVID-19 clinical severity and its mechanisms is essential.

Hematological Profiles and Clinical Outcome of COVID-19 Among Patients Admitted at Debre Markos Isolation and Treatment Center, 2020: A Prospective Cohort Study.

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is coronavirus isolated from SARS patients. As far as the researchers' knowledge, there was paucity of studies conducted in Ethiopia, particularly in the study area. As immune protection is arisen from our blood cells, assessing their level will provide a clue for controlling the disease and monitoring the prognosis. This study will also provide additional information for clinical intervention and patient management. Purpose: This study aimed to investigate the hematological profile and clinical outcome of coronavirus disease-19 (COVID-19) among patients admitted to the Debre Markos Isolation and Treatment Center (DMITC). Material and Methods: A prospective cohort study was conducted among 136 COVID-19 adult patients at DMITC from January 1, 2020 to March 30, 2021. Data related to clinical, hematological profiles and socio-demographic factors were collected, entered into Epi data, and analyzed using STATA 14.2 software. Multivariable logistic regression was applied to determine the predictor variable and a p-value <0.05 was considered significant. Results: Of 136 COVID-19 patients, 28.68% had died. The mean age of patients was 47.21±1.29 years. The hematological profile of the patients revealed that 28% had abnormal leukocyte, 23% abnormal lymphocyte, 44.85% abnormal granulocyte, 22.06% abnormal monocyte, 30.15% abnormal RBC and 87% abnormal platelet counts. The prevalence of anemia was 13.24%. Conclusion: Leukocytosis (mainly granulocytosis and monocytosis) and lymphopenia, were the predominant abnormal findings of complete blood cell count (CBC) analysis of the patient's blood. Most of the patients had abnormally low platelet counts. RBC count and hematocrit determination were the only significant predictors of death. The clinician could manage cases according to the hematological findings of the patients. Further experimental studies should be conducted to determine hematological parameter changes and the clinical outcome of the disease.

Prevalence, associated factors and rifampicin resistance pattern of pulmonary tuberculosis among HIV-positive patients attending antiretroviral treatment clinic at East Gojjam Zone, Ethiopia: An institution-based cross-sectional study.

Background: Drug-resistant tuberculosis (TB) threatens global TB care and prevention, and it remains a major public health concern in many countries particularly in sub-Saharan countries. Pulmonary TB is the most common serious opportunistic infection on HIV-positive patients and it is the leading cause of death among HIV-positive patients in developing countries. Ethiopia is one of the high TB burden countries with high morbidity and mortality. Objective: To determine the prevalence, associated factors and rifampicin resistance of pulmonary TB among HIV-positive attending antiretroviral treatment clinic at East Gojjam. Methods: Hospital-based cross-sectional study was conducted at Debre Markos Referral Hospital, from February to June 2019. A total of 112 HIV-positive TB suspected patients were included using convenient sampling techniques and a bacteriological confirmation test for tuberculosis was performed using Gene-Xpert MTB/RIF assay from a spot sputum sample. Viral load was determined by using a quantitative real-time polymerase chain reaction (RT-PCR) from the blood sample. Socio-demographic and clinical data were collected by face-to-face interview using a semi-structured questionnaire. The data were analyzed by using Statistical Package for Social Sciences (SPSS) software (version 24). Result: Out of the 112 study participants, the prevalence of Pulmonary TB was 11.6 %. Among TB positives 23.1 % were rifampicin resistant. Rifampicin resistance was 100 % among female patients. Having family members treated for pulmonary TB (P = 0.003, [AOR = 4.5; 95 % CI = 3.59-58.8]), cigarette smoking (P = 0.039, [AOR = 2.18; 95 %CI = 1.17-40.5]), being on WHO HIV disease clinical stage II (P = 0.024, [AOR = 1.81; 95 %CI = 1.50-30.99]), and having viral load (1000-9999) RNA copies/ml (P = 0.031, [AOR = 1.54; 95 %CI = 1.32-31.41]) were found to be significantly associated with pulmonary TB. Conclusion: The prevalence of pulmonary TB and rifampicin resistance was high among HIV patients. Having family members treated for Pulmonary TB, history of cigarette smoking, WHO HIV clinical stage, and high viral load were associated risk factors for TB. Therefore, strengthening awareness creation on TB transmission, drug resistance, and treatment adherence are essential. Moreover, early screening and treatment are vital for preventing the transmission and occurrence of drug-resistant TB among study populations.

The Prevalence, Antibiotic Resistance Pattern, and Associated Factors of Bacterial Vaginosis Among Women of the Reproductive Age Group from Felege Hiwot Referral Hospital, Ethiopia.

BACKGROUND: Bacterial vaginosis is an infection of the vagina, which results due to change in the normal balance of vaginal bacteria. The aim of this study was to assess the magnitude and determinants of bacterial vaginosis among women of reproductive age group from Felege Hiwot Referral Hospital. MATERIALS AND METHODS: A cross-sectional study was conducted among women during the reproductive period at Felege Hiwot Referral Hospital from September 1, 2019 to October 2020. About 413 vaginal swab samples were collected and examined using the Nugent scoring system and culture. Data were analyzed by SPSS version 25. The odds ratio (OR) was used as a measure of the strength of association and reported with 95% confidence intervals. P-value ≤ 0.05 was considered to be statistically significant. Bivariate and multivariate logistic regression models were used to identify possible associated factors with bacteria causing bacterial vaginosis. RESULTS: The overall prevalence of bacteria causing bacterial vaginosis was 39.5%. The predominant bacteria were S. aureus (25.4%), G. vaginalis (22.7%), S. agalactiae (14.1%), and E. coli (13.5%). S. aureus was resistant to erythromycin (69.8%) and trimethoprim/sulfamethoxazole (53.5%); despite this, it was susceptible to ciprofloxacillin (93%), gentamycin (93%), and cefoxitin (90.7%). On the other hand, E. coli was resistant to trimethoprim/sulfamethoxazole (91.3%) and ceftriaxone (63.6%), but was susceptible to ciprofloxacillin (95.5%) and gentamycin (93%). CONCLUSION: The high prevalence of bacterial vaginosis was significantly associated with the pH level of the vagina (≥4.5), participant age ≤20, pregnancy, and history of HIV infection. Therefore, early identification of factors leading to bacterial overgrowth on the vagina is very important to protect maternal and child morbidity and mortality.

Incidence and Predictors of Mortality among Preterm Neonates Admitted to the Neonatal Intensive Care Unit at Debre Markos Referral Hospital, Northwest Ethiopia.

BACKGROUND: Prematurity is the most frequent cause of neonatal death and the second leading cause of under-five mortality. Preterm related complications accounts for 35 % of neonatal deaths within the first week after birth. So far, most studies done in Ethiopia have focused on estimating the prevalence and determinant factors of premature neonatal death. The current study aimed to assess the incidence and predictors of mortality among preterm neonates admitted to neonatal intensive care unit at Debre Markos Referral Hospital. METHODS: An institution-based retrospective follow up study was conducted among premature neonates admitted to Neonatal Intensive Care Unit at Debre Markos Referral Hospital from July 2019 to October 2019. Around 498 patients were selected randomly. A multivariable cox proportional hazards model was fitted to identify predictors of mortality. RESULTS: A total of 498 preterm babies were followed, and the mean age for follow up at the time of admission to NICU was 15 hours ± 38 SD. Death rate in preterm was estimated to be 27.11% (95% CI: 23.3%, 31.1%). Preterm neonates with gestational age of less than 32 weeks (AHR=1.51; 95% CI: 1.02, 2.24), respiratory distress syndrome (AHR=1.49; 95% CI: 1.03, 2.17), perinatal asphyxia (AHR=1.74, 95% CI: 1.01, 2.76) and congenital malformation (AHR=3.38, 95% CI: 1.21, 8.77) were statistically significant predictors of mortality among preterms. CONCLUSION: The incidence of death in preterm neonates is relatively low. Gestational age less than 32 weeks, perinatal asphyxia, respiratory distress syndrome and congenital malformation were found as predictors.

Child Feeding Practice and Primary Health Care as Major Correlates of Stunting and Underweight among 6- to 23-Month-Old Infants and Young Children in Food-Insecure Households in Ethiopia.

BACKGROUND: Child undernutrition is a major public health problem in Ethiopia. Stunting is highest in food-insecure areas and insufficient evidence may impair the design of suitable interventions. OBJECTIVES: This study aimed to identify key factors contributing to undernutrition among 6- to 23-mo-old children. METHODS: A community-based cross-sectional study in food-insecure areas of Amhara and Oromia regions in April-June, 2018, enrolled 464 mother-child dyads. Bivariate and multivariate logistic regression analyses were conducted. RESULTS: The prevalence of stunting (43.1%), wasting (12.3%), and underweight (27.3%) were high. Factors significantly associated with both stunting and underweight were child age of 12-23 mo (vs 6-11 mo), female, more siblings, lack of zinc supplement for diarrhea, inadequate diet diversity, and lack of iodized salt in complementary food. Conclusions: Our findings support the need to emphasize appropriate child feeding practices and iodized salt utilization. Improvement of primary health care services related to micronutrient supplementation and family spacing also are important to address child undernutrition in the study area.

Nasal colonization of methicillin resistant Staphylococcus aureus in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is one of a medically important Gram-positive bacteria, which can be harboured majorly in the nasal cavity. Risk of consequent infection in a person colonized with S. aureus as well as MRSA upsurges with time and remains insistently increased. Hence, the objective of this meta-analysis was to determine the prevalence of S. aureus and MRSA nasal colonization in Ethiopia at large. METHODS: PubMed, Google Scholar, Embase, Hinari, Sci Hub, Scopus, and the Directory of Open Access Journals were searched and a total of 10 studies have been selected for meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the literature search strategy, selection of publications, data extraction, and the reporting of results for the review. All statistical analyses were performed using STATA version 11 software via random effects model. The pooled prevalence was presented in forest plots and figure with 95% CI. RESULTS: A total of ten studies with 2495 nasal swab samples were included in this meta-analysis, and the overall pooled estimated prevalence of S. aureus and MRSA nasal colonization in Ethiopia were 30.90% [95% CI 21.81-39.99%], 10.94% [95% CI 8.13-13.75%] respectively. Subgroup analysis was also noted in different regions of Ethiopia, henceforth Oromia region ranked first 21.28% [95% CI 8.22-34.35%], followed by Amhara region 6.78% [95% CI 3.02-10.54%], whereas relatively low magnitude of MRSA colonization was demonstrated from Tigray region 4.82% [95% CI 2.18-7.45%]. CONCLUSION: The analysis showed that the overall prevalence of S. aureus and MRSA nasal colonization in Ethiopia were comparable with the global prevalence. But a huge variation between the regions, so the Ministry of Health of Ethiopia should design appropriate decolonization program that can address the specific regional groups as well as the national population.

Bacterial Infections and Their Antibiotic Resistance Pattern in Ethiopia: A Systematic Review.

BACKGROUND: Antibiotic resistance is a global challenge in the public health sector and also a major challenge in Ethiopia. It is truly difficult to report bacterial antibiotic resistance pattern in Ethiopia due to the absence of a review which is done comprehensively. The aim of this systematic review was to provide an overview of the works of literature on the antibiotic resistance pattern of the specific bacterial isolates that can be obtained from different clinical samples in the context of Ethiopia. MATERIALS AND METHODS: A web-based search using PubMed, Google Scholar, Hinari, Sci Hub, Scopus and the Directory of Open Access Journals was conducted from April to May 2018 for published studies without restriction in the year of publication. Works of literature potentially relevant to the study were identified by Boolean search technique using various keywords: Bacterial infection, antimicrobial resistance, antibiotic resistance, drug resistance, drug susceptibility, anti-bacterial resistance, Ethiopia. Study that perform susceptibility test from animal or healthy source using <10 isolates and methods other than prospective cross-sectional were excluded. RESULTS: The database search delivered a total of 3459 studies. After amendment for duplicates and inclusion and exclusion criteria, 39 articles were found suitable for the systematic review. All studies were prospective cross-sectional in nature. The review encompasses 12 gram-positive and 15 gram-negative bacteria with their resistance pattern for around 12 antibiotics. It covers most of the regions which are found in Ethiopia. The resistance pattern of the isolates ranged from 0% up to 100%. The overall resistance of M. tuberculosis for antituberculosis drugs ranges from 0% up to 32.6%. The percentage of resistance increases among previously treated tuberculosis cases. Neisseria gonorrhea, S. typhimurium, S. Virchow, Group A Streptococci (GAS), and Group B Streptococci (GBS) were highly susceptible for most of the tested antibiotics. Methicillin-Resistant Staphylococcus aureus was highly resistant to most of the antibiotics with a slightly increased susceptibility to gentamycin. CONCLUSIONS: Total bacterial isolates obtained from a different source of sample and geographic areas were 28, including M. tuberculosis. Majority of the bacterial isolates were resistant to commonly used antibiotics. A continuous monitoring and studies on the multidrug-resistant bacterial isolates are important measures.

Prevalence and Associated Factors of Intestinal Parasitic Infections among Food Handlers at Prison, East and West Gojjam, Ethiopia.

INTRODUCTION: One of the top ten major public health problems in developing countries including Ethiopia is the intestinal parasitic infection. Most of the time, intestinal parasitic infections do not show clinical signs and symptoms and also have a number of potential carriers, such as food handlers, which makes it too difficult to eradicate and control. OBJECTIVE: The aim of this study is to assess the prevalence and associated factors of intestinal parasitic infection among food handlers at prison, East and West Gojjam, Ethiopia, 2017. METHODS: An institution-based cross-sectional study design was conducted at East and West Gojjam prison. A total of 416 study participants, with a response rate of 82.7%, were included in the study for both stool exam and questioner. Data were collected using a structured questionnaire, and the sample was collected and examined based on the standard parasitological procedure. Epi data Version 3.1 was used to enter data, and SPSS version 20 was used to analyze the data. RESULTS: The overall prevalence of intestinal parasitic infections in the present study was 61.9%. The most prevalent parasite was A. lumbricoides (157 (45.6%)). Protozoan infection was higher than helminth infection. Multiple intestinal infections were identified; among study participants, 34.6% had double infection. The most significant associated factors of intestinal parasitic infections were fingernail status, residence, information about food contamination related to intestinal parasitic infection, income, and handwashing before having contact with food and after toilet with water only. CONCLUSIONS: A high proportion of intestinal parasitic infection was detected among food handlers working at East and West Gojjam prison. Training must be given to the food handlers on personal hygienic conditions (finger trimming, handwashing after toilet and before having contact with food with water and soap, etc.).

Bacterial and Parasitic Assessment from Fingernails in Debre Markos, Northwest Ethiopia.

BACKGROUND: Food handlers with untrimmed finger nails could contribute or serve as a vehicle for the transmission of food poisoning pathogens. OBJECTIVES: This study was conducted to determine the prevalence of bacteria and intestinal parasites among food handlers and antibiotic susceptibility profile of the isolated bacteria in Debre Markos University, Ethiopia. MATERIALS AND METHODS: This laboratory-based cross-sectional study involved 220 food handlers working in food service establishments in Debre Markos University between 1st January 2015 to 31th June 2016. Subjects' finger nail specimens of both hands were examined microscopically for intestinal parasites. For bacterial isolation, samples were cultured and bacterial species were identified following standard laboratory procedures. Antimicrobial susceptibility test was performed for all bacterial isolates by using Kirby-Bauer disk diffusion method. RESULTS: Of the total 220 subjects examined, 29.5% showed positive culture for different bacterial species from their fingernail contents. Coagulase-negative Staphylococcus was the predominant bacteria species (12.3%) followed by Staphylococcus aureus (5%), E. coli (2.7%), Klebsiella species (2.7%), Enterococcus species (1.8%), Pseudomonas aeruginosa (1.8%), Proteus species (1.4%), Citrobacter species (1.4%), and Serratia species (0.9%). None of the food handlers showed positive culture for Shigella and salmonella and parasites in respect of their finger nail specimens. Isolation of bacteria in finger nail has significant association with finger nail status (P=0.044) and inverse relation with service years (P=0.048). All Staphylococcus aureus and coagulase-negative Staphylococcus species isolates were uniformly susceptible to vancomycin. Only one (9.1%) of Staphylococcus aureus isolates was resistant for methicillin. CONCLUSION: To prevent the food poisoning pathogens, implementation and adherence to infection are the key practices, specially food handlers with long finger nail harbor food debris, microbial contaminations, and allergens.

Prevalence and antimicrobial susceptibility pattern of Salmonella and Shigella among food handlers in catering establishments at Debre Markos University, Northwest Ethiopia.

BACKGROUND: Food-borne diseases are a major health problem in developing countries including Ethiopia. This study determined the prevalence and antibiotic susceptibility patterns of Shigella and Salmonella among food handlers working in student and staff food service establishments at Debre Markos University. METHODS: A laboratory-based cross-sectional study was conducted among 220 food handlers from January 2015 to June 2016. Stool and fingernail samples from the subjects were cultured on bacteriological culture medium, and Shigella and Salmonella were isolated and identified following standard procedures. Antimicrobial susceptibility testing was performed for all isolates using the Kirby-Bauer disk diffusion method. RESULTS: The overall prevalence of Shigella and Salmonella in this study was 5.9%, with 3.6% of stool specimens testing positive for Salmonella species and 2.3% testing positive for Shigella species. None of the food handlers had positive cultures for Shigella or Salmonella in respect of their fingernail specimens. The isolation of either Shigella or Salmonella had a significant inverse relationship with the number of service years (p=0.017). All isolates of Shigella and Salmonella were 100% susceptible to ciprofloxacin, norfloxacin, and gentamicin. However, all isolated pathogens were resistant to ampicillin (100%). CONCLUSIONS: The findings of this study highlight the importance of food handlers in the transmission of pathogens to the customers (students and the general population). Screening of food handlers, training for food handling and hand hygiene practices, and regular monitoring of the food handling practices should be done in order to avoid diseases that can be acquired through improper food handling, like bacterial infections.

The Role of Private Health Sector for Tuberculosis Control in Debre Markos Town, Northwest Ethiopia.

BACKGROUND: Tuberculosis has been declared to be a global epidemic. Despite all the effort, only less than half the annual estimated cases are reported by health authorities to the WHO. This could be due to poor reporting from the private sector. In Ethiopia, tuberculosis has also been a major public health problem. The aim of this study was to assess the role of the private health sector in tuberculosis control in Debre Markos. METHODS: An institution based cross-sectional descriptive study was carried out in private health facilities. A total of 260 tuberculosis suspects attending the private clinics were interviewed. Focus group discussion, checklist, and structured questionnaire were used. RESULTS: Majority of the private clinics were less equipped, poorly regulated, and owned by health workers who were self-employed on a part-time basis. Provider delay of 4 and more months was significantly associated higher likelihood of turning to a private provider (OR = 2.70, 95% CI = (1.20, 6.08)). CONCLUSIONS AND RECOMMENDATIONS: There is significant delay among tuberculosis patients. Moreover, there is poor regulation of the private health sector by public health authorities. The involvement of the private sector in tuberculosis control should be limited to identification and refer to tuberculosis cases and suspects.

Nasal colonization and antimicrobial susceptibility pattern of Staphylococcus aureus among pre-school children in Ethiopia.

BACKGROUND: Staphylococcus aureus is one of the bacterium that can asymptomatically colonize the human upper respiratory tract (i.e. nose and throat). Carriage of S. aureus, including methicillin resistant S. aureus, is common to children. The aim at this study was to determine the nasal colonization, associated factors and antimicrobial susceptibility patterns of S. aureus isolates among pre-school children in Debre Markos town. METHODS: Institutional-based cross sectional study was conducted. A total of 400 nasal swabs were collected from pre-school children from April to June, 2015 following standard microbiological methods. MRSA was detected using both Cefoxitin (30 µg) and Oxacillin (6 µg) (Oxoid Ltd. England) discs in combination and associated factors were assessed using self-administered pretested questionnaires, which were delivered to the children's parents/guardians. Statistical analysis of the data (logistic regression) was done using SPSS V-22. RESULTS: A total of 52 S. aureus isolate was recovered from 400 nasal swap samples. The prevalence of S. aureus among pre-School children was 13% (52/400). The susceptibility patterns of the isolates to commonly used antibiotics were: 84.62% to Chloramphenicol, 69.2% to Doxycycline and Tetracycline, 92.3% to Kanamycin, 7.7% to Ampicillin and Penicillin, 86.6% to Ceftriaxone, and 76.9% to Augmentin. All the isolates were sensitive to Oxacillin and Cefoxitin, mean there was no methicillin resistant S. aureus isolate, and also sensitive to Gentamycin, Erythromycin and Clindamycin. The main associated factors of nasal colonization of S. aureus in the study area was, having recurrent acute otitis media (AOM) [AOR = 2.37 (1.11, 5.06)], Children admission in hospital [AOR = 1.96 (1.03, 3.73)] and cough [AOR = 2.09 (1.08, 4.09)]. CONCLUSIONS: The prevalence of S. aureus nasal colonization among pre-school children was relatively low in absence of MRSA. Factors like; recurrent AOM, hospital admission and cough were significantly associated with S. aureus nasal colonization. Most of the isolates were resistant to ß-lactam drugs and sensitive to drugs like Gentamycin, Erythromycin, Clindamycin, Chloramphenicol, Doxycycline, Tetracycline, Kanamycin and Augmentin.