Six-year trend analysis of malaria prevalence at University of Gondar Specialized Referral Hospital, Northwest Ethiopia, from 2014 to 2019.

Globally, malaria is the major public health disease caused by plasmodium species and transmitted by the bite of the female anopheles mosquito. Assessment of the trend of malaria prevalence is important in the control and prevention of the disease. Therefore, the objective of this study was to assess the six year trend of malaria prevalence at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia, from 2014 to 2019. A retrospective laboratory registration logbook review study was conducted on the malaria blood film examination results at the University of Gondar Comprehensive Specialized Hospital. The data was collected by using a data extraction tool and entered into SPSS version 20 for analysis. Descriptive statistics were used to summarize the socio-demographic characteristics of study participants and presented by graphs, tables and texts. The binary logistic regression was also used to test the association the trend of malaria prevalence and different factors like sex, age, year, and season. From a total of 17,500 malaria blood film examinations, 1341 (7.7%) were confirmed for malaria parasites. Of the confirmed malaria cases, 47.2%, 45.6% and 7.2% were P. vivax, P. falciparum and mixed infection, respectively. The proportion of P. vivax was the predominant species in the first three study years (2014-2016) and P. falciparum became the predominant species in the last three study years (2017-2019). The odds of malaria prevalence was lower by 68%, 60% and 69% in the year 2017, 2018 and 2019 compared to 2014, respectively. It was also 1.41 times higher in males than in females. Moreover, the odds of malaria prevalence were 1.60, 1.64, 2.45 and 1.82 times higher in the age group of < 5, 5-14, 15-24 and 25-54 years old compared to the older age groups (> 54 years old), respectively. Even there was a significant declining in prevalence trend; malaria is still a major public health problem. The study showed that there was high seasonal fluctuation from year to year. Moreover, males and the younger age groups were more affected than females and old age groups, respectively. Therefore, malaria prevention and control activities should be strengthened and require extra efforts by considering these variability.

Evaluation of Hookworm Diagnosis Techniques from Patients in Debre Elias and Sanja Districts of the Amhara Region, Ethiopia.

BACKGROUND: Inappropriate diagnosis could intimidate the prevention and control of hookworm infection. Thus, this study was aimed at evaluating the performance of hookworm diagnosis methods. METHODS: An institution-based cross-sectional study was conducted from patients in Debre Elias and Sanja districts of the Amhara region, Ethiopia, from November 2019 to January 2020. The study subjects were selected conveniently. After the data was entered into Statistical Package for the Social Sciences (SPSS), sensitivity, specificity, predictive values, test accuracy, and agreement of the different hookworm diagnosis methods, namely, test tube flotation technique (TFT), McMaster (MM), formol-ether concentration (FEC), Kato-Katz (KK), and direct wet mount microscopy (DWMM), were calculated by using SPSS software. The composite reference standard (CRS) was used as the gold standard method. The kappa (κ) test was used to measure the level of agreement between diagnosis tests. RESULT: A total of 389 stool samples were collected from patients in the study. The overall prevalence of hookworm was 63.24%. The test tube flotation technique (TFT) was found to be the highest both in terms of sensitivity and diagnostic accuracy (100%). McMaster (MM) was the second most sensitive test (68.7%), followed by FEC (44.3%) and KK (38.2%). On the other hand, DWMM had the lowest sensitivity (37.4%), and its diagnostic accuracy was also the least (60%). Only TFT had a perfect agreement (agreement = 100%, kappa = 1) with the CRS. The sensitivity of DWMM, KK, and FEC showed a kind of linear function with the intensity of infection, but TFT and MM methods were not affected by the infection intensity. CONCLUSION: Hookworm is still a public health problem in the study area. TFT is by far more sensitive than MM, FEC, KK, and DWMM techniques.

In vivo and in vitro efficacy of a single dose of albendazole against hookworm infection in northwest Ethiopia: open-label trial.

BACKGROUND: Control of hookworm and other soil-transmitted helminth infections primarily relies on preventive chemotherapy using a single dose of albendazole/mebendazole drugs on high-risk groups. Herein, the efficacy of a single dose (400 mg) of albendazole (ALB) was investigated both in vivo and in vitro model in northwest Ethiopia. METHODS: An open-label, single-arm clinical trial was conducted to assess anti-hookworm effect of albendazole. Stool samples were collected and examined using McMaster and Harada-Mori filter paper culture. Eligible hookworm-infected patients were treated with a single dose of ALB. After 14-21 days post-treatment, stool samples were also taken again and re-examined using the abovementioned technique. Egg reduction rate (ERR) and larval motility were used as a therapeutic outcome measure. An independent t test was used to compare the mean difference in egg counts, and probit analysis was performed for calculating the lethal concentration dose of albendazole. P value < 0.05 at 95% CI was considered statistically significant. RESULTS: A total of 70 participants had completed the drug efficacy study. The efficacy of ALB against hookworm in terms of CR and ERR was 87% and 93%, respectively. Participants who had not eaten one or more hours prior to treatment had higher CR than those who had eaten within 1 h before treatment (97.4% vs 74.2%), while individuals with heavy infection intensity had a lower post-treatment ova clearing rate than those who were with light infection intensity (43% vs 94.6%). The in vitro larvicidal effect of ALB was 63-93% after applying 50-250 µg/ml concentration of ALB solution. The LC50 and LC99 were 152 µg/ml and 573 µg/ml, respectively. CONCLUSION: A single dose of albendazole was found to be effective for treating hookworm infections according to WHO anthelminthic evaluation standard in the study area. Preventive chemotherapy might therefore be extended to risk groups, with proper continuous monitoring of its efficacy to strengthen and keep the ongoing control and prevention measures one step ahead. TRIAL REGISTRATION: This trial is retrospectively registered with www.pactr.org , number PACTR202010511829332 on October 26, 2020.

Prevalence and Intensity of Schistosoma mansoni Infection and Its Associated Risk Factors Among Patients with and without HIV at Chuahit Health Center, Dembia District, Northwest Ethiopia.

BACKGROUND: Human Immunodeficiency Virus-1/AIDS and Schistosoma mansoni are widely spread in sub-Saharan Africa including Ethiopia and the co-infection is also prevalent, occurs commonly. Schistosoma mansoni infection has been suggested to be a risk factor for HIV transmission and progression. This study aims to assess the prevalence and intensity of Schistosoma mansoni infection and associated risk factors among individuals with and without human immunodeficiency virus (HIV) at Chuahit Health Center, West Dembia, Northwest Ethiopia. METHODS: Institutional based cross-sectional study was conducted from March to April 2019. Two hundred sixty-six study subjects were included in the study by using a systemic and convenient sampling technique. Pretested structured questionnaire was employed to collect data. Single stool samples were collected and examined for S. mansoni eggs. Finger prick and venous blood samples were collected for HIV-1 screening and viral load count. Data were analyzed using SPSS version 20. Independent t-test and one-way ANOVA were used to compare the mean of egg counts with HIV status and viral load counts, respectively. A P-value of less than 0.05 was taken as statistically significant. RESULTS: The overall prevalence and intensity of S. mansoni infection was 41 (15.4%) and 162.24 egg per gram of faeces (EPG), respectively. Prevalence of S. mansoni was higher in seronegative study participants though the difference is statistically insignificant. Higher intensity of infection was observed among seropositive study participants with high viral load counts (>1000 copies/mL). CONCLUSION: Relatively higher prevalence and intensity of S. mansoni infection were found. Study participants' occupation was identified as potential risk factor to S. mansoni infection. Further studies are needed to know the impact of HIV on the prevalence and intensity of S. mansoni infection in the study area.

Prevalence of Anemia and Iron Deficiency Among Pregnant Women Attending Antenatal Care Service at University of Gondar Hospital, Northwest Ethiopia.

BACKGROUND: Anemia, particularly pregnancy related iron deficiency anemia, increases the risk of maternal morbidity and mortality and the effects are more devastating in less developed and developing continents where pregnant women have low socioeconomic status. Thus, this study aimed to assess the prevalence and associated factors of anemia and iron deficiency anemia among pregnant women. METHODS: This institution based, cross-sectional study was conducted from January 1 to April 30, 2015 on a total of 217 pregnant women attending at University of Gondar Hospital, Northwest Ethiopia. A structured, pretested questionnaire was used to obtain sociodemographic information, nutritional factors, obstetrics and gynecological factors, and clinical condition. About 3 mL blood sample was collected for hemoglobin and serum ferritin deter-mination. Hgb concentrations and other RBC parameters were analyzed using a Cell Dyne 1800 hematology analyzer. Serum ferritin was measured by an automated Elecsys 1,020 using commercial kits. The data was entered to Epi info version 3.5.3 software and analyzed using SPSS 20. Frequency, proportion, and summery statistics was used to describe the study population in relation to study variables. Bi-variable and multi-variable statistical analysis was used. P-value < 0.05 was considered as statically significant. RESULTS: Out of 217 women enrolled in the study, 28 (12.9%) were found to be anemic with 75% mild, 21.4% moderate and 3.6% severe type of anemia. Anemia was more prevalent in the first (21%) and third (17.9%) trimesters. The overall prevalence of iron deficiency anemia was 3.2% (7/217) while from anemic pregnant women one fourth (25%) of them developed iron deficiency anemia. CONCLUSIONS: The overall prevalence of anemia was low and it was considered a mild public health problem. In this study, there were no statistically associated risk factors for anemia. Based on this finding, iron supplementation should be encouraged as a prophylactic measure.

Malaria-visceral leishmaniasis co-infection and associated factors among migrant laborers in West Armachiho district, North West Ethiopia: community based cross-sectional study.

BACKGROUND: Malaria and leishmaniasis are the two largest parasitic killers in the world. Due togeographical overlap of these diseases, malaria-visceral leishmaniasis co-infections occur in large populations and exist in different areas even if they have been poorly investigated. The aim of this study was to determine malaria-visceral leishmaniasis co-infection and their associated factors among migrant laborers. METHODS: Community based cross-sectional study was conducted from October-December 2016 on migrant laborers who are residents of rural agricultural camp in West Armachiho district and involved in sesame and sorghum harvesting. Standardized questionnaire was used to collect socio-demographic data and risk factors. Capillary blood was collected for giemsa stained blood film examination to detect and identify Plasmodium parasites. Recombinant kinensin (rk39) antigen test was performed to detect anti-leishmania donovani antibody. Data was coded, entered, checked for completeness and analyzed using SPSS version-20 statistical software. Chi-square test was applied to show a significant association between variables. P-value < 0.05 was considered as statistically significant. RESULTS: A total of 178 migrant laborers were included in this study. Of these, 74.2% belong to the age group 15-29; 61.2% come from lowland areas and 51.6% visit the area more than four times. Seroprevalence of visceral leishmaniasis was 9.6% (17/178); and 22.4% (40/178) of tested migrant laborers were found malaria infected. The overall prevalence of malaria-visceral leishmaniasis co-infection was 2.8%. Of the total migrant laborer, 47.8% used bed nets, of them 1.2% were malaria-visceral leishmaniasis co-infected; 72.5% used outdoor sites as usual sleeping site, among them 3.1% were malaria-visceral leishmaniasis co-infected; 60.1% were migrants, of which 2.8% were malaria-visceral leishmaniasis co-infected. All variables were not significantly associated with malaria-visceral leishmaniasis co-infection (P > 0.05). CONCLUSIONS: Prevalence of malaria-visceral leishmaniasis co-infection was low and it is not significantly associated with residence, number of visits, bed net utilization and outdoor sleeping habit even if both diseases are prevalent in the study area.

Rubella virus infections and immune status among pregnant women before the introduction of rubella vaccine in Amhara Regional State, Ethiopia.

BACKGROUND: Rubella and its associated congenital anomalies have been greatly reduced in most developed countries through use of the rubella vaccine. However, the magnitude of the problem is underestimated and there are no well-established rubella/congenital rubella syndrome prevention and control strategies in many developing countries, including Ethiopia. The aim of this study was to determine the prevalence of rubella virus infections among pregnant women and their immune status before the introduction of rubella vaccine in Amhara Regional State, Ethiopia. METHODS: A prospective cross-sectional study was conducted among pregnant women in Dessie, Felege-Hiwot, and University of Gondar referral hospitals, from December 2015 to February 2017. After obtaining written informed consent, socio-demographic data, reproductive history, clinical manifestations, and the possible risk factors for rubella virus infections were collected using a structured questionnaire. The laboratory analysis of rubella-specific antibodies was done using an enzyme-linked immunoassay method on venous blood samples. Data were entered and analyzed using IBM SPSS Statistics version 20. Binary logistic regression was used to determine the strength of association between the dependent variables and covariates. RESULTS: A total of 600 pregnant women were included in the study. Their mean age was 26.4±5years (range 16-40 years). The overall seroprevalence of rubella infection was 89%. Of the total study participants, 9.5% were positive for rubella-specific IgM antibody, which indicates acute/recent rubella virus infection. In contrast, 79.5% of them had protective levels of rubella-specific IgG antibody and were immune as a result of previous wild-type rubella infection. However, 11% of the pregnant women were negative for both rubella-specific antibodies; these women represent the susceptible group. CONCLUSIONS: A large number of pregnant women had acute/recent rubella virus infections at the time of data collection, indicating that the virus is endemic in the study area. More than a tenth of pregnant women were found to be susceptible to acquiring the infection in future pregnancies, with the possible risk of rubella-associated congenital anomalies. Hence screening of all women of child-bearing age before conception and during pregnancy might reduce the devastating effects of the virus on the developing fetus.

Comparison of Partec Rapid Malaria Test with Conventional Light Microscopy for Diagnosis of Malaria in Northwest Ethiopia.

Background. Laboratory diagnosis of malaria is the key for effective disease management. Diagnosis of malaria infection requires rapid, sensitive, and specific test methods with an affordable cost. This study was aimed to assess the diagnostic performance of Partec rapid malaria test with reference to light microscopy for the diagnosis of malaria in Northwest Ethiopia. Methods. A total of 180 febrile patients were tested for malaria using Giemsa stain microscopy and Partec rapid malaria test from June to July 2013 at Gendewuha health centers, Metema district. Data were analyzed using SPSS version 20 statistical software. Odds ratio with 95% CI was calculated. Result. The sensitivity and specificity of Partec rapid malaria test were 93.8% (95% CI = 87.1%-100%) and 87.9% (95% CI = 79.7%-96.1%), respectively, while the positive predictive value and negative predictive value were 6.4% (95% CI = 77.2%-95.5%) and 94.6% (95% CI = 88.7%-100%), respectively. There was also an excellent agreement between two tests with Kappa value of 0.811 (95% CI = 0.625-0.996). Conclusion. Partec rapid malaria test showed good sensitivity and specificity with an excellent agreement to the reference light microscopy. Therefore PT can be considered as alternative diagnostic tools in malaria endemic areas.

Malaria, Typhoid Fever, and Their Coinfection among Febrile Patients at a Rural Health Center in Northwest Ethiopia: A Cross-Sectional Study.

Background. Malaria and typhoid fever are major public health problems in tropical and subtropical countries. People in endemic areas are at risk of contracting both infections concurrently. Objectives. The study was aimed at determining the prevalence and associated risk factors of malaria, typhoid, and their coinfection among febrile patients. Methods. A cross-sectional study was conducted on 200 febrile patients suspected for malaria and/or typhoid fever from April to May, 2013, at Ayinba Health Center, Northwest Ethiopia. Blood samples were collected for blood culture, Widal test, and blood film preparation. Data were analyzed using SPSS version 20 statistical software. Results. The prevalence of malaria was 36.5% (n = 73). Among these 32 (43.8%), 30 (41.1%) and 11 (15.1%) were positive for P. falciparum, P. vivax, and mixed infections, respectively. The seroprevalence of typhoid fever was 38 (19%), but 1 (0.5%) with blood culture. Malaria typhoid fever coinfection was 13 (6.5%). 2-5-year-old children and poor hand washing habit were significantly associated with malaria and typhoid infection, respectively (P < 0.05). Conclusions. The prevalence of malaria and typhoid fever was found high. Further studies should be done on the other determinants of malaria and typhoid fever coinfection in different seasons and different study areas.