Efficacy of Albendazole and Mebendazole Against Soil Transmitted Infections among Pre-School and School Age Children: A Systematic Review and Meta-Analysis.

BACKGROUND: Soil-transmitted helminthic (STH) infections are the leading cause of stunting among children. To lessen the burden, the World Health Organization (WHO) recommended a periodic deworming program through the use of single-dose therapy in the endemic regions. Therefore, the purpose of this study was to synthesize evidence about the efficacy of anthelminthic drugs against STH infections among preschool and school-age children. METHODS: The Preferred Reposting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were followed in this study. Relevant electronic databases, including PubMed, Scopus, Embase, DOAJ, Science Direct, the WHO Clinical Trials.gov library, Google Scholar, and AJOL databases, were searched for relevant publications. Randomized controlled trials (RCTs) and non-randomized interventional studies focused on the efficacy of albendazole and mebendazole against STHs in children were included in the study. Review Manager was used to analyze the data. A random effects model was used to obtain the pooled estimated efficacy. To evaluate heterogeneity, the I2 test and Cochrane Q (χ2) were employed. The risk of publication bias was investigated using Egger's test and the funnel plot. The protocol of this review was registered at the PROSPERO international prospective register of systematic reviews (CRD42023401196). RESULTS: Of the 69 publications selected for the systematic review, 66 with complete data were included in the meta-analysis. Single doses of albendazole and mebendazole have shown satisfactory efficacy [egg reduction rate (ERR)] against Ascaris lumbricoides [95.54% (95% CI: 88.75-102.34%) and 98.69% (95% CI: 97.68-99.65%), respectively. The effectiveness of these two drugs against Trichuris trichiura and hookworms was comparatively low (< 80% ERR), except for albendazole, which showed high ERRs [93.44% (95%CI: 92.39-94.49%)] against hookworms. The cure rate (CR) of albendazole against T. trichiura, A. lumbricoides, and hookworms were 50.8%, 91.3%, and 78.32%, respectively. Likewise, mebendazole showed CRs of 48.15%, 92.8%, and 49.32% against T. trichiura, A. lumbricoides, and hookworms, respectively. Subgroups such as studies conducted after 2000, diagnostic type (McMaster), and longer follow-up weeks significantly reduced the efficacy of the two drugs against T. trichura. While the combination of albendazole or mebendazole with other drugs and RCT showed significantly improved efficacy against T. trichura. The count of eggs per gram of stool (EPG) was identified as one of the variables that negatively and significantly influenced the efficacy of albendazole or mebendazole against A. lumbricoides. CONCLUSION: Despite the wide range of ERRs and CR reported in the different articles included in this review, the pooled estimated efficacy of albendazole and mebendazole against STHs falls in the satisfactory category of WHO recommendations. Further evaluation of the combination of anthelminthic drugs as a preventive chemotherapy option and routine drug efficacy testing are necessary to prevent the emergence and widespread use of drug-resistant STHs.

Adherence to Anti-Retroviral Therapy (ART) and Its Determinants Among People Living with HIV/AIDS at Bonga, Kaffa, South-West Ethiopia.

Background: The scaling-up of antiretroviral therapy (ART) is the greatest accomplishment to reduce the burden of acquired immunodeficiency syndromes (AIDS) to date. However, it requires optimal adherence to be effective. Thus, this study was designed to assess the level of adherence of people living with HIV (PLWH) to ART and its determinants in one of the hardest-hit areas with HIV in Ethiopia. Methods: A health facility-based cross-sectional study design was conducted among adult PLWH, age >18 years, and receiving ART in southwest Ethiopia. Data was collected by face-to-face interviews following the Self-Rating Scale Item for drug adherence and from participants' medical cards. The effects of variables related to socio-demographic and socio-economic factors, disease and medication, health facilities, and patients' behavior on ART adherence were analyzed using a binary logistic regression model. The data was analyzed using R software. Results: Self-reported good adherence to ART recorded in this study was 73.1% (n =301/412). The risk of poor adherence was significantly higher among those who were divorced, merchants, used ART for longer durationsand were found in stage IV WHO pathogenesis. Contrarily, those who had a positive perception of the effectiveness of ART had significantly better adherence to ART. Longer duration on ART and frequency of pills taken, ≥3 pills per day, were significantly associated with a low CD4+ cell count (<500 cells/mm3). For each unit increase in medication frequency per day, the likelihood of having a high viral load of >1000 copies/mL was 5.35 times higher. Conclusion: The ART adherence documented in this study was graded as moderately low. Some variables, such as clinical, medical, and behavioral, were found to affect the adherence of people living with HIV to ART. Hence, care providers should be aware of such variables in the process of treatment, follow-up, and monitoring of people living with HIV in the study area.

The changing malaria trend and control efforts in Oromia Special zone, Amhara Regional State, North-East Ethiopia.

BACKGROUND: Countries in malaria endemic regions are determinedly making an effort to achieve the global malaria elimination goals. In Ethiopia, too, all concerned bodies have given attention to this mission as one of their priority areas so that malaria would be eradicated from the country. Despite the success stories from some areas in the country, however, malaria is still a major public health concern in most parts of Ethiopia. Therefore, this study is aimed at analysing the changing malaria trend and assessing the impact of malaria control efforts in one of the malaria endemic regions of Ethiopia. METHODS: Five years data on clinical malaria cases diagnosed and treated at all health facilities (including 28 Health Centres, 105 Health Posts and 2 Hospitals) in Oromia Special zone, Amhara Regional State, Ethiopia, were reviewed for the period from June 2014 to June 2019. Data on different interventional activities undertaken in the zone during the specified period were obtained from the Regional Health Bureau. RESULTS: The cumulative malaria positivity rate documented in the zone was 12.5% (n = 65,463/524,722). Plasmodium falciparum infection was the dominant malaria aetiology and accounted for 78.9% (n = 51,679). The age group with the highest malaria burden was found to be those aged above 15 years (54.14%, n = 35,443/65,463). The malaria trend showed a sharp decreasing pattern from 19.33% (in 2015) to 5.65% (in 2018), although insignificant increment was recorded in 2019 (8.53%). Distribution of long-lasting insecticidal nets (LLIN) and indoor residual spraying (IRS) were undertaken in the zone once a year only for two years, specifically in 2014 and 2017. In 2014, a single LLIN was distributed per head of households, which was not sufficient for a family size of more than one family member. Number of houses sprayed with indoor residual spray in 2014 and 2017 were 33,314 and 32,184 houses, respectively, leading to the assumption that, 151,444 (25.9%) and 141,641 (24.2%) population were protected in year 2014 and 2017, respectively. The analysis has shown that P. falciparum positivity rate was significantly decreased following the interventional activities by 3.3% (p = 0.009), but interventional efforts did not appear to have significant effect on vivax malaria, as positivity rate of this parasite increased by 1.49% (p = 0.0218). CONCLUSION: Malaria burden has shown a decreasing pattern in the study area, although the pattern was not consistent throughout all the years and across the districts in the study area. Therefore, unremitting surveillance along implementation of interventional efforts should be considered taking into account the unique features of Plasmodium species, population dynamics in the zone, seasonality, and malaria history at different districts of the zone should be in place to achieve the envisaged national malaria elimination goal by 2030.

In vivo efficacy of anti-malarial drugs against clinical Plasmodium vivax malaria in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ethiopia is one of the few countries in Africa where Plasmodium vivax commonly co-exists with Plasmodium falciparum, and which accounts for ~ 40% of the total number of malaria infections in the country. Regardless of the growing evidence over many decades of decreasing sensitivity of this parasite to different anti-malarial drugs, there has been no comprehensive attempt made to systematically review and meta-analyse the efficacy of different anti-malarial drugs against P. vivax in the country. However, outlining the efficacy of available anti-malarial drugs against this parasite is essential to guide recommendations for the optimal therapeutic strategy to use in clinical practice. The aim of this study was to synthesize evidence on the efficacy of anti-malarial drugs against clinical P. vivax malaria in Ethiopia. METHODS: All potentially relevant, peer-reviewed articles accessible in PubMed, Scopus, Web of Science, and Clinical Trial.gov electronic databases were retrieved using a search strategy combining keywords and related database-specific subject terms. Randomized controlled trials (RCTs) and non-randomized trials aiming to investigate the efficacy of anti-malarial drugs against P. vivax were included in the review. Data were analysed using Review Manager Software. Cochrane Q (χ2) and the I2 tests were used to assess heterogeneity. The funnel plot and Egger's test were used to examine risk of publication bias. RESULTS: Out of 1294 identified citations, 14 articles that presented data on 29 treatment options were included in the analysis. These studies enrolled 2144 clinical vivax malaria patients. The pooled estimate of in vivo efficacy of anti-malarial drugs against vivax malaria in Ethiopia was 97.91% (95% CI: 97.29-98.52%), with significant heterogeneity (I2 = 86%, p < 0.0001) and publication bias (Egger's test = -12.86, p < 0.001). Different anti-malarial drugs showed varied efficacies against vivax malaria. The duration of follow-up significantly affected the calculated efficacy of any given anti-malarial drug, with longer duration of the follow-up (42 days) associated with significantly lower efficacy than efficacy reported on day 28. Also, pooled PCR-corrected efficacy and efficacy estimated from altitudinally lower transmission settings were significantly higher than PCR-uncorrected efficacy that estimated for moderate transmission settings, respectively. CONCLUSION: The overall efficacy of anti-malarial drugs evaluated for the treatment of vivax malaria in Ethiopia was generally high, although there was wide-ranging degree of efficacy, which was affected by the treatment options, duration of follow-up, transmission intensity, and the confirmation procedures for recurrent parasitaemia. Regardless of evidence of sporadic efficacy reduction reported in the country, chloroquine (CQ), the first-line regimen in Ethiopia, remained highly efficacious, supporting its continuous utilization for confirmed P. vivax mono-infections. The addition of primaquine (PQ) to CQ is recommended, as this is the only approved way to provide radical cure, and thus ensure sustained efficacy and longer protection against P. vivax. Continuous surveillance of the efficacy of anti-malarial drugs and clinical trials to allow robust conclusions remains necessary to proactively act against possible emergence and spread of drug-resistant P. vivax in Ethiopia.

Plasmodium vivax epidemiology in Ethiopia 2000-2020: A systematic review and meta-analysis.

BACKGROUND: Ethiopia is one of the scarce African countries where Plasmodium vivax and P. falciparum co-exist. There has been no attempt to derive a robust prevalence estimate of P. vivax in the country although a clear understanding of the epidemiology of this parasite is essential for informed decisions. This systematic review and meta-analysis, therefore, is aimed to synthesize the available evidences on the distribution of P. vivax infection by different locations/regions, study years, eco-epidemiological zones, and study settings in Ethiopia. METHODS: This study was conducted in accordance with Preferred Reposting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Studies conducted and published over the last two decades (2000 to 2020) that reported an estimate of P. vivax prevalence in Ethiopia were included. The Cochrane Q (χ2) and the I2 tests were used to assess heterogeneity, and the funnel plot and Egger's test were used to examine publication bias. A p-value of the χ2 test <0.05 and an I2 value >75% were considered presence of considerable heterogeneity. Random effect models were used to obtain pooled estimate of P. vivax infection prevalence. This study is registered with PROSPERO (International Prospective Register of Systematic Reviews): ID CRD42020201761. RESULTS: We screened 4,932 records and included 79 studies that enrolled 1,676,659 confirmed malaria cases, from which 548,214 (32.69%) were P. vivax infections and 1,116,581 (66.59%) were due to P. falciparum. The rest were due to mixed infections. The pooled estimate of P. vivax prevalence rate was 8.93% (95% CI: 7.98-9.88%) with significant heterogeneity (I2 = 100%, p<0.0001). Regional differences showed significant effects (p<0.0001, and I2 = 99.4%) on the pooled prevalence of P. vivax, while study years (before and after the scaling up of interventional activities) did not show significant differences (p = 0.9, I2 = 0%). Eco-epidemiological zones considered in the analysis did show a significant statistical effect (p<0.001, I2 = 78.5%) on the overall pooled estimate prevalence. Also, the study setting showed significant differences (p = 0.001, and I2 = 90.3%) on the overall prevalence, where significant reduction of P. vivax prevalence (4.67%, 95%CI: 1.41-7.93%, p<0.0001) was observed in studies conducted at the community level. The studies included in the review demonstrated lack of publication bias qualitatively (symmetrical funnel plot) and quantitatively [Egger's test (coefficient) = -2.97, 95% CI: -15.06-9.13, p = 0.62]. CONCLUSION: The estimated prevalence of P. vivax malaria in Ethiopia was 8.93% with P. vivax prevailing in the central west region of Ethiopia, but steadily extending to the western part of the country. Its distribution across the nation varies according to geographical location, study setting and study years.

Magnitude of Anemia and Its Associated Factors among Pregnant Women Attending Antenatal Care at Najo General Hospital, Northwest Ethiopia.

Anemia is one of the major causes of morbidity for pregnant women in resource-limited regions. Yet robust research-based evidence on this vital public health problem in remote areas where the problem could be massive is quite limited in Ethiopia, one of the developing countries. Thus, this study is aimed to assess the magnitude of anemia and its associated risk factors among pregnant women attending one of the health facilities in Ethiopia. A facility-based cross-sectional study design was employed in 2019. A total of 384 pregnant women attending the antenatal care (ANC) unit of Najo General Hospital, Northwest Ethiopia, were included in the study. Their sociodemographic characteristics, and medical, obstetric, and gynecological history were collected using pretested interview questionnaires. Blood samples were collected from each participant for the determination of malaria parasite and hemoglobin (Hb) level. In addition, stool samples were collected for examination of intestinal parasites. Data were analyzed using Statistical Package for Social Science (SPSS) software version 25. The overall magnitude of anemia among pregnant women was 37.8% (95% CI, 32.8%-42.3%). The proportion of mild anemia, moderate anemia, and severe anemia was 24%, 11%, and 2.3%, respectively. Some variables such as absence of malaria infection (AOR: 0.195, 95% CI: 0.066-0.576), lack of history of abortion (AOR: 0.469, 95% CI: 0.265-0.830), and absence of history of anemia (AOR: 0.227, 95% CI: 0.134-0.385) were identified as protective variables of anemia during pregnancy, while urban residence (AOR: 1.753, 95% CI: 1.013-3.034) was unexpectedly found as a predisposing factor. Despite the higher number of anemic pregnant women observed in the current study, pregnancy-associated anemia is moderate public health importance in the study area.

Prevalence and Determinants of Soil-Transmitted Helminthic Infections among School Children at Goro Primary School, South West Shewa, Ethiopia.

BACKGROUND: Soil-transmitted helminths (STH)/geohelminths are human parasitic nematodes which need soil contact for their egg development and become infectious. It is widely prevalent in developing countries. In Ethiopia, too, the same problem exists although the prevalence varies from place to place depending on the presence of risk factors and hygienic status of the community. Therefore, the current study is designed to assess the prevalence and determinants of STH among school children at Goro Primary School of Southwest Ethiopia. METHODS: A cross-sectional study design was employed from April to June 2019. The stool samples were collected in prelabeled, clean, and leak-proof stool cups and examined immediately. Direct wet mount and formalin ether concentration techniques were utilized to detect the STHs in a stool sample collected from all study subjects. A total of 387 stool samples were analyzed. Moreover, community- and individual-level risk factors associated with STH infection were assessed using semistructured questionnaire. RESULTS: The overall prevalence of soil-transmitted helminth infections observed at the study area was 15.8% (n = 61/387). Among these, the most abundant STH parasite was hookworms (n = 39/61, 63.93%) followed by Ascaris lumbricoides (n = 22/61, 36.06%). Factors independently associated with soil-transmitted helminth infections were children from illiterate mother (AOR = 2.3, 95% CI: 1.1-4.8, P = 0.021), lack of habit of wearing shoes (AOR = 4.1, 95% CI: 2.0-8.5, P < 0.001), lack of frequent handwashing practice before meal (AOR = 2.3, 95% CI: 1.2-4.5, P = 0.019), use of unprotected drinking water (AOR = 39, CI:3.9-393, P = 0.002), and presence of dirt in their fingernails (AOR = 3.5, 95% CI: 1.8-6.9, P < 0.001). CONCLUSIONS: STH infection observed in the study area could be classified into the low-risk area group (according to the World Health Organization classification) calling for none or case-by-case treatment. Thus, enhancing awareness of the community in the study area on how to keep personal hygiene and environmental sanitation is quite important to keep the burden to a controllable level, besides implementation of regular deworming program in the locality.

The haematological consequences of Plasmodium vivax malaria after chloroquine treatment with and without primaquine: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis.

BACKGROUND: Malaria causes a reduction in haemoglobin that is compounded by primaquine, particularly in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The aim of this study was to determine the relative contributions to red cell loss of malaria and primaquine in patients with uncomplicated Plasmodium vivax. METHODS: A systematic review identified P. vivax efficacy studies of chloroquine with or without primaquine published between January 2000 and March 2017. Individual patient data were pooled using standardised methodology, and the haematological response versus time was quantified using a multivariable linear mixed effects model with non-linear terms for time. Mean differences in haemoglobin between treatment groups at day of nadir and day 42 were estimated from this model. RESULTS: In total, 3421 patients from 29 studies were included: 1692 (49.5%) with normal G6PD status, 1701 (49.7%) with unknown status and 28 (0.8%) deficient or borderline individuals. Of 1975 patients treated with chloroquine alone, the mean haemoglobin fell from 12.22 g/dL [95% CI 11.93, 12.50] on day 0 to a nadir of 11.64 g/dL [11.36, 11.93] on day 2, before rising to 12.88 g/dL [12.60, 13.17] on day 42. In comparison to chloroquine alone, the mean haemoglobin in 1446 patients treated with chloroquine plus primaquine was - 0.13 g/dL [- 0.27, 0.01] lower at day of nadir (p = 0.072), but 0.49 g/dL [0.28, 0.69] higher by day 42 (p < 0.001). On day 42, patients with recurrent parasitaemia had a mean haemoglobin concentration - 0.72 g/dL [- 0.90, - 0.54] lower than patients without recurrence (p < 0.001). Seven days after starting primaquine, G6PD normal patients had a 0.3% (1/389) risk of clinically significant haemolysis (fall in haemoglobin > 25% to < 7 g/dL) and a 1% (4/389) risk of a fall in haemoglobin > 5 g/dL. CONCLUSIONS: Primaquine has the potential to reduce malaria-related anaemia at day 42 and beyond by preventing recurrent parasitaemia. Its widespread implementation will require accurate diagnosis of G6PD deficiency to reduce the risk of drug-induced haemolysis in vulnerable individuals. TRIAL REGISTRATION: This trial was registered with PROSPERO: CRD42016053312. The date of the first registration was 23 December 2016.

A declining pattern of malaria prevalence in Asendabo Health Center Jimma zone, Southwest Ethiopia.

OBJECTIVE: To assess the status of malaria prevalence in one of the malaria endemic areas of Ethiopia. RESULTS: A 10-year report of malaria cases were obtained from Asendabo Health Center, Jimma zone, Southwest Ethiopia. Following a retrospective study design, data of 68, 421 febrile patients diagnosed and treated in the health center were included in the study. The year with the highest prevalence rate (34.9%) was 2010, whereas the lowest was 2016 (0.62%). The number of diagnosed malaria cases from September to November were significantly higher (P = 0.023, n = 6336, 46.5%) than in other months. Plasmodium falciparum (52.1%, n = 7087) and Plasmodium vivax (44.2%, n = 6009) were the two principal plasmodium species accountable for malaria infections in the study area. The current study is a supportive evidence for the reduction of malaria prevalence in malaria endemic areas of Ethiopia.

The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis.

BACKGROUND: Chloroquine remains the mainstay of treatment for Plasmodium vivax malaria despite increasing reports of treatment failure. We did a systematic review and meta-analysis to investigate the effect of chloroquine dose and the addition of primaquine on the risk of recurrent vivax malaria across different settings. METHODS: A systematic review done in MEDLINE, Web of Science, Embase, and Cochrane Database of Systematic Reviews identified P vivax clinical trials published between Jan 1, 2000, and March 22, 2017. Principal investigators were invited to share individual patient data, which were pooled using standardised methods. Cox regression analyses with random effects for study site were used to investigate the roles of chloroquine dose and primaquine use on rate of recurrence between day 7 and day 42 (primary outcome). The review protocol is registered in PROSPERO, number CRD42016053310. FINDINGS: Of 134 identified chloroquine studies, 37 studies (from 17 countries) and 5240 patients were included. 2990 patients were treated with chloroquine alone, of whom 1041 (34·8%) received a dose below the target 25 mg/kg. The risk of recurrence was 32·4% (95% CI 29·8-35·1) by day 42. After controlling for confounders, a 5 mg/kg higher chloroquine dose reduced the rate of recurrence overall (adjusted hazard ratio [AHR] 0·82, 95% CI 0·69-0·97; p=0·021) and in children younger than 5 years (0·59, 0·41-0·86; p=0·0058). Adding primaquine reduced the risk of recurrence to 4·9% (95% CI 3·1-7·7) by day 42, which is lower than with chloroquine alone (AHR 0·10, 0·05-0·17; p<0·0001). INTERPRETATION: Chloroquine is commonly under-dosed in the treatment of vivax malaria. Increasing the recommended dose to 30 mg/kg in children younger than 5 years could reduce substantially the risk of early recurrence when primaquine is not given. Radical cure with primaquine was highly effective in preventing early recurrence and may also improve blood schizontocidal efficacy against chloroquine-resistant P vivax. FUNDING: Wellcome Trust, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.

Anti-plasmodial activities of Combretum molle (Combretaceae) [Zwoo] seed extract in Swiss albino mice.

OBJECTIVE: Objective of the study was to evaluate in vivo anti-plasmodial activities of Combretum molle seed extract. METHODS: As a standard protocol, initially the acute toxicity of the plant seed extract was checked following single administration of crude seed extract of the plant at doses 500, 1000 and 2000 mg/kg. This was followed by evaluation of anti-plasmodial activity of crude seed extract of the plant following a 4 days suppressive test. RESULTS: In acute toxicity study sign of toxicity was not observed. Also physical and behavioural changes were not detected. The crude seed extract of C. molle showed, 63.5% parasite suppression in mice infected with Plasmodium berghei ANKA (PbA) murine parasite and treated with 250 mg/kg of seed extract of C. molle. Relative survival time of mice treated with 250 mg/kg showed significantly longer survival than the negative control, while lower than mice treated with the standard drug, chloroquine. The plant seed extract on day-4 post-infection showed significant (P < 0.05) protection against body weight reduction, high body temperature and hemolysis of RBC at relatively lower doses. At optimum dose the crude extract of C. molle seed has good chemo-suppressive activity against PbA parasite and improved some clinical symptoms of malaria in mice.

Prevalence and Antimicrobial Resistance in Salmonella and Shigella Species Isolated from Outpatients, Jimma University Specialized Hospital, Southwest Ethiopia.

This study was designed to investigate the prevalence of Salmonella and Shigella among outpatients in Jimma University Specialized Hospital, Southwest Ethiopia. Cross-sectional study was conducted involving a total of 176 outpatients. Stool specimens from both adult and pediatric outpatients were collected and analyzed for the presence of presumptive Salmonella and Shigella colonies followed by confirmation by biochemical tests. Pure cultures of Salmonella and Shigella species were further subjected to test for antibiotic resistance against the commonly used antibiotics. Furthermore, growth potential of the isolates in selected foods items was assessed following standard procedures. The result indicated that the prevalence of Salmonella and Shigella among outpatients in the study area was 19 (10.8%) and 2 (1.1%), respectively. In addition, Salmonella species were resistant to ampicillin (100%) followed by tetracycline (47.4%) and nalidixic acid (26.3%) while Shigella species were highly resistant to ampicillin and tetracycline (100%, each). Multidrug resistance towards maximum of four drugs was observed in both pathogens. The pathogens were observed growing to their infective dose within 24 hours. In conclusion, Salmonella and Shigella are still among microbes of public health importance in the study area. Thus, this calls for frequent monitory and evaluation of their prevalence and drug resistance patterns besides awareness development on water sanitation and hygienic food handling practices to the public at large.

Complicated malaria symptoms associated with Plasmodium vivax among patients visiting health facilities in Mendi town, Northwest Ethiopia.

BACKGROUND: Malaria is still a major health problem in some parts of the world. Plasmodium falciparum is the common pathogenic parasite and is responsible for majority of malaria associated deaths. Recently the other benign parasite, P. vivax, is reported to cause life threatening severe malaria complications. Thus, this study was aimed to assess incidence of severe malaria symptoms caused by P. vivax parasite in some malaria endemic areas of Ethiopia. MATERIALS AND METHODS: Presumptive malaria patients (all age groups) seeking medication at the selected health facilities in Mendi town, Northwest Ethiopia, were recruited for the study. Socio-demographic, clinical and parasitological characteristics were assessed following standard procedures. Data was analyzed using descriptive statistics, chi-square test and relative risk. RESULTS: Of the 384 patients enrolled in the study for P. vivax mono-infection, 55 (14.3 %) of them were fulfilled at least one of the WHO criteria for severe malaria indicators. Some of these clinical manifestations were: prostration 14 (25.45 %), persistent vomiting 9 (16.36 %), respiratory distress 6 (10.9 %), hypoglycemia 5 (9.1 %), hyperpyrexia 8 (14.5 %), and severe anemia 13 (23.63 %). Differences in parasite load did not affect the frequency of some severe malaria symptoms. However, severe anemia, prostration, and persistent vomiting were significantly affected (P < 0.05) by relatively higher load of parasitemia, (OR = 3.8, 95 % CI, 1.1-13.7; OR = 4.4, 95 % CI, 1.4-13.9; and OR = 7, 95 % CI, 1.8-27.4) respectively. CONCLUSION: P.vivax associated severe malaria symptoms observed in this study is supportive evidence for the notion that P.vivax is no longer benign parasite but rather virulent. Thus, to meet international and regional targets of malaria eradication, a holistic prevention and control approaches should be designed.

Severe Malaria Associated with Plasmodium falciparum and P. vivax among Children in Pawe Hospital, Northwest Ethiopia.

Despite rigorous effort made to control malaria for more than a century, it is still among the main public health problems in least developed regions of the world. Majority of deaths associated with malaria occur in sub-Sahara Africa among biologically risked groups. Thus, this study was designed to assess the incidence of severe malaria syndromes among children in Pawe Hospital, Northwest Ethiopia. Children seeking medication for malaria infection in Pawe Hospital during the study period were recruited. Sociodemographic characteristics, physical, hematological, and clinical features of complicated malaria were assessed following standard parasitological and clinical procedures. A total of 263 children were found malaria positive. Among these, 200 were infected with Plasmodium falciparum. Most of the severe malaria symptoms were observed among children infected with P. falciparum and P. vivax. The study showed that significant number of the children developed severe life threatening malaria complications. This calls for prompt early diagnosis and effective treatment of patients to reduce mortality and complications associated with malaria in the study site.

Physico-chemical and bacteriological quality of drinking water of different sources, Jimma zone, Southwest Ethiopia.

BACKGROUND: The quality of drinking water has always been a major health concern, especially in developing countries, where 80% of the disease cases are attributed to inadequate sanitation and use of polluted water. The inaccessibility of potable water to large segment of a population in the rural communities is the major health concern in most part of developing countries. This study was designed to evaluate the physico-chemical and bacteriological qualities of drinking water of different sources in the study area. METHODS: The study was conducted at Serbo town and selected kebeles around the same town in Kersa district of Jimma Zone, southwest Ethiopia. Socio-demographic characteristics of the study populations were gathered using structured and pre-tested questionnaires. Standard microbiological methods were employed for determination of bacterial load and detection of coliforms. Physico-chemical analyses [including total dissolved substances (TDS), total suspended substances (TSS), biological oxygen demand (BOD), nitrate and phosphate concentrations, turbidity and electrical conductivities] were conducted following guidelines of American Public Health Association and WHO. Correlations among measured parameters of water samples collected from different water sources were computed using SPSS software (version 20). RESULT: Only 18.1% (43/237) of the study population had access to tap water in the study area. More than 50% of the community relies on open field waste disposal. Members of the family Enterobacteriaceae, Bacillus and Pseudomonas were among dominant bacterial isolates in the water samples. All water samples collected from unprotected water sources were positive for total coliforms and fecal coliforms (FC). Accordingly, FC were detected in 80% of the total samples with counts ranging between 0.67 and 266.67 CFU/100 ml although 66.67% of tap water samples were negative for FC. The recorded temperature and pH ranged between 20.1-29.90 °C and 5.64-8.14, respectively. The lowest and highest mean TDS were 116 and 623 mg/l, respectively. Furthermore, the mean concentration of TSS ranged between 2.07 and 403.33 mg/l. Turbidity, electric conductivity, and nitrate concentration of the water samples ranged, respectively, between 0.01-65.4 NTU, 30.6-729 µS/cm, and below detection limit to 95.80 mg/l. In addition, the mean dissolved oxygen values were found to be between 1.62 and 10.71 mg/l; whereas BOD was within the range of 8-77 mg/l. In all water samples, the concentrations of zinc were within the WHO maximum permissible limits (3 mg/l) although the lead concentration in about 66.7% of the samples exceeded the maximum permissible limit (0.01 mg/l). CONCLUSION: The present study has revealed that some of the bacteriological data and physico-chemical parameters of the different water sources had values beyond the maximum tolerable limits recommended by WHO. Thus, it calls for appropriate intervention, including awareness development work and improving the existing infrastructure in order to minimize the potential health problems of those communities currently realizing of the available water sources.

Incidence of Severe Malaria Syndromes and Status of Immune Responses among Khat Chewer Malaria Patients in Ethiopia.

Although more emphasis has been given to the genetic and environmental factors that determine host vulnerability to malaria, other factors that might have a crucial role in burdening the disease have not been evaluated yet. Therefore, this study was designed to assess the effect of khat chewing on the incidence of severe malaria syndromes and immune responses during malaria infection in an area where the two problems co-exist. Clinical, physical, demographic, hematological, biochemical and immunological data were collected from Plasmodium falciparum mono-infected malaria patients (age ≥ 10 years) seeking medication in Halaba Kulito and Jimma Health Centers. In addition, incidences of severe malaria symptoms were assessed. The data were analyzed using SPSS (version 20) software. Prevalence of current khat chewer malaria patients was 57.38% (95%CI =53-61.56%). Malaria symptoms such as hyperpyrexia, prostration and hyperparasitemia were significantly lower (P<0.05) among khat chewer malaria patients. However, relative risk to jaundice and renal failure were significantly higher (P<0.05) in khat chewers than in non-khat chewer malaria patients. Longer duration of khat use was positively associated with incidence of anemia. IgM and IgG antibody titers were significantly higher (P<0.05) among khat chewer malaria patients than among malaria positive non-chewers. Although levels of IgG subclasses in malaria patients did not show significant differences (P>0.05), IgG3 antibody was significantly higher (P<0.001) among khat chewer malaria patients. Moreover, IgM, IgG, IgG1and IgG3 antibodies had significant negative association (P<0.001) with parasite burden and clinical manifestations of severe malaria symptoms, but not with severe anemia and hypoglycemia. Additionally, a significant increment (P<0.05) in CD4+ T-lymphocyte population was observed among khat users. Khat might be an important risk factor for incidence of some severe malaria complications. Nevertheless, it can enhance induction of humoral immune response and CD4+ T-lymphocyte population during malaria infection. This calls for further investigation on the effect of khat on parasite or antigen-specifc protective malaria immunity and analysis of cytokines released upon malaria infection among khat chewers.

Effect of chronic khat (Catha edulis, Forsk) use on outcome of Plasmodium berghei ANKA infection in Swiss albino mice.

BACKGROUND: The objective of this study was to explore effects of khat (Catha edulis) on outcome of rodent malaria infection and its anti-plasmodial activities on Plasmodium berghei ANKA (PbA). METHODS: Female Swiss albino mice were orally treated with crude khat (Catha edulis) extracts (100, 200 and 300 mg/kg) on a daily basis for 4 weeks prior to PbA infection. Physical, clinical, hematological, biochemical and histo-pathological features of the mice were assessed. In addition, in vivo anti-plasmodial activities of khat were evaluated. RESULTS: The finding of this study showed that khat use was strongly associated with increment of levels of liver and kidney biomarkers, leucopenia, severe anemia, rise in level of inflammation biomarkers: C-reactive protein (CRP), uric acid (UA), increased monocyte-lymphocyte count ratio (MLCR), manifestation of cerebral malaria symptoms such as ataxia, paralysis and deviation of the head but with no pulmonary edema. Significantly lower level of parasitemia (P<0.05), rectal temperature, but, high level of hemoglobin were observed at the early stage of the PbA infection in khat treated mice than the control. With extension of the treatment period, however, drastic increments were observed in parasite load and rectal temperature although there was reduction in hemoglobin (Hb) level. Moreover, khat showed poor anti-plasmodial activity with <10% parasite suppression activity and lack protection against major malaria symptoms. The significant reduction (P<0.01) of hematological parameters during PbA infection strengthen the notion that hematological parameters could be good predictors of severe malaria complications in human. CONCLUSIONS: In mice model treated with khat prior to infection with the rodent malaria parasite, khat was found to worsen manifestation of most malaria complications. Furthermore, the same plant showed poor in vivo anti-plasmodial activity and protection against major malaria symptoms.

Evaluation of immunomodulatory activities of methanolic extract of khat (Catha edulis, Forsk) and cathinone in Swiss albino mice.

BACKGROUND: The objective of this study was to explore the immunomodulatory effect of khat and its active component, cathinone, using mice. MATERIALS AND METHODS: Female Swiss albino mice aged 7-8 weeks weighing 25-30 g were used in the study. Mice were randomized into eight groups of 6 each and oral treatment of khat crude extract and cathinone were given daily for four weeks. Physical, hematological, biochemical, and immunological parameters were measured. Immunological studies included humeral immunity (IgG and IgM), cellular immune response (delay type hypersensitivity), phagocytic activities of reticuloendothelial system, and determination of T-lymphocyte population: CD3(+), CD4(+), CD8(+) count and CD4(+)/CD8(+) status. RESULTS: Findings of this study showed that, khat and its major metabolite, cathinone, can positively affect immune system in dose dependent manner. When doses of crude khat extract and cathinone increase, the induction of humeral (IgG and IgM) and cellular immune responses were up-regulated significantly (P < 0.05), while at higher dose of khat (200 mg/kg) cellular immune response was suppressed. In support of this, as doses of the two test substances increased, the count of T helper cells (CD4(+)) was significantly increased (P < 0.05), while higher dose significantly reduced whole white blood cell (WBC), CD8(+), and CD3(+) counts. CONCLUSION: At relatively lower dose (50-100 mg/kg), crude khat extract has immune stimulating property, although higher dose (200 mg/kg) leads to suppression of cellular immune response. Cathinone also share all immune modulating property of its parent compound, khat, but with intense strength. Thus, it calls for further detailed investigation of khat for practical application of the same in human medication.

Microbial load and safety of paper currencies from some food vendors in Jimma Town, Southwest Ethiopia.

BACKGROUND: Paper currency is used for every type of commerce and plays an important role in the life of human beings. However, the combination of its widespread use and constant exchange make paper currency a likely agent for disease transmission. Thus, the aim of this study was to evaluate the microbial load and safety of Ethiopian paper currencies collected from some food vendors in Jimma town. METHODS: Standard microbiological methods were used for the enumeration of various microbial groups, isolation and characterization of pathogenic bacteria and their growth potential in selected weaning foods. A total of 100 samples of Ethiopian paper currencies, consisting of five denominations, from street food venders, hotels and cafeterias in Jimma town were collected aseptically. Sterile cotton swabs moistened with buffered peptone water solution were used for swabbing and the swabs were separately soaked into 10 ml sterile buffered peptone water solution. RESULTS: Mean microbial counts of Aerobic mesophilic bacteria, Staphylococci, Enterobacteriaceae, coliforms and Aerobic bacterial spores were (log CFU/cm2) 6.32, 4.43, 3.14, 2.98 and 3.78, respectively. However, mean counts of Yeasts and Moulds were below detectable levels. There was statistically significant variation (p<0.05) among the mean counts of microbes isolated from samples of paper currencies. The predominantly isolated microbial groups were Staphylococcus spp. (34.06%) followed by Bacillus spp. (31.88%), Enterobacteraceae (13.39%), Micrococcus spp. (9.55%) and Streptococcus spp. (9.03%). Overall, 25% and 10% of the samples were positive for S. aureus and Salmonella spp, respectively. In challenge study, Salmonella spp. and S. aureus reached the infective dose within 12 to 18 hours of inoculation. CONCLUSION: Thus, paper currencies could be considered as one of the possible vehicles for transmission of disease causing microorganisms. Poor handling practices and personal hygiene of the food vendors could contribute to the observed microbial counts. Thus, it calls for awareness development on the potential risks associated with poor handling of paper currencies at all level of the food establishments.