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Background: Streptococcus pyogenes is one of the major public health concerns causing human infections ranging from skin and throat infections to acute rheumatic fever and post streptococcal glomerulonephritis. Moreover, nowadays drug-resistant strains of S. pyogenes are emerging and can be transmitted through apparently healthy carriers to susceptible individuals. Objective: To assess the prevalence, antimicrobial susceptibility pattern and associated factors S. pyogenes among apparently healthy school children in Mekelle city primary schools, Northern Ethiopia. Methods: A cross-sectional study was conducted among 504 apparently healthy school children from February to May 2018. We used structured questionnaire to collect socio-demographic data. Throat specimens were collected using sterile cotton Swab and transported for culture, antimicrobial susceptibility and identification of S. pyogenes according to standard operating procedures. Data were analyzed using Stata 13 for descriptive statistics, bivariate and multivariate logistic regression. P-value <0.05 was declared statistically significance. Results: The mean age of the study participants was 11.5 years of which 55 % of them were females. The overall prevalence of S. pyogenes was 8.3 %. Being female, having low monthly income, weak personal hygiene, poor hand washing habit and crowded living style were significantly associated with the occurrence of S. pyogenes. The isolates of S. pyogenes showed resistance to Penicillin (69.1 %), Amoxicillin-Clavulanic acid (62 %), Ampicillin (54.6 %), Ceftriaxone (47.6 %), Tetracycline (14.4 %), Cefoxitin (7.2 %). About 57.15 % isolates were multidrug-resistant. Conclusions: This study revealed that some isolates of S. pyogenes among the apparently healthy school children were resistant to commonly prescribed antibiotic agents and associated with hygienic conditions and living style. Therefore, it is recommended to practice antimicrobial susceptibility test to maintain rational antibiotic use and improve hygienic and hand washing practices to decrease the likelihood of carriage rate.
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BACKGROUND: Infective endocarditis (IE) is a continuously evolving disease with a high mortality rate despite different advances in treatment. In Ethiopia, there is a paucity of data regarding IE. Therefore, this study is aimed at assessing IE-related in-hospital mortality and characterization of IE patients based on their microbiological, clinical features, and management profiles in the Ayder Comprehensive Specified Hospital (ACSH). METHODS: We conducted a hospital-based prospective follow-up study with all consecutive sampling techniques for suspected infective endocarditis patients admitted to ACSH from January 2020 to February 2022. Echocardiography was performed, and three sets of blood samples for blood culture were taken as per the standard protocol. We also performed isolation of microbial etiologies and antimicrobial susceptibility tests. The data was analyzed using STATA version 16. Stepwise logistic regression was run to identify predictors of in-hospital mortality. Effects were measured through the odds ratio at the 5% level of significance. RESULTS: Seventy-four cases of suspected infective endocarditis were investigated; of these, 54 episodes fulfilled modified Duke's criteria. Rheumatic heart disease (RHD) (85.2%) was the most common underlying heart disease. Murmur (94.4%), fever (68.5%), and pallor (57.4%) were the most common clinical findings. Vegetation was present in 96.3% of episodes. Blood culture was positive only in 7 (13%) episodes. Complications occurred in 41 (75.9%) cases, with congestive heart failure being the most common. All patients were managed medically, with no surgical intervention. The in-hospital mortality was 14 (25.9%). IE-related in-hospital mortality was significantly associated with surgery recommendation and myalgia clinical symptoms. CONCLUSION: IE occurred relatively in a younger population, with RHD as the most common underlying heart disease. There was a high rate of culture-negative endocarditis, and the majority of patients were treated empirically. Mortality was high. The establishment of cardiac surgery and strengthening microbiology services should be given top priority.
Subject(s)
Endocarditis , Hospital Mortality , Humans , Ethiopia/epidemiology , Male , Female , Adult , Middle Aged , Endocarditis/mortality , Endocarditis/microbiology , Endocarditis/diagnosis , Prospective Studies , Young Adult , Hospitals, Special , Aged , Follow-Up Studies , Echocardiography , Adolescent , Risk FactorsABSTRACT
BACKGROUND: Food borne diseases is a challenging problem nowadays. Salmonella and Shigella species are great concern of food-born outbreaks. Thus, this study was aimed to assess the prevalence, antimicrobial susceptibility test and associated factors of Salmonella and Shigella species in fruit juices and salads. METHODS: A community based cross sectional study design was carried out on 50 juice houses from December to March 2020 in Mekelle. One hundred fifty samples were collected aseptically from the juice houses for laboratory analysis. Information related to risk factors was obtained using a structured questionnaire. In the laboratory, samples were homogenized using peptone water and incubated overnight for enrichment. Then, Salmonella and Shigella species were isolated on Salmonella-Shigella agar and Xylose Lysine Deoxycholate agar. Disc diffusion method was used to perform antimicrobial susceptibility test. Using SPSS (version 22) package, descriptive statistics and Chi square test (χ2) were used to analyze the data, and p < 0.05 was considered as statistically significant. RESULT: The overall prevalence of Salmonella and Shigella species was 41/150 (27.33%; 95% CI: 20.20 - 34.46) with 33 (22%) Salmonella spp. and 8(5.33%) Shigella spp. Antimicrobial susceptibility tests of both Salmonella and Shigella spp.showed high resistance against ampicillin (100%), tetracycline (63.6 and 62.5%, respectively) and amoxicillin-clavulanic acid (100%). Accessibility of fruits to flies and dust had statistical association (p = 0.021) with occurrence of Salmonell a and/or Shigella spp. CONCLUSION: The overall prevalence of Salmonella and Shigella spp. was found to be significant. The resistant rate of isolates against ampicillin, tetracycline and amoxicillin-clavulanic acid was high. Storage sites for fruits should be inaccessible to flies and dust. Therefore, routine monitoring of juice houses should be promoted and regular evaluation of bacterial resistance pattern should be done for selective antimicrobial therapy. Furthermore, consistent training of juice makers on food safety and hygiene should be implemented by the concerned body.
Subject(s)
Anti-Infective Agents , Salads , Shigella , Amoxicillin-Potassium Clavulanate Combination , Ethiopia/epidemiology , Prevalence , Cross-Sectional Studies , Agar , Fruit and Vegetable Juices , Microbial Sensitivity Tests , Salmonella , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Ampicillin , Tetracycline , DustABSTRACT
Background: Campylobacter species are the most predominant bacterial agents to cause diarrhea in under-five children. It poses a serious challenge to public health worldwide with ongoing acquisition of resistance to different antimicrobials with multiple patterns. Thus, this study aimed to determine the prevalence, and antimicrobial resistance of Campylobacter species, and associated factors among under-five children with diarrhea in selected public health facilities. Methods: A cross-sectional study was conducted among under-five children with diarrhea using convenient sampling. Health facilities were selected using a simple random sampling method. The stool samples collected from 214 study participants were transported and processed following standard microbiological protocols. Campylobacter isolates were identified using Gram staining, biochemical test, serological test, and aerobic growth at 25°C. Antimicrobial susceptibility profiles of isolates were performed using the Kirby-Bauer method. Data were analyzed using SPSS ver. 25.0. Association between variables was assessed using Chi-square test and Logistic regression, with P ≤ 0.05. Results: The subject's mean age was 31.3 (±3.9) months. Of the 214 samples cultured, 14 (6.5%) of them were positive for Campylobacter species with 95% CI (3.3-10.3). Out of the isolated species, 12 (85.7%) were Campylobacter jejuni /Campylobacter coli and 2 (14.3%) were other Campylobacter species. Bottle feeding and history of direct contact to domestic animals were associated with Campylobacter species (AOR=5.13, CI=1.21-21.6, p=0.026 and AOR=4.93, CI=1.33-18.17, P=0.016), respectively. Campylobacter isolates were highly resistant to ciprofloxacin 5 (35.7%), and tetracycline 3 (21.4%). Conclusion: A higher incidence of Campylobacter species was obtained in children who were bottle-fed and who had a history of direct contact with domestic animals. The isolates were highly resistant to ciprofloxacin and tetracycline. These findings indicate that special attention is needed for better management of Campylobacter drug resistance in under-five children. To enhance and support our current findings, further research using molecular techniques is needed to identify the resistant and virulent genes of the bacterial isolates.
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Background: Little is known about bacteria that produce extended-spectrum beta-lactamases (ESBLs) and carbapenemase in patients with urinary tract infections (UTIs) in Tigrai, Ethiopia. The aim of this study was to describe the magnitude of ESBL- and carbapenemase -producing gram-negative bacteria among patients suspected of community- and hospital-acquired UTIs at a referral hospital in Tigrai, Ethiopia. Methods: A cross-sectional study was conducted at Ayder Comprehensive Specialized hospital from January 2020 to June 2020. A 10-20 mL sample of morning mid-stream and catheter urine was collected from consenting participants. Urine samples were cultured on cysteine lactose electrolyte deficient medium and MacConkey agar, and bacteria were identified using standard microbiological protocols. The Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing. The combination disk and modified Hodge tests were used detect ESBL and carbapenemase production, respectively. The data was entered into EPI 3.1 software and analyzed using SPSS version 21. Results: Overall, 67 gram-negative bacteria were recovered from 64 participants. Escherichia coli was the predominant isolate (68.6%), followed by Klebsiella pneumoniae (22.4%), while ESBL production was found in both Escherichia coli and Klebsiella pneumoniae (52.2% and 86.7%, respectively). Isolates recovered from patients with hospital-acquired UTIs were more likely to produce ESBLs (AOR= 16.2; 95% CI: 2.95-89.5). Carbapenemase was produced by 4.3% of E. coli and 20% of Klebsiella pneumoniae isolates. High resistance rates were found against tetracycline (84.8%), ampicillin (78.3%), amoxicillin/clavulanic acid (58.7%) for Escherichia coli isolates and against ampicillin (93.3%), sulphamethexazole trimethoprim (93.3%), cefotaxime (86.6%), and ceftazidime (86.6%), and tetracycline (73.3%) for Klebsiella pneumoniae. Conclusion: Most UTIs were caused by ESBL-producing bacteria, especially those that were related to healthcare. Microbiological-based therapy for patients with UTIs is essential at our study site due to high rates of ESBL and significant carbapenemase production with concomitant high rates of drug resistance to several antibiotics.
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BACKGROUND: Neonatal septicemia is a life threatening medical emergency that requires timely detection of pathogens with urgent rational antibiotics therapy. METHODS: A cross-sectional study was conducted between March 2017 to September 2018 among 317 septicemia suspected neonates at neonatal intensive care unit, Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, North Ethiopia. A 3 mL of blood was collected from each participant. Identification of bacterial species was done using the standard microbiological techniques. Antibiotic sensitivity test was done using disk diffusion method. Data were entered and analyzed using computer software SPSS version 22. Bivariate and multivariate regression analysis was applied to determine the association between variables. RESULTS: Of the 317 (190 male and 127 female) neonates, 116 (36.6%) were found to be with culture proven septicemia. Klebsiella species were the predominant etiologic agents. Length of hospital stay (AOR (adjusted odds ratio) = 3.65 (2.17-6.13), p < 0.001) and low birth weight (AOR = 1.64 (1.13-2.78), p = 0.04) were the factors associated with neonatalsepticemia. Most isolates showeda frightening drug resistance rate to the commonly used antimicrobial drugs. K. pneumoniae, E. coli, Enterobacter and Citrobacter species were 57% to100% resistant to ceftazidime, ceftriaxone, gentamycin, amoxacillin-clavulunic acid and ampicillin. All, 9 (100%) isolates of S. aureus were resistant to oxacilline, ampicillin,erythromycin and gentamycin. Furthermore, 55.6% S. aureus isolates were Methicillin Resistant Staphylococcus aureus. CONCLUSION: Neonaltal septicemia is found to be significantly high in the present study. As most of the isolates are potentially related to hospital acquired infections, prevention and control policy should have to be more strengthening in the neonatal intensive care unit.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteria , Neonatal Sepsis , Ampicillin/therapeutic use , Bacteria/classification , Bacteria/drug effects , Bacteria/isolation & purification , Citrobacter/drug effects , Citrobacter/isolation & purification , Cross-Sectional Studies , Drug Resistance, Bacterial , Enterobacter/drug effects , Enterobacter/isolation & purification , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Ethiopia , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Klebsiella/drug effects , Klebsiella/isolation & purification , Male , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Neonatal Sepsis/drug therapy , Neonatal Sepsis/microbiology , Oxacillin/therapeutic use , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purificationABSTRACT
Electronic devices have become ubiquitous in daily life, but they emit electromagnetic radiation, which may have negative health impacts at excessive levels. Little is known regarding the impact of radiation emissions on building occupants or strategies for reducing its intensity. This study applied a novel approach using system analysis to quantify radiation exposure in building spaces, examine building material responses to radiation propagation, and investigate risks to human health in the country of Qatar. Radiation intensity levels varied based on the location and type of building space. Different types of construction materials showed varied responses to electromagnetic field wave propagation. Drywall exhibited the best blocking effect, whereas glass and lumber walls exhibited poor blocking effects. The field strengths quantified in this study are less than the corresponding reference values specified by some jurisdictions, but they are still significantly higher than the safety levels defined in many other countries, which could result in significant health risks. The key strategies for improving indoor environmental quality include the use of shielding materials, spatial design, reduction of exposure time, increased exposure distance, and complete avoidance of exposure in sensitive areas.
Subject(s)
Air Pollution, Indoor/analysis , Construction Materials/analysis , Electromagnetic Radiation , Environmental Exposure/analysis , Environmental Monitoring/methods , Risk Assessment/methods , HumansABSTRACT
BACKGROUND: Pneumonia is a condition, where bacterial infections are implicated as the most common causes of morbidity and mortality in humans. The actual burden of HIV-infected patients with pneumonia is not well documented in Mekelle region of Ethiopia. This study estimated the prevalence of bacterial pneumonia in HIV patients, antimicrobial susceptibility patterns of pathogens implicated in pneumonia, and associated risk factors in Mekelle zone, Tigray, Northern Ethiopia, during August-December 2016. METHODS: Sputum specimens were collected from 252 HIV seropositive individuals with suspected pneumonia. Data on sociodemographics and risk factors were also collected using a structured questionnaire. Blood, Chocolate, and Mac Conkey agar plates (Oxoid, Hampshire, UK) were used to grow the isolates. The isolated colonies were identified based on Gram stain, colony morphology, pigmentation, hemolysis, and biochemical tests. The antimicrobial susceptibility test was performed using the modified Kirby-Bauer disc diffusion method. The analysis was performed using SPSS version 22 and p-value < 0.05 with corresponding 95% confidence interval (CI) was considered statistically significant. RESULTS: Out of the 252 samples, 110 (43.7%) were positive for various bacterial species. The predominant bacterial species were Klebsiella pneumoniae (n=26, 23.6 %) followed by Streptococcus pneumoniae (n=17, 15.5 %), Escherichia coli (n=16, 14.5%), Klebsiella spp. (n=15, 13.6%), Staphylococcus aureus (n=9, 8.2%), Enterobacter spp. (n=7, 6.3%), Pseudomonas aeruginosa (4, n=3.6%), Proteus spp. (n=4, 3.6%), Citrobacter freundii (n=7, 6.3%), Streptococcus pyogenes (3, 2.7%), and Haemophilus influenzae (n=2, 1.8%). Young age (18-29), recent CD4+ count less than 350 cells/mL, alcohol consumption, and HIV WHO stage II showed significant association with the occurrence of bacterial pneumonia. Resistance to penicillin, co-trimoxazole, and tetracycline was observed in 81.8%, 39.8%, and 24.5% of the isolates, respectively. CONCLUSIONS: The problem of pneumonia among HIV patients was significant in the study area. The high prevalence of drug-resistant bacteria isolated from the patient's samples possesses a health risk in immunocompromised HIV patients. There is a need to strengthen and expand culture and susceptibility procedures for the administration of appropriate therapy to improve patients management and care which may aid in decreasing the mortality.
Subject(s)
Bacteria , Drug Resistance, Bacterial , HIV Infections/epidemiology , HIV Infections/microbiology , HIV-1 , Pneumonia, Bacterial/epidemiology , Pneumonia, Bacterial/microbiology , Adolescent , Adult , Aged , Bacteria/classification , Bacteria/growth & development , Bacteria/isolation & purification , Cross-Sectional Studies , Disk Diffusion Antimicrobial Tests , Ethiopia , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , Pneumonia, Bacterial/drug therapy , Prevalence , Risk FactorsABSTRACT
Key goal and targets of the Ethiopia National Malaria Control Program are to achieve malaria elimination within specific geographical areas with historically low malaria transmission and to reach near-zero malaria transmission in the remaining malarious areas by 2020. However, back and forth population movement between high-transmission and low-transmission area imposes challenge on the success of national malaria control programs. Therefore, examining the effect of human movement and identification of at-risk populations is crucial in an elimination setting. A matched case-control study was conducted among 520 study participants at a community level in low malaria transmission settings in northern Ethiopia. Study participants who received a malaria test were interviewed regarding their recent travel history. Bivariate and multivariate analyses were carried out to determine if the reported travel was related to malaria infection. Younger age (adjusted odds ratio [AOR] = 3.20, 95% confidence interval [CI]: 1.73, 5.89) and travel in the previous month (AOR = 11.40, 95% CI: 6.91, 18.82) were statistically significant risk factors for malaria infection. Other statistically significant factors, including lower educational level (AOR = 2.21, 95% CI: 1.26, 3.86) and nonagricultural in occupation (AOR = 2.0, 95% CI: 1.02, 3.94), were also found as risk factors for malaria infection. Generally, travel history was found to be a strong predictor for malaria acquisition in the high-altitude villages. Therefore, besides the existing efforts in endemic areas, targeting those who frequently travel to malarious areas is crucial to reduce malaria infection risks and possibility of local transmissions in high-altitude areas of northern Ethiopia.
Subject(s)
Malaria, Falciparum/epidemiology , Malaria, Vivax/epidemiology , Adolescent , Adult , Case-Control Studies , Ethiopia/epidemiology , Female , Humans , Logistic Models , Male , Middle Aged , Risk Factors , Socioeconomic Factors , Travel , Young AdultABSTRACT
AbstractPatients' delay in seeking diagnosis is a major problem in the management of tuberculosis (TB). Relative to the burden of TB, there is lack of data on the magnitude of delays in seeking care and why patients fail to seek early care at health facilities in Ethiopia. A facility-based cross-sectional study was conducted from April to July 2013 in East Gojjam Zone, Amhara, Ethiopia, to assess patients' delays and associated factors in TB patients. Using simple random sampling, 605 (327 male and 278 female) participants were recruited. Of the total, 323 (53.4%) TB patients were delayed in seeking health care (median = 45 days; mean = 78.5 days). The following independent variables were associated with patient delays: age ≥ 45 years (adjusted odds ratio [AOR] = 8.74, 95% confidence interval [CI] = 4.71-16.23, P < 0.001); working as a farmer (AOR = 4.18, 95% CI = 1.44-12.11, P = 0.009); prior visit to holy water sites, traditional healers, and/or private drug shops (AOR = 69.11, 95% CI =13.91-343.29, P < 0.001; AOR = 14.74, 95% CI = 1.43-152.31, P = 0.024; AOR = 2.10, 95% CI = 1.22-3.59, P = 0.007, respectively); poor knowledge about TB (AOR = 2.79, 95% CI = 1.74-4.92, P = 0.006), and extrapulmonary TB (AOR = 14.69, 95% CI = 8.21-26.26, P < 0.001). Generally, patients' delay in seeking care at health facilities was high (53.4%). Most of TB patients getting treatment from holy water (95.3%; 101/106) and traditional healers (84.6%; 11/13) were delayed. Therefore, for early seeking in modern health care, a combination of interventions is required to encourage TB patients.
Subject(s)
Antitubercular Agents/therapeutic use , Health Knowledge, Attitudes, Practice , Patient Acceptance of Health Care/psychology , Time-to-Treatment/statistics & numerical data , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Adolescent , Adult , Age Factors , Cross-Sectional Studies , Delayed Diagnosis , Ethiopia/epidemiology , Farmers/psychology , Female , Humans , Male , Medicine, African Traditional/psychology , Middle Aged , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/isolation & purification , Rural Population , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/microbiology , Urban PopulationABSTRACT
OBJECTIVES: The aim of this study was to assess the utilization of standard operating procedures for acid-fast bacilli (AFB) smear microscopy. METHODS: A facility-based cross-sectional study was conducted in select health institutions in Mekelle City, Ethiopia, from July 1, 2015, through August 30, 2015. Using a simple random sampling technique, 18 health facilities were included in the study. Data were collected using a standard checklist and entered into Epi Info version 3.5.4 (Centers for Disease Control and Prevention, Atlanta, GA) for editing. Analysis was done using SPSS version 20 (SPSS, Chicago, IL). RESULTS: Of the 18 laboratory facilities, only seven (38.9%) had a legible AFB registration book. In three (16.7%) of the laboratories, heat fixation was not applied before adding primary staining reagent. In 12 (66.7%), the staining reagents had precipitates. Two laboratories had microscopes with mechanical stages that could not move freely on both axes. Seven (38.9%) of the laboratories reported samples to be negative before examining all required fields. Most laboratories, 16 (88.9%) and 17 (94.4%), respectively, did not run positive and negative controls after new batch reagent preparation. CONCLUSIONS: Tuberculosis microscopy was found to be substandard with clear gaps in documentation, sample collection, and processing.
Subject(s)
Bacteriological Techniques/standards , Cytodiagnosis/standards , Microscopy/standards , Quality Control , Tuberculosis, Pulmonary/diagnosis , Bacteriological Techniques/methods , Cross-Sectional Studies , Cytodiagnosis/methods , Ethiopia , Humans , Microscopy/instrumentation , Microscopy/methods , Sputum/microbiology , Staining and Labeling/methods , Staining and Labeling/standardsABSTRACT
BACKGROUND: Bacteriological examination of sputum is the cornerstone in diagnosis of pulmonary tuberculosis in developing world, which is usually done using a Ziehl-Nelseen (ZN) method. However, due to limited laboratory facilities that can satisfy the procedure, applicability of this procedure appears to be adversely affected in field conditions and at peripheral health institutions. Hence, it has become necessary to look for a procedure which can be used as alternative in such conditions.In a cross-sectional study, using convenient sampling technique 362 pulmonary tuberculosis suspected patients who attended at Mekelle University Hospital (MUH) between November 2011 and February 2012 were included. After obtaining an informed consent, spot-morning-spot sputum samples were collected from suspected patients. Then a set of duplicate slides, of which one was allocated to a two-reagent cold method (a method of staining which requires carbol fuchsine as a primary stain and Gabbet's methylene blue both as a decolorizer and counter stain) and the other to the Zeihl-Nelseen method were smeared evenly from representative portion of each specimen using the protocol for duplicate smear preparation. Stained smears were read blindly by two technologists at different occasions. Finally to assure quality, all positive smears and 25% of the negative smears were cross checked by senior experienced examiner. FINDINGS: Overall concordance between the two methods was 99.7% (kappa (κ) = 0.98; 95%, confidence interval 0.93-1.00), and the observed agreement was statistically significant (p<0.001). When evaluated against Ziehl-Nelseen method, sensitivity and specificity of the two-reagent cold staining method were 95.8% (95% confidence interval 93.7-97.9) and 100% respectively. Positive and negative predictive values of the two-reagent cold staining method were respectively 100% and 99.7%. Positive and negative agreements between the two techniques were respectively 97.9% and 99.9%. CONCLUSION: The two-reagent cold staining method was found to be a suitable alternative to the conventional Ziehl-Nelseen method; it was at least as specific as Ziehl-Neelsen method although somewhat less sensitive. However, large scale multicentric studies need to be performed for further evaluation of this cold staining method.