Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Multi-drug resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa are major causes of nosocomial infections globally. They are the current World Health Organization critical priority pathogens for resistance, Antimicrobial resistance (AMR) surveillance and discovery of new antibiotics. However, there is paucity of data on nosocomial infections (NIs) caused by such superbugs in Ethiopia. Therefore, this study determined the magnitude and profile of nosocomial MDR A. baumannii and P. aeruginosa infections among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia. METHODS: A cross-sectional study was conducted at Felegehiwot referral hospital from April 1 to July 31, 2018. A total of 238 patients with blood stream, urinary tract and surgical site NIs were enrolled conveniently. Either blood, urine and wound swab specimens were collected and processed using standard bacteriological procedures. A. baumannii and P. aeruginosa isolates were identified using standard bacteriological techniques and confirmed by automated Vitek2 Compact. Antimicrobial susceptibility testing on isolates was performed using the disk diffusion technique. The results were interpreted as per the standard zone sizes of Clinical and Laboratory Standards Institute.Chi-square test was done to determine associations among variables. P value < 0.05 was considered statistical significant. RESULTS: The median age of participants was 29 years. Overall,20(8.4%) of patients had nosocomial MDR A. baumannii and P. aeruginosa infections. The proportion of nosocomial MDR blood stream, urinary tract and surgical site infections were 13(8.9%), 5(8.3%) and 2 (6.3%), respectively. Patients with NI had lower mean age (24.9 years) (P = 0.035). All isolates of NIs were from patients with intravenous catheterization. The frequency of NI was 9(3.8%) for MDR A. baumannii and 11(4.6%) for MDR P.aeruginosa. A. baumannii and P. aeruginosa isolates were 100% MDR. All isolates of A. baumannii and P. aeruginosa were 100% resistant to ampicillin and piperacillin.A. baumannii isolates were 33.3 and 44.5% resistance against meropenem and ciprofloxacin, respectively while P.aeruginosa isolates revealed 36.4 and 45.5% resistance against ciprofloxacin and meropenem, respectively. CONCLUSIONS: Health care associated infections of MDR A.baumannii and P. aeruginosa are critical problems in the study area. Therefore, urgent focused interventions required to contain the spreading of MDR NIs. Treatment of NIs for patients on health care should be guided by antimicrobial susceptibility testing.

Multivariate analysis of factors associated with Schistosoma mansoni and hookworm infection among primary school children in rural Bahir Dar, Northwest Ethiopia.

BACKGROUND: Soil-transmitted helminths and Schistosoma mansoni infections are the major causes of morbidity and mortality in Sub-Saharan countries. The highest burden of the disease resides in school-age children. Poor water sanitation and hygiene are believed to be the major contributing factors for the high prevalence. Therefore, the goal of this study was to determine the prevalence of intestinal parasite infections in rural Bahir Dar, Northwest Ethiopia. METHODS: A cross-sectional study was conducted from April 2017-June 2017 among 409 randomly selected primary school children. A structured questionnaire was used to obtain socio-demographic information and determinant factors through interviewing the students. Stool examination was done by Ritchie's concentration method. The data were entered and analyzed using SPSS version 22. Prevalence of helminthic infections was calculated using descriptive statistics. The association between helminthic infection and determinant factors was determined by Bavarian regression. The confounding effect was checked by multivariate regression at 95% confidence interval. Any association was significant when the p-value was < 0.05. RESULT: The overall prevalence of intestinal parasite infection was 47.2%.(193/409).. The prevalence of Hookworm species and Schistosoma mansoni was 31.1 and 8.0%, respectively. Co-infection of Hookworm species with Schistosoma mansoni was 5.1% (21/409). The highest prevalence of Schistosoma mansoni was recorded for boys (21%), older children (21.4%) and rural children (17.6%) (P < 0.05). Schistosoma mansoni infection was also higher among children whose household drinking water was sourced from streams/rivers (P < 0.05). The multivariate analysis showed lower odds of Schistosoma mansoni infection for those with no history of bathing (AOR = 3.7, 95% CI: 1.1-12.2; P = 0.034), washing clothes/utensils (AOR = 3.4; 95% CI: 1.2-9.7; P = 0.022), swimming (AOR = 2.8, 95% CI: 1.2-6.9; P = 0.023), and irrigation (AOR = 2.8, 95% CI: 1.3-6.0; P = 0.01). Significantly, higher odds of Hookworm infection was recorded for older children (AOR = 2.3, 95% CI: 1.08-4.89; P = 0.029), boys (AOR = 1.9, 95% CI: 1.12-3.24; P = 0.018), and rural children (AOR = 1.8, 95% CI: 1.04-3.0; P = 0.037). Regular shoe wearing (AOR = 0.29, 95% CI: 0.16-0.50; P = 0.00) is protective for hookworm infection. Higher odds of hookworm infection was also recorded for schoolchildren who had the habit of eating raw vegetables (AOR = 1.2 95% CI: 1.1-1.7 P = 0.011). CONCLUSION: Hookworm infection and schistosomiasis are prevalent in the school children in rural Bahir Dar in Northwest Ethiopia. Various activities and behaviors of the children were strongly associated with helminthic infection. Hence health education should be delivered regularly to minimize/avoid the risky behaviors and water-based activities. Deworming programs should also be implemented on a regular basis.

BURDEN AND DETERMINANT FACTORS OF ANEMIA AMONG ELEMENTARY SCHOOL CHILDREN IN NORTHWEST ETHIOPIA: A COMPARATIVE CROSS SECTIONAL STUDY.

BACKGROUND: Anemia is an indicator of both poor nutrition and health. In low-income countries like Ethiopia, the prevalence of anemia remains high due to several determinant factors. There is a lack of regular surveillance system to determine the magnitude of anemia among school age children. The aim of this study was to determine the burden and determinant factors of anemia among school children. MATERIALS AND METHODS: A comparative cross-sectional study was conducted from March 2014 to May 2014 among elementary school children in Northwest Ethiopia. Multi stage and simple random sampling techniques were used to select the schools and the study subjects. Standard questionnaire was employed to assess the socioeconomic status of study participants. Intestinal parasitosis infections and hemoglobin level were determined by formula ether concentration technique and automated hematology analyzer, respectively. Descriptive statistics were used to determine the burden of anemia. Stepwise logistic regression was used to identify the determinants of anemia. RESULTS: Among 2,372 elementary school children, the prevalence of anemia was 7.6% (95 % CI: 7% - 9%). The mean hemoglobin level was 11.6 g/dl ranging from 10 g/dl to 13g/dl. The magnitude of hookworm infection was 530 (22.3%). In multivariate analysis anemia was found associated with residence, source of water, availability of latrine, maternal education, family size and hookworm infection. CONCLUSION: Anemia still remains as a major public health problem among the school children in the study area. Residence, source of water, availability of latrine, maternal education, family size and hookworm infection are also the major determinant factors for the high prevalence of anemia. Therefore, health education, iron supplement and deworming should be given to school age children.

Profile of tuberculosis and its response to anti-TB drugs among tuberculosis patients treated under the TB control programme at Felege-Hiwot Referral Hospital, Ethiopia.

BACKGROUND: Tuberculosis (TB) is a global concern for both developing and developed countries. Currently it becomes more complex due to increasing levels of drug resistance and HIV co-infection. Delayed diagnosis and high case load are major factors contributing to continued transmission and failure to the treatment outcome. The study was conducted to determine the profile and treatment outcomes of TB patients at Felege-Hiwot Referral Hospital. METHODS: We analyzed the records of 1761 TB patients registered for treatment in Felege Hiwot Referral Hospital from July 2010 to June 2015. Data on patients' socio-demographic characteristics, type of TB, HIV status and treatment outcome were analysed. Descriptive statistics and binary logistic regression models were used to present data. The odds ratio and the 95 % confidence intervals were calculated. A p-value of < 0.05 was considered statistical significant. RESULTS: The proportion of smear positive, smear-negative and extra-pulmonary TB were 205 (11.6 %), 548 (31.1 %) and 1008 (57.2 %), respectively. The overall treatment success rate accounts 542(80.8 %) with unsuccessful treatment of 129(19.2 %). The treatment outcome varied by the years from 68.9 to 97.4 %. Among tuberculosis patients, 459(26.1 %) of them were HIV positive. Being HIV positive (AOR = 4.29, 95 % CI, 2.20-8.37 P = 0.001), retreatment (AOR = 5.32, 95 % CI, 1.92-14.3, P = 0.001), rural residency (AOR = 18.0, 95 % CI, 9.06-37.82, P = 0.001) and the age group of 15-24 years (AOR = 2.91, 95%CI, 1.00-8.45, P = 0.04) showed statistical significant association for poor treatment outcome. CONCLUSIONS: In the studied region, the overall treatment success rate was still below the WHO target of success rate, 85 %. However, the trend of treatment success rate showed a promising increment. Patients at high risk of unsuccessful treatment outcome should be identified early and given additional follow-up, medical intervention and social support.