Hepatitis B vaccine effectiveness among vaccinated children in Africa: a systematic review and meta-analysis.

BACKGROUND: Globally, 257 million people have chronic hepatitis. Even though a safe and effective prophylactic vaccine against HBV infection has been available, it causes significant morbidity and mortality. HBV vaccines were designed to improve or modulate the host immune responses. The effectiveness of the vaccine is determined by measuring serum hepatitis B surface antibody (Anti-HBs) level. Therefore, this systematic review aimed to evaluate the effectiveness of hepatitis B vaccine among vaccinated children. METHODS: Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines was applied for systematically searching of different databases. Only cross-section studies measuring the level of anti-HBs of vaccinated children were included. The seroprotective level with anti-HBs > 10mIU/ml was extracted. The meta-analysis was performed using statistical software for data sciences (STATA) version 14. Effectiveness estimates were reported as a proportion of anti-HBs level. The heterogeneity between studies was evaluated using the I2 test, and I2 > 50% and/or P < 0.10 was considered significant heterogeneity. Significant publication bias was considered when Egger's test P-value < 0.10. The new castle Ottawa scale was used to assess the quality of the studies. RESULTS: A pooled sample size of the included papers for meta-analysis was 7430. The pooled prevalence of seroprotected children was 56.95%, with a heterogeneity index (I2) of 99.4% (P < 0.001). 35% of the participants were hypo-responders (10-99mIU/ml) and 21.46% were good responders (> 100mIU/ml). Based on subgroup analysis using country of studies conducted, the highest prevalence of anti-HBs was 87.00% (95% CI: 84.56, 89.44), in South Africa, and the lowest was 51.99% (95% CI: 20.41-83.58), with a heterogeneity index I2 = 70.7% (p = 0.009) in Ethiopia. CONCLUSION AND RECOMMENDATIONS: Hepatitis B vaccine seroprotective level in the current pooled analysis have suboptimal, which failed to demonstrate consistent effectiveness for global hepatitis B virus elimination plan in 2030. Using consistent age group may have a significant value for the decision of the HB vaccine effectiveness. A significant heterogeneity was observed both in studies conducted in Ethiopia and Egypt. Therefore, the impact of HB vaccination on the prevention of hepatitis B virus infection should be assessed regularly in those countries. Future meta-analysis is needed to investigate all possible vaccines in a separate way of reviewing, which will lead to a strong conclusion and recommendations.

Seroprevalence of Hepatitis B Virus Infection Among Patients Attending at Addis Alem Primary Hospital, Bahir Dar, Northwest Ethiopia.

BACKGROUND: Hepatitis B virus (HBV) causes severe liver disease, such as hepatocellular carcinoma (HCC) and life-threatening liver disease. Hepatitis B virus infection is one of the most dominant public health problems these days. Therefore, this study aimed to determine the seroprevalence of HBV infection among patients attending Addis Alem Hospital, Bahir Dar, Northwest Ethiopia. METHODS: A retrospective study was conducted from January to February 2019 on HBV registered from January 2016 to December 2018 for three years period. The presence of HBsAg in serum was detected using the One Step Cassette Style HBsAg test kit. Data were analyzed using SPSS version 20. Descriptive statistics were used to describe the characteristics of participants with HBV infection. Statistical association of the determinants with HBV infection was determined by the X2 test. RESULTS: In this study, a total of 2010 participants of HBsAg rapid test records in the laboratory logbook were included. The median age of women was 25 years. The overall seroprevalence of HBsAg was 78 (3.9%). There was a general increment of HBV infection from 2016 to 2018, X2 =7.52; P=0.023. Age (X2 =8.19; P= 0.042) and sex (X2 =37.77; P <0.001) were associated with HBsAg positivity. CONCLUSION AND RECOMMENDATIONS: An intermediate seroprevalence of HBV infection was detected among participants in our study area. This figure raises significant public health concerns. Therefore, implementing strategies for routine screening of women for HBV and hospital attendants would be critical.

Prevalence and determinants of stunting and wasting among public primary school children in Gondar town, northwest, Ethiopia.

BACKGROUND: Undernutrition among school age children has an impact on their health, cognition, and educational achievement. Therefore, this study aimed to assess the prevalence and associated factors of stunting and wasting among school age children in Gondar town, northwest, Ethiopia. METHODS: An institution-based cross-sectional study was done among school children aged 6-14 years. Data on socio-demographic, nutritional and dietary status of children were collected using structured questionnaire. Anthropometric measurements were carried out to determine the status of stunting and wasting. Data were entered into Epi-Info version 3.5.3 and transferred to SPSS version 20 for further analysis. Bivariable and multivariable logistic regression models were fitted to identify associated factors of stunting and wasting. Both crude odds and adjusted odds ratios with 95% CI were used to measure the strength of associations. In the multivariable analysis, variables with < 0.05 p-values were considered statistically significant. RESULTS: A total of 523 school age children were with the median age of 12 (10-13 inter quartile range) years participated in the study. The overall prevalence of stunting and wasting among primary school children was 241(46.1%; 95% CI: 42.3, 50.3) and 47 (9%; 95% CI: 6.7, 11.7), respectively. Child age (AOR = 1.9, 95% CI: 1.29, 2.80), public tab/yard water source (AOR = 2.22; 95%CI: 1.46, 3.39), DDS < 4 (AOR = 1.89 95%CI: 1.08, 3.30), tea drinking habit (AOR = 0.46, 95%CI: 0.27, 0.80) and anemia (AOR = 1.72 95%CI: 1.05, 2.83) were significant predictors of stunting. Moreover, child age (AOR = 3.91; 95% CI: 1.62, 9.44), maternal/care-givers' age ≤ 34 (AOR = 0.34; 95%CI: 0.16, 0.71), maternal education (AOR = 2.55; 95%CI: 1.15, 5.65), family poverty (AOR = 3.23; 95% CI: 1.30, 7.93) and alcohol consumption (AOR = 2.93; 95%CI: 1.16, 7.42) were found significantly associated with wasting. CONCLUSION: Stunting and wasting were then major problems among school age children. Child age, water source for dinking, DDS < 4 and anemia resulted in stunting. On the other hand, child age, maternal education and age, family poverty and alcohol drinking were risk factors for wasting. Therefore, launching community based nutritional education programs, implementing school feeding and strengthening economic level of the communities are essential to reduce the problems.

Prevalence, associated risk factors and antimicrobial susceptibility patterns of Shigella infections among diarrheic pediatric population attending at Gondar town healthcare institutions, Northwest Ethiopia.

BACKGROUND: Diarrhea caused by Shigella species remains a major public health threat especially in the pediatric population. A regular surveillance system needs to be in place, in order to explore the burden, antimicrobial resistance patterns and associated risk factors for Shigella infections. Therefore, the aim of this study was to assess the prevalence, antimicrobial susceptibility patterns and associated risk factors of Shigella infections among diarrheic pediatric population attending at selected healthcare institutions in Gondar town. METHODS: A cross-sectional study was conducted in Gondar town healthcare institutions from January to March 2018. A simple random sampling technique was used to enroll 272 study participants. Structured questionnaires were used to gather socio-demographic, environmental and associated risk factors data. Stool samples were collected from diarrheic pediatric patients and inoculated onto MacConkey media, salmonella-shigella agar, and xylose-lysine deoxy-cholate agar. Identification of the bacterial species was carried out by using biochemical tests. The disc-diffusion method was used to determine the antimicrobial susceptibility of the isolates by standardizing the bacterial suspension with a 0.5 McFarland solution. A statistical analysis was done using SPSS version 20 statistical package and P-value < 0.05 was considered as statistically significant. RESULTS: From the total study participants, 29(10.7%) of the patients were culture positive for Shigella species. The habit of eating raw food and nutritional status of children were statistically significant with shigellosis (p < 0.05). Shigella species were found highly resistant to amoxicillin and tetracycline but susceptible to nitrofurantoin and norfloxacin. CONCLUSION: High prevalence of Shigella species were detected in this study. Through in-vitro drug susceptibility testing, norfloxacin and nitrofurantoin were found to be effective against the isolates, while high resistance rates were observed for tetracycline, and amoxicillin. The findings highlighted the need for regular drug resistance information for the best management of infections.

Seroprevalence of Hepatitis B virus infection and associated factors among mothers in gondar, North-West Ethiopia: a population based study

Background: Hepatitis B virus (HBV) is the main cause of serious liver infection. Factors that increase the risk of HBV infection include contact during child birth and different horizontal means of transmission, such as unprotected sexual exposure with an infected person and having direct contact with the blood of an infected person. Objectives: The main aim of this study is to determine seroprevalence of HBV infection and associated risk factors among mothers in Gondar, Northwest Ethiopia. Methods: A community based cross-sectional study was conducted on mothers in Gondar from March to November 2016. Study participants were selected using a multistage cluster random sampling technique and a total of 419 mothers were included. Sociodemographic data and exposure to associated factors (hospital admission, history of circumcision, history of contact with jaundiced family and history of abortion) were collected through a structured questionnaire. Five milliliters of blood were collected from each study participant. Serum level hepatitis B surface antigen (HBsAg) and anti-HBc were detected using sandwich and indirect ELISA, respectively. The data were entered with Epi Info 7 and analyzed using SPSS version 20. To declare the presence of association, odds ratio with 95% confidence interval and p-value <0.05 were considered statistically significant. Result: A total of 419 mothers with the median age of 29 (20-58) years old were enrolled. The sero-prevalence of HBsAg and anti-HBc was 3.8% and 36.0%, respectively. Statistically significant association with HBV infection was observed for age (AOR= 6.960, 96% CI, 2.047-23.659, P= 0.002), history of hospital admission (AOR= 3.279, 95% CI, 1.054-10.195, P= 0.04), history of circumcision (AOR= 4.394, 95% CI, 1.463-13.198, P= 0.008), history of contact with jaundiced family (AOR= 3.877, 95% CI, 1.274-11.795, P= 0.017) and history of abortion (AOR= 4.867, 95% CI, 1.438-16.473, P= 0.011). Conclusions and recommendations: An intermediate seroprevalence of HBV infection, which is an important public health problem in the area, was detected. Therefore, implementing strategies for routine screening and care of mothers for hepatitis B virus would be important. Further, health education on modes of transmission and precautions and immunization of HBV has to be strengthened

Immune protection of Hepatitis B vaccine among children living in gondar, Northwest Ethiopia

Background: Hepatitis B virus infection is a worldwide health problem and highly endemic in developing countries including Ethiopia. Hepatitis B vaccine is included in the routine Expanded Program on Immunization since 2007 in Ethiopia. Objective: The aim of this study is to assess the seroprotection level of hepatitis B vaccination among children who have received the vaccine. Methods: A cross-sectional study was conducted on children attending kindergarten and elementary school in Gondar. A pretested structured questionnaire was used to collect the sociodemographic data. Blood samples were collected and serum separated to measure anti-HBs, anti-HBc, and HBsAg levels. Data were analyzed using SPSS statistical software version 21. Binary logistic regression analysis was done. P-value less than 0.05 was considered as statistically significant. Results: Out of 431 children screened, 27 were excluded from analysis because they were positive for anti-HBc (27/431, 6.3%) and/or for HBsAg (18/431 or 4.2%). Out of the rest 404 children, 130 (32.2%) had anti-HBs titers >10 mIU/ml (seroprotected), while 274 (68.8%) had anti-HBs titers <10 mIU/ml (non-protected). Among 130 sero-protected children, 99 (76.2%) were hypo-responders (antibody titer 10-100 mIU/ml) and 31 (23.8%) were good responders (antibody titer >100 mIU/ml). In multivariate analysis, children of age 6 and 8 years old were 2.4 times (AOR: 2.436, 95% CI 1.049-5.654) (P=0.038) and 3.3 times (AOR: 3.397, 95% CI1.306-8.837) (p=0.012) better responders compared to 9 years old children, respectively. Moreover, children whose mothers had no previous history of hepatitis were 2.0 times (AOR: 2.009, 95% CI 1.101-3.665) (P= 0.023) better responders compared to their counterparts. Conclusion: The seroprotection level among vaccinated children in Gondar was surprisingly low. Age and children from mothers with a history of hepatitis B infection were associated with seroprotection. The preliminary findings obtained in this study call for a thorough assessment of the effectiveness of the current hepatitis B vaccination program in this study region

Incidence of human rabies virus exposure in northwestern Amhara, Ethiopia.

BACKGROUND: Clinical Rabies is a widely distributed almost 100% fatal viral zoonotic disease. Most human rabies cases occur in developing countries, especially in Asia and Africa. It can be prevented by immunization, post exposure prophylaxis. Ethiopia is assumed to be among African countries with high incidence of human rabies exposure cases. However, there is limited documented data on the incidence of human rabies exposure in the study area in particular and in Ethiopia in general. Thus, this study aimed to determine the Incidence of Human Rabies Virus exposure in Northwestern Amhara, Ethiopia. METHODS: Retrospective cross-sectional study was conducted during August and September, 2017. The study was conducted at Addis Alem Hospital, a district level hospital in Bahir Dar. Data on human rabies exposure cases registered from September 1, 2015 to August 31, 2017 were collected from anti-rabies post exposure prophylaxis registration log book. Data was collected using a structured data collection questionnaire developed for this purpose. Descriptive statistics was used to describe relevant variables. THE RESULTS: A total of 924 human rabies exposure cases was recorded. The overall human rabies incidence per 100, 000 population was 6.5 in 2015 and 7.5 in 2016. Males (55.2%, 510/924) and children of age less than fifteen (46.3%, 428/924) were most affected groups. The majority of human rabies exposure cases (71.9%, 664/924) were from rural settings. Dogs were the principal sources of exposure (96.3%) followed by cat (1.5%) and donkey (1.3%). High incidence rate of rabies exposure was reported during spring (360, 39%) and summer (244, 26.4%) seasons. There was significant difference between rural and urban exposure cases (p = 0.001) in respect to the time of arrival to the hospital. CONCLUSION: Taking these into account, a significant proportion of the population was exposed to rabies virus during the study years. There was high human rabies exposure rate in children and in the rural community. This shows the need for organizing preventive and control strategies and to build community awareness.

Sero-prevalence of hepatitis B virus infection and associated factors among health care workers and medical waste handlers in primary hospitals of North-west Ethiopia.

OBJECTIVE: The aim of this cross-sectional study was to determined the sero-prevalence of HBV infection and associated factors among health care workers and medical waste handlers in primary hospitals of North-west Ethiopia. RESULTS: A total of 388 study participants were included in this study. Of which, 268 (69%) were health care workers and 120 (31%) were medical waste handlers. Males accounted 54.9% and the mean age for all study participants was 28.3 (standard deviation = 6.9). Hepatitis B virus surface antigen (HBsAg) was detected in 2.6% health care workers and 2.5% medical waste handlers and the overall hepatitis B virus infection was 10 (2.6%). High rate of hepatitis B virus infection was detected in single participants and those in the age group of 30-40 years were more infected (6.6%). History of contact with HBV infected case (8.3%) (AOR = 6.8, 95% CI = 1.6-28.5, P = 0.009) and history of jaundice (15.4%) (AOR = 10.5, 95% CI = 2.1-12.2, P = 0.03) were statistically associated factors for HBV infection. More than half (54.4%) of the study participants did not take training on infection and 9 (4.3%) of them were positive for HBsAg (COR = 1.3, 95% CI = 0.0.02-1.02, P = 0.052).