The Role of Neutrophil to Lymphocyte Count Ratio in the Differential Diagnosis of Pulmonary Tuberculosis and Bacterial Community-Acquired Pneumonia: a Cross-Sectional Study at Ayder and Mekelle Hospitals, Ethiopia.

BACKGROUND: The differential diagnosis of pulmonary tuberculosis and bacterial community-acquired pneumonia is often a challenging phenomenon. The neutrophil to lymphocyte count ratio, a suitable indicator of inflammation, has been demonstrated to be a useful biomarker for predicting bacteremia. The main aim this study is to evaluate the role of neutrophil to lymphocyte count ratio in the differential diagnosis of pulmonary tuberculosis and bacterial Community-Acquired Pneumonia at Ayder and Mekelle hospitals, Mekelle, Ethiopia. METHODS: A hospital based cross-sectional study was conducted from February to May 2017 on a total of 146 patients at Ayder and Mekelle hospitals. After taking written informed consent, study participants were interviewed for a detailed history and 5 mL of blood was collected for hematological analysis. Pulmonary tuberculosis was diagnosed by using Ziehl-Neelsen and Gene X-pert. Community acquired pneumonia was diagnosed using sputum culture. Student's t-test, Pearson's chi-square test, and receiver operating characteristics curve analysis were used. A p-value < 0.05 was considered statistically significant. RESULTS: The neutrophil to lymphocyte count ratio and eythrocyte sedimentation rate were significantly higher in pulmonary tuberculosis patients than bacterial community-acquired pneumonia patients. Neutrophil to lymphocyte count ratio and eythrocyte sedimentation rate with cutoff values of ≥ 2.72 and ≥ 39, respectively, showed the highest area under the curve (AUC = 0.69; 95% CI: 0.62, 0.77). CONCLUSIONS: Neutrophil to lymphocyte count ratio and eythrocyte sedimentation rate together at a time with their respective cutoff values gave a 69% accuracy in differentiating pulmonary tuberculosis from bacterial community-acquired pneumonia. Therefore, neutrophil to lymphocyte count ratio and erythrocyte sedimentation rate can be used in differentiating pulmonary tuberculosis from PTB patients from bacterial Community-acquired pneumonia, especially in resource-limited settings.

Prevalence of anemia and associated factors among school children in Gondar town public primary schools, northwest Ethiopia: A school-based cross-sectional study.

BACKGROUND: Anemia is a global public health problem affecting 305 million school children (SC) worldwide. It has deleterious effects in SC, including lower school achievement due to impaired cognitive development and physical growth, fatigue and poor attention span, and increased morbidity because of reduced resistance to infection. Hence, the aim of this study was to assess the prevalence and associated factors of anemia among SC attending public primary schools in Gondar town, northwest Ethiopia. METHODS: A school-based cross sectional study was conducted on a total of 523 SC aged from 6-14 years old. Multi-stage sampling followed by systematic random sampling techniques were employed to select study participants. Data on socio-demographic and socio-economic characteristics, and dietary status of children were collected using pre-tested structured questionnaire through face-to-face interview of children's caregivers. Anthropometric measurements were taken. Hemoglobin (Hb) concentration was determined by using HemoCue 301+analyser. Stool and blood samples were collected in the school premises, and examined for intestinal and hemoparasites, respectively. Data were entered into Epi Info version 3.5.3 and transferred to SPSS version 20 for analysis. Bivariate and multivariate binary logistic regression models were fitted to identify associated factors of anemia. P-value < 0.05 was considered as statistically significant. RESULT: Of the total SC participated in the study, 269 (51.4%) were males. The median (inter quartile range (IQR)) age was 12 (10-13) years, and 332 (63.5%) of them were in the age group 11-14 years. About 81 (15.5%; 95%CI: 12.4%, 18.7%) of them were anemic: 56 (69.1%) and 25 (38.9%) of them were mildly and moderately anemic, respectively. Low maternal education (AOR = 2.30; 95%CI: 1.11, 4.78), stunting (AOR = 2.22; 95%CI: 1.30, 3.80), severe food insecurity (AOR = 5.11; 95%CI: 1.53, 17.13), and soil-transmitted helminthic (STH) infection (AOR = 7.13; 95%CI: 3.16, 16.86) were found significantly associated with anemia. CONCLUSION: Anemia among SC was found to be a mild public health problem. It was strongly associated with low maternal education, food insecurity, stunting and intestinal helminthic infection. Focused policies and strategies towards the above factors should be designed to reduce anemia among SC.