Community seroprevalence of hepatitis B, C and human immunodeficiency virus in adult population in gojjam zones, northwest Ethiopia.

BACKGROUND: In Ethiopia, there is lack of data on the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) infections in adult population at community level. This study aimed at determining the HBV, HCV and HIV seroprevalence in adult population at community level in East and West Gojjam zones in Amhara region, Ethiopia. METHODS: A cross-sectional study was conducted between October 01 and November 30, 2015. The Hepatitis B surface antigen (HBsAg) and anti-HCV were detected using the standard serological tests. The antibody to HIV infection was tested using the national HIV rapid tests algorithms. RESULTS: A total of 481 adults comprised of 51% females with median age of 25 years took part in the study. Overall, 7.5% (95% CI: 5.5-10.2%) of adult population were infected either with HBV, HCV and HIV. The prevalence of HBV was 15 (3.1%) and for HIV was 16 (3.3%). The seroprevalence of HCV was five (1.0%). HIV-HCV co-infection was found to be two (0.4%). HIV prevalence was higher in non-educated population than their counter parts (P = 0.001). HIV prevalence was high in housewives (6.0%) and merchants (4.7%). CONCLUSIONS: This study revealed an intermediate HBV prevalence and low prevalence of HCV in adult population at community level. HIV prevalence is still a major public health problem in the area. To have the national data, we recommend further study on genotypes of HBV and HCV including local risk factors for transmissions. Moreover, health education on HBV, HCV and HIV transmission should be an intervention measure in the community.

Knowledge, attitude, and practice towards blood donation among health care providers in hospitals at Bahir Dar City, Ethiopia.

Like other sub-Saharan Africa, in Ethiopia there is a shortage of adequate and safe blood supplies. Health care providers are potential resource and promoter of voluntary blood donation. This study was conducted to determine the knowledge, attitude and practice towards blood donation among health care providers in Bahir Dar City, Ethiopia. Paper based questionnaire was distributed to 276 health care providers from May 01 to June 30, 2016. Overall, 42.8% had donated blood at least once. Of these, males accounted for 60%. The median age of blood donors was 26 years. Voluntary-unpaid donation was 21.2%. Overall, 75.5% health care providers were knowledgeable. The levels of knowledge were significantly different among different disciplines (One-way ANOVA; F=69.7; P=0.004). Males were more knowledgeable than females (P<0.05). The overall favorable attitude was 78.6%. Previous practice of blood donation determined the odds of favorable attitude to be a future regular voluntary-unpaid blood donor (OR: 5.7, 95% CI: 3.2-10.4). Majority of health care providers had adequate knowledge and favorable attitude. However, voluntary-unpaid donation practice (21.1%) was lower compared to 100% target of voluntary-unpaid donation. There should be motivation packages to enhance voluntary-unpaid blood donation among health care professionals.

Prevalence of human immunodeficiency virus and hepatitis B virus infections in young women seeking abortion care in Ethiopia: a cross - sectional study.

BACKGROUND: Young women aged 15-24 years are members of key populations at higher risk for Human Immunodeficiency Virus (HIV) acquisition through sexual intercourse. In areas where unprotected sex is a common practice, Hepatitis B virus (HBV) commonly transmitted via sexual and parenteral routes. The study aimed at determining HIV and HBV infections prevalence in young women attending health institutions for abortion care in Bahir Dar city, Ethiopia. METHODS: A cross - sectional study was conducted from January 2015 to June 2015. Convenient sampling technique was used. Demographic and explanatory variables were collected using a structured questionnaire via face to face interview. The presence of antibody to HIV infection was detected using national HIV diagnostic test algorithm. Hepatitis B surface antigen (HBsAg) was detected using ELISA. Data were analyzed using descriptive, fisher's exact and independent sample T test as appropriate. RESULTS: A total of 360 young women aged 15-24 years participated in the study. The median age of the women was 22 years. Overall, 16 (4.4 %) (95 % CI: 2.7-7.1 %) women were positive for either HBV or HIV infections. The prevalence of HIV and HBV infections were 9 (2.5 %) (95 % CI: 1.3-4.7 %) and 7 (1.94 %) (95 % CI: 0.95-4.0 %), respectively. The mean age of first sexual intercourse was 17.6 and 19.3 in HIV and HBV infected women, respectively. The prevalence of HIV infection was significantly associated with lower educational status (P < 0.001), divorced marital status (P = 0.009) and ever had symptom of other sexually transmitted infections (P = 0.001). The proportion of HBV was higher in women aged 15-17 years (P = 0.02). CONCLUSION: Though there were no co-infections, HIV and HBV infections are major health problems in young women seeking abortion care. Therefore, appropriate prevention, treatment and care services must be reached to these higher risk populations.

Challenges in visceral leishmaniasis control and elimination in the developing countries: A review.

Leishmaniasis is a disease caused by an obligate intracellular protozoan that affects animals and human. Transmission is zoonotic and/or anthroponotic through the bite of an infected female sandfly. Control and elimination of visceral leishmaniasis (VL) require proper case detection, identification of reservoir hosts, and launching of effective vector control strategies in endemic areas. The aim of this review was to highlight the challenges in VL control in developing countries. Literatures pertaining to VL burden, diagnosis, prevention and control from the year 1969 to 2014 were systematically reviewed from PubMed, Scopus, Medline and Google scholar sources during July 2015. Poor vector control strategies, limited diagnostic services, drugs, treatments and lack of community awareness are the most important challenges in VL control and elimination especially in endemic areas. Absence of highly sensitive and specific tests, lack of trained man power, and community awareness are the major challenges in VL control. Therefore, proper case diagnosis, community mobilization and launching of effective vector control strategies in endemic areas are vital.

Performance evaluation of rapid diagnostic test for malaria in high malarious districts of Amhara region, Ethiopia.

BACKGROUND & OBJECTIVES: Malaria is one of the leading public health challenges in Ethiopia. To address this, the Federal Ministry of Ethiopia launched a laboratory diagnosis programme for promoting use of either rapid diagnostic tests (RDTs) or Giemsa microscopy to all suspected malaria cases. This study was conducted to assess the performance of RDT and influencing factors for Giemsa microscopic diagnosis in Amhara region. METHODS: A cross-sectional study was conducted in 10 high burden malaria districts of Amhara region from 15 May to 15 June 2014. Data were collected using structured questionnaire. Blood samples were collected from 1000 malaria suspected cases in 10 health centers. RDT (SD BIOLINE) and Giemsa microscopy were performed as per standard procedures. Kappa value, logistic regression and chi-square test were used for statistical analysis. RESULTS: The overall positivity rate (PR) of malaria parasites by RDT and Giemsa microscopy was 17.1 and 16.5% respectively. Compared to Giemsa microscopy as "gold standard", RDT showed 83.9% sensitivity and 96% specificity. The level of agreement between first reader and second reader for blood film microscopy was moderate (Kappa value = 0.74). Logistic regression showed that male, under five year of age and having fever more than 24 h prior to malaria diagnosis had statistically significant association with malaria positivity rate for malaria parasites. INTERPRETATION & CONCLUSION: The overall specificity and negative predictive values of RDT for malaria diagnosis were excellent. However, the sensitivity and positive predictive values of RDT were low. Therefore, in-service training, quality monitoring of RDTs, and adequate laboratory supplies for diagnostic services of malaria would be crucial for effective intervention measures.

Common causes of vaginal infections and antibiotic susceptibility of aerobic bacterial isolates in women of reproductive age attending at Felegehiwot Referral Hospital, Ethiopia: a cross sectional study.

BACKGROUND: Bacterial vaginosis, candidal, trichomonal and Gonococcal vaginal infections are a major health problems associated with gynecologic complications and increase in replication, shedding and transmission of HIV and other STIs in women of reproductive age. The study aimed at determining the prevalence of common vaginal infections and antimicrobial susceptibility profiles of aerobic bacterial isolates in women of reproductive age, attending Felegehiwot referral Hospital. METHODS: A hospital based cross sectional study was conducted from May to November, 2013. Simple random sampling technique was used. Demographic variables were collected using a structured questionnaire. Clinical data were collected by physicians. Two vaginal swab specimens were collected from each participant. Wet mount and Gram staining were carried out to identify motile T.vaginalis, budding yeast and clue cells. All vaginal specimens were cultured for aerobic bacterial isolates using standard microbiology methods. Antimicrobial susceptibility was performed using disc diffusion technique as per the standard by Kirby-Bauer method. The results were analyzed using descriptive, chi-square and fisher's exact test as appropriate. RESULTS: A total of 409 women in reproductive age (15 - 49 years) participated in the study. The median age of the women was 28 years. Overall, 63 (15.4 %) of women had vaginal infections. The proportion of vaginal infection was higher in non-pregnant (17.3 %) than pregnant women (13.3 %) (P = 0.002). The most common identified vaginal infections were candidiasis (8.3 %) and bacterial vaginosis (2.8 %) followed by trichomoniasis (2.1 %). The isolation rate of N. gonorrhoeae and group B Streptococcus colonization was 4 (1 %) and 6 (1.2 %), respectively. Bacterial vaginosis was higher in non-pregnant (5.6 %) than pregnant women (0.5 %) (P = 0.002). Religion, age, living in rural area and having lower abdominal pain were significantly associated with bacterial vaginosis and candidiasis (P < 0.05). E.coli, Pseudomonas spp. and S.aureus were frequently isolated. Norfloxacin (75.6 %), ciprofloxacin (79.6 %) and gentamicin (77.6 %) revealed high level of sensitivity whereas high resistance rates were observed for amoxicillin (82.2 %), tetracycline (63.3 %) and cotrimoxazole (62.2 %). CONCLUSIONS: Bacterial vaginosis, candidiasis and trichomoniasis are a common problem in women of reproductive age. Therefore, screening of vaginal infections in women of reproductive age should be implemented. Moreover, ciprofloxacin, norfloxacin and gentamicin are the recommended drugs for empiric therapy and prophylaxis as needed.

Epidemiology of elephantiasis with special emphasis on podoconiosis in Ethiopia: A literature review.

Elephantiasis is a symptom of a variety of diseases that is characterized by the thickening of the skin and underlying tissues, especially in the legs, male genitals and female breasts. Some conditions having this symptom include: Elephantiasis nostras, due to longstanding chronic lymphangitis; Elephantiasis tropica or lymphatic filariasis, caused by a number of parasitic worms, particularly Wuchereria bancrofti; non-filarial elephantiasis or podoconiosis, an immune disease caused by heavy metals affecting the lymph vessels; proteus syndrome, the genetic disorder of the so-called Elephant Man, etc. Podoconiosis is a type of lower limb tropical elephantiasis distinct from lymphatic filariasis. Lymphatic filariasis affects all population at risk, whereas podoconiosis predominantly affects barefoot subsistence farmers in areas with red volcanic soil. Ethiopia is one of the countries with the highest number of podoconiosis patients since many people are at risk to red-clay soil exposure in many parts of the country. The aim of this review was to know the current status and impact of podoconiosis and its relevance to elephantiasis in Ethiopia. To know the epidemiology and disease burden, the literatures published by different scholars were systematically reviewed. The distribution of the disease and knowledge about filarial elephantiasis and podoconiosis are not well known in Ethiopia. It is relatively well studied in southern Ethiopia but data from other parts of the country are limited. Moreover, programmes that focus on diagnosis, treatment, prevention and control of filarial elephantiasis and podoconiosis are also non-existent even in endemic areas. Furthermore, the disease mapping has not been carried out country-wide. Therefore, in order to address these gaps, Ethiopian Ministry of Health needs to take initiative for undertaking concrete research and mapping of the disease in collaboration with stakeholders.

Sero-prevalence and risk factors of hepatitis B virus and human immunodeficiency virus infection among pregnant women in Bahir Dar city, Northwest Ethiopia: a cross sectional study.

BACKGROUND: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are the two most important agents of infectious diseases. Both HBV and HIV share common modes of transmission and have serious effects on both pregnant women and infants. In Bahir Dar city administration, there is a scarcity of information on sero-prevalence of HIV and HBV infection among pregnant women. The main objective of this study was to assess sero-prevalence and risk factors of HIV and HBV infection among pregnant women attending antenatal care in Bahir Dar city, Northwest Ethiopia. METHODS: A cross-sectional study was conducted from March 2013 to April 2013. Socio-demographic and explanatory variables were collected using a structured questionnaire by face to face interview. Hepatitis B surface antigen (HBsAg) was detected using an enzyme linked immunosorbent assay (ELISA). HIV infection was also detected using the national HIV test algorithms. The results were analyzed with descriptive statistics and binary logistic regression. The odds ratio and 95% Confidence intervals were calculated. RESULTS: A total of 318 pregnant women with the mean age of 25.72 (SD. ±5.14) years old were enrolled. Overall, 21/318 (6.6%) and 12 /318 (3.8%) of the pregnant women were positive for HIV and HBsAg, respectively. Of these, HIV/HBV co-infection rate was 4 (19.0%). Previous history of blood transfusion (AOR = 3.7, 95% CI, 9.02-14.84), body tattooing (AOR = 5.7, 95% CI, 1.24-26.50), history of surgery (AOR = 11.1, 95% CI, 2.64-46.88) and unsafe injection (AOR = 5.6, 95% CI, 1.44-22.19) were significantly associated with HBV infection. Previous history of piercing with sharp materials (AOR = 3.0, 95% CI 1.17-7.80) and history of abortion (AOR = 6.6, 95% CI 2.50-17.71) were also statistically significant for HIV infection. CONCLUSIONS: This study indicates that HIV and HBV infections are important public health issues in our region that need to be addressed. All pregnant women need to be screened for both HIV and HBV infections during antenatal care. Furthermore, health education about modes of transmission of HIV and HBV has to be given.

Sexual behaviours and associated factors among students at Bahir Dar University: a cross sectional study.

BACKGROUND: Sexual behaviour is the core of sexuality matters in adolescents and youths. Their modest or dynamic behaviour vulnerable them to risky sexual behaviours. In Ethiopia, there is scarcity of multicentered representative data on sexual behaviours in students to have a national picture at higher education. This study therefore conducted to assess sexual behaviours and associated factors at Bahir Dar University, Ethiopia. METHODS: A cross sectional study was conducted among Bahir Dar University students from December to February 2013. Multistage sampling and self administered questionnaires were employed. Descriptive statistics such as frequency and mean were used to describe the study participants in relation to relevant variables. Multivariate analysis was carried for those variables that had a p-value of ≤ 0.2 in the bivariate analysis to identify the predictor variables. RESULTS: Of the 817 study participants, 297 (36.4%) students had ever had sex. The mean age at first sexual practice was 18.6 years. Unprotected sex, having multiple sex partners, sex with commercial sex workers and sex for the exchange of money was practiced by 184 (62%), 126 (42.7%), 22 (7.4%) and 12 (4%) of sexually active students, respectively. The proportion of attending night clubs and watching porn videos was 130 (15.8%) and 534 (65.4%), respectively. Male respondents had significant positive association with watching porn videos (AOR = 4.8, CI = 3.49 - 6.54) and attending night clubs (AOR = 3.9, CI = 2.3 - 6.7). Watching porn videos, attending night clubs, khat chewing and taking alcohol frequently were significantly associated for ever had sex and having multiple sexual partners. Khat chewing practice (AOR = 8.5, CI =1.31 - 55.5) and attending night clubs (AOR = 4.6, CI = 1.8 - 11.77) had statistical significant association with the purpose of sexual intercourse for the sake of money and for having sex with commercial sex workers, respectively. CONCLUSIONS: Significant number of students had different risky sexual behaviours. Substance use, attending night clubs and watching porno video were predictor factors for practicing different sexual behaviours. Therefore, preventive intervention programmes should be strengthened, effectively implemented and monitored both in the earlier school and in the universities.

The epidemiology of Schistosoma mansoni in the Lake Tana Basin (Ethiopia): Review with retrospective data analyses.

Schistosoma mansoni is one of the major waterborne diseases grouped underwater based Neglected Tropical Diseases in Africa. In Ethiopia, the Lake Tana Basin has favorable environment (temperature and water) for S. mansoni transmission. The prevalence of S. mansoni varies among regions based on environmental conditions and human water contact. Therefore, this review was conducted to identify hot spots districts and determine the prevailing S. mansoni prevalence in the Lake Tana Basin. Research articles published in English in the last 65 years were searched from Google scholar, PubMed, and Web of science. In addition, four-year S. mansoni data that were reported in health care facilities were extracted from health management information system in 61 districts of the Lake Tana Basin. In total, 43 research articles on S. mansoni that met the inclusion criteria and were published between 1957 and 2022. Over 98% of the articles were cross-sectional studies, while five articles addressed malacological studies. Among 61 districts, 19 (31%) were identified as hotspot districts for S. mansoni infection in the Lake Tana Basin. S. mansoni prevalence and the abundance of its host snail showed spatial and seasonal variations. On average 2000 school children/year attended health care facilities for S. mansoni infection. Swimming habits [adjusted odds ratio (AOR) = 3.2, p = 0.030], irrigation practice (AOR = 3:09, p ≤ 0.001), fishing (AOR = 2:43, p = 0.005) and being male (AOR = 1.74, p = 0.002) were risk factors for contributing to S. mansoni infection. This study showed the spatial and seasonal variations of S. mansoni prevalence and its endemicity in the hottest lowland areas of the Lake Tana Basin. The research articles on S. mansoni had poor geographical coverage. Malacological studies on water bodies, assessments on knowledge and attitude in the community towards S. mansoni transmission are areas of future studies.

Prevalence and antimicrobial susceptibility patterns of shigella species at Felege Hiwot Referral Hospital, Northwest Ethiopia.

BACKGROUND: Shigella species infections coupled with increased levels of antimicrobial resistances are major public health problems in developing countries particularly in children. OBJECTIVES: The present study was conducted to determine the prevalence and antimicrobial resistance pattern of Shigella species among patients with diarrhea at Felege Hiwot Referral Hospital. METHODS: A cross-sectional prospective study was undertaken among patients with diarrhea (n=215) from August to November 2009. A4 pre-tested structured questionnaire was used for collecting data. Stool samples were investigated for identification of Shigella species following standard procedures and antimicrobial susceptibility tests were performed using disc diffusion technique. RESULTS: The isolation rate of Shigella species was 32/215 [14.9% (95% CI.: 10.5-20.5)], with high prevalence in patents under five years of age. Educational level, latrine usage, source of drinking water, and hand washing habits showed a statistically significant association with the prevalence of Shigella species (p = 0.004). All isolates of Shigella species were susceptible to ciprofloxacin and high level of sensitivity was observed for norfloxacin (90.6%) and gentamicin (75%). Multiple drug resistance to as many as nine antibiotics was also detected CONCLUSION: High prevalence of Shigella with multiple antibiotic resistance isolates was observed in this study. Public health workers should emphasize, on primary preventive measures and periodic surveillance for antibiotic susceptibility pattern of Shigella isolates. When culturing and antibiotic susceptibility testing facilities are not available, prescription of ciprofloxacin as a choice of treatment is recommended.

Voluntary HIV counseling and testing service in Northwest Ethiopia: the cases of counselor's perception, client's satisfaction, and in-service observations.

BACKGROUND: Voluntary HIV counseling and testing allows individuals to know their HIV status and serve as a key strategy entry point to prevention, treatment, care and support services. Voluntary counselling and HIV testing have become an increasingly important area of HIV prevention and care in Ethiopia. OBJECTIVE: To assess the current Voluntary Counseling and Testing (VCT) service in Amhara Regional State, Northwest Ethiopia in terms of physical facilities, client's satisfaction on VCT services and counselor's perception. METHODS: A cross sectional study was conducted in 37 VCT centers. A total of 45 counselors and 222 VCT clients who came to get VCT services participated in the study. A structured and pre-tested questionnaire was used to collect information on the physical facilities, client's satisfaction and counselor's perception on the services. RESULTS: All VCT service delivery rooms were small in size and more than half of the VCT rooms were poorly ventilated. None of them had behavior change communication (BCC) or information education and communication (IEC) materials for teaching clients. Most counselors thought that they had not received in-service training supervision and support. Clients with high educational status were less willing to get VCT Though clients were dissatisfied with the physical facilities of the VCT centers, they also expressed feelings of satisfaction and fulfillment during counseling. Thirteen of the counselors were community counselors. The most important reason for seeking VCT services were found to be fear of being exposed for HIV infection. Females were more likely to be motivated of perception of own high risk sexual behaviour than males (P value = 0.0001). CONCLUSION: The physical facilities and VCT procedures in many of the VCT centers were below satisfactory. A large number of people visit VCT despite the poor facilities and procedures in most VCT centers. This study augmented information to the literature on motivation for HIV testing and introduction of community counsellors in Ethiopia. However, to provide good quality VCT service, accessible physical facilities and VCT procedures need to be improved

Vancomycin-resistant enterococci and coagulase-negative staphylococci prevalence among patients attending at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia.

BACKGROUND: Vancomycin resistant enterococci (VRE) and vancomycin resistance coagulase negative staphylococci (VRCoNS) are common pathogens causing difficult to treat health care associated infections (HAI). Hence, the World Health Organization listed VRE as one of the high priority pathogens for new antibiotic discovery and antimicrobial resistance surveillance. Despite this, data on the prevalence of VRE and VRCoNS in Ethiopia is scarce. Thus, the present study determined prevalence of VRE and VRCoNS among patients attending Felege-Hiwot comprehensive specialized hospital, Ethiopia. METHODS: A hospital based cross-sectional study was conducted on 384 patients selected conveniently from February to March 2020. Data on demographic and clinical variables were collected using a structured questionnaire by face-to-face interview. Simultaneously urine, venous blood and wound swab were collected and processed following standard bacteriological technique. Antimicrobial susceptibility test was performed by minimum inhibitory concentration method using E-test for vancomycin and Kirby-Bauer disc diffusion method for other classes of antibiotics. Data was entered and analyzed using SPSS version 23. Logistic regression was performed to identify factors associated with VRE infection. P. value < 0.05 was considered as statistically significant. RESULTS: The prevalence of enterococci and CoNS were 6.8% and 12% respectively. The prevalence of VRE was 34.61% (9/26), while all CoNS (46 isolates) were susceptible to vancomycin. The majority (66.7%) of VRE was isolated from blood samples. Furthermore all VRE (100%), 58.8% of vancomycin susceptible enterococci and 45.7% of CoNS were multidrug resistant (MDR). Having educational level of secondary school and below (AOR = 12.80, CI = 1.149-142.5), previous exposure to catheterization (AOR = 56.0, CI = 4.331-724.0) and previous antibiotic use practice (AOR = 26.25, CI = 3.041-226.2) were a significant associated explanatory factor for VRE infection. CONCLUSIONS: The prevalence of vancomycin resistance enterococci, which is also multidrug resistant, was significantly high. Though no vancomycin resistance CoNS detected, the MDR level of CoNS was high. Thus to limit enterococci and CoNS infections and MDR development, focused infection prevention measures should be implemented.

Antimicrobial suceptibility of V. cholerae in north west, Ethiopia.

OBJECTIVES: Various Vibrio cholerae serogroups cause cholera, which occurs as major epidemic disease in most developing countries. This study was aimed at determining the antimicrobial susceptibility patterns of V. cholerae and its serotypes from cholera cases. METHODS: The study was undertaken during cholera epidemics in North West Ethiopia from August 2006 to September 2008. Diarrheic stool samples were processed per the standard microbiology procedures at Bahir Dar Regional Health Research Laboratory. Antimicrobial susceptibility tests were performed using disc diffusion technique per Kirby-Bauer method. RESULTS: Eighty one V. cholerae 01 serotype Inaba were isolated from stools of cholera cases. Antibiograms of V. cholerae 01 Inaba showed that 71.6% of isolates were resistant against two, 18.4% to three and 5% to four antibiotics. All V. cholerae Inaba isolates were resistant to co-trimoxazol 81 (100%). High levels of resistance were also shown to chloramphenicol 76 (94%) and ampicillin 72 (89%) with least resistance to erythromycin 12 (15%), tetracycline 5 (6.2) and ciprofloxacilin 1 (1.2%). However, all isolates remain susceptible to doxycycline 81 (100%). CONCLUSION: In the study area, doxycycline or ciprofloxacilin could be used for treatment of adult cholera cases whereas erythromycin is alternative for young children. Antimicrobial susceptibility tests are strongly recommended for V. cholerae strains in treatment intervention during epidemics.

Extended spectrum beta lactamase producing bacteria among outpatients with ear infection at FelegeHiwot Referral Hospital, North West Ethiopia.

BACKGROUND: Antibiotic resistant bacteria particularly extended-spectrum beta lactamase (ESBL) producing are of major concern for management of outpatients. They can spread rapidly and are associated with poor patient outcome. However, there is scarcity of information on ear infection with ESBL producing bacteria in Ethiopia. Therefore, this study investigates the prevalence of ear infection with ESBL producing bacteria among outpatients attending Felegehiwot Referral Hospital, Northwest Ethiopia. METHODS: A hospital based cross-sectional study was conducted from May, 2018 to January, 2019. Demographic and clinical data were collected with face to face interview and were complemented with patient card review. Ear discharge specimens were collected from study participants using swab technique. All ear swab specimens were cultured using standard microbiological techniques. The ESBL producing bacteria were detected by double disc synergy test and interpreted based on Clinical and laboratory Standards Institute Guidelines. Chi-square and fisher's exact tests were calculated to check association between variables. RESULTS: A total of 236 patients (male = 138 and female = 98) with ear infection took part in the study. The median age of the participants was 20years. Overall, 10 (4.23%, 95%CI; 2.3-7.6%) of patients had ear infection with ESBL producing bacteria. Other chronic illnesses (p = 0.003), history of hospital visit and treatment (p = 0.006) and history of antibiotic use without physician's prescription (p<0.001) had significant association with prevalence of ESBL producing bacteria in ear infection. The proportion of ear infection with ESBL producing P.mirabilis, P.aeruginosa and K.pneumoniae were 4 (1.7%), 3 (1.3%) and 2 (0.8%), respectively. All ESBL producing isolates were MDR (100%). Overall, 58 (43%) species were MDR. P.aeruginosa was the leading MDR isolate 29 (53.7%).For all bacterial isolates of ear infection, ampicillin(93.3%) and amoxicillin-clavulanic acid (58.5%) revealed high level of resistance whereas low resistance rates were observed for ciprofloxacin (5.2%), third generation cephalosporin (11.9-20%) and aztreonam (16.3%). CONCLUSIONS: Ear infection due to ESBL producing bacteria coupled with high levels of MDR is becoming a growing concern for outpatients in the study area. Regular detection of these bacteria and wise use of antibiotics are needed to stop the spread of this form of resistance.

Effects of Water Source, Sanitation and Hygiene on the Prevalence of Schistosoma mansoni among School Age Children in Jawe District, Northwest Ethiopia.

BACKGROUND: Intestinal schistosomiasis is a disease caused by infection with one of the blood flukes called Schistosoma mansoni. The distribution of Schistosoma mansoni infection is high in Sub-Saharan Africa due to water source, sanitation and hygiene problems. This study aimed to determine the effect of water source, sanitation and hygiene on the prevalence of schistosomiasis among school-age children in Northwest Ethiopia. METHODS: A cross-sectional study was conducted from Apr 2016 to Aug 2016. Children were selected by systematic random sampling and Formol Ether Concentration Technique (FECT) was used to identify Schistosoma mansoni infection. Statistical analysis was done using descriptive statistics and strength of association of schistosomiasis with determinant factors was calculated by bivariate analysis. RESULTS: Among 333 children, 7% were infected with Schistosoma mansoni. Using surface water for drinking, poor hand wash habit and latrine utilization were significantly associated (P<0.05) with Schistosoma mansoni infection. CONCLUSION: Absence of safe water for bathing, washing and swimming, poor sanitation and hygiene practices were major risk factors for schistosomiasis. Therefore, health education should be given on the transmission of S. mansoni infection, pure water, sanitation and hygiene in S. mansoni endemic areas.

Aetiology of acute diarrhoea and antimicrobial usage among children aged under five years at health centres in Bahir Dar, Ethiopia.

The aetiology of diarrhoea with Cryptosporidium species and pathogenic bacteria has not been identified in the Ethiopian primary healthcare system. Thus, antibiotic consumption for unconfirmed pathogenic diarrhoea is not infrequent. A total of 344 children aged <5 years with diarrhoea were included in the present study to determine protozoal or bacterial aetiology and antibiotic use. Overall, 47.1% of children with diarrhoea had either protozoan or bacterial pathogens. The prevalence of Cryptosporidium species was 12.8% while bacterial pathogens were 13.1%. Based on direct microscopic stool examination, 77.6% (267/344) of children with diarrhoea were treated with antimicrobials. Of these, 16.7%-51.4% of prescribed antimicrobials were appropriate. None of the children with Cryptosporidium diarrhoea were treated with the appropriate antimicrobial. Enteric bacterial pathogens showed a resistance of 51.6% to cotrimoxazole. Empirical treatments are not appropriate for the majority of child cases of diarrhoea.

Quality of care for tuberculosis patients in public health facilities of Debre Tabor town, Northwest Ethiopia.

BACKGROUND: Even though there are different tuberculosis (TB) prevention and control measures implemented globally including Ethiopia, TB is still major public health problem. This is partly due to compromised quality of care delivered for tuberculosis patients in health facilities (HFs) during diagnosis, treatment and follows-up. Thus this study is intended to determine the quality of care delivered for TB patients in all public HFs of Debre Tabor town, Northwest Ethiopia. METHODS: Cross sectional study was conducted from January to May 2018. Data were collected with face-to-face interview and TB registration book review using structured questionnaire and checklist respectively. Collected data was entered and processed using SPSS and P value <0.05 was considered statistically significant. The quality of care for each HF was graded as very good, good, moderate, poor and very poor if HFs achieve [90-100%], [80-90%), [70-80%), [60-70%) and <60% of performance indicators respectively using Donabedian structure, process and outcome model of health care quality. RESULTS: All HFs have sputum collection area, enough microscopic slide, at least one functional microscope and sufficient anti TB drug supply. But HFs lack backup laboratory stains. Overall structural aspects of quality of care in all HFs were very poor achieving 42.5-52.9% structural performance indicators out of 100%. Similarly the overall process aspects of quality of care was poor in all public HFs which achieved 60-68.9% of the scores out of 100%. In the study; 68.9%, 54.5% and 80.6% of Medical Laboratory, pharmacy and other healthcare workers (HWs) provided correct response respectively on TB causative agent, risk factor, transmission, treatment, prevention, case management and case finding strategies. HWs who knew at least two TB case finding strategies in DTH was significantly higher than those HWs working in Health Centers (P = 0.004). On the other hand, except Ginbot 20 HC, HFs was graded as good by scoring 86.6-89.3% of performance indicators on the outcome aspects of quality of care. In all HFs studied, all TB patients' unit TB registration number, sex, age, TB category, treatment initiation date and intensive phase treatment start year were properly registered. Moreover 110 (78%) and 147 (69%) contact person address in DTH and HCs was properly registered on TB unit register book respectively with no statistical difference in hospital and HCs (P = 0.063). There was proper TB patients' address registration in hospital than HCs studied (P< 0.001). CONCLUSIONS: The outcome aspects of quality of care for TB patients in all HFs were promising. But structural & process aspects of quality of care was compromised which necessitate different corrective actions to be taken by different stakeholders to enhance quality of care for TB patients in public HFs studied. Moreover based on the study findings, continuous supply of drugs, laboratory equipment and reagents, availing current guideline/s in HFs, providing up-to-date training for HWs on TB and proper documentation are important to improve quality of care provided for TB patients.

Prevalence and Factors Associated with Intestinal Parasitic Infections among Pregnant Women in West Gojjam Zone, Northwest Ethiopia.

BACKGROUND: Intestinal parasitic infections are the major causes of morbidity and mortality in sub-Saharan countries. The disease burden of these parasites is significantly high among pregnant women in developing countries like Ethiopia. Poor living conditions, sanitation, and hygiene are believed to be the contributing factors. The aim of this study was to determine the magnitude of intestinal parasitic infection and factors associated with pregnant women. METHODS: A cross-sectional study was conducted from February 2017 to June 2017. A structured questionnaire was used to obtain the sociodemographic and other explanatory variables via face-to-face interviews. Stool samples were collected and examined using formol ether concentration technique. The magnitude of parasitic infection was calculated using descriptive statistics. The association between intestinal parasitic infection and determinant factors was assessed by logistic regression. The differences were considered to be statistically significant if the p value was less than 0.05. RESULTS: From a total of 743 pregnant women, the overall prevalence of intestinal parasitosis was 277 (37.3%). The prevalence of hookworm 138 (18.6%) was the leading cause of intestinal parasitosis followed by E. histolytica/dispar 113 (15.2%). Dwelling in rural area (AOR: 2.9 (95% CI: 1.85-4.85)), being a farmer (AOR: 1.91 (95% CI: 1.20-3.03)), eating raw vegetables (AOR: 1.45, 95% CI:0.09-0.24), lack of proper use of latrine (AOR: 2.89 (95%1.18-7.08)), poor environmental sanitation (AOR: 0.19 (95%: CI:0.08-0.47)), habit of soil eating (AOR: 0.42 (95% CI: 0.25-0.72)), having irrigation practice (AOR: 0.47 (95% CI: 0.29-0.77)), and lack of health education (AOR: 0.32 (95% CI: 0.13-0.77)) were significantly associated with intestinal parasitic infections. CONCLUSIONS: Intestinal parasitic infection is a major problem among pregnant women in the study area. High parasitic infection is associated with poor hygienic and sanitation practices. Therefore, awareness creation through health education should be given to pregnancy on intestinal parasitic infection and associated factors.

Physicochemical and bacteriological quality of bottled drinking water in three sites of Amhara Regional State, Ethiopia.

BACKGROUND: The consumption of bottled drinking water is becoming increasing in Ethiopia. As a result there has been a growing concern about the chemical, physical and bacteriological quality of this product. Studies on the chemical, physical and bacteriological quality of bottled water is quite scarce in Ethiopia. OBJECTIVE: This study was therefore aimed to assess the physicochemical and bacteriological qualities of three factories of bottled drinking water products produced in Amhara region. METHODS: A Laboratory based comparative study was conducted to evaluate the physicochemical and bacteriological quality of three factories of bottled drinking water produced in Amhara region. Analysis on the quality of bottled drinking water from the sources, wholesalers and retailers were made with World Health Organization and Quality and Standards Authority of Ethiopia recommendations. Triplicate samples from three types of bottled drinking water were randomly collected and analyzed from June, 2006 to December, 2006. RESULT: A total of 108 commercial bottled drinking water samples were analyzed. The result showed that except pH of factory A all the physicochemical parameters analyzed were with in the recommended limits. The pH value of factory A tested from sources is 5.3 and from wholesalers and retailers is 5.5 and 5.3, respectively, which is below the normal value set by World Health Organization (6.5-8.0) and Quality and Standards Authority of Ethiopia (6.0-8.5). Our analyses also demonstrated that 2 (16.7%) of the samples tested from sources and 1 (8.3%) from wholesalers of factory B were contaminated with total coliforms, where as 2 (16.7%) samples from retailers were also contaminated with total coliforms. On the other hand, 1 (8.3%) of the samples tested from wholesalers and 2 (16.7%) of the samples tested from retailers of factory A were also contaminated with total coliforms. Total coliforms were not detected from all samples of factory C, fecal coliforms were not also isolated from all samples. Percent of coefficient of variation showed that variations in total coliforms counts were significant with in the samples of both factory A and B (CV > 10%). CONCLUSIONS: Based on the recommended limit of World Health Organization and Quality and Standards Authority of Ethiopia, 7.4% of bottled drinking water sold commercially could be considered unfit for human consumption. Consumers of bottled water should be aware of this.