Malaria case investigation with reactive focal testing and treatment: operational feasibility and lessons learned from low and moderate transmission areas in Amhara Region, Ethiopia.

BACKGROUND: When malaria transmission is very low, investigation of passively detected malaria cases and reactive focal testing and treatment (FTAT) in the case and neighbouring households can identify and contain the source and spread of infections. METHODS: Case investigation with reactive FTAT for malaria was implemented in 10 villages in Amhara Region, Ethiopia during the 2014/2015 malaria transmission season. Intervention villages were purposively selected based on the incidence of passively detected Plasmodium falciparum and mixed infections (P. falciparum and Plasmodium vivax) during the 2013 transmission season. A passively detected P. falciparum or mixed index case triggered an investigation that targeted the index case household and the closest 10 neighbouring households in a 100-m radius. All consenting household members received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether-lumefantrine (P. falciparum, mixed) or chloroquine (P. vivax). RESULTS: From October 2014 to February 2015, 407 P. falciparum or mixed index cases (approximately 6.5 per 1000 population) were passively detected. Of these, 220 (54.1%) were investigated, of which 87.3% were male, 61.8% were age 20-39 years [median age: 27 years (range 1-90)], and 58.6% spent ≥ 1 night away from home in the past month (ranging from 0.0 to 94.1% by village). Among the 4077 residents in the 914 households investigated, 3243 (79.5%) received an RDT and 127 (3.9%) were RDT-positive (2.2% P. falciparum, 0.5% P. vivax, 1.2% mixed). Three epidemiological patterns were found. In six villages, there were almost no cases, with less than 10 index and secondary cases. In three villages, most index cases had a history of travel (> 62%), but there were a small number of secondary cases (< 10). Lastly, in one village none of the index cases had a history of recent travel and there was a large number of secondary cases (n = 105). CONCLUSIONS: Three types of malaria transmission patterns were observed: (1) low importation and low local transmission; (2) high importation and low local transmission; and, (3) low importation and high local transmission. To achieve malaria elimination in Amhara Region, intervention strategies targeting these different patterns of transmission and population movement are required.

Mass testing and treatment for malaria in low transmission areas in Amhara Region, Ethiopia.

BACKGROUND: In areas with ongoing malaria transmission, strategies to clear parasites from populations can reduce infection and transmission. The objective of this paper was to describe a malaria mass testing and treatment (MTAT) intervention implemented in six kebeles (villages) in Amhara Region, Ethiopia, at the beginning of the 2014 transmission season. METHODS: Intervention kebeles were selected based on incidence of passively detected Plasmodium falciparum and mixed (P. falciparum and P. vivax) malaria cases during the 2013 malaria transmission season. All households in intervention kebeles were targeted; consenting residents received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether-lumefantrine for P. falciparum/mixed infections or chloroquine for P. vivax. Data were collected on MTAT participation, sociodemographic characteristics, malaria risk factors, and RDT positivity. RESULTS: Of 9162 households targeted, 7974 (87.0 %) participated in the MTAT. Among the 35,389 residents of these households, 30,712 (86.8 %) received an RDT. RDT-positivity was 1.4 % (0.3 % P. vivax, 0.7 % P. falciparum, 0.3 % mixed), ranging from 0.3 to 5.1 % by kebele; 39.4 % of RDT-positive individuals were febrile, 28.5 % resided in the same household with another RDT-positive individual, 23.0 % were not protected by vector control interventions [mosquito net or indoor residual spray (IRS)], and 7.1 % had travel history. For individuals under 10 years of age, the odds of being RDT-positive was significantly higher for those with fever, recent use of anti-malarial drugs or residing in the same household with another RDT-positive individual; 59.0 % of RDT-positive individuals had at least one of these risk factors. For individuals 10 years of age and older, the odds of being RDT positive was significantly higher for those with reported travel, fever, recent use of anti-malarial drugs, no use of vector control, and those residing in the same household as another RDT-positive individual; 71.2 % of RDT-positive individuals had at least one of these risk factors. CONCLUSIONS: In the Ethiopia setting, an MTAT intervention is operationally feasible and can be conducted with high coverage. RDT-positivity is low and varies widely by kebele. While several risk factors are significantly associated with RDT-positivity, there are still many RDT-positive individuals who do not have any of these risk factors. Strategies that target populations for testing and treatment based on these risk factors alone are likely to leave many infections undetected.

Rapid Bioethical Assessment for Mycobacterium tuberculosis and Host Genetic Study in Amhara Regional State, Ethiopia: Towards a Context-Specific Ethical Approach.

Background: Rapid Ethical Assessment (REA) is a rapid qualitative study anticipated to understand the ethical sphere of the research setting prior to recruiting study subjects. This study assessed the communities' knowledge about tuberculosis (TB) and research, understand the social arrangements advisable for recruiting research participant and appraised the information provision and consent process. Methods: The study was conducted in Amhara region, Ethiopia from 5th-30th January 2021. Google-based survey, face-to-face in-depth interview and focus group discussion were carried out to collect the data from researchers, data collectors, health professionals, TB program officers. A structured questionnaire was administered to assess the knowledge of TB patients and healthy controls about TB, research, gene, (co)evolution and consent process. Results: Over 71% of researchers were not satisfied with the current consent process, and 82.7% of researchers agreed that the best interest of the research participants was not adequately addressed in the current research practices in ANRS. TB patients and healthy controls misunderstood research and its goals. Participants advised the researchers to approach the community with the assistance of health extension workers (HEW) or religious/local leaders. Combined use of verbal and written based information provision at individual participant level is the preferred way for information provision. Conclusions: The adherence of researchers to standard information provision and consent process was very low. Healthy controls and TB patients have low level of knowledge and awareness about research, ethics and genomic research-related common terms. Hence, public education is required to strengthen the research ethics in the region.

Health and nutrition emergency response among internally displaced persons at Ranch collective site, Chagni, Ethiopia: The role of emergency operation center, lessons from the field, and way forwards.

Background: In October 2020, about 79,041 ethnically Amhara/Agew people had been internally displaced (IDPs) from Metekel zone of Benishangul-Gumuz region and lived in Ranch collective site, Chagni town, Ethiopia. Onsite PHEOC met the health and nutrition needs of the IDPs as per international humanitarian response standards. Methods: On January 11/2021, the Amhara Public Health Institute (APHI) established an onsite Public Health Emergency Operation Center (PHEOC) at Ranch collective site. Health workers and vehicles were deployed. A temporary clinic having nine outlets was built. Drugs and medical supplies were mobilized from different sources. The overall response period lasted about 8 months, from December 2020 up to June 2021. Results: A total of 33,410 IDPs had received free essential health services. Mental health and psychosocial support services had been given for 1,803 cases. Specialized medical services such as trachomatous trichiasis (30), cataract surgery (8) and sputum samples for mycobacterium tuberculosis (120) have been done. Moreover, 454 women received antenatal care services and 137 women gave birth at health facilities. About 837 children have got measles supplementary dose and 1,280 adults took a COVID-19 vaccination. A total of 1,448 children under five, 454 pregnant and 402 lactating women had been screened on monthly basis. Of which, severe and moderate malnutrition rate was 46 (3.2%) and 75 (5.2%), respectively. A total of 194 trench latrine seats, 74 shower rooms and 50 hand washing facilities had been constructed. There were no human feces present nor solid wastes accumulated around the shelters or settlements. Both active and passive surveillance activities were carried out throughout the camp life. We also conducted regularly Risk Communication and Community Engagement activities on priority health issues. Conclusion: We adequately met the health and nutrition needs of the IDPs as stated in the Sphere humanitarian handbook. We sought to have a strong Incident Management System and coordination platforms like PHEOC, a resilient health system, a training curriculum called Leading in Emergencies, and a multipurpose collective center with infrastructures, humanitarian response guidelines, training materials, and risk/vulnerability-based preparedness plan.

Recent HIV infection among newly diagnosed cases and associated factors in the Amhara regional state, Northern Ethiopia: HIV case surveillance data analysis (2019-2021).

Background: Distinguishing a recent from long-standing HIV infection is a critical step to reduce new infections in 2030. Therefore, this analysis determines the proportion of recent HIV infections among newly diagnosed cases and associated factors in the Amhara regional state between 2019 and 2021. Methods: We got the HIV case-based surveillance dataset (July 2019 up to August 12/2021) from the Amhara Public Health Institute. Recent infection is an infection gained within the last 12 months as identified by Asante recency test kits. Logistic regression was carried out to identify factors associated with recent infection. Adjusted odd with 95% CI and a p-value of < 0.05 was considered to declare significant associations. Results: Out of 5,689 eligible cases, 3,129 (55%) recency tests had been performed. The proportion of recent HIV infection is 443 (14.2%, 95% CI: 13, 15.4%). High proportion of recent infections is reported from Bahir Dar city (23.3%), Central Gondar (17.7%), West Gojjam (16.5%), North Shewa (16.5%) and South Gondar zones (15.7%). Besides, the proportion of recent infection is high among clients aged ≥ 51 years (32.4%), illicit drug users (30.6 %), homelessness (28.5%), current commercial sex workers (27.9%), prisoners (21.1%), and among clients with invasive medical procedures (22.2%). Recent infection is significantly associated with females (AOR: 1.9, 95% CI: 1.2-3.1), secondary and above education (AOR: 2.1, 95% CI: 1.3-3.4), commercial sex workers (AOR: 1.8, 95% CI: 1.2-2.7), having contact with index case (AOR: 0.5, 95% CI: 0.3-0.8) and illicit drug utilization (AOR: 3.6, 95% CI: 1.1-12.4). Conclusion: In the Amhara region, the proportion of recent HIV infection is high with marked variation across sociodemographic characteristics. We identified the risk or preventive factors associated with a recent infection. Therefore, all HIV responders should target their prevention efforts toward hot spot areas and sub-populations to stop further transmission.

COVID-19 Knowledge, Attitude, Practices and Their Associated Factors Among Dessie City Residents, Northeast Ethiopia: A Cross-Sectional Study.

BACKGROUND: Sufficient knowledge and favorable attitude are among the key determinants for people's adherence to coronavirus disease (COVID-19) precaution measures. Hence, this study assessed Dessie city resident's knowledge, attitude, and practice on COVID-19. METHODS: We used a facility-based cross-sectional study among 424 Dessie city residents from 17 to 21/05/2020. We dichotomized knowledge, attitude and practice scores based on the mean value. We entered the data into EpiData manager software 4.2 and exported to SPSS-20 for data analysis. We run three independent logistic regression analyses to determine factors associated with sufficient knowledge, a favorable attitude, and adequate practice. We defined significant association at a p-value of <0.05. RESULTS: Among 424 participants, 92.7% have sufficient knowledge about COVID-19, while 96% have a favorable attitude to prevent and control the pandemic. However, the practice was adequate only in 44.6% of the participants. Increasing educational status (AOR: 6.5, 95% CI: 2-21.4), availability of television (AOR: 3.8, 95% CI: 1.4-10.5), having a telephone (AOR: 3.4, 95% CI: 1.3-9.1) and radio (AOR: 4.2, 95% CI: 1.1-15.5) are the factors associated with sufficient knowledge, while sufficient knowledge (AOR: 5.4, 95% CI: 1.7-17.2), is the only predictor identified for favorable attitude. Similarly, being a farmer (AOR: 0.14, 95% CI: 0.047-0.4), availability of telephone (AOR: 3.1, 95% CI: 1.2-8.2), and sufficient knowledge (AOR: 15.2, 95% CI: 1.9-118) are the predictors of adequate practice. CONCLUSION: In the study area, the participant's knowledge and attitude are found to be sufficient to halt coronavirus transmission. However, practice in the vast majority is not adequate to stop coronavirus transmission. Educational status, television, telephone, radio, occupation and knowledge are the significant factors for successful prevention and control of coronavirus. Despite escalating public knowledge, our finding suggests the government to follow some compulsory regulations for uniform implementation of preventive measures.

Determination of urinary iodine excretion to assess iodine deficiency level and iodine intake in primary school children, Bahir Dar, northwest Ethiopia.

BACKGROUND: Iodine deficiency is a major public health problem all over the world, particularly among preschool children and pregnant women in low-income countries like Ethiopia and it is known to be the most common cause of preventable brain damage. OBJECTIVES: to determine urinary iodine concentration and to assess the level of iodine deficiency disorders. METHODS: A cross-sectional study was conducted in 386 randomly selected primary school children to determine urinary iodine concentrations as to assess level of iodine deficiency and iodine in take in Bahir Dar town. RESULTS: Median urinary iodine excretion was 58.8 mg/L (12.89 mg/L to 564.5 mg/L) which indicated the presence of mild iodine deficiency. Eighty seven percent of the children had urinary iodine excretion of below 100 mg/L and the intake of iodine was below 150 mg/day. CONCLUSIONS: Mild iodine deficiency disorder was found in Bahir Dar primary school children, Iodine intake was also found insufficient. Therefore, use of salt ionization should be advocated and strengthened.

A Venue-Based Survey of Malaria, Anemia and Mobility Patterns among Migrant Farm Workers in Amhara Region, Ethiopia.

BACKGROUND: Mobile populations present unique challenges to malaria control and elimination efforts. Each year, a large number of individuals travel to northwest Amhara Region, Ethiopia to seek seasonal employment on large-scale farms. Agricultural areas typically report the heaviest malaria burden within Amhara thereby placing migrants at high risk of infection. Yet little is known about these seasonal migrants and their malaria-related risk factors. METHODS AND FINDINGS: In July 2013, a venue-based survey of 605 migrant laborers 18 years or older was conducted in two districts of North Gondar zone, Amhara. The study population was predominantly male (97.7%) and young (mean age 22.8 years). Plasmodium prevalence by rapid diagnostic test (RDT) was 12.0%; One quarter (28.3%) of individuals were anemic (hemoglobin <13 g/dl). Nearly all participants (95.6%) originated from within Amhara Region, with half (51.6%) coming from within North Gondar zone. Around half (51.2%) slept in temporary shelters, while 20.5% regularly slept outside. Only 11.9% of participants had access to a long lasting insecticidal net (LLIN). Reported net use the previous night was 8.8% overall but 74.6% among those with LLIN access. Nearly one-third (30.1%) reported having fever within the past two weeks, of whom 31.3% sought care. Cost and distance were the main reported barriers to seeking care. LLIN access (odds ratio [OR] = 0.30, P = 0.04) and malaria knowledge (OR = 0.50, P = 0.02) were significantly associated with reduced Plasmodium infection among migrants, with a similar but non-significant trend observed for reported net use the previous night (OR = 0.16, P = 0.14). CONCLUSIONS: High prevalence of malaria and anemia were observed among a young population that originated from relatively proximate areas. Low access to care and low IRS and LLIN coverage likely place migrant workers at significant risk of malaria in this area and their return home may facilitate parasite transport to other areas. Strategies specifically tailored to migrant farm workers are needed to support malaria control and elimination activities in Ethiopia.

Prevalence and risk factors of louse-borne relapsing fever in high risk populations in Bahir Dar city Northwest, Ethiopia.

BACKGROUND: Louse- borne relapsing fever (LBRF) is a vector borne acute febrile illness caused by Borrelia recurrentis and the disease is more prevalent in the high risk groups like prisoners, yekoloremaries and street children. However, prevalence and risk factors of LBRF in these populations about the disease are not known. Therefore, the aim of this study was to determine the prevalence and risk factors of LBRF in high risk populations. METHODS: A cross- sectional survey on prevalence and risk factors of LBRF in high risk populations in Bahir Dar city was conducted in December, 2012. For the study, blood was taken from the tip of the left ring finger of the participants by laboratory technicians and thick blood film was prepared from each participant and stained with 3% Giemsa for 30 min. The slides were examined and the result was reported as positive or negative using light microscopy and finally, data was also collected using a pre- tested questionnaire by face to face interviews. RESULTS: Of the 407 study participants, 383 (94.1%) were males with the mean age of 31 years and 243 (59.7%) had no formal education. The prevalence of LBRF was 2.5% and the positivity rate of LBRF was highest in yekolotemaries (6.1%) followed by street children (4.9%). However, prisoners had nil and statistically significance association was observed between high risk populations and LBRF prevalence (p < 0.001). Those study participants who lived in mud houses had the highest positivity rate (2.2%), followed by those in wood houses (0.3%). However, those who lived in brick houses had nil. Study participants who had low levels of knowledge had the highest prevalence rate of LBRF. CONCLUSION: The overall prevalence of LBRF was 2.5% and the rate of positivity was highest in yekolotemaries, followed by street children. Therefore, health education should be given for these high risk populations.