Abebe Animut

Therapeutic efficacy of Artemether/Lumefantrine (Coartem®) against Plasmodium falciparum in Kersa, South West Ethiopia

BackgroundArtemether/Lumefantrine (Coartem®) has been used as a first-line treatment for uncomplicated Plasmodium falciparum infection since 2004 in Ethiopia. In the present study the therapeutic efficacy of artemether/lumefantrine for the treatment of uncomplicated P. falciparum infection at Kersa, Jima zone, South-west Ethiopia, has been assessed.MethodsA 28 day therapeutic efficacy study was conducted between November 2007 and January 2008, in accordance with the 2003 WHO guidelines. Outcomes were classified as early treatment failure (ETF), late clinical failure (LCF), late parasitological failure (LPF) and adequate clinical and parasitological response (ACPR).Results90 patients were enrolled and completed the 28 day follow-up period after treatment with artemether/lumefantrine. Cure rate was very high, 96.3%, with 95% CI of 0.897-0.992 (PCR uncorrected). Age-stratified data showed adequate clinical and parasitological response (ACPR) to be 100% for children under 5 and 97.4% and 87.3% for children aged 5-14, and adults, respectively. There was no early treatment failure (ETF) in all age groups. Fever was significantly cleared on day 3 (P < 0.05) and 98% of parasites where cleared on day 1 and almost all parasites were cleared on day 3. 72.5% of gametocytes were cleared on day 1, the remaining 27.5% of gametocytes were maintained up to day 3 and total clearance was observed on day 7. Hemoglobin concentration showed a slight increase with parasitic clearance (P > 0.05). No major side effect was observed in the study except the occurrence of mouth ulcers in 7% of the patients.ConclusionsThe current study proved the excellent therapeutic efficacy of artemether/lumefantrine in the study area and the value of using it. However, the proper dispensing and absorption of the drug need to be emphasized in order to utilize the drug for a longer period of time. This study recommends further study on the toxicity of the drug with particular emphasis on the development of oral ulcers in children.

Antibacterial activities of selected medicinal plants in traditional treatment of human wounds in Ethiopia

OBJECTIVE To evaluate the activity of selected Ethiopian medicinal plants traditionally used for wound treatment against wound-causing bacteria. METHODS Samples of medicinal plants (Achyranthes aspera, Brucea antidysenterica, Datura stramonium, Croton macrostachyus, Acokanthera schimperi, Phytolacca dodecandra, Millettia ferruginea, and Solanum incanum) were extracted using absolute methanol and water and tested for their antimicrobial activities against clinical isolates and standard strains of wound-causing bacteria using agar well diffusion and micro titer plate methods. RESULTS Most of the plant extracts had antibacterial activities, among which Acokanthera schimperi and Brucea antidysenterica inhibited growth of 100% and 35% of the test organisms, respectively. Methanolic extracts had higher activities compared with their corresponding aqueous extracts. The most susceptible organism to the extracts was Streptococcus pyogens while the most resistant were Escherichia coli and Proteus vulgaris. CONCLUSIONS This finding justifies the use of the plants in wound healing and their potential activity against wound-causing bacteria. Their toxicity level and antimicrobial activity with different extraction solvents should further be studied to use them as sources and templates for the synthesis of drugs to control wound and other disease-causing bacteria.

Ethnobotanical study of antimalarial plants in Shinile District, Somali Region, Ethiopia, and in vivo evaluation of selected ones against Plasmodium berghei.

ETHNOPHARMACOLOGICAL RELEVANCE The study documented medicinal plants that are traditionally used for treatment of malaria in Shinile District, eastern Ethiopia, and evaluated selected medicinal plants for their antiplasmodial activities against Plasmodium berghei. MATERIALS AND METHODS The study was conducted in four kebeles of Shinile District, Somali Region, Ethiopia. A total of 15 traditional healers were sampled based on recommendations of local elders and administrators. Specimens of the reported antimalarial plants were collected and stored at the Mini Herbarium of the Aklilu Lemma Institute of Pathobiology, Addis Ababa University, following identification. Crude aqueous and ethanol extracts of Aloe sp., Azadirachta indica and Tamarindus indica were tested in vivo against Plasmodium berghei. The three plants were selected based on the frequency antimalarial use report by healers. RESULTS The study revealed 27 antimalarial plants, the majority of which were harvested from the wild. Root was the most frequently sought plant part. Most of the remedies were used in decoction form. Aloe sp., Azadirachta indica and Tamarindus indica were the most commonly reported plants for their antimalarial use. For the in vivo test, all the plant extracts were given to mice orally. Ethanol and aqueous leaf extracts of Aloe sp. caused 73.94% and 58.10% parasitaemia suppression, respectively at dose of 650 mg/kg. Ethanol extract of Azadirachta indica leaves induced 54.79% parasitaemia suppression at the dose of 650 mg/kg and its water extract induced 21.47% parasite suppression at a similar dose. Water extract of the fruits of Tamarindus indica showed the highest parasitaemia suppression (81.09%) at the dose of 650 mg/kg. Most Plasmodium berghei infected mice treated with high dose of plant extracts survived relatively longer compared to their respective controls although the difference was not significant. CONCLUSIONS The result of this study may support the traditional use of Aloe sp., Azadirachta indica and Tamarindus indica in the study area against malaria. Results of this study can be used as a basis for further phytochemical and pharmacological investigations in the effort for search of new and locally affordable antimalarial agents.

Malaria and related outcomes in patients with intestinal helminths: a cross-sectional study

BackgroundThe effects of helminth co-infection on malaria in humans remain uncertain. This study aimed to evaluate the nature of association of intestinal helminths with prevalence and clinical outcomes of Plasmodium infection.MethodsA cross-sectional study involving 1,065 malaria suspected febrile patients was conducted at Dore Bafeno Health Center, Southern Ethiopia, from December 2010 to February 2011. Plasmodium and intestinal helminth infections were diagnosed using Giemsa-stained blood films and Kato-Katz technique, respectively. Haemoglobin level was determined using a haemocue machine.ResultsAmong 1,065 malaria suspected febrile patients, 28.8% were positive for Plasmodium parasites (P. falciparum =13.0%, P. vivax =14.5%, P. falciparum and P. vivax =1.3%). Among 702 patients who provided stool samples, 53.8%, 31.6% and 19.4% were infected with intestinal helminths, Plasmodium alone and with both Plasmodium and intestinal helminths, respectively. The prevalence of infections with Ascaris lumbricoides (A. lumbricoides), Trichuris trichiura (T. trichiura), Schistosoma mansoni (S. mansoni) and hookworm (9.8%) were 35.9%, 15.8%, 11.7% and 9.8%, respectively. Out of the 222 (31.6%) Plasmodium infected cases, 9 (4.1%) had severe malaria. P. falciparum infection was more common in febrile patients infected with A. lumbricoides alone (21.3%), T. trichiura alone (23.1%) and S. mansoni alone (23.1%) compared to those without intestinal helminth infections (9.3%) (p<0.001 for all). Prevalence of non-severe malaria was significantly higher in individuals infected with intestinal helminths than in those who were not infected with intestinal helminths (adjusted OR=1.58, 95% CI=1.13-2.22). The chance of developing non-severe P. falciparum malaria were 2.6, 2.8 and 3.3 times higher in individuals infected with A. lumbricoides alone, T. trichiura alone and S. mansoni alone, respectively, compared to intestinal helminth-free individuals (p<0.05 for all). The odds ratio for being infected with non-severe P. falciparum increased with the number of intestinal helminth species (p<0.001). Mean Plasmodium density among intestinal helminth infected individuals was significantly increased with the number of intestinal helminths species (p=0.027). Individuals who were co-infected with different species of intestinal helminths and Plasmodium showed lower mean haemoglobin concentration than individuals who were infected only with Plasmodium.ConclusionsInfections with A. lumbricoides, T. trichiura and S. mansoni were positively associated with P. falciparum infection. However, further studies are required to investigate how these helminths could contribute to increased prevalence of P. falciparum infection.

Malaria severity status in patients with soil-transmitted helminth infections.

OBJECTIVE To investigate the possible impact of soil-transmitted helminth (STH) infection on malaria severity, level of parasitaemia and clearance/reduction of Plasmodium parasites following treatment with anti-malarial drugs. METHODS 458 voluntary malaria patients who visited the Alaba Kulito Health Center, southern Ethiopia, for medical treatment in November and December 2007 were included in this study. Giemsa-stained thick and thin blood films were used for the determination of parasitaemia and identification of Plasmodium species, respectively. Stool sample was collected from these patients and diagnosed for intestinal helminths using Kato-Katz technique. Haemoglobin concentration was measured using a portable spectrophotometer (HemoCue HB 201). Malaria parasite clearance was checked on day 3 post-treatment. FINDINGS The prevalence of co-infection of malaria with the major soil-transmitted helminths (STHs), i.e., with hookworm species, Ascaris lumbricoides and Trichuris trichiura was 9.6%, 6.3% and 2.1%, respectively. About 8.1% of the study subjects had severe malaria. Intensity of hookworm infection showed positive association with malaria parasite densities (F=3.510, P=0.033). STHs infection in general was negatively correlated with the symptoms of severe malaria (OR=0.317, 95% CI=0.315-0.86, P=0.01), but a small proportion (4.5%) of malaria patients who were concurrently harboring one or more intestinal helminths had severe malaria. Only few malaria patients (2.3%) co-infected with STHs were found positive for Plasmodium parasites on day 3 post-treatment. CONCLUSION The present findings indicate that soil-transmitted helminths have very little contribution to malaria severity in co-infected individuals. The findings also indicate that STHs do not have significant impact on clearance rate of Plasmodium falciparum and Plasmodium vivax when treated with anti-malarial drugs.

Malaria and helminth co-infections in outpatients of Alaba Kulito Health Center, southern Ethiopia: a cross sectional study.

BackgroundDistribution of malaria and intestinal helminths is known to overlap in developing tropical countries of the world. Co-infections with helminth and malaria parasites cause a significant and additive problem against the host. The aim of this study was to asses the prevalence of malaria/helminth co-infection and the associated problems among febrile outpatients that attended Alaba Kulito Health Center, southern Ethiopia November and December 2007. A total of 1802 acute febrile patients were diagnosed for malaria. 458 Giemsa-stained thick and thin blood films were used for identification of Plasmodium species and Stool samples prepared using Kato-Katz technique were used to examine for intestinal helminths. Haemoglobin concentration was measured using a portable spectrophotometer (Hemocue HB 201). Anthropometry-based nutritional assessment of the study participants was done by measuring body weight to the nearest 0.1 kg and height to the nearest 0.1 cm.Findings458 of the total febrile patients were positive for malaria. Co infection with Plasmodium and helminth parasites is associated with significantly (p < 0.001) higher anaemia prevalence than single infection with Plasmodium parasites. And this difference was also significant for haemoglobin concentration (F = 10.18, p = 0.002), in which patients co infected with Plasmodium and helminth parasites showed lower mean haemoglobin concentration. More than one-third of the infected cases in both malaria infections and malaria/helminth co infections are undernourished. However the statistics for the difference is not significant.ConclusionMalaria and soil-transmitted helminthiasis obviously contribute to anaemia and low weight status and these conditions are more pronounced in individuals concurrently infected with malaria and soil-transmitted helminths. Hence, simultaneous combat against the two parasitic infections is very crucial to improve health of the affected communities.

Impact of housing condition on indoor-biting and indoor-resting Anopheles arabiensis density in a highland area, central Ethiopia

BackgroundExposure of individuals to malaria infection may depend on their housing conditions as houses serve as biting and resting places of vectors. This study describes the association of housing conditions with densities of indoor-biting and indoor-resting Anopheles arabiensis in Hobe, Dirama and Wurib villages of a highland area in central Ethiopia.MethodsData on housing conditions, including presence of house apertures, number of occupants and number and the type of domestic animal tethered inside, were collected. Indoor-biting mosquitoes were sampled using Centers for Disease Control (CDC) light traps and indoor-resting mosquitoes sampled with pyrethrum spray catches (PSCs) monthly for two years (July 2008 to June 2010). Female anophelines were identified to species and processed. Univariate and general linear estimating equation allowing for repeated measures were used to assess the contribution of housing conditions for indoor-biting and indoor-resting An. arabiensis.ResultsAbout 96% (4,597/4,788) of anophelines were caught inside residential houses. Nine anopheline species were identified, among which An. arabiensis was most prevalent (2,489; 52%). Vectors entering houses were higher in those situated at low (β = 4.475; 95% CI = 3.475-5.476; p <0.001; β = strength of the association) and medium (β = 2.850; 95% CI = 1.975-3.724; p <0.001) altitudes compared to high altitude, and where houses have no windows (β = -0.570; 95% CI = -1.047-0.094; p = 0.019) compared with those that have. Numbers of indoor-resting vectors were higher in those situated at low (β = 6.100; 95% CI = 4.571-7.629; p <0.001) and medium (β = 4.411; 95% CI = 2.284-6.537; p <0.001) altitudes compared to high altitudes, and where houses had open eaves (β =1.201; 95% CI = 0.704-1.698; p <0.001) compared with those that had closed eaves.ConclusionHousing conditions such as presence of open eaves, absence of window, location at low and mid altitudes, were strong predictors of indoor exposure to An. arabiensis bite in a highland area of south-central Ethiopia.

Abundance and dynamics of anopheline larvae in a highland malarious area of south-central Ethiopia.

BackgroundMalaria is a public health problem in Ethiopia, and increasingly so in highland areas, possibly because of global warming. This study describes the distribution, breeding habitat and monthly dynamics of anopheline larvae in Butajira, a highland area in south-central Ethiopia.MethodsA study of the abundance and dynamics of Anopheles larvae was undertaken at different sites and altitudes in Butajira from July 2008 to June 2010. The sites included Hobe (1817 m.a.s.l), Dirama (1995m.a.s.l.) and Wurib (2196m.a.s.l.). Potential anopheline larval habitats were surveyed once per month in each village. The recorded characteristics of the habitats included habitat type, pH, surface debris, emergent plants, algae, substrate, turbidity, temperature, length, width, depth, distance to the nearest house and anophelines. The Spearman correlation coefficient and Mann–Whitney U test were used to calculate the degree of association between the density of anopheline species and key environmental factors.ResultsAmong the different types of habitat surveyed, the Odamo, Akamuja and Assas streams and Beko swamp were positive for anopheline larvae. A total of 3,957 third and fourth instar larvae were collected from the three localities, and they represented ten species of anophelines. These were: Anopheles cinereus (32.5%), An. arabiensis (31.4%), An. chrysti (23%), An. demeilloni (12.2%), An. pretoriensis (0.6%), An. azaniae (0.1%), An. rufipes(0.1%), An. sergentii (0.06%), An. garnhami (0.06%) and An. pharoensis (0.03%). The density of anopheline larvae was highest during the dry months. An. arabiensis was widely distributed, and its density decreased from the lowest elevation in Hobe to the highest in Wurib. The density of An. arabiensis larvae was correlated positively with larval habitat temperature (r = 0.33, p < 0.05) and negatively with depth of larval habitat (r = −0.56, p < 0.05).ConclusionTen species of anophelines were identified, including two known vectors of malaria (An. arabiensis and An. pharoensis), along streams in Butajira. Larvae of An. arabiensis were found in streams at 2200m.a.s.l. This possible expansion of the malaria vector to highland areas indicates an increasing risk of malaria because a large proportion of the Ethiopian population live above this altitude.

The association between multiple intestinal helminth infections and blood group, anaemia and nutritional status in human populations from Dore Bafeno, southern Ethiopia.

In this cross-sectional study, the associations between helminth infections and ABO blood group, anaemia and undernutrition were investigated in 480 febrile outpatients who visited Dore Bafeno Health Centre, southern Ethiopia, in December 2010. Stool specimens were processed using the Kato-Katz method and examined for intestinal helminth infections. Haemoglobin level was measured using a HemoCue machine and blood group was determined using an antisera haemagglutination test. Nutritional status of the study participants was assessed using height and weight measurements. Among the study participants, 50.2% were infected with intestinal helminths. Ascaris lumbricoides (32.7%), Trichuris trichiura (12.7%), Schistosoma mansoni (11.9%) and hookworm (11.0%) were the most frequently diagnosed helminths. The odds of infection and mean eggs per gram of different intestinal helminth species were comparable between the various blood groups. Among individuals who were infected with intestinal helminth(s), the mean haemoglobin level was significantly lower in individuals harbouring three or more helminth species and blood type AB compared to cases with double or single helminth infection and blood type O, respectively. The odds of being underweight was significantly higher in A. lumbricoides and T. trichiura infected individuals of age ≤ 5 and ≥ 20 years, respectively, when compared to individuals of the matching age group without intestinal helminths. In conclusion, infection with multiple intestinal helminths was associated with lower haemoglobin level, which was more severe in individuals with blood type AB. Future studies should focus on mechanisms by which blood group AB exacerbates the helminth-related reduction in mean haemoglobin level.

In vivo Antimalarial Activity of a Labdane Diterpenoid from the Leaves of Otostegia integrifolia Benth

In Ethiopian traditional medicine, the leaves of Otostegia integrifolia Benth. are used for the treatment of several diseases including malaria. In an ongoing search for effective, safe and cheap antimalarial agents from plants, the 80% methanol leaf extract O. integrifolia was tested for its in vivo antimalarial activity, in a 4‐day suppressive assay against Plasmodium berghei. Activity‐guided fractionation of this extract which showed potent antiplasmodial activity resulted in the isolation of a labdane diterpenoid identified as otostegindiol. Otostegindiol displayed a significant (P < 0.001) antimalarial activity at doses of 25, 50 and 100 mg/kg with chemosuppression values of 50.13, 65.58 and 73.16%, respectively. Acute toxicity studies revealed that the crude extract possesses no toxicity in mice up to a maximum dose of 5000 mg/kg suggesting the relative safety of the plant when administered orally. The results of the present study indicate that otostegindiol is among the antimalarial principles in this medicinal plant, and further support claims for the traditional medicinal use of the plant for the treatment of malaria. Copyright