Anteneh Amsalu

Impact of HIV Status on Treatment Outcome of Tuberculosis Patients Registered at Arsi Negele Health Center, Southern Ethiopia: A Six Year Retrospective Study.

Background Despite implementation of different strategies, the burden and mortality of human immunodeficiency virus (HIV)-associated tuberculosis (TB) remains a challenge in Ethiopia. The aim of this study was to assess the impact of HIV status on treatment outcome of tuberculosis patients registered at Arsi Negele Health Center, Southern Ethiopia. Methods A six-year retrospective data (from September 2008 to August 2014) of tuberculosis patients (n = 1649) registered at the directly observed therapy short-course (DOTS) clinic of Arsi Negele Health Center was reviewed. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Data were entered and analyzed using SPSS version 20. Multinomial logistic regression analysis was used to examine the effect of HIV status separately on default/failure and death in relation to those who were successfully treated. Odds ratios with 95% confidence intervals were used to check the presence and strength of association between TB treatment outcome and HIV status and other independent variables. Results Out of the 1649 TB patients, 94.7% (1562) have been tested for HIV of whom 156(10%) were HIV co-infected. The mean (standard deviation) age of the patients was 28.5(15.5) years. The majority were new TB cases (96.7%), male (53.7%), urban (54.7%), and had smear negative pulmonary TB (44.1%). Overall, the treatment success rate of TB patients with or without HIV was 87.3%. Using cure/completion as reference, patients without known HIV status had significantly higher odds of default /failure [aOR, 4.26; 95%CI, 1.684–10.775] and transfer-out [aOR, 2.92; 95%CI, 1.545–5.521] whereas those who tested positive for HIV had a significantly higher odds of death [aOR, 6.72; 95%CI, 3.704–12.202] and transfer-out [aOR, 2.02; 95%CI, 1.111–3.680]. Conclusion Overall, treatment outcome and HIV testing coverage for TB patients is promising to reach the WHO target in the study area. However, default/failure among patients without known HIV status, and higher rate of mortality among HIV positive TB patients and transfer-out cases deserves concern. Therefore further prospective studies on quality of services, socioeconomics and psychology of this group should be conducted.

Seroprevalence and associated risk factors of hepatitis B virus among pregnant women in southern Ethiopia: a hospital-based cross-sectional study

OBJECTIVES: Hepatitis B virus (HBV) is a major blood-borne and sexually transmitted infectious agent that is a significant global public health issue. The aim of this study was to determine the seroprevalence and risk factors of HBV among pregnant women attending the antenatal clinic of the Hawassa University referral hospital in Ethiopia. METHODS: A cross-sectional study was conducted from April to May, 2015. A total of 269 consecutive pregnant women attending antenatal consultations were enrolled. Sociodemographic information and data regarding possible risk factors were collected using a structured questionnaire. Hepatitis B surface antigen (HBsAg) screening was performed using an enzyme-linked immunosorbent assay, and the data were analyzed. RESULTS: The overall seroprevalence of HBsAg among the 269 participants enrolled in the study was 7.8% (n=21). The prevalence of human immunodeficiency virus (HIV) infection was 5.2% (n=14), of whom two participants (14.2%) were also positive for HBsAg. Study participants with no formal education (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.27 to 10.68; p<0.05) were more likely to be infected with HBV than those who had completed at least secondary school. Although HBsAg was detected more often in pregnant women who had multiple exposure factors (8.8%, n=13) than in pregnant women who had not experienced possible risk factors (4%, n=1), this difference was not statistically significant (OR, 2.33; 95%CI, 0.29 to 18.63). CONCLUSIONS: A high prevalence of HBV infection was detected in the study population. Neither the type of risk factors nor exposure to multiple risk factors was significantly associated with HBV infection. Hence, screening pregnant women regardless of risk factors and improving awareness of the transmission routes of HBV within this group may reduce the risk of HBV infections.

Potential bacterial pathogens of external ocular infections and their antibiotic susceptibility pattern at Hawassa University Teaching and Referral Hospital, Southern Ethiopia

Bacterial external ocular infection is a common health problem along with increase and spread of drug resistance in Ethiopia. The objective of this study was to identify potential bacterial isolate of external ocular infections and their antimicrobial susceptibility patterns in patients attending eye clinic of the Hawassa University Teaching and Referral Hospital, from December 2012 to April 2013. A total of 281 consecutive, non-repetitive ocular specimens were collected among conjunctivitis cases (n=140), blepharitis cases (n=55), keratitis cases (n=31), dacryocystitis cases (n=19), and other cases (n=36). All samples were processed for culture and identification by standard methods. Susceptibility testing was done by Kirby-Bauer method as per Clinical and Laboratory Standards Institute (CLSI) guideline. Out of 281 ocular specimens submitted to culture, 137 (48.8%) specimen were positive. The most common bacterial isolates were Gram positive cocci (n=88; 61.5%). The predominant bacterial species isolated was Staphylococcus aureus (n=30; 21.0%) followed by coagulase negative Staphylococci (CoNS) (n=26; 18.2%) and Streptococcus pneumoniae (n=20; 14.0%). In vitro ciprofloxacin was effective against 86% of isolated pathogen. Multi-drug resistance was observed in 69.9% of the bacterial isolates. Our study confirmed that S. aureus was the overall predominant isolated pathogen followed by CoNS, S. pneumoniae and Klebsiella spp. Gram positive isolates were more susceptible to amoxicillin-clavulanic acid and vancomycin, whereas Gram negative isolates were more susceptible to ciprofloxacin and gentamicin. Relatively, ciprofloxacin is effective against most isolated pathogen. Key words: External ocular infections, conjunctivitis, blepharitis, keratitis, dacryocystitis, susceptibility.

Methicillin resistant Staphylococcus aureus in Ethiopia: a meta-analysis

BackgroundThe burden of methicillin resistant Staphylococcus aureus is a major public health concern worldwide; however the overall epidemiology of multidrug resistant strains is neither coordinated nor harmonized, particularly in developing countries including Ethiopia. Therefore, the aim of this meta-analysis was to assess the burden of methicillin resistant Staphylococcos aureus and its antibiotic resistance pattern in Ethiopia at large.MethodsPubMed, Google Scholar, and lancet databases were searched and a total of 20 studies have been selected for meta-analysis. Six authors have independently extracts data on the prevalence of methicillin resistant Staphylococcus aureus among clinical isolates of Staphylococcus aureus. Statistical analysis was achieved by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3) softwares. The overall prevalence of methicillin resistant Staphylococcus aureus and its antibiotic resistance pattern were pooled by using the forest plot, table and figure with 95% CI.ResultsThe pooled prevalence of methicillin resistant Staphylococcus aureus was 32.5% (95% CI, 24.1 to 40.9%). Moreover, methicillin resistant Staphylococcus aureus strains were found to be highly resistant to penicillin, ampicillin, erythromycin, and amoxicillin, with a pooled resistance ratio of 99.1, 98.1, 97.2 and 97.1%, respectively. On the other hand, comparably low levels of resistance ratio were noted to vancomycin, 5.3%.ConclusionThe overall burden of methicillin resistant Staphylococcus aureus is considerably high, besides these strains showed extreme resistance to penicillin, ampicillin, erythromycin and amoxicillin. In principle, appropriate use of antibiotics, applying safety precautions are the key to reduce the spread of multidrug resistant strains, methicillin resistant Staphylococcus aureus in particular.

Prevalence of uropathogen and their antibiotic resistance pattern among diabetic patients

OBJECTIVE Diabetes mellitus (DM) and antibiotic resistance is an emerging public health problem in Ethiopia. Urinary tract infections (UTIs) are common and occasionally life-threatening condition among diabetic patients. Despite, all these problems, antibiotics are prescribed empirically which may adversely affect antibiotic resistance so far. Therefore the aim of this study was to identify the etiologic agents of UTI and their antibiotic resistance pattern among diabetic patients attending diabetic clinic of Hawassa University Referral Hospital. MATERIAL AND METHODS A cross-sectional study was conducted in a total of 240 diabetic patients from June to October, 2014. After obtaining an informed written consent, socio-demographic and clinical data were collected using pre-structured questionnaire. Clean catch mid-stream urine samples were collected and processed for identification of uropathogen through culture using standard microbiologic procedure. Antibiotic susceptibility test was carried out using Kirby-Bauer disc diffusion method. RESULTS The overall prevalence of diabetic UTI was 13.8%. Out of the total number of patients, 11.2% and 23.1% had asymptomatic and symptomatic bacteriuria respectively. DM patients with no previous history of UTI [AOR=3.55; 95% CI=1.186-10.611] and illiterate [AOR=2.5; 95% CI=1.052-5.989] had higher odds of UTI compared with their counterparts. E. coli was the commonest isolated uropathogen followed by coagulase-negative Staphylococci. All the isolated bacteria were resistant to ampicillin but sensitive to nitrofurantoin. Gram-negative isolates demonstrated high level of resistance to trimethoprim-sulphamethoxazole in 9 (81.8%), gentamicin in 8 (72.7%) and ceftriaxone in 7 (63.6%) patients. Gram-positive bacteria showed resistance to penicillin in 14 (87.5%), norfloxacin in 10 (62.5%) and ciprofloxacin in 8 (50.0%) patients. Multidrug resistance was observed in 93.9% of the isolated uropathogens. CONCLUSION Illiterate DM patients with no previous history of UTI were significantly associated with UTI. Nitrofurantoin can be used as a drug of choice for empiric treatment of UTI in the study area. Multidrug resistance to commonly used antibiotics is an alarming phenomenon. Therefore, performing of urine cultures and periodic surveillance of UTI among DM patients is necessary.

HIV screening among TB patients and level of antiretroviral therapy and co-trimoxazole preventive therapy for TB/HIV patients in Hawassa University Referral Hospital: a five year retrospective study

Introduction Initiation of antiretroviral therapy (ART) and co-trimoxazole preventive therapy (CPT) is recommended for tuberculosis (TB)/human immunodeficiency virus (HIV) co-infected patients to prevent opportunistic infection. The aim of this study was to assess the prevalence of HIV among TB patients and initiation of ART and provision of CPT for TB/HIV co-infected patients in Hawassa university referral hospital. Methods A five year document review was done on 1961 TB patients who are registered at TB clinic of Hawassa university referral hospital from September 2009 to august 2014. Data were collected using checklist. Data analysis was done by using SPSS version 20 software. Bivariate and multivariate logistic regression analysis was used to determine the predictors of TB/HIV co-infection. Results Among 1961 TB patients diagnosed in the hospital, 95% (1765) were screened for HIV. Of these, 13.9% (246) were HIV positive. Out of 246 TB/HIV co-infected patients 31.7% (78/246) and 37.4% (92/246) were enrolled to start ART and CPT respectively. Roughly the trends of TB/HIV co-infection decreased with increased linkage to CPT, while linkage to ART was not regular across the year. The rate of TB/HIV co-infection was significantly associated with type of TB. Conclusion Although, trend of HIV among TB patients has decreased across the year, only a minority of co-infected patients was linked to start ART and CPT. Therefore, screening of all TB patients for HIV and linkage of co-infected patients to HIV care to start ART and CPT should be strengthened in-line with the national guidelines.

Visceral Leishmaniasis-Malaria Coinfection and Their Associated Factors in Patients Attending Metema Hospital, Northwest Ethiopia: Suggestion for Integrated Vector Management

Background Despite high prevalence of visceral leishmaniasis and malaria in the study area, their coinfection remains unknown. Therefore, this study was aimed to document VL-malaria coinfections and their associated factors. Methods A cross-sectional study was conducted among clinical suspected VL patients attending Metema hospital, Northwest Ethiopia, from January 2014 to June 2014. Blood sample was tested by rk39 antigen-based DiaMed IT-Leish dipstick and Giemsa stain microscopic examination of thick and thin blood smears for malaria detection was performed. Result A total of 384 VL suspected patients were included in the study. Out of these, the prevalence of VL was 83 (21.6%) while the prevalence of malaria was 45 (11.7%). Of malaria cases, 40 (89%) were positive for P. falciparum and 5 (11%) positive for P. vivax. The overall prevalence of VL-malaria coinfection was 16 (4.2%). One-hundred eighty (46.9%) study participants have history of travel. Of these, 10 (5.6%) have VL-malaria coinfections. Age less than 5 years was associated with VL-malaria coinfection. Conclusion This study highlights the importance of performing malaria screening amongst VL patients living in malaria-endemic areas, particularly in patients under five years.

Bacterial pathogens associated with external ocular infections alongside eminent proportion of multidrug resistant isolates at the University of Gondar Hospital, northwest Ethiopia

BackgroundExternal ocular infection is a public health problem in Ethiopia. The aim of this study was to determine the prevalence and antimicrobial susceptibility pattern of external ocular bacterial infections.MethodsA cross sectional study was conducted at the University of Gondar Hospital among patients seeking health services at the Department of Ophthalmology from January to April, 2016. All patients with suspected external ocular infections were examined under slit lamp microscope. External ocular samples were collected using aseptic techniques. All samples were investigated by culture and bacteria were identified using standard methods. Drug susceptibility test was done using the Kirby-Bauer Disk diffusion method according to the guidelines of Clinical and Laboratory Standard Institute (CLSI).ResultA total of 312 samples were collected and 58.3% were culture positive. The proportion of Gram positive bacterial pathogens was (88%), and Staphylococcus aureus (50.3%) was the predominantly isolated pathogen, followed by Coagulase negative staphylococci (CoNS) (33.5%) and Klebsiella species (4.7%). Conjunctivitis was the dominant clinical feature, but a high positive result for bacterial pathogens was observed among patients with dacryocystitis cases. The Gram positive bacterial isolates were susceptible to ciprofloxacin, chloramphinicol, amoxicillin-clavulanate and ceftriaxone. However, 65% of these Gram positive bacterial pathogens showed resistance to penicillin, ampicillin and amoxicillin. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection was 24% and multidrug resistance (MDR) was observed in 87% of the isolated bacteria.ConclusionConjunctivitis was the dominant ophthalmic disease followed by blepharitis. The dominant bacteria species was S. aureus and MRSA infection is increasingly prevalent. The overall MDR bacterial pathogen proportion was very high. The high prevalence of MRSA and MDR bacterial pathogens dictate the need for effective prevention as important as for therapies.

Genital Chlamydia trachomatis Infection among Women of Reproductive Age Attending the Gynecology Clinic of Hawassa University Referral Hospital, Southern Ethiopia.

Background Urogenital infection with Chlamydia trachomatis(CT) is one of the most common bacterial sexually transmitted infections (STIs) world-wide, especially in developing nations where routine laboratory diagnosis is unavailable. Little is known about the epidemiology of this infection in Ethiopia where other STIs are prevalent. This study was conducted to determine the prevalence and associated factors of CT infection among women of reproductive age. Methods A cross-sectional study was conducted among 322 consecutive women aged between 15–49 years at Hawassa University Referral Hospital from November 2014 to April 2015. Data on socio-demography and potential risk factors for genital infection were collected using structured questionnaires. Moreover, endocervical swabs were collected from all participants, screened for CT antigen using rapid immunochromatography assay, and cultured following the standard bacteriological method to isolate Neisseria gonorrhoeae. Result In this study, the overall prevalence of CT antigen and N. gonorrhoeae infection was 61(18.9%) and 1(0.31%), respectively. Women aged 15–24 years had the highest prevalence of CT infection (24.2%), followed by those aged 25–34 years (16.8%) and those aged 35–49 years (9.6%). CTinfection was associated with women who had unprotected sex within the last six months (aOR = 3.459; 95% CI = 1.459–8.222) and were sexually active for 6–10 years (aOR = 3.076; 95% CI = 1.152–8.209). None of the clinical symptoms and diagnoses was significantly associated with CT antigen positivity. Conclusions The high prevalence of genital CT infection in this study highlights the need for further large-scale studies on the general population. Thus, screening of women regardless of their symptoms should be in place.

Prevalence, Infectivity, and Associated Risk Factors of Hepatitis B Virus among Pregnant Women in Yirgalem Hospital, Ethiopia: Implication of Screening to Control Mother-to-Child Transmission

Background Hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive mother has up to 90% likelihood of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) to newborns in the absence of any prophylaxis or antiviral therapy utilization. However, routine antenatal screening and intervention strategies are not yet practiced in Ethiopia. Therefore, this study was conducted to determine the prevalence, infectivity, and associated risk factors of HBV among pregnant women. Methods A cross-sectional study was conducted from October 2015 to August 2016 in Yirgalem Hospital. A total of 475 pregnant women were recruited, and data on sociodemography and potential risk factors were collected using a structured questionnaire. In addition, blood samples were tested for HBsAg, and HBsAg positive samples were retested for HBeAg using commercially available strip test. The status of HIV was collected from the records. Results The seroprevalence of HBsAg was 34 (7.2%), of whom 13 (38.8%) were positive for HBeAg. The prevalence of HIV infection was 10.1% (48/475). Ten out of 34 HBV positive cases (29.4%) were coinfected with HIV. The overall HBV/HIV coinfection rate was 2.1% (10/475). Women with history of multiple sexual partners and being HIV positive were significantly associated with HBsAg positivity. Among the study participants, 35.4% were aware of MTCT of HBV and only 12 (2.5%) have taken HBV vaccine. Conclusions High prevalence of HBsAg and HBeAg as well as low awareness and practices of HBV prevention methods suggests that perinatal transmission of HBV might be the prevailing mode of HBV transmission in the study area. Thus, screening of all pregnant women, particularly those who had history of multiple sexual partners and HIV coinfection, and provision of health education about HBV prevention methods are inevitable.