Daniel Mekonnen

Risk Factors for Bovine Tuberculosis (bTB) in Cattle in Ethiopia

Bovine tuberculosis (bTB) infection is generally correlated with individual cattle’s age, sex, body condition, and with husbandry practices such as herd composition, cattle movement, herd size, production system and proximity to wildlife—including bTB maintenance hosts. We tested the correlation between those factors and the prevalence of bTB, which is endemic in Ethiopia’s highland cattle, in the Afar Region and Awash National Park between November 2013 and April 2015. A total of 2550 cattle from 102 herds were tested for bTB presence using the comparative intradermal tuberculin test (CITT). Data on herd structure, herd movement, management and production system, livestock transfer, and contact with wildlife were collected using semi-structured interviews with cattle herders and herd owners. The individual overall prevalence of cattle bTB was 5.5%, with a herd prevalence of 46%. Generalized Linear Mixed Models with a random herd-effect were used to analyse risk factors of cattle reactors within each herd. The older the age of the cattle and the lower the body condition the higher the chance of a positive bTB test result, but sex, lactation status and reproductive status were not correlated with bTB status. At herd level, General Linear Models showed that pastoral production systems with transhumant herds had a higher bTB prevalence than sedentary herds. A model averaging analysis identified herd size, contact with wildlife, and the interaction of herd size and contact with wildlife as significant risk factors for bTB prevalence in cattle. A subsequent Structural Equation Model showed that the probability of contact with wildlife was influenced by herd size, through herd movement. Larger herds moved more and grazed in larger areas, hence the probability of grazing in an area with wildlife and contact with either infected cattle or infected wildlife hosts increased, enhancing the chances for bTB infection. Therefore, future bTB control strategies in cattle in pastoral areas should consider herd size and movement as important risk factors.

The quality of sputum smear microscopy in public-private mix directly observed treatment laboratories in West Amhara region, Ethiopia.

Ethiopia adopted Public-Private Mix Directly Observed Treatment Short Course Chemotherapy (PPM-DOTS) strategy for tuberculosis (TB) control program. Quality of sputum smear microscopy has paramount importance for tuberculosis control program in resource-poor countries like Ethiopia. A cross-sectional study was conducted to assess the quality of sputum smear microscopy in 37 Public-Private Mix laboratories in West Amhara, Ethiopia. The three external quality assessment methods (onsite evaluation, panel testing and blind rechecking) were employed. Onsite assessment revealed that 67.6% of PPM-DOTS laboratories were below the standard physical space (5 X 6) m2. The average monthly workload per laboratory technician was 19.5 (SD±2.9) slides with 12.8% positivity rate. The quality of Acid Fast Bacilli (AFB) staining reagents was sub-standard. The overall agreement for blind rechecking of 1,123 AFB slides was 99.4% (Kappa = 0.97). Reading of 370 AFB panel slides showed 3.5% false reading (Kappa = 0.92). Moreover, the consistency of reading scanty bacilli slides was lower (93%) compared to 1+, 2+ and 3+ bacilli. Based on blind rechecking and panel testing results, PPM-DOTS site laboratories showed good agreement with the reference laboratory. Physical space and qualities of AFB reagents would be areas of intervention to sustain the quality of sputum smear microscopy. Therefore, regular external quality assessment and provision of basic laboratory supplies for TB diagnosis would be the way forward to improve the quality of sputum smear microscopy services in PPM-DOTS laboratories.

Antibiogram profile of uropathogens isolated at Bahir Dar Regional Research Laboratory Centre, Ethiopia

Introduction Antimicrobial resistance among bacteria that cause urinary tract infection (UTI) has been increasing since the introduction of chemotherapy. This study was aimed to assess the types of isolates from patients with UTI and to determine their current antimicrobial susceptibility profile. Methods A record based retrospective analysis of bacterial uropathogens processed in the period of January 2012 to December 2014 at Bahir Dar Health Research Laboratory Center (BRHRLC) was determined. According to standard microbiological procedures, midstream urine samples were collected and processed with conventional culture and biochemical tests. Isolates were tested against commonly used antibiotics by Kirby-Bauer disc diffusion methods. Chi-square test was calculated to compare the proportion of bacterial isolates between sex and age and statistical significance was set at p value < 0.05. Results Out of 446 patients, female constituted at 299 (67%). Significant bacteriuria was reported on 30.5% (95% CI: 26.4-34.9%) cultures. Of these, 78% (95% CI: 71.0-84.7%) were from females. Age and sex were found associated with significant bacteriuria at p=0.046 and p=0.001 respectively. The most commonly identified isolates were Escherichia coli, at 72 (49 %) followed by Klebshella pneumonia at 20 (13.6%) and Pseudomonas aureginosa at 11 (7.5%). The overall antimicrobial susceptibility profile showed that Trimetoprim-sulphamethoxazole, amoxicillin/clavulanate and ampicillin revealed high level of resistance, at 84(66.7%), 61(79.2%), 106(91.4% respectively. Conversely, 64.2-100% sensitivity rate was documented for ciprofloxacin, gentamycin and pepracillin. Conclusion UTI associated with multiple drug resistant bacteria is an important health concern of the study population. Therefore, ongoing surveillance of the types of uropathogens and their up-to-date antimicrobial resistance profile is crucial for better management of patients.

Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia

Background Asymptomatic pharyngeal colonization by potential bacteria is the primary reservoir for bacterial species within a population and is considered a prerequisite for development of major childhood diseases such as sinusitis, otitis media, pneumonia, bacteremia, and meningitis. However, there is dearth of data on the colonization and drug resistance pattern of the main bacterial pathogens in the pharynx of HIV infected children in Ethiopia. Therefore, this study determined the pharyngeal colonization and drug resistance profile of bacterial pathogens in HIV infected children attending ART clinic of Felegehiwot Referral Hospital (FHRH), Amhara Region, Ethiopia. Methods A hospital based cross-sectional study was conducted from May 2016 to June 2017 at the ART clinic of FHRH. A total of 300 HIV infected children were enrolled in the study. Data on socio-demographic characteristics of the study participants were collected with face-to-face interview and patient—card review using structured questionnaire. Bacterial species were identified using standard bacteriological techniques. Drug susceptibility testing was performed using disk diffusion technique. Chi-square test was done to determine associations among variables. Results The median age of the participants was 11 years. Overall, 153 (51%) of children were colonized by respiratory bacteria in their pharynx. Colonization rate was higher in children from mothers who had attained college and above levels of education than others (P = 0.04). It was also higher in children without the sign of malnutrition than others (P = 0.004). The colonization rate of S.aureus, M.catarrhalis, S.pneumoniae and H.influenzae were 88 (29%), 37 (12.3%), 31 (10.3%) and 6 (2%), respectively. S.aureus—M.catarrhalis concurrent colonization was found in 14 (4.7%) of children. Age (P = 0.03), schooling (P = 0.045) and history of running nose (P = 0.043) were significantly associated with S.aureus colonization. Living in urban setting (P = 0.042) and children from mothers with college and above levels of education (P = 0.002) were significantly associated with M.catarrhalis colonization. Majority of the isolates were resistant to penicillin (68.5%) and cotrimoxazole (52.5%).S.aureus isolates were resistant to penicillin (84.1%) and cotrimoxazole (51.1%).M.catarrhalis isolates were resistant to penicillin (94.6%), erythromycin (86.5%)and cotrimoxazole (78.4%). Overall, 99 (59.3%) of the isolates were multi-drug (MDR) resistant. The overall MDR rates among S.aureus, M.catarrhalis and S.pneumoniae isolates were 65.9%, 78.4% and 22.6%, respectively. Conclusions Pharyngeal colonization of respiratory bacteria in HIV infected children is a major public health problem. Single and multiple antibiotic resistant is alarmingly high among respiratory colonizers. Therefore, regular screening of HIV infected children for culture and antimicrobial susceptibility testing is recommended to prevent the development of severe opportunistic infections.

Drug resistance patterns of bacterial isolates from infected wounds at Bahir Dar Regional Health Research Laboratory Center, Northwest Ethiopia

Background: An increased antibiotic resistance of bacterial isolates from wound infections is a major therapeutic challenge. The aim of this study was to identify bacterial isolates associated with wound infection and to determine their current antimicrobial susceptibility profile. Methods: This is a retrospective cross-sectional study in which we analyzed the records of 380 wound swab culture results that have been processed at Bahir Dar Regional Health Research Laboratory Center in the period of 1 January 2013 to 30 December 2015. Swabs from different wound types were collected aseptically and analyzed using standard bacteriological procedures. Antimicrobial susceptibility testing was performed using disc diffusion technique as per the standard protocol. Demographic and bacteriological data were collected using a data extraction sheet. The data were cleaned, entered and analyzed using SPSS version 22. Results: The overall bacterial isolation rate was at 61.6% (234/380). More than half 123 (52.6%) of the isolates were gram positive and 111 (47.4%) were gram negatives. The predominant isolates were S. aureus a t 100 (42.7%) followed by E. coli , 33 (14.1%), P. aeruginosa , 26 (11.1%) and S. pyogenes , at 23 (9.8%). The proportion of multidrug resistant (MDR) bacterial pathogens was at 54.3%. Out of these, 35 (15.1%) of the isolates were resistant to more than five drugs. The highest resistance rate at (85.9%) was documented for ampicillin by gram-negative isolates. Whereas the highest resistance rate among gram positive isolates was against erythromycin (31.1%). The resistance rate of S. aureus for penicillin was at 69.7%. Conclusions: High frequency of mono and multi-drug resistant bacterial pathogens were documented. Thus, an alternative method to the causative agent and antimicrobial susceptibility testing surveillance in areas where there is no culture facility is needed to assist health professionals for the selection of appropriate antibiotics. [ Ethiop. J. Health Dev . 2016;30(3):112-117] Keywords: Wound infection, bacterial isolates, and antimicrobial susceptibility profile

Correction: Risk Factors for Bovine Tuberculosis (bTB) in Cattle in Ethiopia

[This corrects the article DOI: 10.1371/journal.pone.0159083.].