Desalegn Woldeyohannes

Micronutrient levels and nutritional status of school children living in Northwest Ethiopia

BackgroundSeveral micronutrients are essential for adequate growth of children. However, little information is available on multiple micronutrient status of school children in Ethiopia. The present study was designed to evaluate the relationship between multiple micronutrient levels and nutritional status among school children.MethodIn this cross-sectional study, anthropometric data, blood and stool samples were collected from 100 children at Meseret Elementary School in Gondar town, Northwest Ethiopia. Serum concentration of magnesium, calcium, iron, copper, zinc, selenium and molybdenum were measured by inductively coupled plasma mass spectrometer. Anthropometric indices of weight-for-age, height-for-age and BMI-for-age were used to estimate the childrens nutritional status. Stool samples were examined by standard microscopic methods for intestinal parasites.ResultsThe prevalence of stunting, underweight, wasting and intestinal parasitoses among school children was 23%, 21%, 11% and18%, respectively. The mean serum levels of magnesium, calcium, iron, copper, zinc, selenium and molybdenum were 2.42±0.32 (mg/dl), 15.31±2.14 (mg/dl), 328.19±148.91 (μg/dl), 191.30±50.17 (μg/dl), 86.40±42.40 (μg/dl), 6.32±2.59 (μg/dl), and 0.23±0.15 (μg/dl), respectively. Selenium deficiency, zinc deficiency and magnesium deficiency occurred in 62%, 47%, and 2% of the school children, respectively. Height-for-age showed significant positive correlation with the levels of copper and molybdenum (p = 0.01) and with the levels of magnesium (p = 0.05).ConclusionDeficiencies of selenium and zinc were high among the school children although the deficiencies were not significantly related with their nutritional status. The prevalence of both malnutrition and intestinal parasitism was not negligible. These calls for the need to undertake multicentre studies in various parts of the country to substantiate the data obtained in the present study so that appropriate and beneficial strategies for micronutrient supplementation and interventions on nutritional deficiencies can be planned.

Infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions, Northwest Ethiopia

BackgroundIt has been estimated that 430,000 children under 15 years of age were newly infected with HIV in 2008, and more than 71% are living in sub-Saharan Africa. In the absence of intervention to prevent mother-to-child transmission, 30-45% of infants born to HIV-positive mothers in developing countries become infected during pregnancy, delivery and breastfeeding. The aim of this study was to assess infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics of Northwest Ethiopia.MethodsInstitution based cross sectional study was conducted from January to May 2011 among all HIV positive mothers with less than two years old child attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions. A structured pre-tested questionnaire using interview technique was used for data collection. The data was entered and analyzed using SPSS version 16 statistical package.ResultsA total of 209 HIV positive mothers were included in the study. Of these, 187 (89.5%) had followed the recommended way of infant feeding practice while significant percentage (10.5%) had practiced mixed breast feeding. In multivariate analysis, disclosure of HIV status with their spouse, insufficient breast milk and occupational status were found to be independently associated (p-value of < 0.05) with recommended infant feeding practice. Lack of resource, stigma of HIV/AIDS, and husband opposition were also obtained as factors that influenced choice of infant feeding options by respondents.ConclusionsHigher proportion of respondents used the recommended way of infant feeding practice by WHO as well as by Ethiopian Ministry of Health. However, mixed feeding in the first 6 months of age, an undesirable practice in infant feeding, were reported in this study. Infant feeding education that is aligned to national policy should be strengthened in primary health care, particularly in situations where prevention of mother to child transmission of HIV is prioritized.

Comparison of CareStart™ HRP2/pLDH COMBO rapid malaria test with light microscopy in north-west Ethiopia.

BackgroundIn Ethiopia, light microscopy is the gold standard for malaria diagnosis although it is not available in most peripheral health facilities. It is time consuming, requires trained personnel and needs careful preparation and application of reagents to ensure quality results. This study was aimed at testing the diagnostic performance of CareStart™ malaria rapid diagnostic test (RDT) with reference to light microscopy for the diagnosis of falciparum and vivax malaria in Ethiopia.MethodsBlood samples were collected from 254 patients suspected to have malaria at Kola Diba Health Center in the late malaria transmission peak season from November 2011 to December 2011. The samples were examined immediately by light microscopy and the RDT (CareStart™ Malaria HRP2/pLDH COMBO Test kit). Statistical analysis was performed using SPSS version 16 and the JavaStat two-way contingency table analysis.ResultsThe overall sensitivity and specificity of CareStartTM RDT was found to be 95% (90–97.9%, 95% CI) and 94.2% (90.9–96%, 95% CI), respectively. The sensitivity of the CareStartTM RDT for Plasmodium falciparum or mixed infection was calculated to be 92.9% (82.5–98%, 95%CI) while a sensitivity of 90.9% (74.1–98.4%, 95%CI) was found for non-falciparum species. The specificity for P. falciparum or mixed infections was found to be 95.4% (92.5–96.8%, 95%CI) while it was 97.3% (94.8–98.4%, 95%CI) for non-falciparum species. There was an excellent agreement between the two tests with a kappa value of 0.918.ConclusionThe CareStartTM RDT test showed good sensitivity and specificity with an excellent agreement to the reference light microscopy. The RDT could therefore be used in place of light microscopy, which in poor set-ups cannot be used routinely.

Nutritional status, intestinal parasite infection and allergy among school children in Northwest Ethiopia

BackgroundParasitic infections have been shown to have deleterious effects on host nutritional status. In addition, although helmintic infection can modulate the host inflammatory response directed against the parasite, a causal association between helminths and allergy remains uncertain. The present study was therefore designed to evaluate the relationship between nutritional status, parasite infection and prevalence of allergy among school children.MethodsA cross sectional study was performed involving school children in two elementary schools in Gondar, Ethiopia. Nutritional status of these children was determined using anthropometric parameters (weight-for-age, height-for-age and BMI-for-age). Epi-Info software was used to calculate z-scores. Stool samples were examined using standard parasitological procedures. The serum IgE levels were quantified by total IgE ELISA kit following the manufacturer’s instruction.ResultA total of 405 children (with mean age of 12.09.1 ± 2.54 years) completed a self-administered allergy questionnaire and provided stool samples for analysis. Overall prevalence of underweight, stunting and thinness/wasting was 15.1%, 25.2%, 8.9%, respectively. Of the total, 22.7% were found to be positive for intestinal parasites. The most prevalent intestinal parasite detected was Ascaris lumbricoides (31/405, 7.6%). There was no statistically significant association between prevalence of malnutrition and the prevalence of parasitic infections. Median total serum IgE level was 344 IU/ml (IQR 117–2076, n = 80) and 610 IU/ml (143–1833, n = 20), respectively, in children without and with intestinal parasite infection (Z = −0.198, P > 0.8). The prevalence of self reported allergy among the subset was 8%. IgE concentration was not associated either with the presence of parasitic infection or history of allergy.ConclusionThe prevalence of malnutrition, intestinal parasitism and allergy was not negligible in this population. In addition, there was no significant association between the prevalence of allergy and their nutritional status, and parasite infection. Further research prospective observational and intervention studies are required to address the question of causality between nutritional factors, parasites, and allergy.

Current status of soil transmitted helminths and Schistosoma mansoni infection among children in two primary schools in North Gondar, Northwest Ethiopia: a cross sectional study

BackgroundSchool age children are one of the groups at high risk for intestinal parasitic infections especially in developing countries like Ethiopia as the supply of good quality drinking water and latrine coverage are poor. Though there are previous data on the prevalence of soil transmitted helminths (STHs) and Schistosoma mansoni infection among these high risk groups current status in the study area is unknown. Therefore, the aim of this study was to determine the current prevalence and associated risk factors of STHs and S. mansoni infections among school children.MethodsA cross-sectional study was carried out in Gorgora and Chuahit towns, North Gondar Zone, North West Ethiopia from January 20 to February 25, 2012 involving 261 school children. A pre-tested and structured questionnaire was used to collect socio-demographic data and possible risk factors. Stool samples were collected and examined for intestinal parasites using Kato Katz method. Chi-square test was used to see if there is association between sociodemographic factors and other risk factors for STH and S. mansoni infection and odds ratio with 95% CI was computed as measures of association. P < 0.05 was taken as statistically significant.ResultsOut of the 261 study participants, 174 (66.7%) were infected with one or more species of intestinal parasites. Ascaris lumbricoides was the predominant isolates (39.8%) followed by Trichuris trichiura (6.1%) and Hookworms (4.9%). Schistosoma mansoni was detected in 33.7% of the children. Among infected individuals, 9.5% were coinfected by S. mansoni and A. lumbricoides and 1.5% with S. mansoni and T. trichiura. Swimming habit (OR: 2.536, 95% CI: 1.122, 5.737, P = 0.022) was significantly associated with S. mansoni infection.ConclusionThe prevalence of STH and S. mansoni was high among school children. This should call for implementation of an integrated strategy to reduce morbidity and control of transmission of STH and S. mansoni.

Active trachoma and associated risk factors among children in Baso Liben District of East Gojjam, Ethiopia

BackgroundTrachoma is the leading cause of preventable blindness worldwide. It is common in areas where the people are socio-economically deprived. The aim of this study was to assess active trachoma and associated risk factors among children 1–9 years in East Gojjam.MethodsCommunity-based cross-sectional study was conducted in Baso Liben District from February to April 2012. A two-stage random cluster-sampling technique was employed and all children 1–9 years old from each household were clinically assessed for trachoma based on simplified WHO 1983 classification. Data were collected by using semi-structured interview, pre-tested questionnaire and observation. The data were entered and analyzed using SPSS version 16 statistical package.ResultsFrom a total of 792 children screened for trachoma (of which 50.6% were girls), the overall prevalence of active trachoma was 24.1% consisting of only 17.2% [95% CI: 14.8, 20.1] TF and 6.8% TI. There were variations among children living in low land (29.3%) and in medium land (21.4%). In multivariate analysis, low monthly income (AOR = adjusted odds ratio) 2.98; 95% CI (confidence interval): 1.85-7.85), illiterate family (AOR = 5.18; 95% CI: 2.92-9.17); unclean face (AOR = 18.68; 95% CI: 1.98-175.55); access to water source (AOR = 2.01; 95% CI: 1.27-3.15); less than 20 liters of water use (AOR = 4.88; 95% CI: 1.51-15.78); not using soap for face washing (AOR = 5.84; 95% CI: 1.98-17.19); not using latrine frequently (AOR = 1.75; 95% CI: 0.01-0.42); density of flies (AOR = 3.77; 95% CI: 2.26-6.29); less knowledgeable family (AOR = 3.91; 95% CI: 2.40-6.38) and average monthly income (AOR = 2.98; 95% CI: 1.85-7.85) were found independently associated with trachoma.ConclusionActive trachoma is a major public problem among 1–9 years children and significantly associated with a number of risky factors. Improvement in awareness of facial hygiene, environmental conditions, mass antibiotic distribution and health education on trachoma transmission and prevention should be strengthened in the District.

Bacterial Sepsis in Patients with Visceral Leishmaniasis in Northwest Ethiopia

Background and Objectives. Visceral leishmaniasis (VL) is one of the neglected diseases affecting the poorest segment of world populations. Sepsis is one of the predictors for death of patients with VL. This study aimed to assess the prevalence and factors associated with bacterial sepsis, causative agents, and their antimicrobial susceptibility patterns among patients with VL. Methods. A cross-sectional study was conducted among parasitologically confirmed VL patients suspected of sepsis admitted to the University of Gondar Hospital, Northwest Ethiopia, from February 2012 to May 2012. Blood cultures and other clinical samples were collected and cultured following the standard procedures. Results. Among 83 sepsis suspected VL patients 16 (19.3%) had culture confirmed bacterial sepsis. The most frequently isolated organism was Staphylococcus aureus (68.8%; 11/16), including two methicillin-resistant isolates (MRSA). Patients with focal bacterial infection were more likely to have bacterial sepsis (P < 0.001). Conclusions. The prevalence of culture confirmed bacterial sepsis was high, predominantly due to S. aureus. Concurrent focal bacterial infection was associated with bacterial sepsis, suggesting that focal infections could serve as sources for bacterial sepsis among VL patients. Careful clinical evaluation for focal infections and prompt initiation of empiric antibiotic treatment appears warranted in VL patients.

Directly Observed Treatment Short-course (DOTS) for tuberculosis control program in Gambella Regional State, Ethiopia: ten years experience

BackgroundTuberculosis is still the leading cause of illness in the world which accounted for 2.5% of the global burden of disease, and 25% of all avoidable deaths in developing countries. The aim of study was to assess impact of DOTS strategy on tuberculosis case finding and treatment outcome in Gambella Regional State, Ethiopia from 2003 up to 2012 and from 2002 up to 2011, respectively.MethodsHealth facility-based retrospective study was conducted. Data were collected and reported in quarterly basis using WHO reporting format for TB case finding and treatment outcome from all DOTS implementing health facilities in all zones of the region to Federal Ministry of Health.ResultsA total of 10024 all form of TB cases had been registered between the periods from 2003 up to 2012. Of them, 4100 (40.9%) were smear-positive pulmonary TB, 3164 (31.6%) were smear-negative pulmonary TB and 2760(27.5%) had extra-pulmonary TB. Case detection rate of smear-positive pulmonary TB had increased from 31.7% to 46.5% from the total TB cases and treatment success rate increased from 13% to 92% with average mean value of being 40.9% (SD = 0.1) and 55.7% (SD = 0.28), respectively for the specified year periods. Moreover, the average values of treatment defaulter and treatment failure rates were 4.2% and 0.3%, respectively.ConclusionIt is possible to achieve the recommended WHO target which is 70% of CDR for smear-positive pulmonary TB, and 85% of TSR as it was already been fulfilled the targets for treatments more than 85% from 2009 up to 2011 in the region. However, it requires strong efforts to enhance case detection rate of 40.9% for smear-positive pulmonary TB through implementing alternative case finding strategies.

Bovine Cysticercosis in Cattle Slaughtered at Zeway Municipal Abattoir: Prevalence and its Public Health Importance

A cross-sectional study on bovine cysticercosis was conducted at Zeway municipal abattoir from November 2010 to March 2011 with the main objectives of determining the prevalence of cysticercosis in animals, taeniasis in human and estimates the worth of taeniasis treatment in Zeway/Batu town. Active abattoir and questionnaire survey and inventory of pharmaceutical shops were performed to accomplish the study. Out of the total 400 inspected animals, 12 animals had variable number of Cysticercus bovis giving an overall prevalence of 12 (3%). Anatomical distribution of the cyst showed that the highest proportions of C.bovis cyst were observed in tongue 33 (34.4%) followed by heart 27 (28.1%), triceps 21 (21.9%) and masseter muscle 15(15.6%). A total of 96 C. bovis were collected during the inspection; out of these, 32 (33.3%) were found to be live cysts while 64 (66.7%) were degenerative cysts. Of the total 120 interviewed respondents, 68 (56.7%) had contracted T. saginata infection at least once in their life time. Human taeniasis prevalence showed significant difference (p<0.05) with habit of raw meat consumption, sex and use of latrine. Accordingly frequent raw meat consumers (OR=10.71, 95%CI [1.54-74.42], male individuals (OR=2.15, 95% CI [0.95-4.88] and non latrine users (OR=4.40, 95% CI [1.58-12.45] had higher odds for acquiring taeniasis than occasional meat consumer, female and latrine users, respectively. An inventory of taeniacidal drugs from private pharmacies, rural drug venders, clinics and public health centers indicate that drugs worth of 110,560 Ethiopian birr was sold in the past one year (2009/10). Therefore, attention should be given for awareness creation for people not to consume raw meat and to use latrine to decrease the contamination of grazing areas.

Potential risk of HIV transmission in barbering practice in Ethiopia: from public health and microbiological perspectives

BackgroundHIV and other blood borne infections can be transmitted through the use of improperly sterilized and disinfected sharp equipments.MethodsA cross sectional study was conducted from January to June, 2010 to assess the potential risk of HIV transmission in barbering practice in Ethiopia from public health and microbiological perspectives. Barbers in barbershop were interviewed using pre-designed questionnaires and check lists were used to evaluate barbering practice. Microbiological data from tips of the sharpener before and after the barbering was collected and processed as per the standard procedure.ResultsOne hundred and twenty three barbering sessions and barbers were observed in which 106 (86.2%) were males. Ninety six (78%) of the respondents knew that HIV could be transmitted by sharing non-sterile sharp instruments. Among the total participants 59 (48%) had the correct knowledge of what sterilization mean and 111 (94.1%) of them believed its importance in their work place. Barbers had a mean knowledge score of 6 ± 1.5 out of a score of 10 regarding sterilization and disinfection as well as in the transmission of HIV in their work place. Three (2.5%) barbers were disagreed that unsterilized blade can transmit skin diseases and 26 (21.3%) of them believed disinfection is enough to avoid microbes from sharp objects. Ninety two (76.7%) barbers were using sterilization in their establishment. According to Likert scaling almost all sterilization and disinfection procedures were riskily practiced and respondents had poor level of knowledge. No significant association was found to influence the decontamination and sterilization of barbering equipments except monthly income, pre and post colony count of microbes identified. The isolation of normal skin flora in the pre-and post- sterilization and disinfectant procedures and less average percent colony reduction showed that sterilization and disinfectant practices in barbershop were generally poor that proofed proper sterilization and/or disinfection techniques were unfavorable.ConclusionThis study has revealed the presence of potential risk of HIV and other blood borne disease transmission among the barbers of the study areas. Thus continuous and intensified public health strategies on health education, training, supervision and monitoring are needed to facilitate the adoption of effective methods of sterilization and/or disinfection.