Endale Tadesse

Sero-prevalence of latent Toxoplasma gondii infection among HIV-infected and HIV-uninfected people in Addis Ababa, Ethiopia: A comparative cross-sectional study

BackgroundToxoplasmosis in immuno-compromised hosts manifests primarily as a life threatening condition, toxoplasmic encephalitis. However, there is scarce information about the magnitude of Toxoplasma gondii infection among HIV-infected people in Ethiopia. This study was, therefore, conducted to determine the sero-prevalence of T. gondii infection among HIV-infected and HIV-uninfected subjects.FindingsSera were collected from people with and without HIV infection for the purpose of studying hepatitis B virus (HBV) at St. Paul Hospital, Addis Ababa, Ethiopia from 24 January 2007 to 15 February 2007. Among these sera, the first 330 consecutive sera, 165 from each HIV sero-group, were selected and tested for anti-T. gondii IgG antibodies using Enzyme Linked Immunosorbent Assay. The seroprevalence of Toxoplasma infection was assessed against socio-demographic characteristics, HIV and HBV serostatus and HBV-related risk factors. The overall sero-prevalence of latent T. gondii infection among the study subjects was 90.0%. Toxoplasma infection was observed with respective prevalence of 93.3% and 86.7% among HIV-infected and HIV-uninfected people. Though Toxoplasma infection seems to be influenced by age, gender and HIV serostatus, only HBV serostatus was significantly associated (OR 2.71, CI 1.12 to 6.57) in multivariate logistic regression analysis.ConclusionThe seroprevalence of latent T. gondii infection is high and similar by HIV status. Educating people to prevent acquisition of new Toxoplasma infection and minimizing the risk of disease manifestations among HIV-Toxoplasma co-infected individuals is important.

Burden of metabolic syndrome among HIV-infected patients in Southern Ethiopia

BACKGROUND HIV infection and highly active antiretroviral therapy (HAART) can induce metabolic disturbances including lipodystrophy, dyslipidemia, and insulin resistance, which are reminiscences of metabolic syndrome (MS). However, little is known regarding the magnitude of MS in Ethiopian HIV population. This study, aimed to estimate the prevalence of MS among HIV positive patients with and without HAART. METHODS A cross-sectional study was conducted at Hawassa University Referral Hospital, southern Ethiopia between February 2012 and April 2013. Data on demographic and anthropometric characteristics were collected from a total of 374 HIV positive participants (188 on ART and 186 on Pre-ART) using WHO stepwise approach. Fasting blood glucose, total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol was measured. The International Diabetes Federation (IDF) and the National Cholesterol Education Program: Adult Treatment Panel III (ATP) Criteria were used to define MS. RESULT Of the 374 study participants 68% were females, and 50.3% were receiving ART. Using the IDF criteria, metabolic syndrome was diagnosed in 25% of patients receiving ART compared to 22.5% of the ART naïve group (OR: 1.14 CI: 0.71-1.84). Using the ATP criteria, the prevalence of MS was 18.1% in the ART groups compared to 15.6% in ART naïve group (OR: 1.20, CI: 0.69-2.06). Patients receiving ART had significantly elevated Cholesterol, triglyceride, glucose and LDL-c levels but lower CD4(+) cell counts than the Pre-ART groups. Being a female, having BMI of at least 25, older age (i.e. age≥45 years) and having total cholesterol of at least 200mg/dl were significantly associated with the presence of MS. Using the ATP criteria to define MS, taking d4T-3TC-EFV regimen was significantly associated with higher odds of MS. CONCLUSION Almost a quarter of HIV patients on ART developed metabolic syndrome. Furthermore patients on ART had elevated lipid profile and glucose metabolism disturbance than the ART naïve.

Asymptomatic urinary tract infection among pregnant women attending the antenatal clinic of Hawassa Referral Hospital, Southern Ethiopia

BackgroundUntreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications including pyelonephritis and delivery of premature or low-birth-weight infants. However, little is known about asymptomatic bacteriuria in pregnancy in Ethiopia. This study aimed to assess the prevalence of asymptomatic bacteriuria, bacterial agents, and their antibiotic susceptibility pattern in pregnant women attending antenatal clinic of the Hawassa Teaching and Referral Hospital.MethodsA cross-sectional study was conducted in a total of 244 pregnant women with no sign and symptom of urinary tract infection from March 2012 to September 2012. Clean catch mid-stream urine samples were collected from all study participants using sterile containers. Urine samples were cultured using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done.ResultOut of 244 pregnant women, 46(18.8%) were positive for asymptomatic bacteriuria (Colony Forming Unit ≥ 105/mL). There was no difference in prevalence of asymptomatic bacteriuria with respect to age (p = 0.07) and trimester (p = 0.27).The most frequently isolated bacteria were coagulase negative Staphylococcus (32.6%), followed by Escherichia coli (26.1%), and Staphylococcus auerus (13%). The susceptibility rate of bacterial isolate was highest for norfloxacin (64.7%) and lowest for ampicillin (17.6%).ConclusionThe high prevalence of ASB in pregnant women warrant the need to screen all pregnant women and treat those infected with appropriate antimicrobial regimens in order to reduce its complications.

The diagnostic performance evaluation of the SD BIOLINE HIV/syphilis Duo rapid test in southern Ethiopia: a cross-sectional study

Objective To determine the diagnostic performance of the SD BIOLINE HIV/syphilis Duo rapid test. Design A hospital-based cross-sectional study. Setting This evaluation was conducted at one of the largest hospitals in southern Ethiopia. Participants Serum samples obtained from clients attending the antiretroviral therapy and voluntary counselling and testing centres were used. Sera were originally collected for the purpose of investigating syphilis epidemiology. The performance of the test to detect HIV was evaluated using 400 sera (200 HIV positives and 200 HIV negatives). Also, its performance to detect syphilis was evaluated using 85 syphilis positive and 100 syphilis negative serum samples. Individuals <15 years of age or syphilis treated or those with ≤50 cells/µL CD4 cell count were originally excluded. Outcome measures HIV screening was carried out according to the national rapid diagnostic testing (RDT) algorithm: Shenghai Kehua Bioengineering (KHB) test kit as a screening test, followed by the HIV1/2 STAT-PAK assay if positive. Where the result of the STAT-PAK is discordant with KHB, Unigold HIV is used as a tiebreaker to determine the result. We also used ELISA to resolve discordant HIV results. Syphilis serostatus was determined using the Treponema pallidum haemagglutination assay (TPHA). Results The respective sensitivity, specificity, positive predictive value and negative predictive value of the SD BIOLINE HIV/syphilis Duo test were 100, 99.5, 99.5 and 100% for HIV and 97.6, 96, 95.4 and 98% for syphilis testing, respectively. In reference to TPHA, the test kit reported 4 false positives and 2 false negative results for syphilis. The κ values were 0.99 for HIV testing and 0.94 for syphilis testing. Conclusions The excellent performance of the SD BIOLINE HIV/syphilis Duo test to detect HIV as well as syphilis facilitates the integration of syphilis testing and treatment to the already established HIV prevention programme, ultimately contributing to the dual HIV and syphilis elimination goal.

Seroprevalence of Helicobacter pylori infection and its related risk factors in symptomatic patients in southern Ethiopia

BackgroundHelicobacter pylori is the main etiology of peptic ulcers and chronic gastritis. Various studies showed that blood type ‘O’ is more common among patients with peptic ulcer. The aim of this study was to determine the seroprevalence of H. pylori antibodies and its relationship with ABO/Rhesus blood groups, age, sex and residence of symptomatic patients in southern Ethiopia.MethodsA cross-sectional study was conducted in a total of 408 consecutive patients with upper abdominal complaints at Hawassa University Hospital from October 2012 to January 2013. Data on demographic factors was collected from all participants using questionnaires. Blood samples were also collected and tested for ABO and Rh blood group phenotype using hemagglutination test and for anti-H. pylori antibody (IgG) using two different ELISAs..ResultsThe overall seroprevalence of H. pylori infection was 83.3% (340/408), and it was significantly higher in rural (71.2%) compared to urban residents (28.8%) (p = 0.008). Participants with blood group AB, A, O, B, and Rh positive had H. pylori prevalence of 88.9, 84.2, 83.7, 80.9, and 83.5%, respectively. H. pylori infection was not significantly influenced by age, sex, occupation, educational status and ABO/ Rh status (p >0.05).ConclusionThe high seroprevalence of H. pylori infection especially among rural residents calls for immediate intervention measures so that its clinical consequences could be minimized. ABO/Rh blood group was not found to be associated with H. pylori infection.

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.

DIAGNOSTIC PERFORMANCE EVALUATION OF THE SD BIOLINE MALARIA ANTIGEN AG PF/PAN TEST (05FK60) IN A MALARIA ENDEMIC AREA OF SOUTHERN ETHIOPIA

SUMMARY Rapid diagnostic tests (RDTs) capable of detecting and differentiating Plasmodium species are needed in areas in which microscopy is unsuitable. This study was conducted to assess the diagnostic performance of the rapid test kit - SD BIOLINE Malaria Ag Pf/Pan(r) (05FK60) in an endemic area. Microscopy of Giemsa-stained blood films were performed to detect and estimate the Plasmodium density in malaria suspected patients. The performance of the SD BIOLINE Malaria Ag Pf/Pan test was evaluated using 272 Plasmodium-positive and 102 negative blood samples. The overall sensitivity of the SD BIOLINE Malaria Ag Pf/Pan test was 99.5% for P. falciparum and 92.6% for non-P. falciparum malaria infections. The respective specificity, PPV, and NPV of the test were 98.0, 98.4, and 99.0% for the diagnosis of P. falciparum, and 100.0 %, 100.0%, and 94.4% for non-P. falciparum species. The SD BIOLINE Malaria Ag Pf/Pan test showed an excellent performance in diagnosing Plasmodium infections in an endemic setting. Therefore, this point-of-care test could be used as an alternative to microscopy in places where P. falciparum is endemic and microscopy is unsuitable.

Preservice laboratory education strengthening enhances sustainable laboratory workforce in Ethiopia

BackgroundThere is a severe healthcare workforce shortage in sub Saharan Africa, which threatens achieving the Millennium Development Goals and attaining an AIDS-free generation. The strength of a healthcare system depends on the skills, competencies, values and availability of its workforce. A well-trained and competent laboratory technologist ensures accurate and reliable results for use in prevention, diagnosis, care and treatment of diseases.MethodsAn assessment of existing preservice education of five medical laboratory schools, followed by remedial intervention and monitoring was conducted. The remedial interventions included 1) standardizing curriculum and implementation; 2) training faculty staff on pedagogical methods and quality management systems; 3) providing teaching materials; and 4) procuring equipment for teaching laboratories to provide practical skills to complement didactic education.ResultsA total of 2,230 undergraduate students from the five universities benefitted from the standardized curriculum. University of Gondar accounted for 252 of 2,230 (11.3%) of the students, Addis Ababa University for 663 (29.7%), Jimma University for 649 (29.1%), Haramaya University for 429 (19.2%) and Hawassa University for 237 (10.6%) of the students. Together the universities graduated 388 and 312 laboratory technologists in 2010/2011 and 2011/2012 academic year, respectively. Practical hands-on training and experience with well-equipped laboratories enhanced and ensured skilled, confident and competent laboratory technologists upon graduation.ConclusionsStrengthening preservice laboratory education is feasible in resource-limited settings, and emphasizing its merits (ample local capacity, country ownership and sustainability) provides a valuable source of competent laboratory technologists to relieve an overstretched healthcare system.

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.

Evaluation of SD BIOLINE rapid antibody test for diagnosis of Helicobacter pylori infection

Helicobacter pylori infection is most prevalent and known to cause chronic gastritis and peptic ulcer disease in Ethiopia. To date, simple and rapid point-of-care tests are commercially available; however, information is limited regarding their diagnostic significance. This cross-sectional study was conducted to evaluate the diagnostic performance of SD BIOLINE H. pylori rapid antibody test. A consecutive 203 enzyme linked immunosorbent assay (ELISA) confirmed sera (148 H. pylori positive and 55 negative) from dyspeptic patients were tested using SD BIOLINE H. pylori kit (Standard Diagnostic Inc, Korea) at Hawassa Teaching and Referral Hospital, southern Ethiopia from October, 2012 to January, 2013. Individuals under 15 years old, who were on anti- H. pylori treatment during the month prior to the study, those with discordant ELISA results, and refused to participate, were excluded. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the SD BIOLINE H. pylori test kit were 95.3, 94.5, 97.9, 88.1 and 95.1%, respectively. Therefore, this point-of-care test could be used as alternative to ELISA testing and best fit our context. Key words: Helicobacter pylori, point-of-care, enzyme linked immunosorbent assay (ELISA), SD BIOLINE.