Kassu Desta

Prevalence of intestinal parasites, salmonella and shigella among apparently health food handlers of Addis Ababa University student’s cafeteria, Addis Ababa, Ethiopia

BackgroundFood contamination may occur at any point during its journey through production, processing, distribution, and preparation. The risk of food getting contaminated depends largely on the health status of the food handlers, their personal hygiene, knowledge and practice of food hygiene. Food borne diseases are a public health problem in developed and developing countries like Ethiopia.MethodA cross sectional study was conducted among food handlers in Addis Ababa student’s cafeteria from January to May 2013. Structured questionnaire was used to collect socio demographic data and associated risk factors. Stool specimens were examined for bacteria and intestinal parasites following standard procedures. Biochemical tests were done to identify the species of bacterial isolates. Sensitivity testing was done using Kirby- Baur disk diffusion method.ResultA total of 172 food handlers were enrolled in the study. The majority of study participants were females 134 (77.9%). About 78 (45.3%) of food handlers were found to be positive for different intestinal parasites with the most abundant parasite of Entameoba histolytica/dispar 68 (70.8%) followed by Giardia lamblia 18 (18.8%), Taenia species 5 (5.2%), Ascaris lumbricoides 2 (2.1%), hookworm 2 (2.1%) and Trichuris trichiura 1 (1.1%). Stool cultures revealed 3.5% of Salmonella isolates (Sero-grouping on Salmonella isolate was not done), while Shigella species was not isolated from any of the stool samples obtained from Food handlers. All isolates of Salmonella were sensitive to ciprofloxacin, amikacin and gentamicin but resistant to ampicillin, clindamycin, and erythromycin.ConclusionThe present study revealed a high prevalence of intestinal parasite in asymptomatic (apparently health) food handlers. Such infected food handlers can contaminate food, drinks and could serve as source of infection to consumers via food chain.

Assessment of Patients' Knowledge, Attitude, and Practice Regarding Pulmonary Tuberculosis in Eastern Amhara Regional State, Ethiopia: Cross-Sectional Study

Tuberculosis (TB) is a major public health problem in Ethiopia and the Amhara region. Assessment of knowledge, attitude, and health-seeking practice in this region is essential to plan, implement, and evaluate advocacy, communication, and social mobilization work. This may improve the case detection rate. The aim of this study was to assess the knowledge, attitude, and practice of patients toward TB in the Eastern Amhara region of Ethiopia. A cross-sectional survey was conducted among suspected and confirmed TB patients who were 18 years of age and older. For this purpose, 422 participants were enrolled. A structured and pre-validated questionnaire was used to collect data. In addition χ(2) and multivariate logistic regression analysis was used to see an association with different variables. The mean and median knowledge score of respondents about pulmonary TB was 6.81 and 7, respectively. The majority of respondents had several misconceptions in all aspects of the most infectious form of TB. About half of the respondents did not know the current free cost of TB diagnosis and treatment. The 69.9% of respondents claimed that cost is the main reason for not getting care. The majority of respondents had several misconceptions about TB. The TB control program needs to consider advocacy, communication, and social mobilization for addressing the gap in the study sites.

Isolation and Antibiotic Susceptibility Patterns of Shigella and Salmonellaamong Under 5 Children with Acute Diarrhoea: A Cross-Sectional Study atSelected Public Health Facilities in Addis Ababa, Ethiopia

Background: Diarrhoeal illness remains one of the leading causes of morbidity and mortality among children<5 years of age worldwide. In Ethiopia, about 230,000 deaths estimated to occur. Shigella and Salmonella are major causes of gastroenteritis in children and is associated with high resistance levels. Thus, the aims of this study was to isolate and determine susceptibility patterns of Shigella and Salmonella, isolated from under five children with diarrhoea attending at some selected health facilities in Addis Ababa, Ethiopia. Methods: A total of 253 children 115 males and 138 females with acute diarrhoea were enrolled. Stool samples were cultured and isolated Shigella and Salmonella species were run for antimicrobial susceptibility testing using disk diffusion method. Results: A total of 190 entropathogens were isolated. Sixty one (24.1%) was E. coli, (9.1%) was Shigella followed by (3.95%) Salmonella and Citrobacter species and 86 (34.0%) was parasites. The overall resistance rates of isolated Shigella and Salmonella spp were high for Ampicillin (95.7%, 80.0%) and Augmentin (91.4%, 80) respectively. However, high sensitivity was observed among both isolates for Ciprofloxacin (91.3%, 100%) and Ceftraxion (91.4%, 100%). More than 87% of Shigella species were multiple resistances (resistance for two or more antibiotics). Whereas, 70.0% for Salmonella species. The prevalence of Shigella species was significantly varied among children with different employment parent’s status. Raw meat consumption was an independent predictor variable for exposures of Salmonella infection (P≤0.05). Conclusion: Isolation of high frequency of multidrug resistant Shigella and Salmonella spp. from children in the study area is an alarming for the present situation of emerging drug resistance. However, there is still a chance to use ciprofloxacin and ceftriaxone in area of no culture and sensitivity test performed.

The Effect of Maternal Helminth Infection on Maternal and Neonatal Immune Function and Immunity to Tuberculosis

Background M. tuberculosis and helminth infection each affects one third of the world population. Helminth infections down regulate cell mediated immune responses and this may contribute to lower efficacy of BCG vaccination and higher prevalence of tuberculosis. Objective To determine the effect of maternal helminth infection on maternal and neonatal immune function and immunity to TB. Methods In this cross sectional study, eighty five pregnant women were screened for parasitic and latent TB infections using Kato-Katz and QFT-GIT tests, respectively. IFN-γ and IL-4 ELISpot on Cord blood Mononuclear Cells, and total IgE and TB specific IgG ELISA on cord blood plasma was performed to investigate the possible effect of maternal helminth and/or latent TB co-infection on maternal and neonatal immune function and immunity to TB. Result The prevalence of helminth infections in pregnant women was 27% (n = 23), with Schistosoma mansoni the most common helminth species observed (20% of women were infected). Among the total of 85 study participants 25.8% were QFT-GIT positive and 17% had an indeterminate result. The mean total IgE value of cord blood was significantly higher in helminth positive than negative women (0.76 vs 0.47, p = 0.042). Cross placental transfer of TB specific IgG was significantly higher in helminth positive (21.9±7.9) than negative (12.3±5.1), p = 0.002) Latent TB Infection positive participants. The IFN-γ response of CBMCs to ESAT-6/CFP-10 cocktail (50 vs 116, p = 0.018) and PPD (58 vs 123, p = 0.02) was significantly lower in helminth positive than negative participants. There was no significant difference in IL-4 response of CBMCs between helminth negative and positive participants. Conclusions Maternal helminth infection had a significant association with the IFN-γ response of CBMCs, total IgE and cross placental transfer of TB specific IgG. Therefore, further studies should be conducted to determine the effect of these factors on neonatal immune response to BCG vaccination.

Drug Resistance Pattern of Mycobacterium tuberculosis in Eastern Amhara Regional State, Ethiopia

Background: Tuberculosis (TB) is a major public health problem in Amhara region, Ethiopia where the TB case detection rate is low (22%). This situation has been worsened by the emergence and spread of drug resistance strains which have been threatening efforts of TB control. Objectives: The aim of this study was to assess the magnitude of drug resistance patterns of M. tuberculosis in Eastern Amhara region, Ethiopia. Methods: A facility based cross sectional study was conducted among 230 (165 new and 65 retreated) smear positive TB patients (age ≥18 years old) from September 2010 to June 2011. Socio-demographic data of the study participants and possible factors for development of drug resistance were collected using pre-tested structured questionnaire. Smear positive sputum samples were processed and decontaminated by the modified Petrof method. Primary isolation and drug susceptibility testing (DST) were carried out on egg based Lowenstein –Jensen media (LJ). Data were entered and analyzed using SPSS version 16 software. Multivariate analysis using the logistic regression model was computed. P-values less than 0.05 were considered as statistically significant. Results: The overall prevalence of drug resistance to at least a single drug was 77/230(33.5%). The prevalence of MDR-TB in all, new and re-treated patients was 15/230(6.5%), 3/165(1.8%) and 12/65 (18.5%), respectively. In the multivariate analysis previous exposure to anti-TB drugs and 1+ bacterial load were significantly associated with anti TB drug resistance (P<0.05). Conclusion: A high rate of drug resistance for main anti-tuberculosis drugs was observed on new and previously treated cases. Previous exposure to anti-TB drugs and bacterial load were important determinants of development of drug resistance. So, patient’s adherence to anti-TB drugs (especially re-treated cases) and scaling up of DST service at district hospital level will help to reduce the development of drug resistance in the study area.

Podoconiosis and soil-transmitted helminths (STHs): double burden of neglected tropical diseases in Wolaita zone, rural Southern Ethiopia.

Background Both podoconiosis and soil-transmitted helminth (STH) infections occur among barefoot people in areas of extreme poverty; however, their co-morbidity has not previously been investigated. We explored the overlap of STH infection and podoconiosis in Southern Ethiopia and quantified their separate and combined effects on prevalent anemia and hemoglobin levels in podoconiosis patients and health controls from the same area. Methods and Principal Findings A two-part comparative cross-sectional study was conducted in Wolaita zone, southern Ethiopia. Data were collected from adult patients presenting with clinically confirmed podoconiosis, and unmatched adult neighborhood controls living in the same administrative area. Information on demographic and selected lifestyle factors was collected using interviewer-administered questionnaires. Stool samples were collected and examined qualitatively using the modified formalin-ether sedimentation method. Hemoglobin level was determined using two different methods: hemoglobinometer and automated hematology analyzer. A total of 913 study subjects (677 podoconiosis patients and 236 controls) participated. The prevalence of any STH infection was 47.6% among patients and 33.1% among controls (p<0.001). The prevalence of both hookworm and Trichuris trichiura infections was significantly higher in podoconiosis patients than in controls (AOR 1.74, 95% CI 1.25 to2.42, AOR 6.53, 95% CI 2.34 to 18.22, respectively). Not wearing shoes and being a farmer remained significant independent predictors of infection with any STH. There was a significant interaction between STH infection and podoconiosis on reduction of hemoglobin level (interaction p value = 0.002). Conclusions Prevalence of any STH and hookworm infection was higher among podoconiosis patients than among controls. A significant reduction in hemoglobin level was observed among podoconiosis patients co-infected with hookworm and ‘non-hookworm STH’. Promotion of consistent shoe-wearing practices may have double advantages in controlling both podoconiosis and hookworm infection in the study area.

Evaluation of genotype MTBDR plus VER 2.0 line probe assay for the detection of MDR-TB in smear positive and negative sputum samples

BackgroundMulti drug resistant tuberculosis (MDR-TB) poses formidable challenges to TB control due to its complex diagnostic and treatment challenges and often associated with a high rate of mortality. Accurate and rapid detection of MDR-TB is critical for timely initiation of treatment. Line Probe Assay (LPA) is a qualitative in vitro diagnostic test based on DNA-STRIP technology for the identification of the M. tuberculosis complex and its resistance to rifampicin (RMP) and/or isoniazid (INH). Hain Lifescience, GmbH, Germany has improved the sensitivity of Genotype MTBDRplus VER 2.0 LPA for the detection of MDR-TB; with the possibility of applying the tool in smear negative sputum samples.MethodA cross sectional study was conducted on 274 presumptive MDR-TB patients referred to the National TB Reference Laboratory (NTRL), Ethiopian Public Health Institute (EPHI) who submitted sputum samples for laboratory diagnosis of drug resistant-TB testing. Seventy-two smear and culture positive samples processed in smear positive direct LPA category and 197 smear negative sputum samples were processed for direct LPA. Among the smear negative samples 145 (73.6%) were culture negative and 26 (13.2%) were culture positive. All specimens were processed using NALC-NaOH method and ZN smear microscopy done from sediments. Genotype MTBDRplus VER 2.0 done from processed sputum sediments and the result was compared against the reference, BACTEC MGIT 960 culture and DST. Sensitivity, specificity, PPV and NPV of Genotype MTBDRplus VER 2.0 assay was determined and P-value <0.05 was considered as statistically significant.ResultsThe sensitivity, specificity, PPV and NPV of Genotype MTBDRplus VER 2.0 LPA were 96.4, 100, 100 and 96.9%, respectively for the detection of MDR-TB from direct smear positive sputum samples. The sensitivity, specificity, PPV and NPV of Genotype MTBDR plus VER 2.0 LPA were 77.8, 97.2, 82.4 and 97.2%, respectively, for the detection of M. tuberculosis from direct smear negative sputum samples. Fourteen (53.8%) samples had valid results with LPA among the 26 smear negative culture positive samples. The remaining 8 (30.8%) and 4 (15.4%) were invalid and negative with LPA, respectively. The sensitivity and specificity of Genotype MTBDRplus VER 2.0 LPA were 100% for the detection of MDR-TB among 14 direct smear negative and culture positive sputum samples.The most common mutations associated with RMP and INH resistance were S531L and S315TL, respectively. A single rare mutation (C15T/A16G) was detected for INH resistance.ConclusionThe diagnostic performance of Genotype MTBDRplus VER 2.0 LPA in direct smear positive sputum sample was highly sensitive and specific for early detection of MDR-TB. However, the diagnostic performance of this molecular assay in direct smear negative sputum sample was low and showed a high level of invalid results for detection of M. tuberculosis and its resistance to RMP and/or INH so it is unlikely to implement Genotype MTBDRplus VER 2.0 for the detection of MDR-TB in direct smear negative sample in our routine settings. The sensitivity of the assay should be improved for detection of MDR-TB in direct smear negative sputum specimens.

Helminth Infection Increases the Probability of Indeterminate QuantiFERON Gold in Tube Results in Pregnant Women

Background. Approximately one-third of the world population is infected with M. tuberculosis and helminths (Kariminia et al. (2009), Walson et al. (2010)). Pregnancy and Helminth infection are known to suppress the TH1 response (Kariminia et al. (2009), Elias et al. (2006)) on which the QuantiFERON Gold in Tube (QFT-GIT) assay, that measures the released IFN-γ upon in vitro stimulation with mycobacterial antigens, relies on (Thomas et al. (2010)). Objective. To determine whether QFT-GIT indeterminate result is significantly associated with helminth infection or not. Methods. In this cross-sectional study, eighty-five pregnant mothers were screened for parasitic and LTBI using Kato-Katz and QFT-GIT test-respectively, Result. The prevalence of helminth infection in pregnant mothers was 23 (27%) of this 17 (20%) was due to Schistosoma mansoni. Among the total of 85 study participants 26.8% were QFT-GIT positive and 14 (17%) had indeterminate results. Three samples (21.4%) were randomly selected from the indeterminate QFT-GIT results and retested to check the reproducibility of the assay and remained indeterminate. QFT-GIT indeterminate result showed significant association with helminth infection. Conclusion. Helminth infections were significantly associated with indeterminate QFT-GIT results in pregnant mothers. Therefore further study is important to evaluate the possible effect of helminth infection by excluding the effect of pregnancy, as pregnancy also downregulates cellular immunity.

Performance Evaluation of Malaria Microscopists at Defense Health Facilities in Addis Ababa and Its Surrounding Areas, Ethiopia.

Background Blood film microscopy is the gold standard approach for malaria diagnosis, and preferred method for routine patient diagnosis in health facilities. However, the inability of laboratory professionals to correctly detect and identify malaria parasites microscopically leads to an inappropriate administration of anti-malarial drugs to the patients and incorrect findings in research areas. This study was carried out to evaluate the performance of laboratory professionals in malaria diagnosis in health facilities under the Defense Health Main Department in Addis Ababa and its surroundings, Ethiopia. Method A cross sectional study was conducted from June to July 2015. Totally, 60 laboratory professionals out of the selected 16 health facilities were included in the study. Data were collected by distributing standardized pre-validated malaria slide-panels and self-administered questionnaires among professionals, onsite in each study facility. Sensitivity, specificity, and strength of agreement (with kappa score) in performance among the study participants against WHO-certified expert malaria microscopists were calculated. Result Of the 60 study participants, 8.3% (5/60) correctly read all the distributed slides in terms of parasite detection, species identification and parasite counting; whereas, each of the remaining 55(91.7%) interpreted at least two slides incorrectly. The overall sensitivity and specificity of participants’ performance in detection of malaria parasites were 65.7% and 100%, respectively. Overall, fair agreement (71.4%; Kappa: 0.4) in detection of malaria parasite was observed between the study subjects and expert readers. The overall sensitivity and specificity of participants in species identification of malaria parasites were respectively 41.3% and 100%. Overall, slight agreement (51.1%; kappa: 0.04) in identification of malaria species was observed. Generally, agreement was lower in parasite detection and species identification at low parasite density and mixed infection cases. Conclusion The general agreement between the study participants and expert microscopists in malaria parasite detection and species identification was very low, particularly in the cases of low-parasite density and mixed infections. Therefore, regular external quality assessments and further refreshment trainings are crucial to enhance the skill of professionals in malaria microscopy; particularly for those in non-malarious areas where exposure to malaria diagnosis is low.

External quality assessment of AFB smear microscopy performances and its associated factors in selected private health facilities in Addis Ababa, Ethiopia

Tuberculosis (TB) is still a public health problem in sub Saharan African countries. In resource-limited settings, TB diagnosis relies on sputum smear microscopy, with low and variable sensitivities, especially in paucibacillary pediatric and HIV-associated TB patients. Tuberculosis microscopy centers have several weaknesses like overworking, insufficiently trained personnel, inconsistent reagent supplies, and poorly maintained equipments; thus, there is a critical need for investments in laboratory infrastructure, capacity building, and quality assurance schemes. The performance of TB microscopy centers in the private health facilities in Addis Ababa is not known so far. The main objective of the study was to assess laboratory performance of acid fast bacilli (AFB) smear microscopy and its associated factors in selected private health facilities in Addis Ababa, Ethiopia. A cross-sectional study was conducted in 33 selected private health facilities of Addis Ababa, Ethiopia comprising 7 hospitals, 2 NGO health centers, 23 higher clinics and 1 diagnostic laboratory that provide AFB smear microscopy services. The study was conducted from January to April 2014. A total of 283 stained sputum smears were randomly collected from participant laboratories for blinded rechecking, 320 panel slides were sent to 32 microscopy centers to evaluate their performance on AFB reading, staining and reporting. Checklists were used to assess quality issues of laboratories. Data were captured, cleaned, and analyzed using SPSS version 16.0; χ2 tests, kappa statistics were used for comparison purpose. P value < 0.05 considered statistically significant. Among the 32 participant laboratories, 2-scored 100%, 15 scored 80-95% & the remaining 15 scored 50-75% for overall proficiency test performance. There were 10 (3.15%) major errors and 121 (37.8%) minor errors. The sensitivity, specificity, PPV and NPV of panel reading by microscopy centers were 89%, 96%, 96%, and 90% respectively. Out of 283 randomly selected slides for blind rechecking, 11 (3.9%) slides interpreted falsely for AFB, with overall agreement of 97.5%, sensitivity of 88.4% and specificity of 99.3%. In terms of slide quality assessment, 71.6% of AFB slides were graded as good for evenness, cleanness, thickness, size, staining and labeling. The performance score for AFB slide evenness was 56.9% (161 slides) and for labeling quality was 90.8% (257 slides); having significant difference in slide quality (p value < 0.05). On-site evaluation indicated problems in terms of infrastructure, standard operating procedure, reagent quality; equipment maintenance, data management and training issues. Most of the health facilities had poor maintenance scheme for microscope (53.5%) and poor inventory management (25.0%) system. Microscopy centers that scored a proficiency of 75.5%; which is below the acceptable minimum score of 80% and an overall error rate of 3.9% for blinded rechecking needs attention. Moreover, there are gaps identified through on site assessment including poor SOP, reagent quality, equipment maintenance, data management & lack of updated training on AFB microscopy techniques, requiring a concerted effort to alleviate the bottle neck problems and strengthening the public private partnership to control TB.