Megbaru Alemu

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.

Foodborne intestinal protozoan infection and associated factors among patients with watery diarrhea in Northern Ethiopia; a cross-sectional study

BackgroundIntestinal protozoa are parasites transmitted by consumption of contaminated water and food and mainly affect children and elder people and cause considerable health problems. They are the leading causes of outpatient morbidity due to diarrhea in the developing countries. So, assessing water and food source of diarrheal patients and identifying the main associated factors for transmission of protozoan parasitic infections help for effective control measures of protozoan infections. Hence, the current study was aimed at determining the prevalence of foodborne intestinal protozoa infections and associated factors among diarrheic patients in North Ethiopia.MethodsA health facility based cross-sectional study was conducted among 223 patients with watery diarrhea in four selected government health facilities in North Ethiopia from November 2016–June 2017. A structured questionnaire was used to collect data on socio-demography of study participants and factors associated with foodborne protozoa infections. The diarrheic stool samples were collected, transported, and processed using direct wet mount, formal-ether concentration and modified ZiehlNeelson staining methods. The data were analyzed using SPSS version 21 and descriptive statistics, bi-variate, and multivariate logistic regressions were computed. P-value <u20090.05 at 95% confidence interval was considered statistically significant.ResultsThe overall prevalence of foodborne protozoa infection was 101 (45.3%). The predominant protozoa species identified was Entamoeba histolytica/dispar 55 (24.7%), followed by Giardia intestinalis 25 (11.2%) and Cryptosporidium species 5 (2.2%). The highest proportion of protozoa infection was observed among males (23.3%) and the age group 15–24xa0years (13.5%). Statistically significant associations were observed between foodborne protozoan infection and not using any type of recipe to decontaminate salads and fruits (AORu2009=u20092.64, 95 CI: 1.34–5.19, Pu2009=u20090.005) and using vinegar as a decontaminant (AORu2009=u20092.83, 95 CI: 1.24–6.48, Pu2009=u20090.014). Eating out (meals at a restaurant) on the other hand was found to be protective for foodborne protozoan infection (AORu2009=u20090.43, 95 CI: 0.23–0.78, Pu2009=u20090.006).ConclusionOur study revealed that foodborne protozoa infections are of public health significance in the study area. Vinegar, which is frequently used as a recipe for decontaminating salads and fruits, is inversely related to foodborne protozoa parasite infection .

Intestinal parasitosis and anaemia among patients in a Health Center, North Ethiopia

ObjectiveThe aim of this cross-sectional study was to determine the magnitude of intestinal parasitosis and anaemia in a Health Center, North Ethiopia.ResultsA total of 427 outpatients were enrolled and the median age of the participants was 22xa0years. The prevalence of intestinal parasitosis was 143 (33.5%). Age, place of residence and occupation were significantly associated with intestinal parasitosis. When we see parasite specific factors, significant associations were observed for source of drinking water (Pxa0=xa00.02), age (Pxa0<xa00.001) and family size (Pxa0=xa00.003), respectively with Entameba histolytica, Hookworm and Giardia lamblia infections. The overall prevalence of anaemia was 35 (8.2%). The mean haemoglobin concentration among the study participants was 12.8xa0mg/dl. The highest prevalence of anemia was recorded for the age group of 15–19xa0years (29.6%). The proportion of anemia among intestinal parasite -infected and non-infected participants was 10.7 and 7.0%, respectively. Study participants infected with S. stercoralis and hookworm were more likely to develop anaemia than the non- infected ones; AOR (adjusted odds ratio)xa0=xa05.3, 95% CI (1.01–27.4); Pxa0=xa00.028 and AORxa0=xa011.1, 95% CI (3.36–36.9); Pxa0=xa00.000, respectively.

Multivariate analysis of factors associated with Schistosoma mansoni and hookworm infection among primary school children in rural Bahir Dar, Northwest Ethiopia

BackgroundSoil-transmitted helminths and Schistosoma mansoni infections are the major causes of morbidity and mortality in Sub-Saharan countries. The highest burden of the disease resides in school-age children. Poor water sanitation and hygiene are believed to be the major contributing factors for the high prevalence. Therefore, the goal of this study was to determine the prevalence of intestinal parasite infections in rural Bahir Dar, Northwest Ethiopia.MethodsA cross-sectional study was conducted from April 2017–June 2017 among 409 randomly selected primary school children. A structured questionnaire was used to obtain socio-demographic information and determinant factors through interviewing the students. Stool examination was done by Ritchie’s concentration method. The data were entered and analyzed using SPSS version 22. Prevalence of helminthic infections was calculated using descriptive statistics. The association between helminthic infection and determinant factors was determined by Bavarian regression. The confounding effect was checked by multivariate regression at 95% confidence interval. Any association was significant when the p-value was <u20090.05.ResultThe overall prevalence of intestinal parasite infection was 47.2%.(193/409).. The prevalence of Hookworm species and Schistosoma mansoni was 31.1 and 8.0%, respectively. Co-infection of Hookworm species with Schistosoma mansoni was 5.1% (21/409). The highest prevalence of Schistosoma mansoni was recorded for boys (21%), older children (21.4%) and rural children (17.6%) (Pu2009<u20090.05). Schistosoma mansoni infection was also higher among children whose household drinking water was sourced from streams/rivers (Pu2009<u20090.05). The multivariate analysis showed lower odds of Schistosoma mansoni infection for those with no history of bathing (AORu2009=u20093.7, 95% CI: 1.1–12.2; Pu2009=u20090.034), washing clothes/utensils (AORu2009=u20093.4; 95% CI: 1.2–9.7; Pu2009=u20090.022), swimming (AORu2009=u20092.8, 95% CI: 1.2–6.9; Pu2009=u20090.023), and irrigation (AORu2009=u20092.8, 95% CI: 1.3–6.0; Pu2009=u20090.01). Significantly, higher odds of Hookworm infection was recorded for older children (AORu2009=u20092.3, 95% CI: 1.08–4.89; Pu2009=u20090.029), boys (AORu2009=u20091.9, 95% CI: 1.12–3.24; Pu2009=u20090.018), and rural children (AORu2009=u20091.8, 95% CI: 1.04–3.0; Pu2009=u20090.037). Regular shoe wearing (AORu2009=u20090.29, 95% CI: 0.16–0.50; Pu2009=u20090.00) is protective for hookworm infection. Higher odds of hookworm infection was also recorded for schoolchildren who had the habit of eating raw vegetables (AORu2009=u20091.2 95% CI: 1.1–1.7 Pu2009=u20090.011).ConclusionHookworm infection and schistosomiasis are prevalent in the school children in rural Bahir Dar in Northwest Ethiopia. Various activities and behaviors of the children were strongly associated with helminthic infection. Hence health education should be delivered regularly to minimize/avoid the risky behaviors and water-based activities. Deworming programs should also be implemented on a regular basis.

Incidence of Plasmodium infections and determinant factors among febrile children in a district of Northwest Ethiopia; a cross-sectional study

BackgroundAccording to the Ethiopian national malaria indicator survey of 2015, the highest burden of Plasmodia infection resided among the school-age children. Even though several studies revealed various determinant factors of childhood malaria, consistent findings are not reported across the nation and elsewhere. This in turn creates obstacles in implementing exactprevention and control measures in the study area in particular and the country at large.ObjectivesThe aim of this study is to determine the incidence of Plasmodium and determinant factors among febrile children in Northwest Ethiopia.MethodsThis cross-sectional study was conducted from April–August 2016. Blood samples were collected from febrile children selected by systematic random sampling. Thin and thick blood films were prepared and stained with Giemsa. Statistical analysis was done via SPSS version 20 statistical software and data were summarized with percentages and frequencies. The bi-variate and multi-variate logistic regressions were used to measure strength of association between Plasmodium infection and determinant factors, and to rule out confounders, respectively.ResultAmong a total of 333 febrile children, 146 (43.8%) were positive for the Plasmodia. The prevalence of plasmodium infection was 47%, 50%, and 40%, among the age groups of 6–8, 9–10 and 11–14xa0years, respectively. Prevalence of plasmodium among male and female children was 44.2% and 43.5%, respectively. Shorter distance from stagnant water (AOR (adjusted odds ratio) =43, 95% CI (confidence interval):2.8–680.7; Pu2009<u20090.01), family size (AOR =14.7, 95% CI:(1.4–151.2; Pu2009=u20090.02), outdoor sleeping (AOR =36.6, 95% CI:2.4–554.2; Pu2009<u20090.01, irregular bed net use (AOR =21.1, 95% CI:2.9–154.7; Pu2009<u20090.01), and late bed time (AOR =31.9, 95% CI:2.8–371.3; Pu2009<u20090.01) showed statistically significant association with plasmodium infection.ConclusionThe incidence of Plasmodium infection is high among febrile children in the study area. Shorter distance from stagnant water, larger family size, outdoor sleeping, irregular bed net use, and late night sleeping are the major determinant factors for the high incidence of malaria. Therefore, community mobilization and health education should focus on the specific determinant factors of plasmodium infection to alleviate incidence of malaria among the school children.

Magnitude and associated factors of postpartum morbidity in public health institutions of Debre Markos town, North West Ethiopia

BackgroundPostpartum maternal morbidity is maternal illness that occurs after one hour of expulsion of placenta up to six weeks of childbirth. Though the true burden of this problem is not well known estimates of WHO, UNICEF and UNFPA showed that 1.4 million women experience acute obstetric morbidity annually. Knowledge of magnitude and predicting factors postpartum morbidity is central to understand the extent of the problem and will help as a cornerstone in designing and implementing better preventive strategies.ObjectivesTo assess the magnitude and factors associated with postpartum morbidity in public health institutions in Debre Markos town.MethodInstitutional based cross sectional study was conducted in Debre Markos town public health institutions by reviewing delivery charts, delivery records and reporting log books. Total deliveries in each health institution in the previous year were identified and number of records to be included from each institution was determined by probability proportion to size. Systematic sampling technique was employed to select 308 charts for review. Data was collected by trained midwifes using structured checklist; entered by epi info and analyzed using SPSS 20. To present findings descriptive statistics using frequencies, charts and figures were used accordingly. Finally binary and multiple logistic regressions were performed to identify predicting factors.ResultsThe magnitude of postpartum morbidity was found to be 101(32.8%). Divorced/widowed women [AORu2009=u200910.920, 95% CI: (2.168, 54.998)], women who didn’t have ANC follow up [AORu2009=u20093.710, 95% CI: (1.749, 7.870)], abnormal labour [AOR =3.496, 95% CI: (1.69, 7.22)], women delivered by doctor [AOR =0.111, 95% CI: (0.027, 0.454)] and women who were not attended postpartum visit [AOR =0.088, 95% CI: (0.040, 0.194)] were the factors associated with postpartum maternal morbidity.ConclusionMaternal morbidity in Debre Markos health institution was found to be major maternal health issue. Being divorced/widowed, absence of ANC visit, intrapartum abnormalities, delivery attended by skilled professionals and no post-partum visit were important predictors of maternal postpartum morbidity.

Under diagnosis of intestinal schistosomiasis in a referral hospital, North Ethiopia

ObjectiveThe present cross-sectional study was aimed at determining the magnitude of under diagnosis of intestinal schistosomiasis among patients requested for routine ova/parasite examination at Ayder referral hospital.ResultsA total of 280 stool samples were collected and only 5% of the patients were positive for ova of Schistosoma mansoni in the routine direct wet mount microscopy. On the other hand, 12.5% of the patients were positive for ova Schistosoma mansoni when the stool samples were processed by either Kato Kat or formol ether concentration techniques. Moderate test agreement (κu2009=u20090.48) was recorded for wet mount. Formol-ether concentration (κu2009=u20090.89) and Kato-Katz (κu2009=u20090.92) showed excellent agreements with the ‘Gold’ standard. Direct wet mount technique exhibited the poorest sensitivity (35%) of detection of ova of Schistosoma mansoni. Hence, the Kato-Katz technique should be implemented in parallel with the direct wet mount microscopy for Schistosoma mansoni presumptive patients.

Performance of Laboratory Professionals Working on Malaria Microscopy in Tigray, North Ethiopia

Background Microscopic analysis of stained blood smear is the most suitable method of malaria diagnosis. However, gaps were observed among clinical laboratory professionals in microscopic diagnosis of malaria. Methods A cross-sectional study was conducted in December 2015 among 46 laboratory professionals. Data was collected via on-site assessment and panel testing. The slide panel testing was composed of positive and negative slides. The kappa score was used to estimate the agreement between participants and reference reader. Results The overall agreement between the study participants and the reference reader in malaria detection was 79% (kappa = 0.62). Participating in refresher training on malaria microscopy (Adjusted Odds Ratio (AOR = 7, CI = 1.5–36.3)) and malaria epidemic investigation (AOR = 4.1 CI = 1.1–14.5) had statistical significant association with detection rate of malaria parasites. Conclusion Laboratory professionals showed low performance in malaria microscopy. Most of the study participants were graded “in-training” in laboratory diagnosis of malaria.