Solomon Gebre-Selassie

Hepatitis B virus infection among people attending the voluntary counselling and testing centre and anti-retroviral therapy clinic of St Paul’s General Specialised Hospital, Addis Ababa, Ethiopia

Objective: To determine the prevalence of hepatitis B virus (HBV) infection and its risk factors among people attending the HIV voluntary counselling and testing (VCT) centre and anti-retroviral therapy (ART) clinic at St Paul’s General Specialised Hospital. Methods: A cross-sectional study was carried out on consecutive attendees from 24 January 2007 to 15 February 2007. Blood samples and data on sociodemographic and HBV risk factors were collected from 620 individuals (384 VCT and 236 HIV-infected ART clinic clients). Sera were screened for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc) and hepatitis B e antigen (HBeAg). Results: The prevalence of HBsAg and anti-HBc in VCT clients was 5.7% and 44.8%, respectively. Among HIV-infected persons, 3.9% were seropositive for HBsAg. There was no significant difference in HBsAg or anti-HBc seropositivity between HIV-positive and HIV-negative subjects. Anti-HBc positivity was significantly higher in men, in the age range 40–49 years, and in subjects with a history of catheterisation. Conclusion: This study shows a high prevalence and similar distribution of HBV infection in HIV-positive and HIV-negative people. However, with the emphasis given to HIV-positive cases, screening for HBV infection is important.

Nosocomial bacterial infections in a tertiary hospital in Ethiopia

The aim of this study was to determine the magnitude of nosocomial infection and isolate the bacterial aetiologic agents in a tertiary hospital. A total of 215 patients admitted to surgical wards and intensive care unit were followed prospectively. Specimens from patients were determined using standard techniques. Of the patients observed, 77 (35.8%) had 84 (39.1%) nosocomial infections. The overall incidence of nosocomial infections was 35.8/100 patients. Surgical site, urinary tract and blood stream infections comprised 38 (49.4%), 23 (29.8%) and 16 (20.8%), respectively. Of the bacterial isolates, 58/84 (69.0%) were Gram negative and 26/84 (31.0%) Gram positive. Pseudomonas aeruginosa (22.7%) and Escherichia coli (45.8%) were the major causes of surgical site and urinary tract infections, respectively. Staphylococcus aureus was isolated in 37.5% of the blood stream infections. The incidence of nosocomial infection in the hospital was high. There is a need to reduce the problem with continuous surveillance and the implementation of infection prevention strategies.

Therapeutic Efficacy of Artemether-Lumefantrine for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Northern Ethiopia.

Introduction. Multidrug resistance of Plasmodium falciparum is spreading throughout Africa. This has posed major challenges to malaria control in sub-Saharan Africa. Objective. The aim of the study was to evaluate the efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in North Ethiopia. Methods. This prospective study was undertaken during August–November 2009 on 71 malaria patients that fulfilled the inclusion criteria set by the WHO. Patients were followed up for 28 days. Thick and thin blood films were prepared by Giemsa stain for microscopy to determine parasite density. A standard six-dose regimen of artemether-lumefantrine was administered over three days and was followed up with clinical and parasitological evaluations over 28 days. Results. The cure rate (ACPR) was found to be high (97.2%) in this study. The parasite and fever clearance time was also rapid. Artemether-lumefantrine for the treatment of acute uncomplicated Plasmodium falciparum malaria in the study area showed 97.2% cure rate and only 2.8% failure rate. Conclusion. The result showed that the drug could continue as first line for the treatment of uncomplicated Plasmodium falciparum malaria in the study area. The efficacy of artemether-lumefantrine needs to be carefully monitored periodically in sentinel sites representing different areas of the country.

Assessment of antibiotic- and disinfectant-resistant bacteria in hospital wastewater, south Ethiopia: a cross-sectional study

INTRODUCTION Large quantities of antimicrobials are used in hospitals for patient care and disinfection. Antibiotics are partially metabolized and residual quantities reach hospital wastewater, exposing bacteria to a wide range of biocides that could act as selective pressure for the development of resistance. METHODOLOGY A cross-sectional study was conducted between December 2010 and February 2011 on hospital wastewater. A total of 24 composite samples were collected on a weekly basis for bacteriological analysis and susceptibility testing. Indicator organisms and pathogenic and potentially pathogenic bacteria were found and isolated on selective bacteriologic media. Disinfectant activity was evaluated by use-dilution, and minimum inhibitory concentration (MIC) was determined by the agar dilution method. Similarly, antibiotic susceptibility tests were performed using the Kirby-Bauer disk diffusion method. RESULTS Pathogenic (Salmonella, Shigella, and S. aureus) and potentially pathogenic (E. coli) bacteria were detected from effluents of both hospitals. Dilution demonstrated tincture iodine to be the most effective agent, followed by sodium hypochlorite; the least active was 70% ethanol. MIC for ethanol against S. aureus and Gram-negative rods from Yirgalem Hospital (YAH) showed 4 and 3.5 log reduction, respectively. Salmonella isolates from YAH effluent were resistant to ceftriaxone, tetracycline, and doxycycline. Isolates from Hawassa University Referral Hospital (HURH) effluent were resistant to the above three antibiotics as well as gentamycin. CONCLUSIONS Hospital effluents tested contained antibiotic-resistant bacteria, which are released into receiving water bodies, resulting in a threat to public health.

Baseline predictors of antiretroviral treatment failure and lost to follow up in a multicenter countrywide HIV-1 cohort study in Ethiopia

Background Antiretroviral therapy (ART) has been rapidly scaled up in Ethiopia since 2005, but factors influencing the outcome are poorly studied. We therefore analysed baseline predictors of first-line ART outcome after 6 and 12 months. Material and methods 874 HIV-infected patients, who started first-line ART, were enrolled in a countrywide prospective cohort. Two outcomes were defined: i) treatment failure: detectable viremia or lost-to-follow-up (LTFU) (confirmed death, moved from study sites or similar reasons); ii) LTFU only. Using stepwise logistic regression, four multivariable models identified baseline predictors for odds of treatment failure and LTFU. Results The treatment failure rates were 23.3% and 33.9% at 6 and 12 months, respectively. Opportunistic infections (OI), tuberculosis (TB), CD4 cells <50/μl, and viral load >5 log10 copies/ml increased the odds of treatment failure both at 6 and 12 months. The odds of LTFU at month 6 increased with baseline functional disabilities, WHO stage III/IV, and CD4 cells <50/μl. TB also increased the odds at month 12. Importantly, ART outcome differed across hospitals. Compared to the national hospital in Addis Ababa, patients from most regional sites had higher odds of treatment failure and/or LTFU at month 6 and/or 12, with the exception of one clinic (Jimma), which had lower odds of failure at month 6. Conclusions In this first countrywide Ethiopian HIV cohort, a high ART failure rate was identified, to the largest extent due to LTFU, including death. The geographical region where the patients were treated was a strong baseline predictor of ART failure. The difference in ART outcome across hospitals calls the need for provision of more national support at regional level.