Publications by authors named "Ebba Abate"

46 Publications

The first and second waves of the COVID-19 pandemic in Africa: a cross-sectional study.

Lancet 2021 04 24;397(10281):1265-1275. Epub 2021 Mar 24.

Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.

Background: Although the first wave of the COVID-19 pandemic progressed more slowly in Africa than the rest of the world, by December, 2020, the second wave appeared to be much more aggressive with many more cases. To date, the pandemic situation in all 55 African Union (AU) Member States has not been comprehensively reviewed. We aimed to evaluate reported COVID-19 epidemiology data to better understand the pandemic's progression in Africa.

Methods: We did a cross-sectional analysis between Feb 14 and Dec 31, 2020, using COVID-19 epidemiological, testing, and mitigation strategy data reported by AU Member States to assess trends and identify the response and mitigation efforts at the country, regional, and continent levels. We did descriptive analyses on the variables of interest including cumulative and weekly incidence rates, case fatality ratios (CFRs), tests per case ratios, growth rates, and public health and social measures in place.

Findings: As of Dec 31, 2020, African countries had reported 2 763 421 COVID-19 cases and 65 602 deaths, accounting for 3·4% of the 82 312 150 cases and 3·6% of the 1 798 994 deaths reported globally. Nine of the 55 countries accounted for more than 82·6% (2 283 613) of reported cases. 18 countries reported CFRs greater than the global CFR (2·2%). 17 countries reported test per case ratios less than the recommended ten to 30 tests per case ratio range. At the peak of the first wave in Africa in July, 2020, the mean daily number of new cases was 18 273. As of Dec 31, 2020, 40 (73%) countries had experienced or were experiencing their second wave of cases with the continent reporting a mean of 23 790 daily new cases for epidemiological week 53. 48 (96%) of 50 Member States had five or more stringent public health and social measures in place by April 15, 2020, but this number had decreased to 36 (72%) as of Dec 31, 2020, despite an increase in cases in the preceding month.

Interpretation: Our analysis showed that the African continent had a more severe second wave of the COVID-19 pandemic than the first, and highlights the importance of examining multiple epidemiological variables down to the regional and country levels over time. These country-specific and regional results informed the implementation of continent-wide initiatives and supported equitable distribution of supplies and technical assistance. Monitoring and analysis of these data over time are essential for continued situational awareness, especially as Member States attempt to balance controlling COVID-19 transmission with ensuring stable economies and livelihoods.

Funding: None.
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http://dx.doi.org/10.1016/S0140-6736(21)00632-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046510PMC
April 2021

Increasing smear positive tuberculosis detection using a clinical score - A stepped wedge multicenter trial from Africa.

Int J Infect Dis 2021 Mar 20. Epub 2021 Mar 20.

Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Denmark; GloHAU, Center for Global Health, School of Public Health, Aarhus University, Denmark.

Background: The Bandim TBscore is a clinical score that predicts treatment outcome in Tuberculosis (TB) patients and proved useful as an indicator of which healthcare-seeking adults to refer for sputum smear microcopy. We aimed to test in a randomized trial if the TBscore could be used to enhance the detection of smear positive (SP) TB.

Methods: We carried out a stepped wedge cluster-randomized trial at six health centers in Bissau, Guinea-Bissau, and Gondar, Ethiopia. The primary outcome was diagnostic yield for SP TB. Secondary outcomes were successful treatment and effect on overall 12 months mortality. The study was registered at the Pan African Clinical Trials Registry (PACTR201611001838365).

Results: We included 3571 adults. Overall, there was no effect of the intervention on SP PTB detected (OR 1.39 (95%CI 0.75 - 2.56). Analysis stratified by country, showed that the TBscore increased case detection in Gondar (OR 4.05 (95%CI 1.67 - 9.85)) but no effect was found in Bissau (OR 0.47 (95%CI 0.22 - 1.05)) where take-up was much lower. Overall mortality decreased during the intervention (HR 0.31 (95%CI 0.13-0.72)).

Conclusion: Using the TBscore for triage before smear microscopy may improve case detection and decrease mortality if there is sufficient laboratory capacity to increase sputum smears.
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http://dx.doi.org/10.1016/j.ijid.2021.03.041DOI Listing
March 2021

Knowledge, practice and associated factors towards the prevention of COVID-19 among high-risk groups: A cross-sectional study in Addis Ababa, Ethiopia.

PLoS One 2021 11;16(3):e0248420. Epub 2021 Mar 11.

Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

Background: Coronavirus disease (COVID-19) is a highly transmittable virus that continues to disrupt livelihoods, particularly those of low-income segments of society, around the world. In Ethiopia, more specifically in the capital city of Addis Ababa, a sudden increase in the number of confirmed positive cases in high-risk groups of the community has been observed over the last few weeks of the first case. Therefore, this study aims to assess knowledge, practice and associated factors that can contribute to the prevention of COVID-19 among high-risk groups in Addis Ababa.

Methods: A cross-sectional in person survey (n = 6007) was conducted from 14-30 April, 2020 following a prioritization within high-risk groups in Addis Ababa. The study area targeted bus stations, public transport drivers, air transport infrastructure, health facilities, public and private pharmacies, hotels, government-owned and private banks, telecom centers, trade centers, orphanages, elderly centers, prison, prisons and selected slum areas where the people live in a crowded areas. A questionnaire comprised of four sections (demographics, knowledge, practice and reported symptoms) was used for data collection. The outcomes (knowledge on the transmission and prevention of COVID-19 and practice) were measured using four items. A multi variable logistic regression was applied with adjustment for potential confounding.

Results: About half (48%, 95% CI: 46-49) of the study participants had poor knowledge on the transmission mode of COVID-19 whereas six out of ten (60%, 95% CI: 58-61) had good knowledge on prevention methods for COVID-19. The practice of preventive measures towards COVID-19 was found to be low (49%, 95% CI: 48-50). Factors that influence knowledge on COVID-19 transmission mechanisms were female gender, older age, occupation (health care and grocery worker), lower income and the use of the 8335 free call centre. Older age, occupation (being a health worker), middle income, experience of respiratory illness and religion were significantly associated with being knowledgeable about the prevention methods for COVID-19. The study found that occupation, religion, income, knowledge on the transmission and prevention of COVID-19 were associated with the practice of precautionary measures towards COVID-19.

Conclusion: The study highlighted that there was moderate knowledge about transmission modes and prevention mechanisms. Similarly, there was moderate practice of measures that contribute towards the prevention of COVID-19 among these priority and high-risk communities of Addis Ababa. There is an urgent need to fill the knowledge gap in terms of transmission mode and prevention methods of COVID-19 to improve prevention practices and control the spread of COVID-19. Use of female public figures and religious leaders could support the effort towards the increase in awareness.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248420PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951807PMC
March 2021

Distribution and determinants of serum high-sensitivity C-reactive protein in Ethiopian population.

Clin Chim Acta 2021 Jun 4;517:99-107. Epub 2021 Mar 4.

National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

Background: C-reactive protein (CRP) is an important inflammatory marker associated with different disease conditions, and its concentration differs among ethnicity. This study aimed to determine the distribution and determinants of serum high-sensitive method CRP (hsCRP) that can measure the typically low concentrations, among the Ethiopian population, for which there is no data.

Methods: A cross-sectional community-based study was conducted in April-June 2015. A total of 5162 individuals aged 15-69 were included. Behavioral, physical, and biochemical measurements were taken using the WHO STEPS non-communicable diseases (NCDs) risk factors assessment tool. Serum hsCRP was determined using Cobas Integra 400 Plus (Roche). Factors associated with hsCRP levels were also considered.

Results: median hsCRP was 0.80 mg/L (Interquartile range, 0.19-2.12) (males: 0.91 mg/L, females: 0.74 mg/L). More than 18% of the study participants had hsCRP greater than 3 mg/L according to the American Heart Association and Centers for Diseases Control and Preventions cut off value. Higher BMI, living in Somali and in Dire Dawa region, and not consuming of fruit or vegetables were independent risk factors for high hsCRP levels.

Conclusion: Serum hsCRP levels distribution is comparable to other studies. Until now, no data have been reported in the literature about the Ethiopian population.
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http://dx.doi.org/10.1016/j.cca.2021.02.013DOI Listing
June 2021

Helminth species specific expansion and increased TNF-alpha production of non-classical monocytes during active tuberculosis.

PLoS Negl Trop Dis 2021 Mar 2;15(3):e0009194. Epub 2021 Mar 2.

Department of Biomedical and Clinical Sciences, Linköping University, Sweden.

Both Mycobacterium tuberculosis infection and helminths may affect innate immune mechanisms such as differential effects on monocytes towards the non-classical and intermediate subsets that favor bacterial persistence. Our aim, was to investigate helminth species specific effects on the frequency and functional activity of monocyte subsets in patients with active tuberculosis and healthy subjects. HIV-negative patients with active pulmonary tuberculosis (PTB) and community controls (CCs) in Gondar, Ethiopia were screened for helminth infection by stool microscopy. Flow cytometric analysis of peripheral blood mononuclear cells (PBMCs) and ex vivo stimulation with purified protein derivative (PPD) and helminth antigens were used to characterize the distribution of monocyte subsets and their function. A total of 74 PTB patients and 57 CCs with and without helminth infection were included. Non-classical monocytes were increased in PTB patients with Ascaris and hookworm infection but not in Schistosoma-infected patients. Ascaris had the strongest effect in increasing the frequency of non-classical monocytes in both PTB patients and CCs, whereas PTB without helminth infection did not affect the frequency of monocyte subsets. There was a helminth specific increase in the frequency of TNF-α producing non-classical monocytes in hookworm infected PTB patients, both with and without PPD-stimulation. Low-to-intermediate TB disease severity associated with increased frequency of non-classical monocytes only for helminth-positive PTB patients, and the frequency of TNF-α producing monocytes were significantly higher in intermediate and non-classical monocytes of helminth positive PTB patients with an intermediate disease score. Helminth infection affected the frequency of monocyte subsets and function both in TB patients and controls which was helminth species dependent in TB patients. The clinical role of this potential immunomodulatory effect needs further study and may affect the response and protection to tuberculosis in areas where helminth infections are endemic.
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http://dx.doi.org/10.1371/journal.pntd.0009194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954301PMC
March 2021

Mentorship on malaria microscopy diagnostic service in Ethiopia: baseline competency of microscopists and performance of health facilities.

Malar J 2021 Feb 25;20(1):115. Epub 2021 Feb 25.

Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia.

Background: In Ethiopia, malaria cases are declining as a result of proven interventions, and in 2017 the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. This study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.

Methods: A cross-sectional study was conducted from 1 August to 30 September, 2019 in 9 regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked and proficiency of microscopists was tested using a WHO-certified set of slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, sensitivity, specificity, and positive and negative predictive values were calculated.

Results: In this study, 102 health facilities (84 health centres and 18 hospitals) were included, from which 202 laboratory professionals participated. In slide re-checking, moderate agreement (agreement (A): 76.0%; Kappa (K): 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1 and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7 and 89.1%, respectively. In identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts.

Conclusion: The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Implementing comprehensive malaria microscopy mentorship, in-service training and supportive supervision are key strategies to improve the overall performance of health facilities in malaria microscopy.
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http://dx.doi.org/10.1186/s12936-021-03655-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908686PMC
February 2021

Progress towards the 2020 fast track HIV/AIDS reduction targets across ages in Ethiopia as compared to neighboring countries using global burden of diseases 2017 data.

BMC Public Health 2021 Feb 4;21(1):285. Epub 2021 Feb 4.

Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.

Background: Sustainable Development Goal (SDG) 3.3, targets to eliminate HIV from being a public health threat by 2030. For better tracking of this target interim Fast Track milestones for 2020 and composite complementary measures have been indicated. This study measured the Fast Track progress in the epidemiology of HIV/AIDS in Ethiopia across ages compared to neighboring countries.

Methods: The National Data Management Center for health's research team at the Ethiopian Public Health Institute has analyzed the Global Burden of Disease (GBD) 2017 secondary data for the year 2010 to 2017 for Ethiopia and its neighbors. GBD 2017 data sources were census, demographic and a health survey, prevention of mother-to-child HIV transmission, antiretroviral treatment programs, sentinel surveillance, and UNAIDS reports. Age-standardized and age-specific HIV/AIDS incidence, prevalence, mortality, Disability-Adjusted Life Years (DALYs), incidence:mortality ratio and incidence:prevalence ratio were calculated with corresponding 95% confidence intervals.

Results: Ethiopia and neighboring countries recorded slow progress in reducing new HIV infection since 2010. Only Uganda would achieve the 75% target by 2020. Ethiopia, Tanzania, and Uganda already achieved the 75% mortality reduction target set for 2020. The incidence: prevalence ratio for Ethiopia, Rwanda, and Uganda were < 0.03, indicating the countries were on track to end HIV by 2030. Ethiopia had an incidence: mortality ratio < 1 due to high mortality; while Kenya, Rwanda, Tanzania and Uganda had a ratio of > 1 due to high incidence. The HIV incidence rate in Ethiopia was dropped by 76% among under 5 children in 2017 compared to 2010 and the country would likely to attain the 2020 national target, but far behind achieving the target among the 15-49 age group.

Conclusions: Ethiopia and neighboring countries have made remarkable progress towards achieving the 75% HIV/AIDS mortality reduction target by 2020, although they progressed poorly in reducing HIV incidence. By recording an incidence:prevalence ratio benchmark of less than 0.03, Ethiopia, Rwanda, and Uganda are well heading towards epidemic control. Nonetheless, the high HIV/AIDS mortality rate in Ethiopia for its incidence requires innovative strategies to reach out undiagnosed cases and to build institutional capacity for generating strong evidence to ensure sustainable epidemic control.
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http://dx.doi.org/10.1186/s12889-021-10269-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863245PMC
February 2021

Improving National Intelligence for Public Health Preparedness: a methodological approach to finding local multi-sector indicators for health security.

BMJ Glob Health 2021 01;6(1)

International Health Regulations Strengthening Project, Public Health England, London, UK.

The COVID-19 epidemic is the latest evidence of critical gaps in our collective ability to monitor country-level preparedness for health emergencies. The global frameworks that exist to strengthen core public health capacities lack coverage of several preparedness domains and do not provide mechanisms to interface with local intelligence. We designed and piloted a process, in collaboration with three National Public Health Institutes (NPHIs) in Ethiopia, Nigeria and Pakistan, to identify potential preparedness indicators that exist in a myriad of frameworks and tools in varying local institutions. Following a desk-based systematic search and expert consultations, indicators were extracted from existing national and subnational health security-relevant frameworks and prioritised in a multi-stakeholder two-round Delphi process. Eighty-six indicators in Ethiopia, 87 indicators in Nigeria and 51 indicators in Pakistan were assessed to be valid, relevant and feasible. From these, 14-16 indicators were prioritised in each of the three countries for consideration in monitoring and evaluation tools. Priority indicators consistently included private sector metrics, subnational capacities, availability and capacity for electronic surveillance, measures of timeliness for routine reporting, data quality scores and data related to internally displaced persons and returnees. NPHIs play an increasingly central role in health security and must have access to data needed to identify and respond rapidly to public health threats. Collecting and collating local sources of information may prove essential to addressing gaps; it is a necessary step towards improving preparedness and strengthening international health regulations compliance.
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http://dx.doi.org/10.1136/bmjgh-2020-004227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839902PMC
January 2021

Time to recovery and its predictors among adults hospitalized with COVID-19: A prospective cohort study in Ethiopia.

PLoS One 2020 30;15(12):e0244269. Epub 2020 Dec 30.

Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

Background: Various factors may determine the duration of viral shedding (the time from infection to viral RNA-negative conversion or recovery) in COVID-19 patients. Understanding the average duration of recovery and its predictors is crucial in formulating preventive measures and optimizing treatment options. Therefore, evidence showing the duration of recovery from COVID-19 in different contexts and settings is necessary for tailoring appropriate treatment and prevention measures. This study aimed to investigate the average duration and the predictors of recovery from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection among COVID-19 patients.

Method: A hospital-based prospective cohort study was conducted at Eka Kotebe General Hospital, COVID-19 Isolation and Treatment Center from March 18 to June 27, 2020. The Center was the first hospital designated to manage COVID-19 cases in Ethiopia. The study participants were all COVID-19 adult patients who were admitted to the center during the study period. Follow up was done for the participants from the first date of diagnosis to the date of recovery (negative Real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCT) test of throat swab).

Result: A total of 306 COVID-19 cases were followed up to observe the duration of viral clearance by rRT-PCR. Participants' mean age was 34 years (18-84 years) and 69% were male. The median duration of viral clearance from each participant's body was 19 days, but the range was wide: 2 to 71 days. Cough followed by headache was the leading sign of illness among the 67 symptomatic COVID-19 patients; and nearly half of those with comorbidities were known cancer and HIV/AIDS patients on clinical follow up. The median duration of recovery from COVID-19 was different for those with and without previous medical conditions or comorbidities. The rate of recovery from SARS-CoV-2 infection was 36% higher in males than in females (p = 0.043, CI: 1.01, 1.85). The rate of recovery was 93% higher in those with at least one comorbidity than in those without any comorbidity. The risk of delayed recovery was not influenced by blood type, BMI and presence of signs or symptoms. The findings showed that study participants without comorbidities recovered more quickly than those with at least one comorbidity. Therefore, isolation and treatment centers should be prepared to manage the delayed stay of patients having comorbidity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244269PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773180PMC
January 2021

Evidence of chikungunya virus infection among febrile patients in northwest Ethiopia.

Int J Infect Dis 2021 Mar 26;104:183-188. Epub 2020 Dec 26.

Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. Electronic address:

Background: Chikungunya virus (CHIKV) infection has similar clinical presentations to malaria. Hence, febrile illnesses are often misdiagnosed as malaria. Therefore, this study aimed to generate baseline data on CHIKV infection in northwest Ethiopia where malaria is endemic.

Methods: A hospital-based cross-sectional study was conducted among febrile patients presenting at the Metema and Humera Kahsay Abera hospitals from March 2016 to May 2017. Data on socio-demographic, clinical presentations, and possible risk factors were collected using a structured questionnaire. Serum samples were screened for immunoglobulin-M (IgM) and IgG antibodies to CHIKV infections using enzyme-linked immunosorbent assay. Logistic regression analysis was used to determine the strength of association.

Results: Of 586 samples screened, the overall seroprevalence of CHIKV infection was 23%. Of the total study participants, 22.5% had CHIKV-specific IgM, indicating recent CHIKV infection. During monsoon and post-monsoon periods, increased prevalence of anti-CHIKV IgM seropositivity was found. The most common clinical presentation observed was fever, followed by headache and joint pain. Men had twice the likelihood of CHIKV infection. The presence of stagnant water near the residence almost doubled the risk for CHIKV infection.

Conclusions: Most of the study participants had recent infection with CHIKV, suggesting the need to design disease prevention and intervention strategies.
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http://dx.doi.org/10.1016/j.ijid.2020.12.057DOI Listing
March 2021

The burden of injuries in Ethiopia from 1990-2017: evidence from the global burden of disease study.

Inj Epidemiol 2020 Dec 21;7(1):67. Epub 2020 Dec 21.

Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.

Background: Mortality caused by injuries is increasing and becoming a significant global public health concern. Limited evidence from Ethiopia on road traffic, unintentional and intentional injuries indicate the potential public health impact of problems resulting from such injuries. However, there is a significant evidence gap about the actual national burden of all injuries in Ethiopia. This data base study aimed to reveal the national burden of different injuries in Ethiopia.

Methodology: Data for this study were extracted from the estimates of the Global Burden of Diseases (GBD) 2017 study. Estimates of metrics such as Disability-Adjusted Life Years (DALYs), death rates, incidence, and prevalence were extracted. The metrics were then examined at different injury types, socio-demographic categories such as age groups and sex. Trends of the metrics were also explored for these categories across years from 2007 to 2017. The DALYs and deaths due to injuries in Ethiopia were also compared with other East African countries (specifically Kenya, Tanzania, Uganda, and Zambia) in order to evaluate regional differences across years, by sex and by different injury types such as transport injuries, unintentional injuries, self-harm and interpersonal violence.

Results: The age-standardized injury death rate has decreased to 69.4; 95% UI: (63.0-76.9) from 90.11; 95% UI: (82.41-97.73) in 2017 as compared with 2007. Road injury, falls, self-harm and interpersonal violence were the leading causes of mortality from injuries occurring in 2017. The age-standardized injury DALYs rate has decreased to 3328.2; 95% UI: (2981.7-3707.8) from 4265.55; 95% UI: (3898.11-4673.64) in 2017 as compared with 2007. The number of deaths resulting from injuries in 2017 was highest for males, children under 5 years, people aged 15-24.

Conclusion: The current age-standardized death rate and DALYs from injuries is high and the observed annual reduction is not satisfactory. There is a difference in gender and age regarding the number of deaths resulting from injuries. The data indicates that the current national efforts to address the public health impact of injuries in Ethiopia are not sufficient enough to bring a marked reduction. As a result, a more holistic approach to address all injuries is recommended in Ethiopia.
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http://dx.doi.org/10.1186/s40621-020-00292-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751094PMC
December 2020

Prevalence and genetic variability of occult hepatitis B virus in a human immunodeficiency virus positive patient cohort in Gondar, Ethiopia.

PLoS One 2020 19;15(11):e0242577. Epub 2020 Nov 19.

Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Occult hepatitis B (OHB) is a major concern in HIV infected patients as it associates with a high risk of HBV reactivation and disease progression. However, data on the prevalence of OHB among HIV positive patients in Ethiopia is lacking. This study aims to determine the prevalence of OHB in HBV/HIV co-infected patients from Gondar, Ethiopia.

Methods: A total of 308 consented HIV positive patients were recruited from the University of Gondar Teaching Hospital, Ethiopia. Clinical and demographic data of the participants were recorded. Plasma was tested for HBsAg and anti-HBc using commercial assays (Abbott Architect). In HBsAg negative anti-HBc positive patient samples, total DNA was isolated and amplified using nested PCR with primers specific to HBV polymerase, surface and pre-core/core regions, followed by Sanger sequencing and HBV mutational analysis using MEGA 7.0.

Results: Of the total study subjects, 62.7% were female, median age 38.4 years, interquartile range (IQR): 18-68, and 208 (67.5%) had lifestyle risk factors for HBV acquisition. Two hundred and ninety-one study subjects were HIV+/HBsAg-, out of which 115 (39.5%) were positive for anti-HBc. Occult hepatitis B was detected in 19.1% (22/115) of anti-HBc positive HIV patients. HBV genotype D was the predominant genotype (81%) among OHB positive patients. Mutations associated with HBV drug resistance, HBV reactivation, and HCC risk were detected in 23% (5/22), 14% (3/22) and 45.5% (10/22) of patients, respectively.

Conclusion: This study found a high rate of occult hepatitis B in HIV patients. Further, high rates of mutations associated with HBV reactivation, drug resistance, and HCC risk were detected in these patients. These data highlighted the need for integrating OHB screening for proper management of liver diseases in HIV patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242577PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704059PMC
January 2021

Establishment of COVID-19 testing laboratory in resource-limited settings: challenges and prospects reported from Ethiopia.

Glob Health Action 2020 12;13(1):1841963

Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia.

The Coronavirus pandemic is recording unprecedented deaths worldwide. The temporal distribution and burden of the disease varies from setting to setting based on economic status, demography and geographic location. A rapid increase in the number of COVID-19 cases is being reported in Africa as of June 2020. Ethiopia reported the first COVID-19 case on 13 March 2020. Limited molecular laboratory capacity in resource constrained settings is a challenge in the diagnosis of the ever-increasing cases and the overall management of the disease. In this article, the Ethiopian Public Health Institute (EPHI) shares the experience, challenges and prospects in the rapid establishment of one of its COVID-19 testing laboratories from available resources. The first steps in establishing the COVID-19 molecular testing laboratory were i) identifying a suitable space ii) renovating it and iii) mobilizing materials including consumables, mainly from the Malaria and Neglected Tropical Diseases (NTDs) research team at the EPHI. A chain of experimental design was set up with distinct laboratories to standardize the extraction of samples, preparation of the master mix and detection. At the commencement of sample reception and testing, laboratory contamination was among the primary challenges faced. The source of the contamination was identified in the master mix room and resolved. In summary, the established COVID-19 testing lab has tested more than 40,000 samples (August 2020) and is the preferred setting for research and training. The lessons learned may benefit the further establishment of emergency testing laboratories for COVID-19 and/or other epidemic/pandemic diseases in resource-limited settings.
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http://dx.doi.org/10.1080/16549716.2020.1841963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671712PMC
December 2020

Sero-prevalence of transfusion transmittable infections: HIV, Hepatitis B, C and Treponema pallidum and associated factors among blood donors in Ethiopia: A retrospective study.

PLoS One 2020 29;15(10):e0241086. Epub 2020 Oct 29.

Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

Background: Blood transfusion is a therapeutic procedure that has proven to be effective in saving millions of lives. However, its safety is still a crucial issue that needs due attention. Unsafe blood transfusion is one of the sources of transmission for infectious agents. Therefore, the objective of this study was to assess the sero-prevalence of Transfusion Transmittable Infections (TTIs) such as Human immunodeficiency virus (HIV), Hepatitis B Virus (HBV), Hepatitis C virus (HCV), Treponema pallidum, and associated factors among blood donors in Ethiopia.

Methods: A retrospective cross-sectional study design was used to measure the prevalence of transfusion transmittable infections using data collected from 2014 to 2019 in fourteen blood bank facilities in Ethiopia. Screening of HIV, HBV and HCV was done by using the Enzyme-Linked Immunosorbent Assay (ELISA). Presence of Treponema pallidum infection was assessed using rapid plasma reagin (RPR). Records of blood donors were collected using a checklist from Central Blood Bank Laboratory (BBL) electronic database and reviewed. Data was entered, cleaned and analyzed using SPSS version 23. Logistic regression was fitted to identify factors associated with cumulative TTIs positivity, and for each of the transfusion transmittable infection. P value < 0.05 was considered statistically significant.

Result: A total of 554,954 blood donors in the fourteen blood bank facilities from 2014-2019 was included in the study. The overall sero-prevalence of HBV, Treponema pallidum, HIV and HCV, was 2.4%, 0.9%, 0.4% and 0.4% respectively. The prevalence of TTIs was comparatively higher in 2014, 5.70% and lowest in 2019, 3.40%. The odds of screening HBV in blood donors in age group of 35-39 and 40-44 were 1.2 [1.1, 1.3] and 1.3 [1.1, 1.5] respectively. The odds of screening HCV in blood donors in the age group of 25-34, 35-44 and 45-54 were 1.3 [1.1, 1.5], 1.3 [1.1, 1.7] and 1.7 [1.2, 2.2] respectively. The likelihood of having at least one infection among blood donors was 1.2 [1.1, 1.3] times in male blood donors compared to female. The odds of getting at least one TTI and Treponema pallidum in unemployed blood donors were 2.4 [2.0, 2.8] and 8.1 [6.1, 10.7] respectively. The probability of getting those who have at least one TTIs, HBV and Treponema pallidum were higher in blood donors those who live in Semi Urban and Rural parts of the country than those who live in Urban areas. The odds of having at least one TTI, HBV and HCV in blood donors with mobile mode of blood donation were 1.4 [1.3, 1.6], 1.6 [1.4, 1.8], and 1.6 [1.1, 2.2].

Conclusion: The current magnitudes of TTIs are lower when compared to other previous studies conducted in Ethiopia. Older age, male, occupation, donations from mobile sites, residents of semi urban and rural settings were found to be strongly associated with sero-positivity of TTIs. Hence, strict donor screening and testing particularly taking the above factors into consideration is strongly recommended.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241086PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595291PMC
December 2020

The burden of cardiovascular diseases in Ethiopia from 1990 to 2017: evidence from the Global Burden of Disease Study.

Int Health 2020 Sep 18. Epub 2020 Sep 18.

Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

In Ethiopia, evidence on the national burden of cardiovascular diseases (CVDs) is limited. To address this gap, this systematic analysis estimated the burden of CVDs in Ethiopia using the Global Burden of Disease (GBD) 2017 study data. The age-standardized CVD prevalence, disability-adjusted life years (DALYs) and mortality rates in Ethiopia were 5534 (95% uncertainty interval [UI] 5310.09 - 5774.0), 3549.6 (95% UI 3229.0 - 3911.9) and 182.63 (95% UI 165.49 - 203.9) per 100 000 population, respectively. Compared with 1990, the age-standardized CVD prevalence rate in 2017 showed no change. But significant reductions were observed in CVD mortality (54.7%), CVD DALYs (57.7%) and all-cause mortality (53.4%). The top three prevalent CVDs were ischaemic heart disease, rheumatic heart disease and stroke in descending order. The reduction in the mortality rate due to CVDs is slower than for communicable, maternal, neonatal and nutritional disease mortalities. As a result, CVDs are the leading cause of mortality in Ethiopia. These findings urge Ethiopia to consider CVDs as a priority public health problem.
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http://dx.doi.org/10.1093/inthealth/ihaa069DOI Listing
September 2020

Neglected Tropical Diseases: responding to calls for action from the front lines in Ethiopia.

J Infect Dev Ctries 2020 06 29;14(6.1):1S-2S. Epub 2020 Jun 29.

UNICEF, UNDP, WORLD BANK, WHO, Special Programme for Research and Training in Tropical Disease (TDR), World Health Organisation, Geneva, Switzerland.

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http://dx.doi.org/10.3855/jidc.12790DOI Listing
June 2020

Prevalence of Hyperhomocysteinaemia and Associated Factors among Ethiopian Adult Population in a 2015 National Survey.

Biomed Res Int 2020 11;2020:9210261. Epub 2020 Jan 11.

Center for Food Science and Nutrition, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Hyperhomocysteinaemia (HHcy) is an independent risk factor for major cardiovascular diseases, but data on the prevalence and predictors of HHcy in low- and middle-income countries like Ethiopia are scant. The aim of this study was to estimate the prevalence of HHcy and associated risk factors in the Ethiopian adult population. A cross-sectional survey on risks of noncommunicable diseases (NCDs) using the STEPwise approach to surveillance (STEPS) survey was conducted between April and June 2015. A total of 4,175 study participants were surveyed. Serum homocysteine (Hcy) and metabolic profile were determined using Cobas Integra 400 Plus and CardioChek PA analyzer, respectively. Factors associated with HHcy were determined using logistic regression. The mean serum tHcy concentration was 14.6 mol/L, with 16.4 mol/L in males and 13.4 mol/L in females. Overall, 38% had HHcy, with figures in males (49%) higher than females (30%). Increased age, being male, and high blood pressure and/or taking blood pressure medication, as well as low consumption of fruit and/or vegetables, were independent risk factors for HHcy. In conclusion, the prevalence of HHcy among the adult Ethiopian population is alarmingly high. Improving diets through the promotion of fruit and vegetable consumption is needed to reduce the risk of NCDs.
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http://dx.doi.org/10.1155/2020/9210261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201487PMC
February 2021

Physicians' satisfaction with clinical laboratory services at public hospitals in Ethiopia: A national survey.

PLoS One 2020 30;15(4):e0232178. Epub 2020 Apr 30.

Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

Introduction: Physician is a central figure in the client list of clinical laboratory. Monitoring physicians' satisfaction with laboratory service is an important indicator of the quality management system and required by international laboratory standards. However, there is no national data on physician satisfaction with laboratory services in Ethiopia. Therefore, the aim of this national survey was to assess satisfaction level of physicians with laboratory services at public hospitals in Ethiopia.

Methods: Institutional based cross-sectional study design was employed from November 1-30/2017. A total of 327 physicians were randomly selected from 60 public hospitals from all regions of Ethiopia. Data was collected using pre-tested self-administered questionnaire and analyzed with SPSS version 23 software. Logistic regression model was fitted to identify predictors of physician satisfaction with laboratory services. A p-value of less than 0.05 was taken as statistically significant.

Results: Overall, 55% of physicians were satisfied with the clinical laboratory services. More than half of the physicians were satisfied with the existing laboratory request form (69%), legibility and completeness of laboratory report (61%), notification of new test (78%) and test interruption (70%). On the other hand, many physicians were dissatisfied with the absence of laboratory hand book (87.5%), the existing test menu (68%), lab-physician interface (62%), availability of referral and/or back up service (62%), notification of Turn Around Time (TAT) (54%), timely notification of panic result (55%), long TAT (33.1%), provision of urgent service (67%), and timely advisory service (57%). Most of the physicians perceived that consistent quality of service was not delivered at all working shifts (71%). At 5% level of significance, we did not find enough evidence to conclude that sex, age, marital status, education level, and experience were statistically associated with physician satisfaction (p-values > 0.05).

Conclusion: This national survey revealed nearly half of the physicians were unsatisfied with laboratory service at public hospitals in Ethiopia, which mainly related to lack of adequate test menu, laboratory hand book, on time notification of panic result, provision of urgent service, timely advisory service, delivery of quality services in all working shifts and weak lab-physician interface. Therefore, hospital management should address the gaps and improve the needs of physicians for better patient health care. In addition, laboratories should evaluate and monitor physician satisfaction level at regular interval.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232178PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192407PMC
July 2020

Patients' satisfaction with clinical Laboratory Services in Public Hospitals in Ethiopia.

BMC Health Serv Res 2020 Jan 3;20(1):13. Epub 2020 Jan 3.

Ethiopian Public Health Institute, P.O.BOX: 1242/5654, Addis Ababa, Ethiopia.

Background: Knowing customers' level of satisfaction is relevant to improve and provide quality health care services. In the clinical laboratory, monitoring customers' satisfaction is an important indicator of the quality management system and required by international laboratory standards. However, in Ethiopia, there has not been baseline data about the satisfaction level of patients' with laboratory services at the national level. The aim of this national level survey was to assess patients' satisfaction level with laboratory services at public hospitals in Ethiopia.

Methods: A national survey was conducted using an institutional based cross-sectional study design was employed from 01 to 30 November 2017. A total of 2399 patients were selected randomly from 60 public hospitals. Data was collected using structured questionnaire, entered in Epi Info and analyzed with SPSS software. Multiple logistic regression model was fitted to identify predictors of patients' satisfaction with laboratory services. A p-value of less than 0.05 was taken as statistically significant.

Result: Overall, 78.6% of the patients were satisfied with the clinical laboratory services. Patients were dissatisfied with cleanness of latrine (47%), long waiting time (30%), clear and understandable advisory service during specimen collection (26%), adequacy of waiting area (25%), easy accessibility of laboratory (19%) and latrine location (20%), availability of requested service (18%), unfair payment of service (17%) and missing of result (12%). The educational status (P = 0.032), and distance (P = 0.000) were significantly associated with client overall satisfaction level.

Conclusion: Most laboratory patients' were satisfied with the service provided by public hospital laboratories in public hospitals in Ethiopia. However, patients' were dissatisfied with the accessibility of sites, adequacy of waiting area, cleanness of latrine, long TAT, communication, missing of results, availability of requested service and cost of service. Therefore, responsible bodies in each level should act on the identified gaps and improve the need of patients in each hospital laboratory. In addition, all hospital laboratories should conduct a satisfaction survey and meet the needs of laboratory patients.
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http://dx.doi.org/10.1186/s12913-019-4880-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942306PMC
January 2020

The Geshiyaro Project: a study protocol for developing a scalable model of interventions for moving towards the interruption of the transmission of soil-transmitted helminths and schistosome infections in the Wolaita zone of Ethiopia.

Parasit Vectors 2019 Oct 29;12(1):503. Epub 2019 Oct 29.

London Centre for Neglected Tropical Disease Research, Department of Infectious Diseases Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK.

Background: National deworming programmes rely almost exclusively on mass drug administration (MDA) to children to control morbidity caused by these parasitic infections. The provision of other interventions, consisting of preventive chemotherapy at high population level coverage together with water, sanitation and hygiene (WaSH) and changes in risk behaviour, should enable sustainable control of soil-transmitted helminths (STH) and schistosomiasis and ultimately interrupt transmission.

Methods/design: Two interventions will be implemented by the project: (i) community-wide biannual albendazole and annual praziquantel treatment with a target of 80-90% treatment coverage ("expanded MDA"); and (ii) provision of WaSH with behaviour change communication (BCC), within the Wolaita zone, Ethiopia. The project has three study arms: (i) expanded community-wide MDA, WaSH and BCC; (ii) expanded community-wide MDA only; and (iii) annual school-based MDA (the current National STH/schistosomiasis Control Programme). The impact of these interventions will be evaluated through prevalence mapping at baseline and endline (after four rounds of MDA), combined with annual longitudinal parasitological surveillance in defined cohorts of people to monitor trends in prevalence and reinfection throughout the project. Treatment coverage and individual compliance to treatment will be monitored by employing fingerprint biometric technology and barcoded identification cards at treatment. WaSH utilisation will be evaluated through school and household level observations and annual WaSH assessment survey. Complementary qualitative surveys will explore practices, cultural and social drivers of risk behaviours, uptake of WaSH and treatment, and assessing the impact of the BCC.

Discussion: The study has the potential to define an 'End Game' for STH and schistosomiasis programmes through provision of multiple interventions. Interrupting transmission of these infections would eliminate the need for long-term repeated MDA, lead to sustained health improvements in children and adults, thereby allowing health systems to focus on other disease control priorities.
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http://dx.doi.org/10.1186/s13071-019-3757-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820996PMC
October 2019

Latent tuberculosis infection and associated risk factors among people living with HIV and apparently healthy blood donors at the University of Gondar referral hospital, Northwest Ethiopia.

BMC Res Notes 2019 Aug 16;12(1):515. Epub 2019 Aug 16.

Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences (CMHS), The University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia.

Objective: Immuno-compromised individuals with latent tuberculosis infection (LTBI) are at an increased risk for tuberculosis reactivation compared with the general population. The aim of this study was to determine the prevalence of latent tuberculosis infection among people living with human immunodeficiency virus (PLWH) and apparently healthy blood donors. Human Immunodeficiency Virus positive individuals and for the purpose of comparison apparently healthy blood donors were enrolled. Blood sample was collected and tested for LTBI using QuantiFeron-TB Gold In-Tube assay (QFT-GIT) and CD4+ T cell count was determined by using BD FACS count.

Results: The overall prevalence of LTBI regardless of HIV status was 46%. The prevalence of LTBI among PLWH was 44% and that of blood donors 48%. ART naïve HIV positive patients were three times more likely to have LTBI than patients under ART treatment (P = 0.04). Data also showed statistically significant negative association between previous or current preventive INH therapy and LTBI among HIV positive cases (P = 0.005). The proportion of LTBI was slightly lower among HIV positive individuals than apparently healthy blood donors. Nevertheless, HIV positive individuals should be screened for LTBI and take INH prophylaxis.
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http://dx.doi.org/10.1186/s13104-019-4548-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698024PMC
August 2019

The role of water, sanitation and hygiene interventions in reducing soil-transmitted helminths: interpreting the evidence and identifying next steps.

Parasit Vectors 2019 May 28;12(1):273. Epub 2019 May 28.

Global Health, Bill & Melinda Gates Foundation, Seattle, USA.

The transmission soil transmitted helminths (STH) occurs via ingestion of or contact with infective stages present in soil contaminated with human faeces. It follows therefore that efforts to reduce faecal contamination of the environment should help to reduce risk of parasite exposure and improvements in water, sanitation and hygiene (WASH) are seen as essential for the long-term, sustainable control of STH. However, the link between WASH and STH is not always supported by the available evidence from randomised controlled trials, which report mixed effects of WASH intervention on infection risk. This review critically summarises the available trial evidence and offers an interpretation of the observed heterogeneity in findings. The review also discusses the implications of findings for control programmes and highlights three main issues which merit further consideration: intervention design, exposure assessment, and intervention fidelity assessment.
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http://dx.doi.org/10.1186/s13071-019-3532-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540378PMC
May 2019

Polymorphisms in CARD8 and NLRP3 are associated with extrapulmonary TB and poor clinical outcome in active TB in Ethiopia.

Sci Rep 2019 02 28;9(1):3126. Epub 2019 Feb 28.

Division of Microbiology Infection and Inflammation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.

Innate immunity is a first line defense against Mycobacterium tuberculosis infection where inflammasome activation and secretion of the pro-inflammatory cytokine IL-1beta, plays a major role. Thus, genetic polymorphisms in innate immunity-related genes such as CARD8 and NLRP3 may contribute to the understanding of why most exposed individuals do not develop infection. Our aim was to investigate the association between polymorphisms in CARD8 and NLRP3 and active tuberculosis (TB) as well as their relationship to treatment outcome in a high-endemic setting for TB. Polymorphisms in CARD8 (C10X) and NLRP3 (Q705K) were analysed in 1190 TB patients and 1990 healthy donors (HD). There was a significant association between homozygotes in the CARD8 polymorphism and extrapulmonary TB (EPTB), which was not the case for pulmonary TB or HDs. Among TB-patients, there was an association between poor treatment outcome and the NLRP3 (Q705K) polymorphism. Our study shows that inflammasome polymorphisms are associated with EPTB and poor clinical outcome in active TB in Ethiopia. The practical implications and determining causal relationships on a mechanistic level needs further study.
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http://dx.doi.org/10.1038/s41598-019-40121-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395648PMC
February 2019

Evaluation of diagnostic performance of non-invasive HIV self-testing kit using oral fluid in Addis Ababa, Ethiopia: A facility-based cross-sectional study.

PLoS One 2019 25;14(1):e0210866. Epub 2019 Jan 25.

Ethiopian Public health institute, Addis Ababa, Ethiopia.

Background: Human immunodeficiency virus (HIV) testing is critical for early linkage to treatment and care services. However, there is a substantial gap in HIV testing, particularly in resource limited settings due to low accessibility of HIV testing sites, inconvenient testing hours, and concerns about loss of confidentiality. Thus, adopting new strategies such as HIV self-testing (HIVST) could overcome these barriers and increases HIV testing uptake.

Objective: The aim of this study was to evaluate the diagnostic performance of non-invasive HIVST kit using oral fluid for HIV diagnosis. This study also aimed to assess the ability of clients in interpretation of OraQuick HIVST results.

Method: Between December 2017 and February 2018, a total of 400 study participants were enrolled into the study to assess a diagnostic accuracy of Oral fluid-based HIVST kit (OraQuick) in 15 public health facilities in Addis Ababa, Ethiopia. Participants were provided with instructions and visual aids on how to perform HIVST and interpret results. They also underwent a blood-based rapid HIV antibody test as per the current national algorithm. The results of HIVST were interpreted independently by the participants and respective health care workers (HCWs). The sensitivity, specificity, positive predictive value (PPV), Negative predictive value (NPV) and inter-rater agreement of the test were computed.

Results: Out of 200 participants who tested positive on the national algorithm testing, oral fluid-based self-testing was positive in 199 (99.5%), false negative in 1 (0.5%). Of 200 participants who tested negative on the national algorithm testing, self-testing was negative in 200 (100%). There were no false positive and invalid tests. The sensitivity and specificity of the OraQuick HIVST were 99.5% (95%CI: 97.26-99.99) and 100% (95%CI: 98.18-100.0), respectively. The overall agreement between the two tests was high (κ value = 0.995). The PPV and NPV of OraQuick test were 100% and 99.5% (95%CI: 96.59-99.93) respectively.

Conclusion: This study showed a high diagnostic performance of OraQuick HIV self-test and suggests that OraQuick HIVST kit has a potential to be used for HIV testing in Ethiopia along with the national algorithm.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210866PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347142PMC
November 2019

A study of clinical, hematological, and biochemical profiles of patients with dengue viral infections in Northwest Ethiopia: implications for patient management.

BMC Infect Dis 2018 Dec 4;18(1):616. Epub 2018 Dec 4.

Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Dengue is one of the most common arboviral diseases with increased outbreaks annually in tropical and subtropical areas. In Ethiopia, there are no data regarding clinical, hematological and biochemical parameters which are very important in the clinical management of dengue patients. Hence this study was carried out to provide the first baseline data of clinical, hematological and biochemical profiles of patients infected with dengue virus.

Methods: A cross-sectional study was carried out among febrile patients in northwest Ethiopia from March 2016 to May 2017. Blood samples were collected from dengue presumed cases and tested against dengue specific IgM antibody by enzyme-linked immunosorbent assay (ELISA). Those study participants who fulfilled the inclusion criteria were enrolled in the study. Clinical examination findings were recorded, hematological and biochemical parameters tests were done.

Results: During the study period, a total of 102 dengue cases were included in the study. Of these, there were 16 (15.7%) children and 86 (84.3%) adults between 1 and 76 year age. The most common clinical presentations followed by fever (100%) were a headache 89 (87.3%), myalgia 82 (80.4%), nausea/vomiting 71 (69.6%). The common hematological findings were thrombocytopenia 61 (59.8%), followed by anemia 45 (44.1%) and leucopenia 27 (26.5%) and the elevated levels of biochemical parameters were AST 46 (45.1%) and ALT in 18 (17.6%).

Conclusions: This study highlights the most common clinical and laboratory profiles of dengue viral infections that could alert physicians to the likelihood of dengue virus infections in the study area.
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http://dx.doi.org/10.1186/s12879-018-3557-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278031PMC
December 2018

A serologic study of dengue in northwest Ethiopia: Suggesting preventive and control measures.

PLoS Negl Trop Dis 2018 05 31;12(5):e0006430. Epub 2018 May 31.

Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Dengue is one of the most serious and rapidly spreading arboviral diseases in the world. Despite many acute febrile illnesses in Ethiopia, the burden of illness due to dengue in the country is largely unknown. Thus, the present study aimed to provide the first baseline data on seroprevalence and associated risk factors of dengue virus (DENV) infection in the country.

Methods: A cross-sectional study of febrile patients who were visiting Metema and Humera hospitals in Northwest Ethiopia from March 2016 to May 2017 was conducted. Blood samples were collected from each participant and serum samples were separated and tested for IgM and IgG antibodies against DENV infection by enzyme-linked immunosorbent assay (ELISA). Risk factors associated with the prevalence of anti-DENV antibodies were tested using logistic regression analysis.

Results: Of the 600 samples tested, the overall seroprevalence against DENV infection was 33.3%, while the seroprevalence by the study area was 40% in Metema and 27.5% in Humera. The overall prevalence of IgM and IgG antibodies against DENV infection was 19% and 21% respectively. Of these, 6.7% were positive for both IgM and IgG antibodies. Residence and occupational status were significantly associated with the prevalence of anti-DENV IgM seropositivity and anti-DENV IgM-/G+serostatus. The seasonal variation was significantly associated with the prevalence of anti-DENV IgM but not with anti-DENV IgM-/G+serostatus. The prevalence of anti-DENV IgM-/G+serostatus was significantly higher in Metema than Humera. High prevalence of anti-DENV IgM seropositivity was found in the summer and spring, with a peak in the month of August. The presence of uncovered water either indoor or outdoor and lack of mosquito net use was identified as risk factors for DENV infection.

Conclusions: These findings provide the preliminary data on seroprevalence and associated risk factors of DENV infection in the country. The presence of antibodies against DENV infection indicates dengue as one of the causes of undifferentiated febrile illnesses in the study areas. This suggests that prevention and control measures should be designed considering the risk factors identified by this study. Furthermore, we recommend a large-scale study to include DENV infection in the differential diagnosis of all febrile illnesses in Ethiopia.
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http://dx.doi.org/10.1371/journal.pntd.0006430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978788PMC
May 2018

Distribution and larval breeding habitats of mosquito species in residential areas of northwest Ethiopia.

Epidemiol Health 2018 23;40:e2018015. Epub 2018 Apr 23.

Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Objectives: The mosquito is a vector for transmitting many arboviruses. Knowledge of the breeding habitat of this vector is vital for implementing appropriate interventions. Thus, this study was conducted to determine the breeding habitats and presence of mosquito species in the study areas.

Methods: A house-to-house cross-sectional survey of mosquito breeding habitats was carried out in Metema and Humera, Ethiopia, in August 2017. All available water-holding containers present in and around houses were inspected for the presence of immature stages of mosquitoes, and they were collected and reared to the adult stage for species identification. In the larval survey, the house index, container index, and Breteau index were computed as risk indices.

Results: Of the 384 houses surveyed for the presence of mosquito larval breeding, 98 were found to be positive for larvae. During the survey, a total of 566 containers were inspected, of which 186 were found to be infested with mosquito larvae, with a container index of 32.9, a house index of 25.5, and a Breteau index of 48.4. The most common mosquito breeding habitats were discarded tires (57.5%), followed by mud pots (30.0%). Of the 1,077 larvae and pupae collected and reared, (49.3%), (6.5%), and species (44.2%) were identified.

Conclusions: Discarded tires were the most preferred breeding habitats for mosquitoes. Moreover, , the main vector of dengue and other arboviruses, was identified for the first time in this region, suggesting a high potential for arbovirus transmission in the study areas.
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http://dx.doi.org/10.4178/epih.e2018015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968207PMC
May 2018

Bacterial Profile, Antibacterial Resistance Pattern, and Associated Factors from Women Attending Postnatal Health Service at University of Gondar Teaching Hospital, Northwest Ethiopia.

Int J Microbiol 2018 25;2018:3165391. Epub 2018 Feb 25.

Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

Introduction: Surgical site infection is a vital cause of maternal mortality and morbidity, especially in resource-limited countries. The rise of antibiotic resistance bacterial infection poses a big threat to this vulnerable population. However, there is lack of studies around the study area.

Objective: The purpose of this study was to identify bacterial profile, antibacterial resistance pattern, and associated factors among mothers attending postnatal care health service.

Methods: Institutional based cross-sectional study was conducted on 107 study participants at University of Gondar Teaching Hospital from 1 January 2016 to 30 May 2016. Wound swab, aspirate, and biopsy were collected and performed for culture and drug resistance testing. Data were entered and analyzed by using SPSS version 20. Bivariate and multivariate logistic regression models were fitted to determine the associated factors for bacterial infection. Odds ratio (95% CI) was calculated to determine the strength of statistically significant associated factors.

Result: Bacterial growth was confirmed in 90 (84.1%) of 107 study participants suspected to have surgical site infection. The predominant bacterial isolates were (41.6%), (19.8%), (13.9%), (12.9%), and spp. (4%). The majority of isolates were resistant to ampicillin, amoxicillin, and tetracycline but susceptible to ceftriaxone and amikacin. Multidrug-resistant bacteria species were isolated. Using a procedure such as cesarean section and episiotomy for delivery and premature rapture of membrane had strong association with bacterial infection.

Conclusion: The high prevalence of bacterial profile and isolation of multidrug-resistant bacteria pose a big threat to postnatal mothers and their children. Factors such as cesarean section, episiotomy for delivery, and premature rapture of membrane were predictors for bacterial infection. Therefore, there should be done a continuous surveillance as well as rational use of antibiotics and a longitudinal study using phenotypic and genotypic methods will be done.
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http://dx.doi.org/10.1155/2018/3165391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845495PMC
February 2018

The burden of hepatitis B virus (HBV) infection, genotypes and drug resistance mutations in human immunodeficiency virus-positive patients in Northwest Ethiopia.

PLoS One 2017 27;12(12):e0190149. Epub 2017 Dec 27.

Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

Background: In sub-Saharan Africa, the hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections are endemic. Although there has been great progress in HIV care, universal HBV vaccination and care is lacking. In this study, we aimed to determine the prevalence of HBV, HBV genotypes, and drug resistance mutations in dual infected cases in a cohort of HIV patients in Northwest Ethiopia.

Methods: A total of 308 HIV-1 positive patients were enrolled into the study and tested for HBsAg in plasma. In HBsAg positive samples, HBV DNA was analyzed for HBV genotype using in-house nested PCR with HBV-specific pre-core / core or surface primers, and for HBV drug resistance mutations (DRMs) in polymerase region. Odds ratio at 95% confidence interval was calculated.

Results: Of the 308 HIV-positive subjects, 62.7% were female, median age 38 years (range 18-68, IQR: 27-49), and the median CD4 count 405 cells/μl (IQR: 75-734). Overall, 94.2% were on antiretroviral therapy (ART) frequently with combinations of Zidovudine (AZT)- Lamivudine (3TC)-Nevirapine (NVP). HBsAg was detected in 5.5% (95%CI 2.95-8.08%) of the study participants, of which the majority were infected with HBV genotype A (7A, 2E, 2D, 1C, 1 G). All HIV/HBV positive cases were on ART with anti-HBV activity (i.e., 3TC) and 3TC associated HBV DRMs (i.e., rtV173L, rtL180M, and rtM204V) were detected in 7/13 (53.8%) subjects.

Conclusion: In this cross-sectional study of HIV-infected individuals, we found 5.5% HBV/HIV co-infected cases. Most were receiving the first generation anti-HBV therapy with a low genetic barrier to resistance, and several carried mutations associated with anti-HBV (3TC) drug resistance. These data underscore the importance of integrating HBV screening to the HIV treatment guidelines for better management and prevention of HBV-related liver disease.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190149PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5744989PMC
February 2018

Vitamin D deficiency among newly diagnosed tuberculosis patients and their household contacts: a comparative cross-sectional study.

Arch Public Health 2017 19;75:25. Epub 2017 Jun 19.

Department of Immunology & Molecular Biology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.

Background: Recent studies suggest that the incidence and severity of tuberculosis is associated with low levels of vitamin D. Even though individuals living in Ethiopia have a high exposure to sunlight which is a source of vitamin D, tuberculosis is still one of the major causes of morbidity and mortality in the country. Therefore, this study aimed to determine the prevalence and associated factors of vitamin D deficiency in newly diagnosed tuberculosis patients, household contacts and community controls in Gondar, Ethiopia.

Methods: A comparative cross-sectional study design was conducted. Blood samples were collected from newly diagnosed smear positive pulmonary TB patients, their household contacts and community controls. Serum 25(OH)-vitamin D was determined by an Enzyme Linked Immunosorbent Assay. A serum level of 25(OH)-vitamin D below < 50 nmol/L was defined as vitamin D deficiency and <25 nmol/L as severe vitamin D deficiency.

Results: A total of 126 newly diagnosed smear positive TB patients, 57 house hold contacts and 70 apparently community controls were included in the study. The mean ± SD age (years) of TB patients, house hold contacts and community controls was 29.8 ± 11.9, 24.3 ± 14.7 and 27.3 ± 7.6 respectively. Ninety out of 126 (71.4%) TB patients were underweight with a BMI of < 18.5 kg/m. The mean 25(OH)-vitamin D level of TB patients (30.1 ± 19.3 nmol/L) was significantly lower than community controls (38.5 ± 20.9 nmol/L,  = 0.005 and household contacts (37.7 ± 12.8 nmol/L, =0.031).). The prevalence of vitamin D deficiency was higher in TB patients (83.3%) than in community controls (67.1%,  = 0.009). The prevalence of vitamin D deficiency was also found higher in household contacts (80.7%). Severe vitamin D deficiency was observed in 53%(67/126), 30% (21/70), 19.3%(11/57) of TB patients, community controls and household contacts respectively. Low BMI (AOR = 2.13; 95%CI: 1.02, 3.28) and being positive for tuberculosis (AOR = 1.93; 95%CI: 1.06, 2.86) were significant predictors of severe vitamin D deficiency.

Conclusion: High prevalence of vitamin D deficiency was found among newly diagnosed TB patients and in their household contacts. The present study warrants further studies to determine the role of vitamin D supplementation in the prevention and treatment of tuberculosis in Ethiopia.
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http://dx.doi.org/10.1186/s13690-017-0195-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474861PMC
June 2017