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BackgroundThe full pentavalent (DPT-HepB-Hib) vaccination is the main strategy to prevent five communicable diseases in early childhood, especially in countries with huge communicable disease burdens like Ethiopia. Exploring spatial distributions and determinants of full pentavalent vaccination status in minor ecological areas in Ethiopia is crucial for creating targeted immunization campaigns and monitoring the advancement of accomplishing sustainable development goals. This study aimed to investigate the spatial disparities and determinants of full pentavalent vaccination among 12-23-month-old children in Ethiopia.MethodThe data on pentavalent vaccine uptake was found in the Ethiopian Health and Demographic Survey (EDHS, 2019). A two-stage cluster sampling method was applied to collect the EDHS data. The enumeration area was the primary sample unit while the household served as the secondary sampling unit. The geographical variations of full pentavalent vaccine uptake were explored using Quantum Geographic Information System (QGIS) software. The significant predictors of full pentavalent vaccination were identified using a simple logistic regression model through R version 4.1 software.ResultThe national full pentavalent vaccine uptake was 59.2%. The spatial distribution of full pentavalent vaccine uptake was not uniform in Ethiopia. Spatial cluster analysis revealed that most of low coverage regions for full pentavalent vaccine uptake were Afar, Somali, and Harari. The regions with the highest and lowest rates of vaccine uptake were Tigray and Harari region, respectively. Maternal age of 35-49 years (AOR = 3.42; 95% CI: 1.99, 5.87), and 25-34 years (AOR = 1.55; 95% CI: 1.17, 2.19), primary education attended (AOR = 1.51; 95%CI: 1.07, 2.11), richness wealth index (AOR = 1.96; 95% CI: 1.40, 2.75), birth order of 1-3 (AOR = 1.88; 95% CI: 1.19, 2.96), and delivery in the health facility (AOR = 3.41: 95% CI: 2.52, 4.61) were the determinants of full pentavalent vaccine uptake in Ethiopia.ConclusionEthiopia's full pentavalent vaccine uptake was far lower than the global target. Older maternal age, maternal education, wealth index, birth order, and giving birth in a health facility were the determinants of full pentavalent vaccine uptake. Special attention should be given to Afar, Somali, and Harari regions, to strengthen the vaccine uptake. Moreover, improved socioeconomic status and getting maternal health services during delivery are necessary to enhance vaccine uptake.

BackgroundAdolescents who have the human immunodeficiency virus face difficulties in their lives not just from the physical consequences of the illness but also from social stigma and discrimination. The quantitative side of this issue was the focus of earlier Ethiopian research. However, there hasn't been any prior research done extensively in Ethiopia on the real-life experiences of teenagers infected with HIV. Therefore, in order to address the real issues that these teenagers encounter, it is imperative that we investigate their lived experiences as HIV-positive adolescents.ObjectiveThe goal is to investigate the experiences that adolescents at Felege Hiwot Comprehensive Specialized Hospital who are infected with HIV have on a daily basis.MethodA phenomenological approach was conducted among thirteen purposively selected adolescents at Felege Hiwot Comprehensive Specialized Hospital, Bahir-Dar, northwest Ethiopia, from March 25 to April 30, 2023. Information saturation was used to estimate the sample size. Data was gathered through semi-structured open-ended interview guides and in-depth interview techniques. The talk was recorded using an audio recorder. The data was transcribed verbatim. The conceptual translation approach was used to translate the transcribed data from Amharic to English. For additional analysis, the translated data was entered into the Atlas.ti.8 program. To demonstrate findings, the inductive thematic analysis technique was applied using illustrative quotes. Colleague feedback, member checks, and a debriefing were used to guarantee the quality of the data.ResultEleven subthemes, including main theme of "lived with burdens of immunodeficiency virus," "disclosure," "ART adherence," and "future aspiration," were used to describe the findings. The participants discussed how difficult it has been for them to deal with social, emotional, and psychological difficulties in addition to living with the HIV infection. They kept their illness a secret from others out of fear of prejudice and stigma. In conclusion, adolescents infected with the human immunodeficiency virus faced a variety of difficulties related to their mental health, relationships, emotions, and compliance. It is advised that the community get ongoing, comprehensive health education in order to prevent stigmatization and discrimination against young people who have the virus.

BackgroundAfter a live birth, the recommended interval before attempting the next pregnancy is at least 24 months (birth to pregnancy interval) in order to reduce the risk of adverse maternal, perinatal and infant outcomes. Short inter pregnancy interval associated with adverse perinatal and maternal outcomes.ObjectiveThe objective of this review was to determine the effect of short inter pregnancy interval on perinatal and maternal outcomes in Sub-Saharan Africa 2023.MethodsA systematic and a comprehensive literature searching mechanism were used without any restriction, through Google scholar, PubMed, Scopus, Web of Sciences, and Grey literature databases for reporting the effect of short inter pregnancy interval. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis was used for this review. All statistical analyses were done using STATA version17 software for windows, and meta-analysis was used with a random-effects method. The results are presented using texts, tables and forest plots with measures of effect and 95% confidence interval.ResultsThirteen studies were included in this review and most of the studies level of heterogeneity across the study was considerable, mainly due to methodological variations, Statistical heterogeneity, and population and intervention variations of included studies. The effect of short inter pregnancy interval on perinatal and maternal outcome were low birth weight(RR (RR (95% CI) 1.98 (1.48, 2.47); I2:62.97%, preterm birth (RR (95% CI) 1.67 (1.31, 2.03); I2:51%, intra uterine growth retardation(RR (95% CI) 3.78 (2.07, 5.49); I2: 8.52%, low APGAR score(RR (95% CI) 3.49 (1.41, 5.57)); I2: 71.11%, premature rapture of membrane(RR (95% CI) 2.87 (1.22, 4.51)); I2: 49.22%, perinatal mortality(RR (95% CI) 2.95 (1.10, 4.81)); I2: 54.37% and maternal anemia(RR (95% CI) 3.06 (2.12, 3.99)); I2: 74.74%.ConclusionsAs per our review the main effect of short inter pregnancy interval is low birth weight, preterm birth, intra uterine growth retardation, low APGAR score, premature rapture of membrane, perinatal mortality and maternal anemia. This might be very useful for healthcare policymakers and NGOs to emphasize on it.

Non-typhoidal Salmonella (NTS) is a zoonotic pathogen that exerts huge public health and economic impacts in the world. The severity of illness is mainly related to the serovars involved, the presence of virulence genes, and antimicrobial resistance (AMR) patterns. However, data are scarce on serovars, virulence genes, and AMR among NTS identified from the human-dairy interface in Northwest Ethiopia. Thus, this study investigated the serovars, common virulence genes, and AMR patterns of NTS isolates in the area. The study was conducted from June 2022 to August 2023 among randomly selected 58 dairy farms. A total of 362 samples were processed to detect NTS using standard bacteriological methods. The presumptive positive colonies were confirmed by Matrix-Assisted Laser Desorption Ionization-Time-of-Flight (MALDi-ToF). Polymerase chain reaction (PCR) was used to detect virulence genes, including invA and spvC. A slide agglutination test according to the White-Kauffmann-Le Minor scheme was employed to identify the serovars of the NTS isolates. The Kirby-Bauer disk diffusion method was used to assess the antimicrobial susceptibility patterns. Of the processed samples (362), 28 (7.7%) NTS isolates were detected. When distributed among samples, the proportions were 11.9%, 10.5%, 10.3%, 5.2%, 4.3%, and 1.7% among cows' feces, dairy farm sewage, pooled raw milk, milk container swabs, milkers' stool, and milkers' hand swab samples, respectively. Six serovars were detected with the dominancy of S. Uganda (39.3%), followed by S. enterica subsp. diarizonae (25.0%) and S. Typhimurium (21.4%). Among the 28 NTS isolates, 100% and 21.4% had the virulence genes invA and spvC, respectively. The susceptibility profile showed that 89.3% of the NTS isolates were resistant to at least one antimicrobial agent and 46.4% were resistant to three or more classes of antimicrobials (multidrug-resistant). Among antimicrobials, isolates were highly resistant to ampicillin (57.1%), followed by tetracycline (42.9%) and chloramphenicol (35.7%). On the other hand, the NTS isolates were 100%, 96.4%, and 96.4% susceptible to ceftriaxone, azithromycin, and norfloxacin, respectively. In conclusion, we detected NTS from humans, dairy cows, raw milk, dairy utensils, and the environment (sewage), showing the potential of the human-dairy farm-environment nexus in the NTS circulation. These further highlight that the interface is a good point of intervention in the control and prevention of NTS infection. The susceptibility profiles of the isolate necessitate interventions including the prudent use of the antimicrobials.

BackgroundStreet women are women, who make their living on the streets by begging, sleeping in the streets, or on the sides of roads. They are the most marginalized and neglected segment of society, with little access to health care, including modern contraception, and a lack of knowledge about health services, particularly in Ethiopia. Therefore, this study aimed to examine modern contraceptive utilization and associated factors among street women.MethodsA systematic review and meta-analysis were conducted on observational community-based studies published from January 2010 up to February 1, 2023. PubMed, Google Scholar, HINAR, Scopus, Web of Sciences, and grey literature were used to search primary studies. We used Microsoft Excel for data entry and extracting data. STATA-17 statistical software was used to analyze the data as well and I2 tests evaluated study heterogeneity. The pooled utilization of the modern contraceptive method was predicted using a random-effect model.ResultsA total of eight studies were included. The pooled prevalence of modern contraceptive utilization was 51.89% (95% CI: 40.89-62.9). Being married (OR = 4.22, 95%CI, 2.75-6.49); facing a history of sexual assault/rape at a street life (OR = 3.59, 95%CI, 2.46-5.23); age between 25-35 years (OR = 3.27, 95%CI, 1.73-6.18), getting advise from the health professionals (OR = 6.23, 95%CI, 1.44-27.07), having a history of pregnancy in street life (OR = 1.90, 95%CI, 1.28-2.81) and no more children wanted (OR = 2.47, 95%CI, 1.52-5.00) were significantly associated with modern contraceptive utilization.ConclusionsThe pooled modern contraceptive utilization was suboptimal. Every concerned body or stakeholder should give more consideration to their lifestyles and living conditions by raising awareness and providing access to contraception.

ObjectivesThis study aimed to assess the level of health literacy and its associated factors among Jimma town public high school adolescents, Jimma, Oromia, Southwest Ethiopia, 2023.MethodsA facility-based cross-sectional study was conducted in June 2023 among 604 Jimma town public high school adolescents. A multistage sampling technique was employed to recruit study participants. A pretested self-administered questionnaire was used to collect data. Data was entered into epidata 4.6 and exported to SPSS version 26.0 for analysis. Bivariable and multivariable logistic regressions were performed to identify factors associated with the level of health literacy. P-values less than 0.05 at 95% CI were used to declare statistically significant associations. The results were presented by text, tables and charts as necessary.ResultsFrom 634 total sample size about 604 participated. About 317 (52.5%) were males. The age of participants ranged from 14 to 19 years, with a mean age of 16.95+1.52. The finding revealed that only 35.26% (95% CI; 31.44, 39.09) of participants had desired health literacy, while 64.74% of them had limited health literacy levels. Age of 18-19 [AOR = 3.99(2.41, 6.60): pConclusionSince a significant number of students in our study area had limited health literacy, we recommend schools to integrate a school health service that contains health education services. Moreover, efforts should be undertaken to raise adolescent health literacy for middle adolescents, early adolescents, and students whose families were not employed.

BackgroundStudies focusing on the occurrence and correlates of hyperemesis gravidarum in Ethiopia have reported varied values in different regions of the country. Additionally, there is no systematic review and meta-analysis summarizing the prevalence of hyperemesis gravidarum and its determinants in Ethiopia. Hence, this systematic review and meta-analysis aimed to estimate the overall prevalence of hyperemesis gravidarum and explore its determinants in Ethiopia.MethodsCross-sectional or case-control studies conducted in Ethiopia, written in English, and reporting the prevalence or the determinant of hyperemesis gravidarum among pregnant women were included in the review. International databases (PubMed, Scopus, Cochrane Library, Google Scholar, Science Direct, African Journal Online, Directory of Open Access Journal, and African Index Medicus) and Ethiopian university repositories (Jimma, Addis Ababa, Haramaya, Hawassa, and Gondar Universities) were searched from September 4-15, 2023, to identify articles published on the topic. The pooled prevalence of hyperemesis gravidarum with a 95% confidence interval was presented using the forest plots. The heterogeneity of the studies was checked by I2 with its corresponding p-values and the Galbraith plot. Subgroup analysis and meta-regression were performed to identify sources of heterogeneity. Funnel plot, Egger, and Begg's tests were used to assess publication bias.ResultsA total of 11 articles with a 3510-sample size were included in this systematic review and meta-analysis. The pooled prevalence of hyperemesis gravidarum among pregnant women in Ethiopia was 7.12% with a 95% CI (4.09-10.15) and a high level of heterogeneity (I2 = 86.5%, pConclusionThe prevalence of hyperemesis gravidarum among pregnant women in Ethiopia is high. Targeting pregnant women in the first trimester, with a previous history of hyperemesis gravidarum, and those with Helicobacter pylori infection during prenatal counseling on how to manage and reduce hyperemesis gravidarum is very helpful to avert related complications.RegistrationThe review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number "CRD42023461808", on September 19, 2023.

BackgroundShigellosis is an acute gastroenteritis infection and one of Ethiopia's most common causes of morbidity and mortality, especially in children under five. Antimicrobial resistance (AMR) has spread quickly among Shigella species due to inappropriate antibiotic use, inadequacies of diagnostic facilities, and unhygienic conditions. This study aimed to characterize Shigella sonnei (S. sonnei) using whole genome sequence (WGS) analysis in Addis Ababa, Ethiopia.MethodsThe raw reads were quality-filtered and trimmed, and a minimum length of 50bp was retained and taxonomically classified using MiniKraken version 1. The whole genome data were aligned with Antibiotic Resistance Gene (ARG) sequences of the Comprehensive Antibiotic Resistance Database (CARD) by Resistance Gene Identifier (RGI). Plasmids were analyzed using the PlasmidFinder tool version 2.1. Additionally, AMR and virulence genes were screened at the Centre for Genomic Epidemiology (CGE) web-based server.ResultsAll isolates in our investigation contained genes encoding blaEC-8 and blaZEG-1. Here, 60.7% of the isolates were phenotypically sensitive to cefoxitin among the blaEC-8 genes detected in the genotyping analysis, whereas all isolates were completely resistant to amoxicillin and erythromycin phenotypically. The study also identified genes that conferred resistance to trimethoprim (dfrA). Plasmid Col156 and Col (BS512) types were found in all isolates, while IncFII and Col (MG828) plasmids were only identified in one isolate.ConclusionThis study found that many resistant genes were present, confirming the high variety in S. sonnei strains and hence a divergence in phylogenetic relationships. Thus, combining WGS methods for AMR prediction and strain identification into active surveillance may be beneficial for monitoring the spread of AMR in S. sonnei and detecting the potential emergence of novel variations.

BackgroundDespite progress in national reproductive health, pastoralist regions, including the Fentale District in Eastern Ethiopia, face challenges with limited contraceptive coverage due to gaps in understanding and adoption among couples.MethodsThis cross-sectional study of 1496 couples in Fentale District, Eastern Ethiopia, from October 1 to December 25, 2021, utilized multistage sampling. Data entered into EPI Data underwent analysis with SPSS (v23.0) and STATA (v14.0), employing descriptive statistics, bivariate analysis, and binary logistic regression to identify predictors of contraceptive knowledge.ResultsOf the 1496 couples, 93.8% (1404) participated in the survey. Significant educational disparities were observed, with 53.8% having no formal education, particularly among women (65.2%). Despite this, 80.2% of couples were aware of at least one family planning (FP) method, and 78.6% knew modern methods. The median knowledge of contraception methods was 3 for both genders. Men showed higher awareness of male (43.2%) and female condoms (17.4%) compared to women (31.8% and 6.0%). Overall, 27.4% of couples used contraception, with a significant gender difference: 41.2% of women and 13.5% of men. Modern contraceptives were used by 18.2% of couples, predominantly by women (34.8%). Binary logistic regression analysis indicated positive associations between contraceptive knowledge and education, bank account ownership, occupation, proximity to healthcare, and media exposure, while a nomadic-pastoralist lifestyle and specific treatment preferences showed negative associations.ConclusionThe limited knowledge and utilization of family planning in the Fentale District stem from gaps in comprehension and disparities among couples. Factors influencing this situation include socio-demographic considerations, such as variations based on education, occupation, media exposure, bank account ownership, treatment preferences, and distance from healthcare facilities. This ensures that the interventions are having the desired effect and allows for adjustments as needed to promote family planning uptake.

BackgroundThe burden of parallel and overlapping infections of Sexually Transmitted Infections (STIs), particularly HIV, syphilis, hepatitis B (HBV), and hepatitis C virus (HCV) are disproportionately higher among pregnant women globally, leading to unwanted consequences. These infections pose significant public health challenges as they can be transmitted vertically to the offspring. This study aimed to determine the sero-epidemiological patterns and predictors of STIs (HIV, syphilis, HBV, and HCV) among pregnant women attending antenatal care clinics at ten health facilities in North-eastern Ethiopia.MethodsAn institution-based multi-center cross-sectional study was conducted from May to November 2022 among 422 pregnant women selected using simple random sampling technique. Semi-structured questionnaire was used to collect socio-demographic characteristics and predictor variables of STIs through face-to-face interviews. Venous blood was collected and it was tested for anti-HIV, HBsAg, anti-HCV, and anti-Treponemal antibodies using immunochromatographic test kits. Multinomial logistic regression analysis was used to identify associated factors of STIs. Variables with an adjusted odds ratio (AOR) and a p-value ResultsThe overall prevalence of STIs was 23.9% (95% CI = 20.08-28.25). The prevalence of parallel infections of HIV, hepatitis B, hepatitis C, and syphilis were 6.4%, 9%, 1.7%, and 6.9%, respectively. The overlapping infections for HIV-HBV was 4% but HIV-HCV overlapping infection wasn't found. Increased age, tattooing, multiple sexual partners, exposure to unsafe sex, and RH status were independent factors of HBV. Likewise, increased age, rural residence, illiteracy, and tattooing were independently associated with HCV. Moreover, rural residence and a history of tattooing were independent predictors for the acquisition of HIV, whereas multiple sexual partners and RH status were found to be significant predictors of syphilis infection among pregnant women.ConclusionThe magnitude of overlapping and parallel STD infections is still continued to be a problem among pregnant women. Moreover, there were overlapping infections of HBV-HIV. Therefore, continuous screening of pregnant women for HIV, syphilis, hepatitis B, and C infections should be performed, and special attention should be given to pregnant women who have co-infections.

BackgroundShort inter-pregnancy or birth interval is associated with an increased risk of adverse perinatal outcomes. However, some emerging evidence questions this association and there are also inconsistencies among the existing findings. This study aimed to systematically review the evidence regarding the effect of short inter-pregnancy or birth intervals on adverse perinatal outcomes in the Asia-Pacific region.MethodsA comprehensive search of five databases was conducted targeting studies published between 2000 to 2023. Studies that reported on short inter-pregnancy or birth interval and examined adverse perinatal outcomes, such as low birthweight (LBW) preterm birth (PTB), small for gestational age (SGA), and neonatal mortality were included and appraised for methodological quality using the Joanna Briggs Institute critical appraisal tools. Three reviewers independently screened the studies and performed data extraction. Narrative synthesis and meta-analyses were conducted to summarise the key findings.ResultsA total of 41 studies that fulfilled the inclusion criteria were included. A short-interpregnancy interval was associated with an increased risk of low birthweight (odds ratio [OR] = 1.65; 95%CI:1.39, 1.95), preterm birth (OR = 1.50; 95%CI: 1.35, 1.66), and small for gestational age (OR = 1.24; 95%CI:1.09, 1.41). We also found elevated odds of early neonatal mortality (OR = 1.91; 95%CI: 1.11, 3.29) and neonatal mortality (OR = 1.78; 95%CI: 1.25, 2.55) among women with short birth intervals.ConclusionThis review indicates that both short inter-pregnancy and birth interval increased the risk of adverse perinatal outcomes. This underscores the importance of advocating for and implementing strategies to promote optimal pregnancy and birth spacing to reduce the occurrence of adverse perinatal outcomes. Reproductive health policies and programs need to be further strengthened and promote access to comprehensive family planning services and increase awareness about the importance of optimal pregnancy and birth spacing.

BackgroundRheumatic heart disease is a global health concern with a persistently high incidence in developing countries, including Africa. It has a significant economic, morbidity, and mortality burden, particularly for children and young adults during their most productive years. However, in the last ten years, the extent of its impact in Africa has remained unclear. Limited studies conducted on the continent have reported diverse prevalence rates of rheumatic heart disease. As a result of these, the study aimed to aggregate and synthesize findings from population-based studies to offer a comprehensive and updated overview of rheumatic heart disease prevalence and pattern at the African level.MethodsThe studies were identified through a comprehensive literature search of the electronic databases, including PubMed, Google Scholar, Web searches, and manual searches. The descriptive information for the study is presented in the table, and the quantitative results are presented in forest plots. The Cochrane Q test and I2 test statistic were used to test heterogeneity across studies. The pooled estimate of the prevalence of rheumatic heart disease was computed by a random effects model.ResultsOut of 22 population-based studies analyzed using random-effects, the pooled magnitude of rheumatic heart disease was found to be 18.41/1000 (95% CI: 14.08-22.73/1000). This comprised definite cases of rheumatic heart disease at a prevalence rate of 8.91/1000 (95% CI: 6.50-11.33/1000) and borderline cases at a prevalence rate of 10.69/1000 (95% CI: 7.74-13.65/1000). The combined prevalence of rheumatic heart disease in males was almost equivalent to that in females. Mitral valve regurgitation was the predominant valve affected by rheumatic heart disease, accounting for approximately 73%.ConclusionThis study analysis found the prevalence of rheumatic heart disease in Africa is high. Because of this, policies and interventions should give attention to prioritize continuous population based active surveillance for early detection of cases to the reduction of rheumatic heart disease sequel, especially in the children and adolescent population.

BackgroundOxygen therapy is a life-saving intervention used in various healthcare settings to maintain adequate tissue oxygenation while minimizing cardiopulmonary work. Its effective and safe administration depends largely on the knowledge, attitudes, and practices of health professionals. However, there are no pooled studies that examined these skills in the context of Ethiopia. Therefore, this study aimed to assess the pooled prevalence of health professionals' knowledge, attitude, practice, and determinant factors about oxygen therapy in Ethiopia.MethodsThe databases PubMed, Web of Science, Scopus, Hinari, Science Direct, African Journal of Online, and Google Scholar were used to search for published studies; Direct Google searches and institutional repositories were used to search for unpublished studies. Duplicate studies were eliminated with Endnote X8 and reported according to PRISMA guidelines. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist. A random-effects model was used to estimate the pooled prevalence of KAP among health professionals. Heterogeneity was assessed using Cochran's Q test and I2 statistics. Publication bias was checked by visual inspection of a funnel plot and Egger's regression test. STATA version 11 software was used for statistical analysis.ResultsA total of 14 studies with 2,960 participants for knowledge and practice and 9 studies with 1,991 participants for attitude were used to estimate the pooled prevalence of KAP among health professionals. The pooled prevalence of good knowledge, positive attitude, and good practice regarding oxygen therapy were 52.13% (95% CI: 43.88, 60.39), 55.08% (95% CI: 50.80, 59.35%), and 48.94% (95% CI: 41.14, 56.74) respectively. Both good knowledge and positive attitude were affected by the availability of oxygen therapy guidelines, with adjusted odds ratios (AOR) of 6.11 (95% CI: 2.45, 15.22) and 2.17 (95% CI: 1.39, 3.39) respectively. Additionally, good knowledge (AOR: 4.31, 95% CI: 1.53, 12.11), training (AOR: 4.09, 95% CI: 2.04-8.20), and having an adequate oxygen supply and delivery system (AOR: 3.12, 95% CI: 1.92-5.07) were statistically associated with good practice.Conclusion and recommendationsThe national pooled prevalence of good knowledge, positive attitude, and good practice among health professionals was low. Therefore, thorough monitoring, supervision, and evaluation of their oxygen therapy is highly recommended for all stakeholders. Yet again, we strongly advise that the identified factors be improved by organizing training sessions, making oxygen therapy guidelines available, and maintaining an adequate oxygen supply system.Trial registrationThe review protocol was registered in the international prospective register of systematic reviews with registration number PROSPERO: CRD42023486036.

Staphylococcus aureus infection and colonization in patients may be transmitted to healthcare providers and the environment and subsequently cause healthcare-associated infections in other patients. Pathogenic S. aureus strains produce virulence factors, such as Panton-Valentine Leukocidin (PVL), that contribute to the severity of infections and aid in their spread. The emergence of antimicrobial resistance (AMR) is additional concern with respect to S. aureus infection. In this study, the virulence genes and antibiotic resistance profiles of S. aureus were characterized from patients' clinical isolates, healthcare workers' (HCWs') nasal colonization screenings, and the environment at a tertiary healthcare hospital in Addis Ababa, Ethiopia. A total of 365 samples were collected from September 2021 to September 2022: 73 patients' clinical specimens, 202 colonization screenings from HCWs, and 90 hospital environment's swabs. Fifty-one (25.2%) HCW and 10/90 (11.1%) environment S. aureus isolates were identified. Among the 134 isolates, 10 (7.5%) were methicillin-resistant S. aureus (MRSA). Three (4.1%), five (9.8%), and two (20.0%) of the MRSA isolates were identified from the patients, HCWs, and the environment, respectively. Overall, 118 (88.1%) were ampicillin and penicillin resistant; 70 (52.2%) were trimethoprim sulfamethoxazole resistant; and 28 (20.9%) were erythromycin resistant. S. aureus isolates from patients were more resistant to antibiotics than isolates from HCWs or the hospital environment (p

BackgroundThe emergence of drug-resistant tuberculosis (DR-TB) has been a major obstacle to global tuberculosis control programs, especially in developing countries, including Ethiopia. This study investigated drug resistance patterns and associated mutations of Mycobacterium tuberculosis Complex (MTBC) isolates from the Amhara, Gambella, and Benishangul-Gumuz regions of Ethiopia.MethodsA cross-sectional study was conducted using 128 MTBC isolates obtained from patients with presumptive tuberculosis (TB). Phenotypic (BACTEC MGIT 960) and genotypic (MTBDRplus and MTBDRsl assays) methods were used for drug susceptibility testing. Data were entered into Epi-info and analyzed using SPSS version 25. Frequencies and proportions were determined to describe drug resistance levels and associated mutations.ResultsOf the 127 isolates recovered, 100 (78.7%) were susceptible to four first-line anti-TB drugs. Any drug resistance, polydrug resistance, and multi-drug resistance (MDR) were detected in 21.3% (27), 15.7% (20), and 15% (19) of the isolates, respectively, by phenotypic and/or genotypic methods. Mono-resistance was observed for Isoniazid (INH) (2, 1.6%) and Streptomycin (STR) (2, 1.6%). There were two genotypically discordant RIF-resistant cases and one INH-resistant case. One case of pre-extensively drug-resistant TB (pre-XDR-TB) and one case of extensively drug-resistant TB (XDR-TB) were identified. The most frequent gene mutations associated with INH and rifampicin (RIF) resistance were observed in the katG MUT1 (S315T1) (20, 76.9%) and rpoB (S531L) (10, 52.6%) genes, respectively. Two MDR-TB isolates were resistant to second-line drugs; one had a mutation in the gyrA MUT1 gene, and the other had missing gyrA WT1, gyrA WT3, and rrs WT1 genes without any mutation.ConclusionsThe detection of a significant proportion of DR-TB cases in this study suggests that DR-TB is a major public health problem in Ethiopia. Thus, we recommend the early detection and treatment of DR-TB and universal full first-line drug-susceptibility testing in routine system.

Background Post-partum haemorrhage occurs in over 10% of all births and is the leading cause of maternal mortality, accounting for 25% of all maternal deaths worldwide. Active management of the third stage of labor is the most important intervention for reducing maternal morbidity and mortality by preventing postpartum hemorrhage. Previously, documented primary studies had been great discrepancy, inconsistent results, and there is a lack of comprehensive study. Hence, this systematic review and meta-analysis were intended to assess the prevalence and associated factors of the practice of active management of the third stage of labour among obstetric care providers in Ethiopia. Method Cross-sectional studies were systematically searched from January 01, 2010, to December 24, 2020, using PubMed, Google Scholar, HINARI, Cochrane Library, and grey literature. The pooled prevalence of active management of the third stage of labour practice and associated factors was estimated using DerSemonial-Laird Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic was used to assess the studies’ heterogeneity. A funnel plot and Egger’s test were used to check for publication bias. A subgroup analysis was performed to minimize the underline heterogeneity depending on the study years and the sample sizes. Results Seven hundred fifty articles were extracted. The final ten studies were included in this systematic review, including 2438 participants. The pooled prevalence of practices of active management of the third stage of labour among obstetric care providers in Ethiopia was 39.65% (30.86, 48.45%). Educational status (OR = 6.11, 95%CI, 1.51–10.72), obstetric care training (OR = 3.56, 95% CI: 2.66, 4.45), work experience (OR = 2.17, 95%CI, 0.47, 3.87) and knowledge of active management of the third stage of labour (OR = 4.5, 95% CI: 2.71, 6.28) were significantly associated with active management of the third stage of labour practices. Conclusion The practice of active management of the third stage of labour in Ethiopia was low. This study showed that educational status, taking obstetric care training, knowledge of AMTSL, and work experience of obstetric care providers were associated with of practices of active management of the third stage of labour. Therefore, obstetric care professionals should improve their academic level, knowledge, and skills in order to provide useful service to AMTSL and save mothers’ lives. All obstetric care providers should get obstetric care training. Furthermore, the government should increase obstetric care professionals’ educational level.

Background Lipids and glucose concentrations in the blood rise during pregnancy period. Poor control of these analytes results in cardio metabolic dysfunction. Despite this, there are no documented studies which investigate lipids and glucose among pregnant women in Tigrai, northern Ethiopia. Objective The objective of this study was to assess lipid and glucose levels and identify their correlates among pregnant women in Tigrai, northern Ethiopia. Method We conducted a facility-based cross sectional study comprising of systematically selected 200 pregnant women from July to October 2021. Those who were severely ill were excluded from the study. We used a structured questionnaire to collect socio-demographic and clinical characteristics of pregnant women. Lipids such as triglycerides, low density lipoprotein, cholesterol and blood glucose were also measured using Cobas C311 chemistry machine from plasma samples. The data were analyzed using SPSS version 25. Logistic regression was performed and statistical significance was declared at p-value < 0.05. Result Proportion of pregnant women with cholesterol, triglyceride, low density lipoprotein and blood glucose levels above the upper limit of the normal range used for clinical decision were 26.5%, 43%, 44.5% and 21%, respectively. Pregnant women’s income > = 10,000 ETB (AOR = 3.35; 95%CI: 1.46–7.66), age (AOR = 3.16; 95%CI: 1.03–9.68), gestational age 29–37 weeks (AOR = 8.02; 95%CI: 2.69–23.90) and having systolic blood pressure greater than 120 mmHg (AOR = 3.99; 95%CI: 1.64–9.75) demonstrated statistically significant association with raised levels of lipids. Conclusion and recommendation Proportion of pregnant women with out of normal range values of lipids, particularly triglycerides and low density lipoprotein, is high. Gestational age is a strong predictor of increase in blood levels for both lipids. Provision of life style related health education and dietary intake to pregnant mothers matters. Moreover, monitoring lipid profile and glucose level during antenatal care period is essential.

Background Variations in admission patterns have been previously identified in non-elective surgical services, but minimal data on the subject exists with respect to burn admissions. Improved understanding of the temporal pattern of burn admissions could inform resource utilization and clinical staffing. We hypothesize that burn admissions have a predictable temporal distribution with regard to the time of day, day of week, and season of year in which they present. Study design A retrospective, cohort observational study of a single burn center from 7/1/2016 to 3/31/2021 was performed on all admissions to the burn surgery service. Demographics, burn characteristics, and temporal data of burn admissions were collected. Bivariate absolute and relative frequency data was captured and plotted for all patients who met inclusion criteria. Heat-maps were created to visually represent the relative admission frequency by time of day and day of week. Frequency analysis grouped by total body surface area against time of day and relative encounters against day of year was performed. Results 2213 burn patient encounters were analyzed, averaging 1.28 burns per day. The nadir of burn admissions was from 07:00 and 08:00, with progressive increase in the rate of admissions over the day. Admissions peaked in the 15:00 hour and then plateaued until midnight (p0.05), though weekend admissions skewed slightly later (p = 0.025). No annual, cyclical trend in burn admissions was identified, suggesting that there is no predictable seasonality to burn admissions, though individual holidays were not assessed. Conclusion Temporal variations in burn admissions exist, including a peak admission window late in the day. Furthermore, we did not find a predictable annual pattern to use in guiding staffing and resource allocation. This differs from findings in trauma, which identified admission peaks on the weekends and an annual cycle that peaks in spring and summer.

BackgroundMaternal exposures to environmental hazards during pregnancy are key determinants of birth outcomes that affect health, cognitive and economic status later in life. In Ethiopia, various epidemiological evidences have suggested associations between environmental exposures such as household air pollution, cigarette smoking, and pesticide exposure and pregnancy outcomes such as low birth weight, preterm birth, and birth defects.ObjectiveThis review aimed at generating summarized evidence on the association between maternal exposure to environmental factors (household air pollution, cigarette smoking, and pesticide) and pregnancy outcomes (birth weight, preterm birth, and birth defects) in Ethiopia.MethodA systematic literature search was performed using PubMed, Google Scholar, and the Cochrane Library databases. All observational study designs were eligible for inclusion in the review. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) quality assessment tools adopted for case-control and cross-sectional studies. The random-effects model was applied in computing the pooled estimates and their corresponding 95% confidence interval (CI). Funnel and Doi plots were used for detecting the potential publication bias. All statistical analyses were performed using comprehensive meta-analysis (CMA 2.0) and MetaXL version 5.3 software.ResultThe pooled estimates revealed that prenatal biomass fuel use increased the risk of giving a low birth weight baby by twofold (OR = 2.10, 95% CI: 1.33-3.31), and has no separate kitchen increases the risk of having low birth weight baby nearly by two and half times (OR = 2.48, 95% CI: 1.25-4.92). Overall, using biomass fuel as the main energy source for cooking and /or having no separate kitchen from the main house is 2.37 times more likely to give low birth weight babies (OR = 2.37, 95% CI: 1.58-3.53). Active cigarette smoker women were 4 times (OR = 4.11, 95% CI: 2.82-5.89) more prone to have low birth weight babies than nonsmokers; and passive smoker women were 2.6 times (OR = 2.63, 95% CI: 1.09-6.35) more risked to give low birth weight babies. It was also estimated that active cigarette smoker women were nearly 4 times (OR = 3.90, 95% CI: 2.36-6.45) more likely to give preterm birth babies. Pesticide exposure during pregnancy also increases the risk of the birth defect 4 times (OR = 4.44, 95% CI: 2.61-7.57) compared with non-exposed pregnant women.ConclusionHousehold air pollution from biomass fuel use, active and passive cigarette smoking, and pesticide exposures are significantly associated environmental risk factors for low birth weight, preterm birth, and birth defects in Ethiopia. Therefore, Pregnant and lactating women should be aware of these environmental hazards during pregnancy. Promoting clean energy and improved and efficient stoves at the household level will help to reduce household air pollution-related adverse health effects.Trial registrationPROSPERO 2022: CRD42022337140.

BackgroundMalaria elimination effort is hampered not only by the lack of effective medication but also due to the lack of sensitive diagnostic tools to detect infections with low levels of parasitemia. Therefore, more sensitive and specific high-throughput molecular diagnostic approaches are needed for accurate malaria diagnosis.MethodsIn the present study, the performance of a novel single-tube MC004 real-time polymerase chain reaction (PCR) assay (MRC-Holland, Amsterdam, the Netherlands) was assessed for the detection of infection and discrimination of Plasmodium species. Blood samples (n = 150) were collected from malaria suspected patients at Adama malaria diagnosis and treatment centre, Adama, central Ethiopia. The positive predictive value (PPV), negative predictive value (NPV), analytical sensitivity and specificity of the assay were assessed against the conventional microscopic method.ResultsPlasmodium species were detected in 59 (39.3%) of the samples by microscopy and in 62 (41.3%) by the novel MC004 RT-PCR. Plasmodium vivax, Plasmodium falciparum and mixed infections with Plasmodium falciparum & Plasmodium vivax accounted for 47.5%, 40.6% and 11.9% respectively as detected by microscopy. The MC004 RT-PCR assay identified 59.7% and 40.3% of the samples positive for Plasmodium vivax and Plasmodium falciparum respectively. The sensitivity, specificity, PPV, and NPV of the MC004 RT-PCR assay were 95.8%, 97.8%, 92%, and 98.9%, respectively. No mixed infections were detected using the MC004 assay.ConclusionThe MC004 RT-PCR assay is a useful tool for the early detection of malaria and identification of Plasmodium species with a high degree of sensitivity and specificity. Due to its high sensitivity, and simplicity (being a single-tube assay), the MC004 is suitable for use in clinical settings and epidemiological studies.

BackgroundAnthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region.MethodsFollowing reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR).ResultsIn Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR.ConclusionWe report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage.

In Ethiopia, data on the burden and determinants of chronic kidney disease (CKD) in the general population is limited. This community-based study was conducted to assess the burden and associated factors of CKD among adults in Southwest Ethiopia. The study was conducted from August 23, 2018-October 16, 2018. Study participants were selected using a random sampling method. A structured questionnaire was used to collect relevant data. Blood pressure and anthropometric indices were measured following standard procedures. About 5 ml of urine sample was collected and the dipstick test was performed immediately. A blood sample of 3-5ml was collected for serum creatinine and blood glucose level determination. The three commonest estimators of glomerular filtration rate and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative were used to define and stage CKD. Data were analyzed using SPSS 21. Multivariable logistic regression was employed and p-value

BackgroundMany health risks in pregnant women and their foetuses can be reduced by practicing antenatal exercise. However, the adequate practice of antenatal exercise among pregnant women is low in Ethiopia. Therefore, this study aimed to assess the practice of antenatal exercise and its associated factors among pregnant women in Arba Minch town.MethodsA community-based cross-sectional study design was conducted. Data were collected by using a structured questionnaire from 422 pregnant women selected by a simple random sampling technique. Descriptive statistics were computed and a binary logistic regression model was fitted. In multivariable logistic-regression adjusted odds ratio (AOR) with 95% confidence intervals were used to determine the strength of associations. The significance level was declared at a p-value < 0.05.ResultsAmong 410 participants, 32.9% (95% CI 28%-37%) adequately practiced antenatal exercise. Factors negatively associated with an adequate antenatal exercise were husband's primary school level [Adjusted odds ratio (AOR) = 0.3, (95% CI: 0.1, 0.7)], history of miscarriage [AOR = 0.3, (95% CI: 0.1, 0.7)], inadequate knowledge [AOR = 0.2, (95% CI: 0.1, 0.3)], and unfavorable attitude [AOR = 0.3, (95% CI 0.2, 0.5)]. Whereas, factors positively associated with an adequate antenatal exercise were employment status of women [AOR = 4.8, (95% CI: 1.8, 13.1)], and a practice of regular exercise before current pregnancy [AOR = 1.9, (95% CI: 1.1, 3.2)].ConclusionsThe findings of this study indicated that adequate practice of antenatal exercise was found to be low. Appropriate measures should be taken to improve the husband's educational level, mother's occupation, knowledge, and attitudes towards antenatal exercise. Special consideration should be given to those with a history of miscarriage and women should be encouraged to practice regular exercise before pregnancy.

Background Type 2 diabetes mellitus (T2DM) and its treatment impact patients’ physical health as well as emotional and social wellbeing. This study aimed to assess health-related quality of life (HRQoL) and associated factors among patients with T2DM at a tertiary care hospital in Ethiopia. Methods A face-to-face cross-sectional survey was conducted among patients with T2DM at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. We collected data using a validated Amharic version of the 5-level EuroQoL-5 dimensions (EQ-5D-5L) questionnaire. Descriptive statistics were used to present patient characteristics. Kruskal-Wallis and Mann-Whitney U tests were performed to explore differences in the median scores of EQ-5D-5L utility and visual analog scale (EQ-VAS). Multivariable Tobit regression models were used to identify predictors of HRQoL. Utility scores were calculated using disutility weights of the Ethiopian general population. Statistical significance was determined at p < 0.05. Results A total of 360 patients with T2DM participated. Mean (SD) age was 64.43(10.61) years. Reported health problems were mostly in the pain/discomfort (67.3%) dimension followed by mobility (60.5%), whereas the usual activities domain (34.1%) was the least health problem being reported. The median (IQR) EQ-5D-5L utility and EQ-VAS scores were 0.95 (0.88–0.96) and 80 (75.0–85.0), respectively. In multivariable Tobit regression models older age, having poor glycemic control, longer duration of diabetes, insulin usage, obesity, and having diabetes-related complications were significant negative predictors of HRQoL. Conclusions Overall, patients with T2DM had lower HRQoL than the general population, which was attributed to being older age, longer duration of diabetes, insulin use, obesity, inadequate glycemic control, and diabetes-related complications. The utility index we generated can be used in future economic evaluations to inform decisions about alternative interventions and resource allocation.

BackgroundAnemia is a major public health problem worldwide which accounts 24.8% of the population. Subsequently, anemia is a leading killer of people living with human immunodeficiency virus and many of these deaths occur in developing countries including Ethiopia. Cross sectional studies have done on anemia and human immunodeficiency virus. However, there is limited study on incidence of anemia and its predictors among adults on HIV care, especially no survival study has been conducted in the study area.ObjectiveTo assess incidence and predictors of anemia among adults on Human immunodeficiency virus care.MethodsAn institution-based retrospective cohort study was conducted among 434 adults on HIV care from January 1st 2015 to December 30th 2019 at Debre Tabor Referral Hospital. A computer-generated simple random sampling technique was employed to select the study participants. Ethical clearance was obtained from the Institutional Review Board of Bahir Dar University, and also, we got implied consent to review charts from the concerned bodies in the hospital. Data were entered using Epi-data version 3.1 and analyzed by using STATA version 14.0. A Kaplan Meier survival curve was utilized to estimate anemia free survival time. Bivariable and Multivariable Cox proportional hazards model were fitted to identify predictors of anemia.ResultsThe overall incidence density rate of anemia was 6.27 (95% CI: 0.051, 0.077) per 100 person years. Clinical stage III/IV (AHR = 1.04; 95% CI = 1.02, 1.06), Body Mass Index less than 18.5 kg/m2 (AHR = 3.11; 95% CI = 1.56, 6.22), serum creatinine greater than 1.1 IU/L(AHR = 2.07; 95% CI = 1.12, 3.81) and fair/poor level of adherence(AHR = 1.05; 95% CI = 1.03, 1.07) were statistically significant predictors of anemia while increased anti-retroviral treatment duration (AHR = 0.98; 95% CI = 0.97, 0.99) decrease the risk of anemia at 95% confidence level.ConclusionThe overall incidence density rate of anemia was high. Patients with clinical stage III/IV, body mass index < 18.5 kg/m2, serum creatinine greater than 1.1 IU/L and fair/poor level of adherence were significant predictors of anemia while increased antiretroviral treatment duration had decreased the risk of anemia.RecommendationEven if the overall incidence rate of anemia was lower as compared to previous studies in Ethiopia, still the incidence of anemia was high. So, prevention measures should be taken beside with HIV care especially within 6-months ART initiation.

BackgroundCOVID-19 is an ongoing public health pandemic regardless of the countless efforts made by various actors. Quality diagnostic tests are important for early detection and control. Notably, several commercially available one step RT-PCR based assays have been recommended by the WHO. Yet, their analytic and diagnostic performances have not been well documented in resource-limited settings. Hence, this study aimed to evaluate the diagnostic sensitivities and specificities of three commercially available one step reverse transcriptase-polymerase chain reaction (RT-PCR) assays in Ethiopia in clinical setting.MethodsA cross-sectional study was conducted from April to June, 2021 on 279 respiratory swabs originating from community surveillance, contact cases and suspect cases. RNA was extracted using manual extraction method. Master-mix preparation, amplification and result interpretation was done as per the respective manufacturer. Agreements between RT-PCRs were analyzed using kappa values. Bayesian latent class models (BLCM) were fitted to obtain reliable estimates of diagnostic sensitivities, specificities of the three assays and prevalence in the absence of a true gold standard.ResultsAmong the 279 respiratory samples, 50(18%), 59(21.2%), and 69(24.7%) were tested positive by TIB, Da An, and BGI assays, respectively. Moderate to substantial level of agreement was reported among the three assays with kappa value between 0 .55 and 0.72. Based on the BLCM relatively high specificities (95% CI) of 0.991(0.973-1.000), 0.961(0.930-0.991) and 0.916(0.875-0.952) and considerably lower sensitivities with 0.813(0.658-0.938), 0.836(0.712-0.940) and 0.810(0.687-0.920) for TIB MOLBIOL, Da An and BGI respectively were found.ConclusionsWhile all the three RT-PCR assays displayed comparable sensitivities, the specificities of TIB MOLBIOL and Da An were considerably higher than BGI. These results help adjust the apparent prevalence determined by the three RT-PCRs and thus support public health decisions in resource limited settings and consider alternatives as per their prioritization matrix.

Background Diarrhoea is the leading cause of morbidity and mortality in the world particularly in developing countries and among vulnerable groups of the population. Gram-negative enteric bacterial pathogens (GNEBPs) are a group of organisms that reside mainly in the intestine and induce diarrhoea. Antimicrobial agents are usually the part of their treatment regimen. The therapeutic effect of antimicrobials is hindered by the emergence and spread of drug-resistant strains. The information regarding the prevalence and antimicrobial resistance patterns of GNEBPs in Ethiopia is limited and found in a scattered form. Objectives This study was designed to determine the pooled prevalence and drug resistance patterns of GNEBPs by meta-analysis of data from diarrhoeic patients in Ethiopia. Method A comprehensive literature search was conducted through internet searches using Google Scholar, PubMed, Science Direct, HINARI databases, and reference lists of previous studies. Published articles were included in the study based on priorly set inclusion and exclusion criteria. Results were presented in the forest plot, tables, and figures with a 95% confidence interval (CI). The inconsistency index (I2) test statistics was used to assess heterogeneity across studies. The pooled prevalence estimate of GNEBPs and their drug resistance patterns were computed by a random-effects model. Software for Statistics and Data Science (STATA) version 14 statistical software was used for the analysis. Result After removing those articles which did not fulfil the inclusion criteria, 43 studies were included in the analysis. Studies were conducted in 8 regions of the country and most of the published articles were from the Amhara region (30.23%) followed by Oromia (18.60%) and Southern Nations, Nationalities, and Peoples’ region (SNNP) (18.60%). The pooled prevalence of GNEBPs was 15.81% (CI = 13.33–18.29). The funnel plot indicated the presence of publication bias. The pooled prevalence of GNEBPs in Addis Ababa, Amhara, SNNP, and Oromia regions were 20.08, 16.67, 12.12, and 11.61%, respectively. The pooled prevalence was 14.91, 18.03, and 13.46% among studies conducted from 2006–2010, 2011–2015, and 2016–2021, respectively and it was the highest (20.35%) in children having age less than or equal to 15 years. The pooled prevalence of Escherichia coli, Campylobacter spp., Shigella spp., and Salmonella enterica were 19.79, 10.76, 6.24, and 5.06%, respectively. Large proportions (60–90%) of the isolates were resistant to ampicillin, amoxicillin, tetracycline, and trimethoprim-sulphamethoxazole. The pooled prevalence of multidrug resistance (MDR) was 70.56% (CI = 64.56–76.77%) and MDR in Campylobacter spp., Shigella spp., E. coli, and S. enterica. were 80.78, 79.08, 78.20, and 59.46%, respectively. Conclusion The pooled estimate showed a high burden of GNEBPs infections and a high proportion of drug resistance characters to commonly used antimicrobial agents in Ethiopia. Therefore, performing drug susceptibility tests, establishing an antimicrobial surveillance system and confirmation by molecular techniques are needed.

Non-Human Primates (NHPs) harbor Cryptosporidium genotypes that can infect humans and vice versa. NHPs Chlorocebus aethiops and Colobus guereza and humans have overlapping territories in some regions of Ethiopia, which may increase the risk of zoonotic transmission of Cryptosporidium. This cross-sectional study examined the molecular prevalence and subtypes of Cryptosporidium spp. from 185 fecal samples of Chlorocebus aethiops and Colobus guereza in rural and urban areas in Ethiopia. Samples were tested for Cryptosporidium infection using nested polymerase chain reaction (PCR), and subtypes were determined by sequencing a fragment of the 60-kDa glycoprotein gene (gp60). Of the 185 samples, fifty-one (27.56%) tested positive for Cryptosporidium infection. The species detected were C. parvum (n = 34), C. hominis (n = 12), and C. cuniculus (n = 3). Mixed infection with C. parvum and C. hominis were detected in 2 samples. Four C. hominis family subtypes (Ia, Ib, Id, and Ie) and one C. parvum family subtype (IIa) were identified. C. hominis IaA20 (n = 7) and C. parvum IIaA17G1R1 (n = 6) were the most prevalent subtypes detected. These results confirm that Chlorocebus aethiops and Colobus guereza can be infected with diverse C. parvum and C. hominis subtypes that can also potentially infect humans. Additional studies could help to understand the role of NHPs in the zoonotic transmission of Cryptosporidium in Ethiopia.

BackgroundEthiopia is one of the high multidrug-resistant tuberculosis (MDR-TB) burden countries. However, phenotypic drug susceptibility testing can take several weeks due to the slow growth of Mycobacterium tuberculosis complex (MTBC) strains. In this study, we assessed the performance of a Sanger sequencing approach to predict resistance against five anti-tuberculosis drugs and the pattern of resistance mediating mutations.MethodsWe enrolled 226 MTBC culture-positive MDR-TB suspects and collected sputum specimens and socio-demographic and TB related data from each suspect between June 2015 and December 2016 in Addis Ababa, Ethiopia. Phenotypic drug susceptibility testing (pDST) for rifampicin, isoniazid, pyrazinamide, ethambutol, and streptomycin using BACTEC MGIT 960 was compared with the results of a Sanger sequencing analysis of seven resistance determining regions in the genes rpoB, katG, fabG-inhA, pncA, embB, rpsL, and rrs.ResultDNA isolation for Sanger sequencing was successfully extracted from 92.5% (209/226) of the MTBC positive cultures, and the remaining 7.5% (17/226) strains were excluded from the final analysis. Based on pDST results, drug resistance proportions were as follows: isoniazid: 109/209 (52.2%), streptomycin: 93/209 (44.5%), rifampicin: 88/209 (42.1%), ethambutol: 74/209 (35.4%), and pyrazinamide: 69/209 (33.0%). Resistance against isoniazid was mainly mediated by the mutation katG S315T (97/209, 46.4%) and resistance against rifampicin by rpoB S531L (58/209, 27.8%). The dominating resistance-conferring mutations for ethambutol, streptomycin, and pyrazinamide affected codon 306 in embB (48/209, 21.1%), codon 88 in rpsL (43/209, 20.6%), and codon 65 in pncA (19/209, 9.1%), respectively. We observed a high agreement between phenotypic and genotypic DST, such as 89.9% (at 95% confidence interval [CI], 84.2%-95.8%) for isoniazid, 95.5% (95% CI, 91.2%-99.8%) for rifampicin, 98.6% (95% CI, 95.9-100%) for ethambutol, 91.3% (95% CI, 84.6-98.1%) for pyrazinamide and 57.0% (95% CI, 46.9%-67.1%) for streptomycin.ConclusionWe detected canonical mutations implicated in resistance to rifampicin, isoniazid, pyrazinamide, ethambutol, and streptomycin. High agreement with phenotypic DST results for all drugs renders Sanger sequencing promising to be performed as a complementary measure to routine phenotypic DST in Ethiopia. Sanger sequencing directly from sputum may accelerate accurate clinical decision-making in the future.

BackgroundThe care of epileptic patients is complicated by the cognitive adverse effect of the drug, disease, pharmacokinetics, and pharmacodynamics properties of antiepileptic drugs which in turn intensify the risk of drug therapy problems among epileptic patients.ObjectiveTo assess drug therapy problems and predicting factors among ambulatory epileptic patients at Jimma University Medical Center, Southwest Ethiopia, from September 2020 to May 2021.MethodologyA hospital-based prospective observational study was conducted. A semi-structured questionnaire was used to collect data from patients as well as from charts. Drug therapy problems were identified using Cipolle's, Morley, and Strand drug therapy problem identification and classification method. Data were entered into Epi data manager version 4.6 and exported to statistical software package for social science version 23.0 for analysis. Multiplestepwise backward logistic regression analysis was carried out to identify predictors of drug therapy problems. The 95% CI was used to show an association between the dependent and independent variables. P-value < 0.05 was considered as statistically significant.ResultsOf the total 320 epileptic patients 224(70.0%) patients had at least one drug therapy problem. A total of 395 drug therapy problems were identified among two hundred twenty-four patients with an average of 1.2 drug therapy problems per patient. The frequently identified drug therapy problems were non-compliance 115(29.11), adverse drug reaction 110(27.84%), and dose too low 103(26%). Getting of a drug by purchasing [AOR = 4.6,95%CI:(2.05-10.7)], poorly involvement of the patients in therapeutic decision making [AOR = 3.02,95%CI:(1.5-6.06)], the number of medications ≥ two [AOR = 5.3,95%CI:(1.2-22.9)] and having had uncontrolled seizure [AOR = 10.9,95%CI:(4.9-24.2)] were independent predictors of drug therapy problems.ConclusionsDrug therapy problems were common among epileptic patients in the study area. Patients who were getting their drugs by purchasing, poorly involved in therapeutic decision making, having had an uncontrolled seizure, and taking two and above drugs were more likely to experience drug therapy problems. Therefore, due attention should be given to patients with the aforementioned problems to decrease the occurrence of drug therapy problems and improve overall outcomes among epileptic patients.

IntroductionMoringa stenopetala Bak. Cuf. is a native plant of Ethiopia with important nutraceutical applications. However, little is known about its nutritional, ethno-pharmaceutical and therapeutic properties. Hence, the present study sought to assess the nutraceutical applications of M. stenopetala among traditional healers in southern Ethiopia.MethodsA community-based cross-sectional study was conducted on 50 selected administrative units in Gamo Gofa, Segen areas and south Omo zones of southern Ethiopia from May to June 2020. Data were gathered using a semi-structured interview, field observation, and group discussion. Both quantitative and qualitative data were analysed using Excel 2019 and open code version 4.03, respectively. The results were presented using descriptive statistics, with the fidelity level (FL)% used to distinguish the preferential use of various plant parts.ResultsA total of 120 individuals participated in the study, and the majority of them, 89 (74.2%), were male and farmers by occupation. Eight four (70%) of them were residents of the Gamo Gofa Zone. The fidelity level revealed that the leaf and root were the most commonly used parts for nutraceutical purposes. Remarkably, M. stenopetala is used to treat human ailments such as leprosy and kidney and liver infections via various modes of utilisation and administration. As a result, the most common methods of utilising plant products are chewing or consuming crushed plant parts, and the oral route is the much-preferred method of application. On the other hand, the larvae of Moringa moth Nurda blitealis, are a defoliating insect during the rainy season and have been identified as a limiting factor for its production.ConclusionsThe nutraceutical aspects of M. stenopetala are extremely important to the rural community in southern Ethiopia. However, the defoliating moth larvae threaten its growth and biomass production, necessitating the need to manage and improve the plant's productivity and sustainable use. Additionally, conducting experimental studies to validate the plant's pharmacological potential correspond to a milestone in drug discovery.

Introduction Twin pregnancy carries a high risk of pregnancy-related complications including adverse perinatal outcomes. Although evidence from international studies indicated an increased risk of adverse perinatal outcomes in twin pregnancies, little is known about the adverse perinatal outcomes in twin pregnancies and associated factors in Ethiopia. The purpose of this study was, therefore, to estimate the incidence of twin pregnancies and related-adverse perinatal outcomes and identify factors associated with adverse perinatal outcomes in twin pregnancies in Ethiopia. Methods A hospital-based retrospective cross-sectional study was conducted among 322 mothers who gave twin birth at Adama Hospital Medical College between 08 July 2015 and 07 June 2017. In this study, the adverse perinatal outcome was defined as the presence of any of the following main conditions: low birth weight, preterm birth, stillbirth, low Apgar Scores, mal-presentation, Admission to neonatal Intensive Care Unit (NICU), and early neonatal deaths. The data were analyzed using SPSS version 20.0. Multivariable logistic regression was conducted to identify factors associated with adverse perinatal outcome at 95% CI or P-value of less than 0.05. Result Of 10,850 births recorded in the hospital, 354 births were twins and 322 of these paired records had complete perinatal information. One hundred ninety-nine (61.8%) of the 322 paired birth records had at least one adverse perinatal outcome on one or both twins. Low birth weight was the most common perinatal outcome followed by preterm birth. After adjusting for confounding factors, younger maternal age (AOR = 4.1, 95% CI; 1.3, 12.5) and not having ultrasound scan during antenatal care (AOR = 2.0, 95% CI: 1.2, 3.1) were significantly associated with adverse perinatal outcomes. Conclusion The incidence of adverse perinatal outcome in twin pregnancies was high, that is, in 61.8% of twin births, there was at least one adverse perinatal outcome on one or both twins. Moreover, younger maternal age at birth and not having an ultrasound scan during antenatal care were found to be strong predictors for the observed high incidence of adverse perinatal outcomes.

BackgroundThe awareness of women towards oral health during pregnancy is an important aspect of her general health. It can compromise pregnancy outcomes, as well as it may affect the newborn's overall health. Every pregnant woman plays a critical role in shaping the oral hygiene habits adopted by her if she is aware of pregnancy-related oral health and result in good perinatal outcomes. This study aimed to assess knowledge of oral health during pregnancy and associated factors among pregnant mothers who attend antenatal care at South Omo Zone public hospitals, Southern Ethiopia, 2021.MethodsAn institution-based cross-sectional study was conducted among pregnant women attending routine antenatal care from October 01 to November 30. A systematic random sampling method was conducted to select study participants. Data had been collected through face-to-face interviews using semi-structured questionnaires. Data were entered using epi data version 3.1 and exported to Statistical Package for the Social Sciences version 25 for data analysis. Descriptive statistics had calculated for each variable, and binary logistic regression analysis with 95% confidence intervals was carried out to assess the factors associated with the outcome variables. Variables with P-value less than 0.05 were used to declare statistical significance.ResultOverall good knowledge of pregnant mothers regarding oral health was 34.1% with 95% CI, (32.76, 35.44). Having access to health facility (AOR = 2.60, 95% CI, 1.44, 4.70), having the educational status of secondary and above (AOR 1.37, 95% CI, 1.44, 4.31), having the educational status of primary education (AOR = 0.43, 95% CI, 0.20, 0.92), having a median income of > = 1500 Ethiopian birr (AOR = 0.41, 95% CI, 0.23, 0.72), being governmental employee (AOR = 0.11, 95% CI, 0.03, 0.41), received oral health hygiene counseling during pregnancy (AOR = 1.33, 95% CI, 1.62, 2.84) were significantly associated with good knowledge of oral health of pregnant mothers.ConclusionThis study showed that the knowledge of pregnant mothers about oral health was 34.1%. Educational status, monthly income, occupation, access to health services, and receiving counseling on oral hygiene at antenatal care were some factors associated with good knowledge of oral health during pregnancy. Therefore strengthening counseling during antenatal care, improving access to a health facility, improving educational status, monthly income, and being government employee are crucial to enhance knowledge of women towards oral health during pregnancy.

BackgroundSevere acute respiratory syndrome coronavirus-2 is a global health care problem with high mortality. Despite early mortality seeming alarming, data regarding factors that lead to increased early mortality of COVID 19 patients is not well-documented yet. The objective of this study was to identify the risk factors of early mortality in patients with confirmed COVID-19 infections.MethodologyA case-control study design was employed. With this, a total of 261 COVID-19 deceased recordings were reviewed. The cases of the study were recordings of patients deceased within three days of intensive care unit admission whereas, the rest 187 were recordings of patients who died after three days of admission. Data were collected using an extraction checklist, entered into Epi data version 4.4.2.2, and analyzed by SPSS version 25. After the description, binary logistic regression was run to conduct bivariate and multivariable analyses. Finally, statistical significance was declared at p-value ResultThe analysis was performed on 261 (87 cases and 174 controls) recordings. About 62.5% of the participants were aged above 65 years and two-thirds were males. The presence of cardiovascular disease (AOR = 4.79, with 95%CI: 1.73, 13.27) and bronchial-asthma (AOR = 6.57; 95% CI: 1.39, 31.13) were found to have a statistically significant association with early mortality. The existence of complications from COVID-19 (AOR = 0.22; 95% CI: 0.07, 0.74) and previous history of COVID-19 infection (AOR = 0.17, 95% CI: 0.04, 0.69) were associated with decreased risk of early mortality.ConclusionsHaving cardiovascular diseases and bronchial asthma was associated with an increased risk of early mortality. Conversely, the presence of intensive care unit complications and previous history of COVID-19 infection were associated with decreased risk of early mortality.

Recent increases in the burn area and severity of wildfires in the western US have raised concerns about the impact on stream water temperature-a key determinant of cold-water fish habitats. However, the effect on seasonal water temperatures of concern, including winter and summer, are not fully understood. In this study, we assessed the impact of wildfire burns at Boulder Creek (Oregon), Elk Creek (Oregon), and Gibbon River (Wyoming) watersheds on the downstream winter and summer water temperatures for the first three post-fire years. To obtain results independent of the choice of the analytical method, we evaluated the consequence of each burn using three different statistical approaches that utilize local water temperature data. Our results from the three approaches indicated that the response of water temperatures to wildfire burns varied across seasons and sites. Wildfire burns were associated with a median increase of up to 0.56°C (Standard Error; S.E. < 0.23°C) in the summer mean water temperatures (MWT) and 62 degree-day Celsius (DDC; S.E. < 20.7 DDC) in the summer accumulated degree days (ADD) for the three subsequent years across studied stream sites. Interestingly, these burns also corresponded to a median decrease of up to 0.49°C (S.E. < 0.45°C) in the winter MWT and 39 DDC (S.E. < 40.5 DDC) in the winter ADD for the same period across sites. Wildfire effects on the downstream water temperatures diminished with increasing site distance from the burn perimeter. Our analyses demonstrated that analytical methods that utilize local watershed data could be applied to evaluate fire effects on downstream water temperatures.

Background Hyperemesis gravidarum is severe nausea and excessive vomiting, starting between 4 and 6 gestational weeks, peak at between 8 and 12 weeks and usually improve and subside by 20 weeks of pregnancy. Identifying the determinants of hyperemesis gravidarum has a particular importance for early detection and intervention to reduce the health, psychosocial and economic impact. In Ethiopia there is low information on determinants of hyperemesis gravidarum. Methods Institution based unmatched case-control study design was conducted from April 12- June 12, 2021. A structured face-to-face interviewer administered questionnaire and checklist for document review were used to collect the data from 360 study participants (120 cases and 240 controls). The data were collected by KoBocollect 1.3, and then exported to statistical package for social science version 25 for further analysis. Both bi-variable and multivariable logistic regression analysis were done to identify the determinants and a p-value < 0.05 with a 95% confidence level was used to declare statistical significance. Result Being an urban dweller (AOR = 2.1, 95% CI: 1.01, 4.34), having polygamous husband (AOR = 2.92, 95% CI: 1.27, 6.68), having history asthma/ other respiratory tract infections (AOR = 3.56, 95% CI: 1.43, 8.82), saturated fat intake (AOR = 4.06 95% CI: 1.98, 8.3), no intake of ginger (AOR = 3.04 95% CI: 1.14, 8.09), and inadequate intake of vitamin B rich foods (2.2, 95% CI: 1.14–4.2) were the determinants of hyperemesis gravidarum. Conclusion This study revealed that, urban residence, having polygamous husband, history of asthma/other respiratory tract infections, intake of saturated fat, no intake of ginger, inadequate intake of vitamin B reach foods were found to be independent determinants of hyperemesis gravidarum. It is better if healthcare providers and government authorities exert continual effort to give health education and counselling service concerning to dietary practice and asthma attacks. It is advisable if pregnant women adhere to healthy diets and limit intake of saturated fats and also husband and nearby relatives give care and support for pregnant women.

Laboratory identification of nontuberculous mycobacteria (NTM) species is not regularly performed while, they have a public health importance with a prevalence of more than 5% among pulmonary tuberculosis (PTB) patients in Ethiopia. Hence, this study aimed to identify the NTM species and their clinical significance among PTB patients. A retrospective study was conducted at the Ethiopian Public Health Institution’s (EPHI’s) national TB referral laboratory. Stored NTM isolates were genotyped using GenoType Mycobacterium CM/AS kit (Hain Life science, Germany). Data pertinent to the study was extracted from the EPHI’s database and patients’ medical records. Between January 2 & December 28 of 2017, a total of 3,834 samples were processed from 698 TB patients of whom 50% were female. Among 3,317 samples with mycobacterial culture results 7.3% were NTM and majority of them were identified from smear negative TB patients. M. simiae was the /predominant NTM among the genotyped isolates. All the studied NTM species were not clinically important however, considering the similarity of clinical and radiologic findings between NTM and MTBC infected patients, integrating NTM species identification in the routine TB laboratory diagnosis may augment clinicians’ decision particularly in DR-TB patients. Additional similar prospective study with a larger sample size is recommended. Moreover, urgent improvements on patients’ record keeping practice are required in the studied hospitals.

IntroductionTraditionally, single critical concentrations of drugs are utilized for Mycobacterium tuberculosis (Mtb) drug susceptibility testing (DST); however, the level of drug resistance can impact treatment choices and outcomes. Mutations at the katG gene are the major genetic mutations in multidrug resistant (MDR) Mtb and usually associated with high level resistance. We assessed the minimum inhibitory concentrations (MICs) of MDR or rifampin resistant (RR) and isoniazid (INH) resistant Mtb isolates to determine the quantification of drug resistance among key anti-tuberculosis drugs.MethodsThe study was conducted on stored Mtb isolates collected as part of a national drug resistance survey in Ethiopia. MIC values were determined using Sensititre™ MYCOTB plates. A line probe assay (MTBDRplus) was also performed to identify genetic determinants of resistance for all isolates.ResultsMIC testing was performed on 74 Mtb isolates including 46 MDR, 2 RR and 26 INH phenotypically resistant isolates as determined by the Löwenstein Jensen (LJ) method. Four (15%) INH resistant Mtb isolates were detected as borderline rifampin resistance (MIC = 1 μg/ml) using MYCOTB MIC plates and no rifampin resistance mutations were detected by LPA. Among the 48 MDR/RR TB cases, 9 (19%) were rifabutin susceptible (MIC was between ≤0.25 and 0.5μg/ml). Additionally, the MIC for isoniazid was between 2-4 μg/ml (moderate resistance) for 58% of MDR TB isolates and 95.6% (n = 25) of the isolates had mutations at the katG gene.ConclusionOur findings suggest a role for rifabutin treatment in a subset of RR TB patients, thus potentially preserving an important drug class. The high proportion of moderate level INH resistant among MDR Mtb isolates indicates the potential benefit of high dose isoniazid treatment in a high proportion of katG gene harboring MDR Mtb isolates.

Introduction Metabolic syndrome is a group of metabolic risk factors which are associated with an increased risk of cardiovascular disease and type2 diabetes. Nowadays, several studies have shown that the burden of metabolic syndrome is increasing among epileptic patients, and leads to MS-associated complications, including cardiovascular disease. However, getting published documents has been limited in Ethiopia and the study area. Therefore, we aimed to analyze the magnitude and associated factors of metabolic syndrome among epileptic patients in Dessie Comprehensive Specialized Hospital in compression with respective controls. Methods Hospital-based comparative cross-sectional study design was implemented from June 25 to August 20, 2021. A total of 204 participants with an equal number of cases and controls (n = 102 each) were included. The data was collected through face-to-face interviews and biochemical analyses such as fasting blood glucose and lipid profiles were done through the enzymatic technique. The magnitude of metabolic syndrome was determined using both National Cholesterol Education Program Adult Treatment Panel III and International Diabetes Federation definition criteria. The STATA version 14 was used for statistical data analysis, and a comparison of categorical and continuous variables was done with χ2 and an independent t-test, respectively. The multivariable binary logistic regression analysis was used to identify factors associated with metabolic syndrome, and variables having a P-value of Result The prevalence of metabolic syndrome among the epileptic group was (25.5% in National Cholesterol Education Program Adult Treatment Panel III and 23.5% in International Diabetes Federation criteria), whereas it was 13.7% in National Cholesterol Education Program Adult Treatment Panel III and 14.7% in International Diabetes Federation criteria among control groups. According to the International Diabetes Federation criteria, low physical activity (adjusted odds ratio = 4.73, 95% CI: 1.08–20.68), taking multiple antiepileptic drugs (adjusted odds ratio = 8.08, 95% CI: 1.52–42.74), having a total cholesterol level of ≥ 200 mg/dl (adjusted odds ratio = 5.81, 95%: 1.32–41.13) and body mass index (adjusted odds ratio = 1.57, 95% CI = 1.16–2.11) were significantly associated with metabolic syndrome among epileptic participants. Applying National Cholesterol Education Program Adult Treatment Panel III criteria, taking multiple antiepileptic drugs (adjusted odds ratio = 6.81, 95% CI: 1.29–35.92), having a total cholesterol level > 200 mg/dl (adjusted odds ratio = 7.37, 95% CI: 1.32–41.13) and body mass index (adjusted odds ratio = 1.53, 96% CI: 1.16–2.01) were also significantly associated. Conclusion The prevalence of metabolic syndrome among epileptic patients was higher than that of control groups and reaches statistically significant by National Cholesterol Education Program Adult Treatment Panel III. Being on multiple antiepileptic drugs, body mass index, having low physical activity and raised total cholesterol were significantly associated with metabolic syndrome among the epileptic group. Therefore, it is better to focus on controlling weight, having sufficient physical exercise, and regular monitoring of total cholesterol levels in epileptic patients.

BackgroundGlobally, TB is the leading cause of infectious disease morbidity and mortality with many diagnostic uncertainties. Access to affordable and rapid diagnostics remained a major challenge for many developing countries which bear the greatest burden of TB delaying the initiation time to treatment.ObjectiveThis study aimed to assess the GeneXpert MTBRIF assay probe utility for the detection of pulmonary TB and Rifampicin-resistant TB cases in Addis Ababa, Ethiopia.Materials and methodsA cross-sectional study was performed from October 2019 to July 2020 in Saint Peter TB Specialized Hospital in Addis Ababa metropolitan area, Ethiopia. This study enrolled 216 clinically suspected new presumptive pulmonary TB cases confirmed by GeneXpert MTB/RIF Assay. Sociodemographic and clinical characteristics were captured using a structured tool. Data were entered in Microsoft Excel 2019, checked for inconsistency, cleaned promptly, and exported to IBM SPSS Statistics for Windows, Version 26.0. Armonk, N.Y: IBM Corp, the USA for analysis. Descriptive analysis and binary and multivariate logistics regression were performed and all statistical significance was determined at a 95% confidence level.ResultsThe majority of the study participants, 55.1% [119/216] were males aged 6-80 years. The prevalence of RR MTB was 11.11% [24/216]. A higher proportion of RR TB was found in female patients [54.2%, 13/24], in patients in the age group of 30-50 years [45.8%, 11/24], in married individuals [62.5%, 15/24], in persons whose residence is urban [79.2%, 19/24], in persons who had a previous history of TB symptoms [100%, 24/24], in persons who had a history of contact with active and LTBI [33.3%, 8/24], and in persons who had a history of HIV and IDUs [41.7%, 10/24]. Occupation (AOR 22.868, 95% CI 1.655-316.022, p = 0.019), history of previous PTB+ (AOR 4.222, 95% CI 1.020-17.47, p = 0.047), and history of HIV and IDUs (AOR 4.733, 95% CI 1.416-15.819, p = 0.012) were independent predictors associated with RR-TB emergence. The commonest mutation 62.5% [15/24] was found in probe E (codons 529-533) region. There was no mutation associated with probe A (codons 507-511), probe B (codons 511-518), and probe C (codons 518-523) regions, as well as no combination of missed probes, was revealed. However, 12.5% [3/24] of RR TB patients were found without unidentified missed probe types detected outside of the RRDR. The delta Ct max was >4.0 and the highest proportion of 35.6% [77/216] RR TB was detected in samples of medium DNA load.ConclusionThe proportion of RR-TB we observed in this study was high. Similarly, a higher proportion of RR TB was detected outside of the RRDR. Moreover, a significant number of the GeneXpert MTB/RIF Assay probes were identified as unhybridized and this critical observation would mean that most of the probes had no or minimal utility in this geographical region. This calls for further studies to uncover mutation in the rpoB gene conferring RR and reshape TB triage and definite diagnostic algorithm in Ethiopia.

A newborn has a limited capacity to maintain temperature when exposed to cold environment. Neonatal hypothermia, a common neonatal problem, carries high case fatality rate particularly if concurrently occurs with other neonatal problems. This study assessed neonatal thermal care practices and beliefs among rural women in west Guji Zone, south Ethiopia. A community based cross sectional quantitative study combined with qualitative study was undertaken in rural areas of west Guji Zone, Ethiopia. Randomly selected 388 rural mothers of infants less than 6 months old were participated in the quantitative study. Three focus group discussions were conducted among mothers of infants less than 6 months old. Quantitative data were collected by using structured and pretested Afaan Oromo version questionnaire adapted from relevant literatures. Qualitative data were collected by focus group discussion guide. The quantitative data were cleaned, coded and analyzed by SPSS version 20. Qualitative data were transcribed, translated, coded, and analyzed by thematic analysis approach. In general rural women believe that thermal protection of newborn is important. The findings show that approximately 75% and 85% of newborns were dried and wrapped respectively after delivery. However drying and wrapping of newborn are usually done after the first newborn’s bath. Just over 84% of newborns were bathed within the first 6 hours of delivery and majority of them were bathed with warm water. About 69.1% and 57.7% of women put head cover to their newborns immediately after birth, and initiated breast feeding within one hour of delivery respectively. Skin to skin care of newborn is non-existent in the study area and perceived as an odd, frightening and potentially dangerous practice. Studied women practice some of the recommended neonatal thermal cares and believe in their importance in keeping newborn warm. However, practice and beliefs about delayed first bath is against standard recommendation, whereas skin to skin care is non-existent and perceived as an odd practice. Interventions to familiarize skin to skin care and reduce misconceptions surrounding it should be introduced into the study area to improve thermal cares of high risk newborns.

BackgroundEthiopia aims to eliminate lymphatic filariasis by 2020, through a dual approach of mass drug administration to interrupt transmission and morbidity control which includes making hydrocele surgery available in all endemic areas. Locating patients requiring surgery, providing high quality surgeries, and following up patients are all formidable challenges for many resource-challenged or difficult-to-reach communities. To date, hydrocele surgery in Ethiopia has only occurred when a patient has the knowledge, time and resources to travel to regional hospitals. Ethiopia tested the novel approach of using a surgical camp, defined as mobilizing, transporting, providing surgery at a static site, and following up of a large cohort of hydrocele patients within a hospital's catchment area, to address delays in seeking and receiving care.Methodology and resultsHealth extension workers mobilized 252 patients with scrotal swelling from a list of 385 suspected hydrocele cases from seven endemic districts in the region of Beneshangul-Gumuz. Clinical health workers and surgeons confirmed 119 as eligible for surgery. Of 70 additional patients who self-referred, 56 were eligible for surgery. Over a two-week period at a regional hospital, 175 hydrocele excision surgeries were conducted. After discharge three days after surgery, trained clinical health workers followed up with the patients on Day 5, Day 8, Day 14 and 1st-month benchmarks with a randomized follow-up of a selection of patients conducted at 9-12 months. There were no post-operative complications upon discharge at Day 3 and 22, while minor complications occurred (12.6%) between Day 3 and one month. The 9-12 month follow-up found patients self-reported an improvement in quality of life, health and economic status.ConclusionA hydrocele surgery camp was effective at providing a large number of quality surgeries in a short time. Using peripheral health workers to mobilize and follow up patients helped address delays in seeking and receiving quality care. Mainstreaming patient mobilization and follow-up into a community health system could be effective in other countries. The camp's results also influenced two regions in Ethiopia to change their policies in order to offer free hydrocele surgery (including patient transport, consultation, surgery, diagnostic tests and necessary medications).