QuantiFERON-TB Gold In-Tube® (QFT-GIT) test is used for the diagnosis of latent tuberculosis (TB) infection. Besides, QFT-GIT test could allow tracking changes in immune response among TB patients and their contacts. In high TB burden settings, reports on QFT-GIT conversions and reversions among TB patients and their contacts are limited. As part of a major project to study immune responses to TB infection, we investigated QFT-GIT test conversions and reversions among smear positive pulmonary TB patients and their household contacts over 12 months.
We followed a total of 107 HIV negative participants (33 patients and 74 contacts) in Addis Ababa. We did QFT-GIT test at baseline and 12 months later according to the manufacturer’s instructions.
At baseline, 25/33 (75.8%) of the patients and 50/74 (67.6%) of the contacts were QFT-GIT positive. At 12 months, 2 more patients (1 test negative and 1 indeterminate) became test positive. Besides, 11/24 (45.8%) test negative contacts became positive. Only one patient and one contact who were test positive at baseline became test negative 12 months later. At 12 months, the proportions of QFT-GIT test positives for patients and contacts were, therefore, 78.8% and 81.1%, respectively. Among contacts, the proportion of QFT-GIT test positives at 12 months was significantly higher compared to the corresponding proportion at baseline (McNemar, p = 0.006); similarly, the median IFN-γ response significantly increased at 12 months compared with the baseline level (Wilcoxon matched-pairs signed rank test, p = 0.01). Patients, however, had comparable median IFN-γ levels at baseline and 12 months later (p = 0.56).
Nearly half of QFT-GIT negative household contacts at baseline became positive at 12 months. This suggests that repeated screening of QFT-GIT negative contacts may be needed for epidemiological studies and interventions of latent TB in an endemic setting. A large longitudinal study may be needed to confirm our observations.
Electronic supplementary material
The online version of this article (doi:10.1186/s12879-014-0654-5) contains supplementary material, which is available to authorized users.
Tuberculosis; QuantiFERON-TB-Gold In-Tube; Conversion; Reversion; Patients; Contacts; Ethiopia
The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia.
A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule.
We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.
Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.
Electronic supplementary material
The online version of this article (doi:10.1186/s12916-014-0138-x) contains supplementary material, which is available to authorized users.
Homelessness; Rooflessness; Mental illness; Severe mental disorder; Prevalence; Unmet needs; Low- and middle-income country; Ethiopia
Human immunodeficiency virus (HIV) epidemic among youth is largely ignored and remains invisible to both young people themselves and to the society as a whole. Thus, the aim of the study was to assess the extent of perception risk of HIV and utilization of voluntary counseling and testing (VCT) service among high school students at Debre-berhan Town, Amhara Regional State, Ethiopia.
A cross-sectional study was carried out from November 2010 up to January 2011 among secondary school students at Debre-berhan Town. Perception risk and VCT use were considered as dependant variables. A stratified random sampling technique was used to recruit study participants by taking schools as strata. Semi-structured self-administered questionnaire was used to collect the necessary data. Data was entered and analyzed using SPSS version 17.0. P-value < 0.05 was considered as statistically significant.
A total of 339 students were consented to participate in the study and the response rate was 96.3%. The student ages’ were ranged from 15 up to 24 years. Among the study participants, 30 (8.8%) had sexual contact and the mean age of first sexual encounter was 16.4 (SD =2.05) years. Of sexually active students, 12 (40%) had sex with different persons within the last 6 months, 13 (43.3%) had ever used condom and 15 (50%) had used VCT service. There was no statistically significant association between risk perception towards HIV infection and ever use of VCT service (AOR (95% CI) = 1.0(0.30, 4.02).
Some students were engaged in risky sexual behavior even though they had heard about HIV/AIDS. The perception of risk for acquisition of HIV infection and utilization of VCT were low. Thus, education on topic of HIV/AIDS through integrating as part of school curriculum and encouraging the existing health institutions to provide youth-friendly sexual counseling services including VCT for HIV are strongly recommended.
Students; Risk perception; VCT use; HIV; Debre-berhan; Ethiopia
Though tuberculosis (TB) is preventable and curable, its global burden remains enormous. Similarly, TB is one of the major public health problems in Ethiopia, particularly in geographically isolated areas like Shinile town. The people in Shinile town, Somali Regional State of Ethiopia, are underserved in all forms of health care and suffer from high burden of TB. Low level of knowledge about TB could affect the health-seeking behavior of patients and sustain the transmission of the disease within the community. Therefore, the current study was undertaken in Shinile town with the objective of assessing communities’ knowledge, attitude and practices towards TB.
Community-based cross-sectional survey, involving 410 randomly selected individuals, was conducted in Shinile town from January to May, 2013. Data were analyzed using STATA V.11. Logistic regression technique was used to determine the association between socio-demographic characteristics and communities’ knowledge of TB.
While 94.9% of the respondents said that they ever heard about TB, only 22.9% knew that TB is caused by bacteria. Eighty percent have awareness that TB can be transmitted from a patient to another person and 79.3% know that transmission of TB can be preventable. Persistence cough (72.4%) was the most commonly stated symptom of TB and modern drugs used in health institutions (68.1%) was the preferred choice of treatment. Two hundred and ninety one respondents (71.0%) said that they would seek treatment at health facility if they realized that they had symptoms related to TB. Two hundred and twenty seven respondents (55.4%) considered TB as a very serious disease and 284 (69.3%) would experience fear if they themselves had TB. Individuals with educational level of grade 8 up to grade 12 had increased odds of having good level of overall TB knowledge compared to illiterate individuals (OR = 2.3; 95% CI: 1.2 to 4.6).
The communities in Shinile town have basic awareness about TB which is not translated into the knowledge about the cause of the disease. Therefore, health education directed towards bringing a significant change in the knowledge of TB must be stepped-up within the TB control program.
Electronic supplementary material
The online version of this article (doi:10.1186/1471-2458-14-804) contains supplementary material, which is available to authorized users.
Tuberculosis; KAP; Shinile town
As part of a situational analysis for a research programme on the integration of mental health care into primary care (Programme for Improving Mental Health Care-PRIME), we conducted a baseline study aimed at determining the broad indicators of the population level of psychosocial distress in a predominantly rural community in Ethiopia.
The study was a population-based cross-sectional survey of 1497 adults selected through a multi-stage random sampling process. Population level psychosocial distress was evaluated by estimating the magnitude of common mental disorder symptoms (CMD; depressive, anxiety and somatic symptoms reaching the level of probable clinical significance), harmful use of alcohol, suicidality and psychosocial stressors experienced by the population.
The one-month prevalence of CMD at the mild, moderate and severe threshold levels was 13.8%, 9.0% and 5.1% respectively. The respective one-month prevalence of any suicidal ideation, persistent suicidal ideation and suicide attempt was 13.5%, 3.8% and 1.8%. Hazardous use of alcohol was identified in 22.4%, significantly higher among men (33.4%) compared to women (11.3%). Stressful life events were widespread, with 41.4% reporting at least one threatening life event in the preceding six months. A similar proportion reported poor social support (40.8%). Stressful life events, increasing age, marital loss and hazardous use of alcohol were associated with CMD while stressful life events, marital loss and lower educational status, and CMD were associated with suicidality. CMD was the strongest factor associated with suicidality [e.g., OR (95% CI) for severe CMD = 60.91 (28.01, 132.48)] and the strength of association increased with increase in the severity of the CMD.
Indicators of psychosocial distress are prevalent in this rural community. Contrary to former assumptions in the literature, social support systems seem relatively weak and stressful life events common. Interventions geared towards modifying general risk factors and broader strategies to promote mental wellbeing are required.
Common mental disorders; Psychosocial distress; Mental distress; Suicidality; Hazardous alcohol use; Wellbeing; Developing country; Africa South of the Sahara; Sub-Saharan Africa; Ethiopia
Depression is common among elderly in developed countries and it is more pronounced in institutional settings. In Pakistan there is a lack of empirical data on depression among this segment of the population particularly with reference to their living arrangements.
The objectives of the present study are to report the magnitude of depression among elderly having two different residential arrangements and to examine the association of depression and its established demographic factors.
Data were collected from 141 respondents. 108 were community residents (m = 57 and f = 51) and 33 were living in the care homes (m = 29 and f = 4).
Prevalence of depression as assessed by Geriatric Depression Scale (GDS) among community and Care Homes (CHs) participants was 31.5 percent and 60.6 percent, respectively.
On Centre of Epidemiological Studies Depression Scale (CES-D), 42.6 percent of the community and 69.7 percent of the CH respondents were deemed depressed. Before adjusting for any other potential risk factors the odds of being depressed was significantly increased if the study participants were living in CH, relatively older, female, not currently married, had low educational level, had lower Mini Mental State Examination (MMSE) scores, and reported lower perceived emotional and practical support. In a partially adjusted logistic regression model an increased risk of depression was not confounded by any of the above mentioned risk factors.
However, the risk associated was not significant when it was adjusted for social support.
The findings of the current study are consistent with previous research and throws light on the dire need for interventions to address mental health needs of Pakistani elderly.
Implications for improving the mental health status of elderly are also presented.
Elderly mental health; Social support; Living arrangement
Increased resistance by Plasmodium falciparum parasites led to the withdrawal of the antimalarial drugs chloroquine and sulphadoxine-pyrimethamine in Ethiopia. Since 2004 artemether-lumefantrine has served to treat uncomplicated P. falciparum malaria. However, increasing reports on delayed parasite clearance to artemisinin opens up a new challenge in anti-malarial therapy. With the complete withdrawal of CQ for the treatment of Plasmodium falciparum malaria, this study assessed the evolution of CQ resistance by investigating the prevalence of mutant alleles in the pfmdr1 and pfcrt genes in P. falciparum and pvmdr1 gene in Plasmodium vivax in Southern and Eastern Ethiopia.
Of the 1,416 febrile patients attending primary health facilities in Southern Ethiopia, 329 febrile patients positive for P. falciparum or P. vivax were recruited. Similarly of the 1,304 febrile patients from Eastern Ethiopia, 81 febrile patients positive for P. falciparum or P. vivax were included in the study. Of the 410 finger prick blood samples collected from malaria patients, we used direct sequencing to investigate the prevalence of mutations in pfcrt and pfmdr1. This included determining the gene copy number in pfmdr1 in 195 P. falciparum clinical isolates, and mutations in the pvmdr1 locus in 215 P. vivax clinical isolates.
The pfcrt K76 CQ-sensitive allele was observed in 84.1% of the investigated P.falciparum clinical isolates. The pfcrt double mutations (K76T and C72S) were observed less than 3%. The pfcrt SVMNT haplotype was also found to be present in clinical isolates from Ethiopia. The pfcrt CVMNK-sensitive haplotypes were frequently observed (95.9%). The pfmdr1 mutation N86Y was observed only in 14.9% compared to 85.1% of the clinical isolates that carried sensitive alleles. Also, the sensitive pfmdr1 Y184 allele was more common, in 94.9% of clinical isolates. None of the investigated P. falciparum clinical isolates carried S1034C, N1042D and D1246Y pfmdr1 polymorphisms. All investigated P. falciparum clinical isolates from Southern and Eastern Ethiopia carried only a single copy of the mutant pfmdr1 gene.
The study reports for the first time the return of chloroquine sensitive P. falciparum in Ethiopia. These findings support the rationale for the use of CQ-based combination drugs as a possible future alternative.
Malaria; Plasmodium falciparum; Plasmodium vivax; Ethiopia; pfcrt; pfmdr1; pvmdr1; pfmdr1 gene copy number
People with severe mental disorders (SMD) are at higher risk of suicide. However, research into suicide attempts and completed suicide in people with SMD in low- and middle-income countries is mostly limited to patients attending psychiatric facilities where selection bias is likely to be high.
A population-based cohort of 919 people with SMD from rural Ethiopia (who received standardized clinician diagnoses of schizophrenia (n = 358) major depressive disorder (n = 216) and bipolar I disorder (n = 345)) were followed up annually for an average of 10 years. The Longitudinal Interval Follow-up Evaluation chart was administered by psychiatrists and used to evaluate systematically suicidal behavior and risk factors, which may be amenable to intervention.
Over the follow-up period, the cumulative risk of suicide attempt was 26.3% for major depression, 23.8% for bipolar I disorder and 13.1% for schizophrenia, (p < 0.001). The overall incidence of completed suicide was 200.2/100,000 person-years (CI = 120.6, 312.5). Hanging was the most frequent method used (71.5%) for both attempters and completers. Most people who completed suicide were successful on the first attempt (84.2%), but the case-fatality rate for suicide attempt was 9.7%. In the adjusted logistic regression model, being currently married (Adjusted OR) =2.17, 95% CI = 1.21, 3.91), and having a diagnosis of bipolar I disorder (Adjusted OR = 2.59, 95% CI = 1.57, 4.26) or major depression (Adjusted OR = 2.71, 95% CI = 1.60, 4.58) were associated significantly with increased risk of suicide attempts.
In this sample of people with SMD from a rural setting, the rate of suicide was high. Initiatives to integrate mental health service into primary care need to focus on limiting access to suicide methods in people with SMD in addition to expanding access to mental health care.
Suicide; Schizophrenia; Major depression; Bipolar I disorder; Developing countries; sub-Saharan Africa; Ethiopia
To assess the knowledge of Abaye Deneba community members regarding intestinal parasites and prevalence of intestinal parasitic infections.
Knowledge about intestinal parasites was assessed by administering a questionnaire to 345 randomly selected household heads. Parasitological stool examination of 491 randomly selected individuals was done using the formol ether concentration technique.
Knowledge of the Abaye Deneba community about parasitic diseases such as schistosomiasis, amoebiasis, ascariasis and taeniasis was very low. However, 204 (59.3%) members correctly responded that the cause of giardiasis is related to contaminated water and 176 (51.2%) knew how to prevent it. In some cases, respondents did correctly identify causes, symptoms of intestinal parasite infection and ways to prevent it, but they did not accurately link it to the appropriate disease caused by the different intestinal parasite species. Among the 491 stool samples examined, 50.2% of study participants showed infection with at least one intestinal parasite. Schistosoma mansoni was the most prevalent (41.3%) followed by Trichuris trichiura(9.4%), Ascaris lumbricoides (8.4%), Taenia saginata (2.4%), Enterobius vermicularis (2.0%) and hookworm (0.4%). Prevalence of schistosomiasis was highest in men aged 15-24 years.
Intestinal parasitic infection is highly prevalent in communities of the Abaye Deneba area. Nevertheless, the knowledge of the community members about the parasite is less. Implementation of preventive chemotherapy, supplemented with health education, provision and use of sanitary facilities would be recommended to reduce morbidity and control transmission of intestinal parasites in this area.
Community awareness; Intestinal parasites; Prevalence; Ethiopia
Determining the variation of circulating cathodic antigen (CCA) in urine and egg counts variation in stool between days in Schistosoma mansoni (S. mansoni) infected individuals is vital to decide whether or not to rely on a single-sample test for diagnosis of Schistosomiasis. In this study, the magnitude of day-to-day variation in urine-CCA test scores and in faecal egg counts was evaluated in school children in Ethiopia.
A total of 620 school children (age 8 to 12 years) were examined for S. mansoni infection using double Kato-Katz and single urine-CCA cassette methods (batch 32727) on three consecutive days.
The prevalence of S. mansoni infection was 81.1% based on triple urine-CCA-cassette test and 53.1% based on six Kato-Katz thick smears. Among the study participants, 26.3% showed fluctuation in urine CCA and 32.4% showed fluctuation in egg output. Mean egg count as well as number of cases in each class of intensity and intensity of cassette band color varied over the three days of examination. Over 85% of the children that showed day-to-day variations in status of S. mansoni infection from negative to positive or vice versa by the Kato-Katz and the CCA methods had light intensity of infection. The fluctuation in both the CCA test scores and faecal egg count was not associated with age and sex.
The current study showed day-to-day variation in CCA and Kato-Katz test results of children infected with S. mansoni. This indicates the necessity of more than one urine or stool samples to be collected on different days for more reliable diagnosis of S. mansoni infection in low endemic areas.
Schistosoma mansoni; Urine-CCA cassette; Kato-Katz method; Variation; Ethiopia
The hypothesis that paracetamol, one of the most widely used medicines, may increase the risk of asthma and allergic disease is of obvious importance but prospective cohort data looking at dose and timing of exposure are lacking.
The aim of the study is to investigate the role of paracetamol use in early life on the prevalence and incidence of wheeze, eczema, rhinitis and allergic sensitization, prospectively over 5 years in an Ethiopian birth cohort.
In 2005/6 a birth cohort of 1006 newborns was established in Butajira, Ethiopia. Questionnaire data on allergic disease symptoms, paracetamol use and numerous potential confounders were collected at ages 1, 3 and 5, and allergen skin sensitivity measured at ages 3 and 5. Multivariate logistic regression was used to determine independent effects of paracetamol exposure on the incidence of each outcome between ages 3 and 5, and prevalence at age 5.
Paracetamol use in the first 3 years of life was reported in 60% of children and was associated with increased incidence of wheeze, eczema, rhinitis and allergic sensitisation between ages 3 and 5 which was statistically significant for wheeze and eczema. High exposure (reported use in the past month at age 1 and 3) was associated with a more than 3-fold increased risk of new onset wheeze (adjusted odds ratio (OR) 3.64; 95% confidence interval, 1.34 to 9.90) compared to never users. Use in the past year at age 3 but not age 1 was associated with ORs at least as large as those for use in first year of life only. Significant positive dose-response effects of early life use were seen in relation to the prevalence of all outcomes at age 5.
Use of paracetamol in early life is a strong risk factor for incident allergic disease in childhood.
Intestinal schistosomiasis, caused by digenetic trematodes of the genus Schistosoma, is the most prevalent water related disease that causes considerable morbidity and mortality. Although prevalence of Schistosoma mansoni infection has been reported for the present study area, earlier studies have not estimated intensity of infections in relation to periportal fibrosis, which would have been crucial for epidemiological and clinical evaluations. Hence, a community based cross sectional study was conducted from December 2011 to March 2012 to assess prevalence of infection and schistosomal periportal fibrosis in Waja-Timuga, northern Ethiopia.
In a cross sectional study involving 371 randomly selected individuals, fresh stool samples were collected and processed by the Kato-Katz method and examined microscopically. Ultrasonography was used to determine status of schistosomal periportal fibrosis and to detect hepatomegaly and/or splenomegaly. Serum was collected for assay of hepatic activity. Statistical analysis was performed using STATA 11 statistical soft ware. P-value <0.05 was reported as statistically significant.
The prevalence of S.mansoni infection was 73.9%, while the prevalence of schistosomal periportal fibrosis was 12.3% and mean intensity of infection was 234 eggs per gram of stool. Peak prevalence and intensity of S.mansoni infection was documented in the age range of 10–20 years. Among the study individuals, hepatomegaly was recorded in 3.7% and splenomegaly was recorded in 7.4% of the study individuals. Similarly, among the study individuals who had definite periportal fibrosis, 5.9% had elevated liver enzyme levels.
The high prevalence of Schistosoma mansoni infection and schistosomal periportal fibrosis observed in the study area calls for a periodic deworming program to reduce disease, morbidity and transmission. Preventive chemotherapy complemented with other control measures is highly required for sustainable control of schistosomiasis in the study area.
Schistosoma mansoni; Intensity; Periportal fibrosis; Waja-Timuga; Ethiopia
The African Program for Onchocerciasis Control (APOC) has been working with ultimate goal of reducing the public health and socio-economic problems associated with onchocerciasis within a period of 12–15 years. Although dedicated community engagement is crucial for the success of the program, there is little/no information on the levels of community’s knowledge, attitude and practice about onchocerciasis as well as about the ongoing control program in Ethiopia. In this study, we have assessed the level of knowledge, attitude and practice of Quara district residents about onchocerciasis and the current control strategies in the area.
This community-based cross-sectional study was conducted between October 2012 and January 2013 in Quara District, Amhara Regional State, North West of Ethiopia. The study participants were recruited from randomly selected kebeles (small administrative units) of the study area and were interviewed about onchocerciasis and about community directed treatment with ivermectin (CDTI) using structured questionnaire. The collected data were double entered into a data entry file using EpiData software, V.3.1. The data were transferred to SPSS soft-ware V.16 and analyzed according to the different variables.
Out of 418 respondents, 401 (95.9%) of the respondents have heard about onchocerciasis (locally known as ‘wara’) and 11.2% said that they knew about the etiology of the disease, which was named as filarial worm. However, 356 (88.8%) had at least one misconception about the causative agent of onchocerciasis. More than half (69.4%) knew that the transmission of the disease is related to black fly biting. Overall, 93.3% participants believed that onchocerciasis is preventable, of whom 49.5% indicated use of drug as the means of preventing the disease. Majority (95.5%) of the participants perceived CDTI as very useful program.
Although onchocerciasis is endemic disease in the study area, large proportion of the community had conspicuous misconceptions in all issues about its causation, transmission and preventive methods. This could affect the success of the CDTIP in the present study area. Therefore we recommend increasing the awareness about onchocerciasis in the area through community-based campaigns during drug distribution with especial focuses on females and age group less than 35 years”.
Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.
A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts.
The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care.
The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
With 75% of the Ethiopian population at risk of malaria, accurate diagnosis is crucial for malaria treatment in endemic areas where Plasmodium falciparum and Plasmodium vivax co-exist. The present study evaluated the performance of regular microscopy in accurate identification of Plasmodium spp. in febrile patients visiting health facilities in southern Ethiopia.
A cross-sectional study design was employed to recruit study subjects who were microscopically positive for malaria parasites and attending health facilities in southern Ethiopia between August and December 2011. Of the 1,416 febrile patients attending primary health facilities, 314 febrile patients, whose slides were positive for P. falciparum, P. vivax or mixed infections using microscopy, were re-evaluated for their infection status by PCR. Finger-prick blood samples were used for parasite genomic DNA extraction. Phylogenetic analyses were performed to reconstruct the distribution of different Plasmodium spp. across the three geographical areas.
Of the 314 patients with a positive thick blood smear, seven patients (2%) were negative for any of the Plasmodium spp. by nested PCR. Among 180 microscopically diagnosed P. falciparum cases, 111 (61.7%) were confirmed by PCR, 44 (24.4%) were confirmed as P. vivax, 18 (10%) had mixed infections with P. falciparum and P. vivax and two (1.1%) were mixed infections with P. falciparum and P. malariae and five (2.8%) were negative for any of the Plasmodium spp. Of 131 microscopically diagnosed P. vivax cases, 110 (84%) were confirmed as P. vivax, 14 (10.7%) were confirmed as P. falciparum, two (1.5%) were P. malariae, three (2.3%) with mixed infections with P. falciparum and P. vivax and two (1.5%) were negative for any of the Plasmodium spp. Plasmodium falciparum and P. vivax mixed infections were observed. Plasmodium malariae was detected as mono and mixed infections in four individuals.
False positivity, under-reporting of mixed infections and a significant number of species mismatch needs attention and should be improved for appropriate diagnosis. The detection of substantial number of false positive results by molecular methodologies may provide the accurate incidence of circulating Plasmodium species in the geographical region and has important repercussions in understanding malaria epidemiology and subsequent control.
Malaria; Plasmodium; Nested PCR; Microscopy; Ethiopia
Marital circumstances have been indicated to be a salient risk factor for disproportionately high prevalence of depression and anxiety among Pakistani women. Although social support is a known buffer of psychological distress, there is no clear evidence as to how different aspects of marital relations interact and associate with depression and anxiety in the lives of Pakistani married women and the role of social supports in the context of their marriage.
Two hundred seventy seven married women were recruited from Rawalpindi district of Pakistan using a door knocking approach to psychometrically evaluate five scales for use in the Pakistani context. A confirmatory factor analysis approach was used to investigate the underlying factor structure of Couple satisfaction Index (CSI-4), Locke-Wallace Marital Adjustment Test (LWMAT), Relationship Dynamic Scale (RDS), Multidimensional Scale for Perceived Social Support (MSPSS) and the Hospital Anxiety and Depression Scale (HADS). The interplay of the constructs underlying the three aspects of marital relations, and the role of social support on the mental health of married Pakistani women were examined using the Structural Equation Model.
The factor structures of MSPSS, CSI-4, LWMAT, RDS and HADS were similar to the findings reported in the developed and developing countries. Perceived higher social support reduces the likelihood of depression and anxiety by enhancing positive relationship as reflected by a low score on the relationship dynamics scale which decreases CMD symptoms. Moreover, perceived higher social support is positively associated with marital adjustment directly and indirectly through relationship dynamics which is associated with the reduced risk of depression through the increased level of reported marital satisfaction. Nuclear family structure, low level of education and higher socio-economic status were significantly associated with increased risk of mental illness among married women.
Findings of this study support the importance of considering elements of marital relationship: satisfaction, adjustment and negative interactions which can be prioritized to increase the efficiency of marital interventions. It also highlights the role of social support in the context of marital relationships among Pakistani women. Furthermore, the study presents the etiological models of depression and anxiety with reference to the above.
Marriage; Mental health; Social support; Scale validation
Schizophrenia is understood to be a heterogeneous brain condition with overlapping symptom dimensions. The negative symptom dimension, with its protean cognitive manifestations, responds poorly to treatment, which can be a particular challenge in countries where clozapine therapy is not available. Preliminary data indicate that minocycline may be beneficial adjunct in the treatment of schizophrenia: positive, negative, and cognitive symptoms.
In this study we aim to assess the efficacy of adjunctive minocycline to alleviate symptoms of schizophrenia in patients who have failed to respond to a therapeutic trial of antipsychotic medications.
The study is a parallel group, double-blind, randomized, placebo-controlled trial. Participants will be adults (aged 18 years and above) with first episode or relapse episode of schizophrenia of under 5 years’ duration. Patients who failed to show adequate therapeutic response to at least one antipsychotic medication given for a minimum of 4 weeks will be recruited from a psychiatry hospital in Addis Ababa and a psychiatry clinic in Butajira, Ethiopia. A total of 150 participants (75 in each arm) will be required to detect a five-point mean difference between the intervention arms adjusting for baseline symptom severity, at 90% power and 95% confidence. Patients in the intervention arm will receive minocycline (200 mg/day orally) added on to the regular antipsychotic medications participants are already on. Those in the placebo arm will receive an inactive compound identical in physical appearance to minocycline. Intervention will be offered for 12 weeks. Diagnosis will be established using the operational criteria for research (OPCRIT). Primary outcome measure will be a change in symptom severity measured using the positive and the negative syndrome scale for schizophrenia (PANSS). Secondary outcome measures will include changes in severity of negative symptoms, proportion achieving remission, and level of functioning. Whether changes are maintained post intervention will also be measured (PANSS). Key assessment for the primary outcome will be conducted at the end of trial (week 12). One post-intervention assessment will be conducted 4 weeks after the end of intervention (week 16) to determine sustainability of change.
Clinicaltrials.gov identifier: NCT01809158.
Minocycline; Schizophrenia; Intervention; Clinical trial; Ethiopia
Transmission of Mycobacterium tuberculosis (M. tuberculosis) complex could be possible between farmers and their cattle in Ethiopia.
A study was conducted in mixed type multi-purposes cattle raising region of Ethiopia on 287 households (146 households with case of pulmonary tuberculosis (TB) and 141 free of TB) and 287 herds consisting of 2,033 cattle belonging to these households to evaluate transmission of TB between cattle and farmers. Interview, bacteriological examinations and molecular typing were used for human subjects while comparative intradermal tuberculin (CIDT) test, post mortem and bacteriological examinations, and molecular typing were used for animal studies. Herd prevalence of CIDT reactors was 9.4% and was higher (p<0.01) in herds owned by households with TB than in herds owned by TB free households. Animal prevalence was 1.8% and also higher (p<0.01) in cattle owned by households with TB case than in those owned by TB free households. All mycobacteria (141) isolated from farmers were M. tuberculosis, while only five of the 16 isolates from cattle were members of the M. tuberculosis complex (MTC) while the remaining 11 were members of non-tuberculosis mycobacteria (NTM). Further speciation of the five MTC isolates showed that three of the isolates were M. bovis (strain SB1176), while the remaining two were M. tuberculosis strains (SIT149 and SIT53). Pathology scoring method described by “Vordermeier et al. (2002)” was applied and the average severity of pathology in two cattle infected with M. bovis, in 11 infected with NTM and two infected with M. tuberculosis were 5.5, 2.1 and 0.5, respectively.
The results showed that transmission of TB from farmers to cattle by the airborne route sensitizes the cows but rarely leads to TB. Similarly, low transmission of M. bovis between farmers and their cattle was found, suggesting requirement of ingestion of contaminated milk from cows with tuberculous mastitis.
The occurrence of antibiotic resistant Neisseria gonorrhoeae isolates is a serious public health problem in different corners of the globe. The objective of this study was to analyze the antimicrobial susceptibility pattern of N. gonorrhoeae in Northwest Ethiopia.
This was a retrospective study of N. gonorrhoeae isolated from genital swabs of patients referred to the Amhara Regional Health Research Laboratory between September 2006 and June 2012 in Bahir Dar, Ethiopia. A structured check list was used to collect socio-demographic and laboratory variables. Data were analyzed using SPSS software version 16.
Out of 352 genital specimens processed, 29 clinical strains of N. gonorrhoeae were identified. The percentage of N. gonorrhoeae isolates non-susceptible to ceftriaxone, ciprofloxacin, tetracycline and penicillin G was 27.8%, 40.9%, 92.6% and 94.4% respectively. Twenty percent of the isolates were found to be non-susceptible to both ceftriaxone and ciprofloxacin. Non-susceptibility to an injectable cephalosporin and any two of quinolones, penicillins or tetracyclines was observed in 27.8% of the isolates. The percentage of N. gonorrhoeae which were non-susceptible to tetracycline or penicillin G was high throughout the study period. However, the percentage of fluoroquinolone or cephalosporine non-susceptible strains showed an increasing trend.
A high percentage of N. gonorrhoeae isolated from genital specimens in Northwest Ethiopia are non-susceptible to an injectable cephalosporin and any two of quinolones, penicillins or tetracyclines. Treatment of gonorrhea in the study area needs to be guided by antibiotic susceptibility testing of isolates.
Non-susceptible; Neisseria gonorrhoeae; Ethiopia
Worldwide, there were 650,000 multidrug-resistant tuberculosis (MDR-TB) cases in 2010, and in 2008 the World Health Organization estimated that 150,000 deaths occurred annually due to MDR-TB. Ethiopia is 15th among the 27 MDR-TB high-burden countries. This study identifies factors associated with the occurrence of MDR-TB in patients who underwent first-line TB treatment in Addis Ababa City.
A case control study was conducted at St. Peter Hospital and five health centers in Addis Ababa from 1 November 2011 to February 30, 2012. Cases were MDR-TB patients who were confirmed with culture and drug-susceptibility testing and were in treatment at St. Peter Hospital during the study period. Controls were patients who were on first-line anti-TB treatment and were registered as cured or having completed treatment in the period 9 April 2009– 28 February 2010, in five health centers of Addis Ababa City. Accordingly, 134 cases and an equal number of controls were included in this study. A structured interview questionnaire was used to assess factors that could potentially be associated with the occurrence of MDR-TB.
Factors that were significantly associated with MDR-TB: drug side effects during first-line treatment (adjusted odds ratio (AOR): 4.5, 95% CI; 1.9 - 10.5); treatment not directly observed by a health worker (AOR = 11.7, 95% CI; 4–34.3); interruption of treatment of at least a day (AOR = 13.1, 95% CI 3.0-56.6); duration of treatment between 2 and 7 months (AOR = 14.8, 95% CI 2.3-96.4); and retreatment with the Category II regimen (P = 0.000). In the current study, HIV infection was not significantly associated with the occurrence of MDR-TB.
Patients who were not in strict DOTS programs and did not adhere to first-line TB treatment and patients who experienced side effects during first-line treatment and Category II retreatment were at significantly increased risk of developing MDR-TB. The DOTS program should, therefore, be strengthened to increase patient adherence. Drug-susceptibility testing is also highly recommended for all Category I treatment regimen failures before those patients begin the Category II regimen.
TB; MDR-TB; TB treatment; TB treatment regimens; Adherence to TB treatment; TB treatment failure; DOTS
Tuberculosis (TB) is one of the primary public health problems in developing countries. HIV/AIDS, poverty, undernutrition, over-crowded living conditions and lack of knowledge about the disease have been known to increase the risk of spreading the bacteria and the risk of developing the disease. The objective of this study was to assess the level of TB knowledge, attitudes and practices of rural communities of Itang Special District of the Gambella Regional State of Ethiopia.
Between November 2011 and January 2012, a community-based cross sectional study was carried out in a randomly selected rural kebeles (i.e. the smallest administrative units) of Itang communities. The study participants were interviewed using pre-tested questionnaire. The overall knowledge, attitudes and practices of the study participants were assessed using the mean score of each outcome as a cut-off value. Having a score above the mean on each of the three target outcomes was equated with having a good level of knowledge, or having favorable attitude and good practices towards TB.
Out of 422 study participants (58.5% males and 41.5% females) only 3.3% mentioned bacteria/germ as a cause of pulmonary TB (PTB) and 9.9% mentioned cough for at least two weeks as the sign of TB. Taking the mean knowledge score as the cut-off value, 57.6% (95% CI: 52.7% to 62.3%) of the study participants had good level of knowledge about TB, 40.8% (95% CI: 36.0% to 45.6%) had favorable attitude towards TB and 45.9% (95% CI: 41.1% to 50.9%) had good practices. Female participants were less likely to have good level of knowledge [adjusted odds ratio (AOR) = 0.33, 95% CI, 0.21 to 0.51, p < 0.001], less likely to have favorable attitude (AOR = 0.23, 95% CI, 0.14 to 0.37) and less likely to have good practices (AOR = 0.37, 95% CI, 0.24 to 0.57, p < 0.001) compared to male participants.
Majority of the study participants had no correct information about the causative agent of TB and the main symptom of PTB. Moreover, low level of overall knowledge, attitudes and practices about TB was associated with female participants. Hence, TB control strategy in the present study area should include community awareness raising component.
Toxoplasmosis is a globally distributed zoonosis. Consumption of raw or undercooked meat, which is among the main risk factors for acquiring human infection, is a popular tradition in Ethiopia. However, studies on toxoplasmosis in food animals used for human consumption in Ethiopia are very scarce. Thus, the objectives of the present study were to estimate the seroprevalence and the risk factors of T. gondii infection in sheep in Ambo, Ada’a-Liben and Fentale districts of Central Ethiopia. Sera from 1130 sheep were analyzed for Toxoplasma gondii specific IgG antibodies using an indirect enzyme linked immunosorbent assay (ELISA) with the P30 antigen. A questionnaire was administered to assess potential risk factors for T. gondii seropositivity. Association of seroprevalence with potential risk factors related to altitude, host and farm characteristics were analyzed by univariable and multivariable logistic regression.
Overall flock and animal level seroprevalences were 70.48% (160/227; 95% CI: 64.51, 76.46) and 31.59% (357/1130; 95% CI: 28.88, 34.31), respectively. The multivariable logistic regression model indicated that the probability of acquiring T. gondii was higher in sheep from highland (2300 – 3200 meters above sea level) [Odds ratio (OR) = 4.11, 95% confidence interval (CI): 2.65, 6.36; P < 0.001] and midland (OR = 4.54, 95% CI: 2.76, 7.49; P < 0.001) than from lowland (<1500 meters above sea level), in females than in males (OR = 1.60, 95% CI: 1.04, 2.43, P = 0.033), in adult than in young animals (OR = 2.93, 95% CI: 1.97, 4.35, P < 0.001), in small than in large flocks (OR = 3.34, 95% CI: 1.26, 8.86, P = 0.016), and in sheep that were given tap water (OR = 4.07, 95% CI: 1.07, 15.42, P = 0.039) and river water (OR = 4.18, 95% CI: 1.54, 11.35, P = 0.005) than in those that drunk water from mixed sources (i.e., river, well, lake and pond).
The high flock and animal level seroprevalence of toxoplasmosis in sheep is a good marker of the potential risk for human infections. Altitude, sex, age, flock size and source of water were identified as important risk factors to acquire the infection. Public education and awareness training are imperative in order to alleviate the danger posed to consumers. Further detailed studies to assess the impact of infections are warranted.
Toxoplasma gondii; Sheep; Central Ethiopia; ELISA; Seroprevalence
Toxoplasma gondii infections during pregnancy can result in abortion or congenital defects. Prevalence and risk factors of toxoplasmosis in women of child-bearing age in Ethiopia are unknown. The current study was conducted with the objectives of estimating the seroprevalence and potential risk factors in acquiring T. gondii infection by women of child-bearing age in Central Ethiopia.
A cross-sectional study was conducted from March 2011 to September 2011. Sera of 425 women were analyzed by indirect enzyme linked immunosorbent assay (ELISA). A questionnaire survey was administered for all study participants to gather information on risk factors.
The study revealed that anti- T. gondii IgG antibodies were detected in 81.4% of the samples of which 78.4% were positive for only IgG and 3.06% positive for both IgG and IgM antibodies. Seroprevalence of IgM antibodies to T. gondii (4.0%, 95% CI: 2.14, 5.86) was suggestive of recent infections. Of the 213 pregnant women 9 (4.2 %) were IgM reactive. Out of 17 potential risk factors investigated, univariate logistic regression showed significant association of T. gondii infection with study area, age, pregnancy status, raw vegetable consumption, source of water, presence of cats at home, contact with cats, HIV status and precaution during cats’ feces cleaning (P ≤ 0.05). The final logistic regression model revealed that: the probability of acquiring T. gondii infection by women of Debre-Zeit was 4.46 times (95% CI of adjusted odds ratio [aOR]: 1.67, 11.89; P =0.003) higher compared to women of Ambo, pregnant women were twice (95% CI aOR: 1.13, 3.59; P = 0.018) more likely to be seropositive than non-pregnant women and women who consume raw vegetable were at increased risk of infection (aOR = 2.21, 95% CI: 1.03, 4.78; P = 0.043) than women who didn’t consume.
The seroprevalence of T. gondii infection in women of child-bearing age in Central Ethiopia is high. Study area, pregnancy and raw vegetable consumption are risk factors to acquire T. gondii infection. Educational program, antenatal screening of pregnant women and further epidemiological studies to uncover the economic and health impact of toxoplasmosis are suggested.
Toxoplasma gondii; Seroprevalence; Cross-sectional; Risk factors; Central Ethiopia; ELISA
The effects of helminth co-infection on malaria in humans remain uncertain. This study aimed to evaluate the nature of association of intestinal helminths with prevalence and clinical outcomes of Plasmodium infection.
A cross-sectional study involving 1,065 malaria suspected febrile patients was conducted at Dore Bafeno Health Center, Southern Ethiopia, from December 2010 to February 2011. Plasmodium and intestinal helminth infections were diagnosed using Giemsa-stained blood films and Kato-Katz technique, respectively. Haemoglobin level was determined using a haemocue machine.
Among 1,065 malaria suspected febrile patients, 28.8% were positive for Plasmodium parasites (P. falciparum =13.0%, P. vivax =14.5%, P. falciparum and P. vivax =1.3%). Among 702 patients who provided stool samples, 53.8%, 31.6% and 19.4% were infected with intestinal helminths, Plasmodium alone and with both Plasmodium and intestinal helminths, respectively. The prevalence of infections with Ascaris lumbricoides (A. lumbricoides), Trichuris trichiura (T. trichiura), Schistosoma mansoni (S. mansoni) and hookworm (9.8%) were 35.9%, 15.8%, 11.7% and 9.8%, respectively. Out of the 222 (31.6%) Plasmodium infected cases, 9 (4.1%) had severe malaria. P. falciparum infection was more common in febrile patients infected with A. lumbricoides alone (21.3%), T. trichiura alone (23.1%) and S. mansoni alone (23.1%) compared to those without intestinal helminth infections (9.3%) (p<0.001 for all). Prevalence of non-severe malaria was significantly higher in individuals infected with intestinal helminths than in those who were not infected with intestinal helminths (adjusted OR=1.58, 95% CI=1.13-2.22). The chance of developing non-severe P. falciparum malaria were 2.6, 2.8 and 3.3 times higher in individuals infected with A. lumbricoides alone, T. trichiura alone and S. mansoni alone, respectively, compared to intestinal helminth-free individuals (p<0.05 for all). The odds ratio for being infected with non-severe P. falciparum increased with the number of intestinal helminth species (p<0.001). Mean Plasmodium density among intestinal helminth infected individuals was significantly increased with the number of intestinal helminths species (p=0.027). Individuals who were co-infected with different species of intestinal helminths and Plasmodium showed lower mean haemoglobin concentration than individuals who were infected only with Plasmodium.
Infections with A. lumbricoides, T. trichiura and S. mansoni were positively associated with P. falciparum infection. However, further studies are required to investigate how these helminths could contribute to increased prevalence of P. falciparum infection.
Non-severe malaria; Association; Intestinal helminths; Plasmodium; Co-infections; Ethiopia
One third of the world’s population is thought to have latent tuberculosis infection (LTBI) with the potential for subsequent reactivation of disease. To better characterize this important population, studies comparing Tuberculin Skin Test (TST) and the new interferon-γ release assays including QuantiFERON®-TB Gold In-Tube (QFT-GIT) have been conducted in different parts of the world, but most of these have been in countries with a low incidence of tuberculosis (TB). The aim of this study was therefore to evaluate the use of QFT-GIT assay as compared with TST in the diagnosis of LTBI in Ethiopia, a country with a high burden of TB and routine BCG vaccination at birth.
Healthy medical and paramedical male students at the Faculty of Medicine, Addis Ababa University, Ethiopia were enrolled into the study from December 2008 to February 2009. The TST and QFTG-IT assay were performed using standard methods.
The mean age of the study participants was 20.9 years. From a total of 107 study participants, 46.7% (95%CI: 37.0% to 56.6%) had a positive TST result (TST≥10 mm), 43.9% (95%CI: 34.3% to 53.9%) had a positive QFT-GIT assay result and 44.9% (95%CI: 35.2% to 54.8%) had BCG scar. There was strong agreement between TST (TST ≥10mm) and QFT-GIT assay (Kappa = 0.83, p value = 0.000).
The TST and QFT-GIT assay show similar efficacy for the diagnosis of LTBI in healthy young adults residing in Ethiopia, a country with high TB incidence.
Tuberculosis; Latent; BCG; Tuberculin skin test; Interferon-γ release assay; Ethiopia