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1.  Helminths and malaria co-infections are associated with elevated serum IgE 
Parasites & Vectors  2014;7:240.
Background
Both helminth and malaria infections result in a highly polarized immune response characterized by IgE production. This study aimed to investigate the total serum IgE profile in vivo as a measure of Th2 immune response in malaria patients with and without helminth co-infection.
Methods
A cross sectional observational study composed of microscopically confirmed malaria positive (N = 197) and malaria negative (N = 216) apparently healthy controls with and without helminth infection was conducted at Wondo Genet Health Center, Southern Ethiopia. A pre-designed structured format was utilized to collect socio-demographic and clinical data of the subjects. Detection and quantification of helminths, malaria parasites and determination of serum IgE levels were carried out following standard procedures.
Results
Irrespective of helminth infection, individuals infected by malaria showed significantly high levels of serum IgE compared with malaria free apparently healthy controls (with and without helminth infections). Moreover, malaria patients co-infected with intestinal helminths showed high level of serum IgE compared with those malaria patients without intestinal helminths (2198 IU/ml versus 1668 IU/ml). A strong statistically significant association was observed between malaria parasite density and elevated serum IgE levels (2047 IU/ml versus 1778 IU/ml; P = 0.001) with high and low parasitaemia (parasite density >50,000 parasite/μl of blood), respectively. Likewise, helminth egg loads were significantly associated with elevated serum IgE levels (P = 0.003).
Conclusions
The elevated serum IgE response in malaria patients irrespective of helminth infection and its correlation with malaria parasite density and helminth egg intensity support that malaria infection is also a strong driver of IgE production as compared to helminths.
doi:10.1186/1756-3305-7-240
PMCID: PMC4063426  PMID: 24886689
Helminths; Malaria; Th2; IgE; Ethiopia
2.  Seroprevalence and trend of Helicobacter pylori infection in Gondar University Hospital among dyspeptic patients, Gondar, North West Ethiopia 
BMC Research Notes  2013;6:346.
Background
The growing attention given to H. pylori is not surprising since this pathogen colonizes more than at least half of the world’s inhabitants. In Ethiopia particularly in Gondar, there is no current study conducted about seroprevalence and trend of the prevalence of H. pylori. Therefore the aim of this study was to determine the seroprevalence and its trend of the H. pylori in three consecutive years in North Gondar, North West Ethiopia.
Findings
Retrospective study was conducted using data collected from log book of serology laboratory of Gondar University Hospital. We collected data from January 2009 to December 2011 and 1388 subjects were included whose data were registered completely.
Among all of the study subjects, 912 (65.7%) were found to be seropositive. The prevalence in male was 449/679 (66.1%) and in females it was 463/709 (65.3%). The prevalence of H.pylori infection was significantly higher (77.0%) in patients whose age is greater than 60 years and the lowest positive age group was between 0–20 in which only 59.1% were positive (X2 =14.15,p=0.0146). The seroprevalence was 86.5% in 2009 and it decreased to 51.8% in 2010. But the seroprevalence increased to 61.3% in 2011.
Conclusion
This study showed high seroprevalence of H .pylori among the dyspeptic patients in GUH. The trend of the seroprevalence was varied from year to year in the three consecutive years. In general it showed that the seroprevalence has started increasing.
doi:10.1186/1756-0500-6-346
PMCID: PMC3765695  PMID: 24229376
H. pylori; Dyspeptic patients; Seroprevalence
3.  Epidemiological and clinical correlates of malaria-helminth co-infections in southern Ethiopia 
Malaria Journal  2013;12:227.
Background
In many areas of the world, including Ethiopia, malaria and helminths are co-endemic, therefore, co-infections are common. However, little is known how concurrent infections affect the epidemiology and/or pathogenesis of each other. Therefore, this study was conducted to assess the effects of intestinal helminth infections on the epidemiology and clinical patterns of malaria in southern Ethiopia where both infections are prevalent.
Methods
A cross-sectional study was conducted in 2006 at Wondo Genet Health Center and Bussa Clinic, southern Ethiopia. Consecutive blood film positive malaria patients (N=230) and malaria negative asymptomatic individuals (N=233) were recruited. Malaria parasite detection and quantification was diagnosed using Giemsa-stained thick and thin blood films, respectively. Helminths were detected using direct microscopy and formol-ether concentration techniques. Coarse quantification of helminths ova was made using Kato Katz method.
Results
The over all magnitude of intestinal parasitic infection was high irrespective of malaria infection (67% among malaria positive patients versus 53.1% among malaria non-infected asymptomatic individuals). Trichuris trichiura infection was associated with increased malaria prevalence while increased worm burden of helminths as expressed by egg intensity was associated with increased malaria parasitaemia which could be a potential factor for development of severe malarial infection with the course of the disease. Majority (77%) of the subjects had multiple helminths infection. T. trichiura, Ascaris lumbricoides, Schistosoma mansoni, and hookworm infestation accounted for 64.5, 57.7 %, 28.4%, and 12.2% of the infections, respectively.
Conclusions
Populations in malaria-endemic areas of southern Ethiopia are multi-parasitized with up to four helminths. Mass deworming may be a simple practical approach in endemic areas in reducing the risk of severe malarial attack particularly for those at high risk of both infections.
doi:10.1186/1475-2875-12-227
PMCID: PMC3706225  PMID: 23822192
Malaria; Helminthic infections; Co-infection; Ethiopia
4.  Sexually transmitted infections based on the syndromic approach in Gondar town, northwest Ethiopia: a retrospective study 
BMC Public Health  2013;13:143.
Background
Sexually transmitted infections are among the most common causes of illnesses in the world and have far reaching health, social and economic consequences. They are important because of their magnitude, potential complications and interactions with HIV/AIDS. Though the problem may be generally similar to other developing countries, there is scarce information on the incidence and prevalence of sexually transmitted infections in Ethiopia. This study was then aimed to determine the magnitude of sexually transmitted infections among patients visiting a clinic in Gondar town, Northwest Ethiopia.
Methods
Medical records of patients who visited the clinic from January 2011 to December 2011 were reviewed. Sociodemographic and clinical data were extracted using data extraction form. The data were entered and analyzed using SPSS version 16 statistical package. Descriptive statistics and Chi-square tests were carried out.
Results
A total of 1071 clients visited the clinic during the study period. Among these, 383 (35.8%) had complained symptoms of sexually transmitted infections. The mean (SD) age of the patients was 26.8 ± 7.4 years. The commonest chief complaints were vaginal discharge (38.4%) and urethral discharge (13.6%). Seventy seven percent of the cases did not bring their sexual partners for treatment.
Conclusion
There was a high magnitude of STIs in the clinic according to the syndromic approach. However, the actual prevalence of STIs and the associated factors in the community need to be determined through further studies. The results of this study also urge the need for evaluation of the syndromic approach and test for antimicrobial resistance.
doi:10.1186/1471-2458-13-143
PMCID: PMC3586370  PMID: 23414518
Sexually transmitted infections; Syndromic approach; Ethiopia
5.  Frequent detection of ‘azole’ resistant Candida species among late presenting AIDS patients in northwest Ethiopia 
Background
The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia.
Methods
Two hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method.
Results
The colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent.
Conclusion
HIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs.
doi:10.1186/1471-2334-13-82
PMCID: PMC3577436  PMID: 23398783
Candida species diversity; In vitro susceptibility; Late presenters; Northwest Ethiopia
6.  Epidemiology of intestinal schistosomiasis and soil transmitted helminthiasis among primary school children in Gorgora, Northwest Ethiopia 
Objective
To assess the prevalence and intensity of intestinal schistosomiasis and soil transmitted helminthiasis among primary school children in Gorgora, Northwest Ethiopia.
Methods
A cross-sectional epidemiological study was carried out in Gorgora primary school in Northwest Ethiopia from November to December 2010. Stool sample was collected from 326 children (170 male and 156 female) and examined by Kato-Katz technique for intestinal schistosomiasis and soil transmitted helminth infection.
Results
A total of 120 children (56 males and 64 females) were positive for single or multiple parasitic infection. Four helminth parasite species were identified and the most prevalent was Ascaris lumbricoides (A. lumbricoides) (16.60%), followed by Schistosoma mansoni (S. mansoni) (10.10%), hookworm (5.50%) and Trichuris trichiura (T. trichiura) (4.60%). Furthermore, 1.84%, 2.76% and 2.45% of the study participants were co-infected with Hookworm & A. lumbricoides, A. lumbricoides & S. mansoni and A. lumbricoides & T. trichiura, respectively.
Conclusions
The high prevalence of intestinal schistosomiasis and soil-transmitted helminthiasis observed in the study area shows the need of integrated control programme including periodic deworming, improving sanitation and access to clean water, appropriate health education and environmental measures to have a lasting impact on transmission.
doi:10.1016/S2222-1808(13)60013-4
PMCID: PMC4027258
Ethiopia; Intestinal schistosomiasis; Prevalence
7.  Nutritional status, intestinal parasite infection and allergy among school children in Northwest Ethiopia 
BMC Pediatrics  2013;13:7.
Background
Parasitic infections have been shown to have deleterious effects on host nutritional status. In addition, although helmintic infection can modulate the host inflammatory response directed against the parasite, a causal association between helminths and allergy remains uncertain. The present study was therefore designed to evaluate the relationship between nutritional status, parasite infection and prevalence of allergy among school children.
Methods
A cross sectional study was performed involving school children in two elementary schools in Gondar, Ethiopia. Nutritional status of these children was determined using anthropometric parameters (weight-for-age, height-for-age and BMI-for-age). Epi-Info software was used to calculate z-scores. Stool samples were examined using standard parasitological procedures. The serum IgE levels were quantified by total IgE ELISA kit following the manufacturer’s instruction.
Result
A total of 405 children (with mean age of 12.09.1 ± 2.54 years) completed a self-administered allergy questionnaire and provided stool samples for analysis. Overall prevalence of underweight, stunting and thinness/wasting was 15.1%, 25.2%, 8.9%, respectively. Of the total, 22.7% were found to be positive for intestinal parasites. The most prevalent intestinal parasite detected was Ascaris lumbricoides (31/405, 7.6%). There was no statistically significant association between prevalence of malnutrition and the prevalence of parasitic infections. Median total serum IgE level was 344 IU/ml (IQR 117–2076, n = 80) and 610 IU/ml (143–1833, n = 20), respectively, in children without and with intestinal parasite infection (Z = −0.198, P > 0.8). The prevalence of self reported allergy among the subset was 8%. IgE concentration was not associated either with the presence of parasitic infection or history of allergy.
Conclusion
The prevalence of malnutrition, intestinal parasitism and allergy was not negligible in this population. In addition, there was no significant association between the prevalence of allergy and their nutritional status, and parasite infection. Further research prospective observational and intervention studies are required to address the question of causality between nutritional factors, parasites, and allergy.
doi:10.1186/1471-2431-13-7
PMCID: PMC3565883  PMID: 23311926
Nutritional status; Parasite infection; Allergy; Ethiopia
8.  Prevalence of smear positive pulmonary tuberculosis among prisoners in North Gondar Zone Prison, northwest Ethiopia 
BMC Infectious Diseases  2012;12:352.
Background
People concentrated in congregated systems, such as prisons, are important but often neglected reservoirs for TB transmission, and threaten those in the outside community. Therefore, this study was conducted to determine the prevalence of tuberculosis in a prison system of North Gondar Zone.
Methods
An active case-finding survey in North Gondar Prison was carried out from March to May 2011. All prison inmates who had history of cough for at least a week were included in the study. Three morning sputum samples were collected from suspected inmates and examined through fluorescence microscopy. Fine needle aspiration cytology was done for those having significant lymphadenopathy. Pre and post HIV test counseling was provided after written consent. Binary logistic and multivariable analysis was performed using SPSS version 16.
Results
A total of 250 prisoners were included in the survey. Among these, 26 (10.4%) prisoners were found to have TB giving a point prevalence of 1482.3 per 100,000 populations of smear positive TB among the TB suspects. All the inmates who participated in the study volunteered for HIV testing and a total of 19(7.6%) inmates were found to be reactive for the HIV antibody test amongst of which 9(47.4%) had TB co-infection. The prevalence of HIV infection in the TB infected inmates was found to be 34.6% (9/26). From the 26 TB cases identified 12 (46.2%) were having under nutrition (BMI < 18.5kg/m2).
Conclusions
There is high prevalence of TB in North Gondar Prison with possible active transmission of TB within the prison. There was a high prevalence of HIV among the TB suspects. Strong cooperation between prison authorities and the national tuberculosis control programmes is urgently required to develop locally appropriate interventions to reduce transmission. The determinants for poor nutrition in the prison need also further investigation.
doi:10.1186/1471-2334-12-352
PMCID: PMC3531261  PMID: 23241368
Prison; Tuberculosis; TB/HIV co-infection; Ethiopia
9.  Micronutrient levels and nutritional status of school children living in Northwest Ethiopia 
Nutrition Journal  2012;11:108.
Background
Several micronutrients are essential for adequate growth of children. However, little information is available on multiple micronutrient status of school children in Ethiopia. The present study was designed to evaluate the relationship between multiple micronutrient levels and nutritional status among school children.
Method
In this cross-sectional study, anthropometric data, blood and stool samples were collected from 100 children at Meseret Elementary School in Gondar town, Northwest Ethiopia. Serum concentration of magnesium, calcium, iron, copper, zinc, selenium and molybdenum were measured by inductively coupled plasma mass spectrometer. Anthropometric indices of weight-for-age, height-for-age and BMI-for-age were used to estimate the children's nutritional status. Stool samples were examined by standard microscopic methods for intestinal parasites.
Results
The prevalence of stunting, underweight, wasting and intestinal parasitoses among school children was 23%, 21%, 11% and18%, respectively. The mean serum levels of magnesium, calcium, iron, copper, zinc, selenium and molybdenum were 2.42±0.32 (mg/dl), 15.31±2.14 (mg/dl), 328.19±148.91 (μg/dl), 191.30±50.17 (μg/dl), 86.40±42.40 (μg/dl), 6.32±2.59 (μg/dl), and 0.23±0.15 (μg/dl), respectively. Selenium deficiency, zinc deficiency and magnesium deficiency occurred in 62%, 47%, and 2% of the school children, respectively. Height-for-age showed significant positive correlation with the levels of copper and molybdenum (p = 0.01) and with the levels of magnesium (p = 0.05).
Conclusion
Deficiencies of selenium and zinc were high among the school children although the deficiencies were not significantly related with their nutritional status. The prevalence of both malnutrition and intestinal parasitism was not negligible. These calls for the need to undertake multicentre studies in various parts of the country to substantiate the data obtained in the present study so that appropriate and beneficial strategies for micronutrient supplementation and interventions on nutritional deficiencies can be planned.
doi:10.1186/1475-2891-11-108
PMCID: PMC3574837  PMID: 23237638
School children; Nutritional status; Micronutrients; Gondar; Ethiopia
10.  Effect of emergency oral contraceptive use on condom utilization and sexual risk taking behaviours among university students, Northwest Ethiopia: a cross-sectional study 
BMC Research Notes  2012;5:501.
Background
Young people between the ages of 15 and 24 years are both the most at risk of HIV and the greatest hope for turning the tide against HIV/AIDS. Although various surveys have been done on sexual behaviour of youth in Ethiopia, studies assessing the effect of emergency oral contraceptives on condom utilization of university students are lacking.
Methods
A cross-sectional study was conducted in two major universities of Ethiopia from January to May 2011 using structured self administered questionnaire with the aim to assess the effect of introducing oral emergency contraceptive pills on condom utilization and sexual risk taking behaviours among female university students. Study participants were selected by simple random sampling using the list from the associate registrars of each University. Data were entered, cleaned and analyzed using SPSS version 17.0. Bivariate and multiple logistic regression analyses were used to determine factors associated with condom utilization.
Results
a total of 623 students out of 660 were included giving response rate of 94.4%. A total of 103(16.5%) had history of sexual intercourse and nearly half (45.6%) of them had sex before the age of 20 years. Forty (6.4%) students had history of sexually transmitted infections (STI). Sixty seven percent of students had heard about emergency oral contraceptives. One hundred and ninety one (45.7%) of students believe that EOC is effective in preventing pregnancy. Believing that EOC is effective in preventing pregnancy (adjusted Odds ratio, AOR = 0.22 95% CI 0.06, 0.87), condom prevents STI (AOR = 10.37, 95% CI 1.73, 62.24) and younger age below 20 years (AOR = 11.68 95% CI 1.25, 109.19) were statistically significantly associated with condom use.
Conclusion
a significant number of students had history of sexual intercourse and used emergency contraception. The belief in the effectiveness of EOC negatively affects condom use. The preference for the pill may make teenagers less prepared to practice STI protective behaviours in specific situations. Therefore, there is an urgent need to educate young people in universities about reproductive health and family planning and skills on how to prevent HIV/STIs including unwanted pregnancy.
doi:10.1186/1756-0500-5-501
PMCID: PMC3494538  PMID: 22971668
University students; Emergency contraceptive; Risky sexual behaviour; Condom use; Northwest Ethiopia
11.  Nutritional status and dietary intake of urban residents in Gondar, Northwest Ethiopia 
BMC Public Health  2012;12:752.
Background
There is paucity of data on the dietary intake and nutritional status of urban Ethiopians which necessitates comprehensive nutritional assessments. Therefore, the present study was aimed at evaluating the dietary intake and nutritional status of urban residents in Northwest Ethiopia.
Methods
This cross-sectional community based nutrition survey was conducted by involving 356 participants (71.3% female and 28.7% male with mean age of 37.3 years). Subjects were selected by random sampling. Socio demographic data was collected by questionnaire. Height, weight, hip circumference and waist circumference were measured following standard procedures. Dietary intake was assessed by a food frequency questionnaire and 24-h dietary recall. The recommended dietary allowance was taken as the cut-off point for the assessment of the adequacy of individual nutrient intake.
Results
Undernourished, overweight and obese subjects composed 12.9%, 21.3% and 5.9% of the participants, respectively. Men were taller, heavier and had higher waist to hip ratio compared to women (P < 0.05). Fish, fruits and vegetables were consumed less frequently or never at all by a large proportion of the subjects. Oil and butter were eaten daily by most of the participants. Mean energy intakes fell below the estimated energy requirements in women (1929 vs 2031 kcal/day, P = 0.05) while it was significantly higher in men participants (3001 vs 2510 kcal/day, P = 0.007). Protein intake was inadequate (<0.8 g/kg/day) in 11.2% of the participants whereas only 2.8% reported carbohydrate intake below the recommended dietary allowances (130 g/day). Inadequate intakes of calcium, retinol, thiamin, riboflavin, niacin and ascorbic acid were seen in 90.4%, 100%, 73%, 92.4%, 86.2% and 95.5% of the participants.
Conclusions
The overall risk of nutritional inadequacy among the study participants was high along with their poor dietary intake. Hence, more stress should be made on planning and implementing nutritional programmes in urban settings aimed at preventing or correcting micronutrient and some macronutrient deficiencies which may be useful in preventing nutrition related diseases in life.
doi:10.1186/1471-2458-12-752
PMCID: PMC3490783  PMID: 22958394
Urban Ethiopia; Dietary intake; Nutritional status
12.  Comparison of CareStart™ HRP2/pLDH COMBO rapid malaria test with light microscopy in north-west Ethiopia 
Malaria Journal  2012;11:234.
Background
In Ethiopia, light microscopy is the gold standard for malaria diagnosis although it is not available in most peripheral health facilities. It is time consuming, requires trained personnel and needs careful preparation and application of reagents to ensure quality results. This study was aimed at testing the diagnostic performance of CareStart™ malaria rapid diagnostic test (RDT) with reference to light microscopy for the diagnosis of falciparum and vivax malaria in Ethiopia.
Methods
Blood samples were collected from 254 patients suspected to have malaria at Kola Diba Health Center in the late malaria transmission peak season from November 2011 to December 2011. The samples were examined immediately by light microscopy and the RDT (CareStart™ Malaria HRP2/pLDH COMBO Test kit). Statistical analysis was performed using SPSS version 16 and the JavaStat two-way contingency table analysis.
Results
The overall sensitivity and specificity of CareStartTM RDT was found to be 95% (90–97.9%, 95% CI) and 94.2% (90.9–96%, 95% CI), respectively. The sensitivity of the CareStartTM RDT for Plasmodium falciparum or mixed infection was calculated to be 92.9% (82.5–98%, 95%CI) while a sensitivity of 90.9% (74.1–98.4%, 95%CI) was found for non-falciparum species. The specificity for P. falciparum or mixed infections was found to be 95.4% (92.5–96.8%, 95%CI) while it was 97.3% (94.8–98.4%, 95%CI) for non-falciparum species. There was an excellent agreement between the two tests with a kappa value of 0.918.
Conclusion
The CareStartTM RDT test showed good sensitivity and specificity with an excellent agreement to the reference light microscopy. The RDT could therefore be used in place of light microscopy, which in poor set-ups cannot be used routinely.
doi:10.1186/1475-2875-11-234
PMCID: PMC3411439  PMID: 22818643
CareStart™; Light microscopy; Malaria; Rapid diagnostic test; Ethiopia
13.  Seroprevalence of hepatitis B and C viruses among medical waste handlers at Gondar town Health institutions, Northwest Ethiopia 
BMC Research Notes  2012;5:55.
Background
Viral hepatitis is an inflammation of the liver due to viral infections and there are groups of viruses that affects the liver of which hepatitis B and C viruses are the causative agents of sever form of liver disease with high rate of mortality. Medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions are at risk of exposure to acquire those infections which transmit mainly as a result of contaminated blood and other body fluids including injury with sharp instruments, splash to the eye or mucous membrane. This study aimed to determine the prevalence of hepatitis B and/or C viruses and associated risk factors among medical waste handlers.
Results
A cross-sectional study was conducted from April, 2011 to June, 2011 in government health institutions at Gondar town. Socio-demographic and possible risk factors data from medical waste handlers were collected using pre-tested and well structured questionnaires. Venous bloods were collected and the serums were tested for hepatitis B surface antigen and anti-hepatitis C antibody using rapid Immunochromatography assay. Data was entered and analyzed using SPSS software package (version16). Chi-square and Fisher exact tests were used to assess risk of association. A p-value of < 0.05 was considered statistical significance.
A total of 100 medical waste handlers and 100 non-clinical waste handlers were examined for HBV and HCV viruses. HBV was detected in 6 (6.0%) and 1 (1.0%) and HCV in 1 (1.0%) and 0 (0.0%) of medical waste handlers and non-clinical waste handlers, respectively. Significant differences were observed in the detection rates of HBV (OR = 6.3; X2 = 4.1; P = 0.04) and overall infection rate (HBV + HCV) (OR = 7.5; X2 = 5.2; P: 0.02) in medical waste handlers when compared with non-clinical waste handlers. It was found that none of the observed risk factors significantly associated with rate of hepatitis infection compared to others.
Conclusions
Prevalence of HBV and HCV were significantly higher in medical waste in relation to non-clinical waste handlers. There were poor waste management system which contributed for occurrence of higher degree of sharps injury and blood and body fluids splash.
doi:10.1186/1756-0500-5-55
PMCID: PMC3274440  PMID: 22264306
Medical waste handlers; Hepatitis B virus; Hepatitis C virus; Gondar Ethiopia

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