Enteric pathogens and antimicrobial susceptibility profile among pediatric patients with diarrhea in Addis Ababa, Ethiopia

Background: Diarrheal disease remain a major public health problem in developing countries including Ethiopia. The current study was designed to isolate medically important bacterial enteric pathogens and assess the antimicrobial susceptibility pattern for prescribed drugs. Methods: A cross-sectional study was performed between November 2016 and May 2017 to determine bacterial enteric pathogens that cause diarrhea and assess their antimicrobial susceptibility profile. Stool specimens from pediatric patients aged 0-14 years were collected from two health centers and one specialized hospital to identify bacterial enteric pathogens. Antimicrobial susceptibility tests were performed on bacterial isolates using the Kirby-Bauer disc diffusion method. Results: Out of 290 study patients with diarrhea examined, the majority of bacterial enteropahogens isolated in the study were Shigella species 22(7.6%) followed by enterohemorrgic E.coli O157:H7 13(4.5%) and Salmonella species 7(2.4%). Among the Salmonella species 42.9% showed resistance to trimethoprim-sulphamethoxazole. Among the Shigella species, 77.3% were resistant to ampicillin and 68.2% to trimethoprim-sulphamethoxazole whereas E.coli O157:H7 strains were resistant mostly to ampicillin (69.2%), and trimethoprim-sulphamethoxazole (46.1%). The overall prevalence of multi-drug resistance (MDR) (to ≥3 classes of antibiotics) among the isolates was 26.2%. Conclusion: Salmonella species, enterohemorrhagic E.coli O157:H7and Shigella species were the most frequently isolated pathogens in children with diarrhea. A high proportion of the Salmonella and Shigella isolates identified in the study showed resistance to the most frequently prescribed drugs ampicillin and trimethoprim-sulphamethoxazole. Ciprofloxacin was found to be the best drug of choice for the treatment of diarrhea caused by Salmonella and Shigella. When antibiotics are indicated to treat diarrhea in children, clinicians should rely on stool culture and antimicrobial susceptibility testing before prescribing drugs

Seroprevalence of Hepatitis B virus infection and associated factors among mothers in gondar, North-West Ethiopia: a population based study

Background: Hepatitis B virus (HBV) is the main cause of serious liver infection. Factors that increase the risk of HBV infection include contact during child birth and different horizontal means of transmission, such as unprotected sexual exposure with an infected person and having direct contact with the blood of an infected person. Objectives: The main aim of this study is to determine seroprevalence of HBV infection and associated risk factors among mothers in Gondar, Northwest Ethiopia. Methods: A community based cross-sectional study was conducted on mothers in Gondar from March to November 2016. Study participants were selected using a multistage cluster random sampling technique and a total of 419 mothers were included. Sociodemographic data and exposure to associated factors (hospital admission, history of circumcision, history of contact with jaundiced family and history of abortion) were collected through a structured questionnaire. Five milliliters of blood were collected from each study participant. Serum level hepatitis B surface antigen (HBsAg) and anti-HBc were detected using sandwich and indirect ELISA, respectively. The data were entered with Epi Info 7 and analyzed using SPSS version 20. To declare the presence of association, odds ratio with 95% confidence interval and p-value <0.05 were considered statistically significant. Result: A total of 419 mothers with the median age of 29 (20-58) years old were enrolled. The sero-prevalence of HBsAg and anti-HBc was 3.8% and 36.0%, respectively. Statistically significant association with HBV infection was observed for age (AOR= 6.960, 96% CI, 2.047-23.659, P= 0.002), history of hospital admission (AOR= 3.279, 95% CI, 1.054-10.195, P= 0.04), history of circumcision (AOR= 4.394, 95% CI, 1.463-13.198, P= 0.008), history of contact with jaundiced family (AOR= 3.877, 95% CI, 1.274-11.795, P= 0.017) and history of abortion (AOR= 4.867, 95% CI, 1.438-16.473, P= 0.011). Conclusions and recommendations: An intermediate seroprevalence of HBV infection, which is an important public health problem in the area, was detected. Therefore, implementing strategies for routine screening and care of mothers for hepatitis B virus would be important. Further, health education on modes of transmission and precautions and immunization of HBV has to be strengthened

Prevalence and associated risk factors of Hepatitis B and C virus infections among mothers in Jimma, South West Ethiopia: a community-based study

Background: Viral hepatitis affects over 400 million people globally with 6 to 10 million people newly infected each year. Viral hepatitis infectious agents such as hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the greatest threats to the liver and can cause liver cancer. One of the most important modes of transmission of these viruses is a vertical transmission from mother to child. The aim of this study is to assess the prevalence of HBV and HCV infection as well as its associated risk factors among mothers in Jimma. Methods: A community-based cross-sectional study was conducted among 455 mothers in Jimma from June to December 2016. Simple random sampling was employed to recruit study participants and informed consent was obtained. From each mother, about 5ml of blood was collected and tested for HBsAg, anti-HBc, and HCVAg/Ab using ELISA. Chi-square and logistic regression tests were used to assess statistically significant associations between dependent and independent variables. P-values less than 0.05 were considered statistically significant. Result: HBsAg, anti-HBc and HCVAg/Ab prevalence was 5.7%, 30.5% and 2.5%, respectively. Multivariate logis-ic regression analysis showed that history of hospital admission (AOR = 3.098; P <0.040) and abortion (AOR = 15.514, P <0.001) remained independent predictors of HBsAg seropositivity. Conclusion: Hospital admission and abortion are the major risk factors for hepatitis B and C virus infection among mothers. Awareness creation for adult HBV vaccine and health education on modes of transmission should be promoted and strengthened

Seroprevalence of Hepatitis B virus surface antigen, anti-hepatitis C virus antibody and their associated factors among mothers living in Harar, Eastern Ethiopia

Background: Hepatitis B virus (HBV) and Hepatitis C Virus (HCV) infections are major causes of acute and chronic liver disease and infection by these viruses during pregnancy is associated with maternal, fetal and neonatal health complications. Understanding the epidemiology of these viruses could be valuable to take appropriate preventive measures. Objective: This study aims to determine the seroprevalence and associated factors of HBV and HCV infection among mothers living in Harar, Ethiopia. Materials and Methods: A cross-sectional study was conducted among 461 mothers living in Harar, Eastern Ethiopia from March 1 ­May 30, 2017. The systematic random sampling method was used to select the study participants. Sociodemographic information was collected through face-to-face interviews using pretested structured questionnaires. Five millilitres of venous blood was collected from each study subject and HBsAg and anti-HCV levels in sera were tested using a sandwich third generation Enzyme-Linked Immunosorbent Assay (ELISA). Data was analysed by using Statistical Package for Social Sciences (SPSS) version 20. Result: The seroprevalence rates for HBV and HCV infection were 5.9% and 1.1%, respectively. None of the mothers were co-infected with HBV and HCV. Among the potential risk factors, previous history of abortion (AOR =3.7 95%, CI 1.4-9.6) and multiple sexual exposures (AOR =10.6, 95% CI 4.0-27.9) were significant predictors of HBV infection. Conclusion: This study determined that the prevalence of HBV and HCV infection among mothers was 5.9% and 1.1% respectively. History of abortion and history of multiple sexual partners were significantly associated with HBV infection. Health education programs on the mode of HBV and HCV transmission, high-risk behaviours and methods of preventions are recommended to raise awareness and reduce the spread of infection

Determining seroprevalence of Hepatitis B and C virus infections and associated risk factors among apparently healthy mothers in Addis Ababa, Ethiopia

Introduction: Viral hepatitis is a global public health problem affecting millions of people every year, causing disability and death. Hepatitis B (HBV) and hepatitis C (HCV) viruses spread horizontally, mainly through sexual contact and contaminated needles, and vertically. Both cause considerable morbidity and mortality worldwide. Maternal infection is a risk factor for vertical transmission. Objective: To determine the sero-prevalence of HBsAg and anti-HCV antibody among non-pregnant, apparently healthy mothers and to identify potential risk factors associated with HBV or HCV infection. Methods: A community based cross sectional study was conducted on 454 apparently healthy women, in Addis Ababa, Ethiopia from May 2016 to June 2017. A systematic random sampling method was used to recruit participants. Result: A total of 454 mothers were enrolled. Sero-prevalence of HBsAg and HCV was found to be 3.7% and 2.0%, respectively. HBc antibody was detected in 36.3% of the mothers. None of the participants were co-infected with both viruses. Previous history of liver disease, history of jaundice, HIV infection, and family history of liver disease were significantly associated with HBV infection. Marital status, caring for hepatitis patients, and a history of liver disease were factors significantly associated with HCV infection. Conclusion: Apparently healthy mothers in Addis Ababa had intermediate level of endemicity for hepatitis B and C infections Routine screening and vaccination of high risk reproductive mothers against HBV is advisable. Emphasis should be given to health education and promotion of infection control practices. Population based studies are strongly recommended to help monitor disease transmission patterns and to design evidence-based interventions against the spread of hepatitis infections in Ethiopia

Immune protection of Hepatitis B vaccine among children living in gondar, Northwest Ethiopia

Background: Hepatitis B virus infection is a worldwide health problem and highly endemic in developing countries including Ethiopia. Hepatitis B vaccine is included in the routine Expanded Program on Immunization since 2007 in Ethiopia. Objective: The aim of this study is to assess the seroprotection level of hepatitis B vaccination among children who have received the vaccine. Methods: A cross-sectional study was conducted on children attending kindergarten and elementary school in Gondar. A pretested structured questionnaire was used to collect the sociodemographic data. Blood samples were collected and serum separated to measure anti-HBs, anti-HBc, and HBsAg levels. Data were analyzed using SPSS statistical software version 21. Binary logistic regression analysis was done. P-value less than 0.05 was considered as statistically significant. Results: Out of 431 children screened, 27 were excluded from analysis because they were positive for anti-HBc (27/431, 6.3%) and/or for HBsAg (18/431 or 4.2%). Out of the rest 404 children, 130 (32.2%) had anti-HBs titers >10 mIU/ml (seroprotected), while 274 (68.8%) had anti-HBs titers <10 mIU/ml (non-protected). Among 130 sero-protected children, 99 (76.2%) were hypo-responders (antibody titer 10-100 mIU/ml) and 31 (23.8%) were good responders (antibody titer >100 mIU/ml). In multivariate analysis, children of age 6 and 8 years old were 2.4 times (AOR: 2.436, 95% CI 1.049-5.654) (P=0.038) and 3.3 times (AOR: 3.397, 95% CI1.306-8.837) (p=0.012) better responders compared to 9 years old children, respectively. Moreover, children whose mothers had no previous history of hepatitis were 2.0 times (AOR: 2.009, 95% CI 1.101-3.665) (P= 0.023) better responders compared to their counterparts. Conclusion: The seroprotection level among vaccinated children in Gondar was surprisingly low. Age and children from mothers with a history of hepatitis B infection were associated with seroprotection. The preliminary findings obtained in this study call for a thorough assessment of the effectiveness of the current hepatitis B vaccination program in this study region

Seroprevalence of Hepatitis B virus infection and seroprotection of Hepatitis B vaccine among children in Jimma Town, South-West Ethiopia

Background: Hepatitis B virus is the leading cause of viral hepatitis and about 240 million people worldwide are chronic carriers. The virus is reported to be widely prevalent in Ethiopia and routine vaccination of children has been initiated in the country recently. We assessed the seroprevalence of HBV infection and seroprotection of HBV vaccine among children in Jimma. Methods: A community-based cross-sectional study was conducted among 900 children who were 5-9 years of age between June and December 2016. A simple random sampling technique was employed to recruit study participants by proportional allocation into different Kebeles of Jimma. Data were collected using pretested questionnaire.3-5ml of blood sample was collected from each child and it was tested for HBsAg, anti-HBc, and anti-HBs using ELISA (Bio-rad, Monolisa, Lacquote, France). Data were analyzed using chi-square and logistic regression analysis. Result: HBsAg and anti-HBc prevalence among all participants was 3.5% and 3.8%, respectively. The prevalence of HBsAg among vaccinated and non-vaccinated children was 2.1% and 7.0% whereas anti-HBc positivity was 1.1% and 6.2%, respectively. It was also found that 58.4% of vaccinated children maintained a protective level of HB surface antibodies which is defined as ≥ 10 mIU/ml anti-HBs. While 1.8%(4/222) vaccinated children with protective anti-HBs levels were positive for hepatitis B core antibody, none of the vaccinated children with non-protective anti-HBs levels were positive for hepatitis B core antibody. Multi-variable logistic regression revealed that lack of vaccination (AOR =2.788, P < 0.029), children who were born at home (AOR= 3.211, P < 0.009), and children who had a history of hospital admission (AOR= 7.122, P <0.001) were more likely to be HBV surface antigen positive. Conclusion: The seroprevalence of hepatitis B infection is high among children who have not received HBV vaccination. Hepatitis B vaccine has contributed to the reduction of the infection in this endemic area, though further efforts are required to improve timely vaccination and its coverage. The prevalence of protective anti-HBs is low among fully vaccinated children, hence, it is better to include the monovalent birth dose of the vaccine and conduct further studies to evaluate underlining causes for the waning of serum anti-HBs level

Serum level of anti-hepatitis B surface antigen and hbv associated factors among vaccinated and unvaccinated children in Harar, Eastern Ethiopia: a community - based study

Background: Hepatitis B virus infection is a major global health problem which is known to be the main cause of liver failure, cirrhosis, and hepatocellular carcinoma. Production of anti-HBs which is stimulated by HBV vaccine, provides protection against HBV infection. However, not all vaccinated children develop protective or durable levels of antibody against HBsAg. Therefore, testing for anti-HBs levels after HBV vaccination is important. Objective: The main objective of this study was to assess serum level of antibody against hepatitis B surface antigen among vaccinated and unvaccinated children in Harar, Eastern Ethiopia. Method: A community-based comparative cross-sectional study design was used. 540 children within the ages of 5-8 years (284 vaccinated and 256 unvaccinated) were enrolled in the study using simple random sampling in selected kebeles. Three to five milliliters of blood was collected from each study participant. Serum was separated and anti-HBsAg level was determined using ELISA. A pretested, structured questionnaire was used to collect socio-demographic and HBV associated factors exposure information of the study participants and their parents. Data entry and statistical analysis were done using SPSS statistical software version 21. Logistic regressions with 95% CI were used to identify independent predictors of anti-HBs. A p-value of less than 0.05 was considered statistically significant. Results: The overall seroprotection rate detected in this study was 95.4% among vaccinated children, whereas it was only 6.2% among unvaccinated children. 3.1% of unvaccinated children were positive for HBsAg, indicating chronic disease, whereas 1.1% of vaccinated children were HBsAg+. Anti-HBs levels declined from 414 U/ml at 5 years after vaccination to 105 U/ml after 8 years. Conclusion and Recommendation: Protective levels of anti-HBs were detected in 95.4% of vaccinated children suggesting that there is no need for a further booster dose for these children

Antibody response against Hepatitis B virus after vaccination and seroprevalence of HBV in children in Addis Ababa, Ethiopia

Background: Around two billion people have been infected with HBV worldwide, and more than 240 million are chronic carriers. Vaccine introduction for HBV in children was officially launched by the WHO in 1980. Since then the vaccine response level has been determined in different countries. Since the introduction of the vaccine in Ethiopia in 2007, few studies have been conducted to assess the antibody response against the HBV vaccine. Objectives: The aim of this study is to determine antibody response against HBV after hepatitis B vaccination and assess the seroprevalence of HBV in children in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted using a multistage probability sampling technique. Four hundred and fifty children between the ages of 5 and 8 living in Addis Ababa were enrolled. Socio-demographic characteristics were obtained through a structured questionnaire and three to four ml of blood was collected from each child. ELISA was performed to determine antibody levels against HBV. Results:The mean age was 7+1 (SD) years. Anti-HBs were detected in 54.3% (208/450) of children with a slightly higher proportion of protective level in females 98 (54.7%) than males 110 (53.9%). The overall vaccine coverage in our study was 85.1 %. The proportion of children with a protective level (>10 mIU/ml anti-HBs antibody) declined as the age of the child increased: 52.6%, 60%, 43.5% and 37.1% at the age of 5, 6, 7 and 8 years, respectively. Seroprevalence of HBsAg was 0.4%, whereas seroprevalence of anti-HBc was 5.6%. Age was negatively correlated with the response level (p=0.001), whereas sex and history of HBV infection had no significant association. Age was also significantly associated with seroprevalence of anti-HBc (p=0.003). Conclusion: The HBV vaccine coverage in children was high but antibody response against the vaccine appears low. Seroprevalence of the virus was also low. The low response level to the vaccine should be a concern and revaccination or booster doses should be considered for non-responding children. Further studies should also be undertaken