Comparison of malaria diagnostic methods for detection of asymptomatic Plasmodium infections among pregnant women in northwest Ethiopia.

BACKGROUND: Malaria in pregnancy remains a major public health problem in the globe, especially in sub-Saharan Africa. In malaria endemic areas, most pregnant women remain asymptomatic, but malaria could still cause complications on the mother and her offspring; as well as serve as reservoirs to transmit infection. Despite these effects, no attention is given to the diagnosis of asymptomatic Plasmodium infections (APIs) using highly sensitive and specific laboratory diagnostic tools in Ethiopia. Therefore, the goal of this study was to compare the performance of Rapid Diagnostic Test (RDT), microscopy and real-time polymerase chain reaction (RT-PCR) to detect APIs among pregnant women. METHODS: A health facility based cross -sectional study was conducted among pregnant women attending antenatal care at Fendeka town health facilities Jawi district, northwest Ethiopia from February to March, 2019. A total of 166 participants were enrolled by using convenient sampling technique. Socio-demographic features were collected using a semi structured questionnaire. Dried blood spot (DBS) samples were collected for molecular analysis. Asymptomatic Plasmodium infection on pregnant women was diagnosed using RDT, microscopy and RT-PCR. Descriptive statistics were used to determine the prevalence of APIs. Method comparison was performed, and Cohen's kappa coefficient (k) was used to determine the degree of agreement among the diagnostic methods. Parasite densities were also calculated. RESULTS: The prevalence of API was 9.6%, 11.4% and 18.7% using RDT, microscopy and RT-PCR, respectively. The overall proportion of API was 19.3%. Sensitivity of the RDT was 83.3% as compared with microscopy. Rapid Diagnostic Test and microscopy also showed sensitivity of 50% and 60%, respectively, as compared with RT-PCR. The mean parasite density was 3213 parasites/µl for P falciparum and 1140 parasites/µl of blood for P. vivax. CONCLUSION: Prevalence of API in the study area was high. Both RDT and microscopy had lower sensitivity when compared with RT-PCR. Therefore, routine laboratory diagnosis of API among pregnant women should be given attention and done with better sensitive and specific laboratory diagnostic tools.

A 10-Year Trend Analysis of Intestinal Parasitic Infections at Grarigy Health Center, Northwest Ethiopia: Implication for Epidemic Preparedness.

Background: Intestinal parasitic infections (IPI) are one of the most significant health issues around the world. Their burden is significant in Ethiopia with an estimated five million cases reported annually. This study aimed to evaluate the 10-year trend of IPIs at the Grarigy Health Center in northwest Ethiopia. Methods: A retrospective analysis was done at Grarigy Health Center to determine the 10-year (2011-2020) trend of IPIs by reviewing stool examination reports from a laboratory logbook. The data was collected by laboratory personnel using data extraction sheets. Then, entered into EpiData, cleaned and analyzed using SPSS-20 software. The chi-square test was used to test for significant differences between variables. Results: A total of 9541 stool samples were examined over a 10-year period, of which, 5599 (58.7%) were from male participants and 3942 (41.3%) were from female participants. Participants in the study had an average age of 26.11 years. Infection with intestinal parasites was seen in 58.8% of people (n = 5612) (CI: 57.8-59.8). A significant fluctuating pattern of IPIs was observed from 2011 to 2020 (P < 0.05). The highest peak of IPIs was recorded in 2020 (61.9%; 767 cases) and the lowest peak was observed in 2011 (49%; 99 cases). A total of 10 different genera of intestinal parasites were reported, of which, A. lumbricoides was the predominant (23.5%) followed by E. histolytica/dispar (16.6%). The highest cases of all intestinal parasites were reported between the ages of 5 and 14 years except H. nana (highest case reported in < 5 years). Conclusion: Prevalence of IPIs is substantial at the Grarigy Health Centre. A fluctuating trend was noticed in the past 10 years. A surveillance system should be in place to bring the burden of IPI down to a level where it has no public health effect.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Can Predict the Severity in COVID-19 Patients from Ethiopia: A Retrospective Study.

Background: Coronaviruses are a broad family of pathogens that can cause mild to severe respiratory illnesses. Due to a strong inflammatory response and a weak immunological response, viral pneumonia inflammation, like Coronavirus Disease 2019 (COVID-19), displays an unbalanced immune response. Therefore, circulating biomarkers of inflammation and the immune system can serve as reliable predictors of a patient's prognosis for COVID-19. Hematological ratios are reliable markers of inflammation that are frequently utilized in pneumonia, primarily in viral infections with low cost in developing countries. Purpose: To examine the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in predicting the severity of COVID-19 patients. Methods: An institutional-based retrospective study was done on 105 hospitalized COVID-19 patients at the University of Gondar comprehensive specialized referral hospital, Northwest Ethiopia. The laboratory evaluations that were gathered, evaluated, and reported on included the total leucocyte count (TLC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), NLR, LMR, and PLR. The Kruskal-Wallis test and Wilcoxon matched-pairs signed test were used to see whether there were any differences between the continuous variables. Receiver operating curve (ROC) analysis was used to determine the appropriate cut-off values for NLR, PLR, and LMR. P-value <0.05 was considered a statistically significant association. Results: ANC, NLR, and PLR were highest in the critical group (p = 0.001), while this group had the least ALC and LMR (p = 0.001). We calculated the optimal cut-off values of the hematological ratios; NLR (8.4), LMR (1.4), and PLR (18.0). NLR had the highest specificity and sensitivity, at 83.8% and 80.4%, respectively. Conclusion: Our research showed that NLR and PLR were good indicators of severity in COVID-19. However, our findings indicate that MLR is not a reliable predictor.

A Retrospective Analysis of Malaria Trends in Maksegnit Health Center over the Last Seven Years, Northwest Ethiopia: 2014-2020.

Background: In Ethiopia, despite various public health intervention approaches have been implemented to eliminate malaria, its public health problem remains considerable. There are such numerous studies; however, investigating the trend of malaria infection in various settings is paramount for area-specific evidence-based interventions, evaluating ongoing malaria control programs. Hence, since the trend of malaria infection in Maksegnit has not yet been documented, this study is aimed at assessing the seven-year trend of malaria in Maksegnit Health Center. Methods: An institutional-based retrospective study was conducted to assess the trend of malaria prevalence over the last seven years (2014-2020) using recorded blood smear reports in the laboratory logbook in Maksegnit Health Center, Northwest Ethiopia. Result: Over the last seven years, a total of 28217 clinically malaria-suspected individuals were requested for blood film examination at Maksegnit Health Center. Of whom, microscopically confirmed malaria case was found in 4641/28217 (16.4%). A significant seasonal and interannual variation of malaria cases was observed (P < 0.001). The highest prevalence was observed in years 2014 (25.5%) and 2020 (25.1%), while the minimum annual prevalence was seen in 2017/18 (6.4%). The month of October (25.5%) had the highest number of malaria cases documented, while February had the least (4.7%). Males and individuals under the age group of 15-45 were the most affected segments of the population. A significant interannual fluctuating prevalence of malaria cases was recorded ranging from 25.5% to 6.4% (P < 0.001). Conclusion: Malaria is still a public health threat in the study area despite significant fluctuating patterns of malaria was observed in the last seven years. In particular, a bounced back trend of malaria from 2018 to 2020 is alarming. Thus, the implementation of ongoing intervention approaches should be reconsidered, and uninterrupted efforts of the concerned bodies are still needed.

Intestinal Parasitosis and its Association with CD4+ T Cell Count and Viral Load among People Living with HIV in Parasite Endemic Settings of Northwest Ethiopia.

PURPOSE: To study intestinal parasitosis and its association with viral load and CD4+ T cell count in HIV-infected individuals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS: A cross-sectional study was conducted from March to June 2019. Three hundred and sixteen study participants were selected using systematic random sampling technique. Sociodemographic and clinical data were collected using structured questionnaire. Stool samples were collected and examined using direct saline, formol ether concentration technique and modified acid fast staining. CD4+ T cell counts and viral load were determined by fluorescence-activated cell sorting (BD FACS) and COBAS Ampliprep/COBAS TaqMan HI2CAP assay, respectively. Data were entered into Epi Data 3.1 and transferred to SPSS version 20 software for analysis. Bivariable and multivariable analyses were performed using a binary logistic regression model. P values of less than 0.05 were considered statistically significant. RESULTS: The overall prevalence of intestinal parasitosis was 24.7% (78/316). The most commonly detected parasite was Cryptosporidium species with 5.4% (17/316), followed by Ascaris lumbricoides with 5.1% (16/316). There was a significant association with low CD4+ T cell count (AOR: 3.207; 95% CI: 1.237, 8.317), high viral load (AOR: 2.933; 95% CI: 1.326, 6.489), individuals aged 31-40 years (AOR: 0.305; 95% CI: 0.124, 0.751) and individuals aged 41-50 years (AOR: 0.261; 95% CI: 0.101, 0.671). CONCLUSION: In this study, prevalence of intestinal parasitic infections was high and was associated with low CD4+ T cell count and high viral load. Therefore, screening of HIV patients, especially those with low CD4+ T-cell count and high viral load, particularly for opportunistic intestinal parasitic infections would be of utmost importance in the efforts to prevent and control opportunistic infections in HIV patients.

Praziquantel is an effective drug for the treatment of Schistosoma Mansoni infection among school-aged children in Northwest Ethiopia.

BACKGROUND: The appropriate drug for the treatment of schistosomiasis is praziquantel. However, low cure rate and existence of drug resistance both in vivo and in vitro were reported in different endemic areas. Hence, the aim of this study was to evaluate the effectiveness of praziquantel for Schistosoma mansoni (S. mansoni) treatment. METHODS: A cross-sectional study was conducted in Sanja General Primary School, North Gondar Zone, Amhara region, Northwest of Ethiopia, from March to April, 2017. A total of 245 participants were selected using systematic random sampling. A stool specimen was collected from each participant and examined for S. mansoni ova load count using Kato-Katz technique. Two hundred four infected participants were treated with a single oral dose of praziquantel 40 mg/kg. Four weeks later post-treatment, stool specimens were collected from 176 study participants. The samples were collected using similar procedures like the pre-treatment phase to see egg reduction and cure status. Data were entered and analyzed using SPSS version 20.0 Pearson chi-square (χ 2) was used to determine the association of effectiveness of the drug with the average egg count, age group, and sex. P value ≤ 0.05 at 95% CI was considered statistically significant. RESULTS: Pre-treatment prevalence of S. mansoni infection was 83.3% (204/245) with geometric mean egg count of 357.8. In those not cured post-treatment, the prevalence and egg per gram in geometric mean egg count were 13.1% and 77.6 respectively.After 4 weeks of administration of praziquantel, the cure rate was 86.9% with egg reduction rate of 78.3%. Effectiveness of the drug was not statistically associated with sex, age group, and pre-treatment intensity of infection. CONCLUSION: S. mansoni prevalence was high. Praziquantel is an effective drug for the treatment of S. mansoni. This high prevalence of S. mansoni requires mass drug administration of praziquantel.

Molecular detection of Enteropathogens from diarrheic stool of HIV positive patients in Gondar, Ethiopia.

BACKGROUND: Infectious diarrhea is a common problem in the developing world, especially among people living with HIV/AIDS. Traditional diagnostic methods such as stool culture and microscopic examination are limited by resources and poor sensitivity. The use of molecular diagnostics for enteropathogen detection in this region of sub-Saharan Africa has not been fully explored. We sought to identify risk factors and characterize enteropathogens from diarrheic stools of HIV-positive patients in Gondar, Ethiopia using multiplex molecular panels targeting key infectious agents. METHODS: A cross-sectional study of 100 stool samples was performed. Samples were collected consecutively from HIV- positive patients presenting with diarrhea at University of Gondar Hospital clinic, a major center in NW Ethiopia. Genomic DNA was extracted from stool and processed using a multiplex molecular panel Allplex™ [Seegene, Canada]. Correlations between patient characteristics, symptoms, public health risk factors, and enteropathogen type (s) were studied. Eighty-six samples were successfully analyzed by molecular methods. RESULTS: The mean age was 35 with 43% male. Eighty percent lived in an urban area, 18% had access to well water only, and 81% practiced proper hand hygiene. The majority of patients (72%) were receiving HAART with a median CD4 cell count of 362/µL. Multiple pathogens were detected in 94% of specimens, with an average of 5 enteropathogens per sample. Common bacteria, viruses, and parasites detected were Shigella spp./enteroinvasive E. coli (80%), enterotoxigenic E. coli (73%), Norovirus (16%) and B. hominis (62%). CD4 cell count < 500/ µL was associated with the presence of viruses (p = 0.004) and the absence of STEC (p = 0.010). The use of HAART or CD4 levels was not associated with the number of enteropathogens detected. CONCLUSIONS: Diarrheic stool from HIV-positive outpatients in Gondar, Ethiopia had on average 5 enteropathogens present in their stool. Shigellaspp./enteroinvasive E. coli and enterotoxigenic E. coli are the major pathogens, not dissimilar to immunocompetent individuals in low income countries.