Analysis and reporting of meningococcal meningitis epidemic in north Gondar 2001-2002

Severe epidemic meningococcal meningitis occurs in countries of the meningitis belt of Sub-Saharan Africa, including Ethiopia. Many epidemics occurred in this country in the past decade, the recent being in 2000 in Addis Ababa unusually during the wet and rainy season. The study was a cross-sectional design. Data were collected with prepared questionnaires and the line listing. CSF (Cerebro Spinal Fluid) culture and antibiotic sensitivities were done for a limited number of patients. The objective of the study was to assess the progress and management outcome of the epidemic. During the out breaks of epidemic meningitis in north Gondar zone of the Amhara regional state in 2001 and 2002 children and young adults were most affected. There were 384 cases and 26 deaths in 2001 and 1235 cases and 128 deaths, in 2002, making a total of 1619 cases and 154 deaths with a case fatality rate of 9.5%. The etiologic agent was sero-group A. The most affected age group was 15-30 years. About 80% of the cases were in the age 30 years and below. Surveillance, epidemic preparedness, interventions and response were found to be inadequate. Selective vaccination was not effective in handling the epidemic. Efficient surveillance, local processing and use of data, regional laboratory support, multisectoral approach and mass vaccination were recommended to appropriately and timely handle such epidemics.     

Decline in prevalence of HIV-1 infection and syphilis among young women attending antenatal care clinics in Addis Ababa, Ethiopia: results from sentinel surveillance, 1995-2001

From 1995 to 2001, five rounds of sentinel surveillance were carried out for young women attending antenatal care clinics at four health centers in Addis Ababa, the capital city of Ethiopia, to monitor trends in the prevalence of HIV infection and syphilis. Serum samples were tested for antibodies to HIV (enzyme-linked immunosorbent assay and Western blotting) and antibodies to Treponema pallidum (T. pallidum hemagglutination assay and rapid plasma reagin test). Prevalence ratios for an increase in one calendar year were estimated using log-binomial models. Between 1995 and 2001, the prevalence of HIV infection among young women (age range, 15-24 years) attending antenatal care clinics in inner city health centers declined from 24.2% to 15.1% (prevalence ratio for an increase in one calendar year, 0.91; 95% confidence interval, 0.87-0.95). No change was observed for older age groups or in outer city health centers. The decline in the prevalence of active syphilis (T. pallidum hemagglutination assay and rapid plasma reagin testing positive for antibodies to T. pallidum) was more pronounced among and also restricted to the young age groups (age range, 15-24 years) in the inner city (from 7.6% in 1995 to 1.3% in 2001; prevalence ratio, 0.69; 95% confidence interval, 0.59-0.80). The declining trends in the prevalence of HIV infection and syphilis among young women attending antenatal care clinics in the inner city are encouraging, but these findings require confirmation in future years and for other population groups.     

The use of medicinal plants in self-care in rural central Ethiopia

Medicinal plants are an important element of Ethiopian traditional medicine. This questionnaire survey examined the extent and type of medicinal plants used in self-care by rural Ethiopian community. Six hundred mothers were interviewed using a semi-structured questionnaire. The prevalence of the use of herbal drugs in self-care was found to be 12.5%. Twenty-five plant species belonging to 21 families were reported, each with local names, methods of preparation and parts used. This study showed that self-care using medicinal plants is a major part of health care options in Butajira community.     

Immunogenicity and efficacy of Fermi-type nerve tissue rabies vaccine in mice and in humans undergoing post-exposure prophylaxis for rabies in Ethiopia

Rabies is an acute viral encephalitis that is invariably fatal following the manifestations of clinical signs. To subvert the course of the disease, rabies post-exposure prophylaxis (PEP) is widely utilized. The immunogenicity and efficacy of Fermi-type rabies vaccine produced in Ethiopia was determined in mice subjected to intracranial challenge with rabies virus, and in humans undergoing rabies PEP in Ethiopia. Mice were randomly assigned into 5 groups. Group 1 received 0.25 ml each of phenolized saline intraperitoneally for 14 consecutive days. Mice in groups 2-5 received 0.25 ml of rabies vaccine for human PEP for the same period of time. Blood samples were drawn from the retro-orbital vein of all mice on designated days for the determination of rabies virus neutralizing antibody (VNA) using the mouse serum neutralization test. Mice were subsequently challenged intracranially with rabies virus at a concentration of 64 MICLD50 90 days post initial vaccination. Rabies neutralizing antibody titers in the sera of immunized mice ranged from 4.6 to 25 IU/ml. Booster vaccine doses did not seem to induce significant increases in the immune response of vaccinated mice, all of whom withstood intracranial challenge with rabies virus. Rabies VNA was further determined in 12 patients vaccinated in accordance with the prescribed dosage of Fermi-type vaccine for human rabies PEP. Most had > 0.5 IU/ml of rabies VNA by day 14, and none detectable at day 1. In contrast to mice, booster doses of vaccine may contribute to slightly higher rabies VNA titers in humans but our small sample size, on top of significant defaulter rates in the study participants, limits our interpretation of the effects of booster vaccine doses. The results of this study are the first documentation of the efficacy and immunogenicity of the Ethiopian Fermi type nerve tissue vaccine in both humans and mice.     

Burden,characteristics, management and outcomes of HIV-infected patients with Kaposi’s sarcoma in Zomba,Malawi

Setting:

Antiretroviral treatment (ART) clinic at Zomba Central Hospital, Malawi.

Design:

Retrospective analysis of records (2004–2011) of human immunodeficiency virus (HIV) infected patients with Kaposi’s sarcoma (KS).

Objectives:

To determine the number and characteristics of HIV-infected adult patients with KS on ART and vincristine (VCR) therapy and their treatment outcomes.

Results:

A total of 545 HIV-infected patients with KS (58% male, median age 33 years) were included in the study. The baseline median CD4 count was 180 cells/µl (interquartile range 111–287). Cumulative outcomes were as follows: 168 (31%) were still alive, 133 (24%) had died, 172 (32%) were lost to follow-up and 71 (13%) had transferred out; 229 had received at least one course of VCR, 171 had received less than one full course and 145 had not received VCR. The survival probability for 229 patients who received at least one course of VCR was 65% at 1 year, 42% at 2 years and 13% by 6 years. Patients who started VCR therapy before or concurrently with ART had a higher risk of death and generally a higher risk of death and loss to follow-up than those who started VCR after ART.

Conclusion:

Poor outcomes were noted in HIV-infected patients with KS in a programme setting in Malawi. Other treatment interventions, including combination and/or second-line chemotherapy and earlier ART initiation, are needed to reduce morbidity and mortality.     

Prevalence of Shigella,Salmonella and Cmpylobacter Species and Their Susceptibility Patters Among Under Five Children With Diarrhea in Hawassa Town,South Ethiopia

Background

Diarrhea is the leading cause of morbidity and mortality in under-five children in developing countries including Ethiopia. Therefore, up-to-date data on etiologic agent and susceptibility pattern are important for the management of bacterial diarrhea in under-five children, which was the main objective of this study.

Method

A cross-sectional study was conducted at Hawassa Adare Hospital and Millennium Health Center from June 6 to October 28, 2011. A total of 158 under-five children with diarrhea were selected using convenient sampling technique. Demographic and clinical data were collected using questionnaire. Fecal samples were collected and processed for bacterial isolation, and antimicrobial susceptibility testing following standard bacteriological techniques.

Result

A total of 158 fecal samples were collected from 81(51.3%) males and 77(48.7%) females of under-five children with diarrhea. Of the 158 fecal samples, 35(22.2%) bacterial pathogens were isolated. The isolated bacteria were Campylobacter species, 20 (12.7%), Shigella species, 11 (7.0%), and Salmonella species, 4 (2.5%). The majority of the isolates were sensitive to Chloramphenicol, Ciprofloxacin, Nalidixic acid and Cotrimoxazol and high rate of drug resistance was observed against Erythromycin and Amoxicillin.

Conclusions

The finding of this study indicates that Campylobacter species were the predominant etiologies and the presence of bacterial isolates resistant to the commonly prescribed drugs for treating diarrhea in children. Therefore, periodic monitoring of etiologic agent with their drug resistant pattern is essential in the management of diarrhea in children.