Variations in helminth faecal egg counts in Kato-Katz thick smears and their implications in assessing infection status with Schistosoma mansoni

Examination of stool specimens by Kato-Katz (K-K) thick smears is the standard method recommended by the WHO for field diagnosis of intestinal schistosomiasis. However, there is increasing concern that this technique has low diagnostic sensitivity. In 326 study subjects, we compared the diagnostic yield of examining one, three or five Kato-Katz thick smears prepared from one stool specimen using 41.7 mg templates. In a subset of 169 subjects who had no demonstrable Schistosoma mansoni eggs in their first three Kato-Katz thick smears, we assessed the comparative advantage of examining an additional three Kato-Katz thick smears from another stool specimen, taken four weeks later, to that of cumulative yield obtained by examining all five Kato-Katz thick smears derived from the first stool specimen. For all helminth infections, single Kato-Katz thick smear-based prevalence estimates were significantly lower than those obtained from triplet or quintet Kato-Katz thick smears. Prevalence of S. mansoni infection based on single, triplet and quintet Kato-Katz thick smears from one stool specimen were 31.3%, 45.7% and 52.1%, respectively. Prevalence estimate of S. mansoni based on quintet Kato-Katz thick smears from the first day stool specimens was not different from cumulative estimate obtained with two triplet Kato-Katz thick smears from two stool specimens, 52.1% and 52.8%, respectively. In conclusion, either examination of quintet Kato-Katz thick smears from one stool specimen using 41.7 mg template or initial triplet Kato-Katz thick smears from one stool specimen, and if these are negative, followed by examination of additional triplet Kato-Katz thick smears from subsequent day stool specimen can adequately assess individuals for infection status with S. mansoni.     

Soil-Transmitted Helminthic Infections and Geophagia among Pregnant Women in Jimma Town Health Institutions,Southwest Ethiopia

BackgroundPregnancy is a key step for human''s reproduction and continuity of generation. Pregnant women are among at risk groups for the infection of soil-transmitted helminths (STHs). STHs are highly prevalent in low- and middle-income countries due to the deprived environmental sanitation and personal hygiene. Eating soil (geophagia) is also commonly practiced by pregnant women, particularly in developing countries. The aim of this study was to determine the prevalence of STHs and geophagia, and to assess associated factors among pregnant women in Jimma, Southwest Ethiopia.MethodsA cross sectional study was conducted among 407 pregnant women attending antenatal care (ANC) at different health facilities located in Jimma Town. Data related to sociodemographic and geophagia practice was collected using a structured questionnaire and STH infections status was determined by using McMaster technique.ResultsA total of 407 pregnant women were included in this study. The overall prevalence of any STHs was 19.7% (80/407). Ascaris lumbricoides was the most prevalent 45(56.2%), followed by Trichuris trichiura 19(23.8%) and hookworms 12(15%). There were 4(5%) of double infection with A. lumbricoides and T. trichiura. Overall, 71 (17.4%) of the pregnant women responded to practice geophagia. STHs infection was significantly higher among geophagic pregnant women (p<0.01) and pregnant women who practiced geophagia were 3 times more likely (OR 2.9, 95% CI 1.3–4.2) to have the STHs compared to non-geophagic. Out of those who claimed soil eating habits, 59.1% preferred reddish soil type. Geophagia practice was significantly higher during the third trimester as compared to first and second (p<0.05).ConclusionGeophagia is a risky behavior and this study showed a significant association of geophagia practice with STH infections, although the causal relation could not be established.     

Magnitude of malaria admissions and deaths at hospitals and health centers in Oromia, Ethiopia

Health facility records are important sources of malaria data, not only to describe the disease patterns and trends, but also useful for planning malaria control and evaluating the impact of health interventions. The aim of this study was to assess the burden of malaria admissions and deaths on the services of hospitals and health centers in Oromia, over a period of five years, 1995-2000. A retrospective record review of data routinely collected on malaria admissions and deaths was conducted at all hospitals and health centers located in Oromia during March-May 2001. The total number of admissions and deaths from all causes registered at hospitals and health centers for the overall 1995-2000 period were 302,035 and 16,061. respectively. Malaria accounted for 11.20% of all admissions and 14.26% of all deaths. From 33,808 malaria inpatients, 2,291 (6.78%) died during the period Two thousand and one hundred thirty (92.97%) deaths occurred in hospitals and 161 (7.03%) deaths in health centers. A total of 78,062 (25.85%) admissions among children < 15 years occurred, of whom 12,273 (15.72%) had malaria. The overall percentage of malaria specific admissions during the period was higher for children in the age group of 1-4 (16.59%) and 5-14 years old (20.40%), compared to 7.93% for infants < 1 year and 9:62% for adults greater than 15 years old. Malaria specific admission ratios ranged from 2.95% in Jimma hospital to 47.12% at Merti hospital. Similarly, the proportionate malaria mortality ranged from 7.60% in Jimma hospital to 44.20% in Merti hospital. The majority of malaria admissions and deaths were due to Plasmodium falciparum. This retrospective analysis of records of hospitals and health centers reveals the heavy burden of malaria. Although cost-effective interventions for malaria are available, the burden of the disease is still unacceptably high. In this context, improving the quality of services at health care facilities for accurate diagnosis and effective antimalarial treatment, and increasing the accessibility of health services are crucial steps to reduce the burden of the disease. In addition, improving the quality of surveillance systems to pick up malaria cases and deaths at health care facilities enables decision makers to evaluate the impact of current interventions against the disease.     

Effect of a large dam on malaria risk: the Koka reservoir in Ethiopia

OBJECTIVE: To determine whether the Koka water reservoir in the Rift Valley of Ethiopia contributes to the malaria burden in its vicinity. METHODS: Frequency of malaria diagnosis in fever clinics was correlated with distance of residence from the margin of the Koka reservoir. Annual as well as seasonal malaria case rates were determined in cohorts residing < 3, 3-6 and 6-9 km from the reservoir. Plasmodium falciparum risk was compared with that of Plasmodium vivax. A multiple variable regression model was used to explore associations between malaria case rates and proximity to the reservoir, controlling for other suspected influences on malaria transmission. RESULTS: Malaria case rates among people living within 3 km of the reservoir are about 1.5 times as great as for those living between 3 and 6 km from the reservoir and 2.3 times as great for those living 6-9 km from the reservoir. Proximity to the reservoir is associated with greater malaria case rates in periods of more intense transmission. Plasmodium falciparum is most prevalent in communities located close to the reservoir and P. vivax in more distant villages. The presence of the reservoir, coupled with inter-annual climatic variations, explains more than half of the region's variability in malaria case rates. CONCLUSION: Large water impoundments are likely to exacerbate malaria transmission in malaria-endemic parts of sub-Saharan Africa.     

Cystic lung disease in Birt-Hogg-Dube syndrome

BACKGROUND: To describe the clinical, radiologic, and histopathologic aspects of cystic lung disease occurring in patients with Birt-Hogg-Dubé (BHD) syndrome, a rare, inheritable, multisystem disorder. METHODS: We retrospectively reviewed five patients with BHD syndrome evaluated at the Mayo Clinic Rochester from 1998 through 2005. RESULTS: Mean age (+/- SD) at the time of pulmonary evaluation was 56.4 +/- 4.8 years; four patients were men. Three patients had not received a diagnosis of BHD syndrome at the time of initial CT of the chest. Three patients had a smoking history, and two were nonsmokers. Two patients had a history of recurrent pneumothoraces. Pulmonary function tests available in four patients revealed normal results in one patient and mild airflow obstruction or nonspecific pattern of abnormalities in three patients. CT of the chest revealed cystic lung disease in all five patients; cysts were round to oval in shape, ranged widely in size, and were randomly distributed throughout the lungs, except for a predilection to involve the lung bases more extensively. Three patients with a smoking history had more severe cystic changes compared to nonsmokers and included both patients with recurrent pneumothoraces. Surgical lung biopsy available in one patient revealed emphysema-like changes. Follow-up CT scans available in four patients revealed relative stability over a median interval of 20 months (range, 3 to 66 months). CONCLUSION: We conclude that cystic lung disease in BHD syndrome varies widely in severity, mimics pulmonary lymphangioleiomyomatosis, and may be worsened by smoking.     

Therapeutic efficacy of chloroquine and chloroquine plus primaquine for the treatment of Plasmodium vivax in Ethiopia

Plasmodium vivax is the second most important cause of morbidity in Ethiopia. There is, however, little information on P. vivax resistance to chloroquine and chloroquine plus primaquine treatment although these drugs have been used as the first line treatment for over 50 years. We assessed the efficacy of standard chloroquine and chloroquine plus primaquine treatment for P. vivax infections in a randomized open-label comparative study in Debre Zeit and Nazareth in East Shoa, Ethiopia.A total of 290 patients with microscopically confirmed P. vivax malaria who presented to the outpatient settings of the two laboratory centers were enrolled: 145 patients were randomized to receive CQ and 145 to receive CQ + PQ treatment. Participants were followed-up for 28-157 days according to the WHO procedures. There were 12 (6.5%) lost to follow-up patients and 9 (3.1%) withdrawals. In all, 96% (277/290) of patients were analysed at day 28. Baseline characteristics were similar in all treatment groups. In all, 98.6% (275/277) of patients had cleared their parasitemia on day 3 with no difference in mean parasite clearance time between regimens (48.34 ± 17.68, 50.67 ± 15.70 h for the CQ and CQ + PQ group, respectively, P = 0.25). The cumulative incidence of therapeutic failure at day 28 by a life-table analysis method was 5.76% (95% CI: 2.2-14.61) and 0.75% (95% CI: 0.11-5.2%) in the CQ and CQ + PQ group, respectively (P = 0.19). The relapse rate was 8% (9/108) for the CQ group and 3% (4/132) for the comparison group (P = 0.07). The cumulative risk of relapse at day 157 by a life-table method was 61.8% (95% CI: 20.1-98.4%) in the CQ group, compared with 26.3% (95% CI: 7.5-29.4%) in the CQ + PQ group (P = 0.0038).The study confirms the emergence of CQ and PQ resistance/treatment failure in P. vivax malaria in Ethiopia. Although treatment failures were detected, they were similar between the treatment groups. We recommend regular monitoring and periodic evaluation of the efficacy of these antimalarial drugs in systematically selected sentinel sites to detect further development of resistance and to make timely national antimalarial drug policy changes.     

vanO,a New Glycopeptide Resistance Operon in Environmental Rhodococcus equi Isolates

We describe here the sequence and gene organization of a new glycopeptide resistance operon (vanO) in Rhodococcus equi from soil. The vanO operon has low homology to enterococcal van operons and harbors a vanHOX cluster transcribed in the direction opposite that of the vanS-vanR regulatory system and composed of three open reading frames with unknown function. This finding has clinical interest, since glycopeptides are used to treat R. equi infections and resistance has been reported in clinical isolates.     

Is the legal framework by itself enough for successful WHO code implementation? A case study from Ethiopia

Since 2016, Ethiopia has passed several proclamations and directives to regulate the promotion of commercial breastmilk substitute (BMS). Ethiopia's market potential will undoubtedly be the gravitating point for international infant formula companies due to growing urbanization, purchasing power, population, and the relatively low use of BMS to‐date. The aim of this review is to assess the strengths and weaknesses of the existing laws, standards, and monitoring documents used to regulate the marketing of BMSs in Ethiopia and make future recommendations. The study findings highlighted that the regulation on marketing are comprehensive and strong to limit the promotion of infant formula. On the other hand, the regulation on marketing of follow‐up formulas, complementary foods, and growing‐up milk by manufacturers and distributors, media houses, and communication and advertisement agencies are underregulated, especially with regards to the international 69.9 regulation. The monitoring and enforcement of the existing marketing regulations remain limited in the absence of a formal coordination mechanism. Several violations of the national BMS regulations were observed. Forty‐one percent of mothers reported observing the BMS advertising and logos were detected in 36% of health facilities assessed. In 100% of cases, the infant formula labels contained violations. As the lead national authority mandated to regulate food safety, the Ethiopian Food and Drug Authority needs to update its regulations related to the marketing of BMS to fill the loopholes and revise the national law in line with the international code of marketing of BMSs to protect breastfeeding.