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Background Healthcare associated infection (HAI) is alarmingly increasing in low income settings. In Ethiopia, the burden of HAI is still not well described. Methods Longitudinal study was conducted from May to September, 2016. All wards of Jimma University Medical Centre were included. The incidence, prevalence and risk factors of healthcare associated infection were determined. A total of 1015 admitted patients were followed throughout their hospital stay. Biological specimens were collected from all patients suspected to have hospital aquired infection. The specimens were processed by standard microbiological methods to isolate and identify bacteria etiology. Clinical and laboratory data were collected using structured case report formats. Results The incidence rate of hospital acquired infection was 28.15 [95% C.I:24.40,32.30] per 1000 patient days while the overall prevalence was 19.41% (95% C.I: (16.97–21.85). The highest incidence of HAI was seen in intensive care unit [207.55 (95% C.I:133.40,309.1) per 1000 patient days] and the lowest incidence was reported from ophthalmology ward [0.98 (95% C.I: 0.05,4.90) per 1000patient days]. Among patients who underwent surgical procedure, the risk of HAI was found to be high in those with history of previous hospitalization (ARR = 1.65, 95% C.I:1.07, 2.54). On the other hand, young adults (18 to 30-year-old) had lower risk of developing HAI (ARR = 0.54 95% C.I: 0.32,0.93) Likewise, among non-surgical care groups, the risk of HAI was found to be high in patients with chest tube (ARR = 4.14, 95% C.I: 2.30,7.46), on mechanical ventilation (ARR = 1.99, 95% C.I: 1.06,3.74) and with underlying disease (ARR = 2.01, 95% C.I: 1.33,3.04). Furthermore, hospital aquired infection at the hosoital was associated with prolonged hospital stay [6.3 more days, 95% C.I: (5.16,7.48), t = 0.000] and increased in hospital mortality (AOR, 2.23, 95% CI:1.15,4.29). Conclusion This study revealed high burden and poor discharge outcomes of healthcare associated infection at Jimma University Medical Centre. There is a difference in risk factors between patients with and without surgery. Hence, any effort to control the observed high burden of HAI at the hospital should consider these differences for better positive out put. Electronic supplementary material The online version of this article (10.1186/s13756-017-0298-5) contains supplementary material, which is available to authorized users.

Introduction: An increase in the emergence and spread of multidrug-resistant (MDR)bacteria in recent years is becoming worrisome. Domestic cockroaches can play a significant role in the dissemination of such bacteria between the environment and human beings. This study aimed at determining anti-microbial resistance pattern of food borne illness associated bacteria identified from cockroaches trapped in restaurants and cafeterias. Methods: Trapped cockroaches were picked with surgical gloves, sealed in sterile plastic bags and transported to the Microbiology laboratory. Standard microbiological techniques were used to isolate and identify bacteria. Anti-microbial susceptibility testing was done using Kirby Bauer diffusion technique. Result: A total of five species of food borne illness associated bacteria were detected. Majority (57.1%) of the bacteria were isolated from the gut of cockroaches. More than 89% of the isolates were multi drug resistance (MDR). MDR was higher on gram positive bacteria. S. aureus showed 53.3% resistance against oxacillin(MRSA) and 33.3% against vancomycin. Conclusion: A very high percentage of MDR bacteria was seen in this study. Most of the bacteria tested were isolated from the gut of cockroaches. Potential factors associated with cockroaches that contributed to this high MDR rate of the isolates should be investigated in future. Keywords: MDR, bacteria, cockroaches, food borne.

Background The rates of resistant microorganisms which complicate the management of healthcare associated infections (HAIs) are increasing worldwide and getting more serious in developing countries. The objective of this study was to describe microbiological features and resistance profiles of bacterial pathogens of HAIs in Jimma University Medical Center (JUMC) in Ethiopia. Methods Institution based cross sectional study was carried out on hospitalized patients from May to September, 2016 in JUMC. Different clinical specimens were collected from patients who were suspected to hospital acquired infections. The specimens were processed to identify bacterial etiologies following standard microbiological methods. Antibacterial susceptibility was determined in vitro by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Results Overall, 126 bacterial etiologies were isolated from 118 patients who had HAIs. Of these, 100 (79.4%) were gram negative and the remaining were gram positive. The most common isolates were Escherichia coli 31(24.6%), Klebsiella species 30(23.8%) and Staphylococcus aureus 26 (20.6%). Of 126 bacterial isolates, 38 (30.2%), 52 (41.3%), and 24 (19%) were multidrug-resistant (MDR, resistant to at least one agent in three or more antimicrobial categories), extensively drug resistant (XDR, resistant to at least one agent in all but two or fewer antimicrobial categories (i.e. bacterial isolates remain susceptible to only one or two categories), pan-drug resistant (PDR, resistant to all antibiotic classes) respectively. More than half of isolated gram-negative rods (51%) were positive for extended spectrum beta-lactamase (ESBL) and/or AmpC; and 25% of gram negative isolates were also resistant to carbapenem antibiotics. Conclusions The pattern of drug resistant bacteria in patients with healthcare associated infection at JUMC is alarming. This calls for coordinated efforts from all stakeholders to prevent HAIs and drug resistance in the study setting.

Background Otitis media is the main cause of deafness and hearing impairment and the most common reason for children to visit a medical practitioner. Objective Determination of bacterial etiology of otitis media and its susceptibility to drugs. Methodology A cross sectional study conducted on 191 otitis media patients seen in the Dessie referral hospital, November 2009–2010. Socio-demographic data were collected using a structured questionnaire. Pus from discharging ears was taken and processed for bacterial culture and susceptibility testing using standard bacteriological techniques. Results Participants age range was 3/12–70 years. Majority (83.2%) of them were identified as chronic otitis media. The frequency of otitis media below 15 years was 45.0%. Of 207 isolates, Proteus spp was the leading one, 48 (23.2%) followed by Staphylococcus aureus 44 (21.3%). Escherichia coli, Enterobacter, Citrobacter, and Klebsiella spp were 100% resistant to Amoxicillin. Almost all isolated bacteria became resistant to two or more antimicrobials. Conclusion Children aged less than 15 years were the most affected groups. Proteus spp, S. aureus, and Pseudomonas spp were the major isolated bacteria. Gentamycin and Ciprofloxacin were relatively effective antibiotics. However, all isolates showed multi drug resistance indicating the presence of strong selective pressures so that empirical treatment needs to be discouraged.

BACKGROUND: Microbial contamination of ready-to-eat foods and beverages sold by street vendors and hawkers has become an important public health issue. In Ethiopia, health risks related to such kinds of foods are thought to be common. Thus, this study has tried to determine the bacteriological quality of ready- to- eat foods sold on streets. METHODS: A cross-sectional study was conducted on street foods in Hawassa City from May to September 2014. A total of 72 samples from six food items such as local bread (‘ambasha’ and‘kita’), raw fish, chilli (‘awaze’), avocado and cooked potato were collected. Bacterial isolation, colony count and antimicrobial susceptibility testing were made following standard microbiological techniques. RESULTS: About 31% of the food samples showed total colony counts ranging from 1.7x105 to 6.7x106 colony-forming unit per gram (CFU/g) which is beyond the acceptable limits set for microbiological quality of ready- to -eat foods. The mean coliform and Enterobacteriaceae counts in raw fish, ‘kita’ and ‘ambasha’ were also higher than the limits. E.coli was the most frequent isolate (29.6%) followed by Salmonella species (12.7% and S.aureus (9.9%). All isolates were 100% sensitive to ciprofloxacin. About 89% of Salmonella sp was resistant to chloramphenicol. Alarmingly, 14.3% of S.aureus was resistant to vancomycin. CONCLUSION: This study confirmed considerable rate of contamination in street vended foods in Hawassa City. The identified foodborne bacteria and antibiotic resistance isolates could pose a public health problem in that locality. Therefore, regular inspection, health education and training of vendors on food handling and safety practices are recommended.KEYWORDS: street foods, bacteriological quality, total aerobic count, Hawassa

This document is one important step in a process for improving access to quality of care in family planning by reviewing the medical eligibility criteria for selecting methods of contraception. It updates the third edition of Medical eligibility criteria for contraceptive use published in 2004 and summarizes the main recommendations of an expert Working Group meeting held at the World Health Organization Geneva 1-4 April 2008. (Please see Annex 2 for the list of participants.) The Working Group brought together 43 participants from 23 countries including nine agency representatives. The document provides recommendations for appropriate medical eligibility criteria based on the latest clinical and epidemiological data and is intended to be used by policy-makers family planning programme managers and the scientific community. It aims to provide guidance to national family planning/reproductive health programmes in the preparation of guidelines for service delivery of contraceptives. It should not be seen or used as the actual guidelines but rather as a reference. The document covers the following family planning methods: low-dose combined oral contraceptives (COCs) combined patch (P) combined vaginal ring (R) combined injectable contraceptives (CICs) progestogen-only pills (POPs) depot medroxyprogesterone acetate (DMPA) norethisterone enantate (NET-EN) levonorgestrel (LNG) and etonogestrel (ETG) implants emergency contraceptive pills (ECPs) copper-bearing intrauterine devices (Cu-IUDs) levonorgestrel-releasing IUDs (LNG-IUDs) copper-IUD for emergency contraception (E-IUD) barrier methods (BARR) fertility awareness-based methods (FAB) lactational amenorrhoea method (LAM) coitus interruptus (CI) and female and male sterilization (STER). WHO will update and add to the recommendations in this document at appropriate intervals through expert Working Group meetings every three to four years and through input from its family planning Guidelines Steering Group on an as-needed basis. These recommendations will be made available on the WHO web site (www.who.int/reproductivehealth). The web site will also provide additional information determined by WHO to be relevant to these recommendations pending the next formal consensus Working Group meeting. Such updates may be particularly warranted for issues where the evidence base may change rapidly. WHO encourages research to address key unresolved issues for establishing medical eligibility criteria for contraceptive use. WHO also invites comments and suggestions for improving this guidance.

BACKGROUND: Surgical site infection is the second most common health care associated infection. One of the risk factors for such infection is bacterial contamination of operating rooms’ and surgical wards’ indoor air. In view of that, the microbiological quality of air can be considered as a mirror of the hygienic condition of these rooms. Thus, the objective of this study was to determine the bacterial load and antibiotic susceptibility pattern of isolates in operating rooms’ and surgical wards’ indoor air of Jimma University Specialized Hospital. METHODS: A cross sectional study was conducted to measure indoor air microbial quality of operating rooms and surgical wards from October to January 2009/2010 on 108 indoor air samples collected in twelve rounds using purposive sampling technique by Settle Plate Method (Passive Air Sampling following 1/1/1 Schedule). Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 16 and interpreted according to scientifically determined baseline values initially suggested by Fisher. RESULTS: The mean aerobic colony counts obtained in OR-1(46cfu/hr) and OR-2(28cfu/hr) was far beyond the set 5-8cfu/hr acceptable standards for passive room. Similarly the highest mean aerobic colony counts of 465cfu/hr and 461cfu/hr were observed in Female room-1 and room-2 respectively when compared to the acceptable range of 250-450cfu/hr. In this study only 3 isolates of S. pyogenes and 48 isolates of S. aureus were identified. Over 66% of S. aureus was identified in Critical Zone of Operating rooms. All isolates of S .aureus showed 100% and 82.8% resistance to methicillin and ampicillin respectively. CONCLUSION: Higher degree of aerobic bacterial load was measured from operating rooms’ and surgical wards’ indoor air. Reducing foot trafficking, improving the ventilation system and routine cleaning has to be made to maintain the aerobic bacteria load with in optimal level. KEYWORDS: Indoor air, hospital environment, surgical site infection, Southwest Ethiopia

Cockroaches have been regarded as possible vectors of human enteropathogens. Their presence and crawl particularly in food handling establishments could be risky for human health. Therefore, this study was done to determine the vector potential of cockroach for medically important bacterial pathogens in restaurants and cafeterias. A cross-sectional study was conducted on cockroaches from restaurants and cafeterias in Jimma town from May to September 2014. Standard taxonomic keys and microbiological techniques were applied for species identification and isolation. Data was analyzed in SPSS version 16.0. All cockroaches trapped were the German cockroach,Blattella germanica(L.) (Dictyoptera: Blattidae).Escherichia coliwas the most frequently isolated followed bySalmonellaspecies (serogroups B, D, E, C1, and NG),Bacillus cereus, andShigella flexneri. Wide varieties of bacteria of medical relevance were also identified. Of which,Klebsiellaspp. 49(40.8%),Bacillusspp., andStaphylococcus saprophyticuswere predominant.Blattella germanica(L.) (Dictyoptera: Blattidae) could serve as a potential vector for the dissemination of foodborne pathogens such asSalmonellaspp.,Shigella flexneri,E. coli,S. aureus, andB. cereusand these bacteria could be a major threat to public health. Therefore, environmental sanitation and standard hygiene need to be applied in the food handling establishments in that locality.

Background: Group A Streptococcus (GAS) is an important cause of morbidity, mortality and responsible for 20–30% bacterial pharyngitis in children. Objectives: To determine prevalence, antimicrobial susceptibility pattern and clinical predictors of GAS among children with pharyngitis. Methods: A cross sectional study was conducted on 355 children with pharyngitis attended in Health Centers of Jimma Town from May-December, 2013. Demographic and clinical data collected by questionnaire. Throat swabs were collected and processed with the standard microbiological techniques to isolate GAS. Disc diffusion method was used for antimicrobial susceptibility testing. Statistical analysis was done by SPSS version 20. Results: Mean ± SD age of 355 children with pharyngitis was 8.5 ± 2.7 years. The prevalence of GAS was 11.3%. All isolates of GAS were susceptible to penicillin and erythromycin. However, 52.5% were resistant to tetracycline. Absence of cough [AOR: 3.77, 95% CI 1.73-8.22], tonsillar swelling or exudate [AOR: 4.48, 95% CI 1.63-12.31], temperature >38 0 C [AOR: 3.47, 95% CI 1.61-7.49] were found independent predictors for GAS infection (P Conclusion: Prevalence of GAS was relatively low. So that prospective study in the entire season is required due to the seasonality of GAS infection. Clinical predictors can be considered for the diagnosis of GAS pharyngitis with further validation in different settings.

Background: Parasitic infection of the intestinal tract is a major source of disease in patients with HIV particularly in the tropics, where diarrhea is a common complaint with variable severity and specific pathogens are be identified in more than half of the HIV/AIDS patients with persistent diarrhea. Objective: The objective of this study was to determine the prevalence of intestinal parasites and their association with diarrhea of HIV infected patients. Methods: A cross-sectional study was conducted on 372 consecutive patients from Feb.-July, 2001, on HIV infected and non-infected patients which were confirmed by Wellcozyme ELISA(Murex, UK). Chronic diarrhea was defined as three or more lose stool passed daily for more than two weeks. Parasite infections were diagnosed by examination of single stool specimen which were examined as fresh wet mounts, formol-ether concentration technique and Modified acid fast stain. Result: Diarrhea was more prevalent in HIV infected 99(51.1%) than in HIV non infected patients 53(29.5%). Regardless of their diarrhea status, the general prevalence of intestinal parasites in HIV infected and HIV non-infected were 44.8% and 34.4% respectively. Among the 192 HIV infected patients 54 (28.1%) and 45(23.4%) of them had chronic and acute diarrhea respectively. The prevalence of intestinal parasites were 28(51.9%)in patients with chronic and 17(37.8%) in those acute with diarrhea. C. parvum, I. belli, and C. catyenesis oocyst were detected only in HIV infected patients with chronic diarrhea (P Conclusion: This study re-affirms the previously held view that in more of HIV patients with chronic diarrhea etiologic agent can be identified. Diarrhea and intestinal parasites prevalence were higher in HIV infected than HIV non-infected patients. Intestinal coccidian are opportunist infections which are found exclusively in HIV patients with chronic diarrhea. [Ethiop.J.Health Dev. 2003;17(1):71-78] The retirement of malaria control workers as a critical problem for vector control in Oromia, Ethiopia Wakgari Deressa, Dereje Olana, Shelleme Chibsa : A retrospective record review for the period of seven years was done on retirement and death in February 2001 to assess the current status of malaria control workers in Oromia Regional State. The number of malaria control workers who left Malaria Control Programme due to retirement and death has dramatically increased across the last seven years with an average of about 15 workers annually. Among 106 malaria workers who left the programme during the period, 60% of them were retired and 26% deceased. It was also found that 89% of them were malaria technicians with specialized technical expertise in vector control, while the remaining 11% were highly experienced microscopists. Training of health professionals on malaria control through incorporating the malaria curriculum into the health training schools and institutions seems mandatory. [Ethio.J.Health Dev. 2003;17(1):79-83]

P. aeruginosa is one of the most important pathogen that causes nosocomial infections often acquired from hospital environment and contaminated medical devices. The infections caused by this bacterium are particularly problematic because it is inherently resistant to several unrelated antimicrobial agents and antiseptics. Hence, the aim of this study was to determine drug resistance and disinfectants susceptibility of P. aeruginosa isolated from clinical samples and hospital environments. A laboratory based cross sectional study was conducted from May to September, 2012 on a total of 81 P. aeruginosa isolates. A standard bacteriological technique (conventional biochemical tests and pigment production) was used to identify the bacterium. Drug resistance and disinfectant susceptibility tests were determined by Kirby-Bauer disc-diffusion and through the classic method of successive dilutions respectively. In this study a total of 305 (160 clinical and 145 environmental) samples were investigated for P. aeruginosa and 81 isolates were obtained. This gives an overall P. aeruginosa isolation rate of 26.5% (81/305). About 47.5% of the clinical and 34.2% environmental isolates were detected from wounds and ward sinks respectively. Of these P. aeruginosa isolates, 95.1% were resistance to Trimethoprim-sulphametoxazole, 62% to Gentamicin, and 58% to Ceftriaxone. But, only 4.9% of isolates were resistance to Amikacin. Moreover, disinfectant susceptibility test revealed that hydrogen peroxide and sodium hypochlorite had a higher (92.6% & 91.4%) bactericidal activity compared to ethanol and savlon at the recommended user dilution. In general, our results indicated that P. aeruginosa was significantly resistance to commonly prescribed antimicrobial drugs, a situation that demands a more rational and appropriate use of antibiotics. Hydrogen peroxide and sodium hypochlorite were relatively more effective when used in recommended dilution. However, all tested disinfectants or antiseptics showed reduced bactericidal activities in higher dilutions. Therefore, strict adherence to the recommended dilution is important for better activity. The correct use of them also has to be considered appropriately as part of infection control practices.

Background: Nosocomial infections are the most challenging problem in all health care systems. In developing countries many people are dying daily due to inadequate health care services of which postoperative infections constitute a large proportion of this burden. Objective: The aim of this study was to identify risk factors associated for post operative nosocomial infections among operated patients at Felege Hiwot Referral Hospital. Methods: A cross-sectional study was conducted on patients who under gone operations from October 2010 to January 2011. A structured questionnaire was used for collection of data on socio-demographic characteristics and associated risk factors. The clinical diagnosis was made by respective surgeons and gynaecologists. Bacterial culture confirmation was done for all patients who developed clinical signs and symptoms of surgical site (SSI) and/or bloodstream infection (BSI) starting from the second day of admission until the time of discharge using standard bacteriological techniques. Bivariate analysis was made to generate to identify associated risk factors. P.value 51 years old were likely to develop post operative nosocomial infection (OR=6.38, CI=1.156-35.14). Patient with underlying diseases (OR=2.725, CI=1.269-5.853) and patients who undergone appendectomy ( OR=3.1, CI=1.1-8.3) were more likely developed post operative nosocomial infections. Operation duration of 91-150 minutes (OR=11.00, CI=1.989-60.83), and postoperative hospital stay of greater than 15 days (OR=82.00, CI=5.738-1.172) were also likely to be risk factor for infection. Conclusion: This study confirmed that advanced age, underlying disease, extended preoperative and postoperative hospital stay, longer duration of surgery and appendectomy were the most likely risk factors for post operative infections. Hence, more attention is required in management of such cases through prior identification of underlying disease, use of effective antibiotics as a prophylaxis and adherence of strict aseptic operating procedures.

Background Group A Streptococcus (GAS) is an important cause of morbidity and mortality among children and responsible for 20–30% of bacterial pharyngitis. Objective Determining prevalence, antimicrobial susceptibility pattern and clinical predictors of GAS among children with pharyngitis. Method A cross sectional study was conducted on 355 children with pharyngitis attended in Health Centers of Jimma town from May 8 to December 31, 2013. Demographic and clinical data were collected by questionnaire. Throat swabs were collected and processed with the standard microbiological techniques to isolate GAS. The disc diffusion method was used for antimicrobial susceptibility testing. Descriptive statistics and multivariate logistic regression analysis were done by SPSS version 20. Results Females accounted for 57.7% of 355 children with pharyngitis. Sixty-six percent of the children were 5–9 years old giving mean ± SD age of 8.5 ± 2.7 years. The prevalence of GAS was 11.3%. All isolates of GAS were susceptible to penicillin and erythromycin. However, 52.5% were resistant to tetracycline. Absence of cough, tonsillar swelling or exudate and temperature >38 °C were found to be independent predictors for GAS infection among children with pharyngitis ( P Conclusion In this study the prevalence of GAS was relatively low. However, the seasonality of GAS infection might underestimate the prevalence, so that large-scale prospective study in the entire season and in various settings is required. In addition, the clinical variables that are predictor of GAS pharyngitis can be considered for the diagnosis of GAS pharyngitis with further evaluation of its reproducibility in different settings.

Background The term ’Multidrug-resistant’ (MDR) applies to a bacterium that is simultaneously resistant to a number of antimicrobials belonging to different chemical classes. The effectiveness of currently available antmicrobial drugs is decreasing due to the increasing number of resistant strains causing infections so that available therapeutic options for such organisms are severely limited. Objective The aim of this study was to determine multidrug-resistance rate of bacterial isolates that caused wound infections. Methods A Hospital based cross-sectional study was conducted on 322 wound samples taken from consecutive patients seen at inpatient and outpatient department of Jimma University Specialized Hospital from June to December 2011. Swabs from surgical incisions, burns, abscess and traumatic wounds were collected aseptically using Levine’s technique. Bacteriological culture and examination was done following standard microbiological techniques. Multidrug-resistance test was performed by disk diffusion method against 10 classes of antimicrobials. The data was analyzed for descriptive statistics using SPSS version 16 and Microsoft Excel. Results The overall MDR among gram positive and gram negative bacterial isolates were (77%) and (59.3%) respectively. About, 86.2% S.aureus and 28.6% of Coagulase negative Staphylococci became MDR. Nearly 30.1% of S.aureus was resistant to six classes of antimicrobials. The average MDR rate of Proteus, Klebsiella, and Providencia species was 74.8%, 69.6% and 75% in that order. Nearly, 30.8% of Proteus sp, 32.6% of Klebsiella sp and 61% of Citrobacter sp were resistance to 4 classes each. Surprisingly, the average MDR rate for Citrobacter sp was 100%. About (76.7%) of S.aureus was Oxacillin/Methicillin resistant while (16.4%) were Vancomycin resistant. Proteus species was the predominant isolates (27.9%) followed by P.aeruginosa and S.aureus (19.3%) and (19%) respectively. Conclusion This study indicated that, the overall rate of MDR bacterial pathogens that caused wound infection was very high and many of the isolates were also identified as resistant to three or more classes of antimicrobials. Such widespread resistance to antimicrobial classes is something serious because a few treatment options remain for patients with wound infections. Periodic monitoring of etiology and antimicrobial susceptibility in areas where there is no culture facility is essential to assists physician in selection of chemotherapy.