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The World Health Organization (WHO) has defined moderate-to-heavy intensity (M&HI) infections with soil-transmitted helminths (Ascaris lumbricoides, Trichuris trichiura and the two hookworms, Ancylostoma duodenale and Necator americanus) based on specific values of eggs per gram of stool, as measured by the Kato-Katz method. There are a variety of novel microscopy and DNA-based methods but it remains unclear whether applying current WHO thresholds on to these methods allows for a reliable classification of M&HI infections. We evaluated both WHO and method-specific thresholds for classifying the M&HI infections for novel microscopic (FECPAKG2, McMaster and Mini-FLOTAC) and DNA-based (qPCR) diagnostic methods. For this, we determined method-specific thresholds that best classified M&HI infections (defined by Kato-Katz and WHO thresholds; reference method) in two multi-country drug efficacy studies. Subsequently, we verified whether applying these method-specific thresholds improved the agreement in classifying M&HI infections compared to the reference method. When we applied the WHO thresholds, the new microscopic methods mainly misclassified M&HI as low intensity, and to a lesser extent low intensity infection as M&HI. For FECPAKG2, applying the method-specific thresholds significantly improved the agreement for Ascaris (moderate → substantial), Trichuris and hookworms (fair → moderate). For Mini-FLOTAC, a significantly improved agreement was observed for hookworms only (fair → moderate). For the other STHs, the agreement was almost perfect and remained unchanged. For McMaster, the method-specific thresholds revealed a fair to a substantial agreement but did not significantly improve the agreement. For qPCR, the method-specific thresholds based on genome equivalents per ml of DNA moderately agreed with the reference method for hookworm and Trichuris infections. For Ascaris, there was a substantial agreement. We defined method-specific thresholds that improved the classification of M&HI infections. Validation studies are required before they can be recommended for general use in assessing M&HI infections in programmatic settings., Competing Interests: The FECPAKG2 technology was produced and distributed by Techion Group Ltd, of which ET is an employee and GM is managing director. Both hold stocks in Techion Group Ltd. The Mini-FLOTAC device is a commercial product distributed by GC, LR and MPM through the University of Napoli Federico II. However, their affiliations did not play any role in the preparation and submission of this manuscript. All other authors declared that they have no competing interests.

Introduction: Soil-transmitted helminthiasis (STH) remains a major public health problem in school children in Ethiopia. Although direct wet mount microscopy (DWMM) is the means to diagnose parasitic diseases in health care facilities in Ethiopia, it remains unclear what its diagnostic performance is for STH., Methodology: A cross-sectional study was performed in Jimma Town (Ethiopia) and included 600 children from 10 primary schools. The diagnostic sensitivity of DWMM was compared to a composite reference standard (CRS) consisting of Kato-Katz, McMaster and Mini-FLOTAC. We also explored the impact of intensity of infection (the highest faecal egg counts (FECs; expressed as eggs per gram of stool (EPG)) across the CRS) on the diagnostic sensitivity of DWMM., Results: Based on the CRS, there were 210 Ascaris (35.0%), 312 Trichuris (52.0%) and 102 hookworm cases (17.0%). The median intensity of infections equalled 2,057 EPG for Ascaris, 200 EPG for Trichuris and 110 EPG for hookworms. The sensitivity of DWMM was 73.8% for Ascaris, but was around 17% for both Trichuris and hookworms. The sensitivity significantly increased with intensity of STH. For Ascaris, the odds for detecting an infection intensity of 1,000 EPG was 6.2 times higher than detecting an infection of 100 EPG. For Trichuris and hookworms, these odds ratios were 7.1 and 14., Conclusions: The diagnostic sensitivity of DWMM is low for STH, but it is able to detect those subjects that are in the highest need of treatment, and hence contributes to the global goal to eliminate STH as a public health problem., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2020 Daniel Dana, Johnny Vlaminck, Zeleke Mekonnen, Mio Ayana, Florian Vogt, Kristien Verdonck , Hannock Tweya, Collins Timire, Peter Geldhof, Bruno Levecke.)

Background: Nucleic acid amplification tests (NAATs) are increasingly being used as diagnostic tools for soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Ancylostoma duodenale and A. ceylanicum), Strongyloides stercoralis and Schistosoma in human stool. Currently, there is a large diversity of NAATs being applied, but an external quality assessment scheme (EQAS) for these diagnostics is lacking. An EQAS involves a blinded process where test results reported by a laboratory are compared to those reported by reference or expert laboratories, allowing for an objective assessment of the diagnostic performance of a laboratory. In the current study, we piloted an international EQAS for these helminths (i) to investigate the feasibility of designing and delivering an EQAS; (ii) to assess the diagnostic performance of laboratories; and (iii) to gain insights into the different NAAT protocols used., Methods and Principal Findings: A panel of twelve stool samples and eight DNA samples was validated by six expert laboratories for the presence of six helminths (Ascaris, Trichuris, N. americanus, Ancylostoma, Strongyloides and Schistosoma). Subsequently this panel was sent to 15 globally dispersed laboratories. We found a high degree of diversity among the different DNA extraction and NAAT protocols. Although most laboratories performed well, we could clearly identify the laboratories that were poorly performing., Conclusions/significance: We showed the technical feasibility of an international EQAS for the NAAT of STHs, Strongyloides and Schistosoma. In addition, we documented that there are clear benefits for participating laboratories, as they can confirm and/or improve the diagnostic performance of their NAATs. Further research should aim to identify factors that explain poor performance of NAATs., Competing Interests: The authors have declared that no competing interests exist.

Starting and stopping preventive chemotherapy (PC) for soil-transmitted helminthiasis is typically based on the prevalence of infection as measured by Kato-Katz (KK) fecal smears. Kato-Katz-based egg counts can vary highly over repeated stool samples and smears. Consequentially, the sensitivity of KK-based surveys depends on the number of stool samples per person and the number of smears per sample. Given finite resources, collecting multiple samples and/or smears means screening fewer individuals, thereby lowering the statistical precision of prevalence estimates. Using population-level data from various epidemiological settings, we assessed the performance of different sampling schemes executed within the confines of the same budget. We recommend the use of single-slide KK for determining prevalence of moderate-to-heavy intensity infection and policy decisions for starting and continuing PC; more sensitive sampling schemes may be required for policy decisions involving stopping PC. Our findings highlight that guidelines should include specific guidance on sampling schemes., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.)

Background: Schistosoma mansoni (S. mansoni) infection is a significant public health problem in Ethiopia, and has wide distribution in the country. The impact of the disease is particularly high on school-age children. Nationwide 385 endemic districts were identified, whereby control and elimination interventions are underway using school-based annual mass drug administration (MDA) with praziquantel. The national elimination program targets endemic districts as a whole. The aim of this study was to identify the transmission foci of Schistosoma mansoni and determine prevalence of soil-transmitted helminths (STHs) in Abeshge district., Methods: The study was conducted from April to May, 2019 among school-age children randomly selected from public elementary schools in Abeshge district, South-central Ethiopia. Demographic information and data on risk factors of S. mansoni infection were gathered using pre-tested questionnaire. Moreover, a stool sample was collected from each child and examined using Kato-Katz thick smear technique. The data were analyzed using STATA_MP version 12., Results: A total of 389 school-age children from five public elementary schools were included in the study. The overall prevalence of S. mansoni and STHs was 19.3% (75/389) and 35% (136/389), respectively. The prevalence of S. mansoni was 60.6% in Kulit Elementary school, while it was zero in Geraba. The prevalence of S. mansoni was significantly higher among males (AOR = 2.6, 95% CI 1.3-5.1), those with habit of swimming and/or bathing in rivers (AOR = 2.9, 95%CI 1.3-5.1) and involved in irrigation activities (AOR = 2.9, 95% CI 1.0-8.3). Overall, the prevalence of S. mansoni was significantly higher among school children attending Kulit Elementary School compared to those attending the remaining schools (AOR = 12.5, 95%CI 6.2-25.1)., Conclusion: A wide variation of S. mansoni prevalence was observed among the school children in the different schools. Control interventions better identify and target foci of S. mansoni transmission, instead of targeting the district homogenously.

This systemic review and meta-analysis aimed to investigate the burden of tuberculosis immune reconstitution syndrome (TB-IRIS) and associated mortality to highlight the importance of future direction in preventing and treatment of TB-IRIS. Randomized clinical trials (RCTs) that compared early antiretroviral therapy (ART) versus late ART were included. PubMed, EMBASE, Science Direct and Cochrane Central Register of Controlled Trials electronic databases were searched. This meta-analysis included 8 RCTs with a total of 4, 425 participants. The result of analysis showed that early initiation of ART was associated with increase in TB-IRIS (RR = 1.83; 95% CI: 1.24-2.70, p  = 0.002; I 2  = 74%, p  = 0.0007) and TB-IRIS associated mortality (RR = 6.05; 95% CI: 1.06-34.59, p  = 0.04; I 2  = 0%, p  = 0.78). Early ART was associated with overall mortality compared with late ART initiation. Grade 3 or 4 adverse events, achieving lower viral load and development of new AIDS-defining illness were not associated with the time of ART initiation. Early ART in HIV/TB co-infected patients resulted conclusive evidence of increased TB-IRIS incidence and TB-IRIS associated mortality. Hence, the finding calls for clinical judgment as to the benefits of initiating ART earlier against the risk of TB-IRIS and associated mortality., Competing Interests: The authors declare that they have no competing interests., (© 2020 The Author(s).)

Background: Hypertension has emerged as a new threat to the health and well-being of people living with human immune deficiency virus (PLHIV). However, no data exist on care delivery and blood pressure control over time in Ethiopia. We assessed clinical care & level of blood pressure control among hypertensive people living with Human Immune Deficiency Virus (HIV)., Methods: We conducted a prospective cohort study among adult hypertensive PLHIV and HIV-negative patientsat chronic care clinics of Jimma University Medical Center in Ethiopia. We explored self-management practices and blood pressure control of study participants. Multivariable Cox-regression was used to identify the predictors of the outcome., Results: A total of 303 eligible participants with mean age of 43.30 ± 12.55years were followed and males comprised of 52.1%. After 12 months of follow-up, 60.2% of HIV-positive and 53% of HIV-negative patients showed uncontrolled blood pressure. The overall perception of self-management behaviors was 2.10 ± 0.77 (p = 0.122), which was at moderate level. An increased waist circumference [AHR: 2.16; 95% CI: (1.58-5.18);p = 0.021],chronic disease co-morbidity[AHR:3.94;95%CI:(2.24-8.74);p = 0.046],alcohol use history[AHR:1.26; 95%CI:(1.08-2.23);p = 0.031], HIV infection[AHR:3.06;95%CI:(1.93-11.34);p=0.042], infrequent use of fruits & vegetables [AHR:3.77;95%CI: (1.34-10.57);p=0.012], infrequent engagement on physical exercise[AHR:3.48;95%CI:(1.48-8.17);p = 0.004],frequent use of high fats food [AHR:2.56;95%CI: (1.25-5.25);p = 0.011] were an independent predictors of uncontrolled blood pressure., Conclusion: The rate of uncontrolled blood pressure is significantly higher in the HIV- infected population. There was a gap in the clinical care of hypertension in terms of hypertension self-management among hypertensive HIV-positive patients. Our study highlights the need for better integration of hypertension care to HIV clinical setting., Competing Interests: The authors declared that they have no competing interests., (© 2020 The Author(s).)

Background: The scientific community has recently summarized the desired characteristics for diagnostic tools across the different phases of a soil-transmitted helminth (STH) mass drug administration (MDA) program. Although serology meets some of the desired criteria, there is a scarcity of data on baseline serological profiles in human populations, both prior to and during MDA programs., Methods: In this study, we compared the copromicroscopic and the serological infection profiles in 600 school-aged children (SAC) and 600 adults at the advent of the MDA program in Jimma Town, Ethiopia. The serological profiles were examined by two ELISAs that measure IgG4 responses to the Ascaris suum haemoglobin antigen (AsHb) and a somatic extract of lung stage larvae (AsLungL3). Three years into the MDA program, we sampled another group of 600 SAC from the same schools to assess the reduction in prevalence and intensity of Ascaris infections measured by copromicroscopy and serology., Principal Findings: Prior to the start of MDA, copromicroscopy revealed an Ascaris prevalence of 31.0% and a mean fecal egg count of 2,919 eggs per gram (EPG) in SAC. Following three years of biannual treatment, the prevalence reduced to 13.2% (57.8% reduction) and the mean fecal egg count to 1,513 EPG (48.1% reduction). This reduction was also reflected in the serological results. The seroprevalence reduced with 40.9% and 27.4% and the mean optical density ratio reduced with 44.2% and 38.2% as measured by the AsHb or AsLungL3 ELISA respectively. We also showed that, despite a decreasing coproprevalence, seroprevalence to Ascaris increased with age., Conclusions: This study is the first to provide IgG4 response profiles of an endemic population to two different A. suum antigens. The results suggest that exposure to the infectious stages of Ascaris reaches beyond SAC alone. Furthermore, it highlights the possible use of serological assays to monitor changes in STH exposure during MDA programs., Competing Interests: The authors have declared that no competing interests exist.

Studying the relationship between mental illnesses and their environmental and genetic risk factors in low-income countries holds excellent promises. These studies will improve our understanding of how risk factors identified predominantly in high-income countries also apply to other settings and will identify new, sometimes population-specific risk factors. Here we report the successful completion of two intertwined pilot studies on khat abuse, trauma, and psychosis at the Gilgel Gibe Field Research Center in Ethiopia. We found that the Gilgel Gibe Field Research Center offers a unique opportunity to collect well-characterized samples for mental health research and to perform genetic studies that, at this scale, have not been undertaken in Ethiopia yet. We also supported service development, education, and research for strengthening the professional profile of psychiatry at the site.

Background: Numerous studies have been carried out on assessing the prevalence of intestinal parasites infections (IPIs) amongpreschool and school-age children in Ethiopia, but there is lack of study systematically gathered and analyzedinformation for policymakers. Therefore, the aim of this systematic review and meta-analysis was to provide a summary on prevalence, geographical distribution and trends of IPIs among preschool and school-age childrenin Ethiopia., Methods: The search were carried out in Medline via PubMed, Scopus, Science Direct, Web of Science, and Google Scholar from 1996to July2019 for studies describing prevalence of IPIs among preschooland school-age children. We conducted meta-regression to understand the trends and the source of heterogeneity and pooled the prevalence using 'metaprop' command using STATA software version 14., Results: Eighty-three(83) studies examining 56,786 fecal specimens were included. The prevalence of IPIs was 48%(95%CI: 42 to 53%) and showedsignificantly decreasing trends 17% (95% CI: 2.5 to 32%) for each consecutive 6 years) and was similar in males and females. The pooled prevalence in years 1997-2002, 2003-2008, 2009-2014 and > 2014 was 71% (95% CI: 57 to 86%), 42% (95% CI: 27 to 56%), 48% (95% CI: 40 to 56%) and 42% (95% CI: 34 to 49%), respectively. Poly-parasitism was observed in 16% (95% CI: 13 to 19%,) of the cases., Conclusion: Intestinal parasite infections are highly prevalent among preschool and school-age children and well distributed across the regional states of Ethiopia. Southern and Amhara regional states carry the highest burden. We observed significant decreasing trends in prevalence of IPIs among preschool and school-ageEthiopian children over the last two decades. Therefore, this study is important to locate the geographical distribution and identified high risk areas that should be prioritized further interventions, which complement global efforts towards elimination of IPIs infections by 2020.

Objective: HAART had significantly improved the quality of life of HIV patients. However, it results different adverse effects such as: hepatotoxicity, nephrotoxicity, lipodystrophy, anemia, diarrhea, psychiatric disorder and others. Therefore, this comparative cross sectional study was designed to investigate liver enzyme elevation in patients taking HAART compared with treatment naïve controls at Debre Berhan Referral Hospital., Result: A total of 152 individuals (76 cases and 76 controls) were included in this study. The mean ages of treatment and control groups were 37.37 and 36.38 respectively. The mean values of liver enzymes (ALT, AST and ALP), total bilirubin and direct bilirubin were significantly higher (p < 0.05) while, total protein and creatinine were significantly lower in patients taking HAART compared with treatment naïve controls. In this study, about 19 (25%) of clients in HAART treated groups and 7 (9.2%) of treatment naïve controls had showed liver enzyme changes. Moreover, 23.7% and 1.3% of the HAART treated groups developed mild and moderate liver enzyme elevation or hepatotoxicity, respectively. In this study, significant difference was observed in liver enzyme elevation between ART and pre-ART patients. As a result, regular clinical and laboratory monitoring of liver function will be necessary to prevent severe form of liver injury.

Background: A DNA extraction and preservation protocol that yields sufficient and qualitative DNA is pivotal for the success of any nucleic acid amplification test (NAAT), but it still poses a challenge for soil-transmitted helminths (STHs), including Ascaris lumbricoides, Trichuris trichiura and the two hookworms (Necator americanus and Ancylostoma duodenale). In the present study, we assessed the impact of different DNA extraction and preservativation protocols on STH-specific DNA amplification from stool., Methodology and Principal Findings: In a first experiment, DNA was extracted from 37 stool samples with variable egg counts for T. trichiura and N. americanus applying two commercial kits, both with and without a prior bead beating step. The DNA concentration of T. trichiura and N. americanus was estimated by means of qPCR. The results showed clear differences in DNA concentration across both DNA extraction kits, which varied across both STHs. They also indicated that adding a bead beating step substantially improved DNA recovery, particularly when the FECs were high. In a second experiment, 20 stool samples with variable egg counts for A. lumbricoides, T. trichiura and N. americanus were preserved in either 96% ethanol, 5% potassium dichromate or RNAlater and were stored at 4°C for 65, 245 and 425 days. DNA was extracted using the DNeasy Blood & Tissue kit with a bead beating step. Stool samples preserved in ethanol proved to yield higher DNA concentrations as FEC increased, although stool samples appeared to be stable over time in all preservatives., Conclusions: The choice of DNA extraction kit significantly affects the outcome of NAATs. Given the clear benefit of bead beating and our validation of ethanol for (long-term) preservation, we recommend that these aspects of the protocol should be adopted by any stool sampling and DNA extraction protocol for downstream NAAT-based detection and quantification of STHs., Competing Interests: The authors have declared that no competing interests exist.

Health programs are reliant on complex decision-making to efficiently utilize limited resources, but local-level data use is still challenging. This study aimed to assess barriers to fostering local-level data use culture at each level of a health system. Results show that awareness gaps, lack of motivation, inconsistent supervision, poor community engagement, and lack of accountability are major bottlenecks. Establishing an accountability system and capacity building on health data use could improve its implementation.

Background: Preventive chemotherapy (PC) with benzimidazole drugs is the backbone of soil-transmitted helminth (STH) control programs. Over the past decade, drug coverage has increased and with it, the possibility of developing anthelmintic resistance. It is therefore of utmost importance to monitor drug efficacy. Currently, a variety of novel diagnostic methods are available, but it remains unclear whether they can be used to monitor drug efficacy. In this study, we compared the efficacy of albendazole (ALB) measured by different diagnostic methods in a head-to-head comparison to the recommended single Kato-Katz., Methods: An ALB efficacy trial was performed in 3 different STH-endemic countries (Ethiopia, Lao PDR and Tanzania), each with a different PC-history. During these trials, stool samples were evaluated with Kato-Katz (single and duplicate), Mini-FLOTAC, FECPAKG2, and qPCR. The reduction rate in mean eggs per gram of stool (ERR) and mean genome equivalents / ml of DNA extract (GERR) were calculated to estimate drug efficacy., Principal Findings and Conclusions: The results of the efficacy trials showed that none of the evaluated diagnostic methods could provide reduction rates that were equivalent to a single Kato-Katz for all STH. However, despite differences in clinical sensitivity and egg counts, they agreed in classifying efficacy according to World Health Organization (WHO) guidelines. This demonstrates that diagnostic methods for assessing drug efficacy should be validated with their intended-use in mind and that other factors like user-friendliness and costs will likely be important factors in driving the choice of diagnostics. In addition, ALB efficacy against STH infections was lower in sites with a longer history of PC. Yet, further research is needed to identify factors that contribute to this finding and to verify whether reduced efficacy can be associated with mutations in the β-tubulin gene that have previously been linked to anthelmintic resistance., Trial Registration: ClinicalTrials.gov NCT03465488., Competing Interests: The FECPAKG2 technology was produced and distributed by Techion Group Ltd, of which ET is an employee and GM is managing director. Both hold stocks in Techion Group Ltd. The Mini-FLOTAC device is a commercial product distributed by GC, LR and MPM through the University of Napoli Federico II. However, their affiliations did not play any role in the preparation and submission of this manuscript. All other authors declared that they have no competing interests.

Background: Because the success of deworming programs targeting soil-transmitted helminths (STHs) is evaluated through the periodically assessment of prevalence and infection intensities, the use of the correct diagnostic method is of utmost importance. The STH community has recently published for each phase of a deworming program the minimal criteria that a potential diagnostic method needs to meet, the so-called target product profiles (TPPs)., Methodology: We compared the diagnostic performance of a single Kato-Katz (reference method) with that of other microscopy-based methods (duplicate Kato-Katz, Mini-FLOTAC and FECPAKG2) and one DNA-based method (qPCR) for the detection and quantification of STH infections in three drug efficacy trials in Ethiopia, Lao PDR, and Tanzania. Furthermore, we evaluated a selection of minimal diagnostic criteria of the TPPs., Principal Findings: All diagnostic methods showed a clinical sensitivity of ≥90% for all STH infections of moderate-to-heavy intensities. For infections of very low intensity, only qPCR resulted in a sensitivity that was superior to a single Kato-Katz for all STHs. Compared to the reference method, both Mini-FLOTAC and FECPAKG2 resulted in significantly lower fecal egg counts for some STHs, leading to a substantial underestimation of the infection intensity. For qPCR, there was a positive significant correlation between the egg counts of a single Kato-Katz and the DNA concentration., Conclusions/significance: Our results indicate that the diagnostic performance of a single Kato-Katz is underestimated by the community and that diagnostic specific thresholds to classify intensity of infection are warranted for Mini-FLOTAC, FECPAKG2 and qPCR. When we strictly apply the TPPs, Kato-Katz is the only microscopy-based method that meets the minimal diagnostic criteria for application in the planning, monitoring and evaluation phase of an STH program. qPCR is the only method that could be considered in the phase that aims to seek confirmation for cessation of program., Trial Registration: ClinicalTrials.gov NCT03465488., Competing Interests: The FECPAKG2 technology was produced and distributed by Techion Group Ltd, of which ET is an employee and GM is managing director. Both hold stocks in Techion Group Ltd. The Mini-FLOTAC device is a commercial product distributed by GC, LR and MPM through the University of Napoli Federico II. However, the affiliations of ET, GM, GC, LR and MPM did not play any role in the preparation and submission of this manuscript. All other authors declared that they have no competing interests.

Background: Onchocerciasis (river blindness), caused by the filarial worm species Onchocerca volvulus, is a serious vector-borne neglected tropical disease (NTD) of public health and socioeconomic concern. It is transmitted through the bite of black flies of the genus Simulium, and manifested in dermal and ocular lesions. Ninety-nine percent of the total global risk and burden of onchocerciasis is in Africa. This scoping review examines the key challenges related to the elimination of onchocerciasis by 2020-2025 in Africa, and proposes recommendations to overcome the challenges and accelerate disease elimination. To find relevant articles published in peer-reviewed journals, a search of PubMed and Google Scholar databases was carried out., Main Text: Rigorous regional interventions carried out to control and eliminate onchocerciasis in the past four decades in Africa have been effective in bringing the disease burden under control; it is currently not a public health problem in most endemic areas. Notably, transmission of the parasite is interrupted in some hyperendemic localities. Recently, there has been a policy shift from control to complete disease elimination by 2020 in selected countries and by 2025 in the majority of endemic African countries. The WHO has published guidelines for stopping mass drug administration (MDA) and verifying the interruption of transmission and elimination of human onchocerciasis. Therefore, countries have revised their plans, established a goal of disease elimination in line with an evidence based decision to stop MDA and verify elimination, and incorporated it into their NTDs national master plans. Nevertheless, challenges remain pertaining to the elimination of onchocerciasis in Africa. The challenge we review in this paper are: incomplete elimination mapping of all transmission zones, co-endemicity of onchocerciasis and loiasis, possible emergence of ivermectin resistance, uncoordinated cross-border elimination efforts, conflict and civil unrest, suboptimal program implementation, and technical and financial challenges. This paper also proposes recommendations to overcome the challenges and accelerate disease elimination. These are: a need for complete disease elimination mapping, a need for collaborative elimination activities between national programs, a need for a different drug distribution approach in conflict-affected areas, a need for routine monitoring and evaluation of MDA programs, a need for implementing alternative treatment strategies (ATSs) in areas with elimination anticipated beyond 2025, and a need for strong partnerships and continued funding., Conclusions: National programs need to regularly monitor and evaluate the performance and progress of their interventions, while envisaging the complete elimination of onchocerciasis from their territory. Factors hindering the targeted goal of interruption of parasite transmission need to be identified and remedial actions should be taken. If possible and appropriate, ATSs need to be implemented to accelerate disease elimination by 2025.

[This corrects the article DOI: 10.1371/journal.pntd.0006655.].

Background: Ov16 serology is considered a reference method for Onchocerca volvulus epidemiological mapping. Given the suboptimal sensitivity of this test and the fact that seroconversion takes more than a year after infection, additional serological tests might be needed to guide onchocerciasis elimination programmes. Recently, two linear epitopes encoded in OvMP-1 and OvMP-23 peptides were introduced as serological markers, but the observed antibody cross-reactivity in samples originating from Onchocerca volvulus non-endemic areas required further investigation., Methods: We evaluated both peptide markers in an O. volvulus hypo-endemic setting in Jimma Town, Ethiopia using peptide ELISA. For all individuals (n = 303), the infection status with soil-transmitted helminths and Schistosoma mansoni was known., Results: We found that 11 (3.6%) individuals were positive for anti-Ov16 IgG4 antibodies, while 34 (11.2%) and 15 (5.0%) individuals were positive for OvMP-1 and OvMP-23, respectively. Out of the 34 OvMP-1 positive samples, 33 were negative on the Ov16 IgG4 ELISA. Similarly, out of the 15 OvMP-23 positive samples, 14 scored negative on this reference method. No difference in seroprevalence for all three markers could be observed between uninfected individuals and individuals infected with different soil-transmitted helminths or S. mansoni. Moreover, the intensity of the response to OvMP-1, OvMP-23 or Ov16 was not significantly stronger in individuals carrying patent STH or S. mansoni infections, nor was there any correlation between the intensities of the responses to the three different antigens., Conclusions: This study demonstrates that a patent infection with either soil-transmitted helminths or S. mansoni does not lead to increased antibody recognition of both OvMP-1 and OvMP23.

Introduction: Up to date, the frequency of preventive chemotherapy based on the prevalence is the only strategy in the control programmes of soil-transmitted helminths (STHs). However, prevalence of STHs may be affected by climatic and/or seasonal changes, particularly when these are important determinants of transmission of STH infections. Our objective was to describe the prevalence and infection intensity and seasonal variation (mainly dry vs rainy season) of any STHs among school age children., Methods: Assessment of infection intensity and prevalence of STHs was carried out during dry season (February-March, 2012) and end of rainy season (September-October, 2012) across 14 primary schools in Jimma Town, Jimma, Ethiopia. A total of 1,680 school children (840 in each season) were included. All stool samples were processed by the McMaster egg counting method. Odds of infection and intensity was performed to assess any differences in prevalence and infection intensity between the schools and the two seasons. The pooled odd ratio and their 95% confidence interval was also computed and presented using the "metafor" package of the statistical software R. The level of significance was declared at p < 0.05., Results: Infections with any STH were observed in 824/1,680 (49.0%) subjects. T. trichiura was the most prevalent (35.5%), followed by A. lumbricoides (23.4%) and hookworms (9.9%). Among the schools there were a huge variation in prevalence, ranging from 16.7% to 68.3% for any STH, 6.7% to 39.2% for A. lumbricoides , 10.8% to 55.0% for T. trichiura and 0 % to 28.3% for hookworms. A significant difference in prevalence (for T. trichiura ) and in infection intensity (for A. lumbricoides and T. trichiura ) across seasons was observed. Generally, STH infections were more prevalent in the dry season (52.4%) compared to the rainy season (45.7%) and as well intensity of all three STH infections was higher in the dry season., Conclusion: Our data suggested that there were huge variation in STH prevalence among schools and a significant difference in infection intensity and prevalence across seasons. This in turn might limits how national governments and international organizations define and target resources to combat the disease burden due to STH infection. Long term studies are needed to confirm the influence of seasonal factors and related ecological, environmental and socio-economic factors., Competing Interests: The authors declare no competing interests.

Introduction: School children are among the high risk groups for soil-transmitted helminths (STHs) and Schistosoma mansoni (S. mansoni) infections in developing countries. The aim of this study was to determine the prevalence and associated factors of STHs and S. mansoni among primary school children., Methodology: A cross-sectional study was conducted from February 15 to March 30, 2016, involving a total of 340 primary school children (age range 6 to 19 years). Socio-demographic and related data were collected using interviewer-administered questionnaire. Stool samples were collected from each study participant and examined using direct wet mount and modified Kato-Katz thick smear technique. Intensity of the STHs and S. mansoni were determined by estimating the eggs per gram (EPG) of stool. Factors associated with STH and S. mansoni infections were analyzed using multivariable logistic regression model., Results: Prevalence of the STHs and S. mansoni were 38.2% and 12.94%, respectively. The main predictors of STH infections among the children studied were being in the age group of 16-19 years, untrimmed finger nail and household latrine unavailability. Moreover, male children, children with habit of swimming and bathing in the river had significantly higher odds of S. mansoni infection. Most of the children infected with the parasites had light infection., Conclusions: The burden of STHs and S. mansoni was high among the school children. Deworming intervention should be strengthened, along with awareness creation on proper disposal of human excreta and personal hygiene. Regular monitoring of the burden of the parasites and mass drug administration is required., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2018 Temam Ibrahim, Endalew Zemene, Yaregal Asres Ayenew, Dinberu Seyoum, Abebaw Tiruneh, Lealem Gedefaw, Zeleke Mekonnen.)

Background: Otitis media is among the leading causes of childhood illnesses although it can also affect the adults resulting in frequent physician visits, drug prescription and a key contributor to antibiotic resistance. The aim of this study was to determine the risk factors, bacterial profile, and the antimicrobial susceptibility pattern of the isolates from patients with discharging ears which clinically equates to draining otitis media in developing countries with limited medical resources such as otoscope., Methods: A prospective cross-sectional study was conducted on 173 patients with draining otitis media. The ear discharge specimens were collected and analyzed by standard microbial techniques. The antibiotic susceptibility profiles were determined for 19 different antibiotics by the standard disk diffusion method. Data was analyzed by SPSS version 22 and the P value of less than 0.05 was considered as statistically significant., Results: Among 173 otitis media patients participated in the study; majority, 102(63%) were pediatrics, out of which 72 (41.61%) were in the age group of less than 4 years. Ear infection was bilateral in 39 (22.54%) and chronic in 100 (57.8%) of the patients. Pathogens were isolated from 160 (92.5%) of the patients with a total of 179 isolates. The predominant isolate was Staphylococcus aureus (30.72%) followed by Proteus spp. (17.89%). The result of this study showed that adult age ( p  = 0.031), rural residence ( p  = 0.005), previous history of health care visit and treatment ( p  = 0.000), upper respiratory tract infection ( p  = 0.018) and presence of cigarette smoker in the house ( p  = 0.022) had statistically significant association with chronic otitis media. Most of the isolated bacteria showed high level of resistance to ampicillin/amoxicillin (88.3%), penicillin G (79.5%) followed by trimethoprim /sulfamethoxazole (73.8%). Conversely, the majority of bacterial isolates showed moderate susceptibility to ciprofloxacin (72.9%), gentamicin (70.4%), and amikacin (69.3%). Bacterial isolates identified in this study showed trend of multiple drug resistance, majority (67%) being resistant to three or more antimicrobials., Conclusions: Majority of the bacterial isolates were multidrug resistant, hence, efforts to isolate microorganisms and determine the susceptibility pattern should be strengthened to improve the treatment outcome of otitis media instead of the usual trend of empirical treatment., Competing Interests: Ethical clearance was obtained from the institutional review board (IRB) of Institute of Health, Jimma University (Ref no: IHRPGC/280/071) and permission was obtained from the health facilities where the study was conducted. Informed voluntary assent was obtained from children and written consent was obtained from all adult patients and parents/guardians of the children involved before commencing the study. Patients with a positive result were communicated about their result to their respective health professional/physician for proper management.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: To work towards reaching the WHO goal of eliminating soil-transmitted helminth (STH) infections as a public health problem, the total number of children receiving anthelmintic drugs has strongly increased over the past few years. However, as drug pressure levels rise, the development of anthelmintic drug resistance (AR) is more and more likely to appear. Currently, any global surveillance system to monitor drug efficacy and the emergence of possible AR is lacking. Consequently, it remains unclear to what extent the efficacy of drugs may have dropped and whether AR is already present. The overall aim of this study is to recommend the best diagnostic methods to monitor drug efficacy and molecular markers to assess the emergence of AR in STH control programs., Methods: A series of drug efficacy trials will be performed in four STH endemic countries with varying drug pressure (Ethiopia and Brazil: low drug pressure, Lao PDR: moderate drug pressure and Tanzania: high drug pressure). These trials are designed to assess the efficacy of a single oral dose of 400 mg albendazole (ALB) against STH infections in school-aged children (SAC) by microscopic (duplicate Kato-Katz thick smear, Mini-FLOTAC and FECPAKG2) and molecular stool-based diagnostic methods (quantitative PCR (qPCR)). Data will be collected on the cost of the materials used, as well as the time required to prepare and examine stool samples for the different diagnostic methods. Following qPCR, DNA samples will also be submitted for pyrosequencing to assess the presence and prevalence of single nucleotide polymorphisms (SNPs) in the β-tubulin gene. These SNPs are known to be linked to AR in animal STHs., Discussion: The results obtained by these trials will provide robust evidence regarding the cost-efficiency and diagnostic performance of the different stool-based diagnostic methods for the assessment of drug efficacy in control programs. The assessment of associations between the frequency of SNPs in the β-tubulin gene and the history of drug pressure and drug efficacy will allow the validation of these SNPs as a marker for AR in human STHs., Trial Registration: The trial was retrospectively registered the 7th of March 2018 on Clinicaltrials.gov (ID: NCT03465488)., Competing Interests: The Mini-FLOTAC apparatus has been developed and is patented by GC, but the patent will be handed over to the University of Naples Federico II. The FECPAKG2 technology was developed and patented by Techion Group Ltd, of which GM and ET are employees. These affiliations however did not play any role in the preparation and submission of this study protocol. All other authors declare that they have no competing interests.

Background: Clinical laboratory reference intervals are an important tool to identify abnormal laboratory test results. The generating of hematological parameters reference intervals for local population is very crucial to improve quality of health care, which otherwise may lead to unnecessary expenditure or denying care for the needy. There are no well-established reference intervals for hematological parameters in southwest Ethiopia., Objective: To generate hematological parameters reference intervals for apparently healthy individuals in southwest Ethiopia., Methods: A community-based cross-sectional study was conducted involving 883 individuals from March to May 2017. Four milliliter of blood sample was collected and transported to Jimma University Medical Center Laboratory for hematological analysis and screening tests. A hematological parameters were measured by Sysmex XS-500i hematology analyzer (Sysmex Corporation Kobe, Japan). The data were analyzed by SPSS version 20 statistical software. The non-parametric independent Kruskal-Wallis test and Wilcoxon rank-sum test (Mann-Whitney U test) were used to compare the parameters between age groups and genders. The 97.5 percentile and 2.5 percentile were the upper and lower reference limit for the population., Results: The reference interval of red blood cell, white blood cell, and platelet count in children were 4.99 × 10 12 /L (4.26-5.99 × 10 12 /L), 7.04 × 10 9 /L (4.00-11.67 × 10 9 /L), and 324.00 × 10 9 /L (188.00-463.50 × 10 9 /L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in adults was 5.19 × 10 12 /L (4.08-6.33 × 10 12 /L), 6.35 × 10 9 /L (3.28-11.22 × 10 9 /L), and 282.00 × 10 9 /L (172.50-415.25 × 10 9 /L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in geriatrics were 5.02 × 10 12 /L (4.21-5.87 × 10 12 /L), 6.21 × 10 9 /L (3.33-10.03 × 10 9 /L), and 265.50 × 10 9 /L (165.53-418.80 × 10 9 /L), respectively. Most of the hematological parameters showed significant differences across all age groups., Conclusion: Most of the hematological parameters in this study showed differences from similar studies done in the country. This study provided population-specific hematological reference interval for southwest Ethiopians. Reference intervals should also be established in the other regions of the country., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Standard diagnosis of human soil-transmitted helminth (STH) infections is based on the microscopic detection of helminth eggs in stool and supports programmatic decision making in control programs. However, the current standard diagnostic techniques still show a number of limitations. Recently, the FECPAKG2 method was developed to detect helminth infections and asses drug efficacy in sheep or cattle. It includes a device that takes digital images of helminth eggs that have been concentrated into one microscopic field of view and stores these images online for future evaluation. The goal of this study was to introduce a standard operating procedure (SOP) for the detection and quantification of human STH eggs using the FECPAKG2 and to optimize 2 crucial steps of the protocol, namely the sedimentation step (aimed at separating sinking eggs from floating debris) and the accumulation step (aimed at concentrating the eggs by flotation)., Methodology/principal Findings: A total of 55 stool samples from naturally infected children were used from 4 different geographical areas (Ethiopia, Laos, Tanzania and Brazil). The results showed that Trichuris eggs generally moved slower than eggs of the other two STH species during both sedimentation in water in the FECPAKG2 sedimenter as during accumulation in flotation solution in the FECPAKG2 cassettes. The highest number of eggs were present in the slurry of the sedimenter after overnight sedimentation (Ascaris: 95.7%, Trichuris: 89.8% and hookworm: 94.2% of the eggs). A minimum of 24 minutes were needed to ensure the accumulation of at least 80% of the eggs from all three STH species in the FECPAKG2 cassette (Ascaris: 96.1%; Trichuris: 88.2% and hookworm: 87.6%)., Conclusions/significance: This study introduces for the first time a SOP for the FECPAKG2 method. Different aspects of the method for diagnosing human STH infections were optimized. Our study forms the basis for a thorough and objective evaluation of the system as a diagnostic tool that could be implemented in STH control programs., Competing Interests: The FECPAKG2 technology was developed and patented by Techion Group Ltd, of which GM and HM are employees. SSo holds stock in Techion Group LtD. These affiliations however did not play any role in the preparation and submission of this manuscript. All other authors declare that they have no competing interests.

Background: Different types of dietary lipids have been shown to affect lipid metabolism and lipid profile differently., Objective: This study aims to assess the effect of local niger seed oil on serum lipid profile compared to palm oil and sunflower oil in rats., Methods: The effect of the 15% plant oils on serum lipid profile, body weight gain percentage, and feed efficiency ratio was assessed after 8 weeks of experimental period., Results and Conclusion: The 15% niger seed oil showed decrease and increase in the level of lipid profile as compared to rats fed with 15% palm oil and sunflower oil (except Triacylglycerol), respectively. The 15% niger seed oil showed significant decrease and increase in body weight gain percentage as compared to the 15% palm oil and 15% sunflower oil, respectively. The feed efficiency ratio was significantly higher and lower in the 15% niger seed oil compared to rats fed with 15% sunflower oil and control group and the palm oil fed rats, respectively. The current study concluded that consumption of locally manufactured niger seed oil decreased the blood lipid profiles, body weight gain percentage, and feed efficiency ratio as compared to palm oil. Utilization of oils containing more unsaturated fatty acids like niger seed oil is recommended to reduce the risk of developing cardiovascular disease.

Background: Giardia duodenalis is a species complex consisting of multiple genetically distinct assemblages. The species imposes a major public health crisis on developing countries. However, the molecular diversity, transmission dynamics and risk factors of the species in these countries are indeterminate. This study was conducted to determine the molecular epidemiology of G. duodenalis infection in asymptomatic individuals in Southern Ethiopia., Methods: From March to June 2014, fresh stool samples were collected from 590 randomly selected individuals. Socio-demographic data were gathered using a pre-tested structured questionnaire. The genotyping was done using triosephosphate isomerase gene-based nested polymerase chain reaction and DNA sequencing. The genetic identity and relatedness of isolates were determined using the basic local alignment search tool and phylogenetic analysis. Risk factors associated with G. duodenalis infection were analysed using binary and multinomial logistic regression models., Results: The results showed that 18.1% (92/509) of the study subjects were infected by G. duodenalis. Among the isolates, 35.9% (33/92) and 21.7% (20/92) were sub-typed into assemblages A and B, respectively, whereas 42.4% (39/92) showed mixed infections of A and B. Most of the assemblage A isolates (94%,31/33) were 100% identical to sequences registered in GenBank, of which the majority belonged to sub-assemblage AII. However, the high genetic variability and frequency of double peaks made sub-genotyping of assemblage B more problematic and only 20% (4/20) of the isolates matched 100% with the sequences. The risk factors of age (P = 0.032) and type of drinking water source (P = 0.003) both showed a significant association with the occurrence G. duodenalis infection., Conclusions: This study established the endemicity of G. duodenalis in Southern Ethiopia. Infection with assemblage A was more frequent than with assemblage B, and the rate of infection was higher in children and in municipal/tap and open spring water consumers than the other groups. Sub-typing of assemblage B and determining the origin of double peaks were challenging. The present study confirms the need for further inclusive studies to be conducted focusing on sub-types of assemblage B and the origin of heterogeneity.

This randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of a new chewable, rapidly-disintegrating mebendazole (MBZ) 500 mg tablet for Ascaris lumbricoides and Trichuris trichiura infection treatment. Pediatric patients (1-15 years; N = 295; from Ethiopia and Rwanda) excreting A. lumbricoides and/or T. trichiura eggs were enrolled. The study had a screening phase (3 days), a double-blind treatment phase (DBP, 19 days), and an open-label phase (OLP, 7 days). Patients received MBZ or placebo on day 1 of DBP and open-label MBZ on day 19 ± 2 after stool sample collection. Cure rates (primary endpoint), defined as species-specific egg count of 0 at the end of DBP, were significantly higher in the MBZ group than placebo for A. lumbricoides (83.7% [72/86; 95% CI: 74.2%; 90.8%] versus 11.1% [9/81; 95% CI: 5.2%; 20.1%], P < 0.001) and for T. trichiura (33.9% [42/124; 95% CI: 25.6%; 42.9%] versus 7.6% [9/119; 95% CI: 3.5%; 13.9%], P < 0.001). Egg reduction rates (secondary endpoint) were significantly higher in the MBZ group than placebo for A. lumbricoides (97.9% [95% CI: 94.4; 99.9] versus 19.2% [95% CI: -5.9; 41.5]; P < 0.001) and T. trichiura (59.7% [95% CI: 33.9; 78.8] versus 10.5% [95% CI: -16.8; 32.9]; P = 0.003). Treatment-emergent adverse events (TEAEs) in MBZ group occurred in 6.3% (9/144) of patients during DBP and 2.5% (7/278) during OLP. No deaths, serious TEAEs, or TEAEs leading to discontinuations were reported. A 500 mg chewable MBZ tablet was more efficacious than placebo for the treatment of A. lumbricoides and T. trichiura infections in pediatric patients, and no safety concerns were identified.

Background: In this cross-sectional study, we compared the performance of Mini Parasep® solvent-free (SF) faecal parasite concentrator, Kato-Katz thick smear and McMaster techniques for the diagnosis of intestinal parasitic infections among children in Wosha Soyama Primary School, Ethiopia., Methods: Stool samples were collected from 381 children and examined for intestinal parasitic infections using Mini Parasep® SF faecal parasite concentrator, Kato-Katz thick smear and McMaster techniques., Results: About 86.1% of children were infected with at least one species of intestinal parasite based on combined results of the three techniques. The sensitivity and negative predictive values of Mini Parasep® SF, Kato-Katz and McMaster tests for detecting at least one species of intestinal parasite infections were 90.2% and 62.4%, 80.0% and 44.5%, and 55.2% and 26.5%, respectively. While Mini Parasep® SF was more sensitive in detecting Ascaris lumbricoides, Schistosoma mansoni and Hymenolepis nana infections, Kato-Katz was more sensitive in detecting Trichuris trichiura infection, and McMaster had higher sensitivity in diagnosing hookworm infection., Conclusions: The Mini Parasep® SF faecal parasite concentrator technique showed better performance than the Kato-Katz and McMaster techniques for the detection of intestinal helminth infections in stool samples, particularly for S. mansoni, A. lumbricoides and H. nana. Hence, Mini Parasep® SF could be used as one of the suitable faecal examination methods for surveillance and monitoring of preventive chemotherapy of schistosomiasis.

Background: East Africa, where Leishmania donovani is prevalent, faces the highest burden world-wide of visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) coinfection. However, data on the risk and predictors of VL relapse are scarce. Such information is vital to target medical follow-up and interventions to those at highest risk., Methods: We conducted a retrospective cohort study at a Médecins Sans Frontières-supported health center in northwest Ethiopia. We included adult VL-HIV coinfected patients treated for VL and discharged cured between February 2008 and February 2013. The risk of relapse was calculated using Kaplan-Meier methods, and predictors were determined using Cox regression models., Results: Of the 146 patients included, 140 (96%) were male and the median age was 31 years. At the index VL diagnosis, 110 (75%) had primary VL, 57 (40%) were on antiretroviral therapy (ART), and the median CD4 count was 149 cells/µL. The median follow-up time after cure was 11 months, during which 44 (30%) patients relapsed. The risk of relapse was 15% at 6 months, 26% at 12 months, and 35% at 24 months. Predictors of relapse were: not being on ART at VL diagnosis, ART not initiated during VL treatment, and high tissue parasite load (parasite grade 6+) at VL diagnosis., Conclusions: The risk of VL relapse in coinfected patients was high, particularly in those not on ART or presenting with a high tissue parasite load. These patients should be preferentially targeted for secondary prophylaxis and/or regular medical follow-up. Timely ART initiation in all coinfected patients is crucial., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.)

Background: Reference interval is crucial for disease screening, diagnosis, monitoring, progression and treatment efficacy. Due to lack of locally derived reference values for the parameters, clinicians use reference intervals derived from western population. But, studies conducted in different African countries have indicated differences between locally and western derived reference values. Different studies also indicated considerable variation in clinical chemistry reference intervals by several variables such as age, sex, geographical location, environment, lifestyle and genetic variation., Objective: This study aimed to determine the reference intervals of common clinical chemistry parameters of the community of Gojjam Zones, Northwest Ethiopia., Method: Population based cross-sectional study was conducted from November 2015 to December 2016 in healthy adult populations of Gojjam zone. Data such as, medical history, physical examination and socio-demographic data were collected. In addition, laboratory investigations were undertaken to screen the population. Clinical chemistry parameters were measured using Mindray BS 200 clinical chemistry autoanalyzer as per the manufacturer's instructions. Descriptive statistics was used to calculate mean, median and 95th percentiles. Independent sample T-test and one way ANOVA were used to see association between variables., Results: After careful screening of a total of 799 apparently healthy adults who were consented for this study, complete data from 446 (224 females and 222 males) were included for the analysis. The mean age of both the study participants was 28.8 years. Males had high (P<0.05) mean and 2.5th-97.5th percentile ranges of ALT, AST, ALP, creatinine and direct bilirubin. The reference intervals of amylase, LDH, total protein and total bilirubin were not significantly different between the two sex groups (P>0.05). Mean, median, 95% percentile values of AST, ALP, amylase, LDH, creatinine, total protein, total bilirubin, and direct bilirubin across all age groups of participants were similar (P>0.05). But, there was a significant difference in the value of ALT (P<0.05). The reference intervals of ALT, total protein and creatinine were significantly (P<0.05) high in people having monthly income >1500 ETB compared to those with low monthly income. Significant (P<0.05) higher values of the ALT, ALP and total protein were observed in people living in high land compared to low land residences., Conclusion: The study showed that some of the common clinical chemistry parameters reference intervals of healthy adults in Gojjam zones were higher than the reference intervals generated from developed countries. Therefore, strict adherence to the reference values generated in developed countries could lead to inappropriate diagnosis and treatment of patients. There was also variation of reference interval values based on climate, gender, age, monthly income and geographical locations. Therefore, further study is required to establish reference intervals for Ethiopian population.

Introduction: Establishing national population haematological and immunological reference ranges are essential for clinical management of patients. However, there is scarcity of information on community based haematological reference ranges established from Ethiopian population. Therefore, this study aimed at determining haematological and CD4+ T cells reference ranges in healthy adults from East and West Gojjam zones, Ethiopia., Methods: Community based cross-sectional study was conducted from May 2015 to December 2015 in healthy adult residents of Gojjam zone. A total of 481(246 females and 235 males) healthy adults enrolled in the study. Healthy adults were defined by medical history, physical examination and laboratory screening for HIV, HBV, HCV and intestinal parasitosis. Haematological parameters were measured using haematology analyzer MindrayBC320 (Mindray Biomedical electronic Corporation, China). CD4+Tcells were enumerated using FACS count (Becton Dickinson)., Results: The median age of the participants was 25 years. The overall median and 95th percentile of CD4+ T cells count were 869 cells/mm3 and396-1598 cells/mm3, respectively. Females had a significantly higher CD4+ T cell counts compared to males (P = 0.002). The 95th percentile range for red blood cells (RBCs) was 3.93-6.1 x 106cells/mm3and for hematocrit (Hct) was 40-58% while for hemoglobin (Hb) was 15.69-17.84g/dl. Males had significantly higher values of RBC and Hct than females (P < 0.001). Females (120-379 x 106 cells/mm3) had significantly higher platelet counts than males (106-352 x106 cells/mm3) (P < 0.001). The overall median of WBC was6.78 x103/mm3and its95thpercentile range was3.5-11.5 x103/mm3. The overall 95th percentile range of MCV, MCH and MCHC were 89.5-107.5 fl, 28-34 pg and 30-33.2g/dl, respectively. The higher mean absolute count of RBCs was found in the youngest age groups (P = 0.03). The mean count of RBCs and Hct were significantly higher in highschool completed and above than other participants (P < 0.001). The lower and upper limit of platelet counts was significantly higher in highland (118 -383x106 cells/mm3) compared to lowland residents (107-352 x106 cells/mm3) (P < 0.001). Moreover, it was significantly higher in residents with better monthly income (124-383 x106 cells/mm3) compared to the counters (115-368 x106 cells/mm3) (P = 0.02)., Conclusions: Some of the haematological and CD4+ T cells reference ranges of the healthy adults in this study showed variations with the reference ranges used and reported so far in Ethiopia, Africa and Western countries. We recommend further study considering gender, altitude, and residency in other parts of Ethiopia to establish national reference ranges for Ethiopian population.

Background: In Ethiopia, case fatality rates among subgroups of visceral leishmaniasis (VL) patients are high. A clinical prognostic score for death in VL patients could contribute to optimal management and reduction of these case fatality rates. We aimed to identify predictors of death from VL, and to develop and externally validate a clinical prognostic score for death in VL patients, in a high HIV co-infection burden area in Ethiopia., Methodology/principal Findings: We conducted a retrospective cohort study in north west Ethiopia. Predictors with an adjusted likelihood ratio ≥1.5 or ≤0.67 were retained to calculate the predictor score. The derivation cohort consisted of 1686 VL patients treated at an upgraded health center and the external validation cohort consisted of 404 VL patients treated in hospital. There were 99 deaths in the derivation cohort and 53 deaths in the external validation cohort. The predictors of death were: age >40 years (score +1); HIV seropositive (score +1); HIV seronegative (score -1); hemoglobin ≤6.5 g/dl (score +1); bleeding (score +1); jaundice (score +1); edema (score +1); ascites (score +2) and tuberculosis (score +1). The total predictor score per patient ranged from -1 to +5. A score of -1, indicated a low risk of death (1.0%), a score of 0 an intermediate risk of death (3.8%) and a score of +1 to +5, a high risk of death (10.4-85.7%). The area under the receiver operating characteristic curve was 0.83 (95% confidence interval: 0.79-0.87) in derivation, and 0.78 (95% confidence interval: 0.72-0.83) in external validation., Conclusions/significance: The overall performance of the score was good. The score can enable the early detection of VL cases at high risk of death, which can inform operational, clinical management guidelines, and VL program management. Implementation of focused strategies could contribute to optimal management and reduction of the case fatality rates.

Introduction: International guidelines are promoting early enteral nutrition (EN) as a means of feeding critically ill adult patients to improve clinical outcomes. The question of how much calorie intake is enough to improve the outcomes still remained inconclusive. Therefore, we carried out a meta-analysis to evaluate the effect of low calorie (LC) versus high calorie (HC) delivery on critically ill patients' outcomes., Methods: We included randomized clinical trials (RCTs) that compared LC EN with or without supplemental parenteral nutrition with HC delivery in this meta-analysis irrespective of the site of nutritional delivery in the gastrointestinal tract. We searched PubMed, EMBASE, and Cochrane central register of controlled trials electronic databases to identify RCTs that compared the effects of initially different calorie intake in critical illness. The primary outcome was overall mortality., Results: This meta-analysis included 17 RCTs with a total of 3,593 participants. The result of analysis showed that there was no significant difference between the LC group and HC group in overall mortality (risk ratio [RR], 0.98; 95% confidence interval [CI], 0.87-1.10; P = 0.74; I 2 = 6%; P = 0.38), or new-onset pneumonia (RR, 0.92; 95% CI, 0.73-1.16, P = 0.46; I 2 = 38%, P = 0. 11)., Conclusion: The current meta-analysis showed that there was no significant difference in mortality of critically ill patients initially between the two groups., Competing Interests: There are no conflicts of interest.

Background: In Ethiopia, there is lack of data on the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) infections in adult population at community level. This study aimed at determining the HBV, HCV and HIV seroprevalence in adult population at community level in East and West Gojjam zones in Amhara region, Ethiopia., Methods: A cross-sectional study was conducted between October 01 and November 30, 2015. The Hepatitis B surface antigen (HBsAg) and anti-HCV were detected using the standard serological tests. The antibody to HIV infection was tested using the national HIV rapid tests algorithms., Results: A total of 481 adults comprised of 51% females with median age of 25 years took part in the study. Overall, 7.5% (95% CI: 5.5-10.2%) of adult population were infected either with HBV, HCV and HIV. The prevalence of HBV was 15 (3.1%) and for HIV was 16 (3.3%). The seroprevalence of HCV was five (1.0%). HIV-HCV co-infection was found to be two (0.4%). HIV prevalence was higher in non-educated population than their counter parts (P = 0.001). HIV prevalence was high in housewives (6.0%) and merchants (4.7%)., Conclusions: This study revealed an intermediate HBV prevalence and low prevalence of HCV in adult population at community level. HIV prevalence is still a major public health problem in the area. To have the national data, we recommend further study on genotypes of HBV and HCV including local risk factors for transmissions. Moreover, health education on HBV, HCV and HIV transmission should be an intervention measure in the community.

Background: One third of the world population is estimated to be infected with intestinal parasites. The most affected people are children and the poor people living in tropics and subtropics. Polyparasitism (the concurrent infection with multiple intestinal parasite species) is found to be the norm among the same population although accurate estimate of its magnitude is unknown. It was found that polyparasitism might have a greater impact on morbidity than single species infection which might also increase susceptibility to other infections. Therefore, this study aimed at determining the prevalence and distribution of intestinal polyparasitism with special emphasis on Soil-Transmitted Helminths (STH) among residents around Gilgel Gibe dam located in Jimma zone of Oromia regional state, Ethiopia., Methods: A total of 1,021 participants were recruited in this study and provided stool samples for parasitological examination. Direct wet mount and Kato-Katz techniques were employed for stool examination. Pearson chi-square test was employed to assess the association of infection status and polyparasitism with gender and age group of the study participants., Results: Five hundred thirty two individuals were infected with at least one parasite, providing the overall prevalence of 52.1%. Among positive individuals, 405 (76.1%), 114 (21.4%), and 13 (2.5%) individuals were infected with only one, two and three species of parasites, respectively. The overall prevalence of intestinal polyparasitism observed among the study participants was 12.4% (127/1,021). The predominant STH was hookworm, with a prevalence of 44.1%. Hookworm and Ascaris lumbricoides were the most frequently recorded combination in cases of polyparasitic infection. The study revealed that there was no significant difference in the distribution of polyparasitism with regard to age group and sex of the study participants (p > 0.05)., Conclusion: The study indicated the presence of high prevalence of parasites as well as distribution of polyparasitism in the area. Moreover, the detection of Schistosoma mansoni in the community living within close proximity of the newly constructed dam would be taken as an indication of future risk factor. Further investigation on the predictors of polyparasitism and the assessment of effects of polyparasitism on the population are needed. Finally, there is a need to undertake integrated control strategies which involve improved sanitation, health education and chemotherapy that targets the whole community instead of only certain segments of populations.

Background: The diagnosis of soil-transmitted helminths (STHs; Ascaris, Trichuris and hookworms) is traditionally based on the demonstration of eggs in stool using microscopic techniques. While molecular techniques are more appropriate to speciate STH species they are seldom applied. In this study we speciated STH eggs from stool using molecular techniques to gain insights into the distribution of both human and animal STH species in the human host., Methods: We speciated 207 STH egg isolates from stool collected during the baseline survey of six drug efficacy trials conducted in Brazil, Cambodia, Cameroon, Ethiopia, Tanzania and Vietnam applying a PCR - restriction fragment length polymorphisms based approach., Results: DNA of Ascaris was detected in 71 (34.3%) samples, of which all were identified as the human roundworm Ascaris lumbricoides. In 87 (42.0%) samples, DNA of Trichuris spp. was found and further speciation demonstrated the presence of the human Trichuris trichiura (100%) and the canine Trichuris vulpis (n=7; 8.0%; in Cameroon only). Hookworms were identified in 104 (50.2%) samples, with Necator americanus (n=73; 70.2%) being the predominant species followed by Ancylostoma duodenale (n=40; 38.5%)., Conclusions: Our study indicates that STH infections in humans are predominantly caused by human STH species. They also suggest that zoonotic transmission occurs on a local scale., (© The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Intestinal schistosomiasis is one of the neglected tropical parasitic diseases caused by Schistosoma mansoni. Currently, the control measures for the disease are mainly based on mass drug administration (MDA) with praziquantel (PZQ) targeting the school-age children. In Ethiopia, the potential foci for schistosomiasis and therapeutic efficacy of PZQ among school-age children remain poorly explored. Therefore, we determined both the prevalence and intensity of S. mansoni infection and the therapeutic efficacy of PZQ among school children in the Manna District (new foci for S. mansoni), Jimma Zone, southwest Ethiopia., Methods: A cross-sectional study was conducted among the school children aged between 6 and 18 years in three primary schools in Manna district from March to April 2014. For diagnosis of S. mansoni, a single stool sample was obtained from each child and processed using single Kato Katz and examined under light microscopy. A questionnaire was used to collect demographic information of the school children participated in the study. School children excreting eggs of S. mansoni were administered with 40 mg/kg of PZQ and re-examined after three weeks post-treatment. The therapeutic efficacy of PZQ against S. mansoni was evaluated by means of cure rate and egg reduction rate., Results: The overall prevalence of S. mansoni among the school children in the three primary schools in Manna District was 24.0 %. Higher prevalence was recorded for males 25.6 % (61/238) than for females 22.5 % (59/262). Majority (27.5 %) of infection intensity was light with mean faecal egg count (FEC) of 202 eggs per gram (EPG). The therapeutic efficacy of PZQ at a dose of 40 mg/kg was highly efficient (cure rate of 99.1 % and egg reduction rate of 99.9 %) among the school children in the three primary schools in Manna District., Conclusions: The school children in the three primary schools of Manna District, Jimma Zone were at moderate risk of the morbidity caused by S. mansoni (prevalence > 10 % and < 50 % according to WHO threshold), and hence a biannual MDA with PZQ is required. PZQ available on the local market was found efficient and can be recommended for individual treatment in absence of MDA. The therapeutic efficacy of PZQ at 40 mg/kg against S. mansoni was high in the study area.

Background: Human immunodeficiency virus (HIV) infection and its treatment cause renal diseases. Renal disease is associated with an increasing cause of morbidity and mortality in HIV positive individuals than in the general population. It has been also associated with adverse outcomes, such as complications of decreased renal functions and progression to renal failure., Objective: To determine the prevalence and factors associated with renal function impairment among highly active antiretroviral therapy (HAART) naive and HAART experienced adult HIV positive individuals., Methods: A facility based comparative cross-sectional study was conducted in Jimma University Specialized Hospital (JUSH) from June to September 2014. HIV positive individuals who visited JUSH during the study period were included in the study. Sociodemographic and clinical data were collected using a structured questionnaire. Blood specimen was analyzed for renal function tests. Descriptive statistics, Mann-Whitney U test and logistic regression analysis were done using SPSS version 16 software., Results: A total of 446 HIV positive individuals, 223 HAART naïve and 223 HAART experienced, were recruited. The overall prevalence of renal function impairment was 18.2% [95%CI: 14.6-21.7]. The prevalence of renal impairment in HAART naive and HAART experienced persons was 28.7% [95%CI: 23.1-34.4] and 7.6% [95%CI: 4.6-11.6], respectively. Age ≥ 50 years (AOR = 3.6; 95% CI 1.4, 9.6), advanced WHO stage (AOR = 2.3; 95% CI 1.1, 4.7), and CD4 count <200 (AOR = 6.9; 95% CI 3.3, 14.2) were independent risk factors among HAART naive participants. Female gender (AOR = 6.6; 95 CI % 1.2, 34), age ≥ 50 years (AOR = 12.1; 95% CI 1.7, 84) and CD4 count <200 (AOR = 17; 95% CI 5.2, 58) were independent risk factors among HAART experienced participants., Conclusion: The prevalence of renal function impairment was higher among HAART naïve than HAART experienced HIV positive individuals. Renal function impairment was associated with disease advancement and old age.

Background: There is a lack of cost-effective diagnostic strategies to evaluate whether mass drug administration (MDA) programmes to control Schistosoma haematobium progress as anticipated. The purpose of this study is to provide a proof-of-principle for examination of pooled urine samples as a strategy for rapid assessment of presence and intensity of Schistosoma haematobium infections at the population level., Methods: A total of 640 urine samples were collected from 520 school-aged children (520 at baseline and 120 at follow-up) during a clinical trial that was designed to assess the efficacy of praziquantel against Schistosoma haematobium infections in Ethiopia. Individual and pooled urine samples were screened using the filtration technique (volume of 10 ml urine) to determine the number of S. haematobium eggs in 10 ml of urine. Samples were pooled into pools of 5 (n = 128), 10 (n = 64) and 20 (n = 32) individual samples. The sensitivity, the probability of finding at least one egg in a pooled sample when the mean urine egg count (UEC) of the corresponding individual urine samples was not zero, was calculated for each pool size. UECs of a pooled examination strategy were compared with the mean UECs of the corresponding individual samples., Results: The sensitivity of a pooled examination strategy was 50.6% for pools of 5, 68.6% for pools of 10 and 63.3% for pools of 20. The sensitivity of a pooled examination strategy increased as a function of increasing mean UEC of the corresponding individual urine samples. For each of the three pool sizes, there was a significant positive correlation between mean UECs of individual and those obtained in pooled samples (correlation coefficient: 0.81 - 0.93). Examination of pools of 5 provided significantly lower UECs compared to the individual examination strategy (3.9 eggs/10 ml urine versus 5.0 eggs/10 ml urine). For pools of 10 (4.4 eggs/10 ml) and 20 (4.2 eggs/10 ml), no significant difference in UECs was observed., Conclusions: Examination of pooled urine samples applying urine filtration holds promise for rapid assessment of intensity of S. haematobium infections, but may fail to detect presence of infections when endemicity is low. Further investigation is required to determine when and how pooling can be optimally implemented in monitoring of mass drug administration programmes.

Background: There is a paucity of studies that compare efficacy of drugs obtained by different diagnostic methods., Methods: We compared the efficacy of a single oral dose albendazole (400 mg), measured as egg reduction rate, against soil-transmitted helminth infections in 210 school children (Jimma Town, Ethiopia) using both Kato-Katz thick smear and McMaster egg counting method., Results: Our results indicate that differences in sensitivity and faecal egg counts did not imply a significant difference in egg reduction rate estimates., Conclusion: The choice of a diagnostic method to assess drug efficacy should not be based on sensitivity and faecal egg counts only., (© The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: MRSA infections are becoming more prevalent throughout the HIV community. MRSA infections are a challenge to both physicians and patients due to limited choice of therapeutic options and increased cost of care., Objectives: This study was aimed to determine the prevalence of colonization and co-resistance patterns of MRSA species among HIV positive pediatric patients in the Amhara National Regional State, Northwest Ethiopia., Methods: Culture swabs were collected from the anterior nares, the skin and the perineum of 400 participants. In vitro antimicrobial susceptibility testing was done on Muller Hinton Agar by the Kirby-Bauer disk diffusion method, using 30 μg cefoxitin (OXOID, ENGLAND) according to the recommendations of the Clinical and Laboratory Standards Institute. Methicillin sensitivity/resistance was tested using cefoxitin. Data was analyzed by descriptive statistics and logistic regression model using Epi Info 7., Results: S. aureus was detected in 206 participants (51.5%). The prevalence of MRSA colonization in this study was 16.8%. Colonization by S. aureus was associated with male gender (OR = 0.5869; 95% CI: 0.3812-0.9036; p-value = 0.0155), history of antibiotic use over the previous 3 months (OR = 2.3126; 95% CI: 1.0707-4.9948; p-value = 0.0329) and having CD4 T-cell counts of more than 350 x 10(6) cells / L (OR = 0.5739; 95% CI = 0.3343-0.9851; p-value = 0.0440). Colonization by MRSA was not associated with any one of the variables. Concomitant resistance of the MRSA to clindamycin, chloramphenicol, co-trimoxazole, ceftriaxone, erythromycin and tetracycline was 7.6%, 6%, 5.25%, 20.9%, 23.9% and 72.1%, respectively., Conclusion: High rates of colonization by pathogenic MRSA strains is observed among HIV positive pediatric patients in the Amhara National Regional state.

Background: There is a worldwide upscale in mass drug administration (MDA) programs to control the morbidity caused by soil-transmitted helminths (STHs): Ascaris lumbricoides, Trichuris trichiura and hookworm. Although anthelminthic drugs which are used for MDA are supplied by two pharmaceutical companies through donation, there is a wide range of brands available on local markets for which the efficacy against STHs and quality remain poorly explored. In the present study, we evaluated the drug efficacy and quality of two albendazole brands (Bendex and Ovis) available on the local market in Ethiopia., Methodology/principal Findings: A randomized clinical trial was conducted according to the World Health Organization (WHO) guidelines to assess drug efficacy, by means of egg reduction rate (ERR), of Bendex and Ovis against STH infections in school children in Jimma, Ethiopia. In addition, the chemical and physicochemical quality of the drugs was assessed according to the United States and European Pharmacopoeia, encompassing mass uniformity of the tablets, amount of active compound and dissolution profile. Both drugs were highly efficacious against A. lumbricoides (>97%), but showed poor efficacy against T. trichiura (~20%). For hookworms, Ovis was significantly (p < 0.05) more efficacious compared to Bendex (98.1% vs. 88.7%). Assessment of the physicochemical quality of the drugs revealed a significant difference in dissolution profile, with Bendex having a slower dissolution than Ovis., Conclusion/significance: The study revealed that differences in efficacy between the two brands of albendazole (ABZ) tablets against hookworm are linked to the differences in the in-vitro drug release profile. Differences in uptake and metabolism of this benzimidazole drug among different helminth species may explain that this efficacy difference was only observed in hookworms and not in the two other species. The results of the present study underscore the importance of assessing the chemical and physicochemical quality of drugs before conducting efficacy assessment in any clinical trials to ensure appropriate therapeutic efficacy and to exclude poor drug quality as a factor of reduced drug efficacy other than anthelminthic resistance. Overall, this paper demonstrates that "all medicines are not created equal".

Background: Our group has recently provided a proof-of-principle for the examination of pooled stool samples using McMaster technique as a strategy for the rapid assessment of intensity of soil-transmitted helminth infections (STH, Ascaris lumbricoides, Trichuris trichiura and hookworm). In the present study we evaluated this pooling strategy for the assessment of intensity of both STH and Schistosoma mansoni infections using the Kato-Katz technique., Methods: A cross-sectional survey was conducted in 360 children aged 5-18 years from six schools in Jimma Zone (southwest Ethiopia). We performed faecal egg counts (FECs) in both individual and pooled samples (pools sizes of 5, 10 and 20) to estimate the number of eggs per gram of stool (EPG) using the Kato-Katz technique. We also assessed the time to screen both individual and pooled samples., Results: Except for hookworms, there was a significant correlation (correlation coefficient = 0.53-0.95) between the mean of individual FECs and the FECs of pooled samples for A. lumbricoides, T. trichiura and S. mansoni, regardless of the pool size. Mean FEC were 2,596 EPG, 125 EPG, 47 EPG, and 41 EPG for A. lumbricoides, T. trichiura, S. mansoni and hookworm, respectively. There was no significant difference in FECs between the examination of individual and pooled stool samples, except for hookworms. For this STH, pools of 10 resulted in a significant underestimation of infection intensity. The total time to obtain individual FECs was 65 h 5 min. For pooled FECs, this was 19 h 12 min for pools of 5, 14 h 39 min for pools of 10 and 12 h 42 min for pools of 20., Conclusions: The results indicate that pooling of stool sample holds also promise as a rapid assessment of infections intensity for STH and S. mansoni using the Kato-Katz technique. In this setting, the time in the laboratory was reduced by 70 % when pools of 5 instead of individual stool samples were screened.

Background: Soil-transmitted helminths (STH) remain a major public health problem, particularly in tropical and sub-tropical regions of the world. Though infections are prevalent among all age groups, the world health organization (WHO) considers Pre-school age children (PSAC), school-aged children, and pregnant women as segments of population at high risk of STH morbidities., Objective: This study aimed at determining the prevalence and infection intensity of STH and associated factors among PSAC in Butajira Town, south-central Ethiopia., Methods: A community-based cross-sectional study was conducted from May to June, 2014 in Butajira Town. The PSAC were selected by systematic sampling technique and invited to participate in the present study. McMaster technique was employed for parasitological analysis of stool samples. Pearson's Chi-square and Fisher's exact tests were performed where appropriate to identify any association between STH infection and independent factors. Multivariate logistic regression model was fitted to identify independent predictors of STH among the PSAC. P-value less than 0.05 was considered statistically significant., Results: A total of 377 (with 96% compliance rate) PSAC were able to provide complete data (socio-demographic information and stool sample). The study showed that 23.3% (88/377) PSAC were infected with one or more species of STH. Ascaris lumbricoides was the most prevalent STH (14.9%) followed by Trichuris trichiura (6.4%). The overall infection intensity, expressed as geometric mean for A. lumbricoides, T. trichiura, and hookworms were 229, 178, and 154 eggs per gram of stool, respectively. The multivariate logistic regression model estimated that being in the age group of 36-47 months (AOR: 2.5, 95% CI: 1.2-5.3, P = 0.016), untrimmed finger nail (AOR: 3.2, 95% CI: 1.8-5.5, P < 0.001), and not washing hands before a meal (AOR: 3.0, 95% CI: 1.7-5.4, P < 0.001) were independent predictors of STH infections among the children., Conclusion: The present study showed that STH was a public health problem among PSAC in the study area necessitating annual deworming to control morbidities associated with STH. Besides, the existing health education program should also be strengthened to prevent re-infection.

In this study, the prevalence and intensity of Schistosoma haematobium infection was determined among school-age children living in the Middle and Lower Awash Valley, Afar Regional State of Ethiopia. Between February and May 2014, urine samples were collected from 885 school-age children (5-16 years of age) from the Middle (n = 632; 4 villages) and Lower (n = 253; 3 villages) Awash Valley. All samples were processed using urine filtration to detect and quantify S. haematobium eggs. In addition, a subset of the urine samples was tested for hematuria using a urine dipstick (n = 556). The overall prevalence was 20.8% (95% Confidence Interval (CI) = 18.1%, 23.5%), based on urine filtration but the prevalence considerably varied across villages both in the Middle (from 12.5% to 37.0%) and Lower Awash Valley (from 0 to 5.3%). The overall mean urine egg count (UEC) among the infected children was 4.0 eggs/10 ml of urine (95% CI = 2.43, 5.52). The infection intensity varied from 0.4 eggs/10 ml of urine to 7.7 eggs/10 ml of urine in the Middle Awash Valley, and from 0 to 1.1 eggs/10 ml of urine in Lower Awash Valley. Age and sex were not associated with S. haematobium infection based on the multivariable logistic regression model. The prevalence of hematuria was 56.3% (95% CI = 52.2%, 60.4%) among a subset of the study participants (556) examined using the urine dipstick. The prevalence of hematuria also varies with villages from 8.3% to 93.2%. In conclusion, the prevalence of S. haematobium infection in the Middle Awash Valley was high and it varies across villages. Hence, children living in the present study villages of the Middle Awash Valley need to be treated with praziquantel to reduce morbidity and disrupt transmission.

Background: Human onchocerciasis is a neglected tropical parasitic disease caused by Onchocerca volvulus (O. volvulus) that may result in devastating skin and eye morbidity. Even though the disease is targeted for elimination, there was little or no information on the level of onchocerciasis endemicity for implementation of community directed treatment with ivermectin (CDTI) in the current study area. Thus, this study aimed at investigating the epidemiology of onchocerciasis and the level of awareness towards the disease among communities living close to CDTI area, Jimma Zone, southwestern Ethiopia., Methods: A community based cross-sectional study was conducted from April 23 to May 22, 2012. Data on socio-demographic characteristics, knowledge, attitude and practice towards onchocerciasis were collected using semi-structured questionnaires. Clinical examination was undertaken for onchocercal skin diseases by experienced health professionals. Moreover, two skin snip samples were collected from the right and left gluteal folds. Study participants found positive for O. volvulus infection during the study were treated individually with standard dose of ivermectin as per WHO guideline., Results: The overall prevalence of O. volvulus infection was 22.5 % while the prevalence of onchocercal skin diseases was 29.8 %. The community microfilarial (mf) load was 5.70 mf per skin snip. Age, sex, educational status, occupation and duration of stay in the villages showed significant association with onchocerciasis (P < 0.05). But sex (OR = 0.565, 95 % CI = 0.335, 0.952), educational status (OR = 0.545, 95 % CI = 0.310, 0.958) and duration of stay in the village (OR = 5.933, 95 % CI = 1.017, 34.626) were the independent predictors for O. volvulus infection. Three hundred eighty eight (88.2 %) of the study participants reported that they didn't know about onchocerciasis., Conclusions: There was moderate prevalence of onchocercal infection and onchocercial skin diseases (OSD) in the study area. Result of this study may suggest that the endemicity level of onchocerciasis in the study area was mesoendemic. Hence, intervention using ivermectin treatment should be implemented to reduce the burden of onchocerciasis. Since the majorities of the population had poor knowledge, attitude and practice towards onchocerciasis, inclusion of health education in the intervention package is crucial.

Background: In Ethiopia, urinary schistosomiasis caused by Schistosoma haematobium has been known to be endemic in several lowland areas of the country where it causes considerable public health problems, mainly among school-age children. However, information on recent magnitude and risk factors of the disease is lacking, particularly for Gambella area. Therefore, this study aimed to assess the prevalence of urinary schistosomiasis and associated risk factors among Abobo Primary School children in Gambella, southwestern Ethiopia., Methods: A cross-sectional study involving 304 school children was conducted in Abobo Primary School, Gambella Regional State, southwestern Ethiopia, from February to June 2014. Ten ml of urine sample was collected from each study participant and processed for microscopic examination by the urine filtration method; egg load for positive individuals was determined per 10 ml of urine. Data on socio-demographic characteristics and risk factors were collected using an interview-based questionnaire. The data were entered into and analyzed with SPSS version 20. Logistic regression and odds ratio were used to measure association and strength between variables, respectively. P-value < 0.05 at 95% CI was considered as statistically significant., Results: The prevalence of urinary schistosomiasis was 35.9% (109/ 304) with a mean egg intensity of 8.76 per 10 ml of urine. Being male [AOR (95%CI) = 2.15(1.31, 3.52)], having father as a farmer [AOR (95%CI) = 1.96(1.19, 3.22)] and children living apart from parents [AOR (95% CI): 3.09 (1.14, 8.4)] were significantly associated with urinary schistosomiasis., Conclusion: The present study area in Gambella Regional State, southwestern Ethiopia, represents moderate-risk community for urinary schistosomiasis. Sex, father's occupation and living apart from parents were found to be associated with infection. Treatment of all school-age children and fishermen is required once every 2 years until the prevalence of infection falls below the level of public health importance. It is also recommended to complement praziquantel treatment with supplementary measures such as provision of sanitation facilities and health education.

Background: Pre-school age children (preSAC) remain difficult to reach in mass drug administration (MDA) programmes to control soil-transmitted helminth (STH) infections. Kindergartens provide a unique platform to increase the coverage of MDA in preSAC in Ethiopia, but surveys assessing STHs among preSAC in kindergartens are scarce., Methods: We report the prevalence and intensity of STH infections among 622 preSAC in 12 kindergartens in Jimma, Ethiopia., Results: STHs were found in all kindergartens, with prevalence exceeding 50% in 8 kindergartens. The majority of the infections were of low intensity., Conclusions: This study highlights the importance of kindergartens as an additional opportunity for MDA in Ethiopia., (© The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)