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Abstract Background In Ethiopia, cutaneous leishmaniasis is mainly caused by Leishmania (L.) aethiopica parasites and presents in three main clinical forms. It is still not clear if the host immune response plays a role in the development of these different presentations. Since neutrophils are likely to be one of the first immune cells present at the site of the sand fly bite, we set up an in vitro model of infection of neutrophils with L. aethiopica and assessed some of the main neutrophil effector functions: association with and internalisation of parasites, apoptosis and ROS production. We used three freshly isolated clinical isolates and one isolate that has been kept in culture for decades. Results Our results showed by flow cytometry that all four L. aethiopica isolates had the ability to associate with neutrophils. The three clinical isolates of L. aethiopica associated more efficiently with neutrophils than the long-term cultured L. aethiopica. At 18 h, two distinct populations of neutrophils were identified that associated with L. aethiopica, CD15high and CD15low neutrophils. Confocal microscopy demonstrated that all isolates can be internalised. Our results also showed that all parasites induced apoptosis in L. aethiopica-associated neutrophils. Moreover, our results showed that after 2 h, L. aethiopica-associated neutrophils upregulated their production of ROS, but to a greater extent with the long-term cultured L. aethiopica. After 18 h of incubation, CD15lowparasite+ showed an impaired ability to produce ROS compared to CD15highparasite+. Conclusions Using this in vitro model, our results show that different L. aethiopica parasite isolates, most notably long-term cultured parasites, had differential effects on neutrophil effector functions. Graphical Abstract

Previous studies utilizing the Global Positioning System (GPS) receivers aboard Jason satellites have performed measurements of plasmasphere electron content (PEC) by determining the total electron content (TEC) above these satellites, which are at altitudes of about 1340 km. This study uses similar methods to determine PEC for the Jason-2 receiver for 24 July 2011. These PEC values are compared to previous determinations of PEC from a chain of ground-based GPS receivers in Africa using the SCORPION method, with a nominal ionosphere–plasmasphere boundary at 1000 km. The Jason-2 PECs with elevations greater than 60∘ were converted to equivalent vertical PEC and compared to SCORPION vertical PEC determinations. In addition, slant (off-vertical) PECs from Jason-2 were compared to a small set of nearly co-aligned ground-based slant PECs. The latter comparison avoids any conversion of Jason-2 slant PEC to equivalent vertical PEC, and it can be considered a more representative comparison. The mean difference between the vertical PEC (ground-based minus Jason-2 measurements) values is 0.82 ± 0.28 TEC units (1 TEC unit=1016 electrons m−2). Similarly, the mean difference between slant PEC values is 0.168 ± 0.924 TEC units. The Jason-2 slant PEC comparison method may provide a reliable determination for the plasmasphere baseline value for the ground-based receivers, especially if the ground stations are confined to only midlatitude or low-latitude regions, which can be affected by a non-negligible PEC baseline.

The confluence of recent instrumentation deployments in Africa with developments for the determination of plasmasphere electron content using Global Positioning System (GPS) receivers has provided new opportunities for investigations in that region. This investigation, using a selected chain of GPS stations, extends the method (SCORPION) previously applied to a chain of GPS stations in North America in order to separate the ionosphere and plasmasphere contributions to the total electron content (TEC) during a day (24 July) in 2011. The results span latitudes from the southern tip of Africa, across the Equator, to the southern Arabian Peninsula, providing a continuous latitudinal profile for both the ionosphere and plasmasphere during this day.The peak diurnal vertical ionosphere electron content (IEC) increases from about 14 TEC units (1 TEC unit = 1016 electrons m−2) at the southernmost station to about 32 TEC units near the geographic equator, then decreases to about 28 TEC units at the Arabian Peninsula. The peak diurnal slant plasmasphere electron content (PEC) varies between about 4 and 7 TEC units among the stations, with a local latitudinal profile that is significantly influenced by the viewing geometry at the station location, relative to the magnetic field configuration. In contrast, the peak vertical PEC varies between about 1 and 6 TEC units among the stations, with a more uniform latitudinal variation.Comparisons to other GPS data analyses are also presented for TEC, indicating the influence of the PEC on the determination of latitudinal TEC variations and also on the absolute TEC levels, by inducing an overestimate of the receiver bias. The derived TEC latitudinal profiles, in comparison to global map profiles, tend to differ from the map results only about as much as the map results differ among themselves. A combination of ionosonde IEC and alternative GPS TEC measurements, which in principle permits a PEC determination through their difference, was compared to the composite and separate ionosphere and plasmasphere contributions derived solely by the SCORPION method for one station. Although there is considerably more scatter in the PEC values derived from the difference of the GPS TEC and ionosonde IEC measurements compared to the PEC values derived by the SCORPION method, the average overhead values for this day are comparable for the two methods, near 2 TEC units, at the South African site examined.This initial investigation provides a basis for day-to-day TEC monitoring for Africa, with separate ionosphere and plasmasphere electron content determinations.

It has been well documented that the lunar tidal waves can modulate the ionospheric electrodynamics and create a visible influence on the equatorial electrojet (EEJ). The lunar tide influence gets intensified around noon, primarily during new and full Moon periods. However, the longitudinal, seasonal and solar cycle variability in the lunar tide influence on ionospheric current systems is not well understood yet. In order to investigate this, 17 years (1998–2014) of extensive magnetometer observations at four longitudinal sectors (western American, western and eastern African, and Asian) have been analyzed. All observations performed during magnetically active periods (Kp>3) have been excluded for this study to eliminate storm contributions to the geomagnetic field variation at the geomagnetic equator. This study's quantitative analysis revealed significant longitudinal, seasonal and solar cycle dependence of the lunar tide influence on the equatorial electrojet.

Measurements of equatorial thermospheric winds, temperatures, and 630 nm relative intensities were obtained using an imaging Fabry–Perot interferometer (FPI), which was recently deployed at Bahir Dar University in Ethiopia (11.6° N, 37.4° E, 3.7° N magnetic). The results obtained in this study cover 6 months (53 nights of useable data) between November 2015 and April 2016. The monthly-averaged values, which include local winter and equinox seasons, show the magnitude of the maximum monthly-averaged zonal wind is typically within the range of 70 to 90 ms−1 and is eastward between 19:00 and 21:00 LT. Compared to prior studies of the equatorial thermospheric wind for this local time period, the magnitude is considerably weaker as compared to the maximum zonal wind speed observed in the Peruvian sector but comparable to Brazilian FPI results. During the early evening, the meridional wind speeds are 30 to 50 ms−1 poleward during the winter months and 10 to 25 ms−1 equatorward in the equinox months. The direction of the poleward wind during the winter months is believed to be mainly caused by the existence of the interhemispheric wind flow from the summer to winter hemispheres. An equatorial wind surge is observed later in the evening and is shifted to later local times during the winter months and to earlier local times during the equinox months. Significant night-to-night variations are also observed in the maximum speed of both zonal and meridional winds. The temperature observations show the midnight temperature maximum (MTM) to be generally present between 00:30 and 02:00 LT. The amplitude of the MTM was ∼ 110 K in January 2016 with values smaller than this in the other months. The local time difference between the appearance of the MTM and a pre-midnight equatorial wind was generally 60 to 180 min. A meridional wind reversal was also observed after the appearance of the MTM (after 02:00 LT). Climatological models, HWM14 and MSIS-00, were compared to the observations and the HWM14 model generally predicted the zonal wind observations well with the exception of higher model values by 25 ms−1 in the winter months. The HWM14 model meridional wind showed generally good agreement with the observations. Finally, the MSIS-00 model overestimated the temperature by 50 to 75 K during the early evening hours of local winter months. Otherwise, the agreement was generally good, although, in line with prior studies, the model failed to reproduce the MTM peak for any of the 6 months compared with the FPI data.

In this work, we investigated the veracity of an ion continuity equation in controlling equatorial ionization anomaly (EIA) morphology using total electron content (TEC) of 22 GPS receivers and three ground-based magnetometers (Magnetic Data Acquisition System, MAGDAS) over Africa and the Middle East (Africa–Middle East) during the quietest periods. Apart from further confirmation of the roles of equatorial electrojet (EEJ) and integrated equatorial electrojet (IEEJ) in determining hemispheric extent of EIA crest over higher latitudes, we found some additional roles played by thermospheric meridional neutral wind. Interestingly, the simultaneous observations of EIA crests in both hemispheres of Africa–Middle East showed different morphology compared to that reported over Asia. We also observed interesting latitudinal twin EIA crests domiciled at the low latitudes of the Northern Hemisphere. Our results further showed that weak EEJ strength associated with counter electrojet (CEJ) during sunrise hours could also trigger twin EIA crests over higher latitudes.

While the formation of equatorial electrojet (EEJ) and its temporal variation is believed to be fairly well understood, the longitudinal variability at all local times is still unknown. This paper presents a case and statistical study of the longitudinal variability of dayside EEJ for all local times using ground-based observations. We found EEJ is stronger in the west American sector and decreases from west to east longitudinal sectors. We also confirm the presence of significant longitudinal difference in the dusk sector pre-reversal drift, using the ion velocity meter (IVM) instrument onboard the C/NOFS satellite, with stronger pre-reversal drift in the west American sector compared to the African sector. Previous satellite observations have shown that the African sector is home to stronger and year-round ionospheric bubbles/irregularities compared to the American and Asian sectors. This study's results raises the question if the vertical drift, which is believed to be the main cause for the enhancement of Rayleigh–Taylor (RT) instability growth rate, is stronger in the American sector and weaker in the African sector – why are the occurrence and amplitude of equatorial irregularities stronger in the African sector?

The effects of the 31 March 2001 severe magnetic storm on the Southern Hemisphere ionosphere have been studied using ground-based and satellite measurements. The prime goal of this comprehensive study is to track the ionospheric response from high-to-low latitude to obtain a clear understanding of storm-time ionospheric change. The study uses a combination of ionospheric Total Electron Content (TEC) obtained from GPS signal group delay and phase advance measurements, ionosonde data, and data from satellite in-situ measurements, such as the Defense Metrological Satellite Program (DMSP), TOPographic EXplorer (TOPEX), and solar wind data from the Advanced Composition Explorer (ACE). A chain of Global Positioning System (GPS) stations near the 150° E meridian has been used to give comprehensive latitude coverage extending from the cusp to the equatorial region. A tomographic inversion algorithm has been applied to the GPS TEC measurements to obtain maps of the latitudinal structure of the ionospheric during this severe magnetic storm period, enabling both the spatial and temporal response of the ionosphere to be studied. Analysis of data from several of the instruments indicates that a strong density enhancement occurred at mid-latitudes at 11:00 UT on 31 March 2001 and was followed by equatorward propagating large-scale Travelling Ionospheric Disturbances (TIDs). The tomographic reconstruction revealed important features in ionospheric structure, such as quasi-wave formations extending finger-like to higher altitudes. The most pronounced ionospheric effects of the storm occurred at high- and mid-latitudes, where strong positive disturbances occurred during the storm main phase, followed by a long lasting negative storm effect during the recovery phase. Relatively minor storm effects occurred in the equatorial region.

The ionospheric storm evolution process was monitored during the 22 September 1999 magnetic storm over the Australian eastern region, through measurements of the ionospheric Total Electron Content (TEC) from seven Global Positioning Systems (GPS) stations. The spatial and temporal variations of the ionosphere were analysed as a time series of TEC maps. Results of our analysis show that the main ionospheric effect of the storm under consideration are: the long lasting negative storm effect during a magnetic storm at mid-latitude regions; the strong, positive disturbances during the storm's main phase at auroral latitude regions; the effects of storm-induced equatorward directed wind causing a positive disturbance at high and mid-latitude stations with appropriate time shift between higher and lower latitudes; daytime poleward movement of depleted plasma that causes temporary suppression of the equatorial anomaly during the start of the storm recovery phase; and prompt penetration of eastward electric fields to ionospheric altitudes and the production of nearly simultaneous TEC enhancement at all latitudes. In general, we found dominant negative disturbance over mid and high latitudes and positive disturbance at low latitudes. A comparison of storm-time behaviour of TEC determined from GPS satellites, and foF2 derived from ionosondes at a range of latitudes, showed reasonable agreement between the two independent measurements.

The geomagnetic conditions were moderately disturbed (Kp = 2) during magnetic midnight on 10 December 1999, when the Tasman International Geospace Environment Radar (TIGER), a Southern Hemisphere HF SuperDARN radar, observed a persistent, sharp latitudinal decrease (~ 90 km) in spectral width near - 69°L. The line-of-sight Doppler velocity also rapidly declined across this spectral width boundary (SWB). The region poleward of the SWB was characterized by high spectral widths (>200 m/s), and the start of bursty equatorward and eastward flows (>500 m/s), which rapidly expanded equatorward. The relationships between familiar ionospheric and magnetospheric regions were inferred by comparing TIGER data with spectrograms calculated from precipitating particles measured on board the Defence Meteorology Satellite Program (DMSP) F14 satellite. The high spectral width scatter is often observed, and on this evening it was associated with irregularities forming on the open (but soon to be reconnected) field lines threading the polar cap ionosphere to the southern tail lobe. The region equatorward of the SWB was characterized by very low spectral widths (L) and Hobart (- 54°L), and the ionograms recorded at the same stations, as well as at Bundoora (- 49°L), also helped to validate the interpretation.Key words. Ionosphere (auroral ionosphere; electric fields and currents; ionosphere-magnetosphere interactions)

Background: In Ethiopia, cutaneous leishmaniasis is mainly caused by Leishmania (L.) aethiopica parasites and presents in three main clinical forms. It is still not clear if the host immune response plays a role in the development of these different presentations. Since neutrophils are likely to be one of the first immune cells present at the site of the sand fly bite, we set up an in vitro model of infection of neutrophils with L. aethiopica and assessed some of the main neutrophil effector functions: association with and internalisation of parasites, apoptosis and ROS production. We used three freshly isolated clinical isolates and one isolate that has been kept in culture for decades., Results: Our results showed by flow cytometry that all four L. aethiopica isolates had the ability to associate with neutrophils. The three clinical isolates of L. aethiopica associated more efficiently with neutrophils than the long-term cultured L. aethiopica. At 18 h, two distinct populations of neutrophils were identified that associated with L. aethiopica, CD15 high and CD15 low neutrophils. Confocal microscopy demonstrated that all isolates can be internalised. Our results also showed that all parasites induced apoptosis in L. aethiopica-associated neutrophils. Moreover, our results showed that after 2 h, L. aethiopica-associated neutrophils upregulated their production of ROS, but to a greater extent with the long-term cultured L. aethiopica. After 18 h of incubation, CD15 low parasite + showed an impaired ability to produce ROS compared to CD15 high parasite + ., Conclusions: Using this in vitro model, our results show that different L. aethiopica parasite isolates, most notably long-term cultured parasites, had differential effects on neutrophil effector functions., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval was obtained from the Faculty Ethic Committee University of Greenwich (FES-FREC-20-01.04.08.CA). Informed written consent was obtained from each participant. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Cutaneous leishmaniasis (CL) is a neglected tropical skin disease, caused by the protozoan parasite Leishmania. In Ethiopia, CL is mainly caused by Leishmania aethiopica and can present in different clinical forms. The aim of this study was to assess whether these different forms are associated with differences in parasite genetic and host systemic immune signatures., Methods: Here we analysed the whole genome sequence data for 48 clinical parasite isolates and the systemic immune signature from a cohort of CL patients, who were recruited in Nefas Mewcha, Northern Ethiopia, from January 2019 to January 2022., Results: Our results show that parasites from CL cases with different presentations in a single Ethiopian setting are from the same genetic population based on a permutation test of genome-wide similarity. Furthermore, a logistic regression test for genome wide association did not identify any individual genetic variants significantly associated with disease presentation. We also measured plasma chemokine and cytokine levels of 129 CL patients presenting with different forms of CL. None of the chemokine [eotaxin, eotaxin-3, interleukin (IL)-8, interferon (IFN)-γ-induced protein-10 (IP-10), monocyte chemoattractant protein (MCP)-1, MCP-4, macrophage-derived chemokines (MDC), macrophage inflammatory protein (MIP)-1α, MIP-1β and thymus- and activation-regulated chemokine (TARC)] or cytokine (IFN-γ, IL-1β, interleukin-2, IL-4, IL-6, IL-10, IL-12p70, IL-13, tumor necrosis factor-α) levels measured were significantly different between the different clinical presentations of CL, as measured by Kruskal-Wallis test. We also compared those with healthy nonendemic controls: our results show a chemokine (IP-10, MCP-1, MCP-4, MDC, MIP-1α, MIP-1β and TARC) but not a cytokine immune signature in patients with CL as compared to healthy nonendemic controls, as measured by Mann-Whitney test., Conclusions: The results of our study did not identify a systemic immune signature or parasite genetic factors associated with different clinical presentation of CL., (© 2024. The Author(s).)

Background: Most people diagnosed with chronic hepatitis B (CHB) need treatment to help reduce the risk of liver disease and limit disease transmission. Therapeutic vaccine (TV) candidates have been under study for their clinical effects on inducing HBV-specific host immune responses. This review aimed to systematically synthesize updated evidence on the efficacy and safety of TVs in patients with CHB., Methods: This systematic review was performed by searching different databases from January to February 2021. Completed randomized controlled trials that reported TVs' efficacy and/or safety for treating CHB compared with the standard of care (SOC) or placebo were included. Efficacy and safety estimates were reported as the logarithm of the odds ratio and risk differences, respectively. I2 > 50% was considered significant heterogeneity. Significant publication bias was considered when Egger's test P value < .10. The risk of bias was assessed using the Cochrane Risk of Bias tool. The GRADE methodology was used to assess the certainty of the evidence for each outcome., Results: Twenty-four articles with 2889 pooled samples were included. TVs made a significant difference in hepatitis B envelope antigen (HBeAg) SC (log OR = 0.76, P = .01) and (log OR = 0.40, P = .03) compared to placebo and combination therapy, respectively. HBeAg SC was significantly affected by TVs at the end of follow up (log OR = 0.49, P = .01), with significant HBsAg mean difference (MD = -0.62, P = .00). At the end of treatment, the TVs had no significant effect on HBV DNA negativity over the SOC (log OR = 0.62, P = .09) or placebo (log OR = -0.07, P = .91). TVs do not significantly affect the risk of serious adverse events (RD 0.02, 95% CI 0.00-0.04)., Conclusion: In patients with CHB, TVs had significant effects on HBeAg SC compared to the SOC or placebo. There was no significant difference between serious adverse events. TVs are promising treatment strategy to overcome CHB., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Visceral leishmaniasis (VL) is a neglected tropical disease caused by parasites from the Leishmania (L.) donovani complex. VL is characterised by uncontrolled parasite replication in spleen, liver and bone marrow, and by an impaired immune response and high systemic levels of inflammation. Monocytes have been poorly characterised in VL patients. The aim of this study was to evaluate the expression levels of markers involved in the regulation of T cell responses on different subsets of monocytes from the blood of VL patients and healthy non-endemic controls (HNEC). Monocytes can broadly be divided into three subsets: classical, intermediate and non-classical monocytes. Our results show that the percentages of all three subsets stayed similar at the time of VL diagnosis (ToD) and at the end of anti-leishmanial treatment (EoT). We first looked at co-stimulatory receptors: the expression levels of CD40 were significantly increased on classical and intermediate, but not non-classical monocytes, at ToD as compared to EoT and HNEC. CD80 expression levels were also increased on intermediate monocytes at ToD as compared to EoT and HNEC, and on classical monocytes only as compared to HNEC. The levels of CD86 were similar at EoT and ToD and in HNEC on classical and intermediate monocytes, but significantly higher at EoT on non-classical monocytes. We also looked at an inhibitory molecule, PD-L1. Our results show that the expression levels of PD-L1 were significantly higher on all three monocyte subsets at ToD as compared to HNEC, and to EoT on classical and intermediate monocytes. These results show that monocytes from the blood of VL patients upregulate both co-stimulatory and inhibitory receptors and that their expression levels are restored at EoT., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Adem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by Leishmania parasites, that can cause long-term chronic disabilities. The clinical presentation of CL varies in both type and severity. CL presents as three main clinical forms: localised lesions (localised cutaneous leishmaniasis, LCL); mucocutaneous leishmaniasis (MCL) that affects the mucosa of the nose or the mouth; or as disseminated not ulcerating nodules (diffuse cutaneous leishmaniasis, DCL). Here we recruited a cohort of CL patients in a newly established leishmaniasis treatment centre (LTC) in Lay Gayint, Northwest Ethiopia, and collected detailed demographic and clinical data. The results of our study show that more males than females present to the LTC to seek diagnosis and treatment. 70.2% of CL patients presented with LCL and 20.8% with MCL. A small number of patients presented with DCL, recidivans CL (a rare form of CL where new lesions appear on the edges of CL scars) or with a combination of different clinical presentations. The duration of illness varied from 1 month to 180 months. Over a third of CL patients had additional suspected CL cases in their household. Despite the majority of CL patients having heard about CL, only a minority knew about its transmission or that it could be treated. Most CL patients lived in areas where environmental factors known to be associated with the transmission of CL were present. This work highlights that CL is an important public health problem in Lay Gayint and emphasises the urgent need for more CL awareness campaigns, better health education and better disease management practices., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yizengaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: We aimed to analyze a four-year trend of Cutaneous leishmaniasis (CL) to determine risk levels and hotspots in North-central Ethiopia., Methods: This retrospective study was conducted at Boru Meda Hospital (BMH) from March to April 2023, focusing on CL patients treated at the leishmaniasis treatment center (LTC). Data collected included age, gender, CL type, and other clinical factors. Each patient's origin was traced and geographically mapped by elevation to assess CL risk levels., Results: There were a total of 573 CL patients reported from 46 districts, with a higher number of male patients (n=356) compared to female patients (n=217) ( P <0.001). The median age of the patients was 21 years [15-30], with the highest number of CL cases observed among individuals aged 16 to 30 years. The majority of cases (69%) presented with localized CL (LCL). About 39% of patients had a previous treatment history for CL. A significant clustering of CL cases was observed at elevation of 2301-3300 meters above sea level (χ2:17.5; P < 0.001), with the highest incidence (case notification) of 14.2/100,000 population., Conclusion: Foci of CL, were burdened at higher elevations and no clinical variation were observed between elevation differences. The majority of cases were concentrated in an area covering approximately 21.4% of the total land mass. CL continues to be a significant issue in North-central Ethiopia and has the potential to spread to new areas., Competing Interests: Conflict of interest The authors declare that they have no competing interests, (Copyright © 2024 Gashaw et al. Published by Tehran University of Medical Sciences.)

Introduction: Cutaneous Leishmaniasis (CL) is caused by protozoan parasite called Leishmania. It is endemic in more than 100 countries globally. Despite its vast prevalence and impact on quality of life, it is one of the most neglected tropical dermatological diseases. The CL burden has often been expressed based on the physical disfigurement caused by the disease. However, considering the impact of the disease beyond physical impairment and changes in patients' appearance would help to better understand the disease as a public health problem. The effect of CL on patients' quality of life was determined in this study., Methods: The data that were related to quality of life were collected using Standard one-week Dermatology Life Quality Index (DLQI) questionnaire. The questions were categorized under seven domains: symptoms & feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question was scored on a three-point scale: Very much (3), A lot (2), A little (1), Undecided (0), and Not at all (0). The sum of the scores lied between 0 and 48. A higher score shows worse quality of life. The data were entered and analysed using Statistical Package for Social Science 23. Frequencies and proportions were used to describe the data. Differences were considered statistically significant at p < 0.05., Results: The lives of the majority of CL patients (60.7%) were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% of the CL patients. In 32.1% of the CL patients, the effect of CL on patients' quality of life was very large. The quality of one CL patient's life was extremely largely affected. The disease had a small effect on 32.1% of the CL patients. Personal relationship was the most affected domain followed by symptoms and feelings and treatment. Future study including rural regions is required., Conclusion: The Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients., (© 2024. The Author(s).)

Introduction: Visceral leishmaniasis (VL), a neglected tropical disease that causes substantial morbidity and mortality, is a serious health problem in Ethiopia. Infections are caused by Leishmania ( L .) donovani parasites. Most individuals remain asymptomatic, but some develop VL, which is generally fatal if not treated. We identified the area of Metema-Humera in Northwest Ethiopia as a setting in which we could follow migrant workers when they arrived in an endemic area. The demographic characteristics of this population and factors associated with their risk of asymptomatic infection are poorly characterised., Methods: We divided our cohort into individuals who visited this area for the first time (first comers, FC) and those who had already been in this area (repeat comers, RC). We followed them from the beginning (Time 1, T1) to the end of the agricultural season (Time 2, T2), performing tests for sand fly bite exposure (anti-sand fly saliva antibody ELISA) and serology for Leishmania infection (rK39 rapid diagnostic test and the direct agglutination test) at each time point and collecting information on risk factors for infection., Results: Our results show that most migrant workers come from non-endemic areas, are male, young (median age of 20 years) and are farmers or students. At T1, >80% of them had been already exposed to sand fly bites, as shown by the presence of anti-saliva antibodies. However, due to seasonality of sand flies there was no difference in exposure between FC and RC, or between T1 and T2. The serology data showed that at T1, but not at T2, a significantly higher proportion of RC were asymptomatic. Furthermore, 28.6% of FC became asymptomatic between T1 and T2. Over the duration of this study, one FC and one RC developed VL. In multivariable logistic regression of asymptomatic infection at T1, only age and the number of visits to Metema/Humera were significantly associated with asymptomatic infection., Conclusion: A better understanding of the dynamics of parasite transmission and the risk factors associated with the development of asymptomatic infections and potentially VL will be essential for the development of new strategies to prevent leishmaniasis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Yimer, Takele, Yizengaw, Nibret, Sumova, Volf, Yismaw, Alehegn, Rowan, Müller, Cotton, Chapman and Kropf.)

Background: Globally, 257 million people have chronic hepatitis. Even though a safe and effective prophylactic vaccine against HBV infection has been available, it causes significant morbidity and mortality. HBV vaccines were designed to improve or modulate the host immune responses. The effectiveness of the vaccine is determined by measuring serum hepatitis B surface antibody (Anti-HBs) level. Therefore, this systematic review aimed to evaluate the effectiveness of hepatitis B vaccine among vaccinated children., Methods: Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines was applied for systematically searching of different databases. Only cross-section studies measuring the level of anti-HBs of vaccinated children were included. The seroprotective level with anti-HBs > 10mIU/ml was extracted. The meta-analysis was performed using statistical software for data sciences (STATA) version 14. Effectiveness estimates were reported as a proportion of anti-HBs level. The heterogeneity between studies was evaluated using the I 2 test, and I 2  > 50% and/or P < 0.10 was considered significant heterogeneity. Significant publication bias was considered when Egger's test P-value < 0.10. The new castle Ottawa scale was used to assess the quality of the studies., Results: A pooled sample size of the included papers for meta-analysis was 7430. The pooled prevalence of seroprotected children was 56.95%, with a heterogeneity index (I 2 ) of 99.4% (P < 0.001). 35% of the participants were hypo-responders (10-99mIU/ml) and 21.46% were good responders (> 100mIU/ml). Based on subgroup analysis using country of studies conducted, the highest prevalence of anti-HBs was 87.00% (95% CI: 84.56, 89.44), in South Africa, and the lowest was 51.99% (95% CI: 20.41-83.58), with a heterogeneity index I 2  = 70.7% (p = 0.009) in Ethiopia., Conclusion and Recommendations: Hepatitis B vaccine seroprotective level in the current pooled analysis have suboptimal, which failed to demonstrate consistent effectiveness for global hepatitis B virus elimination plan in 2030. Using consistent age group may have a significant value for the decision of the HB vaccine effectiveness. A significant heterogeneity was observed both in studies conducted in Ethiopia and Egypt. Therefore, the impact of HB vaccination on the prevention of hepatitis B virus infection should be assessed regularly in those countries. Future meta-analysis is needed to investigate all possible vaccines in a separate way of reviewing, which will lead to a strong conclusion and recommendations., (© 2024. The Author(s).)

Background: Cutaneous leishmaniasis (CL) is a neglected tropical disease that primarily affects the most vulnerable populations. In Ethiopia, where this study took place, CL is an important health problem, however, the incidence of CL is poorly monitored., Objectives: This study took place in a recently established CL treatment centre, at Nefas Mewcha Hospital, Lay Gayint. This area was considered to be endemic for CL, however, no cases of CL from Lay Gayint had previously been officially reported to the Amhara Regional Health Bureau., Methods: Following a CL awareness campaign, a retrospective data review was performed of patients presenting to this centre between July 2019 and March 2021. Basic demographic and clinical data were collected by a nurse and recorded in the logbook of the CL treatment centre., Results: Two hundred and one patients presented for diagnosis and treatment. The age of the patients ranged from 2 to 75 years and 63.2% were males. Most patients were between 10- and 19-years-old. The majority (79.1%) of the patients presented with localised cutaneous leishmaniasis and 20.9% with mucocutaneous leishmaniasis. 98% of the patients tested positive for Leishmania parasites by microscopy., Conclusions: This work underpinned how CL is a major public health problem in the Lay Gayint district. It also shows that raising awareness about CL in the community and providing diagnosis and treatment encouraged patients to travel to seek diagnosis and treatment., Competing Interests: The authors have declared that no conflict of interest exists., (© 2023 The Authors. Skin Health and Disease published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Background: Anti-retroviral treatment enhances the immune status and reduces unwanted outcomes. However, development of treatment failure and drug resistance raises concern over lifelong treatments to chronic diseases such as HIV/AIDS., Objectives: This study determined proportion of treatment failure (TF) and identified factors associated with TF among people living with human immunodeficiency virus (HIV) in Bahir Dar, Northwest Ethiopia., Methods: Facility based cross sectional study was carried out from November, 2017 to April, 2018. Sociodemographic and clinical data were collected using structured questioner. Blood sample was collected and analyzed for viral load, complete blood count (CBC), liver and kidney function test and CD4 count. A patient is declared as treatment failure when viral load value is higher than 1000 RNA copies/ml in two consecutive viral load analyses within three months interval. Data were entered and analyzed using SPSS version 23. To identify factors associated with TF, logistic regressions model was employed., Results: A total of 430 people who had six months and above antiretroviral treatment (ART) follow up were enrolled in the study. Of these, 57.9% were females & the mean age was 38 years. The mean month of ART follow up was 83 months. In the first viral load analysis, 106 (24.7%) of the cohort were virologically failed. These failed people were followed for 3 months with intensive adherence support; then second viral load analysis showed a viralogical failure among 65 people of the second cohort. Thus, the overall viralogical failure or TF was 15.1%. The re-suppression rates were 41(38.7%). Male gender, people with history of drug discontinuation, poor adherence, irregular time of drug intake, multiple sexual practice showed significant association with TF. Moreover, base line and current CD4 counts of <200 cells/ml also demonstrated significant association with TF., Conclusion: Significant proportion of treatment failure was reported in the present study. Moreover, behavioral factors such as drug discontinuation, poor adherence, multiple sexual partner were associated with treatment failure. Hence, to avoid TF, regular patient counseling and monitoring should be in place. To identify the predictors for treatment failure, further follow-up study is desirable., (© 2021 Genet A et al.)

Background: Hepatitis B virus (HBV) causes severe liver disease, such as hepatocellular carcinoma (HCC) and life-threatening liver disease. Hepatitis B virus infection is one of the most dominant public health problems these days. Therefore, this study aimed to determine the seroprevalence of HBV infection among patients attending Addis Alem Hospital, Bahir Dar, Northwest Ethiopia., Methods: A retrospective study was conducted from January to February 2019 on HBV registered from January 2016 to December 2018 for three years period. The presence of HBsAg in serum was detected using the One Step Cassette Style HBsAg test kit. Data were analyzed using SPSS version 20. Descriptive statistics were used to describe the characteristics of participants with HBV infection. Statistical association of the determinants with HBV infection was determined by the X 2 test., Results: In this study, a total of 2010 participants of HBsAg rapid test records in the laboratory logbook were included. The median age of women was 25 years. The overall seroprevalence of HBsAg was 78 (3.9%). There was a general increment of HBV infection from 2016 to 2018, X 2 =7.52; P=0.023. Age (X 2 =8.19; P= 0.042) and sex (X 2 =37.77; P <0.001) were associated with HBsAg positivity., Conclusion and Recommendations: An intermediate seroprevalence of HBV infection was detected among participants in our study area. This figure raises significant public health concerns. Therefore, implementing strategies for routine screening of women for HBV and hospital attendants would be critical., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Geta et al.)

The aetiology of diarrhoea with Cryptosporidium species and pathogenic bacteria has not been identified in the Ethiopian primary healthcare system. Thus, antibiotic consumption for unconfirmed pathogenic diarrhoea is not infrequent. A total of 344 children aged <5 years with diarrhoea were included in the present study to determine protozoal or bacterial aetiology and antibiotic use. Overall, 47.1% of children with diarrhoea had either protozoan or bacterial pathogens. The prevalence of Cryptosporidium species was 12.8% while bacterial pathogens were 13.1%. Based on direct microscopic stool examination, 77.6% (267/344) of children with diarrhoea were treated with antimicrobials. Of these, 16.7%-51.4% of prescribed antimicrobials were appropriate. None of the children with Cryptosporidium diarrhoea were treated with the appropriate antimicrobial. Enteric bacterial pathogens showed a resistance of 51.6% to cotrimoxazole. Empirical treatments are not appropriate for the majority of child cases of diarrhoea.

Background: Clinical Rabies is a widely distributed almost 100% fatal viral zoonotic disease. Most human rabies cases occur in developing countries, especially in Asia and Africa. It can be prevented by immunization, post exposure prophylaxis. Ethiopia is assumed to be among African countries with high incidence of human rabies exposure cases. However, there is limited documented data on the incidence of human rabies exposure in the study area in particular and in Ethiopia in general. Thus, this study aimed to determine the Incidence of Human Rabies Virus exposure in Northwestern Amhara, Ethiopia., Methods: Retrospective cross-sectional study was conducted during August and September, 2017. The study was conducted at Addis Alem Hospital, a district level hospital in Bahir Dar. Data on human rabies exposure cases registered from September 1, 2015 to August 31, 2017 were collected from anti-rabies post exposure prophylaxis registration log book. Data was collected using a structured data collection questionnaire developed for this purpose. Descriptive statistics was used to describe relevant variables., The Results: A total of 924 human rabies exposure cases was recorded. The overall human rabies incidence per 100, 000 population was 6.5 in 2015 and 7.5 in 2016. Males (55.2%, 510/924) and children of age less than fifteen (46.3%, 428/924) were most affected groups. The majority of human rabies exposure cases (71.9%, 664/924) were from rural settings. Dogs were the principal sources of exposure (96.3%) followed by cat (1.5%) and donkey (1.3%). High incidence rate of rabies exposure was reported during spring (360, 39%) and summer (244, 26.4%) seasons. There was significant difference between rural and urban exposure cases (p = 0.001) in respect to the time of arrival to the hospital., Conclusion: Taking these into account, a significant proportion of the population was exposed to rabies virus during the study years. There was high human rabies exposure rate in children and in the rural community. This shows the need for organizing preventive and control strategies and to build community awareness.

The resistance of anthelminthic drugs makes helminth control difficult. The aim of our study was to assess the efficacy of single dose albendazole and praziquantel drugs among helminth-infected children. A cross-sectional study was conducted from April to June, 2017. Stool examination was done by the Formol-Ether concentration technique. Students infected with geohelminths and s chistosoma mansoni were treated with a single dose of albendazole and praziquantel, respectively. Post-treatment stool examination was performed after two weeks. The magnitude of parasite infection, percentage of egg count reduction and cure rate following treatment were calculated using descriptive statistics. A total of 409 Sebatamet primary school students were included. The total prevalence of intestinal parasitosis was 58%. The cure rate of albendazole against hookworm was only 76.8%. Praziquantel had a 91.4% cure rate against Schistosoma mansoni. Therefore, periodic evaluation of the efficacy of anthelminthic drugs is required.

Objective: The aim of this cross-sectional study was to determined the sero-prevalence of HBV infection and associated factors among health care workers and medical waste handlers in primary hospitals of North-west Ethiopia., Results: A total of 388 study participants were included in this study. Of which, 268 (69%) were health care workers and 120 (31%) were medical waste handlers. Males accounted 54.9% and the mean age for all study participants was 28.3 (standard deviation = 6.9). Hepatitis B virus surface antigen (HBsAg) was detected in 2.6% health care workers and 2.5% medical waste handlers and the overall hepatitis B virus infection was 10 (2.6%). High rate of hepatitis B virus infection was detected in single participants and those in the age group of 30-40 years were more infected (6.6%). History of contact with HBV infected case (8.3%) (AOR = 6.8, 95% CI = 1.6-28.5, P = 0.009) and history of jaundice (15.4%) (AOR = 10.5, 95% CI = 2.1-12.2, P = 0.03) were statistically associated factors for HBV infection. More than half (54.4%) of the study participants did not take training on infection and 9 (4.3%) of them were positive for HBsAg (COR = 1.3, 95% CI = 0.0.02-1.02, P = 0.052).

Background: Soil-transmitted helminths and Schistosoma mansoni infections are the major causes of morbidity and mortality in Sub-Saharan countries. The highest burden of the disease resides in school-age children. Poor water sanitation and hygiene are believed to be the major contributing factors for the high prevalence. Therefore, the goal of this study was to determine the prevalence of intestinal parasite infections in rural Bahir Dar, Northwest Ethiopia., Methods: A cross-sectional study was conducted from April 2017-June 2017 among 409 randomly selected primary school children. A structured questionnaire was used to obtain socio-demographic information and determinant factors through interviewing the students. Stool examination was done by Ritchie's concentration method. The data were entered and analyzed using SPSS version 22. Prevalence of helminthic infections was calculated using descriptive statistics. The association between helminthic infection and determinant factors was determined by Bavarian regression. The confounding effect was checked by multivariate regression at 95% confidence interval. Any association was significant when the p -value was < 0.05., Result: The overall prevalence of intestinal parasite infection was 47.2%.(193/409).. The prevalence of Hookworm species and Schistosoma mansoni was 31.1 and 8.0%, respectively. Co-infection of Hookworm species with Schistosoma mansoni was 5.1% (21/409). The highest prevalence of Schistosoma mansoni was recorded for boys (21%), older children (21.4%) and rural children (17.6%) ( P  < 0.05). Schistosoma mansoni infection was also higher among children whose household drinking water was sourced from streams/rivers (P < 0.05). The multivariate analysis showed lower odds of Schistosoma mansoni infection for those with no history of bathing (AOR = 3.7, 95% CI: 1.1-12.2; P  = 0.034), washing clothes/utensils (AOR = 3.4; 95% CI: 1.2-9.7; P  = 0.022), swimming (AOR = 2.8, 95% CI: 1.2-6.9; P  = 0.023), and irrigation (AOR = 2.8, 95% CI: 1.3-6.0; P  = 0.01). Significantly, higher odds of Hookworm infection was recorded for older children (AOR = 2.3, 95% CI: 1.08-4.89; P  = 0.029), boys (AOR = 1.9, 95% CI: 1.12-3.24; P  = 0.018), and rural children (AOR = 1.8, 95% CI: 1.04-3.0; P  = 0.037). Regular shoe wearing (AOR = 0.29, 95% CI: 0.16-0.50; P  = 0.00) is protective for hookworm infection. Higher odds of hookworm infection was also recorded for schoolchildren who had the habit of eating raw vegetables (AOR = 1.2 95% CI: 1.1-1.7 P  = 0.011)., Conclusion: Hookworm infection and schistosomiasis are prevalent in the school children in rural Bahir Dar in Northwest Ethiopia. Various activities and behaviors of the children were strongly associated with helminthic infection. Hence health education should be delivered regularly to minimize/avoid the risky behaviors and water-based activities. Deworming programs should also be implemented on a regular basis., Competing Interests: The proposal was ethically approved by the ethical review committee of Bahir Dar University, College of Medicine and Health Science. Permission letter was obtained from Amhara Regional Educational Bureau, and provided to the specific study area to conduct the research. Parents of children were informed of their children’s participation and gave informed written consent for their children to participate. Assents were also collected from children. Participants positive for any of the soil-transmitted helminths were treated with a single dose of Mebendazole (500 mg) and Praziquantel (40 mg/kg, single dose) was given for children infected with Schistosoma mansoni.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: Asymptomatic pharyngeal colonization by potential bacteria is the primary reservoir for bacterial species within a population and is considered a prerequisite for development of major childhood diseases such as sinusitis, otitis media, pneumonia, bacteremia, and meningitis. However, there is dearth of data on the colonization and drug resistance pattern of the main bacterial pathogens in the pharynx of HIV infected children in Ethiopia. Therefore, this study determined the pharyngeal colonization and drug resistance profile of bacterial pathogens in HIV infected children attending ART clinic of Felegehiwot Referral Hospital (FHRH), Amhara Region, Ethiopia., Methods: A hospital based cross-sectional study was conducted from May 2016 to June 2017 at the ART clinic of FHRH. A total of 300 HIV infected children were enrolled in the study. Data on socio-demographic characteristics of the study participants were collected with face-to-face interview and patient-card review using structured questionnaire. Bacterial species were identified using standard bacteriological techniques. Drug susceptibility testing was performed using disk diffusion technique. Chi-square test was done to determine associations among variables., Results: The median age of the participants was 11 years. Overall, 153 (51%) of children were colonized by respiratory bacteria in their pharynx. Colonization rate was higher in children from mothers who had attained college and above levels of education than others (P = 0.04). It was also higher in children without the sign of malnutrition than others (P = 0.004). The colonization rate of S.aureus, M.catarrhalis, S.pneumoniae and H.influenzae were 88 (29%), 37 (12.3%), 31 (10.3%) and 6 (2%), respectively. S.aureus-M.catarrhalis concurrent colonization was found in 14 (4.7%) of children. Age (P = 0.03), schooling (P = 0.045) and history of running nose (P = 0.043) were significantly associated with S.aureus colonization. Living in urban setting (P = 0.042) and children from mothers with college and above levels of education (P = 0.002) were significantly associated with M.catarrhalis colonization. Majority of the isolates were resistant to penicillin (68.5%) and cotrimoxazole (52.5%).S.aureus isolates were resistant to penicillin (84.1%) and cotrimoxazole (51.1%).M.catarrhalis isolates were resistant to penicillin (94.6%), erythromycin (86.5%)and cotrimoxazole (78.4%). Overall, 99 (59.3%) of the isolates were multi-drug (MDR) resistant. The overall MDR rates among S.aureus, M.catarrhalis and S.pneumoniae isolates were 65.9%, 78.4% and 22.6%, respectively., Conclusions: Pharyngeal colonization of respiratory bacteria in HIV infected children is a major public health problem. Single and multiple antibiotic resistant is alarmingly high among respiratory colonizers. Therefore, regular screening of HIV infected children for culture and antimicrobial susceptibility testing is recommended to prevent the development of severe opportunistic infections.

Objective: The aim of this cross-sectional study was to determine the magnitude of intestinal parasitosis and anaemia in a Health Center, North Ethiopia., Results: A total of 427 outpatients were enrolled and the median age of the participants was 22 years. The prevalence of intestinal parasitosis was 143 (33.5%). Age, place of residence and occupation were significantly associated with intestinal parasitosis. When we see parasite specific factors, significant associations were observed for source of drinking water (P = 0.02), age (P < 0.001) and family size (P = 0.003), respectively with Entameba histolytica, Hookworm and Giardia lamblia infections. The overall prevalence of anaemia was 35 (8.2%). The mean haemoglobin concentration among the study participants was 12.8 mg/dl. The highest prevalence of anemia was recorded for the age group of 15-19 years (29.6%). The proportion of anemia among intestinal parasite -infected and non-infected participants was 10.7 and 7.0%, respectively. Study participants infected with S. stercoralis and hookworm were more likely to develop anaemia than the non- infected ones; AOR (adjusted odds ratio) = 5.3, 95% CI (1.01-27.4); P = 0.028 and AOR = 11.1, 95% CI (3.36-36.9); P = 0.000, respectively.

Like other sub-Saharan Africa, in Ethiopia there is a shortage of adequate and safe blood supplies. Health care providers are potential resource and promoter of voluntary blood donation. This study was conducted to determine the knowledge, attitude and practice towards blood donation among health care providers in Bahir Dar City, Ethiopia. Paper based questionnaire was distributed to 276 health care providers from May 01 to June 30, 2016. Overall, 42.8% had donated blood at least once. Of these, males accounted for 60%. The median age of blood donors was 26 years. Voluntary-unpaid donation was 21.2%. Overall, 75.5% health care providers were knowledgeable. The levels of knowledge were significantly different among different disciplines (One-way ANOVA; F=69.7; P=0.004). Males were more knowledgeable than females (P<0.05). The overall favorable attitude was 78.6%. Previous practice of blood donation determined the odds of favorable attitude to be a future regular voluntary-unpaid blood donor (OR: 5.7, 95% CI: 3.2-10.4). Majority of health care providers had adequate knowledge and favorable attitude. However, voluntary-unpaid donation practice (21.1%) was lower compared to 100% target of voluntary-unpaid donation. There should be motivation packages to enhance voluntary-unpaid blood donation among health care professionals., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Soil-transmitted helminthiases (hookworms, Ascaris lumbricoides and Trichuris trichiura) are extremely prevalent in school-aged children living in poor sanitary conditions. Recent epidemiological data suggest that Strongyloides stercoralis is highly unreported. However, accurate data are essential for conducting interventions aimed at introducing control and elimination programmes., Methods: We conducted a cross-sectional survey of 396 randomly selected school-aged children in Amhara region in rural area in north-western Ethiopia, to assess the prevalence of S. stercoralis and other intestinal helminths. We examined stools using three techniques: conventional stool concentration; and two S. stercoralis-specific methods, i.e. the Baermann technique and polymerase chain reaction. The diagnostic accuracy of these three methods was then compared., Results: There was an overall prevalence of helminths of 77.5%, with distribution differing according to school setting. Soil-transmitted helminths were recorded in 69.2%. Prevalence of S. stercoralis and hookworm infection was 20.7 and 54.5%, respectively, and co-infection was detected in 16.3% of cases. Schistosoma mansoni had a prevalence of 15.7%. Prevalence of S. stercoralis was shown 3.5% by the conventional method, 12.1% by the Baermann method, and 13.4% by PCR, which thus proved to be the most sensitive., Conclusions: Our results suggest that S. stercoralis could be overlooked and neglected in Ethiopia, if studies of soil-transmitted helminths rely on conventional diagnostic techniques alone. A combination of molecular and stool microscopy techniques yields a significantly higher prevalence. In view of the fact that current control policies for triggering drug administration are based on parasite prevalence levels, a comprehensive diagnostic approach should instead be applied to ensure comprehensive control of helminth infections.

Immunologically, active visceral leishmaniasis (VL) is characterized by profound immunosuppression, severe systemic inflammatory responses, and an impaired capacity to control parasite replication. Neutrophils are highly versatile cells, which play a crucial role in the induction as well as the resolution of inflammation, the control of pathogen replication, and the regulation of immune responses. Neutrophil functions have been investigated in human cutaneous leishmaniasis; however, their role in human VL is poorly understood. In the present study we evaluated the activation status and effector functions of neutrophils in patients with active VL and after successful anti-leishmanial treatment. Our results show that neutrophils are highly activated and have degranulated; high levels of arginase, myeloperoxidase, and elastase, all contained in neutrophils' granules, were found in the plasma of VL patients. In addition, we show that a large proportion of these cells are immature. We also analyzed effector functions of neutrophils that are essential for pathogen clearance and show that neutrophils have an impaired capacity to release neutrophil extracellular traps, produce reactive oxygen species, and phagocytose bacterial particles, but not Leishmania parasites. Our results suggest that impaired effector functions, increased activation, and immaturity of neutrophils play a key role in the pathogenesis of VL.

Backgroud: Giardia duodenalis and Cryptosporidium spp. are enteric protozoan causing gastrointestinal illness in humans and animals. Giardiasis and cryptosporidiosis are not formally considered as neglected tropical diseases, but belong to the group of poverty-related infectious diseases that impair the development and socio-economic potential of infected individuals in developing countries., Methods: We report here the prevalence and genetic diversity of G. duodenalis and Cryptosporidium spp. in children attending rural primary schools in the Bahir Dar district of the Amhara Region, Ethiopia. Stool samples were collected from 393 children and analysed by molecular methods. G. duodenalis was detected by real-time PCR, and the assemblages and sub-assemblages were determined by multilocus sequence-based genotyping of the glutamate dehydrogenase and β-giardin genes of the parasite. Detection and identification of Cryptosporidium species was carried out by sequencing of a partial fragment of the small-subunit ribosomal RNA gene., Principal Findings: The PCR-based prevalences of G. duodenalis and Cryptosporidium spp. were 55.0% (216/393) and 4.6% (18/393), respectively. A total of 78 G. duodenalis isolates were successfully characterized, revealing the presence of sub-assemblages AII (10.3%), BIII (28.2%), and BIV (32.0%). Discordant typing results AII/AIII and BIII/BIV were identified in 7.7% and 15.4% of the isolates, respectively. An additional five (6.4%) isolates were assigned to assemblage B. No mixed infections of assemblages A+B were found. Extensive genetic variation at the nucleotide level was observed within assemblage B (but no within assemblage A), resulting in the identification of a large number of sub-types. Cryptosporidium diversity was demonstrated by the occurrence of C. hominis, C. parvum, and C. viatorum in the population under study., Conclusions: Our data suggest an epidemiological scenario with an elevated transmission intensity of a wide range of G. duodenalis genetic variants. Importantly, the elevated degree of genetic diversity observed within assemblage B is consistent with the occurrence of intra-assemblage recombination in G. duodenalis.