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Getasew Kassaw,1 Rezika Mohammed,1 Getahun Mengistu Tessema,1 Tesfaye Yesuf,1 Ayenew Molla Lakew,2 Gebrekidan Ewnetu Tarekegn2 1Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia; 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, EthiopiaCorrespondence: Gebrekidan Ewnetu Tarekegn, Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box. 196, Gondar, Ethiopia, Tel +251 930781289, Email ewnetuwendale@gmail.comBackground: Severe community-acquired pneumonia is a common life-threatening infection with a high rate of unfavorable outcome. This study aimed to assess the outcomes and predictors of hospitalized severe community-acquired pneumonia patients at University of Gondar comprehensive specialized hospital.Methods: A prospective follow-up study was conducted at University of Gondar comprehensive specialized hospital from May 1 to September 31, 2021. The data was collected by reviewing patients’ charts and interviewing the patients themselves. Descriptive statistics, binary and multivariable logistic regression analysis were performed accordingly. Variables with p-value < 0.2 on binary logistic regression were analyzed using multivariable logistic regression and variables with p< 0.05 were considered to have significant association.Results: A total of 239 admitted patients with severe community-acquired pneumonia were enrolled in the study. An unfavorable outcome was observed in 105 (44%) patients; 24.27% was in-hospital all-cause mortality, 12.5% was nonresolution, 5.8% was complicated cases, and 1.26% were gone against medical care for poor prognosis. After analyzing multivariable logistic regression, confusion (OR= 4.84; 95%CI: 1.47– 15.88), anemia (OR= 2.36; 95%CI: 1.01– 5.52), leukopenia (OR=4.38; 95%CI: 1.26– 15.25), leukocytosis (OR=3.15; 95%CI: 1.23– 7.96), elevated creatinine (OR=5.67; 95%CI: 1.72– 18.65), intubation (OR=7.27; 95%CI: 1.58– 33.37) and antibiotic revision during treatment for a different reason (OR=0.02; 95%CI: 0.01– 0.07) were variables significantly associated with unfavorable outcome.Conclusion: Unfavorable outcome was high among hospitalized severe community acquired pneumonia patients, and confusion, elevated creatinine, anemia, leukopenia, leukocytosis, intubation during admission, and antibiotic revision during the course were independent predictors associated significantly with the unfavorable outcome. It is important to consider the development of a treatment protocol for the hospital and to further research incorporating the microbiologic profile of the patients.Keywords: pneumonia, unfavorable outcome, community-acquired pneumonia, Ethiopia

BACKGROUND: Acute ischemic stroke has been reported to occur in a significantly higher number of COVID-19 patients as compared to healthy controls with variable proposed pathophysiologic mechanisms. To our knowledge, sufficient data regarding this subject is lacking in Ethiopia and the African continent at large. In this case series, we report the clinical characteristics and management of 5 cases with COVID-19 infection and acute ischemic stroke to shed light on the diagnostic and therapeutic challenges in resource-limited setups.METHODS: This is a case series including data collected from the medical records of 5 participants with confirmed RT-PCR positive COVID-19 infection and radiologically confirmed acute ischemic stroke, admitted at Eka Kotebe General Hospital Intensive Care Unit (ICU) in Addis Ababa, Ethiopia from June 10, 2020, to November 04, 2020.RESULTS: Cryptogenic stroke was documented in 4/5 participants included in this series with the most common vascular risk factors identified for stroke being hypertension and diabetes mellitus. The median time from onset of COVID-19 symptoms to the identification of stroke was 07 days. Two fifth of the participants in this series died during their ICU admission with the immediate cause of deaths reported to be related to the severe COVID-19 infection but not stroke.CONCLUSION: Cryptogenic stroke was documented in 4/5 patients in this series despite the presence of vascular risk factors for other stroke subtypes. The overall prevalence, subtypes, and outcomes of stroke in COVID-19 patients in Ethiopia and the African continent as a whole needs additional research to elucidate the local burden of the disease and define the predominant pathophysiologic mechanisms for stroke in COVID-19 in the region.

IntroductionCancer, the most stressful event a person may experience often triggers depression. Depression among these groups of people, in turn, affects chemotherapy adherence, length of hospitalization, quality of life and cancer treatment outcome. Even though the problem is enormous studies that address it are limited. Therefore this study was conducted to determine the prevalence of depression and associated factors among cancer patients on chemotherapy in Felege-Hiwot referral hospital and University of Gondar referral hospital, Northwest Ethiopia.MethodsAn institution-based cross-sectional study was conducted from April to May 2019. A total of 302 cancer patients on chemotherapy were included. Depression was assessed using the patient health questionnaire (PHQ-9). Binary logistic regression was used to select variables and determine Crude Odds Ratio (COR). Variables with P value < 0.2 were entered into multivariable logistic regression. Adjusted Odds Ratio (AOR) with 95% confidence intervals for variables with P-value < 0.05 was estimated to show factors affecting depression among cancer patients. The fitness of the model was checked by using the Hosmer-Lemeshow goodness-of-fit test.ResultsThe prevalence of depression among cancer patients on chemotherapy was 70.86% (95% CI: 65.38, 75.92). Educational status of college and above (AOR = 0.1, 95% CI: 0.02, 0.43), Jobless (AOR = 0.15, 95% CI: 0.04, 0.58), Underweight(AOR = 2.39, 95% CI: 1.10, 5.19)chemotherapy duration ≥ 6 months or more (AOR = 2.36, 95% CI: 1.16, 4.79) were notably associated with depression.ConclusionThe burden of depression among cancer patients in this study was high. We recommend concerned bodies working to curve the problem to intervene based on the identified risk factors. Improving educational status, reducing work stress and maintaining normal weight would reduce depression.

Background Outcome measures of patient satisfaction are increasingly accepted as an integral component of the overall healthcare quality assessment. Aims of study A survey of the outpatient neurology services in Addis Ababa, Ethiopia was performed to determine the overall patient satisfaction, provide an assessment of current services and form the foundation for improved expansion of neurological care. Methods 233 patients were recruited from the Addis Ababa University Teaching Hospital outpatient general neurology clinic by a cross-sectional sample survey design. Data from structured interview and abstraction of medical records were analyzed by SPSS for Windows version 15.0 computer software. Visual analysis of mean satisfaction scores and Spearman's rho correlation coefficients generated priority indices serving to guide expansion of neurology services. Results 212 patients with mean age of 40.1 and a 1:1 M: F ratio completed the survey. The variation of overall patient satisfaction (mean, 70.4; SD, 12.4) was independently predicted by patient clinical outcome expectations and satisfaction on waiting area, overall service of doctor and card room [R2 = 0.305; F (8,195) = 10.685, p = 0.000]. Mean satisfaction scores for specific dimensions of the outpatient general neurology clinic ranged from 57.2 for waiting time at the clinic to 74.0 for overall service of the guards. Waiting time at the clinic stood first among the top five priority indices. Conclusion This survey demonstrates predictors of overall patient satisfaction with the outpatient neurology services, and delineates priority areas warranting further improvement. It is the first African study on patient satisfaction with neurology services, and provides a guide for neurological or other specialty clinics seeking to improve and expand medical services.

Dissecting the specificities of human antibody responses following disease caused by serogroup A meningococci may be important for the development of improved vaccines. We performed a study of Ethiopian patients during outbreaks in 2002 and 2003. Sera were obtained from 71 patients with meningitis caused by bacteria of sequence type 7, as confirmed by PCR or culture, and from 113 Ethiopian controls. Antibody specificities were analyzed by immunoblotting (IB) against outer membrane antigen extracts of a reference strain and of the patients' own isolates and by enzyme-linked immunosorbent assay for immunoglobulin G (IgG) levels against lipooligosaccharide (LOS) L11 and the proteins NadA and NspA. IB revealed that the main antigens targeted were the proteins PorA, PorB, RmpM, and Opa/OpcA, as well as LOS. MenA disease induced significant increases in IgG against LOS L11 and NadA. The IgG levels against LOS remained elevated following disease, whereas the IgG anti-NadA levels returned to acute-phase levels in the late convalescent phase. Among adults, the anti-LOS IgG levels were similar in acute-phase patient sera as in control sera, whereas anti-NadA IgG levels were significantly higher in acute-phase sera than in controls. The IgG antibody levels against LOS and NadA correlated moderately but significantly with serum bactericidal activity against MenA strains. Future studies on immune response during MenA disease should take into account the high levels of anti-MenA polysaccharide IgG commonly found in the population and seek to clarify the role of antibodies against subcapsular antigens in protection against MenA disease.

The objective of this study was to investigate serum levels of vitamin A in patients with active tuberculosis (TB) at the time of diagnosis and after completion of an intensive phase of anti-TB chemotherapy in comparison with the levels in controls. In a prospective semilongitudinal study, sera were collected from 222 patients with TB at baseline and from 57 of them 2 months after initiation of the anti-TB treatment in Gondar, Ethiopia. Healthy controls (n = 92) and asymptomatic HIV-infected blood donors (n = 30) were also included. Serum vitamin A levels were measured by high-performance liquid chromatography. At baseline, the mean serum vitamin A levels in the patients with TB with (n = 115) or without (n = 107) HIV coinfection and in the asymptomatic HIV-infected blood donors were significantly lower than those in the controls ( P μ mol/L) was observed in 62.6% and 56.1% of the patients with and without HIV coinfection, respectively. Thirteen percent of the controls and 33.3% of the asymptomatic HIV-infected blood donors were deficient in vitamin A. The serum levels of vitamin A increased significantly after anti-TB chemotherapy both in patients with (n = 34) and without (n = 23) HIV coinfection ( P

Epilepsy is arguably the most common neurological condition encountered by neurologists in Africa. Neuroimaging (CT and MRI) represents the most important recent contribution to the diagnosis, classification and management of the patient with epilepsy.To describe the role of neuroimaging in the evaluation of Ethiopian patients with epilepsy, by identifying intracranial pathology, and formulating syndromic and etiological diagnoses.We performed a retrospective review of neuroimaging in 181 patients with epilepsy presenting to a specialized referral hospital (Addis Ababa University Tikur Anbessa Teaching Hospital) and a private clinic (Yehuleshet Higher Clinic) in Addis Ababa, Ethiopia between September 2008 and August 2010. Each patient had an interictal EEG recording.Neuroimaging demonstrated abnormal intracranial structural lesions in 65 of 181 or 35.9% of epileptic patients (31% with CT; 38% with MRI). Brain lesions were single in 28 (42.8%) and multiple in 23 (35.4%) patients. The lesions were lateralized in 35 patients (53.8%), with 23 (35.4%) on the left add 12 (18.5%) on the right. Twenty seven (41.5%) of these lesions originated in or involved the temporal or frontal lobes. Over one third of the lesions were lobar equally divided among temporal, frontal and parietal regions. The imaging findings demonstrated intracranial space occupying lesions (ICSOL) in 17 (9.4%) patients (with 64.7% brain tumors), cerebral infarctions in 15 (8.3%), cortical atrophy in 9 (5.0%), and gliosis in 7(3.9%). The interictal EEG recordings revealed epileptiform abnormalities in 60/181 patients (33.1%).Neuroimaging detected intracranial pathology in more than one third of Ethiopian patients with epilepsy. A significant proportion of the cases demonstrated focal epileptiform discharges and non-epileptiform features with abnormal intracranial pathologies. Further prospective neuroimaging studies are recommended. Brain scan and EEG did help in the diagnosis, classification and treatment of epileptics.

Summary objectives To determine the prevalence of intestinal helminth infections in active tuberculosis patients and their healthy household contacts and to assess its association with active TB in an area endemic for both types of infections. methods Smear-positive pulmonary TB patients and healthy household contacts were tested for intestinal helminths using direct microscopy and the formol-ether concentration techniques. Three consecutive stool samples were examined before the start of TB chemotherapy. Sputum microscopy was done using the sodium hypochlorite concentration techniques. Participants were also tested for HIV by commercial sandwich enzyme linked immunosorbent assay. results The study population consisted of 230 smear-positive TB patients and 510 healthy household contacts. The prevalence of intestinal helminths was 71% in patients and 36% in controls. HIV seroprevalence was significantly higher in patients than in controls (46.7% vs. 11.6%, P < 0.001). Conditional logistic regression analysis showed a strong association between TB and intestinal helminth infection (OR ¼ 4.2, 95% CI 2.7‐5.9, P < 0.001), and between TB and HIV infection (OR ¼ 7.8, 95% CI 4.8‐12.6, P < 0.0001). The odds of being a TB patient increased with the number of helminth species per person: in individuals with mono-infection it was 4.3 (95% CI 2.8‐6.8); in people infected with two species was 4.7 (95% CI 2.5‐8.7), and in patients infected with three or more helminths was 12.2 (3.9‐52.6). conclusion Intestinal helminth infection may be one of the risk factors for the development of active pulmonary TB in addition to HIV infection. This finding may have important implications in the control of TB in helminth endemic areas of the world.

Ethiopia is host to a large number of international collaborative research projects in the areas of science, medicine and health. This paper attempts to (1) Give a brief introduction to Ethiopia and its health care system, including its primary and referral health care institutions and its medical education; (2) Briefly discuss four examples of international collaborations in Ethiopia, on very different scales: National HIV/AIDS Programme, Gondar Chronic Illness Project, Dabat and Butajira Health Surveillance Projects, a local schistosomiasis project and related laboratory studies; (3) Summarize some of the lessons learned from these projects and to suggest some common characteristics of successful international projects.

The level of HIV infection and intestinal parasitoses among TB patients was assessed in a hospital-based cross-sectional study involving 257 patients in Gondar, Ethiopia. In TB patients, our study reported co-infection with HIV (52.1%) and intestinal parasites (40.9%) The high prevalence of HIV and intestinal parasites indicates an increased morbidity inTB patients and emphasized the importance of continued HIV sero-surveillance, stool analysis and treatment.

Meningitis is usually caused by viral, bacterial or fungal pathogens. Bacterial meningitis is a medical emergency and if untreated has a high mortality rate. Even among those who survive the infection, some may develop permanent neurological disorders.This study was undertaken to isolate and identify the bacterial and fungal etiologic agents of meningitis and to access the susceptibility pattern of bacterial isolates.During the period of November 2007 to June 2008, 340 cerebrospinal fluid (CSF) specimens were obtained from suspected cases of meningitis admitted to Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. Microbiological analysis was performed on CSF specimens using standard procedures.Of the 340 patients investigated, 53.5% were males and 46.5% were females. Over half of the patients (51.2%) were children (1 month to 16 years) and the remaining 32.6% and 16.2% were neonates (below 1 month of age) and adults (above 16 yrs of age), respectively. Fever was the commonest clinical feature observed in all age groups. Of the 340 CSF specimens, 26 (7.6%) had a positive bacterial or fungal culture. Bacterial isolates accounted for 84.6% of the total isolates. Among the bacteria, Streptococcus pneumoniae accounted for 36.4% followed by Haemophilus influenzae type b (Hib) and Nessieria meningitidis (serogroup A and C) (13.6%) each. Cryptococcus neoformans was the only fungal isolate. All gram positive bacteria were sensitive to ceftriaxone, ciprofloxacin, chloramphenicol, erythromycin and rifampicin and showed low level of resistance (60%) to penicillin, tetracycline and trimethoprim-sulphamethoxazole. The gram-negative bacteria showed high level of resistance (80%) to tetracycline and trimethoprim-sulphamethoxazole, intermediate level of resistance (60-80%) to ampicilin and low level of resistance (60%) to ceftriaxone, ciprofloxacin, gentamicin, chloramphenicol and rifampicin. Multiple resistance (resistance to two or more drugs) was observed in 18.2% and 100% gram positive and gram-negative bacteria, respectively.This study showed that the predominant pathogens of meningitis were S. pneumoniae, H. influenzae and N. meningitidis. Ceftriaxone and ciprofloxacin were the most effective drugs against these organisms. Continuous periodic surveillance is required to form a comprehensive and updated understanding of the etiologies and antimicrobial resistance pattern for appropriate management of meningitis cases in the country.

Background Alternative treatments for visceral leishmaniasis (VL) are required in East Africa. Paromomycin sulphate (PM) has been shown to be efficacious for VL treatment in India. Methods A multi-centre randomized-controlled trial (RCT) to compare efficacy and safety of PM (20 mg/kg/day for 21 days) and PM plus sodium stibogluconate (SSG) combination (PM, 15 mg/kg/day and SSG, 20 mg/kg/day for 17 days) with SSG (20 mg/kg/day for 30 days) for treatment of VL in East Africa. Patients aged 4–60 years with parasitologically confirmed VL were enrolled, excluding patients with contraindications. Primary and secondary efficacy outcomes were parasite clearance at 6-months follow-up and end of treatment, respectively. Safety was assessed mainly using adverse event (AE) data. Findings The PM versus SSG comparison enrolled 205 patients per arm with primary efficacy data available for 198 and 200 patients respectively. The SSG & PM versus SSG comparison enrolled 381 and 386 patients per arm respectively, with primary efficacy data available for 359 patients per arm. In Intention-to-Treat complete-case analyses, the efficacy of PM was significantly lower than SSG (84.3% versus 94.1%, difference = 9.7%, 95% confidence interval, CI: 3.6 to 15.7%, p = 0.002). The efficacy of SSG & PM was comparable to SSG (91.4% versus 93.9%, difference = 2.5%, 95% CI: −1.3 to 6.3%, p = 0.198). End of treatment efficacy results were very similar. There were no apparent differences in the safety profile of the three treatment regimens. Conclusion The 17 day SSG & PM combination treatment had a good safety profile and was similar in efficacy to the standard 30 day SSG treatment, suggesting suitability for VL treatment in East Africa. Clinical Trials Registration www.clinicaltrials.gov NCT00255567, Author Summary Visceral leishmaniasis (VL) is a parasitic disease with about 500,000 new cases each year and is fatal if untreated. The current standard therapy involves long courses, has toxicity and there is evidence of increasing resistance. New and better treatment options are urgently needed. Recently, the antibiotic paromomycin (PM) was tested and registered in India to treat this disease, but the same dose of PM monotherapy evaluated and registered in India was not efficacious in Sudan. This article reports the results of a clinical trial to test the effectiveness of injectable PM either alone (in a higher dose) or in combination with sodium stibogluconate (SSG) against the standard SSG monotherapy treatment in four East African countries—Sudan, Kenya, Ethiopia and Uganda. The study showed that the combination of SSG &PM was as efficacious and safe as the standard SSG treatment, with the advantages of being cheaper and requiring only 17 days rather than 30 days of treatment. In March 2010, a WHO Expert Committee recommended the use of the SSG & PM combination as a first line treatment for VL in East Africa.

Background Visceral leishmaniasis (VL) is a major health problem in developing countries. The untreated disease is fatal, available treatment is expensive and often toxic, and drug resistance is increasing. Improved treatment options are needed. Paromomycin was shown to be an efficacious first-line treatment with low toxicity in India. Methods This was a 3-arm multicentre, open-label, randomized, controlled clinical trial to compare three treatment regimens for VL in East Africa: paromomycin sulphate (PM) at 15 mg/kg/day for 21 days versus sodium stibogluconate (SSG) at 20 mg/kg/day for 30 days; and the combination of both dose regimens for 17 days. The primary efficacy endpoint was cure based on parasite-free tissue aspirates taken 6 months after treatment. Findings Overall, 135 patients per arm were enrolled at five centres in Sudan (2 sites), Kenya (1) and Ethiopia (2), when the PM arm had to be discontinued due to poor efficacy. The trial has continued with the higher dose of PM as well as the combination of PM and SSG arms. These results will be reported later. Baseline patient characteristics were similar among treatment arms. The overall cure with PM was significantly inferior to that with SSG (63.8% versus 92.2%; difference 28.5%, 95%CI 18.8% to 38.8%, p, Author Summary Visceral leishmaniasis (VL) is a fatal parasitic disease with 500,000 new cases each year according to WHO estimates. New and better treatment options are urgently needed in disease endemic areas due to the long courses, toxicity and development of resistance to current treatments. Recently, the antibiotic paromomycin was tested and registered in India to treat this disease. The current study describes a clinical trial to test the effectiveness of injectable paromomycin, either alone or in combination with the standard drug sodium stibogluconate in three East African countries—Sudan, Kenya and Ethiopia. The study showed that at the same paromomycin dose that was successfully used and registered in India, a far poorer outcome was obtained, particularly in Sudan, suggesting that there are either differences in the patients ability to respond to the drug or in the susceptibility of parasites in East Africa compared with those in India. However, no major safety concerns were noted with the treatment. Further research was initiated to see if a higher dose of paromomycin would perform better, especially in Sudan. The results of this and the performance of the combination arm will be reported later. Our study highlights the importance of considering geographical differences to treatment responses.

Background: HIV-1 RNA viral load is a powerful predictor of risk for disease progression in subjects infected with HIV. However, studies assessing VL in co-infected patients are very scarce. This study was, therefore, aimed at determining VL in tuberculosis (TB) and HIV-1 co-infected patients with or without intestinal parasites and also to assess its variation with treatment. Methods: TB was diagnosed following standard clinical, bacteriological, radiological and histological procedures. HIV serostatus was checked by enzyme linked immunosorbent assay. One hundred nineteen TB/HIV-1 co-infected patients were includedas a baseline and 22 were re-examined at the end of intensive phase of anti-TB chemotherapy. Stool samples were examined for intestinal parasites by conventional microscopy and serum viral load was determined using an Amplicor HIV-1 Monitor RTPCR assay. Results: Forty-five (37.8%) patients were found infected with one or more species of intestinal parasites. Ascaris lumbricoides and Strongyloides stercoralis were the most frequently detected species. The mean (±SD) serum viral load (log10 RNA copies/ ml) of patients at baseline was 4.82 (±0.66) without a significant difference by status of intestinal parasitoses. In patients with follow up treatment the viral load declined from 4.84 (±0.45) to 4.52 (±0.66) at the end of the intensive phase of anti-TB chemotherapy (P=0.07). In five patients who were also treated for intestinal parasites, viral load declined from 5.02 (±0.38) to 4.47 (±0.66) (P, Ethiopian Journal of Health and Biomedical Sciences, Vol. 1 No. 1 (2008): ETHIOPIAN JOURNAL OF HEALTH AND BIOMEDICAL SCIENCES

Headache disorders are the most common complaints worldwide. Migraine, tension-type and cluster headaches account for majority of primary headaches and impose a substantial burden on the individual, family or society at large. The burden is immense on workers, women and children in terms of missing work and school days. There are few studies that show relatively lower prevalence of primary headaches in Africa as compared to Europe and America. There might be many reasons for this lower prevalence. The objective of this study is to determine the prevalence and burden of primary headaches among the Akaki textile factory workers, which may provide data for the local and international level toward the campaign of lifting the burden of headache worldwide. The overall 1-year prevalence of all types of primary headaches was found to be 16.4%, and that of migraine was 6.2%. The prevalence of migraine in females was 10.1% while it was 3.7% in males. The prevalence of tension-type headaches was found to be 9.8%. This was 16.3 % in females as compared to 5.7% in males. The burden of the primary headaches in terms of lost workdays, gross under recognition and absence of effective treatment is tremendous. In conclusion, the prevalence of primary headaches in the Akaki textile mill workers is significant, particularly in females, and the burden is massive, in a place of poverty and ignorance. We recommend the availability and administration of specific therapy to the factory workers with primary headaches, and community based well-designed study for the whole nation’s rural and urban population.

Worldwide after malaria and sleeping sickness leishmaniases are the third most important vector borne diseases. Visceral leishmaniasis (kala-azar) is a disseminated protozoan infection caused by L. donovani L. infantum or L. arachibaldi and transmitted by the female phlebotomine sand fly bite. Coinciding with HIV infection the number of visceral leishmaniasis cases in Ethiopia has increased in the last decade. The objective was to assess the clinical and laboratory manifestations and factors associated with mortality and morbidity of visceral leishmaniasis with or without HIV co-infection. A hospital-based case series study of visceral leishmaniasis assessing clinical manifestations laboratory data treatment outcomes and HIV sero-status was conducted in Gondar University Teaching Hospital over a period of five years and seven months (from January 1999 to July 2004). A total of 221 kala-azar patients participated in the study. Out of 212 visceral leishmaniasis cases tested for HIV 87(41.0%) were HIV co-infected. Age > 20 years was independently associated with HIV co-infection. Out of 213 kala-azar patients treated with sodium stibogluconate (SSG) 52 died resulting in a case fatality rate of 24.4%. The case fatality rates among HIV positive and HIV negative kala-azar cases were 39.3% and 13.0% respectively. Using logistic regression HIV infection body mass index (BMI) of 15 and below bleeding tendency and age > 20 years were identified as independent variables predicting death. HIV co-infection and the case fatality rates are very high among patients with Visceral leishmaniasis. We recommend further study and improved care for HIV co-infected visceral leishmaniasis cases. (authors)

to determine the prevalence and type of intestinal parasites in HIV infected and uninfected patients with diarrhea.A cross-sectional study was conducted at Gondar University hospital, Northwest Ethiopia, between March 2003 and October 2004.A total 312 consecutive diarrheic patients were included in the study. Stool specimens were collected and examined for intestinal parasites following direct, formol-ether concentration and modified acid fast staining methods.Among the patients, 63.8% were found to be HIV seropositive. The prevalence of intestinal parasites in HIV seropositive and seronegative diarrheic patients was 30.6% and 33.6%, respectively. The most prevalent parasites were Strongyoides stercoralis (9.0%) and Entamoeba histolytica (8.3%) followed by Ascaris lumbricoides (5.4%) and Cryptosporidium species (5. 1%).The prevalence of intestinal parasites in diarrheic patients was very high. Institution of appropriate intervention measures are needed to reduce morbidity in such patients.

The pattern of clinical presentations of tuberculosis (TB) is reflected in the microbiological, radiological, and histological characteristics of the disease. However, coinfection with human immunodeficiency virus (HIV) poses special diagnostic and therapeutic challenges. This study was aimed at assessing the clinical manifestations of TB in patients with or without HIV coinfection in a hospital-based cross-sectional study in Gondar, Ethiopia.TB was diagnosed following standard clinical, bacteriological, radiological, and histological procedures. HIV serostatus was checked by enzyme-linked immunosorbent assay.This study included 257 TB patients, of whom 52.1% were coinfected with HIV. Pulmonary TB and extrapulmonary TB were diagnosed in 64.2% and 35.8% of the patients, respectively. No significant association was found between sputum smear positivity and HIV serostatus. One-fifth of the patients reported hemoptysis. More than one-third had chest pain, and90% reported fever and weight loss. Night sweats and cough were reported by 86% and 82.5%, respectively. Coarse crepitations were the most frequent auscultatory finding (33.9%). Sputum smear positivity rate was 26.8%. Cavitation was significantly associated with sputum smear positivity (odds ratio = 9.0, 95% confidence interval = 2.4-34.1). Wasting, cough ofor=5 months' duration, crepitation, chronic diarrhea, and herpes zoster scar were significantly associated with HIV-positive serology.Coinfection with HIV was very high in patients with TB. The presence of herpes zoster scar, chronic diarrhea, coarse crepitations, and cough ofor=5 months' duration may assist in identifying TB patients with HIV infection.

Pregnant women are prone to severe malaria despite previous malaria attacks because of decreased immunity. This puts both the mother and the fetus at a greater risk.To assess the pattern of severe malaria among pregnant women.A six year retrospective, record analysis of all women of reproductive age with severe malaria was done at Gondar University hospital.It was found that out of 204 reproductive age women admitted with severe malaria 57.8% were pregnant. Signs of severity occurred more frequently in the pregnant women and rural dwellers. The several neurological manifestations were most common complications for more than 70.0% of the pregnant women and in 60.0% of the non-pregnant women, namely cerebral malaria, convulsions, altelred mental state and prostration. The case fatality rate 33.1% among the pregnant women was found to he significantly higher than the non pregnant (p = 0.03, OR 2.2. 95% confidence interval 1.1-4.2). Cerebral malaria, pulmonary edema, shock and acidotic breathing were the severe manifestations statistically associated with maternal mortality in pregnant women. Again cerebral malaria and shock were significantly associated with either maternal or infant death or both (bad outcome of pregnancy).It is this recommended that special attention for pregnant mothers in prevention, early detection and prompt treatment of malaria is needed.

To elucidate critical components of protective immune responses induced during the natural course of serogroup A meningococcal disease, we studied acute-, early-convalescent-, and late-convalescent-phase sera from Ethiopian patients during outbreaks in 2002 to 2003. Sera were obtained from laboratory-confirmed patients positive for serogroup A sequence type 7 (ST-7) meningococci (A:4/21:P1.20,9) ( n = 71) and from Ethiopian controls ( n = 113). The sera were analyzed using an enzyme-linked immunosorbent assay to measure levels of immunoglobulin G (IgG) against serogroup A polysaccharide (APS) and outer membrane vesicles (OMVs) and for serum bactericidal activity (SBA) using both rabbit and human complement sources. Despite relatively high SBA titers and high levels of IgG against APS and OMVs in acute-phase patient sera, significant increases were seen in the early convalescent phase. Antibody concentrations returned to acute-phase levels in the late convalescent phase. Considering all patients' sera, a significant but low correlation ( r = 0.46) was observed between SBA with rabbit complement (rSBA) using an ST-5 reference strain and SBA with human complement (hSBA) using an ST-7 strain from Ethiopia. While rSBA demonstrated a significant linear relation with IgG against APS, hSBA demonstrated significant linear relationships with IgG against both APS and OMV. This study indicates that antibodies against both outer membrane proteins and APS may be important in providing the protection induced during disease, as measured by hSBA. Therefore, outer membrane proteins could also have a role as components of future meningococcal vaccines for the African meningitis belt.

Background : Malaria is a major health threat in Ethiopia. Unstable malaria transmissions cause severe clinical manifestations and result in high case fatality. Objective : The aim of this study was to asses the clinical features and treatment outcome of severe malaria cases with special emphasis on the neurologic manifestations. Methods : A retrospective medical records analysis was done at Gondar University hospital, which is located in Gondar town. br> Results : Severe malaria accounted for 4.4% of the admissions and for 7.3% of the deaths occurring in the medical wards of the hospital. Neurological manifestations were observed in 61.5% of cases. The crude case fatality rate was 28.4% with 87.1% of the deaths having neurologic manifestations. Cerebral malaria accounted for 58.1% of the deaths and it was the most significant independent variable predicting poor outcome. Other poor prognostic indicators were late presentation to the hospital, acidotic breathing, pulmonary edema, shock or/hypotension, hyperparasitemia, rural residence and age 40 years and above in adults. Conclusion and recommendations : Neurological manifestations were the major determinant of morbidity and mortality in severe malaria cases in adults. This study indicates that more emphasis needs to be given to prevention and early management of malaria. Priority should also be given to patients with neurologic manifestations and they should be cared for in intensive care units. The Ethiopian Journal of Health Development Vol. 20 (2) 2006: 106-111

Three novel diagnostic tests for visceral leishmaniasis (VL), namely FD-DAT, rK39 dipstick and KATEX, were evaluated under field conditions using 101 clinical cases suspected of having VL enrolled in a trial either by active (63 patients) or passive (38 patients) surveillance. VL was confirmed in 49 patients: 35 by both aspirate smear microscopy and NNN culture, 10 by NNN culture alone and 4 by aspirate smear microscopy alone. Based on tests performed in the field, sensitivity for FD-DAT, rK39 dipstick and KATEX was determined to be 95.3% (95% CI 82.9-99.2%), 71.7% (95% CI 56.3-83.5%) and 57.4% (95% CI 42.3-71.4%), respectively. Similarly, the specificity was determined to be 62.7% (95% CI 48.1-75.5%), 82.4% (95% CI 68.6-91.1%) and 84.3% (95% CI 70.9-92.5%), respectively. A higher sensitivity of KATEX (73.9% vs. 41.7%) and higher specificity of FD-DAT (100.0% vs. 48.6%) were demonstrated under passive case detection compared with active case detection. FD-DAT is recommended for confirmation of VL diagnosis in hospital settings, whereas its use in the field will be limited to exclude VL in clinical suspects. The sensitivity of KATEX and rK39 dipstick tests needs to be improved to promote their use as first-line diagnostic tests in the field setting of northwestern Ethiopia.

To determine the prevalence of intestinal helminth infections in active tuberculosis patients and their healthy household contacts and to assess its association with active TB in an area endemic for both types of infections.Smear-positive pulmonary TB patients and healthy household contacts were tested for intestinal helminths using direct microscopy and the formol-ether concentration techniques. Three consecutive stool samples were examined before the start of TB chemotherapy. Sputum microscopy was done using the sodium hypochlorite concentration techniques. Participants were also tested for HIV by commercial sandwich enzyme linked immunosorbent assay.The study population consisted of 230 smear-positive TB patients and 510 healthy household contacts. The prevalence of intestinal helminths was 71% in patients and 36% in controls. HIV seroprevalence was significantly higher in patients than in controls (46.7%vs. 11.6%, P0.001). Conditional logistic regression analysis showed a strong association between TB and intestinal helminth infection (OR = 4.2, 95% CI 2.7-5.9, P0.001), and between TB and HIV infection (OR = 7.8, 95% CI 4.8-12.6, P0.0001). The odds of being a TB patient increased with the number of helminth species per person: in individuals with mono-infection it was 4.3 (95% CI 2.8-6.8); in people infected with two species was 4.7 (95% CI 2.5-8.7), and in patients infected with three or more helminths was 12.2 (3.9-52.6).Intestinal helminth infection may be one of the risk factors for the development of active pulmonary TB in addition to HIV infection. This finding may have important implications in the control of TB in helminth endemic areas of the world.

SUMMARY Tuberculosis remains a major health problem worldwide in the era of HIV/AIDS. Co-infection with intestinal parasites has been suggested to worsen the outcome of infection by polarizing the immune response towards Th2. This study investigated serum IgE levels of 241 tuberculosis patients and compared the IgE profiles in the tuberculosis patients either with or without intestinal helminthic infection and/or HIV infection. The serum levels of IgE in tuberculosis patients before initiation of antimycobacterial chemotherapy were found to be 1722 ± 1290 IU/ml (Mean ± SD) in HIV seronegatives and 2366 ± 1849 IU/ml in HIV seropositives. Further, the IgE level was significantly higher in patients coinfected with intestinal helminthes and HIV compared to those infected with helminthes or without coinfection (P

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

There are population variations in human immune responses to infection with Schistosoma mansoni prior to and following treatment. The aims of the present study were a) to study some of the factors correlating with antibody levels against the parasite infection, b) to determine whether there were changes in antibody responses to the parasite in infected young people following drug treatment, and c) to identify some of the social, demographic and clinical factors associated with infection in this age group. The study population comprised 10 to 14 year old children attending Gorgora Primary School. One hundred sixty fife of the 325 children screened by Kato smear were found to be excreting S. mansoni eggs, a prevalence of 50.8%. The infected children were treated with Praziquantel, and examined for infection six weeks later. Levels of IgG and IgA antiworm antibodies were determined by ELISA from blood samples drawn prior to and six weeks after treatment. IgG antibody titres in the infected children were higher in the older children and were higher in males than in females. Antibody titres did not show significant change six weeks after treatment. A significantly higher proportion of the boys is infected, and the infected boys had higher egg counts than the infected girls. There was no correlation between egg excretion and any of the clinical symptoms measured. The age of the children significantly affected prevalence, whereas sex and swimming habit had only marginal effects. Place of residence, clinical profiles and presence of other parasites did not affect prevalence. Male sex and older age were associated with higher IgG titer to parasite antigens.

HIV prevalence has been surveyed in a sample of young people from a rural small town, representing a group in which little surveillance has been undertaken. Only two of the 141 were found to test positive using the rapid HIV test. This age group represents a part of the population in which suitable education and motivation could slow the progression of the spread of HIV/AIDS. [Ethiop.J.Health Dev. 2003;17(1):85-87]

The efficacy of praziquantel against schistosomiasis mansoni has been measured in 10-14 years old schoolchildren in a highly endemic area of north-west Ethiopia. The egg reduction rate was 97% and the cure rate was 94%, as assessed by a single Kato smear. No evidence for praziquantel resistance was detected.

Summary Background A third of the world's population has latent infection with Mycobacterium tuberculosis, and in areas of low endemicity, most cases of active tuberculosis arise as a result of reactivation of latent bacilli. We sought to establish the cellular location of these latent organisms to facilitate their elimination. Methods We applied in-situ PCR to sections of macroscopically normal lung tissue from 13 individuals from Ethiopia and 34 from Mexico who had died from causes other than tuberculosis. Sections of lung tissue from six Norwegian individuals (ie, individuals from a non-endemic population) acted as negative controls, and six Ethiopian tuberculosis cases acted as positive controls. Findings Control necropsy samples from the Norwegian individuals were all negative by in-situ PCR and conventional PCR, whereas all samples from known Ethiopian tuberculosis cases were positive by both methods. However, in macroscopically normal lung tissue from Ethiopian and Mexican individuals without tuberculous lesions, the in-situ PCR revealed five of 13 and ten of 34 positive individuals, respectively. These results were confirmed by conventional PCR with extracted DNA. Positive cells included alveolar and interstitial macrophages, type II pneumocytes, endothelial cells, and fibroblasts. Interpretation M tuberculosis can persist intracellularly in lung tissue without histological evidence of tuberculous lesions. M tuberculosis DNA is situated not only in macrophages but also in other non-professional phagocytic cells. These findings contradict the dominant view that latent organisms exist in old classic tuberculous lesions, and have important implications for strategies aimed at the elimination of latent and persistent bacilli.

Data on age, sex, occupation, HIV serostatus and year of donation were collected from the blood donors log book of Gondar College of Medical Sciences Hospital, Northwest Ethiopia, for the period between January 1995 and December 2002 and analysed. The crude HIV seroprevalence was 9.9% (1109/11,204). A declining trend in the prevalence was observed from as high as 15.7% (207/1321) in 1995 to 9.3% (123/1327) in 1999 and down to 4.3% (68/1576) in 2002. The declining trend observed in recent years is encouraging and should further be strengthened by making use of the blood bank as an entry point for HIV testing and counselling services.

To determine the prevalence of Helicobacter pylori (H pylori) among dyspeptic patients and to assess the relationship between H pylori infection, blood group, HIV infection and life style of the patients.In a hospital-based cross-sectional study, patients attending Outpatient Department of University of Gondar Hospital were enrolled. Socio-demographic information was collected using questionnaires. Serum was analyzed for anti-H pylori IgG antibodies using a commercial kit. HIV serostatus was determined by enzyme-linked immunosorbent assay (ELISA). Blood grouping was performed by slide agglutination tests.A total of 215 dyspeptic patients were included in the study. One hundred and sixteen patients (54%) were females and 99 (46%) were males. Anti-H pylori IgG antibodies were detected in sera of 184 (85.6%) patients. The prevalence was significantly higher in patients aged 50 years and above. Twenty point five percent of the patients were found to be seropositive for HIV. No significant association was found between sex, ABO blood groups, consumption of spicy diets, socio-economic status and seropositivity for H pylori. However, alcohol consumption was significantly associated with H pylori serology.The prevalence of H pylori infection is associated with a history of alcohol intake and older age. The effect of different diet, alcohol and socioeconomic status as risk factors for H pylori infection needs further study.

Background Headache disorders are the most common complaints worldwide. Migraine, tension type and cluster headaches account for majority of primary headaches and improvise a substantial burden on the individual, family or society at large. There is a scanty data on the prevalence of primary headaches in sub-Saharan Africa in general and Ethiopia in particular. Moreover there is no population based urban study in Ethiopia. The purpose of this study is to determine the prevalence and burden of primary headaches in local community in Addis Ababa, Ethiopia. Methods Cross-sectional sample survey was carried out in Addis Ketema sub city, Kebele 16/17/18 (local smallest administrative unit). Using systematic random sampling, data were collected by previously used headache questionnaire, over a period of 20 days. Results The study subjects were 231 of which 51.5% were males and 48.5% were females. The overall one year prevalence of primary headache disorders was 21.6% and that for migraine was 10%, migraine without aura 6.5% migraine with aura was 2.6% and probable migraine was 0.9%. The prevalence of tension type of headache was found to be 10.4%, frequent episodic tension type headache was 8.2% followed by infrequent tension type headache of 2.2%. The prevalence of cluster headache was 1.3%. The burden of primary headache disorders in terms of missing working, school or social activities was 68.0%. This was 78.3% for migraineurs and 66.7% for tension type headache. Majority 92.0% of primary headache cases were not using health services and 66.0% did not use any drug or medications during the acute attacks and none were using preventive therapy. Conclusion Prevalence and burden of primary headache disorders was substantial in this community. Health service utilization of the community for headache treatment was poor.