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Background: Nosocomial infection is defined as an infection, which is not present or incubating on admission and is usually not manifested in the first 72 hours of hospitalization. Infectious diseases including hospital acquired infections account for 25% of mortality worldwide and 45% in low-income countries Objective: To assess the susceptibility pattern of the bacterial causes of common nosocomial infections and their susceptibility pattern in surgical patients. Methods: A one-year prospective survey of nosocomial infections of surgical patients admitted in 1999-2000 at Tikur Anbesa Hospital (TAH) and Saint Paul Hospital (SPH) was performed. The samples were collected and processed following standard microbiological techniques as part of the routine clinical management of the patient. Antibiotic sensitivity testing was done on pure culture isolates employing the disc-diffusion method for the commonly used antibiotics Results: A total of 133 patients in Tikur Anbesa (69) and Saint Paul (64) were found to have nosocomial infection among surgical patients admitted in the study period making the prevalence 6.19% in TAH and 5.74% in SPH. Wound infection was the leading nosocomial infection 36(52.1%) in TAH and 54(79%) in SPH followed by urinary tract infection 26 (38%) in TAH and 10(15.9%0) in SPH. The most frequently isolated organisms were Escherichia coli 16(25.4%) in TAH and 29(46.0%) in SPH, followed by Klebsiella 22(34%) in TAH, 13 (25.4%) in SPH and Proteus species 5(6.8). The percentage of resistant strains to Gentamycin was found to be 56% in samples taken from Hospital acquired infection at TAH. The resistance level is even higher for the penicillin group such as, crystalline penicillin and ampicillin which is (95%) of isolates from nosocomial infection Conclusions: Most isolates from hospital-acquired infection were found to be resistant to the most frequentl used antibiotics in the setting where the study was conducted., Ethiopian Journal of Health and Biomedical Sciences, Vol. 2 No. 1 (2009): ETHIOPIAN JOURNAL OF HEALTH AND BIOMEDICAL SCIENCES

Samples of 15 different fruit and vegetable types were purchased from five small groceries around Addis Ababa. Enumeration, isolation and identification processes were performed for the microbial flora of each sample before and after 15-30 days of preservation. Both direct and enrichment culture media were used to distinguish these microflora as members of the groups of normal contaminants, indicators, spoilage and foodborne disease causing organisms. The overall result of this work indicates that a total of 25 different organisms, comprising 3 (12%) indicators, 15 (60%) spoilage, 5 (20%) food-borne pathogens and 2 (8%) normal contaminants, were isolated. The predominant isolates of these groups were Escherishia coli type I, among the indicators Bacilli, molds and Enterobacter species among the spoilage and Staphylococcus aureus, Salmonella typhimurium and Bacillus cereus among the pathogens. The direct inoculation method revealed the isolation of more than one indicator organisms from each of 7 (46.7%) fresh or unpreserved fruit and vegetable samples, more than 3 spoilage organisms from each of 8 (53.3%) samples, and, at least, one pathogenic organism from each of another 8 (53.3%) samples. When enrichment culture method was applied, all these results were increased as: >1 indicators in 10 (67%), >3 spoilage organisms in 9 (60%), and pathogens in 9 (60%) of the unpreserved samples. The enumeration values of the indicator/organisms and the spoilage groups of mesophyllic aerobes/anaerobes, molds and/or yeasts were all above the accepted limits for such fruits and vegetable samples. This was shown to be true in 10 (66.7%), 4 (26.7%) and 6 (40%) samples for the indicators, spoilage mesopheles, and mold or yeasts respectively. The preservation processes have proved to be effective in eliminating or reducing the numbers and types of the organisms isolated from each fresh sample. The effectivity of the preservation methods is discussed and its applicability in a simplified and comprehensive manual for a small-scale (household level) preservation of fruits and vegetables has been recommended.

Using the Thin Layer Chromatographic (TLC) methods of the AOAC procedures, the aflatoxin content of 486 samples of six cereal varieties was determined and 71 (14.6%) of these were found to be positive, anging from 9 mcg/kg to 39.0 mcg/kg. Of these, 23 (32.4%) were maize grains followed by the white sorghum, 12 16.9%) and mixed sorghum, 11 (15.5%). The positive numbers of white, mixed and red teff samples were significantly as low as 7 (9.8%),8(11.3%) and 10 (14.1%), respectively. Similarly, out of the 60 injera samples tested only 1 (5%) sample of teff injera was positive at the 7th day of storage, while 5 (25%) and 7 (35%) samples of maize and sorghum respectively, were positive after the 4th day of storage. In all cases, it was observed that some environmental factors like temperature, moisture content and relative humidity have influenced the aflatoxin formation in the examined samples. It was also confinned that poor storage conditions like open sacs in market areas and warehouses were more conducive to aflatoxin formation than the modern silo bin storage systems. Although the maximum level of aflatoxin yield (39 mcg/kg) determined in this study is not much greater than the accepted standard limit (30 ppb ), it is possible to deduce that maize and sorghum are more susceptible to aflatoxin accumulation than teff grains both before and after baking. In view of these results, therefore, we consider it necessary to recommend some essential measures of controlling food materials for aflatoxin contamination.

The distribution and frequency of some Sills among 282 female sex workers in Addis Ababa randomly selected out of a larger group subjected to HIV serosurvey was studied. Demographic and social information, clinical examination including use of speculum and laboratory detection of Sill pathogens were performed following an informed consent of all participants. An alarmingly high prevalence of Sills was found in the study population. Gonorrhoea was detected in 78 subjects (30.1%), trichomoniasis in 62 (23.9% ), vaginal candidiasis in 51 (19.7% ) and out of 203 sera studied 76 (37.4% ) were positive for syphilis. The duration in sex work was found to have a significant association with seropositivity for syphilis (p < 0.001). Neither the marital status nor regular intake of oral pills influenced the prevalence of Sills. Further laboratory investigation on a broader panel of STDs along with KAPB studies for assessment and evaluation of social and behavioral determinants related to sex work are recommended.

Cervical and vaginal discharge samples, collected from282 randomly selected prostitutes of Addis Ababa, were examined for Sill causative agents. The subjects represented 900 females included in the 1990 sero-survey-for HIV infection. The results of the laboratory tests indicated that 117 (41.5%) of the examined females had a single infection by one of the five organisms tested for, while the others 18.1 % had experienced mixed infections of two organisms, and 4.2% of three organisms. The five organisms included Neisseria gonorrhoea isolated from 78 subjects (28.1 %), Trichomonas vaginalis -from 56 (20.6%), Candida albicans -from 40 (14.7%), and Gardnerella vaginosis -associated clue cells -from 27 individuals (9.9%). The presence of syphilis infection was indicated by the TPHA test in 72 subjects, representing 37.3% of the study samples. Among the N. gonorrhea isolates, PPNG strains comprised 57 (73.0%). Resistant strains were obtained to penicillin in 100.0%, ampicillin in 96.0%, bactrim (sxt) in 80.7%, among the PPNG strains; 19.1% of the NPPNG strains to penicillin, 38.1% to kanamycin, 66.6% of a bactrim and 66.7% of ampicillin. Both groups were, however, sensitive to erythromycin, tetracycline, chloramphenicol, norfloxacin, spectinomycin and ceftriaxone. Significant correlation was observed between these results and the MIC values obtained for each drug.

This study was conducted to investigate a reported diarrhoeal diseaseboutbreak among higher education students recruits in Bilate Military Training Centre, Sidamo Administrative Region, Out of the total patients of 5,248 who visited at the out-patient department 1,616 (30.1% ) were patients with diarrhoea. There were 99 patients admitted to the hospital out of which 27 (27.2 % ) were diarrhoeal patients. There ere no deaths reported. A total of 965 (75.6%) were treated with antimicrobial, mainly Tetracyclines, Chloramphenicol, Metronidazole and Chloroquine. Only 114 (8.9% ) were treated with Oral Rehydration Salts (ORS) while 86 (7.11 % ) with Anti-diarrhoeal (Charcoal) and ORS. There was no proper excreta disposal and the water source was found to be bacteriologically non-potable. Among the 34 stool specimens collected for culture and sensitivity tests, the genus Shigella was isolated in 6 patients; where 4 were higellaflexneri (Group B) and 2 were Shigella dysenteriae (Group A) one type 1 (Shiga's Bacillus) and the other type 2 (Schmittz's Bacillus). Shigella dysenteriae serogroups 1 and 2 showed resistance to eight and seven drugs including Trimethoprim Sulpha-Methoxazole (TSM) respectively. This study highlights the importance of safe water and improvement of general hygiene and environmental sanitation for prevention and control of epidemics and indicates the importance of continuous surveillance of drug resistant Shigella for the control of outbreaks of Shigellosis.

We report methods used to characterize an outbreak of food-borne acute toxicity among the labour force of a cotton plantation in Middle Awash Agricultural Development Enterprise in July and August 1984. Among 1492 patients seen at the Enterprise and Ministry of Health clinics during this period, 688 (46.1% ) exhibited unusual sign and symptoms. Thirty three patients required hospitalization for intensive medical care while nine patients were reported to have died due to this condition. Contamination of corn flour with pesticides was initially suspected and laboratory animal tests were carried out which failed to show any signs of acute toxicity. Investigation of the source of the corn and its processing was simultaneously conducted and revealed the contamination of the corn with seeds of an indigenous plant identified as Daturastramoniwn, an antimuscarinic alkaloid. These alkaloids contain hyoscine and hyoscyamine which is known to have toxic effect on the exocrine glands, heart, and the autonomic nervous system in man. Signs and symptoms observed in the patients and preventive measures implemented are discussed.

In the Gurage zone of central Ethiopia, the association between fly density and the occurrence of trachoma has been investigated across varying altitudes. The seasonal pattern of fly density in the area was also explored. When, over short sampling periods (10 min/child indoors and 10 min/child outdoors), hand nets were used to collect flies from the eyes of children aged 2-8 years, only Musca sorbens and M. domestica were caught. Almost all of the 13,147 'eye-seeking' flies collected came from villages at low (2000 m; 40.7%) or mid altitudes (2200-2500 m; 58.6%) with only 0.7% of them caught in the high-altitude villages investigated (at3000 m). Musca sorbens predominated outdoors and M. domestica indoors. Almost all (99.3%) of the eye-seeking M. sorbens collected were caught outdoors whereas most (76.7%) of the M. domestica were caught indoors (P0.0001 for each). The median numbers of flies caught, per child, per 10-min collection, in the low-, mid- and high-altitude villages were 9.5, six and zero, respectively, for M. sorbens, and eight, three and zero, respectively, for M. domestica. The altitudinal trends in these numbers of 'eye-seeking' flies matched those in the prevalences of active trachoma among children aged 1-10 years, which were high in the villages at low (81.6%) and mid altitude (78.7%) but much lower (1.7%) in the high-altitude villages. In conclusion, trachoma is a common disease of public-health importance only in the low- and mid-altitude villages in the Gurage zone, where there are large numbers of eye-seeking flies, and not in the villages that lie3000 m above sea level, where there is a dearth of such flies.

In the indigenous health care delivery system of Ethiopia, numerous plant species are used to treat diseases of infectious origin. Regardless of the number of species, if any of such claims could be verified scientifically, the potential significance for the improvement of the health care services would be substantial. The objective of this study was, therefore, to determine the presence of anti-microbial activity in the crude extracts of some of the commonly used medicinal plants as well as to identify the class of compounds in the plants that were subjected to such screening. Thus, the crude methanol, petroleum ether and aqueous extracts of 67 plant species were subjected to preliminary screening against 10 strains of bacterial species and 6 fungal strains using the agar dilution method. A sample concentration of 250-2000 microg/ml and 500-4000 microg/ml were used for the bacterial and fungal pathogens, respectively. The results indicated that 44 different plant species exhibited activity against one or more of the bacteria while one species, viz., Albizzia gummifera showed activity against all the 10 bacteria at different gradient of dilution. Twenty three species inhibited or retarded growth of one or more organisms at dilution as low as 250 microg/ml. Extracts of same plants species were also tested against six different fungal pathogenic agents of which eight species showed growth inhibition against one or more of the organisms. Trichila emetica and Dovyalis abyssinica, which inhibited growth of four and five fungal strains at 100 microg/ml concentration, respectively, were the most promising plants. Chemical screening conducted on the extracts of all the plants showed the presence of several secondary metabolites, mainly, polyphenols, alkaloids, tannins sterols/terpenes, saponins and glycosides. The plants containing more of these metabolites demonstrated stronger anti-microbial properties stressing the need for further investigations using fractionated extracts and purified chemical components.

In 1992, HIV/AIDS researchers in Amsterdam were invited to work in partnership with researchers in Ethiopia to build an HIV/AIDS research infrastructure in Addis Ababa. This project, which began in 1994, was envisioned to contribute meaningfully to fighting the HIV pandemic in the decades to come. Its immediate objective was to establish an HIV research laboratory to serve international partnerships pursuing HIV vaccine research in Ethiopia and to support national health authorities fighting the HIV epidemic in Ethiopia. The overall goal was to develop research capacity at the Ethiopian Health and Nutrition Research Institute (EHNRI) by improving facilities, training technical and academic personnel at the Ph.D., M.Sc., and M.P.H. levels, establishing cohort studies to study HIV infection progression, and helping the government to implement a national HIV surveillance program. During the period 1994-2002, the projected HIV/AIDS research laboratory was built and several existing sections of EHNRI were renovated and upgraded. An active HIV-research program also was established. Staff grew to more than 60, including three Ethiopian and three expatriate researcher/managers. Two Ph.D. students graduated in immunology and virology (University of Amsterdam, 2000), and five are currently in training. Several technical persons were trained, and over 19 M.Sc./M.P.H. programs were supported at Addis Ababa University (AAU). The first Ethiopian Ph.D. graduate became the national program manager for ENARP. Two ENARP cohort studies and several HIV-prevalence studies have helped document the severity of the HIV epidemic in Ethiopia, assisting national authorities in formulating national and regional policies to prevent HIV transmission. Initial funding for ENARP from the Netherlands government was for eight years, to end by 2003. It was expected that management responsibilities would then be transferred from expatriate to Ethiopian staff and all ENARP activities integrated into EHNRI.

Listeriosis, a bacterial disease in humans and animals, is mostly caused by ingestion of Listeria monocytogenes via contaminated food and/or water, or by a zoonotic infection. Globally, listeriosis has in general a low incidence but a high case fatality rate.The objective of this study was to investigate the occurrence, antimicrobial profiles, and genetic relatedness of L. monocytogenes from raw meat and dairy products (raw milk, cottage cheese, cream cake), collected from the capital and five neighboring towns in Ethiopia.Two hundred forty food samples were purchased from July to December 2006 from food vendors, shops, and supermarkets, using a cross-sectional study design. L. monocytogenes were isolated and subjected to molecular serotyping. The genetic relatedness and antimicrobial susceptibility patterns were investigated using pulsed-field gel electrophoresis (PFGE) and minimum inhibitory concentration determinations.Of 240 food samples tested, 66 (27.5%) were positive for Listeria species. Of 59 viable isolates, 10 (4.1%) were L. monocytogenes. Nine were serotype 4b and one was 2b. Minimum inhibitory concentration determination and PFGE of the 10 L. monocytogenes isolates showed low occurrence of antimicrobial resistance among eight different PFGE types.The findings in this study correspond to similar research undertaken in Ethiopia by detecting L. monocytogenes with similar prevalence rates. Public education is crucial as regards the nature of this organism and relevant prevention measures. Moreover, further research in clinical samples should be carried out to estimate the prevalence and carrier rate in humans, and future investigations on foodborne outbreaks must include L. monocytogenes.

Background. Listeriosis, a bacterial disease in humans and animals, is mostly caused by ingestion of Listeria monocytogenes via contaminated food and/or water, or by a zoonotic infection. Globally, listeriosis has in general a low incidence but a high case fatality rate. Objective. The objective of this study was to investigate the occurrence, antimicrobial profiles, and genetic relatedness of L. monocytogenes from raw meat and dairy products (raw milk, cottage cheese, cream cake), collected from the capital and five neighboring towns in Ethiopia. Methods. Two hundred forty food samples were purchased from July to December 2006 from food vendors, shops, and supermarkets, using a cross-sectional study design. L. monocytogenes were isolated and subjected to molecular serotyping. The genetic relatedness and antimicrobial susceptibility patterns were investigated using pulsed-field gel electrophoresis (PFGE) and minimum inhibitory concentration determinations. Results. Of 240 food samples tested, 66 (27.5%) were positive for Listeria species. Of 59 viable isolates, 10 (4.1%) were L. monocytogenes. Nine were serotype 4b and one was 2b. Minimum inhibitory concentration determination and PFGE of the 10 L. monocytogenes isolates showed low occurrence of antimicrobial resistance among eight different PFGE types. Discussion and Conclusions. The findings in this study correspond to similar research undertaken in Ethiopia by detecting L. monocytogenes with similar prevalence rates. Public education is crucial as regards the nature of this organism and relevant prevention measures. Moreover, further research in clinical samples should be carried out to estimate the prevalence and carrier rate in humans, and future investigations on foodborne outbreaks must include L. monocytogenes.

The occurrence of liver disease out break of unknown origin and of a significant morbidity and mortality with a major symptom of abdominal dropsy was reported among the inhabitants of Tsaeda--Emba village, Tahtay Koraro woreda, Tigray during mid December, 2005.The aim of this study was to assess if chemical intoxicants were the responsible agents for the outbreak in the affected locality.The experimental approach towards the identification of the possible causative agent from the consumables and environmental samples collected from the affected village were determination of physico-chemical quality parameters and chemical analysis using instrumental and chromatographic techniques.The intoxicant was found to stem from the consumption of the water from the unprotected well in which pyrrolizidine containing plant, Ageratum sp, abundantly thrives.The water source was intimately linked to the outbreak of disease and, therefore, immediate intervention and preventive measures are called for.

The aerobic gram-negative microbiota and virulence properties of Escherickia coli were studied in 157 rectal biopsy specimens from 50 patients with a first attack of inflammatory bowel disease (IBD) and in 56 such specimens from 20 patients with infectious colitis or infectious-type colitis (non-relapsing colitis, NRC). E. coli strains that produced both haemolysin, enterohaemolysin or colicin were found to a similar extent in IBD and NRC. E. coli strains carrying recognised virulence factors, such as enterotoxins and adhesins, were rarely isolated from patients of either group. No property was found more often in active than in inactive phases of the disease. In addition, the properties of E. coli were evenly distributed between ulcerative colitis and Crohn’s disease. E. coli strains belonging to classical enteropathogenic or enteroinvasive serotypes were not isolated. Non-motile E. coli lacking H antigen were isolated to a similar extent in IBD and NRC. Repeated isolation of the same serotype of E. coli was more common in IBD (P

Escherichia coli strains were isolated as the dominating organism of faecal cultures from 65 children with acute diarrhoea, 13 with persistent diarrhoea and from 35 healthy controls in whom Salmonella sp, Shigella sp or Campylobacter jejuni were not isolated. Nor were parasites detected. Enterotoxigenic E. coli were the most commonly detected enterovirulent organism. Enteroaggregative E. coli were also isolated more frequently from cases than controls ( p

Respiratory Tract infections continue to be a major cause of morbidity and mortality world wide. There is a failure to treat respiratory infections due to the emergence of antibiotic resistant strains among the most common respiratory pathogens.To evaluate the in vitro antibacterial activities of two traditionally used plants: Albizia gummifera (Ambabesa-Muka, Oromifa, Sessa-Amharic.) and Ferula communis (Doge-Oromifa, Dog-Amharic) against clinical isolates of S. pyogenes and S. pneumoniae.The study involving the antibacterial susceptibility test of traditionally used plant species against Gram-positive bacterial pathogens was conducted over a period of 5 months (January - August, 2004) at the Ethiopian Health, and Nutrition Research Institute. The in vitro antibacterial activities of 80% methanol crude extracts prepared from the seeds of Ablizia gummifera and, roots of Ferula communis as well as their respective hydro alcoholic solvent fractionates of both plant species were tested for inhibitory activity against the clinical isolates of six S. pneumonae and twenty two S. pyogenes using agar dilution method.Eighty percent ethanol solubilized fractions of both plants were found to have antibacterial effects to all assayed bacteria while aqueous solubilized fractions did not exhibit any effect. Minimum inhibitory concentration (MIC) of the 80% ethanol solubilized fractions was determined and the MIC of the fractions ranged from 500 mg/ ml to 1000 mg/ml for both plants showing the extracts may contain bioactive compounds of therapeutic interest.All extracts showed antibacterial activities against clinical isolates of S. pyogenes and S. pneumoniae. The extracts may contain compounds with potential therapeutic activity. Further purification and identification are needed to be tested using animal models.

Brucellosis is a Zoonosis, recognized worldwide as a serious public health hazard and economically significant disease. The etiologic agent of this disease is a bacterial species of the genus Brucella that causes undulant fever, sterility and other systemic illnesses in human. Thus, the aim of this study was to undertake seroepidemiological study of brucellosis on occupationally exposed persons in Addis Ababa abattoirs enterprise and different dairy farms.Three hundred thirty six human individuals were screened using Rose Bengal Plate Test (RBPT) and the sera were further subjected to 2- Mercapto Ethanol Test (2-MET). Simultaneously, survey was conducted in farms and slaughterhouse to investigate epidemiological factors.An overall seroprevalence rate of 4.8% (16/336) was determined by taking RBPT+/2MET+ as confirmatory test (P0.05). Some of the risk factors contributing to the occurrence of the disease include occupation, gender, and unsafe handling of infected materials. Raw milk and meat consumption, lack of awareness and use of detergents were also found as important factors.The seroprevalence of brucellosis is expected to be more in other areas of the Region, where there is high human-animal contact and high number of cattle population with a respective traditional system of animal rearing.

No Abstract. Keywords : Antibiotic resistance; Ethiopia; Prevalence; Shingella Ethiop. J. Bio. Sci. Vol. 3 (2) 2004: pp. 191-235

Objective: To determine antimicrobial susceptibility and resistance of Yersinia enterocolitica, Shigella, E.coli and Salmonella isolated strains from diarrhoeal out-patients. Design: A cross-sectional study.Setting: Ethiopian Health and Nutrition Research Institute (EHNRI) in Addis Ababa Ethiopia. Subjects: Fifty one strains of enteric pathogenic bacterial isolates from 205 diarrhoeal out-patient cases. Results: All fifty one strains of enteric pathogenic bacterial isolates were sensitive to nalidixic acid, norfloxacin, and polymyxin B and 46 strains were resistant to cephalothin. Sensitivity to gentamycin, nalidixic acid, norfloxacin and polymyxin B is greater than 90% for the tested strains, while resistance to cephalothin, ampicillin and tetracycline was greater than 50%. All strains of Yersinia enterocolitica were sensitive to carbenicillin, chloramphenicol, gentamycin, kanamycin, nalidixic acid, norfloxacin, polymyxin B, streptomycin, sulphadiazene and trimethoprim-sulphamethoxazole. All strains of Yersinia enterocolitica were resistant to ampicillin. All of the 12 strains of Shigella were sensitive to nalidixic acid, norfloxacin, polymyxin B, gentamycin and kanamycin. Ampicillin, carbenicillin, cephalothin, streptomycin sulphadiazene, tetracycline and trimethoprimsulphamethoxazole were sensitive against

Objective : To determine antimicrobial susceptibility and resistance of Yersinia enterocolitica, Shigella, E.coli and Salmonella isolated strains from diarrhoeal out-patients. Design : A cross-sectional study. Setting : Ethiopian Health and Nutrition Research Institute (EHNRI) in Addis Ababa Ethiopia. Subjects : Fifty one strains of enteric pathogenic bacterial isolates from 205 diarrhoeal out-patient cases. Results : All fifty one strains of enteric pathogenic bacterial isolates were sensitive to nalidixic acid, norfloxacin, and polymyxin B and 46 strains were resistant to cephalothin. Sensitivity to gentamycin, nalidixic acid, norfloxacin and polymyxin B is greater than 90% for the tested strains, while resistance to cephalothin, ampicillin and tetracycline was greater than 50%. All strains of Yersinia enterocolitica were sensitive to carbenicillin, chloramphenicol, gentamycin, kanamycin, nalidixic acid, norfloxacin, polymyxin B, streptomycin, sulphadiazene and trimethoprim-sulphamethoxazole. All strains of Yersinia enterocolitica were resistant to ampicillin. All of the 12 strains of Shigella were sensitive to nalidixic acid, norfloxacin, polymyxin B, gentamycin and kanamycin. Ampicillin, carbenicillin, cephalothin, streptomycin sulphadiazene, tetracycline and trimethoprimsulphamethoxazole were sensitive against Shigella isolates. Among the isolates, 91.7% were resistant against tetracycline, 50% against cephlothin, and 75% against each of ampicillin and streptomycin. Totally, ten different patterns of resistance were noted for Shigella spp . All strains of diarrhoeagenic E. coli were sensitive to gentamycin, kanamycin, nalidixic acid, norfloxacin and polymyxin B, while 90.9% of them were sensitive to chloramphenicol. Of all these isolates, 81.8% strains were resistant to cephalothin and 63.6% to sulphadiazene. All Salmonella isolates were sensitive to norfloxacin, polymyxin B and nalidixic acid while 21 (95.5%) of strains were sensitive to gentamycin and kanamycin. Resistance level of 86.4% was found against cephalothin, 36.4% for ampicillin and 27.0% to sulphadiazene and to both streptomycin and trimethoprim-sulphamethoxazole in 22.7% of these strains. Eleven different combinations of resistant patterns were observed for all the Salmonella strains. Conclusion : Gentamycin, kanamycin, nalidixic acid, norfloxacin and polymyxin B can be effective in the treatment of diarrhoea due to the enteropathogens. East African Medical Journal Vol. 82(5) 2005: 241-246

To determine antimicrobial susceptibility and resistance of Yersinia enterocolitica, Shigella, E. coli and Salmonella isolated strains from diarrhoeal out-patients.A cross-sectional study.Ethiopian Health and Nutrition Research Institute (EHNRI) in Addis Ababa Ethiopia.Fifty one strains of enteric pathogenic bacterial isolates from 205 diarrhoeal out-patient cases.All fifty one strains of enteric pathogenic bacterial isolates were sensitive to nalidixic acid, norfloxacin, and polymyxin B and 46 strains were resistant to cephalothin. Sensitivity to gentamycin, nalidixic acid, norfloxacin and polymyxin B is greater than 90% for the tested strains, while resistance to cephalothin, ampicillin and tetracycline was greater than 50%. All strains of Yersinia enterocolitica were sensitive to carbenicillin, chloramphenicol, gentamycin, kanamycin, nalidixic acid, norfloxacin, polymyxin B, streptomycin, sulphadiazene and trimethoprim-sulphamethoxazole. All strains of Yersinia enterocolitica were resistant to ampicillin. All of the 12 strains of Shigella were sensitive to nalidixic acid, norfloxacin, polymyxin B, gentamycin and kanamycin. Ampicillin, carbenicillin, cephalothin, streptomycin sulphadiazene, tetracycline and trimethoprim-sulphamethoxazole were sensitive against50% of Shigella isolates. Among the isolates, 91.7% were resistant against tetracycline, 50% against cephlothin, and 75% against each of ampicillin and streptomycin. Totally, ten different patterns of resistance were noted for Shigella spp. All strains of diarrhoeagenic E. coli were sensitive to gentamycin, kanamycin, nalidixic acid, norfloxacin and polymyxin B, while 90.9% of them were sensitive to chloramphenicol. Of all these isolates, 81.8% strains were resistant to cephalothin and 63.6% to sulphadiazene. All Salmonella isolates were sensitive to norfloxacin, polymyxin B and nalidixic acid while 21 (95.5%) of strains were sensitive to gentamycin and kanamycin. Resistance level of 86.4% was found against cephalothin, 36.4% for ampicillin and 27.0% to sulphadiazene and to both streptomycin and trimethoprim-sulphamethoxazole in 22.7% of these strains. Eleven different combinations of resistant patterns were observed for all the Salmonella strains.Gentamycin, kanamycin, nalidixic acid, norfloxacin and polymyxin B can be effective in the treatment of diarrhoea due to the enteropathogens.

Objective: To determine risk factors associated with the failure of syndromic management of sexually transmitted diseases (STDs) among women seeking treatment in primary healthcare centre in Addis Ababa, Ethiopia. Methods: Women with symptomatic STDs seeking care in a health centre were prospectively enrolled. A total of 259 women were interviewed and underwent clinical examination; 106 were enrolled and received syndromic STD treatment and 91% returned for follow up. Logistic regression analysis was used to identify risk factors associated with treatment failure. Results: Of the 106 women enrolled and presenting with symptomatic STDs 67% were HIV seropositive. Syndromic STD treatment did not result in clinical improvement in 30% of the women. Having genital ulcer disease, genital ulcer disease with genital discharge, genital warts, bacterial vaginosis and plasma HIV-1 load .10 000 copies RNA/ml or being HIV seropositive were all significantly associated with treatment failure. In multivariate analysis, however, only genital ulcer disease was significantly associated with treatment failure. Conclusion: In our setting, the association between HIV and genital ulcer disease caused by herpes may, therefore, be the reason for the failure of treatment.

This cross-sectional study was designed to determine and describe the prevalence of diarrhoea caused by Yersinia enterocolitica isolates in comparison with the commonly encountered diarrhoeagenic Salmonella and Shigella among all age group out-patients of Addis Ababa, Ethiopia. Standardized bacteriological isolation and biochemical test techniques were used. Among the stool samples of 205 patients tested for bacteriological cultures, only 3 (1.5%) were positive for Yersinia enterocolitica, 22 (10.7%) for Salmonella and 12 (5.8%) for Shigella. In this study, Yersinia enterocolitica did not seem to be the main aetiological enteric pathogenic agent when compared with the well-studied diarrhoeacogenic bacteria agents like Salmonella and Shigella strains.

In 1992, HIV/AIDS researchers in Amsterdam, the Netherlands, were invited to work in partnership with researchers in Ethiopia to build an HIV/AIDS research infrastructure in Addis Ababa. This project, which began in 1994, was envisioned to contribute meaningfully to fighting the HIV pandemic in the decades to come. Its immediate objective was to establish an HIV research laboratory to serve international partnerships pursuing HIV vaccine research in Ethiopia and to support national health authorities fighting the HIV epidemic in Ethiopia. The overall goal was to develop research capacity at the Ethiopian Health and Nutrition Research Institute (EHNRI) by improving facilities, training technical and academic personnel (at PhD, MSc, and MPH level), establishing cohort studies to study HIV infection progression, and helping the government to implement a national HIV surveillance program. In the period 1994-2002, the projected HIV/AIDS research laboratory was built and several existing sections of EHNRI were renovated and upgraded. An active HIV-research program was established. Staff grew to more than 60, including three Ethiopian and three expatriate research/managers. Two PhD. students have graduated in immunology and virology (University of Amsterdam, 2000), and five are currently in training. Several technical persons were trained and over 19 MSc/MPH-programs were supported at Addis Ababa University (AAU). The first Ethiopian PhD graduate became the national program manager for ENARP. Two ENARP cohort studies and several HIV-prevalence studies have helped to document the severity of the HIV epidemic in Ethiopia, assisting national authorities in formulation of national and regional policies to prevent HIV transmission. Initial funding for ENARP from the Netherlands government was projected for eight years, to end by 2003. It was expected that management responsibilities would then be transferred from expatriate to Ethiopian staff and all ENARP activities integrated into EHNRI.

Background information: Neisseria gonorrhoea is one of the most world wide prevalent Gram-negative diplococci bacteria causing the disease called Sexually Transmitted Disease on humans. Its stages of infection involve, first, colonization of columnar epithelial cells of mucosal surfaces; then an inflammatory response is elicited; and finally, the phagocytosis of the organisms by PMNs results in the formation of purulent discharges where the PMNs are found accumulated in it. The antigenic composition of N.gonorrhoea is complex with three major classes that are associated with the surface layers, namely, the pilus protein antigens, the polysaccharide component of cell wall and the outer membrane protein constitution. The pathogenicity determinant factors of N.gonorrhoea have been proved to include: Colonial Morphology which indicates that the virulence factors are based on the five major colony forms designated as T1, T2, T3, T4 and T5, indicating differences in surface antigens, virulence and in colony appearances; and, the Pili are the other pathogenesis determinant factors that are functioning by having adherence to the mucosal cell surface and serving as conjugal transfer of genetic material. It has been observed that piliated bacterial strains are resistant to phagocytosis, giving inefficient digestion ability to the macrophages compared to nonpiliated strains. Thus, types T1 and T2 are most virulent to humans because they are the piliated (fimbriated) strains. The Ethiopian situation in relation to gonococcal infections indicates that it is known to be highly prevalent among both sexes of most age groups. However no work has been conducted to assess the prevalence of the different virulence factors of N.gonorrhoeae strains. Objective : The aim of this study was thus to assess the prevalence of all the essential surface antigens as virulence factors of N.gonorrhoeae among the most vulnerable group of individuals for the infection and try to assess and recommend the possibility of getting important surface components to serve as vaccine candidates against gonococcal infections. Patients & methods: a total of over 300 STD male and female patients from three study sites, Addis Ababa, Nazareth, and Awassa, were used as study subjects by collecting urogenital specimen after their clinical examination. The specimens were then used for the isolation of the N.gonorrhoea strains that were identified for their virulence types, tested for their antimicrobial sensitivity patterns and determined their surface antigenic components for the most prevalent virulence factors using haemagglutination and other detection assay methods. Results: It was found that out of the total 335 specimens, N.gonorrhoea strains were isolated in 59% positive rate from males compared to the 43% positive rate was obtained from the females. The sensitivity pattern of these strains indicate that there were 19 different antibiogram patterns showing that only 12.3% were sensitive to all drugs while over 70% of the strains were resistant against more than two combined drugs and above 90% of these multi-drug resistant strains showed to be PPNGs. Out the total N.gonorrhoea isolates, 200 were tested for their haemagglutination and Iron-binding protein production properties and 35% of them were found to be Mannose Resistant Haemagglutinating (MRHA) strains while 20% were Mannose Sensitive Haemaggluintating (MSHA) strains when tested using the human AB blood types of. By the use guinea pig blood cells this was found to be 15% MRHA and 25% MSHA strains. When tested for their iron-binding protein (IBP) production, the MRHAs were positive for IBPs while the MSHA were positive for this property in 10%. Finally, based on the results obtained conclusions and recommendations are given at the end of the paper. [J Ethiopia Med Pract. 2002;4(1):14– 20]

Objectives: To examine the impact of sexually transmitted diseases (STD) syndromic treatment on genital shedding of HIV and the impact among women in whom STD treatment was not successful. Design: Seventy-one HIV-infected women were included; 60 had symptomatic STD [72% with genital discharge syndrome (GDS) and 28% with genital ulcer syndrome (GUS)] and 11 controls did not have symptomatic STD. Cervical HIV load in 94% women was measured at baseline and after STD treatment. Results: Cervical HIV load at entry was significantly higher in women with symptomatic STD than in controls [median, 3.15; interquartile range (IQR), 1.90-3.34 versus median, 1.90; IQR, 1.90-2.19 log 10 RNA copies/swab, respectively; P=0.024]. Women with STD were also more likely to have detectable cervical HIV RNA (68% versus 27%; P= 0.016). Cervical HIV load was significantly higher in women with GUS than in those with GDS (median 3.46; IQR, 2.84-4.18 versus median, 2.83; IQR, 1.90-3.31 log 10 copies/swab; P = 0.019). There was no significant reduction in genital HIV shedding after syndromic treatment of GDS or GUS. However, significant decreases were limited to only those with clinical improvement (median, 2.91; IQR, 1.90-3.45 versus median, 2.25; IQR, 1.90-3.08 log 10 RNA copies/swab, respectively; P= 0.006). GUS was significantly associated with treatment failure, independent of plasma HIV RNA load and CD4 T-cell count (odds ratio, 4.79; 95% confidence interval, 1.32-17.46). Conclusions: The fact that STD syndromic treatment impacts very little in reducing genital HIV shedding underscores the need for appropriate validation of STD syndromic diagnosis and management to control heterosexual transmission of HIV.

In 1992, HIV/AIDS researchers in Amsterdam, the Netherlands, were invited to work in partnership with researchers in Ethiopia to build an HIV/AIDS research infrastructure in Addis Ababa. This project, which began in 1994, was envisioned to contribute meaningfully to fighting the HIV pandemic in the decades to come. Its immediate objective was to establish an HIV research laboratory to serve international partnerships pursuing HIV vaccine research in Ethiopia and to support national health authorities fighting the HIV epidemic in Ethiopia. The overall goal was to develop research capacity at the Ethiopian Health and Nutrition Research Institute (EHNRI) by improving facilities, training technical and academic personnel (at PhD, MSc, and MPH level), establishing cohort studies to study HIV infection progression, and helping the government to implement a national HIV surveillance program. In the period 1994-2002, the projected HIV/AIDS research laboratory was built and several existing sections of EHNRI were renovated and upgraded. An active HIV-research program was established. Staff grew to more than 60, including three Ethiopian and three expatriate research/managers. Two PhD. students have graduated in immunology and virology (University of Amsterdam, 2000), and five are currently in training. Several technical persons were trained and over 19 MSc/MPH-programs were supported at Addis Ababa University (AAU). The first Ethiopian PhD graduate became the national program manager for ENARP. Two ENARP cohort studies and several HIV-prevalence studies have helped to document the severity of the HIV epidemic in Ethiopia, assisting national authorities in formulation of national and regional policies to prevent HIV transmission. Initial funding for ENARP from the Netherlands government was projected for eight years, to end by 2003. It was expected that management responsibilities would then be transferred from expatriate to Ethiopian staff and all ENARP activities integrated into EHNRI.

The study on the prevalence of rabies was conducted on a retrospective data gathered from EHNRI rabies diagnostic laboratory Addis Ababa, in the years 1979-1987. During this period a total of 8036 animals were brought to the rabies diagnostic laboratory. Ninety one percent (7329) of these animals were dogs. The remaining 8.8% (707) comprised of cats, domestic animals (donkeys, cows, sheep) and wild animals (monkeys, jackals and hyenas). Out of 7329 dogs examined 832 were positive for rabies. Dogs accounted for the majority of animal rabies (94.01% of the total positive animals). The remaining 5.99% (53) of the animals diagnosed with rabies-comprised of cats, domestic animals and some wild animals. A total of 15,940 people were given post exposure anti-rabies prophylaxis treatment that came from different parts of the country in the years 1979-1987. The prevalence rates of rabies were found to be higher soon after dogs' breeding seasons. Such an observation indicates that among dogs infection, transmission through biting is significant during the breeding season. However, despite the high incidence of rabies in Ethiopia, only 320 people were reported to have died of rabies in the years 1979-1984. This supports, the hypothesis that there is a lack of appropriate reporting system on prevalence of rabies and its impact on humans in Ethiopia.

The anti bacterial activity of polar and non-polar extracts prepared from the roots of Plumbago zeylanica L. (Plumbaginaceae), a plant widely used in Ethiopian traditional medicine for various ailments were investigated using hole plate diffusion method against some pneumonia causing pathogens. The aqueous extract did not exhibit any activity while petroleum ether extract was found to have strong anti-bacterial effects as compared to the ethanol extract which showed a significant activity. Activity guided chromatographic purification of the petroleum ether extract led to the isolation of three compounds, of which the compound identified as 5-hydroxy-2-methyl-1, 4-naphthoquinone, plumbagin, found to be the active component on the tested microorganisms. Minimum inhibitory concentration value of this particular compound showed comparative activity resembling the commonly used broad spectrum antibiotic, tetracycline. The strong antibacterial effect of the petroleum ether extract is discussed to show that it was attributable to this compound rather than the other two that were found to have trace of activities. Key words/phrases: Anti-bacterial activity, Minimum inhibitory concentration, Plumbago zeylanica, pneumonia SINET: Ethiopian Journal of Science Vol.25(2) 2002: 285-294

The anti bacterial activity of polar and non-polar extracts prepared from the roots of Plumbago zeylanica L. (Plumbaginaceae), a plant widely used in Ethiopian traditional medicine for various ailments were investigated using hole plate diffusion method against some pneumonia causing pathogens. The aqueous extract did not exhibit any activity while petroleum ether extract was found to have strong anti-bacterial effects as compared to the ethanol extract which showed a significant activity. Activity guided chromatographic purification of the petroleum ether extract led to the isolation of three compounds, of which the compound identified as 5-hydroxy-2-methyl-1, 4-naphthoquinone, plumbagin, found to be the active component on the tested microorganisms. Minimum inhibitory concentration value of this particular compound showed comparative activity resembling the commonly used broad spectrum antibiotic, tetracycline. The strong antibacterial effect of the petroleum ether extract is discussed to show that it was attributable to this compound rather than the other two that were found to have trace of activities. Key words/phrases: Anti-bacterial activity, Minimum inhibitory concentration, Plumbago zeylanica, pneumonia SINET: Ethiopian Journal of Science Vol.25(2) 2002: 285-294

Background : In Ethiopia, as most developing countries, there is little information on chronic suppurative otitis media (CSOM) in children. Awareness about the seriousness of the condition is limited among the caretakers. Treatment is largely empirical owing to lack of microbiological data. Objectives : The study was conducted to identify bacterial isolates associated with the chronic suppurative otitis media in children and determine their antibiotic susceptibility pattern. Methods : Children consecutively seen for chronic otitis media at Department of Pediatrics and Child Health of the Tikur Anbessa Hospital during January - May 2000 were included in the study. Clinical/demographic data were collected using in a pre-formed questionnaire. Ear swabs were collected, transported, and cultured using standards methods. Biochemical tests were used in identifying Gram-negative bacteria. All isolates were tested for their susceptibility to different antibiotics. Results : A total of 158 bacterial agents were isolated from 120 ear swabs collected from 112 patients aged between 3 months and 12 years. The most frequent isolates were Proteus species (31%), Staphylococcus aureus (18%), Escherichia coli (16%), Klebsiella species (12%), and Pseudomonas species (6%). Most of the isolates were resistant to commonly used antibiotics but sensitive to kanamycin (72%), augmentin (84%) and gentamycin (88%). Triple antibiotics resistance was most common resistance pattern. Conclusions : The high rate of multiple drug resistance, particularly to cheap and frequently used antibiotics, raises serious concern. More comprehensive studies are required to define the true magnitude of CSOM, to determine the microbiological profile of isolates and produce data for policy decision on optimal intervention modalities. (Ethiopian Journal of Health Development, 2001, 15(2): 89-96)

A study was conducted in the Ethio-Swedish Children's Hospital and different schools and kindergartens in Addis Ababa to determine the prevalence of bacterial agents that are associated with acute respiratory infection in children from 1998-1999. A total of 883 subjects were studied, out of which 77% were cases from the Ethio-Swedish Children's Hospital and 23% were controls from different schools and kindergartens. From each case and control throat and nasopharyngeal specimens were collected. Culture and different biochemical tests were used to isolate the potential bacterial pathogens. Clinical findings like cough, difficult breathing and fever were correlated with laboratory findings. S. pneumoniae and H. influenzae type b were the most commonly isolated bacteria in both throat and nasopharyngeal specimens; 74% and 70% in the cases and 2% and 5% in the control groups, respectively. This paper discusses the association between throat and nasopharyngeal carriership of bacteria and acute respiratory infection in children in Addis Ababa.

Escherichia coli strains isolated from faecal specimens of 108 Ethiopian patients with acute watery diarrhoea (n = 30), acute bloody (n = 9), and persistent (n = 25) diarrhoea, and from 44 patients who recently had recovered from diarrhoea were analyzed for the presence of virulence factors using DNA probes, and for adhesion to HeLa cells. Eighty-two patients were under five years of age. Enterotoxigenic E.coli (ETEC) were most frequently isolated (63 patients, 58%). Eighteen of the ETEC strains also hybridized with probes for EPEC adherence factor (EAF) and Enteroaggregative (EAgg) adherence. Enteroaggregative E. coli (EAggEC) were more frequently isolated than EAF positive E.coli, and more frequently from patients with persistent diarrhoea (10/25) than from patients with acute diarrhoea (11/39). In total, 103 of the patients harboured faecal E. coli which hybridized with one or more of the virulence probes. Haemagglutination of one or more erythrocyte species was expressed by 65/70 strains. Using monoclonal antibodies to Colonization Factor Antigen I and Coli Surface antigens 1-5, only 18/66 strains were found to produce one or more of these adhesions and no more than 15 of 43 ETEC strains were agglutinated by the antisera to these adhesins. Forty-nine strains adhered to HeLa cells in autoaggregative (23 strains), localized (17 strains) or diffuse (9 strains) pattern. The study shows that E.coli strains carrying genes for the different virulence factors are prevalent in Ethiopia. Testing for the presence of these virulence factors, as well as for putative colonization factor antigens, should be included in epidemiological studies in this area.

Invasive Escherichia coli strains of certain serotypes invade by the same mechanism as the Shigella sp. It has been proposed that invasion of epithelial cells by EPEC strains may also occur; this is a previously overlooked property. In the present study E. coli strains isolated from patients with diarrhoea or ulcerative colitis, lacking the inv plasmid mediating classical invasion, but hybridizing with probes for different adhesins, were analyzed for their ability to invade HeLa and Caco-2 cells. The majority of strains invaded Caco-2 cells to a higher extent than HeLa cells. Adhesion to Caco-2 cells was a prerequisite for subsequent invasion of the cells but EAF, eae, EAgg and other known virulence factors were not sufficient to mediate invasion. In 8 9 E. coli strains invasion was enhanced after growth under iron restriction. Growth during anaerobic conditions did not influence subsequent invasion by E. coli strains whereas 6 9 strains had their invasive ability significantly decreased after growth in the presence of 1% glucose. The invasive process was inhibited by mannose but not by lactose, fucose or galactose. Our data indicate that strains of E. coli may invade Caco-2 cells by novel mechanisms which require adhesion to the cells but which differ from those of Salmonella sp., Yersinia sp., Shigella sp. and classical enteroinvasive E. coli.

In order to study the occurrence of bacteraemia, 634 consecutively febrile children aged less than or equal to 14 years with Initial rectal temperature or 39 degrees C and above were evaluated. The overall frequency of bacteraemia was 7.7% (49 cases). Salmonellae, Streptococci and Staphylococci accounted for 57%, 16% and 14% respectively. No statistically significant difference was noted between cases and controls with regard to the nutritional status mean age in months +/- SD (55.9 +/- 49.1 vs 39 +/- 41), and haemoglobin levels in g/dl +/- SD (11.1 +/- 1.5 vs 11.1 +/- 1.5) (P greater than 0.05). None of the parameters studied was a strong predictor of bacteraemia and systemic bacterial infection did not strongly correlate with the magnitude of the clinical illness.