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Mekonen B, Dugassa S, Feleke SM, Dufera B, Gidisa B, Adamu A, Mandefro A, Tasew G, Golassa L. Widespread pfhrp2/3 deletions and HRP2-based false-negative results in southern Ethiopia. Malar J 2024; 23:108. [PMID: 38632640 PMCID: PMC11025231 DOI: 10.1186/s12936-024-04904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDTs) play a significant role in expanding case management in peripheral healthcare systems. Histidine-rich protein-2 (HRP2) antigen detection RDTs are predominantly used to diagnose Plasmodium falciparum infection. However, the evolution and spread of P. falciparum parasite strains with deleted hrp2/3 genes, causing false-negative results, have been reported. This study assessed the diagnostic performance of HRP2-detecting RDTs for P. falciparum cases and the prevalence of pfhrp2/3 deletions among symptomatic patients seeking malaria diagnosis at selected health facilities in southern Ethiopia. METHODS A multi-health facilities-based cross-sectional study was conducted on self-presenting febrile patients seeking treatment in southern Ethiopia from July to September 2022. A purposive sampling strategy was used to enroll patients with microscopically confirmed P. falciparum infections. A capillary blood sample was obtained to prepare a blood film for microscopy and a RDT using the SD Bioline™ Malaria Pf/Pv Test. Dried blood spot samples were collected for further molecular analysis. DNA was extracted using gene aid kits and amplification was performed using nested PCR assay. Exon 2 of hrp2 and hrp3, which are the main protein-coding regions, was used to confirm its deletion. The diagnostic performance of RDT was evaluated using PCR as the gold standard test for P. falciparum infections. RESULTS Of 279 P. falciparum PCR-confirmed samples, 249 (89.2%) had successful msp-2 amplification, which was then genotyped for hrp2/3 gene deletions. The study revealed that pfhrp2/3 deletions were common in all health centres, and it was estimated that 144 patients (57.8%) across all health facilities had pfhrp2/3 deletions, leading to false-negative PfHRP2 RDT results. Deletions spanning exon 2 of hrp2, exon 2 of hrp3, and double deletions (hrp2/3) accounted for 68 (27.3%), 76 (30.5%), and 33 (13.2%) of cases, respectively. The study findings revealed the prevalence of P. falciparum parasites lacking a single pfhrp2-/3-gene and that both genes varied across the study sites. This study also showed that the sensitivity of the SD Bioline PfHRP2-RDT test was 76.5% when PCR was used as the reference test. CONCLUSION This study confirmed the existence of widespread pfhrp2/3- gene deletions, and their magnitude exceeded the WHO-recommended threshold (> 5%). False-negative RDT results resulting from deletions in Pfhrp2/3- affect a country's attempts at malaria control and elimination. Therefore, the adoption of non-HRP2-based RDTs as an alternative measure is required to avoid the consequences associated with the continued use of HRP-2-based RDTs, in the study area in particular and in Ethiopia in general.
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Affiliation(s)
- Bacha Mekonen
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Sisay Dugassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sindew Mekasha Feleke
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Boja Dufera
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bedasa Gidisa
- Malaria and NTDs Research Team, Armeur Hansen Research Institute, Addis Ababa, Ethiopia
| | - Aderaw Adamu
- Department of Medical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Aynalem Mandefro
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
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Mengistu B, Liyew EF, Chernet M, Tasew G, Gomez SR, Maddren R, Collyer B, Anjulo U, Tamiru A, Forbes K, Mehari Z, Deribe K, Yadeta T, Salasibew M, Tollera G, Anderson R. Correction: Progress in controlling the transmission of schistosome parasites in Southern Ethiopia: the Geshiyaro Project in the Wolaita Zone. Parasit Vectors 2024; 17:158. [PMID: 38549079 PMCID: PMC10979624 DOI: 10.1186/s13071-024-06251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024] Open
Affiliation(s)
- Birhan Mengistu
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK.
| | - Ewnetu Firdawek Liyew
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melkie Chernet
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Santiago Rayment Gomez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
| | - Rosie Maddren
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
| | - Benjamin Collyer
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
| | - Ufaysa Anjulo
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Addis Ababa, Ethiopia
| | - Adugna Tamiru
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Addis Ababa, Ethiopia
| | - Kathryn Forbes
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
| | | | | | | | | | - Getachew Tollera
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
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Mengsitu B, Liyew EF, Chernet M, Tasew G, Gomez SR, Maddren R, Collyer B, Anjulo U, Tamiru A, Forbes K, Mehari Z, Deribe K, Yadeta T, Salasibew M, Tollera G, Anderson R. Progress in controlling the transmission of schistosome parasites in Southern Ethiopia: the Geshiyaro Project in the Wolaita Zone. Parasit Vectors 2024; 17:113. [PMID: 38448997 PMCID: PMC10919034 DOI: 10.1186/s13071-024-06156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND This paper describes changes in the prevalence and intensity of schistosome parasite infections in a project integrating mass drug administration (MDA), water, sanitation, and hygiene (WaSH), and behavioral change interventions. METHODS The Geshiyaro Project comprises three intervention arms. Arm 1 is subdivided into "Arm 1 pilot" (one district) and Arm 1 (four other districts), both receiving integrated community-wide MDA with intensive WaSH interventions. Arm 2 involves 17 districts with community-wide MDA interventions, while Arm 3 serves as a control with school-based MDA interventions in three districts. A total of 150 individuals, stratified by age group, were randomly selected from each of the 45 sentinel sites. Arm sizes were 584 (Arm 1 pilot), 1636 (Arm 1), 2203 (Arm 2), and 2238 (Arm 3). Statistical tests were employed to compare infection prevalence and intensity across the different arms. RESULTS The prevalence of schistosome parasite infection ranged from 0% to 2.6% and from 1.7% to 25.7% across districts, employing the Kato-Katz (KK) and point-of-care circulating cathodic antigen (POC-CCA) diagnostics, respectively. The mean infection intensity level showed no marked difference between baseline and follow-up surveys when measured by KK, except in Arm 2 (t = 6.89, P < 0.0001). Infection prevalence decreased significantly in Arm 1 (t = 8.62, P < 0.0001), Arm 2 (t = 6.94, P < 0.0001), and Arm 3 (t = 8.83, P < 0.0001), but not in Arm 1 pilot (t = 1.69, P = 0.09) by POC-CCA, when trace was considered positive. The decrease was significant only in Arm 1 (t = 3.28, P = 0.0001) and Arm 2 (t = 7.62, P < 0.0001) when the trace was considered negative in POC-CCA. Arm 2 demonstrated a significant difference in difference (DID) compared to the control group, Arm 3, regardless of whether trace in POC-CCA was considered positive (DID = 3.9%, df = 8780, P = 0.025) or negative (DID = -5.2, df = 8780, P = 0.0004). CONCLUSIONS The prevalence of schistosomiasis was low when employing the KK diagnostic but moderate in some locations by the POC-CCA diagnostic. The infection level had decreased across all arms of the Geshiyaro study at mid-term of the 7-year project, but further efforts are needed to reduce the rate of parasite transmission based on the POC-CCA diagnostic scores.
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Affiliation(s)
- Birhan Mengsitu
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK.
| | - Ewnetu Firdawek Liyew
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melkie Chernet
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Santiago Rayment Gomez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
| | - Rosie Maddren
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
| | - Benjamin Collyer
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
| | - Ufaysa Anjulo
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Addis Ababa, Ethiopia
| | - Adugna Tamiru
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Addis Ababa, Ethiopia
| | - Kathryn Forbes
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
| | | | | | | | | | - Getachew Tollera
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, UK
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Walelign S, Tesfaye M, Tasew G, Desta K, Tsegaye A, Taye B. Association between helminth infection and allergic disorders among children in Batu, Ethiopia. Immun Inflamm Dis 2024; 12:e1222. [PMID: 38517214 PMCID: PMC10959016 DOI: 10.1002/iid3.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Helminths are potent immunomodulators and in their chronic infection state they may protect against allergy-related disease and atopy. However, they are also known for inducing allergic conditions. This study aimed to assess the association between helminths, atopy and allergic conditions. METHODS A total of 461 school children participated in this cross-sectional study. Data on allergic symptoms and a range of confounding variables was gathered from parents via an interviewer-led questionnaire. Skin sensitization to house dust mite and cockroaches was analyzed, and a stool sample was collected for helminth analysis. Serum total Immunoglobulin E using enzyme-linked immunosorbent assay and eosinophil count were also measured. RESULTS Overall sensitivity to both allergens was 2.4%. Self-reported allergic outcomes in the last 12 months for the 461 participants had been : wheezing 3.7%, asthma 2.2%, eczema 13.2% and hay fever 6.9%. Overall, the prevalence of helminth infection was 11.9% (53/444). A borderline significant association was found between atopy and any allergy symptoms (odds ratio [OR]: 3.32, 95% confidence interval [95% CI: 0.99, 11.1], p = .052). There was no significant association between helminths and atopy (OR: 0.64 [95% CI: 0.29, 1.41], p = .268) and also between helminths and allergic symptoms (OR: 0.64 [95% CI: 0.29, 1.41], p = .268). Bivariate analysis showed keeping an animal in the house increases the risk of atopy while maternal and paternal history of allergy increases the risk of developing allergic symptoms in the children. CONCLUSION AND CLINICAL RELEVANCE This study found a non-significant inverse association between helminths infection and atopy and allergic disorders, likely due to reduced statistical power, resulting in a lower prevalence of atopy and allergic conditions. A high powered longtitudinal study is necessary to explore the casuality and potential therapeutic benefits of helminths for allergic disorders.
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Affiliation(s)
- Sosina Walelign
- Department of Medical Laboratory SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Mheret Tesfaye
- Bacteriology and Mycology National Reference LaboratoryEthiopian Public Health InstituteAddis AbabaEthiopia
| | - Geremew Tasew
- Bacterial, Parasitic, and Zoonotic Diseases Research DirectorateEthiopian Public Health InstituteAddis AbabaEthiopia
| | - Kassu Desta
- Department of Medical Laboratory SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Aster Tsegaye
- Department of Medical Laboratory SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Bineyam Taye
- Department of BiologyColgate UniversityHamiltonNew YorkUSA
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Birhanu M, Abegaz WE, Schröder D, Mihret A, Abebe T, Jacobsson S, Tasew G, Addis T, Abdeta A, Alem Y, Desalegn Z, Ademe M, Teka B, Yohannes M, Yigeremus M, Golparian D, Gebre-Selassie S, Unemo M. Antimicrobial susceptibility in Neisseria gonorrhoeae and epidemiological data of gonorrhoea patients in five cities across Ethiopia, 2021-22. JAC Antimicrob Resist 2024; 6:dlae002. [PMID: 38304725 PMCID: PMC10833647 DOI: 10.1093/jacamr/dlae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Abstract
Introduction Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern and enhanced global gonococcal AMR surveillance is imperative. As in many African countries, regular, representative and quality-assured gonococcal AMR is lacking in Ethiopia. We describe the AMR in gonococcal isolates from five cities across Ethiopia, 2021-22, and patient epidemiological data. Methods Urethral discharge from males and cervical discharge from females were collected from October 2021 to September 2022. Epidemiological data were collected using a questionnaire. MIC determination (ETEST; eight antimicrobials) was performed on gonococcal isolates and EUCAST breakpoints (v13.1) were used. Results From 1142 urogenital swab samples, 299 species-identified gonococcal isolates were identified; 78.3% were from males and 21.7% from females. The median age for males and females was 25 and 23 years, respectively. Most isolates (61.2%) were identified in Addis Ababa, followed by Gondar (11.4%), Adama (10.4%), Bahir Dar (10.0%) and Jimma (7.0%). The resistance level to ciprofloxacin, tetracycline and benzylpenicillin was 97.0%, 97.0% and 87.6%, respectively, and 87.6% of isolates were producing β-lactamase. All isolates were susceptible to ceftriaxone, cefixime, azithromycin and spectinomycin. Recommended therapy [ceftriaxone (250 mg) plus azithromycin (1 g)] was used for 84.2% of patients. Conclusions We present the first national quality-assured gonococcal AMR data from Ethiopia. Resistance levels to ciprofloxacin, tetracycline and benzylpenicillin were exceedingly high. However, all isolates were susceptible to ceftriaxone, cefixime, azithromycin and spectinomycin. In Ethiopia, it is essential to strengthen the gonococcal AMR surveillance by including further epidemiological data, more isolates from different cities, and WGS.
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Affiliation(s)
- Muluken Birhanu
- Department of Medical Laboratory Science, College of Health Science, Assosa University, Assosa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Woldaregay Erku Abegaz
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Schröder
- Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Bacteriology, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Susanne Jacobsson
- Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden
| | - Geremew Tasew
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tesfa Addis
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abera Abdeta
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Alem
- Department of Medical Laboratory Sciences, Ambo University, Ambo, Ethiopia
| | - Zelealem Desalegn
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Muluneh Ademe
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanu Teka
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meron Yohannes
- Department of Medical Laboratory Science, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahlet Yigeremus
- Department of Gynecology and Obstetrics, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Golparian
- Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden
| | - Solomon Gebre-Selassie
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Magnus Unemo
- Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, UK
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Rayment Gomez S, Maddren R, Liyew EF, Chernet M, Anjulo U, Tamiru A, Tollera G, Tasew G, Mengistu B, Collyer B, Forbes K, Anderson R. Spatial heterogeneity in mass drug administration from a longitudinal epidemiological study assessing transmission interruption of soil transmitted helminths in the Wolaita zone of southern Ethiopia (Geshiyaro Project). PLoS Negl Trop Dis 2024; 18:e0011947. [PMID: 38330143 PMCID: PMC10880954 DOI: 10.1371/journal.pntd.0011947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/21/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Deworming programmes of soil-transmitted helminths are generally monitored and evaluated by aggregating drug coverage and infection levels at a district level. However, heterogeneity in drug coverage at finer spatial scales means indicators may remain above thresholds for elimination as a public health problem or of transmission in some areas. This paper aims to highlight the misleading information that aggregating data at larger spatial scales can have for programme decision making. METHODS Drug coverage data from the Geshiyaro project were compared at two spatial scales with reference to the World Health Organisation's targets. District (woreda) and village (kebele) level were compared. The association between infection levels and drug coverage was analysed by fitting a weighted least-squares function to the mean intensity of infection (eggs per gram of faeces) against drug coverage. RESULTS The data show clearly that when the evaluation of coverage is aggregated to the district level, information on heterogeneity at a finer spatial scale is lost. Infection intensity decreases significantly (p = 0.0023) with increasing drug coverage. CONCLUSION Aggregating data at large spatial scales can result in prematurely ceasing deworming, prompting rapid infection bounce-back. There is a strong need to define context-specific spatial scales for monitoring and evaluating intervention programmes.
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Affiliation(s)
- Santiago Rayment Gomez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Rosie Maddren
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Ewnetu Firdawek Liyew
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melkie Chernet
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ufaysa Anjulo
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Wolaita, Ethiopia
| | - Adugna Tamiru
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Wolaita, Ethiopia
| | - Getachew Tollera
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Birhan Mengistu
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Benjamin Collyer
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Kathryn Forbes
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
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Assefa A, Fola AA, Tasew G. Emergence of Plasmodium falciparum strains with artemisinin partial resistance in East Africa and the Horn of Africa: is there a need to panic? Malar J 2024; 23:34. [PMID: 38273360 PMCID: PMC10809756 DOI: 10.1186/s12936-024-04848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
The emergence and spread of artemisinin partial resistance in East and Horn of Africa is alarming. However, artemisinin-based combination therapy (ACT) generally remains efficacious for the treatment of falciparum malaria. The emergence of partial artemisinin resistance does not currently meet the criteria to initiate change on treatment guidelines nor affect ACT routine procurement and distribution. It is high time for scientists and transitional researchers to be more critical and vigilant on further changes so that national programmes will be able to make informed decisions as well as remain alert and prepared for any change that may be required in the future.
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Affiliation(s)
- Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Abebe A Fola
- Center for Computational Molecular Biology, Brown University, Providence, RI, USA
| | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Tafa Regassa B, Tosisa W, Eshetu D, Beyene D, Abdeta A, Aseffa Negeri A, Shiferaw Teklu D, Tasew G, Tulu B, Awoke T. Correction: Antimicrobial resistance profiles of bacterial isolates from clinical specimens referred to ethiopian public health institute: analysis of 5-year data. BMC Infect Dis 2024; 24:40. [PMID: 38166761 PMCID: PMC10763127 DOI: 10.1186/s12879-023-08921-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Belay Tafa Regassa
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.
| | - Wagi Tosisa
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Daniel Eshetu
- Yirgalem Hospital Medical College, Yirgalem, Sidama Regional, Ethiopia
| | - Degefu Beyene
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abera Abdeta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Begna Tulu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abera A, Mamecha T, Abose E, Bokicho B, Ashole A, Bishaw T, Mariyo A, Bogale B, Terefe H, Tadesse H, Belachew M, Difabachew H, Eukubay A, Kinde S, Ali A, Regasa F, Seife F, Kebede Z, Wossen M, Tollera G, Hailu M, Manaye N, Van Reet N, Priotto G, van Griensven J, Pareyn M, Tasew G. Reemergence of Human African Trypanosomiasis Caused by Trypanosoma brucei rhodesiense, Ethiopia. Emerg Infect Dis 2024; 30:125-128. [PMID: 37967521 PMCID: PMC10756368 DOI: 10.3201/eid3001.231319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
We report 4 cases of human African trypanosomiasis that occurred in Ethiopia in 2022, thirty years after the last previously reported case in the country. Two of 4 patients died before medicine became available. We identified the infecting parasite as Trypanosoma brucei rhodesiense. Those cases imply human African trypanosomiasis has reemerged.
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Regassa BT, Tosisa W, Eshetu D, Beyene D, Abdeta A, Negeri AA, Teklu DS, Tasew G, Tulu B, Awoke T. Antimicrobial resistance profiles of bacterial isolates from clinical specimens referred to Ethiopian Public Health Institute: analysis of 5-year data. BMC Infect Dis 2023; 23:798. [PMID: 37968587 PMCID: PMC10647041 DOI: 10.1186/s12879-023-08803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is one of the common global public health problems. The emergence of antimicrobial resistance is multifactorial, and tackling its development is challenging. Consequently, infections caused by resistant bacteria are unresponsive to conventional drugs, resulting in prolonged and severe illnesses, higher mortality rates, and considerable healthcare costs. Therefore, understanding the antimicrobial resistance profiles of bacterial pathogens is essential to optimize treatments and reduce the risks associated with infections. This study aimed to determine the antimicrobial resistance patterns of bacterial isolates from different clinical specimens at the Ethiopian Public Health Institute (EPHI). MATERIALS AND METHODS The retrospective cross-sectional study was conducted on the bacterial culture and antibiotic susceptibility reports of different clinical specimens referred to the Bacteriology Laboratory of EPHI from September 2015 to August 2019. Standard bacteriological techniques were used for the isolation and identification of the bacteria. Data were extracted from 840 patients' records, which included the type of clinical sample cultured, the name of the bacteria, the representations of the antibiotics used for susceptibility testing, and the susceptibility results. Descriptive statistics were used to describe the bacterial isolates and the antimicrobial resistance profiles. RESULTS Eight types of clinical specimens were analyzed for bacterial isolates and urine specimens were the most analyzed. Ten different genera of bacteria were identified by culture. Almost all the isolates were gram-negative bacteria, while only one species of gram-positive (Staphylococcus aureus) was reported. Antibiotic sensitivity patterns were tested on 840 culture isolates. Escherichia coli strains revealed more than 57% resistance to seventeen antibiotics. Klebsiella pneumoniae showed nearly 70% or greater resistance rates for 17 of the antibiotics used. The overall detected multidrug resistance (MDR) was 64.29%. The highest MDR was reported in Acinetobacter strains (84%) followed by K. pneumoniae (80%). CONCLUSIONS The multidrug resistance rates found in this study were alarming. Strengthening antimicrobial resistance surveillance at the national level is mandatory, and antimicrobial sensitivity testing should be accessible at local diagnostic centers.
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Affiliation(s)
- Belay Tafa Regassa
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.
| | - Wagi Tosisa
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Daniel Eshetu
- Yirgalem Hospital Medical College, Yirgalem, Sidama Regional State, Ethiopia
| | - Degefu Beyene
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abera Abdeta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Begna Tulu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Fola AA, Feleke SM, Mohammed H, Brhane BG, Hennelly CM, Assefa A, Crudal RM, Reichert E, Juliano JJ, Cunningham J, Mamo H, Solomon H, Tasew G, Petros B, Parr JB, Bailey JA. Plasmodium falciparum resistant to artemisinin and diagnostics have emerged in Ethiopia. Nat Microbiol 2023; 8:1911-1919. [PMID: 37640962 PMCID: PMC10522486 DOI: 10.1038/s41564-023-01461-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
Diagnosis and treatment of Plasmodium falciparum infections are required for effective malaria control and are pre-requisites for malaria elimination efforts; hence we need to monitor emergence, evolution and spread of drug- and diagnostics-resistant parasites. We deep sequenced key drug-resistance mutations and 1,832 SNPs in the parasite genomes of 609 malaria cases collected during a diagnostic-resistance surveillance study in Ethiopia. We found that 8.0% (95% CI 7.0-9.0) of malaria cases were caused by P. falciparum carrying the candidate artemisinin partial-resistance kelch13 (K13) 622I mutation, which was less common in diagnostic-resistant parasites mediated by histidine-rich proteins 2 and 3 (pfhrp2/3) deletions than in wild-type parasites (P = 0.03). Identity-by-descent analyses showed that K13 622I parasites were significantly more related to each other than to wild type (P < 0.001), consistent with recent expansion and spread of this mutation. Pfhrp2/3-deleted parasites were also highly related, with evidence of clonal transmissions at the district level. Of concern, 8.2% of K13 622I parasites also carried the pfhrp2/3 deletions. Close monitoring of the spread of combined drug- and diagnostic-resistant parasites is needed.
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Affiliation(s)
- Abebe A Fola
- Center for Computational Molecular Biology, Brown University, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | | | - Christopher M Hennelly
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca M Crudal
- Center for Computational Molecular Biology, Brown University, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Emily Reichert
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jonathan J Juliano
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jonathan B Parr
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Jeffrey A Bailey
- Center for Computational Molecular Biology, Brown University, Providence, RI, USA.
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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12
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Phillips AE, Ower AK, Mekete K, Liyew EF, Maddren R, Mengistu B, Anjulo U, Chernet M, Dunn JC, Mohammed H, Belay H, Gidey B, Tasew G, Tadesse G, Salasibew M, Tollera G, Anderson R. Baseline soil-transmitted helminth and schistosome infection in the Geshiyaro project, Ethiopia: A unique transmission interruption project using biometric fingerprinting for longitudinal individual analysis. PLoS Negl Trop Dis 2023; 17:e0011589. [PMID: 37851666 PMCID: PMC10615263 DOI: 10.1371/journal.pntd.0011589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/30/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Geshiyaro project aims to assess the feasibility of interrupting transmission of soil-transmitted helminths (STH) and schistosome (SCH) infection in the Wolaita zone of southern Ethiopia through high coverage community-wide mass drug administration (MDA), in combination with improved water, sanitation, and hygiene services and behaviour change communication delivered through the existing health care infrastructure. To accurately measure treatment coverage a population census was conducted enrolling individuals with biometric fingerprinting and barcoded ID cards. This paper details the baseline census and parasitology surveys conducted before the start of any interventions. METHODS The census was conducted in five of the 15 Wolaita districts between October 2018 and December 2019, enrolling all consenting participants from every household. Simultaneously, a cross-sectional parasitology survey was conducted in 130 out of 361 randomly selected communities from all 15 districts, with 100 individuals across all age groups (infant to adult) per community providing stool and urine for analysis by duplicate Kato-Katz and a point-of-care circulating cathodic antigen (POC-CCA) to test for Schistosoma mansoni and STH, and microhaematuria and urine filtration for Schistosoma haematobium. Of the 130 communities, 30 were randomly selected for annual, longitudinal parasitological monitoring, with 150 randomly selected individuals from infant to adult providing two days of stool and urine samples for analysis by the same diagnostic tests per community. RESULTS In total 97,919 households participated in the baseline census enrolling 466,071 individuals, with parasitological data obtained from 10,785 people. At baseline, 15.5% were infected with at least one STH species, with Ascaris lumbricoides (9.5%), followed by hookworm (7.2%) and Trichuris trichiura (1.8%). Substantial heterogeneity in STH prevalence was observed between communities ranging from 0% to 61% where most infections were low intensity. Schistosoma mansoni infection was the dominant schistosome infection (0.85% by Kato-Katz and 13.3% by POC-CCA trace negative and 21.5% trace positive), with few Schistosoma haematobium infections identified (2.77% haematuria positive and 0.13% positive by urine filtration). CONCLUSIONS While the national control program in Ethiopia has made good progress in reducing prevalence of STH and SCH in Wolaita since it was launched in 2015, there remain areas of persistent infection suggesting the existence of environmental or behavioural risk factors that contribute to ongoing transmission. This project aims to identify the most efficient intervention strategies to reduce community burden and reach interruption of transmission.
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Affiliation(s)
- Anna E. Phillips
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Alison K. Ower
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Rosie Maddren
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Birhan Mengistu
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Ufaysa Anjulo
- Children’s Investment Fund Foundation, London, United Kingdom
| | - Melkie Chernet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Julia C. Dunn
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | - Habtamu Belay
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Roy Anderson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
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13
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Alebachew M, Gelaye W, Abate MA, Sime H, Hailgiorgis H, Gidey B, Haile M, Assefa G, Bekele W, Belay H, Parr JB, Tasew G, Mohammed H, Assefa A. Therapeutic efficacy of pyronaridine-artesunate (Pyramax ®) against uncomplicated Plasmodium falciparum infection at Hamusit Health Centre, Northwest Ethiopia. Malar J 2023; 22:186. [PMID: 37330475 PMCID: PMC10276904 DOI: 10.1186/s12936-023-04618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Early case detection and prompt treatment are important malaria control and elimination strategies. However, the emergence and rapid spread of drug-resistant strains present a major challenge. This study reports the first therapeutic efficacy profile of pyronaridine-artesunate against uncomplicated Plasmodium falciparum in Northwest Ethiopia. METHODS This single-arm prospective study with 42-day follow-up period was conducted from March to May 2021 at Hamusit Health Centre using the World Health Organization (WHO) therapeutic efficacy study protocol. A total of 90 adults ages 18 and older with uncomplicated falciparum malaria consented and were enrolled in the study. A standard single-dose regimen of pyronaridine-artesunate was administered daily for 3 days, and clinical and parasitological outcomes were assessed over 42 days of follow-up. Thick and thin blood films were prepared from capillary blood and examined using light microscopy. Haemoglobin was measured and dried blood spots were collected on day 0 and on the day of failure. RESULTS Out of 90 patients, 86/90 (95.6%) completed the 42-day follow-up study period. The overall PCR-corrected cure rate (adequate clinical and parasitological response) was very high at 86/87 (98.9%) (95% CI: 92.2-99.8%) with no serious adverse events. The parasite clearance rate was high with fast resolution of clinical symptoms; 86/90 (95.6%) and 100% of the study participants cleared parasitaemia and fever on day 3, respectively. CONCLUSION Pyronaridine-artesunate was highly efficacious and safe against uncomplicated P. falciparum in this study population.
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Affiliation(s)
- Mihreteab Alebachew
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, P.O Box 1145, Dessie, Ethiopia
| | - Woyneshet Gelaye
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Megbaru Alemu Abate
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- The Unversity of Queensland, School of Public Health, Brisbane, Australia
| | - Heven Sime
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Henok Hailgiorgis
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bokretsion Gidey
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Gudissa Assefa
- Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Habtamu Belay
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Jonathan B. Parr
- Institute for Global Health and Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Geremew Tasew
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hussein Mohammed
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic and Zoonotic Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute for Global Health and Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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14
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Gebrecherkos T, Challa F, Tasew G, Gessesse Z, Kiros Y, Gebreegziabxier A, Abdulkader M, Desta AA, Atsbaha AH, Tollera G, Abrahim S, Urban BC, Schallig H, Rinke de Wit T, Wolday D. Prognostic Value of C-Reactive Protein in SARS-CoV-2 Infection: A Simplified Biomarker of COVID-19 Severity in Northern Ethiopia. Infect Drug Resist 2023; 16:3019-3028. [PMID: 37215303 PMCID: PMC10199690 DOI: 10.2147/idr.s410053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose To evaluate the role of C-reactive protein (CRP) in predicting severe COVID-19 patients. Methods A prospective observational cohort study was conducted from July 15 to October 28, 2020, at Kuyha COVID-19 isolation and treatment center hospital, Mekelle City, Northern Ethiopia. A total of 670 blood samples were collected serially. SARS-CoV-2 infection was confirmed by RT-PCR from nasopharyngeal swabs and CRP concentration was determined using Cobas Integra 400 Plus (Roche). Data were analyzed using STATA version 14. P-value <0.05 was considered statistically significant. Results Overall, COVID-19 patients had significantly elevated CRP at baseline when compared to PCR-negative controls [median 11.1 (IQR: 2.0-127.8) mg/L vs 0.9 (IQR: 0.5-1.9) mg/L; p=0.0004)]. Those with severe COVID-19 clinical presentation had significantly higher median CRP levels compared to those with non-severe cases [166.1 (IQR: 48.6-332.5) mg/L vs 2.4 (IQR: 1.2-7.6) mg/L; p<0.00001)]. Moreover, COVID-19 patients exhibited higher median CRP levels at baseline [58 (IQR: 2.0-127.8) mg/L] that decreased significantly to 2.4 (IQR: 1.4-3.9) mg/L after 40 days after symptom onset (p<0.0001). Performance of CRP levels determined using ROC analysis distinguished severe from non-severe COVID-19 patients, with an AUC value of 0.83 (95% CI: 0.73-0.91; p=0.001; 77.4% sensitivity and 89.4% specificity). In multivariable analysis, CRP levels above 30 mg/L were significantly associated with an increased risk of developing severe COVID-19 for those who have higher ages and comorbidities (ARR 3.99, 95% CI: 1.35-11.82; p=0.013). Conclusion CRP was found to be an independent determinant factor for severe COVID-19 patients. Therefore, CRP levels in COVID-19 patients in African settings may provide a simple, prompt, and inexpensive assessment of the severity status at baseline and monitoring of treatment outcomes.
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Affiliation(s)
- Teklay Gebrecherkos
- Department of Medical Microbiology and Immunology, College of Health Sciences (CHS), Mekelle University (MU), Mekelle, Tigray, Ethiopia
| | - Feyissa Challa
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Department of Bacteriology, Parasitology and Zoonosis, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zekarias Gessesse
- Department of Internal Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Yazezew Kiros
- Department of Internal Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Mahmud Abdulkader
- Department of Medical Microbiology and Immunology, College of Health Sciences (CHS), Mekelle University (MU), Mekelle, Tigray, Ethiopia
| | - Abraham Aregay Desta
- Public Health Research and Emergency Management, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Ataklti Hailu Atsbaha
- Department of Microbiology, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Getachew Tollera
- Research and Technology Transfer Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Saro Abrahim
- HIV/TB Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Britta C Urban
- Department of Clinical Sciences, Respiratory Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Henk Schallig
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Tobias Rinke de Wit
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Joep-Lange Institute, Amsterdam, the Netherlands
| | - Dawit Wolday
- Department of Medical Microbiology and Immunology, College of Health Sciences (CHS), Mekelle University (MU), Mekelle, Tigray, Ethiopia
- HIV/TB Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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15
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Assefa A, Mohammed H, Anand A, Abera A, Sime H, Minta AA, Tadesse M, Tadesse Y, Girma S, Bekele W, Etana K, Alemayehu BH, Teka H, Dilu D, Haile M, Solomon H, Moriarty LF, Zhou Z, Svigel SS, Ezema B, Tasew G, Woyessa A, Hwang J, Murphy M. Correction: Therapeutic efficacies of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium falciparum and chloroquine and dihydroartemisinin-piperaquine for uncomplicated Plasmodium vivax infection in Ethiopia. Malar J 2023; 22:121. [PMID: 37041533 PMCID: PMC10091846 DOI: 10.1186/s12936-023-04537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Affiliation(s)
- Ashenaf Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Anjoli Anand
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adugna Abera
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Heven Sime
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anna A Minta
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Samuel Girma
- ICAP at Columbia University, Addis Ababa, Ethiopia
- U.S. President's Malaria Initiative, USA Agency for International Development, Addis Ababa, Ethiopia
| | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Kebede Etana
- Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Hiwot Teka
- U.S. President's Malaria Initiative, USA Agency for International Development, Addis Ababa, Ethiopia
| | - Dereje Dilu
- Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Hiwot Solomon
- Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Leah F Moriarty
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhiyong Zhou
- Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samaly Souza Svigel
- Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bryan Ezema
- Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adugna Woyessa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Murphy
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Gubae K, Mohammed H, Sime H, Hailgiorgis H, Mare AK, Gidey B, Haile M, Assefa G, Bekele W, Tasew G, Abay SM, Assefa A. Safety and therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria at Shecha health centre, Arba Minch, Ethiopia. Malar J 2023; 22:9. [PMID: 36611179 PMCID: PMC9824982 DOI: 10.1186/s12936-022-04436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In 2004, Ethiopia adopted artemether-lumefantrine (AL, Coartem®) as first-line treatment for the management of uncomplicated Plasmodium falciparum malaria. Continuous monitoring of AL therapeutic efficacy is crucial in Ethiopia, as per the World Health Organization (WHO) recommendation. This study aimed to assess the therapeutic efficacy of AL in the treatment of uncomplicated P. falciparum infection. METHODS A 28 day onearm, prospective evaluation of the clinical and parasitological response to AL was conducted at Shecha Health Centre, Arba Minch town, Southern Ethiopia. Patients were treated with six-dose regimen of AL over three days and monitored for 28 days with clinical and laboratory assessments. Participant recruitment and outcome classification was done in accordance with the 2009 WHO methods for surveillance of anti-malarial drug efficacy guidelines. RESULTS A total of 88 study participants were enrolled and 69 of them completed the study with adequate clinical and parasitological response. Two late parasitological failures were observed, of which one was classified as a recrudescence by polymerase chain reaction (PCR). The PCRcorrected cure rate was 98.6% (95% CI 92.3-100). AL demonstrated a rapid parasite and fever clearance with no parasitaemia on day 2 and febrile cases on day 3. Gametocyte clearance was complete by day three. No serious adverse events were reported during the 28 days follow-up. CONCLUSION The study demonstrated high therapeutic efficacy and good safety profile of AL. This suggests the continuation of AL as the first-line drug for the treatment of uncomplicated P. falciparum malaria in Ethiopia. Periodic therapeutic efficacy studies and monitoring of markers of resistance are recommended for early detection of resistant parasites.
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Affiliation(s)
- Kale Gubae
- grid.449044.90000 0004 0480 6730Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia ,grid.7123.70000 0001 1250 5688Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hussein Mohammed
- grid.452387.f0000 0001 0508 7211Malaria and Other Parasitological and Entomological Research Team, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Heven Sime
- grid.452387.f0000 0001 0508 7211Malaria and Other Parasitological and Entomological Research Team, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Henok Hailgiorgis
- grid.452387.f0000 0001 0508 7211Malaria and Other Parasitological and Entomological Research Team, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anteneh Kassahun Mare
- grid.7123.70000 0001 1250 5688Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bokretsion Gidey
- grid.452387.f0000 0001 0508 7211Malaria and Other Parasitological and Entomological Research Team, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mebrahtom Haile
- grid.414835.f0000 0004 0439 6364Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Gudissa Assefa
- grid.414835.f0000 0004 0439 6364Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Geremew Tasew
- grid.452387.f0000 0001 0508 7211Malaria and Other Parasitological and Entomological Research Team, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Solomon Mequanente Abay
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ashenafi Assefa
- grid.452387.f0000 0001 0508 7211Malaria and Other Parasitological and Entomological Research Team, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia ,grid.10698.360000000122483208Institute of Infectious Disease and Global Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Mohammed H, Sime H, Hailgiorgis H, Chernet M, Alebachew M, Solomon H, Assefa G, Haile M, Girma S, Bekele W, Tasew G, Gidey B, Commons RJ, Assefa A. Efficacy and safety of pyronaridine-artesunate (Pyramax ®) for the treatment of uncomplicated Plasmodium vivax malaria in Northwest Ethiopia. Malar J 2022; 21:401. [PMID: 36587210 PMCID: PMC9805271 DOI: 10.1186/s12936-022-04422-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Declining efficacy of chloroquine for the treatment Plasmodium vivax malaria has been reported in different endemic settings in Ethiopia. This highlights the need to assess alternative options for P. vivax treatment with artemisinin-based combination therapy, such as pyronaridine-artesunate. This treatment regimen has shown high efficacy for uncomplicated malaria in both Africa and Asia. However, limited data are available from Ethiopia. This study was conducted to assess the efficacy and safety of pyronaridine-artesunate for the treatment of uncomplicated P. vivax malaria in Northwest Ethiopia. METHODS A single arm prospective efficacy study was conducted in the Hamusite area, Northwest Ethiopia. Fifty-one febrile adult patients with uncomplicated P. vivax malaria were enrolled between March and July 2021. Patients were treated with pyronaridine-artesunate once daily for three days. Clinical and parasitological parameters were monitored over a 42-day follow-up period using the standard World Health Organization protocol for therapeutic efficacy studies. RESULTS A total of 4372 febrile patients were screened with 51 patients enrolled and 49 completing the 42-day follow-up period. The PCR-uncorrected adequate clinical and parasitological response (ACPR) was 95.9% (47/49; 95% CI 84.9-99.0) on day 42. Two patients had recurrences [4.0% (2/49); 95% CI 0.7-12.1] on days 35 and 42. The parasite clearance rate was rapid with fast resolution of clinical symptoms; 100% of participants had cleared parasitaemia on day 1 and fever on day 2. All 16 (31.4%) patients with gametocyte carriage on day 0 had cleared by day 1. There were no serious adverse events. CONCLUSION In this small study, pyronaridine-artesunate was efficacious and well-tolerated for the treatment of uncomplicated P. vivax malaria. In adults in the study setting, it would be a suitable alternative option for case management.
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Affiliation(s)
- Hussein Mohammed
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Heven Sime
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Henok Hailgiorgis
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melkie Chernet
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mihreteab Alebachew
- grid.467130.70000 0004 0515 5212Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hiwot Solomon
- grid.414835.f0000 0004 0439 6364National Malaria Elimination Program, Ministry of Health, Addis Ababa, Ethiopia
| | - Gudissa Assefa
- grid.414835.f0000 0004 0439 6364National Malaria Elimination Program, Ministry of Health, Addis Ababa, Ethiopia
| | - Mebrahtom Haile
- grid.414835.f0000 0004 0439 6364National Malaria Elimination Program, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Geremew Tasew
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bokretsion Gidey
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Robert J. Commons
- grid.1043.60000 0001 2157 559XGlobal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia ,General and Subspecialty Medicine, Grampians Health, Ballarat, Australia
| | - Ashenafi Assefa
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia ,grid.410711.20000 0001 1034 1720Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
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Assefa A, Mohammed H, Anand A, Abera A, Sime H, Minta AA, Tadesse M, Tadesse Y, Girma S, Bekele W, Etana K, Alemayehu BH, Teka H, Dilu D, Haile M, Solomon H, Moriarty LF, Zhou Z, Svigel SS, Ezema B, Tasew G, Woyessa A, Hwang J, Murphy M. Therapeutic efficacies of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium falciparum and chloroquine and dihydroartemisinin-piperaquine for uncomplicated Plasmodium vivax infection in Ethiopia. Malar J 2022; 21:359. [PMID: 36451216 PMCID: PMC9714156 DOI: 10.1186/s12936-022-04350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Routine monitoring of anti-malarial drugs is recommended for early detection of drug resistance and to inform national malaria treatment guidelines. In Ethiopia, the national treatment guidelines employ a species-specific approach. Artemether-lumefantrine (AL) and chloroquine (CQ) are the first-line schizonticidal treatments for Plasmodium falciparum and Plasmodium vivax, respectively. The National Malaria Control and Elimination Programme in Ethiopia is considering dihydroartemisinin-piperaquine (DHA/PPQ) as an alternative regimen for P. falciparum and P. vivax. METHODS The study assessed the clinical and parasitological efficacy of AL, CQ, and DHA/PPQ in four arms. Patients over 6 months and less than 18 years of age with uncomplicated malaria mono-infection were recruited and allocated to AL against P. falciparum and CQ against P. vivax. Patients 18 years or older with uncomplicated malaria mono-infection were recruited and randomized to AL or dihydroartemisinin-piperaquine (DHA/PPQ) against P. falciparum and CQ or DHA/PPQ for P. vivax. Patients were followed up for 28 (for CQ and AL) or 42 days (for DHA/PPQ) according to the WHO recommendations. Polymerase chain reaction (PCR)-corrected and uncorrected estimates were analysed by Kaplan Meier survival analysis and per protocol methods. RESULTS A total of 379 patients were enroled in four arms (n = 106, AL-P. falciparum; n = 75, DHA/PPQ- P. falciparum; n = 142, CQ-P. vivax; n = 56, DHA/PPQ-P. vivax). High PCR-corrected adequate clinical and parasitological response (ACPR) rates were observed at the primary end points of 28 days for AL and CQ and 42 days for DHA/PPQ. ACPR rates were 100% in AL-Pf (95% CI: 96-100), 98% in CQ-P. vivax (95% CI: 95-100) at 28 days, and 100% in the DHA/PPQ arms for both P. falciparum and P. vivax at 42 days. For secondary endpoints, by day three 99% of AL-P. falciparum patients (n = 101) cleared parasites and 100% were afebrile. For all other arms, 100% of patients cleared parasites and were afebrile by day three. No serious adverse events were reported. CONCLUSION This study demonstrated high therapeutic efficacy for the anti-malarial drugs currently used by the malaria control programme in Ethiopia and provides information on the efficacy of DHA/PPQ for the treatment of P. falciparum and P. vivax as an alternative option.
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Affiliation(s)
- Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia. .,Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hussein Mohammed
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anjoli Anand
- grid.416738.f0000 0001 2163 0069Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA ,grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Adugna Abera
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Heven Sime
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anna A. Minta
- grid.416738.f0000 0001 2163 0069Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA ,grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | | | - Samuel Girma
- ICAP at Columbia University, Addis Ababa, Ethiopia ,U.S. President’s Malaria Initiative, USA Agency for International Development, Addis Ababa, Ethiopia
| | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Kebede Etana
- grid.414835.f0000 0004 0439 6364Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Hiwot Teka
- U.S. President’s Malaria Initiative, USA Agency for International Development, Addis Ababa, Ethiopia
| | - Dereje Dilu
- grid.414835.f0000 0004 0439 6364Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mebrahtom Haile
- grid.414835.f0000 0004 0439 6364Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Hiwot Solomon
- grid.414835.f0000 0004 0439 6364Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Leah F. Moriarty
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Zhiyong Zhou
- grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Samaly Souza Svigel
- grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Bryan Ezema
- grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Geremew Tasew
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adugna Woyessa
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jimee Hwang
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Matthew Murphy
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA USA
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Mohammed H, Sime H, Hailgiorgis H, Gubae K, Haile M, Solomon H, Etana K, Girma S, Bekele W, Chernet M, Tollera G, Tasew G, Gidey B, Commons RJ, Assefa A. Therapeutic efficacy of dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium vivax malaria in Seacha area, Arbaminch Zuria District, South West Ethiopia. Malar J 2022; 21:351. [PMID: 36437454 PMCID: PMC9701447 DOI: 10.1186/s12936-022-04380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Declining efficacy of chloroquine against Plasmodium vivax malaria has been documented in Ethiopia. Thus, there is a need to assess the efficacy of alternative schizontocidal anti-malarials such as dihydroartemisinin-piperaquine (DHA-PPQ) in P. vivax malaria-infected patients. This study was conducted to evaluate the therapeutic efficacy of DHA-PPQ drug in South West Ethiopia. METHODS This is a single-arm, prospective therapeutic efficacy study in patients with uncomplicated P. vivax malaria. The study was conducted from May 2021 to August 2021, based on the standard World Health Organization study protocol for surveillance of anti-malarial therapeutic efficacy. The study endpoint was adequate clinical and parasitological response on day 42. RESULTS A total of 86 patients with uncomplicated vivax malaria were enrolled. Of these, 79 patients completed the scheduled follow up; all showing adequate clinical and parasitological responses to day 42, with a successful cure rate of 100% (95% CI 96-100). Parasitaemias were cleared rapidly (86% by day 1 and 100% by day 3), as were clinical symptoms (100% by day 1). Gametocyte carriage decreased from 44% on Day 0 to 1% on day 1 and 0% on Day 2. Mean haemoglobin concentrations increased between day 0 (mean 12.2 g/dL) and day 42 (mean 13.3 g/dL). Treatment was well tolerated and no severe adverse events were observed. CONCLUSION In summary, treatment with DHA-PPQ demonstrated excellent efficacy for uncomplicated P. vivax, with no recurrences to day 42, and no safety concerns. This treatment, which is also effective against P. falciparum, appears to be an ideal alternative for P. vivax as part of the malaria elimination programme.
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Affiliation(s)
- Hussein Mohammed
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Heven Sime
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Henok Hailgiorgis
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kale Gubae
- grid.449044.90000 0004 0480 6730Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mebrahtom Haile
- grid.414835.f0000 0004 0439 6364National Malaria Elimination Programme, Ministry of Health, Addis Ababa, Ethiopia
| | - Hiwot Solomon
- grid.414835.f0000 0004 0439 6364National Malaria Elimination Programme, Ministry of Health, Addis Ababa, Ethiopia
| | - Kebede Etana
- grid.414835.f0000 0004 0439 6364National Malaria Elimination Programme, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Melkie Chernet
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getachew Tollera
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bokretsion Gidey
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Robert J. Commons
- grid.1043.60000 0001 2157 559XGlobal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia ,General and Subspecialty Medicine, Grampians Health, Ballarat, Australia
| | - Ashenafi Assefa
- grid.452387.f0000 0001 0508 7211Bacterial, Parasitic and Zoonotic Diseases, Ethiopian Public Health Institute, Addis Ababa, Ethiopia ,grid.10698.360000000122483208Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Phillips AE, Ower AK, Mekete K, Liyew EF, Maddren R, Belay H, Chernet M, Anjulo U, Mengistu B, Salasibew M, Tasew G, Anderson R. Association between water, sanitation, and hygiene access and the prevalence of soil-transmitted helminth and schistosome infections in Wolayita, Ethiopia. Parasit Vectors 2022; 15:410. [DOI: 10.1186/s13071-022-05465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
The Geshiyaro project is a 5-year intervention to assess the impact of community- and school-based water, sanitation, and hygiene (WaSH) interventions on reducing infection with soil-transmitted helminths (STH) and schistosome parasites in combination with deworming in Wolayita zone, Ethiopia.
Methods
A population-based, cross-sectional census and parasitological mapping activity was conducted between 2018 and 2019. Individuals in the census were identified using either a registered study ID card or biometric fingerprint to enable linkage of their household WaSH data with baseline STH and schistosome prevalence for risk analysis.
Results
Prevalence of STH was 15.5% for any STH species, 9.47% for Ascaris lumbricoides, 1.78% for Trichuris trichiura, and 7.24% for hookworm. Intestinal schistosomiasis (Schistosoma mansoni) infection prevalence was 0.85% by Kato Katz, 21.6% by POC-CCA trace positive (Tr +), and 13.3% trace negative (Tr-). Microhaematuria was 2.77%, with 0.13% of people examined with S. haematobium eggs detected by urine filtration. At the household level, increased (> 30 min) time taken to collect drinking water, sharing a latrine, and lack of handwashing facilities were all associated with a greater risk of A. lumbricoides, hookworm, and S. mansoni infection. Not disposing of infant stool at the household and clothes washing/recreational freshwater contact were significantly associated with higher risk of schistosomiasis infection. Aggregating WaSH data at the community level showed odds of A. lumbricoides, hookworm, and T. trichiura infection were significantly lower as both community sanitation coverage and access to improved drinking water improved.
Conclusions
The principal finding of this study is that lack of access to WaSH, such as improved drinking water and shared toilet and hand-washing facilities, were linked to an increased risk of infection with STH and schistosome parasites. These associations are difficult to establish at an individual household level because of wide variability in access between houses but are detectable when coverage is aggregated at the community level. Maintenance of WaSH facilities as well as increased access within the whole community is important in influencing the community-wide prevalence of infection with STH and schistosome parasites.
Graphical Abstract
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21
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Landeryou T, Maddren R, Rayment Gomez S, Kalahasti S, Liyew EF, Chernet M, Mohammed H, Wuletaw Y, Truscott J, Phillips AE, Ower A, Forbes K, Anjulo U, Mengistu B, Tasew G, Salasibew M, Anderson R. Longitudinal monitoring of prevalence and intensity of soil-transmitted helminth infections as part of community-wide mass drug administration within the Geshiyaro project in the Bolosso Sore district, Wolaita, Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010408. [PMID: 36121895 PMCID: PMC9521932 DOI: 10.1371/journal.pntd.0010408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/29/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Mass drug administration (MDA), targeted at school-aged children (SAC) is recommended by the World Health Organization for the control of morbidity induced by soil-transmitted helminth (STH) infection in endemic countries. However, MDA does not prevent reinfection between treatment rounds, and research suggests that only treating SAC will not be sufficient to interrupt transmission of STH. In countries with endemic infection, such as Ethiopia, the coverage, community-groups targeted, and rates of reinfection will determine how effective MDA is in suppressing transmission in the long-term. In this paper, individually-linked longitudinal data from three epidemiological STH surveys conducted between November 2018 and November 2020 in the Wolaita region of Ethiopia are analysed to determine how STH prevalence and intensity changes according to individual level treatment data collected over two rounds of MDA. This study demonstrates that while community-wide MDA successfully reduces overall infection intensity across the villages treated, the observed levels of non-compliance to treatment by individuals acts to maintain levels of parasite abundance whereby transmission interruption is not possible at to, despite reasonable levels of MDA coverage in the communities studied (ranging from 65% to 84% of the village populations). This quantifies with substantial data the often-postulated difference between coverage (accepting treatment) and compliance (swallowing of treatment), the latter impacting the former to a previously unquantified level. The paper highlights the need to focus treatment to partially treated, or never treated groups of individuals within existing community wide MDA control activities to interrupt the transmission of STH, and to reduce the basic reproductive number, R0, of the parasites to less than unity in value.
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Affiliation(s)
- Toby Landeryou
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
- * E-mail:
| | - Rosie Maddren
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Santiago Rayment Gomez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Suprabhath Kalahasti
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Ewnetu Firdawek Liyew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melkie Chernet
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hussein Mohammed
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Wuletaw
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - James Truscott
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Anna E. Phillips
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Alison Ower
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Kathryn Forbes
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
| | - Ufaysa Anjulo
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Wolaita, Ethiopia
| | - Birhan Mengistu
- Children’s Investment fund Foundation, London, United Kingdom
| | - Geremew Tasew
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Wolaita, Ethiopia
| | | | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Faculty of Medicine, St Marys Campus, Imperial College London, London, United Kingdom
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22
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Shenkutie TT, Nega D, Hailu A, Kepple D, Witherspoon L, Lo E, Negash MT, Adamu A, Gebremichael SG, Gidey B, Tasew G, Feleke SM, Kebede T. Prevalence of G6PD deficiency and distribution of its genetic variants among malaria-suspected patients visiting Metehara health centre, Eastern Ethiopia. Malar J 2022; 21:260. [PMID: 36076204 PMCID: PMC9461287 DOI: 10.1186/s12936-022-04269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) is cytosolic enzyme, which has a vital role for the integrity and functioning of red blood cells. Lower activity of this enzyme leads to the occurrence of acute haemolytic anaemia after exposure to oxidative stressors like primaquine. Primaquine is an important drug for the radical cure of Plasmodium vivax and blocking transmission of Plasmodium falciparum, and thereby enhancing malaria elimination. However, there is a need to identify G6PD deficient individuals and administer the drug with caution due to its haemolytic side effects. The main objective of this study is to determine the prevalence of G6PD deficiency among malaria-suspected individuals. Methods A facility-based cross-sectional study was conducted from September 2020 to September 2021 in Metehara Health Centre, Eastern Ethiopia. A structured questionnaire was used to collect the socio-demographic and clinical information of the study participants. Capillary and venous blood samples were collected based on standard procedures for onsite screening, dried blood spot preparation, and malaria microscopy. The G6PD enzyme activity was measured by careSTART™ G6PD biosensor analyzer. Data was entered and analysed by SPSS. Results A total of 498 study participants were included in the study, of which 62% (309) were males. The overall prevalence of G6PD deficiency based on the biosensor screening was 3.6% (18/498), of which 2.9% and 4.8% were males and females, respectively. Eleven of the G6PD deficient samples had mutations confirmed by G6PD gene sequencing analysis. Mutations were detected in G267 + 119C/T, A376T, and ChrX:154535443. A significant association was found in sex and history of previous malaria infection with G6PD deficiency. Conclusions The study showed that the G6PD deficient phenotype exists in Metehara even if the prevalence is not very high. G267 + 119C/T mutation is the predominant G6PD variant in this area. Therefore, malaria patient treatment using primaquine should be monitored closely for any adverse effects. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04269-5.
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Affiliation(s)
- Tassew Tefera Shenkutie
- Department of Medical Laboratory Sciences, Debre Berhan University, Debre Berhan, Ethiopia. .,Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia. .,Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Desalegn Nega
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Asrat Hailu
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Kepple
- Department of Biological Sciences, University of North Carolina, Charlotte, NC, USA
| | - Logan Witherspoon
- Department of Biological Sciences, University of North Carolina, Charlotte, NC, USA
| | - Eugenia Lo
- Department of Biological Sciences, University of North Carolina, Charlotte, NC, USA.,School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Meshesha Tsigie Negash
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Aderaw Adamu
- Department of Medical Laboratory Sciences, Wollo University, Dessie, Ethiopia
| | | | - Bokretsion Gidey
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sindew M Feleke
- Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tadesse Kebede
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
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23
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Tasew G. Moving towards the end of the neglected in Ethiopia. J Infect Dev Ctries 2022; 16:1S-2S. [PMID: 36156494 DOI: 10.3855/jidc.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/27/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
- Geremew Tasew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
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24
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Feleke SM, Gidey B, Mohammed H, Nega D, Dillu D, Haile M, Solomon H, Parr JB, Tollera G, Tasew G, Mamo H, Petros B. Field performance of Plasmodium falciparum lactate dehydrogenase rapid diagnostic tests during a large histidine-rich protein 2 deletion survey in Ethiopia. Malar J 2022; 21:236. [PMID: 35971118 PMCID: PMC9377056 DOI: 10.1186/s12936-022-04257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) have expanded diagnostic service to remote endemic communities in Ethiopia, where 70% of malaria services per annum are reliant on them. However, diagnostic strategies are threatened by Plasmodium falciparum parasites with deletions of the histidine-rich protein 2 and/or 3 (pfhrp2/3) genes. Studies have reported pfhrp2/3 gene deletion prevalence in Ethiopia that exceeds the WHO recommended threshold to switch to non-HRP2 targeted RDTs for detection of P. falciparum. Therefore, RDTs that target alternative antigens, such as P. falciparum lactate dehydrogenase (PfLDH) are increasingly in programmatic use. Methods Malaria suspected patients visiting health facilities of Amhara, Tigray, Gambella, and Oromia regions of Ethiopia were screened by community health workers using Carestart Pf/Pv (HRP2/Pv-LDH) and SD-Bioline Pf (HRP2 for Pf/LDH for Pf) RDTs. Dried blood spot (DBS) samples were collected from selected patients for molecular and serological analysis. The clinical data and RDT results were recorded on standard forms, entered into EpiInfo, and analysed using STATA. The Pf-LDH detecting RDT results were compared with real-time PCR and bead-based immunoassay to determine their diagnostic performance. Results The 13,172 (56% male and 44% female, median age of 19 years ranging from 1 to 99 year) study participants were enrolled and tested with PfHRP2 and PfLDH detection RDTs; 20.6% (95% CI: 19.6 to 21.6) were P. falciparum RDT positive. A subset of samples (n = 820) were previously tested using P. falciparum lactate dehydrogenase (pfldh) quantitative real-time PCR, and 456 of these further characterized using bead-based immunoassay. The proportion of samples positive for P. falciparum by the PfHRP2 Carestart and SD-Bioline RDTs were 66% (539/820) and 59% (481/820), respectively; 68% (561/820) were positive for the PfLDH band on the SD-Bioline RDT. The sensitivity and specificity of the PfLDH RDT band were 69% and 38%, respectively, versus pfldh qPCR; and 72% and 36%, respectively, versus PfLDH detection by immunoassay. Among samples with results for RDT, qPCR, and immunoassay, higher proportions of P. falciparum were recorded by pfldh qPCR (90%, 411/456) and PfLDH immunoassay (88%, 363/413) compared to the PfLDH band on the SD-Bioline RDT (74.6%, 340/456). Conclusion and recommendation Both PfHRP2 RDTs detected fewer P. falciparum cases than PfLDH, and fewer cases than qPCR or immunoassay. The poor sensitivity and specificity of the PfLDH RDT compared to qPCR and to immunoassay in this study raises concern. Continuous operator training and RDTs quality assurance programme to ensure quality diagnostic services are recommended.
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Affiliation(s)
| | | | | | - Desalegn Nega
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Jonathan B Parr
- Institute for Global Health and Infectious Diseases and Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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25
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Tameru K, Tsegaye B, Shikur M, Ergete W, Tasew G, Abera A, Wolday D. Case Report: Disseminated Strongloides stercoralis Presenting as an Ulcerated Gastric Mass in an HIV-1-infected Patient. Am J Trop Med Hyg 2022; 106:tpmd210791. [PMID: 35533694 PMCID: PMC9209934 DOI: 10.4269/ajtmh.21-0791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/06/2022] [Indexed: 11/07/2022] Open
Abstract
Disseminated Strongloides stercoralis is a common phenomenon among patients with immunosuppression. In this report, we present a case of disseminated Strongloides stercoralis presenting as a gastric mass in a 42-year-old male patient with a known history of HIV-1 infection and type 2 diabetes mellitus (T2DM). The patient presented with symptoms and signs suggestive of acute on chronic erosive gastritis, which included persistent vomiting. Endoscopic examination revealed a gastric mass with no signs of malignancy or dysplasia. There was noted to be chronic inflammation along with morphologic features consistent with the larvae and eggs of Strongloides nematodes in a biopsied gastric mass tissue and duodenum. The disease subsequently resulted in death despite the administration of ivermectin.
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Affiliation(s)
| | | | | | - Wondwossen Ergete
- Department of Pathology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Bacterial, Fungal and Zoonotic Diseases Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adugna Abera
- Bacterial, Fungal and Zoonotic Diseases Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
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26
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Nega D, Abebe A, Abera A, Gidey B, Gibretsadik A, Tasew G. M103 Low proficiency of microscopists with poor laboratory is a challenge for malaria diagnosis in Ethiopia. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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27
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Mohammed H, Landeryou T, Chernet M, Liyew EF, Wulataw Y, Getachew B, Difabachew H, Phillips A, Maddren R, Ower A, Mekete K, Belay H, Endrias T, Anjulo U, Tasew G, Anderson R, Tollera G, Abate E. Comparing the accuracy of two diagnostic methods for detection of light Schistosoma haematobium infection in an elimination setting in Wolaita Zone, South Western Ethiopia. PLoS One 2022; 17:e0267378. [PMID: 35486627 PMCID: PMC9053789 DOI: 10.1371/journal.pone.0267378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Reagent urinalysis dipstick and filtration have been recommended diagnostic methods for the detection of urogenital schistosomiasis. However, the accurate diagnosis of light infections using these methods presents a major challenge. This study evaluates the diagnosis accuracy of light infection with Schistosoma haematobium in study participants living in Wolaita Zone, an area targeted for sustainable control of Schistosomiasis, and ultimately interrupt transmission. Urine samples were collected from children and adults in surveys carried out during baseline and longitudinal sentinel site surveys conducted from 2018 to 2020. All urine samples were tested using a reagent urinalysis dipstick test (Haemastix) to detect microhaematuria with reference urine filtration technique as a proxy for S. haematobium infection. Sensitivity and specificity were determined in diagnosing urogenital schistosomiasis. Cohen’s Kappa statistics was done for the agreement of these diagnostic methods. A total of 12,102 participants were enrolled in the current baseline study. Among them, 285 (2.35%) samples tested positive for microhaematuria and 21 (0.20%) positive for S. haematobium eggs. A total of 4,357 samples were examined in year 1 and year 2 using urine dipsticks, and urine filtration 172 (3.95%) and 2 (0.05%) were positive for microhaematuria and S. haematobium eggs. The reagent urinalysis dipsticks showed the highest sensitivity and specificity for diagnosing light intensity of infection,100% (95% CI:85.18–100.00) and 97.4% (95% CI: 97.10–97.60), respectively. There is a slight agreement between the two methods (Kappa = 0.09, 95% CI: 0.01–0.18). The present study revealed very low prevalence and light intensity of S. haematobium infections. The study also highlights that the dipstick test is considered a useful adjunct diagnostic tool for population-based control of urogenital schistosomiasis.
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Affiliation(s)
- Hussein Mohammed
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Toby Landeryou
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Melkie Chernet
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ewnetu Firdawek Liyew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Wulataw
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Birhanu Getachew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hailemariam Difabachew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anna Phillips
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Rosie Maddren
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Alison Ower
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Kalkidan Mekete
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Habtamu Belay
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tujuba Endrias
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ufaysa Anjulo
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Wolaita, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Getachew Tollera
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ebba Abate
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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28
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Gebrecherkos T, Kiros YK, Challa F, Abdella S, Gebreegzabher A, Leta D, Desta A, Hailu A, Tasew G, Abdulkader M, Tessema M, Tollera G, Kifle T, Arefaine ZG, Schallig HHDF, Adams ER, Urban BC, de Wit TFR, Wolday D. Longitudinal profile of antibody response to SARS-CoV-2 in patients with COVID-19 in a setting from Sub-Saharan Africa: A prospective longitudinal study. PLoS One 2022; 17:e0263627. [PMID: 35320286 PMCID: PMC8942258 DOI: 10.1371/journal.pone.0263627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/24/2022] [Indexed: 12/14/2022] Open
Abstract
Background Serological testing for SARS-CoV-2 plays an important role for epidemiological studies, in aiding the diagnosis of COVID-19, and assess vaccine responses. Little is known on dynamics of SARS-CoV-2 serology in African settings. Here, we aimed to characterize the longitudinal antibody response profile to SARS-CoV-2 in Ethiopia. Methods In this prospective study, a total of 102 PCR-confirmed COVID-19 patients were enrolled. We obtained 802 plasma samples collected serially. SARS-CoV-2 antibodies were determined using four lateral flow immune-assays (LFIAs), and an electrochemiluminescent immunoassay. We determined longitudinal antibody response to SARS-CoV-2 as well as seroconversion dynamics. Results Serological positivity rate ranged between 12%-91%, depending on timing after symptom onset. There was no difference in positivity rate between severe and non-severe COVID-19 cases. The specificity ranged between 90%-97%. Agreement between different assays ranged between 84%-92%. The estimated positive predictive value (PPV) for IgM or IgG in a scenario with seroprevalence at 5% varies from 33% to 58%. Nonetheless, when the population seroprevalence increases to 25% and 50%, there is a corresponding increases in the estimated PPVs. The estimated negative-predictive value (NPV) in a low seroprevalence scenario (5%) is high (>99%). However, the estimated NPV in a high seroprevalence scenario (50%) for IgM or IgG is reduced significantly to 80% to 85%. Overall, 28/102 (27.5%) seroconverted by one or more assays tested, within a median time of 11 (IQR: 9–15) days post symptom onset. The median seroconversion time among symptomatic cases tended to be shorter when compared to asymptomatic patients [9 (IQR: 6–11) vs. 15 (IQR: 13–21) days; p = 0.002]. Overall, seroconversion reached 100% 5.5 weeks after the onset of symptoms. Notably, of the remaining 74 COVID-19 patients included in the cohort, 64 (62.8%) were positive for antibody at the time of enrollment, and 10 (9.8%) patients failed to mount a detectable antibody response by any of the assays tested during follow-up. Conclusions Longitudinal assessment of antibody response in African COVID-19 patients revealed heterogeneous responses. This underscores the need for a comprehensive evaluation of seroassays before implementation. Factors associated with failure to seroconvert needs further research.
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Affiliation(s)
| | | | - Feyissa Challa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Saro Abdella
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Dereje Leta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Henk HDF Schallig
- Department of Medical Microbiology, and Infection Prevention, Experimental Parasitology Unit, Amsterdam Institute for Infection and Immunity, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
| | - Emily R. Adams
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Britta C. Urban
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tobias F. Rinke de Wit
- Amsterdam Institute Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail: ,
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Ashenefe Wassie B, Fantaw S, Mekonene Y, Teshale AM, Yitagesu Y, Tsige E, Getahun D, Tasew G, Abichu G, Moges B, Abate E, Abayneh T, Zeru T, Belay Z, Mor SM. First PCR Confirmed anthrax outbreaks in Ethiopia—Amhara region, 2018–2019. PLoS Negl Trop Dis 2022; 16:e0010181. [PMID: 35143510 PMCID: PMC8865639 DOI: 10.1371/journal.pntd.0010181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/23/2022] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Anthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region.
Methods
Following reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR).
Results
In Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR.
Conclusion
We report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage.
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Affiliation(s)
| | - Surafel Fantaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Mekonene
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Beyene Moges
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Zewdu Belay
- Amhara Livestock Resource Development and Promotion Agency, Bahir Dar, Ethiopia
| | - Siobhan M. Mor
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- International Livestock Research Institute, Addis Ababa, Ethiopia
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Sisay A, Abera A, Dufera B, Endrias T, Tasew G, Tesfaye A, Hartnack S, Beyene D, Desta AF. Diagnostic accuracy of three commercially available one step RT-PCR assays for the detection of SARS-CoV-2 in resource limited settings. PLoS One 2022; 17:e0262178. [PMID: 35051204 PMCID: PMC8775315 DOI: 10.1371/journal.pone.0262178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background COVID-19 is an ongoing public health pandemic regardless of the countless efforts made by various actors. Quality diagnostic tests are important for early detection and control. Notably, several commercially available one step RT-PCR based assays have been recommended by the WHO. Yet, their analytic and diagnostic performances have not been well documented in resource-limited settings. Hence, this study aimed to evaluate the diagnostic sensitivities and specificities of three commercially available one step reverse transcriptase-polymerase chain reaction (RT-PCR) assays in Ethiopia in clinical setting. Methods A cross-sectional study was conducted from April to June, 2021 on 279 respiratory swabs originating from community surveillance, contact cases and suspect cases. RNA was extracted using manual extraction method. Master-mix preparation, amplification and result interpretation was done as per the respective manufacturer. Agreements between RT-PCRs were analyzed using kappa values. Bayesian latent class models (BLCM) were fitted to obtain reliable estimates of diagnostic sensitivities, specificities of the three assays and prevalence in the absence of a true gold standard. Results Among the 279 respiratory samples, 50(18%), 59(21.2%), and 69(24.7%) were tested positive by TIB, Da An, and BGI assays, respectively. Moderate to substantial level of agreement was reported among the three assays with kappa value between 0 .55 and 0.72. Based on the BLCM relatively high specificities (95% CI) of 0.991(0.973–1.000), 0.961(0.930–0.991) and 0.916(0.875–0.952) and considerably lower sensitivities with 0.813(0.658–0.938), 0.836(0.712–0.940) and 0.810(0.687–0.920) for TIB MOLBIOL, Da An and BGI respectively were found. Conclusions While all the three RT-PCR assays displayed comparable sensitivities, the specificities of TIB MOLBIOL and Da An were considerably higher than BGI. These results help adjust the apparent prevalence determined by the three RT-PCRs and thus support public health decisions in resource limited settings and consider alternatives as per their prioritization matrix.
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Affiliation(s)
- Abay Sisay
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Adugna Abera
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Boja Dufera
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tujuba Endrias
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abraham Tesfaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Diagnostic Unit, Center for Innovative Drug Development and Therapeutic Trials for Africa, CDT- Africa, Addis Ababa, Ethiopia
| | - Sonja Hartnack
- Section of Epidemiology, University of Zurich, Zurich, Switzerland
| | - Dereje Beyene
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adey Feleke Desta
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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31
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Nega D, Abera A, Gidey B, Mekasha S, Abebe A, Dillu D, Mehari D, Assefa G, Hailu S, Haile M, Etana K, Solomon H, Tesfaye G, Nigatu D, Destaw Z, Tesfaye B, Serda B, Yeshiwondim A, Getachew A, Teka H, Nahusenay H, Abdelmenan S, Reda H, Bekele W, Zewdie A, Tollera G, Assefa A, Tasew G, Woyessa A, Abate E. Baseline malaria prevalence at the targeted pre-elimination districts in Ethiopia. BMC Public Health 2021; 21:1996. [PMID: 34732150 PMCID: PMC8567662 DOI: 10.1186/s12889-021-12036-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/18/2021] [Indexed: 12/05/2022] Open
Abstract
Background Encouraged by the previous success in malaria control and prevention strategies, the Ethiopian ministry of health launched malaria elimination with a stepwise approach by primarily targeting the low-transmission Districts and their adjacent areas/zones in order to shrink the country’s malaria map progressively. Hence, this community survey was conducted to establish baseline malaria information at the preliminary phase of elimination at targeted settings. Methods A community-based cross-sectional survey was conducted at 20 malaria-elimination targeted Districts selected from five Regional states and one city administration in Ethiopia. The GPS-enabled smartphones programmed with Open Data Kit were used to enumerate 9326 study households and collect data from 29,993 residents. CareStart™ Malaria PAN (pLDH) Rapid Diagnostic Tests (RDTs) were used for blood testing at the field level. Armpit digital thermometers were used to measure axillary temperature. Result Overall malaria prevalence by RDTs was 1.17% (339/28973). The prevalence at District levels ranged from 0.0 to 4.7%. The proportion of symptomatic cases (axillary temperature > 37.5oc) in the survey was 9.2% (2760/29993). Among the 2510 symptomatic individuals tested with RDTs, only 3.35% (84/2510) were malaria positive. The 75.2% (255/339) of all malaria positives were asymptomatic. Of the total asymptomatic malaria cases, 10.2% (26/255) were under-five children and 89.8% (229/255) were above 5 years of age. Conclusion The study shows a decrease in malaria prevalence compared to the reports of previous malaria indicator surveys in the country. The finding can be used as a baseline for measuring the achievement of ongoing malaria elimination efforts. Particularly, the high prevalence of asymptomatic individuals (0.88%) in these transmission settings indicates there may be sustaining hidden transmission. Therefore, active case detection with more sensitive diagnostic techniques is suggested to know more real magnitude of residual malaria in the elimination-targeted areas.
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Affiliation(s)
- Desalegn Nega
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Adugna Abera
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Sindew Mekasha
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abnet Abebe
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dereje Dillu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Degu Mehari
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Samuel Hailu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Kebede Etana
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | | | - Zelalem Destaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Berhane Tesfaye
- Malaria Control and Elimination Partnership in Africa (MACEPA) at PATH, Addis Ababa, Ethiopia
| | - Belendia Serda
- Malaria Control and Elimination Partnership in Africa (MACEPA) at PATH, Addis Ababa, Ethiopia
| | - Asnakew Yeshiwondim
- Malaria Control and Elimination Partnership in Africa (MACEPA) at PATH, Addis Ababa, Ethiopia
| | - Assefaw Getachew
- Malaria Control and Elimination Partnership in Africa (MACEPA) at PATH, Addis Ababa, Ethiopia
| | - Hiwot Teka
- President's Malaria Initiative (PMI), Addis Ababa, Ethiopia
| | | | | | - Hailemariam Reda
- Clinton Health Access Initiative, Inc. (CHAI), Addis Ababa, Ethiopia
| | - Worku Bekele
- World Health Organization (WHO), Addis Ababa, Ethiopia
| | - Ayele Zewdie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adugna Woyessa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Abdella S, Tessema M, Tasew G, Defar A, Deressa A, Regasa F, Teka F, Tigabu E, Nigussie D, Belachew T, Molla M, Deribew A, Abebe W, Yigzaw T, Nigatu T, Mitike G, Haile T, Taame H, Ahmed M, Nigatu F, Tolesa T, Wolka E, Amogne W, Laillou A, Amare M, Fufa Y, Argaw A, Waganew W, Azazh A, Worku A, Redae B, Sultan M, Walelegn M, Tefera M, Yifru S, Argaw R, Brehau N, Teklu S, Demoz G, Seman Y, Salasibew M, Ejeta E, Whiting SJ, Wolday D, Tollera G, Abate E, Duguma D. Prognostic factors and outcomes of COVID-19 cases in Ethiopia: multi-center cohort study protocol. BMC Infect Dis 2021; 21:956. [PMID: 34530744 PMCID: PMC8443913 DOI: 10.1186/s12879-021-06652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) and became pandemic after emerging in Wuhan, China, in December 2019. Several studies have been conducted to understand the key features of COVID-19 and its public health impact. However, the prognostic factors of COVID-19 are not well studied in the African setting. In this study, we aim to determine the epidemiological and clinical features of COVID-19 cases, immunological and virological courses, interaction with nutritional status, and response to treatment for COVID-19 patients in Ethiopia. Methods A multi-center cohort study design will be performed. Patients with confirmed COVID-19 infection admitted to selected treatment centers will be enrolled irrespective of their symptoms and followed-up for 12 months. Baseline epidemiological, clinical, laboratory and imaging data will be collected from treatment records, interviews, physical measurements, and biological samples. Follow-up data collection involves treatment and prognostic outcomes to be measured using different biomarkers and clinical parameters. Data collection will be done electronically using the Open Data Kit (ODK) software package and then exported to STATA/SPSS for analysis. Both descriptive and multivariable analyses will be performed to assess the independent determinants of the treatment outcome and prognosis to generate relevant information for informed prevention and case management. The primary outcomes of this study are death/survival and viral shedding. Secondary outcomes include epidemiological characteristics, clinical features, genetic frequency shifts (genotypic variations), and nutritional status. Discussion This is the first large prospective cohort study of patients in hospitals with COVID-19 in Ethiopia. The results will enable us to better understand the epidemiology of SARS-CoV-2 in Africa. This study will also provide useful information for effective public health measures and future pandemic preparedness and in response to outbreaks. It will also support policymakers in managing the epidemic based on scientific evidence. Trial Registration: The Protocol prospectively registered in ClinicalTrials.gov (NCT04584424) on 30 October, 2020.
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Affiliation(s)
- Saro Abdella
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Atkure Defar
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Asefa Deressa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Feyisa Regasa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Frehiwot Teka
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Eyasu Tigabu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | - Tsinuel Nigatu
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Getnet Mitike
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | | | | | - Muhammed Ahmed
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Tola Tolesa
- Saint Paul's Hospital, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | | | | | - Misker Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yaregal Fufa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | - Sisay Yifru
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Rahel Argaw
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Natinael Brehau
- COVID-19 Isolation and Treatment Center, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | - Sisay Teklu
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Getachew Demoz
- COVID-19 Isolation and Treatment Center, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | - Yakob Seman
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | | | - Eshetu Ejeta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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33
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Wolday D, Gebrecherkos T, Arefaine ZG, Kiros YK, Gebreegzabher A, Tasew G, Abdulkader M, Abraha HE, Desta AA, Hailu A, Tollera G, Abdella S, Tesema M, Abate E, Endarge KL, Hundie TG, Miteku FK, Urban BC, Schallig HH, Harris VC, de Wit TFR. Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study. EClinicalMedicine 2021; 39:101054. [PMID: 34368662 PMCID: PMC8324426 DOI: 10.1016/j.eclinm.2021.101054] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. Evidence from Africa indicates that significantly less COVID-19 patients suffer from serious symptoms than in the industrialized world. We and others previously postulated a partial explanation for this phenomenon, being a different, more activated immune system due to parasite infections. Here, we aimed to test this hypothesis by investigating a potential correlation of co-infection with parasites with COVID-19 severity in an endemic area in Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites, between July 2020 and March 2021. The primary outcome was the proportion of patients with severe COVID-19. Ordinal logistic regression models were used to estimate the association between parasite infection, and COVID-19 severity. Models were adjusted for sex, age, residence, education level, occupation, body mass index, and comorbidities. Findings: 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37.8%) had intestinal parasitic infection. Only 27/255 (10.6%) severe COVID-19 patients were co-infected with intestinal parasites, while 257/496 (51.8%) non-severe COVID-19 patients were parasite positive (p<0.0001). Patients co-infected with parasites had lower odds of developing severe COVID-19, with an adjusted odds ratio (aOR) of 0.23 (95% CI 0.17-0.30; p<0.0001) for all parasites, aOR 0.37 ([95% CI 0.26-0.51]; p<0.0001) for protozoa, and aOR 0.26 ([95% CI 0.19-0.35]; p<0.0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolepis nana, Schistosoma mansoni, and Trichuris trichiura implied lower probability of developing severe COVID-19. There were 11 deaths (1.5%), and all were among patients without parasites (p = 0.009). Interpretation: Parasite co-infection is associated with a reduced risk of severe COVID-19 in African patients. Parasite-driven immunomodulatory responses may mute hyper-inflammation associated with severe COVID-19. Funding: European and Developing Countries Clinical Trials Partnership (EDCTP) - European Union, and Joep Lange Institute (JLI), The Netherlands. Trial registration: Clinicaltrials.gov: NCT04473365.
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Affiliation(s)
- Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | | | | | | | - Geremew Tasew
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Saro Abdella
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | - Ebba Abate
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | | | | | - Britta C. Urban
- Department of Clinical Sciences, Respiratory Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Henk H.D.F. Schallig
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Vanessa C. Harris
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Tobias F. Rinke de Wit
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Joep Lange Institute, Amsterdam, the Netherlands
- Corresponding author: at Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
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34
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Wolday D, Gebrecherkos T, Arefaine ZG, Kiros YK, Gebreegzabher A, Tasew G, Abdulkader M, Abraha HE, Desta AA, Hailu A, Tollera G, Abdella S, Tesema M, Abate E, Endarge KL, Hundie TG, Miteku FK, Urban BC, Schallig HHDF, Harris VC, de Wit TFR. Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study. EClinicalMedicine 2021; 39:101054. [PMID: 34368662 DOI: 10.1101/2021.02.02.21250995] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 05/28/2023] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. Evidence from Africa indicates that significantly less COVID-19 patients suffer from serious symptoms than in the industrialized world. We and others previously postulated a partial explanation for this phenomenon, being a different, more activated immune system due to parasite infections. Here, we aimed to test this hypothesis by investigating a potential correlation of co-infection with parasites with COVID-19 severity in an endemic area in Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites, between July 2020 and March 2021. The primary outcome was the proportion of patients with severe COVID-19. Ordinal logistic regression models were used to estimate the association between parasite infection, and COVID-19 severity. Models were adjusted for sex, age, residence, education level, occupation, body mass index, and comorbidities. Findings: 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37.8%) had intestinal parasitic infection. Only 27/255 (10.6%) severe COVID-19 patients were co-infected with intestinal parasites, while 257/496 (51.8%) non-severe COVID-19 patients were parasite positive (p<0.0001). Patients co-infected with parasites had lower odds of developing severe COVID-19, with an adjusted odds ratio (aOR) of 0.23 (95% CI 0.17-0.30; p<0.0001) for all parasites, aOR 0.37 ([95% CI 0.26-0.51]; p<0.0001) for protozoa, and aOR 0.26 ([95% CI 0.19-0.35]; p<0.0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolepis nana, Schistosoma mansoni, and Trichuris trichiura implied lower probability of developing severe COVID-19. There were 11 deaths (1.5%), and all were among patients without parasites (p = 0.009). Interpretation: Parasite co-infection is associated with a reduced risk of severe COVID-19 in African patients. Parasite-driven immunomodulatory responses may mute hyper-inflammation associated with severe COVID-19. Funding: European and Developing Countries Clinical Trials Partnership (EDCTP) - European Union, and Joep Lange Institute (JLI), The Netherlands. Trial registration: Clinicaltrials.gov: NCT04473365.
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Affiliation(s)
- Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | | | | | | | - Geremew Tasew
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Saro Abdella
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | - Ebba Abate
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | | | | | - Britta C Urban
- Department of Clinical Sciences, Respiratory Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Henk H D F Schallig
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Vanessa C Harris
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Tobias F Rinke de Wit
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Joep Lange Institute, Amsterdam, the Netherlands
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35
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Chanyalew M, Abebe M, Endale B, Girma S, Tasew G, Bobosha K, Zewide M, Howe R, van Zandbergen G, Ritter U, Gadisa E, Aseffa A, Laskay T. Enhanced activation of blood neutrophils and monocytes in patients with Ethiopian localized cutaneous leishmaniasis in response to Leishmania aethiopica Neutrophil activation in Ethiopian cutaneous leishmaniasis. Acta Trop 2021; 220:105967. [PMID: 34029532 DOI: 10.1016/j.actatropica.2021.105967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 05/04/2021] [Accepted: 05/16/2021] [Indexed: 11/15/2022]
Abstract
Recent studies suggest an essential role of the innate immune effector cells neutrophils and monocytes in protection or disease progression in the early course of Leishmania infection. In areas endemic for cutaneous leishmaniasis in Ethiopia most individuals are exposed to bites of infected sandflies. Still only a minor ratio of the inhabitants develops symptomatic disease. Neutrophils, followed by monocytes, are the first cells to be recruited to the site of Leishmania infection, the initial response of neutrophils to parasites appears to be crucial for the protective response and disease outcome. Our working hypothesis is that neutrophils and/or monocytes in localized cutaneous leishmaniasis (LCL) patients may have defects in function of innate immune cell that contribute to failure to parasite clearance that lead to establishment of infection. The response of cells in Ethiopian LCL patients and healthy controls to Leishmania aethiopica and to the Toll like receptor (TLR) agonists lipopolysaccharide (LPS) and macrophage activating lipopeptide-2 (MALP-2) was investigated by assessing the cell surface expression of CD62L (on neutrophil and monocyte) and CD66b (only on neutrophil), as well as reactive oxygen species (ROS) production by using whole blood-based assays in vitro. No impaired response of neutrophils and monocytes to the microbial constituents LPS and MALP-2 was observed. Neutrophils and monocytes from LCL patients responded stronger to Leishmania aethiopica in the applied whole blood assays than cells from healthy individuals. These experimental findings do not support the hypothesis regarding a possible dysfunction of neutrophils and monocytes in cutaneous leishmaniasis. On the contrary, these cells react stronger in LCL patients as compared to healthy controls. The differential response to L. aethiopica observed between LCL patients and healthy controls have the potential to serve as biomarker to develop FACS based diagnostic/ prognostic techniques for LCL.
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Affiliation(s)
- Menberework Chanyalew
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia.
| | - Markos Abebe
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Birtukan Endale
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Selfu Girma
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia; Leishmaniasis Research Laboratory, Ethiopian Public Health Institute, P.O. Box 1242, Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Martha Zewide
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia.
| | - Rawleigh Howe
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Ger van Zandbergen
- Division of Immunology, Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, Langen D-63225, Germany.
| | - Uwe Ritter
- Regensburg Center for Interventional Immunology (RCI), Institute of Immunology, University Medical Center Regensburg, University of Regensburg, Regensburg D-93053, Germany.
| | - Endalamaw Gadisa
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Tamás Laskay
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck D-23560, Germany.
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Abdella S, Riou S, Tessema M, Assefa A, Seifu A, Blachman A, Abera A, Moreno N, Irarrazaval F, Tollera G, Browning D, Tasew G. Prevalence of SARS-CoV-2 in urban and rural Ethiopia: Randomized household serosurveys reveal level of spread during the first wave of the pandemic. EClinicalMedicine 2021; 35:100880. [PMID: 34124630 PMCID: PMC8176122 DOI: 10.1016/j.eclinm.2021.100880] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The spread of SARS-CoV-2 in Sub-Saharan Africa is poorly understood and to date has generally been characterised by a lower number of declared cases and deaths as compared to other regions of the world. Paucity of reliable information, with insights largely derived from limited RT-PCR testing in high-risk and urban populations, has been one of the biggest barriers to understanding the course of the pandemic and informed policy-making. Here we estimate seroprevalence of anti-SARS-CoV-2 antibodies in Ethiopia during the first wave of the pandemic. METHODS We undertook a population-based household seroprevalence serosurvey based on 1856 participants in Ethiopia, in the capital city Addis Ababa, and in Jimma, a middle-sized town in the Oromia region, and its rural surroundings (districts of Seka and Mana), between 22 July and 02 September 2020. We tested one random participant per household for anti-SARS-CoV-2 antibodies using a high specificity rapid diagnostic tests (RDTs) and evaluated population seroprevalence using a Bayesian logistic regression model taking into account test performance as well as age and sex of the participants. FINDINGS In total, 2304 random households were visited, with 1856 individuals consenting to participate. This produced a sample of 956 participants in Addis Ababa and 900 participants in Jimma. IgG prevalence was estimated at 1.9% (95% CI 0.4-3.7%), and combined IgM/IgG prevalence at 3.5% (95% CI 1.7-5.4%) for Addis Ababa in early August 2020, with higher prevalence in central sub-cities. Prevalence in Jimma town was lower at 0.5% (95% CI 0-1.8%) for IgG and 1.6% (95%CI 0-4.1%) for IgM/IgG, while in rural Jimma IgG prevalence was 0.2% and IgM/IgG 0.4% in early September. INTERPRETATION More than four months after the first cases were detected in Ethiopia, Addis Ababa displayed a prevalence under 5% and likely as low as 2%, while rural Jimma displayed a prevalence of 0.2%. A 2% seroprevalence figure for the capital translated to a number of cases at least five times larger than those reported for the country as a whole. At the same time, it contrasts with significantly higher seroprevalence figures in large cities in Europe and America only two to three months after the first cases. This population-based seroepidemiological study thus provides evidence of a slower spread of SARS-CoV-2 in the Ethiopian population during the first wave of the pandemic and does not appear to support the notion that lower case numbers were simply a reflection of limited testing and surveillance. FUNDING Schmidt Family Foundation, Joachim Hertz Foundation, Nespresso, Peet's and Smuckers.
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Affiliation(s)
- Saro Abdella
- HIV/TB Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | - Samuel Riou
- Enveritas, 24 Innis Lane, Old Greenwich, CT, USA
| | - Masresha Tessema
- Nutrition and Food Sciences Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | - Albab Seifu
- Enveritas, 24 Innis Lane, Old Greenwich, CT, USA
| | | | - Adugna Abera
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | | | | | - Getachew Tollera
- HIV/TB Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
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37
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Wolday D, Tasew G, Amogne W, Urban B, Schallig HD, Harris V, Rinke de Wit TF. Interrogating the Impact of Intestinal Parasite-Microbiome on Pathogenesis of COVID-19 in Sub-Saharan Africa. Front Microbiol 2021; 12:614522. [PMID: 33935986 PMCID: PMC8086792 DOI: 10.3389/fmicb.2021.614522] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Dawit Wolday
- Department of Medicine, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Diseases Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Britta Urban
- Department of Clinical Medicine, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Henk Dfh Schallig
- Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Vanessa Harris
- Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Global Health, Amsterdam Institute of Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
| | - Tobias F Rinke de Wit
- Department of Global Health, Amsterdam Institute of Global Health and Development, University of Amsterdam, Amsterdam, Netherlands.,Global Health, Joep Lange Institute, Amsterdam, Netherlands
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38
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Gidey B, Nega D, Abera A, Abebe A, Mekasha S, Tasew G, Haile M, Dillu D, Mehari D, Assefa A, Liknew W, G/Tsadik A, Mohammed H, Woldie E, Getachew T, Ararso D, Yenealem D, Kebede A, Etana K, Kedida G, Solomon H, Tollera G, Woyessa A, Abate E. Mentorship on malaria microscopy diagnostic service in Ethiopia: baseline competency of microscopists and performance of health facilities. Malar J 2021; 20:115. [PMID: 33632208 PMCID: PMC7908686 DOI: 10.1186/s12936-021-03655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Ethiopia, malaria cases are declining as a result of proven interventions, and in 2017 the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. This study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis. METHODS A cross-sectional study was conducted from 1 August to 30 September, 2019 in 9 regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked and proficiency of microscopists was tested using a WHO-certified set of slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS In this study, 102 health facilities (84 health centres and 18 hospitals) were included, from which 202 laboratory professionals participated. In slide re-checking, moderate agreement (agreement (A): 76.0%; Kappa (K): 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1 and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7 and 89.1%, respectively. In identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts. CONCLUSION The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Implementing comprehensive malaria microscopy mentorship, in-service training and supportive supervision are key strategies to improve the overall performance of health facilities in malaria microscopy.
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Affiliation(s)
- Bokretsion Gidey
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia.
| | - Desalegn Nega
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Adugna Abera
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Abnet Abebe
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Sindew Mekasha
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Mebrahtom Haile
- Federal Ministry of Health (FMoH), Sudan Street, PO Box 80002, Addis Ababa, Ethiopia
| | - Dereje Dillu
- Federal Ministry of Health (FMoH), Sudan Street, PO Box 80002, Addis Ababa, Ethiopia
| | - Degu Mehari
- Federal Ministry of Health (FMoH), Sudan Street, PO Box 80002, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Wondimeneh Liknew
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Abeba G/Tsadik
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Hussien Mohammed
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Ermias Woldie
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Tsegaye Getachew
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Desalegn Ararso
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Dereje Yenealem
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Adisu Kebede
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Kebede Etana
- Federal Ministry of Health (FMoH), Sudan Street, PO Box 80002, Addis Ababa, Ethiopia
| | - Gizachew Kedida
- Ethiopian Medical Laboratory Associations (EMLA), Tewodros Square, PO Box: 4866, Addis Ababa, Ethiopia
| | - Hiwot Solomon
- Federal Ministry of Health (FMoH), Sudan Street, PO Box 80002, Addis Ababa, Ethiopia
| | - Getachew Tollera
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Adugna Woyessa
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
| | - Ebba Abate
- Ethiopian Public Health Institute (EPHI), Patriot Street, Gulele Subcity, PO Box 1242, Addis Ababa, Ethiopia
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Abera A, Belay H, Zewude A, Gidey B, Nega D, Dufera B, Abebe A, Endriyas T, Getachew B, Birhanu H, Difabachew H, Mekonnen B, Legesse H, Bekele F, Mekete K, Seifu S, Sime H, Yemanebrhan N, Tefera M, Amare H, Beyene B, Tsige E, Kebede A, Tasew G, Tollera G, Abate E, Woyessa A, Assefa A. Establishment of COVID-19 testing laboratory in resource-limited settings: challenges and prospects reported from Ethiopia. Glob Health Action 2020; 13:1841963. [PMID: 33200686 PMCID: PMC7671712 DOI: 10.1080/16549716.2020.1841963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The Coronavirus pandemic is recording unprecedented deaths worldwide. The temporal distribution and burden of the disease varies from setting to setting based on economic status, demography and geographic location. A rapid increase in the number of COVID-19 cases is being reported in Africa as of June 2020. Ethiopia reported the first COVID-19 case on 13 March 2020. Limited molecular laboratory capacity in resource constrained settings is a challenge in the diagnosis of the ever-increasing cases and the overall management of the disease. In this article, the Ethiopian Public Health Institute (EPHI) shares the experience, challenges and prospects in the rapid establishment of one of its COVID-19 testing laboratories from available resources. The first steps in establishing the COVID-19 molecular testing laboratory were i) identifying a suitable space ii) renovating it and iii) mobilizing materials including consumables, mainly from the Malaria and Neglected Tropical Diseases (NTDs) research team at the EPHI. A chain of experimental design was set up with distinct laboratories to standardize the extraction of samples, preparation of the master mix and detection. At the commencement of sample reception and testing, laboratory contamination was among the primary challenges faced. The source of the contamination was identified in the master mix room and resolved. In summary, the established COVID-19 testing lab has tested more than 40,000 samples (August 2020) and is the preferred setting for research and training. The lessons learned may benefit the further establishment of emergency testing laboratories for COVID-19 and/or other epidemic/pandemic diseases in resource-limited settings.
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Affiliation(s)
- Adugna Abera
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Habtamu Belay
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Aboma Zewude
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Bokretsion Gidey
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Desalegn Nega
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Boja Dufera
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Abnet Abebe
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Tujuba Endriyas
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Birhanu Getachew
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Henok Birhanu
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Hailemariam Difabachew
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Bacha Mekonnen
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Helina Legesse
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Firdawek Bekele
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Kalkidan Mekete
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Seble Seifu
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Heven Sime
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Nebiyou Yemanebrhan
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Mesfin Tefera
- National Polio and Measles Laboratory, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Hiwot Amare
- Influenza and Arbovirus Research Laboratory, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Berhane Beyene
- Laboratory Coordinator, WHO Ethiopia Country Office , Addis Ababa, Ethiopia
| | - Estifanos Tsige
- Clinical Bacteriology and Mycology Case Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Adisu Kebede
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Geremew Tasew
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | | | - Ebba Abate
- Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Adugna Woyessa
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
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Chanyalew M, Abebe M, Endale B, Girma S, Tasew G, van Zandbergen G, Ritter U, Gadisa E, Aseffa A, Laskay T. Enhanced production of pro-inflammatory cytokines and chemokines in Ethiopian cutaneous leishmaniasis upon exposure to Leishmania aethiopica. Cytokine 2020; 145:155289. [PMID: 32951968 DOI: 10.1016/j.cyto.2020.155289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 11/18/2022]
Abstract
The clinical course and outcome of cutaneous leishmaniasis (CL) vary due to the infecting Leishmania species and host genetic makeup that result in different immune responses against the parasites. The host immune response to Leishmania aethiopica (L.aethiopica), the causative agent of CL in Ethiopia, is poorly understood. To contribute to the understanding of the protective immune response in CL due to L.aethiopica, we characterized the cytokine response to L. aethiopica in patients with the localized form of CL (LCL) and age-and sex-matched apparently healthy controls. By applying a whole blood based in vitro culture we found enhanced release of TNF, IL-6, MCP-1 or CCL2, IP-10 or CXCL10, MIP-1β or CCL4 and IL-8 or CXCL8- but not of IL-10CL patients in response to L. aethiopica compared to the controls. No difference was observed between LCL cases and controls in the secretion of these cytokines and chemokines in whole blood cultures treated with the TLR-ligands LPS, MALP-2 or polyI: C. The observed increased secretion of the pro-inflammatory cytokines/chemokines reflects an enhanced response against the parasites by LCL patients as compared to healthy controls rather than a generally enhanced ability of blood leukocytes from LCL patients to respond to microbial constituents. Our findings suggest that the enhanced production of pro-inflammatory cytokines/chemokines is associated with localized cutaneous leishmaniasis caused by L.aethiopica.
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Affiliation(s)
- Menberework Chanyalew
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia.
| | - Markos Abebe
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Birtukan Endale
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Selfu Girma
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia; Leishmaniasis Research Laboratory, Ethiopia Public Health Institute, P.O. Box 1242, Addis Ababa, Ethiopia
| | - Ger van Zandbergen
- Division of Immunology, Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, Langen D-63225, Germany.
| | - Uwe Ritter
- Regensburg Center for Interventional Immunology (RCI), Institute of Immunology, University Medical Center Regensburg, University of Regensburg, D-93053 Regensburg, Germany.
| | - Endalamaw Gadisa
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Research and Innovation Division, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Tamás Laskay
- Department of Infectious Diseases and Microbiology, University of Lübeck, D-23560 Lübeck, Germany.
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Tasew G, Gadisa E, Abera A, Chanyalew M, Abebe M, Howe R, Ritter U, Aseffa A, Laskay T. Whole blood-based in vitro culture reveals diminished secretion of pro-inflammatory cytokines and chemokines in visceral leishmaniasis. Cytokine 2020; 145:155246. [PMID: 32828639 DOI: 10.1016/j.cyto.2020.155246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/18/2020] [Accepted: 08/08/2020] [Indexed: 11/28/2022]
Abstract
The likelihood of being bitten by sand flies infected with Leishmania (L.) donovani is considered to be high for all inhabitants living in the endemic areas, but only a small ratio of the population develop symptomatic visceral leishmanisis (VL). Since adequate activation of antimicrobial immune response plays a key role in control of pathogens early after infection we hypothesized that a dysfunction of essential cells of the immune system is associated with disease development after infection with L. donovani. In order to obtain insights into the capacity of leukocytes to respond to L. donovani, a whole blood based assay was applied to evaluate the production of cytokines and chemokines in clinical VL versus Ethiopian endemic healthy control (EHC). In response to L. donovani, VL blood cultures showed significantly lower secretion of IL-12p70, IL-6, IL-17, IL-8 and IP-10 compared to EHC. On the contrary, there was a significantly higher secretion of IL-10 observed in VL compared to EHC. In response to LPS also a lower IL-1β, IL-12p70 and IL-6 secretion was observed in VL as compared to EHC. The data clearly indicate a diminished ability of blood leukocytes in VL to respond to L. donovani and to the TLR ligand LPS. This compromised response in VL may contribute to the severe disease development and enhanced susceptibility to secondary infections in VL.
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Affiliation(s)
- Geremew Tasew
- Ethiopian Public Health Institute, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, P.O. Box 1242, Addis Ababa, Ethiopia.
| | - Endalamaw Gadisa
- Armauer Hansen Research Institute, Neglected Tropical Diseases and Malaria Research Team, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Adugna Abera
- Ethiopian Public Health Institute, Bacterial, Parasitic and Zoonotic Diseases Research Directorate, P.O. Box 1242, Addis Ababa, Ethiopia
| | - Menberework Chanyalew
- Armauer Hansen Research Institute, Neglected Tropical Diseases and Malaria Research Team, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Markos Abebe
- Armauer Hansen Research Institute, Neglected Tropical Diseases and Malaria Research Team, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Neglected Tropical Diseases and Malaria Research Team, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Uwe Ritter
- Regensburg Center for Interventional Immunology (RCI), Institute of Immunology, University Medical Center Regensburg and University of Regensburg, Regensburg, Germany
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Neglected Tropical Diseases and Malaria Research Team, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Tamás Laskay
- Department of Infectious Diseases and Microbiology, University of Lübeck, Ratzeburger Allee 160, D-23560 Lübeck, Germany
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Nega D, Abebe A, Abera A, Gidey B, G/Tsadik A, Tasew G. Comprehensive competency assessment of malaria microscopists and laboratory diagnostic service capacity in districts stratified for malaria elimination in Ethiopia. PLoS One 2020; 15:e0235151. [PMID: 32584866 PMCID: PMC7316265 DOI: 10.1371/journal.pone.0235151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Federal Ministry of Health (FMoH) Ethiopia achieved significant declines in malaria mortality and incidence and has recently launched malaria elimination in selected low transmission settings. Successful malaria elimination calls for rapid and accurate diagnosis of cases so that the patients can promptly be treated before the occurrence of transmission. Therefore, this study assessed the competency of malaria microscopists using panal slides, and laboratory service availability and readiness in terms of supplies and equipments in malaria elimination targeted districts in Ethiopia. METHOD A cross-sectional study was conducted from February to June 2018 in all hospitals, health centers and private clinics in 20 malaria elimination targeted districts, selected out of the 6 regional states in Ethiopia. All malaria microscopists available in the study health facilities during the study period were included in the study. Questionnaires were used for interviewing sociodemography of personnel and laboratory supplies. Per World Health Organization (WHO) criteria set for proficiency testing, 10 Giemsa stained malaria slide panels (8 positive low/high density pf/pv/Mixed and 2 negative slides) were administered to each study participant for performance assessment on malaria parasite detection, species identification and parasite count using light microscopy. The slide panels are PCR confirmed and WHO approved ones, which have been stored in the slide banks at the national reference laboratory in Ethiopian Public Health Institute. RESULT In this assessment, 17(16%) district hospitals, 71(67%) health centers (HCs) and 18(17%) private clinics (PCs) were included. Of the 18 PCs, only 10(55.6%) had license certificate. Of the study facilities, 91.5%(97) use light microscopy, 2.83%(3) use RDTs and 2.9%(3) use both microscopy and RDT to detect malaria. Accessible and appropriate storage of Giemsa was reported by 58.8%(10) hospitals, 81.7%(58) HCs & 72.2%(13) private clinics. Of the 1896 malaria positive & 474 negative slides administered to 237 study participants, 318(16.8%) slides reported falsely negative & 47(9.9%) reported falsely positive. The participants achieved "good" grade [Agreement(A): 84.6%, Kappa(K): 0.6] on parasite detection and "poor" agreement (A: 43.8%; K: 0.11) on every species identification. No or slight agreement seen on differentiation of P. falciparum from other species (A: 28.41%; K:0.29). Above 95%(201) of participants, did not count or used plus system of parasite estimation which is the least accurate and unreccomended method per WHO guideline. CONCLUSION In the current study, low performance of malaria microscopists particularly in species identification & poor to moderate capacity of laboratories observed. This is really a great obstacle to malaria elimination strategy of the country. Therefore, national malaria control and elimination program in collaboration with partners is supposed to provide comprehensive training for professionals giving laboratory service and to fulfill laboratory supplies to have the gold standard service.
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Affiliation(s)
- Desalegn Nega
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail: (AA); (DN)
| | - Abnet Abebe
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail: (AA); (DN)
| | - Adugna Abera
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Abeba G/Tsadik
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Berhanu A, Abera A, Nega D, Mekasha S, Fentaw S, Assefa A, Gebrewolde G, Wuletaw Y, Assefa A, Dugassa S, Tekie H, Tasew G. Isolation and identification of microflora from the midgut and salivary glands of Anopheles species in malaria endemic areas of Ethiopia. BMC Microbiol 2019; 19:85. [PMID: 31035931 PMCID: PMC6489185 DOI: 10.1186/s12866-019-1456-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 04/11/2019] [Indexed: 11/22/2022] Open
Abstract
Background Anopheles mosquitoes are of great importance to human health. A number of studies have shown that midgut and salivary gland microflora have an impact on malaria parasite burden through colonization mechanisms, involving either direct Plasmodium microbiota interaction or bacterial-mediated induction of mosquito immune response. The objective of this study was to isolate and identify the microflora from the midgut and salivary glands of Anopheles species. Methods A total of 20 pools (ten per pool) from insectary-reared and 56 pools (five per pool) of field-collected Anopheles mosquitoes were anesthetized by chloroform and dissected. 70% of ethanol was used for surface sterilization of mosquitoes and laboratory equipment, followed by rinsing Anopheles mosquitoes four times with 1X PBS. Each pool of dissected midgut and salivary gland sample was transferred in 1X PBS and squashed, incubated in the water bath and enriched in tryptic soya broth for 24 h at 35 ± 2 °C. As a control, the PBS solutions used to rinse the mosquitoes were also incubated in tryptic soya broth in the same conditions as the sample. After enrichment, a loopful of each sample was taken and inoculated on Blood, Chocolate, MacConkey, and Sabouraud Dextrose agar. Finally, the microbiota was isolated by colony characteristics, biochemical tests, and automated VITEK 2 Compact Analyzer. Results From all field and laboratory mosquitoes, Pseudomonas was found to be the dominant microbiota identified from all species of Anopheles mosquitoes. Acinetobacter and Klebsiellapneumonia and other families of gram-positive and gram-negative bacteria were identified. Conclusions A number of bacteria were isolated and identified. This is the first report on isolation and identification of microbiota from midgut and salivary glands of Anopheles species in Ethiopia. It can be used as a baseline for studying the relationship between microbiota and mosquitoes, and for the development of a new malaria biological control.
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Affiliation(s)
- Abib Berhanu
- Insect Science Stream, Department of Zoological Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adugna Abera
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, P.O. Box: 1242, Addis Ababa, Ethiopia.
| | - Desalegn Nega
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, P.O. Box: 1242, Addis Ababa, Ethiopia
| | - Sindew Mekasha
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, P.O. Box: 1242, Addis Ababa, Ethiopia
| | - Surafel Fentaw
- Clinical Bacteriology and Mycology Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abebe Assefa
- Clinical Bacteriology and Mycology Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gashaw Gebrewolde
- Vaccine and Diagnostic Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Wuletaw
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, P.O. Box: 1242, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, P.O. Box: 1242, Addis Ababa, Ethiopia
| | - Sisay Dugassa
- Vector Biology and Control Research Unit, Aklilu Lemma Institute of Pathobiology, Addis Ababa, Ethiopia
| | - Habte Tekie
- Insect Science Stream, Department of Zoological Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute, P.O. Box: 1242, Addis Ababa, Ethiopia
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Aberra L, Abera A, Belay T, Kebede A, Gadisa E, Tasew G. Evaluation of microcapillary culture method for the isolation of Leishmania aethiopica parasites from patients with cutaneous lesions in Ethiopia. Diagn Progn Res 2019; 3:4. [PMID: 31093574 PMCID: PMC6460804 DOI: 10.1186/s41512-019-0051-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/30/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In addition to direct slide microscopy, traditional culture method (TCM) has long been considered as a gold standard method for the diagnosis of cutaneous leishmaniasis (CL). However, TCM is relatively expensive and time-consuming compared to the newly introduced microculture method (MCM), which has shown to be sensitive and rapid diagnostic method elsewhere for different Leishmania parasite species other than Leishmania (L.) aethiopica. The objective of this study was to evaluate the diagnostic performance of MCM for the diagnosis of CL caused by L. aethiopica. METHODS One hundred forty-three lesion aspirates were collected from 124 suspected CL patients prospectively based on their consecutive series. Portion of the aspirates were cultured in duplicate in TCM with modified Novy-MacNeal-Nicolle (NNN) in tissue culture flask and microcapillary tubes containing RPMI 1640 with 10% fetal bovine serum (FBS) for MCM. Smears on glass slides from the remaining portion of the aspirate were used for direct microscopy to detect the parasite after stained with Giemsa staining solution. Up on a consensus, positive result in any two of the three tests was used as a reference standard to analyze sensitivity. RESULTS As per consensus standard criteria, 52 of the lesions were qualified to evaluate MCM versus TCM. Forty-eight lesion samples were positive by MCM, 36 by TCM, and 37 by smear microscopy. The representative DNA from parasite culture isolates revealed the causative Leishmania parasite was L. aethiopica by ITS1 polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Culturing L. aethiopica in vitro by MCM is more sensitive (92.3%) than by TCM (69.2%), P = 0.003. The median time for L. aethiopica promastigotes emergence in the culture was 3 days for MCM and 6 days for TCM, P < 0.001. CONCLUSIONS Our finding indicated that MCM is a sensitive and a rapid culturing method for the isolation of L. aethiopica than TCM and smear microscopy.
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Affiliation(s)
- Lensa Aberra
- Armauer Hansen Research Institute, Malaria and Neglected Tropical Diseases Research Directorate, P. O. Box 1005, Addis Ababa, Ethiopia
| | - Adugna Abera
- Ethiopia Public Health Institute, Malaria and Neglected Tropical Diseases Research Team, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Tariku Belay
- College of Public and Medical Health, Department of Medical Laboratory and Pathology, Jimma University, P. O. Box 378, Jimma, Ethiopia
| | - Amha Kebede
- Ethiopia Public Health Institute, Malaria and Neglected Tropical Diseases Research Team, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Endalamaw Gadisa
- Armauer Hansen Research Institute, Malaria and Neglected Tropical Diseases Research Directorate, P. O. Box 1005, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Ethiopia Public Health Institute, Malaria and Neglected Tropical Diseases Research Team, P. O. Box 1242, Addis Ababa, Ethiopia
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Gebreyohanns A, Legese MH, Wolde M, Leta G, Tasew G. Prevalence of intestinal parasites versus knowledge, attitude and practices (KAPs) with special emphasis to Schistosoma mansoni among individuals who have river water contact in Addiremets town, Western Tigray, Ethiopia. PLoS One 2018; 13:e0204259. [PMID: 30252865 PMCID: PMC6155513 DOI: 10.1371/journal.pone.0204259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
Background Intestinal parasite infections are major public health problems in resource-limited countries that adversely affect the well-being of millions. Among these, intestinal schistosomiasis is a serious public health problem in tropical and sub-tropical countries. Methods A Community based cross sectional study was conducted from February to April 2017 in Addiremets town, Ethiopia. Socio-demographic associated risk factors and knowledge, attitude and practices of individuals regarding intestinal parasite infection including schistosomiasis were collected from 411 study participants using pretested structured questionnaires. From each study participant, a fresh stool sample was collected and direct microscopy, formol-ether concentration and Kato- Katz techniques were performed. Snails were checked and collected from the nearby study area river. The collected data was entered and analyzed using SPSS version 20. Bi-variant and multiple logistic regressions were used for correlation analysis. A P <0.05 was considered as statistically significant. Result The overall intestinal parasite prevalence was 51.3% (211/411). The most prevalent parasites were S. mansoni 26.3%(108/411) and Hookworm 23.1%(95/411). The prevalence of intestinal parasites among males and females were 54.1%(131/242) and 47.3%(80/169) respectively. The highest proportion of parasite infection was reported among the age group of 5–9 year old participants, at 70.6%(36/51). The prevalence of S. mansoni was 26.3% (108/411) with mean infection intensity of 218 eggs per gram (range: 24 to 1728). Among study participants, 94.4% had good knowledge while 35.9% of them had poor practices towards intestinal parasite and Schistosomes infection prevention. Conclusion High prevalence of intestinal parasitic infection was observed in Addiremets town and the most common parasites identified were S. mansoni and Hookworm. Most study participants had light infection intensity of Schistosomiasis, Ascariasis and Hookworm infection. Majority of the participants in the study area had good knowledge and positive attitude about intestinal parasitic infection and schistosomiasis control. Shells of Biomphalaria species, Bulinus species and Physa species were collected from the Mytsaeda river shore.
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Affiliation(s)
- Alganesh Gebreyohanns
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melese Hailu Legese
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Mistire Wolde
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gemechu Leta
- Ethiopian Public Health Institute, Leishmaniasis Research Laboratory, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Ethiopian Public Health Institute, Leishmaniasis Research Laboratory, Addis Ababa, Ethiopia
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Tafess K, Beyen TK, Abera A, Tasew G, Mekit S, Sisay S, Tadesse L, Siu GKH. Treatment Outcomes of Tuberculosis at Asella Teaching Hospital, Ethiopia: Ten Years' Retrospective Aggregated Data. Front Med (Lausanne) 2018; 5:38. [PMID: 29516002 PMCID: PMC5826330 DOI: 10.3389/fmed.2018.00038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/31/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Directly Observed Treatment Short-course (DOTS) has been one of the major strategies to combat the epidemic of tuberculosis (TB) globally. This study aimed to evaluate TB treatment outcomes between September 2004 and July 2014 under the DOTS program at one of the largest public hospitals in Ethiopia. METHODS A retrospective data of TB patients registered at Asella Teaching Hospital between September 2004 and July 2014 were obtained from hospital registry. Treatment outcomes and types of TB cases were categorized according to the national TB control program guideline. Binomial and multinomial logistic regression models were used to analyze the association between treatment outcomes and potential predictor variables. RESULTS A total of 1,755 TB patients' records were included in the study. Of these, 945 (53.8%) were male, 480 (27.4%) smear-positive TB, 287 (16.4%) HIV positive, and 1,549 (88.3%) new cases. Among 480 smear-positive pulmonary TB cases, 377 (78.5%) patients were cured, 21 (4.40) completed the treatment, 35 (7.3%) transferred out, 19 (4.0%) died, 24 (5.0%) defaulted, and 4 (0.8%) failure. Overall, 398 (82.9%) smear-positive pulmonary TB patients were successfully treated. For smear-negative TB (n = 641) and extrapulmonary TB cases (n = 634), 1,036 (81.3%) completed the treatment and demonstrated favorable response. Taking all TB types into account, 1,434 (81.7%) were considered as successfully treated. In the multivariate binary logistic model, patients in older age group (AOR = 0.386, 95% CI: 0.250-0.596) and retreatment cases (AOR = 0.422, 95% CI: 0.226-0.790) were less likely to be successfully treated compared to younger and new cases, respectively. In multinomial logistic regression, age increment by 1 year increased the risk of death and default of TB patients by 0.05 (adjusted β = 0.05; 95% CI: 0.03, 0.06) and 0.02 (adjusted β = 0.02; 95% CI: 0.01, 0.04). The odds of TB patients who died during treatment were higher among HIV-infected TB patients (adjusted β = 2.65; 95% CI: 1.28, 5.50). CONCLUSION The treatment success rate of TB patients was low as compared to the national target. TB control needs to be strengthened for the enhancement of treatment outcome.
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Affiliation(s)
- Ketema Tafess
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
- Department of Medical Laboratory, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Teresa Kisi Beyen
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Adugna Abera
- Leishmaniasis Research Laboratory, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Leishmaniasis Research Laboratory, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Shimelis Mekit
- Department of Pharmacy, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Solomon Sisay
- Department of Medical, GLRA-Ethiopia, Addis Ababa, Ethiopia
| | - Legesse Tadesse
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Gilman K. H. Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
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Gadisa E, Tasew G, Abera A, Gelaye W, Chanyalew M, Abebe M, Laskay T, Aseffa A. Serological signatures of clinical cure following successful treatment with sodium stibogluconate in Ethiopian visceral leishmaniasis. Cytokine 2016; 91:6-9. [PMID: 27940090 DOI: 10.1016/j.cyto.2016.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/15/2016] [Accepted: 11/29/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND In Ethiopia, visceral leishmaniasis (VL) is a growing public health threat. Among the key challenges in VL control in Ethiopia is lack of an effective test of cure. The recommended test of cure is parasite detection. As sterile cure is not expected with the current widely used drugs, the value of parasite detection as test of cure is questionable. Moreover, the sampling is invasive, requires a well-equipped facility and highly skilled personnel, which are all hardly found in endemic set-ups. OBJECTIVE Our aim was to assess the value of sCD40L, MMP9 and IL-10 serum levels as signature biomarkers of clinical cure in VL cases from Ethiopia. METHODS A total of 45 VL cases before and after treatment and 30 endemic healthy controls were included in the study. Sandwich ELISA was used to measure serum levels of sCD40L, MMP9 and IL-10. RESULT The mean sCD40L, MMP9 and IL-10 serum levels changed significantly at clinical cure. At individual case level sCD40L and MMP9 showed an increasing trend. Yet, the degree of increase in serum level of MMP9 seems to be affected by nutritional status of the individual VL case. The mean IL-10 serum level was significantly reduced at clinical cure. As seen on case by case basis, all demonstrated a declining trend except that two VL cases had a high IL10 level at clinical cure. CONCLUSION Our result is suggestive of the possibility of developing a signature biomarker to monitor VL treatment in Ethiopia using one or a combination of parameters.
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Affiliation(s)
| | - Geremew Tasew
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia; Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Adugna Abera
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - Woyneshet Gelaye
- Amhara Regional State Referral and Research Laboratory, Bahir Dar, Ethiopia.
| | | | - Markos Abebe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
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Yitbarek T, Nega D, Tasew G, Taye B, Desta K. Performance Evaluation of Malaria Microscopists at Defense Health Facilities in Addis Ababa and Its Surrounding Areas, Ethiopia. PLoS One 2016; 11:e0166170. [PMID: 27893838 PMCID: PMC5125591 DOI: 10.1371/journal.pone.0166170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 10/23/2016] [Indexed: 11/19/2022] Open
Abstract
Background Blood film microscopy is the gold standard approach for malaria diagnosis, and preferred method for routine patient diagnosis in health facilities. However, the inability of laboratory professionals to correctly detect and identify malaria parasites microscopically leads to an inappropriate administration of anti-malarial drugs to the patients and incorrect findings in research areas. This study was carried out to evaluate the performance of laboratory professionals in malaria diagnosis in health facilities under the Defense Health Main Department in Addis Ababa and its surroundings, Ethiopia. Method A cross sectional study was conducted from June to July 2015. Totally, 60 laboratory professionals out of the selected 16 health facilities were included in the study. Data were collected by distributing standardized pre-validated malaria slide-panels and self-administered questionnaires among professionals, onsite in each study facility. Sensitivity, specificity, and strength of agreement (with kappa score) in performance among the study participants against WHO-certified expert malaria microscopists were calculated. Result Of the 60 study participants, 8.3% (5/60) correctly read all the distributed slides in terms of parasite detection, species identification and parasite counting; whereas, each of the remaining 55(91.7%) interpreted at least two slides incorrectly. The overall sensitivity and specificity of participants’ performance in detection of malaria parasites were 65.7% and 100%, respectively. Overall, fair agreement (71.4%; Kappa: 0.4) in detection of malaria parasite was observed between the study subjects and expert readers. The overall sensitivity and specificity of participants in species identification of malaria parasites were respectively 41.3% and 100%. Overall, slight agreement (51.1%; kappa: 0.04) in identification of malaria species was observed. Generally, agreement was lower in parasite detection and species identification at low parasite density and mixed infection cases. Conclusion The general agreement between the study participants and expert microscopists in malaria parasite detection and species identification was very low, particularly in the cases of low-parasite density and mixed infections. Therefore, regular external quality assessments and further refreshment trainings are crucial to enhance the skill of professionals in malaria microscopy; particularly for those in non-malarious areas where exposure to malaria diagnosis is low.
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Affiliation(s)
- Tigist Yitbarek
- Emanuel Mental Specialized Hospital, Medical Laboratory Service, Addis Ababa, Ethiopia
- Department of Medical Laboratory Sciences, Collage of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Desalegn Nega
- Malaria, Other Parasite and Vector Borne Parasitic Diseases Research Team; Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Malaria, Other Parasite and Vector Borne Parasitic Diseases Research Team; Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bineyam Taye
- Colgate University, Department of Biology, Hamilton, New York, United States of America
| | - Kassu Desta
- Department of Medical Laboratory Sciences, Collage of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Abera A, Tasew G, Tsegaw T, Kejella A, Mulugeta A, Worku D, Aseffa A, Gadisa E. Visceral Leishmaniasis in Benishangul-Gumuz Regional State, Western Ethiopia: Reemerging or Emerging? Am J Trop Med Hyg 2016; 95:104-8. [PMID: 27139445 DOI: 10.4269/ajtmh.15-0738] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/19/2016] [Indexed: 11/07/2022] Open
Abstract
Kala-azar is a growing public health problem in Ethiopia. Benishangul-Gumuz regional state was previously not known to be endemic for the disease. In response to a case report from the region, we conducted a rapid assessment survey. A pretested questionnaire was used to capture sociodemographic and clinical histories pertinent to kala-azar. Study participants with complaints of fever and headache for 2 weeks or more were tested for kala-azar and malaria. All participants were screened with the leishmanin skin test and the direct agglutination test for exposure to Leishmania, defined as a positive result with either or both tests. Of 275 participants, 20 were exposed giving an overall leishmaniasis seroprevalence rate of 7.3%. Among the 20 positive individuals, 19 were farmers and nine of them reported no travel history outside their district. It appears that kala-azar is emerging in Dangur and Guba districts of Benishangul-Gumuz regional state, probably in connection with human encroachment into one or several previously out-of-reach zoonotic foci. We recommend integrated epidemiological surveys for confirmation and early containment of disease transmission in the area.
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Affiliation(s)
- Adugna Abera
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia. Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Teshome Tsegaw
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Asfaw Kejella
- Benishangul-Gumuz Regional Health Bureau, Assosa, Ethiopia
| | - Abate Mulugeta
- Disease Prevention and Control Programs, World Health Organization, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Dagimlidet Worku
- KalaCORE Consortium, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Tasew G, Gadisa E, Abera A, Zewude A, Chanyalew M, Aseffa A, Abebe M, Ritter U, van Zandbergen G, Laskay T, Tafess K. In vitro permissiveness of bovine neutrophils and monocyte derived macrophages to Leishmania donovani of Ethiopian isolate. Parasit Vectors 2016; 9:218. [PMID: 27090082 PMCID: PMC4836163 DOI: 10.1186/s13071-016-1441-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/09/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Epidemiological studies in Ethiopia have documented that the risk of visceral leishmaniasis (VL, Kala-azar) is higher among people living with domestic animals. The recent report on isolation of Leishmania donovani complex DNA and the detected high prevalence of anti-leishmanial antibodies in the blood of domestic animals further strengthen the potential role of domestic animals in the epidemiology of VL in Ethiopia. In mammalian hosts polymorphonuclear cells (PMN) and macrophages are the key immune cells influencing susceptibility or control of Leishmania infection. Thus to substantiate the possible role of cattle in VL transmission we investigate the permissiveness of bovine PMN and monocyte derived macrophages (MDM) for Leishmania (L.) donovani infection. METHODS Whole blood was collected from pure Zebu (Boss indicus) and their cross with Holstein Friesian cattle. L. donovani (MHOM/ET/67/HU3) wild and episomal green fluorescent protein (eGFP) labelled stationary stage promastigotes were co-incubated with whole blood and MDM to determine infection of these cells. Engulfment of promastigotes by the cells and their transformation to amastigote forms in MDM was studied with direct microscopy. Microscopy and flow cytometry were used to measure the infection rate while PCR-RLFP was used to confirm the infecting parasite. RESULTS L. donovani infected bovine whole blood PMN in the presence of plasma factors and all cellular elements. Morphological examinations of stained cytospin smears revealed that PMN engulfed promastigotes. Similarly, we were able to show that bovine MDM can be infected by L. donovani, which transformed to amastigote forms in the cells. CONCLUSIONS The in vitro infection of bovine PMN and MDM by L. donovani further strengthens the possibility that cattle might serve as source of L. donovani infection for humans.
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Affiliation(s)
- Geremew Tasew
- />Ethiopia Public Health Institute, Leishmaniasis Research Laboratory, P.O. Box 1242, Addis Ababa, Ethiopia
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Endalamaw Gadisa
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Adugna Abera
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Aboma Zewude
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Menberework Chanyalew
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Markos Abebe
- />Armauer Hansen Research Institute, Leishmaniasis Research Laboratory, P.O. Box 1005, Addis Ababa, Ethiopia
| | - Uwe Ritter
- />Department of Immunology, University of Regensburg, Franz-Josef-Strauß-Allee 11, D-93042 Regensburg, Germany
| | - Ger van Zandbergen
- />Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Tamás Laskay
- />Institute for Medical Microbiology and Hygiene, University of Lübeck, Ratzeburger Allee 160, D-23560 Lübeck, Germany
| | - Ketema Tafess
- />Department of Medical Laboratory Science, College of Health Sciences, Arsi University, P.O. Box 193, Asella, Ethiopia
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