The impact of asymptomatic helminth co-infection in patients with newly diagnosed tuberculosis in north-west ethiopia

Background

Areas endemic of helminth infection, tuberculosis (TB) and HIV are to a large extent overlapping. The aim of this study was to assess the impact of asymptomatic helminth infection on the immunological response among TB patients with and without HIV, their house hold contacts and community controls.

Methodology

Consecutive smear positive TB patients (n = 112), their household contacts (n = 71) and community controls (n = 112) were recruited in Gondar town, Ethiopia. Stool microscopy, HIV serology, serum IgE level, eosinophil and CD4 counts were performed and tuberculosis patients were followed up for 3 months after initiation of anti-TB treatment.

Results

Helminth co-infection rate was 29% in TB patients and 21% in both community control and household contacts (p = 0.3) where Ascaris lumbricoides was the most prevalent parasite. In TB patients the seroprevalence of HIV was 47% (53/112). Eosinophilia and elevated IgE level were significantly associated with asymptomatic helminth infection. During TB treatment, the worm infection rate of HIV+/TB patients declined from 31% (10/32) at week 0 to 9% (3/32) at week 2 of TB treatment, whereas HIV−/TB patients showed no change from baseline to week 2, 29% (13/45) vs. 22.2% (10/45). This trend was stable at week 8 and 12 as well.

Conclusion

One third of smear positive TB patients were infected with helminths. Eosinophilia and elevated IgE level correlated with asymptomatic worm infection, indicating an effect on host immunity. The rate of worm infection declined during TB treatment in HIV+/TB co-infected patients whereas no decline was seen in HIV−/TB group.     

Vision Loss and Psychological Distress among Ethiopians Adults: A Comparative Cross-Sectional Study

Background

Vision loss causes major changes in lifestyle and habits that may result in psychological distress and further reduction in the quality of life. Little is known about the magnitude of psychological distress in patients with vision loss and its variation with the normal. The aim of this study is, therefore, to investigate the psychological effects of vision loss and its determinants among Ethiopians.

Methods

A comparative cross-sectional study was conducted on adults attending the Eye clinic of Jimma University Hospital. One hundred fifteen consecutive adults with visual loss at least in one eye and 115 age-and sex-matched controls with normal vision were studied. The psychological distress was measured using standardized Self-Reporting Questionnaire (SRQ-20). Chi-square test and logistic regression were carried out and associations were considered significant at P<0.05.

Results

The overall prevalence of psychological distress was 33.4%. While psychological distress was found in 49.8% of patients who had loss of vision at least in one eye, only 18.3% of the controls had it. In the adjusted analysis, patients with vision loss had 4.6 times higher risk of suffering from psychological distress compared to patients with normal vision (AOR 4.56; 95% CI 2.16-9.62). Moreover, patients with vision loss in both eyes (AOR 4.00; 95% CI 1.453-11.015) and with worse visual acuity in the better eye (AOR 3.66; 95% CI 1.27-10.54) were significantly more likely to have psychological distress than those patients with vision loss in one eye only and good visual acuity in the better eye respectively. The cause of visual loss, pattern of visual loss, duration of visual loss and sociodemographic variables did not influence the likelihood of having psychological distress.

Conclusion

Prevalence of psychological distress was significantly higher in patients with visual loss compared to patients with normal vision. There is a need for integration of psychosocial care into the current medical and surgical treatment of patients with vision loss.     

Prevalence and Associated Factors of Hypertension among Adults in Durame Town,Southern Ethiopia

Background

To date, non-communicable diseases, such as cardiovascular diseases, are becoming severe public health challenges particularly in developing countries. Hypertension is a modifiable risk factor that contributes the leading role for mortality. The problem is significant in low- and middle-income countries like sub-Saharan Africa. However, there are limited studies in developing countries, particularly in Ethiopia. Hence, determining the magnitude of hypertension and identifying risk groups are important.

Methods

A community based cross sectional study was conducted in April 2013 among adults (age>31 years) old. A systematic sampling technique was used to select a total of 518 study participants. Data were collected after full verbal informed consent was obtained from each participant. Multivariable logistic regressions were fitted to control the effect of confounding. Adjusted Odds ratios (OR) with their 95% confidence intervals (95% CI) were calculated to measure associations. Variables having P-value <0.05 were considered as significant.

Results

The overall prevalence of hypertension in Durame town was 22.4% (95% CI: 18.8–26.0). Nearly 40% of hypertensive patients were newly screened. Male sex [AOR  = 2.03, 95% CI; 1.05–3.93], age [AOR  = 29.49, 95% CI; 10.60–81.27], salt use [AOR  = 6.55, 95% CI; 2.31–18.53], eating vegetable three or fewer days per week [AOR  = 2.3,95% CI; 1.17–4.51], not continuously walking at least for 10 minutes per day [AOR  = 7.82, 95% CI; 2.37–25.82], having family history of hypertension [AOR  = 2.46, 95%CI; 1.31–4.61] and being overweight/obese [AOR  = 15.7, 95% CI 7.89–31.21)] were found to be risk factors for hypertension.

Conclusions

The prevalence of hypertension is found to be high. Older age, male sex, having family history of hypertension, physical inactivity, poor vegetable diet, additional salt consumption and obesity were important risk factors associated with hypertension among adults. Community level intervention measures with a particular emphasis on prevention by introducing lifestyle modifications are recommended.     

Disordered eating attitude and associated factors among high school adolescents aged 12–19 years in Addis Ababa,Ethiopia: a cross-sectional study

Background

Eating disorders are very complex, frequently developed and have a public health impact on adolescents. Different studies revealed that eating disorders is a pressing public health problem among adolescents. Eating disorders may also lead to mortality due to their physiological sequelae. There is no previous study regarding disordered of eating attitude in Ethiopian adolescents. Therefore, this study aimed to assess prevalence of disordered eating attitude and its associated factors among adolescents in Addis Ababa high schools.

Methods

A school-based cross sectional study was conducted. Data were collected among 836 high school adolescents aged 12–19 years from May to June, 2015 in Addis Ababa city. The data were collected by self-administered questionnaire containing eating attitudes test-26 items (EAT-26) and socio-demographic factors. Binary logistic regression analysis was carried out to identify factors associated with disordered eating attitude. Both crude odds ratio and adjusted odds ratio were calculated to show the strength of association. In multivariable analysis, variables with a P value of <0.05 were considered statistically significant.

Results

The prevalence of disordered eating attitude among adolescents was 8.6% [95% CI 4.9, 12.3]. Being female [AOR = 1.75, 95% CI 1.03, 3.00], Mother’s educational status (Primary [AOR = 0.28, 95% CI 0.11, 0.78], Certificate/diploma [AOR = 0.22, 95% CI 0.07, 0.58] and first degree and above [AOR = 0.16, 95% CI 0.07, 0.40]) were found to be significantly associated with disordered eating attitude.

Conclusion

The finding of this study revealed that a significant number of adolescents were susceptible to developing disordered eating attitude. Being female and Mothers’ education status were significantly associated with disordered eating attitude among adolescents. Provision of screening test for eating disorders focusing on female adolescents is highly recommended.

     

Mycobacterium tuberculosis Complex and HIV Co-Infection among Extrapulmonary Tuberculosis Suspected Cases at the University of Gondar Hospital,Northwestern Ethiopia

Background

Extrapulmonary Tuberculosis (EPTB) and Human Immunodeficiency Virus (HIV) infection are interrelated as a result of immune depression. The aim of this study was to determine the prevalence of Mycobacterium tuberculosis complex isolates and the burden of HIV co-infection among EPTB suspected patients.

Method

An institution based cross-sectional study was conducted among EPTB suspected patients at the University of Gondar Hospital. Socio-demographic characteristics and other clinical data were collected using a pretested questionnaire. GeneXpert MTB/RIF assay was performed to diagnosis Mycobacterium tuberculosis complex and Rifampicin resistance. All samples were also investigated by cytology and culture. The HIV statuses of all patients were screened initially by KHB, and all positive cases were further re-tested by STAT-pack. Data was analyzed using SPSS version 20 computer software and a P-value of < 0.05 was taken as statistically significant.

Results

A total of 141 extrapulmonary suspected patients were enrolled in this study. The overall prevalence of culture confirmed extrapulmonary tuberculosis infection was 29.8%, but the GeneXpert result showed a 26.2% prevalence of Mycobacterium tuberculosis complex infection. The 78.4% prevalence of extrapulmonary tuberculosis infection was found to be higher among the adult population. The prevalence of HIV infection among EPTB suspected patients was 14.1%, while it was 32.4% among GeneXpert-confirmed extrapulmonary TB cases (12/37). Tuberculosis lymphadenitis was the predominant (78.4%) type of EPTB infection followed by tuberculosis cold abscess (10.7%). Adult hood, previous history of contact with known pulmonary tuberculosis patients, and HIV co-infection showed a statistically significant association with extrapulmonary tuberculosis infection (P<0.013).

Conclusion

The prevalence of culture confirmed-EPTB infection was high, and a higher EPTB-HIV co-infection was also observed.     

Tuberculosis Laboratory Diagnosis Quality Assurance among Public Health Facilities in West Amhara Region,Ethiopia

Introduction

Reliable smear microscopy is an important component of Directly Observed Treatment Scheme (DOTS) strategy for TB control program in countries with limited resources. Despite external quality assessment is established in Ethiopia, there is lower TB detection rate (48%) in Amhara region compared to the World Health Organization (WHO) estimate (70%). This highlights the quality of smear microscopy needs to be evaluated. Therefore, the aim of this study was to assess the quality of sputum smear microscopy performance among health center laboratories in West Amhara region, Ethiopia.

Materials and Methods

A cross sectional study was conducted from July 08, 2013 to July 07, 2014. Data were collected from 201 public health center laboratories using a structured questionnaire. Slides were collected based on Lot Quality Assurance Sampling (LQAS) method and rechecked blindly by trained laboratory technologists. The data were entered into EPI info V.7 and smear quality indicators and AFB results were analyzed by SPSS version 20.

Results

Among 201 laboratories enrolled in this study, 47 (23.4%) laboratories had major errors. Forty one (20.4%) laboratories had a total of 67 false negative and 29 (14.4%) laboratories had a total of 68 false positive results. Specimen quality, smear thickness and evenness were found poor in 134 (66.7%), 133 (66.2%) and 126 (62.7%) laboratories, respectively. Unavailability of microscope lens cleaning solution (AOR: 2.90; 95% CI: 1.25–6.75; P: 0.013) and dirty smears (AOR: 2.65; 95% CI: 1.14–6.18; P: 0.024) were correlated with false negative results whereas no previous EQA participation (AOR: 3.43; 95% CI: 1. 39-8.45; P: 0.007) was associated with false positive results.

Conclusion

The performance of health facilities for sputum smear microscopy was relatively poor in West Amhara region. Hence, strengthening the EQA program and technical support on sputum smear microscopy are recommended to ensure quality tuberculosis diagnostic service.     

External quality assessment of malaria microscopy diagnosis among public health facilities in West Amhara Region,Ethiopia

Objective

To evaluate the importance of external quality assessment program on malaria microscopic diagnosis.

Results

A total of 3148 slides were collected in 4 consecutive external quality assessment rounds and blindly rechecked at Amhara Public Health Institute. The average agreement between health facility and APHI slide readers was 96.6%. The percent agreement for parasite detection and species identification for P. falciparum became improved in four consecutive EQA rounds from 93.88 to 99.24% and 92.67 to 97.35% respectively. The rates of false positive and false negative were also dramatically decreased in each round from 10.5 to 0.79% and 2.14 to 0.74% respectively. Therefore, we recommend that malaria EQA program should maintain and expand in all malaria diagnostic health facilities in the region to provide accurate and reliable malaria microscopic service.