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Changing Trends in Prevalence and Antibiotics Resistance of Uropathogens in Patients Attending the Gondar University Hospital, Northwest Ethiopia
Moges Tiruneh,Sisay Yifru,Mucheye Gizachew,Kassie Molla,Yeshambel Belyhun,Feleke Moges,Mengistu Endris
International Journal of Bacteriology , 2014, DOI: 10.1155/2014/629424
Abstract: Background. In most hospitals of developing countries, urinary tract infections are treated empirically because of lack of culture facilities. This leads to emergence of multiresistant uropathogens. Culturing and drug susceptibility testing are essential to guide therapy. Objectives. To assess changing prevalence and resistance pattern of uropathogens to commonly used antibiotics in a two-year study period. Methods. Urine specimens were collected and cultured. Uropathogens were identified by standard methods and tested for antibiotics resistance. Data were analyzed using SPSS version 16 statistical sofware. P value < 0.05 was considered statistically significant. Results. The commonest isolates in both the previous and present studies were E. coli, Klebsiella, CoNS, S. aureus, Proteus, and Citrobacter species. Previous isolates of Enterobacteriaceae were 100% sensitive to ciprofloxacin, whereas present isolates developed 31% to 60% resistance to it. Previous isolates were less resistant to gentamycin than the present ones. Multiresistance isolates were predominant in present study than previous ones. Conclusion. E. coli was predominant in the two study periods. Present isolates were more resistant than previous ones. Some previous isolates were 100% sensitive to ciprofloxacin, whereas present isolates were increasingly resistant. Ciprofloxacin and gentamicin have been recommended for empiric treatment of urinary tract infections. 1. Background Urinary tract infection is one of the commonest bacterial infections encountered in daily clinical practice [1]. It has been estimated that worldwide about 150 million people suffer from asymptomatic and symptomatic UTIs each year [2]. In most parts of the sub-Saharan Africa, as well as in other developing parts of the world, UTI is among the most common health problems occurring both in the community and hospitalized patients [3]. Since the last two to three decades, just as many community and hospital acquired bacterial infections, UTIs due to multidrug resistant uropathogens have caused a growing concern worldwide [1, 4–6]. Investigators [1, 7, 8] explained that the drug resistance problem in Africa stems from factors like indiscriminate use of antibiotics, inappropriate advertisement, and erratic prescription by unqualified drug sellers. Since the previous two decades, the problem of UTIs due to uropathogens resistant to the commonly used antibiotics was reported by many authors in Ethiopia in general and in Gondar region in particular [1, 9–12]. Consequently, the prevalence of urinary tract pathogens and
HIV-Positive Status Disclosure and Associated Factors among Children in North Gondar, Northwest Ethiopia
Digsu Negese,Kefyalew Addis,Akilew Awoke,Zelalem Birhanu,Dagnachew Muluye,Sisay Yifru,Berihun Megabiaw
ISRN AIDS , 2012, DOI: 10.5402/2012/485720
Abstract: Introduction. Clinical reports have indicated positive outcomes associated with disclosure of HIV-positive status in children. This study assessed the level and associated factors of HIV-positive status disclosure to HIV-infected children in northwest Ethiopia. Methods. Institution-based cross-sectional study was conducted among HIV-positive children from March to April 2012. Data were collected using a structured questionnaire by face-to-face interview technique. Bivariate and multivariate analyses were performed. Results. Of the 428 children, 169 (39.5%) were disclosed their HIV-positive status. The mean age of HIV-positive status disclosure was at 10.7 (±2.3) years. Having a nonbiological parent ( , 95% CI: 1.22, 14.04), child’s age older than 10 years ( , 95% CI: 4.5, 15.53), and death of a family member ( , 95% CI: 1.16, 3.6) were significantly and independently associated with disclosure of HIV-positive status to infected children. Conclusions. The rate of disclosure of HIV-positive status to infected children still remains low in North Gondar. Hence, it is important to target children living with their biological parents and having young parents and children younger than 10 years. The guideline for disclosure of children with HIV/AIDS should be established in an Ethiopian context. 1. Introduction HIV/AIDS is increasingly affecting the health and welfare of children and undermining hard-won gains of child survival in highly affected countries [1]. Recent estimates from the Joint United Nations Programs on HIV/AIDS (UNAIDS) suggest that globally about 2.5 million children younger than 15 years of age are infected with HIV: 90% living in sub-Saharan Africa [2] and about 64,813 living in Ethiopia [3]. Without treatment 75% of HIV-infected children will die before their fifth birthday [4]. As highly active antiretroviral therapy (HAART) becomes increasingly available in low resource settings, infected children are living longer [5]. With increased survival, one of the greatest psychosocial challenges that parents and caregivers of HIV-infected children face is the disclosure of HIV-positive status to their infected children. One of the most difficult issues that families with HIV-infected children face is when and how to talk about HIV to their children. HIV-positive status disclosure to infected children and adolescents should take place in a supportive environment with collaboration and cooperation among caregivers and health care providers. Disclosure is contingent on the caregiver’s acknowledgement of the illness, the readiness to disclose, and
A Meta-Analysis on Higher-Risk Sexual Behavior of Women in 28 Third World Countries  [PDF]
Asres Berhan, Yifru Berhan
World Journal of AIDS (WJA) , 2012, DOI: 10.4236/wja.2012.22011
Abstract: Background: Previous reports on sexual behaviours and risks of HIV infection in relation to socioeconomic status of women were contradictory. The purpose of this study was to determine the consistency of risky sexual behaviour among women with regard to their age, residence, educational level and wealth index. Methods: Subgroup and pooled meta-analysis was done on risky sexual behaviour and HIV prevalence of women aged 15 - 49 years using the recent Demographic and Health Surveys data (DHS 2003-2009) from 28 countries in and outside Africa. Pooled and individual countries odds ratios were calculated using Mantel-Haenszel (M-H) statistical method. Random effect analytic model was applied since there was significant heterogeneity among surveys (I2 > 50%). Sensitivity analysis was also done to examine the effect of outliers. Results: Out of 207,776 women reported to have sex within 12 months prior to the respective surveys, 36,530 (17.6%) were practicing higher-risk sex. Risky sexual behavior was found to have statistically significant association with women living in urban areas, attained secondary and above education and owned middle to highest wealth index. Sensitivity analysis demonstrated the stability of the pooled odds ratios for outliers. Better education attainment, high wealth index and being employed were also associated with high HIV prevalence. Conclusion: This analysis has shown the high prevalence of higher-risk sexual behaviour and high HIV infection among wealthier and better educated women regardless of geographic location of the selected low to middle income countries. Further study is required to establish how and why being good in socioeconomic status associated with risky sexual behaviour.
Single-dose liposomal amphotericin B (AmBisome?) for the treatment of Visceral Leishmaniasis in East Africa: study protocol for a randomized controlled trial
Tansy Edwards, Raymond Omollo, Eltahir AG Khalil, Sisay Yifru, Brima Musa, Ahmed Musa, Monique Wasunna, Peter G Smith, Catherine Royce, Sally Ellis, Manica Balasegaram, Asrat Hailu
Trials , 2011, DOI: 10.1186/1745-6215-12-66
Abstract: An open-label, 2-arm, non-inferiority, multi-centre randomised controlled trial is being conducted to determine the optimal single-dose treatment with AmBisome?.Patients in the single-dose arm will receive one infusion on day 1, at a dose depending on body weight. For the first group of patients entered to the trial, the dose will be 7.5 mg/kg, but if this dose is found to be ineffective then in subsequent patient series the dose will be escalated progressively to 10, 12.5 and 15 mg/kg. Patients in the reference arm will receive a multi-dose regimen of AmBisome? (3 mg/kg/day on days 1-5, 14 and 21: total dose 21 mg/kg). Patients will be hospitalised for approximately one month after the start of treatment and then followed up at three and six months. The primary endpoint is the status of patients six months after treatment. A secondary endpoint is assessment at day 30. Treatment success is determined as the absence of parasites on microscopy samples taken from bone marrow, lymph node or splenic aspirates. Interim analyses to assess the comparative efficacy of the single dose are planned after recruitment of 20 and 40 patients per arm. The final non-inferiority analysis will include 120 patients per arm, to determine if the single-dose efficacy 6 months after treatment is not more than 10% inferior to the multi-dose.An effective, safe single-dose treatment would reduce hospitalization and treatment costs. Results will inform the design of combination treatment studies.ClinicalTrials.gov NCT00832208Visceral Leishmaniasis (VL) is a parasitic disease that is transmitted by phlebotomine sandflies, and is fatal if not treated. Estimates suggest there are 500,000 cases per year, with 90% of cases occurring in India, Bangladesh, Nepal, Sudan, Kenya, Ethiopia and Brazil [1,2]. In East Africa, the disease has been known to occur in cyclical epidemics, one of which resulted in over 100,000 deaths in Southern Sudan between 1984-94 [3,4]. Parasitological diagnosis is determined
Polymorphism in the HASPB Repeat Region of East African Leishmania donovani Strains
Arie Zackay,Abdelmajeed Nasereddin,Yegnasew Takele,Dagimawie Tadesse,Workagegnehu Hailu,Zewdu Hurissa,Sisay Yifru,Teklu Weldegebreal,Ermias Diro,Aysheshm Kassahun,Asrat Hailu,Charles L. Jaffe
PLOS Neglected Tropical Diseases , 2013, DOI: 10.1371/journal.pntd.0002031
Abstract: Background/Objectives Visceral leishmaniasis (VL) caused by Leishmania donovani is a major health problem in Ethiopia. Parasites in disparate regions are transmitted by different vectors, and cluster in distinctive genotypes. Recently isolated strains from VL and HIV-VL co-infected patients in north and south Ethiopia were characterized as part of a longitudinal study on VL transmission. Methodology/Principal Findings Sixty-three L. donovani strains were examined by polymerase chain reaction (PCR) targeting three regions: internal transcribed spacer 1 (ITS1), cysteine protease B (cpb), and HASPB (k26). ITS1- and cpb - PCR identified these strains as L. donovani. Interestingly, the k26 - PCR amplicon size varied depending on the patient's geographic origin. Most strains from northwestern Ethiopia (36/40) produced a 290 bp product with a minority (4/40) giving a 410 bp amplicon. All of the latter strains were isolated from patients with HIV-VL co-infections, while the former group contained both VL and HIV-VL co-infected patients. Almost all the strains (20/23) from southwestern Ethiopia produced a 450 bp amplicon with smaller products (290 or 360 bp) only observed for three strains. Sudanese strains produced amplicons identical (290 bp) to those found in northwestern Ethiopia; while Kenyan strains gave larger PCR products (500 and 650 bp). High-resolution melt (HRM) analysis distinguished the different PCR products. Sequence analysis showed that the k26 repeat region in L. donovani is comprised of polymorphic 13 and 14 amino acid motifs. The 13 amino acid peptide motifs, prevalent in L. donovani, are rare in L. infantum. The number and order of the repeats in L. donovani varies between geographic regions. Conclusions/Significance HASPB repeat region (k26) shows considerable polymorphism among L. donovani strains from different regions in East Africa. This should be taken into account when designing diagnostic assays and vaccines based on this antigen.
Assessment of Challenges in Export Marketing: The Case of Ethiopian Vegetable and Fruit Commercial Growers  [PDF]
Mohammed Alebachew Sisay
iBusiness (IB) , 2018, DOI: 10.4236/ib.2018.101001
Abstract: Globalization forces companies to internationalize their operation in the global market. Exporting plays a vital role in economic development of a nation as well as for the development of the particular exporting company. Although, the benefits derived from exporting in an increasingly globalized marketplace are enormous, but for many companies, exporting is constrained by numerous challenges. The purpose of the study was to assess export marketing challenges of Ethiopian vegetable and fruit commercial growers. The study investigated 20 Ethiopian vegetable and fruit commercial growers and 8 stakeholders with questionnaires and interviews. The research utilized a mixed research design and analysis techniques specifically concurrent embedded approach. It is found out that the Ethiopian vegetable and fruit commercial growers export volume and sales lacks consistency and constrained by different challenges. Of the major challenges which were classified as internal barriers and external barriers, macro environmental barriers highly affected the growers. Local investors were highly affected by both the internal and external problems whereas foreign and joint ventures are affected in some extent with those problems. Less experienced growers were highly affected by the export problems than those who are more experienced. Management commitment problem; technological advancement problem; financial; lack of accessible transport system; low awareness of stakeholders; seasonality of Ethiopian supply; shortage of cargo; shortage of infrastructure; government bureaucracy; lack of potential markets; and shortage of inputs were identified as problems for the vegetable and fruit export. Therefore, to minimize these problems creating enabling policy environment; fair and competitive air freight cost; the growers to incorporate challenges in their export marketing strategy; the government to explore new markets, provide technical supports and long-term loans to growers; to create new competitive input suppliers; integration of stakeholders of the sector; and to recruit skilled manpower are forwarded as recommendations.
Declaration of Statehood by Somaliland and the Effects of Non-Recognition under International Law  [PDF]
Temesgen Sisay Beyene
Beijing Law Review (BLR) , 2019, DOI: 10.4236/blr.2019.101012
Abstract: After the downfall of the Socialist and military Siad Barre regime in Somalia, Somaliland took an immediate action of independent declaration of statehood from its failed “parental state”, Somalia. It has been almost twenty five years since Somaliland declared its independence, established its own government, kept the peace, and managed to flourish in a kind of stability. Nevertheless, the international community has not recognized its act. Among the former Somali Republic territories, it is now only Somaliland that secured democratic and stable government and sustainable peace in the region. Somalia, which was part and “heir” of the former Somali Republic, is now unstable and even challenged by the Islamist extremist group, Al-Shabab. Somaliland, once under the colonial power of the British Empire like other African countries, argues it should be recognized as an independent state. This article investigates the legal understandings of statehood, from the Montevideo Convention to the more recent emphasis on self-determination, and then turns to the case of Somaliland, arguing that Somaliland deserves statehood status and other states should recognize it as a state as there is no legal ground under international law that justifies an otherwise position.
Predictors of Perinatal Mortality Associated with Placenta Previa and Placental Abruption: An Experience from a Low Income Country
Yifru Berhan
Journal of Pregnancy , 2014, DOI: 10.1155/2014/307043
Abstract: A retrospective cohort study design was used to assess predictors of perinatal mortality in women with placenta previa and abruption between January 2006 and December 2011. Four hundred thirty-two women (253 with placenta previa and 179 with placental abruption) were eligible for analysis. Binary logistic regression, Kaplan-Meier survival curve, and receiver operating characteristic (ROC) curve were used. On admission, 77% of the women were anaemic (<12?gm/dL) with mean haemoglobin level of 9.0?±?3.0?gm/dL. The proportion of overall severe anaemia increased from about 28% on admission to 41% at discharge. There were 50% perinatal deaths (neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation). In the adjusted odds ratios, lengthy delay in accessing hospital care, prematurity, anaemia in the mothers, and male foetuses were independent predictors of perinatal mortality. The haemoglobin level at admission was more sensitive and more specific than prematurity in the prediction of perinatal mortality. The proportion of severe anaemia and perinatal mortality was probably one of the highest in the world. 1. Introduction Placenta previa (placenta implanted over the internal cervical os) and placental abruption (premature separation of normally implanted placenta) are the major causes of antepartum haemorrhage in the third trimester of pregnancies and major contributors of obstetric haemorrhage in general [1]. Each of these conditions has a prevalence rate of 0.5% to 2% in most parts of the world [2–4]. Because of the changes in the lower uterine segment length and placental migration as the pregnancy advances, the prevalence of placenta previa has an inverse relation to the gestational age [5]. In other words, it is suggested that reporting of placenta previa in early gestation is likely to overestimate its actual prevalence at term. Placenta previa and placental abruption have long been recognized as major obstetric complications that result in maternal and fetal mortality as well as morbidity. The effect of these two bloody obstetric complications on perinatal health is multifactorial: blood loss, premature delivery, intrauterine growth restriction, the risk of perinatal asphyxia, the risk of sepsis, and hyperbilirubinemia [2, 6–8]. A Danish national cohort study was associated with an increased risk of neonatal mortality, prematurity, low Apgar scores, low birthweight, and transfer to a neonatal intensive care unit [9]. Several other studies from developing countries have also shown that pregnant women complicated by
Intestinal parasitosis and shigellosis among diarrheal patients in Gondar teaching hospital, northwest Ethiopia
Kahsay Huruy, Afework Kassu, Andargachew Mulu, Netsanet Worku, Teshome Fetene, Simon Gebretsadik, Fantahun Biadglegne, Yeshambel Belyhun, Abebe Muche, Aschalew Gelaw, Belay Anagaw, Sisay Yifru, Yemataw Wondie, Assegedech Bekele, Moges Tiruneh, Dieter Reissig, Feleke Moges
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-472
Abstract: A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures.Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was Entamoeba histolytica/dispar (7.3%) followed by Giardia lamblia (5.0%), Cryptosporidium parvum (1.8%) and Isospora belli (1.3%). The dominant helminthic parasite identified was Ascaris lumbricoides (5.5%) followed by Strongyloides stercoralis and Schistosoma mansoni (3.1% each), hookworm infection (1.8%), and Hymenolepis species (1.3%). Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria Shigella and Salmonella species were isolated from 15.6% and 1.6%, respectively, of the patients. Escherichia coli O57:H7 was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the Shigella and Salmonella isolates were resistant to one or more commonly used antibiotics, respectively.Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (P < 0.05). Statistically significant associations were also observed between Shigella infections and patients who were using well and spring water for household consumption, and patients who had dysentery and mucoid stool (P < 0.05).The high prevalence of intestinal parasites and Shigella species in diarrheic patients calls for institution of appropriate public health intervention measures to reduce morbidity and mortality associated with these diseases. The rational use
Arginase Activity - A Marker of Disease Status in Patients with Visceral Leishmaniasis in Ethiopia
Tamrat Abebe equal contributor,Yegnasew Takele equal contributor,Teklu Weldegebreal,Tom Cloke,Ellen Closs,Camille Corset,Asrat Hailu,Workagegnehu Hailu,Yifru Sisay,Karina Corware,Margaux Corset,Manuel Modolell,Markus Munder,Fabienne Tacchini-Cottier,Ingrid Müller,Pascale Kropf
PLOS Neglected Tropical Diseases , 2013, DOI: 10.1371/journal.pntd.0002134
Abstract: The underlying mechanisms resulting in the profound immune suppression characteristic of human visceral leishmaniasis (VL) are not fully understood. Here, we tested the hypothesis that arginase, an enzyme associated with immunosuppression, is higher in patients with VL and contributes to impaired T cell responses. We recruited patients with VL before and after treatment and healthy controls and measured the arginase metabolism in the blood of these individuals. Our results show that arginase activity is significantly higher in the blood of patients with active VL as compared to controls. These high levels of arginase decline considerably once the patients are successfully treated. We identified the phenotype of arginase-expressing cells among PBMCs as neutrophils and show that their frequency was increased in PBMCs of patients before treatment; this coincides with reduced levels of L-arginine in the plasma and decreased expression levels of CD3ζ in T cells.
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