Ethiopian Public Health Institute Research Articles

Establishment of COVID-19 testing laboratory in resource-limited settings: challenges and prospects reported from Ethiopia

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.

Association between maternal mortality and caesarean section in Ethiopia: a national cross-sectional study

BackgroundSeveral studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia.MethodsAnalysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05.ResultsThe overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 livebirths. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51–104) per 100,000 livebirths in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2–20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1–38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2–6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant.ConclusionsAt national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.

Improving Confirmatory Testing for the Antimicrobial Resistance Surveillance Network in Ethiopia

Background: In July 2017, the Ethiopian Public Health Institute (EPHI) launched an antimicrobial resistance (AMR) surveillance network at 4 sentinel laboratories. The National Clinical Bacteriology and Mycology Laboratory (NRL) at EPHI performs monthly confirmatory testing on a subset of isolates submitted by these sites. We assessed the existing confirmatory testing program to identify gaps and develop solutions, including a monitoring and evaluation (M&amp;E) system. Methods: We assembled a technical working group (TWG) of key stakeholders. Laboratory site visits included workflow observation, process mapping, document review, and technologist interviews. Proposed solutions to observed gaps were drafted in formats consistent with their intended application. Feedback from the TWG was incorporated into final drafts. Available AMR network staff members were trained remotely, and they will train remaining staff. Results: Table 1 describes major gaps and solutions identified. Conclusions: Confirmatory testing provides a mechanism to evaluate laboratory testing proficiency, target improvements, and estimate surveillance data quality, yet standardized methods were lacking. Our efforts highlight key components of confirmatory testing programs and provide a model for use in laboratories with similar needs.Funding: NoneDisclosures: None

Incorporating Telementorship Into Laboratory Capacity Building Initiatives for Improved AMR Surveillance in Ethiopia

Background: In July 2017, recognizing the threat that antimicrobial resistance poses to the population, the Ethiopian Public Health Institute (EPHI) launched the Ethiopia AMR Surveillance Network at 4 sentinel laboratories. Simultaneously, laboratory capacity building was initiated to ensure the reporting of quality laboratory data to the surveillance system. One initiative, Project ECHO (Extension for Community Healthcare Outcomes) was used to virtually connect subject matter experts with participating laboratories in remote settings to provide ongoing education and telementoring and to foster peer-to-peer learning and problem solving in microbiology. The 10-month project was supported by the Centers for Disease Control and Prevention (CDC) and the American Society for Microbiology (ASM).Methods: Biweekly 1-hour sessions were held by ASM for 2 sentinel sites, Tikur Anbessa Specialized Hospital and the EPHI Clinical Microbiology and Mycology Laboratory, using a videoconferencing platform. Each virtual session consisted of a didactic session, a case presentation by a participating laboratory, open discussion and feedback. Case presentations focused on technical challenges and problems encountered in the preanalytical, analytical, and postanalytical phases of microbiology testing. Experts from CDC and ASM provided feedback along with a summation of key learning objectives. Sessions were recorded and post session reports were shared with participants. To assess participants’ baseline knowledge, a comprehensive pretest was administered prior to the first session. The same instrument was administered as a posttest 2 weeks after the final session. Unstructured interviews were also conducted to assess participants’ perceptions of the value of ECHO to their work. Results: Mean pretest scores were 69.25% and the posttest scores were 71.04%, a difference of 1.79% (P = NS). Participant interviews revealed perceived benefits of ECHO participation to include enhanced critical thinking and problem resolution in microbiology, increased communication and improved working relationships between participating sites, and improved understanding and application of CLSI standards. As a result of Ethiopia’s participation in Project ECHO, 23 case presentations have been added to ECHO Box, a resource bank and web portal, which allows members of the ECHO community to share and access didactics, documents, and learning materials. Conclusions: Despite minimal difference between pretest and posttest scores, the Project ECHO experience of virtual case-based learning and collaborative problem solving has encouraged critical thinking, peer-to-peer learning, networking among participants, and has provided microbiologists with the resources for improved bacterial isolation, identification, and antibiotic susceptibility testing. The lessons learned could be applied as this project is expanded to additional laboratories in the AMR Surveillance Network.Funding: NoneDisclosures: None

Epidemiological characteristics and treatment outcomes of hospitalized patients with COVID-19 in Ethiopia.

coronavirus disease (COVID-19) has been identified as the cause of an outbreak of respiratory illness which epidemiologically linked to the seafood and wet animal wholesale market in Wuhan, Hubei Province, China. Since there is paucity of research on characteristics and treatment outcomes of COVID-19, the finding of this study will helps to provide insight for the effectiveness of measures to fight against coronavirus disease in resource-limited countries. a retrospective review of released data about cases in daily bases and documents from Ethiopian public health institute website. In this article, we included and analyzed data of cases from 13 March to 13 May 2020 which were available at the time of the review. a total of 263 cases were included (median age, 34 years [range, 0.9-85 years]; 76% male). COVID-19 cases among age group 15-24 years and 25-34 years were 92(35%) and 76(28.9%) respectively. More than half (55.5%) of cases had travel history abroad and African countries are the leading 64(24.3%). About 167(63.5%) cases were identified based on symptom-based surveillance and the finding confirmed an interrupted kind of epidemiological curve. Whereas, one-third (41.1%) were recovered and the overall case fatality rate was 1.9%. Four out of five patients in ICU were deceased after 2-6days spent in critical care. an integrated action includes the provision of health education to youths, taking measures to rise up treatment outcomes, enhancing ICU care quality. Moreover, tightening prevention and restriction measures to flattening the curve and also establishment of fast detection and advanced treatment of cases were critically requires through the patriotic efforts of frontline health workers, leaders, and stakeholders.

Magnitude and determinants of obstetric case fatality rate among women with the direct causes of maternal deaths in Ethiopia: a national cross sectional study

BackgroundIn sub-Saharan Africa, maternal death due to direct obstetric complications remains an important health threat for women. A high direct obstetric case fatality rate indicates a poor quality of obstetric care. Therefore, this study was aimed at assessing the magnitude and determinants of the direct obstetric case fatality rate among women admitted to hospitals with direct maternal complications.MethodsIn 2015, the Ethiopian Public Health Institute conducted a national survey about emergency obstetric and newborn care in which data about maternal and neonatal health indicators were collected. Maternal health data from these large national dataset were analysed to address the objective of this study. Descriptive statistics were used to present hospital specific characteristics and the magnitude of direct obstetric case fatality rate. Logistic regression analysis was performed to examine determinants of the magnitude of direct obstetric case fatality rate and the degree of association was measured using an adjusted odds ratio with 95% confidence interval at p < 0.05.ResultsOverall, 335,054 deliveries were conducted at hospitals and 68,002 (20.3%) of these women experienced direct obstetric complications. Prolonged labour (23.4%) and hypertensive disorders (11.6%) were the two leading causes of obstetric complications. Among women who experienced direct obstetric complications, 435 died, resulting in the crude direct obstetric case fatality rate of 0.64% (95% CI: 0.58–0.70%). Hypertensive disorders (27.8%) and maternal haemorrhage (23.9%) were the two leading causes of maternal deaths. The direct obstetric case fatality rate varied considerably with the complications that occurred; highest in postpartum haemorrhage (2.88%) followed by ruptured uterus (2.71%). Considerable regional variations observed in the direct obstetric case fatality rate; ranged from 0.27% (95% CI: 0.20–0.37%) at Addis Ababa city to 3.82% (95% CI: 1.42–8.13%) at the Gambella region. Type of hospitals, managing authority and payment required for the service were significantly associated with the magnitude of direct obstetric case fatality rate.ConclusionsThe high direct obstetric case fatality rate is an indication for poor quality of obstetric care. Considerable regional differences occurred with regard to the direct obstetric case fatality rate. Interventions should focus on quality improvement initiatives and equitable resource distribution to tackle the regional disparities.

Preparation of In-House Quality Control Human Serum for Urea and its Use in Clinical Chemistry.

Quality control materials play a vital role in the laboratory internal and external quality assessment program. However, Ethiopia and other developing countries are challenged by the unavailability and high cost of commercial control material. Therefore, preparing in-house quality control human serum will be a cost-effective way to obtain QC material for use in poor settings in a country like Ethiopia. To prepare urea in-house control human serum and scientifically evaluate it with commercially available sera already in use in the clinical chemistry laboratory of the Ethiopian Public Health Institute. The urea in-house quality control human serum was prepared as per ISO Guide 80, a guideline document protocol from 57 participants' normal serum specimens at the Ethiopian Public Health Institute clinical chemistry laboratory. The quality control material was analyzed on a fully automated chemistry analyzer (Cobas 6000). The initial 20 values were used for calculation of means, standard deviation (SD) and coefficient of variation (CV). Results were compared with those of commercially available lyophilized human sera. The average concentrations of urea were found to be near the middle of the physiological range of healthy subjects and the in-house serum could be a good substitute for the commercial serum of normal range. The prepared in-house quality control human serum is stable for about three months without any alterations in the concentration of urea. Well prepared in-house quality control human serum is a good substitute for commercially available control serum of normal range, especially in a developing country like Ethiopia.

Incidence of maternal near miss among women in labour admitted to hospitals in Ethiopia

ObjectivesTo assess the incidence of maternal near miss and contributing factors among hospitals in Ethiopia. The study also assessed the ability of hospitals to provide signal functions of emergency obstetric care and its regional distribution. DesignA national dataset accessed from the Ethiopian Public Health Institute were analysed to assess the incidence of maternal near miss and mortality index among women admitted to hospitals with obstetric complications. SettingMaternal health indicators including obstetric complications, maternal deaths and births conducted at all hospitals available in Ethiopia were included. MeasurementsThe maternal near miss incidence ratio, which is the number of near miss cases per 1,000 live births, and the mortality index were presented descriptively. Chi-squared test at p value ≤ 0.05 was used to assess the presence of significant regional differences of the provision of signal functions of emergency obstetric care. ResultsIn 2015, 78,195 women were admitted to hospitals with both the direct (68,002) and indirect (10,193) causes of maternal mortality. Of women who experienced the direct causes, 435 died which means there were 67,567 maternal near miss cases. In the same year, 323,824 live births were reported in hospitals, making the crude maternal near miss incidence ratio of 20.8% (9.1-38.8%) and mortality index of 0.64% (435/68,002) for the direct causes of maternal mortality. A significant regional variation was observed with regard to incidence of maternal near miss, mortality index and the provision of signal functions of emergency obstetric care. Administration of parenteral antibiotics was the most frequently practiced signal function of emergency obstetric care while blood transfusion was the least provided signal function. ConclusionsIn Ethiopian hospitals, the incidence of maternal near miss was unacceptably high. A significant regional variation was detected with regard to maternal near miss incidence ratio, mortality index and the provision of signal functions of emergency obstetric care. The Ethiopian government needs to work on equitable resource distribution and quality improvement initiatives in order to close the detected regional variations. Implications for practiceThe Ethiopian government needs to practice evidence-based maternal health strategies, including capacity building of the regional hospitals in order to improve the distribution of resources and quality of maternal health.

English

Antimicrobials have been playing an important role in preventing illness and death associated with infections due to bacteria. However, the emergence and spread of resistance by pathogens have decreased the effectiveness of the commonly prescribed antimicrobials. Intestinal Escherichia coli are among bacterial pathogens that are endowed with such resistance traits because they are important source and reservoir of genes that encode antimicrobial resistance. To determine the antimicrobial resistance profile of fecal isolates of E. coli from diarrheic patients. Stool samples were collected consecutively from 100 individuals who visited Selam Health Center during the study period, April to June 2018. Samples were collected and transported under sterile condition to the National Clinical Bacteriology and Mycology reference Laboratory, Ethiopian Public Health Institute. The samples were streaked on MacConkey agar and incubated overnight at 37°C. E. coli isolates were further confirmed using conventional biochemical tests. Antimicrobial susceptibility status was determined using the disk diffusion method on Mueller Hinton agar as recommended by the Clinical Laboratory Standard Institute. The raw data was compiled and entered to spreadsheet and analysis was done using SPSS Version 20 with p-value ≤0.05 considered statistically significant. Out of the 100 patients, 43 were female and the rest were male. Confirmed E. coli were isolated from 73 individuals. Antimicrobial susceptibility testing showed that E. coli isolated in this study were highly resistant to trimethoprim-sulfamethoxazole 49 (67.1%) and amoxicillin-clavulanic acid 47(64.4 %). No isolates showed resistance to gentamicin and tobramicin. Of all the isolates, 11(15.1%) were multidrug resistant. No association was observed between antimicrobial resistance status and sex of individuals included in this study. However, there was an association between age and resistance patterns. Resistance to commonly prescribed antibiotics among E. coli isolated in this study was high and a considerable proportions of the strains were multidrug resistant. This is an indication for an alarming rate of resistance of intestinal E. coli to first line antimicrobials. To reduce the problem, regular monitoring and education for the community are very important. Key words: Escherichia coli, antibiotic susceptibility, multidrug resistant, Ethiopia, biochemical tests, disk diffusion.

A35 The first laboratory confirmation of chikungunya outbreak in Ethiopia

Chikungunya is a viral disease (genus Alphavirus) which is transmitted to humans by infected mosquitoes—including Aedes aegypti and A. albopictus. An outbreak of febrile illness, suspected to have been caused by chikungunya, was reported in June 2016 from Dolloado district, Suuf Kebele, in the Somalia regional state of Ethiopia that borders the Mandera county of Kenya where a confirmed chikungunya outbreak was ongoing. Laboratory investigation was carried out to confirm if the outbreak in Ethiopia was caused by Chikungunya virus. Ten serum samples were collected from suspected patients visiting a health center in Suuf Kebel, who were then sent to the Nation laboratory in Ethiopian Public Health Institute. RNA was extracted from the serum samples using QIAgene RNA Mini kit, and PCR detection of dengue, chikungunya, and Zika virus nucleic acid was done using Trioplex Real-time RT-PCR Assay following the protocol from the Center for Disease Control (CDC). The Trioplex Real-time RT-PCR assay, for detection and differentiation of RNA from dengue, Chikungunya and Zika, was provided by CDC as part of the zika emergency preparedness effort. Of the nine samples tested, eight (88.88%) were found to be positive for chikungunya virus nucleic acid but negative for dengue and Zika virus nucleic acids. The median age of the affected sampled patients was 40 years, and males appear to be more affected (66.6% of sampled patients). The laboratory investigation confirmed that the outbreak was caused by chikungunya virus. Even though further molecular characterization of the positive isolates will provide more information as to the circulating genotypes and elucidate the origin of the outbreak virus, it is also possible to assume that the outbreak was an extension of the outbreak in neighboring countries in Kenya and, therefore, warrants that cross-border integration efforts to control chikungunya should be implemented by the concerned countries.

Prevalence of tuberculosis, multidrug resistant tuberculosis and associated risk factors among smear negative presumptive pulmonary tuberculosis patients in Addis Ababa, Ethiopia

BackgroundThe diagnoses of active smear negative PTB, remains difficult. As a result, treatment is often carried out empirically relaying on clinical criteria. The distribution and magnitude of smear negative PTB, smear negative MDR-TB and associated factors in the same day diagnosis strategy are not clearly known in the study area. Therefore, this study aimed to determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear negative pulmonary tuberculosis patients in Addis Ababa, Ethiopia.MethodsAnalytic cross sectional study design was used. A total of 418 smear negative presumptive pulmonary TB patients were enrolled from selected health facilities since August 01, 2017 to January 5, 2018. Sputum samples were examined by Ziehl Neelsen microscopy, Xpert MTB/RIF assay and Culture. Drug susceptibility testing was performed by line probe assay and BACTEC MGIT 960 system. These laboratory tests were performed in Ethiopian Public Health Institute, National TB Reference Laboratory. Data was analyzed by SPSS Ver.20.ResultsFrom the total of 418 enrolled patients, 27 (6.5%) were Xpert MTB/ RIF and 26 (6.4%) were culture confirmed smear negative PTB patients. The positivity rate among male and female was 10.2 and 3.5% (p = 0.005) respectively. From 26 culture positive isolates 3 (11.54%) were MDR TB; from MDR-TB confirmed isolates 2/23 (8.7%) were among new and 1/3 (33.3%) was among retreatment smear negative presumptive pulmonary TB patients. All Rifampicin resistant smear negative pulmonary TB isolates by Xpert MTB/ RIF assay were found to be MDR TB and 7/26 (26.9%) isolates were INH mono resistant. History of migration found to be a potential factor for developing smear negative pulmonary TB.ConclusionIn this study a significant proportion of smear negative pulmonary TB was diagnosed. Furthermore, a high smear negative multi drug resistant (MDR) TB and other mono drug resistant TB prevalence was confirmed. Due to the limitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are missed to be diagnosed and transmission continues in the community.

Methodology for developing and evaluating food-based dietary guidelines and a Healthy Eating Index for Ethiopia: a study protocol

IntroductionFood-based dietary guidelines (FBDGs) are used to promote and maintain healthy eating in a population, by providing country-specific guidance. However, many African countries like Ethiopia do not have FBDGs. This...

Fluoride, Total Dissolved Solid and Electrical Conductivity in Drinking Water Supplies Analyzed in EPHI from April 2017 to December 2018

This retrospective study is aim to examine the Fluoride, Total dissolved solid and Electrical conductivity in drinking water supplies of Ethiopia. The study used 345 water samples data that collected from seven regions plus two administrative cities of the country, which were tested in Environmental Public Health Chemistry Laboratory at Ethiopian Public Health Institute from April 2017 to December 2018 and from these 226, were from well water, 97 from piped and the remaining 22 were from spring water samples. The results of the water samples analysis indicate that the fluoride concentration, total dissolved solid and electrical conductivity in the water sample varied from 0.0 mg/L to 16.96mg/L, 0.25 mg/L to 3360mg/Land 2.04 µS/cm to 4430µS/cm respectively. Generally in analyzed data, 33.6% (n = 76), 55.8% (n=126) and 54.4% (n=123) of the well water samples, 60.8% (n = 59), 99% (n=96) and 99% (n=96) of the piped water samples and 68.2% (n=15), 91% (n=20) and 91% (n=20) of the spring water samples are below 0.5 mg/L, 500mg/l and 700 µS/cm of fluoride, total dissolved solid and electrical conductivity concentration respectively. on the other hand, 24% (n = 54), 9.3% (n=21) and 8.4% (n=19) of the well water samples, 7.2% (n = 7), 1% (n=1) and 1% (n=1) of the piped water samples and 4.6% (n = 1), 4.6% (n = 1) and 4.6% (n = 1) of the spring water samples had fluoride, total dissolved solid and electrical conductivity concentration higher than WHO and national standards maximum allowable concentration (i.e. 1.5mg/l, 1000mg/L and 1500µS/cm) respectively. According to the result obtained, the water sources require a sustainable corrective action in order to alleviate the effect of fluoride, total dissolved solid and electrical conductivity in human health. Hence, the result of this retrospective study will use as base to health authorities as well as other responsible body for the management of water supply regarding fluoride, total dissolved solid and electrical conductivity.

Epidemiological Description of Dengue Fever Outbreak in Kebridhar District, Somali Region, Ethiopia – 2017

Dengue fever is caused by dengue virus (DENV), a member of the genus <i>Flavivirus</i>, family <i>Flaviviridae</i>. The virus is transmitted by the infected female mosquito called <i>Aedes aegypti</i>. There are four serotypes, DENV1 through DENV4. Dengue fever is one of the most important re-emerging arboviral disease, more than half of the world’s population are at risk of this disease. Starting from 2013 over 12,000 cases were reported from Ethiopia. Descriptive cross-sectional study design was applied to describe dengue fever outbreak data from Kebridhar District reported to Ethiopian Public Health Institute from May to June 2017. Ratios, proportions and rates were analyzed by using Microsoft excel and findings were presented by narrations, frequency distributions and graphs. A total of 101 dengue fever cases were reported from Kebridhar District of Somali Region. Sixty-eight-point three percent (69/101) were males and 9.9% (10/101) cases were hospitalized. The positivity rate of dengue virus was 76.9% (10/13). The median age of cases was 27 years (IQR: 22 – 38). The case fatality rate was zero and the attack rate was 86 cases per 100,000 population. Eighteen-point eight percent (19/101) cases had bleeding. All cases reported that, they had open water containers, no spraying of houses for six months prior to the onset of the fever and bed net utilization rate was 30.7%. Males and 50 – 54 years old individuals were highly affected groups. Ministry of Health Regional Health Bureau and District Health Office should work on vector and environmental control activities.

Spatial Variations in Utilization of Modern Contraceptives in Ethiopia

Background: Even though modern contraceptives are known to be important for fertility control, utilization of these services varies across different geographical areas. A geographically linked data analysis using population and health facility data is important to investigate and map the use of family planning services. Thus, this study aimed to assess the spatial patterns of modern contraceptive use and to identify its associated factors among married women in Ethiopia. Method: A secondary data analysis of the 2016 Ethiopia Demographic and Health Survey and the 2014 Ethiopian Service Provision Assessment was conducted. A multilevel analysis was conducted to identify the potential factors associated with the use of modern contraceptives among married women in Ethiopia using the SAS GLIMMIX procedure. Furthermore, a spatial analysis was done to identify the potential hot spot areas of modern contraceptive prevalence rates using ArcGIS. Results: Being exposed to family planning messages, having a higher number of living children, husbands'/partners' education level, and wealth were strongly associated with increased use of modern contraceptives. More importantly, a one unit increase in the mean score of health facilities' readiness to provide short-term modern contraceptives in a typical region was associated with a 20 fold increase in the odds of modern contraceptive use. 24.47% of the variation in the use of modern contraception was accounted for by location. Moreover, the spatial analysis found that Addis Ababa and the Amhara region had high clusters of modern contraceptive use rates as compared to clusters of low contraceptive use rates in the Afar and Somali regions. Conclusion: There were significant variations in the use of modern contraceptives across the different regions of Ethiopia. Therefore, regions with low contraceptive rates and high fertility rates should be targeted for scaling up and tailoring of services to the lifestyles of the population of those regions. Funding: Not applicable. Declaration of Interest: The authors declared that they have no competing interests. Ethical Approval: Ethical approval was obtained from the Human Research Ethics Committee, The University of Newcastle. We also got the Ethiopian Public Health Institute (EPHI) and the Measure DHS program approval to access the datasets.

Antimicrobial resistance surveillance in Ethiopia: Implementation experiences and lessons learned.

IntroductionAntimicrobial resistance (AMR) poses a global threat. High levels of AMR to commonly used antibiotics have been reported in East Africa. A situation analysis of AMR in Ethiopia also indicated high resistance levels. To prevent and contain AMR, Ethiopia established a national surveillance network.ObjectivesThis article describes the steps taken to prioritise AMR and establish the National Antimicrobial Resistance Surveillance System in Ethiopia, as well as present the challenges and lessons learned through implementation.MethodsIn April 2017, Ethiopia had developed and approved the National AMR Surveillance Plan for laboratory-based AMR surveillance. The World Health Organization recommendations and Ethiopias’s current microbiology capacity were used to prioritise organisms for reporting. The surveillance system is comprised of a network linking the national reference laboratory with surveillance sentinel sites. Roll-out of the AMR surveillance network occurred in three phases in order to ensure successful implementation.ResultsElectronic capture and transmission of data, supply chain for the microbiology laboratory and communication problems were challenges observed after implementation started. Support from Ethiopian Public Health Institute focal persons for data entry, regular scheduled communication establishment and procurement of supplies by the American Society for Microbiology were some of the measures taken to address the challenges.ConclusionEthiopia has demonstrated that setting up AMR surveillance in lower resource settings is possible with strong leadership and stakeholder engagement.

Organoleptic and palatability properties of drinking water sources and its health implications in Ethiopia: a retrospective study during 2010-2016

Background: This retrospective study aimed to investigate the physicochemical properties of drinking water sources in Ethiopia and compare the water quality with the health-based target. For this purpose, the water quality database of Ethiopian Public Health Institute (EPHI) from 2010 to 2016 was used. Methods: The concentration and other properties of the water samples were analyzed according to the Standard Methods of Water and Wastewater analysis. Quality control and quality assurance were applied in all stages following our laboratory standard operation procedures (SOPs). Results: The concentration of the selected parameters varied based on the type of water sources. The mean concentration of turbidity was higher in spring water (21.3 NTU) compared to tap (12.6 NTU) and well (3.9 NTU) water sources. The mean concentration of total dissolved solids (TDS), electrical conductivity (EC), sodium (Na+), and sulfate (SO4 -2) was found to be higher in spring water sources than tap and well water sources. Comparably, the concentration of hardness, calcium, and magnesium was found to be higher in well water sources than spring and tap water sources. The bivariate analysis indicated that out of 845 analyzed water samples, more than 50% of the samples from Oromia region had turbidity, pH, TDS, hardness, Ca++, K+, and Na+ within an acceptable limit. In addition, the logistic regression analysis showed that water quality parameters were strongly associated with the type of water sources and regional administration at P&lt;0.05. Conclusion: More than 80% of the samples analyzed from drinking water sources were in agreement with WHO guidelines and national standards. However, the remaining 20% specifically, pH (25%), calcium (20%), hardness (18.1%), TDS (15.5%), and turbidity (13.3%) analyzed from improved water sources did not comply with these recommendations. Due to objectionable or unpleasant taste, people may force to look for alternative unprotected water sources that lead to health concerns.

Virological and bacteriological quality of drinking water in Ethiopia

Background: Since unsafe water is responsible for serious illness, deaths due to highest burdens of diseases and greatest economic failure, monitoring the quality of water is essential. Water Quality monitoring is assessed widely using different indicators. Bacterial and viral indicators provide more complete picture of water quality. Virological quality of water hasn’t been assessed in most countries including Ethiopia. The use of E. coli CB390 minimizes resource and time to perform the tests in simultaneous detection of somatic and male-specific coliphages. Methods & Materials: A cross sectional study was conducted on 218 drinking waters samples collected from various regions of Ethiopia from February to June 2016 to assess water quality using coliphages by the help of CB390 E. coli host, plaque assay; Multiple tube fermentation method for coliforms and pour plate technique for counting heterotrophic bacteria at Ethiopian Public Health Institute. The data were analyzed using SPSS 20. Results: Heterotrophic bacteria, total and thermotolerant coliforms, E. coli and phages were detected in 72.9%, 51.8%, 38.5%, 23.9% and 2.3% of the total samples respectively. Heterotrophic plate count greater than 100 CFU/ml were noted in 41 (18.8%) samples and detections of total and thermotolerant coliforms and E. coli in 38 (17.4%), 24 (11.0%) and 10 (4.6%) samples respectively and no detection of phages in chlorinated waters. While, Heterotrophic plate count greater than 100 CFU/mL were observed in 100 (45.9%) samples and detections of total and thermotolerant coliforms, E. coli and coliphages in 75 (34.4%), 60 (27.5%), 42 (19.3%) and 5 (2.3%) samples respectively for untreated waters. Conclusion: Majority of the waters contained indicators above standard limits. This indicates that the sources are contaminated with environmental and fecal contaminants signifying poor quality and it is a potential threat to human and animals health. Hence regular water monitoring using various indicators should be a priority agenda by all stake holders.

Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia

IntroductionImproving complementary feeding in Ethiopia requires special focus on dietary diversity. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is a government-led multisectoral intervention that aims to integrate the work...

Mycological and Bacteriological Quality and Safety of Bottled Water in Ethiopia.

Background:Safe water supply is vital and can result in significant benefits to health. However, contaminated bottled water poses a great health risk due to the poor microbiological quality of water.Methods and Materials:A retrospective study was conducted on 222 Bottled water samples collected from various regions of Ethiopia from January 2008 to December 2015, tested and recorded in Ethiopian Public Health Institute to determine heterotrophic plate count and Staphylococcus aureus by pour plate method; for coliforms using multiple tubes fermentation techniques; for mould and yeast count using spread method, and for Salmonellae and Shigella spp. using ES ISO 6579 and ES ISO 21567. The data was analyzed using SPSS 20 statistical package.Results:Among the total samples examined from 44 brands, detections of heterotrophic plate count, mould, yeast, total and thermotolerant coliforms, Escherichia coli and Staphylococcus aureus were observed in 114 (51.4%), 33 (14.9%), 5 (2.3%), 2 (0.9%), 1 (0.5%), 1 (0.5%) and 1 (0.5%) samples respectively, but there were no detections of Salmonellae nor Shigellae species.Conclusion:About 40% of bottled water samples were mycologically and bacteriologically unsafe for human consumption. To prevent public health hazards, regular monitoring of bottled water using quality indicators should be a priority agenda.