Gondar University Teaching Hospital Research Articles

Time to recovery from obstetric fistula and determinants in Gondar university teaching and referral hospital, northwest Ethiopia

BackgroundObstetric fistula is an abnormal connection between the vagina and rectum and/or bladder, which leads to continuous urinary or fecal incontinence. It is a serious problem in the world poorest countries, where most mothers give birth without any medical care. In most cases obstetric fistula is preventable and can be treated successfully, if it is carried out by a competent surgeon with a good follow-up of postoperative care. However, there remains to explore more on the duration of obstetric fistula recovery and determinant factors. The aim of this study was to estimate the average recovery time of obstetric fistula and to identify its determinants in Gondar University teaching and referral hospital, northwest Ethiopia.MethodA retrospective follow up study was conducted at Gondar University teaching and referral hospital. A total of 612 fistula cases were included in the study and simple random sampling technique was applied to select the study subjects. Kaplan-Meier and log rank test were computed to explore the data. Weibull regression survival model with univariate frailty was done to identify the determinant factors of time to recovery.ResultsOf 612 fistula patients, 539(88.07%) were recovered. The Average (median) recovery time was 5.14 (IQR = 3.14, 9.14) weeks. Using Antibiotic (AHR = 1.49, 95% CI = 1.11–2.01), having history of antenatal care (ANC) (AHR = 1.95, 95% CI = 1.39–2.73), being literate (AHR = 2.23, 95% CI = 1.62–3.06), duration of bladder catheterization (AHR = 0.93, CI = 0.90–0.95) and being multiparous (AHR = 1.51, 95% CI = 1.17–1.96) were a significant predictors of the rate of recovery. Also, underweight (AHR = 0.45, 95% CI = 0.30–0.68), overweight (AHR = 0.56, 95% CI = 0.41–0.76), being obese (AHR = 0.41, 95% CI = 0.21–0.80), having extensive fistula (AHR = 0.82, 95% CI = 0.73–0.91), large fistula (AHR = 0.42, 95% CI = 0.23–0.78), medium width (AHR = 0.62, 95% CI = 0.43–0.91) and large width (AHR = 0.42, 95% CI = 0.23–0.78) were statistically significant predictors of the rate of recovery from fistula patients.ConclusionThe average recovery time from obstetric fistula patients was 5.14 weeks. Small Length and width of fistula, patients’ educational status (literacy), antibiotic use, history of antenatal care visits, normal BMI, short period catheterization and being multiparous were the significant determinate variables which shorten the recovery time of obstetric fistula.

Prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar University Teaching Hospital in 2014, northwest Ethiopia.

IntroductionThrombocytopenia is a common hematologic abnormality during pregnancy. Pregnant women with thrombocytopenia have a higher risk of bleeding excessively during or after childbirth, particularly if they need to have a cesarean section or other surgical intervention during pregnancy, labor or in the puerperium. The main aim of this study was to determine the prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar University Hospital, northwest Ethiopia.Materials and methodsA cross-sectional study was used to assess the prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar University Hospital from January to April 2015. A total of 217 pregnant women were included in the study and a structured pretested questionnaire was used to obtain sociodemographic information, nutritional factors, obstetrics and gynecological factors, history and clinical condition. Blood samples were collected for platelet count and other platelet parameters, which were determined by using SysmexKX 21 automation. The data were entered to Epi info version 6 software and analyzed using SPSS version 20 software. Bivariable and multivariable statistical analyses were used to evaluate the effect of independent variable over the dependent variable. A p-value of <0.05 was considered as statistically significant.ResultA total of 217 women receiving antenatal care service at Gondar University Hospital participated in the study. Thrombocytopenia among 19 pregnant women showed a prevalence of 8.8%. The mean ± standard deviation platelet count was 238.85×109/L (±74.57). Thrombocytopenia was significantly associated with patients who lived rurally (crude odds ratio =4.3, 95% confidence interval 1.48–12.76).ConclusionThe prevalence of thrombocytopenia was 8.8% predominantly with mild type of thrombocytopenia. Thrombocytopenia was higher among pregnant women who lived rurally. Therefore, health care providers should screen routinely for thrombocytopenia to avoid excessive bleeding during pregnancy, especially in women who live rurally.

Etiologic Agents of Bacterial Sepsis and Their Antibiotic Susceptibility Patterns among Patients Living with Human Immunodeficiency Virus at Gondar University Teaching Hospital, Northwest Ethiopia

Background. Bacterial sepsis is a major cause of illness in human immunodeficiency virus infected patients. There is scarce evidence about sepsis among HIV patients in Ethiopia. This study aimed to determine the etiologic agents of bacterial sepsis and their antibiotic susceptibility patterns among HIV infected patients. Methods. A cross-sectional study was carried out from March 1 to May 2, 2013. One hundred patients infected with HIV and suspected of having sepsis were included. Sociodemographic data were collected by interview and blood sample was aseptically collected from study participants. All blood cultures were incubated aerobically at 35°C and inspected daily for 7 days. The positive blood cultures were identified following the standard procedures and antimicrobial susceptibility testing was performed using disk diffusion technique. Data was entered by Epi-info version 3.5.1 and analysis was done using SPSS version 20. Results. Of the study participants, 31 (31%) confirmed bacterial sepsis. The major isolates were 13 (13%) Staphylococcus aureus, 8 (8%) coagulates negative staphylococci, and 3 (3%) viridans streptococci. Majority of the isolates, 25 (80.6%), were multidrug resistant to two or more antimicrobial agents. Conclusions. Bacterial sepsis was a major cause of admission for HIV infected patients predominated by Staphylococcus aureus and coagulase negative staphylococci species and most of the isolates were multidrug resistant.

The Frequency and Effects of CCR5 Delta 32 Allele in Gondar Population

HIV is the virus that causes AIDS. Its infection occurs by binding to CD4+ receptor and chemokine receptor 5 (CCR5). Recent studies have shown that reasons for progression and non-progression are multi factorial and may involve genetic, virological and immunological factors that influence HIV disease progression in various ways. Chemokine receptors act as important co receptors mediating the entry of the human immunodeficiency virus type 1 (HIV-1) into susceptible cells. The Δ32 mutation at the CCR5 locus is a well-studied example of natural selection acting in humans. Homozygous carriers of the Δ32 mutation are resistant to HIV-1. The aim of the present study was to assess the frequency of CCR5-Δ32 (Chemokine receptor delta 32 allele) in HIV-1 untreated individuals who visited Gondar university teaching hospital. 3 ml blood samples of fifty HIV-1 untreated seropositive individual and equal numbers of age and sex match seronegative individual who are exposed and uninfected were collected using EDTA coated vacutenous tubes. DNA from 1 ml blood samples was isolated using phenol-chloroform method. Specially designed primers, both forward and reverse was used to amplify the alleles of CCR5 using PCR (Polymerase chain reaction). Desirable data regarding study subjects were collected by using specifically designed questioner. SPSS 16 and EPI-info version 3.2 were used to analyze the data. The frequency of the homozygous CCR5 mutant allele was zero in the study population and there was statistically no significance difference between the frequency of the heterozygous allele among cases and controls. There was no homozygous mutant allele both in cases and controls in the present study. This may be due to small sample size and thus another study on the same population with large sample size is warranted to further confirm the result.

Bacteriological profile and drug susceptibility patterns in dacryocystitis patients attending Gondar University Teaching Hospital, Northwest Ethiopia.

BackgroundBacterial pathogens isolated from dacryocystitis patients are diverse and complex in terms of their distribution, prevalence, and antimicrobial susceptibility pattern. The clinical importance of microbial causes of dacryocystitis and pattern of drug resistance has not been reported in northwest Ethiopia. Moreover, the management of dacryocystitis is based on only clinical observation Therefore, this study attempted to identify and define clinical and microbiological characteristics of microbial agents of dacryocystitis and its antibiotic susceptibility patterns.MethodsA cross sectional study was conducted from January 2011-January 2012 among dacryocystitis patients attending ophthalmology outpatient department of Gondar University teaching Hospital. Sociodemographic and clinical data collection, microbiological analysis and antibiotic susceptibility test patterns were done following standard procedures.ResultsFrom the total of 51 dacryocystitis cases, bacterial origins were isolated among 31(60.8%) cases. The dominant isolates were Coagulase negative Staphylococci (CNS) 9(29.0%), Staphylococcus aureus (S. aureus) 6(19.4%), and Pseudomonas species 3(9.7%). S. pneumoniae, Entrobacter species, K. pnemoniae and H. influenzae were each accounted 6.5% isolation rate. Among the commonly prescribed antimicrobials tested for susceptibility pattern; amoxicillin 38.7%, ciprofloxacin 25.8%, chloramphinicol 25.8%, co-trimoxazole 25.8%, and ampicillin 19.4% were resistant to the overall bacterial isolates identified. Only Citrobacter species were sensitive to all antibiotics tested but the rest bacterial isolates were resistant for at least to one, two, three, four and more antibiotics tested. Overall, 9(29.0%) of the bacterial isolates were resistant to only one antibiotics and resistance to two, three and four antibiotics each accounted 5(16.1%) rate.ConclusionsThough the information derived from this study was very meaningful, further studies encompassing viral, fungal, parasitic and anaerobic bacterial origin are important to better define the spectrum and relative incidence of pathogens causing dacryocystitis. Microbiological analysis and antimicrobial susceptibility pattern is mandatory for the selection of a specific antimicrobial therapy and to the control of further resistance development of bacterial strains.

Proportion of Neonatal Hypothermia and Associated Factors among New-borns at Gondar University Teaching and Refferal Hospital, Northwest Ethiopia: A Hospital Based Cross Sectional Study

Introduction: Hypothermia is highly prevalent and a major contributor of neonatal morbidity and mortality, even in warmer tropical countries. Neonatal hypothermia is increasingly recognized as a risk factor for new-born survival in Ethiopia. It is crucial and effective to reduce perinatal and neonatal morbidity and mortality. The aim of the study was to assess the proportion of neonatal hypothermia and associated factors among new-borns at Gondar University Teaching and Referral Hospital, Northwest Ethiopia, 2014. Methods: Across sectional study was carried out from September to October 2014 at Gondar University teaching and referral Hospital. A total of 421 new-borns delivered in the hospital were included using systematic random sampling technique. Data were entered into Epi data version 3.1 and analyzed by Statistical package for social science version 20. P-value <0.05 was taken as statistically significant association. Result: The proportion of hypothermia in the study area was found to be 69.8%. Low birth weight (AOR=3.75, 95%CI: 1.29, 10.88), no skin to skin contact (AOR=2.81, 95%CI: 1.40, 5.66), night time delivery (AOR=6.61, 95%CI: 3.75, 11.66), delayed initiation of breast feeding (AOR=7.58, 95%CI: 3.61, 15.91) and problems of the neonates (AOR=3.10, 95%CI: 1.06, 9.46) were significantly associated with hypothermia. Conclusion: In this study the proportion of hypothermia among new-borns was found to be high. Low birth weight, no skin to skin contact, night time delivery, delayed initiation of breast feeding and problem of neonate were significantly associated with hypothermia. Therefore, attention is needed Improve basic routine practice such as warm environment, early breast feed and skin to skin contact by health care providers.

Improving Adult ART Clinic Patient Waiting Time by Implementing an Appointment System at Gondar University Teaching Hospital, Northwest Ethiopia

Background. Long waiting time has been among the major factors that affect patient satisfaction and health service delivery. The aim of this study was to determine the median waiting time at the Anti-Retroviral Therapy (ART) Clinic before and after introduction of an intervention of the systematic appointment system.Methods. Patient waiting time was measured before and after the introduction of an intervention; target population of the study was all adult HIV patients/clients who have visited the outpatient ART Clinic in the study period. 173 patients were included before and after the intervention. Systematic patient appointment system and health education to patients on appointment system were provided as an intervention. The study period was from October 2011 to the end of January 2012. Data were analyzed using SPSS software version 17.0. Independent samplet-test at 95% confidence interval and 5% significance level was used to determine the significance of median waiting time difference between pre- and postintervention periods.Results and Conclusion. The total median waiting time was reduced from 274.8 minutes (IQR 180.6 minutes and 453.6 minutes) before intervention to 165 minutes (IQR 120 minutes and 377.4 minutes) after intervention (40% decrease,p=0.02). Overall, the study showed that the introduction of the new appointment system significantly reduces patient waiting time.

A three year retrospective study on seroprevalence of syphilis among pregnant women at Gondar University Teaching Hospital, Ethiopia.

Sexually transmitted infections (STIs) are a serious public health problem in low income countries, including Ethiopia. Syphilis caused by Treponema pallidum remains a major cause of reproductive morbidity and poor pregnancy outcomes in low income countries. Stillbirth, perinatal death, serious neonatal infection and low-birth weight babies are common among seropositive mothers. To assess the seroprevalence of syphilis and risk factor correlates of this infection at Gondar University Teaching Hospital, Ethiopia. The study was done on 2385 pregnant women attending the antenatal care clinic (ANC) from January 2009 to December 2011. Data was abstracted from the antenatal care clinic medical database. Chi-square test was used, using SPSS version 16 and significance level was chosen at 0.05 level with a two-tailed test. Of the total, 69(2. 9%) of pregnant women were confirmed as seropositive for syphilis. Pregnant women with an age group of 21-25 years of old were the most seropositive (3.4%), followed by 26-30 years of old (3.1%). The prevalence of syphilis infection was 3.2% in urban and 2.2% in rural pregnant women. Relatively high prevalence of syphilis infection were identified among students (4.2%) followed by governmental employees (3.8%). The seroprevalence of syphilis among pregnant women attending ANC is declining. However, syphilis is more prevalent in the young and urban pregnant women. Emphasis on education to young people on STI risk behavioral change and partner follow up and notification for exposure to syphilis and treatment should be given.

Isolation and characterization of multiple drug resistance bacterial pathogens from waste water in hospital and non-hospital environments, Northwest Ethiopia

BackgroundThe importance of bacterial isolates from waste water environment as a reservoir of antibiotic resistance and a potential source of novel resistance genes to clinical pathogens is underestimated. This study is aimed at to isolate and characterize public health important bacteria from waste water in hospital and non- hospital environments and evaluate the distribution of multiple drug resistance bacteria in the study area.MethodsA cross-sectional study was conducted at Gondar from January-June 2012. The hospital waste water was taken from different sections of the Gondar University Teaching Hospital. Non- hospital environment samples were taken at different sites of the university campuses, Gondar College of Teachers education, and soft drink factory in Gondar. Samples were aseptically collected, transported and processed with in two hours following standard procedure. Identified organisms were assessed for different antibiotics following Kirby-Bauer disk diffusion method. All data was registered and entered in to SPSS version 16 computer program. P-values less than 0.05 were taken as statistically significant.ResultA total of 60 waste water samples were processed for the presence of drug resistance pathogens. Among the total samples 113 bacterial isolates were recovered and of these 65 (57.5%) were from hospital environment and 48 (42.5%) were from non-hospital environment. The most frequently identified bacterium was Klebsiella spp. 30 (26.6%) followed by Pseudomonas spp. 19(16.8%), E. coli (11.5%) and Citrobacter spp (11.5%), and Staphylococcus aureus (8.2%). The over all prevalence of multiple drug resistance (MDR) in this study was 79/113 (69.9%). MDR in hospital environment was found to be 53/68 (81.5%) while in non hospital environment was found to be 26/48 (54.2%).ConclusionsMultiple drug resistance to the commonly used antibiotics is high in the study area. The contamination of waste water by antibiotics or other pollutants lead to the rise of resistance due to selection pressure. The presence of antibiotic resistance organisms in this waste water should not be overlooked. Since this organisms may be vital to the safety and well-being of patients who are hospitalized and individual susceptible to infection. Therefore, proper waste water treatment plant should be established and improved sanitary measure should be practice.

Antimicrobial susceptibility patterns of Streptococcus pneumoniae over 6 years at Gondar University Hospital, Northwest Ethiopia

ObjectiveTo assess the magnitude and antimicrobial susceptibility patterns of Streptococcus pneumoniae isolates from various clinical specimens. MethodsA record based on retrospective study was conducted at Gondar University Teaching Hospital from September 2007 to January 2012. All patients who visited Gondar University Hospital and provided clinical specimens (body fluids, discharge, swab and blood) for routine bacteriological culturing and antimicrobial susceptibility testing were taken for analysis. Clinical specimens were processed for bacterial culture according to the standard procedures. Antimicrobial susceptibility test for isolated organisms was done using agar disk diffusion method. The data were entered and analyzed using SPSS software version 16 package. ResultsOne hundred and fifty three Streptococcus pneumoniae were isolated from patients who visited Gondar University Teaching Hospital bacteriology laboratory for culture. Majority of the pneumococcal isolates were from inpatients [111(72.5%)], and 74(48.4%) were from body fluids. Out of the total isolates, 93(61%) were found to be resistant to at least one antibiotic used for susceptibility testing. Forty eight (43.2%) of the isolates were multi-drug resistant (resistant to two or more drugs). The resistance rate noted for both ciprofloxacin 17(11.1%) and ceftriaxone 15(9.8%) were alarming. ConclusionsHigh proportions of the isolates tend to be increasingly resistant to the commonly prescribed drugs. The recommended drug of choice like ciprofloxacin and ceftriaxone were found to be less susceptible in the study area. Based on the findings, we therefore recommend that antimicrobial agents should be inspected for acceptable activity before they are prescribed and administered empirically. Further study with a better design and survey of antimicrobial susceptibility at large scale shoule be performed to draw advanced information.

Seroprevalence of hepatitis B and C virus infection among patients attending serology laboratory of Gondar University Hospital

BackgroundHepatitis B virus (HBV) and hepatitis C virus (HBV) infections accounts for substantial proportions of the world wide liver disease. The two hepatotropic virus share common modes of transmission and their co-infection are common. Patients with dual HBV and HCV infection have more severe liver disease and are at increased risk of progression to hepatic cell carcinoma. This study was aimed to assess the prevalence of HBV and HCV among patients attending serology laboratory of Gondar University Teaching Hospital.MethodsA retrospective study was conducted from January 2007 to December 2011 at serology laboratory of Gondar University Teaching Hospital. Data were cross checked for completeness, entered and analyzed using SPSS version 16 statistical package.ResultsFrom the total of 2,684 clinicaly suspected hepatitis patients, 563 (20.98%) were positive for HBsAg and anti-HCV test. Of all, 14.4% were seropositive for HBV (male= 7.89% female=6.27%) (p-value=0.011) while 12.4% were seropositive for HCV (male =7.6% and female=4.13%) (p-value<0.001). The co-incidence of HBV and HCV were found to be 36 (6.39%) (male=3.9% and female=2.4%) (p-value <0.001). Majority of HBV (30.2%) and HCV (30.7%) infections were detected among age group of 25–34 years old (p-value=0.36) and 15–24 years old (p-value<0.001) respectively.ConclusionThe overall prevalence of HBV and HCV is high. Males and younger age groups were more affected. Community awareness about the transmission and prevention of viral hepatitis infection should be strengthened by giving health education and herd immunization.

Nasopharyngeal Carriage Rate and Antimicrobial Susceptibility Pattern of Potential Pathogenic Bacteria among Paediatrics Outpatients at Gondar University Teaching Hospital, Ethiopia

Background: Neisseria meningitidis and Staphylococcus aureus usually carried without symptoms in nasopharynx, but carriage of these pathogens can lead to serious infectious diseases in children. Meningitis beyond the neonatal period caused by N. meningitidis remains the main reason for morbidity and mortality among children in developing countries. The aim of the study was to assess nasopharyngeal carriage and antimicrobial susceptibility pattern of N. meningitidis and S. aureus among pediatrics outpatients at Gondar, Ethiopia. Method: A cross-sectional study was conducted on children aged ≤ 10 years from February to May, 2012. Data on potential risk factors were gathered by interview-based questionnaire. Nasopharyngeal specimens were collected with a sterile plastic cotton tip swab. Bacteria were characterised by colony appearance, Gram staining and biochemical tests. Antimicrobial susceptibility test was performed using disc diffusion method. A logistic regression analysis was used to examine possible risk factors. All tests with P-value less than 0.05 were considered statistically significant. Result: Of 234 samples screened, 37 (15.8%) had positive cultures, with 24 (10.3%) being S. aureus and 14 (6.0%) N. meningitidis. The higher carriage rate of S. aureus 9 (14.3%) and N. meningitidis 6 (9.6%) were found among 8-10 years old children. S. aureus were resistant to 24 (100%) ampicillin, 20 (83.3%) amoxicillin, 8 (33.3%) tetracycline, 6 (25%) erythromycin and 2 (8.2%) chloramphenicol. However, N. meningitidis isolates were resistant only to cotrimoxazole 14 (100%), ciprofloxacin 7 (50%) and ceftriaxone 3 (21.4%). Conclusion: N. meningitidis nasopharyngeal carriage was considerably higher among older children. All isolates of S. aureus showed higher resistance rate for ampicillin and amoxicillin.

Birth Outcome after Caesarean Section among Mothers who Delivered by Caesarean Section under General and Spinal Anesthesia at Gondar University Teaching Hospital North-West Ethiopia

Introduction: Intrapartum death is the leading cause of child mortality in the world. In Africa, 62 new borns die out of 1000 live births. Anesthesia is responsible for 89 intrapartum deaths per 1000 live births and 3-12% maternal deaths; which are almost associated with the use of general anesthesia. The objective of this study was to assess neonatal outcomes using APGAR score among mothers delivered by caesarean section at Gondar University Hospital, North west Ethiopia. Methods: An institution based cross sectional study was used to assess neonatal outcomes after caesarean sectionamong mothers delivered by caesarean section under anesthesia. All mothers that came for caesarean section from January1, to April 30, 2012 were included in this study Data were collected using structured questionnaires. All pre delivery questionnaires were filled during pre operative preparation after taking informed consent and other intra operative events were recorded intra operatively in the operation room. Data entry and analysis was done using SPSS version 16, each variable was entered to bivariate analysis, variables with P value <0.2 were taken to multivariate analysis using logistic regression. Results: The use of general anesthesia for caesarean section in this particular study was more frequent when compared with spinal anesthesia (65%). The risk of Low APGAR score 5 was increased in babies born under general anesthesia as compared with babies born under Spinal anesthesia (AOR=3.19,95% C.I.(1.73, 5.90)). Low Fetal weight was associated with low APGAR score of new borns (AOR=1.38 with 95% C.I. (1.10, 1.70)). Pre anesthetic fetal heart rate and uterine incision to delivery time were also found to be associated with APGAR score 5 of neonates (AOR=2.12, (95% CI, 1.20; 3.60) and 2.57, (95% CI, 1.20, 3.50)) respectively. Conclusion: Neonates born under Spinal anesthesia had better physiologic profile as evidenced by APGAR score 5. The use of general anesthesia should be reduced and reserved for special indications that are contra indicated to spinal anesthesia only. Low birth weight, prolonged uterine incision to delivery of the baby and pre anesthetic fetal heart beat has affected APGAR score 5 of newborns.

Postoperative Surgical Site Bacterial Infections and Drug Susceptibility Patterns at Gondar University Teaching Hospital, Northwest Ethiopia

The study aimed to determine the prevalence, etiological agents and drug susceptibility pattern of bacterial pathogens isolated from postoperative surgical site infections and hospital environment in Gondar University Teaching Hospital. Specimens were taken from patients with post operative surgical site infections seen at wards and from hospital environment. Specimens were processed for bacteriological analysis and antibiotic susceptibility test according standard procedures. Antimicrobial susceptibility test for isolated organisms was done using disk diffusion method. Of 111 pathogenic bacteria, Escherichia coli 27 (24.3%), Staphylococcus aureus 26 (23.4%), Coagulase negative Staphylococci 22 (19.8%) and Enterobacter spp. 11 (9.9%) were dominant isolates. The prevalence of methicillin resistant S. aureus was 9 (34.6%). Seventeen (77.3%) and 1 (4.5%) of coagulase negative Staphylococcus were methicillin and vancomycin resistant, respectively. Coagulase negative Staphylococcus 41 (41.8%), S. aureus 19 (19.4%) and P. aeruginosa 16 (16.3%) were the major isolates from 75 sites of the hospital environment with an isolation rate of 41 (54.7%). The prevalence of methicillin resistant S.aureus from the environment was 2 (2.0%). High level of multi-drug resistance was observed in bacteria isolates from patients compared to the bacteria isolated from the hospital environments. This study demonstrated high level of multi-drug resistance. Thus, antibiotic sensitivity testing should be carried out for all bacterial isolates of surgical wounds before chemotherapy administered to detect drug resistant strains.

Seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors at Gondar University Teaching Hospital, Northwest Ethiopia: declining trends over a period of five years

BackgroundTransfusion-transmissible infectious agents such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for the recipient. This study aimed to determine the seroprevalence, risk factors and trends of HIV, HBV, HCV and syphilis infections among blood donors over a period of five years at Gondar University Teaching Hospital, Northwest Ethiopia.MethodsA retrospective analysis of consecutive blood donors' records covering the period between January 2003 and December 2007 was conducted. Logistic regression analysis was used to determine risk factors associated with HIV, HBV, HCV and syphilis infections.ResultsFrom the total of 6361 consecutive blood donors, 607 (9.5%) had serological evidence of infection with at least one pathogen and 50 (0.8%) had multiple infections. The overall seroprevalence of HIV, HBV, HCV and syphilis was 3.8%, 4.7%, 0.7%, and 1.3% respectively. Among those with multiple infections, the most common combinations were HIV - syphilis 19 (38%) and HIV - HBV 17 (34%). The seropositivity of HIV was significantly increased among female blood donors, first time donors, housewives, merchants, soldiers, drivers and construction workers. Significantly increased HBV seropositivity was observed among farmers, first time donors and age groups of 26 - 35 and 36 - 45 years. Similarly, the seroprevalence of syphilis was significantly increased among daily labourers and construction workers. Statistically significant association was observed between syphilis and HIV infections, and HCV and HIV infections. Moreover, significantly declining trends of HIV, HCV and syphilis seropositivity were observed over the study period.ConclusionsA substantial percentage of the blood donors harbour HIV, HBV, HCV and syphilis infections. Strict selection of blood donors and comprehensive screening of donors' blood using standard methods are highly recommended to ensure the safety of blood for recipient.

Magnitude and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy among people living with HIV/AIDS in Northwest Ethiopia: a cross - sectional study

BackgroundAdequate antiretroviral drug potency is essential for obtaining therapeutic benefit, however, the behavioral aspects of proper adherence and readiness to medication, often determine therapeutic outcome. Therefore, this study aimed to assess the level and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy (HAART) among people living with HIV/AIDS (PLWHA) at Gondar University Teaching Hospital and Felege Hiwot Hospital in Northwest Ethiopia.MethodsA cross-sectional study was conducted between July and September 2008 using structured interviewer-administered questionnaire. All consecutive adult outpatients who were receiving antiretroviral treatment for at least three months, seen at both hospitals during the study period and able to give informed consent were included in the study. Multivariate logistic regression was used to determine factors associated with nonadherence and nonreadiness.ResultsA total of 504 study subjects were included in this study. The prevalence rates of nonadherence and nonreadiness to HAART were 87 (17.3%) and 70 (13.9%) respectively. Multivariate logistic regression analysis revealed that medication adverse effects, nonreadiness to HAART, contact with psychiatric care service and having no goal had statistically significant association with nonadherence. Moreover, unwillingness to disclose HIV status was significantly associated with nonreadiness to HAART.ConclusionsIn this study the level of nonadherence and nonreadiness to HAART seems to be encouraging. Several factors associated with nonadherance and nonreadiness to HAART were identified. Efforts to minimize nonadherence and nonreadiness to HAART should be integrated in to regular clinical follow up of patients.

Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

BackgroundIn Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia.MethodsWe analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables.ResultsFrom the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%), smear negative pulmonary tuberculosis in 2196 (54.9%) and smear positive pulmonary tuberculosis in 671 (16.8%) cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%), defaulted in 730 (18.3%), died in 403 (10.1%), treatment failed in six (0.2%) and transferred out in 1680 (42.0%) patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2%) to 228(42.9%). Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate.ConclusionThe treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%). A high proportion of patients died (10.1%) or defaulted (18.3%), which is a serious public health concern that needs to be addressed urgently.

Serodiversity and Antimicrobial Resistance Pattern of &lt;i&gt;Shigella&lt;/i&gt; Isolates at Gondar University Teaching Hospital, Northwest Ethiopia

The aims of this study were to determine the distribution of serogroups and serotypes as well as the antimicrobial resistance pattern of Shigella isolates from Gondar patients with acute diarrhea. A cross-sectional study was conducted from August 2006 to February 2008. Stool specimens were received from study subjects and cultured. Isolates were confirmed by biochemical and serological tests. The isolates were tested for antimicrobial susceptibility by the disc diffusion method. Of the 1,200 stool specimens, 90 (7.5%) yielded Shigella isolates with the serogroups of Shigella flexneri (72.2%), S. dysenteriae (10.0%), S. boydii (8.9%), and S. sonnei (8.9%). S. flexneri was the predominant serogroup. S. dysenteriae type 1 was absent, and S. sonnei was present. Eighty-five (94.5%) of the isolates showed resistance to one or more drugs, and 79% of those were multi-resistant. S. flexneri showed the highest resistance (91.2%). S. flexneri serotype 1, resistant to ciprofloxacin and norfloxacin, was observed. All isolates were sensitive to nalidixic acid and ceftriaxone. Only 5 (5.6%) of the isolates were sensitive to all antibiotics tested. Based on these findings, we recommend ciprofloxacin as the drug of choice for treatment of shigellosis in Gondar, with frequent monitoring of drug susceptibility testing.

Antimicrobial Resistance Pattern of Salmonella Isolates from Gondar University Hospital, Northwest Ethiopia

Salmonellosis is a major health problem, especially in developing countries. Moreover, Salmonella species are becoming resistant to the commonly used antimicrobials in most parts of the world. Nevertheless, studies on Salmonella are limited in Ethiopia. The aim of this paper is, therefore to determine the antibiotic resistance pattern of Salmonella species isolated from clinical specimens in the Gondar University Teaching Hospital from September 2001 to August 2005. Data were obtained from the laboratory records on bacterial culture, isolation and antimicrobial sensitivity testing, which were done following the standard and conventional bacteriological methods. From a total of 3363 miscellaneous specimens cultured, 59 yielded Salmonella species. The isolates were from stool (N = 28, 47.5%), blood (N = 25, 42.3%), pus (N = 4, 6.8 %) and urine (N = 2, 3.4 %). Resistance to one or more antibiotics was observed in 94.9% of the isolates, with multiple drug resistance in 84.7%. 91.5%, 78%, 78%, 64.4%, 44.1% and 10.2% of the Salmonella species, were resistant to ampicillin, chloramphenicol, tetracycline, cotrimoxazole, gentamicin and ciprofloxacin, respectively. Resistance to all the six antibiotics was observed in 3.4% of the isolates. The results demonstrated widespread emergence of ampicillin, tetracycline and chloramphenicol resistant Salmonella isolates. Multiple patterns of antibiogram and predominance of certain multi-resistant isolates were observed. Comparison with reports from elsewhere in Ethiopia indicated resistance to the commonly available broad spectrum antibiotics is a nation-wide problem. Rational drug use for the currently available potent antibiotics such as the fluoroquinolones should be enforced. Keywords: salmonellosis, multi-drug resistance, pan-resistance, Salmonella, antibiogramEthiopian Pharmaceutical Journal Vol. 25 (2) 2007: pp. 85-90

Visceral Lieshmaniasis and HIV co-infection in patients admitted to Gondar University Hospital, Northwest Ethiopia

Worldwide after malaria and sleeping sickness leishmaniases are the third most important vector borne diseases. Visceral leishmaniasis (kala-azar) is a disseminated protozoan infection caused by L. donovani L. infantum or L. arachibaldi and transmitted by the female phlebotomine sand fly bite. Coinciding with HIV infection the number of visceral leishmaniasis cases in Ethiopia has increased in the last decade. The objective was to assess the clinical and laboratory manifestations and factors associated with mortality and morbidity of visceral leishmaniasis with or without HIV co-infection. A hospital-based case series study of visceral leishmaniasis assessing clinical manifestations laboratory data treatment outcomes and HIV sero-status was conducted in Gondar University Teaching Hospital over a period of five years and seven months (from January 1999 to July 2004). A total of 221 kala-azar patients participated in the study. Out of 212 visceral leishmaniasis cases tested for HIV 87(41.0%) were HIV co-infected. Age > 20 years was independently associated with HIV co-infection. Out of 213 kala-azar patients treated with sodium stibogluconate (SSG) 52 died resulting in a case fatality rate of 24.4%. The case fatality rates among HIV positive and HIV negative kala-azar cases were 39.3% and 13.0% respectively. Using logistic regression HIV infection body mass index (BMI) of 15 and below bleeding tendency and age > 20 years were identified as independent variables predicting death. HIV co-infection and the case fatality rates are very high among patients with Visceral leishmaniasis. We recommend further study and improved care for HIV co-infected visceral leishmaniasis cases. (authors)