Browsing by Author "Biruk Zerfu"

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    Molecular Detection of Respiratory Viruses and Bacterial Pathogens Causing Severe Acute Respiratory Infection and Influenza-Like Illness in Under-Five Children at Health Facilities in Ethiopia
    (Addis Ababa University, 2026-07-01) AdimkewuAgunie; Kassu Desta; Biruk Zerfu; AdamuTayachewu
    Background: Acute Respiratory Infections (Aris) Are A Major Public Health Concern Globally. The Cause of ARI In Children Under Five Includes Viruses and Bacteria. In Ethiopia Less Coverage of The Influenza Positivity Rate Among Suspected Cases from Both Severe Acute Respiratory Illness (SARI) And Influenza-Like Illness (ILI) Sentinel Sites. However, The Role of Other Causative Pathogens and Bacterial Agents Has Not Been Comprehensively Investigated. This Study Aims to Investigate Viral and Bacterial Etiology from SARI And ILI Cases in Children Under 5 Years of Age in Ethiopia. Objective: To Assess Common Respiratory Viruses and Bacterial Pathogens Causing Severe Respiratory Infection and Influenza-Like Illness in Children Under Five Years Old at Health Facilities Serving as Influenza Sentinel Sites in Ethiopia. Methods: This Study Employed a Cross-Sectional Study Design. Epidemiological Data and Throat, Nasal, And Nasopharyngeal Swab Samples Were Collected From 14 Influenza Sentinel Sites for Influenza Surveillance from January to April 2026. After Testing for Influenza, Select All Samples Under 5, Extract, And Perform Detection at the Influenza National Reference and Referral Laboratory of the Ethiopian Public Health Institute (EPHI). A Chi-Squared Test Was Used to Compare Differences, And A Bivariate Logistic Regression Analysis Was Used for Associated Factors with Independent Variables. Result: A Total Of 422 Children Under Five Were Tested Across 14 Ethiopian Influenza Sentinel Sites, Which Found That (131) 31% Were Positive For At Least One Viral Pathogen And (156)37% For At Least One Bacterial Pathogen, With the Highest Burden Concentrated in Infants Under Two Years. Human Adenovirus (32) 7.5%, Influenza (27) 6.4%, And RSV (19) 4.5% Were the Leading Viral Pathogens, While Haemophiles Influenzae (84) 20% And Streptococcus Pneumoniae (58)13.8% Dominated the Bacterial Pathogen Findings. A Viral Co-Detection Rate Of 20 Of 131 (15.2%) Was Recorded, And A Bacterial-Viral Co-Detection Rate Of 4.6% Of the Total 64 Co-Detections; This Finding Underscores the Remarkable Complexity of Pediatric Respiratory Illness in Ethiopia. Conclusion: This Study Detected the Circulation of Viral and Bacterial Pathogens Causing SARI And ILI In Children Under Five, And It Confirms That Adenovirus, Influenza, RSV, H. Influenzae, And S. Pneumoniae Are the Dominant Etiological Agents.
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    Polymyxin B And Tigecycline Susceptibility Profiles Among Carbapenem Resistant Gram-Negative Bacilli Clinical Isolates at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
    (Addis Ababa University, 2026-06-01) Bruke Gezhagene; Biruk Zerfu; Abebe Aseffa
    Background: Carbapenem-Resistant Gram-Negative Bacilli (CRGNB) Are A Growing Threat To Clinical Care Because Treatment Options Are Increasingly Limited. Polymyxin B And Tigecycline Remain Among the Few Agents Used Against These Pathogens, Yet Local Susceptibility Data In Addis Ababa, Ethiopia, Are Scarce. Objective: To Determine the Susceptibility Profiles of Polymyxin B And Tigecycline Among Stored CRGNB Isolates at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia. Methods: A A Retrospective Laboratory-Based Cross-Sectional Study Was Conducted On 130 Non-Duplicate Stored CRGNB Isolates Collected from January 1, 2019, To December 28, 2023. Isolates Were Revived on Tryptic Soy Agar and MacConkey Agar. Carbapenem Resistance Was Confirmed Using Meropenem, Imipenem, And Ertapenem Disks According to CLSI M100, 35th Edition, And EUCAST Version 14 Criteria. Phenotypic Carbapenems Detection Used the Modified Carbapenem Inactivation Method (Mcim) And EDTA-Modified Carbapenem Inactivation Method (Ecim). Polymyxin B Activity Was Assessed by MIC Testing, Whereas Tigecycline Susceptibility Was Determined by Disk Diffusion. The Data Analysis Was Done Using SPSS Version 27 And Pythone 13.5 Version Software. Results: Among 130 Isolates, Carbapenem-Resistant Acinetobacter Baumannii 48 (36.9%) And Carbapenem-Resistant Klebsiella Pneumoniae 33 (25.4%) Predominated. Urine, Pus, And Blood Were The Main Specimen Sources. Of 130 Isolates with Complete Confirmatory Results, 44 (34.4%) Were Mcim Positive, 40 (31.3%) Were Ecim Positive, 3 (2.3%) Showed A Serine Carbapenems Pattern, and 3.9% Were ESBL Positive. Tigecycline Showed Better Overall Activity Than Polymyxin B. Among 115 Isolates with Valid Tigecycline Results, 109 (93.1%) Were Susceptible And 8 (6.8%) Were Resistant. Polymyxin B Demonstrated a Predominantly Intermediate Interpretive Range, With Susceptibility In 120 (92.3%) And Resistance Observed In 10 (7.7%) Of Isolates. High Resistance to Cephalosporins, Fluoroquinolones and Newer Β-Lactam/Β-Lactamase Inhibitors Was Common, Most Isolates Met the MDR And XDR Definitions. Conclusion: CRGNB Isolates Were Dominated by Carbapenem-Resistant A. Baumannii And Carbapenem-Resistant K. Pneumoniae. Tigecycline And Polymyxin B Retained the Best In Vitro Activity, Although Polymyxin B Showed a Less Favorable Categorical Profile but Mostly Low to Moderate MIC Values. Ongoing Surveillance, Susceptibility Testing, Carbapenems Detection, Infection Control, And Antimicrobial Stewardship Are Needed.
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    Prevalence of Dengue and Chikungunya in Malaria-Suspected Febrile Patients: Mosquito-Borne Diseases’ Knowledge, Practices and Diagnostic Challenges in Selected Districts of Afar National Regional State, Northeast Ethiopia
    (Addis Ababa Universtity, 2025) Biruk Zerfu; Mengistu Legesse; Tesfu Kassa
    Dengue virus (DENV) and chikungunya virus (CHIKV) infections are an emerging burden to rising non-malarial febrile illnesses in tropical and subtropical regions, including Ethiopia. Ethiopia has experienced several significant outbreaks of arboviral diseases over the past two decades, particularly in the eastern and northeastern regions, including in the Afar National Regional State. Given the overlap in symptoms and the risk of co-infection, it is important to assess the true burden of these diseases among malaria-suspected patients during non-outbreak periods and understand community awareness and healthcare worker (HCW) challenges to improve public health intervention and strengthen healthcare response to these diseases. Hence, this study was designed to assess the prevalence of DENV and CHIKV infection in malaria-suspected febrile patients, community knowledge, attitudes, and practices (KAP) about these arboviral diseases and healthcare workers’ (HCWs) knowledge, practices and challenges in diagnosing and managing arboviral and non-malarial febrile illnesses in malaria-endemic selected districts of the Afar National Regional State, northeast Ethiopia. Methods: Between September 2022 to March 2023, a cross-sectional study was conducted among malaria-suspected febrile patients, with axillary body temperature of ≥37.5°C, attending healthcare facilities to assess the prevalence of CHIKV and DENV infection. Socio-demographic and clinical features were collected using a structured questionnaire. Five milliliters of venous blood were collected and thick and thin blood films were prepared for the diagnosis of malaria on-site. Sera were separated from remaining blood and stored appropriately. It was tested for anti-DENV and anti-CHIKV IgM and IgG antibodies using enzyme-linked immunosorbent assay (ELISA). IgM-positive sera were pooled and screened for viral RNA using in-house reverse transcription-polymerase chain reaction (RT-PCR) and a one-step multiplex RT-PCR. Those positive pools were disaggregated and retested individually to identify specific RNA-positive patient serum. To assess community KAP and HCWs’ knowledge, practices, and challenges, structured questionnaires, as well as focus group discussions (FGDs) with community members, in-depth interviews (IDIs) with frontline HCWs were conducted. Additionally, secondary data on febrile patient diagnosis and management were reviewed from public healthcare facilities to evaluate HCW diagnostic practices and trends. Quantitative data were coded and entered into EpiData 3.1, and exported and analyzed using Stata 14, with p-value < 0.05 statistically significant. Thematic analysis was applied to qualitative data. Results: A total of 411 malaria-suspected febrile patients (55.5% female, age ranged from 5-80 years, with a mean age ± SD of 27.3± 13.9) years participated in the prevalence study. Among 368 sera tested for anti-CHIKV antibodies, 176(47.8%) were IgM positive, indicating acute CHIKV infection and 23(6.3%) were IgG positive, suggesting previous exposure. Non-married patients and those having back pain were associated with positivity for acute CHIKV infection (AOR = 2.34, 95% CI: 1.14- 4.96 and AOR = 1.78, 95% CI: 1.08-2.95), respectively. Among 410 sera tested for anti-DENV IgM, 101(24.6%) were positive, indicating acute DENV infection. Of 367 sera tested for IgG, 142 (38.7%) were positive, indicating a previous exposure. Previous DENV exposure was significantly associated with being female (AOR = 2.24; 95% CI: 1.32-3.26) and employed (AOR = 1.90; 95% CI: 1.03-8.15) participants. From all 411 febrile patients, only 44 (10.7%) were positive for Plasmodium infection, mainly due to P. falciparum (84.1%). Co-infections were observed in 15.8% of patients for acute DENV-CHIKV, 4.4% for acute DENV-malaria and 4.3% for acute CHIKV-malaria among those tested for both infections. Out of 53-pooled samples positive for one or both viruses’ IgM, three were confirmed positive for DENV RNA, two of which were from DENV-CHIKV dual IgM-positive samples and the remaining one from a CHIKV IgM-positive only pooled sample by in-house RT-PCR, while two CHIKV RNA samples were identified from DENV-CHIKV dual IgM-positive pools using commercial RT-PCR methods. In the KAP study, 296 community members (mean age 34.2 ± 10.6 years; 36.8% female) and 116 FGD participants were included. While 67.3% of the community had heard of CHIK, only 44.7% recognized it as viral, 48.7% identified Aedes mosquitoes as vectors, and 16.5% knew they bite during the day. The mean KAP scores were moderate, with knowledge at 63.2%, attitudes at 60% and practices at 60%. Higher education (9-12) and student status were linked to good knowledge; age 45–59 and being single were associated with positive attitudes. Among 82 HCWs surveyed (plus 10 in IDIs), 93.9% had heard of CHIKV and DENV, with the overall mean knowledge score of 13.1 ± 3.9 (62.4%), showing a moderate knowledge level, but only 36.4% demonstrated good knowledge, while 35.1% showed moderate knowledge of the diseases. Higher knowledge was significantly associated with higher educational levels. The patient record review revealed over-diagnosis of malaria infection and low diagnosis of non-malarial febrile illness, while limited differential testing capability for arbovirus infections, inadequate training for HCWs, low community involvement and low awareness of arboviral and non-malarial mosquito-borne febrile diseases were identified as challenges. Conclusion: The seroprevalence of DENV and CHIKV infections is substantial among malaria-suspected acute febrile patients, highlighting the need for integration of arbovirus infections in regular screening, management and control of the infections in the study area. Limited awareness and diagnostic capability demand strengthening diagnostic capacity, updating fever case management and diagnosis policies, such as availing rapid test kits, serological tests (IgM tests) and affordable PCR tests for arboviral infections and scaling up HCW training and community sensitization are critical for effective arboviral and other mosquito-borne diseases control in malaria-endemic settings.
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    Seroprevalence of Hepatitis B Virus Among People Living with Hiv with Unsuppressed Viral Loads in Ethiopia
    (Addis Ababa University, 2026-06-07) Zewude Birhanu; Kassu Desta; Biruk Zerfu; Gadissa Gutama