Browsing by Author "Gemechu, Daniel (PhD)"

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    Modified Diagnostic Approach and Molecular Epidemiology of Childhood Tuberculosis in Hawassa, Ethiopia ity Testing, Treatment Outcome
    (Addis Ababa University, 2018-06-04) Desta, Moges; Feleke, Adey (PhD); Lakew, Mekuria (PhD); Gemechu, Daniel (PhD)
    Childhood TB accounts to 1 million (10%) of the estimated 10.4 million new cases of TB globally. It is known to be the major contributor of childhood morbidity and mortality. The prevalence of childhood TB/HIV co-infection and multidrug resistance (MDR) presumed to have grown up with the advent of HIV. Unfortunately it has been given less attention as a challenge at international level; there are no sufficient epidemiological data even in high burden countries and the effects are not included with the national policies and strategies i.e. is neglected. Due to this scarcity of epidemiological data the attempts that have been made to develop tools for childhood TB diagnosis, treatment, control and to understand how the immunological and pathological responses differ from that of the adult is very little. It is in recognition of these gaps of knowledge and attention that the present work was set with the following objectives: to use modified approach for diagnosis and determine the prevalence of childhood active TB cases, identify the strains of Mycobacterium tuberculosis, determine their drug susceptibility pattern and assess the treatment outcome. A prospective cross sectional study was done on 700 children clinically suspected for TB and 350 of them were used to determine the prevalence, molecular characterization and drug susceptibility pattern of TB isolates and the remaining 350 were used to evaluate modified childhood TB diagnostic approach. A five year retrospective cross sectional study was also done to evaluate the treatment outcome of children with TB in the study area. The results showed an overall prevalence of smear positive (7.4%) and Culture confirmed TB cases (9.7%). Drug susceptibility testing showed one (2.9%) MDR case from the isolates and Spoligotyping of 34 isolates revealed 15 different patterns, 11 of which corresponded to Shared International Types (SITs) and 4 to orphan strains. The dominantly identified strains IV were SIT 53, SIT 149, and SIT 442. The isolates belonged to Euro-American lineage (94.1%) and East-African-Indian lineage (5.9%). A 13.2% incremental yield was obtained due to testing of pooled samples compared to either of the first or second sample using GeneXpert MTB/RIF assay in diagnostic evaluation study. The overall treatment success rate among all children with TB at the study facilities was 39.7%. The lower prevalence of pediatric pulmonary TB could be due to the less sensitive nature of culture and microscopy diagnostic tools thus the modified diagnostic approach may show the real magnitude by increasing case detection. Clustering of strains in spoligotyping suggested an on-going and active transmission of M. tuberculosis in the study area. The identified MDR case showed DST is warranted to optimize the management of childhood TB. The Overall treatment success rate among all children with TB was unsatisfactory compared to WHO target of 85% and 54.7% of children with TB in the study facilities were transferred out. There should be a system to track transfer out cases are on treatment.
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    Modified Diagnostic Approach and Molecular Epidemiology of Childhood Tuberculosis in Hawassa, Ethiopia ity Testing, Treatment Outcome
    (Addis Ababa University, 6/4/2018) Desta, Moges; Feleke, Adey (PhD); Lakew, Mekuria (PhD); Gemechu, Daniel (PhD)
    Childhood TB accounts to 1 million (10%) of the estimated 10.4 million new cases of TB globally. It is known to be the major contributor of childhood morbidity and mortality. The prevalence of childhood TB/HIV co-infection and multidrug resistance (MDR) presumed to have grown up with the advent of HIV. Unfortunately it has been given less attention as a challenge at international level; there are no sufficient epidemiological data even in high burden countries and the effects are not included with the national policies and strategies i.e. is neglected. Due to this scarcity of epidemiological data the attempts that have been made to develop tools for childhood TB diagnosis, treatment, control and to understand how the immunological and pathological responses differ from that of the adult is very little. It is in recognition of these gaps of knowledge and attention that the present work was set with the following objectives: to use modified approach for diagnosis and determine the prevalence of childhood active TB cases, identify the strains of Mycobacterium tuberculosis, determine their drug susceptibility pattern and assess the treatment outcome. A prospective cross sectional study was done on 700 children clinically suspected for TB and 350 of them were used to determine the prevalence, molecular characterization and drug susceptibility pattern of TB isolates and the remaining 350 were used to evaluate modified childhood TB diagnostic approach. A five year retrospective cross sectional study was also done to evaluate the treatment outcome of children with TB in the study area. The results showed an overall prevalence of smear positive (7.4%) and Culture confirmed TB cases (9.7%). Drug susceptibility testing showed one (2.9%) MDR case from the isolates and Spoligotyping of 34 isolates revealed 15 different patterns, 11 of which corresponded to Shared International Types (SITs) and 4 to orphan strains. The dominantly identified strains IV were SIT 53, SIT 149, and SIT 442. The isolates belonged to Euro-American lineage (94.1%) and East-African-Indian lineage (5.9%). A 13.2% incremental yield was obtained due to testing of pooled samples compared to either of the first or second sample using GeneXpert MTB/RIF assay in diagnostic evaluation study. The overall treatment success rate among all children with TB at the study facilities was 39.7%. The lower prevalence of pediatric pulmonary TB could be due to the less sensitive nature of culture and microscopy diagnostic tools thus the modified diagnostic approach may show the real magnitude by increasing case detection. Clustering of strains in spoligotyping suggested an on-going and active transmission of M. tuberculosis in the study area. The identified MDR case showed DST is warranted to optimize the management of childhood TB. The Overall treatment success rate among all children with TB was unsatisfactory compared to WHO target of 85% and 54.7% of children with TB in the study facilities were transferred out. There should be a system to track transfer out cases are on treatment.
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    Prevalence of Transfusion Transmitted Infections Among Blood Donors at Yirgalem Hospital and Hawassa Blood Bank Center, Sidama Zone, Snnprs, Ethiopia
    (Addis Ababa University, 2015-10) Bonja, Fisseha; Gemechu, Daniel (PhD)
    Background Blood is one of the integral components of body constituents. Blood transfusion is important therapy during maternal bleeding, surgery and also a lifesaving procedure for anemic patients. Transfusion reaction and transfusion transmitted infections (TTI) are major problems associated with blood transfusion. TTI is ranging from 8% up to 43%. The burden of transfusion transmitted infections in developed countries decline from time to time but it is still a challenge of developing countries like Ethiopia due to lack of adequate volunteer donors, testing material, good infrastructure and well trend personnel because of resource constraints. In addition to that there are insufficient data on seropostivity of TTI among blood donors in our setting. Objective To assess the prevalence of transfusion transmitted infections among blood donors at Yirgalem hospital blood bank and Hawassa blood bank center, Sidama zone, SNNPRS Ethiopia. Methodology Institutional based cross-sectional study was conducted, convenient sampling techniques used to address 384 donors and blood collection was done from health volunteers and replacement donors from April-May, 2015 G.C at Yirgalem Hospital and Hawassa regional Blood bank. Data was coded, cleaned, entered and analyzed by using SPSS version 21.Proportion, odds ratio and p-value were used for analyses. P-value <0.05 considered as statistically significant. Result A total of 384 blood donors were screened and the overall prevalence of TTI was 28 (7.29%). The Seroprevalence of HIV, HBV, HCV, Syphilis and Malaria was 6(1.6%), 16(4.2%), 2(0.5%), 3(0.8%) 1(0.3%) respectively. Two out of 384(0.5%) had multiple infections. The combinations were HIV- HBV 1/384(0.26%) and HIV-HCV1/384(0.26%). The prevalence of HBV was 13/258(5.0%) and 3/126(2.4%) in male and female respectively, p=0.001. When see the age of donors, 15/331(4.5%) and 1/41(2.4%) in age group18-24 and 25-34 years respectively. The prevalence of HIV was 1/25(4.0%) and 5/359(1.4%) in urban and rural respectively, p=0.002 Conclusion and Recommendation The prevalence of TTI was 28(7.29%), the seroprevalence of HIV 6(1.6%), HBV 16(4.2%), HCV2 (0.5%), Syphilis 3(0.8%) and Malaria 1(0.3%). High prevalence of HBV, HCV and syphilis infection were found among family replacement blood donors when compared with voluntary blood donors. Students highly participated in voluntary blood donation program when compared with others. Creating awareness among the public is important to have voluntary donors and this helps to provide safe blood to blood transfusion and collection services.