BackgroundIn Sub-Saharan African countries, including Ethiopia, malaria in pregnancy is a major public health threat which results in significant morbidities and mortalities among pregnant women and their fetuses. In malaria endemic areas, Plasmodium infections tend to remain asymptomatic yet causing significant problems like maternal anemia, low birth weight, premature births, and still birth. This study was conducted to determine the prevalence and predictors of asymptomatic Plasmodium infection among pregnant women in the rural surroundings of Arba Minch Town, Southern Ethiopia.MethodsA community based cross-sectional study comprising multistage sampling was conducted between April and June, 2013. Socio-demographic data were collected by using a semi-structured questionnaire. Plasmodium infection was diagnosed by using Giemsa-stained blood smear microscopy and a rapid diagnostic test (SD BIOLINE Malaria Ag Pf/Pv POCT, standard diagnostics, inc., Korea).ResultsOf the total 341 pregnant women participated in this study, 9.1% (31/341) and 9.7% (33/341) were confirmed to be infected with Plasmodium species by microscopy and rapid diagnostic tests (RDTs), respectively. The geometric mean of parasite density was 2392 parasites per microliter (μl); 2275/ μl for P. falciparum and 2032/ μl for P. vivax. Parasitemia was more likely to occur in primigravidae (Adjusted odds ratio (AOR): 9.4, 95% confidence interval (CI): 4.3–60.5), secundigravidae (AOR: 6.3, 95% CI: 2.9–27.3), using insecticide treated bed net (ITN) sometimes (AOR: 3.2, 95% CI: 1.8- 57.9), not using ITN at all (AOR: 4.6, 95% CI: 1.4–14.4) compared to multigravidae and using ITN always, respectively.ConclusionAsymptomatic malaria in this study is low compared to other studies’ findings. Nevertheless, given the high risk of malaria during pregnancy, pregnant women essentially be screened for asymptomatic Plasmodium infection and be treated promptly via the antenatal care (ANC) services.

BackgroundAs per the WHO recommendation, the development of resistance by P. falciparum to most artemisinin combination therapies (ACTs) triggered the need for routine monitoring of the efficacy of the drugs every two years in all malaria endemic countries. Hence, this study was carried out to assess the therapeutic efficacy of Artemether-Lumefantrine (Coartem®) in treating the uncomplicated falciparum malaria, after 9 years of its introduction in the Metehara, Eastern Ethiopia.MethodThis is part of the therapeutic efficacy studies by the Federal Ministry of Health Ethiopia, which were conducted in regionally representative sentinel sites in the country from October 2014 to January 2015. Based on the study criteria set by WHO, febrile and malaria suspected outpatients in the health center were consecutively recruited to study. A standard six-dose regimen of AL was administered over three days and followed up for measuring therapeutic responses over 28 days. Data entry and analysis was done by using the WHO designed Excel spreadsheet and SPSS version 20 for Windows. Statistical significant was considered for P-value less than 0.05.ResultOf the 91 patients enrolled, the day-28 analysis showed 83 adequate clinical and parasitological responses (ACPRs). Per protocol analysis, PCR-uncorrected & corrected cure rates of Coartem® among the study participants were 97.6% (95%CI: 93.6–99.5) and 98.8% (CI: 93.5–100%), respectively. No parasite detected on day 3 and onwards. Fever clearance was above 91% on day-3. Mean hemoglobin was significantly increased (P<0.000) from 12.39 g/dl at day 0 to 13.45 g/dl on day 28. No serious adverse drug reactions were observed among the study participants.ConclusionThis study showed high efficacy of AL in the study area, which suggests the continuation of AL as first line drug for the treatment of uncomplicated P. falciparum malaria in the study area. This study recommends further studies on drug toxicity, particularly on repeated cough and oral ulceration.

BackgroundBlood film microscopy is the gold standard approach for malaria diagnosis, and preferred method for routine patient diagnosis in health facilities. However, the inability of laboratory professionals to correctly detect and identify malaria parasites microscopically leads to an inappropriate administration of anti-malarial drugs to the patients and incorrect findings in research areas. This study was carried out to evaluate the performance of laboratory professionals in malaria diagnosis in health facilities under the Defense Health Main Department in Addis Ababa and its surroundings, Ethiopia.MethodA cross sectional study was conducted from June to July 2015. Totally, 60 laboratory professionals out of the selected 16 health facilities were included in the study. Data were collected by distributing standardized pre-validated malaria slide-panels and self-administered questionnaires among professionals, onsite in each study facility. Sensitivity, specificity, and strength of agreement (with kappa score) in performance among the study participants against WHO-certified expert malaria microscopists were calculated.ResultOf the 60 study participants, 8.3% (5/60) correctly read all the distributed slides in terms of parasite detection, species identification and parasite counting; whereas, each of the remaining 55(91.7%) interpreted at least two slides incorrectly. The overall sensitivity and specificity of participants’ performance in detection of malaria parasites were 65.7% and 100%, respectively. Overall, fair agreement (71.4%; Kappa: 0.4) in detection of malaria parasite was observed between the study subjects and expert readers. The overall sensitivity and specificity of participants in species identification of malaria parasites were respectively 41.3% and 100%. Overall, slight agreement (51.1%; kappa: 0.04) in identification of malaria species was observed. Generally, agreement was lower in parasite detection and species identification at low parasite density and mixed infection cases.ConclusionThe general agreement between the study participants and expert microscopists in malaria parasite detection and species identification was very low, particularly in the cases of low-parasite density and mixed infections. Therefore, regular external quality assessments and further refreshment trainings are crucial to enhance the skill of professionals in malaria microscopy; particularly for those in non-malarious areas where exposure to malaria diagnosis is low.

BackgroundAnemia during pregnancy is a well known medical condition most of the time under-recognized as it is overshadowed by the normal physiological condition during pregnancy. This study aimed at determining the prevalence and predictors of anemia among pregnant women residing in the rural surroundings of Arbaminch Town, south Ethiopia.MethodsA cross-sectional community based study was conducted between April and June, 2013. A structured questionnaire was used to collect socio-economic and socio-demographic characteristics of the pregnant women. Hematocrit (HCT) level was determined to classify the pregnant women as anemic and non-anemic. Diagnosis of asymptomatic malaria parasitemia was done by Giemsa stained blood smear microscopy. HCT < 33%, (HCT ≥ 30% & < 33%), (HCT ≥ 21% & < 30%), and HCT < 21% was used to indicate anemia, mild anemia, moderate anemia, and severe anemia respectively.ResultsA total of 341 pregnant women participated in this study, out of which 118 (34.6%) were anemic. The median age of the pregnant women was 25 years (Inter-quartile range: 23–29). The mean HCT was 35.2% (95% CI: 34.6%–35.8%) with SD of ±5.5%. Of those 118 anemic women; 73(61.9%) were mildly anemic, 38(32.2%) were moderately anemic, and 7(5.9%) were found to be severely anemic. The prevalence of asymptomatic malaria parasitemia was 9.1% (31/341). The odds of being anemic were 15.72 times [AOR: 15.72, 95% CI (3.97, 62.22), P-value ≤ 0.001] more likely to occur in parasitemic individuals relative to the non parasitemic pregnant women. Not using insecticide treated bed net (ITN) was a significant predictor of anemia among the pregnant women [AOR: 3, 95% CI: (1.72, 5.22), P < 0.001].ConclusionThis study highlighted the significant association between anemia and asymptomatic malaria among pregnant women in the study area. Therefore, the practice of routine screening for malaria and anemia followed by prompt management should be encouraged to curb the effect of malaria and anemia on the pregnant women as well as her fetus. Further studies should also be in place to test the effectiveness of routine screening for malaria and anemia followed by prompt management.

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Background Federal Ministry of Health (FMoH) Ethiopia achieved significant declines in malaria mortality and incidence and has recently launched malaria elimination in selected low transmission settings. Successful malaria elimination calls for rapid and accurate diagnosis of cases so that the patients can promptly be treated before the occurrence of transmission. Therefore, this study assessed the competency of malaria microscopists using panal slides, and laboratory service availability and readiness in terms of supplies and equipments in malaria elimination targeted districts in Ethiopia. Method A cross-sectional study was conducted from February to June 2018 in all hospitals, health centers and private clinics in 20 malaria elimination targeted districts, selected out of the 6 regional states in Ethiopia. All malaria microscopists available in the study health facilities during the study period were included in the study. Questionnaires were used for interviewing sociodemography of personnel and laboratory supplies. Per World Health Organization (WHO) criteria set for proficiency testing, 10 Giemsa stained malaria slide panels (8 positive low/high density pf/pv/Mixed and 2 negative slides) were administered to each study participant for performance assessment on malaria parasite detection, species identification and parasite count using light microscopy. The slide panels are PCR confirmed and WHO approved ones, which have been stored in the slide banks at the national reference laboratory in Ethiopian Public Health Institute. Result In this assessment, 17(16%) district hospitals, 71(67%) health centers (HCs) and 18(17%) private clinics (PCs) were included. Of the 18 PCs, only 10(55.6%) had license certificate. Of the study facilities, 91.5%(97) use light microscopy, 2.83%(3) use RDTs and 2.9%(3) use both microscopy and RDT to detect malaria. Accessible and appropriate storage of Giemsa

Background: Preeclampsia is a multisystem hypertensive disorder of pregnancy with new onset after 20 weeks gestation which is a leading cause of worldwide maternal and fetal morbidity-mortality. Objective: To assess causes of ICU admission and outcomes among pre-eclampsia and eclampsia mothers admitted to Jimma University Specialized Hospital. Methods: A retrospective cross sectional study was conducted at JUSH from May 3 to 8, 2015, all ICU admitted preeclampsia and eclampsia mother's records from January 1, 2010 to December 31, 2014 were included by consecutive sampling with inclusion and exclusion criteria. Causes of admission, complications and outcomes were obtained from patient records and analyzed by SPSS version 16.0, finally the results presented using simple frequency tables and figures. Chi square (x2) test calculated to analyze the statistical association between patients outcome and other variables, p-value less than 0.05 was considered statistically significant. Result: A total of 1981 patients admitted to Jimma University specialized hospital ICU over the last five years (January 1, 2010 to December 31, 2014) from this 326 of them were preeclampsia and eclampsia mothers and this gives admission rate of 16.5%. For this study only total of 314 preeclampsia and eclampsia mothers records were used and 12mothers cards were excluded by exclusion criteria. The main causes of admission to ICU were eclampsia 106 (33.8%), General condition need close observation 77(24.5%), pulmonary edema 63 (20.1%), postoperative bleeding 31(9.9%) While the main complications were pulmonary edema 82(26.1%), acute renal injury 76(24.2), HELLP syndrome 57(18.2%) and mortality rate of 7.3%.There is association level of blood pressure with maternal outcomes. Conclusion: Rate of maternal admission, complications and mortality is found to be high at JUSH ICU, Jimma University with other stakeholders has to work in improving high quality of cares provided to reduce maternal complications and mortality.

Background Anopheles mosquitoes are of great importance to human health. A number of studies have shown that midgut and salivary gland microflora have an impact on malaria parasite burden through colonization mechanisms, involving either direct Plasmodium microbiota interaction or bacterial-mediated induction of mosquito immune response. The objective of this study was to isolate and identify the microflora from the midgut and salivary glands of Anopheles species. Methods A total of 20 pools (ten per pool) from insectary-reared and 56 pools (five per pool) of field-collected Anopheles mosquitoes were anesthetized by chloroform and dissected. 70% of ethanol was used for surface sterilization of mosquitoes and laboratory equipment, followed by rinsing Anopheles mosquitoes four times with 1X PBS. Each pool of dissected midgut and salivary gland sample was transferred in 1X PBS and squashed, incubated in the water bath and enriched in tryptic soya broth for 24 h at 35 ± 2 °C. As a control, the PBS solutions used to rinse the mosquitoes were also incubated in tryptic soya broth in the same conditions as the sample. After enrichment, a loopful of each sample was taken and inoculated on Blood, Chocolate, MacConkey, and Sabouraud Dextrose agar. Finally, the microbiota was isolated by colony characteristics, biochemical tests, and automated VITEK 2 Compact Analyzer. Results From all field and laboratory mosquitoes, Pseudomonas was found to be the dominant microbiota identified from all species of Anopheles mosquitoes. Acinetobacter and Klebsiellapneumonia and other families of gram-positive and gram-negative bacteria were identified. Conclusions A number of bacteria were isolated and identified. This is the first report on isolation and identification of microbiota from midgut and salivary glands of Anopheles species in Ethiopia. It can be used as a baseline for studying the relationship between microbiota and mosquitoes, and for the development of a new malaria biological control.