Background. The World Health Organization has emphasized the importance of understanding the epidemiology of MDR organisms from a local standpoint. Here, we report on a spectrum of bacteria associated with surgical site infections in two referral hospitals in Eritrea and the associated antibiotic susceptibility patterns. Methods. This survey was conducted between February and June 2017. A total of 83 patients receiving treatment for various surgical conditions were included. Swabs from infected surgical sites were collected using Levine technique and processed using standard microbiological procedures. In vitro antimicrobial susceptibility testing was performed on Mueller–Hinton Agar by the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. The data were analyzed using SPSS version 20. Results. A total of 116 isolates were recovered from 83 patients. In total, 67 (58%) and 49 (42%) of the isolates were Gram-positive and Gram-negative bacteria, respectively. The most common isolates included Citrobacter spp., Klebsiella spp., Escherichia coli, Proteus spp., Pseudomonas aeruginosa, Salmonella spp., Enterobacter spp., and Acinetobacter spp. In contrast, Staphylococcus aureus, CONS, and Streptococcus viridians were the predominant Gram-positive isolates. All the Staphylococcus aureus isolates were resistant to penicillin. MRSA phenotype was observed in 70% of the isolates. Vancomycin, clindamycin, and erythromycin resistance were observed in 60%, 25%, and 25% of the isolates, respectively. Furthermore, a high proportion (91%) of the Gram-negative bacteria were resistant to ampicillin and 100% of the Pseudomonas aeruginosa and Escherichia coli isolates were resistant to >5 of the tested antibiotics. The two Acinetobacter isolates were resistant to >7 antimicrobial agents. We also noted that 4 (60%) of the Klebsiella isolates were resistant to >5 antimicrobial agents. Possible pan-drug-resistant (PDR) strains were also isolated. Conclusion. Due to the high frequency of MDR isolates reported in this study, the development and implementation of suitable infection control policies and guidelines is imperative.

Eritrea is an East African multiethnic country with an intermediate endemicity for hepatitis B. Our aim was to establish the most prevalent genotypes of hepatitis B virus (HBV) among patients with liver disease. A total of 293 Eritrean patients with liver disease who were hepatitis B surface antigen (HBsAg) positive were enrolled. All sera were tested for liver transaminases, HBV DNA viral load, and hepatitis B seromarkers including HBsAg, anti-HBcAb (total), HBeAg, and anti-HBeAb. Those reactive for HBsAg and anti-HBc (total) were further tested for HBV genotyping. The median (interquartile range) of HBV DNA viral load and ALT levels were 3.47 (1.66) log IU/mL and 28 (15.3) IU/L, respectively. Using type-specific primer-based genotyping method, 122/293 (41.6%) could be genotyped. Irrespective of mode of occurrence, HBV genotype D (21.3%) was the predominant circulating genotype, followed by genotypes C (17.2%), E (15.6%), C/D (13.1%), and C/E (10.7%). Genotypes C/D/E (7.4%), A/D (4.9%), D/E (4.1%), A (2.5%), and B, A/E, B/E, and A/D/C (0.8%) were also present. HBV in Eritrea is comprised of a mixture of HBV genotypes. This is the first study of HBV genotyping among patients with liver disease in Eritrea.

BackgroundReducing attrition in paediatric HIV-positive patients using combined antiretroviral therapy (cART) programmes in sub-Saharan Africa is a challenge. This study explored the rates and predictors of attrition in children started on cART in Asmara, Eritrea.MethodsThis was a retrospective cohort study using data from all paediatric patients on cART between 2005 and 2020, conducted at the Orotta National Referral and Teaching Hospital. Kaplan-Meier estimates of the likelihood of attrition and multivariate Cox proportional hazards models were used to assess the factors associated with attrition. All p values were two sided and p<0.05 was considered statistically significant.ResultsThe study enrolled 710 participants with 374 boys (52.7%) and 336 girls (47.3%). After 5364 person-years’ (PY) follow-up, attrition occurred in 172 (24.2%) patients: 65 (9.2%) died and 107 (15.1%) were lost to follow-up (LTFU). The crude incidence rate of attrition was 3.2 events/100 PY, mortality rate was 2.7/100 PY and LTFU was 1.2/100 PY. The independent predictors of attrition included male sex (adjusted HR (AHR)=1.6, 95% CI: 1 to 2.4), residence outside Zoba Maekel (AHR=1.5, 95% CI: 1 to 2.3), later enrolment years (2010–2015: AHR=3.2, 95% CI: 1.9 to 5.3; >2015: AHR=6.1, 95% CI: 3 to 12.2), WHO body mass index-for-age z-score <−2 (AHR=1.4, 95% CI: 0.9 to 2.1), advanced HIV disease (WHO III or IV) at enrolment (AHR=2.2, 95% CI: 1.2 to 3.9), and initiation of zidovudine+lamivudine or other cART backbones (unadjusted HR (UHR)=2, 95% CI: 1.2 to 3.2). In contrast, a reduced likelihood of attrition was observed in children with a record of cART changes (UHR=0.2, 95% CI: 0.15 to 0.4).ConclusionA low incidence of attrition was observed in this study. However, the high mortality rate in the first 24 months of treatment and late presentation are concerning. Therefore, data-driven interventions for improving programme quality and outcomes should be prioritised.

Background Understanding the natural history of chronic hepatitis B (CHB) virus infection is important for determining optimal management and predicting prognosis in patients. The aim of this study was to determine the prevalence of different phases of CHB infection among Eritrean patients and to identify the proportion of patients who are eligible for treatment according to the latest American Association for the Study of Liver Diseases (AASLD) guidelines. Methods This cross-sectional study enrolled 293 CHB patients (213 males and 80 females) between Jan 2017 and Feb 2019. The patients were classified into immune-tolerant, immune-active, and inactive CHB phases of the infection, which is based on the results of Hepatitis B virus (HBV) serological panel (HBsAg, anti-HBc total, HBeAg, and anti-HBe), ALT levels, and HBV DNA viral load. The 2018 AASLD guidelines were also used to identify patients who needed treatment. Results The mean age of the patients was 41.66 ± 13.84 years. Of these, 3 (1.0%) were at the immune tolerant phase, 58 (19.8%) at the immune-active CHB phase, and 232 (79.2%) at the inactive CHB phase. As most subjects (93%) were HBeAg-negative, based on AASLD guidelines, only 5 (1.7%) were currently eligible for treatment. Conclusions Our data show that CHB patients in Eritrea were predominantly in the inactive CHB phase. Although initiating antiviral therapy is not recommended in these patients, periodic assessment of liver function and disease severity should be considered in patients older than 40 years. The immune-tolerant phase had the fewest patients, most of whom were aged above 20 years, attesting to the success of incorporating HBV vaccine in the national childhood immunization program since 2002. Our study shows that adopting AASLD treatment guidelines with adjustments to suit the local setting is a suitable option in the management of Eritrean CHB patients.

Background: Many view attrition as one of the biggest barriers to effective delivery of cART in resource-limited settings in sub-Saharan Africa (SSA). In this study, our objective was to describe the incidence and predictors of attrition among adults enrolled in cART programs in two referral hospitals in the northern coastal areas of Eritrea. Methods: This was a retrospective review of patient records of 464 patients [Male: 149(35.6%) vs. Females: 269(64.4%)] aged 18 years who initiated cART between 2005 and 2021. The main outcome measures were attrition (loss-to-follow-up (LTFU) plus mortality) and associated outcomes. Kaplan-Meier statistics were used to evaluate survival probability of attrition. Independent predictors of attrition were evaluated using a multivariable Cox proportional hazard model. Results: A total of 418 patients [Male: 149(35.6%) vs. Female: 269 (64.4%)] were studied. At baseline, the mean (±SD) age (SD) was 34(±11.2) years; median (±IQR) CD4 T-cell count was 151 (IQR: 87-257) cells/µL. After a follow-up time of 39,883 months, 127 ((30.4%), 95% CI [26-35]) attrition events were reported, translating into a cumulative incidence of 2.9/1000(2.4-3.5) per 1,000 people-months (PMs) were reported. During the same period, 97 (23.11%) patients died, 32(7.7%) were LTFU, and 47(11.2%) transferred out. In the adjusted multivariate Cox regression model, an increased risk of attrition was associated with the year of enrollment (aHR = 1.07, 95% CI 1.00-1.15, p-value = 0.04); ethnicity (Afar: aHR=3.21, 95% CI: 1.84-5.59, p value < 0.001) (Others: aHR = 2.67, 95% CI: 1.14-6.25, p value = 0.024) and cART backbone: (TDF+FTC: aHR=2, 95% CI: 1.21-3.32, p value = 0.007). On the contrary, the risk of attrition decreased per unit increase in baseline CD4 T-cells/μL (uHR=0.998, 95% CI 0.996-0.999, p-value<0.001). Conclusion: Despite expanded treatment and decentralization of cART programs, mortality due to advanced disease at enrollment remains high in peripheral settings. A concerted effort is required to reduce late enrollment and improve the management of patients with advanced disease in decentralized programs.

Background: The periodically emerging new and old infectious microorganisms greatly magnify the global burden of infectious diseases. The majority of emerging infectious events are caused by bacteria, which can be associated with the evolution of drug-resistant strains and the overwhelming of the natural host defenses. Medicinal plants play an important role in the treatment of various infectious diseases. The objective of this study is to evaluate the in vitro antimicrobial activities of crude extracts of aqueous and solvents from two Eritrean traditional medicinal plants (Silene macrosolen and Solanum incanum). Methodology: Roots and leaves of Solanum incanum and stems and roots of Silene macrosolen were collected and extracted using standard methods. The extracted ingredients were then subjected to standard bacterial strains (Escherichia. coli ATCC-25923, Staphylococcus. aureus ATCC-25922, and Pseudomonas. aeruginosa ATCC-27853) to determine their antibacterial activity by measuring their zone of inhibition. Phytochemical analysis of the crude extract to see the presence of phytochemical compounds in the extract of selected plants. Results: The highest inhibition zone was observed for methanol extracted S. macrosolen stem and chloroform extracted S. incanum root against S. aureus in 400 mg / ml with 23mm and 24.5mm respectively. Methanol and cold aqueous extracted stem of S. macrosolen also showed the highest inhibition of 26mm and 23mm diameter, against P. aeruginosa and E. coli respectively. The MIC and MBC of the cold aqueous extract of S. macrosolen stem were found at 25 mg / ml and 50mg/ml respectively, against both E. coli and P. aeruginosa, while the MIC of the chloroform-extracted root of S. incanum was found at 50mg/ml, however, the MBC could not be found in the concentration tested against S. aureus. Conclusion: Based on the finding of this study S. aureus was found to be more susceptible to the plant extracts than E. coli and P. aeruginosa, and the methanolic and cold aqueous extracts of the S. macrosolen stem revealed the highest antibacterial activity.

Background Hepatitis B virus (HBV) infection is a major global public health threat especially in developing countries. The World Health Organization (WHO) estimates that in 2015, about 60 million Africans were living with chronic HBV infection [1]. Most African countries fall within the high endemicity regions [2]. Infection with HBV is usually acquired through perinatal or childhood exposure to the virus, contaminated blood transfusions or unprotected sexual contact [3] and progresses to long-term HBV infection in about 15% to 40% of cases depending on viral and host factors [4,5]. Although chronic HBV infection is commonly asymptomatic, an estimated 15% to 25% of patients will die from disease progression and complication such as liver cirrhosis (LC) and hepatocellular carcinoma (HCC)[4].

Medicinal plants play great roles in the treatment of various infectious diseases. S.macrosolen and S.incanum are both important medicinal plants used traditionally for treatment of infectious diseases in many places around Eritrea. The periodically emerging new and old infectious microorganisms greatly magnify the global burden of infectious diseases. The majorities of emerging infectious events are caused by bacteria which can be associated with evolution of drug resistant strains and overwhelming of the natural host defenses. Therefore, the search of new or alternative mechanisms to effectively treat and prevent infectious diseases, particularly bacterial diseases, have to be encouraged to effectively reduce these global burden. The objective of the study is to evaluate the in vitro antibacterial activities of the aqueous and solvent crude extract of leaf and stem of S.macrosolen, and leaf and root of S.incanum against standard strains of selected bacterial species, which can in turn provide a clue for the identification of active constituent responsible for the antibacterial activity. The antibacterial activity of the aqueous ( cold and hot water) and solvent extracts (ethanol, methanol, and chloroform) were evaluated on different selected bacterial strains (E.coli, S.aureus, and P.aeruginosa) using agar well diffusion method on Mueller-Hinton agar at different concentration with the presence of positive control (Chloramphenicol and ciprofloxacin) and negative control (sterile distilled water and 5%DMSO) controls. The highest inhibition zone was observed for methanol extracted S.macrosolen stem and chloroform extracted S.incanum root against S.aureus at 400mg/ml with 23mm and 24.5mmrespectively. Methanol and cold aqueous extracted S.macrosolen stem also showed the highest inhibition of 26mm, 23mm diameter, against P.aeruginosa, and E.coli respectively. The reason for the high inhibition zone could be due to the presence of secondary metabolites such as saponins, tannins, flavonoids, phenols and glycosides. The least result was seen in hot aqueous extract for each plant with no inhibition for all the bacteria. MIC and MBC was determined using tube dilution and plating method for those plant extracts which showed highest and consistent inhibition zone at different concentrations. The MIC and MBC of cold aqueous extract of S.macrosolen stem was found at 25mg/ml, and 50mg/ml respectively, against both E.coli and P.aeruginosa, while the MIC of chloroform extracted S.incanum root was found at 50mg/ml, however, the MBC was not determined in the concentration tested against S.aureus. The paper published after getting the results of the investigation would be anticipated to contribute for the resolution of the burden of the drug resistant bacteria species.