Comparative efficacy of albendazole and three brands of mebendazole in the treatment of ascariasis and trichuriasis

Objective: To evaluate the comparative efficacy of 400 mg albendazole (Smith Kline Beecham) as a single dose and three brands of mebendazole (Janssen, Unibios and East African Pharmaceuticals) at doses of 100 mg twice a day for three consecutive days in the treatment of single or mixed infections with Ascaris lumbricoides and or Trichuris trichiura in four treatment groups of school children. Design: Randomized trial. Setting: Wondo-Genet, southern Ethiopia. Subjects: School children, aged six to nineteen years. Results: The percentage cure rate and egg reduction rate obtained with albendazole and mebendazole from the three brands were not significantly different in the treatment of ascariasis. However, significant differences were found among the percentage cure rates and egg reduction rates of the four treatment groups in the treatment of trichuriasis. Comparatively, high cure rate (89.8%) and egg reduction rate (99.1%) were observed in vermox (Janssen) treated group followed by Unibios (India) treated group (53.3% and 96.53% cure and egg reduction rates, respectively), whereas low cure rate (17.1%) and egg reduction rate (69.8%) were seen in the albendazole treated group. Conclusion: The results of this study suggest that in areas of single or mixed infections with Trichuris trichiura and/or Ascaris lumbricoides are common public health problems and where laboratory facilities are not available to make parasite identification, mebendazole (particularly vermox, a product of Janssen laboratory) would be the drug of choice to treat trichuriasis and ascariasis. However, either mebendazole from the different brands or albendazole is effective in the treatment of ascariasis in areas where trichuriasis is not prevalent. East African Medical Journal Vol. 81 No. 3 March 2004: 134-13

Current status of intestinal Schistosomiasis and soiltransmitted helminthiasis among primary school children in Adwa Town, Northern Ethiopia

Background: Epidemiological baseline information on the prevalence and intensity of parasitic infections in a given locality is a prerequisite for development and evaluation of sound control strategies.Objective: To determine the current status of schistosomiasis and soil-transmitted helminthiasis among primary school children in Adwa Town, northern Ethiopia.Methods: A cross-sectional epidemiological study was carried out in eight primary schools in Adwa Town between October and November 2007. Fecal samples of 386 school children in the age group 7-18 were collected andmicroscopically examined using the Kato-Katz and formol-ether concentration methods. A questionnaire was used to identify determinants for Schistosoma mansoni and soil-transmitted helminth infections.Results: The most prevalent intestinal parasitic infection among primary school children in Adwa Town as determined by Kato-Katz (58.7%) and formol ether concentration (60.6%) methods was intestinal schistosomiasis, with an overall intensity of 95.8 eggs per gram of stool. The prevalence of S. mansoni infection was higher in males (70.7%) than in females (57%), as determined by both methods. Less common parasites observed included Ascaris lumbricoides, hookworm species, Hymenolepis nana, Strongyloides stercoralis, and Entamoeba histolytica/dispar.Conclusion: The residents of Adwa Town represent a high-risk community with respect to intestinal schistosomiasis. Hence, mass praziquantel administration to school-age children and all adults considered to be at risk is required once a year until the level of infection falls below the level of public health importance. There is also a need to supplement chemotherapy with other measures such as environmental sanitation and health education to make the impact of chemotherapy sustainable

Evaluation of Soil Cations in Agricultural Soils of East Wollega Zone in South Western Ethiopia

No Abstract

Status of onchocerciasis in Teppi area, Southwestern Ethiopia, after four years of annual community-directed treatment with ivermectin

Background: Information on the impact of annual community-directed treatment with ivermectin (CDTI) on the prevalence and intensity of onchocerciasis as well as its transmission following years of repeated ivermectin distribution is vital to monitor the impact of the control efforts.Objective: To determine the status of the prevalence and intensity of onchocerciasis after four years of ivermectin distribution in Teppi area.Methods: Skin snips were obtained from 390 study participants and kept in physiological saline at room temperature for 24 hours. The emerged microfilariae were counted under 10x microscope objective. The skin snips were weighed and the microfilarial load was expressed as the arithmetic mean of two skin snips per mg of skin snip.Results: Out of the total 390 examined subjects, 87 (22.3%) were found to be positive for microfilaridermia. Significant differences in the prevalence and microfilarial load of the disease were not found among untreated and treated subjects (p > 0.05). Significant reductions of the prevalence (25.5%) and intensity of infection (0.08 – 8mf, mean 1.3) were found compared to prevalence (81%) and intensity of infection ( 0-855, mean 33 ± 5.6) reported before the initiation of the CDTI programme in the study area.Conclusion: The overall results of the study showed a high reduction both in the prevalence and intensity of infection compared to prevalence and intensity of the disease before the initiation of the CDTI programme in the study area. Nevertheless, continued assessment of the long-term impact of repeated annual CDTI programme on onchocerciasis and identification of factors that could affect the sustainability of the programme in various CDTI areas of Ethiopia, could contribute towards the effective control of the programme. [Ethiop. J. Health Dev. 2010;24(1):51-56

Transmission of Schistosoma mansoni in Tikur Wuha area, Southern Ethiopia

Background: Although the epidemiology of schistosomiasis is well established and the disease distribution has also been mapped in Ethiopia, discovery of new foci has continuously been reported.Objectives: The objective of this study was to assess the establishment of transmission of schistosomiasis mansoni in Tikur Wuha area, southern Ethiopia.Methods: A cross-sectional epidemiological study involving 375 school children in Tikur Wuha Elementary School was conducted in December 2007 and January 2008. Stool specimens were collected and microscopically examined using Kato-Katz method. Snail survey was also conducted using scoop in Tikur Wuha River and littoral zone of Lake Awassa on the side of Tikur Wuha Kebele (administrative unit). The snails collected were checked for trematode infection by shedding. Laboratory-bred mice were exposed to schistosome cercariae and definite identification of the schistosome was made using eggs and adult worm morphology.Results: The prevalence and intensity of schistosomiasis mansoni was 12% and 69 eggs per gram (epg) of stool, respectively. Biomphalaria sudanica collected in Tikur Wuha River shed schistosome cercariae. Adult S. mansoni worms were harvested from laboratory-bred mice after 6 weeks of laboratory maintenance.Conclusion: The prevalence and intensity of schistosomiasis mansoni among school children was low and the area represents low-risk community. The finding of S. mansoni infected young children, the collection of B. sudanica infected with schistosome cercariae, and the establishment of infection in lab-bred mice all confirmed the transmissionof schistosomiasis mansoni in Tikur Wuha area. Appropriate intervention measures need to be in place to reduce morbidity and transmission of intestinal schistosomiasis in the area

Performance of CareStart™ Malaria Pf/Pv Combo test for the diagnosis of Plasmodium falciparum and Plasmodium vivax infections in the Afar Region, North East Ethiopia

Background: CareStart™ Malaria Pf/Pv Combo test has shown encouraging results for the diagnosis of P. falciparum and P. vivax infections in Ethiopia. Nevertheless, the performance of the test could be affected by different factors like gene polymorphisms, excess heat and humidity. Hence, evaluation of the performance of the test in different settings in Ethiopia is vital for the routine diagnosis of malaria.Objective: To evaluate the diagnostic performance of CareStartTM Malaria Pf/Pv Combo test for the diagnosis of P. falciparum and P. vivax infections in the Afar Region, Northeast Ethiopia.Methods: Finger prick blood samples were collected from a total of 1092 patients who had malaria symptoms and visited three different health facilities in the Afar Region. Giemsa-stained thin and thick blood smears were prepared and microscopically examined under 100 × magnifications for Plasmodium species identification and determination of parasitaemia. CareStart Malaria Pf/Pv Combo test was also performed as per the manufacturer's instructions. The sensitivity and the specificity of the test was determined using microscopy as gold standard.Results: The sensitivity and specificity of the test were 98.5% and 98.0% respectively, with a positive predictive value (PPV) of 91.7% and a negative predictive value (NPV) of 99.7% for the diagnosis of P. falciparum infection. The corresponding sensitivity and specificity for the diagnosis of P. vivax infection were 100% and 99.6% respectively, with PPV and NPV of 86.2% and 100%, respectively.Conclusion: The results of this study revealed high sensitivity and specificity of CareStartTM Malaria Pf/Pv Combo test for the diagnosis of both P. falciparum and P. vivax infections in the study area, though additional study may be needed in the most peripheral hottest areas of the region. [Ethiop. J. Health Dev. 2011;25(3):206-211

Podoconiosis treatment in northern Ethiopia (GoLBet): study protocol for a randomised controlled trial

BACKGROUND Podoconiosis is one of the forgotten types of leg swelling (elephantiasis) in the tropics. Unlike the other, better-known types of leg swelling, podoconiosis is not caused by any parasite, virus or bacterium, but by an abnormal reaction to minerals found in the clay soils of some tropical highland areas. Non-governmental Organizations (NGOs) have been responsible for the development of simple treatment methods without systematic evaluation of its effectiveness. It is essential that a large scale, fully controlled, pragmatic trial of the intervention is conducted. We aim to test the hypothesis that community-based treatment of podoconiosis lymphoedema reduces the frequency of acute dermatolymphangioadenitis episodes ('acute attacks') and improves other clinical, social and economic outcomes. METHODS/DESIGN This is a pragmatic, individually randomised controlled trial. We plan to randomly allocate 680 podoconiosis patients from the East Gojjam Zone in northern Ethiopia to one of two groups: 'Standard Treatment' or 'Delayed Treatment'. Those randomised to standard treatment will receive the hygiene and foot-care intervention from May 2015 for one year, whereas those in the control arm will be followed through 2015 and be offered the intervention in 2016. The trial will be preceded by an economic context survey and a Rapid Ethical Assessment to identify optimal methods of conveying information about the trial and the approaches to obtaining informed consent preferred by the community. The primary outcome will be measured by recording patient recall and using a simple, patient-held diary that will be developed to record episodes of acute attacks. Adherence to treatment, clinical stage of disease, quality of life, disability and stigma will be considered secondary outcome measures. Other outcomes will include adverse events and economic productivity. Assessments will be made at baseline and at 3, 6, 9 and 12 months thereafter. DISCUSSION The evidence is highly likely to inform implementation of the new master plan for integrated control of Neglected Tropical Diseases (NTDs), in which podoconiosis is identified as one of eight NTDs prioritised for control. Potentially, an estimated 3 million patients in Ethiopia will therefore benefit from the results of this trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number. REGISTRATION NUMBER ISRCTN67805210 . Date of registration: 24 January 2013

Intestinal parasitic infections among under-five children and maternal awareness about the infections in Shesha Kekele, Wondo Genet, Southern Ethiopia

Background: Few studies have reported the magnitude of intestinal parasitic infections among under-five children in tropical countries. Moreover, there is little information on maternal awareness about intestinal parasitosis.Objective: To determine the prevalence of intestinal parasitosis among under-five children, and assess maternal awareness about it in Shesha Kebkele, Wondo Genet, Southern Ethiopia.Methods: A cross-sectional study involving 288 under-five children was conducted and stool samples were collected and examined for intestinal parasites using Kato-Katz and formol-ether concentration methods. In addition, a total of 130 mothers of under-five children were interviewed regarding their awareness about intestinal parasitic infections.Results: Of the 288 children, 245 (85.1%) were found infected with one or more intestinal parasites. The prevalence of Trichuris trichiura, Schistosoma mansoni and Ascaris lumbricoides, hookworm, and Hymenolepis nana infections as determined by Kato-Katz were 74.7%, 37.2%, 25.7%, 5.9%, and 4.5%, respectively. On the other hand, theprevalence of Strongyloides stercoralis, Giardia lamblia, Entamoeba histolytica/dispar, and Entamoeba coli infections as determined by formol-ether concentration method were 0.69%, 13.2%, 0.35%, and 2.1%, respectively. Most mothers were reasonably aware of the mode of transmission of ascariasis, amoebiasis and giardiasis while they hadvery limited knowledge of bilharzia and hookworm transmission. Almost all of the respondents reported that infections with intestinal parasites could cause retardation of growth and death in children unless treated.Conclusion: Intestinal parasitic infections were prevalent in varying magnitude among under-five children in Wondo Genet area, Southern Ethiopia. Mothers in the study area had a fairly good knowledge of the impact of infections but limited knowledge of the mode of transmission of intestinal parasitic infections. Improvement of sanitation and healtheducation are required besides preventive chemotherapy to control worms (except for schistosomiasis in under-five which need treatment on an individual basis) and other intestinal parasitic infections in the area

Rapid ethical assessment on informed consent content and procedure in Hintalo-Wajirat, Northern Ethiopia: a qualitative study

Background Informed consent is a key component of bio-medical research involving human participants. However, obtaining informed consent is challenging in low literacy and resource limited settings. Rapid Ethical Assessment (REA) can be used to contextualize and simplify consent information within a given study community. The current study aimed to explore the effects of social, cultural, and religious factors during informed consent process on a proposed HPV-serotype prevalence study. Methodology A qualitative community-based REA was conducted in Adigudom and Mynebri Kebeles, Northern Ethiopia, from July to August 2013. Data were collected by a multi-disciplinary team using open ended questions concerning informed consent components in relation to the parent study. The team conducted one-to-one In-Depth Interviews (IDI) and Focus Group Discussions (FGDs) with key informants and community members to collect data based on the themes of the study. Tape recorded data were transcribed in Tigrigna and then translated into English. Data were categorized and thematically analyzed using open coding and content analysis based on pre-defined themes. Results The REA study revealed a number of socio-cultural issues relevant to the proposed study. Low community awareness about health research, participant rights and cervical cancer were documented. Giving a vaginal sample for testing was considered to be highly embarrassing, whereas giving a blood sample made participants worry that they might be given a result without the possibility of treatment. Verbal consent was preferred to written consent for the proposed study. Conclusion This rapid ethical assessment disclosed important socio-cultural issues which might act as barriers to informed decision making. The findings were important for contextual modification of the Information Sheet, and to guide the best consent process for the proposed study. Both are likely to have enabled participants to understand the informed consent better and consequently to comply with the study