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PubMed | University of Gondar, Addis Ababa Institute of Technology and Ethiopian Health and Nutrition Research Institute EHNRI
Type: | Journal: Anemia | Year: 2015

Iron deficiency anemia among pregnant women is a widespread problem in developing countries including Ethiopia, though its influence on neonatal iron status was inconsistently reported in literature. This cross-sectional study was conducted to compare hematologic profiles and iron status of newborns from mothers with different anemia status and determine correlation between maternal and neonatal hematologic profiles and iron status in Ethiopian context. We included 89 mothers and their respective newborns and performed complete blood count and assessed serum ferritin and C-reactive protein levels from blood samples collected from study participants. Maternal median hemoglobin and serum ferritin levels were 12.2g/dL and 47.0ng/mL, respectively. The median hemoglobin and serum ferritin levels for the newborns were 16.2g/dL and 187.6ng/mL, respectively. The mothers were classified into two groups based on hemoglobin and serum ferritin levels as iron deficient anemic (IDA) and nonanemic (NA) and newborns of IDA mothers had significantly lower levels of serum ferritin (P = 0.017) and hemoglobin concentration (P = 0.024). Besides, newborns ferritin and hemoglobin levels showed significant correlation with maternal hemoglobin (P = 0.018; P = 0.039) and ferritin (P = 0.000; P = 0.008) levels. We concluded that maternal IDA may have an effect on the iron stores of newborns.

PubMed | Addis Ababa Institute of Technology, Clinton HIV AIDS Access Initiative CHAI, U.S. Center for Disease Control and Prevention, Centers for Disease Control and Prevention and Ethiopian Health and Nutrition Research Institute EHNRI
Type: Journal Article | Journal: African journal of laboratory medicine | Year: 2016

Early diagnosis of infants infected with HIV (EID) and early initiation of treatment significantly reduces the rate of disease progression and mortality. One of the challenges to identification of HIV-1-infected infants is availability and/or access to quality molecular laboratory facilities which perform molecular virologic assays suitable for accurate identification of the HIV status of infants.We conducted a joint site assessment and designed laboratories for the expansion of DNA polymerase chain reaction (PCR) testing based on dried blood spot (DBS) for EID in six regions of Ethiopia. Training of appropriate laboratory technologists and development of required documentation including standard operating procedures (SOPs) was carried out. The impact of the expansion of EID laboratories was assessed by the number of tests performed as well as the turn-around time.DNA PCR for EID was introduced in 2008 in six regions. From April 2006 to April 2008, a total of 2848 infants had been tested centrally at the Ethiopian Health and Nutrition Research Institute (EHNRI) in Addis Ababa, and which was then the only laboratory with the capability to perform EID; 546 (19.2%) of the samples were positive. By November 2010, EHNRI and the six laboratories had tested an additional 16 985 HIV-exposed infants, of which 1915 (11.3%) were positive. The median turn-around time for test results was 14 days (range 14-21 days).Expansion of HIV DNA PCR testing facilities that can provide quality and reliable results is feasible in resource-limited settings. Regular supervision and monitoring for quality assurance of these laboratories is essential to maintain accuracy of testing.

Kassa D.,Ethiopian Health and Nutrition Research Institute EHNRI | Kassa D.,University Utrecht | Gebremichael G.,Ethiopian Health and Nutrition Research Institute EHNRI | Alemayehu Y.,Ethiopian Health and Nutrition Research Institute EHNRI | And 3 more authors.
AIDS Research and Therapy | Year: 2013

Background: HIV/TB coinfection remains a major challenge even after the initiation of HAART. Little is known about Mycobacterium tuberculosis (Mtb) specific immune restoration in relation to immunologic and virologic outcomes after long-term HAART during co-infections with latent and active TB.Methods: A total of 232 adults, including 59 HIV patients with clinical TB (HIV + TB+), 125 HIV patients without clinical TB (HIV + TB-), 13 HIV negative active TB patients (HIV-TB+), and 10 HIV negative Tuberculin Skin TST positive (HIV-TST+), and 25 HIV-TST- individuals were recruited. HAART was initiated in 113 HIV + patients (28 TB + and 85 TB-), and anti-TB treatment for all TB cases. CD4+ T-cell count, HIV RNA load, and IFN-γ responses to ESAT-6/CFP-10 were measured at baseline, 6 months (M6), 18 months (M18) and 24 months (M24) after HAART initiation.Results: The majority of HIV + TB- (70%, 81%, 84%) as well as HIV + TB + patients (60%, 77%, 80%) had virologic success (HIV RNA < 50 copies/ml) by M6, M18 and M24, respectively. HAART also significantly increased CD4+ T-cell counts at 2 years in HIV + TB + (from 110.3 to 289.9 cells/μl), HIV + TB- patients (197.8 to 332.3 cells/μl), HIV + TST- (199 to 347 cells/μl) and HIV + TST + individuals (195 to 319 cells/μl). Overall, there was no significant difference in the percentage of patients that achieved virologic success and in total CD4+ counts increased between HIV patients with and without TB or LTBI. The Mtb specific IFN-γ response at baseline was significantly lower in HIV + TB + (3.6 pg/ml) compared to HIV-TB + patients (34.4 pg/ml) and HIV + TST + (46.3 pg/ml) individuals; and in HIV-TB + patients compared to HIV-TST + individuals (491.2 pg/ml). By M18 on HAART, the IFN-γ response remained impaired in HIV + TB + patients (18.1 pg/ml) while it normalized in HIV + TST + individuals (from 46.3 to 414.2 pg/ml).Conclusions: Our data show that clinical and latent TB infections do not influence virologic and immunologic outcomes of ART in HIV patients. Despite this, HAART was unable to restore optimal TB responsiveness as measured by Mtb specific IFN-γ response in HIV/TB patients. Improvement of Mtb-specific immune restoration should be the focus of future therapeutic strategies. © 2013 Kassa et al.; licensee BioMed Central Ltd.

Johns B.,Abt Associ. Inc. | Asfaw E.,Ethiopian Health and Nutrition Research Institute EHNRI | Wong W.,Abt Associ. Inc. | Bekele A.,Ethiopian Health and Nutrition Research Institute EHNRI | And 3 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2014

Objective: To evaluate the effects, costs, and cost-effectiveness of different degrees of antiretroviral therapy task shifting from physician to other health professionals in Ethiopia. Design: Two-year retrospective cohort analysis on antiretroviral therapy patients coupled with cost analysis. Interventions: Facilities with minimal or moderate task shifting compared with facilities with maximal task shifting. Maximal task shifting is defined as nonphysician clinicians handling both severe drug reactions and antiretroviral drug regimen changes. Secondary analysis compares health centers to hospitals. Main outcome measures: The primary effectiveness measure is the probability of a patient remaining actively on antiretroviral therapy for 2 years; the cost measure is the cost per patient per year. Results: All facilities had some task shifting. About 89% of patients were actively on treatment 2 years after antiretroviral treatment (ART) initiation, with no statistically significant differences between facilities with maximal and minimal or moderate task shifting. It cost about $206 per patient per year for ART, with no statistically significant difference between the comparison groups. The cost-effectiveness of maximal task shifting is similar to minimal or moderate task shifting, with the same results obtained using regression to control for facility characteristics. Conclusions: Shifting the handling of both severe drug reactions and antiretroviral drug regimen changes from physicians to other clinical officers is not associated with a significant change in the 2- year treatment success rate or the costs of ART care. As an observational study, these results are tentative, and more research is needed in determining the optimal patterns of task shifting. © 2013 by Lippincott Williams & Wilkins.

PubMed | Medical Biotech Laboratory, University Utrecht, Leiden University and Ethiopian Health and Nutrition Research Institute EHNRI
Type: | Journal: Tuberculosis (Edinburgh, Scotland) | Year: 2016

Identification of Mtb specific induced cytokine/chemokine host biomarkers could assist in developing novel diagnostic, prognostic and therapeutic tools for TB. Levels of IFN-, IL-2, IL-17, IL-10, IP-10 and MIP-1 were measured in supernatants of whole blood stimulated with Mtb specific fusion protein ESAT-6/CFP-10 using xMAP technology. The study groups were HIV positive TB patients (HIV(+)TB(+)), HIV negative TB patients (HIV(-)TB(+)), HIV positive tuberculin skin test positive (TST+) (HIV(+)TST(+)), HIV negative TST+ (HIV(-)TST(+)), and HIV(-)TST(-) individuals. Compared to HIV(-)TST(-), latent TB infection led to increased levels of IP-10, IFN- and IL-17, while levels of IL-2 and IP-10 were increased with active TB. Levels of IFN-, IL-17, MIP-1, and IL-10 were increased in HIV(-)TST(+) individuals compared to HIV(-)TB(+) patients. HIV coinfection decreased the level of IFN-, IL-17, IP-10 and IL-2. After six months (M6) of anti-TB treatment (ATT) in HIV(-)TB(+) patients, IFN-, IL-10, and MIP-1 levels normalized. After M6 and M18 of ATT plus HAART in HIV(+)TB(+) patients, levels of MIP-1 and IL-10 normalized, while this was not the case for IFN-, IL-2, IL-17, and IP-10 levels. In HIV(+)TST(+) patients on HAART, levels of IFN-, IL-17, IL-10 and MIP-1 normalized, while no change in the levels of IL-2 and IP-10 were observed. In conclusion, the simultaneous measurement of IFN-, IL-17 and IP-10 may assist in diagnosing LTBI; IL-2 and IP-10 may assist in diagnosing active TB; while IFN-, IL-17, MIP-1, and IL-10 levels could help to discriminate LTBI and active TB. In addition, IL-10 and MIP-1 levels could help to monitor responses to TB treatment and HAART.

Akalu G.,Ethiopian Health and Nutrition Research Institute EHNRI | Taffesse S.,Ethiopian Health and Nutrition Research Institute EHNRI | Gunaratna N.S.,Nevin Scrimshaw International Nutrition Foundation | De Groote H.,International Maize and Wheat Improvement Center
Food and Nutrition Bulletin | Year: 2010

Background. Undernutrition is a persistent problem in Africa, especially in rural areas where the poor largely depend on staples and have limited access to a diverse diet. Quality protein maize (QPM) consists of maize varieties biofortified with increased lysine and tryptophan levels. Several studies in controlled settings have indicated the positive impact of QPM on the nutritional status of children. Objective. Two 1-year, randomized, controlled studies were undertaken to measure the effect of QPM on the nutritional status of children consuming typical maize-based diets when QPM was cultivated by their households in the western Ethiopian highlands. Methods. The first study used a cluster-randomized design with 151 children aged 5 to 29 months; the second study used a completely randomized design with 211 children aged 7 to 56 months. In both studies, half of the households were provided with QPM seed and the other half with seed of an improved conventional maize variety. Results. Undernutrition was pervasive, and maize was the dominant food in the children's complementary diets. In the first study, a positive effect of QPM was observed for weight but not height, with children in the QPM group recovering from a drop in weight-for-height. In the second study, children consuming conventional maize progressively faltered in their growth, whereas children consuming QPM did not change significantly in height-for-age and had a marginal increase in weight-for-age. Conclusions. These studies indicate that in major maize-producing and -consuming areas of Africa, home cultivation and use of QPM in children's diets could reduce or prevent growth faltering and may in some cases support catch-up growth in weight. © 2010, The United Nations University.

Baye K.,Addis Ababa Institute of Technology | Retta N.,Addis Ababa Institute of Technology | Abuye C.,Ethiopian Health and Nutrition Research Institute EHNRI
Food and Nutrition Bulletin | Year: 2014

Background. In light of the continuing rise in food prices during and after the 2008 world food crisis, whether food and cash transfers are equally effective in improving food security and diet quality is debatable. Objective. To compare the effects of conditional food and cash transfers of the Ethiopian Productive Safety Net Program (PSNP) on household food security and dietary diversity. Methods. Data on household dietary diversity, child anthropometry, food security, and preference of transfer modalities (food, cash, or mixed) were generated from a cross-sectional survey of 195 PSNP beneficiary households (67 receiving food and 128 receiving cash) in Hawella Tulla District, Sidama, southern Ethiopia. Results. Most beneficiaries (96%) reported food shortages, and 47% reported food shortages that exceeded 3 months. Households receiving cash had better household dietary diversity scores (p =.02) and higher consumption of oils and fats (p =.003) and vitamin A-rich foods (p =.002). Compared with households receiving food, households receiving cash were more affected by increases in food prices that forced them to reduce their number of daily meals (p <.001) and spend less on nonstaples (p <.001). While most households receiving food (82%) preferred to continue receiving food, households receiving cash (56%) preferred a mix of food and cash. Conclusions. Households receiving cash had better household dietary diversity than households receiving food, a result suggesting that cash transfers may be more effective. However, the continuing rise in food prices may offset these benefits unless cash transfers are index-linked to food price fluctuations. © 2014, The Nevin Scrimshaw International Nutrition Foundation.

Misgena D.K.,Ethiopian Health and Nutrition Research Institute EHNRI
Ethiopian Journal of Health Development | Year: 2011

Background: Since the advent of HAART, there is a significant reduction in opportunistic Infections (OIs), morbidity, mortality and HIV transmission. However, the low antiretroviral Therapy (ART) coverage in resource-limited countries (42%) and the presence of globally 500-800 thousand patients on first-line having to required switch to second-line drugs in 2010 are some concerns. Other challenges related to HAART include: lifelong therapy, failed treatment response, optimal time to start treatment and switching regimens, drug interaction, toxicity, cardiovascular risks, drug resistance, lost to follow-up, immune reconstitution inflammatory syndrome (IRIS), early mortality, and lack of restoration of solid immunity against HIV. To achieve the goals of ART, national ART programmes focus on the vital patient monitoring systems including clinical, immunologic, virologic, adherence, lost to follow-up and mortality. Objectives: This review is aimed at addressing the profile of immunovirological responses to HAART and the factors associated with, with a special emphasis on the drawbacks of immunologic assessment to diagnose virologic failures. Main findings: WHO recommends clinical and immunological assessments as surrogates of plasma viral load (VL) to identify first-line treatment failures in resource-poor settings. However, immunological tools have poor sensitivity (20-30%) and specificity (86-90%) to identify virologic failures that may lead to continue with failed regimen or to unnecessary switch of regimen which could result in a more complex profile of resistance. There are three main types of immunovirologic responders in clinical practice: concordant responders (40-60%), concordant non-responders (12-27.3%), and discordant responders that include lack of CD4+ increases despite viral suppression (7-48%), and optimal CD4+ responses in the absence of viral suppression (5-23.8%), whereby the risk of morbidity and mortality is higher in the concordant non-responders and discordant responders. Conclusions: ART benefits a substantial number of HIV patients even in resource-poor settings. Since clinico-immunological assessments have lower performance in diagnosing virologic failures, moving towards the availability of VL testing to confirm treatment failures, if not pre-HAART resistance testing, is a logical and timely approach for resource limited countries like Ethiopia where the long-term effect of the roll-out ART is not well investigated. However, the high cost and technical demand of VL testing, lack of experience of health professionals, weak infrastructure and health care system, the unavailability and high costs of second-line drugs could be the major challenges during expansion of VL testing. Moreover, longitudinal studies on long-term effects of HAART, and surveys focused on transmitted or acquired HIV drug resistance, and Early Warning Indicators are highly pertinent.

Woyessa A.,Ethiopian Health and Nutrition Research Institute EHNRI | Hadis M.,Ethiopian Health and Nutrition Research Institute EHNRI | Kebede A.,Ethiopian Health and Nutrition Research Institute EHNRI
International Journal of Technology Assessment in Health Care | Year: 2013

Objective: The aim of this study was to investigate malaria elimination in Ethiopia. Ethiopia has planned to eliminate malaria by 2015 in areas of unstable malaria transmission and in the entire country by 2020. However, there is a shortage and maldistribution of the health workforce in general and malaria experts in particular. Training, motivating, and retaining the health workforce involved in malaria control is one strategy to address the shortage and maldistribution of the health workforce to achieve the goal of elimination. Methods: Policy options include the following: (i) in-service training (educational outreach visits, continuing education meetings and workshops, audit and feedback, tailored interventions, and guideline dissemination) may improve professional practice; (ii) recruiting and training malaria specialists together with academic support, career guidance, and social support may increase the number of malaria experts; and (iii) motivation and retention packages (such as financial, educational, personal, and professional support incentives) may help motivate and retain malaria professionals. Results: Implementation strategies include the following: (i) massive training of health personnel involved in malaria elimination and malaria experts (requiring special training) at different levels (national, sub-national, District & community levels), and (ii) recruiting highly qualified health personnel and retention and motivation mechanisms are needed. Conclusions: The lack of adequately trained human resources and personnel attrition are major challenges to effectively implement the planned multi-faceted malaria elimination by 2020 strategy in Ethiopia. Although a reduction in malaria incidence has been observed in the last 3-4 years, maintaining this success and achieving the malaria elimination goal with the present human resource profile will be impossible. A clear strategy for developing the capacity of the health workers in general, and malaria experts in particular, and retaining and motivating staff are crucial for malaria control and elimination. Copyright © Cambridge University Press 2013.

Tegegne D.,Health Science University | Desta K.,Addis Ababa Institute of Technology | Tegbaru B.,Ethiopian Health and Nutrition Research Institute EHNRI | Tilahun T.,Ethiopian Health and Nutrition Research Institute EHNRI
BMC Research Notes | Year: 2014

Background: Hepatitis B Virus is a major public health problem worldwide. In 2012 alone, over 350 million chronic carriers and 1. 2 million annual deaths were occurred. Hepatitis B Virus causes 60 to 80% of the world's primary liver cancer and nearly 90% infants infected due to vertical transmission are at higher risk of developing chronic liver disease and cancer. Hence determining the burden of maternal and neonatal Hepatitis B Virus infection is a priority. Methods. A cross sectional study was conducted from July - September 2012 at St. Paul's Hospital Millennium Medical College and Selam Health Center, Addis Ababa, Ethiopia. Blood samples from delivering mothers (n = 265) and their corresponding cords (n = 265) were collected. A pretested questionnaire was used to collect data. Hepatitis B Virus surface antigen was detected using Enzyme Linked Immunosorbent Assay. Frequency analysis and logistic regression test was used to identify the potential risk factors associated with Hepatitis B Virus positivity using SPSS Version -15. Results: A total of 265 delivering women with the mean age of 25.8 years were enrolled in the study. Of these delivering women, 8 (3.0%) of mothers were positive for Hepatitis B Virus surface antigen, whereas 6 (2.3%) of cord bloods were positives with 75% concordance rate of exposed infants with sero-positive mothers. However, only one maternal positive case was observed for Hepatitis B e Ag test. Only 11% of the mothers know their Hepatitis B Virus status. Of the total mothers assessed for possible risk factors, 69 (26%) had only one type, while 161 (60.8%) had multiple exposure factors such as ear pricing, history of tribal marks, abortion, multiple-sexual partner and history of surgical procedures experienced from high to low frequency. The remaining 35 (13.2%) of the participants had not experienced possible risk factors. Conclusion: Though the maternal positivity rate was low, the rate of positivity in cord bloods was almost equal to those infected mothers. Therefore, screening of pregnant mothers and vaccination of infants could help to reduce the transmission. To minimize the higher overall risk exposure status of mothers, increasing awareness and intensive public health education is also recommended. © 2014 Tegegne et al.; licensee BioMed Central Ltd.

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