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Santana-Morales M.A.,University of La Laguna | Afonso-Lehmann R.N.,University of La Laguna | Quispe M.A.,University of La Laguna | Reyes F.,Gambo General Rural Hospital | And 4 more authors.
Malaria Journal | Year: 2012

Background: Malaria is a leading public health problem in Ethiopia. Accurate diagnosis of Plasmodium infections is crucial for the reduction of malaria in tropical areas and for epidemiological studies. The role of light microscopy (LM) as gold standard has been questioned and, therefore, new molecular methods have been developed for the detection of Plasmodium species. The aim of the present work was to compare different malaria diagnostic methods in order to detect the most common species of Plasmodium and to broaden the knowledge of malaria prevalence in a hospital in a rural area in Ethiopia. Methods. A cross-sectional survey of 471 individuals was carried out in a hospital in the rural area of Gambo (Ethiopia). Blood samples were prepared for microscopic observation and collected in filter paper for Seminested-Multiplex PCR (SnM-PCR) and real time PCR (qPCR) testing. The SnM-PCR was considered as the gold standard technique and compared with the rest. Thus, agreement between SnM-PCR and LM was determined by calculating Kappa Statistics and correlation between LM and qPCR quantification was calculated by pair-wise correlation co-efficient. Results: Samples analysed by LM and SnM-PCR were positive for Plasmodium sp. 5.5% and 10.5%, respectively. Sensitivity was 52.2% by LM and 70% by qPCR. Correlation co-efficient between microscopy counts and qPCR densities for Plasmodium vivax was R2=0.586. Prevalence was estimated at 7% (95% CI: 4.7-9.3). Plasmodium vivax was the dominant species detected and the difference was statistically significant ( 2=5.121 p<0.05). The highest prevalence of the parasite (10.9%) was observed in age groups under 15years old. Conclusion: Accurate malaria diagnostic methods have a great effect in the reduction of the number of malaria-infected individuals. SnM-PCR detection of malaria parasites may be a very useful complement to microscopic examination in order to obtain the real prevalence of each Plasmodium species. Although SnM-PCR shows that it is a good tool for the determination of Plasmodium species, today light microscopy remains the only viabletool for malaria diagnosis in developing countries. Therefore, re-inforcement in the training of microscopists is essential for making the correct diagnosis of malaria. Plasmodium vivax was the predominant species in Gambo, a meso-endemic area for this species. © 2012 Santana-Morales et al.; licensee BioMed Central Ltd.

PubMed | Autonomous University of Madrid, Hospital Universitario Infanta Leonor, Gambo General Rural Hospital and University Miguel Hernández
Type: Journal Article | Journal: International journal of mycobacteriology | Year: 2016

The goal of this study is to describe the experience with smear microscopy examination for acid-fast bacilli (AFB) of spontaneous sputum from children in a district hospital located in a rural zone of Ethiopia. All sputum reports of children were retrospectively reviewed from July 2007 until June 2012. During the period of study, 875 children less than 15years old were screened and 48 (5.5%, 95% confidence interval [CI]: 4.1-7.3%) were diagnosed with pulmonary tuberculosis sputum smear positive. The mean age of the children with sputum positive for AFB was significantly higher than children with sputum negative for AFB (11.4 versus 10.4) (p=0.001). Only 1 out of 47 (1.3%) children of 6years or less had sputum positive for AFB. In 13- and 14-year-old children, 8.7% had sputum positive for AFB (20 of 229) (p=0.03). Spontaneous sputum has a low diagnostic yield in childhood in low-income countries. Alternative methods should be implemented in rural areas to improve diagnosis of pulmonary TB, particularly in children less than 12years old.

PubMed | Autonomous University of Madrid, Gambo General Rural Hospital and University Miguel Hernández
Type: Journal Article | Journal: International journal of mycobacteriology | Year: 2016

The purpose of this study is to describe the experience of the completion of the Tuberculosis (TB) Contact Screening Logbook (TB-CSL). The TB-CSL was retrospectively analyzed from July 2007 until June 2012. During the study period, 122 patients were included in the TB-CSL; however, 17 (13.9%) patients with TB were written in the TB-CSL, but without registering any contacts. Of the 105 TB patients with contacts registered, the family and household contacts were finally performed in 68 index TB patients (55.7% of TB patients). These 68 index TB cases had 299 family and household contacts; the median contact per patient was 4.4 (1.9). Of the 299 contacts, 160 (53.5%) were screened. The median of those screened per patient was 2.3 (1.9). Of the 160 family and household contacts screened, 34 (31.3%) of them were children 5years of age. TB was diagnosed after screening in 16 (10.1%) contacts. Isoniazid preventive therapy was prescribed in 22 of 34 (64%) children <5years of age. Alternative methods should be implemented in rural areas to improve TB screening contacts, especially in children under 5years of age.

PubMed | Autonomous University of Madrid, Gambo General Rural Hospital and University Miguel Hernández
Type: Journal Article | Journal: International journal of mycobacteriology | Year: 2016

Treatment of new tuberculosis (TB) cases in Directly Observed Treatment Short Course (DOTS) programmes is believed to be the most valuable strategy for TB control. The aim of this study is to describe the experience of diagnosed cases of TB in a district hospital situated in a rural zone of Ethiopia and of transferred out TB cases from the hospital to their local health facilities using the DOTS programme spanning a period of 8years. Data collection was obtained by using a TB register book in a rural district hospital from 2004 to 2011. The collected information included the type of TB, age, HIV status, and treatment outcomes using standardized definitions; 6459 patients with all forms of TB were diagnosed. Twenty-eight percent were smear-positive pulmonary TB (PTB) cases, 28.97% were smear-negative PTB cases, and 42.8% were extra-pulmonary TB (EPTB). The global transferred out rate was 78.5% (5073/6459); the transferred out rate after diagnosis at hospital and before starting DOTS was 72.6% (4689/6459), and after finishing the intensive phase and admission was 21.8% (385/1770). The proportion of total cases transferred out in smear-negative PTB cases (70.2%) was less than smear-positive PTB cases (79.2%) (odd ratio [OR]: 0.81; 95% confidence interval [CI]: 0.76-0.87) and was higher in EPTB cases (83.3%) (OR: 1.15; 95% CI: 1.05-1.19). The percentage of transferred out after hospital admission was higher in HIV-positive cases (16.8%) than in HIV-negative cases (8.5%) (OR: 2.13; 95% CI: 1.28-3.53). In conclusion, district hospitals are still important facilities for the diagnosis of TB cases, particularly EPTB.

Ramos J.M.,Gambo General Rural Hospital | Ramos J.M.,Hospital General Universitario Of Elche | Reyes F.,Gambo General Rural Hospital | Lemma D.,Gambo General Rural Hospital | And 2 more authors.
Tropical Doctor | Year: 2011

We assessed the epidemiology of disabilities in leprosy cases treated in a rural hospital over a10-year period.This is a retrospective data collection using leprosy registers and treatment cards in a rural privatemission hospital. Over the10-year period, 210 patients with leprosy were registered for treatment. One hundred and twentyeight (61.5%) had disabilities (26.0%grade1and 35.6%grade 2):13.5% ocular disabilities, 44.5% disabilities in hands and 44.7% foot impairment. Patients >19 years had more disabilities (66.7% versus 50.7%) (P = 0.03), especially ocular disabilities (16.7% in >20 versus 6.0% in <20 years) (P = 0.03).This study detected a high prevalence of disabilities.

Ramos J.M.,Hospital General Universitario Of Elche | Ramos J.M.,Gambo General Rural Hospital | Toro C.,Hospital Carlos III | Reyes F.,Gambo General Rural Hospital | And 2 more authors.
Journal of Clinical Virology | Year: 2011

Background: Human immunodeficiency virus type 1 (HIV-1), hepatitis B virus (HBV), human T-cell lymphotropic virus type 1 (HTLV-1) and Treponema pallidum represent major public health problems in sub-Saharan countries. These infections can be transmitted from mother to children and may cause severe morbidities in their offspring. Ethiopia is among the countries where HIV-1, HBV and T. pallidum infections are highly prevalent. However, information on seroprevalence of these infections among antenatal care attendees is very scarce and the majority of studies have been conducted in pregnant women from urban areas. Objectives: To determine the seroprevalence of HIV-1, HBV, HTLV-1 and T. pallidum infections among pregnant women in a rural hospital in Southern Ethiopia. Study design: A cross-sectional study was conducted among consecutive pregnant women attending a mother and child clinic in August 2008. Results: A total of 165 pregnant women were included. The seroprevalence of HIV-1 was 1.8% (95% confidence intervals [CI]: 0.6-5.2%), and for HBV (HBsAg seropositivity) was 6.1% (95% CI: 3.3-10.8%). Co-infection with HIV-1 and HBV was detected in one patient (prevalence: 0.6%; 95% CI: 0.1-3.4%). No cases of HTLV-1 infection and syphilis were found (95% CI: 0-2.3%). Conclusions: A far from negligible percentage of pregnant women from rural areas harbour HBV, and to a lesser extent, HIV-1 infections. Continuing efforts to strengthen the existing health education program and comprehensive screening for all pregnant women are necessary to prevent mother-to-child transmission of HBV and HIV-1. © 2011 Elsevier B.V.

Mula P.,Institute of Tropical Medicine | Fernandez-Martinez A.,Institute of Tropical Medicine | De Lucio A.,Institute of Tropical Medicine | Ramos J.,Gambo General Rural Hospital | And 5 more authors.
Malaria Journal | Year: 2011

Background: In Ethiopia, malaria is caused by Plasmodium falciparum and Plasmodium vivax, and anti-malarial drug resistance is the most pressing problem confronting control of the disease. Since co-infection by both species of parasite is common and sulphadoxine-pyrimethamine (SP) has been intensively used, resistance to these drugs has appeared in both P. falciparum and P. vivax populations. This study was conducted to assess the prevalence of anti-malarial drug resistance in P. falciparum and P. vivax isolates collected at a rural hospital in southern Ethiopia. Methods. A total of 1,147 patients with suspected malaria were studied in different months across the period 2007-2009. Plasmodium falciparum dhfr and dhps mutations and P. vivax dhfr polymorphisms associated with resistance to SP, as well as P. falciparum pfcrt and pfmdr1 mutations conferring chloroquine resistance, were assessed. Results: PCR-based diagnosis showed that 125 of the 1147 patients had malaria. Of these, 52.8% and 37.6% of cases were due to P. falciparum and P. vivax respectively. A total of 10 cases (8%) showed co-infection by both species and two cases (1.6%) were infected by Plasmodium ovale. Pfdhfr triple mutation and pfdhfr/pfdhps quintuple mutation occurred in 90.8% (95% confidence interval [CI]: 82.2%-95.5%) and 82.9% (95% CI: 72.9%-89.7%) of P. falciparum isolates, respectively. Pfcrt T76 was observed in all cases and pfmdr1 Y86 and pfmdr1 Y1246 in 32.9% (95% CI: 23.4%-44.15%) and 17.1% (95% CI: 10.3-27.1%), respectively. The P. vivax dhfr core mutations, N117 and R58, were present in 98.2% (95% CI: 89.4-99.9%) and 91.2% (95% CI: 80.0-96.7%), respectively. Conclusion: Current molecular data show an extraordinarily high frequency of drug-resistance mutations in both P. falciparum and P. vivax in southern Ethiopia. Urgent surveillance of the emergence and spread of resistance is thus called for. The level of resistance indicates the need for implementation of entire population access to the new first-line treatment with artemether-lumefantrine, accompanied by government monitoring to prevent the emergence of resistance to this treatment. © 2011 Mula et al; licensee BioMed Central Ltd.

PubMed | Institute of Tropical Medicine, Hospital General Universitario Of Alicante and Gambo General Rural Hospital
Type: | Journal: Malaria journal | Year: 2015

Approximately 50 million people (60 %) live in malaria risk areas in Ethiopia, at altitudes below 2000 m. According to official data, 60-70 % of malaria cases are due to Plasmodium falciparum, and 40-30 % by Plasmodium vivax. The species Plasmodium ovale was detected in 2013 in the northwest of the country, being the first report of the presence of this species in Ethiopia since the 60 s. The aim of this study was to assess the diagnosis by microscopy and PCR, and demonstrate the presence of other Plasmodium species in the country.The survey was conducted in Bulbula, situated in the Rift Valley (West Arsi Province, Oromia Region). From December 2010 to October 2011, 3060 samples were collected from patients with symptoms of malaria; the diagnosis of malaria was done by microscopy and confirmation by PCR.736 samples were positive for malaria by microscopy. After removing the 260 samples (109 positives and 151 negatives) for which it was not possible to do PCR, there were a total of 2800 samples, 1209 are used for its confirmation by PCR and quality control (627 are positives and 582 negatives by microscopy). From the 627 positive samples, 604 were confirmed as positive by PCR, 23 false positives were detected, and the group of 582 negative samples, 184 were positive by PCR (false negatives), which added to the previous positive samples is a total of 788, positive samples for some species of Plasmodium sp. 13.3 % more positives were detected with the PCR than the microscopy. Importantly, 23 samples were detected by PCR as P. ovale, after the sequencing of these samples was determined as P. ovale curtisi.The PCR detected more positive samples than the microscopy; in addition, P. ovale and P. ovale/P. vivax were detected that had not been detected by microscopy, which can affect in the infection control.

PubMed | Hospital General Universitario Of Elche, Gambo General Rural Hospital and University Miguel Hernández
Type: Journal Article | Journal: Annals of agricultural and environmental medicine : AAEM | Year: 2015

The presented report describes the epidemiology of potential rabies exposures and examines the utilization of anti-rabies vaccine in a rural area of Ethiopia during a period of 43 months. A total of 683 persons (51.1% females, 73% children) with animal- related bites were included in the retrospective, registry-based study. The most common site of exposure was the leg (66.8%). In children under 8 years of age the face was more often involved than in adults (9.5% vs. 4.8%; p=0.03). The main type of exposure was a bite with bleeding (66.3%) followed by contamination of mucous membranes with saliva (19.7%). The primary sources were dogs (93.4%) followed by cats (2.6%). Children under 15 years were more likely to be exposed to dogs (94.9%) than adults (88.7%) (p=0.01). The most common way of coming in contact with animals was walking by (83.9%). Children came in contact with animals while playing with (10.7%) more often than adults (1.1%) (p<0.001). All the patients received an anti-rabies nervous-tissue vaccine, 99% of whom completed the vaccination course. Animal bites continue to be a problem in rural Ethiopia, mainly among children. Efforts to protect children against animal bites must be of paramount importance in preventing rabies in this population.

Ramos J.M.,Gambo General Rural Hospital | Ramos J.M.,Hospital General Universitario Of Elche | Reyes F.,Gambo General Rural Hospital | Tesfamariam A.,Gambo General Rural Hospital
BMC Public Health | Year: 2010

Background. Many DOTS experiences in developing countries have been reported. However, experience in a rural hospital and information on the differences between children and adults are limited. We described the epidemiology and treatment outcome of adult and childhood tuberculosis (TB) cases, and identified risk factors associated with defaulting and dying during TB treatment in a rural hospital over a 10-year period (1998 to 2007). Methods. Retrospective data collection using TB registers and treatment cards in a rural private mission hospital. Information was collected on number of cases, type of TB and treatment outcomes using standardised definitions. Results. 2225 patients were registered, 46.3% of whom were children. A total of 646 patients had smear-positive pulmonary TB (PTB), [132 (20.4%) children]; 816 had smear-negative PTB [556 (68.2%) children], and 763 extra-PTB (EPTB) [341 (44.8%) children]. The percentage of treatment defaulters was higher in paediatric (13.9%) than in adult patients (9.3%) (p = 0.001). The default rate declined from 16.8% to 3.5%, and was independently positively associated with TB meningitis (AOR: 2.8; 95% CI: 1.2-6.6) and negatively associated with smear-positive PTB (AOR: 0.6; 95% CI: 0.4-0.8). The mortality rate was 5.3% and the greatest mortality was associated with adult TB (AOR: 1.7; 95% CI: 1.1-2.5), TB meningitis (AOR: 3.6; 95% CI:1.2-10.9), and HIV infection (AOR: 4.3; 95% CI: 1.9-9.4). Decreased mortality was associated with TB lymphadenitis (AOR: 0.24; 95% CI: 0.11-0.57). Conclusion. (1) The registration of TB cases can be useful to understand the epidemiology of TB in local health facilities. (2) The defaulter and mortality rate of childhood TB is different to that of adult TB. (3) The rate of defaulting from treatment has declined over time. © 2010 Ramos et al; licensee BioMed Central Ltd.

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