Brhane Berhe

Schistosomiasis and salmonellosis are major public health problems in Africa, contribute substantially to morbidity. Schistosoma-Salmonella co-infection is a neglected and overlooked health condition with important clinical and public health implications. Therefore, we conducted a systematic review and meta-analysis to synthesize evidence on the epidemiology, biological mechanisms, and antimicrobial resistance of Schistosoma-Salmonella co-infection in Africa. A systematic review and Meta-analysis were conducted following the PRISMA framework. The pooled prevalence of co-infection was estimated using a random effects model, with at 95% confidence intervals. Between studies heterogeneity was assessed using Cochran’s Q test and the I ² statistic. Subgroup analyses were performed according to Schistosoma species and country to explore potential source of heterogeneity. This systematic review found that the pooled prevalence of Schistosoma-Salmonella co-infection in Africa was 9%. Species specific pooled prevalence was 4% for Schistosoma mansoni -Salmonella co-infection and 12% for Schistosoma hematobium -Salmonella co-infection. Country based subgroup analysis showed prevalence of Schistosoma mansoni -Salmonella co-infection of 2% in Ethiopia, 9% in Sudan, 2% in Democratic republic of Congo and 4% in Nigeria, while Schistosoma hematobium -Salmonella co-infection prevalence were 0%, 25%, and 8% in Ethiopia, Sudan, and Nigeria respectively. Schistosoma-Salmonella co-infection is driven by immune modulation, tissue pathology, and parasite bacterium interactions that support persistent infection and compromise therapeutic efficacy, thereby contributing to treatment failure and the emergence of antimicrobial resistance. Schistosoma-Salmonella co-infection represents an important and under-recognized public health concern in Africa, with a pooled prevalence of 9%. The findings demonstrate notable variation in co-infection prevalence across Schistosoma species and geographical settings, with higher rates observed among Schistosoma haematobium compared with Schistosoma mansoni . Strengthened surveillance systems, improving early diagnosis, and implementing integrated control strategies are essential to reduce the burden and enhance clinical management of this neglected co-infection in Africa.

Soil-transmitted helminths (STH) remain a significant public health concern in children, particularly in tropical and subtropical areas of the world. Even though these infections are preventable, the World Health Organization (WHO) considers school-aged children to be at elevated risk of soil-transmitted helminth morbidities. Hence, we aimed to assess the prevalence, intensity, and associated factors of soil-transmitted helminthiasis among school-age children in Tigray, Ethiopia, in the aftermath of conflict. A school-based cross-sectional study was conducted from September 2024 to February 2025. Data on socio-demographic characteristics and possible associated factors were collected using a structured questionnaire. Four hundred eighteen school-age children were included and recruited using a systematic random sampling technique. The collected stool specimens were examined using wet mount, formal ether, and the Kato Katz technique. A logistic regression model was employed to assess the associations between dependent and independent variables. Data was analyzed by using SPSS version 25. P value < 0.05 at a 95% confidence interval was considered statistically significant. Out of 418 school-aged children enrolled, the overall prevalence of soil-transmitted helminth infections was 52.6%. The most identified species were Ascaris lumbricoides (35.5%), followed by hookworm (34.0%) and Trichuris trichiura. Co-infections were seen at 3.8%, and triple infection in 0.8% of participants. Most infections were of light intensity, particularly for hookworm (78.7%) and T. trichiura (79.1%), while moderate to heavy intensities were more frequent in A. lumbricoides. Soil-transmitted helminth infections were significantly associated with lower grade levels, large family size, lack of latrines, use of river water, and low paternal education. Protective factors included being male, consistent hand washing, and avoiding river crossings (p < 0.05). Conclusions: Soil-transmitted helminth infections are still a significant public health concern among school-age children in the Aftermath of the Conflict of Tigray, with over half of the children infected (52.6%). Ascaris lumbricoides was most prevalent, and risk was intricately linked to poor hygiene, unsafe water, and lack of sanitation. Targeted interventions such as regular deworming, improved access to latrines, safe water supply, and hygiene education, particularly hand washing, are essential. Strengthening these efforts through school and community-based programs can reduce infection rates and improve child health in post-conflict settings. What is Known: • Soil-transmitted helminth infections are common among school-age children in low-resource settings. • Conflict and displacement disrupt deworming, hygiene, and sanitation programs, increasing infection risk. What is New: • This study provides the first post-conflict data on STH prevalence and intensity among school-age children in Tigray, Ethiopia. • The findings highlight the need to restore and strengthen deworming and sanitation programs in conflict-affected communities.

Background: Despite being preventable and treatable, malaria continues to have a devastating impact on people’s health and livelihoods around the world. In Ethiopia, it is one of the three leading causes of hospital admission and mortality. Therefore, the aim of this study was to assess the trend, burden, seasonal variations, and interventional assessment of malaria in Western Tigray, Ethiopia, from 2011 to 2019. Methods: A hospital‐based retrospective cross‐sectional study was carried out to determine trend, burden, seasonal variations, and interventional assessment of malaria in Kahsay Abera General Hospital, Western Tigray, North Ethiopia, from 2011 to 2019. All recorded microscopically confirmed malaria cases in the Health Management Information System of the hospital were carefully taken and analyzed. Also, malaria intervention activities applied in the area were assessed using a checklist, personal communication with hospital administrators, and observations. All data of malaria cases were entered and analyzed using Microsoft Office Excel and presented in tables and figures. Results: A total of 36,438 malaria cases with 50 (0.14%) hospital mortality and 2016 (5.5%) hospital admissions were recorded from 2011 to 2019. Plasmodium falciparum, with 22,621 cases (62.1%), was the predominant malaria species identified. The highest hospital malaria death was observed in the age group ≥ 15 years, with 38 cases (0.10%), and the highest hospital deaths occurred during October–December, with 21 cases (0.06%) of the total confirmed malaria cases. Although the fluctuating trend of malaria cases, with no shift in species, was statistically significant ( p = 0.001) over the study period, the trend in hospital mortality due to malaria was not statistically significant ( p = 0.62). Conclusions: Despite Ethiopia’s notable progress in malaria control, the disease remains a major health problem with fluctuating annual trends.

Hepatitis B and C viruses are the major public health concerns of the globe. The two hepatotropic viruses share common modes of transmission and their co-infection is common. Despite the provision of an effective prevention mechanism, the infections caused by these viruses remain a significant problem worldwide, particularly among developing countries like Ethiopia. This institutional-based retrospective study was conducted between January 2014 December and December 2019 from documented laboratory logbooks of Adigrat general hospital serology laboratory, Tigrai, Ethiopia. data were collected and checked for completeness on a daily based, coded, entered, and cleaned using Epinfo version 7.1, exported and analyzed using SPSS version 23. Binary logistic regression analysis and Chi-square test (X²) assessed the association between dependent and independent variables. The corresponding variables with a P-value (P < 0.05) and 95% confidence interval were considered statistically significant. Out of 20,935 clinically suspected individuals, 20,622 were given specimens and tested for hepatitis B and C viruses with total completeness of 98.5%. The overall prevalence of hepatitis B and hepatitis C virus was found to be 3.57% (689/19,273) and 2.13% (30/1,405), respectively. The positivity rate of the hepatitis B virus was 8.0% (106/1317) and 3.24% (583/17,956) among males and females, respectively. Additionally, 2.49%( 12/481) of males and 1.94% (18/924) of females were positive for hepatitis C virus infection. The overall prevalence of co-infection for both hepatitis B and hepatitis C virus was 7.4% (4/54). Sex and age were significantly associated with hepatitis B and C virus infection. The overall prevalence of hepatitis B and C is low intermediate according to the WHO criteria. Although there was a fluctuating trend of hepatitis B and C through the years 2014–2019, the result shows moreover declining trend. Both hepatitis B and C share similar routes of transmission and affect all age categories but males were more highly affected than females. Therefore, awareness creation of the community about the methods of transmission, education about prevention, and control of hepatitis B and C virus infection, and improving coverage of youth-friendly services in health facilities should be strengthened.

Background: Food handlers play a significant role in the transmission of foodborne infections.SalmonellaandShigellaare the most common foodborne pathogens and their infections are a major public health problem globally. Thus, this study aimed to determine the prevalence, antimicrobial susceptibility patterns, and associated factors ofSalmonellaandShigellacolonization among food handlers.Methodology: A cross-sectional study was conducted from March to August 2018 at Adigrat University student cafeteria, Northern Ethiopia. Data on socio-demographic and associated factors were collected using a structured questionnaire. Fresh stool samples were collected from 301 food handlers and transported to Adigrat University Microbiology Laboratory. Bacterial isolation and antimicrobial susceptibility test were performed using standard bacteriological methods. Data analysis was performed using SPSS version 22 andP < 0.05 where a corresponding 95% confidence interval was considered statistically significant.Results: A total of 301 food handlers were included in this study. The majority of study participants were females 265 (88.0%). About 22 (7.3%) and 11 (3.7%) of food handlers were found to be positive forSalmonellaandShigellarespectively. Hand washing after using a bathroom with water only, no hand washing after using the bathroom, no hand washing after touching dirty materials, no hand washing before food handling, and untrimmed fingernails were significant associated factors identified. None of theSalmonellaandShigellaisolates were sensitive to ampicillin, yet low resistance against chloramphenicol, ceftriaxone, and ciprofloxacin was found.Conclusion: The present study revealed that the prevalence ofSalmonellaandShigellaamong food handlers was 22 (7.3%) and 11 (3.7%) respectively. Such colonized food handlers can contaminate food, and drinks and could serve as a source of infection to consumers. This indicates that there is a need for strengthened infection control measures to preventSalmonellaandShigellatransmission in the students’ cafeteria.

Background: Access to safe drinking water is one of the basic human rights and is critical to health. However, much of the world’s population lacks access to adequate and safe water. Approximately 884,000, 000 people in the world still do not get their drinking water from safe sources; Sub-Saharan Africa accounts for over one third of this number. It is estimated that 80% of all illnesses in the world are related to use of unsafe and contaminated water. Methods: A cross-sectional study was conducted from August 1st 2017 to July 30th 2018 in three randomly selected woreda (districts) of Eastern Zone Tigrai. Water samples were examined for total coliforms and thermotelorant coliforms using the most probable number method. Standard biochemical testing was performed on samples that tested positive to identify the genus of bacteria. The contaminant risk of water sources were assessed using the sanitary inspection checklist of the World Health Organization. The results were interpreted using World Health Organization guidelines for drinking water quality. Data was collected using laboratory checklist and sanitary inspection check list. It was entered, cleared and analyzed using SPSS version 21.0 and a variable having a P < 0.05 was considered as statistically significant in all tests. Results: A total of 290 drinking water samples were analyzed for bacteriological quality. A total of 32.4% (n = 94) of water sources showed contamination with faecal and total coliforms. Of these 3.4% (n = 10) samples were contaminated with total coliforms and 29% (n = 84) contaminated with faecal coliforms. The leading water contaminant organisms were Escherichia coli (62.4%), Legionella species (8.5%), and Shigella species (7.5%) respectively. Based on WHO criteria, 15% of water sources were grouped in the very high risk group. Animal excreta and inadequate fencing of water sources were significantly associated with water contamination rate. Conclusion: Our findings suggest that most water sources in woredas of Eastern Tigrai are contaminated by faecal coliforms. Therefore, regular sanitary inspection, bacteriological analysis, and adequate fencing should be mandatory to protect drinking water sources from faecal contamination.

Background: Visceral leishmaniasis causes alterations of lipid metabolism and it is associated with hypocholesterolemia and severe hypertriglyceridemia. Hepatic dysfunction and life-threatening hepatitis are associated with visceral leishmaniasis. Kidney damage is frequently associated with increased morbidity and mortality in visceral leishmaniasis patients. Methods: A cross-sectional study was carried out to assess the alterations of clinical chemistry parameters among visceral leishmaniasis patients attending Kahsay Abera and Mearg hospitals, Northwest Ethiopia. A total of 100 visceral leishmaniasis patients and 100 healthy controls without visceral leishmaniasis were selected by using convenient sampling techniques. Data were entered and analyzed using statistical package for social sciences (SPSS) version 23. Results: Results were showed that the mean value of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, and triglyceride was significantly higher in visceral leishmaniasis patients than in apparently healthy controls, but the mean value of serum urea and total cholesterol was significantly lower in visceral leishmaniasis patients than healthy controls. Conclusion: The finding of this study concluded that visceral leishmaniasis causes significant alterations of clinical chemistry tests like liver and lipid profile tests compared to healthy controls.

Background: In Ethiopia, despite the integrated implementation of antiretroviral therapy since 2005, the human immunodeficiency virus remains a public health concern. Managing and detecting antiretroviral treatment response is important to monitor the effectiveness of the therapy for individuals who experience failed virological response. An increased viral load indicating drug resistance or rapid progression of viral replication needs early detection. Hence, we aimed to assess the prevalence and determinants of virological response among human immunodeficiency virus-infected patients on highly active antiretroviral therapy. Methods: A hospital-based cross-sectional study was conducted in Adigrat General Hospital from September to December, 2019, on a total of 422 participants. An interviewer-based questionnaire was used for data collection. About 4 mL of venous blood was collected for viral load determination. Patient records were reviewed for the previous results of CD4+ T cell counts. STATA 14 software was used to analyze the data. Descriptive data were presented using tables and figures. Bivariate and multivariate analyses were performed. A p-value < 0.05 was considered a statistically significant association. Results: The mean age of study participants was 39 years (SD ± 12.2 years), of which 66.7% of them were females. The overall prevalence of virological failure was 12.47% (49/393). Moreover, the prevalence of virological failure was observed to be higher among tuberculosis co-infected individuals (26%) compared with the mono-infected HIV patients (6.3%). The odds of virological failure were higher among obese and undernourished individuals, tuberculosis co-infected, and individuals with the failure of immune reconstitution. Conclusion: There was a high rate of virological failure among the study participants. Tuberculosis infection increased the rate of failure. There should be consistent assessment of viral load testing to determine the status of virological response for appropriate drug switching to clients. HIV patients with virological failure are recommended for switching of the antiretroviral therapy.

Background: Globally, the novel coronavirus, is a public health problem causing respiratory infections. Since the outbreak of severe acute and Middle East respiratory syndromes coronavirus was not reported to cause human infections. Now, it become an epidemic proportion with growing number of cases and deaths. Methods: A scoping review was conducted following the methodological framework. In this scoping review, 50 records published before 28 March, 2020 were included and discussed to better understand the current epidemiology, pathogenesis, immunological response, diagnosis, evasion mechanisms and suggested strategies to boost immune system, challenges, treatment, and future preventions of the virus. PubMed, BioRxiv, MedRxiv, Global Health and google scholars were searched comprehensively for articles, preprints, grey literatures, reports, websites, conference proceedings and expert information. Studies conducted in human and published in English language were included in the analysis. All the findings and statements of the review regarding the outbreak are based on published information as listed in citations. Results: We identified 360 records, of which 50 studies met the inclusion criteria. We synthesized the data from the included records and dig out the deep insights of them and pooled into this review. The burden of the outbreak is worsening due to overcrowding, presence of asymptomatic carriers, scarcity of test kits, the immune escaping ability of the virus and lack of awareness. Conclusions and recommendations: Due to the fast-spreading nature of COVID-19 the prevention and control strategies become challenging. It is imposing social, psychological, and socio-economic impacts. We recommended that following social distancing, isolation suspects, using personal protective equipment, health education and introducing hand-washing practices, avoiding contact with animals, vaccine development and treatment for controlling and prevention.