Background: Diagnosing pulmonary tuberculosis (pTB) in children is challenging due to the difficulties in acquiring respiratory specimens, which unspecific and paucibacillary disease presentation, and the lack of sensitive diagnostic assays with non-invasive sample collection methods. As a result, millions of children around the world get tuberculosis (TB) each year, which is a leading cause of morbidity and mortality.
Objective: The aim of this study was to assess the diagnostic accuracy of Stool and Respiratory Sample-based Genexpert MTB/RIF assay from presumptive TB among children in Northwest, Ethiopia.
Methods and Materials: Hospital based cross-sectional with diagnostic accuracy study was conducted on consecutively recruited presumptive TB children. Data were collected by sem-structured questionnaires. Single respiratory (5ml) and 3g stool specimen were collected Lowenstein Jensen (LJ) and Xpert assay. Laboratory SOPs were strictly followed to assure the quality of whole procedures. The diagnostic accuracy of stool Xpert was evaluated against respiratory specimen Xpert, culture and composite reference standards (CRS). Sensitivity, specificity, and predictive values for the stool Xpert assay were calculated with a 95% confidence interval (95% CI) with MedCal statistical software. Data were entered in EPIData V4.2 and exported to SPSS 25 for further analysis.
Results: A total of 557 children were recruited; 510 of whom had complete microbiological results. Overall, pTB was diagnosed in 52/510 (10.2%) of the children with presumptive TB. Of these, only four had microbiologically unconfirmed pTB, were clinically diagnosed with positive response to anti-TB and the remaining 48 were microbiologically confirmed (Positive Xeprt and LJ culture). Stool specimen Xpert had sensitivity of 93.8 %( 95%CI: 82.8-98.6) and specificity of 99.8% (95%CI: 98.7–100) compared to culture; however, the sensitivity of stool was 88.5% (72-95.6) and specificity 100% (99.2-100) when compared to CRS. The Xpert on respiratory specimen had sensitivity and specificity of 95.8 % (85.8– 99.5) and 99.8% (98.7–100) to culture and 92.3 %( 81.4-97.9) and 100% (99.2-100) compared to CRS.
Conclusion: The sensitivity and specificity of Xpert assay for stool specimen is almost similar to that of respiratory specimen. Stool specimen is a highly promising alternative specimen in the diagnosis of pTB in children when respiratory specimen is impossible.


Key words: Diagnostic accuracy, pulmonary tuberculosis, Xpert MTB/RIF, Stool, Children

Background: Hepatitis B virus (HBV) is highly infectious and poses significant global health challenges. Healthcare workers (HCWs) are particularly at risk of HBV infection due to occupational exposure through contact with infected blood or body fluids. To mitigate this risk, hepatitis B vaccination is recommended for all healthcare workers and is administered in three doses at 0, 1, and 6 months, aiming to reduce exposure and provide immunity against the virus. However, the effectiveness of the HBV vaccine remains uncertain in the study area.
Objective: This study aimed to evaluate hepatitis B vaccine efficacy and factors affecting vaccine effectiveness among healthcare workers in all Hospitals of East Gojjam Zone Amhara Region, North West Ethiopia
Materials and Methods: A hospital-based cross-sectional study was conducted among 422 healthcare workers from March 25, 2024, to November 30, 2024. Simple random sampling technique was used to recruit the study participants. Total sample size was allocated proportionally to each hospital. Socio-demographic and clinical data were collected using a pretested structured questionnaire. Moreover, venous blood samples (4–5 ml) were collected from the study participants, and serum samples were analyzed to measure and detect the concentrations of anti-hepatitis B surface antigen (anti-HBs), hepatitis B surface antigen (HBsAg), and anti-hepatitis B core antibody (anti-HBc) using a sandwich enzyme-linked immunosorbent assay (ELISA). Additionally, hepatitis B virus DNA (HBV DNA) was assessed using real-time polymerase chain reaction (qPCR). Data were analyzed using SPSS software version 25. Logistic regression model with 95% CI was used to show the statistical association. P value < 0.05 was considered as statistically significant.
Results: The overall sero-prevalence of HBsAg among all study participants was 23/422 (5.5%) (95% CI: 3.0-8.0). In multivariable logistic regression, blood transfusion (AOR: 16.5, 95% CI: 1.53, 29.24) (P<0.011) and dental extraction (AOR: 13.5, 95% CI: 3.99, 45.57) (P<0.000) were significantly associated with HBsAg positivity. In addition, the overall sero-reactivity of anti-HBc was 30/422 (7.1%) (95% CI: 5.0-10.0). Injectable medication (AOR: 4.3, 95% CI: 1.73, 10.72) (P<0.002) was significant determinant for anti-HBc sero-positivity. Furthermore, of fully vaccinated healthcare workers, 346/422 (82.0%) (95% CI: 78.0- 86.0 %) of them were sero-protected (had anti-HBs titer ≥ 10 mIU/ml). The paradoxical sero-positivity of HBsAg and anti-HBs among fully vaccinated healthcare workers was 16(4.6%). Moreover, among HBsAg-positive individuals, HBV DNA was detected in 17 (73.9%) of them.
Conclusions and recommendations: The study identified intermediate HBV seroprevalence among vaccinated healthcare workers, indicating suboptimal vaccine efficacy. These findings emphasize the necessity of monitoring post-vaccination anti-HBs antibody levels to address gaps in protection.
Keywords: Hepatitis B vaccine effectiveness, Healthcare workers, Hospitals

Background: Staphylococcus aureus is a major pathogenic bacterium associated with high morbidity and mortality worldwide. It exhibits resistance to multiple antibiotics, complicating treatment options. Despite its clinical significance, there is limited data on the prevalence of S. aureus infections and the patterns of methicillin and inducible clindamycin resistance, particularly in Ethiopia. Understanding these resistance trends is essential for guiding appropriate therapy and improving patient outcomes.
Objective: To assess the prevalence of S. aureus, methicillin and inducible clindamycin resistance patterns, and associated factors among patients with suspected bacterial infection at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.
Method: A hospital-based cross-sectional study was conducted among patients suspected of bacterial infections from 10 June 2023 to 28 February 2024. Blood, wound swab, cerebrospinal fluid, urine, eye swab, synovial fluid, ear swab, and pleural fluid were collected aseptically and inoculated onto appropriate media. S. aureus was identified based on colony morphology, Gram staining, DNase test and biochemical tests. Antimicrobial susceptibility testing was performed on the isolates using the disk diffusion and the D-test techniques based on CLSI guideline. Data were entered into SPSS version 26 for analysis. Logistic regression was applied to assess the relationship between predictors and the outcome variable. A P-value of ≤ 0.05 with a 95% CI was considered statistically significant.
Results: Among the 339 study participants, 38 (11.2%) (95% CI: 8-15) tested positive for S. aureus. Of these isolates, 14/38 (36.9%) were resistant to methicillin, 5/38 (13.1%) isolates were resistance to clindamycin by routine disk diffusion test whereas 10/38 (26.3%) isolates exhibited inducible clindamycin resistance using the D-test. The level of multidrug resistance was noted in 10/38 (26.3%) of the isolates. Significant factors associated with S. aureus infection included illiteracy (AOR = 13.51; 95% CI: 3.56-21.90; P = 0.018), having larger family size (AOR = 12.14; 95% CI: 2.38-20.43; P = 0.024), and income level of less than 3,000 ETB (AOR = 6.20; 95% CI: 1.03-30.09; P = 0.046).
Conclusion: The study revealed an 11.2% occurrence of S. aureus among the study participants, with a substantial proportion exhibiting methicillin resistance (36.9%) and inducible clindamycin resistance (26.3%). These findings highlight a higher burden of clindamycin resistance in MRSA, underscoring the need for routine D-test screening to guide appropriate antibiotic therapy. Additionally, factors such illiteracy, low income and residing in rural areas were associated with S. aureus infection. Targeted health education initiatives should be implemented, especially in rural areas and among populations with low literacy levels, to improve hygiene practices and reduce transmission.

Keywords: Ethiopia; S. aureus; antimicrobial resistance; inducible clindamycin resistance; methicillin resistance; prevalence.

Background: In countries with a high prevalence of TB, such as Ethiopia, direct sputum smear microscopy remains the most cost-effective tool for diagnosing patients with infectious tuberculosis and monitoring their progress on treatment. However, poor-quality sputum microscopy services may lead to the failure to detect persons with active tuberculosis and may cause unnecessary anti-TB treatment for non-TB cases. Proficiency level is the percentage agreement between participants'readings and the reference panel results. The aim of this study was to assess proficiency and associated factors of laboratory professionals in sputum smear microscopy for acid-fast bacilli at selected peripheral public and private diagnostic laboratories in East Gojjam Zone, Northwest Ethiopia, in 2023.
Method: An institutional-based cross-sectional study design was conducted from March 2023 to June 2023 at selected peripheral public diagnostic laboratories in East Gojjam Zone. 65 laboratory professionals were selected randomly from 41 peripheral public diagnostic laboratories in the study area. A validated questionnaire and 10 panel slides were used as data collection tools. The panel consisted of 5 pre-stained and 5 unstained slides. Data were entered and analyzed using the Statistical Package for Social Sciences software (SPSS version 20). P values less than 0.05 were considered statistically significant when looking for associations between dependent and independent variables.
Result: The overall proficiency level of laboratory professionals in tuberculosis smear microscopy was 81.92% with 95% CI [78.46-85.38]. Previous TB smear microscopy training, work experience, and institution of education had a significant association with the overall performance of laboratory professionals in TB smear microscopy.
Conclusion: The overall TB smear microscopy performance level of laboratory professionals at peripheral diagnostic laboratories in Ethiopia, was satisfactory, indicating a good level of competence. However, notable technical errors related to smear reading and reporting were observed. Thus, higher education institutions, especially private institutions, and the Zonal Health Department, should implement educational and training interventions to address the identified gaps and ultimately contribute to the national TB control program.

Keywords: AFB microscopy; AFB panel slide preparation; Proficiency testing; Tuberculosis.

Background: Neisseria gonorrhoeae is the causative agent of gonorrhea and accounts for the majority of sexuallytransmitted infections globally. There are few studies on the prevalence and antimicrobial susceptibility patternsof N. gonorrhoeae in Ethiopia.Objective: This study aimed to assess the prevalence, antimicrobial susceptibility patterns, and associated factorsof N. gonorrhoeae.Method: A cross-sectional study was conducted among women attending Debre Markos town health institutions;in Northwest Ethiopia from June 1, 2022 to October 30, 2022. An endocervical swab was collected and culturedon Modified Thayer Martin medium. Antimicrobial susceptibility testing was performed using the modifiedKirby-Bauer disk diffusion technique for isolates, following Clinical and laboratory standards institute guidelines.Logistic regression was applied to show the relationship between dependent and independent variables. P-value

Background: Healthcare-associated infections occur in patients under medical care, which is a major public health issue in hospitals worldwide. The prevalence is two to three folds higher in developing countries compared to developed countries. Inanimate objects used by healthcare professionals such as gowns, mobile phones, and stethoscopes are highly prone to bacterial contamination from the healthcare setting. In Ethiopia, there is a paucity of published data on the bacterial profile and susceptibility patterns of an isolates.
Objective: To determine the bacterial profile and antimicrobial susceptibility patterns from inanimate objects used by healthcare professionals and associated factors at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.
Methods: A cross-sectional study was conducted at Debre Markos Comprehensive Specialized Hospital from inanimate objects from April 10, 2023 to June 30, 2023 using simple random sampling technique with lottery method. Socio-demographic data was collected using a structured questionnaire. A swab sample from healthcare professionals' gowns, mobile phones, and stethoscopes were collected and inoculated onto blood agar, chocolate and MacConkey agar. Isolates were identified and characterized by colony morphology, Gram staining and biochemical tests. Antimicrobial susceptibility testing was performed in all isolates by the disk diffusion technique on Muller Hinton agar according to CLSI, 2022 guidelines. Data was entered into EPI-Data and analyzed using SPSS version 25. Logistic regression model was used. Variables with p-value ≤ 0.25 in bivariable logistic regression was fitted to multivariate logistic regression analysis. A p-value of ≤ 0.05 with 95%CI was considered statistically significant.
Result: A total of 376 healthcare professionals' inanimate objects were included from 191 study participants. Overall, 60.1% (226/376) (95%CI: 55.1-65) inanimate objects were contaminated. The proportion of bacterial contamination was (65.1%; 82/126), (60.3%; 76/126) and (54.8%; 68/124) for mobile phones, gowns and stethoscopes, respectively. Staphylococcus aureus was the most frequent isolate accounting (22.1%; 83/376) followed by Staphylococcus epidermidis (17.0%; 64/376), Escherichia coli (8.8%; 33/376) and Pseudomonas aeruginosa (4.9%; 18/376). Working in gynecology/ obstetrics wards (AOR: 8.69; 95%CI: 1.09-69.41, P = 0.041), did not disinfect mobile phones (AOR: 2.69; 95%CI: 1.15-6.25; P = 0.021) and stethoscopes regularly (AOR: 3.06, 95%CI: 1.23-7.59; P = 0.016), carry mobile phones with patient care materials (AOR: 2.72; 95%CI: 1.18-6.29, P = 0.019) and not taken infection prevention training (AOR:3.91; 95%CI:1.71-8.93; P = 0.001) were significantly associated with bacterial contamination.Most Gram-negative bacteria were resistant to ampicillin, trimethoprim-sulfamethoxazole and amoxacilline-clavunic acid, while Gram-positive isolates showed high level of resistant to penicillin. On the other hand, meropenem, for Gram-negative and clindamycin for Gram-positive bacteria showed lower level of resistance. Multidrug resistance among Gram-positive and Gram-negative bacteria were (62.6%; 92/147) and (75.3%; 64/85), respectively with over all MDR (67.2%, 156/232).
Conclusion: Inanimate objects commonly used by healthcare professionals are important sources of bacterial contamination. S. aureus, S. epidermidis and E. coli were the predominant isolates. Most Gram-negative bacteria were resistant to ampicillin while Gram-positive isolates showed high level of resistant to penicillin. All healthcare professionals should regularly disinfect their inanimate objects to prevent bacterial colonization and potential spread of infection.