Background: Antimicrobial-resistant (AMR) bacterial infection is a significant global threat to the healthcare systems. Pseudomonas aeruginosa, the leading infectious agent in the healthcare setting is now one of the major threats due to AMR. A comprehensive understanding of the magnitude of AMR, particularly highly public health important pathogens such as P. aeruginosa, is necessary for the management of infections based on local information. Objective: This systematic review and meta-analysis aimed to determine the country-wide AMR of P. aeruginosa. Methods: Systematic searches were performed to retrieve articles from PubMed, Scopus, Web of Science, ScienceDirect electronic databases, Google Scholar search engine, and repository registrars from 2015 to 31^st December 2023. Twenty-three studies that provided important data on AMR in P. aeruginosa were systematically reviewed and analyzed to determine the country-wide magnitude of P. aeruginosa AMR profile from healthcare-associated infections. AMR of P. aeruginosa to 10 different antibiotics were extracted separately into Microsoft Excel and analyzed using STATA 17.0. Cohen’s kappa was computed to determine the agreement between reviewers, the Inverse of variance (I²) was used to evaluate heterogeneity across studies, and Egger’s test to identify publication bias. A random effect model was used to determine the pooled resistance to each antibiotic. Subgroup analysis was performed by infection type and year of publication. Results: This systematic review and meta-analysis revealed that the pooled prevalence of P. aeruginosa in clinical specimens associated with HAI was 4.38%(95%CI: 3.00–5.76). The pooled prevalence of AMR in P. aeruginosa for different antibiotics varies, ranging from 20.9% (95%CI: 6.2–35.8) for amikacin to 98.72% (95%CI: 96.39–101.4) for ceftriaxone. The pooled resistance was higher for ceftriaxone (98.72%), Trimethoprim-sulfamethoxazole (75.41), and amoxicillin-clavulanic acid (91.2). In contrast relatively lower AMR were observed for amikacin (20.9%) and meropenem (28.64%). The pooled multi-drug resistance (MDR) in P. aeruginosa was 80.5% (95%CI: 66.25–93.84). Upon subgroup analysis by infection types and year of publication, P. aeruginosa isolated from healthcare-associated infections exhibited higher resistance to ceftazidime (94.72%) compared to isolates from mixed types of healthcare-associated infections (70.84%) and surgical site infections (57.84%). Antimicrobial resistance in gentamicin was higher during the periods of 2018–2020 (73.96%), while comparatively lower during 2021–2023 (42.69%) and 2015–2017 (29.82%) Conclusions: Significantly high AMR and MDR were observed from this systematic review and meta-analysis. AMR obtained from this systematic review and meta-analysis urges the need for improved infection control, antimicrobial stewardship practices, and strengthened surveillance systems to control the spread of AMR and ensure effective treatment of P. aeruginosa infections. Protocol registration: This systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024518145).

Background: Despite the decline in tuberculosis (TB) incidence across many regions worldwide, including Ethiopia, the disease remains highly concentrated among vulnerable or socially marginalized populations and in high-risk settings. This systematic review and meta-analysis aims to estimate the pooled prevalence of pulmonary tuberculosis (PTB) among key and vulnerable populations (KVPs) residing in hotspot settings in Ethiopia. Methods: Potential papers were searched systematically in PubMed, Scopus, ScienceDirect databases, Google Scholar search engine, and institutional electronic repositories/registrars. A total of 34 potential articles that provide necessary information on the prevalence of PTB were reviewed and data were analyzed to determine the pooled prevalence of PTB among KVPs. The relevant data were recorded and analyzed using STATA 17.0. Cohen’s kappa was computed to determine the agreement between reviewers, the Inverse of variance (I²) to evaluate heterogeneity across studies, and Egger’s test to identify publication bias. A random effect model was used to determine the pooled prevalence of PTB, subgroup analysis was computed by types of hotspot settings and year of publication. Results: This meta-analysis demonstrates that the pooled prevalence of PTB among populations residing in hotspot settings in Ethiopia was 11.7% (95% confidence interval (95CI): 7.97–15.43) with an I² of 99.91% and a p< 0.001. Furthermore, the subgroup analysis unveiled the pooled prevalence of PTB among KVPs residing in different hotspot settings as follows: Prison inmates 8.8% (95CI: 5.00–12.55%), University students 23.1% (95CI: 15.81–30.37%), Refugees 28.4% (95CI: -1.27–58.15%), Homeless peoples 5.8% (95CI: -0.67–12.35%), Healthcare settings 11.1% (95CI: 0.58–21.63%), Spiritual holy water sites attendees 12.3% (95CI: -6.26–30.80%), and other high-risk settings 4.3% (95CI: 0.47–8.09%). Besides, the subgroup analysis revealed that the pooled prevalence of PTB post-2015 was 10.79% (95CI: 5.94–15.64%), whereas it stood at 14.04% (95CI: 10.27–17.82%) before 2015. Conclusion: The prevalence of PTB among KVPs residing in the hotspot settings in Ethiopia remains significant, with a weighted pooled prevalence of 11.7%. Thus, the national TB control programs should give due attention and appropriate control measures should be instituted that include regular systematic TB screening, compulsory TB testing for presumptive TB cases among KVPs, and tightened infection control at hotspot settings.

Background: The definitive treatment of open tibial shaft fractures remains challenging and nonunion after treatment of open tibial shaft fractures with external fixation complicates a significant proportion of cases. There are varying rates of occurrence of nonunion and the prevalence is not well known in Ethiopia. The objective of the study is to assess the prevalence and associated factors of nonunion in open tibial shaft fractures treated with EX FIX in TGSH. Methods: The study was conducted using a cross-sectional study in patients with open tibial shaft fractures who were admitted and treated with external fixation in the Tibebe Ghion Specialized Hospital orthopedics department from January 1, 2019, to January 29, 2021. The study involved 75 patients, which was the total number of cases in the study period and fulfilled the inclusion criteria. Bivariate and multiple variable logistic regression analyses were used to analyze the association between variables. The degree of association between variables was determined at the p-value of <0.05. Results: The overall prevalence of nonunion in open tibial shaft fractures treated with external fixation in TGSH was 21.3%. The severity of the injury, presence of wound infection, and treatment factors affect the occurrence of nonunion. It occurs in 9 of 19 (47.4%) Gustilo-Anderson grade IIIB fractures and 6 of 48 (12.5%) Gustilo-Anderson grade IIIA fractures. A delay in soft tissue covering of Gustilo-Anderson grade IIIB fracture of 15 days or more increases the nonunion rate to 72.7%. Nonunion occurred in 41.7% of cases with SSI and 11.8% of cases without SSI. Gustilo-Anderson grade (AOR=4.85, CI 95%: 1.31-18.01), surgical site infection (AOR=4.12, CI 95%: 1.11-15.26), and time until coverage of bone of Gustilo-Anderson grade IIIB fracture (AOR=18.23, CI 95%: 1.17-284.8) have statistically significant association with nonunion. Conclusion and Recommendation: External fixation use for definitive treatment of open tibial fractures should be disfavored as the prevalence of nonunion in open tibial shaft fractures treated with EX FIX is higher than other previous studies done in European and Asian countries. Gustilo-Anderson grade of injury, surgical site infection, and time from injury to bone coverage of Gustilo-Anderson grade IIIB fractures were found to be statistically significantly associated with the occurrence of nonunion. Therefore, attention should be given to early soft tissue reconstruction of exposed bones to establish a favorable environment for bone healing and to make treatment with internal fixations possible. Better management of wounds to minimize surgical site infections is required for better healing of open tibial shaft fractures. Prospective studies are also recommended on the issue.

Malaria is a significant public health concern, particularly in endemic regions. Asymptomatic blood donors pose a risk for transfusion-transmitted malaria,

Plasmodium falciparum parasites carrying the pfkelch13 R622I variant, associated with artemisinin resistance, are prevalent in the Horn of Africa. These parasites can also harbour histidine rich protein 2/3 (pfhrp2/3) gene deletions that are associated with false-negative rapid diagnostic tests. This study assessed the efficacy of artemisinin-based combination therapies artemether-lumefantrine plus primaquine or pyronaridine-artesunate plus primaquine in an area with high levels of pfkelch13 mutations and pfhrp2/3 gene deletions. We conducted a phase 2/3, observer-masked, randomised, parallel-group trial at the Maksegnit and Enfranz health centres (primary health-care units) in Ethiopia. Individuals with fever (measured or history of fever in the past 24 h) with uncomplicated P falciparum-caused malaria were randomly assigned (1:1 per health centre) to receive artemether-lumefantrine plus primaquine or pyronaridine-artesunate plus primaquine. Patients with severe anaemia, chronic diseases, or who were pregnant or breastfeeding were excluded from enrolment. Outcome assessors, but not participants or clinicians, were masked to treatment allocation. Primary outcomes were PCR-corrected adequate clinical and parasitological response (ACPR) on day 28 for artemether-lumefantrine plus primaquine and on days 28 and 42 for pyronaridine-artesunate plus primaquine, analysed per protocol, and safety profile and tolerability monitored at each visit (on days 0-3 and weekly from days 7-42) through clinical assessments and self-reports. The study was powered to assess ACPR per group and not for a comparison between the groups. The study was registered with the Pan African Clinical Trials Registry (PACTR202110520435408) and is now completed. Between Dec 17, 2021, and May 20, 2022, 199 individuals (136 [68%] male and 63 [32%] female; median age 25 years [IQR 19-36]) with microscopy-confirmed P falciparum were enrolled into the artemether-lumefantrine plus primaquine (n=101) and pyronaridine-artesunate plus primaquine (n=98) groups. Day 28 PCR-corrected ACPR was 96·8% (95% CI 90·9-99·3) for the artemether-lumefantrine plus primaquine group and 98·9% (93·9-99·9) for the pyronaridine-artesunate plus primaquine group; day 42 ACPR in the pyronaridine-artesunate plus primaquine group was 96·5% (90·0-99·3). No early treatment failures were observed. The most commonly detected mild adverse events were headache, weakness, and body ache. Headaches were recorded in 46 (45%) of 101 participants in the artemether-lumefantrine plus primaquine group vs 43 (44%) of 98 participants in the pyronaridine-artesunate plus primaquine group on day 1, declining to eight (8%) of 96 vs 18 (19%) of 95 on day 7. Weakness was reported in 27 (27%) of 101 participants in the artemether-lumefantrine plus primaquine group vs 24 (24%) of 98 in the pyronaridine-artesunate plus primaquine group on day 1, declining to five (5%) of 96 vs six (6%) of 95 on day 7. Body ache was reported in 24 (24%) of 101 participants in the artemether-lumefantrine plus primaquine group vs 24 (24%) of 98 participants in the pyronaridine-artesunate plus primaquine group on day 1, declining to three (3%) of 96 vs seven (7%) of 95 on day 7. No serious adverse events were reported. Our findings reinforce the continued use of artemether-lumefantrine plus primaquine for treating uncomplicated P falciparum malaria. Pyronaridine-artesunate plus primaquine also shows promise as an alternative regimen. Continued surveillance remains essential to safeguarding both therapeutic effectiveness and diagnostic accuracy. FGT was supported by grants from the US President's Malaria Initiative, Gates Foundation, and the Wellcome Trust.