Background: The poultry sector is one of the largest and fastest-growing agricultural sub-sector, especially in developing countries like Ethiopia. In poultry production, poultry farmers use sub-optimum doses of antibiotics for growth promotion and disease prevention purpose. This indiscriminate use of antibiotics in poultry farms contributes to the emergence of antibiotic-resistant bacteria, which has adverse implications for public health. Therefore, this study is aimed to assess multidrug resistance and extended-spectrum beta-lactamase-producing Enterobacteriaceae from chicken droppings in poultry farms. Methods: A total of 87 pooled chicken-dropping samples were collected from poultry farms from March to June 2022. Samples were transported with buffered peptone water. Selenite F broth was used for the enrichment and isolation of Salmonella spp. Isolates were cultured and identified by using MacConkey agar, Xylose lysine deoxycholate agar, and routine biochemical tests. Kirby-Bauer disk diffusion technique and combination disk test were used for antibiotic susceptibility testing and confirmation of extended-spectrum beta-lactamase production, respectively. Data were entered using Epi-data version 4.6 and then exported to SPSS version 26 for analysis. Result: Out of 87 pooled chicken droppings, 143 Enterobacteriaceae isolates were identified. Of these, E. coli accounts for 87 (60.8%), followed by Salmonella spp. 23 (16.1%), P. mirabilis 18 (12.6%) and K. pneumoniae 11 (7.7%). A high resistance rate was observed for ampicillin 131 (91.6%), followed by tetracycline 130 (90.9), and trimethoprim-sulfamethoxazole 94 (65.7%). The overall multidrug resistance rate was 116/143 (81.1%; 95% CI: 74.7–87.5). A total of 12/143 (8.4%; CI: 3.9–12.9) isolates were extended-spectrum beta-lactamase producers, with 11/87 (12.6%) E. coli and 1/11 (9.1%) K. pneumoniae. Conclusion and recommendations: High prevalence of multi-drug resistant isolates was observed. This study alarms poultry as a potential reservoir of extended-spectrum beta-lactamase-producing Enterobacteriaceae, which might shed and contaminate the environment through faecal matter. Prudent use of antibiotics should be implemented to manage antibiotic resistance in poultry production.

Background: Visceral leshimaniasis is a parasitic disease characterized by systemic infection of phagocytic cells and an intense inflammatory response. The progression of the disease or treatment may have an effect on hematological parameters of these patients'. Thus, the current study sought to compare the hematological profiles of visceral leishmaniasis patients before and after treatment with anti-leishmaniasis drugs. Method: An institutional-based retrospective cohort study was conducted among visceral leishmaniasis patients admitted to the University of Gondar comprehensive specialized referral hospital leishmaniasis research and treatment centre between September 2013 and August 2018. Hematological profiles were extracted from the laboratory registration book before and after treatment. Data were entered to Epi-info and exported to SPSS for analysis. Descriptive statistics were summarized using frequency and percentage to present with the table. The mean, standard deviation, median, and interquartile range were used to present the data. Furthermore, using the paired t-test and the Wilcoxon Signed rank test, the mean difference for normally and non-normally distributed data was compared. Spearman and Pearson correlation analysis were used to describe the relationship between hematological parameters and various variables. A P value of 0.05 was considered statistically significant. Result: With the exception of the absolute neutrophil count, all post-treatment hematological parameters show a significant increase when compared to pre-treatment levels. Prior to treatment, the prevalence of anemia, leukopenia, and thrombocytopenia was 85.5, 83.4, and 75.8%, respectively, whereas it was 58.3, 38.2, and 19.2% following treatment. Furthermore, parasite load was found to have a statistically significant negative correlation with hematological profiles, specifically with white blood cell and red blood cell parameters. Conclusion: According to our findings, patients with visceral leishmaniasis had improved hematological profiles after treatment. The effect of treatment on parasite proliferation and concentration within visceral organs, in which the parasite load could directly affect the patient's hematological profiles, may be associated with the change in hematological profiles.

Urinary tract infection (UTI) is one of the most common infections worldwide, particularly in developing countries. It also is among the most prevalent nosocomial infections, largely due to the widespread use of urinary catheters in hospitalized patients. These catheters often act as reservoirs for multidrug-resistant bacteria, including extended-spectrum beta-lactamase- and carbapenemase-producing pathogens, which significantly limit treatment options and delay appropriate care. This systematic review and meta-analysis, therefore, aimed to assess the pooled prevalence of ESBL- and carbapenemase-producing Gram-negative bacteria associated with UTIs in Ethiopia. A systematic literature search of all available electronic databases such as PubMed, Hinari, Google Scholar and EMBASE, Scopus, and African journal online was performed. The quality of the included studies was assessed via the Joanna Briggs Institute critical appraisal tool. The data were extracted from the eligible studies via Microsoft Excel 2019 and analysed via STATA version 17. The presence of between-study heterogeneity was checked via the Cochrane Q statistic, and the magnitude was quantitatively measured via I2 statistics. To determine the possible sources of heterogeneity, a subgroup analysis was performed. Additionally, a sensitivity analysis was conducted to determine the influence of single studies on the pooled estimates. Publication bias was checked via funnel plots and Egger’s regression tests. A p value of less than 0.05 was evidence of heterogeneity and small study effects according to the Cochrane Q statistic and Egger’s test, respectively. The protocol was registered (PROSPERO ID: CRD42024564656). A total of 20 studies with 1010 and 557 Gram-negative bacterial isolates from 6263 and 2199 study participants for extended-spectrum beta-lactamase and carbapenemase, respectively, were included. The overall pooled prevalence rates of extended-spectrum beta-lactamase-producing and carbapenemase-producing Gram-negative bacteria in Ethiopia were 30.92% (95% CI: 21.23–40.61, P < 0.001) and 15.12% (95% CI: -0.28–30.52, P < 0.001), respectively. The most common extended-spectrum beta-lactamase producers were Klebsiella spp., 43.91% (95% CI: 30.63–57.18, P < 0.001), followed by E. coli, 31.14% (95% CI: 21.27–41.01, P < 0.001). Similarly, the predominant carbapenemase producer was Klebsiella spp., 17.78% and E. coli, 11.42%. and recommendations. In this meta-analysis, the pooled prevalence of extended-spectrum beta-lactamase- and carbapenemase-producing Gram-negative bacteria was significantly high. During the development of empiric treatment protocols for urinary tract infections, extended-spectrum beta-lactamase- and carbapenemase-producing uro-pathogens should not be underestimated.

Pseudomonas aeruginosa and Acinetobacter baumannii are common nosocomial pathogens in hospital settings. Recently, they have also been found in non-hospital environments, such as poultry farms. While most studies in Ethiopia have focused on these bacteria's antibiotic resistance patterns in hospitals, information regarding their prevalence and resistance in veterinary settings, particularly poultry farms, is limited. This study aimed to assess the prevalence and antibiotic resistance patterns of P. aeruginosa and A. baumannii isolated from chicken droppings on poultry farms. A cross-sectional study was conducted from March 2022 to June 2022. A total of 87 poultry farms were included in this study, and pooled chicken dropping samples were collected. The samples were subsequently transferred to buffered peptone water and cultured on MacConkey agar. Species of the isolates were identified via routine biochemical tests, including oxidase, catalase, urease, Simon's citrate, sulfide indole motility medium, triple sugar iron agar and growth at temperatures of 37 °C and 42 °C. The Kirby–Bauer disk diffusion technique was used for antibiotic susceptibility testing. The data were entered into EpiData version 4.6 and then exported to SPSS version 26 for analysis. Fisher's exact test was used to observe an appropriate association between independent variables and the occurrence of isolates. The results are presented in the text, figures and tables. Among the 87 poultry farms, 41 (47.1 %) were positive for Pseudomonas and Acinetobacter. Among these strains, 24 (27.6 %) P. aeruginosa strains and 13 (14.9 %) A. baumannii strains were recovered. P. aeruginosa showed complete resistance to tetracycline (24, 100.0 %) and trimethoprim-sulfamethoxazole (24, 100.0 %). Additionally, there was a high rate of resistance to ciprofloxacin (13, 54.2 %) and amikacin (12, 50.0 %). Similarly, 13 (100.0 %) A. baumannii isolates were resistant to tetracycline, and 12 (92.3 %) were resistant to trimethoprim-sulfamethoxazole. However, both isolates presented lower resistance rates to piperacillin-tazobactam (4, 9.8 %) and cefepime (7, 17.1 %). Both A. baumannii and P. aeruginosa exhibited multidrug resistance in 10/13 (76.9 %) and 16/24 (66.7 %) of the strains, respectively. The overall prevalence of multidrug resistance in this study was 28/41 (68.3 %). This study demonstrated that poultry farms may be potential reservoirs for P. aeruginosa and A. baumannii, including antibiotic-resistant strains. This is a significant concern to public health because poultry farmers may be contaminated, increasing their dissemination to the community. Therefore, poultry farmers should improve sanitation and reduce the misuse and overuse of antibiotics at poultry farms.

Background: The human intestinal tract contains many commensals. However, during an imbalance of the normal microbiota following exposure to antibiotics, extended-spectrum β-lactamase- and carbapenemase-producing Enterobacterales emerge. Individuals colonized with these bacteria may develop subsequent infections themselves. Therefore, this review aimed to estimate the colonization rate of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacterales in Ethiopia. Methods: The protocol was registered (PROSPERO ID: CRD42024550137). A systematic literature search was conducted in electronic databases, including PubMed, Google Scholar, and Hinari, to retrieve potential studies. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tool. The data were extracted from the eligible studies using Microsoft Excel 2019 and analyzed using STATA version 11. Heterogeneity between studies was checked using I² test statistics. Publication bias was assessed using funnel plots and Egger’s test. A random-effects model of DerSimonian-Laird method was employed to estimate the outcomes. Results: A total of 15 studies with 4713 participants were included in the meta-analysis. The overall pooled colonization rates of extended-spectrum β-lactamase-producing and carbapenemase-producing Enterobacterales in Ethiopia were 28.5% (95% CI: 16.4-40.5%, I² = 95.9%, p < 0.001) and 4.4% (95% CI: 0.9–7.9%, I² = 0.0%, p = 0.64), respectively. The majority of the extended-spectrum β-lactamase producers were E. coli (20.6%, 95% CI: 9.3–31.9%, I² = 94.4%, p < 0.001), followed by Klebsiella spp. (11.1%, 95% CI: 7.7–14.6%, I² = 20.2%, p = 0.245). Similarly, the predominant carbapenemase producers were E. coli (2.7%, 95% CI: -1.3–6.7, I² = 0.0%, p = 0.941) and Klebsiella spp. (2.1%, 95% CI: -1.7–5.9%, I² = 0.0%, p = 0.999). Furthermore, the pooled estimate of multidrug resistance among extended-spectrum β-lactamase producers was 71.7% (95% CI: 55.25–88.05%, I² = 92.9%, p < 0.001). Conclusion and recommendations: Approximately one-quarter of Ethiopians are colonized with ESBL-PE, while about one in 25 is colonized with CPE. These findings were obtained from studies with a moderate-to-low risk of bias. However, the results for ESBL-PE showed significant variability, indicating high heterogeneity among the studies. This colonization may lead to subsequent extraintestinal infections. Therefore, proactive action from all stakeholders is required to combat the unrecognized spread of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacterales in humans.

Background: Open defecation is a harmful and unsafe practice that contributes to environmental pollution and disproportionately affects developing nations, particularly those in Sub-Saharan Africa. According to the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) Joint Monitoring Programme (JMP), Sub-Saharan Africa is home to 46% of the global population still practising open defecation. Socio-economic factors, cultural norms, and individual attitudes play crucial roles in shaping sanitation behaviours and influencing open defecation practices. Therefore, this study aims to determine the prevalence, spatial distribution, and geographic inequalities of open defecation in Sub-Saharan Africa. Methods: A community-based cross-sectional survey was conducted, including 20,130 clusters and 496,957 households from 34 Sub-Saharan African countries. The Demographic and Health Survey (DHS) data were weighted, cleaned, and analyzed using Microsoft Excel, Stata version 17, ArcGIS version 10.7, and SaTScan™ version 10.1. Spatial analyses were performed using ArcGIS version 10.7 and Kulldorff’s SaTScan™ version 10.1, while Geographically Weighted Regression (GWR) analyses were conducted using ArcGIS version 10.7. Results: The prevalence of open defecation among households in Sub-Saharan Africa was 23.24% (95% CI: 23.12–23.35). The practice was clustered across enumeration areas (Global Moran’s I = 0.25, Z-score = 366.12, P-value ≤ 0.001). The Getis-Ord Gi* statistic identified hotspots of open defecation primarily in East Africa, Central Africa, and West Africa. Anselin Local Moran’s I detected both high and low clusters of open defecation, while SaTScan cluster analysis identified 146 windows containing significant clusters of households practising open defecation across Sub-Saharan Africa. Geographically Weighted Regression (GWR) analysis revealed that several factors were positively associated with open defecation, including lack of educational attainment, unimproved drinking water sources, lack of basic access to water, younger household heads, and extreme poverty. Additionally, household size greater than four, the richest households and urban and rural residency were negatively associated with open defecation practices. Conclusion: This study reveals a high prevalence of open defecation (23.24%) in Sub-Saharan Africa with significant geographic clustering, particularly in East, Central, and West Africa. This estimate is higher than the 18% reported by the 2021 WHO/UNICEF Joint Monitoring Programme (JMP). Novel spatial and GWR analyses uncovered associations with poverty, lack of education, water access, age of household heads, and wealth status. These findings underscore the need for geographically targeted, multi-sectoral sanitation interventions that address underlying socio-demographic disparities. Future research should explore the effectiveness of spatially tailored programs and integrate behavioral insights to accelerate progress toward Sustainable Development Goal 6.