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Prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia: A systematic review and meta-analysis.

ABSTRACT: Typhoid fever continues to be a health challenge in low-and middle-income countries where access to clean water and sanitation infrastructure is scarce. The non-confirmatory diagnostic method continues to hinder effective diagnosis and treatment, ensuring in a high antimicrobial resistance. This systematic review and meta-analysis aimed to estimate the pooled prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia. The review was designed based on the condition-context-population review approach. Fifteen eligible articles were identified from PubMed, Google Scholar, and Science Direct databases. Risk of bias and quality of studies were assessed using the Joanna Briggs Institute's appraisal criteria. Heterogeneity was assessed using Cochran's Q test and I² statistics. The review protocol was registered in PROSPERO (registration number CRD42021224478). The estimated pooled prevalence of typhoid fever from blood and stool culture diagnosis was 3% (95% CI: 2%-4%, p < 0.01) (I² = 82.25) and Widal test examination 33% (95% CI: 22%-44%) (I² = 99.14). The sub-group analyses identified a lower detection of typhoid fever of 2% (95% CI: 1%-3%) among febrile patients compared to typhoid suspected cases of 6% (95% CI: 2%-9%). The stool culture test identified was twofold higher, value of 4% (95% CI: 2%-7%) salmonella S. Typhi infection than blood culture test of 2% (95% CI: 1%-4%). The antimicrobial susceptibility of salmonella S. Typhi for antibiotics was 94%, 80% and 65% for ceftriaxone, ciprofloxacin, and gentamycin respectively. Low susceptibility of salmonella S. Typhi isolates against nalidixic acid 22% (95% CI: 2%-46%) and chloramphenicol 11% (95% CI: 2%-20%) were observed. The diagnosis of typhoid fever was under or overestimated depending on the diagnostic modality. The Widal test which identified as nonreliable has long been used in Ethiopia for the diagnosis of salmonella S. Typhi causing high diagnosis uncertainties. Antimicrobial susceptibility of salmonella S. Typhi was low for most nationally recommended antibiotics. Ethiopian Food and Drug Authority must strengthen its continued monitoring and enhanced national antimicrobial surveillance system using the best available state-of-the-art technology and or tools to inform the rising resistance of salmonella S. Typhi towards the prescription of standard antibiotics. Finally, it is crucial to develop an evidence-based clinical decision-making support system for the diagnosis, empiric treatment and prevention of antimicrobial resistance.

SUBMITTER: Teferi MY

PROVIDER: S-EPMC8686025 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundCampylobacter jejuni and Campylobacter coli accounts for most cases of human gastrointestinal infections. The infection occurs through ingestion of contaminated food or water, and direct contact with feces of infected animal or human. Regardless of few local reports of Campylobacter and its antimicrobial susceptibility profile, there is no comprehensive data that show the burden of Campylobacter infection at national level in Ethiopia. This systemic review and meta-analysis aimed to determine the pooled prevalence of Campylobacter and its resistance patterns in Ethiopia from different sources.MethodA comprehensive literature search of PubMed, Google scholar, Science direct and Google engine search was conducted for studies published from 2000 to July 30, 2020 on prevalence and antimicrobial susceptibility of Campylobacter in human, animal and food. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Checklist. Data from articles was extracted using a standardized data extraction format. The quality of the studies was assessed based on the Newcastle-Ottawa scale. The Q test and I2 test statistic were used to test heterogeneity across studies. The Pooled estimate of prevalence of Campylobacter species and its antimicrobial susceptibility profile was computed by a random effects model using STATA 16.0 software. Results were presented in forest plot, tables, funnel plot and figures with 95% confidence interval.ResultsA total of 291 articles were retrieved initially. The pooled prevalence of Campylobacter species from different sources was 10.2% (95% CI 3.79, 16.51). In this meta-analysis, the lowest prevalence was 6.0% whereas the highest prevalence was 72.7%. In the sub-group analysis, the pooled prevalence was similar in Amhara and Oromia region, higher in Gambella and lower in Sidama. Prevalence of Campylobacter was higher in animals (14.6%) compared to humans (9%). The pooled antimicrobial resistance rates of Campylobacter species to different antimicrobials ranged from 2.9-100%. Overall, higher rate of resistance was to cephalothin (67.2%), gentamicin (67.2%), and trimethoprim-sulfamethoxazole (33.3%) in Campylobacter isolates from all sources. In isolates from human, resistance to cephalothin was 83% followed by amoxicillin (80%), amoxicillin-clavulnate (36%), trimethoprim-sulfamethpxazole (32%), clindamycin (31%) and ceftriaxone (28%). On the other hand, higher rate of resistance to penicillin (100%), cephalothin (60%), ciprofloxacin (71.2%), and trimethoprim-sulfamethoxazole (39%) was recorded in isolates from animals.ConclusionThe present study highlights the burden of Campylobacter species in the country and higher rate of resistance among investigated isolates. Designing appropriate prevention strategies and further local in-depth studies are recommended to establish actual epidemiological burden of the bacteria in the country.

Project description:BackgroundAntimicrobial resistance is one of the major public health challenges in Ethiopia. However, there is no comprehensive summary of existing AMR data in the country.AimTo determine the prevalence of antimicrobial resistance and its clinical implications in Ethiopia.MethodsA systematic literature search was performed on the PubMed/Medline database. Original studies on antimicrobial resistance conducted in Ethiopia between 1st January 2009 and 31st July 2019 were included. The outcome measure was the number of isolates resistant to antimicrobial agents in terms of specific pathogens, and disease condition. Data was calculated as total number of resistant isolates relative to the total number of isolates per specific pathogen and medication.ResultsA total of 48,021 study participants enrolled from 131 original studies were included resulting in 15,845 isolates tested for antimicrobial resistance. The most common clinical sample sources were urine (28%), ear, nose, and throat discharge collectively (27%), and blood (21%). All the studies were cross-sectional and 83% were conducted in hospital settings. Among Gram-positive bacteria, the reported level of resistance to vancomycin ranged from 8% (Enterococcus species) to 20% (S. aureus). E. coli, K. pneumoniae and P. aeruginosa were the most common Gram-negative pathogens resistant to key antimicrobial agents described in the national standard treatment guideline and were associated with diverse clinical conditions: urinary tract infections, diarrhea, surgical site infections, pneumonia, ocular infections, and middle ear infections.ConclusionOverall, there is a high prevalence of antimicrobial resistance in Ethiopia. Empirical treatment of bacterial infections needs to be guided by up-to-date national guidelines considering local antimicrobial susceptibility patterns. Equipping diagnostic laboratories with culture and drug susceptibility testing facilities, and establishing a strong antimicrobial stewardship program should be high priorities.

Project description:BackgroundIn sub-Saharan Africa, where there is the scarcity of proper diagnostic tools, febrile illness related symptoms are often misdiagnosed as malaria. Information on causative agents of febrile illness related symptoms among pastoral communities in Ethiopia have rarely been described.MethodsIn this a community based cross-sectional survey, we assessed the prevalence of typhoid fever, typhus, brucellosis and malaria among individuals with a set of given symptoms in Amibara district, Afar Region, Ethiopia. Blood samples were collected from 650 study participants, and examined by Widal and Weilfelix direct card agglutination test (DCAT) as well as test tube based titration test for Salmonella enterica serotype Typhi (S. Typhi) and Rickettsia infections. Rose Bengal Plate Test (RBPT) and Complement Fixation Test (CFT) were used to screen Brucella infection. Thin and thick blood smears were used to diagnosis malaria.ResultsOut of 630 sera screened by DCAT, 83 (13.2%) were reactive to H and/or O antigens for S. Typhi infection. Among these, 46 (55.4%) were reactive by the titration test at the cut off value ≥ 1:80. The combined sero-prevalence for S. Typhi by the two tests was 7.3% (46/630). The seroprevalence for Rickettsia infection was 26.2% (165/630) by DCAT and 53.3% (88/165) by the titration test at the cut off value ≥ 1:80. The combined sero-prevalence for Rickettsia infection by the two tests was 14.0% (88/630). The sero-prevalence for Brucella infection was 12.7% (80/630) by RBPT, of which 28/80 (35%) were positive by CFT. The combined sero-prevalence for Brucella infection by the two tests was 4.4% (28/630). Out 650 suspected individuals for malaria, 16 (2.5%) were found positive for P. falciparum infection.ConclusionIn this study, typhoid fever, typhus, brucellosis and malaria were observed among symptomatic individuals. The study also highlighted that brucellosis cases can be misdiagnosed as malaria or other disease based solely on clinical diagnosis. Therefore, efforts are needed to improve disease awareness and laboratory services for the diagnosis of brucellosis and other zoonotic diseases to identify other causes of febrile illness in this pastoral setting.

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Prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia: A systematic review and meta-analysis.

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