Sub-Saharan Africa carries the largest burden of pediatric HIV infection. The success of second line anti-retroviral treatment and related factors among African children is not well-defined. ...Objectives: We aimed to identify the rate and determinants of second line anti-retroviral treatment failure among children and adolescents on follow-up at an Ethiopian tertiary teaching hospital. A retrospective observational cohort study was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa. Structured forms were used to collect socio-demographic, clinical and diagnostic data. Descriptive statistics and bivariate analysis were used to describe the magnitude of the problem and its associations. A total of 76 children and adolescents taking second line anti-retroviral treatment were analyzed (mean age: 16.1 years). Failure of therapy was seen in 14/76 while four were eligible for a switch to third line anti-retrovirals. Mean duration on second line treatment till virologic failure was diagnosed was 17.6 months while mean viral load upon requiring a third line regimen was 82,131.3 copies/ml. Second line antiretroviral treatment virologic failure was significantly associated with the age of the child or adolescent. A high rate of virologic failure exists among the study population. Findings underline need for provision of third line anti-retroviral drugs in Ethiopia. Challenges for delivering a standard care were irregular viral load testing and delayed initiation of second line treatment after failure of first line regimens.
Ethiopia launched free access for antiretroviral therapy in 2005. The number of patients on second line antiretroviral treatment has increased with each passing year. The objectives of this study ...were to describe the clinical, immunological and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals, Yekatit 12 and Zewditu Memorial Hospitals, in Addis Ababa, Ethiopia.
This was a hospital based retrospective cohort study conducted among children and adolescents aged 18 years and less and receiving a second line antiretroviral drugs. Data was collected using structured questionnaires. Means and percentages were used for nominal variables. Statistical analysis was made using statistical software-SPSS 23.0. Kaplan Meier analysis, long rank test and multivariate Cox proportion model were used to identify factors affecting survival.
A total of 75 children and adolescents were studied with a mean age of 13.28 years (SD: 4) with a mean treatment period on second line regimens of 35.2 months (SD: 21.8 months). Forty-eight participants were experiencing successful measures (in all three parameters) for their second line anti-retroviral treatment. Ten had virologic treatment failure while seven had died. Both treatment failure and death rates were higher within the first two years of treatment. Poor treatment adherence (Adjusted hazard ratio: 5.1 (95% CI: 1.1-23.2; p-value = 0.02)) and advanced World Health Organization clinical stage at start of the second line antiretrovirals (Adjusted hazard ratio: 7.51 (95% CI: 1.35-18.02; p-value = 0.002)) correlated significantly with survival of children and adolescents receiving treatment.
The study describes clinical, immunological and virologic outcomes of second line antiretroviral treatment in a pediatric cohort under care in two hospitals in Addis Ababa, Ethiopia. Poor adherence and pre-treatment advanced clinical stages were predictors of survival.
Community nasal meningococcal carriage rates are high across Africa. Meningococcal infections are major causes of morbidity and mortality in the continent; especially among children and adolescents. ...This study aimed to determine the prevalence of nasal carriage and antibiotic susceptibilities of meningococcal isolates from healthy Ethiopian children and adolescents.
A cross-sectional study was conducted in one of the sub-cities of Addis Ababa, Ethiopia. Nasal swabs were collected and processed for identification, serogrouping and testing susceptibilities for three antibiotics using standard microbiological techniques. Data on epidemiologic risk factors were collected using a structured questionnaire and the magnitude of their association with carriage was assessed using bivariate and multivariate analysis.
A total of 240 samples were collected (115 from males and 125 from females). The mean age of study participants was 11.1 years. The prevalence of nasal carriage for Neisseria meningitidis was 20.4% (49/240). Carriage was significantly higher among children living under crowded conditions (OR 1.268; 95% CI: 1.186-1.355; p = 0.006). The predominant serogroups were W135-20/49 isolates (40.8%) and C-12/49 isolates (24.5%) and 83.7% of meningococci were sensitive for Ciprofloxacin. In contrast, isolates showed high resistance to Ceftriaxone (69.4%) while only 4.2% were sensitive for Penicillin. Multi-drug resistance was documented for 14.3% of the isolates.
Meningococcal carriage rate was found to be high with higher rates associated with children and adolescents living in crowded living conditions. Predominant isolates were of serogroup W135 and C and the isolates showed marked susceptibility to Ciprofloxacin and resistance to Ceftriaxone and Penicillin.
Trisomy 21 (Down syndrome) is a chromosomal disorder associated with humoral and cellular immunologic impairments among other systemic manifestations. It occurs at a frequency of 1 in 750 live ...births. There are increasing reports of children with Down syndrome presenting signs of severe COVID-19. The literature from Africa on pediatric COVID-19 and risk stratification for severe disease is scant. A summary of the clinical features, complications, and treatment outcomes of three Ethiopian children with Trisomy 21 and severe COVID-19 along with a discussion of the correlation between trisomy 21 immunology and severe SARS CoV-2 infection is presented.
Hepatocellular carcinoma in children with hepatitis B virus infection is rarely reported. Metastases to the vertebrae are an even more unusual phenomenon.
We report on a case of a 10-year-old ...Ethiopian boy with hepatitis B infection presenting with paraplegia and incontinence of 10 days' duration. A diagnosis of hepatocellular carcinoma with vertebral metastases was confirmed with serum α-fetoprotein, fine-needle aspirate cytology, and abdominal imaging.
Surveillance of children not immunized against hepatitis B virus prevents infection and its complications, such as hepatocellular carcinoma. Among children in endemic countries prone to development of hepatocellular carcinoma, metastatic disease can present as sudden weakness of extremities with radiologic findings of vertebral body collapse.
Wiskott Aldrich syndrome is a primary immunodeficiency notable for eczema, recurrent infections, bleeding diathesis and microcytic thrombocytopenia.
A 4½ year old boy presented with recurrent ...sinopulmonary infections, repeated treatment for severe eczema since infancy, thrombocytopenia with low platelet volume. His brother and uncles died during childhood due to repeated illnesses. We outline ways to diagnose and manage children in resource limited settings.
Wiskott Aldrich syndrome can be diagnosed by its clinical triad of syndromes. Mutation of the WASP gene confirms diagnosis. Increasing reports of primary immune deficiencies in Ethiopia call for improved education and care for clinical immunology.
Chronic hepatitis B affects close to 300 million people globally with 1.5 million new infections per year. It causes the highest numbers of cirrhosis and liver cancer diagnoses each year. In ...children, perinatal transmission and contact with infected blood or body fluids remain the main methods of transmission. There are increasing reports of breakthrough hepatitis B infections in fully vaccinated children born to hepatitis B-negative mothers, especially in low- and middle-income countries. Our study aimed to measure the adequacy of hepatitis B surface antibody levels among children and adolescents who received three rounds of hepatitis B vaccination during infancy and delivered to hepatitis B-negative mothers in Addis Ababa, Ethiopia.
This was a retrospective cohort study analyzing results of paired serology tests for hepatitis B surface antibody and antigen tests performed for children aged 1-18 years from July 2022 to June 2023. All recorded data were transferred to SPSS version 29.0. The prevalence of adequate hepatitis B surface antibody levels was determined and sub-group analysis conducted using descriptive statistics, frequencies and tables. The magnitude of association between different variables and vaccine-induced hepatitis B immunity was assessed using logistic regression. Statistically significant differences were taken at
< 0.05.
A total of 256 children were included in the study (mean age: 7.53 years). Six children (2.3%) had breakthrough hepatitis B infections. Overall, 37 children (14.4%) were categorized as having optimal hepatitis B surface antibody levels (vaccine-induced antibody titers of >10 IU/mL), while 219 (85.6%) had low titers of <10 IU/mL. Nearly all (97.4%) of the sub-group aged 10 years and above had below-par antibody levels, with adolescents (11-18 years) being ten times more likely to have low seroprotection than those aged less than 5 years.
Our study showed markedly low vaccine-induced hepatitis B surface antibody levels among the study population, especially adolescents. The presence of breakthrough infections may suggest a genuine lack of response and not just a mere drop in antibody titers and thus could highlight a significant public health problem in Ethiopia. Further immunologic studies and a thorough analysis of vaccine storage and administration should be conducted to inform prevention programs.
Meningitis is one of the top ten causes of death among Ethiopian infants. Group B streptococcus (GBS) has emerged as a leading cause of meningitis in neonates and young infants, resulting in high ...mortality. Despite this, there is no report on GBS associated meningitis in Ethiopia where infant meningitis is common. Hence, the aim of this study was to determine the proportion of GBS associated meningitis among Ethiopian infants. PCR was prospectively used to detect GBS in culture-negative cerebrospinal fluid (CSF) samples, which were collected from infants suspected for meningitis, at Tikur Anbessa specialized hospital, Ethiopia, over a one-year period. GBS was detected by PCR in 63.9% of culture-negative CSF samples. Out of the 46 GBS positive infants, 10.9% (n = 5) of them died. The late onset of GBS (LOGBS) disease was noted to have a poor outcome with 3 LOGBS out of 5 GBS positive samples collected from patients with the final outcome of death. PCR was advantageous in the identification of GBS in culture-negative CSF samples. GBS was detected in 64% of the CSF samples from infants with meningitis compared with zero-detection rate by culture.
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