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The UN will formulate ambitious Sustainable Development Goals for 2030, including one for health. Feasible goals with some quantifiable, measurable targets can influence governments. We propose, as a quantitative health target, “Avoid in each country 40% of premature deaths (under-70 deaths that would be seen in the 2030 population at 2010 death rates), and improve health care at all ages”. Targeting overall mortality and improved health care ignores no modifiable cause of death, nor any cause of disability that is treatable (or also causes many deaths). 40% fewer premature deaths would be important in all countries, but implies very different priorities in different populations. Reinforcing this target for overall mortality in each country are four global subtargets for 2030: avoid two-thirds of child and maternal deaths; two-thirds of tuberculosis, HIV, and malaria deaths; a third of premature deaths from non-communicable diseases (NCDs); and a third of those from other causes (other communicable diseases, undernutrition, and injuries). These challenging subtargets would halve under-50 deaths, avoid a third of the (mainly NCD) deaths at ages 50–69 years, and so avoid 40% of under-70 deaths. To help assess feasibility, we review mortality rates and trends in the 25 most populous countries, in four country income groupings, and worldwide. UN sources yielded overall 1970–2010 mortality trends. WHO sources yielded cause-specific 2000–10 trends, standardised to country-specific 2030 populations; decreases per decade of 42% or 18% would yield 20-year reductions of two-thirds or a third. Throughout the world, except in countries where the effects of HIV or political disturbances predominated, mortality decreased substantially from 1970–2010, particularly in childhood. From 2000–10, under-70 age-standardised mortality rates decreased 19% (with the low-income and lower-middle-income countries having the greatest absolute gains). The proportional decreases per decade (2000–10) were: 34% at ages 0–4 years; 17% at ages 5–49 years; 15% at ages 50–69 years; 30% for communicable, perinatal, maternal, or nutritional causes; 14% for NCDs; and 13% for injuries (accident, suicide, or homicide). Moderate acceleration of the 2000–10 proportional decreases in mortality could be feasible, achieving the targeted 2030 disease-specific reductions of two-thirds or a third. If achieved, these reductions avoid about 10 million of the 20 million deaths at ages 0–49 years that would be seen in 2030 at 2010 death rates, and about 17 million of the 41 million such deaths at ages 0–69 years. Such changes could be achievable by 2030, or soon afterwards, at least in areas free of war, other major effects of political disruption, or a major new epidemic. UK Medical Research Council, Norwegian Agency for Development Cooperation, Centre for Global Health Research, and Bill & Melinda Gates Foundation.

Bacterial bloodstream infections are of great concern globally. Of late, the emergence of drug resistant bacteria worsen the related morbidity and mortality. This study was aimed to determine the bacterial profile, antimicrobial susceptibility patterns, and associated factors among the blood stream infection (BSI) suspected patients attending the Arba Minch General Hospital (AMGH), southern Ethiopia, from 01 June through 31st August, 2020. A cross-sectional study was conducted among 225 BSI suspected patients. Systematic random sampling method was used to select patients. Blood culture was done to isolate bacterial pathogens. Antimicrobial susceptibility test was performed by employing the Kirby-Bauer disc diffusion method. Descriptive statistics and multivariable logistic regression analysis were done by Statistical Package for Social Service (SPSS) version 22. The rate of prevalence of bacteriologically confirmed cases was 22/225 (9.8%). Majority of BSI were caused by Gram-positive cocci, 13/22 (59.1%), particularly the isolates of S. aureus, 7/22 (31.8%) followed by Enterococci species, 4/22 (18.2%) and coagulase-negative Staphylococci (CoNS), 2/22 (9.1%). Among the Gram-negative bacteria 9/22 (41.1%), Klebsiella species 4/22 (18.2%) was the prominent one followed by Escherichia coli 2/22 (9.1%), Pseudomonas aeruginosa 2/22 (9.1%), and Enterobacter species 1/22 (4.5%). All the isolates of Gram-negative bacteria were susceptible to meropenem whereas 69.2% of the isolates of Gram-positive counterparts were susceptible to erythromycin. Slightly above two third (68.2%) of the total isolates were multidrug resistant. Insertion of a peripheral intravenous line was significantly associated with BSI [ p  = 0.03; Adjusted Odds Ratio = 4.82; (Confidence Interval: 1.08–21.46)]. Overall results revealed that eventhough the prevalence of BSI in Arba Minch is comparatively lower (9.8%), multidrug resistance is alarmingly on the rise, which is to be addressed through effective surveillance and control strategies.

The emergence of drug-resistant Gram-negative bacterial uropathogens poses a grave threat worldwide, howbeit studies on their magnitude are limited in most African countries, including Ethiopia. Therefore, measuring the extent of their drug resistance is essential for developing strategies to confine the spread. A cross-sectional study was conducted at title hospital from 01 June to 31 August 2020. Midstream urine specimens were collected and inoculated onto MacConkey agar. Positive urine cultures showing significant bacteriuria as per the Kass count (>10 5 CFU/mL) were further subjected to biochemical tests to identify the type of uropathogens. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disk diffusion technique, and potential carbapenemase producers were phenotypically determined by the modified carbapenem inactivation method as per the CLSI guidelines. Data were analyzed using SPSS version 26; P-value <0.05 was considered statistically significant. Totally, 422 patients were included, and the majority were females (54.7%). The prevalence of carbapenem-resistant Gram-negative uropathogens was 12.9%, and 64.7% of them were carbapenemase producers. Klebsiella pneumoniae (n = 5) was the predominant carbapenemase producer, followed by Pseudomonas aeruginosa (n = 4). Consumption of antibiotics prior to six months of commencement of the study, the presence of chronic diseases and hospitalizations were statistically associated with UTI caused by carbapenem-resistant Gram-negative uropathogens. Carbapenemase producers were resistant to most of the antibiotics tested. Our findings highlight the need for periodic regional bacteriological surveillance programs to guide empirical antibiotic therapy of UTI.

Individuals with Methicillin-Resistant Staphylococcus aureus (MRSA) colonized nasal cavities were at greater risk of developing the infection and can serve as potential reservoirs of transmission. Aim of this study is to determine the extent of nasal carriage and associated factors linked to MRSA in medical and health science students of Arba Minch University (AMU), Ethiopia, who are much prone. An institution based cross-sectional study was conducted at AMU from 01st August through 30th November, 2020 by means of a systematic sampling technique using a structured questionnaire. Nasal swabs samples were collected and S. aureus were identified following standard microbiological methods. Methicillin resistance was tested using cefoxitin disk and antimicrobial susceptibility tests were performed by Kirby-Bauer disk diffusion. Biofilm forming ability was phenotypically detected by micro-titer plate assay. Descriptive statistics and multivariable logistic regression analysis were done by Statistical Package for Social Service (SPSS) version 25. The overall prevalence of Staphylococcus aureus and MRSA were 27.1% (70/258) and 7.4% (19/258) respectively. Methicillin-Resistant S. aureus carriage were higher among medical interns, 16.9% (11/65). Isolates in general were co-resistant to antibiotics, such as trimethoprim-sulfamethoxazole (63.2%) and tetracycline (48.4%). Multidrug resistance (MDR) were observed among 52.6% (10/19) of the isolates. Besides, 31.4% (6/19) of MRSA were biofilm producers and all of them were MDR. Multivariable analysis showed that mean exposure for > 2 years to hospital settings [ p  = 0.048, AOR: 4.99, 95% CI 1.01–24.66] and the habit of sharing clothing and sports equipment [ p  = 0.017, AOR: 5.43, 95% CI 1.35–21.83] were statistically significant. The overall prevalence of nasal colonized MRSA among students were comparatively lower than that observed in other studies done in Ethiopia itself. An alarming factor is that, 60% of MDR-MRSA were biofilm producers.

ObjectiveThis study aimed to assess the prevalence of delayed treatment seeking and its associated factors among patients with malaria in the Andabet district, Northwest Ethiopia, 2022.DesignAn institution-based cross-sectional study was conducted from 8 July 2022 to 21 August 2022. Data were collected from malaria patients using structured and pretested questionnaires and entered using Epi data V.4.6 and analysed by using Stata SE V.14. Both bivariable and multivariable logistic regression analyses were used to identify the factors associated with delay seeking treatment among malaria patients. P values less than 0.05 with 95% CI and adjusted OR (AOR) were considered statistically significant.SettingThe study was conducted in the Andabet district, Northwest Ethiopia.ParticipantsA total of 403 malaria patients participated in this study. The sample was allocated proportionally for the six health centres and participants were selected through systematic random sampling techniques.Outcome measuresThe primary outcome is the prevalence of delay in seeking malaria treatment.ResultsA total of 403 malaria patients with a mean age of 27.6±SD 14.26 years were included in this study. The prevalence of delayed malaria treatment seeking was 78.41% (95% CI 74.11%, 82.17%). Do not know the cause of malaria (AOR=2.24, 95% CI (1.07, 4.65)), do not know malaria signs and symptoms (AOR=2.52, 95% CI (1.04, 6.07)), distance greater than 5 km travelled (AOR=5.37, 95% CI (1.22, 23.55)) and fear of treatment cost (AOR=1.88, 95% CI (1.05, 3.36)) were the statistically significant factors associated with delayed treatment seeking among malaria patients.ConclusionsThe prevalence of delayed malaria treatment was high. Lack of knowledge of the cause of malaria, lack of knowledge of malaria signs and symptoms, a distance greater than 5 km travelled and fear of treatment cost were significantly associated with delayed malaria treatment seeking. Therefore, community awareness of early treatment is crucial.

Infectious diarrhoea is one of the leading causes of paediatric morbidity and mortality in developing countries like Ethiopia; several factors contribute to the worsening of condition. This study was aimed to determine the prevalence and associated factors of enteropathogens, and antimicrobial susceptibility patterns of enterobacteria among paediatric patients attending four selected government health institutions in Arba Minch, southern Ethiopia. The study materials were stool samples collected from 367 paediatric patients with acute diarrhoea, which were then inoculated onto MacConkey agar, xylose lysine deoxycholate agar, and Campylobacter selective media for the isolation of enteric bacteria. Catalase, oxidase, indole, hydrogen sulfide, citrate, urease, and carbohydrate fermentation tests were performed for the phenotypic identification of the recovered isolates. The antibiotic susceptibilities of enterobacteria were determined via the Kirby-Bauer disc diffusion method. The wet mount and formol-ether concentration techniques were also used to identify enteroparasites. Descriptive and inferential statistical analyses were done using SPSS, and P-values ≤ 0.05 were considered statistically significant. Among 367 paediatric patients, 39.8% ( n  = 146) were tested positive for any one of the entero-pathogens, constituting 37.6% ( n  = 138) entero-parasites and the rest 2.2% ( n  = 8) corresponded to enterobacteria; Giardia lamblia (17.9%, n  = 66) and Entamoeba histolytica (14.4%, n  = 42) were predominant among the former; Shigella dysenteriae (1.1%, n  = 4), followed by Salmonella Typhimurium and Campylobacter jejuni/coli (0.55%, n  = 2 each), were the dominant bacteria. Invariably, all isolates were 100% susceptible to ciprofloxacin. The occurrence of bloody diarrhoea [(AOR = 3.01, 95% CI (1.65–5.48)] and having illiterate parents [(AOR = 5.46, 95% CI (1.79–16.66)] were found to be statistically associated with the enteric infection. More than a fourth of the paediatric patients in the cohort were affected by enteropathogens; intestinal protozoans were the predominant group, highlighting a significant health concern that demands immediate attention. Besides, edifying the parents of paediatric patients about personal hygiene and sanitation practices would be the most important intervention strategy to emphasise.

Neonatal omphalitis is a true medical emergency that can rapidly progress to sepsis and even death if not promptly diagnosed and treated appropriately. Empirical therapy is widely practised in this case, too, in low-income countries like Ethiopia, paving the way for severe drug resistance and posing serious challenges. To determine the magnitude, bacterial profile, antibiotic susceptibility patterns, and associated factors of omphalitis among clinically suspected neonates attending four government health institutions in Arba Minch, southern Ethiopia, during the second half of 2023. A facility-based multi-centred cross-sectional study was conducted among 379 clinically suspected neonates who attended the inpatient/outpatient departments and intensive care units of four government health institutes of Arba Minch from June 1 to December 28, 2023. Study participants were consecutively recruited, and their demographic and clinical data were collected using a pre-tested questionnaire. Samples were aseptically collected and inoculated onto a series of bacterial culture media, namely MacConkey agar, mannitol salt agar, chocolate, and blood agar, and different species were identified by means of several biochemical tests. Antibiotic susceptibility tests were performed through the Kirby–Bauer disc diffusion technique. Bivariable and multivariable logistic regression models (SPSS version 25) were utilized to analyze the association between dependent and independent variables; P -values ≤ 0.05 were considered statistically significant. The overall number of clinically suspected and culture-confirmed cases of omphalitis, respectively, were 379 and 130 per 1000 live births. Gram-positive (GPB) and Gram-negative bacteria (GNB) were detected in 50.4% ( n  = 71) and 49.6% ( n  = 70) of cases, respectively. The often isolated bacteria were S. aureus , 53.5% ( n  = 38), and E. coli , 47.1% ( n  = 33); GNB were highly resistant (> 60%) to tetracycline, sulfamethoxazole-trimethoprim, and ampicillin. The overall multi-drug resistance was 34.7% ( n  = 49); methicillin-resistant S. aureus was 34.1% ( n  = 14). The GNB isolates comprised extended-spectrum beta-lactamase, 15.7% ( n  = 11), and carbapenemase, 10% ( n  = 7) producers. The lack of hand washing practices [AOR = 2.08, (95% CI 1.26–3.41), P value = 0.004] and lower gestation period (< 37 weeks) [AOR = 2.3, (95% CI 1.33–3.93), P value = 0.003] were statistically associated. The overall prevalence of omphalitis was higher; WHO-prioritised drug-resistant bacterial pathogens were also detected. This study underscores the importance of factors such as maternal/caregiver hand hygiene and antenatal care. Thus, a more comprehensive approach towards the management of omphalitis employing precise diagnostic tools and an antimicrobial stewardship program is essential in all the four study settings.

External ocular infections are of serious global concern, which cause significant visual morbidity and even blindness, particularly in low-income and resource-limited countries. Herewith, we are reporting the profile of bacteria and fungi causing external ocular infections and the associated factors in Arba Minch, southern Ethiopia. An institution-based cross-sectional study was conducted among 259 suspected individuals with external ocular infections from 01 January to 10 June 2020 in Arba Minch General Hospital. The demographic data were obtained using a structured questionnaire, while corneal scrapings and conjunctival swabs were collected for culture. Samples were inoculated onto MacConkey, blood, mannitol salt and Sabouraud dextrose agar plates. Bacteria were characterised using conventional microbiological techniques. Fungal isolates were identified by culture and morphology by means of microscopy. Antibiotic susceptibility tests for bacteria were performed via the Kirby-Bauer disk diffusion technique. A logistic regression analysis determined the association between dependent and independent variables; P values ≤ 0.05 were considered statistically significant. The most common clinical manifestations in culture-proven cases were conjunctivitis (38.6%, n  = 100) and blepharoconjunctivitis (25.9%, n  = 67). The overall prevalence of external ocular bacterial and fungal infections was 73.2 ( n  = 115) and 26.8% ( n  = 42), respectively. Isolates of Staphylococcus aureus (24.8%, n  = 39) and Pseudomonas aeruginosa (13.4%, n  = 21) were the predominant Gram-positive and Gram-negative bacteria, respectively. The prevalence of multidrug-resistant bacteria was 71.3% ( n  = 82). The World Health Organisation-prioritised bacteria such as methicillin-resistant S. aureus (61.5%, n  = 24), extended-spectrum beta-lactamase (22.6%, n  = 12), and carbapenemase-producing Enterobacteriaceae (15.1%, n  = 8) were also detected. The prominent fungi recovered from patients with keratitis and conjunctivitis were Aspergillus spp. and Candida albicans , respectively (9.5%, n  = 15 each). Age (26–49 years) and family income were statistically associated with ocular infections ( P  ≤ 0.05). The results provide insights into the characteristics of major ocular bacterial and fungal pathogens circulating in the ophthalmic patients of Arba Minch. Conjunctivitis is the main ocular manifestation observed, with a predominance of S. aureus . More than two-thirds of the ocular bacteria were MDR, and the highest prevalence corresponds to S. aureus . The aggravation of multi-drug resistance, including the WHO-prioritised ones, warrants periodic evaluations.

Reproductive tract infections (RTIs) are a persistent public health threat worldwide, particularly among women in low-income countries of Africa, including Ethiopia, where drug resistance is also a growing problem. It is crucial to address this problem to ensure women's health and well-being. A cross-sectional study was carried out among a cohort of 398 women of reproductive age who sought medical attention at the Gynecology Department of the Arba Minch General Hospital, southern Ethiopia, from January to June 2020. They were chosen through systematic random sampling, and a pre-tested structured questionnaire was used to collect the data. The collection of vaginal and/or cervical swabs were done to diagnose bacterial vaginosis (BV) and aerobic vaginitis (AV) using Nugent and AV score analyses, respectively. The swabs were subjected to standard microbiological culture techniques to detect the isolates causing AV and vaginal candidiasis (VC). The susceptibility profiles of the causative agents of AV were checked by the Kirby-Bauer disc diffusion technique. Descriptive and inferential statistical analyses were also done. Aerobic vaginitis was the predominantly diagnosed RTI (n = 122, 30.7%), followed by BV (n = 117, 29.4%) and VC (n = 111, 27.9%). The prominent bacteria of AV were  Escherichia coli  (n = 36, 34.2%) and Klebsiella pneumoniae  (n = 30, 28.5%). The overall rate of multidrug-resistant (MDR) bacteria was 65.71% (n = 69). History of abortion ( p  = 0.01; AOR = 4.0, 95% CI = 2.1, 7.7) and the habit of using vaginal pH-altering contraceptives ( p  = 0.01; AOR = 4.7, 95% CI = 2.5, 8.8) have the greatest odds of RTI. The high prevalence of RTIs in our study warrants an urgent intervention to minimize the associated morbidities and complications. The overall rate of MDR bacterial isolates necessitates the implementation of an effective surveillance program in the study setting.

Typical pneumonia is a pressing issue in the treatment of human immunodeficiency virus (HIV) patients, especially in Sub-Saharan Africa, where it remains a significant menace. Addressing this problem is crucial in improving health outcomes and the reduction of the burden of diseases in this vulnerable category of patients. To determine the prevalence of community-acquired typical pneumonia among HIV patients in Public Hospitals in southern Ethiopia. A cross-sectional study was done among 386 HIV patients clinically suspected of typical pneumonia attending the anti-retroviral therapy (ART) clinics of two hospitals from March to September 2022. A pretested structured questionnaire was employed to collect the demographic, clinical, and behavioral data. Sputum samples were collected and inspected for bacteria following standard procedures, and antimicrobial susceptibility testing was performed employing the Kirby-Bauer disk diffusion method. Besides, extended-spectrum β-lactamase (ESβL) and carbapenemase-producing Gram-negative bacteria were inspected by the double disk synergy test and modified carbapenem inactivation method. Descriptive and inferential statistical analyses were also done. Overall, 39.1% (151/386) of sputum cultures (95% Confidence Interval: 32.4-44) were bacteriologically positive. A total of 151 bacteria were identified, comprising 72.8% (n = 110) of Gram-negative bacteria. The predominant isolate was Klebsiella pneumoniae (25.8%, n = 39), followed by Staphylococcus aureus (17.9%, n = 27); 59.6% (n = 90) of the entire isolates were multidrug-resistant (MDR). Forty percent (11/27) of S. aureus were methicillin-resistant S. aureus (MRSA), and 28.1% (n = 31) and 20.9% (n = 23) of Gram-negative bacteria were extended-spectrum beta-lactamases (ESBL) and carbapenemase producers, respectively. Occupational status, alcohol consumption, cluster of differentiation4 (CD4) Thymocyte cell count < 350, interruption of trimethoprim-sulfamethoxazole prophylaxis and antiretroviral treatment, and recent viral load ≥ 150 were found statistically significant. The higher rates of MDR, MRSA, ESBL, and carbapenem-resistant Enterobacterales (CRE) indicate that bacterial pneumonia is a vexing problem among HIV patients and therefore it is advisable to implement an antimicrobial stewardship program in the study area.