This research was carried out in three health centers; Janmeda health center woreda 06, Arada health center woreda 10, and Gerji health center woreda 13, Addis Ababa, Ethiopia. The selected health centers are administered under the Addis Ababa Health Bureau in Addis Ababa, Ethiopia.
Study Design and Period
A cross-sectional study was conducted to compare the Syndromic approach versus etiologic based approach on STI at a selected Health center in Addis Ababa, Ethiopia, from April 2019–March 2020.
All clients who visited in selected health center outpatient department, OPD for medical service with a compliant of sign and symptoms of urethral /vaginal discharge.
The study populations were patients in the selected health facilities of Addis Ababa who were participated in the study. All Out Patient Department (OPD) clients for STI according to WHO standard Syndromic approach STI management guideline between April 2019–March 2020 were included in this study.
Clients who visited the study site OPD and have a history of urethral /vaginal discharge Neisseria gonorrhoeae and willing to participate in the study.
Clients who have no signs and symptoms of Neisseria gonorrhoeae and patients having a history of taking antibiotics for the past 10 days are to be excluded.
Sample Size Calculation and Sampling Method
In this study sample size was calculated by using single population proportion formula with a confidence interval of 95%and5%marginal error by taking prevalence of the case(74.1%)from a study conducted at Gondar town hospital and health centers, Ethiopia (8). And by adding 10% of calculated sample sizes for contingency, finally, the sample size was determined to be three hundred twenty-five. And convenience sampling method is used (9, 10).
Appropriate ureteral and vaginal discharge and blood (serum) samples was collected by a trained clinical nurse. The ureteral and vaginal discharges were transported by Amies with charcoal transport media.
A sterile cotton-tipped swab was used to obtain swab specimens. Then sterile Dacron swabs tipped applicator were used to collect urethral secretions. The swabs were inoculated on in-house prepared Modified Thayer Martin Agar plates made of Gonococcal agar base supplemented with isovitalex (vitox); vancomycin, colistin, nystatin, and trimethoprim (VCNT); and synthetic hemoglobin (Oxoid and BBL).The inoculated plates were incubated on the site using candle jar and transported to the Ethiopian Public Health Institute (EPHI), Clinical Bacteriology and Mycology Reference Laboratory within the same day of collection. Swab was rolled onto a microscopy slide, labeled, heat fixed, placed in a slide box and sent to EPHI for Gram-stain analysis. Gram stain was performed to look for polymorph nuclear leucocytes with Gram-negative intracellular diplococci microscopically. Then the isolates were identified as Neisseria gonorrhoeae by presumptive diagnosis method based on colony morphology, Gram staining, catalase test, Oxidase test, and superoxide test.
Culture and identification:
In the clinical bacteriology laboratory, inoculated plates were incubated at 35oC in carbon dioxide enriched environment (5-8 % CO2) for 72 hours inspecting every day for the growth of small, translucent and non-pigmented colonies. Gram negative diplococcic convex, glistening, elevated, mucoid colony characteristics and oxidase, catalase and supercool (30% H2O2) positive were considered as probable N. gonorrhoeae. Antimicrobial susceptibility testing was performed by on enriched GC agar (Oxoid Ltd) plus 1% BBL Isovitalex Enrichment. Minimum Inhibitory Concentration (MIC) was done using concentration gradient strips (E-test) of the same antibiotics. The range of inhibition zones and MIC for each type of antibiotic disk were interpreted according to Clinical Laboratory Standard Institute (CLSI) guideline (11). N. gonorrhoeae reference strain ATCC 49226 was used a positive control.
Data Analysis and Interpretation
For data entry and analysis, SPSS (the Statistical Package for Social Sciences for Windows) version 23 statistical software was used. Bivariate analysis was used to determine Socio-demographic Characteristics versus Neisseria gonorrhoeae, percentage was calculated.
This study was ethically cleared by Research and Ethics Committee of the Addis Ababa University College of Health Sciences Department of Medical Laboratory Technology and Addis Ababa Public Health Research and Emergency Management Directorate.
At the enrollment visit, all participants with urethral discharge or vaginal discharge were given written consent diagnosed according to the syndromic treatment guidelines currently approved in Ethiopia. Those who are eligible (> 18 years of age) and willing to participate in the study were asked using structured questionnaire for their demographic and behavioral data. All data were kept confidential anonymously. Participants were informed of their rights to resign from the study at any level of the study without any restriction if they were feeling uncomfortable in the study. Their results of all positive individuals were reported to the respective health facilities for better management of the patients.