determine associations between the preferred feeding choices and the factors affecting the decisions.Results: The findings revealed good knowledge (60%) of the infant feeding options among the respondents. About 42.9% of the women felt the counsellors were not convinced to certain limit which method was best, hence they not confidently guide them on the correct options. The adoption of infant feeding options as recommended by WHO was not optimal. Reasons included deterrents like financial limitations in 36.9% of respondents which was statistically significant at the bivariate (p= <0.001) and multivariate (p=0.013, odds ratio = 32.779) levels. This showed that respondents with financial constraints were 32 times less likely to practice the ideal feeding options than women who are not financially constrained. Also, sociocultural norms and beliefs in 40%, and the knowledge of risks associated with some feeding practices (38.5%) statistically significant (p=0.022 and 0.023 at bivariate and multivariate levels respectively). In the course of feeding their children, the respondents had challenges of insufficient breast milk, stigma and discrimination, among others.Conclusion: High proportions of respondents know the recommended infant feeding options, though the adoption of, and adherence to the ideal methods is not practiced. Sociocultural norms, fear of stigma, discrimination, and financial constraints affect their ability to do so. It is recommended that effective counselling services should be made available to HIV positive women in the hospital by trained hospital personnel to guide such women on making correct choices.

Visceral leishmaniasis (VL) was firstly reported in Armenia in 1913. Following a considerable increase of the number of cases until the mid 1950s, the disease disappeared after 1969 and re-emerged in 1999. Scientific literature about VL in Armenia is available only in Russian or Armenian. This paper presents a historical overview about leishmaniasis in Armenia based on this literature as well as an epidemiological update since the re-emergence of the disease. In 1999–2016, 116 indigenous VL cases were recorded mainly in children in 8 of the 11 districts, however, VL is underreported because of lack of trained medical personal and diagnostic facilities. The aim of this work was to apply for the first time molecular diagnosis of VL in Armenia. Out of 25 VL suspected patients, 22 were positive by microscopy and polymerase chain reaction (PCR). Genotyping using internal transcribed spacer 1-PCR-restriction fragment length polymorphism and sequencing identified the causative agent of VL in Armenia as Leishmania infantum. The present work is an important step towards the inclusion of molecular techniques in the current diagnosis of VL in Armenia and the establishment of local molecular diagnostic facilities.

Background Visceral leishmaniasis (VL) is re-emerging in Armenia since 1999 with 167 cases recorded until 2019. The objectives of this study were (i) to determine for the first time the genetic diversity and population structure of the causative agent of VL in Armenia; (ii) to compare these genotypes with those from most endemic regions worldwide; (iii) to monitor the diversity of vectors in Armenia; (iv) to predict the distribution of the vectors and VL in time and space by ecological niche modeling. Methodology/Principal findings Human samples from different parts of Armenia previously identified by ITS-1-RFLP as L. infantum were studied by Multilocus Microsatellite Typing (MLMT). These data were combined with previously typed L. infantum strains from the main global endemic regions for population structure analysis. Within the 23 Armenian L. infantum strains 22 different genotypes were identified. The combined analysis revealed that all strains belong to the worldwide predominating MON1-population, however most closely related to a subpopulation from Southeastern Europe, Maghreb, Middle East and Central Asia. The three observed Armenian clusters grouped within this subpopulation with strains from Greece/Turkey, and from Central Asia, respectively. Ecological niche modeling based on VL cases and collected proven vectors (P. balcanicus, P. kandelakii) identified Yerevan and districts Lori, Tavush, Syunik, Armavir, Ararat bordering Georgia, Turkey, Iran and Azerbaijan as most suitable for the vectors and with the highest risk for VL transmission. Due to climate change the suitable habitat for VL transmission will expand in future all over Armenia. Conclusions Genetic diversity and population structure of the causative agent of VL in Armenia were addressed for the first time. Further genotyping studies should be performed with samples from infected humans, animals and sand flies from all active foci including the neighboring countries to understand transmission cycles, re-emergence, spread, and epidemiology of VL in Armenia and the entire Transcaucasus enabling epidemiological monitoring.

BackgroundScant information is available on the infectious causes of febrile illnesses in Armenia. The goal of this study was to describe the most common causes, with a focus on zoonotic and arboviral infections and related epidemiological and clinical patterns for hospitalized patients with febrile illnesses of infectious origin admitted to Nork Infectious Diseases Clinical Hospital, the referral center for infectious diseases in the capital city, Yerevan.MethodA chart review study was conducted in 2014. Data were abstracted from medical charts of adults (≥18 years) with a fever (≥38 °C), who were hospitalized (for ≥24 h) in 2010–2012.ResultsOf the 600 patients whose charts were analyzed, 76 % were from Yerevan and 51 % were male; the mean age (± standard deviation) was 35.5 (±16) years. Livestock exposure was recorded in 5 % of charts. Consumption of undercooked meat and unpasteurized dairy products were reported in 11 and 8 % of charts, respectively. Intestinal infections (51 %) were the most frequently reported final medical diagnoses, followed by diseases of the respiratory system (11 %), infectious mononucleosis (9.5 %), chickenpox (8.3 %), brucellosis (8.3 %), viral hepatitis (3.2 %), and erysipelas (1.5 %). Reviewed medical charts included two cases of fever of unknown origin (FUO), two cutaneous anthrax cases, two leptospirosis cases, three imported malaria cases, one case of rickettsiosis, and one case of rabies. Engagement in agricultural activities, exposure to animals, consumption of raw or unpasteurized milk, and male gender were significantly associated with brucellosis.ConclusionOur analysis indicated that brucellosis was the most frequently reported zoonotic disease among hospitalized febrile patients. Overall, these study results suggest that zoonotic and arboviral infections were not common etiologies among febrile adult patients admitted to the Nork Infectious Diseases Clinical Hospital in Armenia.

ObjectiveTo understand the disease burden, we studied the epidemiological and clinical characteristics and associated costs for brucellosis patients hospitalized in Nork hospital in 2016.IntroductionBrucellosis, endemic in Armenia, is recognized as a significant public health challenge with a major economic burden. To address the regional threat of brucellosis for both animal health and public health, the “One Health Surveillance of Brucellosis in Armenia” was initiated in December 2016. The project aims to develop scientifically sound strategies and policies for sustainable control of the disease.MethodsIn 2016, 265 patients diagnosed with brucellosis were hospitalized at “Nork” hospital, of whom 16 were 0-14 years old and 94% were males. Diagnosis was confirmed using agglutination test and ELISA. The SPSS program was used to analyze the data.ResultsDistribution of the disease by marz revealed that the most cases came from Ararat (53), followed by Kotayk (49), Armavir (38), Aragatsotn (36), Yerevan (28), Gegharkunik (26), Vayots Dzor (24), Syunik (8), and Lori (3). Clinical data indicated that 71% of patients had acute brucellosis with fever, arthralgia and night sweating while 29% suffered chronic brucellosis with damage of organ systems. The primary complaints included arthralgia (80%), sweating (60%) and fever (40%). Joint pain was mainly located in knee, elbow, and sacroiliac regions. Average grade of fever was 37,9±0,95oC. Total days spent in hospital were 1798, economic losses for the hospital were estimated at AMD 36 million per year.ConclusionsThose at the highest risk for brucellosis were males living in Ararat and Kotayk marzes who work with livestock.