Distribution and Availability of Essential Tuberculosis Diagnostic Items in Amhara Region, Ethiopia.
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ABSTRACT:
SUBMITTER: Sinishaw MA
PROVIDER: S-EPMC4671647 | biostudies-literature | 2015
REPOSITORIES: biostudies-literature
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Distribution and Availability of Essential Tuberculosis Diagnostic Items in Amhara Region, Ethiopia.
Sinishaw Mulusew Alemneh MA Gebregergs Gebremedhin Berhe GB Shiferaw Melashu Balew MB
PloS one 20151207 12
Adequate supplies of tuberculosis laboratory reagents and consumables are necessary for tuberculosis diagnosis and monitoring of treatment response. This study assessed the distribution and stock levels of laboratory commodities used in tuberculosis control in health centers of Amhara region, Ethiopia. A cross-sectional study was conducted in 82 health centers, among 801, providing sputum microscopy services. Stock levels were calculated, and distribution of reagents and consumables assessed. Th ...[more]
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Project description:BackgroundTo end Tuberculosis (TB) by 2030, early detection and timely treatment of Drug-Resistant Tuberculosis (DR-TB) is vital. The role of rapid, accurate, and sensitive DR-TB diagnostic tool is indispensable to accelerate the TB control program. There are evidence breaks in the time difference and its effect on treatment outcomes among different DR-TB diagnostic tools in Ethiopia. This article aimed to compare the different DR-TB diagnostic tools with time pointers and evaluate their effect on the treatment outcomes.MethodWe performed a retrospective chart review of 574 DR-TB patients from September 2010 to December 2017 to compare the impact of molecular DR-TB diagnostic tests (Xpert MTB/RIF, Line Probe Assay (LPA), and solid culture-based Drug Susceptibility Testing (DST)) on time to diagnosis, treatment initiation, and treatment Outcomes. Kruskual-Wallis test was employed to assess the presence of a significant difference in median time among the DR-TB diagnostic tests. Chi-Square and Fisher exact tests were used to test the presence of relations between treatment outcome and diagnostic tests.ResultThe data of 574 DR-TB patients were included in the analysis. From these, 321, 173, and 80 patients were diagnosed using Xpert MTB/RIF, Line Probe Assay (LPA), and solid culture-based DST, respectively. The median time in a day with (Interquartile range (IQR)) for Xpert MTB/RIF, LPA, and solid culture-based DST was from a first care-seeking visit to diagnosis: 2(0, 9), 4(1, 55), and 70(18, 182), from diagnosis to treatment initiation: 3(1, 8), 33(4, 76), and 44(9, 145), and from a first care-seeking visit to treatment initiation: 4(1, 11), 3(1, 12) and 76(3.75, 191) respectively. The shorter median time was observed in the Xpert MTB/RIF followed by the LPA, and this was statistically significant with a p-value <0.001. There was no statistically significant difference concerning treatment outcomes among the three DST tests.ConclusionXpert MTB/RIF can mitigate the transmission of DR-TB significantly via quick diagnosis and treatment initiation followed by LPA as equating to the solid culture base DST, particularly in smear-positive patients. However, we didn't see a statistically significant impact in terms of treatment outcomes. Xpert MTB/RIF can be used as the first test to diagnose DR-TB by further complimenting solid culture base DST to grasp the drug-resistance profile.
| S-EPMC7891731 | biostudies-literature
Project description:BACKGROUND:Unreliable laboratory results lead to unnecessary tests, procedures or treatments which may harm the patient. Continuous quality improvement (CQI) is a useful objective tool to improve processes and services. The use of quality indicators that meet requirements for effectiveness is an important quality improvement tool. However, the quality of critical aspects of pre-examination, examination, and post-examination processes have not been evaluated in Ethiopia including our setting. Hence, this study aimed to assess the performance of continuous quality improvement of TB and HIV laboratory tests in the Amhara Public Health Institute (APHI). METHODS:A cross-sectional study was conducted to evaluate the quality indicators of advanced TB and HIV related laboratory tests in APHI from 01 January to 30 September 2019. HIV viral load, exposed infant diagnosis (EID), GeneXpert and TB culture quality indicators data were used as a quality improvement tool and evaluated in comparison to established targets. Data were extracted from excel database and record review of patient information, and entered and analyzed using SPSS V20 software. RESULTS:A total of 26,487 samples were received from 01 January to 30 September 2019. The overall specimen rejection rate was 0.43% (115/26,487). Specifically, viral load and TB culture had 0.43% and 1.14% rejection rates, respectively. The highest monthly rejection was documented for TB culture (5.3%) and viral load (2.4%) in September 2019. Centrifugation problems (46.1% [53/115]) and the use of the wrong container (40.9% [47/115]) were the main reasons for the rejections. Moreover, EID test was interrupted for a total of 54 days and 22 days due to reagent stock out and equipment down time, respectively. Similarly, about 82% of viral load and 100% of the EID tests had long turnaround time (TAT) with an average of 24.1 and 29.3 days respectively in September 2019. CONCLUSIONS:There were high rates of TB culture and viral load specimen rejection, and EID test interruptions. The TAT of viral load and EID tests were longer than the targeted goal (10 days) average TAT. Hence, training of sample collectors, functional equipment maintenance systems and supply chain management are recommended for continuous quality improvement.
| S-EPMC7081999 | biostudies-literature
Project description:BackgroundDelayed presentation is a major problem contributing to the high burden and transmission of tuberculosis (TB) in developing countries. The delay may be due to patient delay if the patient visits health-facility for diagnosis after the onset of symptoms of more than 3 weeks or health system delay if the patient is not diagnosed and treated at the time of the first visit. Ethiopia, where no more than two-thirds of TB cases are detected is no exception. Therefore, the aim of this study was to assess delay in diagnosis of tuberculosis among patients taking anti-TB treatment in North Shoa Zone, Ethiopia.MethodsInstitution based cross-sectional study was conducted from 01 to 30 December 2017. All TB patients who took their treatment in the health facilities of the seven selected districts of North Shoa Zone were included. Data was entered into EPI INFO version 3.5.1 statistical software and transferred into SPSS version 20.0 for further analysis. Bivariate and multivariate analysis was used to identify associated factors for delayed TB diagnosis.ResultsOut of 170 tuberculosis patients included, 162 patients were studied with a response rate of 95.3%. The proportion of tuberculosis patients who had delayed diagnosis was 59.9%. The mean time of health-seeking after developing the symptom of tuberculosis was 7.6 weeks. Tuberculosis patients with extra pulmonary site involvements were about four times more likely to be delayed in seeking health services (OR: 4.00, 95% CI: 1.77-9.03) as compared to patients with pulmonary TB. New patients were about three times more likely to come lately for TB diagnosis (OR: 2.94, 95% CI: 1.26-6.84) as compared to patients who had previous-history of treatment. Patients who had no information about TB before they started TB treatment were also around three times to be delayed (OR: 3.37, 95% CI: 1.43-8.00) as compared to those who had the information.ConclusionsMore than 50% of TB patients reported in health-seeking relatively a longer time. Strengthening the health education activities for the community about tuberculosis and capacity building of the health care provider to increase suspicion of identifying tuberculosis and early diagnosis is crucial.
| S-EPMC6469046 | biostudies-literature
Project description:BACKGROUND:The emergence of pre-extensively and extensively drug-resistant tuberculosis (Pre-XDR/XDR-TB) is the major hurdle for TB prevention and care programs especially in developing countries like Ethiopia. The less emphasis on universal access to laboratory techniques for the rapid diagnosis of TB and drug susceptibility testing (DST) makes the management of MDR-TB a challenge. Early detection of second line anti-TB drugs resistance is essential to reduce transmission of Pre-XDR/XDR-TB strains and adjusting the treatment regimen in MDR-TB. OBJECTIVE:To determine the prevalence and resistance pattern of Pre-XDR- and XDR-TB among MDR-TB patients in the Amhara region, Ethiopia. METHODS:A cross sectional study was carried out in nine MDR-TB treatment centers in the Amhara region. Sputum samples were collected from all pulmonary rifampicin resistant (RR) or MDR-TB patients prior to anti-TB treatment. L?wenstein-Jensen (LJ) culture, Ziehl Neelsen (ZN) smear, MTBDRplus and MTBDRsl assays were performed according to the standard procedures. Data were analyzed using SPSS 20 software. Chi-square and/or Fishers exact test was employed. RESULTS:Overall, 6.3% of MDR-TB isolates were resistant to at least one second line drugs. Pre-XDR-TB and XDR-TB isolates accounted 5.7% and 0.6% respectively. Moreover, 3.4% were resistant to FQs and 3.4% were resistant to second line injectable drugs. All isolates were susceptible for low level kanamycin. Almost all pre-XDR-TB strains (90%) were previously treated with anti-TB drugs. Drug resistant Mycobacterium tuberculosis isolates were disproportionately distributed in districts of the Amhara region and the majorities were concentrated in urban areas. CONCLUSIONS:The high proportion of MDR-TB patients resistant to at least one second line drug is alarming. Strengthening the laboratory facilities to monitor pre-XDR and XDR-TB patients is crucial. The TB programs need to give emphasis on the effective and rational use of second line drugs for newly diagnosed MDR-TB patients to prevent the emergence of pre-XDR/XDR-TB strains.
| S-EPMC7018133 | biostudies-literature
Project description:BackgroundHealth care workers (HCWs) are at an increased risk of acquiring tuberculosis (TB) compared to the general population, because of the frequent face to face contact or potential exposure to TB through shared air or space with infectious patient(s), regardless of economic setting and local TB incidence. Information on the burden of active TB disease among HCWs will help guide control measures, can be utilized to evaluate the effectiveness of TB infection prevention programs in the health care setting, and guide necessary actions. However, data on TB among HCW in Ethiopia is limited. Therefore, this study aimed to determine the prevalence of active TB disease among healthcare workers and support staff in healthcare settings in the Amhara region of Ethiopia.MethodsA cross-sectional study design was used to recruit a total of 580 randomly selected study participants in the Amhara region. Data were collected over four months in selected hospitals and health centers. Implementation of TB prevention and control measures was evaluated using a standardized checklist. The main outcome indicator was active TB as measured by a laboratory diagnosis using GeneXpert technology.ResultsA total of 580 study participants were enrolled. The mean age was 31.3 (±7.8 standard deviation) years, with about two-thirds (65.3%) aged between 18-24 years. A total of 9 (1.6%) MTB cases were detected, 4 (1.4%) in HCWs and 5 (1.7%) in support staff, which did not significantly differ (P = 0.50). About 90% of the participants had not received TB infection prevention and control training ever. More than half (54%) of the study participants worked in poorly ventilated rooms. Triage of coughing patients was not practiced in 32% of the studied facilities (health centers and hospitals).ConclusionsThe magnitude of TB among healthcare workers and support staff in healthcare settings was higher than in the general population (140 per 100000 population). The status of implementation of tuberculosis prevention and control measures indicated missed opportunities. Hence, strict implementation of developed infection control plans of TB in healthcare settings needs to be improved.
| S-EPMC8195404 | biostudies-literature
Project description:Tuberculosis (TB) is a major public health concern in low- and middle-income countries including Ethiopia. This study aimed to assess the spatiotemporal distribution of TB and identify TB risk factors in Ethiopia's Oromia region. Descriptive and spatiotemporal analyses were conducted. Bayesian spatiotemporal modeling was used to identify covariates that accounted for variability in TB and its spatiotemporal distribution. A total of 206,278 new pulmonary TB cases were reported in the Oromia region between 2018 and 2022, with the lowest annual TB case notification (96.93 per 100,000 population) reported in 2020 (i.e., during the COVID-19 pandemic) and the highest TB case notification (106.19 per 100,000 population) reported in 2019. Substantial spatiotemporal variations in the distribution of notified TB case notifications were observed at zonal and district levels with most of the hotspot areas detected in the northern and southern parts of the region. The spatiotemporal distribution of notified TB incidence was positively associated with different ecological variables including temperature (β = 0.142; 95% credible interval (CrI): 0.070, 0.215), wind speed (β = -0.140; 95% CrI: -0.212, -0.068), health service coverage (β = 0.426; 95% CrI: 0.347, 0.505), and population density (β = 0.491; 95% CrI: 0.390, 0.594). The findings of this study indicated that preventive measures considering socio-demographic and health system factors can be targeted to high-risk areas for effective control of TB in the Oromia region. Further studies are needed to develop effective strategies for reducing the burden of TB in hotspot areas.
| S-EPMC10536582 | biostudies-literature
Project description:BackgroundTrachoma recrudescence after elimination as a public health problem has been reached is a concern for control programs globally. Programs typically conduct district-level trachoma surveillance surveys (TSS) ≥ 2 years after the elimination threshold is achieved to determine whether the prevalence of trachomatous inflammation-follicular (TF) among children ages 1 to 9 years remains <5%. Many TSS are resulting in a TF prevalence ≥5%. Once a district returns to TF ≥5%, a program typically restarts costly mass drug administration (MDA) campaigns and surveys at least twice, for impact and another TSS. In Amhara, Ethiopia, most TSS which result in a TF ≥5% have a prevalence close to 5%, making it difficult to determine whether the result is due to true recrudescence or to statistical variability. This study's aim was to monitor recrudescence within Amhara by waiting to restart MDA within 2 districts with a TF prevalence ≥5% at TSS, Metema = 5.2% and Woreta Town = 5.1%. The districts were resurveyed 1 year later using traditional and alternative indicators, such as measures of infection and serology, a "wait and watch" approach.Methods/principal findingsThese post-surveillance surveys, conducted in 2021, were multi-stage cluster surveys whereby certified graders assessed trachoma signs. Children ages 1 to 9 years provided a dried blood spot and children ages 1 to 5 years provided a conjunctival swab. TF prevalence in Metema and Woreta Town were 3.6% (95% Confidence Interval [CI]:1.4-6.4) and 2.5% (95% CI:0.8-4.5) respectively. Infection prevalence was 1.2% in Woreta Town and 0% in Metema. Seroconversion rates to Pgp3 in Metema and Woreta Town were 0.4 (95% CI:0.2-0.7) seroconversions per 100 child-years and 0.9 (95% CI:0.6-1.5) respectively.Conclusions/significanceBoth study districts had a TF prevalence <5% with low levels of Chlamydia trachomatis infection and transmission, and thus MDA interventions are no longer warranted. The wait and watch approach represents a surveillance strategy which could lead to fewer MDA campaigns and surveys and thus cost savings with reduced antibiotic usage.
| S-EPMC10914254 | biostudies-literature
Project description:BackgroundThe association between diabetes mellitus (DM) and tuberculosis (TB) is re-emerging worldwide. Recently, the prevalence of DM is increasing in resource poor countries where TB is of high burden. The objective of the current study was to determine the prevalence and analyze associated factors of TB and DM comorbidity in South-Eastern Amhara Region, Ethiopia.MethodsThis was a facility based cross-sectional study. All newly diagnosed TB patients attending selected health facilities in the study area were consecutively screened for DM. DM was diagnosed based on the World Health Organization diagnostic criteria. A pre-tested semi-structured questionnaire was used to collect socio-demographic, lifestyles and clinical data. Logistic regression analysis was performed to identify factors associated with TB and DM comorbidity.ResultAmong a total of 1314 patients who participated in the study, the prevalence of DM was estimated at 109 (8.3%). Being female [odds ratio (OR) 1.70; 95% confidence interval (CI) (1.10-2.62)], patients age [41-64 years (OR 3.35; 95% CI (2.01-5.57), 65-89 years (OR 3.18; 95% CI (1.52-6.64)], being a pulmonary TB case [(OR 1.69; 95% CI 1.09-2.63)] and having a family history of DM [(OR 4.54; 95% CI (2.36-8.73)] were associated factors identified with TB and DM comorbidity.ConclusionThe prevalence of DM among TB patients in South-Eastern Amahra Region is high. Routine screening of TB patients for DM is recommended in the study area.
| S-EPMC4726615 | biostudies-literature
Project description:BackgroundDrug resistant Mycobacterium tuberculosis prevention and care is a major challenge in Ethiopia. The World health organization has designated Ethiopia as one of the 30 high burden multi-drug resistant tuberculosis (MDR-TB) countries. There is limited information regarding genetic diversity and transmission dynamics of MDR-TB in Ethiopia.ObjectiveTo investigate the molecular epidemiology and transmission dynamics of MDR-TB strains using whole genome sequence (WGS) in the Amhara region.MethodsForty-five MDR-TB clinical isolates from Amhara region were collected between 2016 and 2018, and characterized using WGS and 24-loci Mycobacterium Interspersed Repetitive Units Variable Number of Tandem Repeats (MIRU-VNTR) typing. Clusters were defined based on the maximum distance of 12 single nucleotide polymorphisms (SNPs) or alleles as the upper threshold of genomic relatedness. Five or less SNPs or alleles distance or identical 24-loci VNTR typing is denoted as surrogate marker for recent transmission.ResultsForty-one of the 45 isolates were analyzed by WGS and 44% (18/41) of the isolates were distributed into 4 clusters. Of the 41 MDR-TB isolates, 58.5% were classified as lineage 4, 36.5% lineage 3 and 5% lineage 1. Overall, TUR genotype (54%) was the predominant in MDR-TB strains. 41% (17/41) of the isolates were clustered into four WGS groups and the remaining isolates were unique strains. The predominant cluster (Cluster 1) was composed of nine isolates belonging to lineage 4 and of these, four isolates were in the recent transmission links.ConclusionsMajority of MDR-TB strain cluster and predominance of TUR lineage in the Amhara region give rise to concerns for possible ongoing transmission. Efforts to strengthen TB laboratory to advance diagnosis, intensified active case finding, and expanded contact tracing activities are needed in order to improve rapid diagnosis and initiate early treatment. This would lead to the interruption of the transmission chain and stop the spread of MDR-TB in the Amhara region.
| S-EPMC10351181 | biostudies-literature
Project description:Diseases from food of animal origin are common health problems in Ethiopia. A cross-sectional study was carried out to estimate health and economic burden, and to identify demographic factors associated with community awareness of foodborne zoonotic diseases in Amhara region, Ethiopia. Data was collected from 435 households in three towns: Gondar, Lalibela and Debark. A retrospective data was also collected from health records in each town. The health burden due to zoonotic diseases was estimated at 0.2, 0.1 and 1.3 DALYs per household per year and at 73.2, 146.6 and 1,689.5 DALYs out of 100,000 populations per year in Gondar, Lalibela and Debark, respectively. The overall health burden due to foodborne zoonotic diseases (aggregated over the 435 households in the three towns) was estimated to be 89.9 DALYs per 100,000 populations per year. The economic impact of foodborne zoonotic diseases in the three towns of Amhara regional state was 278.98 Ethiopian Birr (ETB) (1ETB = 0.025 US Dollar) per household per year and 121,355.68 ETB per year. Costs of preventive measures followed by costs of patients' time made the highest contribution while costs of diagnosis made the lowest contribution to the total economic burden of foodborne zoonotic diseases. From a total of 435 respondents, 305 (70.1%) had known the presence of zoonotic diseases. Level of education, number of families in the house and income were highly associated with awareness of zoonosis. Although majority of respondents had known zoonotic diseases exists (70.1%) and disease can be acquired from animal source food (63.2%), the health and economic burden associated to foodborne zoonotic diseases are still high. Therefore, changing mindset and practical training aiming in controlling foodborne zoonotic diseases may be suggested to the community in the health improvement extension service.
| S-EPMC8719781 | biostudies-literature