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BACKGROUND: Ethiopia reported a high rate of extra-pulmonary tuberculosis (EPTB) and the cases are increasing since the last three decades. However, diagnostic evidence to initiate TB treatment among EPTB cases is not well known. Therefore, we described the epidemiology and assessed how EPTB is diagnosed in a teaching hospital in Ethiopia. METHODS: We conducted a retrospective review among all adult EPTB cases diagnosed in Yekatit 12 Hospital Medical College from 2015 to 2019. Using a standardized data abstraction sheet, we collected data from patients' medical records on sociodemographic, sites, and laboratory diagnosis of EPTB cases. RESULTS: Of the 965 total TB cases, 49.8%(481) had a recorded diagnosis of EPTB during the study period. The mean age of EPTB patients was 32.9 years (SD±13.9) and 50.7% were males. Tubercular lymphadenitis (40.3%), abdominal (23.4%), and pleural TB(13.5%) were the most common sites of EPTB involvement, followed in descending order by the genitourinary, skeletal, central nervous system, abscess, breast, and laryngeal TB. We found a histopathology finding consistent with EPTB in 59.1% of cases, Acid-fast bacilli positive in 1.5%, and the rest diagnosed on radiological grounds. In the majority of cases, more than one diagnostic method was used to diagnose EPTB cases. CONCLUSIONS: Nearly half of TB patients had a recorded diagnosis of EPTB that comprise heterogeneous anatomical sites. All EPTB patients were started anti-TB therapy without definitive microbiology results. This indicates the diagnostic challenge of EPTB faced in our setting and proves to be significant for TB control in Ethiopia.
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Tuberculosis Ganglionar/epidemiología , Tuberculosis Pleural/epidemiología , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Antituberculosos/uso terapéutico , Etiopía/epidemiología , Femenino , Hospitales de Enseñanza , Humanos , Masculino , Factores de Riesgo , Tuberculosis Ganglionar/tratamiento farmacológico , Tuberculosis Ganglionar/microbiología , Tuberculosis Ganglionar/patología , Tuberculosis Pleural/tratamiento farmacológico , Tuberculosis Pleural/microbiología , Tuberculosis Pleural/patología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/patología , Adulto JovenRESUMEN
BACKGROUND: Ethiopia has shown significant efforts to address the burden of TB/HIV comorbidity through the TB/HIV collaborative program. However, these diseases are still the highest cause of death in the country. Therefore, this systematic review and meta-analysis evaluated this program by investigating the overall proportion of unknown HIV status among TB patients using published studies in Ethiopia. METHODS: We conducted a systematic review and meta-analysis of published studies in Ethiopia. We identified the original studies using the databases MEDLINE/PubMed, and Google Scholar. The heterogeneity across studies was assessed using Cochran's Q test and I 2 statistics. The Begg's rank correlation and the Egger weighted regression tests were assessed for the publication bias. We estimated the pooled proportion of unknown HIV status among TB patients using the random-effects model. RESULTS: Overall, we included 47 studies with 347,896 TB patients eligible for HIV test. The pooled proportion of unknown HIV status among TB patients was 27%(95% CI; 21-34%) and with a substantial heterogeneity (I2 = 99.9%). In the subgroup analysis, the pooled proportion of unknown HIV status was 39% (95% CI; 25-54%) among children and 20% (95% CI; 11-30%) among adults. In the region based analysis, the highest pooled proportion of unknown HIV status was in Gambella, 38% (95% CI; 16-60%) followed by Addis Ababa, 34%(95% CI; 12-55%), Amhara,30%(95% CI; 21-40%),and Oromia, 23%(95% CI; 9-38%). Regarding the study facilities, the pooled proportion of unknown HIV status was 33% (95% CI; 23-43%) in the health centers and 26%(95% CI; 17-35%) in the hospitals. We could not identify the high heterogeneity observed in this review and readers should interpret the results of the pooled proportion analysis with caution. CONCLUSION: In Ethiopia, about one-third of tuberculosis patients had unknown HIV status. This showed a gap to achieve the currently implemented 90-90-90 HIV/AIDS strategic plan in Ethiopia, by 2020. Therefore, Ethiopia should strengthen TB/HIV collaborative activities to mitigate the double burden of diseases.
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Coinfección/epidemiología , Infecciones por VIH/epidemiología , Servicios Preventivos de Salud/estadística & datos numéricos , Tuberculosis/epidemiología , Adolescente , Adulto , Niño , Coinfección/microbiología , Coinfección/prevención & control , Etiopía/epidemiología , Infecciones por VIH/microbiología , Infecciones por VIH/prevención & control , Estado de Salud , Humanos , Evaluación de Programas y Proyectos de Salud , Tuberculosis/microbiología , Tuberculosis/prevención & control , Adulto JovenRESUMEN
INTRODUCTION: The rapid spread of drug resistance is forcing standard treatment guidelines (STGs) to become more appropriate with due consideration of the evidence on the antimicrobial resistance (AMR) situation in Ethiopia. Therefore, we aimed to assess the local AMR recommendations in the STGs for empirical antibacterial prescriptions for the five common infectious syndromes. We also determined the quality of AMR reviews conducted in the country. METHODS: We conducted a review of the STGs used in the health centers, general hospitals, and primary hospitals in Ethiopia and assessed the AMR recommendations in STGs for empirical antibacterial prescriptions for community-acquired pneumonia (CAP), urinary tract infection (UTI), tonsillopharyngitis, acute otitis media (AOM), and bacterial dysentery. Next, we performed an overview of AMR reviews published in Ethiopia. We used the MEDLINE/PubMed, Embase, Cochrane Library, and Google Scholar databases to identify AMR reviews. The review characteristics were extracted. We also evaluated the quality of each included AMR review using a measurement tool to assess the systematic review scale (AMSTAR 2). RESULTS: A total of 6 STGs and 12 AMR reviews conducted in the country were included. The choice of empirical antibacterials for similar infectious syndromes (and editions) was comparable across the three levels of the health care system. None of the STGs evaluated included the local AMR recommendations for empirical antibacterial prescriptions for five common infectious syndromes. Of all the AMR reviews included, 75% had low and below methodologic quality, and none had a high-quality score using the AMSTAR 2 tool. CONCLUSION: Standard treatment guidelines did not consider local AMR recommendations for empirically prescribing antibacterials for common infectious syndromes. The AMR reviews published in the country produced poor methodologic quality evidence for clinical applications. This highlights the need to improve the methodologic quality to provide the best available evidence for clinical decision-making and curb the ongoing AMR in Ethiopia. TRIAL REGISTRATION: Retrospectively registered (15/07/2020).
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BACKGROUND: In Ethiopia individual report indicated nearly 30% of incident cases of tuberculosis remained undiagnosed. Therefore, this systematic review and meta-analysis was aimed to determine the pooled prevalence rate of undiagnosed smear positive pulmonary tuberculosis (PTB) using community based studies published in Ethiopia. METHODS: MEDLINE/PubMed, 'Cochrane' library, and Google scholar databases were searched, and reference list of studies on tuberculosis in Ethiopia were reviewed. We used table to present descriptive information of original studies and quantitative results were presented in forest plots. The Cochrane Q test and I2 test statistic were used to test heterogeneity across studies. The Pooled prevalence and point estimates of undiagnosed smear positive PTB were computed by a random effects model. RESULTS: From the nine studies included in the analysis, the pooled prevalence rate and point estimate of undiagnosed smear positive PTB was 0.11%(95% CI, 0.06-013%, p < 0.001) and 79.8/100,000(95% CI; 56.3-112.8) respectively. Pooled prevalence rate and point estimate of bacteriologically confirmed PTB were 0.17%(95%CI; 0.13-0.22%, P < 0.001) and 191/100000(95% CI; 141.3-258) respectively. The ratio of active to passive case detection was 2.3(95% CI, 0.42-4.1). Pooled prevalence rate of presumptive PTB was 2.7%(95% CI; 1.3-5.3%). CONCLUSIONS: The analysis revealed that the magnitude of undiagnosed smear positive PTB cases in the community is high in Ethiopia. This indicated the ongoing transmission of tuberculosis in community due to missed infectious cases. Active tuberculosis finding in the community should be strengthened in Ethiopia. TRIAL REGISTRATION: 140611.