Mortality and Disability-Adjusted Life-Years (Dalys) for Common Neglected Tropical Diseases in Ethiopia, 1990-2015: Evidence from the Global Burden of Disease Study 2015.

INTRODUCTION: Neglected tropical diseases (NTDs) are important public health problems in Ethiopia. In 2013, the Federal Ministry of Health (FMOH) has launched a national NTD master plan to eliminate major NTDs of public health importance by 2020. Benchmarking the current status of NTDs in the country is important to monitor and evaluate the progress in the implementation of interventions and their impacts. Therefore, this study aims to assess the trends of mortality and Disability-adjusted Life-Years (DALY) for the priority NTDs over the last 25 years. METHODS: We used the Global Burden of Disease (GBD) 2015 estimates for this study. The GBD 2015 data source for cause of death and DALY estimation included verbal autopsy (VA), Demographic and Health Surveys (DHS), and other disease specific surveys, Ministry of Health reports submitted to United Nations (UN) agencies and published scientific articles. Cause of Death Ensemble modeling (CODEm) and/or natural history models were used to estimate NTDs mortality rates. DALY were estimated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD). RESULTS: All NTDs caused an estimated of 6,293 deaths (95% uncertainty interval (UI): 3699-10,080) in 1990 and 3,593 deaths (95% UI: 2051 - 6178) in 2015, a 43% reduction over the 25 years. Age-standardized mortality rates due to schistosomiasis, STH and leshmaniasis have declined by 91.3%, 73.5% and 21.6% respectively between 1990 to 2015. The number of DALYs due to all NTDs has declined from 814.4 thousand (95% UI: 548 thousand-1.2million) in 1990 to 579.5 thousand (95%UI: 309.4 thousand-1.3 million) in 2015. Age-standardized DALY rates due to all NTDs declined by 30.7%, from 17.6 per 1000(95%UI: 12.5-26.5) in 1990 to 12.2 per 1000(95%UI: 6.5 - 27.4) in 2015. Age-standardized DALY rate for trachoma declined from 92.7 per 100,000(95% UI: 63.2 - 128.4) in 1990 to 41.2 per 100,000(95%UI: 27.4-59.2) in 2015, a 55.6% reduction between 1990 and 2015. Age-standardized DALY rates for onchocerciasis, schistosomiasis and lymphiaticfilariasis decreased by 66.2%, 29.4% and 12.5% respectively between 1990 and 2015. DALY rate for ascariasis fell by 56.8% over the past 25 years. CONCLUSIONS: Ethiopia has made a remarkable progress in reducing the DALY rates for most of the NTDs over the last 25 years. The rapid scale of interventions and broader system strengthening may have a lasting impact on achieving the 2020 goal of elimination of most of NTDs. Ethiopia should strengthen the coverage of integrated interventions of NTD through proper coordination with other health programs and sectors and community participation to eliminate NTDs by 2020.

Documentation and treatment outcomes of smear-negative and extra-pulmonary tuberculosis in Ethiopia.

BACKGROUND: Smear-negative and extra-pulmonary tuberculosis (TB) comprise two thirds of TB cases reported in Ethiopia. Neither treatment outcomes nor underlying associated factors are routinely reported for these cases. OBJECTIVE: To assess treatment outcomes and associated risk factors of smear-negative and extra-pulmonary TB in comparison with smear-positive cases. DESIGN: Record review of all TB cases registered in 14 randomly selected public and private health facilities in Addis Ababa, Ethiopia, over a 1-year period. RESULTS: Percentages of smear-negative and extra-pulmonary TB were independent of human immunodeficiency virus (HIV) status, and were not evenly distributed among health facilities. Extra-pulmonary TB was overrepresented in the private sector, and smear-negative TB was more frequent in health clinics than in hospitals. Outcomes reported by clinics were more favourable than those of the hospitals; no differences were observed when comparing public and private health facilities. Only 54% of the TB registers were complete; missing information correlated with unfavourable outcomes. Younger age, but not sex or HIV status, was associated with favourable outcomes. CONCLUSION: The uneven distribution of smear-negative and extra-pulmonary TB among different health facilities requires further study and may provide important insight into diagnosis and care of these patients. Incomplete TB register information may be an underappreciated factor contributing to unfavourable outcomes.

Cadre : La tuberculose (TB) extra-pulmonaire et la TB à frottis négatif constituent deux tiers des cas déclarés en Ethiopie, mais les rapports de routine ne précisent pas les résultats du traitement ni les facteurs sous-jacents associés.Objectif : Evaluer les résultats du traitement et les facteurs de risque associés à la TB extra-pulmonaire et à frottis négatif par comparaison avec les cas à frottis positif.Schéma : Revue des dossiers de tous les cas enregistrés dans 14 structures de santé publiques et privées sélectionnées au hasard à Addis Abeba pendant une période d'une année.Résultats : Les proportions de TB à frottis négatif et extra-pulmonaire étaient indépendantes du statut à l'égard du virus de l'immunodéficience humaine (VIH) et n'étaient pas distribuées de façon égale dans les différentes structures. La TB extra-pulmonaire était surreprésentée dans le secteur privé et la TB à frottis négatif se trouvait plutôt dans les centres de santé que dans les hôpitaux. Les résultats rapportés par les centres de santé étaient plus favorables que ceux des hôpitaux ; aucune différence n'a été observée entre les structures publiques et privées. Seulement 54% des dossiers de TB étaient complets ; il y avait une corrélation entre le manque d'informations et des résultats défavorables. Un âge plus jeune était associé à un résultat favorable, mais le sexe et le statut VIH ne l'étaient pas.Conclusion : La distribution inégale de la TB à frottis négatif et extra-pulmonaire dans les différentes institutions justifie une nouvelle étude et pourrait révéler d'importantes perspectives en matière de diagnostic et de soins de ces patients. Le caractère incomplet des dossiers des patients tuberculeux pourrait être un facteur sous-estimé contribuant aux résultats défavorables.

Marco de referencia: La tuberculosis (TB) con baciloscopia negativa y la TB extrapulmonar (EPTB) representan dos tercios de los casos notificados en Etiopía. Estas notificaciones no comportan sistemáticamente datos sobre los desenlaces terapéuticos ni los factores subyacentes.Objetivo: Evaluar los desenlaces clínicos de los casos de TB con baciloscopia negativa y EPTB, determinar los factores de riesgo que se asocian con su aparición y compararlos con los casos de TB con baciloscopia positiva.Método: Se examinaron las historias clínicas de todos los casos de TB atendidos durante un período de un año en 14 establecimientos sanitarios públicos y privados de Addis Abeba, escogidos de manera aleatoria.Resultados: Los porcentajes de casos de TB con baciloscopia negativa y EPTB fueron independientes de la situación frente el virus de la inmunodeficiencia humana (VIH). La distribución de estos casos no fue homogénea en las diferentes instituciones. La EPTB se encontró sobrerrepresentada en el sector privado y la TB con baciloscopia negativa fue más frecuente en los consultorios que en los hospitales. Los desenlaces terapéuticos notificados por los consultorios fueron más favorables que los comunicados por los hospitales y no se observaron diferencias entre las instituciones del sector público y el sector privado. Solo el 54% de los registros de TB estaba completo y la información incompleta se correlacionó con los desenlaces desfavorables. La menor edad se asoció con los desenlaces favorables, pero no el sexo ni la situación frente al VIH.Conclusión: La distribución heterogénea de los casos de TB con baciloscopia negativa y EPTB en las diferentes instituciones de salud justifica futuras investigaciones que podrían revelar aspectos importantes sobre el diagnóstico y la atención de estos pacientes. La información incompleta en los registros de TB puede ser un factor que contribuye a los desenlaces clínicos desfavorables y que no se ha valorado hasta el momento.