Tuberculosis treatment delay and contributing factors within tuberculosis patients in Ethiopia: A systematic review and meta-analysis.

Background: Tuberculosis (TB) is a significant public health disease and a major contributor to illness and death worldwide, including in Ethiopia. There are many information from first source which had inconclusive result in Ethiopia. Therefore, this review aimed to produce pooled evidence on the TB treatment delay and factors associated with it. Methods: The absence of a similar study with a systematic review and meta-analysis was confirmed. Articles from online available and unpublished sources conducted within Ethiopia between 2002 and 2024, were thoroughly screened using electronic sources such as Medline, Embase, Hinari, PubMed, the Cochrane Library, the Web of Science, and Google Scholar. Data analysis was performed using STATA version 14. Heterogeneity was assessed using Inverse of Variance (I2) and Cochrane Q tests. The funnel plot was employed to rule existence of publications subjectively while bias was checked using Egger's statistical method to quantify the bias. Result: Prevalence of TB treatment delay in Ethiopia was 50.42% at 95% (43.21, 57.64). Factors such as knowledge about TB, distance to health facilities less than 10 km, initial contact at a government service providing center for TB, having some educations, having pulmonary Tuberculosis, urban residency, were prtotective towards treatment delay. Female in gender, no chest pain symptom, disease severity with no restriction on daily activity, alcohol drinkers, and unmarried respondents were at higher risk to miss on time tuberculosis treatment. Conclusion and recommendation: The tuberculosis treatment delay in Ethiopia was considerably unexpected and basic personal variables and facility related variables were statistically associated with treatment. Therefore, Ethiopian TB control programs have to recognize and tackle the problem, obstacles, and vulnerability across the continuum patient care taking down and connecting to treatment post-diagnosis. This can be achieved by capacitating both government and non-governmental service provision centers and minimizing unfilled difference across professional awareness and skill, which will contribute further to minimizing delay.

Rapid antigen test as a screening tool for SARS-CoV-2 infection: Head-to-head comparison with qRT-PCR in Ethiopia.

Objective: This study aimed to determine the diagnostic accuracy of the antigen rapid diagnostic test (Ag-RDT) as a screening tool for SARS-CoV-2 infection compared to Quantitative reverse transcription polymerase chain reaction (qRT-PCR). Methods: This study was conducted at six referral hospitals in Oromia Region, Ethiopia. One thousand seven hundred twenty-one patients who visited the hospitals for various medical conditions were tested with qRT-PCR and/or Ag-RDTs. Qualitative detection of SARS-CoV-2 antigen was performed using the Panbio™ COVID-19 Ag rapid test device. Results: Compared with qRT-PCR, Ag-RDTs had a sensitivity of 33.3 % (95%CI: 30.9%-35.9 %) and a specificity of 99.3 % (95%CI: 98.8%-99.7 %) to detect active SARS-CoV-2 infection. The area under the receiver operator curve was 0.67 (95%CI: 0.63-0.69). The sensitivity of Ag-RDTs appeared high in patients with shortness of breath (73.3 %) and those presenting with all three symptoms - fever, cough, and dyspnea (71.4 %). In all instances, specificity was more than 98 %. The Ag-RDT positivity rate also correlated well with viral load: 51.7 % in cases with cycle threshold (Ct) < 25 (high viral load) and only 3.4 % when Ct > 25 (low viral load). Conclusion: Although Ag-RDT for diagnosing SARS-CoV-2 is a good option as a point-of-care screening tool, it has a low sensitivity to detect active infections. Using Panbio™ COVID-19 Ag Rapid test for diagnostic and treatment decisions may lead to a false negative, resulting in patient misdiagnosis, ultimately contributing to disease spread and poor patient outcome.

Spatiotemporal Distribution of Tuberculosis in the Oromia Region of Ethiopia: A Hotspot Analysis.

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 (ß = 0.142; 95% credible interval (CrI): 0.070, 0.215), wind speed (ß = -0.140; 95% CrI: -0.212, -0.068), health service coverage (ß = 0.426; 95% CrI: 0.347, 0.505), and population density (ß = 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.

Escalating spread of SARS-CoV-2 infection after school reopening among students in hotspot districts of Oromia Region in Ethiopia: Longitudinal study.

BACKGROUND: COVID-19 pandemic caused by extended variants of SARS-CoV-2 has infected more than 350 million people, resulting in over 5.5 million deaths globally. However, the actual burden of the pandemic in Africa, particularly among children, remains largely unknown. We aimed to assess the seroepidemiological changes of SARS-CoV-2 infection after school reopening among school children in Oromia, Ethiopia. METHODS: A prospective cohort study involving students aged 10 years and older were used. A serological survey was performed twice, at school reopening in December 2020 and four months later in April 2021. Participants were selected from 60 schools located in 15 COVID-19 hotspot districts in Oromia Region. Serology tests were performed by Elecsys anti-SARS-CoV-2 nucleocapsid assay. Data were collected using CSentry CSProData Entry 7.2.1 and exported to STATA version 14.2 for data cleaning and analysis. RESULTS: A total of 1884 students were recruited at baseline, and 1271 completed the follow-up. SARS-CoV-2 seroprevalence almost doubled in four months from 25.7% at baseline to 46.3% in the second round, with a corresponding seroincidence of 1910 per 100,000 person-week. Seroincidence was found to be higher among secondary school students (grade 9-12) compared to primary school students (grade 4-8) (RR = 1.6, 95% CI 1.21-2.22) and among those with large family size (> = 5) than those with a family size of <3 (RR = 2.1, 95% CI 1.09-4.17). The increase in SARS-CoV-2 seroprevalence among the students corresponded with Ethiopia's second wave of the COVID-19 outbreak. CONCLUSION: SARS-CoV-2 seroprevalence among students in hotspot districts of the Oromia Region was high even at baseline and almost doubled within four months of school recommencement. The high seroincidence coincided with the second wave of the COVID-19 outbreak in Ethiopia, indicating a possible contribution to school opening for the new outbreak wave.

Emerging COVID-19 virus variants and low vaccination coverage in Ethiopia: The need for tailored vaccination strategy

The world has faced multiple waves of COVID-19 outbreaks, with more than 300 million cases and 5.5 million deaths officially reported globally as of Jan 8, 2022. Within the first year of the pandemic, there was hope that it would soon be under control, yet the pandemic sustains to be the world's priority health agenda. This brief communication provides emerging time-sensitive perspectives on the need for a tailored COVID-19 vaccination strategy in Ethiopia by reviewing studies and expert opinions. As of Jan 8, 2022, Ethiopia has reported 443,339 cases and 7,020 COVID-19-related deaths. Only 9,361,640 people (8%) of the Ethiopian population received at least one dose of the COVID-19 vaccine. While the short supply of vaccines is mentioned as a major bottleneck, the role of vaccine skepticism is largely overlooked, though the vaccine is the primary means to combat the emergence of new variants. Therefore, we recommend vaccine advocacy and awareness creation, planning for vaccine mandate for certain groups of the society, and targeted vaccination and economical use of the vaccines.

COVID-19 in Oromia Region of Ethiopia: a review of the first 6 months' surveillance data.

INTRODUCTION: Despite unrelenting efforts to contain its spread, COVID-19 is still causing unprecedented global crises. Ethiopia reported its first case on 13 March 2020 but has an accelerated case load and geographical distribution recently. In this article, we described the epidemiology of COVID-19 in Oromia Region, the largest and most populous region in Ethiopia, during the early months of the outbreak. METHODS: We analysed data from the COVID-19 surveillance database of the Oromia Regional Health Bureau. We included all reverse transcription-PCR-confirmed cases reported from the region between 13 March and 13 September 2020. RESULTS: COVID-19 was confirmed in 8955 (5.5%) of 164 206 tested individuals. The test positivity rate increased from an average of 1.0% in the first 3 months to 6.3% in August and September. About 70% (6230) of the cases were men; the mean age was 30.0 years (SD=13.3), and 90.5% were <50 years of age. Only 64 (0.7%) of the cases had symptoms at diagnosis. Cough was the most common among symptomatic cases reported in 48 (75.0%), while fever was the least. Overall, 4346 (48.5%) have recovered from the virus; and a total of 52 deaths were reported with a case fatality rate of 1.2%. However, we should interpret the reported case fatality rate cautiously since in 44 (84.6%) of those reported as COVID-19 death, the virus was detected from dead bodies. CONCLUSION: Despite the steady increase in the number of reported COVID-19 cases, Ethiopia has so far avoided the feared catastrophe from the pandemic due to the milder and asymptomatic nature of the disease. However, with the current pattern of widespread community transmission, the danger posed by the pandemic remains real. Thus, the country should focus on averting COVID-19-related humanitarian crisis through strengthening COVID-19 surveillance and targeted testing for the most vulnerable groups.

Predictor of multidrug resistant tuberculosis in southwestern part of Ethiopia: a case control study.

BACKGROUND: Curable disease tuberculosis is becoming incurable or difficult to treat due to drug resistance. Multi drug resistance tuberculosis is a major health problem for less developed countries. Development of drug resistance is mainly as result of man related factors and poor lifestyle. Identifying predictors of drug resistance and working on them is the important way of reducing the expansion in high burden countries. Ethiopia is one of TB, TB/HIV, and multi-drug resistant tuberculosis (MDR-TB) high burden country globally. This study was aimed to assess predictor of MDR-TB in southwest part of Ethiopia. METHODS: Unmatched case control study was conducted in case to control ratio of 1:1.2 in southwest part of Ethiopia. The cases were recruited from confirmed MDR-TB patient enrolled on second line treatment in Shenen Gibe Hospital (MDR-TB treatment center of the prefecture) and the controls were recruited from previously TB patients who cured or patient with smear negative at the end of treatment month during the study period in the same area. The data was collected by structured questionnaire by interview and logistic regression analyses were used to identify predictors of MDR-TB. Odds ratios with 95% CI were computed to determine the predictors. RESULT: From the total 132 participants about 45% of them were cases. None disclosed tuberculosis infected to relatives [AOR = 3.4, 95% CI (1.2-9.8)], insufficient instruction on how to take anti-TB drug [AOR = 4.7, 95% CI (1.4-14.6)], contact history with MDR-TB [AOR = 8.5, 95% CI (2.9-25.5)], interruption of first-line anti-TB treatment for at list 1 day [AOR = 7.9, 95% CI (2.5-24.9)], and having alcohol drinking habits [AOR = 5.1, 95% CI (1.4-18.7)] were identified predictors for MDR-TB infection in study area. CONCLUSION: TB infection disclosure status, insufficient instruction on drug usage, contact history with MDR-TB, interruption of first-line anti-TB drugs, and alcohol drinking habits were identified predictor of MDR-TB case. Therefore, early detection and proper treatment of drug susceptible TB, strengthening directly observed treatment, short-course on daily bases, community involvement, and supporting the patient to intervene identified factors is paramount.