Spatio-Temporal Variation of Malaria Incidence and Risk Factors in West Gojjam Zone, Northwest Ethiopia.

Introduction: Malaria is a life-threatening acute febrile illness which is affecting the lives of millions globally. Its distribution is characterized by spatial, temporal, and spatiotemporal heterogeneity. Detection of the space-time distribution and mapping high-risk areas is useful to target hot spots for effective intervention. Methods: Time series cross sectional study was conducted using weekly malaria surveillance data obtained from Amhara Public Health Institute. Poisson model was fitted to determine the purely spatial, temporal, and space-time clusters using SaTScan™ 9.6 software. Spearman correlation, bivariate, and multivariable negative binomial regressions were used to analyze the relation of the climatic factors to count of malaria incidence. Result: Jabitenan, Quarit, Sekela, Bure, and Wonberma were high rate spatial cluster of malaria incidence hierarchically. Spatiotemporal clusters were detected. A temporal scan statistic identified 1 risk period from 1 July 2013 to 30 June 2015. The adjusted incidence rate ratio showed that monthly average temperature and monthly average rainfall were independent predictors for malaria incidence at all lag-months. Monthly average relative humidity was significant at 2 months lag. Conclusion: Malaria incidence had spatial, temporal, spatiotemporal variability in West Gojjam zone. Mean monthly temperature and rainfall were directly and negatively associated to count of malaria incidence respectively. Considering these space-time variations and risk factors (temperature and rainfall) would be useful for the prevention and control and ultimately achieve elimination.

Duration of exposure and educational level as predictors of occupational respiratory symptoms among adults in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Occupational respiratory symptoms are manifestations of respiratory diseases because of exposure to dust or chemicals such as asbestos, silicon and aluminium in the workplace like cement factory, tannery, textile and/or street sweeping, all of which affect the health condition and productivity. In Ethiopia, several primary studies were conducted regarding the magnitude of occupational respiratory symptoms with the prevalence of 68.89% in street sweepers and associated factors with inconsistent results. This meta-analysis aimed to pool the prevalence of respiratory symptoms and their associated factors among Ethiopian adults working in different workplaces. METHODS: PubMed, African Journals Online, Google Scholar, Cochrane Library and Direct Google were systematically searched to identify primary studies. Two authors performed data abstraction and quality assessment for each included study independently. Cochran's Q-statistic and I2 (I-squared) statistic were used to check heterogeneity. DerSimonian and Laird random-effects models were used to estimate the pooled prevalence and associated factors of respiratory symptoms. Publication bias was checked by funnel plot and Egger's test, and also sensitivity analyses were performed. RESULTS: Ten primary studies with 3441 study participants were included for the narrative synthesis and meta-analysis of the pooled prevalence of occupational respiratory symptoms. The pooled prevalence of overall occupational respiratory symptom was 54.58% (95% CI: 45.37-63.79). Dry cough was the most encountered respiratory symptom [34.93, 95% CI: 29.52-40.35], followed by breathlessness [28.67%, 95% CI: 20.13-37.22]. Work experience of over 5 years [OR = 2.24, 95% CI: 1.21-4.16] and educational level of Grade 8 and lower [OR = 1.28, 95% CI: 1.06-1.55] were significantly associated with occupational respiratory symptoms. CONCLUSION: In this review, the pooled prevalence of occupational respiratory symptoms was high. The findings of this study dictate the need for the implementation of workplace safety measures. Special attention is required to employees with lower educational level and longer duration of work experience. PROSPERO REGISTRATION: CRD42020176826.

Developing and Piloting TB Medication and Refilling Reminder System in Ethiopia.

This project followed waterfall model to develop a context tailored and user-friendly reminder system to support home based TB treatment. Piloting was conducted on expert and patient levels. We developed a flexible and user-friendly web-based system that allows medication and refiling reminder. Participants agreed on its usefulness despite infrastructure and personal related challenges.

Time to sputum culture conversion and its determinants among Multi-drug resistant Tuberculosis patients at public hospitals of the Amhara Regional State: A multicenter retrospective follow up study.

BACKGROUND: In Ethiopia, Multi-drug resistant Tuberculosis (MDR-TB) is one of the major public health problems that need great attention. Time to sputum culture conversion is often used as an early predictive value for the final treatment outcome. Although guidelines for MDR-TB are frequently designed, medication freely provided, and centers for treatment duly expanded, studies on time to sputum culture conversion have been very limited in Ethiopia. This study was aimed at determining the time to sputum culture conversion and the determinants among MDR-TB patients at public Hospitals of the Amhara Regional State. METHODS: A retrospective follow up study was conducted between September 2010 and December 2016. Three hundred ninety two MDR-TB patients were included in the study. Parametric frailty models were fitted and Cox Snell residual was used for goodness of fit, which the Akaike's information criteria was used for model selection. Adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported to show the strength of association. RESULT: Out of the 392 participants, sputum culture changed for 340(86.7%) during the follow up period. The median culture conversion time in this study was 65 (60-70 days). Alcohol drinking (AHR = 3.79, 95%CI = 1.65-8.68), sputum smear grading +2 (AHR = 0.39, 95%CI 0.19-0.79), smear grading +3 (AHR = 0.30, CI = 0.14-064), cavitations (AHR = 0.36, 95%CI = 0.19-0.68), and consolidation (AHR = 0.29, CI = 0.13-0.69) were the determinants of time to sputum culture conversion. CONCLUSION: In this study, time to sputum culture was rapid as compared to 4 months WHO recommendation. Alcohol drinking, sputum smear grading, cavitations and consolidations were found to be the determinants of time to sputum culture conversion. Therefore, providing a special attention to patients who had baseline radiological finding is recommended, high bacillary load and patients with a history of alcohol intake at baseline should be given priority.