Sputum culture reversion in longer treatments with bedaquiline, delamanid, and repurposed drugs for drug-resistant tuberculosis.

Sputum culture reversion after conversion is an indicator of tuberculosis (TB) treatment failure. We analyze data from the endTB multi-country prospective observational cohort (NCT03259269) to estimate the frequency (primary endpoint) among individuals receiving a longer (18-to-20 month) regimen for multidrug- or rifampicin-resistant (MDR/RR) TB who experienced culture conversion. We also conduct Cox proportional hazard regression analyses to identify factors associated with reversion, including comorbidities, previous treatment, cavitary disease at conversion, low body mass index (BMI) at conversion, time to conversion, and number of likely-effective drugs. Of 1,286 patients, 54 (4.2%) experienced reversion, a median of 173 days (97-306) after conversion. Cavitary disease, BMI < 18.5, hepatitis C, prior treatment with second-line drugs, and longer time to initial culture conversion were positively associated with reversion. Reversion was uncommon. Those with cavitary disease, low BMI, hepatitis C, prior treatment with second-line drugs, and in whom culture conversion is delayed may benefit from close monitoring following conversion.

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho.

BACKGROUND: A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear. OBJECTIVES: We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection. METHODS: Secondary data from a prospective cohort of patients initiating a longer (18-20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status. RESULTS: Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status. CONCLUSIONS: Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.

Formula feeding and associated factors among mothers with infants 0-6 months old in Mettu Town, Southwest Ethiopia.

Adequate nutrition during infancy is essential for children's normal development and well-being. However, the duration of breastfeeding has been declining and is being replaced by formula feeding, particularly in the urban communities of developing countries, including Ethiopia. Hence, this study aimed to assess formula feeding and its associated factors, as relatively little information is available regarding this problem in Ethiopia, particularly in Mettu Town. A community-based cross-sectional study was conducted in Mettu Town from May 17 to July 1, 2021, among 366 mothers with infants 0-6 months old. A simple random sampling technique was used in this study. Pre-tested semi-structured questionnaires were used to collect the data. Descriptive statistics and multivariable logistic regression were performed, and variables with a p-value <0.05 in the final model were declared statistically significant with formula feeding found to be 28.4% [95% CI: (24.0-33.0)]. Primiparity [AOR = 3.27, 95% CI: (1.71-6.27)], cesarean delivery [AOR = 2.62, 95% CI: (1.28-5.35)], initiation of breastfeeding after 24 h [AOR = 3.5, 95% CI: (1.74-10.0)], employed mothers [AOR = 2.4, 95% CI: (1.29-4.19)], positive attitude toward formula feeding [AOR = 2.4, 95% CI: (1.29-4.19)], and poor knowledge of formula feeding [AOR = 2.6, 95% CI (1.49-4.74)] were factors significantly associated with formula feeding. Almost one-third of the mothers were formula feeding their infants. Primiparity, maternal employment, initiation of breast milk after 24 h, cesarean delivery, poor maternal knowledge, and positive attitude toward formula feeding were among the contributing factors to this high formula-feeding practice. Hence, much effort should be invested in educating pregnant and lactating mothers to improve their knowledge of formula feeding while working on activities that change their attitude toward formula feeding.

Complication experience during pregnancy and place of delivery among pregnant women: a cross-sectional study.

BACKGROUND: Unlike other causes such as abortion, obstetric complications like hemorrhage, and hypertensive disorders of pregnancy, which are difficult to resolve for women who give birth out of health facilities are persisted or increased to be the cause of maternal mortality in Ethiopia. Direct obstetric complications resulted in the crude direct obstetric case fatality rate in this country. This study aimed to assess the relationship between Complication Experience during Pregnancy and Place of Delivery among Pregnant Women. METHOD: A community-based cross-sectional study was conducted to assess the baseline information as a part of a randomized control trial study. The sample size that was calculated for the cohort study with the assumptions to detect an increase in a minimum acceptable diet from 11 to 31%, with 95% CIs and 80% power, an intra-cluster correlation coefficient of 0·2 for a cluster size of 10 was used for this study. Statistical analysis was done using SPSS version 22. RESULT: The prevalence of self-reported pregnancy-related complications and home delivery were 79(15.9%, CI; 12.7-19.1) and 46.90% (95%CI; 42.5-51.1) respectively. Women who did not face vaginal bleeding were five times AOR 5.28(95% CI: 1.79-15.56) more like to give birth at home than those who faced this problem. Women who did not face severe headache were nearly three AOR 2.45(95%CI:1.01-5.97) times more like to give birth at home. CONCLUSION: This study concluded that home delivery was high among the study participants whereas pregnancy-related complications such as vaginal bleeding and severe headache were identified as protective factors for facility delivery. Hence, the researchers recommended the incorporation of "storytelling" into the existing health extension program packages to improve facility delivery which shall be applied after the approval of its effectiveness by further research.

All-oral longer regimens are effective for the management of multidrug-resistant tuberculosis in high-burden settings.

BACKGROUND: Recent World Health Organization guidance on drug-resistant tuberculosis treatment de-prioritised injectable agents, in use for decades, and endorsed all-oral longer regimens. However, questions remain about the role of the injectable agent, particularly in the context of regimens using new and repurposed drugs. We compared the effectiveness of an injectable-containing regimen to that of an all-oral regimen among patients with drug-resistant tuberculosis who received bedaquiline and/or delamanid as part of their multidrug regimen. METHODS: Patients with a positive baseline culture were included. 6-month culture conversion was defined as two consecutive negative cultures collected >15 days apart. We derived predicted probabilities of culture conversion and relative risk using marginal standardisation methods. RESULTS: Culture conversion was observed in 83.8% (526 out of 628) of patients receiving an all-oral regimen and 85.5% (425 out of 497) of those receiving an injectable-containing regimen. The adjusted relative risk comparing injectable-containing regimens to all-oral regimens was 0.96 (95% CI 0.88-1.04). We found very weak evidence of effect modification by HIV status: among patients living with HIV, there was a small increase in the frequency of conversion among those receiving an injectable-containing regimen, relative to an all-oral regimen, which was not apparent in HIV-negative patients. CONCLUSIONS: Among individuals receiving bedaquiline and/or delamanid as part of a multidrug regimen for drug-resistant tuberculosis, there was no significant difference between those who received an injectable and those who did not regarding culture conversion within 6 months. The potential contribution of injectable agents in the treatment of drug-resistant tuberculosis among those who were HIV positive requires further study.

Sexual behaviors and its association with life skills among school adolescents of Mettu town, South West Ethiopia: A school-based cross-sectional study.

BACKGROUND: Adolescents need to have adequate life skills along with personal and social competencies to build responsible adults for healthy behavior. Works of literature agree that life skills improve adolescent's cognitive, social, and emotional skills; however, there is a paucity of evidence on the association of life skills with sexual behaviors. Therefore, this study aimed to determine the association of life skills with sexual behavior among school adolescents aged 15-19 years in Mettu Town, South West Ethiopia. METHODS: School-based cross-sectional study was employed among 372 school adolescents from 15 to 25 April 2016. A list of school adolescents aged 15-19 years old from students' register was taken as a sampling frame. Then, simple random sampling was employed using computer-generated random numbers for final study participants' selection. A pretested self-administered questionnaire was used. The data were entered into Epidata version 4.1 and analyzed using SPSS version 20. A bivariable and multivariable logistic regression analysis was carried out. RESULTS: Ninety-one (24.5%) adolescents ever practiced sexual intercourse, of which 19.1% of them were exposed to risky sexual behaviors. Unfavorable life skill dimensions, that is, social (adjusted odds ratio = 3.71; 95% confidence interval = 1.64, 8.38), coping with emotions (adjusted odds ratio = 3.114; 95% confidence interval = 1.286, 7.542), and cognitive (adjusted odds ratio = 2.835; 95% confidence interval = 1.288, 6.239), were found to be statistically significant associations with risky sexual behaviors, after controlling for confounders, that is, use of psychoactive substance (adjusted odds ratio = 6.73; 95% confidence interval = 2.27, 19.87) and urban adolescents who dwell in a rental house (adjusted odds ratio = 4.05; 95% confidence interval = 1.59, 10.33) as compared to those living with families. CONCLUSION: Developing life skills helps adolescents make more reasoned and intentional choices sexually, which will result in fewer unwanted pregnancies, less sexually transmitted disease, and stronger relationships.