Impacts of armed conflicts on tuberculosis burden and treatment outcomes: a systematic review.

OBJECTIVES: This systematic review aimed to summarise existing literature on the impacts of armed conflicts on tuberculosis burden and treatment outcomes. DESIGN: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, ScienceDirect, Embase and medRxiv. DATA EXTRACTION AND SYNTHESIS: Three reviewers independently screened, selected eligible studies and extracted data. A narrative review was undertaken to summarise the findings qualitatively. RESULTS: Eleven studies were included in this review, reporting on tuberculosis incidence rates, prevalence and treatment outcomes, including mortality. Overall, the impact of armed conflicts on case notifications was variable. Six studies reported overall increases in tuberculosis case notifications following the onset of conflicts, while three studies reported overall decreases in tuberculosis case notifications. Factors, including limited access to healthcare services, challenges in surveillance and laboratory confirmation, the destruction of health systems and incapacitating the healthcare workforce, contributed to a decrease in the number of notified cases. The higher tuberculosis notification in some of the studies could be attributed to the disruption of tuberculosis prevention and control programmes as well as increased socioeconomic deprivation, including malnutrition, mass migration, poor living conditions and overcrowding that are worsened during conflicts. Armed conflicts without effective interventions were associated with worse tuberculosis treatment outcomes, including lower proportions of people with treatment success and higher proportions of people with loss to follow-up, mortality and treatment failure. However, implementing various interventions in conflict settings (such as establishing a National Tuberculosis Control Programme) led to higher tuberculosis notification rates and treatment success. CONCLUSION: The impact of armed conflicts on tuberculosis notification is complex and is influenced by multiple factors. The findings of this review underscore the importance of concerted efforts to control tuberculosis in conflict settings using available resources.

Determinants of drug-resistant tuberculosis in Hunan province, China: a case-control study.

BACKGROUND: Drug-resistant tuberculosis (DR-TB) is a major public health threat in Hunan Province, with an increasing clinical burden in recent years. This study aimed to identify socio-demographic and clinical factors associated with DR-TB in Hunan province, China. METHODS: A case-control study was conducted in Hunan province. Cases were all DR-TB patients who were confirmed by culture and Drug susceptibility testing (DST) and enrolled at the DR-TB treatment center of Hunan Chest Hospital from 2013 to 2018. Controls were all Drug Susceptible TB (DS-TB) patients confirmed by DST and enrolled at the same hospital during the same period. A multivariable logistic regression model was fitted to identify factors significantly associated with DR-TB. RESULTS: A total of 17,808 patients (15,534 DS-TB controls and 2274 DR-TB cases) were included in the study, with a mean age of 42.5 years (standard deviation (SD) ± 17.5 years) for cases and 46.1 years (SD ± 19.1 years) for controls. Age 15-64 years (Adjusted odds ratio (AOR = 1.5, 95% CI; 1.4, 1.8)), ethnic minorities (AOR = 1.5; 95% CI; 1.4, 1.8), and a history of previous TB treatment (AOR) = 1.84; 95% CI: 1.57, 2.15) was significantly associated with DR-TB. Being resident in a province outside Hunan was also a significant risk factor (AOR = 1.67; 1.27, 2.21) for DR-TB. CONCLUSION AND RECOMMENDATIONS: To prevent the occurrence of DR-TB in Hunan Province, interventions should be targeted at high-risk demographic groups such as ethnic minorities, individuals of productive age, and residents living outside the province. Interventions must also be targeted to previously treated cases, suggesting the appropriateness of diagnosis, treatment, and follow-up. Understanding the risk factors at the province level helps design strategies for controlling DR-TB due to variations by socioeconomic differences, quality of health care, and healthcare access.

Risk factors for diagnosis and treatment delay among patients with multidrug-resistant tuberculosis in Hunan Province, China.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a global health threat associated with high morbidity and mortality rates. Diagnosis and treatment delays are associated with poor treatment outcomes in patients with MDR-TB. However, the risk factors associated with these delays are not robustly investigated, particularly in high TB burden countries such as China. Therefore, this study aimed to measure the length of diagnosis and treatment delays and identify their risk factors among patients with MDR-TB in Hunan province. METHODS: A retrospective cohort study was conducted using MDR-TB data from Hunan province between 2013 and 2018. The main outcomes of the study were diagnosis and treatment delay, defined as more than 14 days from the date of symptom to diagnosis confirmation (i.e., diagnosis delay) and from diagnosis to treatment commencement (i.e., treatment delay). A multivariable logistic regression model was fitted, and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify factors associated with diagnosis and treatment delay. RESULTS: In total, 1,248 MDR-TB patients were included in this study. The median length of diagnosis delays was 27 days, and treatment delays were one day. The proportion of MDR-TB patients who experienced diagnosis and treatment delay was 62.82% (95% CI: 60.09-65.46) and 30.77% (95% CI: 28.27-33.39), respectively. The odds of experiencing MDR-TB diagnosis delay among patients coming through referral and tracing was reduced by 41% (AOR = 0.59, 95% CI: 0.45-0.76) relative to patients identified through consultations due to symptoms. The odds of experiencing diagnosis delay among ≥ 65 years were 65% (AOR = 0.35, 0.14-0.91) lower than under-15 children. The odds of developing treatment delay among foreign nationalities and people from other provinces were double (AOR = 2.00, 95% CI: 1.31-3.06) compared to the local populations. Similarly, the odds of experiencing treatment delay among severely ill patients were nearly 2.5 times higher (AOR = 2.49, 95% CI: 1.41-4.42) compared to patients who were not severely ill. On the other hand, previously treated TB cases had nearly 40% (AOR = 0.59, 95% CI: 0.42-0.85) lower odds of developing treatment delay compared with new MDR-TB cases. Similarly, other ethnic minority groups had nearly 40% (AOR = 0.57, 95% CI: 0.34-0.96) lower odds of experiencing treatment delay than the Han majority. CONCLUSIONS: Many MDR-TB patients experience long diagnosis and treatment delays in Hunan province. Strengthening active case detection can significantly reduce diagnosis delays among MDR-TB patients. Moreover, giving attention to patients who are new to MDR-TB treatment, are severely ill, or are from areas outside Hunan province will potentially reduce the burden of treatment delay among MDR-TB patients.

Burden of drug-resistant tuberculosis among contacts of index cases: a protocol for a systematic review.

INTRODUCTION: People having close contact with drug-resistant tuberculosis (DR-TB) patients are at increased risk of contracting and developing the disease. However, no comprehensive review has been undertaken to estimate the burden of DR-TB among contacts of DR-TB patients. Therefore, the current systematic review will quantify the prevalence and incidence of DR-TB among contacts of DR-TB patients. METHOD AND ANALYSIS: Systematic searches will be conducted in Medline, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases. The search will be conducted without restrictions on time, language and geography. A random-effects meta-analysis will be conducted for effect estimates. The pooled prevalence and incidence of DR-TB will be compared between people with and without contact with DR-TB patients. The presence of heterogeneity between studies will be assessed by Higgins I2 statistics. Subgroup analysis will be conducted to determine the source of heterogeneity. The risk of bias will be assessed using a visual inspection of the funnel plot and Egger's regression test statistics. Trim and fill analysis will be done in the presence of publication bias. A sensitivity analysis will be conducted by trimming low-quality studies. The systematic review will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. ETHICS AND DISSEMINATION: Ethical approval will not be required for this study as it will be a systematic review and meta-analysis based on previously published evidence. The findings of the systematic review will be presented at scientific conferences and published in scientific journals. PROTOCOL REGISTRATION: The protocol is published in PROSPERO with registration number CRD42023390339.

Economic burden of multidrug-resistant tuberculosis on patients and households: a global systematic review and meta-analysis.

Multidrug-resistant tuberculosis (MDR-TB) is a major health threat worldwide, causing a significant economic burden to patients and their families. Due to the longer duration of treatment and expensive second-line medicine, the economic burden of MDR-TB is assumed to be higher than drug-susceptible TB. However, the costs associated with MDR-TB are yet to be comprehensively quantified. We conducted this systematic review and meta-analysis to determine the global burden of catastrophic costs associated with MDR-TB on patients and their households. We systematically searched five databases (CINHAL, MEDLINE, Embase, Scopus, and Web of Science) from inception to 2 September 2022 for studies reporting catastrophic costs on patients and affected families of MDR-TB. The primary outcome of our study was the proportion of patients and households with catastrophic costs. Costs were considered catastrophic when a patient spends 20% or more of their annual household income on their MDR-TB diagnosis and care. The pooled proportion of catastrophic cost was determined using a random-effects meta-analysis. Publication bias was assessed using visualization of the funnel plots and the Egger regression test. Heterogeneity was assessed using I2, and sub-group analysis was conducted using study covariates as stratification variables. Finally, we used the Preferred Reporting Items for Reporting Systematic Review and Meta-Analysis-20 (PRISMA-20). The research protocol was registered in PROSPERO (CRD42021250909). Our search identified 6635 studies, of which 11 were included after the screening. MDR-TB patients incurred total costs ranging from $USD 650 to $USD 8266 during treatment. The mean direct cost and indirect cost incurred by MDR-TB patients were $USD 1936.25 (SD ± $USD 1897.03) and $USD 1200.35 (SD ± $USD 489.76), respectively. The overall burden of catastrophic cost among MDR-TB patients and households was 81.58% (95% Confidence Interval (CI) 74.13-89.04%). The catastrophic costs incurred by MDR-TB patients were significantly higher than previously reported for DS-TB patients. MDR-TB patients incurred more expenditure for direct costs than indirect costs. Social protection and financial support for patients and affected families are needed to mitigate the catastrophic economic consequences of MDR-TB.

Population-Modifiable Risk Factors Associated With Childhood Stunting in Sub-Saharan Africa.

Importance: Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals. Objective: To evaluate key modifiable risk factors associated with childhood stunting in SSA. Design, Setting, and Participants: This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries. Exposures: Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel. Main Outcomes and Measures: Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors. Results: This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA. Conclusions and Relevance: This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.

Prognostication of treatment non-compliance among patients with multidrug-resistant tuberculosis in the course of their follow-up: a logistic regression-based machine learning algorithm.

Introduction: Drug compliance is the act of taking medication on schedule or taking medication as prescribed and obeying other medical instructions. It is the most crucial aspect in the treatment of chronic diseases particularly for patients with multidrug-resistant tuberculosis (MDR-TB). Drug non-compliance is the main reason for causing drug resistance and poor treatment outcomes. Hence, developing a risk prediction model by using early obtainable prognostic determinants of non-compliance is vital in averting the existing, unacceptably high level of poor treatment outcomes and reducing drug resistance among MDR-TB patients. Materials and methods: A retrospective follow-up study was conducted on a total of 517 MDR-TB patients in Northwest Ethiopia. A logistic regression-based machine learning algorithm was used to develop a risk score for the prediction of treatment non-compliance among MDR-TB patients in selected referral hospitals of Northwest Ethiopia. The data were incorporated in EpiData version 3.1 and exported to STATA version 16 and R version 4.0.5 software for analysis. A simplified risk prediction model was developed, and its performance was reported. It was also internally validated by using a bootstrapping method. Results: Educational status, registration group (previously treated/new), treatment support, model of care, and khat use were significant prognostic features of treatment non-compliance. The model has a discriminatory power of area under curve (AUC) = 0.79 with a 95% CI of 0.74-0.85 and a calibration test of p-value = 0.5. It was internally validated by using a bootstrapping method, and it has a relatively corrected discriminatory performance of AUC = 0.78 with a 95% CI of 0.73-0.86 and an optimism coefficient of 0.013. Conclusion: Educational status, registration group, treatment supporter, model of care, and khat use are important features that can predict treatment non-compliance of MDR-TB patients. The risk score developed has a satisfactory level of accuracy and good calibration. In addition, it is clinically interpretable and easy to use in clinical practice, because its features are easily ascertainable even at the initial stage of patient enrolment. Hence, it becomes important to reduce poor treatment outcomes and drug resistance.

Protocol for a systematic review of long-term physical sequelae and financial burden of multidrug-resistant and extensively drug-resistant tuberculosis.

INTRODUCTION: Multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are major public health threats that are significant causes of physical sequelae and financial consequences for infected people. Treatment for MDR- and XDR-TB are more toxic and take longer duration than for drug-susceptible-TB. As a result, the long-term sequelae are thought to be more common among patients with MDR- and XDR-TB than drug-susceptible-TB, but this is yet to be quantified. Hence, the aim of this systematic review and meta-analysis is to quantify the global burden and types of long-term physical sequelae and financial burden associated with both MDR- and XDR-TB. METHOD AND ANALYSIS: We will search CINHAL, MEDLINE, Embase, Scopus, and Web of science for studies that report physical and financial sequelae associated with rifampicin-resistant (RR), MDR- and XDR-TB or their treatments. The search will be conducted without time, language, and place restrictions. A random-effects meta-analysis will be conducted to estimate the pooled prevalence of each physical sequela. Heterogeneity will be measured using the Higgins I2 statistics. We will assess publication bias visually using the funnel plot and statistically using Egger's test. Adjustments for publication basis will be made using Tweedie's and Duval Trim and Fill analysis. ETHICS AND DISSEMINATION: Since the study is based on published evidence, ethics approval is not required. The findings of the systematic review will be presented at various conferences and will be published in a peer-reviewed journal. PROTOCOL REGISTRATION: The protocol is published in the PROSPERO with registration number CRD42021250909.

Incidence and determinants of nosocomial infection among hospital admitted adult chronic disease patients in University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia, 2016-2020.

Background: Nosocomial infections are major public health problem which affects more than 100 million patients each year globally. This leads to prolonged hospital stays, a high mortality rate, and a vast financial burden to the healthcare system as well as the patients. This study aimed to find out the incidence of nosocomial infections and determinant factors among admitted adult chronic illness patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods: An institutional-based retrospective follow-up study design was employed among 597 respondents. The secondary data was collected from April 15 to May 15, 2021. A computer-generated random sampling technique was used to select a total of 599 patients using Open-epi software. Structured checklists were used to collect data. For data entry and analysis Epi-Data version 4.6 and STATA 16 were used respectively. To identify statistically significant variables Cox-regressions (univariable and multivariable) were performed. To declare statistically significant variables based on p < 0.05 in the multivariable Cox-regression model, adjusted hazard ratio with 95% CI was used. Results: A total of 597(99.6%) adult chronic illness patients were included in the study. Of these, 53 (8.88%) participants developed nosocomial infections and the incidence rate of nosocomial infection was 6.6 per 1,000 person-days observation. In this study, not taking antibiotics (AHR = 2.74, 95% CI: 1.49, 5.04), using mechanical ventilation (AHR = 2.67, 95% CI: 1.36, 5.26), being on urinary catheter (AHR = 4.62, 95% CI: 2.22, 9.65), being on intravenous catheter (AHR = 3.42, 95% CI: 1.22, 9.61) and length of hospital stay >20 days (AHR = 2.66, 95% CI: 1.43, 4.94) were significantly associated with nosocomial infections. Conclusions: The findings have indicated that the incidence of nosocomial infection was low. No taking antibiotics, intravenous insertion, mechanical ventilation, length of hospital stay, and urinary catheterization were the predictors for the development of nosocomial infection. Therefore, we recommend that the healthcare providers need to give emphasis on infection prevention and control in the institution on these factors that have a significant effect on nosocomial infection.

Prevalence of long-term physical sequelae among patients treated with multi-drug and extensively drug-resistant tuberculosis: a systematic review and meta-analysis.

Background: Physical sequelae related to multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are emerging and under-recognised global challenges. This systematic review and meta-analysis aimed to quantify the prevalence and the types of long-term physical sequelae associated with patients treated for MDR- and XDR-TB. Methods: We systematically searched CINAHL (EBSCO), MEDLINE (via Ovid), Embase, Scopus, and Web of Science from inception through to July 1, 2022, and the last search was updated to January 23, 2023. We included studies reporting physical sequelae associated with all forms of drug-resistant TB, including rifampicin-resistant TB (RR-TB), MDR-TB, Pre-XDR-TB, and XDR-TB. The primary outcome of interest was long-term physical sequelae. Meta-analysis was conducted using a random-effect model to estimate the pooled proportion of physical sequelae. The sources of heterogeneity were explored through meta-regression using study characteristics as covariates. The research protocol was registered in PROSPERO (CRD42021250909). Findings: From 3047 unique publications identified, 66 studies consisting of 37,380 patients conducted in 30 different countries were included in the meta-analysis. The overall pooled estimate was 44.4% (95% Confidence Interval (CI): 36.7-52.1) for respiratory sequelae, 26.7% (95% CI: 23.85-29.7) for hearing sequelae, 10.1% (95% CI: 7.0-13.2) for musculoskeletal sequelae, 8.4% (95% CI: 6.5-10.3) for neurological sequelae, 8.1% (95% CI: 6.3-10.0) for renal sequelae, 7.3% (95% CI: 5.1-9.4) for hepatic sequelae, and 4.5% (95% CI: 2.7-6.3) for visual sequelae. There was substantial heterogeneity in the estimates. The stratified analysis showed that the pooled prevalence of hearing sequelae was 26.6% (95% CI: 12.3-40.9), neurological sequelae was 31.5% (95% CI: 5.5-57.5), and musculoskeletal sequelae were 21.5% (95% CI: 9.9-33.1) for patients with XDR-TB, which were higher than the pooled prevalence of sequelae among patients with MDR-TB. Respiratory sequelae were the highest in low-income countries (59.3%) and after completion of MDR-TB treatment (57.7%). Interpretation: This systematic review found that long-term physical sequelae such as respiratory, hearing, musculoskeletal, neurological, renal, hepatic, and visual sequelae were common among survivors of MDR- and XDR-TB. There was a significant difference in the prevalence of sequelae between patients with MDR- and XDR-TB. Post-MDR- and XDR-TB treatment surveillance for adverse outcomes needs to be incorporated into the current programmatic management of MDR-TB to enable early detection and prevention of post-treatment sequelae. Funding: Australian National Health and Medical Research Council, through an Emerging Leadership Investigator grant, and the Curtin University Higher Degree Research scholarship.

Unintended medication discrepancies and associated factors upon patient admission to the internal medicine wards: identified through medication reconciliation.

BACKGROUND: Medication reconciliation (MedRec) is a widely accepted tool for the identification and resolution of unintended medication discrepancies (UMD). OBJECTIVE: This study aimed at assessing the magnitude and associated factors of UMD identified through medication reconciliation upon patient admission to the internal medicine wards. METHODS: Prospective cross-sectional study was conducted at the internal medicine wards of Felege Hiwot and Tibebe Ghion comprehensive specialized hospitals in Bahir Dar city, Northwest Ethiopia, from May 01 to July 30, 2021. Data were collected by using a data abstraction format prepared based on standard MedRec tools and previous studies on medication discrepancy. Pharmacists-led MedRec was made by following the WHO High5s "retroactive medication reconciliation model". SPSS® (IBM Corporation) version 25.0 was used to analyze the data with descriptive and inferential statistics. A binary logistic regression analysis was used to identify factors associated with UMD. A statistical significance was declared at a p-value < 0.05. RESULTS: Among 635 adult patients, 248 (39.1%) of them had at least one UMD. The most frequent types of UMDs were omission (41.75%) and wrong dose (21.9%). The majority (75.3%) of pharmacists' interventions were accepted. Polypharmacy at admission (p-value < 0.001), age ≥ 65 (p-value = 0.001), a unit increase on the number of comorbidities (p-value = 0.008) and information sources used for MedRec (p-value < 0.001), and medium (p-value = 0.019) and low adherence (p-value < 0.001) were significantly associated with UMD. CONCLUSION: The magnitude of UMD upon patient admission to the internal medicine wards was considerably high. Omission and the wrong dose of medication were common. Older age, polypharmacy, low and medium adherence, and an increase in the number of comorbidities and information sources used for MedRec are significantly associated with UMDs. Pharmacists' interventions were mostly acceptable. Thus, the implementation of pharmacists-led MedRec in the two hospitals is indispensable for patient safety.

Development and validation of a nomogram for the prediction of late culture conversion among multi-drug resistant tuberculosis patients in North West Ethiopia: An application of prediction modelling.

INTRODUCTION: Multi-drug resistant tuberculosis has impeded tuberculosis prevention and control due to its low treatment efficiency and prolonged infectious periods. Early culture conversion status has long been used as a predictor of good treatment outcomes and an important infection control metric, as culture-negative patients are less likely to spread tuberculosis. There is also evidence that suggests that delayed sputum conversion is linked to negative outcomes. Therefore, this study was aimed at developing a nomogram to predict the risk of late culture conversion in patients with multi-drug resistant tuberculosis using readily available predictors. OBJECTIVE: The objective of this study was to develop and validate a risk prediction nomogram for the prediction of late culture conversion among multi-drug resistant tuberculosis patients in North-West Ethiopia. METHODS: Multi-drug resistant tuberculosis data from the University of Gondar and the Debre Markos referral hospitals have been used and a total of 316 patients were involved. The analysis was carried out using STATA version 16 and R version 4.0.5 statistical software. Based on the binomial logistic regression model, a validated simplified risk prediction model (nomogram) was built, and its performance was evaluated by assessing its discriminatory power and calibration. Finally, decision curve analysis (DCA) was used to assess the generated model's clinical and public health impact. RESULTS: Registration group, HIV co-infection, baseline BMI, baseline sputum smear grade, and radiological abnormalities were prognostic determinants used in the construction of the nomogram. The model has a discriminating power of 0.725 (95% CI: 0.669, 0.781) and a P-value of 0.665 in the calibration test. It was internally validated using the bootstrapping method, and it was found to perform similarly to the model developed on the entire dataset. The decision curve analysis revealed that the model has better clinical and public health impact than other strategies specified. CONCLUSION: The developed nomogram, which has a satisfactory level of accuracy and good calibration, can be utilized to predict late culture conversion in MDR-TB patients. The model has been found to be useful in clinical practice and is clinically interpretable.

Development and Validation of a Nomogram for the Prediction of Unfavorable Treatment Outcome Among Multi-Drug Resistant Tuberculosis Patients in North West Ethiopia: An Application of Prediction Modelling.

Background: Multidrug-resistant tuberculosis (MDR-TB) is a global problem and a health security threat, which makes "Ending the global TB epidemic in 2035" unachievable. Globally, the unfavourable treatment outcome remains unacceptably high. Therefore, this study aimed to develop a risk prediction model for unfavorable treatment outcomes in MDR-TB patients, which can be used by clinicians as a simple clinical tool in their decision-making. Objective: The objective of this study was to develop and validate a risk prediction model for the prediction of unfavorable treatment outcomes among MDR-TB patients in North-West Ethiopia. Methods: We used MDR-TB data collected from the University of Gondar and Debre Markos referral hospitals. A retrospective follow-up study was conducted and a total of 517 patients were included in the study. STATA version 16 statistical software and R version 4.0.5 were used for the analysis. Descriptive statistics were carried out. A multivariable model was fitted using all potent predictors selected by the lasso regression method. A simplified risk prediction model (nomogram) was developed based on the binomial logit-based model, and its performance was described by assessing its discriminatory power and calibration. Finally, decision curve analysis (DCA) was done to evaluate the clinical and public health impact of the developed model. Results: The developed nomogram comprised six predictors: baseline anemia, major adverse event, comorbidity, age, marital status, and treatment supporter. The model has a discriminatory power of 0.753 (95% CI: 0.708, 0.798) and calibration test of (P-value = 0.695). It was internally validated by bootstrapping method, and it has a relatively corrected discrimination performance (AUC = 0.744, 95CI: 0.699, 0.788). The optimism coefficient was found to be 0.009. The decision curve analysis showed the net benefit of the model as threshold probabilities varied. Conclusion: The developed nomogram can be used for individualized prediction of unfavorable treatment outcomes in MDR-TB patients for it has a satisfactory level of accuracy and good calibration. The model is clinically interpretable and was found to have added benefits in clinical practice.

Determinants of modern contraceptive utilization among married women in sub-Saharan Africa: multilevel analysis using recent demographic and health survey.

BACKGROUND: Family planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study aimed at determining the pooled prevalence and determinants of modern contraceptive utilization among married women of sub-Saharan Africa. METHODS: Thirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women was included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Multilevel regression analysis was used to identify the determinants of modern contraceptive use among married women. Four models were fitted to select the best-fitted model using the Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as the best-fitted model. RESULTS: The pooled estimate of modern contraception use in sub-Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization were high among women living in East Africa [AOR = 1.47 (1.40, 1.54)], urban areas [AOR = 1.18 (1.14, 1.24)], and women with primary [AOR = 1.49 (1.44, 1.55)] and secondary and above educational level [AOR = 1.66 (1.58, 1.74)]. Moreover, husbands with primary educational level [AOR = 1.38 (1.33, 1.42)], middle [AOR = 1.17, (1.14, 1.21)], rich wealth status [AOR = 1.29 (1.25, 1.34)], media exposure [AOR = 1.25 (1.22, 1.29)], and postnatal care (PNC) utilization [AOR = 1.25 (1.22, 1.29)] had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility [AOR = 1.74 (1.69, 1.79)] and birth order 2-4 [AOR = 1.36 (1.31, 1.41)] had higher odds of modern contraceptive utilization. On the other hand, women living in Central [AOR = 0.23 (0.22, 0.24)], Western regions [AOR = 0.46 (0.40, 0.54)], women who decided with husband [AOR = 0.90 (0.87, 0.93)], and decisions by husband alone [AOR = 0.73 (0.71, 0.75)] decreased the odds of modern contraceptive utilization. CONCLUSION: The uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention needs to be given to rural residents, illiterate women, and communities with low wealth status.

A Score to Predict the Risk of Major Adverse Drug Reactions Among Multi-Drug Resistant Tuberculosis Patients in Southern Ethiopia, 2014-2019.

Background: Adverse events (AE) contribute to poor drug adherence and withdrawal, which contribute to a low treatment success rate. AE are commonly reported among multi-drug resistance tuberculosis (MDR-TB) patients in Ethiopia. However, predictors of AE among MDR-TB patients were limited in Ethiopia. Thus, the current study aimed to develop and validate a score to predict the risks of major AE among MDR-TB patients in Southern Ethiopia. Methods: A retrospective follow-up study design was employed among MDR-TB patients from 2014-2019 in southern Ethiopia at selected hospitals. A least absolute shrinkage and selection operator algorithm was used to select the most potent predictors of the outcome. The adverse event risk score was built based on the multivariable logistic regression analysis. Discriminatory power and calibration were checked to evaluate the performance of the model. Bootstrapping method with 100 repetitions was used for internal model validation. Results: History of baseline khat use, long-term drug regimen use, and having coexisting disorders (co-morbidity) were predictors of AEs. The score has a satisfactory discriminatory power (AUC = 0.77, 95% CI: 0.68, 0.82) and a modest calibration (Prob > chi2 = 0.2043). It was found to have the same c-statistics after validation by bootstrapping method of 100 repetitions with replacement. Conclusion: A history of baseline khat use, co-morbidity, and long-term drug regimen use are helpful to predict individual risk of major adverse events in MDR-TB patients with a satisfactory degree of accuracy (AUC = 0.77).

The Role of GeneXpert MTB/RIF in Reducing Treatment Delay Among Multidrug Resistance Tuberculosis Patients: A Propensity Score Matched Analysis.

BACKGROUND: GeneXpert MTB/RIF testing is a rapid molecular diagnostic test that is performed with an automated cartilage-based machine that makes treatment initiation prompt. This study aimed at evaluating the impact of GeneXpert in the reduction of treatment delay among multidrug-resistant tuberculosis (MDR-TB) patients in Amhara regional state of Ethiopia. METHODS: A facility-based retrospective follow-up study was conducted from January to February 2019, and a total of 465 MDR-TB patients were included in the study. Socio-demographic, clinical, and treatment-related characteristics were collected from patient's chart retrospectively using data abstraction sheets. Binary logistic regression model was fitted to identify factors associated with treatment delay; adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. A propensity score-matched (PSM) analysis was used to assess the impact of the GeneXpert MTB/RIF test on treatment delay through calculation of average treatment effect (ATE). RESULTS: The majority, 92.4%, of patients had the pulmonary form of TB, and 46.7% of patients were diagnosed by GeneXpert MTB/RIF. The presence of cavitation (AOR = 0.62, 95% CI: 0.39 0.96), extrapulmonary form of TB (AOR = 0.34, 95% CI: 0.14 0.81), and GeneXpert (AOR = 0.15, 95% CI: 0.10 0.24) were factors associated with treatment delay. The average treatment effect (ATE) of PSM analysis showed that GeneXpert MTB/RIF has significantly reduced treatment delay by 41% compared to matched control groups. CONCLUSION: This study revealed that GeneXpert test has a strong association with the reduced treatment delays among MDR-TB patients. This underscores that rapid molecular tests could help improve the health system and lead to prompt initiation of MDR-TB treatment. Therefore, expansion and decentralization of GeneXpert tests to peripheral health facilities are highly recommended. In turn, the case detection and control of the disease will be hastened.

Effect of perinatal depression on birth and infant health outcomes: a systematic review and meta-analysis of observational studies from Africa.

BACKGROUND: Antenatal depression is associated with intrauterine growth retardation, preterm birth, and low birth weight. Infants born to mothers with postnatal depression also may suffer from malnutrition and other health problems. Even though there are few single studies conducted so far, a systematic review of these studies is highly important to highlight the effect of antenatal and perinatal depression on adverse birth and infant health outcomes in Africa. METHODS: We used the Preferred Report Items for Systematic Review and Meta-analysis (PRISMA) when conducting this study. Databases like CINAHL (EBSCO), MEDLINE (via Ovid and PubMed), PsycINFO, Emcare, Psychiatry Online, and Scopus were searched. In addition, Google Scholar and references from a list of eligible studies were explored. We included good quality observational studies based on Newcastle Ottawa Scale which are published in the English language between 2007 and 2018.  Heterogeneity and publication bias were assessed. Meta-analysis with a random effect model was employed to determine the pooled effect sizes with a 95% confidence interval. The review protocol is registered in PROSPERO (CRD42018106714). RESULT: We found three studies (1511 participants) and 11 studies (22,254 participants) conducted on the effect of antenatal depression on birth outcomes and perinatal depression on adverse infant health outcomes, respectively. The overall risk of having adverse birth outcomes was 2.26 (95% CI: 1.43, 3.58) times higher among pregnant mothers with depression. The risk of preterm birth and low birth weight was 1.77 (95% CI: 1.03, 3.04) and 2.98 (95% CI: 1.60, 5.55) respectively. Similarly, the risk of having adverse infant health outcomes namely malnutrition and febrile illness was 1.61 (95% CI: 1.34, 1.95) times higher among mothers who had perinatal depression. CONCLUSIONS: We have found a significant association between antenatal depression and adverse birth outcomes, low birth weight and preterm birth. Similarly, a significant effect of perinatal depression on adverse infant health outcomes namely, malnutrition, and febrile illnesses was observed. The findings highlight that it is time to integrate mental health services with routine maternal health care services to improve birth outcomes and reduce infant morbidity.

Knowledge and Practice for Prevention of Bovine Tuberculosis and Its Derivers Among HIV Positive People in Bahir Dar City Public Hospitals, Ethiopia.

INTRODUCTION: Bovine tuberculosis is an important zoonotic disease caused by Mycobacterium bovis, known to exist in all parts of the world especially in un-hygienic environments. It has a public health impact and humans acquire the infection from infected animals through consumption of raw or unpasteurized milk and dairy products. METHODS: An Institutional-based quantitative cross-sectional study was conducted from February to April 2020 to assess the knowledge and practice level along with their derivatives of bovine tuberculosis among adult HIV-positive people in Bahir Dar city public hospitals. The data were collected using structured interviewer questionnaire and systematic random sampling was employed to select study subjects. Thus, a total of 435 people living with HIV were considered for this study. RESULTS: Out of the total 435 participants 51.5% were male and the mean age was 37.6 years. The overall level of good knowledge and practice of HIV-positive persons for bovine TB were 46.2% and 41.1%, respectively. Moreover, education status, religion, cattle holding, and environmental hygiene were statistically significant associations (p < 0.05) with knowledge level. Likewise, education status, age, and marital status were statistically significant associations with the practice level for bovine TB. Education was a key determinant factor affecting both knowledge and practice. CONCLUSION: In conclusion, the present study showed that the level of good knowledge and practice of the participant for bovine TB was low. Hence, tailor-made training by medical and veterinary professionals on the identified risk factors is recommended.

Occupational Health Problems among Seasonal and Migrant Farmworkers in Ethiopia: A Cross-Sectional Study.

BACKGROUND: Migrant and seasonal farmworkers are at increased risk for occupational fatalities and injuries. Although such employment-related geographical mobility is receiving increasing attention, there is limited evidence about occupational health problems among seasonal farmworkers. Therefore, this study aims to investigate occupational health problems among seasonal and migrant farmworkers in Ethiopia. METHODS: A cross-sectional study design was employed from October to December 2019 among seasonal and migrant farmworkers. The study was carried out in two sites of Amhara regional state, northwest Ethiopia. A cluster sampling technique was used to recruit 990 study participants. Bivariable and multivariable binary logistic regression analyses were performed using SPSS version 20 to identify factors associated with injuries. The significance level was obtained at 95% CI and p-value ≤0.05. RESULTS: In this study, the period prevalence of work-related injury among seasonal and migrant farmworkers was 32.5% (95% CI: 29.7, 35.9). Being unemployed before migration (AOR = 2.22, 95% CI: 1.26, 3.91), working for >8 h/day (AOR = 1.62, 95% CI: 1.16, 2.27), stress (AOR = 1.38, 95% CI: 1.02, 1.88) and thermal discomfort (AOR = 1.48, 95% CI: 1.09, 1.98) were the significant risk factors for work-related injury. In addition, nearly two-third (60.9%) of the study participants have shown three or more heat-related illness symptoms. Moreover, the prevalence of work-related stress among seasonal and migrant farmworkers was 67.6% (95% CI: 64.6, 70.7). CONCLUSION: Occupational health problems among seasonal and migrant farmworkers in northwest Ethiopia remain a major public health problem. Hence, implementing tailored preventive measures like training on health and safety, and hazard control measures would be supremely important to minimize the risk.

Self-Reported Work-Related Musculoskeletal Disorders and Associated Factors among Restaurant Workers in Gondar City, Northwest Ethiopia, 2020.

Introduction: Globally, work-related musculoskeletal disorders (WMSDs) have resulted in occupational disability and injury. Of these, restaurant workers are among the high-risk professionals usually affected by WMSDs. In Ethiopia, evidence on the burden of musculoskeletal disorder and contributing factors among restaurant workers were very limited. Therefore, this study was aimed at assessing the prevalence of self-reported WMSDs and contributing factors among restaurant workers in Gondar city, northwest Ethiopia, 2020. Methods: An institutional-based cross-sectional study was conducted from February 2020 to March 2020 among restaurant workers in Gondar city. A two-stage sampling technique was used to choose 633 study subjects. A structured Nordic questioner was used to collect the data. Data was entered into EpiData version 3.1 and exported to Stata version 14.0 for analysis. Both bivariable and multivariable logistic regression analyses were computed. An adjusted odds ratio with a 95% confidence interval was used to measure the association between WMSDs and independent variables. In the multivariable analysis, a P value of <0.05 was used to declare a statistically significant association. To check the goodness of fit, the Hosmer and Lemeshow test was used. Results: The prevalence of WMSDs among restaurant workers in the past 12 months was 81.5% [95% CI (78.18-84.44)]. Attending primary education [AOR: 2.14, 95% CI (1.17-3.90)], attending secondary education [AOR: 1.71 (1.02-2.86)], and job satisfaction [AOR: 1.90, 95%CI (1.13-3.19)] were significantly associated with WMSDs. Conclusion: In this study, the prevalence of WMSDs among restaurant workers was high. The upper back, lower back, elbow, and wrist were the most affected body parts. Age above 30 years, educational status being primary and secondary, and being dissatisfied by their job were positively associated with a high prevalence of WMSDs.