Time to Sputum Culture Conversion and Its Predictors Among Multidrug Resistant Tuberculosis Patients in Tigray, Northern Ethiopia: Retrospective Cohort Study.

Background: Sputum culture conversion status is a cardinal index of treatment response and patient outcome for MDR TB patients on longer anti-TB drugs. But, there is limited information on time to sputum culture conversion of MDR TB patients on a longer anti-TB treatment regimen. Therefore, this study aimed to evaluate time to sputum culture conversion and its predictors among MDR TB patients in Tigray, Northern Ethiopia. Methods: A retrospective cohort study was conducted from January 2017 through September 2020 among MDR TB patients in Tigray, Northern Ethiopia. Demographic and clinical characteristics including bacteriological data were extracted from the TB registration book and electronic database in Tigray Health Research Institute. Statistical analysis was performed using SPSS version 25. The time to initial sputum culture conversion was analyzed using the Kaplan-Meier method. Bivariate and multivariate Cox proportional hazards regression analyses were used to identify predictors for culture conversions. P <0.05 was considered statistically significant. Results: A total of 294 eligible study participants with a median age of 30 years (IQR: 22.75-40) were included. The participants were followed for a total of 1066.7 person months. Sputum culture conversion was achieved in 269 (91%) of the study participants. The median time of sputum culture conversion was 64 days (IQR: 49-86). In our multivariate model, HIV-positive (aHR=1.529, 95% CI: 1.096-2.132, P=0.012), patients new to anti-TB treatment (aHR=2.093, 95% CI: 1.100-3.982, P=0.024) and baseline AFB smear grading of +1 (aHR=1.982, 95% CI: 1.428-2.750, P=0.001) significantly affected time to initial sputum culture conversion. Conclusion: The median time of culture conversion was 64 days. Moreover, the majority of the study participants achieved culture conversion within the first six months of treatment commencement, which supports predefined standard treatment durations.

Blinded rechecking of sputum smear microscopy performance in public health facilities in Tigray region, Northern Ethiopia: Retrospective cross sectional study.

INTRODUCTION: Tuberculosis disease is the leading cause of death worldwide along with HIV/AIDS. Sputum smear microscopy plays an essential role for initial TB diagnosis and treatment follow up. But, misdiagnosis of sputum smear microscopy revealed a high economical crisis and missing of active TB cases. This study was aimed to determine blinded rechecking of sputum smear microscopy performance in public health facilities in Tigray region, Northern Ethiopia. MATERIALS AND METHODS: A cross sectional retrospective study was conducted from January, 2017 to December, 2018 year. Data was collected retrospectively using electronic and paper based in Tigray health research institute. The data was analyzed using the SPSS version 25 software. The sensitivity, specificity, positive predictive value, and negative predictive value of the smear readings were calculated using 2X2 contingency table. The reading agreement between the microscopic center and reference center was determined using kappa statistics. RESULTS: A total of 23,456 blinded rechecked smear results were reviewed. In average, the performances of sputum smear quality were 61%, 68%, 64%, 66%, 62% and 75% for specimen quality, staining quality, smear size, smear thickness, smear evenness and smear cleanliness respectively. Of the total error (0.48%) reported, 0.25%, 0.19% and 0.085% were false positive, false negative and quantification errors respectively. The concordance rate of health facilities for smear reading was increased to 90% by the end of 2018. Overall, the sensitivity, specificity, PPV, and NPV of the smear readings were 95%, 99.7%, 93% and 99.8% respectively. Likewise, the smear reading agreement was also perfect with kappa value, 0.87. CONCLUSION: The overall performance of public health facilities for blinded rechecking of smear microscopy was satisfactory. But, the high false positive and false negative errors found calls for continuous evaluation and monitoring of the health facilities by reference center.

Community based hematological reference intervals among apparently healthy adolescents aged 12-17 years in Mekelle city, Tigrai, northern Ethiopia: A cross sectional study.

BACKGROUND: Hematological reference intervals are important in clinical and diagnostic management for the assessment of health and disease conditions. Hematological reference intervals are better to be established based on gender and age differences as these are among the main affecting factors. OBJECTIVE: The aim of this study was to establish hematological reference intervals among apparently healthy adolescents aged 12-17 years in Mekelle City, Tigrai, Northern Ethiopia, 2019. METHOD: A community-based cross-sectional study was conducted in 249 adolescents aged 12-17 years from December 2018 to May 2019. About 4ml of blood sample was collected from each study participant using vacutainer tube containing K2EDTA. Hematological parameters were analyzed using Sysmex KX-21N hematology analyzer (Sysmex Corporation Kobe, Japan). Data were entered and analyzed using SPSS version 23. Both parametric and non-parametric analyses were used to calculate the median and 95% of reference intervals. The 97.5th and 2.5th percentiles were calculated using descriptive statistics for the upper and lower reference limits of the study participants. Differences in reference intervals between male and female participants were evaluated using the Mann-Whitney U test. RESULT: Among the 249 participants 122 (49%) were males and 127 (51%) were females with the median age of 14.5 (range 12 to 17) years were recruited in this study. The median and the 95% reference intervals of hematological parameters were determined. The 95% RIs were: Red blood cells (1012/Liter) 4.6-5.9 (Males) and 4.3-5.6 (Females), White blood cells (109/Liter) 2.9-9.6 (Males) and 3.4-10.2 (Females), Hemoglobin (g/dl) 12.6-17.1 (Males) and 12-15.4 (Females), Platelets (109/Liter) 138-364 (Males) and 151-462 (Females). Almost all of the hematological parameters showed significant differences (p<0.05) across gender. CONCLUSION: The hematological reference intervals established in this study showed a difference based on gender. We suggest preparing and using distinct local reference intervals for males and females separately.

Community based reference interval of selected clinical chemistry parameters among apparently healthy Adolescents in Mekelle City, Tigrai, Northern Ethiopia.

BACKGROUND: Locally established clinical laboratory reference intervals (RIs) are required to interpret laboratory test results for screening, diagnosis and prognosis. The objective of this study was establishing reference interval of clinical chemistry parameters among apparently healthy adolescents aged between 12 and 17 years in Mekelle, Tigrai, northern part of Ethiopia. METHODS: Community based cross sectional study was employed from December 2018 to March 2019 in Mekelle city among 172 males and 172 females based on Multi stage sampling technique. Blood samples were tested for Fasting blood sugar (FBS), alanine aminino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), Creatinine, urea, total protein, albumin (ALB), direct and indirect bilirubin (BIL.D and BIL.T) using 25 Bio system clinical chemistry analyzer. Results were analyzed using SPSS version 23 software and based on the Clinical Laboratory Standard Institute (CLSI)/ International Federation of Clinical Chemistry (IFCC) C 28-A3 Guideline which defines the reference interval as the 95% central range of 2.5th and 97.5th percentiles. Mann Whitney U test, descriptive statistics and box and whisker were statistical tools used for analysis. RESULTS: This study observed statistically significant differences between males and females in ALP, ALT, AST, Urea and Creatinine Reference intervals. The established reference intervals for males and females, respectively, were: ALP (U/L) 79.48-492.12 versus 63.56-253.34, ALT (U/L) 4.54-23.69 versus 5.1-20.03, AST 15.7-39.1 versus 13.3-28.5, Urea (mg/dL) 9.33-24.99 versus 7.43-23.11, and Creatinine (mg/dL) 0.393-0.957 versus 0.301-0.846. The combined RIs for Total Protein (g/dL) was 6.08-7.85, ALB (g/dL) 4.42-5.46, FBS(mg/dL) 65-110, BIL.D (mg/dL) 0.033-0.532, and BIL.T (mg/dL) 0.106-0.812. CONCLUSIONS: The result showed marked difference among sex and with the company derived values for selected clinical chemistry parameters. Thus, use of age and sex specific locally established reference intervals for clinical chemistry parameters is recommended.