Impact of COVID-19 on non-communicable disease management services at selected government health centers in Addis Ababa, Ethiopia.

Background: The global pandemic of COVID-19 forced the world to divert resources and asked the public to shelter-in-place, so the diagnosis surveillance system and management of non-communicable diseases has become more challenging. Objective: To identify the impact of COVID-19 on non-communicable diseases management services at government health centers in Addis Ababa, Ethiopia. Methods: Health facility based cross-sectional study was conducted from August to September, 2020. A total of 30 health centers were included in this study. Bivariate and multiple logistic regression models were used to assess association between the outcome and independent variables. Results: The majority, 24 (80%), of the study participants perceived that the COVID-19 pandemic severely disrupted the non-communicable disease management services. There was a statistically significant association between a decrease in outpatient volume at non communicable disease (NCD) management services (25 (83.3%), P-value: 0.006), closure of population level screening programs of NCDs (22 (73.3%), P-value: 0.007), and closure of disease specific NCD clinics and the occurrence of the COVID-19 pandemic (23 (76.7%), P-value: 0.013). Conclusion: The most critical health-care services for non-communicable diseases management were severely disrupted by the COVID-19 pandemic. Therefore, during public health emergencies, policymakers should ensure continuation of critical clinical services and inform the public about proper service utilization.

Magnitude of Streptococcus pneumoniae Among Under-Five Children with Symptom of Acute Respiratory Infection at Hiwot Fana Specialized University Hospital, Harar, Ethiopia: Associated Risk Factors and Antibacterial Susceptibility Patterns.

PURPOSE: Streptococcus pneumoniae is the major cause of pneumoniae infection among under-five children that leads to high morbidity and mortality. Thus, the aim of this study was to determine the magnitude of Streptococcus pneumoniae in under-five children of an acute respiratory infection, assess its antimicrobial susceptibility patterns, and define the associated factors. METHODS: An institutional-based cross-sectional study was conducted on a total of 384 under-five children of acute respiratory infection attending outpatient department of Hiwot Fana Specialized University Hospital, Harar, Ethiopia, from March 1 to 30, 2020. Socio-demographic and clinical data were collected from the study participants using a structured questionnaire. Sputum samples were collected and processed to identify Streptococcus pneumoniae pathogen using the culture and biochemical tests as per the standard procedures. The Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing. Data were entered into Epi-data version 3.1 and analyzed by using Statistical Product and Service Solutions version 22. RESULTS: The proportion of Streptococcus pneumoniae in under-five children with acute respiratory infection was 11.2%. About 50% of isolated Streptococcus pneumoniae was resistant to tetracycline and cotrimoxazole, whereas more than 90% of it was susceptible to Ceftriaxone and amoxicillin-clavulanate. Children who lived in rural areas were 3.6 times more likely to have S. pneumoniae compared to children who lived in urban areas (AOR: 3.6, 95% CI: 1.2-11) and children with familysmokers in a house were 3 times at risk to be infected with S. pneumoniae (AOR: 3, 95% CI: 1.8-8.0). CONCLUSION: High antimicrobial resistance of S. pneumoniae against tetracycline and cotrimoxazole was observed and children who lived in rural areas and live with a family of cigarette smoker are factors associated with Streptococcus pneumoniae. Therefore, providing health educations to the family of children rural residents and isolating smokers from the house where children lived are recommended actions to reduce bacteria caused by Streptococcus pneumoniae.

Tuberculosis knowledge and attitude among non-health science university students needs attention: a cross-sectional study in three Ethiopian universities.

BACKGROUND: Ethiopia is among the 14 high TB, TB/HIV and MDR-TB burden countries globally. Prior studies indicate students attending universities in Ethiopia may be at increased risk for active tuberculosis (TB) relative to the general population, mainly due to the dramatic increase in expansion of the enrollment scale of universities.This study sought to gain insight about non-health science university students' TB knowledge and attitudes to help develop a strategy for TB education in this population. METHODS: A cross-sectional study was conducted from October to December 2018 among non-health science university students at three eastern Ethiopia public universities. Participants were considered having 'good' knowledge on TB when they correctly mentioned the communicability, means of transmission and prevention methods of TB and recognized modern medicine as the best treatment for TB. Participants were considered as having 'acceptable' attitude towards TB when they indicated they would seek immediate care for TB diagnosis, not hide a TB diagnosis and feel compassion to help people with TB. RESULTS: A total of 1720 non-health science university students participated. Only 614 (35.7%) of the students had 'good' knowledge on TB. This differed significantly between universities, with students from Haramaya and Dire Dawa universities more likely to have 'good' TB knowledge than their counterparts from Jigjiga University [COR (Crude Odds Ratio):1.62 and 1.94, respectively; and 95% Confidence Interval (CI): (1.236, 2.079) and (1.511, 2.483), respectively]. Only a third of students, 555 (32.3%) mentioned 'bacteria' as causing TB, and 836 students (48.6%) had ever heard of Multi Drug Resistant-TB (MDR-TB). An 'acceptable' attitude towards people with TB was observed in 666 students (38.7%). Even though 739 students (43%) felt compassion and desire to help TB patients, 213 (12%) and 382 (22%) mentioned they fear and tend to stay away from TB patients, respectively. CONCLUSIONS: The present study revealed that non-health science university students lack important TB knowledge and have misconceptions about TB in eastern Ethiopia. University administrators and other stakeholders striving against TB should provide due attention to university settings and consider development of student education programs to improve awareness and knowledge of TB disease.

Molecular epidemiology and drug resistance patterns of Mycobacterium tuberculosis complex isolates from university students and the local community in Eastern Ethiopia.

BACKGROUND: Previous studies suggest the burden of pulmonary tuberculosis (PTB) in Ethiopia may be greater in university students relative to the overall population. However, little is known about the transmission dynamics of PTB among students and members of the communities surrounding university campuses in Eastern Ethiopia. METHODS: A cross sectional study was conducted in Eastern Ethiopia among prevalent culture-confirmed PTB cases from university students (n = 36) and community members diagnosed at one of four hospitals (n = 152) serving the surrounding area. Drug susceptibility testing (DST) was performed on Mycobacterium tuberculosis complex (MTBC) isolates using BD Bactec MGIT 960 and molecular genotyping was performed using spoligotyping and 24-loci MIRU-VNTR. MTBC strains with Identical genotyping patterns were assigned to molecular clusters as surrogate marker for recent transmission and further contact tracing was initiated among clustered patients. RESULTS: Among all study participants, four MTBC lineages and 11 sub-lineages were identified, with Ethiopia_3 (Euro-American lineage) being most common sub-lineage (29.4%) in both cohorts and associated with strain clustering (P = 0.016). We further identified 13 (8.1%) strains phylogenetically closely related to Ethiopia_3 but with a distinct Spoligotyping pattern and designated as Ethiopia_4. The clustering rate of MTBC strains was 52.9% for university students and 66.7% for community members with a Recent Transmission Index (RTI) of 17.6% and 48.4%, respectively. Female gender, urban residence, and new TB cases were significantly associated with strain clustering (P<0.05). Forty-eight (30%) of the study participants were resistant to one or more first line anti TB drugs, three patients were classified as multidrug resistant (MDR). CONCLUSION: We found evidence for recent transmission of PTB among Ethiopian university students and the local community in Eastern Ethiopia, mainly linked to strains classified as Ethiopia_3 sub lineage. Drug resistance didn't have a major impact on recent transmission but comprehensive molecular surveillance in combination with drug resistance profiling of MTBC strains is desirable to better characterize TB transmission dynamics in high risk congregate living environments such as university campuses and guide regional TB control programs.

BURDEN OF TUBERCULOSIS AMONG STUDENTS IN TWO ETHIOPIAN UNIVERSITIES.

Introduction: Tuberculosis outbreaks emerge occasionally in long-term care facilities and various educational establishments. This study was designed to determine the five year overall prevalence and trend of tuberculosis and associated factors among students at Adama Science and Technology University and Addis Ababa University Sidist Kilo campus. Methods: A five-year retrospective study was conducted on students' medical records of tuberculosis Directly Observed Treatment Short Course clinics from September 2009­ July 2014. The overall prevalence and the trend of smear positive, smear negative and extra pulmonary tuberculosis cases was determined. Odds ratio with 95 percent confidence interval was calculated for categorical variables using a multivariate logistic regression model to assess the strength of association. Results: A total of 112 and 263 tuberculos cases were recorded in Addis Ababa University Sidist Kilo campus and Adama Science and Technology University, respectively. The mean proportion of tuberculosis cases of all types among the total number of students enrolled at Adama Science and Technology University and Addis Ababa University Sidist Kilo campus was 1098.1 and 511.7 cases per 100,000 population, respectively. There was a statistically significant difference in prevalence of tuberculosis among students in Adama Science and Technology University compared to that in Addis Ababa University Sidist Kilo campus [adjusted odds ration: 2.881, 95% CI (1.76-4.71)]. The trend of tuberculosis prevalence showed a steady decline from the first to the last year of the study period. Conclusion: The number of tuberculosis cases observed among university students in this study was high. Governmental and nongovernmental agencies involved in tuberculosis control must consider higher education institutions as focal points for prevention and elimination of tuberculosis in Ethiopia.

Smear-positive pulmonary tuberculosis and AFB examination practices according to the standard checklist of WHO's tuberculosis laboratory assessment tool in three governmental hospitals, Eastern Ethiopia.

BACKGROUND: Using the Directly Observed Treatment-Short course (DOTS) program the World Health Organization's global target was to detect 70% of new sputum-smear positive PTB cases. Smear positive PTB cases are more infectious than the smear negative cases. The TB case detection rate remains very low in Ethiopia, but there are increases in smear-negative PTB diagnosis which could be attributed to several factors including poor quality of sputum smear-microscopy. METHODS: A five years retrospective record review of data between September, 2007 and August, 2012 and an in-depth assessment of AFB staining practices of sputum smear using a standard checklist were made. The proportion of smear positive cases relative to overall Acid Fast Bacilli (AFB) screened was determined over a five year period to indicate the overall prevalence and the trend. Odds ratio with 95 percent confidence interval was calculated for categorical variables using multivariate Logistic Regression model to assess the strength of association. RESULT: A total of 1266 individuals' data were reviewed. The majority of the study participants were male, 704 (55.6%), and rural residents, 690 (54.5%). The overall prevalence rate of smear positive PTB was 21.6%. Age categories between 15-24 and 25-34 years were independent predictors of smear positive PTB with adjusted odds ratio of 2.246 [95% CI (1.098-4.597)] and 2.267 [95% CI (1.107-4.642)], respectively. More males were affected by PTB than females with an adjusted odds ratio of 1.426 [95% CI (1.083-1.879)]. An in-depth interview with the respective laboratory chiefs showed that quality control measures for sputum smear microscopy were used at different levels of the testing activities; however, equipment function verification as a quality control measure was not accomplished regularly in all of the study hospital laboratories. CONCLUSION: The smear positive PTB case detection rate indicated in this study is significantly lower than the countries which met the 70% target of the World Health Organization. Lack of feedback mechanisms in the External Quality Assurance schemes of sputum smear microscopy render the opportunity for improvement difficult; Serial sputum examination showed a considerable rate of positivity in the second sputum sample when compared with the others.

Clients and clinician satisfaction with laboratory services at selected government hospitals in eastern Ethiopia.

BACKGROUND: In clinical laboratory service, patients and clinical service providers are the primary focus of survey of satisfaction in many countries. The objective of the study was to assess clients' and clinicians' satisfaction with laboratory services at selected government hospitals in eastern Ethiopia from May to June, 2010. FINDINGS: A cross sectional study was conducted at Dil Chora, Jugal, Hiwot Fana and Bisidimo hospitals. Data were collected from 429 patients and 54 clinical service providers. A statistical analysis was conducted using Likert Scale and SPSS Version 16 software. Most of the patients (87.6%) were satisfied with the laboratory services. The lowest [2.48 ± 1.39] and highest [4.27 ± 0.83] rate satisfaction were on cleanness of latrine to collect specimens and availability of laboratory staff on working hours respectively. The extent of the patients' satisfaction was different among the study hospitals (P-value < 0.05). Most of the clinical services providers (80%) were also satisfied with the laboratory services. The lowest [3.02 ± 1.36] and highest [3.78 ± 1.03] rate of satisfaction were found on critical value notification and timely test results for HIV/AIDS patients care respectively. CONCLUSION: The overall degree of customers' satisfaction with laboratory services was high. But there were some services such as the cleanness of latrines, information given during specimen collection outside laboratory and critical value notification which need attention. Therefore, the hospital administrations and the laboratory departments should work harder and closely to solve the identified problems. Further study with a larger sample size and more factors is recommended.

Smear Posetive Pulmonary Tuberculosis (PTB) Prevalence Amongst Patients at Agaro Teaching Health Center, South West Ethiopia.

BACKGROUND: World Health organization (WHO) declared tuberculosis as a global emergency because it poses a serious public health threat in different countries especially, in Africa. According to WHO report of 2007, Directly Observed Treatment Short course (DOTS) coverage in Ethiopia reached 95 percent of the population; despite this fact the trend of tuberculosis in most of the districts of Ethiopia is not known. Hence, this study has revealed the trend and determined the overall prevalence of smear positive pulmonary tuberculosis in five years (2005/6-2009/10) in Agaro teaching health center, south west Ethiopia. METHODS: A retrospective study based on record review was conducted at Agaro Teaching Health center on sputum examination record of patient's from 2005/6-2009/10(five years). Socio demographic data and sputum laboratory results were collected using pre-designed questionnaire and the data was entered into a computer using SPSS version 16 for windows. Finally, cross tab analysis and Chi-square was calculated at P-value less than 0.05 to check possible association between socio-demographic variables and smear positivity. RESULTS: The overall five years prevalence of smear positive pulmonary tuberculosis was found out to be 10.9%. On the other hand, the percentage of smear positive pulmonary tuberculosis cases showed gradual decrease from 19.5% in 2005/6 to 5.8% cases in 2009/10. CONCLUSION: Tuberculosis is still the major problem of Agaro health center catchment area even though there is a decrease in trend from year to year. Hence, the respective health bureau and other stake holders should still need to strengthen their effort to control it.