Impact of Xpert MTB/RIF in the Diagnosis of Childhood Tuberculosis in Rural Ethiopia.

BACKGROUND: This study assesses the impact of the Xpert MTB/RIF in the diagnosis of childhood tuberculosis (TB) in a rural hospital in a resource-constrained setting. METHODS: Retrospective cross-sectional study in children evaluated for presumptive TB from 1 June 2016 to 31 May 2017 at the Gambo General Hospital in rural Southern Ethiopia. Children were evaluated according to a defined protocol based on national guidelines. Samples were submitted for Xpert MTB/RIF assay to the nearest reference laboratory. RESULTS: Of the 201 children assessed for presumptive TB, 46.3% (93/201) were diagnosed with TB. Of these, 49.5% (46/93) were microbiologically confirmed, mostly by Xpert MTB/RIF (only one patient was diagnosed by smear alone). The rest were clinically diagnosed. Microbiologically confirmed patients had a higher mean age, longer duration of fever and cough and lymphadenopathy more frequently than those clinically diagnosed. Gastric aspirates were Xpert MTB/RIF-positive in 18.2% of the samples (26/143); none were smear-positive (0/140). Sputum samples were Xpert MTB/RIF-positive in 27.1% (13/35) of the samples and smear-positive in 8.6% (3/35). There were no HIV-positive patients and just one case of rifampicin-resistant TB. A long delay (median 15 days) was detected in returning the results. CONCLUSION: Xpert MTB/RIF serves as an important adjunctive test for diagnosing childhood TB in rural settings, with microbiological confirmation in up to half the TB cases. Processes need to be optimized to achieve an early diagnosis. The diagnosis of childhood TB in high-burden countries such as Ethiopia still relies largely upon diagnostic algorithms and the clinician's skills.Lay summaryWorld Health Organization recommends the use of Xpert MTB/RIF to improve the microbiological diagnosis of childhood tuberculosis (TB) since 2014, but the impact of this test under real conditions in rural areas of low-income countries is not clear. We conducted a cross-sectional study in children evaluated for presumptive TB from 1 June 2016 to 31 May 2017 at the Gambo General Hospital in rural Southern Ethiopia. Children were evaluated according to a clinical protocol based on national guidelines and samples were submitted for Xpert MTB/RIF assay to the nearest reference laboratory.Of the 201 children assessed, 46.3% (93/201) were diagnosed with tuberculosis. Of these, 48.4% (45/93) were microbiologically confirmed by Xpert MTB/RIF [smear microscopy only diagnosed the 5.4% (5/93)]. Patients with microbiologically confirmed tuberculosis had a higher mean age, longer duration of fever and cough and had lymphadenopathy more frequently than those clinically diagnosed. A long delay in returning the results (median 15 days) was detected. Xpert MTB/RIF serves as an important test for diagnosing childhood TB in rural settings, with microbiological confirmation in up to half the cases. Processes need to be optimized to achieve an early diagnosis. The diagnosis of childhood TB in high-burden countries still relies largely upon diagnostic algorithms and the clinician's skills.

Sex differences and HIV status of tuberculosis in adults at a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study.

BACKGROUND: The aim of the study was to compare the epidemiology, clinical characteristics and treatment outcome of tuberculosis (TB), including HIV status, in women and men in southern rural Ethiopia. METHODS: We conducted a register-based retrospective cohort study covering the period from September 1998 to August 2015. RESULT: We included records of 2252 registered TB patients: 1080 (48%) women and 1172 (52%) men. Median age was similar for women and men: 27.5 years and 25.0 years, respectively. Median weight in women was 43.0 kg (interquartile range IQR: 38.0, 49.0), significantly lower than in men (50.0 kg, IQR 44.0, 55.0; p = 0.01). Extrapulmonary TB was significantly more common in women than in men (34.1% versus 28.7%; p=0.006). Treatment outcomes were similar in both sexes: in 70.3% of women and 68.9% of men, TB mortality was slightly lower in women than men (4.7% vs. 6.5%; p=0.08). In patients with TB, female sex was independently associated with low weight (adjusted aOR: 0.91; 95% CI 0.90, 0.92), less mortality (aOR: 0.54; 95% CI 0.36, 0.81), and lymph node TB (aOR: 1.57; 95% CI 1.13, 2.19). CONCLUSION: Lymph node TB was more common in women. Treatment outcomes were similar in both sexes, but women had a lower mortality rate.

Study of susceptibility to antibiotics and molecular characterization of high virulence Staphylococcus aureus strains isolated from a rural hospital in Ethiopia.

We characterised 80 Staphylococcus aureus strains isolated from human patients with SSTIs at a rural hospital in Ethiopia. Susceptibility to antibiotic of all strains was tested. The MLST method was used to type and a phylogenetic analysis was conducted employing the sequences of 7 housekeeping genes. PCR amplification was used to investigate the presence of the following virulence genes in all strains: hla (α-haemolysin), tstH (toxic shock syndrome toxin), luk PV (Panton-Valentine leukocidin), fnbA (fibronectin binding protein A) and mecA (methicillin resistance). Most of the strains were resistant to penicillin and ampicillin, but only 3 strains were resistant to oxacillin, and 1 of them was a true MRSA. The MLST results showed a high diversity of sequence types (ST), 55% of which were new, and ST152 was the most prevalent. A phylogeny study showed that many of the new STs were phylogenetically related to other previously described STs, but bore little relationship to the only ST from Ethiopia described in the database. Virulence gene detection showed a high prevalence of strains encoding the hla, fnbA and pvl genes (98.77%, 96.3% and 72.84%, respectively), a low prevalence of the tst gene (13.58%) and a markedly low prevalence of MRSA (1.25%). S. aureus strains isolated from patients in a rural area in Ethiopia showed low levels of antibiotic resistance, except to penicillin. Moreover, this study reveals new STs in Eastern Africa that are phylogenetically related to other previously described STs, and confirm the high prevalence of the pvl gene and the low prevalence of MRSA on the continent.

Comparing tuberculosis in children aged under 5 versus 5 to 14 years old in a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study.

BACKGROUND: There are few data available about childhood tuberculosis (TB) in rural hospitals in low-income countries. We assessed differences in epidemiological characteristics and treatment outcomes in children with TB aged 0-4 versus 5-14 years in rural Ethiopia. METHODS: For this retrospective cross-sectional study, we analyzed childhood TB registers from a rural Ethiopian hospital. We collected data on the number of cases, type of TB, and treatment outcomes using standard definitions. By means of binary and logistic regression analyses, data were compared from 1998 to 2015 in children aged under 5 versus those aged 5-14 years. RESULTS: We included 1282 TB patients: 583 (45.5%) were under 5 years old, and 699 (54.5%) were aged 5-14 years. More than half (67.2%, n = 862) had pulmonary TB (PTB), which was more common in younger children (82.5%, 481/583) than in older ones (54.5%, 381/699; p < 0.001). Most cases of PTB (87.5%, 754/862) were smear negative, including virtually all (99.6%, 479/481) younger children and most older ones (72.2%, n = 275/381; p < 0.001). The most common types of extrapulmonary TB (EPTB) were TB adenitis (54.5%, 229/420) and bone TB (20%, 84/420). Children under five showed a lower prevalence of adenitis TB (9.9% [58/583] versus 24.5% [171/699], p < 0.001), bone TB (2.9% [17/583] versus 9.6% [69/699], p < 0.001), and abdominal TB (0.9% [5/583] versus 6.3% [44/699], p < 0.001). Most diagnoses were new cases of TB (98.2%, 1259/1282). Overall, 63.5% (n = 814) of the children successfully completed treatment (< 5 years: 56.6%, 330/583; 5-14 years: 69.2%, 489/699; p < 0.001). In total, 16.3% (n = 209) transferred to another center (< 5 years: 19.4%, 113/583; 5-14 years: 13.7%, 96/699; p = 0.006). Thirteen percent of patients (n = 167) were lost to follow-up (< 5 years: 16.0%, 93/583; 5-14 years: 10.4%, 74/699; p = 0.004). Fifty-two (4.1%) children died (no age differences). Being aged 5-14 years was independently associated with successful treatment outcomes (adjusted odds ratio 1.59; 95% confidence interval: 1.16, 1.94, p = 0.002). CONCLUSIONS: We observed a very low diagnostic yield for spontaneous sputum smear in children with TB. In this rural setting in Ethiopia, very young children tend to present with new cases of smear-negative PTB. They have less EPTB than older children but more TB meningitis and show lower rates of treatment success.

Epidemiological and Clinical Characteristics of Children and Adolescents with Leprosy Admitted Over 16 Years at a Rural Hospital in Ethiopia: A Retrospective Analysis.

AIM: To analyse differences in children and adolescents aged ≤18 years admitted to the leprosy ward in a rural Ethiopian hospital >16 years. METHODS: We retrospectively collected data from leprosy admission registry books on patients with leprosy who were admitted to a referral hospital from September 2000 to September 2016. RESULTS: There were 2129 admissions for leprosy during the study period: 180 (8.4%) patients were s ≤ 18 years old. Of these, 98 (54.4%) were male and 82 (45.6%) were female. The proportion of new diagnoses in children and adolescents was 31.7%, significantly higher than in adults (11.7%; p < 0.001). There were also significant differences in the prevalence of lepromatous ulcers (46.9 vs. 61.7%), leprosy reaction (29.4 vs. 13.0%) and neuritis (16.9 vs.5.3%) between these age groups. CONCLUSIONS: There were more new diagnoses, leprosy reactions and neuritis, and fewer lepromatous ulcers, in children and adolescents compared with adults, with younger patients being referred more frequently to reference centres.

Diagnosis of cutaneous anthrax in resource-poor settings in West Arsi Province, Ethiopia.

INTRODUCTION: Cutaneous anthrax is a zoonotic disease caused by the spore-forming bacterium Bacillus anthracis, which typically presents with ulcers after contact with animals or animal products, and is rarely seen in high-income countries but is common in those with low- and middle-incomes. Objective. The aim of this study is to show the main clinical characteristics of cutaneous anthrax in endemic areas. MATERIAL AND METHODS: The study describes the main clinical characteristics of cutaneous anthrax in eight patients (six female and two male, age range 1 - 56 years) admitted to the rural General Hospital of Gambo, West Arsi Province of Ethiopia from 2010-2013. RESULTS: In all cases, lesions began as an erythematous papule located on exposed sites (n=7 head; n=1 thigh) and subsequently became a necrotic black eschar surrounded by an edematous halo. Two patients presented with painful ipsilateral adenopathy near the black eschar. Four patients developed a malignant pustule on the suborbital region of the face. Patients responded positively to treatment, and the lesions resolved, leaving eschars. However, one patient suffered the loss of an eyeball, and another died 12 hours after starting treatment. CONCLUSIONS: Physicians working in rural areas of resource-poor settings should be trained in the clinical identification of cutaneous anthrax. Early antibiotic treatment is essential for decreasing morbidity and mortality.

Malaria and severe anemia over eight years at Gambo Rural Hospital, southern Ethiopia.

Evolution of incident malaria and frequency of anemia were analyzed over eight years in a rural hospital in southern Ethiopia. Capillary blood samples were tested for hemoglobin concentration, and in some instances for malaria parasites, at Gambo Rural General Hospital between January 2007 and September 2014, and the results recorded. Main demographic data were also recorded in subjects with Plasmodium sp. infections. Of a total of 54,493 blood samples taken from 45,096 different patients, 21,723 (39.9%) samples from 19,173 (42.5%) patients were tested for malaria parasites. Malaria was diagnosed in 825 (3.79%, 95% CI 3.55%, 4.06%) instances (58.3% P. vivax and 41.7% P. falciparum; one episode in 575 patients and two episodes in 125 patients). A sustained decrease in yearly incidence of malaria was observed between 2011 (6.1%) and 2014 (2.4%) (p < 0.01). Of all the malaria patients, those with hemoglobin levels less than 8 g/dL, were younger compared to those with levels of 8 g/dL or more (median age of 5 years vs. 18 years; p < 0.01) and more commonly infected with P. falciparum (57.1% vs. 34.8%; p < 0.001). In multivariate analysis, severe anemia (hemoglobin <8 g/dL) in the context of anemia was associated with P falciparum infection (adjusted odd ratio [OR] 2.48, 95% confidence interval [CI] 1.68, 3.65) and younger age (OR 1.06, 95% CI 1.04, 1.07).

EPIDEMIOLOGY OF ROTAVIRUS DIARRHEA AMONG CHILDREN AGED LESS THAN 5 YEARS IN RURAL SOUTHERN ETHIOPIA.

The objective of this study was to determine the epidemiological and clinical features of rotavirus infection among children aged less than 5 years in rural southern Ethiopia. We conducted a hospital-based, prospective study among children aged less than 5 years with acute diarrhea and moderate to severe dehydration attending the outpatient department of Gambo Rural Hospital, Ethiopia during September-November 2012. Three hundred fourteen children were included in the study, of whom 137 (43.6%) had rotavirus infection. The average age of children with rotavirus infection was lower than those without it [odds ratio (OR): 0.94]. Finding severe dehydration on skin pinch test (adjusted OR: 3.76) and having diarrhea for !3 days (adjusted OR: 2.50) were associated with rotavirus infection. The mortality rate was 4.4% among rotavirus infection children and 0% among non-rotavirus diarrhea cases (p=0.006). Rotavirus infection should be suspected in children with severe dehydration on a skin pinch test and among those presenting with diarrhea for 3 days in rural southern Ethiopia.

Detection and molecular characterisation of Giardia duodenalis, Cryptosporidium spp. and Entamoeba spp. among patients with gastrointestinal symptoms in Gambo Hospital, Oromia Region, southern Ethiopia.

OBJECTIVES: To assess the prevalence and genetic diversity of the enteric protozoa species G. duodenalis, Cryptosporidium spp. and Entamoeba histolytica in individuals with gastrointestinal symptoms compatible with infections by these pathogens seeking medical attention in a rural area in southern Ethiopia. METHODS: A total of 92 stool samples were initially screened by direct microscopy and immunochromatography and further confirmed by molecular methods. G. duodenalis-positive samples were molecularly characterised by multilocus genotyping of the glutamate dehydrogenase and ß-giardin genes of the parasite. PCR and DNA sequence analysis of the gene encoding the 60-kDa glycoprotein was used for the subtyping of Cryptosporidium isolates. Detection and differential diagnosis of E. histolytica/dispar were conducted by real-time PCR. RESULTS: PCR-based prevalences were 10.9% for G. duodenalis, 1.1% for Cryptosporidium spp. and 3.3% for Entamoeba spp. Seven (four novel and three known) subtypes of G. duodenalis assemblage B were identified at the GDH locus and 5 (one novel and four known) at the BG locus. A novel variant of C. hominis subtype IbA9G3 was also identified. Two Entamoeba isolates were assigned to E. dispar and an additional one to E. histolytica. CONCLUSION: Although preliminary, our results strongly suggest that giardiasis, cryptosporidiosis and amoebiasis represent a significant burden in Ethiopian rural population.

Epidemiology of animal bites and other potential rabies exposures and anti-rabies vaccine utilization in a rural area in Southern Ethiopia.

The presented report describes the epidemiology of potential rabies exposures and examines the utilization of anti-rabies vaccine in a rural area of Ethiopia during a period of 43 months. A total of 683 persons (51.1% females, 73% children) with animal- related bites were included in the retrospective, registry-based study. The most common site of exposure was the leg (66.8%). In children under 8 years of age the face was more often involved than in adults (9.5% vs. 4.8%; p=0.03). The main type of exposure was a bite with bleeding (66.3%) followed by contamination of mucous membranes with saliva (19.7%). The primary sources were dogs (93.4%) followed by cats (2.6%). Children under 15 years were more likely to be exposed to dogs (94.9%) than adults (88.7%) (p=0.01). The most common way of coming in contact with animals was 'walking by' (83.9%). Children came in contact with animals while 'playing with' (10.7%) more often than adults (1.1%) (p<0.001). All the patients received an anti-rabies nervous-tissue vaccine, 99% of whom completed the vaccination course. Animal bites continue to be a problem in rural Ethiopia, mainly among children. Efforts to protect children against animal bites must be of paramount importance in preventing rabies in this population.

The burden of leprosy in children and adolescents in rural southern Ethiopia.

BACKGROUND: Childhood leprosy has an important bearing on the epidemiology of disease and reflects the level of control in a community. There is limited information about this disease in rural Ethiopia. SUBJECTS AND METHODS: Data were collected retrospectively from leprosy patient records and treatment cards in a rural mission hospital in southern Ethiopia from 1999 to 2011. RESULTS: Over the 13-year period, 298 patients with leprosy were registered for treatment. Of these, 22 (7.4%) were children (under 15 years) and 66 (21.1%) were adolescents (from 15 to 18 years). The male:female ratio was 2.6:1 in children and 1.7:1 in adolescents. Slit skin examination was positive in eight of 15 (36.4%) child patients and in 26 of 53 (41.3%) adolescents. Multibacillary leprosy was the most common type in both age groups, encountered in 95.5% of children and in 84.1% of adolescents. Six (27.3%) children and 18 (28.6%) adolescents had deformities of the hand, feet or eyes (WHO grade II), detected either at the time of diagnosis or during follow-up. Sixty-one per cent of children were transferred to their health institutions for treatment and follow-up; seven children (38.9%) completed the treatment and one (5.9%) defaulted while on therapy. Of 63 adolescent patients, 31 (49.2%) completed the recommended therapy, 28 (44.4%) were transferred out, and four (6.3%) defaulted on therapy. CONCLUSION: Childhood leprosy continues to be a common problem in rural southern Ethiopia. Multibacillary disease and disabilities remain common in children. Early detection and treatment of cases including the study of contacts should reduce the burden of leprosy in the community.

Management and transference of patients diagnosed with tuberculosis in a rural hospital in Southern Ethiopia.

Treatment of new tuberculosis (TB) cases in Directly Observed Treatment Short Course (DOTS) programmes is believed to be the most valuable strategy for TB control. The aim of this study is to describe the experience of diagnosed cases of TB in a district hospital situated in a rural zone of Ethiopia and of "transferred out" TB cases from the hospital to their local health facilities using the DOTS programme spanning a period of 8years. Data collection was obtained by using a TB register book in a rural district hospital from 2004 to 2011. The collected information included the type of TB, age, HIV status, and treatment outcomes using standardized definitions; 6459 patients with all forms of TB were diagnosed. Twenty-eight percent were smear-positive pulmonary TB (PTB) cases, 28.97% were smear-negative PTB cases, and 42.8% were extra-pulmonary TB (EPTB). The global "transferred out" rate was 78.5% (5073/6459); the "transferred out" rate after diagnosis at hospital and before starting DOTS was 72.6% (4689/6459), and after finishing the intensive phase and admission was 21.8% (385/1770). The proportion of total cases "transferred out" in smear-negative PTB cases (70.2%) was less than smear-positive PTB cases (79.2%) (odd ratio [OR]: 0.81; 95% confidence interval [CI]: 0.76-0.87) and was higher in EPTB cases (83.3%) (OR: 1.15; 95% CI: 1.05-1.19). The percentage of "transferred out" after hospital admission was higher in HIV-positive cases (16.8%) than in HIV-negative cases (8.5%) (OR: 2.13; 95% CI: 1.28-3.53). In conclusion, district hospitals are still important facilities for the diagnosis of TB cases, particularly EPTB.

Screening for tuberculosis in family and household contacts in a rural area in Ethiopia over a 20-month period.

The purpose of this study is to describe the experience of the completion of the Tuberculosis (TB) Contact Screening Logbook (TB-CSL). The TB-CSL was retrospectively analyzed from July 2007 until June 2012. During the study period, 122 patients were included in the TB-CSL; however, 17 (13.9%) patients with TB were written in the TB-CSL, but without registering any contacts. Of the 105 TB patients with contacts registered, the family and household contacts were finally performed in 68 index TB patients (55.7% of TB patients). These 68 index TB cases had 299 family and household contacts; the median contact per patient was 4.4 (±1.9). Of the 299 contacts, 160 (53.5%) were screened. The median of those screened per patient was 2.3 (±1.9). Of the 160 family and household contacts screened, 34 (31.3%) of them were children ⩽5years of age. TB was diagnosed after screening in 16 (10.1%) contacts. Isoniazid preventive therapy was prescribed in 22 of 34 (64%) children <5years of age. Alternative methods should be implemented in rural areas to improve TB screening contacts, especially in children under 5years of age.

Mammary, testicular and adnexal tuberculosis diagnosed by histology in a rural hospital in Southern Ethiopia.

This study describes the experience of mammary, testicle and adnexal tuberculosis (TB) diagnosed by histological characteristics in a rural district hospital in Southern Ethiopia over a period of 7years. During the same period, a total of 5589 TB cases were diagnosed. Fourteen cases of breast TB with a prevalence of 0.25% (95% confidence interval [CI]: 0.14-0.43), 8 cases of testicular TB (prevalence 0.14, [95% CI: 0.06-0.29]) and two ovarian TB (prevalence: 0.035 [95% CI: 0.001-0.15]). The breast, testes and adnexal TB may mimic other conditions. Proper diagnosis is encouraged because the disease is curable with anti-TB drugs.

Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: a ten-year retrospective study.

BACKGROUND: Many DOTS experiences in developing countries have been reported. However, experience in a rural hospital and information on the differences between children and adults are limited. We described the epidemiology and treatment outcome of adult and childhood tuberculosis (TB) cases, and identified risk factors associated with defaulting and dying during TB treatment in a rural hospital over a 10-year period (1998 to 2007). METHODS: Retrospective data collection using TB registers and treatment cards in a rural private mission hospital. Information was collected on number of cases, type of TB and treatment outcomes using standardised definitions. RESULTS: 2225 patients were registered, 46.3% of whom were children. A total of 646 patients had smear-positive pulmonary TB (PTB), [132 (20.4%) children]; 816 had smear-negative PTB [556 (68.2%) children], and 763 extra-PTB (EPTB) [341 (44.8%) children]. The percentage of treatment defaulters was higher in paediatric (13.9%) than in adult patients (9.3%) (p = 0.001). The default rate declined from 16.8% to 3.5%, and was independently positively associated with TB meningitis (AOR: 2.8; 95% CI: 1.2-6.6) and negatively associated with smear-positive PTB (AOR: 0.6; 95% CI: 0.4-0.8). The mortality rate was 5.3% and the greatest mortality was associated with adult TB (AOR: 1.7; 95% CI: 1.1-2.5), TB meningitis (AOR: 3.6; 95% CI:1.2-10.9), and HIV infection (AOR: 4.3; 95% CI: 1.9-9.4). Decreased mortality was associated with TB lymphadenitis (AOR: 0.24; 95% CI: 0.11-0.57). CONCLUSION: (1) The registration of TB cases can be useful to understand the epidemiology of TB in local health facilities. (2) The defaulter and mortality rate of childhood TB is different to that of adult TB. (3) The rate of defaulting from treatment has declined over time.

Louse-borne relapsing fever in Ethiopian children: experience of a rural hospital.

We describe the epidemiological and clinical aspects of louse-borne relapsing fever (LBRF) in a series of children attending in a rural hospital in Ethiopia during 1997-2007. From a total of 249 cases of LBRF, 154 (61.4%) were children (<15 years). The most frequent symptoms were: fever, headache, dizziness and musculoskeletal pains. The overall case fatality rate was 2.4 (10% for patients <1.1 years; 3.4% for 1.1 to 4.0 years; and 0% >4.0 years [P = 0.05]). The mortality in children was less than in adults (13.2%) (P = 0.003).

Seroprevalence of human immunodeficiency virus among blood donors in a rural Ethiopian hospital.

We describe our experience of the HIV seroprevalence among blood donors in a rural general hospital in Ethiopia during an eight-year period (January 1998-December 2006). From 3305 blood donors screened, 51 (1.4%) were positive for HIV antibodies.

Tetanus in a rural Ethiopian hospital.

Despite the widespread availability of a safe and effective vaccine, tetanus continues to be a significant public health problem in the developing countries.

Surgical lymph node biopsies in a rural Ethiopian hospital: histopathologic diagnoses and clinical characteristics.

OBJECTIVE: To assess the clinical features and histological diagnoses of patients with lymphadenopathy in a rural general hospital. BACKGROUND: Gambo Rural General Hospital, located between the Arsi and East Shoa regions, 250 km south of Addis Ababa (Ethiopia), and the Department of Pathology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia for the pathology examination carried out between December 2003 and July 2005. METHOD: Retrospective cross-sectional survey. RESULTS: 308 patients with enlarged superficial lymph nodes with surgical lymph node excision. The most common diagnoses were tuberculosis lymphadenitis (TB-L) (74.4%), followed by non-specific reactive lymphadenitis (10.2%), malignant secondary lymphadenopathy (7.5%), and lymphomas (7.1%). In the multivariate analysis, TB-L was significantly associated with previous antibiotic treatment for more than 20 days (adjusted odds ratio (aOR): 3.70; 95% CI: 1.43-9.59) (p = 0.007), and female sex (OR: 2.07; 95% CI: 1.09-3.9). Non-specific reactive lymphadenitis was significantly associated with paediatric cases (aOR: 4.42; 95% CI: 1.78-10.87) (p = 0.001). CONCLUSION: These results show that tuberculosis is a major problem in this area.