Abstract Bovine tuberculosis (bTB) is endemic and has a substantial impact on the livestock sector in Ethiopia and other low and middle-income countries (LMICs). With a national emphasis on dairy ...farm intensification to boost milk production and spur economic growth, the incidence of bTB is anticipated to rise. However, Ethiopia, like other LMICs, lacks a comprehensive national bTB control strategy due to the economic and social infeasibility of traditional test-and-cull (TC) approaches. To inform the development of such a strategy, we evaluated the effectiveness and feasibility of TC and test-and-segregation (TSg) strategies for bTB control on Ethiopian dairy farms. A TC approach was used at Farm A N = 62; comparative cervical test (CCT) > 4 mm, starting prevalence 11.3% while TSg was implemented at Farm B (N = 45; CCT > 4 mm, prevalence 22.2%), with testing intervals of 2–4 months. Both strategies achieved a reduction in bTB prevalence to 0%, requiring seven rounds of TC over 18 months at Farm A, and five rounds of TSg over 12 months at Farm B’s negative herd. The results show that adopting more sensitive thresholds CCT > 0 mm or single cervical test (SCT) > 2 mm during later rounds was pivotal in identifying and managing previously undetected infections, emphasizing the critical need for optimized diagnostic thresholds. Cost analysis revealed that TC was approximately twice as expensive as TSg, primarily due to testing, labor, and cow losses in TC, versus construction of new facilities and additional labor for TSg. This underscores the economic and logistical challenges of bTB management in resource-limited settings. Taken together, our study highlights an urgent need for the exploration of alternative approaches including TSg and or vaccination to mitigate within herd transmission and enable implementation of bTB control in regions where TC is not feasible.
Tuberculosis (TB) is the leading cause of mortality among infectious diseases worldwide. Ninty five percent of TB cases and 98% of deaths due to TB occur in developing countries. Globally, the ...mortality rate has declined with the introduction of effective anti TB chemotherapy. Nevertheless, some patients with active TB still die while on treatment for their disease. In Ethiopia, little is known on survival and risk factors for mortality among a cohort of TB patients. The objective of the study is to determine the magnitude and identify risk factors associated with time to death among TB patients treated under DOTS programme in Addis Ababa, Ethiopia.
This is a retrospective cohort study. Data was obtained by assessing medical records of TB patients registered from June 2004 to July 2009 G.C and treated under the DOTS strategy in three randomly selected health centers. A step-wise multivariable Cox's regression model and Kaplan- Meier curves were used to model the outcome of interest. Mortality was used as an outcome measure. Person-years of observation (PYO) were calculated from the date of starting anti-TB treatment to date of outcome and was calculated as the number of deaths/100 PYO. Statistical analysis SPSS version 16 was used for data analysis and results were reported significant whenever P-value was less than 5%.
From a total of 6,450 registered TB patients 236(3.7%) were died. More than 75% death occurred within eight month of treatment initiation. The mean and median times of survival starting from the date of treatment initiation were 7.2 and 7.9 months, respectively. Comparison of survival curves using Kaplan Meier curves method with log-rank test showed that the survival status was significantly different between patient categories as well as across treatment centers (P < 0.05). The death rate of pulmonary positive, pulmonary negative and extra pulmonary TB patients were 2.7%, 3.6%, and 4.3%, respectively. Body weight at initiation of anti-TB treatment (<35 kg), patient category, year of enrollment and treatment center were independent predictors for time to death.
Most of the patients were died at the end of treatment period. This underlines the need for devising a mechanism of standardizing the existing DOTS programme and nutritional support for underweight patients for better clinical and treatment outcome.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The survival rate of human immunodeficiency virus (HIV)-infected patients receiving treatment in Ethiopia is poorly understood. This study aimed to determine the survival rate and predictors of ...mortality among HIV-infected adults on antiretroviral therapy (ART) at Jinka Hospital, South Omo, Ethiopia.
A 6-year retrospective cohort study was conducted using 350 patient records drawn from 1,899 patients on ART at Jinka Hospital from September 2010 to August 2015. The data were analyzed using Kaplan-Meier statistics and Cox regression models.
Of the 350 study participants, 315 (90.0%) were censored and 35 (10.0%) died. Twenty-two (62.9%) of the deaths occurred during the first year of treatment. The total follow-up encompassed 1,995 person-years, with an incidence rate of 1.75 deaths per 100 person-years. The mean survival time of patients on highly active antiretroviral therapy (HAART) was 30.84±19.57 months. The overall survival of patients on HAART was 64.00% (95% confidence interval CI, 61.85 to 66.21%) at 72 months of follow-up. The significant predictors of mortality included non-disclosure of HIV status (adjusted hazard ratio aHR, 5.82; 95% CI, 1.91 to 17.72), a history of tuberculosis (aHR, 1.82; 95% CI, 1.41 to 3.51), and ambulatory (aHR, 2.97; 95% CI, 1.20 to 8.86) or bedridden (aHR, 4.67; 95% CI, 1.30 to 17.27) functional status, World Health Organization (WHO) clinical stage IV illness (aHR, 24.97; 95% CI, 2.75 to 26.45), and substance abusers (aHR, 3.72; 95% CI, 1.39 to 9.97).
Patients with a history of tuberculosis treatment, ambulatory or bedridden functional status, or advanced WHO clinical stage disease, as well substance abusers, should be carefully monitored, particularly in the first few months after initiating antiretroviral therapy. Patients should also be encouraged to disclose their status to their relatives.
Avian tuberculosis is a growing public health concern and a significant impediment to socioeconomic development, especially in developing countries, where the risk of infection is high. The disease ...is predominantly caused by Mycobacterium avium belonging to serotypes 1, 2, 3, and 6 (genotypes IS901 and IS1245) and Mycobacterium genavense. It mostly occurs in older birds and immunocompromised individuals due to the greater opportunity for infection with age and host immunity. A cross-sectional study anticipated to generate epidemiological information on avian tuberculosis was carried out from November 2016 to June 2017 at highland areas of Gerar Jarso, Ada’a (midland), and Boset (lowland) districts of Oromia region, Ethiopia. Two hundred seventy-three village chickens comprising local breeds, exotic breeds, and crossbreeds of both sexes were used in the study. Single intradermal avian tuberculin test, postmortem inspection of positive reactors, mycobacteriological culturing, and histopathological examination were used to assess information on the epidemiology of the disease. Subsequently, avian tuberculin test revealed an overall apparent prevalence of 11.4% (31/273) and a specific prevalence of 6.8% (6/88) in the highland, 13.4% (13/97) in the midland, and 13.6% (12/88) in the lowland study districts. Besides, it signified a higher odd of exposure in crossbreeds and females as compared to locals and males. In addition, greater odd of exposure was observed in chickens at mid- and low altitudes as compared to those at the highland. Moreover, 40.9% (9/22) of positive reactor chickens sacrificed for necropsy showed gross pathological lesions. Similarly, histopathological examination revealed a granuloma characterized by central necrosis and peripheral mononuclear lymphocytes. Nevertheless, only 0.02% (2/120) of the cultured tissues had shown colonial growth up to 12 weeks of incubation, and both were seen on sodium pyruvate-enriched Lowenstein–Jensen medium slants. Generally, the study revealed an overall increment of the apparent prevalence of avian tuberculosis with decreasing altitude. Besides, it signified a relative breed and sex variation in the risk of acquiring the disease, with crossbreeds and female chickens having higher odds of exposure.
Abstract
Background
The prevalence of diabetes mellitus (DM) is increasing globally and its comorbidity with tuberculosis (TB) is re-emerging, especially in low- and middle-income countries.
...Objective
The main aim of this study is to determine the prevalence of DM and HIV infection and their associated risk factors among active tuberculosis patients in Northwest Ethiopia.
Methods
This hospital-based cross-sectional study was conducted between February 1st and June 30th, 2017 among active TB patients in two hospitals of Northwest Ethiopia. Two hundred and sixty-seven active TB cases aged 18 years or older were screened for diabetes using fasting blood glucose (FBG) test. Semi-structured questionnaires were used to collect demographic data, lifestyle habits and clinical data. Identification of pre-diabetes or diabetes in TB patients was achieved according to American Diabetes Association guidelines (2016).
Results
Prevalence of DM and TB comorbidity was 11.5% (95% confidence interval, CI 7.8–15.2) compared to 24.9% (95% CI 20.1–30.1) for pre-diabetes. Prevalence of HIV/TB co-infection was 21.9% (95% CI 16.7–26.8). Risk of DM was higher in TB patients from a rural location (adjusted odds ratio, aOR 3.13, 95% CI 1.02–9.62,
p
= 0.046). Similarly, DM was higher in TB patients who have a family history of DM (aOR 4.54, 95% CI 1.31–15.68,
p
= 0.017). Furthermore, HIV/TB co-infection was identified as a predictor of DM comorbidity in active TB patients (aOR 5.11, 95% CI 2.01–12.98,
p
= 0.001).
Conclusion
The magnitude of DM and pre-diabetes in active TB patients in Northwest Ethiopia was high, warranting collaborative efforts to improve screening and adopt better clinical management strategies for DM–TB comorbid patients. Furthermore, being rural residents, family history of DM and HIV/TB co-infection were found to associate with DM among TB patients, highlighting the importance of the above-mentioned risk factors in the clinical management of this comorbidity.
The impact of tuberculosis (TB) is exacerbated in Africa because of the human immunodeficiency virus (HIV) pandemic. Pulmonary tuberculosis (PTB) diagnosis is difficult in HIV-infected patients and ...negative sputum results are more common which leads to diagnostic delay and increases morbidity and mortality. Extra-pulmonary samples such as stool may be easier to obtain and our approach may therefore significantly improve PTB detection in people living with HIV.
To detect Mycobacterium tuberculosis from the stool of HIV sero-positive individuals suspected of pulmonary TB.
A total of 117 HIV-infected individuals from three public health facilities in Addis Ababa, Ethiopia were enrolled consecutively in the study. Paired morning sputum and stool samples were simultaneously collected from anti-retroviral therapy (ART) naïve individuals living with HIV and suspected for PTB. The diagnostic accuracy of the smear microscopy, culture and region of difference (RD)9-based polymerase chain reaction (PCR) in stool was compared with the accuracy of sputum testing. Chi-square test and kappa value were used to compare different method used.
Sputum culture positivity for mycobacteria was confirmed in 33(28.2%) of the study subjects. Of 33 individuals positive for sputa culture, 10 individuals were observed to be stools culture positive. Of the 84 individuals negative for mycobacteria by sputum culture, three (3.6%) were stool culture positive and thus, the sensitivity and agreement between stool culture as compare to sputum culture were 30.3% and 0.33, respectively. Of 117 individuals, 11(9.4%) were sputum smear positive and of 11 sputum smear positive three were also stool smear positive. While of the 106 sputum smear negative individuals', only one was stool smear positive resulting in 12.1% sensitivity and 0.18 agreements against sputum culture. On the other hand, the sensitivity of RD9-based PCR directly on stool was 69.7% by considering sputum culture as a reference standard. Moreover, RD9-based PCR directly on sputum detected 7(6.0%) individuals who were sputum culture negative for M. tuberculosis.
M. tuberculosis was detected in stool of individuals living with HIV who were negative for sputum smear microscopy and culture. Hence, examination of stool samples alongside with sputum samples increases the detection of PTB in individuals living with HIV.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Tuberculosis (TB) is a leading cause of morbidity and mortality in Ethiopia. Investigation of the
complex (MTBC) species circulating in the Ethiopian population would contribute to the efforts made ...to control TB in the country. Therefore, this study was conducted to investigate the MTBC species and spoligo patterns in the Oromia region (central) of Ethiopia.
A cross-sectional study design was used to recruit 450 smear positive pulmonary TB (PTB) cases from the Oromia region between September 2017 and August 2018. Mycobacteria were isolated from sputum samples on the Lowenstein Jensen (LJ) medium. Molecular identification of the isolates was performed by spoligotyping. The results of spoligotyping were transferred into a query box in the SITVIT2 database and Run TB-Lineage in the TB Insight website for the identification of spoligo international type (SIT) number and linages of the isolates, respectively. Statistical Product and Service Solutions (SPSS) 20 was applied for statistical analysis.
Three hundred and fifteen isolates were grouped under 181 different spoligotype patterns. The most dominantly isolated spoligotype pattern was SIT149 and it consisted of 23 isolates. The majority of the isolates were grouped under Euro-American (EA), East-African-Indian (EAI), and Indo-Oceanic (IO) lineages. These lineages consisted of 79.4, 9.8, and 9.8% of the isolates, respectively. One hundred and sixty-five of the isolates were classified under 31 clustered spoligotypes whereas the remaining 150 were singleton types. Furthermore, 91.1% of the total isolates were classified as orphan types. Clustering of spoligotypes was associated (
< 0.001) with EAI lineage.
SIT149 and EA lineage were predominantly isolated from the Oromia region substantiating the findings of the similar studies conducted in other regions of Ethiopia. The observation of significant number of singleton and orphan spoligotypes warrants for additional genetic typing of the isolates using method(s) with a better discriminatory power than spoligotyping.
Information on tuberculosis (TB) treatment outcomes would be useful for the improvement of the TB control program. The aim of the present study was to evaluate treatment outcomes of TB and identify ...associated factors in TB patients at the Jinka General Hospital (JGH), remote Zone of Ethiopia.
The result showed that 13.1% (154/1172) of the cases were cured, 60.9% treatment completed, 10.2% died and 9.1% were lost to follow-up. Thus, the overall treatment success rate was 74%. Male patients AOR = 0.70 (0.52-0.93) and HIV co-infected patients AOR = 0.67 (0.45-0.98) were associated with unsuccessful treatment outcomes.
An estimated 17% of all tuberculosis cases in Ethiopia are caused by Mycobacterium bovis. We used M. tuberculosis complex isolates to identify the prevalence of M. bovis as the cause of pulmonary ...tuberculosis. Our findings indicate that the proportion of pulmonary tuberculosis due to M. bovis is small (0.12%).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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