Takele Tadesse

Two-thirds of smear-positive tuberculosis cases in the community were undiagnosed in Northwest Ethiopia: population based cross-sectional study.

Background Tuberculosis (TB) case detection rate remains low in Ethiopia. One of the underlying reasons is the emphasis on passive case finding strategy which may seriously underestimate the burden of the disease. Estimating the prevalence of smear-positive pulmonary TB through active case finding at population level can help assessing the degree to which passive case detection is successful. Methods and findings This is population based cross-sectional study. The study population was all individuals aged ≥14 years. Interviews using a uniform questionnaire were done initially to identify individuals with chronic cough (≥15 days) and the two sputum (spot and morning) samples were gathered for standard smear microscopy. A total of 23,590 individuals aged ≥14 years were interviewed and 984 had a chronic cough for ≥15 days. Of 831 individuals who provided two sputum samples for acid fast bacilli (AFB), 41 had positive smears. A total of 22 smear-positive TB cases detected through passive case finding were on anti-TB treatment. The prevalence of new smear-positive TB was 174 per 100,000 in persons aged ≥14 years (95% CI: 121–227).The ratio of active to passive case finding was 2∶1. Higher rates of smear-positivity were observed among females [AOR: 3.28, 95% CI (1.54–6.77)], and in the age group ≥45 years [AOR: 2.26, 95% CI (1.12–4.59). Conclusions The study revealed that about two-thirds of patients with active TB remain undiagnosed and thus untreated. This may indicate the need for strengthening case detection at the community level. Furthermore, the high burden of TB among females and in the age group ≥45 years warrants appropriate measures to control the disease.

Long distance travelling and financial burdens discourage tuberculosis DOTs treatment initiation and compliance in Ethiopia: a qualitative study.

BackgroundTimely tuberculosis treatment initiation and compliance are the two key factors for a successful tuberculosis control program. However, studies to understand patents’ perspective on tuberculosis treatment initiation and compliance have been limited in Ethiopia. The aim of this study is to attempt to do that in rural Ethiopia.MethodsThis qualitative, phenomenological study conducted 26 in-depth interviews with tuberculosis patients. A thematic content analysis of the interviews was performed using the Open Code software version 3.1.ResultsWe found that lack of geographic access to health facilities, financial burdens, use of traditional healing systems and delay in diagnosis by health care providers were the main reasons for not initiating tuberculosis treatment timely. Lack of geographic access to health facilities, financial burdens, quality of health services provided and social support were also identified as the main reasons for failing to fully comply with tuberculosis treatments.ConclusionsThis study highlighted complexities surrounding tuberculosis control efforts in Dabat District. Challenges of geographic access to health care facilities and financial burdens were factors that most influenced timely tuberculosis treatment initiation and compliance. Decentralization of tuberculosis diagnosis and treatment services to peripheral health facilities, including health posts is of vital importance to make progress toward achieving tuberculosis control targets in Ethiopia.

Epidemiology of needlestick injuries among health-care workers in Awassa City, Southern Ethiopia.

Accidental needlestick injuries sustained by health-care workers are a common occupational hazard and a public health issue in health-care settings. An analytical cross-sectional study was conducted and 30.9% of health-care workers had experienced at least one needlestick injury in the previous year.

Determinants of Occupational Injury: A Case Control Study among Textile Factory Workers in Amhara Regional State, Ethiopia.

Background. Occupational injuries pose major public health and socioeconomic developmental problems. However, efforts towards investigation of determinants among factory workers are very minimal in developing countries. Thus, this study aimed at to identify determinants of occupational injury among textile factory workers in Amahara regional state in Ethiopia. Methods. A case control study was done among 456 textile factory workers (152 cases and 304 controls). Self-reported data from workers and document review from factories clinics were used to ascertain occupational injury status within one-year period. Data was collected using pretested and structured questionnaire by trained data collectors. Odds ratio with 95% confidence interval was used to assess level significance. Results. Young age (<30 years) (AOR 1.90, 95% CI (1.22, 2.94)), male gender (AOR 2.54, 95% CI (1.58, 4.07)), health and safety training (AOR 1.85, 95% CI (1.17, 2.91)), sleeping disturbance (AOR 1.99, 95% CI (1.30, 3.04)), and job stress (AOR 2.25, 95% CI (1.15, 4.41)) were significant predictors of occupation injury. Conclusion. Lack of training, sleeping disturbance, and job stress increased the risk of occupational injury. So, providing basic health and safety training with special emphasis on younger and male workers, reducing stressors, and providing sleep health education were recommended.

Prevalence of malnutrition and associated risk factors among adult visceral leishmaniasis patients in Northwest Ethiopia: a cross sectional study.

BackgroundVisceral leishmaniasis (VL) causes considerable morbidity and mortality in Ethiopia. Data on the prevalence and associated risk factors on malnutrition among VL patients in Ethiopia are scarce. This study aimed to assess the prevalence of malnutrition and its associated risk factor among VL patients in Northwest Ethiopia.MethodsAn institution-based cross-sectional study was conducted from June to September 2012 at four leishmaniasis treatment sites in Northwest Ethiopia. Four hundred and three adult VL patients were enrolled in the study. Malnutrition was defined as a body mass index (BMI) ≤ 18.5 kg/m2. The data collected from the VL patients included sex, age, residence, occupation, weight, height, laboratory results (HIV, hemoglobin, intestinal parasites). Multivariate logistic regression model was used to determine the strength of association between malnutrition and associated risk factors.ResultsAmong 403 adult VL patients 385 (95.5%) were malnourished. Twenty eight percent (n = 113), 30.3% (n = 122), and 37.2% (n = 150) were mildly, moderately and severely malnourished, respectively. The prevalence of intestinal parasitic infection was 47.6% (n = 192) and it was associated with malnutrition (P = 0.01). The prevalence of VL-HIV co-infection was 10.4% (n = 42). Hook worm, Giardia intestinalis and Ascaris lumbircoides were the leading prevalent intestinal parasites. Factors such as age, sex, residence, occupation, HIV status and anemia were not associated with severe malnutrition.ConclusionsThe prevalence of malnutrition in VL patients was very high and it was associated with intestinal parasitic infections. Therefore, screening of severely malnourished VL patients for intestinal parasitic infections during admission is recommended.

Malnutrition and its Correlates among Rural Primary School Children of Fogera District, Northwest Ethiopia

Background: Malnutrition is a major public health concern affecting a significant number of school children influencing their health, growth and development, and school academic performance. Objective: To determine the nutritional status of school children in terms of stunting, underweight and thinness and to identify its correlates at Fogera woreda, Northwest Ethiopia, 2012. Methods: Institutional and community based cross sectional study was conducted from June to December, 2012. The study included 790 primary school children who were selected from the source population by multi stage random sampling technique. Data were collected through interview with parents with a standardized and pretested questionnaire; microscope, physical examination and anthropometric measuring and data were entered and analyzed using SPSS version 16.0 and AnthroPlus softwares. Binary and Multivariate logistic regression analyses were used to identify factors associated with malnutrition among school children. Results: Prevalence of malnutrition was high among school children aged six to fourteen years old (mean age 11.4 ± 2.1 years); Study contents include questionnaire surveys, anthropometric measurement, observation and laboratory methods. Finally 790 school-age students took part in study. The results showed that the overall prevalence of stunting, underweight and thinness were 243 (30.7%), 96 (59.7%) and 294 (37.2%). Those children who were found to be both stunted and underweight were only 1.01% (8). Rice consumption, family size, Family radio, infection, vaccination, latrine availability were significantly associated with malnutrition. However, statistically significant association was not found between malnutrition and parasitic infection and other health conditions. Conclusion: In concluding, the study found high prevalence of malnutrition (stunting, thinness and underweight). Vaccination, family planning, latrine construction and utilization, rice production and prevention and early treatment of infection were identified as essential interventions to reduce the risk of malnutrition. Ownership of radio should be promoted to reduce malnutrition. However, parasitic infection among primary school children was not significantly associated with malnutrition. But, school children should be targeted to deworming to treat parasitic infections.

Evaluating the performance of interpreting Verbal Autopsy 3.2 model for establishing pulmonary tuberculosis as a cause of death in Ethiopia: a population-based cross-sectional study.

BackgroundIn resource- poor settings, verbal autopsy data are often reviewed by physicians in order to assign the probable cause of death. But in addition to being time and energy consuming, the method is liable to produce inconsistent results. The aim of this study is to evaluate the performance of the InterVA 3.2 model for establishing pulmonary tuberculosis as a cause of death in comparison with physician review of verbal autopsy data.MethodsA population-based cross-sectional study was conducted from March to April, 2012. All adults aged ≥14 years and died between 01 January 2010 and 15 February 2012 were included in the study. Data were collected by using a pre-tested and modified WHO designed verbal autopsy questionnaire. The verbal autopsy interviews were reviewed by the InterVA model and the physicians. Cohen’s kappa statistic, receiver operating characteristic curves, sensitivity, and specificity values were applied to compare the agreement between the InterVA model and the physician review.ResultsA total of 408 adult deaths were studied. The proportion of tuberculosis-specific mortality was established to be 36.0% and 23.0% by the InterVA model and the physicians, respectively. The InterVA model predicted pulmonary tuberculosis as a cause of death with the probability of 0.80 (95% CI: 0.75-0.85). In classifying all deaths as tuberculosis and non-tuberculosis, the sensitivity and specificity values were 0.82 and 0.78, respectively. A moderate agreement was found between the model and physicians in assigning pulmonary tuberculosis as a cause of deaths [kappa= 0.5; 95% CI: (0.4-0.6)].ConclusionsThis study has revealed that the InterVA model showed a more promising result as a community-level tool for generating pulmonary tuberculosis-specific mortality data from verbal autopsy. The conclusion is believed to provide policymakers with a highly needed piece of information for allocating resources for health intervention.

The Clustering of Smear-Positive Tuberculosis in Dabat, Ethiopia: A Population Based Cross Sectional Study

Background In Ethiopia where tuberculosis epidemic remains high, studies that describe hotspots of the disease are unavailable. This study tried to detect the spatial distribution and clustering of smear-positive tuberculosis cases in Dabat, Ethiopia. Methods and Findings A population-based cross sectional study conducted in the Dabat Health and Demographic Surveillance System site from October 2010 to September 2011 identified smear-positive tuberculosis cases. Trained field workers collected demographic and location data from each study participant through house-to-house visits. A spatial scan statistic was used to identify purely spatial and space–time clusters of tuberculosis among permanent residents. Two significant (p<0.001) spatial and space-time clusters were identified in the study district. Conclusion Tuberculosis is concentrated in certain geographic locations in Dabat, Ethiopia. This kind of clustering can be common in the country, so the National Tuberculosis Control Program can be more effective by identifying such clusters and targeting interventions.

Incidence of smear-positive tuberculosis in Dabat, northern Ethiopia

OBJECTIVE To determine the incidence of smear-positive tuberculosis (TB) in Dabat District, northern Ethiopia. METHODS Using a population-based longitudinal design, a TB surveillance system was initiated among 46,165 residents at the Dabat Health and Demographic Surveillance System site. Trained field workers visited each household every third month and interviewed all individuals aged ≥14 years using a uniform questionnaire to detect suspected cases of TB (cough ≥15 days), at which time two sputum (spot-morning) samples were collected for smear microscopy. RESULTS A total of 281,820 person-months were observed during the 1-year period, which generated 74 smear-positive TB cases. The incidence of smear-positive TB was calculated at 311 per 100,000 person-years (95%CI 240-382). Higher rates were observed among females (incidence rate ratio [IRR] 2.08, 95%CI 1.24-3.52), persons with no schooling (IRR 2.74, 95%CI 1.11-6.78) and urban residents (IRR 2.39, 95%CI 1.39-4.12). CONCLUSION The incidence of smear-positive TB is high in Dabat District, suggesting a high risk of transmission in the communities. TB control programmes thus need to improve case-finding mechanisms at the community level in Ethiopia, with greater emphasis on risk groups.

Appropriate health-seeking behavior and associated factors among people who had cough for at least two weeks in northwest Ethiopia: a population-based cross-sectional study.

BackgroundTuberculosis remains the major debilitating public health problem in Ethiopia. However, studies to understand the patients’ perspectives on the illness and their health-seeking behavior have been few in the country. In this study, we seek to investigate the magnitude of appropriate health-seeking behavior and factors associated with tuberculosis among people who had cough for at least two weeks.MethodsA population-based cross-sectional study was conducted from July to October 2012 in Dabat, northwest Ethiopia. All people aged ≥15 years and had cough for at least two weeks were included in the study. Data collected by using a pre-tested and structured questionnaire were entered and cleaned using the Epi Info version 2002 statistical software. The statistical Package for the Social Sciences Version 16.0 was also employed for descriptive and logistics regression analysis.ResultsOut of the 25,701 people aged ≥15 years surveyed, the proportion of people who had cough for at least two weeks was reported to be 843(3.3%). Appropriate health-seeking behavior towards tuberculosis was reported by 674(80.0%) of them. Factors significantly associated with health-seeking behavior for tuberculosis were being female [AOR: 0.56, 95%CI: (0.39-0.79)], high monthly real per capita income [AOR: 1.66, 95%CI: (1.15-2.38)], large family size [AOR: 0.50, 95%CI: (0.35-0.72)], and use of traditional-healing practices [AOR: 13.27, 95%CI: (9.10-25.41)].ConclusionThis study showed that the magnitude of appropriate health-seeking behavior during the event of chronic cough was high. However, this doesn’t mean that there will be no need for further strengthening of the intervention activities as significant proportions of the study communities still demonstrate inappropriate health-seeking behavior. So tuberculosis control programs need to emphasize factors, such as sex, family size, socioeconomic inequalities, and traditional-healing practices in resource-poor settings.