Bibliography of the Literatures on Tuberculosis, TB/HIV and MDRTB in Ethiopia from 2001 – 2017

Ethiopia is among the thirty-high tuberculosis (TB) burden countries with multidrug resistant tuberculosis (MDR-TB) and Tuberculosis/Human Immunodeficiency Virus (TB/HIV). Given the public health importance of the problem, it is apparent that probing the work done in this regard is essential to mitigate the problem and thus we reviewed research repositories and compile directories of researches in Ethiopia from Jan 1, 2001 to Dec 30, 2017 in order to avail evidence-based information to stakeholders and beneficiaries intervening the problem in the country. The evidences generated in this bibliography are through different databases and websites using key terms. A range of different published and unpublished literatures (journal articles, conference presentations, reports/manual/book, and graduate theses or dissertations) on TB, MDR-TB, extensively drug resistant TB (XDR-TB), or TB/HIV are presented. We presented literatures by four themes (Biomedical and clinical researches, epidemiological researches, operational or implementation researches, and health systems researches). A total of 1571 researches and reports were accessed through the above search engines and revealed 635 epidemiological researches followed by 538 clinical or biomedical researches, 257 operational or implementation research, and 141 health systems research. Interestingly, up to 2008 clinical or biomedical researchers were the leading researches and from 2009 onwards, epidemiological researches held the largest constituency. In conclusion, TB or TB/HIV and MDR-TB literatures in Ethiopia have substantially increased over years. Referred journal publications took theleading source and epidemiologic studies were the commonest one. We suggest the need to focus on operational or implementation and health system researches to plummet the disease spreading, drug resistance and impact. We also recommend a regular update of the bibliography every 3 to 4 years with annotations

Healthcare waste generation and its management system: the case of health centers in West Gojjam Zone, Amhara Region, Ethiopia

Background: Healthcare service providers generally aim at controlling and preventing diseases such as communicable ones. However, in the course of activities, the generation of hazardous and non hazardous waste is a concern of an environmental risk to health care workers, the public and the environment at large.Objective: To assess healthcare waste type, generation rate, and its management system in health centers in West Gojjam Zone.Methods: Cross-sectional study was employed to estimate waste generation rate and evaluate its management system in ten public health centers from March 2007 to April 2007. Observational checklist, key informant interview guide and weighing scale were data collection tools that were used to characterize waste generation. Weighing of healthcare waste was done for eight consecutive days in each health center. Data were entered and analyzed using EPI Info version 6.04d and SPSS version 13.0.Results: The daily mean ( ± SD) healthcare waste-generation rate was 1.79 ± 0.54 kg, which was equivalent to 0.035 ± 0.05 kg/outpatient/day. About 0.93 ± 0.3 kg/day (52.0%) was general and 0.86 ± 0.33 kg/day (48.0%) was hazardous waste. The mean healthcare waste generation rate among health centers did not significantly vary. Segregation of wastes and pre treatment of infectious wastes were not properly practiced by any of the health centers. Only four out of ten health centers used local type of incinerators, while others used open burning for the final handling of healthcare wastes. Biological wastes such as placenta were generally disposed and buried in nonwatertight disposal pits. Operational guidelines were not found in all assessed health centers. Nine out 70 (13%) interviewed healthcare workers had needle injuries during the last 12 months prior this study. Conclusion: The unit generation rate was relatively small in magnitude when compared with similar health facilities that are found in developing countries. The indiscriminate handling and disposal of biological wastes is a concern. [Ethiop. J. Health Dev. 2010;24(2):119-126

Nutrition and tuberculosis in Ethiopia : the role of vitamin D2 derived from sun exposed oyster mushroom on the treatment outcomes of tuberculosis

Tuberculosis (TB) is an old infectious disease which causes ill-health among millions of people each year. Effective anti-TB drugs are available since 1950s, but still the global burden of TB remains enormous. The disease is very complex and there is a need to look for supportive treatment to the standard anti-TB drugs. Cognizant of this, the present doctoral study was undertaken by giving emphasis on nutrition and TB in Ethiopia. The aim of this doctoral dissertation thesis was to deal with the nutritional situation of people with and without TB and come-up with solutions that could support the effort of combating TB. In this thesis, five papers (four published and one submitted) were included. The first paper encompassed the study of dietary and nutritional assessment. In this study, dietary inadequacy, poor nutritional quality and high risk of micro nutrient deficiencies were identified. The main dietary pattern included cereals, vegetables and legumes. About one-third of the population consumed animal source food (ASF). Malnutrition was the common problem in people with and without TB. This suggested that malnutrition may pave the way for TB. The case-control study in the second paper revealed that more than one-half of TB patients had vitamin A and zinc deficiencies. More than three-fourth of TB patients had below half of the energy fulfillment. The protein intake was above the average fulfillment, but most TB patients relied on cereal-based diets. Patients with TB used a larger proportion of proteins from oral feeding for oxidation and hence for energy production. About half of the patients were undernourished. Thus, vitamin A and zinc deficiencies along with protein-energy malnutrition need to be addressed in the management program of TB. The third paper included systematic review which explored the existence of vitamin D deficiency (VDD). Sunshine, which is very important for the synthesis of vitamin D under the skin is widely available in Africa throughout the year. Surprisingly, more than three-fourth of TB patients in Africa had VDD and vitamin D insufficiency (VDI). Statistically significant variables such as use of sun protection (lack of sun-exposure), inadequate dietary intake, low body mass index (BMI), high skin pigmentation, use of drugs (anti-retro viral and /or anti-TB), low socioeconomic status, rainy season, covering body skin with clothes, old age and co-morbidity were identified as the main predictor variables that hampered the status of vitamin D. Vitamin D can be obtained from dietary intakes apart from endogenous synthesis after sun exposure. Mushroom as such, is a potential non-animal source of vitamin D. The experimental study in the fourth paper revealed that sun-exposure significantly increased the content of vitamin D2 in oyster mushroom. Increasing the surface area for sun-exposure enhanced the production of vitamin D2. Other factors such as duration of sun-exposure and moisture content determined the production of vitamin D2. Exposing slices of oyster mushroom to direct sun for brief period provided enough vitamin D2 that could satisfy the current recommended dietary allowance (RDA) of vitamin D without any visible changes in color and texture. The study in the fifth paper was a randomized controlled trial and demonstrated for the first time the role of mushroom-derived vitamin D2 on the treatment outcomes of TB. Intervention with vitamin D2 derived from sun-exposed oyster mushrooms brought significant improvement in vitamin D status, clinical outcomes and immunological responses, but not in sputum smear and culture conversion. The intervention corrected VDD in more than one-third of TB patients. About one-third of the variability in TB score in the intervention group was accounted for by the change in the serum 25 hydroxy (OH) vitamin D level. There were also significant improvements in the serum IFN-gamma and cathelicidin LL-37 peptide levels after intervention. The balance of cytokines was skewed to TH1 responses due to high level of IFN-gamma. Thus, mushroom-derived vitamin D2 could serve as potential, safe, easily available and cost-effective adjunctive therapy for TB. Taken collectively, foods enriched with vitamin D need to be included in the national TB control program to support the first line anti-TB drugs, increase the cure rate and reduce the infectiousness of TB.Tuberkulose (TB) ist eine alte Infektionskrankheit, an der jedes Jahr Millionen von erkranken. Wirksame Medikamente gegen Tuberkulose sind seit den 1950er Jahren erhältlich, aber die enorme Bürde durch Tuberkulose ist weltweit immer noch groß. Die Krankheit ist sehr komplex und es besteht die Notwendigkeit, eine unterstützende Behandlung für die Standard- Anti-TB-Medikamente zu suchen. In Anbetracht dessen legte die vorliegende Doktorarbeit ihren Fokus auf die Ernährung von Tuberkulose patienten in Äthiopien. Ziel dieser Dissertation war es, sich mit der Ernährungssituation von Menschen mit und ohne Tuberkulose zu befassen und Lösungen zu finden, die den Kampf gegen Tuberkulose unterstützen können. Die Ergebnisse dieser Arbeit resultierten in fünf Artikel (vier veröffentlicht und einer eingereicht). Das erste Artikl befasste sich mit der Bewertung der Ernährung und des Ernährungsstatuses. In dieser Studie wurden unzureichende Ernährung, eine schlechte Ernährungsqualität und ein hohes Risiko für Mikronährstoffmangel festgestellt. Das Hauptnahrungsmuster beinhaltete Getreide, Gemüse und Hülsenfrüchte. Etwa ein Drittel der Bevölkerung konsumierte tierische Nahrung (TN). Unterernährung war das häufigste Problem bei Menschen mit und ohne TB.Dies deutet darauf hin, dass Mangelernährung den Weg für TB ebnen könnte. Die Fall-Kontroll-Studie in der zweiten Veröffentlichung ergab, dass mehr als die Hälfte der TB-Patienten einen Mangel an Vitamin A und Zink aufwies. Mehr als drei Viertel der TB Patienten nahmen weniger als die Hälfte der empfohlenen Energie zu sich. Die Proteinaufnahme lag über dem Durchschnitt, aber die meisten TB-Patienten wiesen eingetreidebasiertes Ernährungsmuster auf. Patienten mit TB verwendeten einen größeren Anteil an Nahrungsprotein zur Oxidation und damit zur Energiegewinnung. Etwa die Hälfte der Patienten war unterernährt. Daher, müssen Vitamin A und Zinkmängel zusammen mit Protein-Energie Mangelernährung im Behandlungs programm für TB angegangen werden. Der dritte Artikel beinhaltete eine systematische Übersicht über die Prävalenz eines Vitamin-D-Mangel (VDD) bei TB-Patienten. Sonnenschein, der für die Synthese von Vitamin D in der Haut sehr wichtig ist, ist in Afrika das ganze Jahr verfügbar. Überraschenderweise hatten mehr als drei Viertel der TB-Patienten in Afrika eine VDD- und Vitamin-D-Insuffizienz (VDI). Statistisch signifikante Variablen wie Sonnenschutz (fehlende Sonnenexposition), unzureichende Nahrungsaufnahme, niedriger Body Mass Index (BMI), hohe Hautpigmentierung, Medikamenteneinnahme (antiretroviral und / oder anti-TB), geringer sozioökonomischer Status, Regenzeit, Bedeckung der Körperhaut durch Kleidung, Alter und Begleiterkrankungen wurden als HauptPrädiktorvariablen identifiziert, die den Status von Vitamin D beeinträchtigten. Vitamin D kann neben der körpereigenen Synthese durch Sonnenexposition auch über die Nahrung aufgenommen werden. Pilz stellen eine potenzielle nicht-tierische Vitamin-D-Quelle dar. Die experimentelle Studie in der vierten Veröffentlichung ergab, dass die Sonnenexposition den Vitamin-D2-Gehalt in Austernpilzen signifikant erhöht. Eine Steigerung der bestrahlten Oberfläche erhöhte die Produktion von Vitamin D2. Andere Faktoren wie die Dauer der Sonneneinstrahlung und der Feuchtigkeitsgehalt beeinflussen die Produktion von Vitamin D2 ebenfalls. Wenn Austernpilzscheiben für kurze Zeit direkter Sonneneinstrahlung ausgesetzt wurden, war der Vitamin D2 Gehalt ausreichend um die derzeit empfohlene Tagesdosis (RDA) für Vitamin D ohne sichtbare Änderungen der Farbe und Textur zu erreichen. Die Studie in der fünften Veröffentlichung war eine randomisierte kontrollierte Studie und zeigte zum ersten Mal die Rolle von aus Pilzen stammendem Vitamin D2 für die Behandlungsergebnisse bei TB. Die Intervention mit Vitamin D2 aus sonnenexponierten Austernpilzen führte zu einer signifikanten Verbesserung des Vitamin D-Status, der klinischen Ergebnisse und der immunologischen Reaktionen, jedoch nicht zu einer Verbesserung des Sputumabstrichs und der bakteriellen Kulturumwandlung. Die Intervention korrigierte VDD bei mehr als einem Drittel der TB-Patienten. Etwa ein Drittel der Variabilität des TB-Scores in der Interventionsgruppe war auf die Veränderung des Serum-25-Hydroxy (OH) -Vitamin-D Spiegels zurückzuführen. Es gab auch signifikante Verbesserungen bei den Serum-IFN-gamma und Cathelicidin-LL-37-Peptidspiegeln nach der Intervention. Das Gleichgewicht der Zytokine wurde aufgrund des hohen IFN-gamma-Spiegels auf TH1 Antworten verzerrt. Somit könnte aus Pilzen gewonnenes Vitamin D2 als potenzielle, sichere, leicht verfügbare und kostengünstige Zusatztherapie für TB dienen. Zusammengenommen müssen mit Vitamin D angereicherte Lebensmittel in das nationale TB-Bekämpfungsprogramm aufgenommen werden, um die ersten Medikamente gegen TB zu unterstützen, die Heilungsrate zu erhöhen und die Infektiosität von TB zu verringern

Bibliography on HIV/AIDS in Ethiopia and Ethiopians in the Diaspora: The 2015 Update

No Abstrac

Tuberculosis Diagnostics in Ethiopia: Assessment of Laboratory Procedural Capabilities and Limitations

Abstract Tuberculosis (TB) is a curable and preventable disease; however, in 2015, 10.4 million people were diagnosed with TB, making it one of the top 10 causes of mortality. A major part of the TB disease burden is carried by low and middle-income countries. In Ethiopia, which ranks 15th among 22 countries with a high burden of TB and multidrug resistant TB (MDR-TB), important diagnostic and treatment gaps persist. This quantitative descriptive study was primarily aimed to determine levels of adherence to standardized TB laboratory procedures by calculating and reporting the number of sputum samples, and reporting valid and documented results of laboratory Ziehl Neelsen (ZN) stain tests and MDR-TB tests for each suspected TB patient at a community health center TB laboratory in Addis Ababa, Ethiopia. The social theory of unanticipated consequences for purposive or social action was the theoretical framework for this study. Study results revealed that the optimal number of 3 samples sputum specimens collected for each suspected TB patient was submitted only for 48.1% of the study population. Also, regarding the percentage of valid and documented results for the 3 samples when performing laboratory ZN stain tests, for each suspected TB patient, there were valid results only for 72.2%, 51.2%, and 47.5% of the study participants, respectively. Finally, the percentage of valid and documented results when performing the MDR-TB test for each suspected TB patient was only 13.6%. For all the data, WHO criteria for error/undocumented results were not met. The study will contribute to changing the way Ethiopian laboratory technicians and managers address local challenges involving TB assessment, resulting in a positive social change in TB diagnosis and treatment

The delivery of comprehensive healthcare services by private health sector in Amhara region, Ethiopia

The purpose of this study was to investigate the health service delivery by private health sector and develop guidelines to enhance provision of health service so as to increase their contribution in the country’s health system. Interviews with 1112 participants were conducted in phase I. Descriptive statistics, chi square tests and logistic regression analysis were used for analysis. Private health facilities (30.5%) were providing healthcare services in their own buildings that were constructed for that purpose while others work in a rented houses built for residence or others. Some facilities (11.7%) received loan services from financial institutions in the region. A significant association was found between obtaining loan and owning building for healthcare services delivery (x2=13.99, p<0.001). Private health facilities were mainly engaged in profit driven and curative services while their participation in the promotive and preventive services like FP, ANC HIV test, TB and malaria prevention and control was not minimal. Majority, 247 (96.5%) provide services for extended hours out of normal working time such as evening, weekends and holidays. Physicians, more than other professionals were found practicing part time work (dual practice). Service consumers of the private health sector were urban dwellers 417 (71.6%) and 165 (28.4%) rural residents. Nearly three-fourth (73.0%) of study participants had a history of multiple visits to both public and private health facilities for current medical condition. Median payment of patients in a single visit including diagnosis and medicine was 860 birr ($30.85) (IQR = 993 ($35.62). Only 2.1% have paid through insurance services while others through out of pocket payments. Price of services delivered in private health facilities were set mainly by owners’ will (91.4%) while others with established team. Satisfaction on the fairness of prices to services obtained from each facility were reported by 63.1% service consumers. Those patients without any companion (AOR=1.83, 95% CI=1.16-2.91) and no history of visit to other facilities (AOR=1.97, 95% CI=1.24-3.12) were more likely to be satisfied than those coming with companions and those with history of visit. In addition, as age of consumers increase, satisfaction to services prices tend to decline (AOR=0.97, 95% CI=0.96-0.99). Uncomplimentary regulatory system to private health facilities, lack of training and continuing education for health professionals, unavailability of enough health workforce in the market and shortage of supplies to private facilities were among main gaps disclosed. Based on findings, five guidelines were developed to enhance health services delivery in the private health sector, namely, increase facilitation for financial access to actors in the sector, increase facilitation to access regular updating trainings and continuing education for healthcare workers, enhance and scale up the capability of existing association in the private health sector, strengthen and support working for extended hours to promote user friendly services and accessibility of healthcare services for the poor through community based health insurance and exemption. Therefore, these recommendations to help enhance the private health sector for better performance and contribution.Health StudiesD.Litt. et. Phil (Health Studies

Support for the Ethiopian Health Sector Development Programme (Federal Ministry of Health MDG Performance Fund)

This Annual Review draws on the findings of the HSDP IV Mid Term Review (MTR), the FMOH’s Annual Performance Report and the Annual Review Mission. As the MDG PF supports implementation of the HSDP IV, this Annual Review examines the performance of the MDG PF as an instrument to achieve sector-wide progress