Investigating the follow-up discontinuation among people living with HIV in North Shoa Zone, Oromia, Ethiopia

IntroductionFollow-up discontinuation among people living with HIV can increase mortality and HIV spread within communities. This study investigates the impact of the COVID-19 on follow-up discontinuation among people living with HIV in Ethiopia.MethodsThis longitudinal study used retrospective document review to compare follow-up status of people living with HIV during the COVID-19 pandemic with their status from 2017 to 2019. Data from selected health facilities were collected using a checklist, entered and cleaned in Excel, and analyzed in Stata. Descriptive statistics were presented in tables and line graphs. Incidence risk (IR) and incidence rate ratios (IRR) were calculated.ResultsBetween 2017 and 2021, a total of 7,447 people living with HIV were registered to begin ART at selected health facilities. Annual retention rates were consistent from 2017 to 2019, ranging from 0.941 to 0.949. During the COVID-19 pandemic, they dropped to 0.837 in 2020 and 0.840 in 2021. Retention rates were significantly correlated with loss to follow-up (r: −0.959, p ≤ 0.001), death (r: −0.968, p ≤ 0.001), and transfer-out (r: −0.979, p ≤ 0.001). Moreover, the incidence of loss to follow-up (IRR: 3.00, 95%CI: 2.71–3.33, p ≤ 0.001), death (IRR: 3.61, 95%CI: 3.13–4.16, p ≤ 0.001), poor adherence (IRR: 2.27, 95%CI: 2.14–2.40, p ≤ 0.001), and severe malnutrition (IRR: 2.32, 95%CI: 2.18–2.47, p ≤ 0.001) significantly increased during the COVID-19.ConclusionThe study found that COVID-19 healthcare disruptions increased follow-up loss among people living with HIV and heightening the disease burden in Ethiopia

Anthrax outbreak surveillance and response in Arba Minch, Ethiopia: After-action review

Background: Anthrax is a serious infectious disease affecting animals and humans and remains a public health issue in developing countries. Aim: This study assessed the overall anthrax outbreak response and identified strengths, challenges, and best practices during surveillance, preparedness, and response in Ethiopia from May 2022 to July 2022. Setting: Conducted in Arba Minch Town, Gamo Zone, Southern Ethiopia. Methods: An after-action review (AAR) using qualitative methods was performed. Experts included clinicians, public health professionals, and government officials were involved in the outbreak response. Data were collected via focus group discussions, key informant interviews, and observations, recorded digitally. Thematic analysis was used. Results: Strong stakeholder engagement and coordination were evident, with mass vaccinations aiding control. However, gaps included unprepared logistics, poor communication, and insufficient training. Despite anthrax being immediately notifiable, weaknesses in surveillance detection and reporting were found. Coordination was effective with intersectoral collaboration and commitment, leading to a commendable, lifesaving response once initiated. Conclusion: The study revealed effective engagement and coordination but identified gaps in preparedness and communication. Addressing these through capacity-building and stronger preparedness is crucial for future outbreak management. Contribution: This study provides valuable evidence-based insights to improve health preparedness and response in the African context

Longer hospital stay is associated with higher rates of tuberculosis-related morbidity and mortality within 12 months after discharge in a referral hospital in Sub-Saharan Africa

BACKGROUND: Nosocomial transmission of pulmonary tuberculosis (PTB) is a problem in resource-limited settings. However, the degree of TB exposure and the intermediate- and long-term morbidity and mortality of hospital-associated TB is unclear. In this study we determined: 1) the nature, patterns and intensity of TB exposure occurring in the context of current TB cohorting practices in medical centre with a high prevalence of TB and HIV; 2) the one-year TB incidence after discharge; and 3) one-year TB-related mortality after hospital discharge. METHODS: Factors leading to nosocomial TB exposure were collected daily over a 3-month period. Patients were followed for 1-year after discharge. TB incidence and mortality were calculated and logistic regression was used to determine the factors associated with TB incidence and mortality during follow up. RESULTS: 1,094 patients were admitted to the medical wards between May 01 and July 31, 2010. HIV was confirmed in 690/1,094 (63.1%) of them. A total of 215/1,094 (19.7%) patients were diagnosed with PTB and 178/1,094 (16.3%) patients died during the course of their hospitalization; 12/178 (6.7%) patients died from TB-related complications. Eventually, 916 (83.7%) patients were discharged and followed for one year after it. Of these, 51 (5.6%) were diagnosed with PTB during the year of follow up (annual TB rate of 3,712 cases per 100,000 person per year). Overall, 57/916 (6.2%) patients died during the follow up period, of whom 26/57 (45.6%) died from confirmed TB. One-year TB incidence rate and TB-associated mortality were associated with the number of days that the patient remained hospitalized, the number of days spent in the cohorting bay (regardless of whether the patient was eventually diagnosed with TB or not), and the number and proximity to TB index cases. There was no difference in the performance of each of these 3 measurements of nosocomial TB exposure for the prediction of one-year TB incidence. CONCLUSION: Substantial TB exposure, particularly among HIV-infected patients, occurs in nosocomial settings despite implementation of cohorting measures. Nosocomial TB exposure is strongly associated with one-year TB incidence and TB-related mortality. Further studies are needed to identify strategies to reduce such exposure among susceptible patients

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

A dynamic simulation model of land-use, population, and rural livelihoods in the central Rift Valley of Ethiopia

The dynamic interactions between society and land resources have to be taken into account when planning and managing natural resources. A computer model, using STELLA software, was developed through active participation of purposively selected farm households from different wealth groups, age groups and gender within a rural community and some members of Kebelle council. The aim of the modeling was to study the perceived changes in land-use, population and livelihoods over the next 30 years and to improve our understanding of the interactions among them. The modeling output is characterized by rapid population growth, declining farm size and household incomes, deteriorating woody vegetation cover and worsening land degradation if current conditions remain. However, through integrated intervention strategies (including forest increase, micro-finance, family planning, health and education) the woody vegetation cover is likely to increase in the landscape, population growth is likely to slow down and households’ income is likely to improve. A validation assessment of the simulation model based on historical data on land-use and population from 1973 to 2006 showed that the model is relatively robust. We conclude that as a supporting tool, the simulation model can contribute to the decision making process

Molecular typing of mycobacteria isolated from extrapulmonary tuberculosis patients at Debre Birhan Referral Hospital, central Ethiopia.

Abstract Background: Extrapulmonary tuberculosis (EPTB) constitutes about 10% to 20% of all cases of tuberculosis in immunocompetent patients and more than 50% of the cases in HIV-positive individuals worldwide. Little information is available on the clonal diversity of Mycobacterium species in Ethiopia from EPTB. Methods: This study was carried out on smear-negative EPTB patients to molecularly characterize Mycobacterium tuberculosis complex strains. A questionnaire, smear staining, culture, deletion typing, and spoligotyping were employed. Results: The proportional distribution of EPTB and isolates did not vary substantially (p > 0.05) amongst the socio-demographic parameters considered in the current investigation. Out of 98 fine needle aspirates processed for culture, 36.7% (36/98) were positive for mycobacterial growth. Further speciation of those culture-positive isolates showed that 88.9% were M. tuberculosis and the remaining could be non-tuberculous mycobacterial species. Spoligotyping revealed 16 clusters out of which 2 were new to the SITVIT database. The most dominant spoligotypes were SIT54, SIT53, and SIT149 in decreasing order. SIT54, SIT134, SIT173, SIT345, SIT357, SIT926, SIT91088, and SIT1580 were reported for the first time in Ethiopia. The family with the highest frequency identified was M. tuberculosis family T1, followed by family 33. Most of the strains belonged to Euro-American (61.4%) and Indo-Oceanic (36.3%) lineages. Conclusions: The present study shows the importance of M. tuberculosis as a major cause of EPTB in the study area. Moreover, the majority of isolates of M. tuberculosis were found in clusters, suggesting the possibility of the existence of recent transmission. This warrants strengthening of the control programs for EPTB in the study area