Performance of QuantiFERON-TB Gold In-Tube (QFTGIT) for the diagnosis of Mycobacterium tuberculosis (Mtb) infection in Afar Pastoralists, Ethiopia

<p>Abstract</p> <p>Background</p> <p>Currently, T-cell based gamma interferon (IFNγ) release assays (IGRAs) are acknowledged as the best methods available for the screening of latent tuberculosis infection (LTBI) and also as aid for the diagnosis of active tuberculosis (TB). To our information, the performance of these diagnostic tests has not been evaluated in Ethiopia. Therefore, the intent of this study was to evaluate the performance of QuantiFERON-TB Gold In-Tube (QFTGIT) in patients clinically suspected of active pulmonary TB (PTB) as well as in healthy subjects prior to its utilization for the epidemiological study of active TB and LTBI in Afar pastoralists.</p> <p>Methods</p> <p>The sensitivity of QFTGIT was evaluated in 140 subjects who were clinically suspected of PTB using the cut-off value recommended by the manufacturer (≥ 0.35 IU/ml) and disease-specific cut-off value. Sputum culture result was used as a gold standard. The specificity of the test was evaluated both in patients and in 55 tuberculin skin test (TST) negative healthy subjects.</p> <p>Results</p> <p>Out of the 140 study participants, 37 (26.4%) were positive for active PTB by culture. Out of the 37 subjects who had positive results by culture, 6 individuals were HIV-seropositive. Out of the 103 subjects who were negative by culture, 6 subjects had indeterminate results and 21 were HIV-seropositive. The performance of the test was assessed using data from 107 (31 culture positive and 76 culture negative) individuals who were clinically suspected of PTB and HIV-seronegatives. Using the manufacturer recommended cut-off value, the sensitivity of the test was 64.5% (20/31), while its specificity was 36.8% (28/76). The sensitivity of the test was increased to 77.4%, while the specificity was reduced to 23.7% using a cut-off value ≥ 0.1 IU/ml of IFNγ as disease-specific cut-off value. In TST negative healthy subjects, the specificity of the test was 58.2%.</p> <p>Conclusion</p> <p>Our findings revealed a low sensitivity of QFTGIT in the diagnosis of <it>Mycobacterium tuberculosis (Mtb) </it>infection in the present study area using the cut-off value recommended by the manufacturer. Nevertheless, the sensitivity increased from 64.5% to 77.4% by lowering the cut-off value recommended by the manufacturer to ≥ 0.1 IU/ml of IFNγ level. Hence, it is of practical importance to evaluate the performance of QFTGIT in population under different settings prior to its application either for the diagnosis of active TB or LTBI.</p

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Measles case, immunization coverage and its determinant factors among 12–23 month children, in Bassona Worena Woreda, Amhara Region, Ethiopia, 2018

Abstract Objective The aims of this study were: (1) to calculate measles vaccination coverage and characterize its determinants, and (2) to qualitatively explore factors associated with reasons associated with not immunization a child. Result In this study, the measles immunization coverage was 71.3%. The main reasons for not using the immunization services were lack of knowledge about immunization, no faith on immunization, fear of side effects and place of the service is too far. Age of mother, awareness about measles immunization, ante natal care service utilization and health facility availability were the factors that significantly associated with measles immunization. The findings of this study revealed that the coverage of measles immunization is low. Therefore health education on measles should be given for community and mothers and other additional measures should be done

Prevalence of Stress and Associated Factors among Regular Students at Debre Birhan Governmental and Nongovernmental Health Science Colleges North Showa Zone, Amhara Region, Ethiopia 2016

Background. Stress is very common among medical students across the globe with the prevalence of 80%. In Ethiopia, the prevalence is 47.7% among college students. Unless it is managed early, it leads to deterioration of academic performance and overall dissatisfaction with life and different serious health problems including anxiety, depression, and suicide. The objective of this study is to assess the prevalence of academic related stress among Debre Birhan governmental and nongovernmental health science college regular students 2015/16. Method. A cross-sectional study was conducted on a sample of 422 health science students selected by stratified proportional random sampling at Debre Birhan governmental and nongovernmental health science colleges in North Shewa zone, Amhara region, Ethiopia in 2016. Data was collected using the Depression Anxiety Stress Scaling (DASS-21). The level of significance of association for multivariable was determined at P value <0.05. Result. Prevalence of stress among Debre Birhan governmental and nongovernmental health science college regular students is 4.1%. There is a significant association between stress and sex AOR = 8.525 (1.023, 71.077), fear of examination AOR = 5.096 (1.183, 21.96), living in uncomfortable environment AOR = 14.86 (3.84, 57.515), and perceived present illness AOR = .030 (0.003, 0.286). Depression and anxiety were also seen among 19.7% and 23.6%, respectively. Conclusion. According to this study, the prevalence of stress among governmental and nongovernmental health science college regular students is not high. However, depression and anxiety were found to be higher than stress and they need immediate management plan. Colleges had better prepared simple screening tool and support students to prevent stress before they cause severe mental health problems

Prevalence of needle-stick and sharp object injuries and its associated factors among staff nurses in Dessie referral hospital Amhara region, Ethiopia, 2018

Abstract Objective The aim of this study was to assess the prevalence of needle-stick and sharp object injuries among staff nurses in Dessie referral hospital, Amhara region, Ethiopia, 2018. Results Among the 151 study participants, 98 (65%) respondents were males. Seventy-five (48.1%) participants had 4–10 years of experience. The overall prevalence of needle stick and sharp object injury among staff nurses in Dessie referral hospital was 43%. In this study, nurses who worked in the emergency department were 11× more likely to experience needle stick and sharp object injury compared with nurses who worked in outpatient department P = 0.004 [AOR = 11.511 95% CI 2.134, 62.09)]. Participants who were worked in adult health department were 10× more likely experience needle stick and sharp object injury when compared with participants who were worked in outpatient department P = 0.006 [AOR = 9.742 95% CI 1.904, 49.859)]. The major implication of these study findings on the health system is the importance of given emphasis for nurses in relation with needle stick and sharp injury

Latrine Utilization and Associated Factors in Mehal Meda Town in North Shewa Zone, Amhara Region, Ethiopia, 2019

Background. Worldwide lack of sanitation is a serious health risk, affecting billions of people around the world, particularly the poor and disadvantaged of people around the world. In Sub-Saharan Africa, the number of people who defecate remains the open field 215 million. According to the 2016 Ethiopian Demographic and Health Surveys report, 56% of the rural households use unimproved toilet facilities. One in every three households in the country has no toilet facility. However, achieving real gains in increasing latrine use and quality remained as a challenge. This study was used to assess the latrine utilization and associated factors in Mehal Meda town in North Shewa zone, Amhara region, Ethiopia, 2019. Result. In this study, a total of 558 participants were included. Out of households, 509 (91.2%) utilized their latrine facility. On the other way, 503 (98.8%) households utilized latrine regularly. Significant variables that were associated to latrine utilization were the occupational status of head of households, observing feces around the compound/latrine, duration of latrine utilization, shape and structure of latrine facility, latrine status during observation, and distance between water well and latrine. According to this study, the magnitude of latrine utilization in Mehal Meda district was 91.2%. It was lower than Ethiopia national expected target of MDGs (100%). Significant variables that were associated to latrine utilization were occupational status of head of households, observing feces around the compound/latrine, shape and structure of latrine facility, latrine status during observation, and distance between water well and latrine facility. Therefore, health education about latrine utilization and its advantage should be given for community in the study area

Association between birth interval and wasting in children under 5 years of age in Ethiopia: a systematic review and meta-analysis protocol

Introduction According to the UNICEF, WHO and World Bank joint estimation, 1 in every 13 children suffered from wasting globally. The highest burden of undernutrition recorded in Asia and Africa. Wasting remains a considerable public health problem in Ethiopia despite the introduction of exhaustive nutritional programmes. As reported in the literature, the prevalence of wasting in Ethiopia has remained high over the last four decades. In Ethiopia, more than one-third of child deaths are associated with malnutrition. The current nutritional interventions implemented in Ethiopia need to be evidence based. For this purpose, systematic review is preferable as it can present a more reliable and precise estimate than individual studies. The aim of this review is to assess the pooled prevalence of wasting and its association with birth interval in Ethiopia.Methodology Studies published after 20 January 2012 will be retrieved from databases, mainly PubMed/Medline, Scopus, Embase, CINAHL and HINARI. The articles retrieved from databases will be selected after reading the title, abstract and full text. Three reviewers will independently assess the quality of each study using both the Joanna Briggs Institute and Ottawa Scale critical appraisal checklists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be used to maintain scientific strength. Funnel plots, Egger’s test and Begg’s test will be used to deal with publication bias, and I2, forest plots and Cochrane’s Q square statistics will be used for heterogeneity. Potential causes of heterogeneity will be explored through sensitivity and subgroup analyses. Because heterogeneity among studies is inevitable, given the wide geographical area and variety of study designs, the Der-Simonian and Laird random-effects model will be used. The presence of a statistical association between birth interval and wasting will be declared if the p value is &lt;0.05 with the 95% CI.Ethics and dissemination Ethical issues will not be applicable to this review and meta-analysis. This review and meta-analysis will report the pooled prevalence of wasting and its association with birth interval in Ethiopia. Effort will be made to publish the findings in a peer-reviewed journal such as the Ethiopian Journal of Health and Development, and the findings will be presented at national conferences. A hard copy will also be sent to Woldia University and Debre Berhan University