Comparing tuberculosis in children aged under 5 versus 5 to 14 years old in a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study

Background: There are few data available about childhood tuberculosis (TB) in rural hospitals in low-income countries. We assessed differences in epidemiological characteristics and treatment outcomes in children with TB aged 0–4 versus 5–14 years in rural Ethiopia. Methods: For this retrospective cross-sectional study, we analyzed childhood TB registers from a rural Ethiopian hospital. We collected data on the number of cases, type of TB, and treatment outcomes using standard definitions. By means of binary and logistic regression analyses, data were compared from 1998 to 2015 in children aged under 5 versus those aged 5–14 years. Results: We included 1282 TB patients: 583 (45.5%) were under 5 years old, and 699 (54.5%) were aged 5–14 years. More than half (67.2%, n = 862) had pulmonary TB (PTB), which was more common in younger children (82.5%, 481/583) than in older ones (54.5%, 381/699; p < 0.001). Most cases of PTB (87.5%, 754/862) were smear negative, including virtually all (99.6%, 479/481) younger children and most older ones (72.2%, n = 275/381; p < 0.001). The most common types of extrapulmonary TB (EPTB) were TB adenitis (54.5%, 229/420) and bone TB (20%, 84/420). Children under five showed a lower prevalence of adenitis TB (9.9% [58/583] versus 24.5% [171/699], p < 0.001), bone TB (2.9% [17/583] versus 9.6% [69/699], p < 0.001), and abdominal TB (0.9% [5/583] versus 6.3% [44/699], p < 0.001). Most diagnoses were new cases of TB (98.2%, 1259/1282). Overall, 63.5% (n = 814) of the children successfully completed treatment (< 5 years: 56.6%, 330/583; 5–14 years: 69.2%, 489/699; p < 0.001). In total, 16.3% (n = 209) transferred to another center (< 5 years: 19.4%, 113/583; 5–14 years: 13.7%, 96/699; p = 0.006). Thirteen percent of patients (n = 167) were lost to follow-up (< 5 years: 16.0%, 93/583; 5–14 years: 10.4%, 74/699; p = 0.004). Fifty-two (4.1%) children died (no age differences). Being aged 5–14 years was independently associated with successful treatment outcomes (adjusted odds ratio 1.59; 95% confidence interval: 1.16, 1.94, p = 0.002). Conclusions: We observed a very low diagnostic yield for spontaneous sputum smear in children with TB. In this rural setting in Ethiopia, very young children tend to present with new cases of smear-negative PTB. They have less EPTB than older children but more TB meningitis and show lower rates of treatment succes

Field Evaluation of Malaria Microscopy, Rapid Malaria Tests and Loop-Mediated Isothermal Amplification in a Rural Hospital in South Western Ethiopia

Background In up to one third of the hospitals in some rural areas of Africa, laboratory services in malaria diagnosis are limited to microscopy by thin film, as no capability to perform thick film exists (gold standard in terms of sensitivity for malaria diagnosis). A new rapid molecular malaria diagnostic test called Loop-mediated isothermal DNA amplification (LAMP) has been recently validated in clinical trials showing exceptional sensitivity and specificity features. It could be a reliable diagnostic tool to be implemented without special equipment or training. Objective The objective of this proof of concept study was to confirm the feasibility of using LAMP technique for diagnosis of malaria in a rural Ethiopian hospital with limited resources. Methodology/Principal Findings This study was carried out in Gambo General Hospital, West Arsi Province (Ethiopia), from November 1st to December 31st 2013. A total of 162 patients with a non-focal febrile syndrome were investigated. The diagnostic capability (sensitivity, specificity, positive predictive and negative predictive values) of rapid malaria tests and microscopy by thin film was evaluated in comparison with LAMP. Eleven (6.79%) out of the 162 patients with fever and suspected malaria, tested positive for LAMP, 3 (1.85%) for rapid malaria tests and none of the eleven cases was detected by thin film microscopy. Conclusions/Significance LAMP can be performed in basic rural laboratories without the need for specialized infrastructure and it may set a reliable tool for malaria control to detect a low level parasitemia.Peer reviewe

Sex differences and HIV status of tuberculosis in adults at a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study

Background. The aim of the study was to compare the epidemiology, clinical characteristics and treatment outcome of tuberculosis (TB), including HIV status, in women and men in southern rural Ethiopia. Methods. We conducted a register-based retrospective cohort study covering the period from September 1998 to August 2015. Results. We included records of 2252 registered TB patients: 1080 (48%) women and 1172 (52%) men. Median age was similar for women and men: 27.5 years and 25.0 years, respectively. Median weight in women was 43.0 kg (interquartile range IQR: 38.0, 49.0), significantly lower than in men (50.0 kg, IQR 44.0, 55.0; p = 0.01). Extrapulmonary TB was significantly more common in women than in men (34.1% versus 28.7%; p=0.006). Treatment outcomes were similar in both sexes: in 70.3% of women and 68.9% of men, TB mortality was slightly lower in women than men (4.7% vs. 6.5%; p=0.08). In patients with TB, female sex was independently associated with low weight (adjusted aOR: 0.91; 95% CI 0.90, 0.92), less mortality (aOR: 0.54; 95% CI 0.36, 0.81), and lymph node TB (aOR: 1.57; 95% CI 1.13, 2.19) Conclusion. Lymph node TB was more common in women. Treatment outcomes were similar in both sexes, but women had a lower mortality rate

Diagnosis of cutaneous anthrax in resource-poor settings in West Arsi Province, Ethiopia

Introduction Cutaneous anthrax is a zoonotic disease caused by the spore-forming bacterium Bacillus anthracis, which typically presents with ulcers after contact with animals or animal products, and is rarely seen in high-income countries but is common in those with low- and middle-incomes. Objective. The aim of this study is to show the main clinical characteristics of cutaneous anthrax in endemic areas. Material and methods The study describes the main clinical characteristics of cutaneous anthrax in eight patients (six female and two male, age range 1 – 56 years) admitted to the rural General Hospital of Gambo, West Arsi Province of Ethiopia from 2010–2013. Results In all cases, lesions began as an erythematous papule located on exposed sites (n=7 head; n=1 thigh) and subsequently became a necrotic black eschar surrounded by an edematous halo. Two patients presented with painful ipsilateral adenopathy near the black eschar. Four patients developed a malignant pustule on the suborbital region of the face. Patients responded positively to treatment, and the lesions resolved, leaving eschars. However, one patient suffered the loss of an eyeball, and another died 12 hours after starting treatment. Conclusions Physicians working in rural areas of resource-poor settings should be trained in the clinical identification of cutaneous anthrax. Early antibiotic treatment is essential for decreasing morbidity and mortality

A cost and time-to-completion analysis for all the methods used was done.

<p>¹: DNA extraction takes 10min + LAMP reaction and reading 50min. Capacity of hot-block is 24 samples: each determination comprises two tubes, one for <i>P</i>. <i>falciparum</i> and one for <i>Plasmodium spp</i>.+ controls (positive and negative for <i>P</i>. <i>falciparum</i> and <i>P</i>. <i>vivax</i>).</p><p>²: To obtain the same sensitivity of examination as that for thick film at high power fields (with 100x oil immersion objective) for 10 min, a thin film should be examined for at least 30 min[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0142842#pone.0142842.ref013" target="_blank">13</a>].</p><p>³: Only treatment with ACT for patients with negative diagnoses with each method were considered.</p><p>⁴: Treatment with ACT was considered exclusively.</p><p>⁵: Total cost of diagnosis + total cost of treatment.</p><p>A cost and time-to-completion analysis for all the methods used was done.</p

Comparison between LAMP, RDTs and on-site thin film microscopy in LAMP positive patients.

<p>Sensitivity, specificity, PPV and NPV for RDTs were 27% (CI95%: 0.58%), 100% (95% CI: 99.6–100%), 100% (95% CI: 83.3%) and 94% (95% CI: 91.2–98.6%), respectively.</p><p><i>RDT</i>: <i>Rapid Diagnostic Test; Mic</i>: <i>Microscopy; Hb</i>: <i>Haemoglobin (g/dl); Pla</i>: <i>Platelets (/μl)</i>, <i>m</i>: <i>male; f</i>: <i>female</i>, <i>N negative</i>, <i>Pf</i>: <i>Plasmodium falciparum</i>, <i>Pv Plasmodium vivax</i>.</p

Quantitative diagnostic parameters and qualitative diagnostic parameters for LAMP positive patients.

<p>*Other symptoms included general malaise, abdominal pain and cough.</p><p>Quantitative diagnostic parameters and qualitative diagnostic parameters for LAMP positive patients.</p