Longer delays in diagnosis and treatment ofpulmonary tuberculosis in pastoralist setting, Eastern Ethiopia

Purpose: This study aimed to assess the extent of patient, health system and total delays in diagnosis and treatment of pulmonary tuberculosis (TB) in Somali pastoralist setting, Ethiopia. Patients and Methods: A cross-sectional study among 444 confirmed new pulmonary TB patients aged ≥15 years in 5 TB care units was conducted between December 2017 and October 2018. Data were collected using a structured questionnaire and record review. We measured delays from symptom onset to provider visit, provider visit to diagnosis and diagnosis to treatment initiation. Delays were summarized using median days. Mann- Whitney and Kruskal-Wallis tests were used to compare delays between categories of explanatory variables. The Log-binomial regression model was used to reveal factors associated with health system delay ≥15 days, presented in adjusted prevalence ratio (APR) with 95% confidence interval (CI). Results: The median age of patients was 30 years, ranged from 15 to 82. The majority (62.4%) were male, and nearly half (46.4%) were pastoralists. The median patient, health system and total delays were 30 (19-48.5), 14 (4.5-29.5) and 50 (35-73.5) days, respec-tively. The median patient delay (35.5 days) and total delay (58.5 days) among pastoralists were substantially higher than the equivalent delays among non-pastoralists [p<0.001]. Of all, 3.8% of patients (16 of 18 were pastoralists) delayed longer than 6 months without initiating treatment. Factors associated with health system delay ≥15 days were mild symptoms [APR (95% CI) = 1.4 (1.1-1.7)], smear-negativity [APR (95% CI) = 1.2 (1.01- 1.5)], first visit to health centers [APR (95% CI) = 1.6 (1.3-2.0)] and multiple provider contacts [APR (95% CI) = 5.8 (3.5-9.6)]. Conclusion: Delay in diagnosis and treatment remains a major challenge of tuberculosis control targets in pastoralist settings of Ethiopia. Efforts to expand services tailored to transhumance patterns and diagnostic capacity of primary healthcare units need to be prioritized. © 2020 Getnet et al.Purpose: This study aimed to assess the extent of patient, health system and total delays in diagnosis and treatment of pulmonary tuberculosis (TB) in Somali pastoralist setting, Ethiopia. Patients and Methods: A cross-sectional study among 444 confirmed new pulmonary TB patients aged ≥15 years in 5 TB care units was conducted between December 2017 and October 2018. Data were collected using a structured questionnaire and record review. We measured delays from symptom onset to provider visit, provider visit to diagnosis and diagnosis to treatment initiation. Delays were summarized using median days. Mann- Whitney and Kruskal-Wallis tests were used to compare delays between categories of explanatory variables. The Log-binomial regression model was used to reveal factors associated with health system delay ≥15 days, presented in adjusted prevalence ratio (APR) with 95% confidence interval (CI). Results: The median age of patients was 30 years, ranged from 15 to 82. The majority (62.4%) were male, and nearly half (46.4%) were pastoralists. The median patient, health system and total delays were 30 (19-48.5), 14 (4.5-29.5) and 50 (35-73.5) days, respec-tively. The median patient delay (35.5 days) and total delay (58.5 days) among pastoralists were substantially higher than the equivalent delays among non-pastoralists [p<0.001]. Of all, 3.8% of patients (16 of 18 were pastoralists) delayed longer than 6 months without initiating treatment. Factors associated with health system delay ≥15 days were mild symptoms [APR (95% CI) = 1.4 (1.1-1.7)], smear-negativity [APR (95% CI) = 1.2 (1.01- 1.5)], first visit to health centers [APR (95% CI) = 1.6 (1.3-2.0)] and multiple provider contacts [APR (95% CI) = 5.8 (3.5-9.6)]. Conclusion: Delay in diagnosis and treatment remains a major challenge of tuberculosis control targets in pastoralist settings of Ethiopia. Efforts to expand services tailored to transhumance patterns and diagnostic capacity of primary healthcare units need to be prioritized. © 2020 Getnet et al

Challenges in delivery of tuberculosis services in Ethiopian pastoralist settings: clues for reforming service models and organizational structures

BACKGROUND: The End-TB strategy aims to see a world free of tuberculosis (TB) by the coming decade through detecting and treating all cases irrespective of socioeconomic inequalities. However, case detections and treatment outcomes have not been as they should be in Somali pastoral settings of Ethiopia. Hence, this study aimed to explore the challenges that hinder the delivery and utilization of TB services in pastoral areas. METHODS: A qualitative study was conducted between December 2017 and October 2018 among pastoralist patients with delay of >/=2 months in seeking healthcare, healthcare providers and programme managers. Data were collected from different sources using 41 in-depth interviews, observations of facilities and a review meeting of providers from 50 health facilities. The data were transcribed, coded and analyzed to identify pre-defined and emerging sub-themes. ATLAS.ti version 7.0 was used for coding data, categorizing codes, and visualizing networks. RESULTS: Poor knowledge of TB and its services, limited accessibility (unreachability, unavailability and unacceptability), pastoralism, and initial healthcare-seeking at informal drug vendors that provide improper medications were the key barriers hindering the uptake of TB medical services. Inadequate infrastructure, shortage of trained and enthused providers, interruptions of drugs and laboratory supplies, scarce equipment, programme management gaps, lack of tailored approach, low private engagement, and cross-border movement were the major challenges affecting the provision of TB services for pastoral communities. The root factors were limited potential healthcare coverage, lack of zonal and district TB units, mobility and drought, strategy and funding gaps, and poor development infrastructure. CONCLUSION: In pastoral settings of Ethiopia, the major challenges of TB services are limited access, illicit medication practices, inadequate resources, structural deficits, and lack of tailored approaches. Hence, for the pastoral TB control to be successful, mobile screening and treatment modalities and engaging rural drug vendors will be instrumental in enhancing case findings and treatment compliance; whereas, service expansion and management decentralization will be essential to create responsive structures for overcoming challenges

Determinants of patient delay in diagnosis of pulmonary tuberculosis in somali pastoralist setting of Ethiopia : a matched case-control study

Background; : Healthcare-seeking behavior is the basis to ensure early diagnosis and treatment of tuberculosis (TB) in settings where most cases are diagnosed upon self-presentation to health facilities. Yet, many patients seek delayed healthcare. Thus, we aimed to identify the determinants of patient delay in diagnosis of pulmonary TB in Somali pastoralist area, Ethiopia.; Methods; : A matched case-control study was conducted between December 2017 and October 2018. Cases were self-presented and newly diagnosed pulmonary TB patients aged ≥ 15 years who delayed &gt; 30 days without healthcare provider consultation, and controls were patients with similar inclusion criteria but who consulted a healthcare provider within 30 days of illness; 216 cases sex-matched with 226 controls were interviewed using a pre-tested questionnaire. Hierarchical analysis was done using conditional logistic regression.; Results; : After multilevel analysis, pastoralism, rural residence, poor knowledge of TB symptoms and expectation of self-healing were individual-related determinants. Mild-disease and manifesting a single symptom were disease-related, and &gt;1 h walking distance to nearest facility and care-seeking from traditional/religious healers were health system-related determinants of patient delay &gt; 30 days [; p; &lt; 0.05].; Conclusion; : Expansion of TB services, mobile screening services, and arming community figures to identify and link presumptive cases can be effective strategies to improve case detection in pastoral settings

Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia

Delay in diagnosis and treatment of pulmonary tuberculosis (PTB) leads to severe disease, adverse outcomes and increased transmission. Assessing the extent of delay and its effect on disease progression in TB affected settings has clinical and programmatic importance. Hence, the aim of this study was to investigate the possible effect of delay on infectiousness (cavitation and smear positivity) of patients at diagnosis in Somali pastoralist area, Ethiopia.; A cross-sectional study was conducted between December 2017 and October 2018, and 434 newly coming and confirmed PTB patients aged ≥15 years were recruited in five facilities. Data were collected using interview, record-review, anthropometry, Acid-fast bacilli and chest radiography techniques. Log-binomial regression models were used to reveal the association of delay and other factors associated with cavitation and smear positivity, and ROC Curve was used to determine discriminative ability and threshold delays.; Median age of patients was 30 years. Of all, 62.9% were males, and 46.5% were pastoralists. Median diagnosis delay was 49 days (IQR = 33-70). Cavitation was significantly associated with diagnosis delay [P &lt; 0.001]; 22.2% among patients diagnosed within 30 days of illness and 51.7% if delay was over 30 days. The threshold delay that optimizes cavitation was 43 days [AUC (95% CI) = 0.67(0.62-0.72)]. Smear positivity was significantly increased in patients delayed over 49 days [p = 0.02]. Other factors associated with cavitation were age ≤ 35 years [APR (95% CI) =1.3(1.01-1.6)], chronic diseases [APR (95% CI) = 1.8(1.2-2.6)] and low MUAC*; female; [APR (95% CI) = 1.8(1.2-2.8)]. Smear positivity was also associated with age ≤ 35 years [APR (95% CI) =1.4(1.1-1.8)], low BMI [APR (95% CI) =1.3(1.01-1.7)] and low MUAC [APR (95% CI) =1.5(1.2-1.9)].; This study highlights delay in diagnosis of pulmonary TB remained high and increased infectiousness of patients in pastoral settings of Ethiopia. Hence, delay should be targeted to improve patient outcomes and reduce transmission in such settings

Seizure-Related Injuries among People with Epilepsy at the Outpatient Department of the University of Gondar Hospital, Northwest Ethiopia: Cross-Sectional Institutional-Based Study

Background. The characteristics of epilepsy such as the episodic nature of impairment of consciousness and motor control, psychomotor comorbidity, seizure frequency, and side effects of antiepileptic drugs impact negatively on the physical safety of the patients. Physical injuries such as burn, fracture, dental loss, and hemorrhage affect the quality of patients’ life to the extent of death. Thus, the main purpose of this study was to assess the prevalence of physical injury and associated factors among people with epilepsy. Methods. The study was carried out among 409 people with epilepsy. Cross-sectional study design was utilized to enroll the selected study participants using systematic random sampling technique. Binary and multivariable logistic regression were fitted to identify associated factors using an odds ratio and 95% CI. Results. The overall estimated prevalence of seizure-related physical injury was found to be 27.9%. Of the 27.9% seizure-related physical injuries, 12.5% had abrasions, 5.9% had burns, 4.4% had dental injuries, 2.2% had fractures, and 1.5% had head injuries and dislocations, respectively. Employment, 2-3 years duration of illness, seizure frequencies, and frequencies of drug taken were factors associated with physical injury. Conclusion. More than a quarter of the study participants experienced physical injury. Designing/strengthening injury prevention strategies is suggested especially for those who had uncontrolled seizure frequency for longer period of time

Measuring socioeconomic inequalities in postnatal health checks for newborns in Ethiopia: a decomposition analysis

BackgroundAddressing health inequity is a top priority for achieving sustainable development goals. The existing evidences in Ethiopia have shown that there are substantial inequalities in the use of health services among various socioeconomic strata. Therefore, the present study aimed to measure socioeconomic inequalities and the contributing factors in postnatal health checks for newborns in Ethiopia.MethodsWe used a secondary data from the recent 2019 Ethiopia Mini Demographic and Health Survey dataset. The study includes a weighted sample of 2,105 women who gave birth in the 2 years preceding to the survey. The study participants were selected using two stage cluster sampling techniques. The socioeconomic inequality in postnatal health checks for newborns was measured using the Erreygers Normalized Concentration Index (ECI) and illustrated by the concentration curve. A decomposition analysis was done to identify factors contributing to the socioeconomic related inequality in postnatal health checks for newborns in Ethiopia.ResultsThe concentration curve of postnatal health checks for newborns lay below the line of equality, and the Erreygers normalized concentration index was 0.133, with a standard error = 0.0333, and a p value &lt;0.001; indicating that the postnatal health check for newborns was disproportionately concentrated among newborns with higher socioeconomic status. The decomposition analysis reported that antenatal care (ANC) visit (59.22%), household wealth index (34.43%), and educational level of the mother (8.58%) were the major contributors to the pro-rich socioeconomic inequalities in postnatal health checks for newborns.ConclusionThe finding revealed that there is a pro-rich inequality in postnatal health checks for newborns in Ethiopia. To reduce the observed socioeconomic health inequality, the government needs to improve ANC visits, implement strategies to access health service for economically disadvantaged groups, and increase educational attainment among women

Rural–urban disparity in community-based health insurance enrollment in Ethiopia: a multivariate decomposition analysis using Ethiopian Mini Demographic Health Survey 2019

BackgroundIn sub-Saharan Africa, achieving universal health coverage (UHC) and protecting populations from health-related financial hardship remain challenging goals. Subsequently, community-based health insurance (CBHI) has gained interest in low and middle-income countries, such as Ethiopia. However, the rural–urban disparity in CBHI enrollment has not been properly investigated using multivariate decomposition analysis. Therefore, this study aimed to assess the rural–urban disparity of CBHI enrollment in Ethiopia using the Ethiopian Mini Demographic Health Survey 2019 (EMDHS 2019).MethodsThis study used the latest EMDHS 2019 dataset. STATA version 17.0 software was used for analyses. The chi-square test was used to assess the association between CBHI enrollment and the explanatory variables. The rural–urban disparity of CBHI enrollment was assessed using the logit-based multivariate decomposition analysis. A p-value of &lt;0.05 with a 95% confidence interval was used to determine the statistical significance.ResultsThe study found that there was a significant disparity in CBHI enrollment between urban and rural households (p &lt; 0.001). Approximately 36.98% of CBHI enrollment disparities were attributed to the compositional (endowment) differences of household characteristics between urban and rural households, and 63.02% of the disparities were due to the effect of these characteristics (coefficients). The study identified that the age and education of the household head, family size, number of under-five children, administrative regions, and wealth status were significant contributing factors for the disparities due to compositional differences between urban and rural households. The region was the significant factor that contributed to the rural–urban disparity of CBHI enrollment due to the effect of household characteristics.ConclusionThere were significant urban–rural disparities in CBHI enrollment in Ethiopia. Factors such as age and education of the household head, family size, number of under-five children, region of the household, and wealth status of the household contributed to the disparities attributed to the endowment, and region of the household was the contributing factor for the disparities due to the effect of household characteristics. Therefore, the concerned body should design strategies to enhance equitable CBHI enrollment in urban and rural households

What factors influence women's empowerment in Ethiopia? A multilevel analysis of Ethiopia's demographic and health survey data

BackgroundWomen's empowerment has been a global priority, as countries can achieve significant growth and economic development by empowering women. Understanding the individual and community-level factors that influence women's empowerment is crucial for policymakers to develop effective policies and to improve women's empowerment.MethodA community-based cross-sectional survey was conducted in 11 administrative regions of Ethiopia. The analysis included a weighted sample of 7,108 married women of reproductive age (15–49 years) from the 2,016 Ethiopian Demographic and Health Survey (EDHS). A multilevel mixed-effect binary logistic regression analysis was used to examine the individual and community-level factors associated with women's empowerment. In the final model, significant variables were identified using a p-value of &lt;0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI).ResultsThe overall magnitude of women's empowerment was 23.7% (95% CI: 22.7–24.7). Only 30.9% of women reported participating in household decision-making, and 32.5% disagreed with all the reasons justifying wife-beating. At individual-level, factors positively associated with women's empowerment included secondary (AOR: 2.72 (1.77–4.23), and higher (AOR: 3.65 (1.81–7.34) education. However, belonging to the Muslim religion was negatively associated with women's empowerment (AOR: 0.63 (0.47–0.85). At the community level, wealthy communities were positively associated with women's empowerment (AOR: 1.60 (1.05–2.44). Conversely, residing in rural areas (AOR: 0.49 (0.29–0.83), and living in the Afar (AOR: 0.35 (0.17–0.70), Amhara (AOR: 0.45 (0.26–0.79), Oromia (AOR: 0.43 (0.26–0.73), South Nation Nationalities, and Peoples (SNNP) (AOR: 0.42 (0.24–0.75), and Gambella (AOR: 0.36 (0.20–0.66) regional states were negatively associated with women's empowerment.ConclusionThe overall magnitude of women's empowerment in this study was low. Factors that positively influenced empowerment included attending secondary and higher education, as well as residing in communities with higher wealth status. On the other hand, being Muslim, residing in rural areas, and living in the Afar, Amhara, Oromia, SNNPR, Gambella, and Tigray regions were negatively associated with women's empowerment. As a result, the government of Ethiopia needs to design community-based women's empowerment strategies and involve women in income-generation activities that improve their participation in household decision-making to empower them

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

BACKGROUND: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. METHODS: For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. FINDINGS: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. INTERPRETATION: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. FUNDING: Bill & Melinda Gates Foundation

Zoonotic tuberculosis in a high bovine tuberculosis burden area of Ethiopia

BackgroundTuberculosis (TB) is a major cause of ill health and one of the leading causes of death worldwide, caused by species of the Mycobacterium tuberculosis complex (MTBC), with Mycobacterium tuberculosis being the dominant pathogen in humans and Mycobacterium bovis in cattle. Zoonotic transmission of TB (zTB) to humans is frequent particularly where TB prevalence is high in cattle. In this study, we explored the prevalence of zTB in central Ethiopia, an area highly affected by bovine TB (bTB) in cattle.MethodA convenient sample of 385 patients with pulmonary tuberculosis (PTB, N = 287) and tuberculous lymphadenitis (TBLN, N = 98) were included in this cross-sectional study in central Ethiopia. Sputum and fine needle aspirate (FNA) samples were obtained from patients with PTB and TBLN, respectively, and cultures were performed using BACTEC™ MGIT™ 960. All culture positive samples were subjected to quantitative PCR (qPCR) assays, targeting IS1081, RD9 and RD4 genomic regions for detection of MTBC, M. tuberculosis and M. bovis, respectively.ResultsTwo hundred and fifty-five out of 385 sampled patients were culture positive and all were isolates identified as MTBC by being positive for the IS1081 assay. Among them, 249 (97.6%) samples had also a positive RD9 result (intact RD9 locus) and were consequently classified as M. tuberculosis. The remaining six (2.4%) isolates were RD4 deficient and thereby classified as M. bovis. Five out of these six M. bovis strains originated from PTB patients whereas one was isolated from a TBLN patient. Occupational risk and the widespread consumption of raw animal products were identified as potential sources of M. bovis infection in humans, and the isolation of M. bovis from PTB patients suggests the possibility of human-to-human transmission, particularly in patients with no known contact history with animals.ConclusionThe detected proportion of culture positive cases of 2.4% being M. bovis from this region was higher zTB rate than previously reported for the general population of Ethiopia. Patients with M. bovis infection are more likely to get less efficient TB treatment because M. bovis is inherently resistant to pyrazinamide. MTBC species identification should be performed where M. bovis is common in cattle, especially in patients who have a history of recurrence or treatment failure