Prospects for tuberculosis elimination in Ethiopia: feasibility, challenges, and opportunities.

To end the global tuberculosis (TB) epidemic and eliminate TB, countries around the world committed to significantly expanding the scope of their efforts, including rapid uptake of new tools, interventions, and strategies, and envisioned a world free of TB. Between 2010 and 2020, Ethiopia experienced a 5% average annual decline in TB incidence. However, at that current rate, ending the TB epidemic (<10 TB cases/100,000 population) may not be possible soon. As a high TB and TB/HIV burden country, Ethiopia's TB epidemic is characterized by a high rate of transmission in the general population and hard-to-reach areas and progression of latent TB infection (LTBI) rather than cross-border migration. Studies suggest that a combination of interventions, such as intensive household screening with TB preventive therapy, has the potential to significantly decrease the incidence of TB. The feasibility of reducing the population-level TB incidence by a combination of interventions in Ethiopia is unknown. Based on the World Health Organization's TB elimination framework and the END TB strategic documents and previously published reviews in TB elimination we conducted a narrative review to summarize and estimated the effect of a combined intervention package (community-based TB screening for active case finding and TB and LTBI prevention and treatment among high-risk groups like household and close contacts). The projected annual decline of TB incidence was above 16%. With this level of impact and nationwide scale-up of the interventions, Ethiopia aligns well with ending the TB epidemic before 2035 and shifting toward TB elimination in the foreseeable future. In the Ethiopia setting, we recommend future studies generating evidence on the impact of the combination intervention package to reduce TB incidence in Ethiopia, which is aiming to shift from control to TB elimination.

Treatment outcomes of tuberculosis patients in nigist Eleni Mohammed general hospital, hosanna, southern nations, nationalities and peoples region, Ethiopia: a five year (June 2009 to August 2014) retrospective study.

BACKGROUND: Tuberculosis remains to be a major public health problem among under developed world due to delay in detection and treatment of patients with active TB. In Ethiopia, tuberculosis has been recognized as a major public health problem for more than fifty years. OBJECTIVE: The main objective of this study was to determine treatment outcomes and associated factors among TB patients attending Nigist Eleni Mohammed General Hospital, Hosanna, SNNPR, Ethiopia. METHODS: A five years medical records on treatment outcomes of tuberculosis was reviewed by using a retrospective study design. A total of 768 tuberculosis patients' cards registered in TB unit register from June 2009 to August 2014 were reviewed. Data was coded, cleaned and entered into a computer data base by using EPI Info version 3.5.3 and then analysed by using Spss version 20.0 Descriptive summary values such as frequency and percentage was used to describe the study variable. Moreover, bivariate and multivariate logistic regression analysis with a confidence level of 95% was performed in order to determine the final predictors of the outcome variable. Association of age, sex, residence, HIV status of the patient and TB type/category was assessed with the TB treatment outcome through bivariate analysis. And residence, TB category and HIV status were found significantly associated with the treatment outcomes in bivariate analysis. Finally, the forward addition model was used for the multivariate analysis, and residence, TB category and HIV status of TB patient were entered into the final model to obtain an adjusted odds ratio (AOR). RESULT: Out of 768 TB patients who were registered at the hospital during the study period, 249 (32.4%) completed the treatment, 84 (10.9%) cured, 11 (1.4%) defaulted, 397 (51.7%) were transferred out to other health facility, 23 (2.9%) died and 4 (0.5%) failed the treatment regimen. In this study, the overall treatment success of TB was 333 (43.3%) as compared to their counterparts, 435 (56.7%). Patients who presented pulmonary TB + ve were more likely to develop risk of poor treatment outcomes as compared to the patients with extra pulmonary TB and pulmonary TB-ve (AOR = 1.915,95% CI;1.213,3.028). The proportion of TB HIV co-infection was16.4%, and HIV + ve TB patients were more likely to develop risk of poor treatment outcomes as compared to their counterparts (AOR = 0.796, 95% CI;0.512,1.236). CONCLUSION: From this study, it was generally observed that the rate of defaulting was very low in the hospital. On the other hand, it was observed that the rate of transfer out of patients from the hospital to other health care facilities was very high during the study period. Furthermore, it was observed that patients who came from urban area were less likely to develop risk of poor treatment outcomes as compared to patients who reside in the rural areas.

Magnitude of Malaria and Factors among Febrile Cases in Low Transmission Areas of Hadiya Zone, Ethiopia: A Facility Based Cross Sectional Study.

BACKGROUND: Despite a remarkable decline in morbidity and mortality since the era of malaria roll back strategy, it still poses a huge challenge in Ethiopia in general and in Hadiya Zone in particular. Although, there are data from routine health management information on few indicators, there is scarcity of data showing magnitude of malaria and associated factors including knowledge and practice in the study area. Therefore, the aim of this study was to assess magnitude and factors affecting malaria in low transmission areas among febrile cases attending public health facilities in Hadiya Zone, Ethiopia. METHODS: A facility based cross-sectional study was conducted in Hadiya Zone from May 15 to June 15, 2014. Simple random sampling was used to select the health facility while systematic random sampling technique was used to reach febrile patients attending public health facilities. Data were collected by a pre-tested structured questionnaire containing sections of socio demographic risk factors and knowledge and prevention practices of malaria. Data were entered to Epi-Info software version 3.5.4 and exported to SPSS version 16 for descriptive and logistic regression analysis. RESULTS: One hundred six (25.8%) of participating febrile patients attending at sampled health facilities were found to have malaria by microscopy. Of which, P.vivax, P.falciparum and mixed infection accounted for 76(71. 7%), 27 (25.5%) and 3 (2.8%), respectively. History of travel to malaria endemic area, [AOR: 2.59, 95% CI: (1.24, 5.38)], not using bed net, [AOR: 4.67, 95%CI:, (2.11, 10.37)], poor practice related to malaria prevention and control, [AOR: 2.28, (95%CI: (1.10, 4.74)], poor knowledge about malaria, [AOR: 5.09,95%CI: (2.26,11.50)] and estimated distance of stagnant water near to the residence, [AOR: 3.32, (95%CI: (1.13, 9.76)] were significantly associated factors of malaria positivity in the study. CONCLUSION: The present study revealed that malaria is still a major source of morbidity in the study area among febrile illnesses. Poor level of knowledge, poor prevention practices, not using bed net, travel history to endemic areas and residing near stagnant water were associated factors with malaria positivity in the study area. Therefore, implementers, policy makers and stakeholders should strengthen the services provided by the community health development army, health extension service and health facilities services focusing on increasing malaria intervention coverage and mobilization of information, education and communication to increase knowledge about malaria transmission, prevention and control practices.