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Miecha H, Dejene M, Adugna D, Kebede A, Yadeta D, Alemayehu A, Abateneh A, Wondimu A, Dayessa M, Shafi M, Taye E, Balcha L, Gadisa S, Negussu N, Mengistu B, Willis R, Jimenez C, Bakhtiari A, Boyd S, Kebede B, Tadesse F, Mamo A, Bekele M, Sinke Z, Solomon AW, Harding-Esch EM. Prevalence of Trachoma after Implementation of Trachoma Elimination Interventions in Oromia Regional State, Ethiopia: Results of Impact Surveys in 131 Evaluation Units Covering 139 Districts. Ophthalmic Epidemiol 2023; 30:647-654. [PMID: 36519534 PMCID: PMC10581666 DOI: 10.1080/09286586.2022.2119257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 08/11/2022] [Accepted: 08/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine the prevalence of trachomatous inflammation-follicular (TF), trachomatous trichiasis (TT), water, sanitation, and hygiene (WASH) access in 131 evaluation units (EUs) after implementation of trachoma elimination interventions in Oromia Region, Ethiopia. METHODOLOGY A population-based cross-sectional survey was conducted in each EU using the World Health Organization-recommended two-stage cluster-sampling methodology. Twenty-six clusters, each with a mean of 30 households were enumerated in each EU. All residents aged ≥1 year in selected households were examined for TF and TT. Information on WASH access in surveyed households was also collected through questioning the household head and direct observation. RESULTS A total of 419,858 individuals were enumerated in 131 EUs, of whom 396,134 (94%) were examined, 54% being female. Age-adjusted EU-level prevalence of TF in children aged 1-9 years ranged from 0.15% (95% confidence interval [CI]: 0.0-0.4) to 37.5% (95% CI: 31.1-43.7). The TF prevalence was <5% in 73/131 (56%) EUs. The EU-level age- and gender-adjusted prevalence of TT unknown to the health system among people aged ≥15 years ranged from 0.001% (95% CI: 0.00-0.02) to 2.2% (95% CI: 1.1-3.1) with 37/131 (28%) EUs having a prevalence <0.2%. Only 48% of all households surveyed had access to improved water sources for drinking. Approximately 96% of households did not have an improved latrine. CONCLUSION Oromia is on the path towards elimination of trachoma as a public health problem.
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Affiliation(s)
- Hirpa Miecha
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | | | - Dereje Adugna
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Ageru Kebede
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Damtew Yadeta
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Asfaw Wondimu
- Asfaw Wondimu Health Research and Consultancy, Addis Ababa, Ethiopia
| | | | | | | | - Leta Balcha
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | | | | | | | - Rebecca Willis
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Cristina Jimenez
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA
| | - Ana Bakhtiari
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Sarah Boyd
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Biruk Kebede
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Ayele Mamo
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | | | - Zelalem Sinke
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Miecha H, Dejene M, Adugna D, Kebede A, Yadeta D, Alemayehu A, Abateneh A, Dayessa M, Shafi M, Taye E, Balcha L, Negussu N, Mengistu B, Willis R, Jimenez C, Bakhtiari A, Boyd S, Kebede B, Tadesse F, Mamo A, Bekele M, Sinke Z, Solomon AW, Harding-Esch EM. Prevalence of Trachoma in Pre-validation Surveillance Surveys in 11 Evaluation Units (Covering 12 Districts) in Oromia Regional State, Ethiopia: Results from 2018-2020. Ophthalmic Epidemiol 2023; 30:655-662. [PMID: 36519777 PMCID: PMC10581667 DOI: 10.1080/09286586.2022.2119258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Interventions to reduce the prevalence of trachoma and transmission of ocular Chlamydia trachomatis have been implemented in Oromia Region, Ethiopia. Following an impact survey in which the trachomatous inflammation-follicular (TF) prevalence in 1-9-year-olds is <5%, a surveillance survey is recommended 2 years later, without additional antibiotic treatment. We report results of surveillance surveys in 11 evaluation units (EUs) covering 12 districts in Oromia Region, to plan whether future interventions are needed. METHOD We use a two-stage cluster-sampling cross-sectional survey design. In each EU, 26 clusters (villages) were systematically selected with probability proportional to size; from each cluster, 30 households were selected using compact segment sampling. Water, sanitation and hygiene (WASH) access was assessed in all selected households. All residents of selected households aged ≥1 year were examined for TF and trachomatous trichiasis (TT) by certified graders. RESULT Of 31,991 individuals enumerated, 29,230 (91% of) individuals were examined. Eight EUs had an age-adjusted TF prevalence in 1-9-year-olds of ≥5% and seven had a TT prevalence unknown to the health system among adults aged ≥15 years of ≥0.2%. About one-third of visited households had access to an improved water source for drinking, and 5% had access to an improved latrine. CONCLUSION Despite TF reductions to <5% at impact survey, prevalence recrudesced to ≥5% in all but three of the 11 EUs. Operational research is needed to understand transmission dynamics and epidemiology, in order to optimise elimination strategies in high-transmission settings like these.
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Affiliation(s)
- Hirpa Miecha
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | - Dereje Adugna
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | - Ageru Kebede
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Damtew Yadeta
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Leta Balcha
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | | | | | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | | | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | | | | | - Ayele Mamo
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | - Zelalem Sinke
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Alemayehu A, Mekonen A, Mengistu B, Mihret A, Asmare A, Bakhtiari A, Mengistu B, Jimenez C, Kebede D, Bol D, Tadesse F, Kebede F, Gebru G, Frawley H, Ngondi J, Jemal M, Brady M, Negussu N, Butcher R, McPherson S, Backers S, Solomon AW, Bejiga MD, Harding-Esch EM. Prevalence of Trachoma After Three Rounds of Antibiotic Mass Drug Administration in 13 Woredas of Gambella Region, Ethiopia. Ophthalmic Epidemiol 2023:1-9. [PMID: 38032947 DOI: 10.1080/09286586.2023.2248624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Following baseline surveys in 2013 and 2014, trachoma elimination interventions, including three rounds of azithromycin mass drug administration (MDA), were implemented in 13 woredas (administrative districts) of Gambella Regional State, Ethiopia. We conducted impact surveys to determine if elimination thresholds have been met or if additional interventions are required. METHODS Cross-sectional population-based surveys were conducted in 13 woredas of Gambella Regional State, combined into five evaluation units (EUs), 6─12 months after their last MDA round. A two-stage systematic (first stage) and random (second stage) sampling technique was used. WHO-recommended protocols were implemented with the support of Tropical Data. Household water, sanitation and hygiene (WASH) access was assessed. RESULTS The age-adjusted prevalence of trachomatous inflammation - follicular (TF) in 1-9-year-olds in the five EUs ranged from 0.3-19.2%, representing a general decline in TF prevalence compared to baseline estimates. The age- and gender-adjusted prevalence of trachomatous trichiasis (TT) unknown to the health system in those aged ≥ 15 years ranged from 0.47-3.08%. Of households surveyed, 44% had access to an improved drinking water source within a 30-minute return journey of the house, but only 3% had access to an improved latrine. CONCLUSION In two EUs, no further MDA should be delivered, and a surveillance survey should be conducted after two years without MDA. In one EU, one further round of MDA should be conducted followed by another impact survey. In two EUs, three further MDA rounds are required. Surgery, facial cleanliness and environmental improvement interventions are needed throughout the region.
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Affiliation(s)
- Addisu Alemayehu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Ademe Mekonen
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Belete Mengistu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Addisalem Mihret
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Aemiro Asmare
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | | | - Bekele Mengistu
- Nekemte Specialized Hospital, Eastern Wollega Zone, Oromia Region, Ethiopia
| | | | - Demis Kebede
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Doul Bol
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Fentahun Tadesse
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fikreab Kebede
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Genet Gebru
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Hannah Frawley
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Jeremiah Ngondi
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Mohammed Jemal
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Molly Brady
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Nebiyu Negussu
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Scott McPherson
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Sharone Backers
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Mengistu B, Wirtu F, Alemayehu A, Alene S, Asmare A, Backers S, Bakhtiari A, Brady M, Butcher RMR, Dayessa M, Frawley H, Gebru G, Jimenez C, Kebede F, Kejela A, McPherson S, Mihret A, Negussu N, Ngondi JM, Taddese F, Willis R, Wondimu A, Dejene M, Solomon AW, Harding-Esch EM. Prevalence of Trachoma in Benishangul Gumuz Region, Ethiopia, after Implementation of the SAFE Strategy: Results of Four Population-Based Surveys. Ophthalmic Epidemiol 2022:1-9. [PMID: 36511584 PMCID: PMC10578310 DOI: 10.1080/09286586.2022.2140439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 09/02/2022] [Accepted: 10/21/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds in Benishangul Gumuz (BGZ) region, Ethiopia. This will help to assess progress towards the elimination of trachoma as a public health problem and determine the need for future interventions against trachoma in the region. METHODS Cross-sectional population-based trachoma prevalence surveys were conducted in four evaluation units (EUs) of BGZ using World Health Organization-recommended survey methodologies. Individuals were examined for clinical signs of trachoma. Household access to water, sanitation and hygiene facilities (WaSH) was assessed. RESULTS A total of 11,778 people aged ≥1 year were examined. The prevalence of TF in 1-9-year-olds was <5% in three EUs and ≥5% in one EU. The prevalence of TT unknown to the health system in people aged ≥15-years was ≥0.2% in all four EUs. The proportion of households with an improved drinking water source within a 30-minute round-trip ranged from 27-60%. The proportion of households with an improved latrine ranged from <1-6%. CONCLUSIONS Surgical interventions for TT are required in all EUs in BGZ. One annual round of mass drug administration (MDA) of azithromycin is required in one EU before resurvey to reassess progress in lowering TF prevalence below the WHO elimination threshold of 5% in 1-9-year-olds. MDA should be stopped in the other three EUs and trachoma surveillance surveys should be conducted at least 24 months after the surveys described here. Ongoing strengthening of WaSH infrastructure may help sustain the low prevalence of trachoma.
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Affiliation(s)
- Belete Mengistu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Fikru Wirtu
- Health Promotion and Disease Prevention Core Process, Benishangul-Gumuz Regional Health Bureau, Ethiopia
| | | | - Shigute Alene
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Aemiro Asmare
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Sharone Backers
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | | | - Molly Brady
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Robert M. R. Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Hannah Frawley
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Genet Gebru
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Ministry of Health, Ethiopia
| | | | - Fikreab Kebede
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Ministry of Health, Ethiopia
| | - Asfaw Kejela
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Scott McPherson
- Act to End NTDs East, RTI International, Washington, DC, USA
| | | | - Nebiyu Negussu
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Ministry of Health, Ethiopia
| | | | - Fentahun Taddese
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Ministry of Health, Ethiopia
| | | | - Asfaw Wondimu
- Asfaw Wondimu Health Research and Consultancy, Addis Ababa, Ethiopia
| | | | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Martindale S, Mableson HE, Kebede B, Kiros FH, Tamiru A, Mengistu B, Krueger A, Mackenzie CD, Kelly-Hope LA. A comparison between paper-based and m-Health tools for collating and reporting clinical cases of lymphatic filariasis and podoconiosis in Ethiopia. Mhealth 2018; 4:49. [PMID: 30505847 PMCID: PMC6232075 DOI: 10.21037/mhealth.2018.09.12] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/20/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) and podoconiosis are disabling diseases, endemic in Ethiopia. The main clinical manifestations include lymphoedema from LF and podoconiosis, and hydrocoele from LF. To ensure access to morbidity management and disability prevention (MMDP) services, data on patient numbers in each implementation unit (IU) is required. House-to-house census is considered the gold standard for determining patient numbers, and data are usually collated and reported using paper-based methods. However, often there are delays in data reaching the regional and central level, which leads to subsequent delays in rolling out and prioritising MMDP services. The increase in mobile phone mHealth tools offers an alternative, potentially more rapid and cost-effective approach. METHODS As part of an LF and podoconiosis burden assessment conducted in Hawella Tula and Bensa districts in Ethiopia, this study compared the standard paper-based methods with the new MeasureSMS-Morbidity tool for clinical cases data collation and reporting. Health extension workers (HEWs) were trained on both methods. Comparisons were made on patient information; age, gender, location (i.e., kebele), condition, severity of condition and acute attacks. Data were analysed for trends, including the differences in ranking the villages in each district based on the highest to lowest number of cases. In addition, financial and human resource requirements were compared. RESULTS In total, 59 HEWs (19 from Hawella Tula; 40 from Bensa) collated and reported a similar number of cases by paper-based (n=2,377) and SMS (n=2,372) methods. Significant correlations were found between the two methods for all cases and lymphoedema cases in both districts, and for hydrocoele cases in Bensa district only. The total cost of paper-based reporting was 13.7% more expensive than SMS reporting due to costs associated with data collection and entry. CONCLUSIONS The rank correlation showed the same villages would be prioritised for delivery of MMDP services, with time and cost-savings observed using SMS reporting, suggesting it is an effective and efficient alternative tool to help facilitate care to those who need it most.
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Affiliation(s)
- Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hayley E. Mableson
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Biruk Kebede
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Fikre H. Kiros
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Abraham Tamiru
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | | | - Anna Krueger
- George Washington University, Washington DC, USA
| | - Charles D. Mackenzie
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
- Michigan State University, East Lansing, MI 48824, USA
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
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Kebede B, Martindale S, Mengistu B, Kebede B, Mengiste A, H/Kiros F, Tamiru A, Davey G, Kelly-Hope LA, Mackenzie CD. Integrated morbidity mapping of lymphatic filariasis and podoconiosis cases in 20 co-endemic districts of Ethiopia. PLoS Negl Trop Dis 2018; 12:e0006491. [PMID: 29965963 PMCID: PMC6044548 DOI: 10.1371/journal.pntd.0006491] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/13/2018] [Accepted: 05/02/2018] [Indexed: 11/24/2022] Open
Abstract
Background Lymphatic filariasis (LF) and podoconiosis are neglected tropical diseases (NTDs) that pose a significant physical, social and economic burden to endemic communities. Patients affected by the clinical conditions of LF (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) need access to morbidity management and disability prevention (MMDP) services. Clear estimates of the number and location of these patients are essential to the efficient and equitable implementation of MMDP services for both diseases. Methodology/Principle findings A community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 woredas (districts) co-endemic for LF and podoconiosis. A total of 612 trained HEWs and 40 supervisors from 20 districts identified 26,123 cases of clinical morbidity. Of these, 24,908 (95.3%) reported cases had leg lymphoedema only, 751 (2.9%) had hydrocoele, 387 (1.5%) had both leg lymphoedema and hydrocoele, and 77 (0.3%) cases had breast lymphoedema. Of those reporting leg lymphoedema, 89.3% reported bilateral lymphoedema. Older age groups were more likely to have a severe stage of disease, have bilateral lymphoedema and to have experienced an acute attack in the last six months. Conclusions/Significance This study represents the first community-wide, integrated clinical case mapping of both LF and podoconiosis in Ethiopia. It highlights the high number of cases, particularly of leg lymphoedema that could be attributed to either of these diseases. This key clinical information will assist and guide the allocation of resources to where they are needed most. Patients affected by the clinical conditions of lymphatic filariasis (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) require access to a minimum package of care to prevent progression of the disease, and to improve their quality of life. Clear estimates of the number and location of these patients is essential for the delivery of this care. To address this, a community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 co-endemic woredas (districts). A total of 26,123 cases of clinical morbidity were identified. Of these, 24,908 (95.3%) had leg lymphoedema, of which 89.3% were bilateral. The results of this study will help assist the Neglected Tropical Disease (NTD) programme at the Federal Ministry of Health (FMOH) in Ethiopia to effectively and equitably plan the delivery of a basic package of care to those suffering from the clinical manifestations of both diseases.
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Affiliation(s)
- Biruk Kebede
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (SM); (LAKH)
| | | | | | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Fikre H/Kiros
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Abraham Tamiru
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, Brighton, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (SM); (LAKH)
| | - Charles D. Mackenzie
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Michigan State University, East Lansing, Michigan, United States of America
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Deribew A, Dejene T, Kebede B, Tessema GA, Melaku YA, Misganaw A, Gebre T, Hailu A, Biadgilign S, Amberbir A, Yirsaw BD, Abajobir AA, Shafi O, Abera SF, Negussu N, Mengistu B, Amare AT, Mulugeta A, Mengistu B, Tadesse Z, Sileshi M, Cromwell E, Glenn SD, Deribe K, Stanaway JD. Incidence, prevalence and mortality rates of malaria in Ethiopia from 1990 to 2015: analysis of the global burden of diseases 2015. Malar J 2017; 16:271. [PMID: 28676108 PMCID: PMC5496144 DOI: 10.1186/s12936-017-1919-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background In Ethiopia there is no complete registration system to measure disease burden and risk factors accurately. In this study, the 2015 global burden of diseases, injuries and risk factors (GBD) data were used to analyse the incidence, prevalence and mortality rates of malaria in Ethiopia over the last 25 years. Methods GBD 2015 used verbal autopsy surveys, reports, and published scientific articles to estimate the burden of malaria in Ethiopia. Age and gender-specific causes of death for malaria were estimated using cause of death ensemble modelling. Results The number of new cases of malaria declined from 2.8 million [95% uncertainty interval (UI) 1.4–4.5 million] in 1990 to 621,345 (95% UI 462,230–797,442) in 2015. Malaria caused an estimated 30,323 deaths (95% UI 11,533.3–61,215.3) in 1990 and 1561 deaths (95% UI 752.8–2660.5) in 2015, a 94.8% reduction over the 25 years. Age-standardized mortality rate of malaria has declined by 96.5% between 1990 and 2015 with an annual rate of change of 13.4%. Age-standardized malaria incidence rate among all ages and gender declined by 88.7% between 1990 and 2015. The number of disability-adjusted life years lost (DALY) due to malaria decreased from 2.2 million (95% UI 0.76–4.7 million) in 1990 to 0.18 million (95% UI 0.12–0.26 million) in 2015, with a total reduction 91.7%. Similarly, age-standardized DALY rate declined by 94.8% during the same period. Conclusions Ethiopia has achieved a 50% reduction target of malaria of the millennium development goals. The country should strengthen its malaria control and treatment strategies to achieve the sustainable development goals.
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Affiliation(s)
- Amare Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia. .,Dilla University, Dilla, Ethiopia. .,Nutrition International (former Micronutrient Initiative), Addis Ababa, Ethiopia.
| | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Gizachew Assefa Tessema
- Department Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia.,School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Yohannes Adama Melaku
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Awoke Misganaw
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Teshome Gebre
- International Trachoma Initiative, The Task Force for Global Health, Addis Ababa, Ethiopia
| | - Asrat Hailu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Amanuel Alemu Abajobir
- School of Public Health, The University of Queensland, St Lucia, QLD, Australia.,Debremarkos University, Debremarkos, Ethiopia
| | - Oumer Shafi
- Rollins Schools of Public Health, Emory University, Atlanta, USA
| | - Semaw F Abera
- School of Public Health, Mekelle University, Mekelle, Ethiopia.,Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany
| | | | | | - Azmeraw T Amare
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | | | | | | - Elizabeth Cromwell
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Falmer, Brighton, UK.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jeffrey D Stanaway
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
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Deribe K, Kebede B, Tamiru M, Mengistu B, Kebede F, Martindale S, Sime H, Mulugeta A, Kebede B, Sileshi M, Mengiste A, McPherson S, Fentaye A. Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia. Bull World Health Organ 2017; 95:652-656. [PMID: 28867846 PMCID: PMC5578380 DOI: 10.2471/blt.16.189399] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require a similar provision of care, but until recently the Ethiopian health system did not integrate the morbidity management. APPROACH To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers carried out integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system. LOCAL SETTING In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services. RELEVANT CHANGES To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts. LESSONS LEARNT In Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic.
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Affiliation(s)
- Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Falmer, Brighton, East Sussex, BN1 9PX, England
| | - Biruck Kebede
- NTD case team, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mossie Tamiru
- NTD case team, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Sarah Martindale
- Center for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, England
| | - Heven Sime
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abate Mulugeta
- Country Office, World Health Organization, Addis Ababa, Ethiopia
| | | | - Mesfin Sileshi
- NTD case team, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | | | - Amha Fentaye
- NTD case team, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
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Deribe K, Kebede B, Mengistu B, Negussie H, Sileshi M, Tamiru M, Tomczyk S, Tekola-Ayele F, Davey G, Fentaye A. Podoconiosis in Ethiopia: From Neglect to Priority Public Health Problem. Ethiop Med J 2017; 55:65-74. [PMID: 28878431 PMCID: PMC5582632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Podoconiosis is a geochemical disease occurring in individuals exposed to red clay soil of volcanic origin. This Neglected Tropical Disease (NTD) is highly prevalent in Ethiopia. According to the nationwide mapping in 2013, the disease is endemic in 345 districts, where an estimated 35 million people live. The government of Ethiopia prioritized podoconiosis as one of eight priority NTDs and included it in the national integrated master plan for NTDs. An integrated lymphoedema management guideline has been developed. Service expansion has continued in the last few years and lymphoedema management services have been expanded to over one hundred endemic districts. The last few years have been critical in generating evidence about the distribution, burden and effective interventions for podoconiosis in Ethiopia. Although the extent of the problem within Ethiopia is considerable, the country is well positioned to now scale-up elimination efforts. Given the extraordinary progress of the past ten years and the current commitment of government, private and third sectors, Ethiopia seems to be on course for the elimination of podoconiosis in our lifetime. We need continued strong partner commitment, evidence-building, and scale-up of activities to accomplish this.
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Affiliation(s)
- Kebede Deribe
- Federal Ministry of Health, Addis Ababa, Ethiopia
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | | | | | - Henok Negussie
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
| | - Mesfin Sileshi
- Federal Ministry of Health, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | | | - Sara Tomczyk
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, USA
| | - Gail Davey
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
| | - Amha Fentaye
- Federal Ministry of Health, Addis Ababa, Ethiopia
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10
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Deribew A, Kebede B, Tessema GA, Adama YA, Misganaw A, Gebre T, Hailu A, Biadgilign S, Amberbir A, Desalegn B, Abajobir AA, Shafi O, Abera SF, Negussu N, Mengistu B, Amare AT, Mulugeta A, Kebede Z, Mengistu B, Tadesse Z, Sileshi M, Tamiru M, Chromwel EA, Glenn SD, Stanaway JD, Deribe K. Mortality and Disability-Adjusted Life-Years (Dalys) for Common Neglected Tropical Diseases in Ethiopia, 1990-2015: Evidence from the Global Burden of Disease Study 2015. Ethiop Med J 2017; 55:3-14. [PMID: 28878427 PMCID: PMC5582634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Neglected tropical diseases (NTDs) are important public health problems in Ethiopia. In 2013, the Federal Ministry of Health (FMOH) has launched a national NTD master plan to eliminate major NTDs of public health importance by 2020. Benchmarking the current status of NTDs in the country is important to monitor and evaluate the progress in the implementation of interventions and their impacts. Therefore, this study aims to assess the trends of mortality and Disability-adjusted Life-Years (DALY) for the priority NTDs over the last 25 years. METHODS We used the Global Burden of Disease (GBD) 2015 estimates for this study. The GBD 2015 data source for cause of death and DALY estimation included verbal autopsy (VA), Demographic and Health Surveys (DHS), and other disease specific surveys, Ministry of Health reports submitted to United Nations (UN) agencies and published scientific articles. Cause of Death Ensemble modeling (CODEm) and/or natural history models were used to estimate NTDs mortality rates. DALY were estimated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD). RESULTS All NTDs caused an estimated of 6,293 deaths (95% uncertainty interval (UI): 3699-10,080) in 1990 and 3,593 deaths (95% UI: 2051 - 6178) in 2015, a 43% reduction over the 25 years. Age-standardized mortality rates due to schistosomiasis, STH and leshmaniasis have declined by 91.3%, 73.5% and 21.6% respectively between 1990 to 2015. The number of DALYs due to all NTDs has declined from 814.4 thousand (95% UI: 548 thousand-1.2million) in 1990 to 579.5 thousand (95%UI: 309.4 thousand-1.3 million) in 2015. Age-standardized DALY rates due to all NTDs declined by 30.7%, from 17.6 per 1000(95%UI: 12.5-26.5) in 1990 to 12.2 per 1000(95%UI: 6.5 - 27.4) in 2015. Age-standardized DALY rate for trachoma declined from 92.7 per 100,000(95% UI: 63.2 - 128.4) in 1990 to 41.2 per 100,000(95%UI: 27.4-59.2) in 2015, a 55.6% reduction between 1990 and 2015. Age-standardized DALY rates for onchocerciasis, schistosomiasis and lymphiaticfilariasis decreased by 66.2%, 29.4% and 12.5% respectively between 1990 and 2015. DALY rate for ascariasis fell by 56.8% over the past 25 years. CONCLUSIONS Ethiopia has made a remarkable progress in reducing the DALY rates for most of the NTDs over the last 25 years. The rapid scale of interventions and broader system strengthening may have a lasting impact on achieving the 2020 goal of elimination of most of NTDs. Ethiopia should strengthen the coverage of integrated interventions of NTD through proper coordination with other health programs and sectors and community participation to eliminate NTDs by 2020.
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Affiliation(s)
- A Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia
- Dilla University, Dilla, Ethiopia
- Micronutrient Initiative, Ethiopia
| | - B Kebede
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - GA Tessema
- Department Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - YA Adama
- School of Medicine, The University of Adelaide, Adelaide South Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - A Misganaw
- Institute for Health Metrics and Evaluation, University of Washington
| | - T Gebre
- International Trachoma Initiative, the Task Force for Global Health, Addis Ababa, Ethiopia
| | - A Hailu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - B Desalegn
- University of South Australia, Adelaide, Australia
| | - AA Abajobir
- School of Public Health, the University of Queensland, Queensland, Australia
- Debremarkos University, Debremarkos, Ethiopia
| | - O Shafi
- Rollind schools of public Health, Emory University, USA
| | - SF Abera
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany
| | - N Negussu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - B Mengistu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - AT Amare
- School of Medicine, The University of Adelaide, Adelaide South Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - A Mulugeta
- World Health Organization, Addis Ababa, Ethiopia
| | - Z Kebede
- World Health Organization, Addis Ababa, Ethiopia
| | - B Mengistu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Z Tadesse
- The Carter Centre, Addis Ababa, Ethiopia
| | - M Sileshi
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - M Tamiru
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | - EA Chromwel
- Institute for Health Metrics and Evaluation, University of Washington
| | - SD Glenn
- Institute for Health Metrics and Evaluation, University of Washington
| | - JD Stanaway
- Institute for Health Metrics and Evaluation, University of Washington
| | - K Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
- School of Public Health, Addis Ababa University, Ethiopia
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Mengistu B, Deribe K, Kebede F, Martindale S, Hassan M, Sime H, Mackenzie C, Mulugeta A, Tamiru M, Sileshi M, Hailu A, Gebre T, Fentaye A, Kebede B. The National Programme to Eliminate Lymphatic Filariasis from Ethiopia. Ethiop Med J 2017; 55:45-54. [PMID: 28878429 PMCID: PMC5582637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Lymphatic filariasis (LF) is one of the most debilitating and disfiguring diseases common in Ethiopia and is caused by Wuchereria bancrofti. Mapping for LF has shown that 70 woredas (districts) are endemic and 5.9 million people are estimated to be at risk. The national government's LF elimination programme commenced in 2009 in 5 districts integrated with the onchocerciasis programme. The programme developed gradually and has shown significant progress over the past 6 years, reaching 100% geographical coverage for mass drug administration (MDA) by 2016. To comply with the global LF elimination goals an integrated morbidity management and disability prevention (MMDP) guideline and a burden assessment programme has also been developed; MMDP protocols and a hydrocoele surgical handbook produced for country-wide use. In Ethiopia, almost all LF endemic districts are co-endemic with malaria and vector control aspects of the activities are conducted in the context of malaria programme as the vectors for both diseases are mosquitoes. In order to monitor the elimination, 11 sentinel and spot-check sites have been established and baseline information has been collected. Although significant achievements have been achieved in the scale up of the LF elimination programme, there is still a need to strengthen operational research to generate programme-relevant evidence, to increase access to morbidity management services, and to improve monitoring and evaluation of the LF programme. However, the current status of implementation of the LF national programme indicates that Ethiopia is poised to achieve the 2020 goal of elimination of LF. Nevertheless, to achieve this goal, high and sustained treatment coverage and strong monitoring and evaluation of the programme are essential.
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Affiliation(s)
| | - Kebede Deribe
- Federal Ministry of Health, Addis Ababa, Ethiopia
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | | | - Sarah Martindale
- Centre for Neglected Tropical Diseases (CNTD), Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | | | - Heven Sime
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Charles Mackenzie
- Centre for Neglected Tropical Diseases (CNTD), Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Abate Mulugeta
- World Health Organization, Menelik Avenue, UNECA compound, P.O. Box 3069, Addis Ababa, Ethiopia
| | | | - Mesfin Sileshi
- Federal Ministry of Health, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | - Asrat Hailu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Gebre
- International Trachoma Initiative, Addis Ababa, Ethiopia
| | - Amha Fentaye
- Federal Ministry of Health, Addis Ababa, Ethiopia
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Sisay S, Mengistu B, Erku W, Woldeyohannes D. Ten years' experience of Directly Observed Treatment Short-course (DOTS) in Gambella Regional State, Ethiopia: An evaluation of tuberculosis control program. Int J Mycobacteriol 2016; 5 Suppl 1:S117-S118. [PMID: 28043497 DOI: 10.1016/j.ijmyco.2016.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND World Health Organization (WHO) declared tuberculosis (TB) as a global public health emergency and recommended DOTS as a standard strategy for controlling the disease. TB is one of the major causes of infectious diseases in the world, and 25% of all avoidable deaths in developing countries. About a third of the world's population is estimated to be infected with tubercle bacilli, and hence at risk of developing active disease. The objective of the study was, therefore, to evaluate the impact of DOTS strategy on smear-positive pulmonary tuberculosis case finding and their treatment outcomes in Gambella Regional State, Ethiopia. METHODS A retrospective health facility-based descriptive study was employed. Quarterly data were collected by using WHO structured reporting format for TB case finding and treatment outcome from all DOTS implementing health facilities in the region. RESULTS A total of 10,024 TB cases (all forms) were registered and reported between the periods from 2003 up to 2012. Out of these, 4100 (40.9%) were smear-positive pulmonary TB, 3164 (31.6%) were smear-negative pulmonary TB and 2760 (27.5%) had extra-pulmonary TB. An average case detection rate (CDR)1 of 40.9% (SD=0.1) and treatment success rate (TSR)2 of 55.7% (SD=0.28) for smear-positive pulmonary TB including other forms of TB were reported for the specified years period. Additionally, the average mean values of treatment defaulter and treatment failure rates were 4.2% and 0.3%, respectively. CONCLUSIONS The recommended TSR set by WHO was achieved as it was already been fulfilled more than 85% from 2009 up to 2011 in the region and the reported CDR was far below (40.9%) for smear-positive pulmonary TB including other forms of TB from the target. Therefore, extensive efforts should be established to maintain the achieved TSR and to increase the low level of CDR for all forms of TB cases through implementing alternative case finding strategies.
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Affiliation(s)
- Solomon Sisay
- Department of Clinical, John Hopkins University-TSEHAI Project, P.O. Box 5606, Addis Ababa, Ethiopia
| | - Belete Mengistu
- Directorate of Pastoralist Health Promotion and Disease Prevention, Federal Ministry of Health, P.O. Box 1234, Addis Ababa, Ethiopia
| | - Woldargay Erku
- Department of Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Desalegne Woldeyohannes
- Department of Public Health, School of Medicine and Health Sciences, Addis Ababa Science and Technology University, P.O. Box 16417, Addis Ababa, Ethiopia
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13
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Tafess K, Mengistu B, Woldeyohannes D, Sisay S. Determining treatment outcome of smear-positive pulmonary tuberculosis cases in Afar Regional State, Ethiopia: A retrospective facility based study. Int J Mycobacteriol 2016; 5:164-9. [PMID: 27242227 DOI: 10.1016/j.ijmyco.2016.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE/BACKGROUND The World Health Organization (WHO) declared tuberculosis (TB) as a global public health emergency and recommended directly observed treatment, short-course (DOTS) as a standard strategy to control the disease. In Ethiopia the strategy was started in 1992 as a pilot in the Arsi and Bale zone, Oromia Region. The DOTS strategy has been subsequently scaled up in the country and implemented at a national level reaching better coverage, although there are recognizable variations from region to region and district to district. The aim of this study was to assess the impact of the DOTS strategy on smear-positive pulmonary TB case findings and their treatment outcomes in the Afar Regional State, Ethiopia, from 2003 to 2012 and from 2002 to 2011, respectively. METHODS A health facility-based retrospective study was conducted. Data were collected and reported on a quarterly basis using the WHO reporting format for TB case findings and their treatment outcomes from all DOTS-implementing health facilities in all zones of the region to the Federal Ministry of Health. RESULTS A total of 34,894 of TB cases had been registered in the period from 2003 to 2012. Out of these, 11,595 (33.2%) were smear-positive pulmonary TB, 13,859 (39.7%) smear-negative pulmonary TB, and 9838 (28.2%) extrapulmonary TB. The case detection rate (CDR) of smear-positive pulmonary TB had increased from 18.3% to 37.2%, with the average value being 32% (standard deviation=6.8) from the total TB cases to its peak of 39% in 2008. The treatment success rate (TSR) had an average value of 86.2% from 2002 to 2011 with its peak value being 96.5% in 2007. Moreover, the average values of treatment defaulter and treatment failure rate were 2.9% and 2.7%, respectively. CONCLUSION The implementation for the DOTS strategy in the area improved the CDR of smear-positive TB, although it is unacceptably lower than the recommended WHO target of 70%. Additionally, the WHO target of 85% for TSR had already been achieved in the region. However, continued efforts should be in place to increase the CDR and maintain the high TSR registered.
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Affiliation(s)
- Ketema Tafess
- Department of Medical Laboratory Sciences, College of Health Sciences, Arsi University, Asella, Ethiopia.
| | - Belete Mengistu
- Directorate of Pastoralist Health Promotion and Disease Prevention, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Desalegn Woldeyohannes
- Department of Zoonoses, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Woldeyohannes D, Sisay S, Mengistu B, Kassa H. Directly observed treatment short-course (DOTS) for treatment of new tuberculosis cases in Somali Regional State, Eastern Ethiopia: ten years retrospective study. BMC Res Notes 2015; 8:357. [PMID: 26285700 PMCID: PMC4539707 DOI: 10.1186/s13104-015-1325-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 08/11/2015] [Indexed: 11/25/2022] Open
Abstract
Background A third of the world population is infected with tuberculosis (TB) bacilli. TB accounts for 25 % of all avoidable deaths in developing countries. The objective of the study was to assess impact of directly observed treatment short-course (DOTS) strategy on new tuberculosis case finding and treatment outcomes in Somali Regional State, Ethiopia from 2003 up to 2012 and from 2004 up to 2013, respectively. Methods A health facility based retrospective study was employed. Quarterly reports were collected using World Health Organization (WHO) reporting format for TB case finding and treatment outcome from all zones in the region to the Federal Ministry of Health. Results A total of 31, 198 all types of new TB cases were registered and reported during the period from 2003 up to 2012, in the region. Out of these, smear positive pulmonary TB cases were 12,466 (40 %), and 10,537 (33.8 %) and 8195 (26.2 %) for smear negative pulmonary TB and extra-pulmonary TB cases, respectively. An average case detection rate (CDR) of 19.1 % (SD 3.6) and treatment success rate (TSR) of 85.5 % (SD 5.0) for smear positive pulmonary TB were reported for the specified years period. For the overall study period, trend chi-squire analysis for CDR was X2 = 2.1; P > 0.05 and X2 = 5.64; P < 0.05 for TSR. Conclusions The recommended TSR set by WHO was achieved (85.5 %) and the CDR reported was far below (19.1 %) from the recommended target. Extensive efforts should be established to maintain the achieved TSR and to increase the low CDR for the smear positive pulmonary TB cases through implementing alternative case finding strategies.
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Affiliation(s)
- Desalegn Woldeyohannes
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P.O.Box 1176, Addis Ababa, Ethiopia.
| | - Solomon Sisay
- Department of Clinical, John Hopkins University-TSEHAI Project, P.O.Box 5606, Addis Ababa, Ethiopia.
| | - Belete Mengistu
- Directorate of Pastoralist Health Promotion and Disease Prevention, Federal Ministry of Health, P.O.Box 1234, Addis Ababa, Ethiopia.
| | - Hiwot Kassa
- Department of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.Box 196, Gondar, Ethiopia.
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15
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Sisay S, Mengistu B, Erku W, Woldeyohannes D. Directly Observed Treatment Short-course (DOTS) for tuberculosis control program in Gambella Regional State, Ethiopia: ten years experience. BMC Res Notes 2014; 7:44. [PMID: 24444379 PMCID: PMC3905666 DOI: 10.1186/1756-0500-7-44] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis is still the leading cause of illness in the world which accounted for 2.5% of the global burden of disease, and 25% of all avoidable deaths in developing countries. The aim of study was to assess impact of DOTS strategy on tuberculosis case finding and treatment outcome in Gambella Regional State, Ethiopia from 2003 up to 2012 and from 2002 up to 2011, respectively. Methods Health facility-based retrospective study was conducted. Data were collected and reported in quarterly basis using WHO reporting format for TB case finding and treatment outcome from all DOTS implementing health facilities in all zones of the region to Federal Ministry of Health. Results A total of 10024 all form of TB cases had been registered between the periods from 2003 up to 2012. Of them, 4100 (40.9%) were smear-positive pulmonary TB, 3164 (31.6%) were smear-negative pulmonary TB and 2760(27.5%) had extra-pulmonary TB. Case detection rate of smear-positive pulmonary TB had increased from 31.7% to 46.5% from the total TB cases and treatment success rate increased from 13% to 92% with average mean value of being 40.9% (SD = 0.1) and 55.7% (SD = 0.28), respectively for the specified year periods. Moreover, the average values of treatment defaulter and treatment failure rates were 4.2% and 0.3%, respectively. Conclusion It is possible to achieve the recommended WHO target which is 70% of CDR for smear-positive pulmonary TB, and 85% of TSR as it was already been fulfilled the targets for treatments more than 85% from 2009 up to 2011 in the region. However, it requires strong efforts to enhance case detection rate of 40.9% for smear-positive pulmonary TB through implementing alternative case finding strategies.
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Affiliation(s)
| | | | | | - Desalegn Woldeyohannes
- Department of Public Health, School of Medicine and Health Sciences, Addis Ababa Science and Technology University, P,O, Box 16417, Addis Ababa, Ethiopia.
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Tu SM, Millikan RE, Mengistu B, Delpassand ES, Amato RJ, Pagliaro LC, Daliani D, Papandreou CN, Smith TL, Kim J, Podoloff DA, Logothetis CJ. Bone-targeted therapy for advanced androgen-independent carcinoma of the prostate: a randomised phase II trial. Lancet 2001; 357:336-41. [PMID: 11210994 DOI: 10.1016/s0140-6736(00)03639-4] [Citation(s) in RCA: 262] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prostate carcinoma is linked to osteoblastic metastasis. We therefore investigated the value of bone-targeted consolidation therapy in selected patients with advanced androgen-independent carcinoma of the prostate. METHODS 103 patients received induction chemotherapy, consisting of ketoconazole and doxorubicin alternating with estramustine and vinblastine. After two or three cycles of induction chemotherapy, we randomly assigned 72 patients who were clinically stable or responders to receive doxorubicin with or without strontium-89 (Sr-89) every week for 6 weeks. FINDINGS Overall 62 of the 103 (60%, 95% CI 50-70) patients had a 50% or greater reduction in serum prostate-specific antigen concentration that was maintained for at least 8 weeks, and 43 (42%, 32-52) had an 80% or greater reduction. 49 (52%) patients with bone pain at registration had complete resolution of pain. After follow-up of 67 patients until death, the estimated median survival for all 103 patients was 17.5 months (range 0.5-37.7). For the 36 patients randomly assigned to receive Sr-89 and doxorubicin, the median survival time was 27.7 months (4.9-37.7), and for the 36 who received doxorubicin alone it was 16.8 months (4.4-34.2) (p=0.0014). The hazard ratio was 2.76 (95% CI 1.44-5.29). INTERPRETATION Bone-targeted consolidation therapy consisting of one dose of Sr-89 plus doxorubicin once a week for 6 weeks, when given to patients with stable or responding advanced androgen-independent carcinoma of the prostate after induction chemotherapy, improved overall survival.
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Affiliation(s)
- S M Tu
- Department of Genitourinary Medical Oncology, University of Texas, M D Anderson Cancer Center, Houston 77030, USA.
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