Ethiopia

A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Between onset of illness and anti-TB treatment course, patients incurred a median of US$201.48. Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median of US$97.62 and US$93.75 during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median of US$21.64 and US$35.02. Patient delay days, provider delay days, number of healthcare facilities visited until TB diagnosis, and TB diagnosis at private facilities independently predicted increased pre-diagnosis cost. Similarly, rural residence, hospitalization during anti-TB treatment, patient delay days, and provider delay days predicted increased post-diagnosis costs. TB patients incur substantial cost for care seeking and treatment despite “free service” for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.

A follow up study among 735 new TB cases registered at health facilities in districts of southwest Ethiopia was conducted from January 2015 to June 2016. Patients reported days elapsed between onset of illness and treatment commencement. The overall treatment success among the treatment cohort was 89.7% respectively among those initiated treatment beyond and within of 30 days of onset of illness. Higher risk of unsuccessful outcome was predicted by treatment initiation beyond 30 days of onset, HIV co-infection, and received treatment at hospital. On the other hand, lower risk of unsuccessful outcome was predicted by weight gain and sputum smear negative conversion the end of second month treatment. Higher risk of unsuccessful outcome is associated with prolonged days elapsed between onset of illness and treatment commencement. Hence, promotion of early care seeking, improving diagnostic and case holding efficiencies of health facilities and TB/HIV collaborative interventions can reduce risk of unsuccessful outcome.

Ethiopia has a high prevalence of tuberculosis (TB) and is one of the countries with the highest burden of multidrug-resistant TB (MDR-TB). This study's purpose was to understand the costs that patients incur in obtaining diagnosis and treatment for MDR-TB. In March 2013, interviews were conducted with 169 MDR-TB patients at three hospitals in Ethiopia to identify the cost to patients and the impact on employment and family income. The average MDR-TB patient incurred a total cost of US$1378, which represented 25 months of a mid-treatment household income of US$54. The impact on the patient's employment and on overall patient and family income was generally catastrophic: 74% of all respondents reported losing their jobs, 66% of patients lost household income, and household income was reduced by 38%. To help cover the costs, 38% of patients sold some type of property, while 7% leased out property and 41% took out loans, any of which could jeopardize their future financial situation even further. Despite services being officially free of charge, most patients incurred catastrophic costs and suffered significant income loss as a result of obtaining diagnosis and treatment for MDR-TB.

Quality of tuberculosis (TB) microscopy diagnosis is not a guarantee despite implementation of external quality assurance (EQA) services in all laboratories of health facilities. Hence, we aimed at evaluating the technical quality and the findings of sputum smear microscopy for acid fast bacilli (AFB) at health centers in Hararge Zone, Oromia Region, Ethiopia. Of the total 55 health center laboratories assessed during the study period (July 2014-July 2015), 20 (36.4%) had major technical errors; 13 (23.6%) had 15 false negative results and 17 (30.9%) had 22 false positive results. The quality of AFB smear microscopy reading and smearing was low in most of the laboratories of the health centers. Therefore, it is essential to strength the EQA program through building the capacity of laboratory professionals.

Our objective was to assess the knowledge of health professionals on Xpert MTB/RIF assay and associated factors in detecting TB/TB drug resistance. An institution based cross–sectional study was conducted from April 4 to June 5, 2015, in Addis Ababa, that involved 209 healthcare providers working in TB clinics.The overall magnitude of knowledge of healthcare workers on Xpert was found to be low. Health workers above age 35 years and those who had read the guidelines on Xpert had greater knowledge of Xpert. Distribution of the national guidelines on Xpert and assigning experienced clinicians to TB DOTs clinics are recommended.

Building coalitions can amplify stakeholder efforts to carry out effective AMR prevention and control strategies. We have developed and implemented an approach to help local stakeholders kick-start the coalition-building process. The five-step process is to (1) mobilise support, (2) understand the local situation, (3) develop an action plan, (4) implement the plan, and (5) monitor and evaluate. Our experience with the coalition-building approach in Ethiopia, Namibia, Zambia, and with the Ecumenical Pharmaceutical Network shows that coalitions can form in a variety of ways with many different stakeholders, including government, academia, and faith-based organisations, to organise actions to preserve the effectiveness of existing antimicrobials and contain AMR.

This study compared the yield of TB among contacts of multidrug-resistant tuberculosis (MDR-TB) index cases with that of drug-sensitive TB (DS-TB) index cases in a program setting. The yield of TB among contacts of MDR-TB and DS-TB using GeneXpert was high as compared to population-level prevalence. The likelihood of diagnosing RR (Rifampicin Resistant)-TB among contacts of MDR-TB index cases is higher in comparison with contacts of DS-TB index cases. The use of GeneXpert in DS TB contact investigation has an added advantage of diagnosing RR cases in contrast to using the nationally recommended AFB microscopy for DS TB contact investigation.

Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting and obstructing sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia.

Clinical monitoring of pediatric HIV treatment remains a major challenge in settings where drug resistance genotyping is not routinely available. As a result, our understanding of drug resistance, and its impact on subsequent therapeutic regimens available in these settings, remains limited. We investigate the prevalence and correlates of HIV-1 drug resistance among 94 participants of the Ethiopia Pediatric HIV Cohort failing first-line combination antiretroviral therapy (cART) using dried blood spot-based genotyping. Overall, 81% (73/90) of successfully genotyped participants harbored resistance mutations. Strikingly, 42% of resistant participants harbored resistance to all four nucleoside reverse transcriptase inhibitors recommended for second-line use in this setting, meaning that there are effectively no remaining cART options for these children. Longer cART duration and prior regimen changes were significantly associated with detection of drug resistance mutations. Replicate genotyping increased the breadth of drug resistance detected in 34% of cases, and thus is recommended for consideration when typing from blood spots. Implementation of timely drug resistance testing and access to newer antiretrovirals and drug classes are urgently needed to guide clinical decision-making and improve outcomes for HIV-infected children on first-line cART in Ethiopia.

Between December 2014 and September 2016, we conducted a prospective cohort study in eight health facilities in Ethiopia. Eligibility criteria included age 3 months-14 years; being on ART for not more than a month. Of 309 children, 304 were included, 52% were male. During 287.7 person-years of observation (PYO), 24 attritions were recorded, yielding an attrition rate of 8.3 per 100 PYO. Younger children, those from rural areas, and children with anaemia were at higher risk of attrition, especially during the early months of treatment, and therefore should be prioritized during treatment follow-up.

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