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Aceng FL, Kabwama SN, Ario AR, Etwom A, Turyahabwe S, Mugabe FR. Spatial distribution and temporal trends of tuberculosis case notifications, Uganda: a ten-year retrospective analysis (2013-2022). BMC Infect Dis 2024; 24:46. [PMID: 38177991 PMCID: PMC10765632 DOI: 10.1186/s12879-023-08951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/25/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Uganda has a high incidence and prevalence of tuberculosis (TB). Analysis of spatial and temporal distribution of TB is an important tool for supporting spatial decision-making, planning, and policy formulations; however, this information is not readily available in Uganda. We determined the spatial distribution and temporal trends of tuberculosis notifications in Uganda, 2013-2022. METHODS We conducted a retrospective analysis of routinely-generated program data reported through the National TB and Leprosy Programme (NTLP) surveillance system. We abstracted data on all TB cases diagnosed from 2013 to 2022 by district and region. We drew choropleth maps for Uganda showing the TB case notification rates (CNR) per 100,000 and calculated the CNR using the cases per district as the numerator and individual district populations as the denominators. Population estimates were obtained from the 2014 National Population and Housing Census, and a national growth rate of 3% was used to estimate the annual population increase. RESULTS Over the entire study period, 568,957 cases of TB were reported in Uganda. There was a 6% annual increase in TB CNR reported from 2013 (134/100,000) to 2022 (213/100,000) (p-value for trend p < 0.00001). Cases were reported from all 12 Ministry of Health regions during the entire period. The distribution of CNR was heterogeneous throughout the country and over time. Moroto, Napak and Kampala districts had consistently high CNR throughout the ten years. Kalangala district had lower CNR from 2013 to 2018 but high CNR from 2019 to 2022. Moroto region, in the northeast, had consistently high CNR while Mbale and Soroti regions in Eastern Uganda had the lowest CNR throughout the ten years. CONCLUSION There was an overall increasing trend in TB CNR from 2013 to 2022. We recommend that the National TB program institutes intensified measures aided by more funding to mitigate and reverse the negative impacts of the COVID-19 pandemic on TB.
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Affiliation(s)
- Freda Loy Aceng
- Uganda Public Health Fellowship Program, P.O. Box 7072, Kampala, Uganda.
| | | | | | - Alfred Etwom
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
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Abebaw Y, Abebe M, Tola HH, Mehammed Z, Getahun M, Gamtesa DF, Diriba G, Hailu M, Yirgu H, Sheth AN, Argaw R, Abegaz WE. Pulmonary tuberculosis case notification and burden of drug resistance among children under 15 years of age in Ethiopia: sub-analysis from third-round drug resistance tuberculosis survey. BMC Pediatr 2023; 23:418. [PMID: 37620787 PMCID: PMC10463301 DOI: 10.1186/s12887-023-04240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Data on the burden of bacteriologically confirmed childhood Tuberculosis (PTB) and drug-resistant TB in Ethiopia is limited due to difficulties related to its diagnosis in this population. Therefore, this study aimed to assess bacteriologically confirmed childhood PTB Case Notification Rates (CNRs) and the burden of Drug Resistant-Tuberculosis among children in Ethiopia. METHOD Retrospective secondary clinical and laboratory data were obtained from 3rd round national DR-TB survey which was conducted between August 2017 and January 2019. We used IBM SPSS 24 for sub-analysis of 3rd round Drug Resistant-Tuberculosis data. Descriptive statistics were used in computing the association between the sociodemographic characteristics and PTB CNRs, and the strength of the associations was determined using binary logistic regression with Odds ratios (OR) with a 95% confidence interval (CI). RESULT Overall, 102 bacteriologically confirmed childhood PTB cases were identified with a median age of 12 (range 1-14) years. Of these, 54 (52.9%) were females and 81 (79.4%) lived in rural areas. HIV-TB co-infection cases were 5/102 (4.3%) and the majority (98%) of cases were newly diagnosed children. Nationally, the incidence of bacteriologically confirmed childhood PTB was calculated to be 5.1 per 100,000 children. The burden of Drug Resistant-Tuberculosis to at least one of the five first-line anti-TB drugs tested was five (6.5%) cases and one (1.3%) was found to be a Multi-drug resistant tuberculosis case. Drug-resistant tuberculosis was significantly associated with the age group 10-14 years (P = 0.002; [AOR] 29.76; [95% CI, 3.51-252.64]) and children living in urban areas (P = 0.027; [AOR] 5.76; 95% CI, 1.22-27.09). CONCLUSION Bacteriologically confirmed childhood PTB cases increased as the age of the children increased. Most of the bacteriologically confirmed childhood PTB and the identified drug Resistant-Tuberculosis cases were new cases. Also, rural children were more affected by TB than their urban, counterparts Drug Resistant-Tuberculosis was higher in urban resident children.
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Affiliation(s)
- Yeshiwork Abebaw
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University and Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Markos Abebe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | | | | | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Michael Hailu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Anandi Nayan Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Rahel Argaw
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Woldaregay Erku Abegaz
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University and Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Assessment of Knowledge, Attitudes, and Practices (KAP): Public Health and Economic Burden of Tuberculosis in Jarso District of West Wollega Zone, Oromia, Western Ethiopia. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3314725. [DOI: 10.1155/2022/3314725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
Tuberculosis is a communicable mycobacterial disease of humans and animals caused by members of Mycobacterium tuberculosis complex, highly impacting the public health and economy of the country in endemic areas. Retrospective and cross-sectional study was conducted between March and August 2021. For knowledge, attitude, and practices study, five villages were randomly selected using simple random sampling. To quantify the public health burden, one-year data were collected from Jarso Health Center, and unregistered patients were identified using snowball method, and the estimation was based on disability-adjusted life years. Younger age groups (18-40 years) had shown 105.8 times more odds of knowledge towards tuberculosis than the older (>60 years). Moreover, tertiary levels of education had 9395.1 times more odds of knowledge towards tuberculosis compared to illiterates. The estimated economic burden was 7,731.25US$. Of the 51 tuberculosis patients, two died from the disease, resulting in 45.03 disability-adjusted life years. Communities of the study district were heard about tuberculosis, however, unaware of the cause and sources of the infection. Therefore, further strategic and continuous community-based health education and awareness should be given for effective control and prevention of tuberculosis in the study area.
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Cheng LT, Chung CH, Peng CK, Shu CC, Wu SY, Wang SH, Wu GJ, Tsao CH, Sun CA, Chien WC, Tang SE. Bidirectional Relationship Between Tuberculosis and Hypothyroidism: An 18-Year Nationwide Population-Based Longitudinal Cohort Study. Front Med (Lausanne) 2022; 9:900858. [PMID: 35903317 PMCID: PMC9320323 DOI: 10.3389/fmed.2022.900858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Some antituberculosis agents may cause hypothyroidism, and thyroid hormones play a vital role in Mycobacterium tuberculosis infection. However, the relationship between tuberculosis (TB) and hypothyroidism has not been clearly established. Therefore, this retrospective, longitudinal cohort study aimed to investigate the association between these two diseases using the 2000–2017 data from the Taiwan's National Health Insurance Research Database. The hypothyroidism and TB cohorts were matched with the control group in a 1:4 ratio. Adjusted hazard ratios (aHRs) were assessed using Cox proportional hazards regression analysis in each cohort. In total, 3,976 individuals with hypothyroidism and 35 120 individuals with TB were included in this study. The risk of developing TB in patients with hypothyroidism was 2.91 times higher than that in those without hypothyroidism (95% confidence interval [CI], 1.50–3.65). The subgroup of thyroxine replacement therapy (TRT) had a 2.40 times higher risk (95% CI, 1.26–3.01), whereas the subgroup of non-TRT had a 3.62 times higher risk of developing TB than those without hypothyroidism (95% CI, 2.19–4.84). On the other hand, the risk of developing hypothyroidism in patients with TB was 2.01 times higher than that in those without TB (95% CI, 1.41–2.38). Our findings provide evidence that TB and hypothyroidism are interrelated. Thus, clinicians and public health authorities should monitor the association between these two diseases to reduce the relevant disease burden.
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Affiliation(s)
- Li-Ting Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- National Defense Medical Center, School of Public Health, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Yu Wu
- National Defense Medical Center, Graduate Institute of Aerospace and Undersea Medicine, Taipei, Taiwan
| | - Sheng-Huei Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Gwo-Jang Wu
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- National Defense Medical Center, School of Public Health, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan
- *Correspondence: Wu-Chien Chien
| | - Shih-En Tang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Aerospace and Undersea Medicine, Taipei, Taiwan
- Shih-En Tang
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Setoodehzadeh F, Barfar E, Ansari H, Sari AA, Azizi N. The economic burden of tuberculosis in Sistan: a high-risk region in Iran. Trop Med Int Health 2021; 26:649-655. [PMID: 33668078 DOI: 10.1111/tmi.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To estimate the economic burden of tuberculosis treatment in Sistan, the region with the highest number of tuberculosis cases in Iran. METHODS All patients with smear-positive pulmonary tuberculosis who had contracted tuberculosis in 2018 and successfully completed their treatment were interviewed. RESULTS Ninety patients with a mean age of 57 ± 18 years were interviewed. Most of them were women (58%), housewives (57%) and resided in rural areas (84%). The mean cost of treatment for tuberculosis was estimated as 6800 USD per patient. Direct costs were 87% of the total cost. Twenty-two patients lost an average income of 530 USD (8514590 rials) during treatment. The results showed the significant correlation of direct and indirect costs with sex, age, place of residence and education (P < 0.05). CONCLUSION It appears essential to improve social protection and implement interventions to promote knowledge in rural areas.
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Affiliation(s)
- Fatemeh Setoodehzadeh
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Eshagh Barfar
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hossein Ansari
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Azizi
- Master of Health Care Management, Zahedan University of Medical Sciences, Zahedan, Iran
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Asemahagn MA, Alene GD, Yimer SA. Spatial-temporal clustering of notified pulmonary tuberculosis and its predictors in East Gojjam Zone, Northwest Ethiopia. PLoS One 2021; 16:e0245378. [PMID: 33449953 PMCID: PMC7810325 DOI: 10.1371/journal.pone.0245378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a key health menace in Ethiopia and its districts. This study aimed to assess the spatial-temporal clustering of notified pulmonary TB (PTB) cases in East Gojjam Zone, Northwest Ethiopia. METHODS A retrospective study was conducted among all PTB cases reported from 2013-2019. Case notification rates (CNRs) of PTB cases at Kebele (the lowest administrative unit), woreda, and zone levels were estimated. The PTB clustering was done using global Moran's I statistics on Arc GIS 10.6. We used Kulldorff SaTScan 9.6 with a discrete Poisson model to identify statistically significant spatial-temporal clustering of PTB cases at Kebele level. Similarly, a negative binomial regression analysis was used to identify factors associated with the incidence of PTB cases at kebele level. RESULTS A total of 5340 (52%) smear-positive and 4928 (48%) smear-negative PTB cases were analyzed. The overall mean CNR of PTB cases at zone, woreda and Kebele levels were 58(47-69), 82(56-204), and 69(36-347) per 100,000 population, respectively. The purely spatial cluster analysis identified eight most likely clusters (one for overall and one per year for seven reporting years) and 47 secondary clusters. Similarly, the space-time scan analysis identified one most likely and seven secondary clusters. The purely temporal analysis also detected one most likely cluster from 2013-2015. Rural residence, distance from the nearest health facility, and poor TB service readiness were factors (p-value <0.05) to PTB incidence at kebele level. CONCLUSION The distribution of PTB cases was clustered. The PTB CNR was low and showed a decreasing trend during the reporting periods. Rural residence, distance from the health facilities, and poor facility readiness were factors of PTB incidence. Improving accessibility and readiness of health facilities mainly to rural and hotspot areas is vital to increase case detection and reduce TB transmission.
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Affiliation(s)
- Mulusew Andualem Asemahagn
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Solomon Abebe Yimer
- Faculty of Medicine, Department of Microbiology, Unit for Genome Dynamics, University of Oslo, Oslo, Norway
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
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