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Fallahi MJ, Nazemi M, Zeighami A, Shahriarirad R. Changes in incidence and clinical features of tuberculosis with regard to the COVID-19 outbreak in Southern Iran. BMC Infect Dis 2024; 24:1043. [PMID: 39333984 PMCID: PMC11430532 DOI: 10.1186/s12879-024-09947-0] [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: 02/01/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a significant global health threat. It results in substantial mortality and may be underrecognized due to insufficient screening and diagnostic challenges. Furthermore, TB's impact is closely linked to complex socioeconomic and healthcare factors. The COVID-19 pandemic has exacerbated these challenges due to similarities in clinical presentation and transmission dynamics with TB. Socioeconomic factors such as limited access to healthcare services, resource constraints, and social stigma further complicate TB management. Historically, TB faced increased burdens during natural disasters, wars, and pandemics. This study analyzes TB incidence changes, emphasizing the crucial need for timely diagnosis within the context of COVID-19 measures. METHOD This cross-sectional study, conducted at Shiraz's TB referral center in Southern Iran, covered the period from January 1, 2018, to December 31, 2022. We analyzed patient data, including epidemiological and demographic factors, clinical and radiological features, and treatment outcomes. Data were compared between the pre-COVID-19 pandemic era and the COVID-19 pandemic era (from March 2020), using standard and regression analyses. A P-value of less than 0.05 was considered statistically significant. RESULTS We analyzed 388 TB patients with a mean age of 48.38 ± 20.53 years, including 264 pulmonary cases (68.0%). The highest incidence of TB was recorded in 2019, representing 27.6% of the cases. During the COVID-19 era, logistic regression analysis identified significant associations with higher education levels (P = 0.032; OR = 1.380; 95% CI: 1.028-1.851), a decrease in symptoms such as sputum production (P = 0.004; OR = 0.342; 95% CI: 0.166-0.705) and chills (P = 0.036; OR = 0.282; 95% CI: 0.087-0.919), and an increase in symptoms of fatigue (P = 0.006; OR = 2.856; 95% CI: 1.358-6.005). CONCLUSION The COVID-19 pandemic has had a prolonged impact on TB cases in our country, resulting in a reduction in reported cases due to challenges in quarantine and screening. However, it has also led to a shift in TB patterns and a potential increase in latent TB cases and future mortality rates. Addressing the repercussions requires enhanced control strategies, prioritized service delivery, and secured funding for intensified case finding, expanded contact-tracing, community engagement, digital health tools, and uninterrupted access to medications.
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Affiliation(s)
- Mohammad Javad Fallahi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Nazemi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Zeighami
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
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Teka G, Woldeab A, Dereje N, Eshetu F, Gizachew L, Tazu Z, Lisanwork L, Tigabu E, Gebeyehu A, Tayachew A, Biru M, Berkessa T, Keraleme A, Bikale F, Shure W, Agune A, Haile B, Addis B, Moges M, Gonta M, Hailemariam A, Binkley L, Nawaz S, Wang SH, Mekuria Z, Aklilu A, Aliy J, Lulseged S, Girmay A, Patrick A, Amare B, Delelegn H, Daves S, Yimer G, Abate E, Wossen M, Melaku Z, Gebreyes W, Williams DE, Abayneh A. Regional and temporal variations in COVID-19 cases and deaths in Ethiopia: Lessons learned from the COVID-19 enhanced surveillance and response. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003175. [PMID: 38781131 PMCID: PMC11115226 DOI: 10.1371/journal.pgph.0003175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The COVID-19 pandemic is one of the most devastating public health emergencies of international concern to have occurred in the past century. To ensure a safe, scalable, and sustainable response, it is imperative to understand the burden of disease, epidemiological trends, and responses to activities that have already been implemented. We aimed to analyze how COVID-19 tests, cases, and deaths varied by time and region in the general population and healthcare workers (HCWs) in Ethiopia. METHODS COVID-19 data were captured between October 01, 2021, and September 30, 2022, in 64 systematically selected health facilities throughout Ethiopia. The number of health facilities included in the study was proportionally allocated to the regional states of Ethiopia. Data were captured by standardized tools and formats. Analysis of COVID-19 testing performed, cases detected, and deaths registered by region and time was carried out. RESULTS We analyzed 215,024 individuals' data that were captured through COVID-19 surveillance in Ethiopia. Of the 215,024 total tests, 18,964 COVID-19 cases (8.8%, 95% CI: 8.7%- 9.0%) were identified and 534 (2.8%, 95% CI: 2.6%- 3.1%) were deceased. The positivity rate ranged from 1% in the Afar region to 15% in the Sidama region. Eight (1.2%, 95% CI: 0.4%- 2.0%) HCWs died out of 664 infected HCWs, of which 81.5% were from Addis Ababa. Three waves of outbreaks were detected during the analysis period, with the highest positivity rate of 35% during the Omicron period and the highest rate of ICU beds and mechanical ventilators (38%) occupied by COVID-19 patients during the Delta period. CONCLUSIONS The temporal and regional variations in COVID-19 cases and deaths in Ethiopia underscore the need for concerted efforts to address the disparities in the COVID-19 surveillance and response system. These lessons should be critically considered during the integration of the COVID-19 surveillance system into the routine surveillance system.
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Affiliation(s)
- Gizaw Teka
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adane Woldeab
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | | | - Frehywot Eshetu
- Division of Global Health Protection (DGHP), US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Lehageru Gizachew
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Zelalem Tazu
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Leuel Lisanwork
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Eyasu Tigabu
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Ayele Gebeyehu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adamu Tayachew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mengistu Biru
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Wolde Shure
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Admikew Agune
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bizuwork Haile
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Beza Addis
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Muluken Moges
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melaku Gonta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Laura Binkley
- The Ohio State University Global One Health initiative (GOHi), Columbus, Ohio, United States of America
| | - Saira Nawaz
- The Ohio State University Global One Health initiative (GOHi), Columbus, Ohio, United States of America
| | - Shu-Hua Wang
- The Ohio State University Global One Health initiative (GOHi), Columbus, Ohio, United States of America
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Zelalem Mekuria
- The Ohio State University Global One Health initiative (GOHi), Columbus, Ohio, United States of America
| | | | - Jemal Aliy
- ICAP at Columbia University, Addis Ababa, Ethiopia
| | | | - Abiy Girmay
- World Health Organization (WHO) Ethiopia Office, Addis Ababa, Ethiopia
| | - Abok Patrick
- World Health Organization (WHO) Ethiopia Office, Addis Ababa, Ethiopia
| | - Berhanu Amare
- Division of Global Health Protection (DGHP), US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Hulemenaw Delelegn
- Division of Global Health Protection (DGHP), US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Sharon Daves
- Division of Global Health Protection (DGHP), US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Getnet Yimer
- University of Pennsylvania, Perelman School of Medicine, Pennsylvania, Philadelphia, United States of America
| | - Ebba Abate
- The Ohio State University Global One Health initiative (GOHi), Addis Ababa, Ethiopia
| | - Mesfin Wossen
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Wondwossen Gebreyes
- The Ohio State University Global One Health initiative (GOHi), Columbus, Ohio, United States of America
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Desmond E. Williams
- Division of Global Health Protection (DGHP), US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
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Israfil SMH, Sarker MMR, Rashid PT, Talukder AA, Kawsar KA, Khan F, Akhter S, Poh CL, Mohamed IN, Ming LC. Clinical Characteristics and Diagnostic Challenges of COVID-19: An Update From the Global Perspective. Front Public Health 2021; 8:567395. [PMID: 33505949 PMCID: PMC7831046 DOI: 10.3389/fpubh.2020.567395] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022] Open
Abstract
Clinical characteristics are essential for the correct diagnosis of diseases. The current review aimed to summarize the global clinical characteristics of the COVID-19 patients systematically and identify their diagnostic challenges to help the medical practitioners properly diagnose and for better management of COVID-19 patients. We conducted a systematic search in PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases for original articles containing clinical information of COVID-19 published up to 7th May 2020. Two researchers independently searched the databases to extract eligible articles. A total of 34 studies from 8 different countries with 10889 case-patients were included for clinical characteristics. The most common clinical symptoms were cough 59.6, fever 46.9, fatigue 27.8, and dyspnea 20.23%. The prominent laboratory findings were lymphocytopenia 55.9, elevated levels of CRP 61.9, aspartate aminotransferase 53.3, LDH 40.8, ESR 72.99, serum ferritin 63, IL-6 52, and prothrombin time 35.47%, and decreased levels of platelets 17.26, eosinophils 59.0, hemoglobin 29, and albumin 38.4%. CT scan of the chest showed an abnormality in 93.50% cases with bilateral lungs 71.1%, ground-glass opacity 48%, lesion in lungs 78.3%, and enlargement of lymph node 50.7%. Common comorbidities were hypertension, diabetes, obesity, and cardiovascular diseases. The estimated median incubation period was 5.36 days, and the overall case fatality rate was 16.9% (Global case fatality outside China was 22.24%: USA 21.24%, Italy 25.61%, and others 0%; whereas the case fatality inside the Hubei Province of China was found to be 11.71%). Global features on the clinical characteristics of COVID-19 obtained from laboratory tests and CT scan results will provide useful information to the physicians to diagnose the disease and for better management of the patients as well as to address the diagnostic challenges to control the infection.
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Affiliation(s)
| | - Md. Moklesur Rahman Sarker
- Department of Pharmacy, State University of Bangladesh, Dhaka, Bangladesh
- Pharmacology and Toxicology Research Division, Health Med Science Research Limited, Dhaka, Bangladesh
| | | | - Ali Azam Talukder
- Department of Microbiology, Jahangirnagar University, Savar, Bangladesh
| | | | - Farzana Khan
- Pharmacology and Toxicology Research Division, Health Med Science Research Limited, Dhaka, Bangladesh
| | - Selina Akhter
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Chit Laa Poh
- Centre for Virus and Vaccine Research, School of Science and Technology, Sunway University, Petaling Jaya, Malaysia
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia (The National University of Malaysia), Cheras, Malaysia
| | - Long Chiau Ming
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
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