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Sata E, Seife F, Ayele Z, Murray SA, Wickens K, Le P, Zerihun M, Melak B, Chernet A, Jensen KA, Gessese D, Zeru T, Dawed AA, Debebe H, Tadesse Z, Callahan EK, Martin DL, Nash SD. Wait and watch: A trachoma surveillance strategy from Amhara region, Ethiopia. PLoS Negl Trop Dis 2024; 18:e0011986. [PMID: 38386689 PMCID: PMC10914254 DOI: 10.1371/journal.pntd.0011986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/05/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Trachoma recrudescence after elimination as a public health problem has been reached is a concern for control programs globally. Programs typically conduct district-level trachoma surveillance surveys (TSS) ≥ 2 years after the elimination threshold is achieved to determine whether the prevalence of trachomatous inflammation-follicular (TF) among children ages 1 to 9 years remains <5%. Many TSS are resulting in a TF prevalence ≥5%. Once a district returns to TF ≥5%, a program typically restarts costly mass drug administration (MDA) campaigns and surveys at least twice, for impact and another TSS. In Amhara, Ethiopia, most TSS which result in a TF ≥5% have a prevalence close to 5%, making it difficult to determine whether the result is due to true recrudescence or to statistical variability. This study's aim was to monitor recrudescence within Amhara by waiting to restart MDA within 2 districts with a TF prevalence ≥5% at TSS, Metema = 5.2% and Woreta Town = 5.1%. The districts were resurveyed 1 year later using traditional and alternative indicators, such as measures of infection and serology, a "wait and watch" approach. METHODS/PRINCIPAL FINDINGS These post-surveillance surveys, conducted in 2021, were multi-stage cluster surveys whereby certified graders assessed trachoma signs. Children ages 1 to 9 years provided a dried blood spot and children ages 1 to 5 years provided a conjunctival swab. TF prevalence in Metema and Woreta Town were 3.6% (95% Confidence Interval [CI]:1.4-6.4) and 2.5% (95% CI:0.8-4.5) respectively. Infection prevalence was 1.2% in Woreta Town and 0% in Metema. Seroconversion rates to Pgp3 in Metema and Woreta Town were 0.4 (95% CI:0.2-0.7) seroconversions per 100 child-years and 0.9 (95% CI:0.6-1.5) respectively. CONCLUSIONS/SIGNIFICANCE Both study districts had a TF prevalence <5% with low levels of Chlamydia trachomatis infection and transmission, and thus MDA interventions are no longer warranted. The wait and watch approach represents a surveillance strategy which could lead to fewer MDA campaigns and surveys and thus cost savings with reduced antibiotic usage.
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Affiliation(s)
- Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Fikre Seife
- Disease Prevention and Control Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Sarah A. Murray
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Karana Wickens
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Internships and Fellowships, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Phong Le
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Ambahun Chernet
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Kimberly A. Jensen
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Taye Zeru
- Research and Technology Transfer Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Adisu Abebe Dawed
- Department of Health Promotion and Disease Prevention, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Hiwot Debebe
- Department of Health Promotion and Disease Prevention, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - E. Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
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Tewabe DS, Azage M, Wubetu GY, Fenta SA, Worke MD, Asres AM, Getnet WA, Kassie GG, Menber Y, Munea AM, Zeru T, Bekele SA, Abdulahi SO, Adamne TB, Belete HD, Beyene BB, Abte M, Mersha TB, Dadi AF, Enquobahrie DA, Frissa SM, Geda YE. Gender-based violence in the context of armed conflict in Northern Ethiopia. Confl Health 2024; 18:1. [PMID: 38172905 PMCID: PMC10763028 DOI: 10.1186/s13031-023-00563-4] [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: 03/13/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Gender-based violence (GBV) particularly against women is unfortunately common during armed conflicts. No rigorous and comprehensive empirical work has documented the extent of GBV and its consequences that took place during the two years of devastating armed conflict in Northern Ethiopia. This study aims to assess GBV and its consequences in war-torn areas of northern Ethiopia. METHODS We used a qualitative method augmented by quantitative method to enroll research participants. We conducted in-depth interviews to characterize the lived experiences of GBV survivors. All interviews were conducted confidentially. The data were collected to the point of data saturation. All interviews were transcribed verbatim into local language, translated into English, and analyzed using a thematic analysis approach. We also used reports from healthcare facilities and conducted a descriptive analysis of the demographic characteristics of study participants. RESULTS One thousand one hundred seventy-seven persons reported GBV to healthcare providers. The qualitative study identified several forms of violence (sexual, physical, and psychological). Gang rape against women including minors as young as 14 years old girls was reported. Additionally, the perpetrators sexually violated women who were pregnant, and elderly women as old as 65 years, who took refuge in religious institutions. The perpetrators committed direct assaults on the body with items (e.g., burning the body with cigarette fire) or weapons, holding women and girls as captives, and deprivation of sleep and food. GBV survivors reported stigma, prejudice, suicide attempts, nightmares, and hopelessness. GBV survivors dealt with the traumatic stress by outmigration (leaving their residences), seeking care at healthcare facilities, self-isolation, being silent, dropping out of school, and seeking counseling. CONCLUSION GBV survivors were subjected to multiple and compounding types of violence, with a wide range of adverse health consequences for survivors and their families. GBV survivors require multifaceted interventions including psychological, health, and economic support to rehabilitate them to lead a productive life.
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Affiliation(s)
| | - Muluken Azage
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.o.Box: 79, Bahir Dar, Ethiopia.
| | | | - Sisay Awoke Fenta
- Emergency Response and Recovery Officer, Amhara Region, Bahir Dar, Ethiopia
| | - Mulugeta Dile Worke
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Wallelign Alemnew Getnet
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Genet Gedamu Kassie
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.o.Box: 79, Bahir Dar, Ethiopia
| | - Yonatan Menber
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.o.Box: 79, Bahir Dar, Ethiopia
| | - Alemtsehay Mekonnen Munea
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.o.Box: 79, Bahir Dar, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Amhara Region, Bahir Dar, Ethiopia
| | | | | | | | | | | | - Melkamu Abte
- Amhara Regional Health Bureau, Amhara Region, Bahir Dar, Ethiopia
| | - Tesfaye B Mersha
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Abel Fekadu Dadi
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Souci M Frissa
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
| | - Yonas E Geda
- Department of Neurology and the Franke Barrow Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ, USA
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3
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Tedijanto C, Aragie S, Gwyn S, Wittberg DM, Zeru T, Tadesse Z, Chernet A, Thompson IJB, Nash SD, Lietman TM, Martin DL, Keenan JD, Arnold BF. Seroreversion to Chlamydia trachomatis Pgp3 antigen among children in a hyperendemic region of Amhara, Ethiopia. J Infect Dis 2023:jiad602. [PMID: 38134305 DOI: 10.1093/infdis/jiad602] [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: 11/27/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023] Open
Abstract
Monitoring trachoma transmission with antibody data requires characterization of decay in IgG to Chlamydia trachomatis antigens. In a three-year longitudinal cohort in a high transmission setting, we estimated a median IgG half-life of 3 years and a seroreversion rate of 2.5 (95% CI: 1.6, 3.5) per 100 person-years.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | | | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dionna M Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | | | | | - Isabel J B Thompson
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Tedijanto C, Aragie S, Gwyn S, Wittberg DM, Zeru T, Tadesse Z, Chernet A, Thompson IJ, Nash SD, Lietman TM, Martin DL, Keenan JD, Arnold BF. Seroreversion to Chlamydia trachomatis Pgp3 antigen among children in a hyperendemic region of Amhara, Ethiopia. medRxiv 2023:2023.02.04.23285360. [PMID: 36798251 PMCID: PMC9934712 DOI: 10.1101/2023.02.04.23285360] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Monitoring trachoma transmission with antibody data requires characterization of decay in IgG to Chlamydia trachomatis antigens. In a three-year longitudinal cohort in a high transmission setting, we estimated a median IgG half-life of 3 years and a seroreversion rate of 2.5 (95% CI: 1.6, 3.5) per 100 person-years.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | | | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | | | | | - Isabel J.B. Thompson
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | | | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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5
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Bogale KA, Zeru T, Tarkegn M, Balew M, Worku M, Asrat A, Adamu A, Mulu Y, Getachew A, Ambaw F. Awareness and care seeking for long COVID symptoms among Coronavirus disease survivors in Bahir Dar City, Northwest Ethiopia: phenomenological study. BMC Public Health 2023; 23:941. [PMID: 37226170 DOI: 10.1186/s12889-023-15889-0] [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: 03/27/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Corona Virus Disease (COVID-19) has long-term sequels that persisted for months to years and manifested with a spectrum of signs and symptoms. Presentations of long COVID-19 symptoms are heterogeneous, vary from person to person, and can reach up to over 200 symptoms. Limited studies are conducted on the awareness of long COVID-19. So, this study aimed to explore the awareness about and care seeking for long COVID-19 symptoms among COVID survivors in Bahir Dar City in 2022. METHODS A qualitative study with a phenomenological design was used. Participants of the study were individuals who survived five months or longer after they tested positive for COVID-19 in Bahir Dar city. Individuals were selected purposively. An in-depth interview guide was prepared and used to collect the data. Open Cod 4.03 software was used for coding and synthesizing. Thematic analysis was used to analyze the transcripts. RESULTS The themes emerged from the data were awareness, experience of symptoms and their effects, and care practices of long COVID-19. Although only one participant mentioned the common symptoms of long COVID-19 the survivors experienced general, respiratory, cardiac, digestive, neurological, and other symptoms. These symptoms include rash, fatigue fever, cough, palpitations, shortness of breath, chest pain, and abdominal pain, loss of concentration, loss of smell, sleep disorder, depression, joint and muscle pain. These symptoms brought various physical and psychosocial effects. The majority of the respondents described that long COVID-19 symptoms will go off by themselves. To alleviate the problems some of the participants had taken different measures including medical care, homemade remedies, spiritual solutions, and lifestyle modification. CONCLUSIONS The result of this study revealed that participants have a significant deficit of awareness about the common symptoms, risk groups, and communicability of Long COVID. However, they experienced the majority of the common symptoms of Long COVID. To alleviate the problems, they had taken different measures including medical care, homemade remedies, spiritual solutions, and lifestyle modification.
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Affiliation(s)
- Kassawmar Angaw Bogale
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Taye Zeru
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Molalign Tarkegn
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Melashu Balew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Masetewal Worku
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Anemaw Asrat
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Ayinengida Adamu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yared Mulu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Rennes University, Rennes, France
| | - Atalay Getachew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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6
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Tedijanto C, Solomon AW, Martin DL, Nash SD, Keenan JD, Lietman TM, Lammie PJ, Aiemjoy K, Amza A, Aragie S, Arzika AM, Callahan EK, Carolan S, Dawed AA, Goodhew EB, Gwyn S, Hammou J, Kadri B, Kalua K, Maliki R, Nassirou B, Seife F, Tadesse Z, West SK, Wittberg DM, Zeru T, Arnold BF. Monitoring transmission intensity of trachoma with serology. medRxiv 2023:2023.02.13.23285881. [PMID: 36824972 PMCID: PMC9949201 DOI: 10.1101/2023.02.13.23285881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1- 9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity (>90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Anthony W. Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | | | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA 94143
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143
| | - Patrick J. Lammie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, GA, USA, 30030
| | - Kristen Aiemjoy
- Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Solomon Aragie
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
- Infection Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Sydney Carolan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | | | - E. Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | - Jaouad Hammou
- Service of Ocular and Otological Diseases, Epidemiology and Disease Control Directorate, Ministry of Health, Morocco
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Malawi
| | | | - Beido Nassirou
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sheila K. West
- Johns Hopkins School of Medicine, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore MD USA
| | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Taye Zeru
- Amhara Public Health Institute, Bahir-Dar, Ethiopia
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
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Mekonnen D, Munshea A, Nibret E, Derbie A, Wubetu M, Taye M, Zeru T, Bezabih B, Azage M, Bobosha K, Aseffa A. Rapid Bioethical Assessment for Mycobacterium tuberculosis and Host Genetic Study in Amhara Regional State, Ethiopia: Towards a Context-Specific Ethical Approach. Ethiop J Health Sci 2023; 33:413-422. [PMID: 37576164 PMCID: PMC10416330 DOI: 10.4314/ejhs.v33i3.4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background Rapid Ethical Assessment (REA) is a rapid qualitative study anticipated to understand the ethical sphere of the research setting prior to recruiting study subjects. This study assessed the communities' knowledge about tuberculosis (TB) and research, understand the social arrangements advisable for recruiting research participant and appraised the information provision and consent process. Methods The study was conducted in Amhara region, Ethiopia from 5th-30th January 2021. Google-based survey, face-to-face in-depth interview and focus group discussion were carried out to collect the data from researchers, data collectors, health professionals, TB program officers. A structured questionnaire was administered to assess the knowledge of TB patients and healthy controls about TB, research, gene, (co)evolution and consent process. Results Over 71% of researchers were not satisfied with the current consent process, and 82.7% of researchers agreed that the best interest of the research participants was not adequately addressed in the current research practices in ANRS. TB patients and healthy controls misunderstood research and its goals. Participants advised the researchers to approach the community with the assistance of health extension workers (HEW) or religious/local leaders. Combined use of verbal and written based information provision at individual participant level is the preferred way for information provision. Conclusions The adherence of researchers to standard information provision and consent process was very low. Healthy controls and TB patients have low level of knowledge and awareness about research, ethics and genomic research-related common terms. Hence, public education is required to strengthen the research ethics in the region.
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Affiliation(s)
- Daniel Mekonnen
- Department of Medical Laboratory Sciences, School of Health Science, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
| | - Abaineh Munshea
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
- Department of Biology, Bahir Dar University, Ethiopia
| | - Endalkachew Nibret
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
- Department of Biology, Bahir Dar University, Ethiopia
| | - Awoke Derbie
- Department of Medical Laboratory Sciences, School of Health Science, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
- The Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Ethiopia
| | - Mastewal Wubetu
- Department of Ethiopia Langue(s) and Literature-Amharic, Faculty of Humanities, Bahir Dar University, Ethiopia
| | - Mengistie Taye
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Ethiopia
- Department of Animal Science, College of Agriculture and Environmental Sciences, Bahir Dar University, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Ethiopia
| | | | - Muluken Azage
- Department of Environmental Health, School of public health, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
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8
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D. Nash S, Chernet A, Weiss P, W. Nute A, Zerihun M, Sata E, Gessese D, A. Jensen K, Ayele Z, Melak B, Zeru T, Mengistu A, Abebe A, Seife F, Tadesse Z, Callahan EK. Prevalence of Ocular Chlamydia trachomatis Infection in Amhara Region, Ethiopia, after 8 Years of Trachoma Control Interventions. Am J Trop Med Hyg 2023; 108:261-267. [PMID: 36623484 PMCID: PMC9896333 DOI: 10.4269/ajtmh.22-0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023] Open
Abstract
Although trachoma mass drug administration (MDA) programs target ocular Chlamydia trachomatis, the global trachoma control program does not monitor infection as a measure of impact but instead relies on monitoring clinical indicators. This study aimed to monitor the prevalence of ocular C. trachomatis among a population-based sample of children ages 1-5 years throughout Amhara, Ethiopia, a region that has received approximately 8 years of annual MDA as part of trachoma control. Between 2014 and 2021, trachoma impact surveys and surveillance surveys were conducted in all 156 districts of Amhara using a multistage cluster randomized methodology. Certified graders assessed individuals ages ≥ 1 year for trachomatous inflammation-follicular (TF), and a random subset of children ages 1-5 years also provided a conjunctival swab. Polymerase chain reaction was used to test for C. trachomatis. A total of 28,410 conjunctival swabs were collected from children ages 1-5 years across Amhara. The regional C. trachomatis infection prevalence was 4.7% (95% uncertainty interval: 4.3-5.1%). Infection was detected in all 10 zones of the region and ranged from 0.2% in Awi Zone to 11.9% in Waghemra Zone. Infection was detected in 17 (26%) districts with a TF prevalence < 10% and in 7 (21%) districts with a TF prevalence < 5%. Through programmatic monitoring of C. trachomatis infection, this study demonstrated that considerable infection remained throughout Amhara despite approximately 8 years of trachoma interventions and that enhanced interventions such as more frequent than annual MDA will be needed if elimination thresholds are to be reached.
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Affiliation(s)
- Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia;,Address correspondence to Scott Nash, The Carter Center, 453 John Lewis Freedom Pkwy. NE, Atlanta, GA 30307. E-mail:
| | - Ambahun Chernet
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Paul Weiss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Andrew W. Nute
- Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Bahir, Dar, Ethiopia
| | | | - Adisu Abebe
- Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | | | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
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9
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Whitson CC, Nute AW, Hailemariam B, Deathe AR, Astale T, Ayele Z, Gessese D, Sata E, Zerihun M, Melak B, Haile M, Zeru T, Getnet B, Wondimteka B, Kabtu E, Getachew H, Shibiru M, Bayecha S, Aragie S, Wittberg DM, Tadesse Z, Callahan EK, Keenan JD, Admassu F, Nash SD. Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia. Trans R Soc Trop Med Hyg 2023; 117:111-117. [PMID: 36162054 PMCID: PMC9890315 DOI: 10.1093/trstmh/trac090] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/03/2022] [Accepted: 09/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND As countries reach the trachoma elimination threshold and cases of trachomatous inflammation follicular (TF) become rare, it becomes difficult to train survey graders to recognize clinical signs. We assess the use of photography as a grading tool, the efficiency of an in-country grading center and the comparability of field and photographic grading. METHODS During January-February 2017 surveys in Amhara, Ethiopia, field graders assessed TF, trachomatous inflammation intense (TI) and trachomatous scarring (TS). Photographs were taken from each conjunctiva and later graded at the Gondar Grading Center (GGC) at the University of Gondar in Amhara. Two trained ophthalmology residents graded each set of photographs and a third grader provided an adjudicating grade when needed. RESULTS A total of 4953 photographs of 2477 conjunctivae from 1241 participants in 10 communities were graded over 5 d at the GGC. Six examined participants were not photographed. Agreement between field and photographic grades were for TF: percent agreement (PA) 96.7%, κ=0.70 (95% confidence interval [CI] 0.64 to 0.77; for TI: PA 94.7%, κ=0.32 (95% CI 0.20 to 0.43); and for TS: PA 83.5%, κ=0.22 (95% CI 0.15 to 0.29). CONCLUSIONS Conjunctival photography may be a solution for programs near the elimination threshold where there are few available community cases for training field graders.
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Affiliation(s)
| | - Andrew W Nute
- Trachoma Control Program, The Carter Center, Atlanta, GA, USA
| | | | - Andrew R Deathe
- Trachoma Control Program, The Carter Center, Atlanta, GA, USA
| | - Tigist Astale
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mahteme Haile
- Research and Technology Transfer Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Taye Zeru
- Research and Technology Transfer Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Banchalem Getnet
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | - Bilen Wondimteka
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | - Endale Kabtu
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | - Habib Getachew
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | - Meskerem Shibiru
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | - Social Bayecha
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | - Solomon Aragie
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Dionna M Wittberg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Fisseha Admassu
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | - Scott D Nash
- Trachoma Control Program, The Carter Center, Atlanta, GA, USA
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10
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Ayele TA, Alamneh TS, Shibru H, Sisay MM, Yilma TM, Melak MF, Bisetegn TA, Belachew T, Haile M, Zeru T, Asres MS, Shitu K. Effect of COVID-19 pandemic on missed medical appointment among adults with chronic disease conditions in Northwest Ethiopia. PLoS One 2022; 17:e0274190. [PMID: 36194566 PMCID: PMC9531804 DOI: 10.1371/journal.pone.0274190] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/06/2021] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND COVID-19 had affected the health-care-seeking behavior of people with chronic medical conditions. The impact is even worse in resource-limited settings like Ethiopia. Therefore, this study was aimed to assess the extent and correlates of missed appointments among adults with chronic disease conditions before and during the COVID-19 pandemic in the Northwest Ethiopia. METHODS A retrospective chart review and cross-sectional survey were conducted from December 2020 to February 2021. A total of 1833 patients with common chronic disease were included by using a stratified systematic random sampling technique. Web-based data collection was done using Kobo collect. The data were explored using descriptive statistical techniques, the rate of missed appointments s before and during the COVID-19 pandemic was determined. A negative binomial regression model was fitted to identify the factors of missed appointment. An incidence rate ratio with its 95% confidence interval (CI) and p-value of the final model were reported. RESULTS The rate of missed appointments was 12.5% (95% CI: 11.13%, 14.20%) before the pandemic, increased to 26.8% (95% CI: 24.73%, 28.82%) during the pandemic (p-value < 0.001). Fear of COVID-19 infection and lack of transport was the most common reasons for missing appointments. Older patients (Adjusted Incidence Rate Ratio (AIRR) = 1.01, 95% CI: 1.001; 1.015), having treatment follow up more than 5 years (AIRR = 1.36, 95%CI: 1.103; 1.69), shorter frequency of follow-up (AIRR = 2.22, 95% CI: 1.63; 2.49), covering expense out of pocket (AIRR = 2.26, 95%CI: 1.41; 2.95), having a sedentary lifestyle (AIRR = 1.36, 95%CI: 1.12; 1.71), and history of missed appointments before COVID-19 pandemic (AIRR = 4.27, 95%CI: 3.35; 5.43) were positively associated with the incidence of missed appointments. CONCLUSION The rate of missed appointment increased significantly during the COVID-19 pandemic. Older age, longer duration of follow up, more frequent follow-up, out-of-pocket expenditure for health service, history of poor follow-up, and sedentary lifestyle had positive relationship with missed appointments during the pandemic. Therefore, it is important to give special emphasis to individuals with these risk factors while designing and implementing policies and strategies for peoples with chronic diseases to ensure the continuity of care and to avoid the long-term impact on their health.
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Affiliation(s)
- Tadesse Awoke Ayele
- Epidemiology & Biostatistics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Epidemiology & Biostatistics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtewold Shibru
- Internal Medicine Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Epidemiology & Biostatistics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfahun Melese Yilma
- Health Informatics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkitu Fentie Melak
- Nutrition Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale Bisetegn
- Health Education & Behavioral Science Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | | | - Taye Zeru
- Amhara Public Health Institute, Bahir-Dar, Ethiopia
| | - Mezgebu Selamsew Asres
- Internal Medicine Department, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kegnie Shitu
- Health Education & Behavioral Science Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Tedijanto C, Aragie S, Tadesse Z, Haile M, Zeru T, Nash SD, Wittberg DM, Gwyn S, Martin DL, Sturrock HJW, Lietman TM, Keenan JD, Arnold BF. Predicting future community-level ocular Chlamydia trachomatis infection prevalence using serological, clinical, molecular, and geospatial data. PLoS Negl Trop Dis 2022; 16:e0010273. [PMID: 35275911 PMCID: PMC8942265 DOI: 10.1371/journal.pntd.0010273] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/10/2021] [Revised: 03/23/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Trachoma is an infectious disease characterized by repeated exposures to Chlamydia trachomatis (Ct) that may ultimately lead to blindness. Efficient identification of communities with high infection burden could help target more intensive control efforts. We hypothesized that IgG seroprevalence in combination with geospatial layers, machine learning, and model-based geostatistics would be able to accurately predict future community-level ocular Ct infections detected by PCR. We used measurements from 40 communities in the hyperendemic Amhara region of Ethiopia to assess this hypothesis. Median Ct infection prevalence among children 0–5 years old increased from 6% at enrollment, in the context of recent mass drug administration (MDA), to 29% by month 36, following three years without MDA. At baseline, correlation between seroprevalence and Ct infection was stronger among children 0–5 years old (ρ = 0.77) than children 6–9 years old (ρ = 0.48), and stronger than the correlation between active trachoma and Ct infection (0-5y ρ = 0.56; 6-9y ρ = 0.40). Seroprevalence was the strongest concurrent predictor of infection prevalence at month 36 among children 0–5 years old (cross-validated R2 = 0.75, 95% CI: 0.58–0.85), though predictive performance declined substantially with increasing temporal lag between predictor and outcome measurements. Geospatial variables, a spatial Gaussian process, and stacked ensemble machine learning did not meaningfully improve predictions. Serological markers among children 0–5 years old may be an objective tool for identifying communities with high levels of ocular Ct infections, but accurate, future prediction in the context of changing transmission remains an open challenge.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- * E-mail:
| | | | | | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Scott D. Nash
- The Carter Center, Atlanta, Georgia, United States of America
| | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
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12
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Ashenefe Wassie B, Fantaw S, Mekonene Y, Teshale AM, Yitagesu Y, Tsige E, Getahun D, Tasew G, Abichu G, Moges B, Abate E, Abayneh T, Zeru T, Belay Z, Mor SM. First PCR Confirmed anthrax outbreaks in Ethiopia—Amhara region, 2018–2019. PLoS Negl Trop Dis 2022; 16:e0010181. [PMID: 35143510 PMCID: PMC8865639 DOI: 10.1371/journal.pntd.0010181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/27/2021] [Revised: 02/23/2022] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Anthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region.
Methods
Following reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR).
Results
In Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR.
Conclusion
We report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage.
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Affiliation(s)
| | - Surafel Fantaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Mekonene
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Beyene Moges
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Zewdu Belay
- Amhara Livestock Resource Development and Promotion Agency, Bahir Dar, Ethiopia
| | - Siobhan M. Mor
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- International Livestock Research Institute, Addis Ababa, Ethiopia
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13
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Gallini JW, Sata E, Zerihun M, Melak B, Haile M, Zeru T, Gessese D, Ayele Z, Tadesse Z, Callahan EK, Nash SD, Weiss PS. Optimizing cluster survey designs for estimating trachomatous inflammation-follicular within trachoma control programs. Int J Infect Dis 2021; 116:101-107. [PMID: 34965463 DOI: 10.1016/j.ijid.2021.12.355] [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: 09/23/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The World Health Organization recommends mass drug administration (MDA) with azithromycin to eliminate trachoma as a public health problem. MDA decisions are based on prevalence estimates from two-stage cluster surveys. Work remains to mathematically evaluate current trachoma survey designs. We aimed to characterize the effects of the number of units sampled on the precision and cost of trachomatous inflammation-follicular (TF) estimates. METHODS We simulated a population of 30 districts to represent the breadth of possible TF distributions in Amhara, Ethiopia. Samples of varying numbers of clusters (14-34) and households (10-60) were selected. Sampling schemes were evaluated on precision, proportion of incorrect and low MDA decisions made, and estimated cost. RESULTS Number of clusters sampled had a greater impact on precision than number of households. The most efficient scheme depended on the underlying TF prevalence in a district. For lower prevalence areas (<10%) the most cost efficient (providing adequate precision while minimizing cost) design was 20 clusters of 20-30 households. For higher prevalence areas (>10%), the most efficient design was 15-20 clusters of 20-30 households. CONCLUSIONS For longer-running programs, using context-specific survey designs would allow for practical precision while reducing survey costs. Sampling 15 clusters of 20-30 households in suspected moderate to high prevalence districts and 20 clusters of 20-30 households in districts suspected to be near the 5% threshold appears to be a balanced approach.
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Affiliation(s)
- Julia W Gallini
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mahteme Haile
- Amhara Public Health Institute, Bahir Dar, Amhara, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Amhara, Ethiopia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - E Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, USA
| | - Scott D Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, USA.
| | - Paul S Weiss
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
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14
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Aragie S, Tadesse W, Dagnew A, Hailu D, Dubie M, Wittberg DM, Melo JS, Haile M, Zeru T, Freeman MC, Nash SD, Callahan EK, Tadesse Z, Arnold BF, Porco TC, Lietman TM, Keenan JD. Changing hygiene behaviours: a cluster-randomized trial, Ethiopia. Bull World Health Organ 2021; 99:762-772A. [PMID: 34737469 PMCID: PMC8542271 DOI: 10.2471/blt.21.285915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/23/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine whether a water, sanitation and hygiene intervention could change hygiene behaviours thought to be important for trachoma control. METHODS We conducted a cluster-randomized trial in rural Ethiopia from 9 November 2015 to 5 March 2019. We randomized 20 clusters to an intervention consisting of water and sanitation infrastructure and hygiene promotion and 20 clusters to no intervention. All intervention clusters received a primary-school hygiene curriculum, community water point, household wash station, household soap and home visits from hygiene promotion workers. We assessed intervention fidelity through annual household surveys. FINDINGS Over the 3 years, more wash stations, soap and latrines were seen at households in the intervention clusters than the control clusters: risk difference 47 percentage points (95% confidence interval, CI: 41-53) for wash stations, 18 percentage points (95% CI: 12-24) for soap and 12 percentage points (95% CI: 5-19) for latrines. A greater proportion of people in intervention clusters reported washing their faces with soap (e.g. risk difference 21 percentage points; 95% CI: 15-27 for 0-5 year-old children) and using a latrine (e.g. risk difference 9 percentage points; 95% CI: 2-15 for 6-9 year-old children). Differences between the intervention and control arms were not statistically significant for many indicators until the programme had been implemented for at least a year; they did not decline during later study visits. CONCLUSION The community- and school-based intervention was associated with improved hygiene access and behaviours, although changes in behaviour were slow and required several years of the intervention.
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Affiliation(s)
| | | | - Adane Dagnew
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | | | - Melese Dubie
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | - Dionna M Wittberg
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | - Jason S Melo
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | | | | | | | | | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | - Travis C Porco
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
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15
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Nash S, Chernet A, Astale T, Sata E, Zerihun M, Nute A, Jensen K, Gessese D, Ayele Z, Melak B, Haile M, Zeru T, Tadesse Z, Kelly Callahan E. Population-Based Prevalence of Ocular Chlamydia trachomatis Infection among Infants in the Trachoma Endemic Amhara Region, Ethiopia. Am J Trop Med Hyg 2021; 106:62-65. [PMID: 34695789 PMCID: PMC8733485 DOI: 10.4269/ajtmh.21-0873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/09/2021] [Accepted: 08/31/2021] [Indexed: 11/12/2022] Open
Abstract
Infants ages < 6 months do not receive azithromycin as part of trachoma control and thus may serve as an infection reservoir in persistently endemic districts. The aim of this study was to determine the population-based Chlamydia trachomatis infection prevalence and infectious load among infants ages 1–12 months in persistently trachoma endemic districts in Amhara, Ethiopia. Across six districts, 475 infants were enumerated, and of these 464 (97.7%) were swabbed for infection testing. The C. trachomatis infection prevalence in the study area among infants was 0.2% (95% CI: 0.0–1.5). Among children ages 0–5 years positive for C. trachomatis, the median load was 31 elementary bodies (EB) (Inter quartile range: 7–244 EB), and the infection-positive infant had a load of 7,755 EB. While it is worth reconsidering azithromycin treatment recommendations for the potential mortality benefits, these results do not support lowering the treatment age for trachoma control.
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Affiliation(s)
- Scott Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Ambahun Chernet
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Tigist Astale
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew Nute
- Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Kimberly Jensen
- Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mahteme Haile
- Research and Technology Transfer Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Taye Zeru
- Research and Technology Transfer Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
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16
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Gwyn S, Nute AW, Sata E, Tadesse Z, Chernet A, Haile M, Zeru T, Bethea D, Laurent C, Callahan EK, Nash SD, Martin D. The Performance of Immunoassays to Measure Antibodies to the Chlamydia trachomatis Antigen Pgp3 in Different Epidemiological Settings for Trachoma. Am J Trop Med Hyg 2021; 105:1362-1367. [PMID: 34398819 PMCID: PMC8592184 DOI: 10.4269/ajtmh.21-0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/13/2021] [Accepted: 06/25/2021] [Indexed: 11/07/2022] Open
Abstract
Programs to eliminate trachoma as a public health problem use prevalence of the clinical sign trachomatous inflammation-follicular (TF) in 1- to 9-year-olds in endemic districts to make decisions to begin or end mass drug administration with azithromycin. Trachomatous inflammation-follicular is used as a proxy for transmission of ocular Chlamydia trachomatis infection. Long-term monitoring of previously endemic districts for recrudescence of ocular C. trachomatis infection would benefit from a simple blood test that could be integrated with other public health programs. In this study, we evaluated multiple tests to measure antibodies against the C. trachomatis antigen Pgp3-a multiplex bead assay (MBA), an ELISA, and two versions of a lateral flow assay (LFA)-in four districts of the Amhara region of Ethiopia with varying levels of TF. Seroprevalence and seroconversion rate (SCR) results were proportional to TF prevalence by district for most tests, with the notable exception of the LFA using colloidal gold as the developing reagent. Changing the test developing reagent to black latex improved agreement between serological measures and TF prevalence and in inter-rater agreement. Seroconversion rate estimates using data derived from the LFA-gold assay were inconsistent with the shape of the age-seroprevalence curve, which did not increase in older ages. These data revealed potential complications with using SCR that will need further evaluation. Data from MBA, ELISA, and LFA with the black test line showed good agreement with each other and proportionality to TF estimates, providing further data that serology has potential utility for trachoma surveillance.
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Affiliation(s)
- Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | - Taye Zeru
- Amhara Public Health Institute, Ethiopia
| | - Danaya Bethea
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christian Laurent
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Diana Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Gwyn S, Aragie S, Wittberg DM, Melo JS, Dagnew A, Hailu D, Tadesse Z, Haile M, Zeru T, Nash SD, Arnold BF, Martin DL, Keenan JD. Precision of Serologic Testing from Dried Blood Spots Using a Multiplex Bead Assay. Am J Trop Med Hyg 2021; 105:822-827. [PMID: 34255738 DOI: 10.4269/ajtmh.21-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/16/2021] [Indexed: 11/07/2022] Open
Abstract
Multiplex bead assays (MBAs) for serologic testing have become more prevalent in public health surveys, but few studies have assessed their test performance. As part of a trachoma study conducted in a rural part of Ethiopia in 2016, dried blood spots (DBS) were collected from a random sample of 393 children aged 0 to 9 years, with at least two separate 6-mm DBS collected on a filter card. Samples eluted from DBS were processed using an MBA on the Luminex platform for antibodies against 13 antigens of nine infectious organisms: Chlamydia trachomatis, Vibrio cholera, enterotoxigenic Escherichia coli, Cryptosporidium parvum, Entamoeba histolytica, Camplyobacter jejuni, Salmonella typhimurium Group B, Salmonella enteritidis Group D, and Giardia lamblia. Two separate DBS from each child were processed. The first DBS was run a single time, with the MBA set to read 100 beads per well. The second DBS was run twice, first at 100 beads per well and then at 50 beads per well. Results were expressed as the median fluorescence intensity minus background (MFI-BG), and classified as seropositive or seronegative according to external standards. Agreement between the three runs was high, with intraclass correlation coefficients of > 0.85 for the two Salmonella antibody responses and > 0.95 for the other 11 antibody responses. Agreement was also high for the dichotomous seropositivity indicators, with Cohen's kappa statistics exceeding 0.87 for each antibody assay. These results suggest that serologic testing on the Luminex platform had strong test performance characteristics for analyzing antibodies using DBS.
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Affiliation(s)
- Sarah Gwyn
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Dionna M Wittberg
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Jason S Melo
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Adane Dagnew
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | | | | | | | - Taye Zeru
- Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | | | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Diana L Martin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, California
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18
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Astale T, Ebert CD, Nute AW, Zerihun M, Gessese D, Melak B, Sata E, Ayele Z, Ayenew G, Callahan EK, Haile M, Zeru T, Tadesse Z, Nash SD. The population-based prevalence of trachomatous scarring in a trachoma hyperendemic setting: results from 152 impact surveys in Amhara, Ethiopia. BMC Ophthalmol 2021; 21:213. [PMID: 33985443 PMCID: PMC8120834 DOI: 10.1186/s12886-021-01972-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trachomatous scarring (TS) results from repeated infection with the bacterium Chlamydia trachomatis. Pronounced scarring is an underlying cause of trachomatous trichiasis (TT) that can lead to blindness. Since the condition is irreversible, TS in adults has been considered a marker of past exposure to trachoma infection. The aim of this report was to estimate the population-based prevalence of TS within Amhara, Ethiopia, a region with a historically high burden of trachoma. METHODS District-level multi-stage cluster surveys were conducted in all districts between 2010 and 2015 to monitor the impact of approximately 5 years of trachoma interventions. Approximately 40 households were sampled per cluster and all participants ages ≥ 1 year were graded for the 5 World Health Organization simplified signs. Before each survey round, trachoma graders participated in a 7-day training and reliability exam that included cases of TS. TS prevalence estimates were weighted to account for sampling design and adjusted for age and sex using post-stratification weighting. RESULTS Across the 152 districts in Amhara, 208,510 individuals ages 1 year and older were examined for the signs of trachoma. Region-wide, the prevalence of TS was 8.2 %, (95 % Confidence Interval [CI]: 7.7-8.6 %), and the prevalence among individuals ages 15 years and older (n = 110,137) was 12.6 % (95 % CI: 12.0-13.3 %). District-level TS prevalence among individuals ages 15 years and older ranged from 0.9 to 36.9 % and was moderately correlated with district prevalence of TT (r = 0.31; P < 0.001). The prevalence of TS increased with age, reaching 22.4 % among those ages 56 to 60 years and 24.2 % among those ages 61 to 65 years. Among children ages 1 to 15 years TS prevalence was 2.2 % (95 % CI: 1.8-2.8 %), increased with age (P < 0.001), and 5 % of individuals with TS also had trachomatous inflammation-intense (TI). CONCLUSIONS These results suggest that Amhara has had a long history of trachoma exposure and that a large population remains at risk for developing TT. It is promising, however, that children, many born after interventions began, have low levels of TS compared to other known trachoma-hyperendemic areas.
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Affiliation(s)
| | - Caleb D Ebert
- F.I. Proctor Foundation, University of California, San Francisco, CA, San Francisco, USA.
| | | | | | | | | | | | | | | | | | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
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19
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Temesgen MM, Alemu T, Shiferaw B, Legesse S, Zeru T, Haile M, Gelanew T. Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21-49 years in Amhara region, Northern Ethiopia. PLoS One 2021; 16:e0248949. [PMID: 33760866 PMCID: PMC7990306 DOI: 10.1371/journal.pone.0248949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background Human papillomavirus (HPV) infection is considered as the major risk factor for the development of cervical cancer, second most frequent cancer in Ethiopia. However, the magnitude of the problem and the associated factors remain unrevealed in the Amhara region. This study aimed to determine the prevalence of HPV infection and factors contributing to the progression of HPV infection to cervical cancer. Methods Facility-based cross-sectional study design was employed among women aged 21 to 49 years of age who came for routine cervical cancer screening to 4 randomly selected hospitals (2 general and 2 referral) of Amhara region from May to October, 2019. The sample size was calculated by using the single population proportion formula, proportionated to hospitals, and women were recruited consecutively. Socio demographic and clinical data were collected using a pretested questionnaire and detection of HPV infection was done using HPV test (OncoE6TM Cervical Test) specific to HPV16/18 in cervical swabs. Visual inspection with acetic acid (VIA) was used to determine cervical lesions (precancerous and cancerous). Descriptive statistics and bivariate and multivariate logistic regression were used to describe HR-HPV and cervical lesions burden and association between HR-HPV, and cervical lesions and potential risk factors. Results Among 337 women 21 to 49 years (median age of 35 years ±SD = 7.1 years) of age enrolled in the study, The overall prevalence of oncogenic HPVs (HPV16/18) and the VIA-positivity rate, possible an indicative of cervical lesions, were 7.1% and 13.1%, respectively. Logistic regression analysis showed a significant association between early age of first sexual intercourse (COR = 2.26; 95% CI: 1.0–5.05) and level of education (COR = 0.31; 95% CI: 0.12–0.78) with cervical lesions. Higher odds of HPV positivity (COR = 1.56; 95% CI: 0.59–4.11, p = 0.36) and VIA positivity (COR = 1.39; 95% CI: 0.64–3.00, p = 0.39) were observed among participants who had a history of sexually transmitted illnesses (STIs). Conclusions There was a relatively low prevalence of oncogenic HPV 16/18 and VIA-positivity in women attending four hospitals in the Amhara Region. Early age sexual contact, high parity, and being uneducated/low level of education were independently associated factors with HR-HPV infection and development of cervical lesions, highlighting the importance of prioritizing the limited HPV testing to those risk groups.
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Affiliation(s)
| | - Tefera Alemu
- Amhara Public Health Institute Dessie Branch, Dessie, Ethiopia
| | | | - Seid Legesse
- Amhara Public Health Institute Dessie Branch, Dessie, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
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20
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Nash SD, Astale T, Nute AW, Bethea D, Chernet A, Sata E, Zerihun M, Gessese D, Ayenew G, Ayele Z, Melak B, Haile M, Zeru T, Tadesse Z, Arnold BF, Callahan EK, Martin DL. Population-Based Prevalence of Chlamydia trachomatis Infection and Antibodies in Four Districts with Varying Levels of Trachoma Endemicity in Amhara, Ethiopia. Am J Trop Med Hyg 2021; 104:207-215. [PMID: 33200728 PMCID: PMC7790060 DOI: 10.4269/ajtmh.20-0777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 01/24/2023] Open
Abstract
The Trachoma Control Program in Amhara region, Ethiopia, scaled up the surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy in all districts starting in 2007. Despite these efforts, many districts still require additional years of SAFE. In 2017, four districts were selected for the assessment of antibody responses against Chlamydia trachomatis antigens and C. trachomatis infection to better understand transmission. Districts with differing endemicity were chosen, whereby one had a previous trachomatous inflammation-follicular (TF) prevalence of ≥ 30% (Andabet), one had a prevalence between 10% and 29.9% (Dera), one had a prevalence between 5% and 10% (Woreta town), and one had a previous TF prevalence of < 5% (Alefa) and had not received antibiotic intervention for 2 years. Survey teams assessed trachoma clinical signs and took conjunctival swabs and dried blood spots (DBS) to measure infection and antibody responses. Trachomatous inflammation-follicular prevalence among children aged 1–9 years was 37.0% (95% CI: 31.1–43.3) for Andabet, 14.7% (95% CI: 10.0–20.5) for Dera, and < 5% for Woreta town and Alefa. Chlamydia trachomatis infection was only detected in Andabet (11.3%). Within these districts, 2,195 children provided DBS. The prevalence of antibody responses to the antigen Pgp3 was 36.9% (95% CI: 29.0–45.6%) for Andabet, 11.3% (95% CI: 5.9–20.6%) for Dera, and < 5% for Woreta town and Alefa. Seroconversion rate for Pgp3 in Andabet was 0.094 (95% CI: 0.069–0.128) events per year. In Andabet district, where SAFE implementation has occurred for 11 years, the antibody data support the finding of persistently high levels of trachoma transmission.
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Affiliation(s)
- Scott D Nash
- 1Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Tigist Astale
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew W Nute
- 1Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Danaya Bethea
- 3Centers for Disease Control and Prevention, DPD, Atlanta, Georgia
| | - Ambahun Chernet
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Gedefaw Ayenew
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mahteme Haile
- 4Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Taye Zeru
- 4Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- 2Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Benjamin F Arnold
- 5Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California.,6Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | | | - Diana L Martin
- 3Centers for Disease Control and Prevention, DPD, Atlanta, Georgia
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21
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Sata E, Nute AW, Astale T, Gessese D, Ayele Z, Zerihun M, Chernet A, Melak B, Jensen KA, Haile M, Zeru T, Beyen M, Dawed AA, Seife F, Tadesse Z, Callahan EK, Ngondi J, Nash SD. Twelve-Year Longitudinal Trends in Trachoma Prevalence among Children Aged 1-9 years in Amhara, Ethiopia, 2007-2019. Am J Trop Med Hyg 2021; 104:1278-1289. [PMID: 33534757 PMCID: PMC8045658 DOI: 10.4269/ajtmh.20-1365] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 10/16/2020] [Accepted: 11/23/2020] [Indexed: 11/07/2022] Open
Abstract
Trachoma control in the Amhara region of Ethiopia, where all districts were once endemic, began in 2001 and attained full scale-up of the Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE) strategy by 2010. Since scaling up, the program has distributed approximately 14 million doses of antibiotic per year, implemented village- and school-based health education, and promoted latrine construction. This report aims to provide an update on the prevalence of trachoma among children aged 1-9 years as of the most recent impact or surveillance survey in all 160 districts of Amhara. As of 2019, 45 (28%) districts had a trachomatous inflammation-follicular (TF) prevalence below the 5% elimination threshold. There was a statistically significant relationship between TF prevalence observed at the first impact survey (2010-2015) and eventual achievement of TF < 5% (2015-2019). Of the 26 districts with a first impact survey < 10% TF, 20 (76.9%) had < 5% TF at the most recent survey. Of the 75 districts with a first survey between 10% and 29.9% TF, 21 (28.0%) had < 5% TF at the most recent survey. Finally, among 59 districts ≥ 30% TF at the first survey, four (6.8%) had < 5% TF by 2019. As of 2019, 30 (18.8%) districts remained with TF ≥ 30%. Amhara has seen considerable reductions of trachoma since the start of the program. A strong commitment to the SAFE strategy coupled with data-driven enhancements to that strategy is necessary to facilitate timely elimination of trachoma as a public health problem regionally in Amhara and nationwide in Ethiopia.
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Affiliation(s)
- Eshetu Sata
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew W Nute
- 2Trachoma Control Program, The Carter Center, Atlanta, Georgia
| | - Tigist Astale
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Demelash Gessese
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Ambahun Chernet
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Mahteme Haile
- 3Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Taye Zeru
- 3Amhara Public Health Institute, Research and Technology Transfer Directorate, Bahir Dar, Ethiopia
| | - Melkamu Beyen
- 4Amhara Regional Health Bureau, Health Promotion and Disease Prevention, Bahir Dar, Ethiopia
| | - Adisu Abebe Dawed
- 4Amhara Regional Health Bureau, Health Promotion and Disease Prevention, Bahir Dar, Ethiopia
| | - Fikre Seife
- 5Federal Ministry of Health, Disease Prevention and Control Directorate, Addis Ababa, Ethiopia
| | - Zerihun Tadesse
- 1Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Jeremiah Ngondi
- 6RTI International, International Development (Global Health), London, United Kingdom
| | - Scott D Nash
- 2Trachoma Control Program, The Carter Center, Atlanta, Georgia
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22
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Pickering H, Chernet A, Sata E, Zerihun M, Williams CA, Breuer J, Nute AW, Haile M, Zeru T, Tadesse Z, Bailey RL, Callahan EK, Holland MJ, Nash SD. Genomics of Ocular Chlamydia trachomatis after 5 years of SAFE interventions for trachoma in Amhara, Ethiopia. J Infect Dis 2020; 225:994-1004. [PMID: 33034349 PMCID: PMC8922003 DOI: 10.1093/infdis/jiaa615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
To eliminate trachoma as a public health problem, the WHO recommends the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement) strategy. As part of the SAFE strategy in the Amhara Region, Ethiopia, the Trachoma Control Program distributed over 124 million doses of antibiotic between 2007 and 2015. Despite this, trachoma remained hyperendemic in many districts and a considerable level of Chlamydia trachomatis (Ct) infection was evident. We utilised residual material from Abbott m2000 Ct diagnostic tests to sequence 99 ocular Ct samples from Amhara and investigated the role of Ct genomic variation in continued transmission of Ct. Sequences were typical of ocular Ct, at the whole-genome level and in tissue tropism-associated genes. There was no evidence of macrolide-resistance in this population. Polymorphism around ompA gene was associated with village-level trachomatous inflammation-follicular prevalence. Greater ompA diversity at the district-level was associated with increased Ct infection prevalence. We found no evidence for Ct genomic variation contributing to continued transmission of Ct after treatment, adding to evidence that azithromycin does not drive acquisition of macrolide resistance in Ct. Increased Ct infection in areas with more ompA variants requires longitudinal investigation to understand what impact this may have on treatment success and host immunity.
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Affiliation(s)
- Harry Pickering
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
| | | | | | | | | | - Judith Breuer
- Division of Infection and Immunity, University College London, UK
| | | | | | - Taye Zeru
- Amhara Public Health Institute Bahir Dar, Ethiopia
| | | | - Robin L Bailey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
| | | | - Martin J Holland
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
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