Tuberculosis In Ethiopia Research Articles

Serodiagnostic Performance of Resat-6-CFP-10 in the Diagnosis of Pulmonary Tuberculosis in Ethiopia

Background: Tuberculosis is a major public health problem globally. Lack of rapid and accurate diagnostic tests remain an obstacle for effective control. The aim of this study was to evaluate the potential of rESAT-6-CFP-10 in detecting active pulmonary tuberculosis in a high burden setting. Methodology/Principal findings: Three hundred twenty three pulmonary tuberculosis suspects were included consecutively from February 2010 to May 2010. Basic socio-demographic data as well as sputum and serum samples were collected. Of the 323 suspects, 107 were confirmed to be pulmonary tuberculosis patients using smear microscopy and culture. IgG-based ELISA was run on 204 (89 culture positive and 115 culture and smear negative) serum samples using rESAT-6-CFP-10 antigen. The sensitivity and specificity were 91.0% (83.3 % - 95.4%) and 41.7% (33.1% - 50.9%), respectively. The sensitivities were 94.6% and 88.5% in smear positive and smear negative pulmonary tuberculosis patients, respectively. The sensitivity and specificity among HIV positive pulmonary tuberculosis suspects were 87.5% and 34.8%, respectively whereas the sensitivity and specificity among HIV negative pulmonary tuberculosis suspects were 93.0% and 42.7%, respectively. Conclusion: The sensitivity of rESA-6-CFP-10 antigen is high but the corresponding specificity is low and therefore, it can’t replace smear microscope in the study area.

Immune Response in Holstein-Zebu Cross and Zebu Calves Vaccinated with Bacillus Calmette-Guérin (BCG) at Bako Agricultural Research Centre, Western Ethiopia

Background: Mycobacterium bovis (M. bovis) bacillus Calmette-Gue´rin (BCG) currently remains the only licensed vaccine for the prevention of tuberculosis. The purpose of this study was to evaluate immune responses in calves vaccinated with BCG in western Ethiopia. Methods: Twelve Holstein-zebus cross breed calves (six vaccinated with 0.5ml of 1 x 106 CFU of BCG and six controls) and nine pure zebu calves (five vaccinated with 0.5ml of 1 x 106 CFU of BCG and four controls) were used in this study. Immune responses were monitored for 23 weeks post vaccination using gamma interferon (IFN-γ) assay and comparative intra-dermal tuberculin test to assess cellular response, and enzyme-linked immunosorbant assay (ELISA) to measure antibody response. Results and interpretation: IFN-γ response was observed starting from week 2, attaining its peak at week 4 post vaccination after which a fall in the response of IFN-γ was observed attaining a constant concentration from week 8 onwards. The mean IFN-γ response (OD450nm: Mean ± SEM, 0.205 ± 0.018) in vaccinated calves was significantly (tcal=2.85, P<0.05) higher than the non-vaccinated calves (Mean ± SEM, 0.168±0.008) at 4th week post vaccination. Within the vaccinated group, the mean IFN-γ response was significantly (tcal=3.01, P<0.05) greater in cross breed (Mean ± SEM, 0.217 ± 0.021) than in zebu breeds (Mean ± SEM, 0.194 ± 0.015) at 4th week post vaccination. On the other hand, no detectable antibody response was observed in vaccinated and non-vaccinated calves while the mean of skin thickness following skin test was significantly (P<0.05) higher in vaccinated calves than in non-vaccinated calves 23 weeks post vaccination. Conclusion: BCG induced IFN-γ responses in both Holstein-zebu cross and zebu calves although stronger IFN-γ response was observed in Holstein-zebu cross breed as compared to the response in zebu, which could suggest the possibility of using BCG for the control of bovine tuberculosis in Ethiopia.

A cross sectional study of camel tuberculosis in Ethiopia

La Tuberculose chez les chameaux à l’Est de l’Ethiopie a été étudiée pour la première fois à travers une étude transversale pour décrire sa prévalence et isoler le Mycobacterium bovis. Un nombre total de 276 chameaux (dromadaires) abattus à l’abattoir de Dire Dawa ont été examinés pour détecter la présence de lésions tuberculeuses macroscopiques et faire une culture afin d’isoler le Mycobacterium bovis. Sur les 276 chameaux examinés, 14 (5,07%) ont été déclarés positifs après l’autopsie. Sur 14 échantillons, 4 ont confirmé la croissance de mycobactérie dans un milieu de Loewenstein-Jensen enrichi au pyruvate indiquant la présence de Mycobacterium bovis. L’âge, le sexe et la carrure des chameaux n’ont eu aucun effet important sur la prévalence (p>0.05). Par rapport à la répartition des lésions tuberculeuses sur les organes du corps, 40% des lésions tuberculeuses étaient localisées dans les poumons, 38% dans les ganglions lymphatiques du médiastin et 8,33% dans les ganglions lymphatiques retro-pharyngiens. Le résultat indique la présence de tuberculose chez le chameau en Ethiopie, ce qui justifie une enquête plus poussée par rapport à son importance épidémiologique et en matière de santé publique.Tuberculosis in camels of eastern Ethiopia was studied for the first time using cross sectional study to describe its prevalence and isolate Mycobacterium bovis. A total of 276 dromedary camels slaughtered at Dire Dawa abattoir were examined for the presence of gross tuberculosis lesions and further cultured to isolate Mycobacterium bovis. Of the 276 camels examined 14 (5.07%) were positive in postmortem examination.From these 14 samples 4 confirmed the growth of mycobacteria on pyruvate-enriched Loewenstein-Jensen medium indicating the presence of Mycobacterium bovis. Age, sex and body conditions of the camels do not have any significant effect on the prevalence (p>0.05). In relation to distribution of the tuberculosis lesions in body organs, 40% of the TB lesions were localized in the lungs, 38% in the mesenteric lymph nodes,12.5% in mediastinal lymph nodes and 8.33% in retropharyngeal lymph nodes. The result indicates the presence of tuberculosis in camel of Ethiopia and warrants further investigation with respect to its epidemiological and public health significance.

Approach to assess the economic impact of bovine tuberculosis in Ethiopia

No Abstract. Ethiopian Journal of Health Development Vol. 22 (special issue) 2008: pp. 135-138

Delays and care seeking behavior among tuberculosis patients in Tigray of Northern Ethiopia

Background: Delayed initiation of treatment among tuberculosis patients is a common problem which might contribute to the high burden of tuberculosis in Ethiopia. There is paucity of evidence on the magnitude of delay and why patients fail to seek modern care early in Tigray. Objectives: To assess patient and health service delays and factors for delay among tuberculosis patients. Methods: Adult tuberculosis patients who began treatment (12/10/2001-15/05/2002) in 47 public health institutions were interviewed using a pre-tested questionnaire to gather information about their health seeking behaviour. Patient charts were also reviewed to determine the magnitude of delays. Result: The median patient delay for 42 pulmonary smear positive, 101 pulmonary smear negative and 94 extra-pulmonary tuberculosis patients was 90 days, 60 days and 90 days respectively, while the overall median health service delay was 9 days. Delayed first consultation (>21 days since onset of illness) was significantly higher among patients with no formal education (Adjusted Odds Ratio (AOR)=2.46; 95%Confidence Interval (CI)=1.21-5.01), among those treated first by a private and/or traditional practitioner (AOR=2.9; 95% CI=1.42-6.08), among those who thought their illness not serious (AOR=2.39; 95% CI= 1.52-3.78) and among those who suspected they had tuberculosis (AOR=2.5; 95% CI=1.18-5.29). Conclusion: This unacceptably long patient delay calls for identification and inclusion of feasible strategies to promote early treatment in the national tuberculosis control program. The Ethiopian Journal of Health Development Vol. 19 2005: 7-12

Variants of the SFTPA1 and SFTPA2 genes and susceptibility to tuberculosis in Ethiopia

Lungs are the central organ affected and targeted by Mycobacterium tuberculosis and immune processes in the lung are of critical importance in the pathogenesis of tuberculosis. A major lung defense against invading pathogens is provided by surfactant protein A, a multi-chain protein encoded by the SFTPA1 and SFTPA2 genes. Here, we investigated polymorphisms in the SFTPA1 and SFTPA2 genes for association with tuberculosis in 181 Ethiopian families comprising 226 tuberculosis cases. Four polymorphisms, SFTPA1 307A, SFTPA1 776T, SFTPA2 355C, and SFTPA2 751C, were associated with tuberculosis (P=0.00008; P=0.019, P=0.029 and P=0.042, respectively). Additional subgroup analysis in male, female and more severely affected patients provided evidence for SFTPA1/2-covariate interaction. Finally, out of five intragenic haplotypes identified in the SFTPA1 gene and nine identified in the SFTPA2 gene, 1A(3) was most significantly associated with tuberculosis susceptibility (P=0.026). These findings suggest that SFTPA1 and SFTPA2 modify the risk of tuberculosis susceptibility and that this risk is influenced by additional covariates.

Female genital tuberculosis in Ethiopia

Objectives: To study the occurrence of female genital tuberculosis (FGTB) in Ethiopia and to compare the different methods available for its diagnosis. Methods: Biopsy or curettage samples from 25 clinically suspected cases of FGTB were investigated with histopathology, smear microscopy, TB culture and PCR for mycobacteria. HIV status was determined by ELISA. CD4:CD8 ratio was evaluated by flow cytometry. Results: Among the 25 clinically suspected patients investigated, only one was AFB smear positive, three were culture positive, seven were histology positive and 12 were positive by PCR (a total of 16 positives). Samples taken from the fallopian tube were more frequently positive than those from the endometrium. Conclusions: The results showed that FGTB is a significant clinical problem in Ethiopia. A combination of PCR with the other available methods was found to be the best alternative to achieve sufficient sensitivity and specificity for the diagnosis of FGTB in this setting.

Occurrence of Pneumocystis carinii in HIV-positive patients with suspected pulmonary tuberculosis in Ethiopia.

To investigate the prevalence of Pneumocystis carinii in consecutive HIV-positive patients with suspected pulmonary tuberculosis (PTB) attending a university hospital in Ethiopia. A PCR for P. carinii and an indirect immunoflorescence (IF) assay were performed on expectorated sputum samples from: 119 HIV-1-positive patients with negative smears and sputum cultures for Mycobacterium tuberculosis; 96 HIV-1-positive patients with culture-verified PTB; and 97 HIV-negative patients with negative mycobacterial cultures and 72 HIV-negative patients with culture-verified PTB, serving as controls. Outcome of PCR and IF were compared with the chest radiographic (CXR) and initial clinical diagnosis. In the HIV+PTB- group, P. carinii was found in 10.9% by IF, 8.4% by single PCR (sPCR) and 30.3% by nested PCR (nPCR). In the HIV+PTB+ group, 3.1% were P. carinii positive by IF and sPCR and 13.5% by nPCR. All IF- and sPCR-positive samples were nPCR positive. In the HIV-PTB+ and HIV-PTB- groups, 4.2% and 3.1% were nPCR positive, respectively. Six out of eight HIV+PTB- patients with CXR suggesting P. carinii pneumonia (PCP) were IF and/or nPCR positive for P. carinii. In the IF-positive and nested PCR-positive HIV+PTB- patients more than one-third were interpreted as PTB by CXR whereas only one patient was diagnosed with clinical PCP. P. carinii is prevalent in HIV-positive PTB suspects, suggesting that PCP may be an important, but not well recognized, differential diagnosis. Our findings have implications for treatment and primary prophylaxis for PCP in Ethiopia.

Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia.

BackgroundDelay in the diagnosis of tuberculosis may worsen the disease, increase the risk of death and enhance tuberculosis transmission in the community. This study aims to determine the length of delay between the onset of symptoms and patients first visit to health care (patient delay), and the length of delay between health care visit and the diagnosis of tuberculosis (health service delay).MethodsA cross sectional survey that included all the public health centres was conducted in Addis Ababa from August 1 to December 31 1998. Patients were interviewed on the same day of diagnosis using structured questionnaire.Results700 pulmonary TB patients were studied. The median patient delay was 60 days and mean 78.2 days. There was no significant difference in socio-demographic factors in those who delayed and came earlier among smear positives. However, there was a significant difference in distance from home to health institute and knowledge about TB treatment among the smear negatives. The health service delay was low (median 6 days; mean 9.5 days) delay was significantly lower in smear positives compared to smear negatives. Longer health service delay (delay more than 15 days) was associated with far distance.ConclusionsThe time before diagnosis in TB patients was long and appears to be associated with patient inadequate knowledge of TB treatment and distance to the health centre. Further decentralization of TB services, the use of some components of active case finding, and raising public awareness of the disease to increase service utilization are recommended.

Dual Infection: The Challenge of HIV/AIDS and Tuberculosis in Ethiopia

Background: Since the early 1990s, the HIV/AIDS epidemic has dramatically escalated in Ethiopia, such that few families, particularly in urban areas, have been unaffected. In describing the symptoms to others, particularly in the early days of the epidemic, reference frequently was made to samba, or lungs. This connection illustrates the tight interaction of HIV infection with tuberculosis (TB) in populations with an already high prevalence of TB, such as those in Ethiopia and others in the developing world, as well as in poor communities in industrialized countries. Objectives: To discuss the biological interactions of HIV and TB in the human host, how the HIV epidemic has affected the rates of TB disease, and how the increase in tuberculosis cases also has a deleterious impact on TB control and general health services. Results: While TB is increasing in nearly all occupational groups in Ethiopia, it is disproportionately affecting people in their 20s and 30s, the primary age group that is dying of AIDS. Some novel community-based approaches to TB control in rural areas, however, seem to be yielding positive results in terms of increasing drug compliance and treatment completion rates. Recommendations: Innovative approaches to strengthen the national TB control program at the community level must be taken by the Ministry of Health in order to moderate the twin scourges of TB and HIV.

Analysis of the Population Structure of Mycobacterium tuberculosis in Ethiopia, Tunisia, and the Netherlands: Usefulness of DNA Typing for Global Tuberculosis Epidemiology

The genetic heterogeneity among Mycobacterium tuberculosis isolates from 501 patients in Ethiopia, Tunisia, and the Netherlands was compared by analysis of DNA polymorphism driven by insertion element IS6110. The percentage of isolates displaying two or more identical patterns differed greatly in the three countries: It was highest among Tunisian isolates and lowest in Dutch isolates. In contrast to isolates from Dutch subjects infected with M. tuberculosis, the majority of strains from Ethiopia and Tunisia were from a few families of genetically highly related strains. Furthermore, little overlap was observed among isolates from the three countries, indicating strict isolation of the bacterial reservoirs in the countries. A few strains from the Netherlands matched strains from Ethiopia and Tunisia. Those strains were invariably isolated from refugees, immigrants, or persons who visited Ethiopia or Tunisia.

Questionnaires in medical education.

The taught may be taught by books, practicals, lectures and more recently by audiovisual presentations especially using microcomputers. The students vary in intellect and in degree of motivation, but have a common goal in qualification. Inevitably there is a degree of frisson between the two groups and anythmg which can be done to either group to help it to understand the other is useful. The word ‘understand’ is used, often glibly as understanding is an incredibly complex event. Students are very desirous of having their problems appreciated by the teaching staff and teaching staff are equally desirous of having feedback (reactions from the students) to enable them to respond. The Sir Lancelot Sprats of film drama are a caricature. A problem is a fact plus a value judgement on that fact and both aspects have to be considered. They are not mutually exclusive. Tuberculosis in Ethiopia is a tragic fact but not a problem, as the Ethiopian peasant accepts it as an act of whatever god he worships. He can do no other as he lacks knowledge and the ability to act in concert. Tuberculosis in Britain is a fact but also a problem because the value judgement is that it can and should be eradicated. The problem with the groups, teachers and taught, is how to communicate to mutual benefit effectively and with the minimum of annoyance to either party. Staff may seek student opinion expecting and accepting it if favourable and ignoring it if critical. Student bodies can whinge, a disease that tends to feed on itself. How do they communicate? One method is by discussion groups. Free discussion is difficult to organise and extremely time-consuming. The compromise is the questionnaire. Most people have a questionnaire within them and having used the method once may have a measure of reluctance for future use. Where the craving does not respond

Bovine tuberculosis—incorporating a review of John Francis' book

Bovine tuberculosis (bTB) is a known endemic disease of cattle in Ethiopia; however, there is lack of a comprehensive information on the status and distribution of the disease in the country. The objectives of this systematic review and meta-analysis were to provide a pooled prevalence estimate of bTB at a national level, assess the level of in-between variance among study reports and illustrate the spatial distribution pattern in the country. Articles published on bTB from January 2000 to December, 2016 in English language were included in the review. Pubmed, CAB direct, AJOL and Web of Science were the databases used in electronic search. A total of 127 articles were retrieved from online sources, of which 56 articles were selected for data extraction based on the specified inclusion criteria. From these selected published articles, 114 animal level data were extracted for quantitative analysis. A pooled prevalence estimate of bovine tuberculosis in Ethiopia was found to be 5.8% (95% CI: 4.5, 7.5). In a multivariable meta-regression analysis, breed and production system explained 40.9% of the explainable proportion of the in-between study variance computed. The prevalence of bovine tuberculosis in Holstein-Friesians, 21.6% (95% CI: 14.7–30.7), was higher than the prevalence in local zebus 4.1 (95% CI: 3.4–4.9). Cattle kept under intensive and semi-intensive production systems had higher prevalence, 16.6% (95% CI: 12.4–21.6), of bTB than those kept in extensive livestock production system, 4.6 (95% CI: 3.4–6.2). Bovine tuberculosis is widely distributed across major livestock producing regions of Ethiopia. However, no valid data could be retrieved from Benishanul-Gumuz, Harari and Dire Dawa. Data obtained on bTB from Somali and Gambella regional states are also few and further studies are suggested in these regions. In conclusion, this review showed that bTB in cattle in Ethiopia is widespread with high prevalence in intensive and semi-intensive management systsems that keep exotic breeds and their crosses in urban and peri-urban areas. Thus, it is suggested that the design and implementation of bTB control strategies in Ethiopia should prioritize these hotspots in order to reduce the impact of the disease on the growing dairy sector.