BackgroundBovine Tuberculosis (BTB) is a widespread and endemic disease of cattle in Ethiopia posing a significant threat to public health. Regular surveillance by skin test, bacteriology and molecular methods is not feasible due to lack of resource. Thus, routine abattoir (RA) inspection will continue to play a key role for national surveillance. We evaluated efficiency of RA inspection for diagnosis of Mycobacterium bovis infection and discussed its public health implications in light of a high risk of human exposure.MethodsThe study was conducted in five abattoirs: Addis Ababa, Adama, Hawassa, Yabello and Melge-Wondo abattoirs. The efficiency of routine abattoir (RA) inspection was validated in comparison to detailed abattoir (DA) inspection, followed by culture and microscopy (CM) and region of difference (RD) deletion analysis. Diagnostic accuracies (with corresponding measures of statistical uncertainty) were determined by computing test property statistics (sensitivity and specificity) and likelihood estimations using web-based SISA diagnostic statistics software. Post-test probability of detecting TB infected carcasses was estimated using nomograms. Agreement between RA and DA inspections was measured using kappa statistics. The study was conducted and reported in accordance with standards for reporting of diagnostic accuracy (STARD) requirements. Both routine and detailed meat inspection protocols were performed on a subpopulation of 3322 cattle selected randomly from among 78,269 cattle slaughtered during the study period. Three hundred thirty seven carcasses identified through detailed meat inspection protocols were subjected to culture and microscopy; of the 337, a subset of 105 specimens for culture and microscopy were subjected to further molecular testing.ResultsThere was a substantial agreement between RA and DA inspections in Addis Ababa (Kappa = 0.7) and Melge-Wondo abattoirs (Kappa = 0.67). In Adama, Hawassa and Yabello abattoirs, the agreement was however poor (Kappa ≤ 0.2). RA inspection was able to detect only 117 of the total 3322 carcasses inspected (3.5%). The sensitivity (Sn) and specificity (Sp) of RA inspection were 28.2% (95/337) [95%CI: 23.4-33.0] and 99.3% (2963/2985) [95%CI: 99.0-99.6], respectively, when DA inspection was considered as reference test. When culture and microscopy (CM) was considered as reference test, the Sn and Sp of RA were 55.2% (58/105) [95%CI: 45.7-64.7] and 84.1% (195/232) [95%CI: 79.3-88.8]. RA inspection failed to detect 71.8% (242/337) and 44.8% (47/105) of TB infected carcasses as judged by DA inspection and CM, respectively. On the other hand, a much higher sensitivity of DA was obtained when CM and RD deletion analysis were considered as reference tests (96.3% (105/109) and 100.0% (24/24), respectively).ConclusionsThe study results indicate that meat inspection protocols currently utilized in abattoirs are insufficient to detect the majority of TB lesions at the gross level. DA inspection protocols were demonstrated to improve the detection level by app...

BackgroundBovine Tuberculosis (BTB) is a widespread and endemic disease of cattle in Ethiopia. Information relating to genotypic characteristics of Mycobacterium bovis strains affecting the cattle population in Ethiopia is limited. We carried out molecular characterization of M. bovis strains isolated from BTB infected cattle using the spoligotyping technique. The relationship between distribution of spoligotypes and recorded variables was also investigated. A new approach that can numerically reflect the degree of genetic polymorphism in a M. bovis population was also developed. The study was conducted from July 2006 to January 2007 in cattle slaughtered at five representative abattoirs in Ethiopia.ResultsForty-five M. bovis isolates were obtained from 406 pathologic tissue specimens collected from 337 carcasses with lesions compatible with BTB. Twelve spoligotypes were identified from 34 distinct strains; with SB1176 as a dominant spoligotype (41.2% of the isolates) followed by SB0133 (14.7%). Comparison of spoligotypes with an M. bovis global database http://www.mbovis.org revealed six new spoligotypes which were subsequently registered in the database with international identification codes of SB1517, SB1518, SB1519, SB1520, SB1521 and SB1522. The majority of strains were obtained from cattle slaughtered at Addis Ababa abattoir. On the basis of the Spoligotype Evolutionary Index, SEI (a numeric expression approach to make standardized comparison of spoligotype evolution), M. bovis isolates from Ethiopia were relatively more heterogeneous (SEI = 3.2) compared to isolates from other countries. This might be attributed to extensive livestock movement linked to trading or seasonal migration, high degree of livestock mingling, and also diversities of the country's agricultural and livestock ecosystems, in addition to lack of disease control measures that led to high infection prevalence. Multiple spoligotype infection was recorded in nine (50%) of infected carcasses and this may indicate the prevailing high degree of super infection.ConclusionsThis study provided molecular evidence for the widespread distribution of M. bovis in the cattle population in Ethiopia. It also demonstrated a relatively high degree of genetic polymorphism of the isolates. Further molecular investigation of M. bovis strains in humans and other domestic animals is recommended in order to elucidate the zoonotic importance as well as reservoirs and pattern of transmission among various hosts.

PURPOSE: African-American (AA) women living in four Black Belt Counties (BBC) of Alabama; consisting of Barbour, Macon, Green and Wilcox are known to have lower mammogram utilization and breast self-exam rates when compared to their white female counterparts. The influence of socioeconomic and demographic factors on these disparities has not been clearly defined so far. Our study was designed to determine whether these observed disparities can be predicted with the socioeconomic and other demographic attributes. METHODS: Health Disparity Questionnaires data (n = 516) for BBC of Alabama was analyzed using a logistic regression model to examine the association of breast cancer screening rates and breast self-exam with income, the level of education, family doctor, type of health insurance, obesity, and age. RESULTS: Income, education, family doctor, age and health insurance were independent predictors for the low utilization rate of mammography and breast self-exam (BSE). CONCLUSION: Improving socioeconomic conditions such as level of education and availability of health care are essential to increase the rates of breast cancer screening test and breast self-exam in the BBC of Alabama.

Bovine TB is a disease of high economic and public health importance particularly in resource poor countries. Many aspects of pathogenesis of bovine TB in cattle have not been well understood. We carried out an investigation on 337 Ethiopian cattle with characteristic TB-like lesions to describe severity of pathology and factors associated with it. Severity of pathology was determined based upon gross lesion characteristics, distribution and presence/absence of viable mycobacteria. Molecular speciation of mycobacteria was performed using Gene-Probe's Accu-Probe method. Mycobacterium bovis was identified by genomic deletion analysis and spoligotyping. Data were analysed using descriptive statistics and regression model. The results showed that TB-like lesions and M. bovis were more frequently observed in lungs and respiratory lymph nodes. Mammary lesions yielded significant proportion of M. bovis upon culturing. Intestinal lesions were the second most frequently encountered pathology; upon culturing, however, the tissue specimens yielded the lowest proportion of M. bovis isolates. Sex, breed and management system were found to significantly affect TB manifestation. Female (β ± SE = 4.1 ± 1.0; P = 0.00) and exotic breed (β ± SE = 1.7 ± 0.9; P = 0.045) were at a relatively higher risk of developing severe tuberculosis. TB pathology was more severe in cattle raised under large-scale farming (β ± SE = 2.3 ± 0.5; P = 0.00). The fact that severe tuberculosis is linked to high degree of disease transmission potential warrants implementation of proper disease surveillance programs in large-scale farms. Isolation of M. bovis from mammary and muscle tissues implies a potential threat of zoonotic transmission, where raw milk and raw beef constitute a customary dietary regimen in Ethiopia.

This study was aimed at investigating risk factors associated with prevalence of tuberculosis (TB)-like lesions and associated mycobacteria in Ethiopian cattle slaughtered. The study was carried out during 2006-2007 in five selected municipal and export abattoirs. Methods of investigation involved detailed necropsy examination of carcasses and isolation of mycobacteria from pathologic tissue specimens. Factors of animal and environment origin were recorded and examined as explanatory variables in relation to the presence or absence of TB-like lesions and the presence of viable mycobacteria. Multivariable logistic regression analysis was used to identify risk factors associated with prevalence of TB-like lesions and mycobacteria. Out of 3,322 carcasses inspected, 10.2% (95% confidence interval (CI) [9.2-11.3]) and 3.2% (95% CI [2.6-3.8]) were positive, respectively, based on necropsy and bacteriologic examinations. The highest and lowest lesion prevalence was recorded in Adama (24.7%) and Yabello (4.2%), respectively. Multivariable logistic regression analysis identified age, breed, abattoir location, geographic origin and management system as being risk factors for prevalence of TB-like lesions and occurrence of viable mycobacteria in Ethiopian cattle. The study demonstrated mycobacterial infection as important infectious disease of Ethiopian cattle. The reported confirmed cases of the disease in different management and geographic settings in Ethiopia disproved the earlier held opinion of its occurrence as a low sporadic profile. In view of a dietary proclivity of Ethiopian communities (milk and meat are predominantly consumed raw) and lifestyle (close contact of people with animals), the risk of bovine tuberculosis as a public health threat is eminent.