The human immune deficiency virus (HIV) is the strongest risk factor for the incidence of tuberculosis (TB) by way of reactivation of latent or new infection. The provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB. To date, there have been limited clinical data regarding the effectiveness of isoniazid preventive therapy (IPT) on TB incidence. This study aimed to assess the effect of isoniazid preventive therapy on the incidence of tuberculosis for seropositive children in Northwest Ethiopia. Methods. A facility-based retrospective follow-up was employed for reviewing 421 files from 1 January 2015 up to 30 December 2019. EpiData version 3.2 and Stata/14 software were used for data entry and analysis, respectively. Categorical variables at bivariable Cox regression were assessed for candidates transferred at P value <0.25 for multivariable Cox regression to claiming predictors associated with TB incidence rate at 95% CI at P < 0.005 . Result. The overall incidence of TB was found to be 4.99 cases per 100 person-years at 95% CI (3.89–6.53). Missed IPT (AHR = 7.45, 95% CI: 2.96, 18.74, P < 0.001 ), missed cotrimoxazole preventive therapy (CPT) (AHR = 2.4, 95% CI: 1.84–4.74, P < 0.022 ), age ≥ 11 years (AHR = 4.2, 95% CI: 1.04–7.03, P < 0.048 ), MUAC ≤ 11.5 cm (AHR = 4.36, 95% CI: 1.97–9.97, P < 0.001 ), WHO stages III and IV (AHR = 2.04, 95% CI: 1.12–3.74, P < 0.022 ), and CD4 count ≤100 cells/μl (AHR = 3.96, 95% CI: 1.52–10.34, P < 0.005 ) were significantly associated with TB incidence. Conclusion. Concomitant administration of ART with IPT had demoted more than ninety-six percent of new TB incidences for this report. Undertaking in-depth TB screening and frequent follow-up among all these children is critical in order to prevent and control tuberculosis.
Infection by the human immune deficiency virus (HIV) is the strongest risk factor for latent or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence of tuberculosis for children living with HIV. Thus, this study assessed time to develop and predictors for incidence of tuberculosis in children attending HIV/AIDS care in public hospitals: North West Ethiopia 2021. Methods. A facility-based retrospective cohort study was conducted among 421 seropositive children on antiretroviral therapy in two hospitals between January 1, 2011 and December 31, 2020. EPI-DATA version 3.2 and STATA/14 software were used for data entry and analysis, respectively. Tuberculosis-free survival time was estimated using the Kaplan-Meier survival curve. Bivariate and multivariable Cox regression model was fitted to identify predictors at a P value <0.05 within 95% CI. Results. In the final analysis, a total of 421 seropositive children were included, of whom, 64 (15.2%) developed tuberculosis at the time of follow-up. The mean (±SD) age of the children was 10.62 ± 3.32 years, with a median (IQR) time to develop TB that was 23.5 ( IQR = ± 19 ) months. This study found that the incidence of tuberculosis was 5.9 (95% CI: 4.7; 7.6) per 100 person-years (PY) risk of observation. Cases at baseline not taking cotrimoxazol preventive therapy (CPT) ( AHR = 2.5 ; 95% CI, 1.4-4.7, P < 0.021 ), being severely stunted ( AHR = 2.9 : 95% CI, 1.2-7.8, P < 0.03 ), and having low hemoglobin level ( AHR = 4.0 ; 95% CI, 2.1-8.1, P < 0.001 ) were found to be predictors of tuberculosis. Conclusion. A higher rate of tuberculosis incidence was reported in our study as compared with previous studies in Ethiopia. Cases at baseline not taking cotrimoxazol preventive therapy (CPT), being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk to developed TB incidence.
Malnutrition and human immunodeficiency virus/acquired immunodeficiency syndrome have complex and multidirectional relationships. Ethiopia is one of the countries hardest hit by the HIV epidemic as well as malnutrition. This study was aimed at assessing the effects of undernutrition on the survival status of HIV-positive children who received HIV/AIDS care in Northwest Ethiopia. Materials and Methods. A facility-based retrospective follow-up was conducted from January 1, 2009, to December 31, 2020. The data was entered into EpiData version 4.2.0. Then, the entered data was exported to STATA 14 software for further analysis, and the Kaplan-Meier survival curve was used to estimate survival time after the initiation of ART. The Bivariable and multivariable Cox regression analyses were conducted to identify predictors of mortality associated with undernutrition. Results. The mean (±SD) age of participant children was found 118.4 (±38.24) months. The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% CI: 3.6, 5.8). Children with CD4 cell counts below the threshold [ AHR = 1.6 ; 95% CI (1.19, 7.85)], advanced WHO clinical stages (III and IV) HIV [ AHR = 4.5 ; 95% CI (2.80, 8.40)], and being severe stunting at the beginning [ AHR = 2.9 ; 95% CI (1.80, 6.40)] were significantly associated with mortality of HIV-positive children. Conclusion. The findings of the current study indicated that HIV-positive children on ART had a high rate of mortality. Baseline undernutrition has the mortality of children who had CD4 counts below a threshold, advanced WHO HIV clinical staging (III and IV), and being severe stunting ( HAZ ≤ − 3 Z score) which were found to be independent predictors for mortality of undernourished HIV.
Objectives: The spread of severe acute respiratory syndrome coronavirus 2 in Ethiopia is below par understood and to date has been poorly characterized by a lower number of confirmed cases and deaths to other regions of the sub-Sahara African including Ethiopia. Timely and effective predictors for inpatient mortality rate were crucial for improving the management of hospitalized cases. This study aimed to assessed predictors for inpatient mortality of COVID-19 hospitalized adult patients in two diagnosed and treatment centers, North West Ethiopia. Methods: A facility-based retrospective cohort study was conducted among COVID-19 adult admitted cases in two treatment centers, Northwest Ethiopia, from 1 October 2020 to 30 December 2020. Data from the records of children were extracted using a standardized checklist. Epi-Data version 3.2 was used for data entry, and Stata version 14 was used for analysis. Bi-variable and multivariable Cox regression analyses were conducted to identify predictors of mortality. Finally, variables with P < 0.05 were a significant predictor of inpatient mortality. Result: The mean (±standard deviation) age of participant cases was 48.6 (±18.8) years. The median (±interquartile range) time for death reported after was 13 (±6) days. The overall incidence rate inpatient mortality rate was determined as 1.8 (95% confidence interval: 1.72, 2.15) per100 person per days of observation. Cases at baseline age ⩾ 61 years (adjusted hazard ratio = 1.56; 95% confidence interval: 1.3, 2.4), being male gender (adjusted hazard ratio = 1.9; 95% CI: 2.1, 8.6), admission with comorbidity (adjusted hazard ratio: 4.4, 95% confidence interval: 2.3, 8.4), and decreased neutrophil count ⩽ 65 103/uL at (P < 0.03) were independent predictors for inpatient mortality. Conclusion: In general, 72.4% of COVID-19 inpatient deaths were occurred within 2 weeks after admission. The mortality risk factors for severe patients identified in this study using a multivariate Cox regression model included elderly age (⩾60 years), being male, baseline comorbidity, and neutrophil count ⩽65 103/uL were associated with inpatient mortality.
The human immune deficiency virus (HIV) is the strongest risk factor for endogenous reactivation of pulmonary tuberculosis (PTB) through target reduction of CD4, T-lymphocytes, and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, information is scarce and meager regarding PTB incidence after ART initiated for seropositive children. Methods. Facility-based multicenter historical cohort was conducted among 721 seropositive children after initiating ART from January 1, 2009, to December 31, 2019. Data from the records of children were extracted using a standardized checklist. The collected data were entered using Epi-Data version 4.2 and exported to STATA (SE) R-14 version statistical soft wares for further analysis. Bivariable and multivariable Cox regression analyses were conducted to identify predictors of PTB incidence. Results. Seven hundred twenty-one (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. During the follow-up periods, 63 (15.2%) participants developed new cases of TB; majority (61/63, 96.8%) of them were PTB. The overall incidence rate and the median (±IQR) time of PTB reported were determined as 5.86 per 100 child years (95% CI: 4.58, 7.5) and 17.8 (±11) months, respectively. At baseline, children being severely stunted (AHR = 2.9 : 95% CI, 1.2–7.8, P = 0.03 ), with Hgb ≤10 mg/dl (AHR = 4.0; 95% CI, 2.1–8.1, P = 0.001 ), and not given isoniazid and cotrimoxazole preventive therapy (AHR = 2.4; 95% CI: 1.2; 5.1, P = 0.001 ) (AHR = 2.5; 95% CI, 1.4–4.7, P = 0.021 ) were significantly associated with PTB incidence. Conclusion. A high incidence rate of PTB was observed in our study as compared with the previous finding in Ethiopia. Cases at baseline not taking IPT and CPT, being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk of developing PTB.
Objective: This study aimed to assess Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia 2009–2019. Methods: Institutional-based retrospective cohort study was employed among 721 on antiretroviral therapy care seropositive children since 2009–2019. Data were entered using EpiData version 4.2 and exported to STATA (SE) R-14 version statistical software for further analysis. Beside, Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. Bivariable and multivariable Cox regression analyses were conducted to identify the predictors of mortality. Finally, variables with p-value less than 0.05 were considered significant predictors of mortality. Result: Overall, 721 (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. A median time of death was reported at 19.5 months (interquartile range = ±8.5). The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% confidence interval: 3.6–5.8). Severe stunting (height for age Z-score <−3) (hazard ratio = 2.9, 95% confidence interval: 1.8–6.4), admission with septic shock (hazard ratio = 2.3, 95% confidence interval: 1.2–4.3, p < 0.008), CD4+ count below threshold (hazard ratio = 1.6, 95% confidence interval: 1.19–7.9), and World Health Organization Stages III and IV (hazard ratio = 2.9, 95% confidence interval: 1.8–6.4) were at high risk of mortality. Conclusion: A high rate of SAM associated mortality rate within short median (±SD) time to death was reported as compared with previous finding in Ethiopia. Seropositive children presenting with CD4 counts being below a threshold, World Health Organization Stages III and IV, and being nutritionally stunted during antiretroviral therapy initiation were at high risk of early mortality.
Objective: The spread of Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) in Ethiopia is below par understood and to date has been poorly characterized by a lower number of confirmed cases and deaths as compared with other regions of the Sub-Saharan African (SSA) countries. We aimed to investigate the seroprevalence of SARS-CoV-2 specific IgG antibodies, using the Abbott anti-nucleocapsid IgG chemiluminescent microparticle immunoassay, in two COVID-19 diagnosed and treatment centers of quarantined population during the first wave of the COVID-19 pandemic (since 30 April–30 May 2020). Methods: We analyzed data of 446 quarantined individuals during the first wave of COVID-19 pandemic. The data were collected using both interviewed and blood sample collection. Participants asked about demographic characteristics, COVID-19 infection symptoms, and its practice of preventive measures. Seroprevalence was determined using the severe acute respiratory syndrome coronavirus 2 IgG test. Results: The mean (± standard deviation) age of the respondent was 37.5 (±18.5) years. The estimated SARS-CoV-2 infection seroprevalence was found 4.7% (95% confidence interval: 3.1–6.2) with no significant difference on age and gender of participants. Severe acute respiratory syndrome coronavirus 2 antibody seroprevalence was significantly associated with individuals who have been worked by moving from home to work area (adjusted odds ratio = 7.8, 95% confidence interval: 4.2–14.3, p < 0.019), not wearing masks (adjusted odds ratio = 2.4, 95% confidence interval: 1.9–3.8, p < 0.02), and baseline comorbidity (adjusted odds ratio = 6.3, 95% confidence interval: 2.3–17.1, p < 0.01) as compared to their counter groups, respectively. Conclusion: Our study concluded that lower coronavirus disease 2019 seroprevalence, yet the large population in the community to be infected and insignificant proportion of seroprevalence, was observed between age and sex of respondents. Protective measures like contact tracing, face covering, and social distancing are therefore vital to demote the risk of community—strengthening factors should be continued as effect modification of anticipation for severe course of coronavirus disease 2019.
Background Severe acute malnutrition (SAM) is defined as a weight-for-height < -3z scores of the median WHO growth standards, or visible severe wasting or the presence of nutritional edema. SAM related mortality rates in under-five children are well documented in Ethiopia but data on their predictors are limited. We aimed to document factors associated with SAM related mortality to inform better inpatient management. Methods A facility-based retrospective cohort study was conducted among children admitted due to SAM at Pawe General Hospital, Northwest Ethiopia, from the 1st of January 2015 to the 31st of December 2019. Data from the records of SAM children were extracted using a standardized checklist. Epi-Data version 3.2 was used for data entry, and Stata version 14 was used for analysis. Bi-variable and multivariable Cox regression analyses were conducted to identify predictors of mortality. Variables with P<0.05 were considered significant predictors of mortality. Results Five-hundred sixty-eight SAM cases were identified of mean age was 27.4 (SD± 16.5) months. The crude death rate was 91/568 (16.02%) and the mean time to death was determined as 13 (±8) days. Independent risk factors for death were: (i) vomiting AHR = 5.1 (1.35–21.1, p = 0.026), (ii) diarrhea AHR = 2.79 (1.46–5.4, p = 0.002), (iii) needing nasogastric therapy AHR = 3.22 (1.65–6.26, p = 0.001), (iv) anemia AHR = 1.89 (1.15–3.2, p = 0.012), and (v) being readmitted with SAM AHR = 1.7 (1.12–2.8, p = 0.037). Conclusion SAM mortality was high in under-five children in our setting. The identified risk factors should inform treatment and prevention strategies. Improved community health education should focus on healthy nutrition and seeking early treatment. Inpatient mortality may be reduced by stricter adherence to treatment guidelines and recognizing early the key risk factors for death.
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