Challenges in delivery of tuberculosis Services in Ethiopian Pastoralist Settings: clues for reforming service models and organizational structures

Getnet, Fentabil; Demissie, Meaza; Worku, Alemayehu; Gobena, Tesfaye; Tschopp, Rea; Farah, Alinoor Mohamed; Seyoum, Berhanu

doi:10.1186/s12913-021-06662-3

Cited by 9 publications

(7 citation statements)

References 52 publications

(46 reference statements)

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“…This might be due to a relatively higher exposure of males to cigarette smoking, traveling a long distance for economic reasons and alcohol consumption as compared to females. However, this finding was contrary to the report of a study done in the Northeast Ethiopia Dessie and Woldia town [10,18,28].…”

Section: Plos Global Public Healthcontrasting

confidence: 99%

Poor adult tuberculosis treatment outcome and associated factors in Gibe Woreda, Southern Ethiopia: An institution-based cross-sectional study

Mengesha

Gebremichael

Watumo

et al. 2022

PLOS Glob Public Health

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Tuberculosis (TB) remains a major medical and public health problem throughout the world, especially in developing countries including Ethiopia. Its control program is currently being challenged by the spread of drug-resistant TB, which is the result of poor treatment outcomes. Hence, this study assessed poor adult TB treatment outcomes and associated factors in Gibe Woreda, Southern Ethiopia. An institution-based cross-sectional study was conducted from March 1, 2020 to March 30, 2020, using a standard checklist to review clinical charts of TB patients who enrolled on first-line TB treatment under DOTS between June 2016 and June 2019. Poor treatment outcomes constituted death during treatment, treatment failure, and loss to follow-up (LTFU). Descriptive statistics were used to describe the characteristics of study participants. A binary logistic regression model was fitted to identify factors influencing treatment outcome and adjusted odds ratios with a 95% confidence interval were reported. The statistical significance of all tests in this study was declared at P-value <5%. A total of 400 adult TB patients were participated. The mean age of study participants was 39.2±16.7 years, 55.5% were males and 79.8% were pulmonary tuberculosis cases. Regarding the treatment outcomes, 58% completed treatment, 27.5% cured, 9.3% were LTFU, 3.2% died, and 2.0% failed. The overall poor treatment outcome was 14.5% (95% CI: 11.1–17.9). Age (aOR = 1.02; 95%CI: 1.01–1.04), male gender (aOR = 1.82; 95% CI: 0.99–3.73), travel ≥ 10 kilometres to receive TB treatment (aOR = 6.55; 95% CI: 3.02–14.19), and lack of family support during the course of treatment (aOR = 3.03; 95% CI: 1.37–6.70), and bedridden baseline functional status (aOR = 4.40; 95% CI: 0.96–20.06) were factors associated with poor treatment outcome. Successful TB treatment outcome in this study area was below the national TB treatment success rate. To improve positive treatment outcomes, remote areas should be prioritized for TB interventions, and stakeholders in TB treatment and care should give special emphasis to adults over the age of 45 years, males, those who travel more than 10 kilometres to receive TB care, having bedridden baseline functional status and those who had no family support.

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Section: Plos Global Public Healthcontrasting

confidence: 99%

Poor adult tuberculosis treatment outcome and associated factors in Gibe Woreda, Southern Ethiopia: An institution-based cross-sectional study

Mengesha

Gebremichael

Watumo

et al. 2022

PLOS Glob Public Health

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“…Only a few previous studies in Ethiopia reported the EAI clade (25, 33). In the neighboring Somalia, 33.6% of isolates M. tuberculosis isolates were reported to be classified under the EAI clade (34), which could suggest that the pastoralists from both countries interact in the border areas on a regular basis as the Somali region of Ethiopia shares a border with Somaliland (Somalia) (9).…”

Section: Discussionmentioning

confidence: 99%

“…More than 83% of the population lives in rural areas, mainly with pastoral or agropastoral livelihood, with livestock serving as the primary source of income. People in the Somali region and those in neighboring countries are ethnically, linguistically, and religiously similar and cross-border movement is common (8,9). In the Somali region, long-running unrest and insecurity severely impeded the government's capacity to offer basic social services to rural populations (10).…”

Section: Methodology Study Area and Settingmentioning

confidence: 99%

Molecular epidemiology of tuberculosis in the Somali region, eastern Ethiopia

Worku

Gumi²,

Mohammedbirhan³

et al. 2022

Front. Med.

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BackgroundTuberculosis (TB) is one of the leading causes of morbidity and mortality in low-income countries like Ethiopia. However, because of the limited laboratory infrastructure there is a shortage of comprehensive data on the genotypes of clinical isolates of Mycobacterium tuberculosis (M. tuberculosis) complex (MTBC) in peripheral regions of Ethiopia. The objective of this study was to characterize MTBC isolates in the Somali region of eastern Ethiopia.MethodsA cross-sectional study was conducted in three health institutions between October 2018 and December 2019 in the capital of Somali region. A total of 323 MTBC isolates (249 from pulmonary TB and 74 from extrapulmonary TB) were analyzed using regions of difference 9 (RD 9)-based polymerase chain reaction (PCR) and spoligotyping.ResultsOf the 323 MTBC isolates, 99.7% (95% CI: 99.1–100%) were M. tuberculosis while the remaining one isolate was M. bovis based on RD 9-based PCR. Spoligotyping identified 71 spoligotype patterns; 61 shared types and 10 orphans. A majority of the isolates were grouped in shared types while the remaining grouped in orphans. The M. tuberculosis lineages identified in this study were lineage 1, 2, 3, 4, and 7 with the percentages of 7.4, 2.2, 28.2, 60.4, and 0.6%, respectively. Most (87.9%) of the isolates were classified in clustered spoligotypes while the remaining 12.1% isolates were singletons. The predominant clustered spoligotypes identified were SIT 149, SIT 21, SIT 26, SIT 53, and SIT 52, each consisting of 17.6, 13.3, 8.4, 7.4, and 5%, respectively. Lineage 3 and lineage 4, as well as the age group (15–24), were associated significantly with clustering.ConclusionThe MTBC isolated from TB patients in Somali region were highly diverse, with considerable spoligotype clustering which suggests active TB transmission. In addition, the Beijing spoligotype was isolated in relatively higher frequency than the frequencies of its isolation from the other regions of Ethiopia warranting the attention of the TB Control Program of the Somali region.

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“…Consequently, the costs of seeking care at private clinics may increase the financial burden of diseases. The financial risk associated with poor access to public facilities is an understudied issue [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Estimated travel time and staffing constraints to accessing the Ethiopian health care system: A two-step floating catchment area analysis

et al. 2023

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Background Despite large investments in the public health care system, disparities in health outcomes persist between lower- and upper-income individuals, as well as rural vs urban dwellers in Ethiopia. Evidence from Ethiopia and other low- and middle-income countries suggests that challenges in health care access may contribute to poverty in these settings. Methods We employed a two-step floating catchment area to estimate variations in spatial access to health care and in staffing levels at health care facilities. We estimated the average travel time from the population centers of administrative areas and adjusted them with provider-to-population ratios. To test hypotheses about the role of travel time vs staffing, we applied Spearman’s rank tests to these two variables against the access score to assess the significance of observed variations. Results Among Ethiopia’s 11 first-level administrative units, Addis Ababa, Dire Dawa, and Harari had the best access scores. Regions with the lowest access scores were generally poorer and more rural/pastoral. Approximately 18% of the country did not have access to a public health care facility within a two-hour walk. Our results suggest that spatial access and staffing issues both contribute to access challenges. Conclusion Investments both in new health facilities and staffing in existing facilities will be necessary to improve health care access within Ethiopia. Because rural and low-income areas are more likely to have poor access, future strategies for expanding and strengthening the health care system should strongly emphasize equity and the role of improved access in reducing poverty.

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Challenges in delivery of tuberculosis Services in Ethiopian Pastoralist Settings: clues for reforming service models and organizational structures

Cited by 9 publications

References 52 publications

Poor adult tuberculosis treatment outcome and associated factors in Gibe Woreda, Southern Ethiopia: An institution-based cross-sectional study

Poor adult tuberculosis treatment outcome and associated factors in Gibe Woreda, Southern Ethiopia: An institution-based cross-sectional study

Molecular epidemiology of tuberculosis in the Somali region, eastern Ethiopia

Estimated travel time and staffing constraints to accessing the Ethiopian health care system: A two-step floating catchment area analysis

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