Risk factors for multidrug‐resistant tuberculosis in northwest Ethiopia: A case–control study

Alene, Kefyalew Addis; Viney, Kerri; McBryde, Emma S.; Gray, Darren J.; Melku, Mulugeta; Clements, Archie C. A.

doi:10.1111/tbed.13188

Cited by 17 publications

(14 citation statements)

References 24 publications

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“…Previous studies have also reported a relatively higher notification rate of TB in urban areas than in rural areas [11, 12]. There could be several reasons for this: the effect of urban residence on TB may be partially due to the higher HIV prevalence in urban areas [13–16]; and higher transmission could also occur in urban areas as a result of overcrowding and higher population density [15, 17]. On the other hand, TB patients living in urban areas may have better access to TB diagnostic services and therefore more likely to report TB cases and be notified compared to patients living in rural areas where there is limited access to TB diagnostic services [18, 19].…”

Section: Discussionmentioning

confidence: 99%

Spatial clustering of notified tuberculosis in Ethiopia: A nationwide study

Alene

Clements

2019

PLoS ONE

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Background Tuberculosis (TB) remains a major health problem worldwide and in Ethiopia. This study aimed to investigate the spatial distributions of notified TB over the whole territory of Ethiopia and to quantify the role of health care access, environmental, socio-demographic, and behavioural factors associated with the clustering of TB. Methods A spatial analysis was conducted using national TB data reported between June 2016 and June 2017 in Ethiopia. Spatial clustering of TB was explored using Moran’s I statistic and the local indicator of spatial autocorrelation (LISA). A multivariate Poisson regression model was developed with a conditional autoregressive (CAR) prior structure and with posterior parameters estimated using Bayesian Markov chain Monte Carlo (MCMC) simulation with Gibbs sampling to investigate the drivers of the clustering. Result A total of 120,149 TB cases were reported from 745 districts in Ethiopia during the study period; 41,343 (34%) were bacteriologically confirmed new pulmonary TB and 33,997 (28%) were clinically diagnosed, new, smear-negative pulmonary TB patients. The nationwide annual incidence rate of notified TB was 112 per 100,000 population. The highest incidence was observed in three city administrative regions, namely Dire Dewa (348 cases per 100,000 population), Addis Ababa (262 per 100,000 population) and Harari (206 per 100,000 population), and the lowest incidence was observed in Somali region (51 per 100,000 population). High-high spatial clustering of notified TB was detected at Humera, Gog, and Surima district, and low-low clustering was detected in some districts located in the Somali region. Poor health care access (IRR = 0.78; 95%CI: 0.66, 0.90) and good knowledge about TB (IRR = 0.84; 95%CI: 0.73, 0.96) were negatively associated with the incidence of notified TB. Conclusion Substantial spatial clustering of notified TB was detected at region, zone and district level in Ethiopia. Health care access and knowledge about TB was associated with incidence of TB. This study may provide policy makers target hotspot areas, where national control programs could be implemented more efficiently for the prevention and control of TB, and to address potential under-reporting in poor access areas.

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Section: Discussionmentioning

confidence: 99%

Spatial clustering of notified tuberculosis in Ethiopia: A nationwide study

Alene

Clements

2019

PLoS ONE

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“…The synergy between TB and HIV infection is strong. While TB is the leading cause of death among people living with HIV [1], HIV infection is the most important risk factor for developing active TB [2, 3]. Tuberculosis and HIV co-infection has been a major public health challenge to the global efforts in achieving elimination goals for both diseases.…”

Section: Introductionmentioning

confidence: 99%

Spatial patterns of tuberculosis and HIV co-infection in Ethiopia

et al. 2019

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BackgroundTuberculosis (TB) and human immunodeficiency virus (HIV) are the leading causes of infectious-disease-related deaths in Ethiopia, but little is known about their spatial distribution across the country. The aim of this study was to investigate the spatial patterns of TB and HIV co-infection in Ethiopia at the district level.MethodsWe conducted an ecological study using TB and HIV data reported from all regions of Ethiopia through the national Health Management Information System (HMIS), between June 2015 and June 2017. Spatial clustering was assessed using Moran’s I statistic and Getis-Ord statistic. Spatial binomial regression models were constructed separately for the prevalence of TB among people living with HIV and for the prevalence of HIV among TB patients, with and without spatial components using a Bayesian approach.ResultsA total of 1,830,880 HIV and 192,359 TB patients were included in the analysis. The prevalence of HIV among TB patients was 7.34%; hotspots were observed in districts located in Amhara, Afar, and Gambela regions, and cold spots were observed in Oromiya and Southern Nations, Nationalities, and People (SNNP) regions. The prevalence of TB among people living with HIV varied from 0.7% in Oromia region to 14.5% in Afar region. Hotspots of TB prevalence among people living with HIV were observed in districts located in Gambela, Afar, Somali, and Oromiya regions; whereas the cold spots were observed in districts located in Amhara and Tigray regions. The ecological-level factors associated with the prevalence of TB among people living with HIV were low wealth index (OR: 1.49; 95% CrI: 1.05, 2.05), low adult literacy rate (OR: 0.67; 95% CrI: 0.46, 0.94), and distance to an international border (OR: 0.61; 95% CrI: 0.40, 0.91). The factors associated with the prevalence of HIV among TB patients were poor health care access (OR: 0.76; 95% CrI: 0.59, 0.95), low wealth index (OR: 1.31; 95% CrI: 1.01, 1.67), and low adult literacy rate (OR: 1.37; 95% CrI: 1.03, 1.78).ConclusionOur study provides evidence for geographic clustering of TB/HIV co-infection in Ethiopia. Health care access, proximity to international borders, and demographic factors such as low wealth index and adult literacy were significantly associated with the prevalence of TB/HIV co-infection.

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“…Then, fulltext screening was conducted for 43 articles. Finally, after the full-text screening, 27 eligible articles were included in the study (Abay et al, 2020;Abdella et al, 2015;Adane et al, 2015;Alene et al, 2019;Arega et al, 2019;Assefa et al, 2017;Babure et al, 2019;Bedewi et al, 2017;Biru et al, 2020;Deressa et al, 2014;Desissa et al, 2018;Dessalegn et al, 2016;Fikre et al, 2019;Gobena et al, 2018;Hamusse et al, 2016;Hirpaet al, 2013;Jaleta et al, 2017;Mehari et al, 2019;Mekonnen et al, 2015;Mesfin etal., 2018;Mulisa et al, 2015;Mulu et al, 2015;Seyoum et al, 2014;Tadesse et al, 2015;Tesfay et al, 2016;Tsega et al, 2017;Welekidan et al, 2020). We presented the detail using the PRISMA flow diagram (Figure 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Risk factors associated with drug-resistant tuberculosis in Ethiopia: A systematic review and meta-analysis

Alemu

Bitew

Diriba

et al. 2021

Preprint

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The emergence of drug-resistant tuberculosis (DR-TB) is becoming a challenge to the national TB control programs including Ethiopia. Different risk factors are associated with the emergence of DR-TB. Identifying these risk factors in a local setting is important to strengthen the effort to prevent and control DR-TB. Thus, this study aimed to assess the risk factors associated with drug-resistant TB in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist was followed to conduct this study. We systematically searched the articles from electronic databases and gray literature sources. We used the Joanna Briggs Institute Critical Appraisal tools to assess the quality of studies. Data were analyzed using STATA version 15. We estimated the pooled OR along with 95%CI for each risk factor. The heterogeneity of the studies was assessed using the forest plot and I heterogeneity test. Besides, we explored the presence of publication bias through visual inspection of the funnel plot and Egger’s regression test. After intense searching, we found 2238 articles, and 27 eligible studies were included in the final analysis. Based on the pooled analysis of the odds ratio, unemployment (OR; 2.71, 95% CI; 1.64, 3.78), having a history of the previous TB (OR; 4.83, 95% CI; 3.02, 6.64), having contact with a known TB patient (OR; 1.72, 95% CI; 1.05, 2.40), having contact with a known MDR-TB patient (OR; 2.54, 95% CI; 1.46, 3.63), and having pulmonary TB (OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of drug-resistant TB. While older age TB patients (OR; 0.77, 95% CI; 0.60, 0.95) including age above 45 years OR; (0.76, 95% CI; 0.55, 0.97), and males (OR; 0.86, 95% CI; 0.76, 0.97) were found to had lower risk of DR-TB compared to their counterparts. A previous history of TB treatment is a major risk factor for acquiring DR-TB in Ethiopia that might be due to poor adherence during the first-line anti TB treatment. Besides, having contact with a known TB patient, having contact with a known MDR-TB patient, having pulmonary TB, and being unemployed were the risk factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for DR-TB might help to detect DR-TB cases as early as possible and could help to mitigate its further transmission across the community.

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Risk factors for multidrug‐resistant tuberculosis in northwest Ethiopia: A case–control study

Cited by 17 publications

References 24 publications

Spatial clustering of notified tuberculosis in Ethiopia: A nationwide study

Spatial clustering of notified tuberculosis in Ethiopia: A nationwide study

Spatial patterns of tuberculosis and HIV co-infection in Ethiopia

Risk factors associated with drug-resistant tuberculosis in Ethiopia: A systematic review and meta-analysis

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