The impact of COVID-19 on the tuberculosis control activities in Addis Ababa

Abstract

The first COVID-19 case was reported in Ethiopia on 13 th March 2020 and series of announcements of set of measures, proclamation and directives have been enacted to fight the coronavirus pandemic. These have implications for the regular health services including the TB control program. This brief communication assesses the impact of the COVID-19 response on the TB control activities of Addis Ababa health centers based on research project data. We compared the patient flows in pre-COVID-19 period (quarter 1, Q1) and during COVID-19 (quarter 2, Q2 and quarter 3, Q3) of 2020 at 56 health centers in Addis Ababa from all 10 sub-cities per sub-city. The patient flow declined from 3,473 in Q1 to 1,062 in Q2 and 1,074 in Q3, which is a decrease by 62-76% and 52-80% in Q2 and Q3 respectively as compared to that of Q1. In Q2, Kolfe keranio and Kirkos sub-cities recorded the biggest decline (76 and 75% respectively) whereas Yeka sub-city had the least decline (62%). In Q3, Kirkos sub-city had the biggest decline (80%) and Addis ketema sub-city had the lowest (52%). We conclude that the series of measures, state of emergency proclamation and government directives issued to counter the spread of COVID-19 and the public response to these significantly affected the TB control activities in Addis Ababa city as attested by the decrease in the patient flow at the clinics. Health authorities may inform the public that essential health services are still available and open to everyone in need of these services.

Impact of COVID-19 on Tuberculosis Case Detection and Treatment Outcomes in Sierra Leone

“…Our observations are consistent with recent studies from Nigeria, Ethiopia, Malawi, Zimbabwe and elsewhere in SSA [14][15][16][17][18][19]. While these findings have been attributed largely to the direct effects of the COVID-19 lockdowns, Thakur et al and others [15][16][17] have suggested that other factors unrelated to the COVID-19 pandemic may be contributory.…”

“…Our observations are consistent with recent studies from Nigeria, Ethiopia, Malawi, Zimbabwe and elsewhere in SSA [14][15][16][17][18][19]. While these findings have been attributed largely to the direct effects of the COVID-19 lockdowns, Thakur et al and others [15][16][17] have suggested that other factors unrelated to the COVID-19 pandemic may be contributory. In Sierra Leone and other low-and middle-income countries (LMICs) in SSA, low health literacy rates; age-and gender-related differences in risk perception and care-seeking behavior; high out-of-pocket formal and informal costs of services; and transportation constraints are important barriers that commonly result in sub-optimal access and utilization of health services [20,21].…”

“…Although there were fewer presumptive cases that underwent testing in 2020, there was a 37% increase in laboratory-confirmed TB cases compared with 2019. Similar findings have been reported in Malawi and Zimbabwe during the COVID-19 pandemic [15,16]. Before 2017, the Chest Clinic at Connaught Hospital relied exclusively on sputum testing for acid-fast bacilli (AFB) by microscopy to confirm TB.…”

Real-Time Impact of COVID-19 on Clinical Care and Treatment of Patients with Tuberculosis: A Multicenter Cross-Sectional Study in Addis Ababa, Ethiopia

“…Studies conducted in different countries indicated a potential bidirectional link between TB and COVID-19. Patients with TB are more likely to experience poor outcomes from COVID-19 [25] and patients co-infected with COVID-19 and TB are more likely to suffer severe disease or death than patients with COVID-19 only [26]. The simultaneity of COVID-19 and pulmonary TB can issue a diagnostic dilemma [27] and new diagnostic challenges for clinicians [28].…”

“…In Ethiopia, there have been limited studies conducted in the area, reporting that the series of COVID-19 containment measures that the government had taken, including state of emergency, had a significant impact on the overall TB care and treatment services in the country including a reduction in the flow of TB patients [38,39]. However, there has been no study that documented the impact of COVID-19 on patients with TB using real-time patient-level data.…”