TUBERCULOSIS: Ethiopia: leading cause of mortality among infectious diseases worldwide

Authors: Belete GetahunGobena AmeniSibhatu BiadgilignGirmay Medhin
Credits/Source: BMC Infectious Diseases 2011, 11:127


Mortality and associated risk factors in a cohort of tuberculosis patients treated under DOTs programme in Addis Ababa, Ethiopia.

Tuberculosis (TB) is the leading cause of mortality among infectious diseases worldwide. Ninty five percent of TB cases and 98% of deaths due to TB occur in developing countries.
Globally, the mortality rate has declined with the introduction of effective anti TB chemotherapy. Nevertheless, some patients with active TB still die while on treatment for their disease.
In Ethiopia, little is known on survival and risk factors for mortality among a cohort of TB patients. The objective of the study is to determine the magnitude and identify risk factors associated with time to death among TB patients treated under DOTS programme in Addis Ababa, Ethiopia.

Methods:
This is a retrospective cohort study.
Data was obtained by assessing medical records of TB patients registered from June 2004 to July 2009 G.C and treated under the DOTS strategy in three randomly selected health centers. A step-wise multivariable Cox's regression model and Kaplan- Meier curves were used to model the outcome of interest.
Mortality was used as an outcome measure. Person-years of observation (PYO) were calculated from the date of starting anti-TB treatment to date of outcome and was calculated as the number of deaths/100 PYO.
Statistical analysis SPSS version 16 was used for data analysis and results were reported significant whenever P-value was less than 5%.

Results:
From a total of 6,450 registered TB patients 236(3.7%) were died. More than 75% death occurred within eight month of treatment initiation.
The mean and median times of survival starting from the date of treatment initiation were 7.2 and 7.9 months, respectively.Comparison of survival curves using Kaplan Meier curves method with log-rank test showed that the survival status was significantly different between patient categories as well as across treatment centers (P<0.05). The death rate of pulmonary positive, pulmonary negative and extra pulmonary TB patients were 2.7%, 3.6%, and 4.3%, respectively.
Body weight at initiation of anti-TB treatment (<35kg), patient category, year of enrollment and treatment center were independent predictors for time to death.

Conclusions
Most of the patients were died at the end of treatment period. This underlines the need for devising a mechanism of standardizing the existing DOTS programme and nutritional support for underweight patients for better clinical and treatment outcome.
http://7thspace.com/headlines/382587/mortality_and_associated_risk_factors_in_a_cohort_of_tuberculosis_patients_treated_under_dots_programme_in_addis_ababa_ethiopia_.html

TUBERCULOSIS: ETHIOPIA: Reducing TB risk in Addis Ababa

23 March 2011 
 Photo: David Gough/IRIN
The country has more than 5,000 MDR TB cases annually

ADDIS ABABA, 23 March 2011 (PlusNews) - Health officials in Ethiopia's capital, Addis Ababa, are concerned about the spread of tuberculosis in the city's crowded public transport networks and tightly packed "DSTV [satellite television] houses" where ardent fans come to watch English and Spanish football. During big matches, a single "DSTV house" can hold up to 100 people.
"I sometimes open windows to avoid bad smells but on most occasions people say they will catch cold and TB... [they think that the] cold that comes through the window gives them the disease, so the windows and doors remain closed most of the time," said Daru Shifa in Addis's Merkato area.
Health officials say there is an urgent need to address the misconceptions about how TB is spread in order to curb the further spread of the disease in the city, whose population is more than 2.7 million.
"People in buses, taxis, 'DSTV houses' and similar places where there are many youngsters who sit together for a long time, often don't appreciate the need to have their windows opened," said Genet Yosef, TB/HIV Officer at the Addis Ababa Health Bureau. "Without allowing fresh air into these very small, crowded rooms, those inside risk catching infectious TB if there is one person among them with it and that is exactly what is happening across the city."

Increasing awareness
"The spread of TB has nothing to with cold, though this has been the understanding held by a significant number of people," said Desalegn Gebreyesus, TB/HIV adviser at the Health Ministry. "This is what we are targeting - educating people through the media, dramas, pamphlets and gatherings - so they understand the real way of TB transmission and therefore prefer to have their windows open to avoid it."
The city's TV and radio stations frequently air commercials urging people with coughs lasting more than two weeks to seek TB testing and treatment; a TV spot also highlights the risk of crowded areas such as the DSTV houses. Many public transportation vehicles also carry messages encouraging passengers to keep windows open to reduce risk.
“This year in particular we are working to launch a [song] prepared by a number of artists, and we hope it will appeal to the youth, creating awareness about TB,” said Genet.

Fast Fact
Case detection for TB in Addis Ababa is 63 percent - lower than WHO's target of 70 percent
According to Desalegn, people in food-insecure areas, children under five and people in crowded spaces are most at risk of TB infection. People whose immunity is compromised, such as those living with HIV, are also at risk. An estimated 300 TB infections occur for every 100,000 Ethiopians annually, according to Ministry of Health statistics.
"Based on WHO's [World Health Organization] latest projections, we expect up to 12,000 new infections to be diagnosed every year [in Addis Ababa] but actually our health facilities had 13,000-14,000 new cases on average over the last three years," said Genet.

Stepping up treatment
Addis Ababa has 35 government health facilities and 40 private health facilities that offer anti-TB treatment. However, case detection for TB in Addis Ababa is 63 percent, lower than the WHO target of 70 percent.
When patients are diagnosed, about 80 percent are successfully treated, mainly through the directly observed treatment short course (DOTS).
"We carefully see whether they have adhered to the regimen or not and counsel them accordingly," said the Addis Ababa Health Bureau's Genet.
The Ministry of Health is keen to avoid the development of drug resistant forms of TB. About 400 multi-drug resistant TB (MDR TB) cases are registered in Addis Ababa, 180 of which are receiving treatment at Addis's St Peter General Specialized Hospital.
The country has more than 5,000 MDR TB cases annually, according to WHO.
"Our effort is to increase our treatment success rate and have the patient cured in the first-line treatment," said Desalegn. "Treatment for MDR TB is costly - our country cannot shoulder [the cost]."
He noted that through WHO's Green Light Committee, the Global Fund to fight AIDS, Tuberculosis and Malaria and other partners, the government was working towards treating at least 1,200 MDR TB patients around the country.
"Among the listed MDR cases you find teachers, even some who teach at nursery schools, and health professionals; these are among informed parts of our society and yet they fail to follow the treatment that could lead to a crisis for our community," Genet said. "We need to improve our attitude towards TB by sending patients to health facilities and follow them until they finish the treatment successfully.
"The responsibility isn't only for oneself, but also for the next generation - that is what we are trying to have the public hear," she added.

http://www.plusnews.org/report.aspx?reportID=92271