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Background The diagnoses of active smear negative PTB, remains difficult. As a result, treatment is often carried out empirically relaying on clinical criteria. The distribution and magnitude of smear negative PTB, smear negative MDR-TB and associated factors in the same day diagnosis strategy are not clearly known in the study area. Therefore, this study aimed to determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear negative pulmonary tuberculosis patients in Addis Ababa, Ethiopia. Methods Analytic cross sectional study design was used. A total of 418 smear negative presumptive pulmonary TB patients were enrolled from selected health facilities since August 01, 2017 to January 5, 2018. Sputum samples were examined by Ziehl Neelsen microscopy, Xpert MTB/RIF assay and Culture. Drug susceptibility testing was performed by line probe assay and BACTEC MGIT 960 system. These laboratory tests were performed in Ethiopian Public Health Institute, National TB Reference Laboratory. Data was analyzed by SPSS Ver.20. Results From the total of 418 enrolled patients, 27 (6.5%) were Xpert MTB/ RIF and 26 (6.4%) were culture confirmed smear negative PTB patients. The positivity rate among male and female was 10.2 and 3.5% (p = 0.005) respectively. From 26 culture positive isolates 3 (11.54%) were MDR TB; from MDR-TB confirmed isolates 2/23 (8.7%) were among new and 1/3 (33.3%) was among retreatment smear negative presumptive pulmonary TB patients. All Rifampicin resistant smear negative pulmonary TB isolates by Xpert MTB/ RIF assay were found to be MDR TB and 7/26 (26.9%) isolates were INH mono resistant. History of migration found to be a potential factor for developing smear negative pulmonary TB. Conclusion In this study a significant proportion of smear negative pulmonary TB was diagnosed. Furthermore, a high smear negative multi drug resistant (MDR) TB and other mono drug resistant TB prevalence was confirmed. Due to the limitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are missed to be diagnosed and transmission continues in the community.

There is limited information on the performance of the XpertThis study aimed to determine the performance of the XpertA cross-sectional study was conducted from August 2017 to January 2018 across 16 health facilities in Addis Ababa, Ethiopia. Two spot sputum samples were collected from 418 presumptive SNPT patients, tested with Xpert® MTB/RIF, then compared to tuberculosis culture. Additionally, culture isolates were tested for RR by BACTEC MGIT™ 960 drug susceptibility testing (DST) and MTBDRplus version 2.The XpertThe performance of the Xpert

Introduction In many developing countries like Ethiopia, access and the utilization of long acting and permanent contraceptive methods (LAPCMs) is very low and it is also difficult to find them from many reproductive health programs. The aim of this study was to assess factors associated with non-utilization of long-acting and permanent contraceptive methods among married women in the reproductive age (15-49 years). Methods A community based unmatched case-control study was conducted in Chencha district, Southern Ethiopia from November 2015 to December 2015. Cases were those women who used contraceptive methods other than LAPCMs and women who were not using contraceptive methods. Controls were women who used LAPCMs in their lifetime. Study participants were selected by simple random sampling technique and records were reviewed and then by tracing their address, the selected samples were interviewed. We analyzed data using SPSS version 20.0 and logistic regression models to identify associated factors. Results We enrolled 328 women: factors such as partner's lower level of education (p = 0.003), less number of live children (p = 0.04), preference to have children in the future (p = 0.042), husband's approval to LAPCMs (p = 0.002), not informed to use contraception (p = 0.006), started using contraceptives during campaign (p = 0.021) and discussion with health professionals (p = 0.039) were predictors of non-utilization of LAPCMs. Conclusion Non-utilization of LAPCMs in the district is associated with knowledge about LAPCMs and quality of health service. Interventions should focus on couple's knowledge, training of service providers in quality care, and the rights of clients, informed choice to contraceptive methods.

Background Both passive and active surveillance of drug resistance have an important role in tuberculosis (TB) control program. Surveillance data are important to estimate the magnitude of drug resistance TB, to know the trend of the disease, assess the performance of the program, and to forecast diagnosis and treatment supplies. Therefore, this study aimed to determine the prevalence and the proportion of drug resistant tuberculosis in Ethiopia based on passively collected data. Methods A cross-sectional study was conducted at the National Tuberculosis Reference Laboratory and seven Regional TB laboratories in Ethiopia on a retrospective data collected from July 2017 to June, 2018. Data were collected by standardized checklist from TB culture laboratory registration book. Percentage of recovery rate, contamination rate, and prevalence of drug resistance TB were determined by Statistical Package for Social Science (SPSS) version 23. Result Of 10 134 TB suspected individuals included into this analysis, 1183 (11.7%) were culture positive. The overall contamination proportion was 5.3% and nontuberculous mycobacteria proportion was 0.98%. First-line drug susceptibility test was performed for 329 Mycobacterium tuberculosis complex isolates, and the proportion of resistance was 5.7 and 6.3% for isoniazid and rifampicin respectively. The proportion of multidrug-resistant tuberculosis (MDR-TB) was 4.3% in new patients, while 6.7% in previously treated patients. However, there was no category for 0.6% patients, and the overall proportion of MDR-TB was 11.6%. Conclusions The result of this study indicated that MDR-TB is a serious public health problem in Ethiopia. Thus, strengthen prevention and control program is vital to halt the burden of drug resistant TB in the country. Electronic supplementary material The online version of this article (10.1186/s40249-019-0554-4) contains supplementary material, which is available to authorized users.

Multilingual abstracts in the five official working languages of the United Nations. (PDF 813 kb)

Background: Anemia is the most common hematologic abnormality in HIV patients and is associated with disease progression and decreased survival. This study aims to describe the prevalence and predictors of anemia in HIV positive patients at the time of ART initiation at public health facilities of Arba Minch town, Southern Ethiopia. Methods: A total of 411 adults (?15 years) HIV positive patients with complete information on hemoglobin levels and CD4 count and clinical characteristics registered from 2006 to 2013 were assessed for anemia prevalence and risk factors at the ART clinic of the Arba Minch hospital and health center. The measurements of Hemoglobin and CD4 + T cell count were performed using standard methodology at baseline of ART initiation. Results: A total of 411 HIV positive patients (195 males and 216 females) with a mean ± SD age of 33.9 ± 9.0 years were assessed. Hemoglobin levels were between 6.0 and 16.5 mg/dL. The overall prevalence of anemia at the time of ART initiation was 52.3%; with 28.1%, 22.9% and 1.3% mild, moderate and severe anemia respectively. The overall prevalence of anemia was 62.4% among males and 46.7% among females (P < 0.001). An increased risk of anemia was seen in males (adjusted OR = 2.78, 95% CI = 1.77 - 4.35); low CD4 cell counts (adjusted OR = 3.48, 95% CI = 2.09 - 5.79); and history of TB (adjusted OR = 2.89, 95% CI = 1.28 - 6.54). Conclusions: Anemia in HIV-positive patients was highly prevalent at the time of ART initiation. Male gender, low CD4 count and history of TB were associated with higher risk of baseline anemia.

Background: There are two approved non-nucleoside reverse transcriptase inhibitor antiretroviral drugs; namely Nevirapine (NVP) and Efavirenz (EFV). Nevirapine and EFV have comparable clinical efficacy when administered in combination regimens. But there is a lack of recent evidence showing the effect of NVP and EFV-based ARTs on immunological responses in HIV infected individuals in Ethiopia in general and Addis Ababa in particular. Methods: Retrospective cohort study design was used to compare immunological response rate of NVP and EFV based HAART regimen in Addis Ababa. Four hundred ninety two HIV infected patients who started HAART in ten selected health facilities were included in the study. Rate of immunologic response was examined at the 6th, 12th, 18th, and 24th months of follow-up period. The time required to get immunological response was analyzed by Kaplan-Meier survival curve. Adjusted hazard ratio was calculated with a 95% confidence interval by Cox proportional hazards model to determine the rate of immunological response. To ascertain the association, bivariate and multi variable Cox proportional hazard model was used. Statistical significance was considered with two sides P-value of 0.05. Results: The mean CD4 count ranged between 132.2 cell/μl at baseline and 302.3 cell/μl at the end of the follow-up period. This change was significant at 95% of CI but did not show significant differences among the comparison group. The median time to get immunological response was 18 (75% percental 12) months. At the end of the follow-up period, 73.2% (76.6% for NVP and 69.8% for EVF P-value 0.13) of the study population had immunological response. Conclusion: As a conclusion, there was a robust and sustained CD4 response and the effect of NVP and EFV based ART on change of mean CD4 count and immunological response was comparable and effective. Initiation of ART with high baseline CD4 count, in combination of IPT and with either NVP or EFV based NNTI was recommended.

Municipal solid waste workers are exposed to a number of pathogens (bacteria, fungi, viruses, parasites and cysts), toxic substances, chemicals that come from the waste itself and from its decomposition. While standards and norms for handling municipal solid waste in industrialized countries have reduced occupational and environmental impacts significantly, the risk levels are still very high in most developing countries including Ethiopia because of inadequate understanding of the magnitude of the problem. Despite the severity of occupational health hazards encounter by solid waste collectors their provision, knowledge and usage of personnel protective equipment is low and there is no adequate and credible evidence on occupational health risks of solid waste collectors in Ethiopia. Therefore, this study was aimed to assess the knowledge, attitude and practices of solid waste collectors towards prevention of occupational health hazards in Lideta sub-city in Ethiopia. A cross-sectional survey was conducted among four hundred six solid waste collectors for this work. The data was collected by using semi-structured questionnaire and observational checklist, which was completed from December 2014 to February 2015. The data was entered into epi info version 3.5.1 and exported to SPSS 20 version for analysis. Multiple logistic regression analysis had been performed. Adjusted odds ratio with confidence interval had been computed to see the presence of association between the dependent and selected independent variables. The results on this finding were reported using different descriptive statistics. The response rate of this study was 94.8%. Female respondents accounted 69.7%. The mean age of the study subjects was 35 years, which varied from 17 to 65 years. About 60.8% of the study participants had satisfactory knowledge on preventing occupational health risks associated with solid waste handling. Most (75.9%) of the solid waste collectors had favorable attitude while only 37.2% of them had safe practice on preventing occupational health hazards. As compared to workers who were satisfied on their job, odds of having safe occupational health practice were 2.8 higher (AOR = 2.8, 95% CI: 1.84 - 4.26). The knowledge and attitudes of workers about prevention of occupational health hazards were moderate but the magnitude of having safe occupational health practice was very low. So, implementation of basic occupational health services with provision of personal protective equipment’s and supervising waste handlers on appropriate utilization is advisable.

Background: Most tuberculosis (TB) patients were not visiting heath facility but transmit disease to healthy individuals in the community for longer time in Ethiopia. This study was aimed at estimating duration of delay for initiation of anti-TB treatment by smear positive pulmonary TB in south Ethiopia and assesses its determinants of patient related factors associated with unacceptable delay for medication of TB. Methods: a cross-sectional study design was used to recruit 218 consecutive smear positive pulmonary TB patients visiting there hospitals in Gamo Goffa Zone. A structured questionnaire was used to collect information on socio demographic, economic, behavioral factors and co morbidity with HIV from the study units. The median delay was used as cut-off point to dichotomize acceptable delay from unacceptable one. Pearson chi square and logistic regressions were used to assess association between patient factors and longer delay before treatment. Results: The median delay for initiation of anti-TB medication by smear positive pulmonary TB patients was 35 days. Fifteen of the study participants were HIV positive and equal number of TB patients involved had previous history of TB. Socio-demographic factors significantly associated with longer delay for treatment of TB in Univariate analysis were place of residence, level of education and marital status while economic factors associated were monthly income, whether the house is owned or rented and ceiling status of the house. However, after controlling the effect of confounding variables only place of residence and monthly income remained statistically significant. TB patients from rural area were 2.82 times at increased risk to delay for longer days than those living in the town (p-value= 0.021). Similarly, patients having monthly income of 450 or less Ethiopian birr were 4.96 times more likely to delay for longer time than those who had no regular monthly income (p-value=0.003). Conclusion: Smear positive pulmonary TB patients delay for more days before taking anti-TB medications which renders them noninfectious after a few weeks of treatment began. They were transmitting the disease in the community making prevention and control more difficult. Those living in the rural area and earn least amount of money per month transmit the disease for longer time. Civil servants who earn the least salary per month had significant increment in the salary recently that might prevent their delay. However, access to diagnosis and treatment of TB for people living in the rural area should be improved so as to help the walk towards the millennium development goal targets.

Background Healthcare waste management options are varying in Ethiopia. One of the first critical steps in the process of developing a reliable waste management plan requires a widespread understanding of the amount and the management system. This study aimed to assess the health care waste generation rate and its management system in some selected hospitals located in Addis Ababa, Ethiopia. Methods Six hospitals in Addis Ababa, (three private and three public), were selected using simple random sampling method for this work. Data was recorded by using an appropriately designed questionnaire, which was completed for the period of two months. The calculations were based on the weights of the health care wastes that were regularly generated in the selected hospitals over a one week period during the year 2011. Average generation indexes were determined in relation to certain important factors, like the type of hospitals (public vs private). Results The median waste generation rate was found to be varied from 0.361- 0.669 kg/patient/day, comprised of 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated was increased as the number of patients flow increased (rs=1). Public hospitals generated high proportion of total health care wastes (59.22%) in comparison with private hospitals (40.48%). The median waste generation rate was significantly vary between hospitals with Kruskal-Wallis test (X2=30.65, p=0.0001). The amount of waste was positively correlated with the number of patients (p < 0.05). The waste separation and treatment practices were very poor. Other alternatives for waste treatment rather than incineration such as a locally made autoclave should be evaluated and implemented. Conclusion These findings revealed that the management of health care waste at hospitals in Addis Ababa city was poor.