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Seasonal variations affect the health system's functioning, including tuberculosis (TB) services, but there is little evidence about seasonal variations in TB case notification in tropical countries, including Ethiopia. This study sought to fill this gap in knowledge using TB data reported from 10 zones, 5 each from Amhara and Oromia regions. Notified TB cases for 2010-2016 were analyzed using SPSS version 20. We calculated the quarterly and annual average TB case notification rates and the proportion of seasonal amplitudes. We applied Winters' multiplicative method of exponential smoothing to break down the original time series into seasonal, trend, and irregular components and to build a suitable model for forecasting. A total of 205,575 TB cases were identified (47.8% from Amhara, 52.2% from Oromia), with a male-to-female ratio of 1.2:1. The means of 8,200 (24%), 7,992 (23%), 8,849 (26%), and 9,222 (27%) TB cases were reported during July-September, October-December, January-March, and April-June, respectively. The seasonal component of our model indicated a peak in April-June and a trough in October-December. The seasonal amplitude in Amhara region is 10% greater than that of Oromia (p < 0.05). TB is shown to be a seasonal disease in Ethiopia, with a peak in quarter four and a low in quarter two of the fiscal year. The peak TB case notification rate corresponds with the end of the dry season in the two agrarian regions of Ethiopia. TB prevention and control interventions, such as efforts to increase community TB awareness about TB transmission and contact tracing, should consider seasonal variation. Regional variations in TB seasonality may require consideration of geographic-specific TB case-finding strategies. The mechanisms underlying the seasonal variation of TB are complex, and further study is needed.

To determine the yield of tuberculosis (TB) and the prevalence of Human Immuno-deficiency virus (HIV) among key populations in the selected hotspot towns of Ethiopia. We undertook a cross-sectional implementation research during August 2017-January 2018. Trained TB focal persons and health extension workers (HEWs) identified female sex workers (FSWs), health care workers (HCWs), prison inmates, homeless, internally displaced people (IDPs), internal migratory workers (IMWs) and residents in missionary charities as key and vulnerable popuaiton. They carried out health education on the importance of TB screening and HIV testing prior to recruitment of the study participants. Symptomatic TB screening and HIV testing was done. The yield of TB was computed per 100,000 background key population. A total of 1878 vulnerable people were screened, out of which 726 (38.7%) presumptive TB cases and 87 (4.6%) TB cases were identified. The yield of TB was 1519 (95% CI: 1218.1-1869.9). The highest proportion (19.5%) and yield of TB case (6,286 (95% CI: 3980.8-9362.3)) was among HCWs. The prevalence of HIV infection was 6%, 67 out of 1,111 tested. IMWs and FSWs represented 49.3% (33) and 28.4% (13) of the HIV infections, respectively. There was a statistically significant association of active TB cases with previous history of TB (Adjusted Odds Ratio (AOR): 11 95% CI, 4.06-29.81), HIV infection (AOR: 7.7 95% CI, 2.24-26.40), and being a HCW (AOR: 2.42 95% CI, 1.09-5.34). The prevalence of TB in key populations was nine times higher than 164/100,000 national estimated prevalence rate. The prevalence of HIV was five times higher than 1.15% of the national survey. The highest yield of TB was among the HCWs and the high HIV burden was detected among the FSWs and IMWs. These suggest a community and health facility based integrated and enhanced case finding approaches for TB and HIV in hotspot settings.

BackgroundSystematic bias to greater severity of rheumatoid arthritis (RA) is often presumed to exist in patients referred for evaluation at academic centers. However, the magnitude of this potential bias has not been quantified to our knowledge.ObjectivesThe objective was to test the hypothesis that patients in a referral population have greater RA severity based on both patient- and clinician-reported measures than local patients.MethodsThis study included eligible patients with RA who attended an in-person or virtual appointment in the outpatient rheumatology clinic at an academic center between 1/1/2020 and 10/28/2021. RA was defined by at least 2 ICD-10 diagnosis codes ≥30 days but <2 years apart plus use of a qualifying RA medication. Referral population was ascertained by geographic distance from patient residence to the clinic building and categorized as local, <50 miles; regional, ≥50 to <150 miles; or national/international, ≥150 miles. Data were collected from the electronic health records for patient-reported and clinician-reported measures of disease severity. Patient-reported measures included global pain, global arthritis, and Patient-Reported Outcomes Information System (PROMIS) computer adaptive tests for Pain Interference, Fatigue, Physical Function, and Ability to Participate in Social Roles and Activities. Chi-square or Kruskal-Wallis tests were used to analyze differences between groups, adjusting for age at the clinic visit and sex. Linear regression models were used to test for differences between groups in PROMIS measures and Clinical Disease Activity Index (CDAI), adjusting for age, sex, race/ethnicity, and appointment type (new vs. established).ResultsThe study population included 3220 patients with RA, including 1631 local, 956 regional, and 633 national/international patients. Overall, mean (SD) age was 62.9 (13.7) yrs., 2312 (72%) were female, and 2947 (91.5%) were in-person visits. Proportions of new patients in the local, regional, and national/international populations were 5%, 9%, and 17%, respectively. All PROMIS measures were available within 7 days of appointment for 2677 (83%) patients, with no differences between groups (p = 0.394). Regional and national/international patients had significantly higher global pain, pain interference, and fatigue and significantly lower physical function and ability to participate than local patients. Regression analysis showed that regional and national/international patients had higher pain interference (on average: 1.3 and 1.6 units; p<0.001 and p<0.001, respectively) and worse physical function (on average: -1.0 and -2.2 units; p=0.008 and p<0.001, respectively) than local referent patients, adjusting for age, sex, race/ethnicity, and appointment type. In contrast, there were no significant differences between groups in CDAI (on average for regional and national/international: 0.3 and 1.1 units; p=0.73 and p=0.29, respectively).VariableLocal (n = 1631)Regional (n = 956)National/ International (n = 633)Total (n = 3220)pGlobal pain score (0-100)35.9 (29.2)39.5 (29.0)41.8 (30.6)38.2 (29.5)0.002PROMIS T-scores Pain Interference57.0 (8.3)58.4 (8.3)58.8 (8.4)57.8 (8.4)<0.001 Fatigue53.5 (9.6)54.9 (9.8)56.2 (10.1)54.4 (9.8)<0.001 Physical Function42.4 (8.8)41.2 (8.2)40.0 (8.6)41.6 (8.6)<0.001 Ability to Participate50.3 (9.1)48.5 (9.4)47.4 (9.2)49.2 (9.3)<0.001Clinical Disease Activity Index12.2 (11.7)12.2 (10.7)13.4 (12.1)12.4 (11.5)0.44C-reactive protein, mg/L7.8 (11.5)7.2 (10.9)7.9 (11.7)7.6 (11.4)0.99Values are mean (SD) or number (%).ConclusionReferral bias by geographic distance from the outpatient rheumatology clinic is more evident in patient-reported than clinician-reported measures of RA severity. The findings inform the interpretation of RA disease severity measures in clinical practice and research and highlight the importance of patient-reported outcome measures.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsJohn M Davis III Grant/research support from: Pfizer, Girihlet, Sara Achenbach: None declared, Courtney Arment: None declared, Delamo Bekele: None declared, Vanessa Kronzer: None declared, Thomas Mason: None declared, Elena Myasoedova: None declared, Lynne Peterson: None declared, Kerry Wright: None declared, Cynthia S. Crowson: None declared.

BackgroundClinical guidelines recommend minimizing glucocorticoid use among patients with rheumatoid arthritis (RA) and many new therapeutic options in recent decades offer alternatives to glucocorticoids, but it is unknown whether glucocorticoid use has declined in patients with RA.ObjectivesTo examine time trends in glucocorticoid use among patients diagnosed with rheumatoid arthritis (RA) during the biologic era.MethodsA population-based inception cohort of RA patients diagnosed during 1999 - 2018 was followed longitudinally through their medical records until death, migration or 12/31/2020. All patients fulfilled 1987 and/or 2010 American College of Rheumatology classification criteria for RA. Glucocorticoid start and stop dates were collected along with dosages in prednisone equivalents. The cumulative incidence of glucocorticoid initiation and discontinuation adjusted for the competing risk of death was estimated. Cox models adjusted for age and sex were used to compare trends between time periods.ResultsThe study population was comprised of 399 patients (71% females) diagnosed in 1999 – 2008 and 430 patients (67% females) diagnosed in 2009 – 2018. Glucocorticoid use was initiated within 6 months of meeting RA criteria in 66.7% of patients in 1999-2008 and 70.9% of patients in 2009-2018, corresponding to a 29% increase in hazard for initiation of glucocorticoids in 2009-2018 (adjusted hazard ratio [HR]: 1.29; 95% confidence interval[CI]: 1.09-1.53). Among glucocorticoid users, similar rates of glucocorticoid discontinuation within 6 months after glucocorticoid initiation were observed in patients with RA incidence in 1999 – 2008 and 2009 – 2018 (39.1% versus 42.9%, respectively), with no significant association in adjusted Cox models (HR: 1.11; 95% CI: 0.93-1.31). Even in the 2009-2018 cohort, a large proportion of patients with RA (52%) remained on glucocorticoids beyond 3 months, and 30% were still on glucocorticoids after 2 years.Older patients with RA were more likely to initiate glucocorticoids (HR 1.06 per 10 year increase in age, 95% CI 1.00-1.13) and less likely to discontinue glucocorticoids (HR 0.91 per 10 year increase in age, 95% CI 0.86-0.96). There was no difference in the initiation of glucocorticoids by sex. Although females had a higher discontinuation rate within the first 12 months, afterwards discontinuation rates of glucocorticoids were similar in females and males. Smokers were less likely to discontinue glucocorticoids compared to non-smokers (HR 0.65; 95% CI: 0.51-0.82).ConclusionMore patients are initiating glucocorticoids early in their disease course now compared to previously despite the availability of biologics and other disease modifying antirheumatic drugs. The rates of glucocorticoid discontinuation are similar. A substantial proportion of patients remain on glucocorticoids for more than 3 months with a large proportion continuing use of glucocorticoidss even beyond 2 years. Real world use of glucocorticoids in patients with RA is not optimal or improving despite advances in RA therapy.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsLisa Crowson: None declared, John M Davis III Grant/research support from: Pfizer, Andrew Hanson: None declared, Elena Myasoedova: None declared, Vanessa Kronzer: None declared, Ashima Makol Consultant of: Boehringer Ingelheim, Lynne Peterson: None declared, Delamo Bekele: None declared, Cynthia S. Crowson: None declared.

Purpose: The absence of high-quality and timely informed consent creates a barrier between the health-care provider and the patient that reinforces a negative view of the healthcare system, deters utilization of health-care services and increases malpractice lawsuits. This research aimed to assess the quality of informed consent in cesarean section (CS) at a large tertiary care center in Ethiopia. Patients and Methods: An institutional cross-sectional study was conducted on 288 women who underwent planned or emergency CS. A structured questionnaire for respondents with standard indicators was developed as per the recommendations of the Royal College of Surgeons for the evaluation of the completeness of the informed consent document on the medical records. Results: The median (IQR) age of the participants was 28 (25.0-32.0) years and 203 (70.5%) has undergone emergency CS. More than half of the respondents 172 (59.7%) were unaware of who would perform the surgery and only 50 (17.4%) of respondents stated they were informed of complications of the CS. A total of 157 (56.3%) of responses fulfilled the criteria for adequate subjective informed consent with an affirmative response while only 109 (37.9%) of responses fulfilled the criteria for adequate objective informed consent. Only educational status of the patient was associated with subjective adequacy of informed consent with those who have some formal education having 2.05 times odds of having adequate subjective consent as compared to those with no formal education. Conclusion: In this study, we have found that women undergoing CS receive inadequate informed consent. This inadequate informed consent occurs across planned and emergency CS. The results highlight the need for better consent process to increase patient awareness and promote patient-centered-care. Keywords: quality, informed consent and cesarean section

Diarrhea is a major leading cause of under-five morbidity and mortality in developing countries. Although the health extension program has been implemented for decades, diarrhea continues to be a major public health problem. To determine determinants of diarrhea among under-five-year-old children in the health extension model and non-model families of Wama Hagelo District 2019. A community-based comparative cross-sectional study was conducted among 512 under-five children among 257 model and 255 non-model health extension families. A multi-stage sampling technique was used. Households with at least one under-five child were selected using a simple random sampling method. Data were collected using an interviewer-administered questionnaire. Bivariate analysis was done to select candidate variables at ≤ 0.2. Determinants of childhood diarrhea were determined by a multivariable logistic regression model at -value less than 0.05. The two-week prevalence of diarrhea among under-five children in model and non-model families was 7.8% (95% CI=4.5-11.1%) and 27.8% (95% CI 22.3-33.3%), respectively. Unimproved water sources (AOR [95% CI] =5.5[2.2, 97.7]) and no vaccination against Rotavirus (AOR [95% CI] = 49.8 [4.2-94.8]) were associated with diarrhea among under-five children in model families. Family size > 5 (AOR [95% CI] = 5.2 [1.7-17.6]), using unimproved water sources (AOR [95% CI] = 7.2 [1.6-13.2]), not using latrine (AOR [95% CI] = 6 [1.8-20.6]), child not vaccinated against Rotavirus (AOR [95% CI] = 10.9 [2.9-41.1]), child not supplemented with vitamin A (AOR [95% CI] = 3.2 [1.4-7.2]), and not being health extension model families (AOR [95% CI] = 2.4 [1.15-4.99]) predict diarrhea among under-five children in non-model families. Diarrhea was more frequent among non-model than model families. Family size, type of water source, using a latrine, place of childbirth, child vaccination against Rotavirus, and vitamin A supplementation were independently associated with the occurrence of diarrhea in under-five children. Encouraging all non-model families to become models in implementing all health extension packages by strengthening community participation is important to decrease childhood diarrhea in under-five children.

Early development of the microbiome has been shown to affect general health and physical development of the infant and, although some studies have been undertaken in high-income countries, there are few studies from low- and middle-income countries. As part of the BARNARDS study, we examined the rectal microbiota of 2,931 neonates (term used up to 60 d) with clinical signs of sepsis and of 15,217 mothers screening for bla CTX-M-15 , bla NDM , bla KPC and bla OXA-48 -like genes, which were detected in 56.1%, 18.5%, 0% and 4.1% of neonates’ rectal swabs and 47.1%, 4.6%, 0% and 1.6% of mothers’ rectal swabs, respectively. Carbapenemase-positive bacteria were identified by MALDI-TOF MS and showed a high diversity of bacterial species (57 distinct species/genera) which exhibited resistance to most of the antibiotics tested. Escherichia coli , Klebsiella pneumoniae and Enterobacter cloacae / E. cloacae complex, the most commonly found isolates, were subjected to whole-genome sequencing analysis and revealed close relationships between isolates from different samples, suggesting transmission of bacteria between neonates, and between neonates and mothers. Associations between the carriage of antimicrobial resistance genes (ARGs) and healthcare/environmental factors were identified, and the presence of ARGs was a predictor of neonatal sepsis and adverse birth outcomes. Analysis of gut microbiota of mothers and its neonates—as part of the BARNARDS study—reveals associations between β-lactamase gene carriage and neonatal sepsis risk in low-income settings.

The use of Efaverinz in reproductive age women needs caution as its use in the first trimster of pregnancy is reportedly associated with an increased risk of neural tube defect (NTD) in the newborn. This concern is based on evidence from animal studies and two human case reports. We report here yet another case of encephalocele born from a mother who was taking efaverenze during conception and the first 8 weeks of gestation, the critical time in the pathogenesis of NTDs.

Severe acute malnutrition is the most prevalent reason for admission to a pediatric unit, and it is a leading cause of mortality in many countries, including Ethiopia, at 25% to 30%, where it affects both developed and developing countries. The objective of this study was to assess treatment outcomes and associated factors among children aged 6-59 months with severe acute malnutrition. A cross-sectional study was conducted using secondary data from medical records of patients enrolled in the therapeutic feeding center from January 2016 to March 2019. There were 385 samples collected at 3 public referral hospitals in Addis Ababa, which were selected by simple random sampling. A structured questionnaire was used to collect data from the available individual folders and registers. The data analysis was performed using binary and multivariable logistic regression models. The odds ratio with 95% CI was used to identify predictor variables. Variables that have a p-value <0.05 were considered significant. Children who had tuberculosis were 79% less likely to recover than those who had no tuberculosis. In this study, deaths accounted for 9.1%, recovered were 72.2%, and defaulters accounted for 11.6% with a mean length of stay of 18.6 (CI: 16.9, 20.2) days and an average weight gain of 7.2 g/kg/day (CI: 5.7, 8.2). Treating comorbidities on time can help children to recover early and reduce readmission. Integration of severe acute malnutrition screening into all service delivery points can help early identification and treatment. In the meantime, treating them with ready-to-use therapeutic feeding has a significant change in recovery.

Chickpea (Cicer arietinum L.) is an economically important crop grown by nearly one million Ethiopian smallholder farmers. The crop is often considered as “stress-loving,” but moisture stress at flowering and grain filling stages could be detrimental. Yield of chickpea is commonly affected by terminal drought stress in the rainfed production system in Ethiopia. The lack of proper field-screening methods has hindered the development of drought-tolerant varieties. This study demonstrates a simple and practical field-level screening method for drought tolerance traits in the conventional breeding programs. A field experiment was conducted using 28 elite chickpea cultivars during the 2018–2019 main cropping season to study their response to moisture regimes of varying drought intensities. We used yield and its components as proxy parameters of screening to select tolerant cultivars. The study revealed significant variation among the cultivars in their response to different moisture regimes. The kabuli cultivars were found more sensitive compared with the desi types. Yield penalty exceeded 70% under severe drought. Conversely, cultivars tested under mild and severe stress drought showed average yield gain of 22 and 48%, respectively, relative to the irrigated treatment. Overall, over 50% yield gain can be obtained in drought-affected rainfed production areas in Ethiopia using supplemental irrigation during pod setting to grain filling stages. For post-rainy-season crops relying on residual soil moisture, such as chickpea, breeding for shorter duration and resilient cultivars are reliable management approaches to minimize drought-caused yield losses.