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The incidence of tuberculosis (TB) has increased in Tigray, Ethiopia due to war and a crippled healthcare system. Although early detection and treatment are critical for TB control, over 30% of TB cases are missed using current diagnostic techniques. Thus, we developed and validated a risk prediction model for pulmonary TB in presumptive cases. In this multicenter cross-sectional study, we consecutively enrolled 907 respondents from primary healthcare facilities in Tigray, northern Ethiopia. We used least absolute shrinkage and selection operator regression to identify variables for the model. Risk scores were generated from the coefficients of multivariable logistic regression. We evaluated the model performance using the area under the curve and calibration plots, and clinical utility using decision curves. Among all respondents, 155 (17%) had GeneXpert-confirmed pulmonary TB. At an optimal cutoff value of 8.5, the model demonstrated a discrimination accuracy of 0.82 (95% CI: 0.78–0.85), a sensitivity of 82.6%, and a specificity of 68.9%. The model had a calibration slope of 0.98 and an intercept of 0.001. The model exhibits acceptable discrimination and calibration performance. Thus, it can be used for screening patients for pulmonary TB in primary healthcare settings where accurate diagnostic resources are limited.

Background Tuberculosis (TB) is Ethiopia’s leading infectious killer disease. The war in the Tigray region of Ethiopia has resulted in the disruption of TB care services. Prediction models are recommended to aid the diagnosis of TB in resource-limited settings. However, the development of such decision-support tools without the participation of end users may not be successful. To inform the tool development, we described barriers to diagnosing TB and identified applicable and desirable parameters for the proposed tool. Methods We conducted a qualitative study between February and June 2023 in two cities in Tigray, Northern Ethiopia. We conducted 12 in-depth interviews and four focus group discussions with healthcare workers (HCWs). Interviews were translated, coded, and analyzed to identify predefined and emergent themes during the thematic analysis. Results Healthcare workers used symptoms, risk factors, signs, and investigations to diagnose TB. However, failure to ask about antibiotic use, the absence and non-affordability of investigations, and patient load were barriers affecting the diagnosis of TB. Most of the classic TB symptoms and their duration were sorted as very important, simple, reliable, generalizable, and desirable indices. In addition, a trial of antibiotics, being chronically sick-looking, having HIV, having a contact history with a TB patient, and an erythrocyte sedimentation rate fulfilled the above criteria. Conclusions In the TB diagnostic process, HCWs account for a variety of data, but they prefer the classic symptoms of TB to heighten their clinical suspicion. Antibiotic trials and some risk factors were also considered reasonable. However, when HCWs have a heavy workload and a shortage of investigations, they experience a suboptimal TB diagnostic process. Hence, appropriate context consideration and care providers’ preferences for parameters will inform tool development.

In Ethiopia, 20,000 women die each year from complications related to pregnancy, childbirth and post-partum. For every woman that dies, 20 more experience injury, infection, disease, or disability. \"Maternal near miss\" (MNM), defined by the World Health Organization (WHO) as a woman who nearly dies, but survives a complication during pregnancy, childbirth or within 42 days of a termination, is a proxy indicator of maternal mortality and quality of obstetric care. In Ethiopia, few studies have examined MNM. This study aims to identify determinants of MNM among a small population of women in Tigray, Ethiopia. Unmatched case-control study was conducted in hospitals in Tigray Region, Northern Ethiopia, from January 30-March 30, 2016. The sample included 103 cases and 205 controls recruited from among women seeking obstetric care at six (6) public hospitals. Clients with life-threatening obstetric complications, including hemorrhage, hypertensive diseases of pregnancy, dystocia, infection, and anemia or clinical signs of severe anemia (in women without hemorrhage) were taken as cases and those with normal obstetric outcomes were controls. Cases were selected based on proportion to size allocation while systematic sampling was employed for controls. Binary and multiple variable logistic regression (\"odds ratio\") analyses were calculated at 95% CI. Roughly 90% of cases and controls were married and 25% experienced their first pregnancy before the age of 16 years. About two-thirds of controls and 45.6% of cases had gestational ages between 37-41 weeks. Among cases, severe obstetric hemorrhage (44.7%), hypertensive disorders (38.8%), dystocia (17.5%), sepsis (9.7%) and severe anemia (2.9%) were leading causes of MNM. Histories of chronic maternal medical problems like hypertension, diabetes were reported in 55.3% of cases and 33.2% of controls. Women with no formal education [AOR = 3.2;95%CI:1.24, 8.12], being less than 16 years of age at first pregnancy [AOR = 2.5;95%CI:1.12,5.63], induced labor[AOR = 3.0; 95%CI:1.44, 6.17], history of cesarean section[AOR = 4.6; 95% CI: 1.98, 7.61] or chronic medical disorder[AOR = 3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR = 2.8;95% CI: 1.19,6.35] had higher odds of experiencing MNM. Macro-developments like increasing road and health facility access as well as expanding education will all help reduce MNM. Work should be continued to educate women and providers about common predictors of MNM like history of C-section and chronic illness as well as teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. Targeted follow-up with women with history of chronic disease and C-section could also help reduce MNM.

Background Male partner involvement in antenatal care (ANC) is defined as a woman’s husband actively participating in prenatal care-related activities and processes during ANC visit. Lack of male partner involvement affects preparation for health facility delivery and postnatal care utilization; this leads to increased maternal mortality. This association is inconsistent from study to study. However, there is limited evidence about the pooled (quantitative) impact of male partner involvement in ANC. This study aimed to assess the relationship between male partner involvement in ANC and both institutional delivery and postnatal care utilization. Methods The data were searched from different electronic databases like PubMed/Medline, Embase, POPLINE, ScienceDirect, and Google Scholar. We included observational studies and randomized trials that reported male partner involvement in ANC and its association with institutional delivery and postnatal care utilization. Qualitative studies, systematic reviews, case reports, and studies done in developed countries were excluded. The study populations were women who had given birth and their male partners. Two authors independently assessed the quality appraisal using the Joanna Briggs Institute checklist. If there were disputes between them, they were solved by the third author. Data were extracted by two independent authors using a pre-prepared Excel spreadsheet and finally analyzed with Stata 14 and Review Manager 5.3. We used a random-effect model to show the pooled result. Subgroup analysis and publication bias were also performed, using a funnel plot and Begg’s test. Results A total of 2206 articles were retrieved from data base, and nineteen articles were included in the meta-analysis. The pooled result showed that there is a positive relationship between husband involvement in ANC and both institutional delivery and postnatal care utilization [OR: 2.2, CI: 95% 1.73–2.80, I²=94% at P  < 0.001] and [OR: 2.81, CI: 95% 1.56–5.07, I²=91% at P  < 0.001], respectively. Based on the Egger’s test, publication bias was non-significant ( P  = 0.62). In the subgroup analysis using the categories of study designs, countries’ income level, and study sample size, the level of heterogeneities was 95%, 91%, and 97%, respectively. Conclusion Husband involvement during ANC has a positive effect on institutional delivery and postnatal care utilization. In developing countries, governments and stakeholders need to exert efforts on the male partner involvement approach of ANC utilization. The PROSPERO registration number of this study is CRD42019147770.

Background People in war-affected areas are more likely to experience excess mortality with hunger. However, information on the causes of death associated with hunger is often nonexistent. The purpose of this study was to verify and investigate hunger and hunger-related deaths after the Pretoria deal in Tigray, northern Ethiopia. Methods A cross-sectional study was conducted in nine districts and 53 IDP sites, which were randomly selected. All households with deceased family members were included and screened for perceived causes of death between November 2, 2022, and August 30, 2023. Suspected starvation deaths were further verified by the WHO-adapted verbal autopsy questionnaire to establish cause-specific mortality. Using a standardized cause-of-death list, three physicians assigned the causes of death, and disagreements over-diagnoses were settled by consensus. The Food and Nutrition Technical Assistance guidelines were also used to quantify household hunger status. Results Verbal autopsies were conducted for 72.2% (1946/2694) of deaths. Of these deaths, 201 (7.5%) in under-five children and 1205 (44.7%) in females were recorded. Deaths increased from 8.6% in March to 16.4% in July. A total of 90.6% of deaths occurred at home. Starvation was the predominant cause of death across all ages (49.3%, n  = 1329). About 94/155 (60.3%) in the IDP center and 1235/2539 (48.6%) in the community died due to starvation. Children under five had a higher risk of starvation-related deaths (OR = 1.7; 95% CI: 1.22–2.34). Females were also more likely to die by starvation than males. Large proportions of households (60.1%) had moderate or severe hunger. Conclusion Starvation was the leading cause of death across all ages in the study group. This reflects an expedited humanitarian response from aid agencies to prevent more deaths. Interventions, including the return of the displaced communities to their original homes, are needed to rescue those facing moderate to severe hunger.

Household contacts of active tuberculosis cases are at high risk of getting tuberculosis disease. Tuberculosis detection rate among contacts of household members is high. Hence, this study investigated household contact screening adherence and associated factors among tuberculosis patients in Amhara region, Ethiopia. A cross-sectional study was conducted from April 10 - June 30, 2013 in five urban districts of Amhara region, where 418 patients receiving treatment at tuberculosis clinic were interviewed. All patients were interviewed using structured and pre-tested questionnaire. Bringing at least one household contact to TB clinic was regarded as adherent to household contacts screening. Bivariate and multiple logistic regressions were used to investigate association. The overall adherence to household contact screening in Amhara region was 33.7%. Adherence was higher among Muslims than Christians. Adherence was high if patient took health education from Health Care Worker [AOR: 3.22, 95% CI: 1.88 to 5.51] and 2.17 times higher if patient had sufficient knowledge on tuberculosis [AOR: 2.17, 95% CI: 1.29 to 3.67] during interview. Relationship with contact was a significant [AOR: 0.4, 95% CI: 0.2 to 0.9] social related factor. One third of tuberculosis patients adhered to household contact screening in health facilities during their treatment course. Promoting knowledge of tuberculosis in the community and continuous health education to tuberculosis patients are recommended.

There are contradicting findings regarding the effect of thoracic spine manipulation in decreasing pain and disability in patients with chronic mechanical neck pain. Hence, the purpose of this review was to evaluate the current evidence on the effectiveness of thoracic spine thrust manipulation in decreasing pain intensity, and neck disability among subjects with chronic mechanical neck pain. We made a comprehensive search of literature published between 2010 and 2020 from the electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Physiotherapy Evidence Database (PEDro). We adhered to Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA). The methodological quality was assessed by the PEDro scale, and the level of evidence rated by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) software. Finally, a meta-analysis was done using RevMan 5.3 with a random-effects model to calculate the mean difference (MD) and 95% confidence intervals for pain and disability. Eight eligible randomized controlled trials were identified with a total of 457 participants. The quality assessment of the included studies was found to be fair in quality (mean PEDro score of 6.63/10). The overall GRADE of the review showed low to moderate level of evidence. Effect size estimates of the studies showed modest differences in pain reduction, as it revealed a significant effect in Visual Analog Scale ((VAS) 0-100mm) (MD -12.46; 95% CI: -17.29, -7.64), and Pain Numeric Rating Scale ((PNRS) 0-10 pts) (MD -0.8; 95% CI: -1.60, -0.10). The thoracic manipulation also resulted in a significant effect in decreasing neck disability, in which the mean difference in Neck disability index (NDI) showed (MD -6.46; 95% CI: -10.43 -2.50). This review suggested that thoracic spine manipulation was effective in reducing pain and neck disability in all adults with chronic mechanical neck pain compared to other interventions.

Background: Although tuberculosis is highly prevalent in low- and middle-income countries, millions of cases remain undetected using current diagnostic methods. To address this problem, researchers have proposed prediction rules. Objective: We analyzed existing prediction rules for the diagnosis of pulmonary tuberculosis and identified factors with a moderate to high strength of association with the disease. Methods: We conducted a comprehensive search of relevant databases (MEDLINE/PubMed, Cochrane Library, Science Direct, Global Health for Reports, and Google Scholar) up to 14 November 2022. Studies that developed diagnostic algorithms for pulmonary tuberculosis in adults from low and middle-income countries were included. Two reviewers performed study screening, data extraction, and quality assessment. The study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. We performed a narrative synthesis. Results: Of the 26 articles selected, only half included human immune deficiency virus-positive patients. In symptomatic human immune deficiency virus patients, radiographic findings and body mass index were strong predictors of pulmonary tuberculosis, with an odds ratio of >4. However, in human immune deficiency virus-negative individuals, the biomarkers showed a moderate association with the disease. In symptomatic human immune deficiency virus patients, a C-reactive protein level ⩾10 mg/L had a sensitivity and specificity of 93% and 40%, respectively, whereas a trial of antibiotics had a specificity of 86% and a sensitivity of 43%. In smear-negative patients, anti-tuberculosis treatment showed a sensitivity of 52% and a specificity of 63%. Conclusions: The performance of predictors and diagnostic algorithms differs among patient subgroups, such as in human immune deficiency virus-positive patients, radiographic findings, and body mass index were strong predictors of pulmonary tuberculosis. However, in human immune deficiency virus-negative individuals, the biomarkers showed a moderate association with the disease. A few models have reached the World Health Organization’s recommendation. Therefore, more work should be done to strengthen the predictive models for tuberculosis screening in the future, and they should be developed rigorously, considering the heterogeneity of the population in clinical work.

Adequate supplies of tuberculosis laboratory reagents and consumables are necessary for tuberculosis diagnosis and monitoring of treatment response. This study assessed the distribution and stock levels of laboratory commodities used in tuberculosis control in health centers of Amhara region, Ethiopia. A cross-sectional study was conducted in 82 health centers, among 801, providing sputum microscopy services. Stock levels were calculated, and distribution of reagents and consumables assessed. Thirty three (40.2%) health centers were under stocked for at least one of the key items for tuberculosis diagnosis at the time of visit. Fifteen (18.3%) health centers had no stocks of at least one of the key items (methylene blue (11%), carbol fuchsin (11%), acid alcohol (8.5%) and sputum cups (3.7%)). Of the 82 health centers, 77 (93.9%) did not fulfill the criteria for effective distribution of tuberculosis laboratory reagents and consumables. There were many health centers that had no or only low stocks of key tuberculosis laboratory reagents and consumables as a result of ineffective distribution system. It is necessary to strengthen supply chain management to ensure uninterrupted TB diagnostic service.

Acquired immunodeficiency syndrome is one of the most serious public health and development challenges in sub-Saharan Africa, including Ethiopia. A particular challenge for prevention strategies has been the emergence of hotspot areas. Therefore, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome programs should not be based on national level statistics, but need to be more focused geographically. Kombolcha is one of the high spot areas with different projects and development corridors. Hence, the aim of this study is to assess the trend of HIV infection rates among patients who visited Africa Service Committee clinic from 2005 to 2014. An institutional-based cross-sectional study was conducted from January 1 to January 30, 2016. All records of new patients enrolled from February 8, 2005 to December 31, 2014 were reviewed. Data on sociodemographic information, risky sexual behavior, and HIV test result were collected from each study participant using data collection format. Data were analyzed using SPSS version 20.0. A multivariate logistic regression model was used to identify risk factors of HIV infection. The overall HIV infection was 10.8% (2,233/20,674). The rate of infection varied from 13.3% in 2005 to 4.5% in 2014, and its trend had significantly declined from 2008 to 2014. Urban residence (adjusted odds ratio [AOR]: 2.53; 95% confidence interval [CI]: 1.22-5.25), patients who ever had intercourse with penetration (AOR: 5.62; 95% CI: 1.11-28.57), and those who had marriage experience (AOR: 11.65; 95% CI: 4.2-32.3) were more infected with HIV. The trend of HIV infection significantly reduced in the last 10 years in Kombolcha area. However, the HIV infection still remains high (4.5%) that needs intervention of those who had marriage experience, risky sexual behavior, and urban dwellers.