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A person with epilepsy experiences recurrent seizures as a result of a persistent underlying disorder. About 50 million people globally are impacted by it, with 4 million of those being in Sub-Saharan Africa. One of the most frequent comorbidities that raise the mortality and morbidity rates of epileptic patients is abnormal Electrocardiographic (ECG) findings. Thus, the purpose of this study is to evaluate the prevalence of abnormal ECG findings in epileptic patients that might lead to increased risk of sudden cardiac death. A hospital based cross-sectional study was at Jimma Medical Center of Ethiopia on epileptic patients who were on follow-up at neurologic clinics during the data collection period. The malignant ECG characteristics and was identified using the ECG abnormality tool. To facilitate analysis, the gathered data was imported into Epidata version 3.1 and exported to the SPSS version 26. The factors of abnormal ECG and sudden death risk were examined using bivariate logistic regression. The study comprised 190 epileptic patients, with a mean age of 32 years. There were more men than women, making up 60.2%. A 43.2% (n = 80) frequency of ECG abnormalities was identified. According to the study, early repolarization abnormalities were the most common ECG abnormalities and increased with male sex and the length of time a person had seizures (AOR) of 4.751 and 95% CI (.273,.933), p = 0.029, compared to their female counterparts. The frequency of malignant ECG alterations in epileptic patients on follow-up at Jimma Medical Center in Ethiopia is described in the study. According to the study, there were significant ECG alterations in epileptic individuals. Male gender and longer duration of epilepsy raise the risk of abnormal ECG findings that could result in sudden cardiac death.

Epilepsy is a chronic neurological disease with a variable therapeutic response. To design effective treatment strategies for epilepsy, it is important to understand treatment responses and predictive factors. However, limited data are available in Africa, including Ethiopia. The aim of this study was therefore to assess treatment response and identify prognostic predictors among patients with epilepsy at Jimma university medical center, Ethiopia. We conducted a retrospective cohort study of 404 newly diagnosed adult epilepsy patients receiving antiepileptic treatment between May 2010 and May 2015. Demographic, clinical, and outcome data were collected for all patients with a minimum follow-up of two years. Cox proportional hazards model was used to identify predictors of poor seizure remission. Overall, 261 (64.6%) of the patients achieved seizure remission for at least one year. High number of pre-treatment seizures (adjusted hazard ratios (AHR) = 0.64, 95% CI: 0.49–0.83) and poor adherence (AHR = 0.57, 95% CI: 0.44–0.75) were significant predictors of poor seizure remission. In conclusion, our study showed that only about two-thirds of patients had achieved seizure remission. The high number of pre-treatment seizures and non-adherence to antiepileptic medications were predictors of poor seizure remission. Patients with these characteristics should be given special attention.

There was a 'missing millions' gap between the incidence of tuberculosis (TB) cases and the notified cases. In many TB high-burden countries, only about 25% of household contacts (HHCs) completing household TB evaluation and 20-89% of eligible contacts did not adhere to TB screening. The study was conducted to assess the yield of door-to-door TB household contact investigation among household contact of bacteriologically confirmed pulmonary TB cases in central Ethiopia. This cross-sectional study was carried out in selected health facilities of central Ethiopia from January 1, 2023 to December 3, 2023.All sequential voluntary bacteriologically confirmed TB patients and their HHCs without discrimination by age were included in the study. Xpert Ultra assay and TB culture were used to investigate active TB from sputum sample. Spearman's correlation analysis was used to determine the correlation between the index case cycle threshold value and the corresponding HHCs. Multivariable logistic regression analysis was done to investigate the associated risk factors for active TB in HHCs. Among 967 HHCs claimed by 303 index cases (259 drug susceptible TB (DS-TB) and 44 multi-drug resistance TB (MDR/RR-TB)), 902(93.07%) HHCs had received baseline symptom-based TB evaluation. Presumptive TB was identified in 20.17% (182) of the evaluated HHCs and 13(1.44%) were diagnosed with active TB. Eleven HHCs (7.24%; 95% CI: 3.85-12.9%) from DS-TB index case contacts and 2 (6.67%; 95% CI: 1.16-23.51) from MDR/RR-TB indexes HHCs were found to be MTB detected Rifampicin resistance not detected cases. The Xpert ultra assay results revealed an 84.62% (95% CI: 57.77-95.68) Rifampicin drug resistance concordance between the index case and the corresponding HHC. Active TB was significantly associated with night sweating and sharing a bed with the index patient, P-value < 0.05. Home-to-home TB contact screening have high active TB yield and implementable in both rural and urban areas of the nation only by mentoring and motivating the health extension workers. Proximity to bacteriologically confirmed TB patient for long time exposes household contacts for active TB. Scheduling convenient times and last-mile service delivery to contacts is very important to address the missed active TB cases in the community.

Despite the fact that patients with rheumatic heart disease (RHD) need early medical attention and follow-up, most patients in developing countries tend to present with debilitating complications. The objective of this study was to evaluate the echocardiographic features of adult individuals diagnosed with RHD and examine the associated complications among patients who started follow-up at Jimma Medical Center's (JMC) cardiac follow-up clinic. A prospective cross-sectional study was conducted at JMC between January 5 and April 15, 2023. Echocardiographic patterns were taken by senior cardiologists; socio-demographic variables, anthropometric measurements, and behavioral factors were collected through a structured questioner. The study recruited a total of 115 participants, of whom 86 (74.8%) were female and 29 (25.2%) were male. The mean age of the patients was 32.31 (SD± 12.16) years. The mitral valve was affected in 98.26% of cases, while the aortic and tricuspid valve abnormalities were diagnosed in 49.5% and 21.7%, respectively. The most frequent combinations of valve lesions were mitral regurgitation (MR) + mitral stenosis (MS) + aortic regurgitation (AR) (15.7%), followed by MR + AR + TR (8.7%). The occurrence of MR+MS+AR was higher in females (17.4%) compared to males (10.3%), whereas the occurrence of MS+MR was higher in males (24.1%) compared to females (20.9%). Females have a severely reduced ejection fraction compared to males (84.8% vs 15.2%, P = 0.044). Nearly two-thirds (63.5%) of individuals experienced RHD-related complications; the most commonly encountered complications were pulmonary hypertension (26.1%) and atrial fibrillation (19.1%). RHD predominantly affects individuals in their active and productive years, particularly females. Most patients have multiple-valve lesions.

The World Health Organization (WHO) has emphasised the need for innovative diagnostic tools to support the control and elimination of neglected tropical diseases (NTDs). Microscopy-based diagnostics, the current standard, rely on trained technicians for labour-intensive processes, posing logistical challenges in the low-resource settings where NTDs are most prevalent. This study describes the technical details of an artificial intelligence-powered digital pathology (AI-DP) platform designed to support large-scale deworming programs for two NTDs, alongside its analytical performance and user experience in laboratory and field settings. The AI-DP platform integrates electronic data capture tools, whole-slide imaging scanners, onboard AI analysis, and result verification software to automate microscopy-based screening. Targeting soil-transmitted helminthiasis (STH) and intestinal schistosomiasis (SCH) as initial use cases, the system was deployed in Ethiopia and Uganda, scanning 951 Kato-Katz (KK) thick smears containing 43,919 verified helminth eggs. Using 5-fold cross-validation, precision/recall/average precision were 95.4%/91.7%/97.1% for Ascaris lumbricoides, 95.9%/86.7%/94.8% for Trichuris trichiura, 84.6%/86.6%/91.4% for hookworm, and 89.1%/79.1%/89.2% for Schistosoma mansoni. Feedback from 14 field users across 30 real-world scenarios indicated the AI-DP platform's improved usability, particularly in hardware portability and software interfaces, though the average scan time of 12.5 minutes per smear was identified as a limitation. The AI-DP platform demonstrates potential as a tool for efficient monitoring and evaluation of STH and SCH control programs by providing near-real-time data with quality controls. However, further validation studies are needed to assess its clinical diagnostic performance, field usability, and cost-effectiveness in large-scale STH and SCH deworming programs. Given that the platform also provides a pipeline for any microscopy-based diagnosis, its potential for other NTDs also needs further attention.

ObjectiveDespite global progress in reducing HIV-related morbidity and mortality, preventable deaths persist, particularly in sub-Saharan Africa. Ethiopia has achieved near-universal antiretroviral therapy (ART) coverage, yet survival outcomes and predictors of mortality in the era of ‘test and treat’ remain underexplored. This study examined survival rates and predictors of mortality among people living with HIV (PLHIV) on ART in Ethiopia between 2016 and 2023.DesignWe conducted a retrospective open cohort study.Setting65 public health facilities across Ethiopia. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were applied. Statistical significance was set at p<0.05.ParticipantsThe analysis included 33 416 PLHIV enrolled in care and treatment from 2016 to 2023. In the current study, baseline is defined as the start date of ART treatment.Primary and secondary outcome measuresThe primary outcome was survival status at the end of follow-up, defined as death versus alive.ResultAmong 33 416 PLHIV, 2659 deaths (8.6%) were documented during 85 972 person-years of follow-up, yielding a mortality incidence rate of 3.09 per 100 person-years. Most deaths occurred within the first 12 months of ART initiation. Independent predictors of mortality included age (≥35 years), bedridden (AHR 2.46, 95% CI 1.78 to 3.40) and ambulatory status (AHR 2.33, 95% CI 1.84 to 2.95), WHO stage IV (AHR 1.40, 95% CI 1.02 to 1.91), having opportunistic infections (AHR 1.41, 95% CI 1.13 to 1.76) and baseline CD4 <200 cells/mm³ (AHR 3.08, 95% CI 2.31 to 4.09). Receipt of tuberculosis preventive therapy (TPT) was protective (AHR 0.36, 95% CI 0.30 to 0.43).ConclusionThe results show that many people appear to start ART late. Factors such as impaired functional status, the presence of opportunistic infections and older age appear to have further compounded risk, while TPT appears to be strongly protective. Improving early diagnosis, timely ART initiation and TPT uptake could further support better outcomes.

Background There is a gap between tuberculosis (TB) infection and the onset of clinical TB disease, which makes identifying TB transmission dynamics a prominent challenge. Different reports were made on the concordance of drug-resistance profiles between the household contact and the purported index case. This study investigated the drug-resistance pattern concordance of the index-household contact pair in central Ethiopia. Method A laboratory-based cross-sectional study was conducted on Mycobacterium tuberculosis isolates identified from bacteriologically confirmed pulmonary TB patients and their household contacts (HHCs) in central Ethiopia from January to December 2023. Sputum specimens were collected from index cases and presumptive HHCs and examined using the Xpert Ultra assay, Xpert XDR assay, and Mycobacterium tuberculosis culture. Descriptive statistics were used to summarize the data. Result Among 902 TB symptoms screened HHCs of 303 index cases, 20.17% (182/902) had Presumptive TB, and 7.14% (13/182) developed active tuberculosis. In index cases, 23.52% (64 /272) showed resistance to at least one of the five first-line anti-TB drugs. The prevalence of mono-resistant to STR, INH, RIF, and PZA was: 2.20% (6 /272), 2.20% (6/272), 6.25% (17/272), and 1.47% (4/272), respectively. Any first-line anti-TB drug resistance was higher among relapse cases than new cases, at 41.67% (10/24) and 21.77% (54/248), respectively. Among the RR/MDR-TB cases tested with the Xpert MTB/XDR assay, 56.81% (25/44) cases showed resistance to INH. Among these 25 INH resistance samples, 5 had no melting point on the wild ahpc gene as well as on the ahpc gene mutant. In HHCs with positive cultures, 23.07% (3/13) displayed resistance to any first-line anti-TB medication. Only 69.23% (9/13) of HHCs had isolates that aligned with the pDST pattern of the index case for all five first-line anti-TB drugs. Conclusion Nearly one-third of the household contacts have discordant drug-resistance profiles from the index patients. This study offers compelling proof that it is not advisable to treat close contacts without DST results based on the DST results of the supposed source case. The low drug resistance rate to new oral second-line drugs in this study did not guarantee the absence of resistance to each drug.

Background An accurate understanding of the geographical distributions of both soil-transmitted helminths (STHs; Ascaris lumbricoides , Trichuris trichiura , and the hookworms Necator americanus and Ancylostoma duodenale ) and schistosomes (SCH; Schistosoma mansoni and S. haematobium ) is pivotal to be able to effectively design and implement mass drug administration (MDA) programmes. The objective of this study was to provide up-to-date data on the distribution of both STH and SCH in Ethiopia to inform the design of the national control program and to be able to efficiently achieve the 75% MDA coverage target set by the WHO. Methods Between 2013 and 2015, we assessed the distributions of STH and SCH infections in a nationwide survey covering 153,238 school-aged children (aged 5–15 years), from 625 woredas (districts), representing all nine Regional States and two City Administrations of Ethiopia. Nationwide disease maps were developed at the woreda level to enable recommendations on the design of the national MDA programme. Results The prevalence of any STH infection across the study population was 21.7%, with A. lumbricoides (12.8%) being the most prevalent STH, followed by hookworms (7.6%) and T. trichiura (5.9%). The prevalence for any SCH was 4.0% in areas where both SCH species were evaluated. Schistosoma mansoni was the most prevalent SCH (3.5 vs 0.3%). STHs were more prevalent in southwest Ethiopia, whereas SCH was found mostly in the west and northeast of the country. The prevalence of moderate-to-heavy intensity infections was 2.0% for STHs and 1.6% for SCH. For STH, a total of 251 woredas were classified as moderately ( n = 178) or highly endemic ( n = 73), and therefore qualify for an annual and biannual MDA program, respectively. For SCH, 67 woredas were classified as endemic and 8 as highly endemic, and hence they require every two years and annual MDA programme, respectively. Conclusions The results confirm that Ethiopia is endemic for both STHs and SCH, posing a significant public health problem. Following the WHO recommendations on mass drug administration, 18 and 14 million school-aged children are in need of MDA for STHs and SCH, respectively, based on the number of SACs that live on the eligible geographical areas.

Background The genotyping of the M. tuberculosis complex has significantly enhanced the comprehension of transmission dynamics and is employed to substantiate transmission dynamics among epidemiologically interconnected cases. This investigation sought to examine genomic diversity, transmission dynamics, and mutations conferring drug resistance in epidemiologically linked pulmonary tuberculosis cases and their household contacts in central Ethiopia. Methods A total of 50 genomes were considered for WGS analysis using the TB- profiler pipeline for drug resistance and genotypic analysis (SNP distance cut-off 12). Results By analyzing the successful WGS data from 48 isolates, we identified that the majority were classified under lineages L4 (Euro-American, 33/48; 68.75%) and L3 (Delhi-CAS, 12/48; 25.0%). The Euro-American sub-lineage (L.4.2.2) was the most common (16/48; 33.33%). The incidence of tuberculosis due to M. bovis was 4.17% (2/48). Approximately one-fifth of the 48 isolates were determined to be at least MDR TB (10/48; 20.83%). The cluster analysis uncovered 4 clusters, resulting in an overall clustering rate of 17.02% (8 /47). Out of the four clusters, three were from the same household, while one cluster was from non-index household contacts. Out of the 10 index-HHC pairs that had valid WGS analysis, three exhibited genomes that were exactly matched. Conclusion People living in regions with a significant prevalence of tuberculosis face the danger of acquiring the disease from external sources. Genomic sequencing provides valuable information about the epidemiological trends of tuberculosis, which helps in developing improved strategies for high-risk groups susceptible to unnoticed TB transmission.

As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia. Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography. Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9-70.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor. We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.