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Childhood tuberculosis (TB) treatment is becoming a major challenge in the TB control efforts of the Ethiopian health system. This study assessed childhood tuberculosis management, and treatment outcomes among children who completed anti-TB treatment in Northwest Ethiopia. A cross-sectional study was conducted among children who completed their anti-TB treatment in Gondar University Referral Hospital and 6 satellite health centers. Data from each child with tuberculosis were obtained from review of medical records. P-values < 0.05 were considered statistically significant. The commonest method of childhood TB diagnosis was clinical assessment combined with chest x-ray (48.5%). Absence of compliance with TB treatment guideline (98.7%), providing inadequate anti-TB regimen (1.8%), and poor adherence to treatment (22.5%) were challenges in management of childhood tuberculosis. Treatment success rate was 78.9%. In the bivariate regression, factors associated with TB treatment outcomes were permanent residence (OR=8.3, 95%CI: 4.1, 16.7), antiretroviral therapy (OR=4.5, 95%CI: 1.2, 16), and adherence to treatment (p < 0.001). After controlling for confounders, adherence to anti-TB treatment (OR=0.003, 95% CI: 0.001, 0.02) was independent predictor of treatment success. Anti-tuberculosis treatment success rate was still low among children in Northwest Ethiopia. The health centers and hospital shall enhance strong follow-up of children on anti-tuberculosis treatment to improve treatment success with focus on rural children.

Numerous challenges exist in provision of prevention of mother-to-child transmission of HIV (PMTCT) such as linking HIV exposed infants (HEI) and their mothers to chronic cares services, and tackling loss to follow up. Limited evidence exists in Ethiopian setting that explains the persisting high HIV infection rate among HEIs and extent of linkage to chronic care. The study assessed the proportion of HIV infection; children linked to chronic care and determinants of HIV infection among HEI in Northern Ethiopia. This institution-based cross-sectional study was conducted in health centers and hospitals of Amhara Region. A total of 484 HEI-mother pairs selected by multistage random sampling were included in the study. Data were collected from PMTCT and anti-retroviral therapy (ART) clinics using pre-tested and structured questionnaires. Quantitative data were entered in Epi Info version 7.0 and exported to SPSS 20.0 for analysis. A total of 484 mother-infant pairs with a response rate of 92.4% were included in the analysis. About 94.2% of infants and women were linked to chronic care follow-up sometime after the diagnosis. The proportion of HIV infection was 12.4%. Antenatal care attendance had a significant association with HIV infection among HEI (p < 0.0001). Delivering in health institution (p < 0.005), mode of delivery (p < 0.032), and provision of both infant (p < 0.0001) and maternal (p < 0.0001) prophylaxis showed a highly significant association with HIV infection among HIV exposed infants. Health facilities shall encourage antenatal care that increased institutional delivery, leads to timely initiation and high uptake of PMTCT to reduce the vertical transmission of HIV infection and meet national targets.

Background Tuberculosis (TB) is the leading killer of people living with HIV (PLHIV). Many of these deaths occur in developing countries. This study aimed at determining the incidence and predictors of tuberculosis among PLHIV. Methods A five year retrospective follow up study was conducted among adult PLHIV. The Cox proportional hazards model was used to identify predictors. Results A total of 470 patients were followed and produced 1724.13 Person-Years (PY) of observation, and 136 new TB cases occurred during the follow up period. The overall incidence density of TB was 7.88 per 100 PY. It was high (95.9/100PY) in the first year of enrolment. The cumulative proportion of TB- free survivals was 79% and 67% at the end of the first and fifth years, respectively. Baseline WHO clinical stage III (AHR = 2.88, 95% CI = 1.53-5.43), WHO clinical stage IV (AHR = 3.82, 95% CI = 1.86-7.85), CD4 count <50 cell/ul (AHR = 2.13, 95% CI = 1.28-3.53) and ambulatory or bed ridden functional status (AHR = 1.64, 95%CI = 1.13-2.38) were predictors of time to TB occurrence. Conclusions TB incidence rate among PLHIV, especially in the first year of enrollment was high. Advanced WHO clinical stage, limited functional status, and low CD4 count (<50 cell cell/ul) were found to be the independent predictors of TB occurrence. Early care seeking and initiation of HAART to improve the CD4 count and functional status are important to reduce the risk of TB infection.

IntroductionAcute lower respiratory infections (ALRIs) are a major contributor to the global infectious disease burden and a common cause of hospitalisation for children under 2 years. We compared clinical severity in children hospitalised with respiratory syncytial virus (RSV), parainfluenza virus (PIV), human metapneumovirus (hMPV) and influenza virus (IFV).MethodsWe used a probabilistically linked population cohort born in Western Australia between 2010 and 2020 and hospitalised before the age of 2 years. Outcomes compared included length of hospital stay (LOS), admission to intensive care unit (ICU), need for respiratory support (RS), complex hospital course (RS, death, ICU admission or LOS >75th percentile), 7-day and 30-day mortality, hospital-in-the-home care, 30-day all-cause and ALRI-specific readmissions and emergency department presentations 14 days prior to hospitalisation. Logistic regression was used for binary outcomes, and negative binomial regression was used for discrete count variables. Incidence rates, time to RS and time to readmissions were calculated using survival analysis techniques.ResultsThe final cohort included 210 997 hospitalised children under 24 months of age for a total of 315 769 admissions. Infants hospitalised before 6 months had the highest rates for all virus-specific hospitalisations, particularly RSV hospitalisations (50.4 per 1000 child-years (95% CI 48.7 to 52.1)). Infants <6 months had higher odds of an ICU admission (adjusted OR (aOR) 2.39, 95% CI 1.36 to 4.19) and RS (aOR 4.68, 95% CI 2.95 to 7.44) and a complex hospital course (aOR 2.69, 95% CI 2.13 to 3.42) with RSV and four times higher hazards of requiring RS earlier (adjusted HR (aHR) 4.06, 95% CI 2.59 to 6.36). An ALRI-coded 30-day readmission was recorded in 10%–24% of virus-specific hospitalisations.DiscussionYoung infants have a more severe and complex hospital course with RSV hospitalisation compared with hospitalisation with other respiratory viruses and should be prioritised for prevention measures such as the single-dose monoclonal antibody, nirsevimab.

Background. In Ethiopia, up to 80% of the population use traditional medicine for primary health care. Studies on the current knowledge and practices of communities in the era of modern health care expansion are lacking. Therefore, this study is aimed at assessing the knowledge, attitude, and practice of traditional medicine among communities in Merawi town. Methods. A descriptive cross-sectional study was carried out among 403 residents of Merawi town. A systematic random sampling was used to select households. Data was collected through house to house interview. Results. 392 out of 403 questionnaires were analysed. Among the participants, 220 (56.1%) were female. The mean (±s.d.) age of the participants was 32.5 (±12.4) years. Nearly two-thirds, 241 (61.5%), of study participants have good knowledge about traditional medicines. Three-quarters of participants prefer modern medicine to traditional drugs. 70.9% of participants had the experience of personal use of traditional therapies. Conclusions. The population in Merawi has good knowledge with high acceptability and use of traditional medicine. The main reasons for high acceptability and practice were cultural acceptability, lesser cost, and good outcome of traditional medicine.

Many children with poor vision due to refractive error remain undiagnosed and perform poorly in school. The situation is worse in the Sub-Saharan Africa, including Ethiopia, and current information is lacking. The objective of this study is to determine the prevalence of refractive error among children enrolled in elementary schools in Gondar town, Ethiopia. This was a cross-sectional study of 1852 students in 8 elementary schools. Subjects were selected by multistage random sampling. The study parameters were visual acuity (VA) evaluation and ocular examination. VA was measured by staff optometrists with the Snellen E-chart while students with subnormal vision were examined using pinhole, retinoscopy evaluation and subjective refraction by ophthalmologists. The study cohort was comprised of 45.8% males and 54.2% females from 8 randomly selected elementary schools with a response rate of 93%. Refractive errors in either eye were present in 174 (9.4%) children. Of these, myopia was diagnosed in 55 (31.6%) children in the right and left eyes followed by hyperopia in 46 (26.4%) and 39 (22.4%) in the right and left eyes respectively. Low myopia was the most common refractive error in 61 (49.2%) and 68 (50%) children for the right and left eyes respectively. Refractive error among children is a common problem in Gondar town and needs to be assessed at every health evaluation of school children for timely treatment.

Background Ethiopia has fairly good coverage but very low utilization of health care services. Emergency medical care services require fast, correct and curious services to clients as they present with acute problems. In Ethiopia and Gondar in particular, the quality of emergency medical care has not been studied. The main aim of this study was to assess the disease profile and patients’ satisfaction in Gondar University Referral Hospital (GURH). Methods A facility based cross-sectional study was conducted among patients visiting GURH for emergency care. Ethical clearance was obtained from the Institutional Review Board of University of Gondar. Patients were selected by systematic random sampling, using patient flow list in the day and night emergency services. Data were collected using a standard Press Ganey questionnaire by BSc health science graduates. Data were entered in to Epi Info 3.5.3 software and exported to SPSS version 20.0 for windows for analysis. Results A total of 963 patients (response rate = 96.8%) were studied. The mean (+ s.d.) age of patients was 28.4 (+17.9) years. The overall satisfaction using the mean score indicates that 498 (51.7%) 95%CI: (48.4% - 54.9%) were satisfied with the service, the providers and the facility suitability whereas 465(48.3%) 95%CI: (45.1%- 51.6%) were not satisfied. Seven hundred and six (73.3%) 95%CI: 70.4%-76.1%, patients reported that they have been discriminated or treated badly during the service provision in the hospital. OPD site visited (p < 0.0001), visiting days of the week (P < 0.049), medical condition on arrival (P < 0.0001), degree of confidence in the hospital (AOR = 1.9, 95%CI: 1.1, 3.1), reported discrimination/bad treatment of patients with service (AOR = 0.4, 95%CI: 0.2, 0.7), were significantly associated determinants of patient satisfaction. Conclusions Non-communicable disease emergencies like injuries and cardiovascular diseases are common. There is a low level of patient satisfaction related to lack of confidence in the hospital for treatment, discrimination towards patient care, and under and delayed treatment of patients who were not in serious medical conditions. Hospitals shall prepare themselves to address the increasing challenge of non-communicable disease emergencies. It is important to revise the service delivery in the emergency department to improve staff courtesy and politeness, commitment, reduce discrimination and bad treatment and proper triage of emergencies at all points of care to increase patient satisfaction giving emphasis to earlier working days.

Introduction: Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is a predominant route of infection for children in Ethiopia. No study has so far reported a nationwide estimate of the risk of MTCT of HBV. We conducted a meta-analysis of surveys and estimated the pooled risk of MTCT of HBV in the context of human immunodeficiency virus (HIV) infection. Methodology: We searched PubMed, EMBASE, Web of Science, Africa Index Medicus, and Google Scholar databases for peer-reviewed articles. The pooled risk of MTCT of HBV was estimated using the DerSimonian-Laird technique with logit transformed proportions and statistical heterogeneity was estimated using I2 statistic, which was explored by subgroup and meta-regression analyses. Results: The overall pooled risk of MTCT of HBV in Ethiopia was 25.5% (95% CI, 13.4%–42.9%). In women without HIV infection, the risk of MTCT of HBV was 20.7% (95% CI 2.8%–70.4%), and 32.2% (95% CI 28.1%–36.7%) in women with HIV infection. After excluding the outlier study, the risk of MTCT of HBV in studies that included only HIV negative women was 9.4% (95% CI, 5.1%–16.6%). Conclusions: The risk of MTCT of HBV in Ethiopia widely varied by HBV/HIV coinfection. A sustainable control and elimination of HBV in Ethiopia requires improved access to birth-dose HBV vaccine and implement immunoglobulin prophylaxis for exposed infants. Given the limited health resources in Ethiopia, prenatal antiviral prophylaxis integrated with antenatal care may be a cost-effective approach to significantly reduce the risk of MTCT of HBV.