Prevalence of Tuberculosis in Gambella Regional Hospital, Southwest Ethiopia: A Retrospective Study ...

Jemberu Alemu, Gezahegne Mamo, Venkataramana Kandi, Mahendra Pal

American Journal of Public Health Research

Prevalence of Tuberculosis in Gambella Regional Hospital, Southwest Ethiopia: A Retrospective Study to Assess the Progress towards Millennium Development Goals for Tuberculosis (2006-2015)

Jemberu Alemu1, Gezahegne Mamo2, Venkataramana Kandi3, Mahendra Pal2,

1College of Agriculture and Natural Resource, Department of Animal Production and Health, Gambella University, Gambella, Ethiopia

2Department of Microbiology, Immunology and Public Health, College of Veterinary Medicine and Agriculture, Addis Ababa University, P.B.No.34, Debre Zeit, Ethiopia

3Department of Microbiology, Prathima Institute of Medical Sciences, Karimnagar, Telengana, India

Abstract

A retrospective study was carried out to evaluate the progress towards millennium development goals and to generate preliminary epidemiological information on tuberculosis (TB) in Gambella town hospital and its surroundings in Southwestern Ethiopia. The medical records of all TB patients registered from 2009 to 2014 were assessed retrospectively. A total of 2519 TB patients were registered for the last 6 years and treated in Gambella Regional Hospital. The sex proportion of male TB patients was 60.18 % (1516/2519). The mean and the standard deviation of age was 23.8±13.18. The age group between 15-44 years in both sexes was most frequently affected with both forms of TB (pulmonary tuberculosis and extra pulmonary tuberculosis), 1660 (65.9%) followed by 0-14 years of age 508 (20.2%). Of 2519 tuberculosis cases registered in the last 6 years, 637(25.3%) of them were extra pulmonary tuberculosis cases and the rest 1884 (74.79%) were pulmonary tuberculosis cases. Out of 2519 TB cases registered during the six years, 1516 (60.18%) were males, and higher tuberculosis cases were registered (χ2 =4.191; p=0.022). The annual trends of TB for both sexes were gradually declined in the last six years. In conclusion, the retrospective study showed that although there was reduction in the number of both pulmonary and extra-pulmonary tuberculosis cases in the study area, what should not be undermined is the importance of regular prognostic evaluation among tuberculosis cases. Hence, we re-emphasize that Tuberculosis Control Program should give attention to control of tuberculosis and HIV-TB co-infection in Gambella Region.

Cite this article:

  • Jemberu Alemu, Gezahegne Mamo, Venkataramana Kandi, Mahendra Pal. Prevalence of Tuberculosis in Gambella Regional Hospital, Southwest Ethiopia: A Retrospective Study to Assess the Progress towards Millennium Development Goals for Tuberculosis (2006-2015). American Journal of Public Health Research. Vol. 5, No. 1, 2017, pp 6-11. http://pubs.sciepub.com/ajphr/5/1/2
  • Alemu, Jemberu, et al. "Prevalence of Tuberculosis in Gambella Regional Hospital, Southwest Ethiopia: A Retrospective Study to Assess the Progress towards Millennium Development Goals for Tuberculosis (2006-2015)." American Journal of Public Health Research 5.1 (2017): 6-11.
  • Alemu, J. , Mamo, G. , Kandi, V. , & Pal, M. (2017). Prevalence of Tuberculosis in Gambella Regional Hospital, Southwest Ethiopia: A Retrospective Study to Assess the Progress towards Millennium Development Goals for Tuberculosis (2006-2015). American Journal of Public Health Research, 5(1), 6-11.
  • Alemu, Jemberu, Gezahegne Mamo, Venkataramana Kandi, and Mahendra Pal. "Prevalence of Tuberculosis in Gambella Regional Hospital, Southwest Ethiopia: A Retrospective Study to Assess the Progress towards Millennium Development Goals for Tuberculosis (2006-2015)." American Journal of Public Health Research 5, no. 1 (2017): 6-11.

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1. Introduction

Tuberculosis (TB) is a highly infectious bacterial zoonosis, which is recognized as one of the most important threats to human and animal health causing significant mortality, morbidity and economic losses in the world, particularly in developing nations [1, 2]. It remains a major global health problem and causes ill-health among millions of people each year and ranks as the second leading cause of death from an infectious disease worldwide after the human immunodeficiency virus (HIV) [3, 4, 5].

Tuberculosis is one of the oldest classic, long lasting and persistent zoonosis, and is the leading cause of death due to single infectious agent known among the adults in the world [6, 7]. The people with HIV/acquired immunodeficiency syndrome (AIDS) are more susceptible to TB [7]. With the advent of chemotherapy during 1940s and establishment of standardized short course treatment regimen in 1970s and 1980s, it was believed that TB would surely be conquered soon. Steady declines in case notifications were observed in most of the developed countries from 1950s to 1980s [8]. While no such declines were seen in most developing countries, a reversal of the declining trend occurred in the developed world during late 1980s [8].

New challenges emerged in the form of HIV epidemic and evolution of multi-drug resistant (MDR) TB. Consequently, TB was declared a global emergency by the World Health Assembly (WHA) in 1991 and a frame work for TB control was developed in the form of DOTS; the internationally recommended strategy for TB control [9]. Within the framework of DOTS, annual targets of 70% case detection of new smear positive pulmonary TB (PTB) cases, and 85% treatment success were set to be achieved by the year 2000, which were later revised to 2005.

The principle target of United Nations Millennium Development Goals (MDGs) for TB control adopted in the year 2000 is to ensure that the incidence rate of TB is declining by 2015 (UNSD, 2007). The supplementary targets are to halve the prevalence of TB and TB mortality rates by 2015 as compared to 1990. The ultimate goal is to eliminate TB by 2050, when the annual incidence should be less than one case per million populations [11].

Globally, the TB mortality rate (deaths per 100 000 population per year) has fallen by 45% since 1990, and TB incidence rates (new cases per 100 000 population per year) are decreasing in most parts of the world. Between 2000 and 2013, an estimated 37 million lives were saved through effective diagnosis and treatment. The global TB strategy developed by WHO for the period 2006-2015 is to stop TB. The overarching goal of this strategy is to achieve 2015 global targets for reductions in the burden of disease caused by TB. These targets are that incidence should be falling, and that prevalence and incidence rates should be halved by 2015 compared with 1990 levels.

In 2013, there were an estimated 9.0 million incident cases of TB (range, 8.6 million 9.4 million) globally, equivalent to 126 cases per 100 000 population. The absolute number of incident cases is falling slowly at an average rate of 1.5% per year 2000−2013 and 0.6% between 2012 and 2013.

Most of the estimated number of cases in 2013 occurred in Asia (56%) and the African Region (29%); smaller proportions of cases occurred in the Eastern Mediterranean Region (8%), the European Region (4%) and the Region of the Americas (3%). There are 22 countries that are sometimes referred to as the TB “high burden” countries, and they have been prioritized at a global level since 2000 (WHO, 2014). The six countries that stand out as having the largest number of incident cases in 2013 were India (2.0 million–2.3 million), China (0.9 million–1.1 million), Nigeria (340 000−880 000), Pakistan (370 000−650 000), Indonesia (410 000−520 000) and South Africa (410 000−520 000); India and China alone accounted for 24% and 11% of global cases, respectively (WHO, 2014).

Of the 9.0 million incident cases, an estimated 550 000 were children and 3.3 million (range, 3.2–3.5 million) occurred among women. The 9.0 million incident TB cases in 2013 included 1.0 million–1.2 million (11–14%) among people living with HIV, with a best estimate of 1.1 million (13%) the proportion of TB cases co-infected with HIV was highest in countries in the African Region. Overall, 34% of TB cases were estimated to be co-infected with HIV in this region, which accounted for 78% of TB cases among people living with HIV world-wide. In parts of southern Africa, more than 50% of TB cases were co-infected with HIV.

Ethiopia is among the 22 TB high burden countries in the world and the seventh ranked country in the world and the second ranked country in Africa (WHO, 2014). The World Health Organization 2009 report indicated that the status of TB in Gambella Region was the highest from all the Ethiopian Regions, with the notification rate (new and relapse) 261- 421/100, 000 [12].

The Gambella Regional Hospital is one of the dominant health delivery centers in the region that holds a total of the whole people of the region estimated to be 406, 000 population (CSA, 2013/2014) and an average of 58, 500 people visit in the hospital and gets service annually.

At present, the Gambella Regional Hospital gives diagnostic and treatment services for TB patients based on the direct observed treatment short course (DOTS) program. TB is one of the listed causes of mortality and morbidity in the area based on the hospital data and WHO, 2009 reports. HIV/AIDS sero-prevalence indicators showed a gradual decline from year 2004 to 2010 from a prevalence of 4.3% to 2.8%, which is found to be high, compared to other parts of the country. This study was designed to evaluate the trends of tuberculosis along the six year duration and to generate preliminary epidemiological information on TB in Gambella town and its surroundings in Southwestern Ethiopia.

2. Materials and Methods

2.1.Study Area

The study was conducted in Gambella Hospital of Gambella town, regional state, Southwest Ethiopia. The Gambella People's Regional State is located south west Ethiopia between the geographical coordinates of 6° 28'38" to 8° 34' North Latitude and 33° to 35° 11’11" East Longitude, 766 km far from Addis Ababa which covers an area of about 34,063 km2. The Region is bounded to the North, North East and East by Oromya National Regional State, to the South and Southeast by the Southern Nations and Nationalities People's Regional State and to the Southwest, West and Northwest by the Republic of south Sudan [13].

Most of Gambella region is flat and its climate is hot and humid. The mean annual temperature of the Region varies from 17.3°C to 28.3°C and absolute maximum temperature occurs in mid-March and is about 45°C and the absolute minimum temperature occurs in December and is 10.3°C. The annual rainfall of the Region in the lower altitudes varies from 900-1,500mm; at higher altitudes it ranges from 1,900-2,100mm. The annual evapotranspiration in the Gambella reaches about 1,612 mm and the maximum value occurs in March and is about 212 mm [14].

Based on the 2013/2014 Census conducted by the Central Statistical Agency of Ethiopia (CSA), the Gambela Region has total population estimation of 406,000 (CSA, 2013/2014).

2.2. Study Methodology

TB registry Casebooks of Gambella Regional Hospital were used to assess the situation of TB from 2009 to 2014 in Gambella town and its surroundings. Variables such as forms of TB, sex, age pattern, patient type and as well as TB and HIV co-infection were assessed.

2.3. Ethical Considerations

Ethical clearance was obtained from the Ethical Committee of Gambella Regional Health Office (Ref. number of 16/3776/7) and working permission was obtained from the hospital higher managers.

2.4. Statistical Data Analysis

The recorded data was entered and stored in Microsoft Excel computer program and analyzed by STATA version 11 (STATA Corp. College station, TX). The variations between different factors were also analyzed using multi variable logistic regression and chi-square (χ2) was used for association of different risk factors. A p-value <0.05 was considered statistically significant at 95% confidence interval was considered.

3. Results

A total of 2519 TB patients were registered for the last 6 years and treated in Gambella Regional Hospital. The sex proportion of male TB patients was 60.18 % (1516/2519). The mean and the standard deviation of age was 23.8±13.18. Tuberculosis most frequently affected the age group between 15- 44 years in both sexes in both forms of TB (PTB and EPTB), 1660 (65.9%) followed by 0-14 years of age 508 (20.2%).

From the 2519 TB cases registered in the last 6 years, 637(25.3%) of them were extra pulmonary tuberculosis cases and the rest 1884 (74.79%) were pulmonary tuberculosis cases. Out of 2519 TB cases registered during the six years, 1516 (60.18%) were males and higher TB cases were registered (χ2 =4.191; p=0.022) and the annual trends of TB for both sexes were gradually declined in the last six years.

Table 1. All forms of tuberculosis cases in Gambella Region from 2009-2014

Figure 1. Trends of all forms of tuberculosis along the six year period
Figure 4. Types of tuberculosis cases observed in the six year trend
Figure 5. Trends of tuberculosis with HIV co-infection

Table 2. Associations of various risk factors with different tuberculosis forms

4. Discussion

Tuberculosis has long been recognized as a major public health problem worldwide since the 1950s. By considering the impact, WHO initiated implementation of DOTS strategy in the 1990s to minimize the problem, yet it ignited by the HIV / AIDS epidemic, still remains a major health problem in Ethiopia and other developing countries [15]. This study used six years TB retrospective data to analyze the progress of TB pattern in the area.

In our study, it was observed that males comprised of the higher proportion of TB compared to females and is in agreements with [16-22][16].

Age groups of 15-44 years were affected more than the other age groups, which is consistent with WHO [27] report. This is also is in agreement with the reports of other previous studies [16-22][16].This may be due to the fact that this age group is sexually active and hence infected with HIV, which predisposes this group to TB. The proportions of the different types of TB recorded in the area were similar with those reported [22, 23, 25]. On the other hand, lower proportions were recorded from India [26]. The proportion of smear positive TB recorded by the present study was similar with that of the Ethiopian national prevalence [27]. It was also observed that most of the cases were smear negative and co-infected with HIV.

The overall fall of annual distribution of all forms of TB registered cases in this study is in agreement with other studies [28], in Japan [29] and the countries profile (WHO, 2012). The probable reasons of falling down may be due to continuous implementation of DOTS, increased availability of health facilities and health service delivery increment and increased awareness by the public about the disease in the area [30]. Currently, due to DOTS program implementations in the study area, the relapse and defaulters cases were generally in a decreasing manner per years in responding to the program, which was similar to other studies done in South Ethiopia [16], in Northwestern Shewa [31], in Western Ethiopia [21] and in Jijiga district [32]; yet these studies showed increased observations of relapse cases contrary to the present study. Thus, this decreasing in the observation of relapse cases may show the low drug resistance strain circulation in the area.

The proportion of TB in HIV positive individuals was found to be 24% in this study, which is higher than the national incidence (6.3%), according to the WHO report [33]. This high proportion of TB and HIV co-infection in area may be due to the high HIV/AIDS dissemination that would have the effect on TB development.

5. Conclusion

Prevalence of both pulmonary and extra-pulmonary tuberculosis showed a downward trend. Most new infections were found to be pulmonary tuberculosis, and no drug resistance was noted among the prevailing Mycobacterium strains. Results of this study have also noted a reduction in the number of relapse infections among pulmonary tuberculosis cases. The cause of concern is the increasing trends in the tuberculosis cases among HIV seropositive individuals, which were noted to be more in this particular region as compared to the average prevalence throughout the country. It is, therefore, imperative that to control the spread and stop TB cases, TB elimination programmes should also concentrate on the HIV-TB co-infection.

References

[1]  Pal, M. (2007). Zoonoses.2nd Ed. Satyam Publishers, Jaipur, India.
In article      
 
[2]  Pal, M., Zenebe, N. and Rahman, M.T. (2014). Growing significance of Mycobacterium bovis in human health.Microbes and Health 3: 21-34.
In article      View Article
 
[3]  WHO. (2013). Global tuberculosis report. World Health Organization, Geneva, Switzerland. Pp.1-180.
In article      
 
[4]  WHO. (2014). Global tuberculosis report. World Health Organization, Switzerland. Pp.1-147.
In article      
 
[5]  Birhanu, T., Mezgebu, E., Ejeta, E. and Gizachew, A. (2015). Review on diagnostic techniques of bovine tuberculosis in Ethiopia. Rep Op 1:7-14.
In article      
 
[6]  Pal, M. (2005). Importance of zoonoses in public health. Ind J Anim Sci 75:586-591.
In article      
 
[7]  Pal, M. (2013). Public health concern due to emerging and re-emerging zoonoses. Intern. J Livestock Research 3: 56-62.
In article      View Article
 
[8]  Rieder, H. L. 1999. Tuberculosis Epidemiology. 1st ed. Paris: IUATLD.
In article      
 
[9]  44th World Health Assembly. Geneva: WHO; 1991 (WHA44/1991/REC/1).
In article      
 
[10]  WHO, Millennium Development Goals (MDGs) http://www.who.int/mediacentre/factsheets/fs290/en/.
In article      
 
[11]  WHO (2006). Global Tuberculosis Control http://apps.who.int/iris/bitstream/10665/144567/1/9241563141_eng.pdf.
In article      
 
[12]  WHO. (2009). Global Tuberculosis Control Epidemiology, Strategy, Financing. WHO/HTM/TB/ 411, World Health Organization, Geneva, Switzerland
In article      
 
[13]  Behailu, H., Tsedal, M., Jemal, A., Katckos, G., Weshik, R., Asere, G., Haile, T., Banjo, A., Wasihun, Z. and Umode, U. (2011). Action plan of adaptation to climatic change. Gambella National Regional States Woredas, Ethiopia. Pp. 1-62.
In article      
 
[14]  Tilahune, H. and Schmidt, E. (2012). Spatial Analysis of Livestock Production Patterns in Ethiopia, Development Strategy and Governance Division, International Food Policy Research Institute – Ethiopia Strategy Support Program II, Ethiopia.
In article      
 
[15]  WHO. (2005). Global Tuberculosis Control. Surveillance, Planning, Financing. WHO Report. WHO/HTM/ TB/2005.349. World Health Organization, Geneva, Switzerland.
In article      
 
[16]  Shargie, B.E. and Lindtjorn, B. (2005). DOTS improves treatment outcomes and services coverage for tuberculosis in Ethiopia: a retrospective tend analysis. Bio Med Center Public Health 5: 62-73.
In article      View Article  PubMed  PubMed
 
[17]  Imam, T.S. and Oyeyi, T.I. (2008). A retrospective study of pulmonary tuberculosis (PTB): Prevalence amongst patients attending Infectious diseases hospital (IDH) In Kano, Nigeria. J Pure and App Sci 1:10-15.
In article      
 
[18]  Datiko, D.G. and Lindtjørn, B. (2009). Tuberculosis recurrence in smear-positive patients cured under DOTS in southern Ethiopia: retrospective cohort study. BMC Public Health 9: 1471-2458.
In article      View Article  PubMed  PubMed
 
[19]  Jetan, C.A., Jamaiah, I., Rohela, M. and Nissapatorn, M. (2010). Tuberculosis: An Eight Year (2000-2007) Retrospective study at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Tuberculosis in Malaysia, 2: 378-385.
In article      
 
[20]  Berhe, G., Enquselassie, F. and Aseffa, A. (2012). Treatment outcome of smear-positive pulmonary tuberculosis patients in Tigray Region, Northern Ethiopia. BMC Public Health 12: 537.
In article      View Article  PubMed  PubMed
 
[21]  Ejeta, E., Legesse, M. and Ameni, G. (2012). Preliminary study on the epidemiology of tuberculosis in Nekemte and its surroundings -Western Ethiopia. STAR 1: 18-25.
In article      
 
[22]  Biadglegne, F., Anagaw, B., Debebe, T., Anagaw, B., Tesfaye, W., Tessema, B., Rodloff, A.C. and Sack, U. (2013). A retrospective study on the outcomes of tuberculosis treatment in Felege Hiwot Referral Hospital, Northwest Ethiopia. International J Medicine and Med Sci 5: 85-91.
In article      
 
[23]  Tessema, B., Muche, A., Bekele, A., Reissing, A., Emmrich, F. and Sack, U. (2009): Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five-year retrospective study.BMC Public Health 9: 371.
In article      View Article  PubMed  PubMed
 
[24]  Prakasha, R.S., Suresh, G., D’sa, P.I., Kumar, G.S., Rao, R. and Shetty, M. (2012). A study of clinical characteristics and trend of different types of tuberculosis in coastal South India. Annals Trop Med and Public Health 5: 489-494.
In article      View Article
 
[25]  Kassu, A., Mengistu, G., Ayele, B., Diro, E., Mekonnen, F., Ketema, D., Moges, F., Mesfine, T., Getachew, A., Ergicho, B., Elis, D., Aseffa, A., Wondmikun, Y., and Ota, F. (2007). Co-infection and clinical manifestation of tuberculosis in human immunodeficiency virus –infected and -uninfected adults at s teaching hospital, North West Ethiopia. J Microbiol Immunol and Infect 40: 116-122.
In article      PubMed
 
[26]  Chakraborty, A. K. (2004). Epidemiology of tuberculosis: Current status in India. Review article, Indian J Med Res 120: 248-276.
In article      PubMed
 
[27]  WHO. (2012). WHO Tuberculosis Fact Sheet No. 104, World Health Organization, Geneva, Switzerland.
In article      
 
[28]  Lobato, M.N., Wang, Y., Becerra, J., Simone, P. and Castro, K. (2006). Improved program activities are associated with decreasing tuberculosis incidence in the United States. Public Health Rep 121:108-115.
In article      PubMed  PubMed
 
[29]  Shimao, T. (2009). Tuberculosis prevalence survey in Japan. KekkakuIB 84:713-20.
In article      
 
[30]  Yun, Lo. H., Chou, P., Yang, S., Lee, C. and Kuol, H. (2011). Trends in tuberculosis in Taiwan, 2002–2008. J Formos Med Assoc 110: 501-510.
In article      View Article
 
[31]  Seyoum, T. S. (2007). Study on tuberculosis in North Western Shewa, Central Ethiopia, M.Sc thesis, Aklilue Lemma Institute of Path biology, Addis Ababa University, Ethiopia.
In article      
 
[32]  Mohammed, I. (2007). Preliminary study on tuberculosis in Jijiga district, Eastern Ethiopia, MSc. thesis, Aklilue Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia.
In article      
 
[33]  WHO (2008). Global Tuberculosis Control: Surveillance, planning, financing: WHO Report. WHO/HTM/TB/2008.393. World Health Organization, Geneva, Switzerland.
In article      
 
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