The first COVID-19 case was reported in Ethiopia on 13 th March 2020 and series of announcements of set of measures, proclamation and directives have been enacted to fight the coronavirus pandemic. These have implications for the regular health services including the TB control program. This brief communication assesses the impact of the COVID-19 response on the TB control activities of Addis Ababa health centers based on research project data. We compared the patient flows in pre-COVID-19 period (quarter 1, Q1) and during COVID-19 (quarter 2, Q2 and quarter 3, Q3) of 2020 at 56 health centers in Addis Ababa from all 10 sub-cities per sub-city. The patient flow declined from 3,473 in Q1 to 1,062 in Q2 and 1,074 in Q3, which is a decrease by 62-76% and 52-80% in Q2 and Q3 respectively as compared to that of Q1. In Q2, Kolfe keranio and Kirkos sub-cities recorded the biggest decline (76 and 75% respectively) whereas Yeka sub-city had the least decline (62%). In Q3, Kirkos sub-city had the biggest decline (80%) and Addis ketema sub-city had the lowest (52%). We conclude that the series of measures, state of emergency proclamation and government directives issued to counter the spread of COVID-19 and the public response to these significantly affected the TB control activities in Addis Ababa city as attested by the decrease in the patient flow at the clinics. Health authorities may inform the public that essential health services are still available and open to everyone in need of these services.
]. 2020 is the year of the rat. The rat is the first of the 12 Chinese zodiac signs, and represents spirit, alertness, flexibility and vitality. In respiratory medicine, we may think of rats as vectors for diseases, such as pulmonary forms of hantavirus disease or leptospirosis, and pneumonic plague. Rodent control is thus part of hygiene guidelines and the International Health Regulations. And yet, the rat's keen sense of smell has led to its incredible career as a living tuberculosis (TB) detector. The TB detection rat journey began with an idea in Tanzania in 2001, roughly 120 years after the TB-causing Mycobacterium tuberculosis was discovered by microscopy and bacterial culture. African giant pouched rats (Cricetomys ansorgei) had already been successfully trained using positive reinforcement to find explosives [1]. So, the question arose if they could do more for humanity by helping to also combat disease. But how would the rats use their noses to find bacteria or otherwise sniff out TB patients? For centuries, olfaction had already informed diagnostics in medical practices, e.g. in detecting metabolic issues such as ketoacidosis or tissue decay such as gangrene [2]. In the Flemish common language, the word tering, which etymologically refers to the smell of tar, is used for TB. The advent of chromatographic techniques allows characterisation of the organic compounds causing odours. Researchers from the Tanzanian National Institute for Medical Research (NIMR), the Sokoine University of Agriculture (SUA) and the Belgium non-profit APOPO, found this evidence intriguing enough to train African giant pouched rats with the odour of heat-inactivated bacteriological culture and later, heat-inactivated human sputum samples, to find out if the rats could identify pulmonary TB. The evaluation setting was, and still is, a locally made aluminium cage to present ten samples in a row to the rat (figure 1). A few years later, the concept was proven: rats can smell TB! [3] Further evaluation followed [4], and over the years, performance characteristics were defined through scientific studies (table 1). The results suggested that the rats are unique in their very high speed, throughput, sensitivity (considering that local
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