Tuberculosis infectious pool and associated factors in East Gojjam Zone, Northwest Ethiopia

Abstract

BackgroundGlobally, tuberculosis (TB) lasts a major public health concern. Using feasible strategies to estimate TB infectious periods is crucial. The aim of this study was to determine the magnitude of TB infectious period and associated factors in East Gojjam zone.MethodsAn institution-based prospective study was conducted among 348 pulmonary TB (PTB) cases between December 2017 and December 2018. TB cases were recruited from all health facilities located in Hulet Eju Enesie, Enebse Sarmider, Debay Tilatgen, Dejen, Debre-Markos town administration, and Machakel districts. Data were collected through an exit interview using a structured questionnaire and analyzed by IBM SPSS version25. The TB infectious period of each patient category was determined using the TB management time and sputum smear conversion time. The sum of the infectious period of each patient category gave the infectious pool of the study area. A multivariable logistic regression analysis was used to identify factors associated with the magnitude of TB infectious period.ResultsOf the total participated PTB cases, 209(60%) were male, 226(65%) aged < 30 years, 205(59%) were from the rural settings, and 77 (22%) had comorbidities. The magnitude of the TB infectious pool in the study area was 78,031 infectious person-days. The undiagnosed TB cases (44,895 days), smear-positive (14,625 days) and smear-negative (12,995 days) were major contributors to the infectious pool. The overall average median TB management time was 142.4 days (IQR, 98–238 days). Similarly, the average sputum smear conversion time of PTB cases (new and repeat) was 46 days. Residence, knowledge, form of TB, smoking, alcohol history, distance from the facility, comorbidity history and stigma were statistically significant factors TB infectious period (p-value< 0.05).ConclusionsThe magnitude of the TB infectious pool is high even if it is lower than the findings of previous studies. This might be an indicator of poor access to TB services, service delays, low community awareness, impaired facility readiness, and poor transportation. Improving personal awareness and behavior, timely management of commodities, and using the TB management time in TB control are crucial to improving TB control activities.

<p>Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design</p>

“…This may suggest that many TB cases remain undetected in the community. This is supported by recent study findings from the study area 39 where the total TB infectious pool was estimated at 56,496 infectious persondays, which is alarming. This is mainly due to the shortage of laboratory staff and facility inputs.…”

“…Similar results were also reported from previous studies in Ethiopia, 8,23,39,44 Ghana, 4,6,7 Mozambique, 5 South Africa, 32 Nigeria, 33 Tanzania, 43 Nepal 47 and Mongolia 35 where most of the rural health facilities had uneven health facility distribution, inaccessible, and poor readiness (lack of staff, reagents, electric power, and equipment) of health facilities.…”

“…This is mainly due to the shortage of laboratory staff and facility inputs. 39,44 The qualitative part of this study also supported this where manpower shortage, limited facility input suppliers, poor management practices and TB program supports were barriers of TB service availability and readiness.…”

“…The East Gojjam Administrtaive Zone is one of those zones which has higher TB incidence and lowest TB case notification rate compared to other administrative zones in the region. 39 Therefore, this study aimed at assessing the geographic distribution, physical accessibility, readiness and barriers of health facilities to offer TB control services in East Gojjam Administrative Zone, Northwest Ethiopia. The findings of this study are crucial to policy makers, health system managers, health facilities, and non governmental organizations (NGOs) to enhance universal health coverage, facility readiness and achieve the End TB targets.…”

Spatial-temporal clustering of notified pulmonary tuberculosis and its predictors in East Gojjam Zone, Northwest Ethiopia

“…It has about 14,010 km 2 area coverage divided into 18 administrative woredas which are further divided into 49 urban and 392 rural Kebeles . East Gojjam Zone is bounded by the Nile river and has diverse geographic features: kola (lowlands), dega (mountainous), woina-dega (plateau), and the Nile river valleys that might affect access and quality of TB control activities [ 12 , 15 ]. The zone’s climate has four seasons: summer (a rainy season in Ethiopia from June to August), autumn (September to November), Bega/winter (a dry season in Ethiopia lasting from December to February), and spring (March to May) [ 9 ].…”