National infection prevention and control guidelines. Multidrug resistant tuberculosis in ethiopian settings and. Tb hiv and mdr tb burden countries with an estimated tb incidence of 164 per 100,000 population of drug susceptible tb. The thesis identified the areas where tb and mdr tb are clustered in northwest ethiopia.
Ethiopia is one of the 30 high mdr tb prevalent countries and the burden of mdr tb is increasing with an estimated incidence of 2. A practical guide to antimicrobial stewardship program in. In ethiopia the mdr tb prevalence based on the 2005 nationwide survey was 1. Levels are much higher in those previously treated about 20%. Ethiopia is one of the 30 high tb, tb hiv and multidrug resistant mdr tb burden countries in the world with more than 126,000 reported cases in 2016 and despite achieving a treatment success rate of more than 90 percent, 30 percent of cases remain undetected. Mdr tb, for the safety and security of our families. Previous studies have documented variable prevalences of multidrugresistant tuberculosis mdr tb and its risk factors in ethiopia. Federal democratic republic of ethiopia ministry of health ethiopian public heath institute. In the present analysis, the pooled estimate of successful treatment was 59. Mdrtb among presumptive mdrtb cases in tigray regional state, ethiopia. Ethiopia is also one of the 27 high mdr tb burden countries.
Expanding ambulatory care to treat drugresistant tb in. The thesis provided some policy recommendations that could assist to achieve the end tb targets. Ethiopia, tb treatment gaps remain especially among mdrtb cases 12. Risk factors of multidrug resistant tuberculosis in addis. A survival guide for clinicians, third edition was created through a collaboration of the curry international tuberculosis center citc and the state of california department of public health, tuberculosis control branch cdph. The authors received no specific funding for this work. Multidrugresistant tuberculosis mdr tb is a form of tuberculosis tb infection caused by bacteria that are resistant to treatment with at least two of the most powerful firstline antitb medications drugs, isoniazid and rifampin. A multicountry cluster of multidrug resistant tuberculosis mdr tb involving 28 migrants has been delineated by whole genome sequencing wgs. By 2015, 105 countries had reported at least one case of xdrtb. Among notified pulmonary tb cases, more than 3 300 mdrtb patients were estimated to occur in 2015 equivalent to an incidence rate of 3.
Management and treatment of patients with multidrug resistant tuberculosis in ethiopia multidrug resistant tb is simply tb disease that cannot be cured with the most effective drugs to date, i. The most powerful predictor of the emergence of mdr tb reported in ethiopia is previous exposure to antitb drug treatment. Otherwise, tb patients may suffer separation and isolation from family and community due to the threat to public health. Open access research knowledge and practice of health workers. Ethiopia tuberculosis profile population 2018 109 million estimates of tb burden.
New ethiopian tb guildline november 2016 slideshare. The second edition of these guidelines was prepared by gini williams. Up to date, the mdrtb treatment outcome is not sufficiently understood in ethiopia. By march 20, 84 countries had reported at least one xdr tb case. Ethiopia is one of the countries with high mdrtb burden. National action plan for combating multidrugresistant tuberculosis. Who treatment guidelines for drug resistant tuberculosis. We analyzed sputum of presumptive tb patients by using the xpert mtbrif assay. Epidemiological evidence of mdr tb in ethiopia the who report in 20 indicated that 450,000 new cases of mdr tb and 170,000 deaths due to mdr tb occurred globally in 2012. Jan 22, 2017 kncv tuberculosis foundation is looking for a fulltime.
Ethiopia is among the 30 high tb, hiv and mdrtb burden countries, with annual. According to the 2014 who global tb report, 22 high burden countries account for 80 percent of the global tb cases and ethiopia has the tenth highest tb burden in the world. Ethiopia is 15th among the 27 mdr tb highburden countries. Pdf tuberculosis burden in ethiopia from 1990 to 2016. Postarrival tb screening of the highrisk refugees and. Ethiopia is one of tb, tb hiv, and multidrug resistant tuberculosis mdrtb high burden country globally. According to the world health organization who, more than half of the global burden of mdr tb is currently in three countries. In ethiopia, tb is still a major public health problem.
Moreover, ethiopia is also one of the 27 countries with a high burden of multidrugresistant tuberculosis mdr tb. Drug susceptibility testing of mycobacteria isolated from. However, there are very few studies in africa that have assess the spatial distribution of tb. Pdf the emergence of drugresistant tuberculosis tb, particularly multidrug resistant mdr and extensively drugresistant xdr tb, is a major. To our knowledge, this is the first combined analysis to evaluate the effectiveness of the currently used mdrtb treatment program in ethiopia.
I wish to share with you the way my own family was impacted by tuberculosis, the number one infectious disease killer in the world. In december 2016, switzerland initially reported a cluster of seven mdr tb cases to the european commission in newlyarrived migrants from somalia 5 cases, eritrea 1 case and ethiopia 1 case. Ethiopia has a high prevalence of tuberculosis tb and is one of the 22 highest tb. The diagnosis of mdr tb can take several months or even longer often too late for the patient. The tb prevalence estimates in ethiopia shows a steady decline since 1995 with an average rate of 4% per year, which is accentuated in the last five years annual decline of 5. Department of medical microbiology, immunology and parasitology, college of medicine and health sciences, bahir dar university, ethiopia 2. Sep 26, 2018 multidrugresistant tb mdr tb, which is resistant to the two most effective antitb drugs, rifampin rif and isoniazid inh, and also to extensively drugresistant tb xdrtb, which is. Up to date, the mdr tb treatment outcome is not sufficiently understood in ethiopia. Technical guideline for tuberculosis tb and tb hiv program implementation mehda was treated successfully for mdr tb in world visionsupported tb clinic in hargeisa, somaliland.
About 9% of mdr tb cases also have resistance to two other classes of drugs, or extensively drugresistant tb xdr tb. Determinants of multidrugresistant tuberculosis in patients. This publication is made possible by the generous support of the american people through the u. Open access research knowledge and practice of health. Ethiopia has notified 125,836 new tb cases and enrolled 702 drugresistant tb case in 2016.
Despite efforts to control tb and mdr tb, ethiopia remains a high mdr tb. A survival guide for clinicians, third edition was created. Ethiopia is one of the countries with high mdr tb burden. Standard treatment of mdr tb can take more than 2 years, including painful daily injections for 6 months, figure 2.
Rapid risk assessment mdr tuberculosis in migrants, multicountry cluster, april 2017 4 figure 2. Pdf predictor of multidrug resistant tuberculosis in. Tb is a costly disease for the health system and also for the patients, their families and society. According to the world health organizations global tb report 2009, the estimated number of tb patients in ethiopia was 314,267 in 2007, with an estimated incidence rate of 378 patients per. Mdr tb planning toolkit introduction and users guide 3 mdr tb planning toolkit introduction and users guide. Tbcare i mdr tb patient costs in ethiopia page 3 recommendations were also made for further research. Multi drug resistant tuberculosis in migrants, multi. Tuberculosis, or tb, continues to be a major global health concern and one of the top 10 causes of deaths worldwide. Technical guideline for tuberculosis tb and tbhiv program.
The treatment outcomes of mdr tb were assessed in ethiopia and china, and a clinical risk score was developed for the prediction of poor treatment outcomes. Ethiopia is making progress in tackling tuberculosis tb, the leading infectious disease killer along with hiv. Spatial patterns of multidrug resistant tuberculosis and. Study subjects were selected using multistage probability sampling. Epidemiology of multidrugresistant tuberculosis mdrtb. Efforts to expand diagnostic services, treatment and care. Multidrugresistant tuberculosis mdr tb has continued to be a challenge for tuberculosis tb control globally. We also assessed the mycobacterium tuberculosis isolates drugsusceptibility patterns and. Dec 21, 2014 multidrugresistant tuberculosis mdr tb is a threat to global tb control and is of major public health concern in several countries. Provisional cdc guidelines for the use and safety monitoring of bedaquiline fumarate sirturo for the treatment of multidrugresistant tuberculosis.
Ethiopia is the third largest and populous country in africa. Review open access multidrugresistant tuberculosis in. The frequency of mdrtb varies substantially between countries. What happened to me happens to 10 million people around the world every year, with resulting. Tuberculosis treatment outcomes in ethiopia from 2003 to. If bacteria are resistant to certain tb drugs this means that the drugs dont work. Mdrtb clinicianinternist addis ababa, ethiopia kncv. The most powerful predictor of the emergence of mdrtb reported in ethiopia is previous exposure to antitb drug treatment.
Mdr tuberculosis critical steps for prevention and control. Abdi, 2, and his mother came to the tb clinic in hargeisa, from ethiopia, and were both treated for tb. Risk factors for multidrug resistant tuberculosis patients. Determinants of tuberculosis treatment outcome under. In addition, the burden of mdr tb in ethiopia is increasing. Ethiopia has a high prevalence of tuberculosis tb and is one of the 22 highest tb burden countries in the world. Risk factors for multidrug resistant tuberculosis patients in amhara national regional state.
In 2014, an estimated 480,000 people developed mdrtb and 190,000 people died from mdrtb. Although the majority of tb cases has affected the productive age group, 15 100 12% cases were reported among children aged under 15 year. Tb care i mdr tb patient costs in ethiopia page 3 recommendations were also made for further research. Kncv is the lead partner in challenge tb, the usaidfunded 5year global program to decrease tb mortality and morbidity in high burdened countries.
This set of tools is designed to help countries develop or strengthen a multidrugresistant tuberculosis mdr tb component within their national tb strategy. Current treatment of multidrug resistant tuberculosis in. The main source of infection is untreated smearpositive pulmonary. Mar 20, 2017 efforts to control the global burden of tuberculosis tb have been jeopardized by the rapid evolution of multidrug resistant mycobacterium tuberculosis mtb, which is resistant to at least isoniazid and rifampicin. However, growing evidence shows that low treatment success rate and high rates of adverse events are associated with this regimen. Ethiopia is among the 30 high tb, hiv and mdr tb burden countries, with annual estimated tb incidence of 177100,000 populations and death rate of 25 per 100,000 populations for 2016. Worldwide and in most countries with a high burden of mdr tb, who. The main purpose of this study was to determine the prevalence of mdr tb and associated factors in ethiopia. According to the 2016 who global tb report, in ethiopia an estimated 2. Hiv coinfection impedes the tb control efforts contributing to around 8% of annually notified tb cases.
Risk factors for multidrug resistant tuberculosis patients in. Open access research drugsusceptible tuberculosis treatment. Drugresistant tuberculosis curry international tuberculosis center. Multidrugresistant tuberculosis mdrtb has continued to be a challenge for tuberculosis tb control globally. Therefore, this analysis aimed to determine the pooled. Whos mdr tb guidelines define communitybased care and support as any action or help provided by, with or from. There are alarming reports of increasing multidrugresistant tuberculosis mtr tb.
Intermittent treatment interruption and its effect on. In ethiopia, resistance to individual firstline anti tb drugs is increasing. Mdr rr tb cases started on secondline treatment in 2016 72% 703 xdr tb cases started on secondline treatment in 2016 tb preventive treatment, 2018. Agency for international development usaid under the terms of cooperative agreement aidoaaa1400046. The country is still among the 22 high tb burden countries with high number of missed and infectious tb cases in the community. In this study, we used the 2016 global burden of diseases, injuries and risk factors gbd data to analyze the incidence, prevalence and mortality rates of tuberculosis tb in ethiopia over the. Aug 28, 20 worldwide, there were 650,000 multidrugresistant tuberculosis mdr tb cases in 2010, and in 2008 the world health organization estimated that 150,000 deaths occurred annually due to mdr tb. Maximum likelihood tree of mdr tb cases by country of isolation, cluster black rectangle of 28 mdr tb cases among migrants, eueea, august 2014 december 2016. The world health organization reported that during 2015, 10. Current treatment of multidrug resistant tuberculosis in ethiopia.
Prevalence and risk factors of adverse drug reactions. Technical guideline for tuberculosis tb and tbhiv program implementation mehda was treated successfully for mdr tb in world visionsupported tb clinic in hargeisa, somaliland. In 2008, there were an estimated 440,000 new cases of mdr tb globally. This indicates that globally, tb has surpassed hivaids as a major cause of mortality. Ethiopia tuberculosis profile world health organization. This study was aimed to assess predictor of mdrtb in southwest part of ethiopia. The 12th national tb research annual conference and. Ethiopia the world health organization who listed ethiopia as one of the 30 high tuberculosis tb, tb hiv, and drugresistant tb dr tb burden countries. All of the participants created a schedule and offered a tft program on tb mdr tb for. Mdr tb strains have emerged in all regions of the world and in africa may be more prevalent than previously appreciated 4.
The main purpose of this study was to determine the prevalence of mdrtb and associated factors in ethiopia. Oct 03, 2014 likewise, two studies reported xdrtb in the range of 1% 4. Rifampicin resistance was lower than 2% in new cases. Costs faced by mdrtb patients during diagnosis and treatment. To determine risk factors of mdrtb patients in amhara national regional state, ethiopia. Annually 20002500 mdr tb cases are estimated to occur among the notified pulmonary tb cases. The most recent who global report classifies ethiopia as one of the top 30 high burden countries for tb, tb hiv and mdr tb.
Postarrival tb screening of the highrisk refugees and immigrants in maryland natasha chida, md msph baltimore city health department march 22nd, 2016. Costs faced by multidrug resistant tuberculosis patients during. Tuberculosis treatment outcomes in ethiopia from 2003 to 2016. Risk factors for multidrugressistant tuberculosis in addis ababa, ethiopia by fikadu tadesse nigusso submitted in accordance with the requirements for the degree of. Phd thesis improving tuberculosis control in ethiopia.
Federal democratic republic of ethiopia ministry of health. It is one form of irrational use manifested when a person takes a legal. Citc is a project of the university of california, san francisco, funded by the centers for. This study determined risk factors associated with mdr tb among mdr tb hiv coinfected cases and tb hiv coinfected controls attending art clinics in addis ababa. Our resources improve and expand tb diagnostic and treatment services and screening in rural areas and among. Effects of trainingfortransformation program on tbmdr. Practical guidelines for infection control in health care facilities world health organization 8 december 2003. The emergence of drugresistant tuberculosis tb, particularly multidrugresistant mdr and extensively drugresistant xdr tb, is a major public health problem. Strengthening early case detection and proper treatment of drugsusceptible tb in accordance with world health organization who.
It means that the tb bacteria that a person is infected with are resistant to two of the most important tb drugs, isoniazid inh and rifampicin rmp. Pdf current treatment of multidrug resistant tuberculosis in. Untreated, mdr tb is a deadly disease affecting impoverished people who cannot afford timely diagnosis and adequate treatment for this curable illness. An estimated 21% of mdrtb cases worldwide have additional resistance to a fluoroquinolone, and 9. As ethiopia moves toward tuberculosis elimination, success. Total costs for diagnosis and current treatment episode for tb patients were estimated to be usd 260 in ethiopia, usd 169 in indonesia, and usd 929 in kazakhstan, compared to. Improving tuberculosis control in ethiopia 1 daniel gemechu datiko 1.
This study identifies factors associated with the occurrence of mdr tb in patients who underwent firstline tb treatment in addis ababa city. Likewise, two studies reported xdrtb in the range of 1% 4. It is committed to reaching the sdg target of ending tb by 2030 and has fully integrated whos end tb strategy the new roadmap for countries to end this deadly disease into its national tb strategic plan. Wondemagegn mulu1, daniel mekonnen1, mulat yimer1, aschalew admassu2, bayeh abera1 1. Based on a recent metaanalysis report, the pooled estimate of mdr tb among new and previously treated cases was 2% 1 to 2% and 15% 12 to 17%,respectively.