Getachew Tollera

Objective: Despite global progress in reducing HIV-related morbidity and mortality, preventable deaths persist, particularly in sub-Saharan Africa. Ethiopia has achieved near-universal antiretroviral therapy (ART) coverage, yet survival outcomes and predictors of mortality in the era of ‘test and treat’ remain underexplored. This study examined survival rates and predictors of mortality among people living with HIV (PLHIV) on ART in Ethiopia between 2016 and 2023. Design: We conducted a retrospective open cohort study. Setting: 65 public health facilities across Ethiopia. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were applied. Statistical significance was set at p<0.05. Participants: The analysis included 33 416 PLHIV enrolled in care and treatment from 2016 to 2023. In the current study, baseline is defined as the start date of ART treatment. Primary and secondary outcome measures: The primary outcome was survival status at the end of follow-up, defined as death versus alive. Result: Among 33 416 PLHIV, 2659 deaths (8.6%) were documented during 85 972 person-years of follow-up, yielding a mortality incidence rate of 3.09 per 100 person-years. Most deaths occurred within the first 12 months of ART initiation. Independent predictors of mortality included age (≥35 years), bedridden (AHR 2.46, 95% CI 1.78 to 3.40) and ambulatory status (AHR 2.33, 95% CI 1.84 to 2.95), WHO stage IV (AHR 1.40, 95% CI 1.02 to 1.91), having opportunistic infections (AHR 1.41, 95% CI 1.13 to 1.76) and baseline CD4 <200 cells/mm³ (AHR 3.08, 95% CI 2.31 to 4.09). Receipt of tuberculosis preventive therapy (TPT) was protective (AHR 0.36, 95% CI 0.30 to 0.43). Conclusion: The results show that many people appear to start ART late. Factors such as impaired functional status, the presence of opportunistic infections and older age appear to have further compounded risk, while TPT appears to be strongly protective. Improving early diagnosis, timely ART initiation and TPT uptake could further support better outcomes.

Effective coverage measurement has emerged as a tool to help understand health system performance for the provision of high-quality health care. Using a cascade approach that combines data on demand- and supply-side steps, effective coverage measures highlight where gaps in the health system exist and how improvements might be made so that more people benefit from the potential of the health services available to them. In practice, however, there are challenges in making this work. This analysis paper aimed to highlight those challenges in calculating effective coverage in Ethiopia, using antenatal care as a test case, and propose a solution. In Ethiopia, government leaders are committed to taking a data-informed approach to improving health care quality. To support this, an effective coverage technical working group was formed of individuals with experience of effective coverage analysis in Ethiopia to share knowledge and create learning for a way forward. Through methods analysis of one common indicator, the effective coverage of antenatal care, four key challenges were identified by the group: (1) features of the data sources used, (2) the number of cascade steps included in the effective coverage calculations, (3) the data elements included within cascade steps and (4) the methods applied to generate composite indicators. Multiple small differences were observed to have an influence on the usability of effective coverage measures for decision-making. The group concluded that greater transparency in reporting effective coverage measures was urgently needed and proposed and discussed the use of a reporting checklist for this purpose.

Pregnancy is a critical period during which major physiologic and metabolic changes occur [1]. During pregnancy, there is an increased requirement for micronutrients, energy, and macronutrients to support the mother’s health and foetal development [2–4]. In sub-Saharan Africa, maternal undernutrition remains a public health concern. This includes Ethiopia, where the prevalence and incidence of maternal […]

The under-five mortality rate has declined in Ethiopia by two-thirds, from 204 in 1990 to 55 in 2019 per 1000 live births [1]. Although causes vary by age group, pneumonia, diarrhoea, and newborn conditions of asphyxia, sepsis, and prematurity account for nearly 90% of under-five deaths in Ethiopia. The underlying cause for almost half of […]

Background: Drug-resistant tuberculosis (DR-TB) is a major challenge hindering global tuberculosis control. Ethiopia conducted a third national antituberculosis (TB) drug resistance survey, and this is the first survey to report on drug resistance using whole genome sequencing (WGS) in addition to genotypic and phenotypic test results. The aim of this study was to obtain up-to-date information regarding the magnitude and pattern of drug resistance in Ethiopia. Methods: A nationwide cross-sectional study was conducted in 217 health facilities across all Ethiopian regional states from August 2017 to January 2019. Sputum specimens were collected from patients with bacteriologically confirmed pulmonary TB to detect resistance to anti-TB drugs with Xpert MTB/RIF assay, culture-based phenotypic drug susceptibility testing (DST), and WGS with phylogenetic analysis. Results: The prevalence of rifampicin-resistant TB (RR-TB) was 1.07% (95% confidence interval [CI], .65%–1.74%) among new cases and 6.89% (95% CI, 4.02%–11.57%) among previously treated cases. The prevalence of isoniazid-resistant, rifampicin-susceptible TB was 4.15% (95% CI, 3.11%–5.53%) among new cases and 4.41% (95% CI, 1.97%–9.57%) among previously treated cases. While resistance to fluoroquinolones was detected in 1 RR-TB case, resistance to bedaquiline and linezolid was not detected in RR-TB cases. Mycobacterium tuberculosis lineage 4 was the most common, followed by lineage 3 and lineage 1, with sublineage 4.2.2 being the most frequent. Conclusions: The level of RR-TB remained low. Expanding baseline DST for isoniazid may help further lower the burden of DR-TB in Ethiopia.

Although under-five mortality has dropped by 60% since 1990, approximately 5.2 million children aged <5 years died in 2019, mostly in low- and middle-income countries (LMICs) [1]. In the same year, diarrhoea was the second leading cause of death for these children [2,3]. The World Health Organization (WHO) defines diarrhoea as the passage of three […]

Although preventable and treatable, diarrhoea is the leading cause of morbidity and mortality among children aged <5 years globally [1]. In 2019, diarrhoea was responsible for the deaths of 370 000 children aged <5 years worldwide [2–5]. Diarrhoea is widespread in low- and middle-income countries (LMICs). Children aged <5 years in low-income countries experience an average […]

Background: Coronavirus disease 2019 (COVID-19) vaccination is crucial for healthcare workers (HCWs) to protect themselves and promote public health. Aim: This study assessed COVID-19 vaccination uptake, barriers and enhancers among HCWs in high-burden cities in Ethiopia. Setting: A cross-sectional survey among 600 randomly selected HCWs from 30 health facilities (May 2023 to July 2023). Methods: Interviewer-administered questionnaires assessed vaccination status, concerns and motivators. Descriptive statistics and modified Poisson regression identified factors associated with vaccination. Results: Overall, 70.3% (n = 422) received at least one dose, and 39.2% (n = 235) were fully vaccinated. Safety concerns (51.9%) were the main barrier. More information on safety and efficacy (53.1%) and regulatory approval (27.3%) were key motivators. Those not recommending vaccination were less likely to be vaccinated (prevalence ratio [PR] = 0.59, 95% confidence interval [CI]: 0.41–0.85). Professionals such as radiographers (PR = 0.78), pharmacists (PR = 0.79) and laboratory personnel (PR = 0.85) were less likely compared to physicians. Older HCWs (> 25 years) were twice as likely to be vaccinated. HCWs in health centres were more likely to be vaccinated than those in hospitals (PR = 1.201, 95% CI: 1.076–1.341). Conclusion: A significant proportion of HCWs were not fully vaccinated. Targeting hospital workers and younger age groups and improving HCWs confidence in recommending vaccination can increase uptake. Contribution: This study reveals COVID-19 vaccine safety, efficacy and confidence concerns of HCWs, highlighting the need for targeted awareness to strengthen national vaccination efforts against pandemics.

The World Health Organization (WHO) defines diarrhoea as the passage of three or more loose or liquid stools per day [1]. It is usually a symptom of an infection in the intestinal tract, which could be bacterial, viral, or parasitic [1,2]. Diarrhoea may cause severe dehydration and malnutrition which increases the risk of death [1,3]. […]