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Analytical summary - Tuberculosis

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Ethiopia ranks third in Africa and eighth among the 22 highest tuberculosis (TB) burdened countries in the world. The prevalence of all forms of TB is estimated at 261 per 100 000 population, leading to an annual mortality rate of 64 per 100 000 population. The incidence rate of all forms of TB is estimated at 359 per 100 000 population, while the incidence rate of smear-positive TB is 108 per 100 000 population. The TB case detection rate, treatment success rate and TB cure rate are 74%, 82.5% and 67%, respectively (see figure).[1]

Multidrug-resistant TB (MDR-TB) is a challenge. A countrywide survey between 2003 and 2006 showed that the prevalence of MDR-TB was 1.6% in new TB cases and 11.8% in retreatment cases. In addition, there was a high TB/HIV coinfection rate, with 25% of registered TB cases also testing positive for HIV.[2]

Trends in TB case detection rate, treatment success rate and cure rate[1]

TB and leprosy prevention and control objectives aim to reduce the incidence and prevalence of TB and related morbidity, mortality and psychological suffering to the extent that the disease is no longer a public health threat. To attain TB and leprosy prevention and control targets, there is a focus on expanding DOTS, the basic package that underpins the Stop TB Strategy, through:

  • maximizing the use of the Health Extension Programme[3]
  • enhancing case detection and management
  • addressing issues related to TB/HIV and MDR-TB
  • promoting research by engaging all providers including the private for-profit sector.

Nearly 92% of hospitals and 95% of health centres implemented DOTS-based services in 2011. In addition, TB treatment follow-up under DOTS was given in 2100 health posts across the country. Overall, there are 4577 public DOTS facilities and 317 public–private mix DOTS facilities.

With respect to community-based DOTS, procedure guidelines and health management information system materials have been prepared and distributed to health extension workers. MDR-TB has been identified as a priority public health problem. A total of 218 patients have begun MDR-TB treatment in hospitals in Addis Ababa and in two other regions. So far, 119 professionals have been trained in the treatment regime.[1]

Fully integrated TB control is constrained by a lack of human resources and difficulty in providing outreach services, particularly in rural areas. Expansion of the network of general health care facilities is expected to improve access to health care and ultimately help achieve targets for TB control. TB control is aligned with this expansion of health care through the national health plan.

The Health Extension Programme,[3] employing almost 30 000 health service extension workers, is the backbone of all interventions carried out at community level and is designed to provide preventive services, including detection and referral of TB suspects, in all rural villages.[2]

References

  1. 1.0 1.1 1.2 Health Sector Development Programme IV. Annual performance report. Addis Ababa, Government of Ethiopia, Ministry of Health, 2011
  2. 2.0 2.1 Global tuberculosis control 2009. Epidemiology strategy financing (pdf 6.95Mb). Geneva, World Health Organization, 2009
  3. 3.0 3.1 Health Extension Program in Ethiopia. Profile (pdf 2.10Mb). Addis Ababa, Government of Ethiopia, Ministry of Health, 2007