Hepatitis E Virus Outbreak among Tigray War Refugees from Ethiopia, Sudan.
Ontology highlight
ABSTRACT:
SUBMITTER: Ahmed A
PROVIDER: S-EPMC9328910 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
Publications
Hepatitis E Virus Outbreak among Tigray War Refugees from Ethiopia, Sudan.
Ahmed Ayman A Ali Yousif Y Siddig Emmanuel Edwar EE Hamed Jehan J Mohamed Nouh S NS Khairy Amna A Zinsstag Jakob J
Emerging infectious diseases 20220801 8
We report hepatitis E virus (HEV) outbreaks among refugees from Ethiopia in Sudan during June 2021-February 2022. We identified 1,589 cases of acute jaundice syndrome and used PCR to confirm HEV infection in 64% of cases. Implementing vaccination, water, sanitation, and hygiene programs might reduce HEV outbreak risk. ...[more]
Similar Datasets
Project description:BackgroundCivilians bear a significant burden of morbidity and mortality in modern armed conflicts, particularly when explosive weapons are used in densely populated areas. Many civilian facilities were attacked in the war in Tigray since the beginning of hostilities in November 2020. This study assessed the impact of airstrikes on civilians from June 2021 until the signing of the Agreement for Lasting Peace through a Permanent Cessation of Hostilities between the Ethiopian Government and the Tigray People's Liberation Front in November 2022.MethodsA retrospective review was conducted of all injury data reported between June 2021-October 2022 from each district health facility in six zones of Tigray, Ethiopia. Descriptive analysis was conducted for variables of interest (e.g., age, sex, location, injury outcomes).ResultsA total of 1,143 casualties from airstrikes were reported from six zones and 24 districts of Tigray, Ethiopia. From the total of 80 instances of drone and aerial bombardments incidents, one third of the airstrikes resulted in death (33.7%, n = 385). The mean age of the victims was 28.9 years (SD = 17.9) with a range of less than 1 year to 87 years. Almost a third of the victims (28.3%, n = 323) were children aged < 18 years. Approximately 5% of casualties were age > 60 years (5.3%, n = 61). Almost half (45.1%, n = 516) of the causalities were female including pregnant and lactating women. The Southern and Northwest zones suffered the most casualties, followed by the Southeast zones and Mekelle. The airstrikes took place predominantly in civilian areas, including marketplaces, internally displaced persons (IDP) camps, residential areas, public transportation, villages, children's playgrounds, churches, mills and hospitals, resulting in numerous casualties that disproportionately affected civilians, especially children, the elderly and women.ConclusionsCivilians suffered significant death and injury from airstrikes during hostilities in the war in Tigray, including a high proportion of women and children. The most common targets were civilian facilities including IDP camps, which the United Nations has determined to be a crime against humanity. Enhanced collaboration between health and protection stakeholders can improve support to victims from immediate post-injury care as well as rehabilitation so that they can live as healthy, dignified, and productive citizens.
| S-EPMC11909939 | biostudies-literature
Project description:BackgroundIn resource-limited countries with weak healthcare systems, women of reproductive age are particularly vulnerable during times of conflict. In Tigray, Ethiopia, where a war broke out on 04 November 2020, there is a lack of information on causes of death (CoD) among women of reproductive age. This study aims to determine the underlying CoD among women of reproductive age during the armed conflict in Tigray.MethodsThis community-based survey was carried out in six Tigray zones, excluding the western zone for security reasons. We used a multistage stratified cluster sampling method to select the smallest administrative unit known as Tabiya. Data were collected using a standardized 2022 WHO Verbal Autopsy (VA) tool. The collected data were analyzed using the InterVA model using R analytic software. The study reported both group-based and cause-specific mortality fractions.ResultsA total of 189,087 households were screened and 832 deaths were identified among women of reproductive age. The Global Burden of Disease classification showed that infectious and maternal disorders were the leading CoD, accounting for 42.9% of all deaths. External causes contributed to 26.4% of fatalities, where assault accounted for 13.2% of the deaths. Maternal deaths made up 30.0% of the overall mortality rate. HIV/AIDS was the primary CoD, responsible for 13.2% of all deaths and 54.0% of infectious causes. Other significant causes included obstetric hemorrhage (11.7%) and other and unspecified cardiac disease (6.6%).ConclusionsThe high proportion of infectious diseases related CoD, including HIV/AIDS, as well as the occurrence of uncommon external CoD among women, such as assault, and a high proportion of maternal deaths are likely the result of the impact of war in the region. This highlights the urgent need for targeted interventions to address these issues and prioritize sexual and reproductive health as well as maternal health in Tigray.
| S-EPMC10936770 | biostudies-literature
Project description:BackgroundThe Coronavirus disease 2019 (COVID-19) has put an enormous encumbrance on the healthcare system and healthcare workers (HCWs) worldwide, particularly in war-torn areas. As the world strives to end the pandemic, knowing the magnitude of the infection and its contributing factors in fragile settings is critical to prevent further waves of the pandemic.MethodsUsing rapid diagnostic tests (RDTs), a facility-based cross-sectional study was conducted to assess the prevalence of COVID-19 and its associated factors. The study was conducted among 326 unvaccinated HCWs in two hospitals in Tigray, Ethiopia from. The study period was from June 26 to December 31, 2021. Descriptive statistics were used to analyze the characteristics of study participants and the magnitude of COVID-19 while multivariate logistic regression was applied to assess factors affecting COVID-19 infection among HCWs.ResultsThe seroprevalence of COVID-19 among HCWs in the war-torn region of Tigray was 52.4% and 56.5% using Cellex and INNOVA antibody RDTs, respectively. The point prevalence, using Abbot Antigen test, was 14.2%. The overall infection prevention and control practice (IPC) and facility preparedness was poor with >85% of the HCWs reporting not wearing eye goggle/face shield and respirator in activities that needed transmission-based precautions; none of the participants reporting as having separate waste disposal system for COVID-19 cases; and only 56.8% reporting as having an isolation area during the time of testing. In the multivariate analysis, not having isolation area (AOR = 19.6, 95% CI: 7.57-50.78), re-using of personal protective equipment (PPE) (AOR = 3.23, 95% CI: 1.54-6.77), being symptomatic (AOE = 2.4, 95% CI: 1.02-5.67), and being a medical doctor, doctor of dental surgery, and anesthetist (AOR = 3.64, 95% CI: 1.05-12.66) were significantly associated with having at least one positive result.ConclusionsShortage of PPE supply, poor IPC practice, suboptimal facility preparedness, and low vaccination coverage in the region contributed to the high rate of COVID-19 infection among HCWs observed in this study.
| S-EPMC11581278 | biostudies-literature
Project description:ImportanceThe war in Tigray, Ethiopia, has disrupted the health care system of the region. However, its association with health care services disruption for chronic diseases has not been well documented.ObjectiveTo assess the association of the war with the utilization of health care services for patients with chronic diseases.Design, setting, and participantsOf 135 primary health care facilities, a registry-based cross-sectional study was conducted on 44 rural and semiurban facilities of Tigray. Data on health services utilization were extracted for patients with tuberculosis, HIV, diabetes, hypertension, and psychiatric disorders in the prewar period (September 1, to October 31, 2020) and during the first phase of the war period (November 4, 2020, to June 30, 2021).Main outcomes and measuresRecords on the number of follow-up, laboratory tests, and patients undergoing treatment of the aforementioned chronic diseases were counted during the prewar and war periods.ResultsOf 4645 records of patients with chronic diseases undergoing treatment during the prewar period, 998 records (21%) indicated having treatment during the war period. Compared with the prewar period, 59 of 180 individuals (33%; 95% CI, 26%-40%) had tuberculosis, 522 of 2211 (24%; 95% CI, 22%-26%) had HIV, 228 of 1195 (19%; 95% CI, 17%-21%) had hypertension, 123 of 632 (20%; 95% CI, 16%-22%) had psychiatric disorders, and 66 of 427 (15%; 95% CI, 12%-18%) had type 2 diabetes records, which revealed continued treatment during the war period. Of 174 records of patients with type 1 diabetes in the prewar period, at 2 to 3 months into the war, the numbers dropped to 10 with 94% decline compared with prewar observations.Conclusions and relevanceThis study found that the war in Tigray has resulted in critical health care service disruption and high loss to follow-up for patients with chronic disease, likely leading to increased morbidity and mortality. Local, national, and global policymakers must understand the extent and impact of the service disruption and urge their efforts toward restoration of those services.
| S-EPMC10472195 | biostudies-literature
Project description:An investigation of a foot-and-mouth disease (FMD) outbreak was conducted between late October and mid-December 2019 in Tigray region. The outbreak investigation team collected epidemiological data from the six villages of Kafta Humera and Seharti Samre districts, including morbidity proportions, mortality proportions, and clinical signs, and cattle management and vaccination history were collected via participatory methods, including interviews and group discussions with local experts and farmers in Kafta Humera and reports from the district veterinarians in Seharti Samre. Twenty-two tissue samples were collected for laboratory confirmation. Overall, 4,299/9,811 (43.8%) and 13,654/16,921 (80.6%) cattle showed clinical signs for FMD in Kafta Humera and Seharti Samre, respectively. In Kafta Humera, the highest morbidity proportion was found in adult cows and heifers (48.1%), followed by 27.8% in oxen and 15.9% in calves. In Seharti Samre, the morbidity proportion was similar in all age groups at ~81%. No death of FMD-suspected cattle was reported throughout the outbreak. The serotype of foot-and-mouth disease virus (FMDV) identified by laboratory analysis differed between the two districts (serotype O in Kafta Humera and serotype A in Seharti Samre). We, therefore, suggest that the outbreaks in the two districts occurred independently from each other. Experts and farmers were interviewed and believed that the outbreak in Kafta Humera was most likely caused by interaction between cattle and wildlife from the surrounding Kafta Sheraro National Park, which share common grazing land. This outbreak investigation showed that FMD can cause devastating cattle morbidity. A regular vaccination program against the identified circulating FMDV serotypes with sufficient coverage is required to avoid future outbreaks.
| S-EPMC10462391 | biostudies-literature
Project description:ObjectiveWe investigated this outbreak to describe the magnitude and associated risk factors due to the malaria outbreak in Tanquae Abergelle district, Tigray, Ethiopia, in 2017.ResultCase fatality rate of this study was zero. Among the 62 cases and 124 controls, the presence of mosquito breeding sites [OR = 6.56 CI (2.09-20.58) P value = 0.001], sleeping outside a home [OR = 5.06 CI (1.75-14.61) P-value = 0.003] and having unscreened window [OR = 14.89 CI (1.87-118.25) P-value = 0.011] were associated with illness in multivariate analysis.
| S-EPMC6778373 | biostudies-literature
Project description:BackgroundMore than 70% of the health facilities in Tigray, northern Ethiopia, have been totally or partially destroyed by the recent war in the region. Diagnosis and management of tuberculosis were among many health services that suffered. In this study we assess the status of tuberculosis care in health facilities of Tigray during the recent war and compare it with the immediate pre-war state.MethodsUsing sequential mixed method, we analyzed and compared the availability of diagnostic services in 69 health facilities and the utilization of tuberculosis care in 50 of them immediately before the war (September-October 2020) and during the war (November-July 2021). TB focal persons in each selected health facility were interviewed to evaluate the status of diagnostic services. Patient service utilization was assessed using health facility registrations. We also compared the average monthly case detection rate of multidrug resistant tuberculosis in the region before and during the war. We computed summary statistics and performed comparisons using t-tests. Finally, existing challenges related to tuberculosis care in the region were explored via in-depth interviews. Two investigators openly coded and analyzed the qualitative data independently via thematic analysis.ResultsAmong the 69 health facilities randomly selected, the registers of 19 facilities were destroyed by the war; data from the remaining 50 facilities were included in the TB service utilization analysis. In the first month of the war (November 2021) the number of tuberculosis patients visiting health facilities fell 34%. Subsequently the visitation rate improved steadily, but not to pre-war rates. This reduction was significant in northwest, central and eastern zones. Tuberculosis care in rural areas was hit hardest. Prior to the war 60% of tuberculosis patients were served in rural clinics; this number dropped to an average of 17% during the war. Health facilities were systematically looted. Of the 69 institutions assessed, over 69% of the microscopes in health centers, 87.5% of the microscopes in primary hospitals, and 68% of the microscopes in general hospitals were stolen or damaged. Two GeneXpert nucleic acid amplification machines were also taken from general hospitals. Regarding drug resistant TB, the average number of multidrug resistant tuberculosis (MDR TB) cases detected per month was reduced by 41% during the war with p-value < 0.001. In-depth interviews with eight health care workers indicated that the main factors affecting tuberculosis care in the area were lack of security, health facility destruction, theft of essential equipment, and drug supply disruption.Conclusion and recommendationMany tuberculosis patients failed to visit health facilities during the war. There was substantial physical damage to health care facilities and systematic looting of diagnostic equipment. Restoring basic public services and revitalizing clinical care for tuberculosis need urgent consideration.
| S-EPMC11005271 | biostudies-literature
Project description:Uganda experienced five Ebola disease outbreaks caused by Bundibugyo virus (n = 1) and Sudan virus (SUDV) (n = 4) from 2000 to 2021. On 20 September 2022, Uganda declared a fifth Sudan virus disease outbreak in the Mubende district, resulting in 142 confirmed and 22 probable cases by the end of the outbreak declaration on 11 January 2023. The earliest identified cases, through retrospective case investigations, had onset in early August 2022. From the 142 confirmed cases, we performed unbiased (Illumina) and SUDV-amplicon-specific (Minion) high-throughput sequencing to obtain 120 SUDV genome-and coding-complete sequences, representing 95.4% (104/109) of SVD-confirmed individuals within a sequence-able range (Ct ≤30) and 10 genome sequences outside of this range and 6 duplicate genome sequences. A comparison of the nucleotide genetic relatedness for the newly emerged Mubende variant indicated that it was most closely related to the Nakisamata SUDV sequence from 2011, represented a likely new zoonotic spillover event, and exhibited an inter- and intra-outbreak substitution rate consistent with previous outbreaks. The most recent common ancestor for the Mubende variant was estimated to have occurred in October and November 2021. The Mubende variant glycoprotein amino acid sequences exhibited 99.7% similarity altogether and a maximum of 96.1% glycoprotein similarity compared to historical SUDV strains from 1976. Integrating the genetic sequence and epidemiological data into the response activities generated a broad overview of the outbreak, allowing for quick fact-checking of epidemiological connections between the identified patients. IMPORTANCE Ebola disease (EBOD) is a public health threat with a high case fatality rate. Most EBOD outbreaks have occurred in remote locations, but the 2013-2016 Western Africa outbreak demonstrated how devastating EBOD can be when it reaches an urban population. Here, the 2022 Sudan virus disease (SVD) outbreak in Mubende District, Uganda, is summarized, and the genetic relatedness of the new variant is evaluated. The Mubende variant exhibited 96% amino acid similarity with historic SUDV sequences from the 1970s and a high degree of conservation throughout the outbreak, which was important for ongoing diagnostics and highly promising for future therapy development. Genetic differences between viruses identified during the Mubende SVD outbreak were linked with epidemiological data to better interpret viral spread and contact tracing chains. This methodology should be used to better integrate discrete epidemiological and sequence data for future viral outbreaks.
| S-EPMC10617429 | biostudies-literature
Project description:BackgroundWater, sanitation and hygiene (WASH) and infection prevention and control (IPC) are compromised during emergencies and in the post-conflict period. The IPC-WASH status of primary healthcare facilities in Tigray, Ethiopia, is not known. The aim of the study was to assess the IPC-WASH status of facilities in war-torn Tigray, Ethiopia.MethodsAs part of a cross-sectional study, data were collected from January to February 2024 in 32 randomly selected primary healthcare facilities using an electronic Open Data Kit (ODK) based on a questionnaire. A descriptive analysis was conducted to describe the IPC-WASH services. The analyzed data were compared with the Joint Monitoring Program (JMP) service ladders and presented in texts, figures and tables.ResultsNearly seven out of ten primary healthcare facilities had improved water sources, nine out of ten had latrines with limited sanitation facilities, and four out of ten had handwashing facilities. Eight out of ten facilities had no access to personal protective equipment, and most facilities surveyed had very limited waste management services, IPC capacity building and IPC committee. According to JMP service ladders, almost one in four primary healthcare facilities had basic water supply, one in ten had basic sanitation, basic hygiene and basic waste disposal.ConclusionsThe overall result of the study shows that access to IPC-WASH is low in primary healthcare facilities in war-torn Tigray, Ethiopia. Collaborative efforts to improve access to basic IPC-WASH facilities and IPC capacity building are essential to improve the quality of care.
| S-EPMC11489058 | biostudies-literature
Project description:Back groundHIV/AIDS remained among the common public health problems in developing country. Despite the extensive delivery of ART and improved coverage of the service access, still, man-made problems like war have negatively influenced the utilization of antiretroviral treatment services. The war in Tigray Region in the northern Ethiopia broke out in November 2020 and thereby has brought about an extreme damage on most of the infrastructure in Tigray, including the health institutions. The purpose of this study is, therefore, to assess and report the trend of HIV service provision across the war affected rural health facilities in Tigray.MethodsThe study was conducted in 33 rural health facilities during the active war in Tigray. A facility based retrospective cross-sectional study design was conducted among health facilities from July 03 to August 05, 2021.ResultA total of 33 health facilities from 25 rural districts were included in the HIV service delivery assessment. A total of 3274 and 3298 HIV patients were seen during pre-war period in September and October 2020, respectively. The number of follow-up patients during the war period in January remained to be only 847(25%) which is significantly reduced with a P value<0.001. A similar trend was observed during the subsequent months until May. The trend of follow-up patients on ART significantly declined from 1940 in September (pre-war) to 331(16.6%) in May (during the war). This study also revealed a 95.5% reduction of laboratory service provision to HIV/AIDS patients during the war in January and with similar trends thereafter (P<0.001).ConclusionThe war has led to a significant decline of HIV service provision in the rural health facilities and most part of the region during the first eight months of active war in Tigray.
| S-EPMC10153695 | biostudies-literature