Therapeutic Effectiveness of Artemether-Lumefantrine for the Treatment of Uncomplicated Plasmodium Falciparum Malaria in Asayita Primary Hospital, Northeast Ethiopia
| dc.contributor.advisor | Tadesse Kebede | |
| dc.contributor.author | Alemayehu Sintayehu | |
| dc.date.accessioned | 2026-06-22T14:52:59Z | |
| dc.date.available | 2026-06-22T14:52:59Z | |
| dc.date.issued | 2025 | |
| dc.description.abstract | Background: There was a global ‘missing millions’ gap between the incidence of tuberculosis (TB) cases and the notified cases. An active household contact (HHCs) investigation is one of the strategies to narrow this gap. It has the advantage of giving early diagnosis and preventive treatment to vulnerable and eligible groups. In many TB high-burden countries, only about 25% of HHCs completed TB screening, and 20–89% of eligible contacts did not adhere to TB preventive treatment. Delivering screening services near the community is important to narrow these gaps. Recognizing the transmission dynamics of Mycobacterium tuberculosis complex (MTBC) and identifying their prevalent lineages and genotypes are important in TB control and management. Objectives: This study investigated the epidemiology of active TB, TB contact screening practice, TB transmission dynamics, genetic diversity, and identified drug-resistance patterns in epidemiologically linked pulmonary TB (PTB) index cases and their HHCs in central part of Ethiopia. Methods: A cross-sectional study was carried out in 15 selected public health facilities of central part of Ethiopia from January 2022 to December 2023. The routine TB contact screening practice was assessed using one year (January, 2022 to December, 2022) data from the registration book of the study sites. Three hundred three voluntary bacteriologically confirmed PTB patients and 902 of their HHCs, without discrimination by age, were included in the study. Household contacts were screened using the World Health Organization (WHO) recommended TB symptom-based screening tool using a pre-tested questionnaire. A morning sputum sample was collected from 303 index cases and 182 HHCs having presumptive TB. Then it was examined on Xpert MTB/RIF Ultra assay, AFB microscopy (from sediment), and M. tuberculosis culture. The culture-positive 272 index cases and 13 HHC isolates were examined by phenotypic drug susceptibility test (pDST). A total of 13 index-HHC pairs and 24 randomly selected index case isolates were whole genome sequenced (WGS) using Illumina Nextseq 550. The TB-profiler and Ridom SeqSphere software were used for drug resistance and genotypic analysis. Data was entered into EPI Info version 7.0 databases and analysed using STATA V.17 software. Descriptive statistics were used to summarize the data. Chi-square test and Yates continuity correction test were used to analyse associated factors. Multivariable logistic regression analysis was done to investigate the associated vi risk factors for active TB in HHCs. Variables with a p-value A), as well as Ethionamide resistance (ethA p. Ile338Ser), which were absent from the WHO 2023 Catalogue of mutations in the Mycobacterium tuberculosis complex. Conclusion: The yield of routine TB contact investigation practice was low, and the quality of screening and adherence were suboptimal. The Home-to-home TB contact screening approach has a high active TB yield and was implementable in both rural and urban areas by mentoring and motivating the health extension workers. Scheduling convenient times and last-mile service delivery to contacts is very important to address the missed active TB cases in the community. Nearly one-third of the HHCs have discordant phenotypic drug-resistance profiles from the index patients. This study offers compelling proof that it is not advisable to treat close contacts without DST results based on the DST results of the supposed source case. Individuals residing in areas with a high burden of tuberculosis are at risk of contracting the disease from sources beyond their homes. Keywords: Active tuberculosis yield, Contact investigation, Household contacts, Index case, Transmission dynamics, Whole genome sequencing | |
| dc.identifier.uri | https://etd.aau.edu.et/handle/123456789/8294 | |
| dc.language.iso | en | |
| dc.publisher | Addis Ababa Universtity | |
| dc.subject | Therapeutic effectiveness | |
| dc.subject | Artemether-lumefantrine | |
| dc.subject | Malaria | |
| dc.subject | Ethiopia | |
| dc.title | Therapeutic Effectiveness of Artemether-Lumefantrine for the Treatment of Uncomplicated Plasmodium Falciparum Malaria in Asayita Primary Hospital, Northeast Ethiopia | |
| dc.type | Thesis |