Spiritual holy water sites in Ethiopia : unrecognized high-risk settings for transmission of pulmonary tuberculosis

Reta, Melese Abate; Maningi, Nontuthuko Excellent; Wubetu, Gizachew Yismaw; Olorunju, Steve A.S.; Fourie, P.B. (Petrus Bernardus)

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Spiritual holy water sites in Ethiopia : unrecognized high-risk settings for transmission of pulmonary tuberculosis

Reta, Melese Abate; Maningi, Nontuthuko Excellent; Wubetu, Gizachew Yismaw; Olorunju, Steve A.S.; Fourie, P.B. (Petrus Bernardus)

URI: http://hdl.handle.net/2263/101456

Date: 2024-04-08

Abstract:

Ethiopia is a high-tuberculosis (TB) burden country with 157 new cases per 100,000 people, with 23,800 TB-related deaths in 2020. In Ethiopia, TB patients have different healthcare-seeking behaviors. They frequently visit spiritual places, such as holy water sites (HWSs), to seek treatment for their illness spiritually. This study examined the prevalence of pulmonary TB (PTB) and drug susceptibility profiles of Mycobacterium tuberculosis (MTB) isolates among spiritual HWS attendees in Northwest Ethiopia. A cross-sectional study was conducted from June 2019 to March 2020. Sputum samples were collected, processed, and cultured using Löwenstein-Jensen (LJ) culture medium. Second-generation line probe assays (LPAs), GenoType®MTBDRplus VER2.0 and GenoType®MTBDRsl VER2.0, were used to detect anti-TB drug-resistant isolates. STATA 17 was utilized to perform descriptive statistics, bivariate, and multivariate regression analyses. Of 560 PTB-symptomatic participants, 21.8% ((95% confidence interval (95 CI): 18.4-25.2%)) were culture-positive, resulting in a point prevalence of 1,183/100,000 attendees. Amongst HWS attendees, culture-positive TB occurred most commonly in persons 18-33 years of age (28.5% (95 CI 23.4-34.3%)). Other participant characteristics significantly associated with culture-positive PTB were as follows: rural residents (adjusted odds ratio (aOR) 2.65; 95 CI 1.38-5.10), married participants (aOR 2.43; 95 CI 1.28-4.63), family members >5 per household (aOR 1.84; 95 CI 1.04-3.24), and sharing living space (aOR 10.57; 95 CI 3.60-31.13). Also, among 438 participants followed for 12 months after showing negative TB culture results while at the HWS, 6.8% (95 CI 4.4-9.4%) developed or contracted culture-positive TB post-residency at the HWSs. Of the 122 tested isolates, 20 (16.4%) were isoniazid (INH) and/or rifampicin (RIF) resistant. Multidrug-resistant (MDR) TB was detected in 15 cases (12.3%), five of which were fluoroquinolones (FLQs) resistant. The findings from this study should raise a concern about HWSs as potential high-risk settings for TB transmission. It is recommended that appropriate control measures be instituted that include compulsory TB testing and tightened infection control at HWSs, where an increased risk exists for transmission of TB.

Description:

DATA AVAILABILITY : The data sets analyzed during this study are available from the corresponding author upon reasonable request.

SUPPLEMENTARY MATERIAL : TABLE S1 illustrates the administrative zones that were included during the study, the spiritual holy water sites that were selected from each administrative zone, the total number of attendees who were screened for pulmonary TB (PTB) symptoms, the number of attendees who had PTB-suggestive symptoms, the number of bacteriologically confirmed cases, and the number of individuals who were Löwenstein–Jensen culture-negative test result. TABLE S2 shows the proportion of PTB positivity by gender and age group. The proportion estimation analysis revealed that the prevalence of culture-positive PTB was nearly equal for males and females (21.8% ± 2.35SE Vs 21.8% ± 2.6SE). Also, participants aged 18 to 33 years had a higher proportion of culture-positive PTB (28.5% ± 2.8SE). TABLE S3 summarizes the bivariate logistic regression analysis of socio-demographic characteristics of participants and associated risk factors for culture-positive PTB. The analysis revealed that participants aged 34–49 years and rural residents were statistically associated with culture-positive PTB (p < 0.05). Furthermore, the analysis revealed that few independent variables were statistically associated with culture-positive PTB (p ≤ 0.01), including a history of TB disease, contact with chronic coughers or active TB patients, having had close contact with a family member who had TB, the number of days spent (>21) at HWS, and sharing living spaces at HWS. In TABLE S4, we compute the proportion of any drug-resistant TB and MDR-TB among each age group of participants in each study area. This allows us to assess the extent to which each age group appears to be affected by any drug-resistant TB and MDR-TB strains. Similarly, as illustrated in TABLE S5, we used a logistic regression analysis model to determine the odds of developing any drug-resistant TB and MDR-TB among participants in each study site. TABLES S6 and S7 provide detailed data about participants who had culture-negative test results while at HWS. TABLE S6 illustrates the profiles of participants and the proportion of developing active TB disease post-residency at the HWS among those who had culture-negative results while at HWS. Besides, TABLE S7 shows the bivariate and multivariate logistic regression analysis of the socio-demographic characteristics of participants and associated factors among those who reported contracting active TB disease post-exposure to HWS.

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