Spatial co-distribution of tuberculosis prevalence and low BCG vaccination coverage in Ethiopia.

While bacille-calmette-guerin (BCG) vaccination is one of the recommended strategies for preventing tuberculosis (TB), its coverage is low in several countries, including Ethiopia. This study investigated the spatial co-distribution and drivers of TB prevalence and low BCG coverage in Ethiopia. This ecological study was conducted using data from a national TB prevalence survey and the Ethiopian demographic and health survey (EDHS) to map the spatial co-distribution of BCG vaccination coverage and TB prevalence. A Bayesian geostatistical model was built to identify the drivers for the spatial distribution of TB prevalence and low BCG vaccination coverage. BCG vaccination coverage was defined as the number of children who received the vaccine divided by the total number of children born within five years preceding the EDHS surveys. Parameter estimation was done using binary logistic regression. Prediction maps for the co-distribution of high TB prevalence and low BCG vaccination coverage were created by overlying spatial prediction surfaces of the two outcomes. Posterior means and a 95% Bayesian credible interval (CrI) were used to summarize the parameters of the model. The national prevalence was 0.40% (95% confidence interval (CI) 0.34%, 0.47%) for TB and 47% (95% CI 46%, 48%) for vaccination coverage. Substantial spatial variation in TB prevalence and low BCG coverage was observed at a regional and local level, particularly in border areas of the country, including the Somali, Afar, and Oromia regions. Approximately 58% of the pixels (i.e., geographical area or spatial units) with high TB prevalence exhibited low BCG coverage in the same location. While travel time to cities (Mean = 0.28, 95% BCI: 0.15, 0.41) and distance to health facilities (Mean = 0.43, 95% CI 0.22, 0.63), were positively associated, population density (Mean = -0.04, 95% BCI -0.05, -0.02) was negatively associated, with the proportion of unvaccinated children for BCG indicating areas near health facilities and cities have better BCG coverage. However, there were no significant predictors for TB prevalence. Substantial spatial co-distribution between high TB prevalence and low BCG coverage was observed in some parts of the country, indicating that there are areas where the TB burden is not being adequately managed through the provision of vaccines in Ethiopia. Scaling up BCG vaccination coverage and TB diagnosis and treatment through improving access to health services in border regions such as Somalia and Afar would be important to reduce the prevalence of TB in Ethiopia.

Wolde HF ，Clements ACA ，Gilmour B ，Alene KA ... -  《Scientific Reports》

Diabetes as a risk factor for tuberculosis disease.

Franco JV ，Bongaerts B ，Metzendorf MI ，Risso A ，Guo Y ，Peña Silva L ，Boeckmann M ，Schlesinger S ，Damen JA ，Richter B ，Baddeley A ，Bastard M ，Carlqvist A ，Garcia-Casal MN ，Hemmingsen B ，Mavhunga F ，Manne-Goehler J ，Viney K ... -  《Cochrane Database of Systematic Reviews》

Geospatial mapping to assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using EDHS 2019: Spatial and geographical weighted regression.

Zero-dose vaccine status refers to a child who has not yet received any childhood vaccines. Globally, zero-dose vaccination status is the major public health problem. In sub-Saharan African countries, among five children, one child did not access the vaccines. The efforts to identify the factors contributing to the zero-dose vaccine have not yet been addressed in Ethiopia. To assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using Ethiopian demographic health survey 2019. A secondary analysis of a cross-sectional study was used among a total of 3208 participants. Stata-14, Arc geographic information system-10.3, and Sat Scan software were used to analyze the data. Moran's I statistic was used to assess the non-random distribution of zero-dose vaccination status. Spatial and geographically weighted regression was used to map the distribution and determinants of zero-dose vaccination status in Ethiopia. The Getis-Ord-statistics and Sat Scan analysis were also used to identify the hot spot area and significant clusters respectively. To identify significant factors, a p-value <0.05 was used. The prevalence of zero-dose vaccination status among children aged 12-35 months old was 16.3% (95%CI, 15%-17.6%). The distribution of zero-dose vaccination status in Ethiopia was not randomly distributed across the area (Moran's I value = 0.4, p<0.001). The hotspot area of zero-dose vaccination status in Ethiopia was located in Afar, Somalia, and the south nations region. The primary cluster was located at 5.479641 N and 42.196835 E within a 405.96 km radius in the Somali region. The highest effect (β, 0.23-0.24) of give birth at home on zero-dose vaccination status was observed in Afar, Somalia, and Tigray, whereas the lowest effect of home delivery (β, 0.21-0.22) was observed in south nations, Gambela, and the western part of Benishangul Gumuz. Additionally, the poor wealth index had the highest effect on zero-dose vaccination status (β, 0.06-0.07) in south nations, Benishangul Gumuz, and the Gambela region, and the lowest effect of the poor wealth index (β, 0.03-0.04) was observed in Somalia and the Afar region. The zero dose child in Ethiopia was low. Geographically, the highest proportion of zero-dose vaccination status among children was in the Somali and Afar regions. Home delivery had the highest and most positive effect on zero-dose vaccination status in Afar, Somalia, and the Tigray region. Additionally, the poor wealth index had the highest and most positive effect in Somalia and the Afar region. Expanding delivery at the health facility and economic empowerment of women are recommended to improve vaccination in Ethiopia.

Agimas MC ，Asmamaw M ，Hailu MK ，Kidie T ，Abuhay HW ，Yismaw GA ，Derseh NM ... -  《PLoS One》

Trends and inequalities in BCG immunisation coverage among one-year-olds in Sierra Leone, 2008-2019.

Bacillus Calmette-Guérin (BCG) vaccination is a cornerstone of childhood immunisation programs, protecting against tuberculosis (TB), a major public health concern. Sierra Leone, a West African nation, faces challenges in achieving equitable and high BCG immunisation coverage. This study delves into the trends and inequalities in BCG coverage among one-year-old children in Sierra Leone between 2008 and 2019. Three rounds of data from the Sierra Leone Demographic and Health Surveys (2008, 2013, and 2019) were used to analysed to examine the inequalities in BCG coverage. Simple measures of inequality [Difference (D) and Ratio (R)] and complex measures of inequality [Population Attributable Ratio (PAR) and Fraction (PAF)] were calculated in the World Health Organization's Health Equity Assessment Toolkit (WHO's HEAT) software. The measures were calculated separately for each of the three surveys for age groups of women, level of education, economic status, residential areas, gender, and sub-national provinces, and their estimates were compared. The findings revealed that BCG immunisation coverage in Sierra Leone has increased significantly from 2008 (82.0%) to 2019 (96.3%). Age-related inequalities between children of older mothers (20-49) and younger mothers (15-19) increased from a Difference of -4.7 percentage points in 2008 to 4.8 percentage points in 2019. The PAF increased from zero in 2008 to 0.4% in 2019. This means that in the absence of age-related inequalities, the national average of BCG immunisation coverage would have increased by 0.4%. Economic-related inequalities between children of mothers in Quintile 5 (richest) and Quintile 1 (poorest) decreased from a Difference of 9.2 percentage points in 2008 to 1.2 percentage points in 2019. Educational-related inequalities between children of mothers with secondary/higher education and no education decreased from a Difference of 14.1 percentage points in 2008 to 0.4 percentage points in 2019. The PAF decreased from 13.3% in 2008 to 0.2% in 2019, indicating that without educational-related inequalities the setting average of BCG immunisation coverage would have increased by 0.2%. Place of residence-related inequalities between children of mothers living in urban areas and rural areas decreased from a Difference of 9.3 percentage points in 2008 to 0.7 percentage points in 2019. The PAF decreased from 8.5% in 2008 to 0.5% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 0.5% without place of residence-related inequalities. The sex of the child-related inequalities between male and female children decreased from a Difference of 5.4 percentage points in 2008 to 0.7 percentage points in 2019. The PAF decreased from 3.3% in 2008 to 0.4% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 0.4% without sex of the child-related inequalities. Provincial inequalities decreased from a Difference of 18.5 percentage points in 2008 to 2.3 percentage points in 2019. The PAF decreased from 14.3% in 2008 to 1.1% in 2019 indicating that the national average of BCG immunisation coverage would have increased by 1.1% without provincial inequalities. The findings indicate a substantial improvement in BCG immunisation coverage in Sierra Leone among one-year-olds, reflecting successful public health initiatives. However, age-related inequalities have worsened, with coverage among children of younger mothers declining relative to those of older mothers, suggesting a need for targeted interventions for this population. In contrast, economic, educational, sex, and place of residence-related inequalities have notably decreased, indicating progress in equitable access to immunisation across different socioeconomic strata. Additionally, provincial inequalities have decreased significantly, yet a difference of 2.3 percentage points remains, highlighting the need for continued efforts to ensure that all provinces, receive adequate healthcare resources and outreach. The absence of economic-related inequality by 2019 is particularly encouraging, as it suggests that economic barriers to immunisation have been effectively addressed. Furthermore, the reduction in educational and provincial inequalities highlights the effectiveness of strategies aimed at improving access and awareness in underserved areas.

Osborne A ，Wongnaah FG ，Bangura C ，Ahinkorah BO ... -  《BMC PUBLIC HEALTH》

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling.

Elwenspoek MM ，Thom H ，Sheppard AL ，Keeney E ，O'Donnell R ，Jackson J ，Roadevin C ，Dawson S ，Lane D ，Stubbs J ，Everitt H ，Watson JC ，Hay AD ，Gillett P ，Robins G ，Jones HE ，Mallett S ，Whiting PF ... -  《-》