A Survivor’s Fight

Shining A Light on Ethiopia’s Mission to Stop Tuberculosis

Ethiopia faces a significant challenge in combating tuberculosis (TB), a highly infectious disease impacting all age groups nationwide. The burden falls particularly heavily (68.1%) on the nation’s productive population, those aged 15-44. This prevalence not only leads to individual illness but also hinders economic growth.The Ministry of Health collaborates with partner organizations to deliver quality healthcare nationwide. However, a large portion of the Ethiopian healthcare system relies on funding from foreign organizations, creating uncertainties about service continuity if funding is withdrawn.USAID is critical in providing substantial financial support for the health system, including TB control programmes. In collaboration with Addis Ababa University and the US Embassy Public Affairs office, USAID recently organized a week-long field reporting session for health journalists. The journalists visited health facilities in Addis Ababa, Hawassa, and Yirgalem, gaining firsthand insights into the fight against TB. EBR’s Dr Brook Genene, a participant in the trip, provides an assessment of his observations and delves deeper into the current state of TB infection in Ethiopia.

Kitaw Teklemariam recounts the difficult path he had to endure to reach where he is now. His brother Sintayehu was suspected of having Tuberculosis, and he was the one responsible for looking after him. Sintayehu didn’t improve during the treatment, and further tests were required. However, during that time, the necessary investigations took months to complete. By the time the results of the tests arrived, Sintaheyu had already passed away two months earlier.

After the loss of his brother, Kitaw faced another challenge. He was diagnosed with TB himself and had to undergo a long and tiring treatment process. He first had to stay for a year at a treatment facility in St. Peter Hospital in Addis Ababa, away from his family. After completing his treatment, the doctors told him that his TB infection was Drug-resistant, which required further extensive treatment.

He was then admitted to the New Multi-Drug Resistant TB Facility Opens at Bishoftu Hospital, established by the funding of the USAID, where he stayed for an additional year and seven months. During these difficult times, Kitaw was separated from his wife and didn’t see his daughter. His friends also didn’t visit him. It was such a lonely time for him. He was affected both emotionally and physically.

Tuberculosis is a chronic bacterial infection caused by a group of bacteria, the Mycobacterium tuberculosis complex. The most common of these is Mycobacterium Tuberculosis. Tuberculosis usually affects the lungs, but any part of the body can also be affected.

TB is one of the most deadly infectious diseases. According to the World Health Organization (WHO), 1.3 million deaths were recorded in 2022 globally among the 10.6 million people who became ill with active TB in the year. WHO findings say one out of four people globally has TB in their system. However, only five to ten per cent of the people infected with TB will eventually get symptoms and develop TB disease.

Ethiopia is among the top 30 TB-burdened countries. TB incidence rate stands at 126 per 100,000 population. TB Mortality rate stands at 17 per 100,000 population. The estimated death because of TB in 2021 was 21,000.

TB is transmitted through the air when people with lung TB cough, sneeze, or spit. A person needs to inhale only a few germs to become infected. HIV infection is one of the common risk factors for the development of active Tuberculosis. The general symptoms of TB are weight loss, fever, night sweats, loss of appetite, fatigue, and malaise.

In Ethiopia, 77% of TB medications come from donations. TB, HIV, and Malaria medications are major public health concerns that receive global funding. Dr. Daniel Gebremicheal, health systems & resilience team leader at USAID, explains that the organization has worked to digitalize the process of TB medication delivery and process in Ethiopia. Digitalization is essential to ensure the quality of service. That’s why eLMIS(electronic logistics management information system (DAGU)), an application designed to manage supply chain functions, have been installed at service delivery points.

Sidama is one of the states with a high burden of TB in Ethiopia. The hospitals in the state have prioritized TB treatment and working with donor organizations to combat the illness. Dr Eyob Bekele, head of anti-retroviral treatment (ART) treatment services at Adare General Hospital in Hawassa, explains that assessing HIV risk for TB patients is a pivotal service they provide. They are working to facilitate enhanced case detection by screening the cases and sending Gene X-pert, a fully automated DNA/molecular diagnostic test to simultaneously detect TB and Rifampicin resistance TB. It is recommended as the initial diagnostic test for all persons being examined for TB.

“We established the cougher clinic during the COVID season. TB and other respiratory illnesses are screened, enabling us to deliver routine healthcare,” states Dr Lakew Muse, Deputy Medical Director of Adare General Hospital. He states that 5 to 10 TB patients are confirmed every day. According to the doctors, family members’ contact will be traced once the test results of a suspect arrive. If the family members are free from infection, they will be educated. If they have TB, then they will get the treatment. “Results are detected within one day, and treatment is started the next day,” says Dr Lakew.

Yirgalem General Hospital is one of the biggest TB treatment centres in Sidama. Health digitalization has enabled the hospital to deliver quality treatment. Auditable Pharmacy Transactions and Services (APTS) introduce transparent and accountable pharmaceutical transactions and services, allowing the hospitals to assess how many patients a health professional has seen. Consumption data can quickly be evaluated using the system. To provide comprehensive treatment, the team is composed of multidisciplinary professionals who will be able to assess and treat comorbidities.

In addition to providing treatment, the hospital staff facilitates patient education, which is organized under the patient literacy unit. Peer education enables people to ask questions. People are more likely to believe the testimony of someone who has received treatment than that of health professionals.

Antibiotics are used to treat Tuberculosis. The treatment is recommended for both TB infection and disease.

These medications must be taken daily for 4–6 months to be effective. It is dangerous to stop the medications early or without medical advice. This can allow TB that is still alive to become resistant to the drugs. Tuberculosis that doesn’t respond to standard drugs is called drug-resistant TB and requires more intense treatment with different medicines.

The Ethiopian Pharmaceutical Supply Service (EPSS) is the organization responsible for distributing TB medical supplies nationwide. The medications are being delivered to the desired targets, and medication wastage has been minimized. Generally, two per cent of medication wastage is allowed. Still, in Ethiopia, the current one is 0.7 from a target of one per cent.

Although government and donor funding are still available, hospitals need more medications because the number of patients outnumbers the resources. Despite the encouraging work done by EPSS, it can only partially meet the demands of some health organizations. There is also a lengthy delay during purchase. This is mainly because there isn’t a different means of buying medications than other commodities. Medications are acquired through the same tiresome bureaucracy that regular office supplies are purchased.

The concerted effort to fight TB has delivered. Indeed, TB incidence declined by 38% between 2015 and 2021 in Ethiopia, with an annual average reduction of six per cent. However, the current situation, the aftermath of the COVID pandemic, is said to have reversed the achievement. But there have been encouraging stats in the fight to combat the disease. The TB mortality rate has shown a decline of 38.4% between 2015-2022. Ethiopia has also transitioned out from the list of high multiple drug resistance (MDR-TB) burden countries in 2020.

From March 22-24, a national TB conference and the 18th annual TB day also took place with the motto ‘We can stop TB infection’. Dr Mekedes Daba, Ethiopi’s new minister of health, stated that the spread of TB has significantly declined due to the work done between 2015 and 2020. She also underlined that Ethiopia is one of seven countries that have committed to stopping the spread of TB by 2030. She further noted that climate change, conflicts, and the COVID-19 pandemic have hindered achieving those goals. One of the main targets of the country’s health policy is to halt the spread of TB by the year 2030, according to Dr Mekdes.

Survivors have joined the Ministry’s effort to combat TB. After recovering from what seemed like an unbeatable illness, Kitaw has now joined the campaign to educate the public and raise awareness about TB. In his own words, he is a “TB champion and advocate.” He has found a second chance in life. After the unfortunate separation from his first wife, he married again and started life all over again. He met his wife during his advocacy work. At that time, she suffered neurological deficits because of the strong medications she was taking to treat her TB infection. “I went to her home to visit her and we fell in love,” Kitaw says. His powerful testimony is a bright light in this challenging battle to beat TB as a country. EBRKitaw Teklemariam recounts the difficult path he had to endure to reach where he is now. His brother Sintayehu was suspected of having Tuberculosis, and he was the one responsible for looking after him. Sintayehu didn’t improve during the treatment, and further tests were required. However, during that time, the necessary investigations took months to complete. By the time the results of the tests arrived, Sintaheyu had already passed away two months earlier.

After the loss of his brother, Kitaw faced another challenge. He was diagnosed with TB himself and had to undergo a long and tiring treatment process. He first had to stay for a year at a treatment facility in St. Peter Hospital in Addis Ababa, away from his family. After completing his treatment, the doctors told him that his TB infection was Drug-resistant, which required further extensive treatment.

He was then admitted to the New Multi-Drug Resistant TB Facility Opens at Bishoftu Hospital, established by the funding of the USAID, where he stayed for an additional year and seven months. During these difficult times, Kitaw was separated from his wife and didn’t see his daughter. His friends also didn’t visit him. It was such a lonely time for him. He was affected both emotionally and physically.

Tuberculosis is a chronic bacterial infection caused by a group of bacteria, the Mycobacterium tuberculosis complex. The most common of these is Mycobacterium Tuberculosis. Tuberculosis usually affects the lungs, but any part of the body can also be affected.

TB is one of the most deadly infectious diseases. According to the World Health Organization (WHO), 1.3 million deaths were recorded in 2022 globally among the 10.6 million people who became ill with active TB in the year. WHO findings say one out of four people globally has TB in their system. However, only five to ten per cent of the people infected with TB will eventually get symptoms and develop TB disease.

Ethiopia is among the top 30 TB-burdened countries. TB incidence rate stands at 126 per 100,000 population. TB Mortality rate stands at 17 per 100,000 population. The estimated death because of TB in 2021 was 21,000.

TB is transmitted through the air when people with lung TB cough, sneeze, or spit. A person needs to inhale only a few germs to become infected. HIV infection is one of the common risk factors for the development of active Tuberculosis. The general symptoms of TB are weight loss, fever, night sweats, loss of appetite, fatigue, and malaise.

In Ethiopia, 77% of TB medications come from donations. TB, HIV, and Malaria medications are major public health concerns that receive global funding. Dr. Daniel Gebremicheal, health systems & resilience team leader at USAID, explains that the organization has worked to digitalize the process of TB medication delivery and process in Ethiopia. Digitalization is essential to ensure the quality of service. That’s why eLMIS(electronic logistics management information system (DAGU)), an application designed to manage supply chain functions, have been installed at service delivery points.

Sidama is one of the states with a high burden of TB in Ethiopia. The hospitals in the state have prioritized TB treatment and working with donor organizations to combat the illness. Dr Eyob Bekele, head of anti-retroviral treatment (ART) treatment services at Adare General Hospital in Hawassa, explains that assessing HIV risk for TB patients is a pivotal service they provide. They are working to facilitate enhanced case detection by screening the cases and sending Gene X-pert, a fully automated DNA/molecular diagnostic test to simultaneously detect TB and Rifampicin resistance TB. It is recommended as the initial diagnostic test for all persons being examined for TB.

“We established the cougher clinic during the COVID season. TB and other respiratory illnesses are screened, enabling us to deliver routine healthcare,” states Dr Lakew Muse, Deputy Medical Director of Adare General Hospital. He states that 5 to 10 TB patients are confirmed every day. According to the doctors, family members’ contact will be traced once the test results of a suspect arrive. If the family members are free from infection, they will be educated. If they have TB, then they will get the treatment. “Results are detected within one day, and treatment is started the next day,” says Dr Lakew.

Yirgalem General Hospital is one of the biggest TB treatment centres in Sidama. Health digitalization has enabled the hospital to deliver quality treatment. Auditable Pharmacy Transactions and Services (APTS) introduce transparent and accountable pharmaceutical transactions and services, allowing the hospitals to assess how many patients a health professional has seen. Consumption data can quickly be evaluated using the system. To provide comprehensive treatment, the team is composed of multidisciplinary professionals who will be able to assess and treat comorbidities.

In addition to providing treatment, the hospital staff facilitates patient education, which is organized under the patient literacy unit. Peer education enables people to ask questions. People are more likely to believe the testimony of someone who has received treatment than that of health professionals.

Antibiotics are used to treat Tuberculosis. The treatment is recommended for both TB infection and disease.

These medications must be taken daily for 4–6 months to be effective. It is dangerous to stop the medications early or without medical advice. This can allow TB that is still alive to become resistant to the drugs. Tuberculosis that doesn’t respond to standard drugs is called drug-resistant TB and requires more intense treatment with different medicines.

The Ethiopian Pharmaceutical Supply Service (EPSS) is the organization responsible for distributing TB medical supplies nationwide. The medications are being delivered to the desired targets, and medication wastage has been minimized. Generally, two per cent of medication wastage is allowed. Still, in Ethiopia, the current one is 0.7 from a target of one per cent.

Although government and donor funding are still available, hospitals need more medications because the number of patients outnumbers the resources. Despite the encouraging work done by EPSS, it can only partially meet the demands of some health organizations. There is also a lengthy delay during purchase. This is mainly because there isn’t a different means of buying medications than other commodities. Medications are acquired through the same tiresome bureaucracy that regular office supplies are purchased.

The concerted effort to fight TB has delivered. Indeed, TB incidence declined by 38% between 2015 and 2021 in Ethiopia, with an annual average reduction of six per cent. However, the current situation, the aftermath of the COVID pandemic, is said to have reversed the achievement. But there have been encouraging stats in the fight to combat the disease. The TB mortality rate has shown a decline of 38.4% between 2015-2022. Ethiopia has also transitioned out from the list of high multiple drug resistance (MDR-TB) burden countries in 2020.

From March 22-24, a national TB conference and the 18th annual TB day also took place with the motto ‘We can stop TB infection’. Dr Mekedes Daba, Ethiopi’s new minister of health, stated that the spread of TB has significantly declined due to the work done between 2015 and 2020. She also underlined that Ethiopia is one of seven countries that have committed to stopping the spread of TB by 2030. She further noted that climate change, conflicts, and the COVID-19 pandemic have hindered achieving those goals. One of the main targets of the country’s health policy is to halt the spread of TB by the year 2030, according to Dr Mekdes.
Survivors have joined the Ministry’s effort to combat TB. After recovering from what seemed like an unbeatable illness, Kitaw has now joined the campaign to educate the public and raise awareness about TB. In his own words, he is a “TB champion and advocate.” He has found a second chance in life. After the unfortunate separation from his first wife, he married again and started life all over again. He met his wife during his advocacy work. At that time, she suffered neurological deficits because of the strong medications she was taking to treat her TB infection. “I went to her home to visit her and we fell in love,” Kitaw says. His powerful testimony is a bright light in this challenging battle to beat TB as a country. EBR