Background Hepatitis C infection virus (HCV) infection is still a major public health concern in Ethiopia, contributing significantly to an increased risk of cirrhosis, hepatocellular carcinoma, and chronic liver disease. This study aimed to assess the national and regional burden of hepatitis C infection in Ethiopia between 2019 and 2023 using findings from the Global Burden of Disease Study 2023. Methods A secondary ecological analysis was conducted using population‐level modeled estimates from the Global Burden of Diseases (GBD) 2023 study. The analysis included national and regional estimates from 2019 to 2023. Key metrics assessed were prevalence, incidence, deaths, mortality rates, Years Lived with Disability (YLDs), Years of Life Lost (YLLs), and Disability‐Adjusted Life Years (DALYs). The Cause of Death Ensemble model (CODEm) was used to estimate cause‐specific mortality, and DisMod‐MR 2.1 was used to model nonfatal outcomes. Descriptive statistical analyses were performed, and results were presented using numbers, rates, and percentages. All analyses were conducted using SPSS Version 27. Results The prevalence of hepatitis C infection in Ethiopia increased from 1,525,506 (UI): 1,233,554–1,882,997) in 2019 to 1,653,765 (UI: 1,332,884–2,039,588) in 2023, an increase of almost 8.5%. Correspondingly, the age‐standardized prevalence rate (ASPR) increased steadily from 1647 per 100,000 population (UI: 1482–1812) in 2019 to 1750 per 100,000 (UI: 1575–1925) in 2023. The incidence increased from 188,080 (UI: 148,692–240,059) in 2019 to 200,228 (UI: 157,812–258,693) in 2023, increased by 6.5%. The age‐standardized incidence rate (ASIR) followed a consistent upward trajectory, increasing from 250 per 100,000 (UI: 225–275) in 2019 to 264 per 100,000 (UI: 238–290) in 2023. The number of deaths increased from 7019 (UI: 4614–10,075) in 2019 to 7623 (UI: 4879–11,225) in 2023 with an 8.6% increase. The crude mortality rate decreased from 7.26 per 100,000 (UI: 6.39–8.13) in 2019 to 7.13 per 100,000 (UI: 6.27–7.99) in 2023. The age‐standardized mortality rate (ASMR), however, increased from 447 per 100,000 (UI: 393–501) in 2019 to 500 per 100,000 (UI: 440–560) in 2023. DALYs increased from 259,112 (UI: 165,317–381,194) in 2019 to 287,140 (UI: 176,866–437,025) in 2023. The age‐standardized DALY rate inclined from 426 per 100,000 (UI: 383–469) in 2019 to 457 per 100,000 (UI: 411–503) in 2023. The age‐standardized YLL rate increased from 418 per 100,000 (UI: 376–460) in 2019 to 450 per 100,000 (UI: 405–495) in 2023. The age‐standardized YLD rate remained stable, from 7.3 per 100,000 (UI: 6.6–8.0) in 2019 to 7.3 per 100,000 (UI: 6.6–8.0) in 2023. Prevalence and incidence were higher in females than males. The highest prevalence was observed in the 55+ years age group. Incidence was highest among children and adolescents (5–24 years). Regionally, Oromia, Amhara, and Southern Nations, Nationalities, and Peoples’ Region (SNNPs) recorded the highest burden. Conclusion The burden of HCV in Ethiopia increased substantially between 2019 and 2023, with premature mortality representing the predominant component of overall health loss. Marked disparities were observed by age, sex, and geographic region. The findings highlight the need to strengthen HCV infection prevention and control.
Introduction Patients with primary sclerosing cholangitis (PSC) experience numerous symptoms that impact quality of life. We sought to identify PSC‐specific symptom clusters and relationships between symptoms to better understand the lived experience of PSC patients. Methods Presence and severity of 16 symptoms were identified from the international “Our Voices” survey collected by PSC Partners Seeking A Cure in 2020. LASSO‐regularized partial correlation network analysis was performed using Spearman correlations. The primary analysis utilized symptoms reported within the past 6 months of survey completion, with subgroup analyses conducted on patients with and without inflammatory bowel disease (IBD). Expected influence was computed to quantify the importance of each measure within networks. The Spinglass algorithm was employed to identify communities within networks. Results Among 970 total participants, 54% were women, and 70% had IBD. Four dominant communities were identified across networks, including global symptoms, psychological symptoms, gastrointestinal symptoms, and cholestatic‐related symptoms. Of the 16 symptoms included in network analyses, fatigue and weakness had the most positive influence across multiple networks and across different communities within each network. Conclusions The complex relationship between co‐occurring symptoms in PSC organizes into four dominant symptom clusters. FTG and WEA emerged as strongly influential symptoms that consistently were associated with other symptoms. Our analyses emphasize the complex, co‐occurring nature of PSC symptoms, identify highly influential symptoms, and highlight the need to develop patient‐reported outcome symptom measures to assess changes in these key symptoms in clinical trials and clinical practice.
Background Inflammatory bowel disease (IBD) therapies can cause myelosuppression and hepatitis. The European Crohn’s and Colitis Organisation (ECCO) recommends 3‐monthly blood test monitoring; however, these recommendations are largely based on expert consensus, and real‐world evidence informing optimal long‐term monitoring intervals remains limited. Aim To determine the incidence of medication‐related hepatitis and myelosuppression in a population‐based IBD cohort and estimate the laboratory monitoring burden required to detect clinically significant adverse events. Methods A retrospective cohort study was performed using the Manawatū IBD incidence cohort. Patients diagnosed with IBD between 1 January 2011 and 31 December 2015 were followed longitudinally until 31 December 2022. Medication exposure, laboratory results, and clinical outcomes were recorded. Hepatitis was defined as alanine aminotransferase (ALT) > 2 × the upper limit of normal, while myelosuppression was defined as a neutrophil count < 1.0 × 10 9 /L. Patients were followed from diagnosis until the first outcome event or last recorded follow‐up. Medication exposure was analysed as a time‐varying variable using cox proportional hazards regression, and the duration of laboratory monitoring required to detect one adverse event was calculated. Results Among 204 incident cases, 12 were excluded due to prediagnosis hepatitis or myelosuppression, leaving 192 patients for analysis. Twenty‐four hepatitis events and two myelosuppression events were observed during 1739 patient‐years of follow‐up. 6‐mercaptopurine (hazard ratio [HR] 39.2, p < 0.001), azathioprine (HR 6.26, p = 0.002), methotrexate (HR 9.94, p = 0.004) and lower mean corpuscular volume (HR 0.89, p = 0.001) were independently associated with hepatitis. Following the initial 6 months of therapy, one hepatitis event was detected for every 33 patient‐years of stable thiopurine exposure monitored with routine quarterly blood testing. Conclusion Clinically significant hepatitis and myelosuppression were uncommon in this population‐based IBD cohort, particularly after the initial 6 months of therapy. These findings suggest that reduced laboratory monitoring frequency in carefully selected patients with established treatment stability warrants evaluation.
Aim Although molecular point‐of‐care testing using intragastric fluid has improved the speed and accuracy of Helicobacter pylori (H. pylori) diagnosis and clarithromycin (CAM) resistance detection, it still requires endoscopy, which limits its application in routine screening and settings where invasive procedures cannot be performed. We aimed to evaluate the clinical performance of the Smart Gene™ molecular point‐of‐care testing kit using stool specimens for H. pylori infection and CAM resistance detection. Methods We used stool specimens from 75 patients with suspected H. pylori infection. All participants underwent conventional diagnostic tests (urea breath test, stool antigen test, culture, and real‐time polymerase chain reaction). CAM resistance–associated mutations (Positions 2142 and 2143 in the 23S rRNA gene) were analyzed using pyrosequencing. Results The stool‐based Smart Gene kit demonstrated a sensitivity of 96.1% and specificity of 100% for H. pylori detection. The sensitivity and specificity for detecting CAM resistance were 100% and 97.0%, respectively, compared to antibiotic susceptibility testing. High concordance was observed between the intragastric polymerase chain reaction and culture results despite the lower stool DNA concentration. The results were obtained within approximately 1 h. Conclusions The Smart Gene™ stool kit offers a rapid, accurate, and noninvasive alternative for diagnosing H. pylori infection and CAM resistance. Its diagnostic performance is comparable to that of the gold‐standard invasive methods while offering practical advantages for outpatient use, mass screening, and nonendoscopy‐feasible populations. This approach increases early H. pylori detection and improves eradication outcomes and contributes to more effective gastric cancer prevention strategies (approval number: R4‐0426001).
