Kefyalew Alene
Head, Geospatial and Tuberculosis
BSc, MPH, PhD
kefyalew.alene@thekids.org.au
+61 404 705 064
Dr Kefyalew Alene is a spatial epidemiologist working on infectious diseases including tuberculosis in low- and middle-income countries. He is currently a Senior Research Fellow at Curtin University, with joint appointments as Honorary Research Fellow at The Kids Research Institute Australia, Australia. He is a recipient of the 2020 Emerging Leadership Investigator Grant from the Australia National Health and Medical Research Council (NHMRC). His research project focus on designing an innovative approach for improving the efficiency and effectiveness of public health interventions to help control and ultimately eliminate tuberculosis in high-burden countries.
He was a visiting Research Fellow at the Australian National University (ANU), and an Assistant Professor of Epidemiology at the University of Gondar, Ethiopia. He received his PhD from the ANU in 2019. His PhD research focussed on the spatial epidemiology of tuberculosis and multidrug-resistant tuberculosis in Ethiopia and China.
Education and Qualifications
- PhD – Australian National University
- MPH – University of Gondar
- BSc – University of Gondar
Projects
Targeting interventions to improve influenza control: a proof of principle geomapping study
Spatial epidemiology of tuberculosis
September 2020
Post tuberculosis disability
September 2020
Published research
Impact of integrating traditional care with the modern healthcare system in reducing tuberculosis diagnosis delays in Ethiopia: a clustered randomized controlled study
Diagnosis and treatment initiation delays for tuberculosis (TB) are significant challenges in resource-limited settings. These delays can result in poor treatment outcomes, disease transmission, and increased costs. This study aimed to assess the effect of integrating traditional care with modern healthcare systems on reducing TB diagnosis delay.
Global Disparities of Cancer and Its Projected Burden in 2050
Cancer prevention and care efforts have been challenged by the COVID-19 pandemic and armed conflicts, resulting in a decline in the global Human Development Index (HDI), particularly in low- and middle-income countries. These challenges and subsequent shifts in health care priorities underscore the need to continuously monitor cancer outcome disparities and statistics globally to ensure delivery of equitable and optimal cancer prevention and care in uncertain times.
Mapping fertility rates at national, sub-national, and local levels in Ethiopia between 2000 and 2019
Fertility rates are key indicators of population health and demographic change, influencing economic development, healthcare planning, and social policies. Understanding subnational variation in fertility rate is important for effective geographical targeting and policy prioritization. This study aimed to identify geographic variation, trends, and determinants of fertility rates in Ethiopia over the past two decades.
Risk factors associated with post-tuberculosis sequelae: a systematic review and meta-analysis
Post-tuberculosis (TB) sequelae present a significant challenge in the management of TB survivors, often leading to persistent health issues even after successful treatment. Identifying risk factors associated with post-TB sequelae is important for improving outcomes and quality of life of TB survivors. This systematic review and meta-analysis aims to identify risk factors associated with long-term physical sequelae among TB survivors.
Ecological-level factors associated with tuberculosis incidence and mortality: A systematic review and meta-analysis
Globally, tuberculosis (TB) is the leading infectious cause of morbidity and mortality, with the risk of infection affected by both individual and ecological-level factors. While systematic reviews on individual-level factors exist, there are currently limited studies examining ecological-level factors associated with TB incidence and mortality. This study was conducted to identify ecological factors associated with TB incidence and mortality.
Prevalence of tuberculosis infection among contacts of drug-resistant tuberculosis patients: A systematic review and meta-analysis
Contact investigations with drug-susceptible tuberculosis (DS-TB) patients have demonstrated a high prevalence of tuberculosis infection (TBI). However, the prevalence of TBI among individuals in close contact with drug-resistant tuberculosis (DR-TB) patients is poorly understood. This systematic review and meta-analysis aimed to determine the prevalence of TBI among household and non-household contacts of DR-TB patients.
Geospatial joint modeling of vector and parasite serology to microstratify malaria transmission
The World Health Organization identifies a strong surveillance system for malaria and its mosquito vector as an essential pillar of the malaria elimination agenda. Anopheles salivary antibodies are emerging biomarkers of exposure to mosquito bites that potentially overcome sensitivity and logistical constraints of traditional entomological surveys.
Undernutrition increases the risk of unsuccessful treatment outcomes of patients with tuberculosis in Ethiopia: A multicenter retrospective cohort study
While undernutrition has been identified as a common risk factor for tuberculosis (TB), its impact on treatment outcomes has yet to be investigated in high TB burden and low-income countries such as Ethiopia. Therefore, this study aimed to investigate the effect of undernutrition on treatment outcomes among patients with TB in northwest Ethiopia.
Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review
Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence. The aim of this study was to determine the effectiveness of nutritional support in improving treatment adherence among patients with TB.
Interventions to prevent post-tuberculosis sequelae: a systematic review and meta-analysis
Tuberculosis (TB) remains a global public health challenge, causing substantial mortality and morbidity. While TB treatment has made significant progress, it often leaves survivors with post-TB sequelae, resulting in long-term health issues.
Impacts of armed conflicts on tuberculosis burden and treatment outcomes: a systematic review
This systematic review aimed to summarise existing literature on the impacts of armed conflicts on tuberculosis burden and treatment outcomes.
Determinants of drug-resistant tuberculosis in Hunan province, China: a case-control study
Drug-resistant tuberculosis (DR-TB) is a major public health threat in Hunan Province, with an increasing clinical burden in recent years. This study aimed to identify socio-demographic and clinical factors associated with DR-TB in Hunan province, China.
Spatiotemporal Distribution of Malaria in the Kingdom of Saudi Arabia
Malaria is a significant public health concern in the Kingdom of Saudi Arabia (KSA). This study aimed to investigate the spatiotemporal distribution of malaria in the KSA between 2017 and 2021.
Protocol for spatial prediction of soil transmitted helminth prevalence in the Western Pacific region using a meta-analytical approach
Soil transmitted helminth infections are estimated to impact 24% of the world's population and are responsible for chronic and debilitating morbidity. Disadvantaged communities are among the worst affected and are further marginalized as infection prevalence fuels the poverty cycle.
Risk factors for diagnosis and treatment delay among patients with multidrug-resistant tuberculosis in Hunan Province, China
Multidrug-resistant tuberculosis (MDR-TB) is a global health threat associated with high morbidity and mortality rates. Diagnosis and treatment delays are associated with poor treatment outcomes in patients with MDR-TB. However, the risk factors associated with these delays are not robustly investigated, particularly in high TB burden countries such as China.
Burden of drug-resistant tuberculosis among contacts of index cases: A protocol for a systematic review
People having close contact with drug-resistant tuberculosis (DR-TB) patients are at increased risk of contracting and developing the disease. However, no comprehensive review has been undertaken to estimate the burden of DR-TB among contacts of DR-TB patients. Therefore, the current systematic review will quantify the prevalence and incidence of DR-TB among contacts of DR-TB patients.
Impacts of body weight change on treatment outcomes in patients with multidrug-resistant tuberculosis in Northwest Ethiopia
Measuring body weight during therapy has received insufficient attention in poor resource settings like Ethiopia. We aimed to investigate the association between weight change during therapy and treatment outcomes among patients with multidrug-resistant tuberculosis in northwest Ethiopia.
Risk mapping and socio-ecological drivers of soil-transmitted helminth infections in the Philippines: a spatial modelling study
The Philippines reports a high prevalence of soil-transmitted helminth (STH) infections despite the implementation of nationwide mass drug administration since 2006. The spatial variation of STH infections in the Philippines was last described using the 2005-2007 national STH and schistosomiasis survey. This study aimed to identify sociodemographic and environmental factors that drive STH transmission and predict high-risk areas in the Philippines.
Development and validation of a risk prediction model for pulmonary tuberculosis among presumptive tuberculosis cases in Ethiopia
Early diagnosis and treatment of tuberculosis (TB) is one of the key strategies to achieve the WHO End TB targets. This study aimed to develop and validate a simple, convenient risk score to diagnose pulmonary TB among presumptive TB cases.
Economic burden of multidrug-resistant tuberculosis on patients and households: a global systematic review and meta-analysis
Multidrug-resistant tuberculosis (MDR-TB) is a major health threat worldwide, causing a significant economic burden to patients and their families. Due to the longer duration of treatment and expensive second-line medicine, the economic burden of MDR-TB is assumed to be higher than drug-susceptible TB.
Geospatial Overlap of Undernutrition and Tuberculosis in Ethiopia
Undernutrition is a key driver of the global tuberculosis (TB) epidemic, yet there is limited understanding regarding the spatial overlap of both diseases. This study aimed to determine the geographical co-distribution and socio-climatic factors of undernutrition and TB in Ethiopia.
Spatiotemporal Distribution of Tuberculosis in the Oromia Region of Ethiopia: A Hotspot Analysis
Tuberculosis (TB) is a major public health concern in low- and middle-income countries including Ethiopia. This study aimed to assess the spatiotemporal distribution of TB and identify TB risk factors in Ethiopia's Oromia region.
Comparative effectiveness of interventions for preventing tuberculosis: systematic review and network meta-analysis of interventional studies
Tuberculosis (TB) is the leading infectious cause of death globally. Several preventive measures are employed to prevent TB, yet there is a paucity of evidence on the effectiveness of these interventions. Therefore, this study aimed to identify the most effective interventions for reducing TB incidence.
Effect of integrating traditional care with modern healthcare to improve tuberculosis control programs in Ethiopia: a protocol for a cluster-randomized controlled trial
Tuberculosis (TB) remains a major cause of morbidity and mortality in the world, despite being a preventable and curable disease. The World Health OrganizationEnd-TB Strategy, aligned with the Sustainable Development Goals, sets a target of reducing the TB mortality rate by 95%, TB incidence rate by 90%, and catastrophic costs due to TB by 2035, compared with a 2015 level. To achieve these ambitious targets, several interventions have been implemented in the last few years, resulting in major progress toward reducing the burden of TB.
Socio-demographic correlates of unhealthy lifestyle in Ethiopia: a secondary analysis of a national survey
Multiple lifestyle risk factors exhibit a stronger association with non-communicable diseases (NCDs) compared to a single factor, emphasizing the necessity of considering them collectively. By integrating these major lifestyle risk factors, we can identify individuals with an overall unhealthy lifestyle, which facilitates the provision of targeted interventions for those at significant risk of NCDs. The aim of this study was to evaluate the socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia.
Mapping tuberculosis prevalence in Ethiopia using geospatial meta-analysis\
Reliable and detailed data on the prevalence of tuberculosis (TB) with sub-national estimates are scarce in Ethiopia. We address this knowledge gap by spatially predicting the national, sub-national and local prevalence of TB, and identifying drivers of TB prevalence across the country.
Impacts on Human Movement in Australian Cities Related to the COVID-19 Pandemic
No studies have yet examined high-resolution shifts in the spatial patterns of human movement in Australia throughout 2020 and 2021, a period coincident with the repeated enactment and removal of varied governmental restrictions aimed at reducing community transmission of SARS-CoV-2. We compared overlapping timeseries of COVID-19 pandemic-related restrictions, epidemiological data on cases and vaccination rates, and high-resolution human movement data to characterize population-level responses to the pandemic in Australian cities.
Acceptability of integrating traditional tuberculosis care with modern healthcare services in the Amhara Regional State of Northwest Ethiopia: A qualitative study
Many people with tuberculosis (TB) rely solely on traditional healthcare services. Integrating traditional healthcare with modern healthcare services can increase access, quality, continuity, consumer satisfaction, and efficiency. However, successful integration of traditional healthcare with modern healthcare services requires stakeholder acceptance.
Protocol for a systematic review of long-term physical sequelae and financial burden of multidrug-resistant and extensively drug-resistant tuberculosis
Multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are major public health threats that are significant causes of physical sequelae and financial consequences for infected people. Treatment for MDR- and XDR-TB are more toxic and take longer duration than for drug-susceptible-TB. As a result, the long-term sequelae are thought to be more common among patients with MDR- and XDR-TB than drug-susceptible-TB, but this is yet to be quantified.
Effectiveness of healthcare workers and volunteers training on improving tuberculosis case detection: A systematic review and meta-analysis
Tuberculosis is the second most common infectious cause of death globally. Low TB case detection remains a major challenge to achieve the global End TB targets. This systematic review and meta-analysis aimed to determine whether training of health professionals and volunteers increase TB case detection.
Prevalence of long-term physical sequelae among patients treated with multi-drug and extensively drug-resistant tuberculosis: a systematic review and meta-analysis
Physical sequelae related to multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are emerging and under-recognised global challenges. This systematic review and meta-analysis aimed to quantify the prevalence and the types of long-term physical sequelae associated with patients treated for MDR- and XDR-TB.
Prevalence of long-term physical sequelae among patients treated with multi-drug and extensively drug-resistant tuberculosis: a systematic review and meta-analysis
Physical sequelae related to multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are emerging and under-recognised global challenges. This systematic review and meta-analysis aimed to quantify the prevalence and the types of long-term physical sequelae associated with patients treated for MDR- and XDR-TB.
The effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis: a systematic review and meta-analysis
We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis.
Mapping national, regional and local prevalence of hypertension and diabetes in Ethiopia using geospatial analysis
This study aimed to map the national, regional and local prevalence of hypertension and diabetes in Ethiopia.
The Prevalence of HIV Infection in Minority Indigenous Populations of the South-East Asia and Western Pacific Regions: A Systematic Review and Meta-analysis
A random effects meta-analysis was used to estimate the pooled prevalence of HIV infection within minority indigenous populations of the South-East Asia (SEAR) and Western Pacific Regions (WPR). Sub-group analyses were conducted, and the sources of heterogeneity explored through meta-regression. The majority of studies were undertaken in high HIV risk subpopulations.
Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018
Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs).
Effects of climatic factors on COVID-19 transmission in Ethiopia
Climatic conditions play a key role in the transmission and pathophysiology of respiratory tract infections, either directly or indirectly. However, their impact on the COVID-19 pandemic propagation is yet to be studied.
Effects of zinc and vitamin A supplementation on prognostic markers and treatment outcomes of adults with pulmonary tuberculosis: a systematic review and meta-analysis
Undernutrition is a major risk factor for tuberculosis (TB), which is estimated to be responsible for 1.9 million TB cases per year globally. The effectiveness of micronutrient supplementation on TB treatment outcomes and its prognostic markers (sputum conversion, serum zinc, retinol and haemoglobin levels) has been poorly understood.
Spatial distribution of rotavirus immunization coverage in Ethiopia: a geospatial analysis using the Bayesian approach
Rotavirus causes substantial morbidity and mortality every year, particularly among under-five children. Despite Rotavirus immunization preventing severe diarrheal disease in children, the vaccination coverage remains inadequate in many African countries including Ethiopia.
Effectiveness of public health interventions in reducing the prevalence of Opisthorchis viverrini: a protocol for systematic review and network meta-analysis
The carcinogenic liver fluke Opisthorchis viverrini is a major public health problem in the Mekong basin region. The liver flukes can induce cholangiocarcinoma, a bile duct cancer that causes a significant burden of mortality and economic loss. Various public health interventions have been conducted to reduce opisthorchiasis but the prevalence of O. viverrini remains high in endemic regions.
Spatiotemporal mapping of malaria incidence in Sudan using routine surveillance data
Malaria is a serious threat to global health, with over 95 % of the cases reported in 2020 by the World Health Organization in African countries, including Sudan. Sudan is a low-income country with a limited healthcare system and a substantial burden of malaria.
Treatment Outcomes among Pregnant Patients with Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-analysis
The management of multidrug-resistant tuberculosis (MDR-TB) during pregnancy is challenging, yet no systematic synthesis of evidence has accurately measured treatment outcomes.
Mapping BCG vaccination coverage in Ethiopia between 2000 and 2019
The Bacille-Calmette–Guerin (BCG) vaccination remains the primary strategy to prevent severe disseminated TB in young children, particularly in high TB-burden countries such as Ethiopia. Accurate knowledge of vaccination coverage in small geographical areas is critically important to developing targeted immunization campaigns. Thus, this study aimed to investigate the spatiotemporal distributions and ecological level determinants of BCG vaccination coverage in Ethiopia.
Spatial codistribution of HIV, tuberculosis and malaria in Ethiopia
HIV, tuberculosis (TB) and malaria are the three most important infectious diseases in Ethiopia, and sub-Saharan Africa. Understanding the spatial codistribution of these diseases is critical for designing geographically targeted and integrated disease control programmes. This study investigated the spatial overlap and drivers of HIV, TB and malaria prevalence in Ethiopia.
Risk factors associated with unsuccessful tuberculosis treatment outcomes in Hunan Province, China
Globally, China has the third highest number of tuberculosis (TB) cases despite high rates (85.6%) of effective treatment coverage. Identifying risk factors associated with unsuccessful treatment outcomes is an important component of maximising the efficacy of TB control programmes.
The impact of ethnic minority status on tuberculosis diagnosis and treatment delays in Hunan Province, China
Tuberculosis (TB) continues to be a major public health challenge in China. Understanding TB management delays within the context of China’s unique ethnic diversity may be of value in tackling the disease. This study sought to evaluate the impact of ethnic minority status on TB diagnosis and treatment delays.
Global distribution of human hookworm species and differences in their morbidity effects: a systematic review
The global distribution and morbidity effects for each specific hookworm species is unknown, which prevents implementation of the optimum intervention for local hookworm control.
The prevalence of tuberculosis and malaria in minority indigenous populations of South- East Asia and the Western Pacific Region: a systematic review and meta-analysis
Infectious diseases have been shown to disproportionately affect indigenous populations. Tuberculosis (TB) and malaria continue to impose a significant burden on humanity and are among the infectious diseases targeted within the 2030 Agenda for Sustainable Development.
The COVID-19 pandemic and healthcare systems in Africa: A scoping review of preparedness, impact and response
The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic.
The prevalence of soil transmitted helminth infections in minority indigenous populations of south-east asia and the western pacific region: A systematic review and meta-analysis
By mapping land use under projections of socio-economic change, ecological changes can be predicted to inform conservation decision-making. We present a land use model that enables the fine-scale mapping of land use change under future scenarios.
Tuberculosis related disability: a systematic review and meta-analysis
The sustainable development goals aim to improve health for all by 2030. They incorporate ambitious goals regarding tuberculosis (TB), which may be a significant cause of disability, yet to be quantified. Therefore, we aimed to quantify the prevalence and types of TB-related disabilities.
The prevalence of tuberculosis, malaria and soil-transmitted helminth infection in minority indigenous people of Southeast Asia and the Western Pacific: protocol for a systematic review and meta-analysis
Infectious diseases such as tuberculosis (TB), malaria and soil-transmitted helminthiasis continue to impose a significant global health burden and socio-economic impact. Globally, minority indigenous people are disproportionately affected by poverty and are shown to experience a disparate burden of disease and poorer health outcomes than the comparative majority population.
Spatiotemporal patterns of tuberculosis in Hunan province, China
Tuberculosis (TB) is the leading cause of death from a bacterial pathogen worldwide. China has the third highest TB burden in the world, with a high reported burden in Hunan Province (amongst others). This study aimed to investigate the spatial distribution of TB and identify socioeconomic, demographic, and environmental drivers in Hunan Province, China. Numbers of reported cases of TB were obtained from the Tuberculosis Control Institute of Hunan Province, China.
Spatial clustering of drug-resistant tuberculosis in Hunan province, China: an ecological study
This study aimed to investigate the spatial distribution of drug-resistant tuberculosis (DR-TB) in Hunan province, China. An ecological study was conducted using DR-TB data collected from the Tuberculosis Control Institute of Hunan Province between 2012 and 2018.
Improving Influenza Vaccination in Children With Comorbidities: A Systematic Review
Children with medical comorbidities are at greater risk for severe influenza and poorer clinical outcomes. Despite recommendations and funding, influenza vaccine coverage remains inadequate in these children. We aimed to systematically review literature assessing interventions targeting influenza vaccine coverage in children with comorbidities and assess the impact on influenza vaccine coverage.
Risk factors for COVID-19 infection, disease severity and related deaths in Africa: A systematic review
The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa. A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa.
COVID-19 in Ethiopia: A geospatial analysis of vulnerability to infection, case severity and death
COVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. Thirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km.
Poor treatment outcomes of children on highly active antiretroviral therapy: protocol for a systematic review and meta-analysis
While access to highly active antiretroviral therapy (HAART) for children with HIV has expanded and the use of HAART has substantially reduced the morbidity and mortality of children due to HIV, poor treatment outcomes among children with HIV are still a major public health problem globally. The aim of this systematic review and meta-analysis is to quantify treatment outcomes among children with HIV.
Multidrug-resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta-analysis
Multidrug-resistant tuberculosis (MDR-TB) is a major global public health concern. However, there is a dearth of literature on whether MDR-TB and its medications impact maternal and perinatal outcomes, and when such evidence exists the findings are conflicting. This systematic review and meta-analysis aimed to examine the impact of MDR-TB and its medications during pregnancy on maternal and perinatal outcomes.
Mapping Tuberculosis Prevalence in Ethiopia: Protocol for a Geospatial Meta-Analysis
In this report, we present a protocol for a geospatial meta-analysis to investigate the spatial patterns of TB prevalence in Ethiopia