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Santos-Mena A, González-Muñiz OE, Jacobo-Delgado YM, Rivas-Santiago B. Shedding light on vitamin D in tuberculosis: A comprehensive review of clinical trials and discrepancies. Pulm Pharmacol Ther 2024; 85:102300. [PMID: 38723942 DOI: 10.1016/j.pupt.2024.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/27/2023] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
Over the past few decades, there has been extensive research on the use of vitamin D as an adjunctive therapy in the treatment and prevention of tuberculosis. In vitro studies have provided valuable insights into the mechanisms by which vitamin D activates the immune response to combat Mycobacterium tuberculosis. These encouraging findings have spurred clinical investigations globally to assess the effectiveness of vitamin D as a preventive measure and as an adjunctive treatment for tuberculosis. However, the results from these clinical studies have been contradictory, with some demonstrating clear efficacy while others report only modest or no activity. In this review, we aim to analyze the clinical studies on vitamin D and examine the possible discrepancies observed in their outcomes.
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Affiliation(s)
- Alan Santos-Mena
- Biomedical Research Unit Zacatecas-IMSS, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Oscar E González-Muñiz
- Biomedical Research Unit Zacatecas-IMSS, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Yolanda M Jacobo-Delgado
- Biomedical Research Unit Zacatecas-IMSS, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico
| | - Bruno Rivas-Santiago
- Biomedical Research Unit Zacatecas-IMSS, Instituto Mexicano Del Seguro Social, Zacatecas, Mexico.
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Sriram S, Albadrani M. Do hospitalizations push households into poverty in India: evidence from national data. F1000Res 2024; 13:205. [PMID: 38606206 PMCID: PMC11007365 DOI: 10.12688/f1000research.145602.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction High percentage of OOP (Out-of-Pocket) costs can lead to poverty and exacerbate existing poverty, with 21.9% of India's 1.324 billion people living below the poverty line. Factors such as increased patient cost-sharing, high-deductible health plans, and expensive medications contribute to high OOP costs. Understanding the poverty-inducing impact of healthcare payments is essential for formulating effective measures to alleviate it. Methods The study used data from the 75th round of the National Sample Survey Organization (Household Social Consumption in India: Health) from July 2017-June 2018, focusing on demographic-socio-economic characteristics, morbidity status, healthcare utilization, and expenditure. The analysis included 66,237 hospitalized individuals in the last 365 days. Logistic regression model was used to examine the impact of OOP expenditures on impoverishment. Results Logistic regression analysis shows that there is 0.2868 lower odds of experiencing poverty due to OOP expenditures in households where there is the presence of at least one child aged 5 years and less present in the household compared to households who do not have any children. There is 0.601 higher odds of experiencing poverty due to OOP expenditures in urban areas compared to households in rural areas. With an increasing duration of stay in the hospital, there is a higher odds of experiencing poverty due to OOP health expenditures. There is 1.9013 higher odds of experiencing poverty due to OOP expenditures if at least one member in the household used private healthcare facility compared to households who never used private healthcare facilities. Conclusion In order to transfer demand from private to public hospitals and reduce OOPHE, policymakers should restructure the current inefficient public hospitals. More crucially, there needs to be significant investment in rural areas, where more than 70% of the poorest people reside and who are more vulnerable to OOP expenditures because they lack coping skills.
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Affiliation(s)
- Shyamkumar Sriram
- Department of Social and Public Health, Ohio University, Athens, Ohio, 45701, USA
| | - Muayad Albadrani
- Department of Family and Community Medicine, Taibah University, Medina, Al Madinah Province, Saudi Arabia
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Malwe S, Bawiskar D, Wagh V. Tuberculosis and the Effectiveness of the Revised National Tuberculosis Control Program (RNTCP) to Control Tuberculosis: A Narrative Review. Cureus 2023; 15:e51418. [PMID: 38299135 PMCID: PMC10828526 DOI: 10.7759/cureus.51418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/30/2023] [Indexed: 02/02/2024] Open
Abstract
The revised National Tuberculosis (TB) Control Program is an initiative undertaken by the government of India and was active from 1997 to 2020. Later it was renamed as National TB Elimination Program, which eyes the complete eradication of TB by 2025. The revised National Tuberculosis Control Programme (RNTCP) is preceded by the National TB Control Program which was activated when the cases of TB were on the rise in the early 1960s and police intervention was needed. National Tobacco Control Cell (NTCP) guided the efforts until 1997 when various shortcomings, which were registered over the course of time, were addressed and the revised program was launched. It has been a mixed success as beneficiaries belonging to the reachable, urban areas were benefitted, and tribal, and backward areas were lagging behind. Although the RNTCP proved to be effective in containing TB and curing it to a certain extent, the successor of the program, which is NTEP, has set an ambitious goal of eradicating TB by 2025 which needs concerted efforts on behalf of all stakeholders.
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Affiliation(s)
- Shraddha Malwe
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dushyant Bawiskar
- Sports Medicine, Abhinav Bindra Sports Medicine and Research Institute, Bhubaneswar, IND
| | - Vasant Wagh
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Thiruvengadam K, Krishnan R, Muniyandi M. The Prevalence of Self-Reported Tuberculosis in the Andaman and Nicobar Islands, India: Evidence from the NFHS-IV and V. Trop Med Infect Dis 2023; 8:464. [PMID: 37888592 PMCID: PMC10611087 DOI: 10.3390/tropicalmed8100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Since 1992, many rounds of the National Family Health Surveys have produced a significant quantity of data in India. The magnitude of the tuberculosis (TB) burden in Andaman and Nicobar Island can be better understood with this data. The household-level information on self-reported TB may provide useful information on the prevalence and distribution of TB as well as care-seeking behaviour. The primary objective is to analyse the data from the NFHS-IV and NFHS-V to understand the prevalence of self-reported TB as well as healthcare-seeking patterns for TB in the Andaman and Nicobar Islands. METHODOLOGY We performed secondary data analysis of NFHS-IV and NFHS-V data. After taking into consideration the survey's cluster design and sampling weights, the prevalence was estimated. The association of identified factors with self-reported TB was investigated using the chi-square and logistic regression models. RESULTS The point prevalence of self-reported TB was 615 (418, 873) and 221 (122, 367) in the NFHS-IV and NFHS-V, respectively (p = 0.012). The elderly, those from rural areas, those belonging to a tribe, and those with a poor wealth index were more likely to report TB. Self-reported TB prevalence was higher in the Nicobar district. There is an increase in a significant proportion of individuals not seeking care. CONCLUSION The NFHS-IV and NFHS-V show a decline in self-reported TB, which is consistent with national estimates. However, the enhanced TB case detection in individuals at high risk of TB among the Nicobar districts and tribal communities could significantly contribute to the fight against tuberculosis. Improved awareness of TB could improve care seeking for TB.
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Affiliation(s)
| | | | - Malaisamy Muniyandi
- ICMR-National Institute for Research in Tuberculosis, Chennai 60031, India; (K.T.)
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5
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Albadrani M. Exploring the Impact of Silicosis Incidence on Tuberculosis Mortality and Morbidity: A Multi-Country Study. Med Sci (Basel) 2023; 11:63. [PMID: 37873748 PMCID: PMC10594424 DOI: 10.3390/medsci11040063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION There are several risk factors attributed to tuberculosis (TB) mortality and morbidity. There are few studies and systematic reviews showing the association of silicosis and tuberculosis at a country level. Very limited studies have been conducted using multi-country data in studying the association of incidence of silicosis with TB mortality and morbidity. Hence, the aim of this research was to explore the association of incidence of silicosis and other important risk factors with TB mortality and morbidity using multi-country data. METHODS Data from 217 WHO region countries were utilized, sourcing TB-related statistics from the Institute of Health Metrics and Evaluation and additional risk factors from the Demographic and Health Survey, Global Burden of Disease, and World Bank for 2019. Regression analysis was conducted to examine the association between silicosis incidence and TB outcomes. RESULTS The study found an average silicosis incidence of 121.92 per 100,000 population. Additionally, 62.69% of the sample population are exposed to air pollution from solid fuel cooking. Sanitation access stands at an average of 59.67%. Regression outcomes indicate that while alcohol consumption's influence on TB is not statistically significant, a unit increase in silicosis incidence significantly elevates TB deaths (235.9, p = 0.005), YLL (9399.3, p = 0.011), and YLD (910.8, p = 0.002). CONCLUSION The burden of silicosis is found to be one of the important determinants of deaths, YLL, and YLD due to tuberculosis. Country-specific strategies to prevent and control silicosis is a need of the hour.
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Affiliation(s)
- Muayad Albadrani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah al-Munawwarah 42353, Saudi Arabia
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Timire C, Pedrazzoli D, Boccia D, Houben RMGJ, Ferrand RA, Bond V, Kranzer K. Use of a Sustainable Livelihood Framework-Based Measure to Estimate Socioeconomic Impact of Tuberculosis on Households. Clin Infect Dis 2023; 77:761-767. [PMID: 37132328 PMCID: PMC10495125 DOI: 10.1093/cid/ciad273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/04/2023] Open
Abstract
Tuberculosis (TB) disproportionally affects impoverished members of society. The adverse socioeconomic impact of TB on households is mostly measured using money-centric approaches, which have been criticized as one-dimensional and risk either overestimating or underestimating the true socioeconomic impacts of TB. We propose the use of the sustainable livelihood framework, which includes 5 household capital assets (human, financial, physical, natural, and social) and conceptualizes that households employ accumulative strategies in times of plenty and coping (survival) strategies in response to shocks such as TB. The proposed measure ascertains to what extent the 5 capital assets are available to households affected by TB as well as the coping costs (reversible and nonreversible) that are incurred by households at different time points (intensive, continuation, and post-TB treatment phase). We assert that our approach is holistic and multidimensional and draws attention to multisectoral responses to mitigate the socioeconomic impact of TB on households.
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Affiliation(s)
- Collins Timire
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Debora Pedrazzoli
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rein M G J Houben
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rashida A Ferrand
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Virginia Bond
- Social Science Unit, Zambart, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katharina Kranzer
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Health Research Unit, Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
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Chandru BA, Varma RP. Factors affecting ability of TB patients to follow treatment guidelines - applying a capability approach. Int J Equity Health 2023; 22:176. [PMID: 37658369 PMCID: PMC10474720 DOI: 10.1186/s12939-023-01991-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines. METHODS This study used an embedded mixed methods design. We collected cross-sectional data from 135 drug sensitive pulmonary TB patients aged 18 years or above in Thiruvananthapuram, Kerala using a structured questionnaire to get the proportion of patients following all treatment guidelines. We also did eight in-depth interviews (four men and four women) from within the survey sample. The in-depth interviews were inductively analysed for getting deeper insights about reasons for the choices people made regarding the treatment guidelines. Written informed consent was taken from all participants and the study was implemented after the necessary programmatic and ethical clearances. RESULTS Of the 105 men and 30 women studied, uninterrupted daily drug consumption was reported by 80 persons (59.3%, 95% Confidence Intervals (CI) 50.8-67.2%). Overall, 38 (28.2%, 95% CI 21.3%-36.3%) persons were able to follow all seven aspects of advised guidelines. Living in an extended/ joint family (Adjusted Odds ratio (AOR) 2.6, 95% CI 1.1-6.0), approximate monthly household expenditure of over rupees 13,500 (AOR 2.9, 95% CI 1.3-6.7) and no perceived delay in seeking initial care (AOR 3.2, 95% CI 1.2-8.7) were significantly associated with following all aspects of treatment guidelines. In-depth interviews revealed reflective treatment related behaviours were influenced by bodily experiences, moral perceptions, social construct of TB, programmatic factors and substance use. Sometimes behaviours were non-reflective also. Programmatic stress was on individual agency for changing behaviour but capability and opportunity for these were influenced social aspects like stigma, gender roles and poverty. CONCLUSION TB patients live amidst a syndemic of biomedical and social problems. These problems influence the capabilities and opportunities of such TB patients to follow treatment guidelines. Interventions should balance focus on individual agency and social abd economic factors.
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Affiliation(s)
- B Aravind Chandru
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Medical College Post Office, Thiruvananthapuram, Kerala, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Medical College Post Office, Thiruvananthapuram, Kerala, India.
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Prinja S, Sharma A, Nadipally S, Rana SK, Bahuguna P, Rao N, Chakraborty G, Shankar M, Rai V. Impact and cost-effectiveness evaluation of nutritional supplementation and complementary interventions for tuberculosis treatment outcomes under mukti pay-for-performance model in Madhya Pradesh, India: A study protocol. Int J Mycobacteriol 2023; 12:82-91. [PMID: 36926768 DOI: 10.4103/2212-5531.307071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background A. "pay-for-performance" (P4P) intervention model for improved tuberculosis (TB) outcomes, called "Mukti," has been implemented in an underdeveloped tribal area of central India. The target of this project is to improve nutritional status, quality of life (QoL), and treatment outcomes of 1000 TB patients through four interventions: food baskets, personal counseling, peer-to-peer learning and facilitation for linkage to government schemes. The current study aims to assess the success of this model by evaluating its impact and cost-effectiveness using a quasi-experimental approach. Methods Data for impact assessment have been collected from 1000 intervention and control patients. Study outcomes such as treatment completion, sputum negativity, weight gain, and health-related QoL will be compared between matched samples. Micro costing approach will be used for assessing the cost of routine TB services provision under the national program and the incremental cost of implementing our interventions. A decision and Markov hybrid model will estimate long-term costs and health outcomes associated with the use of study interventions. Measures of health outcomes will be mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per quality-adjusted life-years gained and cost per unit increase in patient weight in intervention versus control groups. Results The evidence generated from the present study in terms of impact and cost-effectiveness estimates will thus help to identify not only the effectiveness of these interventions but also the optimal mode of financing such measures. Our estimates on scale-up costs for these interventions will also help the state and the national government to consider scale-up of such interventions in the entire state or country. Discussion The study will generate important evidence on the impact of nutritional supplementation and other complementary interventions for TB treatment outcomes delivered through P4P financing models and on the cost of scaling up these to the state and national level in India.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Nadipally
- Partnership for Affordable Healthcare, Access and Longevity, IPE Global Pvt. Ltd, New Delhi, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Neeta Rao
- US Agency for International Development, New Delhi, India
| | | | - Manjunath Shankar
- Partnership for Affordable Healthcare, Access and Longevity, IPE Global Pvt. Ltd, New Delhi, India
| | - Varsha Rai
- State TB Office, National Tuberculosis Elimination Program, Government of Madhya Pradesh, India
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Nagarajan K, Muniyandi M, Sellappan S, Karunanidhi S, Senthilkumar K, Palani B, Jeyabal L, Krishnan R. A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in Chennai. PLoS One 2023; 18:e0280812. [PMID: 36701386 PMCID: PMC9879515 DOI: 10.1371/journal.pone.0280812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/08/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations. METHODS This prospective observational study was conducted in Chennai Corporation treatment units during 2019-2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status. RESULTS A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44-58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150-180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46-55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p<0.05) and illiterates were found more likely to disclose their TB status (AOR 3.91; p<0.05). Post the disclosure, family contacts have mostly provided resource support (44.90%) and two third of all disclosed contacts have provided emotional support for TB patients (>71%). CONCLUSION Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings could inform in developing interventions to facilitate disclosure of disease status in a beneficial way for TB patients.
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Affiliation(s)
- Karikalan Nagarajan
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Malaisamy Muniyandi
- Department of Health Economics, ICMR–National Institute for Research in Tuberculosis, Chennai, India
- * E-mail:
| | - Senthil Sellappan
- ICMR-Regional Medical Research Centre, Port Blair, Andaman and the Nicobar Islands, India
| | - Srimathi Karunanidhi
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Keerthana Senthilkumar
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Bharathidasan Palani
- Department of Statistics, ICMR–National Institute for Research in Tuberculosis, Chennai, India
| | - Lavanya Jeyabal
- District TB Office, National TB Elimination Programme, Chennai, India
| | - Rajendran Krishnan
- Department of Statistics (Epidemiology Unit), ICMR–National Institute for Research in Tuberculosis, Chennai, India
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10
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Zou Z, Liu G, Hay SI, Basu S, Belgaumi UI, Dhali A, Dhingra S, Fekadu G, Golechha M, Joseph N, Krishan K, Martins-Melo FR, Mubarik S, Okonji OC, A MP, Rathi P, Shetty RS, Singh P, Singh S, Thangaraju P, Wang Z, Zastrozhin MS, Murray CJ, Kyu HH, Huang Y. Time trends in tuberculosis mortality across the BRICS: an age-period-cohort analysis for the GBD 2019. EClinicalMedicine 2022; 53:101646. [PMID: 36147625 PMCID: PMC9486016 DOI: 10.1016/j.eclinm.2022.101646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/13/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis is the leading cause of death from a single infectious agent among the HIV-negative population and ranks first among the HIV-positive population. However, few studies have assessed tuberculosis trends in Brazil, Russia, India, China and South Africa (BRICS) or with an emphasis on HIV status. This study assesses the time trends of tuberculosis mortality across the BRICS with an emphasis on HIV status from 1990 to 2019. METHODS We obtained tuberculosis data from the Global Burden of Disease 2019 study (GBD 2019). We calculated the relative proportion of tuberculosis to all communicable, maternal, neonatal, and nutritional diseases by HIV status across the BRICS. We used age-period-cohort modelling to estimate cohort and period effects in tuberculosis from 1990 to 2019, and calculated net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks. FINDINGS There were 549,522 tuberculosis deaths across the BRICS in 2019, accounting for 39.3% of global deaths. Among HIV-negative populations, the age-standardised mortality rate (ASMR) of tuberculosis in BRICS remained far higher than that of high-income Asia Pacific countries, especially in India (36.1 per 100 000 in 2019, 95% UI [30.7, 42.6]) and South Africa (40.1 per 100 000 in 2019, 95% UI [36.8, 43.7]). China had the fastest ASMR reduction across the BRICS, while India maintained the largest tuberculosis death numbers with an annual decrease much slower than China's (-4.1 vs -8.0%). Among HIV-positive populations, the ASMR in BRICS surged from 0.24 per 100 000 in 1990 to 5.63 per 100 000 in 2005, and then dropped quickly to 1.70 per 100 000 in 2019. Brazil was the first country to reverse the upward trend of HIV/AIDS-tuberculosis (HIV-TB) mortality in 1995, and achieved the most significant reduction (-3.32% per year). The HIV-TB mortality in South Africa has realised much progress since 2006, but still has the heaviest HIV-TB burden across the BRICS (ASMR: 70.0 per 100 000 in 2019). We also found unfavourable trends among HIV-negative middle-aged (35-55) adults of India, men over 50 in the HIV-negative population and whole HIV-positive population of South Africa, and women aged 45-55 years of Russia. China had little progress in its HIV-positive population with worsening period risks from 2010 to 2019, and higher risks in the younger cohorts born after 1980. INTERPRETATION BRICS' actions on controlling tuberculosis achieved positive results, but the overall improvements were less than those in high-income Asia Pacific countries. BRICS and other high-burden countries should strengthen specified public health approaches and policies targeted at different priority groups in each country. FUNDING National Natural Science Foundation of China (82073573; 72074009), Peking University Global Health and Infectious Diseases Group.
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Affiliation(s)
- Zhiyong Zou
- School of Public Health, Peking University, Beijing, China
- Institute of Child and Adolescent Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Guangqi Liu
- School of Public Health, Peking University, Beijing, China
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Saurav Basu
- Department of Academics, Indian Institute of Public Health, Gurgaon, India
| | - Uzma Iqbal Belgaumi
- Department of Oral Pathology and Microbiology, Krishna Institute of Medical Sciences Deemed To Be University, Karad, India
| | - Arkadeep Dhali
- Department of GI Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, India
| | - Ginenus Fekadu
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong, China
- Department of Pharmacy, Wollega University, Nekemte, Ethiopia
| | - Mahaveer Golechha
- Department of Health Systems and Policy Research, Indian Institute of Public Health, Gandhinagar, India
| | - Nitin Joseph
- Department of Community Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Kewal Krishan
- Department of Anthropology (Prof K Krishan PhD), Panjab University, Chandigarh, India
| | | | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
| | | | - Mahesh P. A
- Department of Respiratory Medicine, Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India
| | - Priya Rathi
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ranjitha S. Shetty
- Department of Community Medicine, Manipal Academy of Higher Education, Manipal, India
| | - Paramdeep Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Ziyue Wang
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Mikhail Sergeevich Zastrozhin
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
- Addictology Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Christopher J.L. Murray
- Institute for Health Metrics and Evaluation; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hmwe Hmwe Kyu
- Institute for Health Metrics and Evaluation; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Yangmu Huang
- School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- Corresponding author at: Department of Global Health, Peking University School of Public Health, No.38 Xueyuan Rd, Haidian District, Beijing 100191, China.
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Sharma S, N SK, Kokane A, Pakhare AP, Nawaz MM, Joshi A. Quality of Life Amongst Multidrug-Resistant TB Patients: An Exploratory Study About Distributive Dimensions and Interactions. Cureus 2022; 14:e29389. [PMID: 36304356 PMCID: PMC9585424 DOI: 10.7759/cureus.29389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Multidrug-resistant (MDR)-TB has emerged as a major challenge to eliminate TB as envisioned at policy level. Distinctive traits associated with the disease such as physical, psychosocial and environmental dimensions may influence the treatment outcome in both directions. Quality of life (QoL) indicators may capture these traits distinctively. Objective: To quantify the differential effect of MDR-TB on specific QoL domains, their distributions across the strata and to check for possible interactions. Method: This community-based cross-sectional study was conducted on 98 MDR-TB patients registered in the calendar year 2017 under National Tuberculosis Elimination Programme (NTEP) in a central Indian district using the WHO-QoL BREF Scale by patients in their vicinity. The transformed domain scores were descriptively summarized, stratified and exploratory visualised. Likert mapping for each item was done. A two-way ANOVA test was applied to check differences across strata and interaction effects were calculated. Result: Participants perceived a higher QoL in the social domain (median score 69, IQR 56-75) while the psychological health domain (median 31 IQR 20.5-44) was professed as most negotiated by disease. More than 50% of participants were found to be dissatisfied with their assumed physical status in item-wise analysis. A statistically significant interaction (p=0.008) was detected with education strata to income tertile most evident in the physical domain while psychological domain alone (p=0.017) without significant interaction with treatment duration (p=0.316) was associated with the type of TB. Overall QoL scores were tilted in favour of an urban setting, male gender and towards a relatively younger population. Conclusion: The overall deficits in QoL are evident in the study, per se in the psychological and physical domains. Moreover there is an inequitable distribution of these scores as revealed in the study. Inclusion of an additional parameter of periodical QoL assessment may thus predict the outcome at individual level and may address this inequity at policy level.
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Aravindhan V, Bobhate A, Sathishkumar K, Patil A, Kumpatla S, Viswanathan V. Unique Reciprocal Association Seen Between Latent Tuberculosis Infection and Diabetes Is Due to Immunoendocrine Modulation (DM-LTB-1). Front Microbiol 2022; 13:884374. [PMID: 35832818 PMCID: PMC9271927 DOI: 10.3389/fmicb.2022.884374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
Aim The prevalence of latent tuberculosis infection (LTBI) among diabetes patients is poorly studied. In the present study, the prevalence of LTBI among pre-diabetes and diabetes patients was studied, along with immunoendocrine biomarkers (n = 804). Methods LTBI was screened by Quantiferon TB gold in Normal glucose tolerance [(NGT); n = 170, [Pre-diabetes (PDM; n = 209), Newly diagnosed diabetes (NDM; n = 165) and Known diabetes (KDM; n = 260) subjects. CRP, TNF-α, IL-6, IL-1β, IFN-β, IL-12, IFN-γ, IL-2, insulin, leptin, and adiponectin levels in serum and IFN-γ levels in quantiferon supernatants were quantified by ELISA. The expression of T-bet was quantified using qRT-PCR. Serum TBARS and nitrite levels were quantified by colorimetry. Results The LTBI prevalence was 32% in NGT, 23% in PDM, 24% in NDM, and 32% in KDM groups, with an adjusted OR of 0.61 (p < 0.05). Downregulation of CRP, TNF-α, and nitrites and upregulation of adiponectin could be responsible for LTBI mediated protection against insulin resistance (IR), while the high levels of IL-1β, IL-12, and leptin could be responsible for IR mediated anti-TB immunity. The defective antigen-specific IFN-γ response, as seen in the KDM group, could be responsible for the low detection rate of LTBI and high probability of endogenous reactivation. Conclusion There appears to be a biphasic relationship between diabetes-latent tuberculosis: At the early stages of diabetes it is reciprocal, while at a late stage it is synergistic, this important phenomenon obviously needs further research.
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Affiliation(s)
- Vivekanandhan Aravindhan
- Department of Genetics, Dr. ALM PG IBMS, University of Madras, Chennai, India
- *Correspondence: Vivekanandhan Aravindhan
| | - Anup Bobhate
- Prof. M. Viswanathan Diabetes Research Centre, Chennai, India
| | - Kuppan Sathishkumar
- Department of Genetics, Dr. ALM PG IBMS, University of Madras, Chennai, India
| | - Aruna Patil
- ESIC-PGIMSR Medical College and Hospital, Chennai, India
| | | | - Vijay Viswanathan
- Prof. M. Viswanathan Diabetes Research Centre, Chennai, India
- Vijay Viswanathan
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