1
|
Adu PA, Spiegel JM, Yassi A. Towards TB elimination: how are macro-level factors perceived and addressed in policy initiatives in a high burden country? Global Health 2021; 17:11. [PMID: 33430902 PMCID: PMC7802197 DOI: 10.1186/s12992-020-00657-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/17/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Notwithstanding extensive general discussion of the effects of upstream forces on health, there has been limited empirical examination, let alone systematic evidence documenting policy responses to such pathways in the area of tuberculosis (TB) management and control. Our study aimed to gain insight into how macro level drivers of TB are perceived by key stakeholders involved in TB management and control in a high-endemic country, and to assess how such concerns are being addressed in policy initiatives in this setting. South Africa was chosen for this case study due to our team's long-standing collaborations there, its very high burden of TB, and its introduction of a strategic plan to combat this disease. METHOD Semi-structured interviews were conducted with 20 key informants who were purposively selected for their knowledge and expertise of TB in South Africa. South Africa's National Strategic Plan for HIV, TB and STIs 2017-2022 was then reviewed to examine how identified themes from the interviews were reflected in this policy document. RESULTS A history of colonization, the migrant labour system, economic inequality, poor shelter, health system challenges including TB governance, the HIV epidemic, and pertinent socio-cultural factors were all perceived to be major drivers of the epidemic. Although South Africa's current National Strategic Plan makes a firm discursive commitment to addressing the structural or macro-level drivers of TB, our analysis revealed that this commitment was not clearly reflected in projected budgetary allocations. CONCLUSION As in many other high burden settings, macro-level drivers of TB are widely recognized. Nonetheless, while micro-level (biomedical and clinical) measures, such as improving diagnostic procedures and investment in more efficacious drugs, are being (and well should be) implemented, our findings showed that macro-level drivers of TB are underrepresented in budgeting allocations for initiatives to combat this disease. Although it could be argued that structural drivers that undermine health-promoting actions are beyond the purview of the health sector itself, we argue that strategic plans to combat TB in high burden settings need more attention to directly considering such drivers to prompt the necessary changes and reduce the burden of this and other such diseases.
Collapse
Affiliation(s)
- Prince A. Adu
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1ZE Canada
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC V5Z 4R4 Canada
| | - Jerry M. Spiegel
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1ZE Canada
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1ZE Canada
| |
Collapse
|
2
|
Rodrigo T, García-García JM, Caminero JA, Ruiz-Manzano J, Anibarro L, García-Clemente MM, Gullón JA, Jiménez-Fuentes MÁ, Medina JF, Mir I, Penas A, Sánchez F, Souza-Galvão MLD, Caylà JA. Evaluation of the Integrated Tuberculosis Research Program Sponsored by the Spanish Society of Pulmonology and Thoracic Surgery: 11 Years on. Arch Bronconeumol 2019; 56:483-492. [PMID: 31780285 DOI: 10.1016/j.arbres.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/16/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. METHOD Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the χy test for lineal trend. RESULTS A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40-50 and > 50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), sensitivity testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49,664, numbers of projects initiated annually, presentations at conferences, and theses. CONCLUSIONS PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.
Collapse
Affiliation(s)
- Teresa Rodrigo
- Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Fundación Unidad de Investigación en Tuberculosis (fuiTB), Barcelona, España.
| | - José-María García-García
- Servicio de Neumología, Hospital Universitario San Agustín, Avilés, Asturias, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - José A Caminero
- Servicio de Neumología, Hospital General Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España; International Union Against Tuberculosis and Lung Disease, París, Francia; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Juan Ruiz-Manzano
- Servicio de Neumología, Hospital Universitario Germans Trials i Pujol, Badalona, Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Luis Anibarro
- Unidad de Tuberculosis, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Marta M García-Clemente
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - José A Gullón
- Servicio de Neumología, Hospital Universitario San Agustín, Avilés, Asturias, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - M Ángeles Jiménez-Fuentes
- Unidad de Prevención y Control de Tuberculosis, Hospital Universitario Vall d'Hebrón, Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Juan F Medina
- Unidad de Tuberculosis, Hospitales Universitarios Virgen del Rocío, Sevilla, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Isabel Mir
- Servicio de Neumología, Hospital Son Llàtzer, Palma de Mallorca, Baleares, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Antón Penas
- Unidad de Tuberculosis, Hospital Universitario Lucus Augusti, Lugo, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Francisca Sánchez
- Servicio de Medicina Interna, Hospital del Mar, Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Maria Luiza De Souza-Galvão
- Unidad de Prevención y Control de Tuberculosis, Hospital Universitario Vall d'Hebrón, Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| | - Joan A Caylà
- Fundación Unidad de Investigación en Tuberculosis (fuiTB), Barcelona, España; Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
| |
Collapse
|
3
|
Sarvi F, Moghimbeigi A, Mahjub H, Nasehi M, Khodadost M. Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data. Epidemiol Health 2019; 41:e2019032. [PMID: 31319655 PMCID: PMC6713850 DOI: 10.4178/epih.e2019032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/09/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran. METHODS This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages. RESULTS The risk of mortality from TB was found to increase with the unemployment rate (β^=0.02), illiteracy (β^=0.04), household density per residential unit (β^=1.29), distance between the center of the county and the provincial capital (β^=0.03), and urbanization (β^=0.81). The following other risk factors for TB mortality were identified: diabetes (β^=0.02), human immunodeficiency virus infection (β^=0.04), infection with TB in the most recent 2 years (β^=0.07), injection drug use (β^=0.07), long-term corticosteroid use (β^=0.09), malignant diseases (β^=0.09), chronic kidney disease (β^=0.32), gastrectomy (β^=0.50), chronic malnutrition (β^=0.38), and a body mass index more than 10% under the ideal weight (β^=0.01). However, silicosis had no effect. CONCLUSIONS The results of this study provide useful information on risk factors for mortality from TB.
Collapse
Affiliation(s)
- Fatemeh Sarvi
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moghimbeigi
- Modeling of Noncommunicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Mahjub
- Research Center for Health Sciences, Department of Biostatistics, Faculty of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahshid Nasehi
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Khodadost
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|