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Myburgh H, Meehan SA, Wademan DT, Osman M, Hesseling AC, Hoddinott G. TB programme stakeholder views on lessons from the COVID-19 response in South Africa. Public Health Action 2023; 13:97-103. [PMID: 37736584 PMCID: PMC10446663 DOI: 10.5588/pha.23.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/21/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The global COVID-19 pandemic has reversed many of the hard-won gains made in TB programmes and the associated reduction in the number of TB deaths, case notifications and incidence over the last three decades. Modelling estimates show that the impact will be lasting. There are global calls to recover the shortfalls along the TB care cascade that have resulted from COVID-19, with the recognition that the COVID-19 response holds lessons to inform more robust and comprehensive TB programmes and services. OBJECTIVE To explore lessons from response measures to the COVID-19 pandemic in two high TB burden South African provinces. DESIGN This was an exploratory qualitative study. We conducted interviews with TB programme stakeholders (managers and facility-level staff: n = 35) between February and June 2022. RESULTS We identified eight facilitators of the COVID-19 response, including political will, rapid policy development, multi-sectoral collaboration, patient-centred models of care delivery, community engagement, mHealth and telehealth technologies, rigorous contact tracing and widespread mask wearing. Political will was singled out as a critical driver of the response. CONCLUSION Leveraging COVID-19 inspired collaborations, technologies and avenues for health service delivery is an opportunity to maximise benefits for the TB programme. Reinvestment in national TB programmes and political prioritisation of TB are critical.
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Affiliation(s)
- H Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam; Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Mavragani A, Xia L, Wu J, Zhou Z, Zhang W, Luan R. The Environmental and Socioeconomic Effects and Prediction of Patients With Tuberculosis in Different Age Groups in Southwest China: A Population-Based Study. JMIR Public Health Surveill 2023; 9:e40659. [PMID: 36456535 PMCID: PMC9883735 DOI: 10.2196/40659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/04/2022] [Accepted: 12/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND While the End Tuberculosis (TB) Strategy has been implemented worldwide, the cause of the TB epidemic is multifactorial and not fully understood. OBJECTIVE This study aims to investigate the risk factors of TB and incorporate these factors to forecast the incidence of TB infection across different age groups in Sichuan, China. METHODS Correlation and linear regression analyses were conducted to assess the relationships between TB cases and ecological factors, including environmental, economic, and social factors, in Sichuan Province from 2006 to 2017. The transfer function-noise model was used to forecast trends, considering both time and multifactor effects. RESULTS From 2006 to 2017, Sichuan Province had a reported cumulative incidence rate of 1321.08 cases per 100,000 individuals in male patients and 583.04 cases per 100,000 individuals in female patients. There were significant sex differences in the distribution of cases among age groups (trend χ225=12,544.4; P<.001). Ganzi Tibetan Autonomous Prefecture had the highest incidence rates of TB in both male and female patients in Sichuan. Correlation and regression analyses showed that the total illiteracy rate and average pressure at each measuring station (for individuals aged 15-24 years) were risk factors for TB. The protective factors were as follows: the number of families with the minimum living standard guarantee in urban areas, the average wind speed, the number of discharged patients with invasive TB, the number of people with the minimum living standard guarantee in rural areas, the total health expenditure as a percentage of regional gross domestic product, and being a single male individual (for those aged 0-14 years); the number of hospitals and number of health workers in infectious disease hospitals (for individuals aged 25-64 years); and the amount of daily morning and evening exercise, the number of people with the urban minimum living standard guarantee, and being married (for female individuals aged ≥65 years). The transfer function-noise model indicated that the incidence of TB in male patients aged 0-14 and 15-24 years will continue to increase, and the incidence of TB in female patients aged 0-14 and ≥65 years will continue to increase rapidly in Sichuan by 2035. CONCLUSIONS The End TB Strategy in Sichuan should consider environmental, educational, medical, social, personal, and other conditions, and further substantial efforts are needed especially for male patients aged 0-24 years, female patients aged 0-14 years, and female patients older than 64 years.
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Affiliation(s)
| | - Lan Xia
- Department of Tuberculosis, Center for Disease Control and Prevention of Sichuan Province, Chengdu, China
| | - Jianlin Wu
- Department of Tuberculosis, Center for Disease Control and Prevention of Sichuan Province, Chengdu, China
| | - Zonglei Zhou
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wenqiang Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rongsheng Luan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Nordholm AC, Suppli CH, Norman A, Ekstrøm CT, Ertberg P, Koch A, Lillebaek T, Andersen AB. Pregnancy and post-partum tuberculosis; a nationwide register-based case-control study, Denmark, 1990 to 2018. Euro Surveill 2022; 27. [PMID: 35332863 PMCID: PMC8950853 DOI: 10.2807/1560-7917.es.2022.27.12.2100949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Pregnancy increases the risk of tuberculosis (TB), however, data on TB epidemiology in pregnant women are limited. Aim To guide possible interventions, we analysed risk factors for TB in pregnant and post-partum women. Methods We conducted a nationwide retrospective register-based case–control study from January 1990 to December 2018 in Denmark. Cases were women diagnosed with TB during their pregnancy or in the post-partum period. We selected two control groups: pregnant or post-partum women without TB, and non-pregnant women with TB. Differences were assessed by chi-squared or Fisher’s exact test. Risk factors for TB were identified through logistic regression and estimated by odds ratio (OR). Results We identified 392 cases, including 286 pregnant and 106 post-partum women. Most were migrants (n = 366; 93%) with a shorter median time spent in Denmark (2.74 years; interquartile range (IQR): 1.52–4.64) than non-pregnant TB controls (3.98 years; IQR: 1.43–8.51). Cases less likely had a Charlson comorbidity index ≥ 2compared with non-pregnant TB controls (p < 0.0001), and had no increased risk of severe disease (p = 0.847). Migrants from other World Health Organization regions than Europe, especially Africa (OR: 187; 95%CI: 125–281) had persistently higher odds of TB. Conclusions In Denmark, the risk of TB in pregnant and post-partum women is increased in migrant women who have stayed in the country a median time of approximately 3 years. We recommend increased focus on TB risk during pregnancy and suggest evaluating targeted TB screening of selected at-risk pregnant women to promote early case finding and prevent TB among mothers and their newborn children.
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Affiliation(s)
- Anne Christine Nordholm
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Camilla Hiul Suppli
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pia Ertberg
- Department of Obstetrics and Gynaecology, Herlev/Gentofte Hospital, Herlev, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Aase Bengaard Andersen
- Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Chung S, Seon JY, Lee SH, Kim HY, Lee YW, Bae K, Oh IH. The Relationship Between Socio-Demographic Factors and Tuberculosis Mortality in the Republic of Korea During 2008-2017. Front Public Health 2021; 9:691006. [PMID: 34746074 PMCID: PMC8564039 DOI: 10.3389/fpubh.2021.691006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
The Republic of Korea has a high incidence of tuberculosis (TB) and TB-specific mortality rate. In 2019, it had the second highest TB-specific mortality among Organization for Economic Co-operation and Development countries. Understanding the factors associated with TB-specific deaths may help eradicate the disease. Therefore, we aimed to identify the general characteristics associated with TB-specific mortality among Koreans. Using Causes of Death Statistics data from Statistics Korea, we assessed the year of death, sex, age, occupation, area of residence, marital status, and education level reported between 2008 and 2017. Patient characteristics associated with TB-specific deaths were analyzed using the Chi-squared test, while influencing factors of TB-specific mortality were analyzed using logistic regression analysis to calculate adjusted odds ratios (AOR). Female (AOR: 0.509, 95% CI: 0.493–0.526), those with a graduate degree or higher (AOR: 0.559, 95% CI: 0.474–0.660) had lower TB-specific mortality rates than those of their counterparts. Conversely, those aged ≥70 years (AOR: 1.239, 95% CI: 1.199–1.280), single (AOR: 1.355, 95% CI: 1.315–1.396), and skilled agricultural, forestry, and fishery workers (AOR: 1.441, 95% CI: 1.359–1.529) had higher TB-specific mortality rates than those of their counterparts. In conclusion, TB-specific mortality rates differed according to the characteristics of the deceased patients. In order to establish effective TB control, multisectoral action on broader determinants should be strengthened.
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Affiliation(s)
- SeoYeon Chung
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jeong-Yeon Seon
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine Ansan, Korea University Ansan Hospital, Ansan-Si, South Korea
| | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Yeo Wool Lee
- Department of Public Health, School of Medicine, Korea University, Seoul, South Korea
| | - Kyoungeun Bae
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
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Ali SM, Rehal S. Public health practitioners' perspective on the sustainability of the tuberculosis control programme at primary health care level in Pakistan. East Mediterr Health J 2021; 27:899-905. [PMID: 34569045 DOI: 10.26719/emhj.21.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/01/2021] [Indexed: 11/09/2022]
Abstract
Background In resource-limited settings, national tuberculosis (TB) control programmes are highly dependent on external funds, which may pose a challenge to programme sustainability. There is a recognized need for developing guidance around sustainable programming of current TB control initiatives. Aims The aim of this study was to explore public health practitioners' perspectives on the sustainability of TB control initiatives in Pakistan at the primary health care (PHC) level. Methods Guided by an interpretive epistemology, online in-depth interviews were conducted with 10 public health practitioners who had experience as resource planners in the TB control programme in Pakistan. Thematic content analysis was employed to the textual data as the analytical approach. Results Three themes were inductively derived from the thematic analysis: community involvement, stakeholder engagement and efficient use of the PHC system. Community involvement was a determinant in sustaining TB control initiatives. This was attributed to the nature of the disease and prevalent health seeking behaviour. Stakeholder engagement was associated with funding arrangements between public and private partners and considered important in how new initiatives can be made part of the routine structure. Overall, having an efficient PHC system was deemed critical in sustaining current TB control initiatives at the PHC level in Pakistan. Conclusion Fostering an enabling operational environment through regulations, supporting the utilization of existing resources, expanding the network of providers, inclusive planning, increasing spending on research and cost-effective testing are pivotal for sustaining the TB control initiatives.
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Affiliation(s)
- Syed Mustafa Ali
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Satwinder Rehal
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
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Wang X, He W, Lei J, Liu G, Huang F, Zhao Y. Impact of COVID-19 Pandemic on Pre-Treatment Delays, Detection, and Clinical Characteristics of Tuberculosis Patients in Ningxia Hui Autonomous Region, China. Front Public Health 2021; 9:644536. [PMID: 34095053 PMCID: PMC8175850 DOI: 10.3389/fpubh.2021.644536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background: To contain the pandemic of COVID-19, China has implemented a series of public health interventions that impacted the tuberculosis control substantially, but these impacts may vary greatly depending on the severity of the local COVID-19 epidemic. The impact of COVID-19 on TB control in Ningxia Hui Autonomous Region is little known. Methods: Based on the national TB Information Management System (TBIMS), this study accessed the actual impact of COVID-19 on TB by comparing TB notifications, pre-treatment delays, and clinical characteristics of TB cases between 2020 COVID-19 period and 2017-2019 baseline. The data were divided into three periods based on the response started to fight against COVID-19 in Ningxia Hui Autonomous Region, including the control period (10 weeks before the pandemic), intensive period (10 weeks during the Ningxia Hui Autonomous Region lockdown), and regular (10 additional weeks after Ningxia Hui Autonomous Region reopen). Results: TB notification dropped sharply in the first week of the intensive period but took significantly longer to return to the previous level in 2020 compared with the 2017-2019 baseline. Totally, the TB notification rates decreased by more than 60% in the intensive period of COVID-19 compared with the average level of 2017-2019. The sputum smear-positive rate of TB patients diagnosed in intensive period of COVID-19 was significantly higher than that in the corresponding periods of 2017-2019 (P < 0.001). The rate of cavity on X-ray inspection of TB cases diagnosed in the intensive period of COVID-19 was significantly higher than that in period 2 of 2017-2019 (23.5 vs. 15.4%, P = 0.004). The patients' delay in the intensive period was significantly longer than that before the pandemic (P = 0.047). Conclusions: The TB notification in Ningxia was impacted dramatically by the pandemic of COVID-19. To compensate for the large numbers of missed diagnosis as well as delayed diagnosis during the intensive period of COVID-19, an urgent restoration of normal TB services, and further emphasis on enhanced active case finding and scale-up of household contact tracing and screening for TB-related symptoms or manifestation, will be essential.
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Affiliation(s)
- Xiaolin Wang
- The Fourth People's Hospital of Ning Xia Hui Autonomous Region, Yinchuan, China
| | - Wencong He
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juan Lei
- The Fourth People's Hospital of Ning Xia Hui Autonomous Region, Yinchuan, China
| | - Guangtian Liu
- The Fourth People's Hospital of Ning Xia Hui Autonomous Region, Yinchuan, China
| | - Fei Huang
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanlin Zhao
- National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Pereira AC, Reis AC, Ramos B, Cunha MV. Animal tuberculosis: Impact of disease heterogeneity in transmission, diagnosis and control. Transbound Emerg Dis 2020; 67:1828-1846. [PMID: 32155685 DOI: 10.1111/tbed.13539] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
Animal tuberculosis (TB) in terrestrial mammals is mainly caused by Mycobacterium bovis. This pathogen is adapted to a wide range of host species, representing a threat to livestock, wildlife and human health. Disease heterogeneity is a hallmark of multi-host TB and a challenge for control. Drivers of animal TB heterogeneity are very diverse and may act at the level of the causative agent, the host species, the interface between mycobacteria and the host, community of hosts, the environment and even policy behind control programmes. In this paper, we examine the drivers that seem to contribute to this phenomenon. We begin by reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological and socio-environmental factors contribute to the establishment and maintenance of animal TB, setting the grounds for heterogeneity. We then highlight the complex interplay between individual, species-specific and community protective factors with risk/maintenance variables that include animal movements and densities, co-infection and super-shedders. We finally consider how current interventions should seek to consider and explore heterogeneity in order to tackle potential limitations for diagnosis and control programmes, simultaneously increasing their efficacy.
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Affiliation(s)
- André C Pereira
- Instituto Nacional de Investigação Agrária e Veterinária, I. P. (INIAV, IP), Wildlife, Hunting & Biodiversity R&D Unit. Av. da República, Quinta do Marquês, Oeiras, Portugal
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- Biosystems & Integrative Sciences Institute (BioISI), Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Ana C Reis
- Instituto Nacional de Investigação Agrária e Veterinária, I. P. (INIAV, IP), Wildlife, Hunting & Biodiversity R&D Unit. Av. da República, Quinta do Marquês, Oeiras, Portugal
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- Biosystems & Integrative Sciences Institute (BioISI), Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Beatriz Ramos
- Instituto Nacional de Investigação Agrária e Veterinária, I. P. (INIAV, IP), Wildlife, Hunting & Biodiversity R&D Unit. Av. da República, Quinta do Marquês, Oeiras, Portugal
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Mónica V Cunha
- Instituto Nacional de Investigação Agrária e Veterinária, I. P. (INIAV, IP), Wildlife, Hunting & Biodiversity R&D Unit. Av. da República, Quinta do Marquês, Oeiras, Portugal
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- Biosystems & Integrative Sciences Institute (BioISI), Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
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Chen X, Wang W, Wang X, Chai C, Liu K, Peng Y, Wang F, Chen B, Jiang J. Public Awareness of Tuberculosis in Southeast China: A Population-Based Study. Int J Environ Res Public Health 2019; 16:E4290. [PMID: 31694232 DOI: 10.3390/ijerph16214290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
Few provinces in China have recently conducted population-based surveys on tuberculosis (TB) awareness at the provincial level. Hence, we conducted a population-based, cross-sectional study to evaluate the level of awareness of TB knowledge among residents of Zhejiang Province, China from October 2018 to December 2018. A total of 7174 individuals were randomly selected to participate in this survey. The rate of awareness of key information on TB was found to be 48.0%. The study’s participants exhibited a good understanding of the transmission route (80.8%), curable outcome (78.3%), and designated treatment sites (67.0%) of TB. The rate of awareness of suspicious TB symptoms (36.1%) and the relief policy on diagnosis and first-line therapeutic drugs (38.0%) were found to be relatively low among the respondents. People living in rural areas, those who were less educated, and students all showed a low level of awareness of key knowledge about TB. In conclusion, residents in Zhejiang Province generally lacked key information about TB, which is not conducive to the early detection and treatment of TB. Corresponding efforts should be made for different groups of people to achieve favorable effects on the prevention and control of TB.
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Sima BT, Belachew T, Bjune G, Abebe F. Traditional healers' role in the detection of active tuberculosis cases in a pastoralist community in Ethiopia: a pilot interventional study. BMC Public Health 2019; 19:721. [PMID: 31182067 PMCID: PMC6558710 DOI: 10.1186/s12889-019-7074-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Pastoralists rely on traditional healers (THs) for general health problems. However, some studies indicate that such practices result in delays in the diagnosis and treatment of tuberculosis (TB) cases. This study aims to assess the role of traditional healers in the detection and referral of active TB cases in a pastoralist community. Methods We identified 22 traditional healers from 7 villages of Kereyu pastoralist community in the Fentale district in Ethiopia in January 2015. We trained these THs in identifying presumptive TB symptoms and early referral to the nearby healthcare facilities. The training was held during a 1 week period that included a visit to their villages and follow-up. A 1 day meeting was held with the traditional healers, the district TB care and prevention coordinator and health extension workers from the selected sub-district to discuss the referral link between THs and the nearby healthcare facilities. Health providers working at the TB units in the selected healthcare facilities were oriented about the training given and planned involvement of THs in referring presumptive TB case. In addition, documentation of the presumptive TB cases was discussed. Results We succeeded in tracing and interviewing 8 of the 22 THs. The rest were on seasonal migration. According to the THs report for the 1 year period, these 8 THs had referred 24 TB suspects to the healthcare facilities. Sputum smear microscopy confirmed 13 of the 24 suspects as having TB cases. Among those confirmed, 10 completed treatment and three were on treatment. Five presumptive TB cases were confirmed non TB cases through further evaluation at the healthcare facilities and six of the presumptive TB cases were lost to follow up by the THs. Whereas, four of the presumptive TB cases were lost to follow up to the healthcare facility. Conclusions Results of the present study indicate that THs can contribute to the detection of undiagnosed active TB cases in a pastoralist community, provided they are given appropriate training and support. Electronic supplementary material The online version of this article (10.1186/s12889-019-7074-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bezawit Temesgen Sima
- Department of Health Education and Behavioural Science, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia. .,Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway. .,, Oslo, Norway.
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health Science, Jimma University, P.O.Box 378, Jimma, Ethiopia
| | - Gunnar Bjune
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway
| | - Fekadu Abebe
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway
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Shaji B, Arun Thomas ET, Sasidharan PK. Tuberculosis control in India: Refocus on nutrition. Indian J Tuberc 2019; 66:26-29. [PMID: 30797277 DOI: 10.1016/j.ijtb.2018.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/27/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022]
Abstract
Many western societies have eliminated tuberculosis years before the advent of potent anti-tuberculous drugs, as a result of the improved standards of living and good nutrition. But even with the availability of powerful anti-tuberculous drugs, India still has a long road ahead to reach the "End TB by 2025" goal. One of the major reason is that tuberculosis control program in India till now have focused primarily on case detection and medical treatment of active tuberculosis. Drug treatment alone does not completely prevent the occurrence of new infections in the community and also contributes to development of drug resistant strains if used improperly or incompletely. Although the treatment of active cases can reduce the period of transmission of disease, a significant amount of transmission to contacts occurs even before they have been diagnosed and treated. Additionally, this approach cannot prevent re-activation to active TB in the vast pool of persons with latent TB infection. Tuberculosis occurs in those with suppressed cell mediated immunity mainly due to poor nutritional status. Improving the nutritional status of the society by several social interventions hand-in-hand with utilizing the available anti-tuberculous drugs is possibly the only effective strategy. Promising programmatic guidance for nutritional support in TB patients have been formulated by the Central TB division of India but it needs a refocusing of TB control strategies towards nutrition at all levels and strong public health actions for effective implementation.
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Affiliation(s)
- Bhagya Shaji
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - E T Arun Thomas
- Department of Nephrology, Government Medical College, Thiruvanathapuram, Kerala, India.
| | - P K Sasidharan
- Department of Medicine, Government Medical College, Kozhikode, Kerala, India
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11
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Lu CL, Perera R, Farrah H, Waring J. Diabetes screening among active tuberculosis patients in Western Australia Tuberculosis Control Program using HbA1c. Intern Med J 2018; 49:630-633. [PMID: 30329203 DOI: 10.1111/imj.14143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diabetes mellitus is an important risk factor for tuberculosis (TB), and studies in high TB burden countries have shown diabetes screening to be both feasible and to have a high yield. However, scarce information is available for low TB burden countries. Diabetes screening was previously not part of our routine practice. AIM To screen and determine the prevalence of diabetes in the Western Australian Tuberculosis Control Program. METHODS We measured HbA1c and random plasma glucose in patients with active TB. We also collected details on their demographics, TB and diabetes. RESULTS A total of 105 patients was recruited over a year. Of those, 17 (16.2%) had diabetes. Seven cases (6.7%) were newly diagnosed diabetics. Age, cavitating disease and family history of diabetes were found to be significantly associated with diabetes. Multilobar disease, gender, body mass index, smear and culture positivity were not significantly different between groups. CONCLUSION Our study showed high prevalence of diabetes among active TB patients. Diabetes screening at diagnosis of active TB presents as a good opportunity to detect diabetes even in low prevalence country and has become part of our standard care.
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Affiliation(s)
- Cheng L Lu
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ruad Perera
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,The Anita Clayton Centre, Western Australia Tuberculosis Control Program, Perth, Western Australia, Australia
| | - Hussein Farrah
- The Anita Clayton Centre, Western Australia Tuberculosis Control Program, Perth, Western Australia, Australia
| | - Justin Waring
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,The Anita Clayton Centre, Western Australia Tuberculosis Control Program, Perth, Western Australia, Australia
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12
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Thomas B, Priscilla Rebecca B, Dhanalakshmi A, Rani S, Deepa Lakshmi A, Watson B, Vijayalakshmi R, Muniyandi M, Karikalan N. Effectiveness of TB sensitization initiatives in improving the involvement of self help group members in rural TB control in south India. Trans R Soc Trop Med Hyg 2018; 110:714-720. [PMID: 28938052 DOI: 10.1093/trstmh/trx006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background The 'End TB strategy' has highlighted the importance of inter-sectoral collaboration and community mobilization for achieving zero TB deaths by 2020. Objective The aim of the study was to develop and test a model TB sensitization programme involving self help groups (SHGs). Methodology This experimental study was conducted in two blocks (intervention and control), in Tiruvallur district. The intervention content included short-lecture, musical story telling activity, role play, short film on TB. The impact was compared at baseline, third and sixth months in terms of SHGs' awareness, promotion of awareness, identification and referral of presumptive TB cases and provision of TB treatment. Results A total of 764 vs 796 SHGs were enrolled in control and intervention groups, respectively. The knowledge attitude, and practice score (lower score indicated a better attitude and practice), from baseline to 6 months was significantly reduced (29 to 24) in the intervention group. Similarly, a significant difference was observed in identification and referral of chest symptomatics in the intervention group at 3 and 6 months. During the 3 month follow-up a significantly higher proportion of SHG members were involved in TB awareness activities in the intervention (623/748 [83.3%]) vs control group (471/728 [64.7%]; p<0.001). Conclusions Findings from this study highlight the feasibility of involving SHGs through a model TB sensitization program for strengthening TB prevention and control activities.
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Affiliation(s)
- Beena Thomas
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - B Priscilla Rebecca
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - A Dhanalakshmi
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - S Rani
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - A Deepa Lakshmi
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - Basilea Watson
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - R Vijayalakshmi
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - M Muniyandi
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - N Karikalan
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
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13
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Abstract
The accelerated reductions in global TB incidence required to achieve the End TB Strategy goal will result in reductions in the burden of childhood TB. Contact screening and preventive therapy have emerged as important components of TB burden reduction, and family-centered approaches could be an effective route in delivering these activities. Lack of accurate diagnostics for children remains a critical barrier and a need remains for better collaborative and supportive links between the child health and TB control sectors. Irrespective of whether the ambitious targets can be achieved, the unprecedented opportunities provided by the End TB Strategy must be embraced.
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Affiliation(s)
- James A Seddon
- Department of Paediatrics, Imperial College London, London, UK
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia International Union Against Tuberculosis and Lung Disease, Paris, France The Burnet Institute, Melbourne, Australia
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14
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Matteelli A, Centis R, D'Ambrosio L, Sotgiu G, Tadolini M, Pontali E, Spanevello A, Migliori GB. WHO strategies for the programmatic management of drug-resistant tuberculosis. Expert Rev Respir Med 2016; 10:991-1002. [PMID: 27276361 DOI: 10.1080/17476348.2016.1199278] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Adequate management of drug-resistant tuberculosis (TB), including multidrug- (MDR) and extensively drug-resistant (XDR-) TB are within the priorities of the newly launched World Health Organization's End TB and Elimination Strategies. AREAS COVERED This manuscript presents the evidence on the MDR- /XDR-TB epidemiology and discusses how the five recommended priority actions can be applied at the programmatic level to tackle the epidemic: 1) prevent development of MDR-TB thorough high quality treatment of drug- susceptible TB; 2) expand rapid testing and detection of drug-resistant TB; 3) provide immediate access to effective treatment and proper care; 4) prevent transmission through infection control; 5) increase political commitment and financing. A non-systematic review using Pubmed was carried out in addition to additional relevant information taken from the abstracts of international scientific conferences. Expert commentary: Current and future control of MDR-TB significantly relies on the correct use of new diagnostics and new drugs from one side, and on the consistent application of the five core interventions at the programmatic level. In addition, it is mandatory to tackle the social determinants and socio-economic barriers favouring the MDR-TB, otherwise it will not be possible to reach the planned goals as well as TB Elimination.
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Affiliation(s)
- Alberto Matteelli
- a Clinic of Infectious and Tropical Diseases , University of Brescia and Brescia Spedali Civili General Hospital , Brescia , Italy
| | - Rosella Centis
- b World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases , Fondazione S. Maugeri, Care and Research Institute , Tradate , Italy
| | - Lia D'Ambrosio
- b World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases , Fondazione S. Maugeri, Care and Research Institute , Tradate , Italy.,c Public Health Consulting Group , Lugano , Switzerland
| | - Giovanni Sotgiu
- d Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences , University of Sassari, Research, Medical Education and Professional Development Unit, AOU , Sassari , Italy
| | - Marina Tadolini
- e Section of Infectious Diseases, Department of Medical and Surgical Sciences , University of Bologna , Bologna , Italy
| | - Emanuele Pontali
- f Department of Infectious Diseases , Galliera Hospital , Genova , Italy
| | - Antonio Spanevello
- g Pneumology Unit , Fondazione Maugeri, IRCCS , Tradate , Italy.,h Department of Clinical and Experimental Medicine , University of Insubria , Varese , Italy
| | - Giovanni Battista Migliori
- b World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases , Fondazione S. Maugeri, Care and Research Institute , Tradate , Italy
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15
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Pai M, Daftary A, Satyanarayana S. TB control: challenges and opportunities for India. Trans R Soc Trop Med Hyg 2016; 110:158-60. [PMID: 26884494 PMCID: PMC5916376 DOI: 10.1093/trstmh/trw003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/12/2015] [Accepted: 12/28/2015] [Indexed: 11/13/2022] Open
Abstract
India's TB control programme has treated over 19 million patients, but the incidence of TB continues to be high. TB is a major killer and drug-resistant TB is a growing threat. There are several likely reasons, including social conditions and co-morbidities that fuel the TB epidemic: under-investment by the government, weak programme implementation and management, suboptimal quality of care in the private sector, and insufficient advocacy around TB. Fortunately, India possesses the technical know-how, competence and resources to address these challenges. The End TB Strategy by WHO offers India an excellent blueprint to advance the agenda of TB control.
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Affiliation(s)
- Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Canada
| | - Amrita Daftary
- McGill International TB Centre, McGill University, Montreal, Canada
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16
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Abstract
Drug-resistant tuberculosis, in particular Multi-Drug Resistant (MDR-TB) is an increasing global concern and a major burden for some developing countries, especially the BRICS. It is assumed that every year roughly 350 000 new MDR-TB cases occur in the world, on average in 20.5% of TB patients that have been previously treated but also in 3.5% of persons that have never been on TB treatment before. The global distribution of cases is very heterogeneous and is now better understood thanks to a growing number of specific surveys and routine surveillance systems: incidence is much higher in southern Africa and in all countries formerly part of the USSR. Countries with weak health systems and previously inefficient TB control programs are highly vulnerable to MDR epidemics because program failures do help creating, maintaining and spreading resistances. Global response is slowly rolled out and diagnosis capacities are on the rise (mostly with genotypic methods) but adequate and successful treatment and care is still limited to a minority of global cases. From a public health perspective the MDR-TB growing epidemics will not be controlled merely by the introduction of few new antibiotics because it is also linked to patient's compliance and adequate case management supported by efficient TB program. In depth quality improvement will only be achieved after previous errors are thoroughly analyzed and boldly corrected.
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Affiliation(s)
- T Comolet
- Direction générale de la santé, Ministère de la santé des affaires sociales et des droits des femmes, 14, avenue Duquesne, 75007, Paris, France.
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17
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Ukwaja KN, Alobu I, Ifebunandu NA, Osakwe C, Igwenyi C. Trend in case detection rate for all tuberculosis cases notified in Ebonyi, Southeastern Nigeria during 1999-2009. Pan Afr Med J 2013; 16:11. [PMID: 24498460 PMCID: PMC3909695 DOI: 10.11604/pamj.2013.16.11.680] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 04/22/2013] [Indexed: 11/23/2022] Open
Abstract
Unlike previous annual WHO tuberculosis reports that reported case detection rate for only smear-positive tuberculosis cases, the 2010 report presented case detection rate for all tuberculosis cases notified in line with the current Stop TB strategy. To help us understand how tuberculosis control programmes performed in terms of detecting tuberculosis, there is need to document the trend in case detection rate for all tuberculosis cases notified in high burden countries. This evidence is currently lacking from Nigeria. Therefore, this study aimed to assess the trend in case detection rate for all tuberculosis cases notified from Ebonyi state compared to Nigeria national figures. Reports of tuberculosis cases notified between 1999 and 2009 were reviewed from the Ebonyi State Ministry of Health tuberculosis quarterly reports. Tuberculosis case detection rates were computed according to WHO guidelines. 22, 508 patients with all forms of tuberculosis were notified during the study. Case detection rate for all tuberculosis rose from 27% in 1999 to gradually reach a peak of 40% during 2007 to 2008 before a slight decline in 2009 to 38%. However, the national case detection rate for all tuberculosis cases in Nigeria rose from 7% in 1999 and progressively increased to reach a peak of 19% during 2008 and 2009. Since the introduction of DOTS in Ebonyi, the programme has achieved 40% case detection rate for all tuberculosis cases - about 20% better than national figures. However, with the current low case detection rates, alternative mechanisms are needed to achieve the current global stop- TB targets in Nigeria.
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Affiliation(s)
- Kingsley Nnanna Ukwaja
- Department of Internal Medicine, Ebonyi State University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Isaac Alobu
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Ebonyi State Nigeria
| | | | | | - Chika Igwenyi
- Department of Internal Medicine, Ebonyi State University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
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18
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Ramos JM, Tesfamariam A, Balcha S, Biru D, Reyes F, Górgolas M. Management and transference of patients diagnosed with tuberculosis in a rural hospital in Southern Ethiopia. Int J Mycobacteriol 2013; 2:79-83. [PMID: 26785893 DOI: 10.1016/j.ijmyco.2013.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/15/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022] Open
Abstract
Treatment of new tuberculosis (TB) cases in Directly Observed Treatment Short Course (DOTS) programmes is believed to be the most valuable strategy for TB control. The aim of this study is to describe the experience of diagnosed cases of TB in a district hospital situated in a rural zone of Ethiopia and of "transferred out" TB cases from the hospital to their local health facilities using the DOTS programme spanning a period of 8years. Data collection was obtained by using a TB register book in a rural district hospital from 2004 to 2011. The collected information included the type of TB, age, HIV status, and treatment outcomes using standardized definitions; 6459 patients with all forms of TB were diagnosed. Twenty-eight percent were smear-positive pulmonary TB (PTB) cases, 28.97% were smear-negative PTB cases, and 42.8% were extra-pulmonary TB (EPTB). The global "transferred out" rate was 78.5% (5073/6459); the "transferred out" rate after diagnosis at hospital and before starting DOTS was 72.6% (4689/6459), and after finishing the intensive phase and admission was 21.8% (385/1770). The proportion of total cases "transferred out" in smear-negative PTB cases (70.2%) was less than smear-positive PTB cases (79.2%) (odd ratio [OR]: 0.81; 95% confidence interval [CI]: 0.76-0.87) and was higher in EPTB cases (83.3%) (OR: 1.15; 95% CI: 1.05-1.19). The percentage of "transferred out" after hospital admission was higher in HIV-positive cases (16.8%) than in HIV-negative cases (8.5%) (OR: 2.13; 95% CI: 1.28-3.53). In conclusion, district hospitals are still important facilities for the diagnosis of TB cases, particularly EPTB.
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Affiliation(s)
- José Manuel Ramos
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia; Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain; Department of Medicine, Universidad Miguel Hernández de Elche, Spain.
| | - Abraham Tesfamariam
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia
| | - Sable Balcha
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia
| | - Dejene Biru
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia
| | - Francisco Reyes
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia
| | - Miguel Górgolas
- Department of General Medicine and Paediatrics, Gambo General Rural Hospital, Shashemane, Ethiopia; Division of Infectious Diseases, Fundación Jiménez Díaz, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Spain
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