D K Huluka, A W Ashagrie, T H Gebremariam, H Y Ahmed, R A Kebede, A B Binegdie, K G Gebrehiwot, M Tadesse, M Sultan, W W Dode, A A Tumebo, A Abayneh, Y Seman, T Firew, C B Sherman, N W Schluger, D A Haisch
COVID-19, the novel coronavirus, has posed a major threat to low- and middle-income countries (LMICs) due to inadequate health infrastructure and human resources. Ethiopia, a low-income country with the second largest population in Africa, has coordinated a strategic response, leveraging existing infrastructure and health systems and mobilizing public health professionals and specialist expert physicians for a multifaceted, unified government approach and adaptive response. Resource limitations, particularly in critical care, have still posed challenges, but the public health and clinical interventions thus far have prevented the catastrophic toll that many predicted. As the pandemic continues, Ethiopia expects to use a triple care model integrated at all levels, consisting of COVID-19 care, isolation care for suspected cases, and essential health services, and urges intensified non-pharmaceutical interventions alongside equitable global vaccine distribution as the ultimate answers to pandemic control. This paper draws on existing data, national planning and guidelines, and expertise from health leadership to describe this response in hopes of providing an example of how future large-scale health challenges might be faced in LMICs, using Ethiopia's successes and challenges in facing the pandemic.
{"title":"Strategic response to COVID-19 in Ethiopia.","authors":"D K Huluka, A W Ashagrie, T H Gebremariam, H Y Ahmed, R A Kebede, A B Binegdie, K G Gebrehiwot, M Tadesse, M Sultan, W W Dode, A A Tumebo, A Abayneh, Y Seman, T Firew, C B Sherman, N W Schluger, D A Haisch","doi":"10.5588/pha.22.0007","DOIUrl":"10.5588/pha.22.0007","url":null,"abstract":"<p><p>COVID-19, the novel coronavirus, has posed a major threat to low- and middle-income countries (LMICs) due to inadequate health infrastructure and human resources. Ethiopia, a low-income country with the second largest population in Africa, has coordinated a strategic response, leveraging existing infrastructure and health systems and mobilizing public health professionals and specialist expert physicians for a multifaceted, unified government approach and adaptive response. Resource limitations, particularly in critical care, have still posed challenges, but the public health and clinical interventions thus far have prevented the catastrophic toll that many predicted. As the pandemic continues, Ethiopia expects to use a triple care model integrated at all levels, consisting of COVID-19 care, isolation care for suspected cases, and essential health services, and urges intensified non-pharmaceutical interventions alongside equitable global vaccine distribution as the ultimate answers to pandemic control. This paper draws on existing data, national planning and guidelines, and expertise from health leadership to describe this response in hopes of providing an example of how future large-scale health challenges might be faced in LMICs, using Ethiopia's successes and challenges in facing the pandemic.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716818/pdf/i2220-8372-12-4-191.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9991353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Seguin, S Dringus, S Chiomvu, T Apollo, E Sibanda, V Simms, S Bernays, R Chikodzore, N Redzo, P Mlilo, L Ndlovu, P Nzombe, B Ncube, K Kranzer, R Abbas Ferrand, C D Chikwari
Setting: Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV.
Objectives: To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents' perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months' post-HIV diagnosis.
Design: We drew upon: 1) semi-structured interviews (n = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes).
Results: Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (n = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers.
Conclusion: This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions.
{"title":"Process evaluation of an intervention to improve HIV treatment outcomes among children and adolescents.","authors":"M Seguin, S Dringus, S Chiomvu, T Apollo, E Sibanda, V Simms, S Bernays, R Chikodzore, N Redzo, P Mlilo, L Ndlovu, P Nzombe, B Ncube, K Kranzer, R Abbas Ferrand, C D Chikwari","doi":"10.5588/pha.22.0009","DOIUrl":"10.5588/pha.22.0009","url":null,"abstract":"<p><strong>Setting: </strong>Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV.</p><p><strong>Objectives: </strong>To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents' perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months' post-HIV diagnosis.</p><p><strong>Design: </strong>We drew upon: 1) semi-structured interviews (<i>n</i> = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes).</p><p><strong>Results: </strong>Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (<i>n</i> = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers.</p><p><strong>Conclusion: </strong>This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9461220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L Viljoen, P Hendricks, G Hoddinott, N Vanqa, M Osman, A C Hesseling, S-A Meehan
Background: In South Africa, failure to link individuals diagnosed with TB to care remains an important gap in the TB care cascade. Compared to people diagnosed at primary healthcare (PHC) facilities, people diagnosed in hospitals are more likely to require additional support to be linked with PHC TB treatment services. We describe a patient interaction process to support linkage to TB care.
Methods: We implemented a step-by-step early patient interaction process with 84 adults newly diagnosed with TB in one district hospital in Khayelitsha, Cape Town, South Africa (August 2020-March 2021). We confirmed patient contact details, provided TB and health information, shared information on accessing care at PHC facilities and answered patients' questions in their home language.
Results: Most patients (54/84, 64%) provided updated telephone numbers, and 19/84 (23%) reported changes in their physical address. Patients welcomed practical and health information in their home language. The majority (74/84, 88%) were linked to care after hospital discharge.
Conclusions: A simple early patient interaction process implemented as part of routine care is a feasible strategy to facilitate early TB treatment initiation and registration.
{"title":"Early interactions with newly diagnosed TB patients in hospital can support linkage to care.","authors":"L Viljoen, P Hendricks, G Hoddinott, N Vanqa, M Osman, A C Hesseling, S-A Meehan","doi":"10.5588/pha.22.0012","DOIUrl":"https://doi.org/10.5588/pha.22.0012","url":null,"abstract":"<p><strong>Background: </strong>In South Africa, failure to link individuals diagnosed with TB to care remains an important gap in the TB care cascade. Compared to people diagnosed at primary healthcare (PHC) facilities, people diagnosed in hospitals are more likely to require additional support to be linked with PHC TB treatment services. We describe a patient interaction process to support linkage to TB care.</p><p><strong>Methods: </strong>We implemented a step-by-step early patient interaction process with 84 adults newly diagnosed with TB in one district hospital in Khayelitsha, Cape Town, South Africa (August 2020-March 2021). We confirmed patient contact details, provided TB and health information, shared information on accessing care at PHC facilities and answered patients' questions in their home language.</p><p><strong>Results: </strong>Most patients (54/84, 64%) provided updated telephone numbers, and 19/84 (23%) reported changes in their physical address. Patients welcomed practical and health information in their home language. The majority (74/84, 88%) were linked to care after hospital discharge.</p><p><strong>Conclusions: </strong>A simple early patient interaction process implemented as part of routine care is a feasible strategy to facilitate early TB treatment initiation and registration.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Gidado, E M H Mitchell, A O Adejumo, J Levy, O Emperor, A Lawson, N Chukwueme, H Abdur-Razak, A Idris, A Adebowale
Background: Nigeria has an estimated TB prevalence of 219 per 100,000 population. In 2019, Nigeria diagnosed and notified 27% of the WHO-estimated cases of all forms of TB and contributed 11% of the missing TB cases globally.
Objective: To assess TB underreporting by type and level of health facility (HF), and associated factors in Lagos State, Nigeria.
Methodology: Quantitative secondary data analysis of TB cases was conducted in 2015. χ2 test was used to assess the association between treatment initiation, TB underreporting, local government area (LGA) and HF characteristics.
Results: Overall, 2,064 persons with bacteriologically confirmed TB (15.5%) were not matched to patients in sampled TB registers. Treatment status was unknown for 86 cases (IQR 55-97) per LGA. LGAs with higher case-loads had higher proportions of cases with unknown TB status. Discrepant reporting of treated TB was also common (60% HFs). Primary-level TB treatment facilities and unengaged private facilities were less likely to notify.
Conclusion: There was TB under-reporting across all types and levels of HFs and LGAs. There is a need to revise or strengthen the process of supervision and data quality assurance system at all levels.
{"title":"Assessment of TB underreporting by level of reporting system in Lagos, Nigeria.","authors":"M Gidado, E M H Mitchell, A O Adejumo, J Levy, O Emperor, A Lawson, N Chukwueme, H Abdur-Razak, A Idris, A Adebowale","doi":"10.5588/pha.22.0008","DOIUrl":"https://doi.org/10.5588/pha.22.0008","url":null,"abstract":"<p><strong>Background: </strong>Nigeria has an estimated TB prevalence of 219 per 100,000 population. In 2019, Nigeria diagnosed and notified 27% of the WHO-estimated cases of all forms of TB and contributed 11% of the missing TB cases globally.</p><p><strong>Objective: </strong>To assess TB underreporting by type and level of health facility (HF), and associated factors in Lagos State, Nigeria.</p><p><strong>Methodology: </strong>Quantitative secondary data analysis of TB cases was conducted in 2015. χ<sup>2</sup> test was used to assess the association between treatment initiation, TB underreporting, local government area (LGA) and HF characteristics.</p><p><strong>Results: </strong>Overall, 2,064 persons with bacteriologically confirmed TB (15.5%) were not matched to patients in sampled TB registers. Treatment status was unknown for 86 cases (IQR 55-97) per LGA. LGAs with higher case-loads had higher proportions of cases with unknown TB status. Discrepant reporting of treated TB was also common (60% HFs). Primary-level TB treatment facilities and unengaged private facilities were less likely to notify.</p><p><strong>Conclusion: </strong>There was TB under-reporting across all types and levels of HFs and LGAs. There is a need to revise or strengthen the process of supervision and data quality assurance system at all levels.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D Editor, We would like to call on health providers, researchers and decision-makers to develop studies and interventions that address the impact of COVID-19 on TB control in vulnerable populations. This is inspired by the recent article by Dheda and colleagues in the Lancet Respiratory Medicine,1 in which the authors describe the effects of the pandemic on TB control at the global and national levels, but without acknowledging the heterogeneous impact among populations with different sociodemographic characteristics. Alarmed by this omission, we wanted to highlight the need to address the particularly marked impact of COVID-19 on TB care for vulnerable groups. This is exemplified by the current situation affecting indigenous and migrant populations living in the state of Chiapas, Mexico. Chiapas is the southernmost state of Mexico, neighbouring Guatemala. The state has the second highest proportion of speakers of indigenous languages in the country (28.2%),2 and serves as an entry point into Mexico for thousands of migrants each year, mainly from Central America and the Caribbean, with 70% of all national refugee applications concentrated in a single municipality.3 The migrant population in Chiapas has almost doubled over the past 10 years due to political instability, social violence, natural disasters and economic hardship – aggravated by the COVID-19 pandemic – in their countries of origin. In 2018, indigenous populations among the citizens of Chiapas had the highest levels of poverty (above 90%) and lack of access to health services (above 20%),2 exacerbated by widespread racism and a lack of cultural competence among health providers. In the case of migrant populations, almost half had left their home countries due to economic issues and less than 50% had received healthcare when needed.4 It is well known that poorer living conditions, hygiene and health support among indigenous and migrant citizens lead to increased susceptibility to TB, and poorer diagnosis, management and prognosis of the disease in these populations. On top of this, the COVID-19 pandemic has increased economic hardship and limited access to health services for vulnerable groups in Chiapas, who have been disproportionately affected by the COVID-19 disease burden, thereby worsening the state of TB and TB care among indigenous peoples and migrants. For example, TB case detection in indigenous populations declined by 50% from 2019 to 2020 in one of 15 regions in Chiapas, compared to a 30% decrease in the general population.5 This example highlights the importance of gathering evidence on the specific effect of the COVID-19 pandemic on TB control in vulnerable groups. This is often overshadowed by national-level data and demonstrates the need to develop intersectoral interventions to tackle the social determinants that increase susceptibility to TB and impede access to TB care among populations that are particularly affected by the pandemic.
{"title":"The need to address the impact of COVID-19 on TB control for vulnerable groups.","authors":"Z Aranda, H J Sánchez-Pérez","doi":"10.5588/pha.22.0022","DOIUrl":"https://doi.org/10.5588/pha.22.0022","url":null,"abstract":"D Editor, We would like to call on health providers, researchers and decision-makers to develop studies and interventions that address the impact of COVID-19 on TB control in vulnerable populations. This is inspired by the recent article by Dheda and colleagues in the Lancet Respiratory Medicine,1 in which the authors describe the effects of the pandemic on TB control at the global and national levels, but without acknowledging the heterogeneous impact among populations with different sociodemographic characteristics. Alarmed by this omission, we wanted to highlight the need to address the particularly marked impact of COVID-19 on TB care for vulnerable groups. This is exemplified by the current situation affecting indigenous and migrant populations living in the state of Chiapas, Mexico. Chiapas is the southernmost state of Mexico, neighbouring Guatemala. The state has the second highest proportion of speakers of indigenous languages in the country (28.2%),2 and serves as an entry point into Mexico for thousands of migrants each year, mainly from Central America and the Caribbean, with 70% of all national refugee applications concentrated in a single municipality.3 The migrant population in Chiapas has almost doubled over the past 10 years due to political instability, social violence, natural disasters and economic hardship – aggravated by the COVID-19 pandemic – in their countries of origin. In 2018, indigenous populations among the citizens of Chiapas had the highest levels of poverty (above 90%) and lack of access to health services (above 20%),2 exacerbated by widespread racism and a lack of cultural competence among health providers. In the case of migrant populations, almost half had left their home countries due to economic issues and less than 50% had received healthcare when needed.4 It is well known that poorer living conditions, hygiene and health support among indigenous and migrant citizens lead to increased susceptibility to TB, and poorer diagnosis, management and prognosis of the disease in these populations. On top of this, the COVID-19 pandemic has increased economic hardship and limited access to health services for vulnerable groups in Chiapas, who have been disproportionately affected by the COVID-19 disease burden, thereby worsening the state of TB and TB care among indigenous peoples and migrants. For example, TB case detection in indigenous populations declined by 50% from 2019 to 2020 in one of 15 regions in Chiapas, compared to a 30% decrease in the general population.5 This example highlights the importance of gathering evidence on the specific effect of the COVID-19 pandemic on TB control in vulnerable groups. This is often overshadowed by national-level data and demonstrates the need to develop intersectoral interventions to tackle the social determinants that increase susceptibility to TB and impede access to TB care among populations that are particularly affected by the pandemic.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H Manisha, W Amani, A Garrib, M Senkoro, S Mfinanga
Background: TB is a major cause of mortality worldwide, with the highest risk in people living with HIV/AIDS (PLWHA). Isoniazid preventive therapy (IPT), in combination with antiretroviral therapy (ART), reduces the overall incidence and mortality from TB by up to 90% among PLWHA. Tanzania has limited published data on IPT coverage among PLWHA.
Objective: To investigate coverage and determinants of IPT among PLWHA receiving care in selected care and treatment clinics in Dar es Salaam, Tanzania.
Methods: An analytical cross-sectional design to study 31,480 HIV-positive adults. Proportions and comparisons were obtained using χ2 tests, while determinants for IPT were assessed using adjusted multivariable analysis.
Results: The IPT coverage among eligible PLWHA was generally low (28.9%), with increased coverage over time. The determinants for IPT coverage included age >36 years, having WHO Clinical Stages 1 and 2 compared to 3 and 4, and having normal weight, or being overweight and obesity compared to underweight.
Conclusion: IPT coverage in Dar es Salaam is very low; individuals with minor HIV disease severity were more likely to initiate IPT. This shows a possible gap in the prescribing practices among healthcare providers. More efforts to ensure IPT coverage implementation in Dar es Salaam are required.
{"title":"IPT coverage and determinants of care coverage in Tanzania.","authors":"H Manisha, W Amani, A Garrib, M Senkoro, S Mfinanga","doi":"10.5588/pha.22.0018","DOIUrl":"https://doi.org/10.5588/pha.22.0018","url":null,"abstract":"<p><strong>Background: </strong>TB is a major cause of mortality worldwide, with the highest risk in people living with HIV/AIDS (PLWHA). Isoniazid preventive therapy (IPT), in combination with antiretroviral therapy (ART), reduces the overall incidence and mortality from TB by up to 90% among PLWHA. Tanzania has limited published data on IPT coverage among PLWHA.</p><p><strong>Objective: </strong>To investigate coverage and determinants of IPT among PLWHA receiving care in selected care and treatment clinics in Dar es Salaam, Tanzania.</p><p><strong>Methods: </strong>An analytical cross-sectional design to study 31,480 HIV-positive adults. Proportions and comparisons were obtained using χ<sup>2</sup> tests, while determinants for IPT were assessed using adjusted multivariable analysis.</p><p><strong>Results: </strong>The IPT coverage among eligible PLWHA was generally low (28.9%), with increased coverage over time. The determinants for IPT coverage included age >36 years, having WHO Clinical Stages 1 and 2 compared to 3 and 4, and having normal weight, or being overweight and obesity compared to underweight.</p><p><strong>Conclusion: </strong>IPT coverage in Dar es Salaam is very low; individuals with minor HIV disease severity were more likely to initiate IPT. This shows a possible gap in the prescribing practices among healthcare providers. More efforts to ensure IPT coverage implementation in Dar es Salaam are required.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O O Chijioke-Akaniro, E Ubochioma, A Omoniyi, O Fashade, O Olarewaju, S Asuke, E C Aniwada, A N Uwaezuoke, J Sseskitooleko, N Workneh, E Masini, B Morris, A Lawanson, C Anyaike
Background: This was a study on national TB data.
Objective: To assess improvement in TB case notification and treatment coverage through improved data use for action in Nigeria.
Design: We analysed pre- and post-intervention secondary TB programme data comprising data on increased supervisory visits, incentives for health workers, DOTS expansion, outreaches and geo-code monitoring. Trend analysis was performed using Cochran-Armitage χ2 test for linear trends.
Results: Case-finding increased from 104,904 cases in 2017 to 138,591 in 2020. There was an increase of 2.0% from 2017 to 2018, 13.0% in 2018 to 2019 and 15.0% in 2019 to 2020 (P < 0.001). Facility DOTS coverage increased from 7,389 facilities in 2017 to 17,699 in 2020. There was an increase of 30.0% in 2018, 31.0% in 2019 and 40.0% in 2020 (P < 0.001). The number of reporting facilities increased from 5,854 in 2017 to 12,775 in 2020. Compared with 2017, there were an increase of 20.0% in 2018, 38.0% in 2019 and 32.0% in 2020 (P < 0.001). Treatment coverage rate increased from 24% in 2018 to 27% in 2019 and 30% in 2020.
Conclusion: TB service expansion, improved monitoring and the use of data for decision making are key in increasing TB treatment coverage.
{"title":"Improving TB case notification and treatment coverage through data use.","authors":"O O Chijioke-Akaniro, E Ubochioma, A Omoniyi, O Fashade, O Olarewaju, S Asuke, E C Aniwada, A N Uwaezuoke, J Sseskitooleko, N Workneh, E Masini, B Morris, A Lawanson, C Anyaike","doi":"10.5588/pha.22.0001","DOIUrl":"https://doi.org/10.5588/pha.22.0001","url":null,"abstract":"<p><strong>Background: </strong>This was a study on national TB data.</p><p><strong>Objective: </strong>To assess improvement in TB case notification and treatment coverage through improved data use for action in Nigeria.</p><p><strong>Design: </strong>We analysed pre- and post-intervention secondary TB programme data comprising data on increased supervisory visits, incentives for health workers, DOTS expansion, outreaches and geo-code monitoring. Trend analysis was performed using Cochran-Armitage χ<sup>2</sup> test for linear trends.</p><p><strong>Results: </strong>Case-finding increased from 104,904 cases in 2017 to 138,591 in 2020. There was an increase of 2.0% from 2017 to 2018, 13.0% in 2018 to 2019 and 15.0% in 2019 to 2020 (<i>P</i> < 0.001). Facility DOTS coverage increased from 7,389 facilities in 2017 to 17,699 in 2020. There was an increase of 30.0% in 2018, 31.0% in 2019 and 40.0% in 2020 (<i>P</i> < 0.001). The number of reporting facilities increased from 5,854 in 2017 to 12,775 in 2020. Compared with 2017, there were an increase of 20.0% in 2018, 38.0% in 2019 and 32.0% in 2020 (<i>P</i> < 0.001). Treatment coverage rate increased from 24% in 2018 to 27% in 2019 and 30% in 2020.</p><p><strong>Conclusion: </strong>TB service expansion, improved monitoring and the use of data for decision making are key in increasing TB treatment coverage.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S Main, B Dwihardiani, A Hidayat, S Khodijah, J Greig, G Chan, A E Parry, B Nababan, I Billy, P du Cros, R Triasih
Setting: Healthcare workers (HCWs) are at an increased risk of TB worldwide. Individual knowledge and attitudes may influence HCW behaviour, and subsequently, TB risk. Indonesia has the second highest case-load globally.
Objective: To measure TB knowledge and attitudes among a subsection of HCWs in Yogyakarta, Indonesia, and to explore factors associated with knowledge.
Design: A cross-sectional study using an online survey targeting all HCW staff was conducted among HCWs from four pre-selected healthcare facilities in Yogyakarta. Descriptive analysis and a multivariable linear regression were undertaken.
Results: Of 792 HCWs, 290 (37%) completed the survey; 64% (n = 185) were medical staff, 33% (n = 95) reported previously being tested for active TB and 8% (n = 24) for latent TB. The mean knowledge score was 7.2/11 (SD 1.5): this was higher among medical staff and those with university education (average score increase: 0.53, 95% CI 0.15 to 0.90; and 0.38, 95% CI 0.01 to 0.74, respectively). Participants agreed that free access to TB screening (93%) and treatment (93%) should be available, and 57% of medical and 77% of non-medical staff would take preventive therapy if eligible.
Conclusion: Participants had practical understanding of TB; however, gaps were identified in knowledge about TB disease progression and prevention. Prevention programmes were viewed positively. We suggest further TB education and engagement programmes for HCWs.
{"title":"Knowledge and attitudes towards TB among healthcare workers in Yogyakarta, Indonesia.","authors":"S Main, B Dwihardiani, A Hidayat, S Khodijah, J Greig, G Chan, A E Parry, B Nababan, I Billy, P du Cros, R Triasih","doi":"10.5588/pha.22.0017","DOIUrl":"10.5588/pha.22.0017","url":null,"abstract":"<p><strong>Setting: </strong>Healthcare workers (HCWs) are at an increased risk of TB worldwide. Individual knowledge and attitudes may influence HCW behaviour, and subsequently, TB risk. Indonesia has the second highest case-load globally.</p><p><strong>Objective: </strong>To measure TB knowledge and attitudes among a subsection of HCWs in Yogyakarta, Indonesia, and to explore factors associated with knowledge.</p><p><strong>Design: </strong>A cross-sectional study using an online survey targeting all HCW staff was conducted among HCWs from four pre-selected healthcare facilities in Yogyakarta. Descriptive analysis and a multivariable linear regression were undertaken.</p><p><strong>Results: </strong>Of 792 HCWs, 290 (37%) completed the survey; 64% (<i>n</i> = 185) were medical staff, 33% (<i>n</i> = 95) reported previously being tested for active TB and 8% (<i>n</i> = 24) for latent TB. The mean knowledge score was 7.2/11 (SD 1.5): this was higher among medical staff and those with university education (average score increase: 0.53, 95% CI 0.15 to 0.90; and 0.38, 95% CI 0.01 to 0.74, respectively). Participants agreed that free access to TB screening (93%) and treatment (93%) should be available, and 57% of medical and 77% of non-medical staff would take preventive therapy if eligible.</p><p><strong>Conclusion: </strong>Participants had practical understanding of TB; however, gaps were identified in knowledge about TB disease progression and prevention. Prevention programmes were viewed positively. We suggest further TB education and engagement programmes for HCWs.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Remembering Donald A. Enarson.","authors":"G N Kazi","doi":"10.5588/ijtld.22.0048","DOIUrl":"https://doi.org/10.5588/ijtld.22.0048","url":null,"abstract":"","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B Odume, E Chukwu, T Fawole, N Nwokoye, C Ogbudebe, O Chukwuogo, S Useni, C Dim, E Ubochioma, D Nongo, R Eneogu, T Lagundoye Odusote, O Oyelaran, C Anyaike
Setting: This pilot project was conducted in hard-to-reach communities of two Niger Delta States in the South-South Region of Nigeria.
Objective: To assess the usefulness of portable digital X-ray, the Delft-Light Backpack (DLB) for TB active case-finding (ACF) in hard-to-reach Niger Delta communities using the WHO 3B TB screening/diagnosis algorithm.
Design: DLB X-ray was used to screen all consenting eligible participants during community TB screening out-reaches in all hard-to-reach communities of Akwa Ibom and Cross River States in the Niger Delta, Nigeria. Participants with a CAD4TB (computer-aided detection for TB score) ⩾60 had Xpert (sputum) and/or clinical (radiograph) assessment for TB diagnosis. Data from the project were analysed for this study.
Results: A total of 8,230 participants (males: 47.2%, females: 52.8%) underwent TB screening and 1,140 (13.9%) presumptive TB cases were identified. The TB prevalence among all participants and among those with presumptive TB were respectively 1.2% and 8.6%. The number needed to screen was 84. Among people with presumptive TB, the proportion of males and females with confirmed TB was respectively 12.0% and 5.6% (P < 0.001).
Conclusion: TB screening using DLB X-ray during community-based ACF in hard-to-reach Niger Delta communities of Nigeria showed a high TB prevalence among participants. Nationwide deployment of the instrument in hard-to-reach areas is recommended.
{"title":"Portable digital X-ray for TB pre-diagnosis screening in rural communities in Nigeria.","authors":"B Odume, E Chukwu, T Fawole, N Nwokoye, C Ogbudebe, O Chukwuogo, S Useni, C Dim, E Ubochioma, D Nongo, R Eneogu, T Lagundoye Odusote, O Oyelaran, C Anyaike","doi":"10.5588/pha.21.0079","DOIUrl":"https://doi.org/10.5588/pha.21.0079","url":null,"abstract":"<p><strong>Setting: </strong>This pilot project was conducted in hard-to-reach communities of two Niger Delta States in the South-South Region of Nigeria.</p><p><strong>Objective: </strong>To assess the usefulness of portable digital X-ray, the Delft-Light Backpack (DLB) for TB active case-finding (ACF) in hard-to-reach Niger Delta communities using the WHO 3B TB screening/diagnosis algorithm.</p><p><strong>Design: </strong>DLB X-ray was used to screen all consenting eligible participants during community TB screening out-reaches in all hard-to-reach communities of Akwa Ibom and Cross River States in the Niger Delta, Nigeria. Participants with a CAD4TB (computer-aided detection for TB score) ⩾60 had Xpert (sputum) and/or clinical (radiograph) assessment for TB diagnosis. Data from the project were analysed for this study.</p><p><strong>Results: </strong>A total of 8,230 participants (males: 47.2%, females: 52.8%) underwent TB screening and 1,140 (13.9%) presumptive TB cases were identified. The TB prevalence among all participants and among those with presumptive TB were respectively 1.2% and 8.6%. The number needed to screen was 84. Among people with presumptive TB, the proportion of males and females with confirmed TB was respectively 12.0% and 5.6% (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>TB screening using DLB X-ray during community-based ACF in hard-to-reach Niger Delta communities of Nigeria showed a high TB prevalence among participants. Nationwide deployment of the instrument in hard-to-reach areas is recommended.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9176193/pdf/i2220-8372-12-2-85.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10246499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}