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Effectiveness of smoking cessation intervention based on the ABC Approach in patients with TB. 基于 ABC 法的结核病患者戒烟干预的效果。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2024-06-01 DOI: 10.5588/pha.23.0057
A Ohkado, A Querri, J Bermejo, R Bartolome, G Pardilla, D Manese, J Recidoro, L Kawatsu, A M C Garfin, T S Bam

Setting: Urban setting in the Philippines.

Objective: To assess the effectiveness of the ABC Approach developed by The Union as a tobacco-smoking cessation intervention for TB patients at a primary healthcare level in an urban setting in the Philippines.

Design: We set up an intervention group whose patients with TB received the ABC approach and a control group of patients with TB receiving only routine health education in Manila, The Philippines. We collected smoking status and the domestic secondhand-smoking (SHS) status data from patients with TB at months 0, 2, 4, 6, 8, and 12. TB treatment outcome data were also collected.

Results: Patients with TB (n = 2,174) were enrolled upon TB registration. Smoking rates were consistently low in the intervention group (3.9% vs. 8.7% at Month 6). The odds ratios of both tobacco-smoking status and domestic SHS status in the intervention group were significantly lower than those in the control group (tobacco-smoking status: P < 0.001, domestic SHS status: P < 0.01). TB treatment success rates were similar between the groups (85.0% vs. 87.3%; P = 0.201).

Conclusion: The ABC approach successfully reduced tobacco-smoking rates, maintained low domestic SHS rates and TB treatment success rates in the Philippines.

背景:菲律宾的城市环境:菲律宾城市环境:在菲律宾的城市环境中,评估联盟开发的 ABC 方法作为结核病患者初级医疗保健戒烟干预措施的有效性:设计:我们在菲律宾马尼拉设立了一个干预组,其肺结核患者接受 ABC 方法;同时设立了一个对照组,其肺结核患者仅接受常规健康教育。我们收集了肺结核患者在第 0、2、4、6、8 和 12 个月的吸烟状况和家庭二手烟(SHS)状况数据。我们还收集了肺结核治疗结果数据:肺结核病人(n = 2,174 人)在进行肺结核病登记时就被纳入其中。干预组的吸烟率一直很低(第 6 个月时为 3.9% 对 8.7%)。干预组的吸烟状况和家庭 SHS 状况的几率比明显低于对照组(吸烟状况:P < 0.001,家庭 SHS 状况:P < 0.01)。两组的结核病治疗成功率相似(85.0% vs. 87.3%;P = 0.201):ABC方法成功地降低了菲律宾的吸烟率,保持了较低的国内SHS率和结核病治疗成功率。
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引用次数: 0
Appraising perception, accessibility and uptake of DAT among patients with TB. 评估肺结核患者对 DAT 的认知、可及性和使用情况。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2024-06-01 DOI: 10.5588/pha.24.0009
C Ogbudebe, B Odume, I Gordon, O Chukwuogo, N Nwokoye, S Useni, E Efo, M Gidado, E Aniwada, A Ihesie, D Nongo, R Eneogu, O Chijioke-Akaniro, C Anyaike

Introduction: Poor adherence to TB treatment poses a significant public health threat to TB control programmes. The sustainability of directly observed treatment has been questioned because of its non-patient-centred approach and resource-intensive nature, and Digital Adherence Technologies (DATs) provide a suitable alternative. This study assessed the feasibility and acceptability of DATs among patients with TB.

Methods: This descriptive study was conducted in eight states in Nigeria among all patients with drug-susceptible TB.

Result: A total of 230 patients (89.1%) own a phone that no one else uses, and 18 (7.0%) use a family phone. A higher proportion of 189 (73.3%) have airtime credit and 119 (46.1%) have internet credit on their phone. In addition, 216 (83.7%) stated that the reminders they received on their phone helped them remember to take their medicine. Only 11 (4.3%) patients missed a dose of the TB medicine. Equally, 11 (4.3%) patients had taken their TB medicine without using DAT. Of these, 7 (63.3%) did not use DATs because they forgot to text medication labels, and 3 (27.6%) did so because of poor network. Only four (1.6%) purchased additional items to support the use of DATs.

Conclusion: DATs are acceptable in a wide variety of settings, even with reported challenges. Implementation efforts should ensure access, address technical challenges, and minimise additional cost to patients.

导言:结核病治疗依从性差对结核病控制计划构成了重大的公共卫生威胁。直接观察治疗因其不以病人为中心的方法和资源密集的性质,其可持续性受到质疑,而数字依从性技术(DAT)则提供了一个合适的替代方案。本研究评估了肺结核患者对数字坚持治疗技术的可行性和接受程度:这项描述性研究在尼日利亚 8 个州的所有药物敏感型肺结核患者中进行:共有 230 名患者(89.1%)拥有一部无人使用的电话,18 名患者(7.0%)使用家庭电话。有 189 人(73.3%)的手机有通话时间积分,119 人(46.1%)的手机有上网积分。此外,有 216 人(83.7%)表示手机上的提醒有助于他们记住服药时间。只有 11 名(4.3%)患者漏服了一剂结核病药物。同样,有 11 名 (4.3%) 患者在未使用 DAT 的情况下服用了结核病药物。其中,7 人(63.3%)没有使用 DAT,因为他们忘记写药物标签,3 人(27.6%)没有使用 DAT,因为网络不发达。只有 4 人(1.6%)购买了额外的物品来支持 DAT 的使用:结论:即使存在报告中提到的挑战,DAT 在各种环境中都是可以接受的。实施工作应确保可及性,解决技术难题,并尽量减少患者的额外费用。
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引用次数: 0
Depression: an individual-level early warning indicator of virologic failure in HIV patients in South Africa. 抑郁症:南非艾滋病患者病毒学治疗失败的个人预警指标。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2024-06-01 DOI: 10.5588/pha.24.0017
J A Edwards, J Brijkumar, M Dudgeon, C Robichaux, B Johnson, L Rautman, R A Powers, Y V Sun, S Pillay, C Ordonez, J Castillo-Mancilla, F C Tanser, Z Asghar, P Mee, P Moodley, H Sunpath, D R Kuritzkes, V C Marconi, M-Y S Moosa

Objective: To identify individual-level early warning indicators of virologic failure in HIV patients receiving antiretroviral therapy (ART) in South Africa.

Design: A matched case-control study of individuals with and without virologic failure (VF) (>5 months on ART and HIV-1 plasma viral load >1,000 copies/mL) was conducted between June 2014 and June 2018. Of the 1,000 participants enrolled in the parent cohort, 96 experienced VF, and 199 additional controls were identified from the parent cohort and matched 1:2 (some matched 1:3) for sex, age, ART duration, and site. Participants were interviewed while clinical, pharmacy refill, laboratory, and objective pharmacological data were obtained. Multivariate conditional logistic regression models were constructed using model selection to identify factors associated with VF. Significant determinants of VF were identified using an alpha level of 0.05.

Results: In a full conditional model, higher cumulative ART adherence, quantified using tenofovir-diphosphate concentrations in dried blood spots (OR 0.26) and medication possession ratio (OR 0.98) were protective against VF, whereas an increase in total depression score (OR 1.20) was predictive of VF.

Conclusion: This analysis demonstrates the importance of depression as a key individual-level early warning indicator of VF. Efforts to address mental health concerns among patients with people living with HIV could improve virologic suppression.

目的确定南非接受抗逆转录病毒疗法(ART)的艾滋病患者病毒学失败的个体水平预警指标:2014年6月至2018年6月期间,对出现和未出现病毒学失败(VF)(接受抗逆转录病毒疗法>5个月,HIV-1血浆病毒载量>1,000拷贝/毫升)的个体进行了配对病例对照研究。在加入母队列的 1000 名参与者中,有 96 人经历了 VF,另外还从母队列中确定了 199 名对照,并在性别、年龄、抗逆转录病毒疗法持续时间和地点方面进行了 1:2 的匹配(部分匹配为 1:3)。在对参与者进行访谈的同时,还获取了临床、药房续药、实验室和客观药理学数据。采用模型选择法建立多变量条件逻辑回归模型,以确定与 VF 相关的因素。采用 0.05 的阿尔法水平确定了 VF 的重要决定因素:在全条件模型中,较高的累积抗逆转录病毒疗法依从性(用干血斑中的替诺福韦-二磷酸浓度量化)(OR 0.26)和药物持有率(OR 0.98)可防止VF的发生,而抑郁总分的增加(OR 1.20)可预测VF的发生:这项分析表明,抑郁作为 VF 的关键个体预警指标具有重要意义。努力解决艾滋病病毒感染者患者的心理健康问题可以改善病毒抑制效果。
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引用次数: 0
Mirage de tuberculose in the 21st century. 21 世纪结核病的幻影。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2024-06-01 DOI: 10.5588/pha.24.0056
M B Kaelin, S Wieser, B Preiswerk, P W Schreiber, D Russenberger, P Kaiser, B Schulthess, J Nemeth

The occurrence of transient culture positivity for Mycobacterium tuberculosis (MTB), known as mirage de tuberculose, poses significant challenges in understanding its spectrum and implications. Here, we report a case of transient culture positivity, oscillating between detectable and non-detectable MTB cultures with minimal radiological features and review the literature on this phenomenon. The scarcity of scientific literature on this subject stems from the inherent impossibility of systematically studying mirage de tuberculose. Ethical and public health concerns prevent withholding treatment to monitor spontaneous reversion to negative cultures. Based on the literature, we estimate that mirage de tuberculose occurs in approximately one-third of individuals infected with MTB who exhibit no symptoms. Despite the inherently limited nature of these findings, they suggest that the significance of mirage de tuberculose may be greater than currently perceived. Managing cases of mirage de tuberculose presents formidable challenges from a public health perspective. Striking a balance between prompt treatment initiation to prevent transmission and the risk of unnecessary treatment requires careful consideration. In conclusion, mirage de tuberculose remains a poorly understood clinical entity with very limited literature available. Advancing research and interdisciplinary collaborations are essential to unravel the intricacies of this phenomenon and develop effective strategies to address its public health challenges.

结核分枝杆菌(MTB)培养一过性阳性,即所谓的 "结核病海市蜃楼"(mirage de tuberculose),这种现象的出现为了解其谱和影响带来了巨大挑战。在此,我们报告了一例一过性培养阳性病例,该病例在可检测和不可检测的 MTB 培养物之间徘徊,且放射学特征极少,我们还回顾了有关这一现象的文献。有关这一主题的科学文献很少,这是因为不可能对结核病 "海市蜃楼 "进行系统研究。出于伦理和公共卫生方面的考虑,我们无法通过暂停治疗来监测培养结果自发转为阴性的情况。根据文献资料,我们估计约有三分之一的无症状 MTB 感染者会出现结核病海马。尽管这些发现本身具有局限性,但它们表明结核病海马的重要性可能比目前认为的要大。从公共卫生的角度来看,处理结核病海市蜃楼病例是一项艰巨的挑战。在及时开始治疗以防止传播与不必要的治疗风险之间取得平衡需要慎重考虑。总之,结核病 "海市蜃楼 "仍是一个鲜为人知的临床实体,现有文献非常有限。推进研究和跨学科合作对于揭示这一现象的复杂性和制定有效策略以应对其公共卫生挑战至关重要。
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引用次数: 0
Multisectoral action and community involvement are required for long-term improvements in public health. 多部门行动和社区参与是长期改善公共卫生的必要条件。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2024-06-01 DOI: 10.5588/pha.24.0022
G N Kazi, H D Blackbourn
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引用次数: 0
TB-related catastrophic costs in Ethiopia. 埃塞俄比亚与结核病相关的灾难性费用。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2024-06-01 DOI: 10.5588/pha.24.0006
A A Deribew, Z G Dememew, K M Alemu, G Tefera, S G Negash, Y A Molla, A G Woldegiorgis, D G Datiko, P G Suarez

Objectives: To measure the progress towards reducing TB-related catastrophic costs in 19 zones of Amhara, Oromia, SNNP (Southern Nations and Nationalities, and Peoples) and Sidama Regions of Ethiopia.

Methods: A baseline survey was conducted in randomly selected health facilities from all districts within the 19 zones from November 2020 to February 2021. Interventions targeting the major drivers of catastrophic costs identified in the baseline survey, such as installation of 126 GeneXpert and 13 Truenat machines, securing connectivity of 372 GeneXpert, establishing alternative specimen referral systems, and capacity-building of health workers, were implemented. A follow-up survey was conducted from October to December 2022. The WHO generic tool was used to collect data based on probability proportional to size. Data were entered into STATA software, and the proportion of catastrophic costs was calculated and compared between the two surveys.

Results: A total of 433 and 397 patients participated in the baseline and follow-up surveys, respectively. The proportion of catastrophic costs reduced from 64.7% to 43.8% (P < 0.0001). The share of direct non-medical costs decreased from 76.2% to 19.2%, while medical and indirect costs increased from 11.6% and 12.3% to 30.4% and 52.4 %.

Conclusion: The proportion of households facing TB-related catastrophic costs has significantly reduced over the 2-year period. However, it remains unacceptably high and varies among regions. Further reducing the catastrophic costs requires multisectoral response, reviewing the TB service exemption policy, further decentralisation and improving the quality of TB services.

目标:衡量埃塞俄比亚阿姆哈拉、奥罗莫、南方各族州(SNNP)和锡达玛等 19 个地区在降低结核病相关灾难性费用方面的进展情况:2020 年 11 月至 2021 年 2 月,在 19 个地区内的所有县随机抽取医疗机构进行基线调查。针对基线调查中确定的灾难性成本的主要驱动因素实施了干预措施,如安装 126 台 GeneXpert 和 13 台 Truenat 机器、确保 372 台 GeneXpert 的连接、建立替代标本转诊系统以及卫生工作者的能力建设。2022 年 10 月至 12 月进行了一次后续调查。采用世卫组织通用工具,根据概率与规模成正比的原则收集数据。将数据输入 STATA 软件,计算灾难性费用的比例,并比较两次调查的结果:分别有 433 名和 397 名患者参与了基线调查和随访调查。灾难性费用的比例从 64.7% 降至 43.8%(P < 0.0001)。直接非医疗费用所占比例从 76.2% 降至 19.2%,而医疗和间接费用所占比例分别从 11.6% 和 12.3% 增至 30.4% 和 52.4%:结论:在两年的时间里,面临结核病相关灾难性费用的家庭比例大幅下降。结论:在两年的时间里,面临结核病相关灾难性费用的家庭比例已大幅下降,但这一比例仍然高得令人难以接受,而且各地区之间存在差异。要进一步降低灾难性费用,需要采取多部门应对措施、审查结核病服务豁免政策、进一步下放权力以及提高结核病服务质量。
{"title":"TB-related catastrophic costs in Ethiopia.","authors":"A A Deribew, Z G Dememew, K M Alemu, G Tefera, S G Negash, Y A Molla, A G Woldegiorgis, D G Datiko, P G Suarez","doi":"10.5588/pha.24.0006","DOIUrl":"10.5588/pha.24.0006","url":null,"abstract":"<p><strong>Objectives: </strong>To measure the progress towards reducing TB-related catastrophic costs in 19 zones of Amhara, Oromia, SNNP (Southern Nations and Nationalities, and Peoples) and Sidama Regions of Ethiopia.</p><p><strong>Methods: </strong>A baseline survey was conducted in randomly selected health facilities from all districts within the 19 zones from November 2020 to February 2021. Interventions targeting the major drivers of catastrophic costs identified in the baseline survey, such as installation of 126 GeneXpert and 13 Truenat machines, securing connectivity of 372 GeneXpert, establishing alternative specimen referral systems, and capacity-building of health workers, were implemented. A follow-up survey was conducted from October to December 2022. The WHO generic tool was used to collect data based on probability proportional to size. Data were entered into STATA software, and the proportion of catastrophic costs was calculated and compared between the two surveys.</p><p><strong>Results: </strong>A total of 433 and 397 patients participated in the baseline and follow-up surveys, respectively. The proportion of catastrophic costs reduced from 64.7% to 43.8% (<i>P</i> < 0.0001). The share of direct non-medical costs decreased from 76.2% to 19.2%, while medical and indirect costs increased from 11.6% and 12.3% to 30.4% and 52.4 %.</p><p><strong>Conclusion: </strong>The proportion of households facing TB-related catastrophic costs has significantly reduced over the 2-year period. However, it remains unacceptably high and varies among regions. Further reducing the catastrophic costs requires multisectoral response, reviewing the TB service exemption policy, further decentralisation and improving the quality of TB services.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"14 2","pages":"71-75"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493925","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}
引用次数: 0
Perception, acceptability and challenges of digital adherence technology among TB healthcare workers. 结核病医护人员对数字坚持治疗技术的认知、接受程度和挑战。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2024-06-01 DOI: 10.5588/pha.24.0008
I Gordon, B Odume, C Ogbudebe, O Chukwuogo, N Nwokoye, S Useni, E Efo, M Gidado, E Aniwada, A Ihesie, D Nongo, R Eneogu, O Chijioke-Akaniro, C Anyaike

Introduction: Successful treatment of TB requires high levels of adherence to treatment. This has been found to be below optimal with directly observed therapy (DOT), and digital adherence technologies (DATs) offer a promising approach to non-adherence to medication and improving treatment outcomes. This study explores the perception, acceptability, and challenges of DATs among healthcare workers (HCWs).

Methods: The study was conducted in eight states in Nigeria among Health Care workers involved in treating patients with TB. This was a descriptive cross-sectional study using an open questionnaire and analysed using IBM SPSS v25.

Results: Twenty-three HCWs (95.8%) agreed that DATs helped them provide better support and counselling to their patients. All of them would recommend DATs to their patients and found it easy to explain them. Eleven (45.8%) of them were not able to use DATs on a few occasions; their reasons were poor network (n = 9, 37.5%) and (n = 1, 4.2%) power failure.

Conclusion: DATs help HCWs provide better support and care regarding real-time tracking of their patients' adherence to treatment and possibly reduction of attrition. This implies that DATs are a suitable alternative to DOT to help HCWs provide the best care and support to their patients towards achieving the End TB targets.

导言:结核病的成功治疗需要很高的治疗依从性。研究发现,直接观察疗法(DOT)的依从性并不理想,而数字依从性技术(DATs)为解决不依从用药问题和改善治疗效果提供了一种很有前景的方法。本研究探讨了医护人员(HCWs)对数字依从性技术的认识、接受程度和面临的挑战:这项研究在尼日利亚的八个州进行,研究对象是参与治疗肺结核患者的医护人员。这是一项描述性横断面研究,采用开放式问卷调查,并使用 IBM SPSS v25 进行分析:23 名医护人员(95.8%)认为 DATs 有助于他们为患者提供更好的支持和咨询。他们都会向病人推荐 DAT,并认为解释 DAT 很容易。其中11人(45.8%)有几次无法使用数据机,原因是网络不畅(9人,37.5%)和停电(1人,4.2%):结论:DAT 可帮助医护人员在实时跟踪患者的治疗依从性方面提供更好的支持和护理,并可能减少流失。这意味着 DAT 是 DOT 的合适替代品,可帮助医护人员为患者提供最好的护理和支持,以实现终结结核病的目标。
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引用次数: 0
The effect of an intervention to promote isoniazid preventive therapy on leadership and management abilities. 推广异烟肼预防疗法的干预措施对领导和管理能力的影响。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2024-06-01 DOI: 10.5588/pha.24.0002
C Christian, E Kakande, V Nahurira, L B Balzer, A Owaraganise, J R Nugent, W DiIeso, D Rast, J Kabami, J J Peretz, C S Camlin, S B Shade, M R Kamya, D V Havlir, G Chamie

Background: Across sub-Saharan Africa, mid-level healthcare managers oversee implementation of national guidelines. It remains unclear whether leadership and management training can improve population health outcomes.

Methods: We sought to evaluate leadership/management skills among district-level health managers in Uganda participating in the SEARCH-IPT randomised trial to promote isoniazid preventive therapy (IPT) for persons with HIV (PWH). The intervention, which led to higher IPT rates, included annual leadership/management training of managers. We conducted a cross-sectional survey assessing leadership/management skills among managers at trial completion. The survey evaluated self-reported use of leadership/management tools and general leadership/management. We conducted a survey among a sample of providers to understand the intervention's impact. Targeted minimum loss-based estimation (TMLE) was used to compare responses between trial arms.

Results: Of 163 managers participating in the SEARCH-IPT trial, 119 (73%) completed the survey. Intervention managers reported more frequent use of leadership/management tools taught in the intervention curriculum than control managers (+3.64, 95% CI 1.98-5.30, P < 0.001). There were no significant differences in self-reported leadership skills in the intervention as compared to the control group. Among providers, the average reported quality of guidance and supervision was significantly higher in intervention vs control districts (+1.08, 95% CI 0.63-1.53, P = 0.001).

Conclusions: A leadership and management training intervention increased the use of leadership/management tools among mid-level managers and resulted in higher perceived quality of supervision among providers in intervention vs control districts in Uganda. These findings suggest improved leadership/management among managers contributed to increased IPT use among PWH in the intervention districts of the SEARCH-IPT trial.

背景:在撒哈拉以南非洲地区,中层医疗管理人员负责监督国家指导方针的实施。目前仍不清楚领导力和管理培训能否改善人口健康结果:我们试图评估参与 SEARCH-IPT 随机试验的乌干达地区级医疗管理人员的领导力/管理技能,该试验旨在促进艾滋病毒感染者(PWH)的异烟肼预防性治疗(IPT)。干预措施包括对管理人员进行年度领导力/管理培训,从而提高了 IPT 的使用率。我们在试验结束时对管理人员的领导力/管理技能进行了横断面调查。调查评估了领导力/管理工具的自我报告使用情况和一般领导力/管理情况。我们对提供者进行了抽样调查,以了解干预措施的影响。我们采用了基于目标最小损失估计(TMLE)的方法来比较试验组之间的反应:在参与 SEARCH-IPT 试验的 163 名管理人员中,有 119 人(73%)完成了调查。与对照组管理人员相比,干预组管理人员更经常使用干预课程中教授的领导力/管理工具(+3.64,95% CI 1.98-5.30,P <0.001)。与对照组相比,干预组在自我报告的领导技能方面没有明显差异。在服务提供者中,干预组与对照组相比,所报告的指导和监督的平均质量明显更高(+1.08,95% CI 0.63-1.53,P = 0.001):领导力与管理培训干预措施提高了中层管理人员对领导力/管理工具的使用率,并使乌干达干预地区与对照地区的医疗服务提供者认为监督质量更高。这些研究结果表明,在 SEARCH-IPT 试验的干预地区,管理人员领导力/管理水平的提高有助于提高 PWH 使用 IPT 的比例。
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引用次数: 0
Care-seeking pathways and diagnostic delays in extrapulmonary TB patients 肺外结核病患者的就医途径和诊断延误
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0037
Ahmad Wali, N. Safdar, A. Ambreen, S. Tahseen, T. Mustafa
SETTING: This study was conducted at a private tertiary hospital engaged with the TB control programme in the city of Lahore, Pakistan. OBJECTIVE: To assess the healthcare-seeking pathways, different delays and factors associated with delays among the patients who presented in the outpatient department with tuberculous lymphadenitis and pleuritis, the most common manifestations of extrapulmonary TB. DESIGN: This cross-sectional study was conducted prospectively from April 2016 to August 2017. RESULTS: The median age of the 339 patients analysed was 22 years (IQR 17–30); tuberculous lymphadenitis was predominant in females (63%), while pleuritis affected more males (64%). Overall, 62% reported seeking care from healthcare providers before diagnosis, of whom 62% sought care from private facilities, 32% visited facilities >2 times and 8% visited traditional healers. Diagnostic delay was associated with tuberculous lymphadenitis, age 15–44 years, poor socio-economic status and poor TB knowledge. CONCLUSION: There was considerable delay in the management of extrapulmonary TB patients, and the health-system delay was the major contributor, leading to increased patient suffering. Efforts towards minimising health-system delay need to be prioritised for patient screening and diagnosis, with a feasible algorithm that is workable in resource-limited settings.
背景:本研究在巴基斯坦拉合尔市一家参与结核病控制规划的私立三级医院进行。目的:评估门诊结核性淋巴结炎和胸膜炎(肺外结核最常见的表现)患者的求医途径、不同延迟及延迟相关因素。设计:本横断面研究于2016年4月至2017年8月进行前瞻性研究。结果:339例患者的中位年龄为22岁(IQR 17-30);女性以结核性淋巴结炎为主(63%),男性以胸膜炎为主(64%)。总体而言,62%的人报告在诊断前向医疗保健提供者寻求治疗,其中62%的人从私人机构寻求治疗,32%的人访问设施超过2次,8%的人访问传统治疗师。诊断延迟与结核性淋巴结炎、年龄15-44岁、社会经济地位低下和结核病知识贫乏有关。结论:肺外结核患者的管理存在较大的延误,卫生系统延误是导致患者痛苦增加的主要原因。在患者筛查和诊断方面,需要优先考虑尽量减少卫生系统延误的努力,并采用在资源有限的情况下可行的可行算法。
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引用次数: 0
Descriptors of multidrug-resistant TB deaths in Ethiopia 埃塞俄比亚耐多药结核病死亡病例描述
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2023-12-01 DOI: 10.5588/pha.23.0030
Usaid Emawayish Tesema, Z. Dememew, D. G. Datiko, A. Gebreyohannes, Y. Molla, A. Tefera, G. Gizatie, T. Bogale, M. Million, P. G. Suarez, M. M. Aseressa, D. Jerene, M. Biru
Deaths related to multidrug-resistant TB among patients who had received a second-line anti-TB drugs in Ethiopia were analysed. Respectively 38/704 (5.4%) and 44/995 (4.4%) deaths were identified in two cohorts (2015 and 2022). In the 2015 cohort, severe malnutrition was less prevalent, previous treatment rates were three times higher, hypokalaemia was more frequent, and the use of the Xpert® MTB/RIF assay, respiratory failure and severe anaemia/pancytopenia were less common than in the 2022 cohort. We observed that there were variations in adverse events when different treatment regimens were used over different time periods. To ensure proper patient care, correct guidance must be consistently implemented.
对埃塞俄比亚接受二线抗结核药物治疗的患者中与耐多药结核病相关的死亡进行了分析。在2015年和2022年两个队列中分别发现38/704(5.4%)和44/995(4.4%)例死亡。在2015年队列中,严重营养不良的发生率较低,既往治疗率高出3倍,低钾血症更为频繁,Xpert®MTB/RIF检测的使用,呼吸衰竭和严重贫血/全血细胞减少症的发生率低于2022年队列。我们观察到,当不同的治疗方案在不同的时间段使用时,不良事件有所不同。为了确保适当的病人护理,必须始终如一地实施正确的指导。
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引用次数: 0
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