Public Health Action最新文献

Background: This study aimed to investigate the association between water intake and lung function impairment, focusing on the potential effect of dehydration on respiratory health in elderly adults.

Methods: A community-based, cross-sectional study was conducted in rural regions of Taiwan between March and December 2022. A total of 888 participants were enrolled. Data collection included lung function tests, physiological measurements, demographic characteristics, and medical histories. The effects of various variables on lung function were analysed across different age groups.

Results: Both restrictive and obstructive lung function impairment were significantly associated with older age, low water intake, and lower educational attainment. Restrictive lung function impairment was additionally correlated with the presence of cardiometabolic diseases, whereas obstructive lung function impairment was associated with male sex and smoking. Among participants aged over 65 years, low water consumption was associated with increased odds of restrictive and obstructive lung function impairment.

Conclusion: Low water intake is associated with an increased risk of both restrictive and obstructive lung function impairment, particularly in elderly adults. Public health interventions promoting adequate hydration may help preserve pulmonary function in elderly population.

Objective: Antiretroviral therapy has extended HIV patient survival, increasing non-communicable disease prevalence like diabetes mellitus. Strong links exist between HIV, TB, and diabetes. This study examined diabetes prevalence among adults with TB and HIV, or co-infection in Uganda.

Design: Cross-sectional study conducted between August 2021 and January 2022 at three urban hospitals in Kampala, Uganda. Participants aged ≥18 years receiving HIV and/or TB treatment for at least 6 months were enrolled. Diabetes screening was performed using random blood glucose and haemoglobin A1C measurements according to American Diabetes Association guidelines.

Results: Among 924 participants, 832 (90.0%) had HIV only, 50 (5.4%) had TB only, and 42 (4.6%) had both conditions. Overall diabetes prevalence was 4.1% in HIV patients, 7.6% in TB patients, and 14.3% in TB-HIV co-infected patients. Diabetes was significantly more prevalent among older patients (≥36 years) across all disease categories and among males with HIV infection compared to females (6.8% vs. 3.0%, P = 0.011). Among TB patients, central obesity was associated with higher diabetes prevalence (33.3% vs. 4.2%, P = 0.007).

Conclusion: The study reveals elevated diabetes prevalence among patients with TB-HIV co-infection, emphasising the need for integrated screening and management strategies addressing these interconnected conditions in Uganda.

Setting: Anti-retroviral treatment (ART) centres from eight districts of Sierra Leone.

Objectives: Among children and adolescents (0-19 years) registered for ART after January 2023 and currently on care, to assess i) viral load (VL) testing coverage and viral suppression, ii) turnaround time from sample collection to results, and iii) factors associated with not undergoing testing.

Design: A cohort study using programmatic data extracted from April to October 2025.

Results: Of 950 participants, 931 (98%) were eligible for VL testing (on ART for ≥6 months). Of the total participants, 286 (30%) underwent VL testing at least once (coverage), of which 247 (86%) had viral suppression. Median turnaround time was 36 days, ranging from 6 days in districts with centralised VL testing laboratory to 65 days in a district far from the central laboratory. Participants from ART centres situated in the Western Area Urban district (adjusted relative risk: 1.8, 95% confidence interval: 1.0-3.1) were at higher risk of not undergoing VL testing.

Conclusion: Although high viral suppression was appreciable, less than one third of children and adolescents underwent VL testing with a long turnaround time, delaying virological failure detection and appropriate care. The national AIDS control programme should decentralise VL testing and strengthen sample transportation to ensure equitable access.

Background: Prior to the COVID-19 pandemic, TB treatment in Peru was delivered almost exclusively through facility-based directly observed therapy (DOT). During the pandemic, selected adolescents were allowed home-based TB treatment under caregiver supervision, along with video-supported treatment (VST) for adolescents with access to a smartphone.

Methods: We conducted 16 focus groups, each with 4-10 participants of adolescents with rifampicin-susceptible TB, their caregivers, and health care workers (HCWs). We used semi-structured guides to gather perspectives on facility-based DOT versus home-based treatment. Two authors applied inductive thematic analysis and identified emerging themes.

Results: HCWs assigned facility-based DOT or home-based treatment based on subjective assessment of the adolescent's level of responsibility and support from caregivers. Almost all adolescents and caregivers preferred home-based treatment because it reduced disruptions to routine activities, TB-related stigma, and costs. A few disagreed, stating that facility-based DOT was better for guaranteeing adherence and support for adverse drug reactions. Most HCWs preferred facility-based DOT because they did not feel confident about adherence without direct visualisation by a provider, even with VST; moreover, they found VST to be time-consuming.

Conclusion: Home-based TB treatment benefits adolescents and caregivers but must be further modified to achieve feasibility and acceptability among HCWs.

Background: In Japan, a low-TB-burden country, approximately 4000 cases of sputum smear-positive TB are reported annually and the patients are typically isolated in a TB ward until they become smear-negative. However, there are some patients who resist or refuse isolation. This study aims to characterize these patients.

Methods: A descriptive study. A self-administered questionnaire was sent to local health offices about patients registered from April 2022 to March 2024 who resisted or refused isolation.

Results: A total of 71 patients (0.99%) who resisted or refused isolation were identified among 7,186 with smear-positive TB in the study period. In 2022, 22 (31.0%) such cases were reported, whereas there were 49 (69.0%) in 2023. Fifty-seven of these patients (80.3%) were male, with age that peaked in their 70s, 61 (85.9%) were born in Japan, and 28 (39.4%) were unemployed. Tokyo, the capital, reported 13 (18.3%) such cases, followed by Osaka (12, 16.9%) and Saitama (8, 11.3%) prefectures, whereas 24 (51.1%) of 47 prefectures reported none.

Conclusion: Although the number of patients with TB who resisted or refused isolation was small, there should be one or two TB facilities with law enforcement officials readily available to enforce isolation.

Recent cuts in international donor funding threaten global progress in TB control, particularly in countries that are heavily reliant on external support. With TB still the deadliest infectious disease, reduced funding could lead to millions of preventable cases and deaths. However, this crisis also presents an opportunity: governments must increase domestic investment, integrate TB care into broader health systems, and build resilient, patient-centered services. Doing so strengthens pandemic preparedness and addresses climate-related health risks. Ultimately, sustained progress against TB requires strong national leadership to move from donor dependency to self-reliant, equitable and sustainable health systems.

Background: Rajasthan in India, is a high TB burden state with a high prevalence to notification ratio. This gap calls for alternative strategies to find the non-notified people with TB. Because cough is the most prominent symptom of TB and cough syrups are one of the highest over the counter drugs in India, its sale might be used as a proxy for missed TB cases.

Methods: This was an ecological study to assess the correlation between cough syrup sales and missed TB notifications in the private sector. We calculated the missed TB notification rate as the difference between the estimated people on TB treatment and TB notification in the private sector from January 2021 to March 2023, across all districts of Rajasthan (n = 33). We analysed district level mean quarterly cough syrup sales and TB notification rates/100,000 population.

Results: We found positive correlation between cough syrup sales and TB notification [overall (r = 0.43), private (r = 0.63) and missed private TB notification (r = 0.39)]. Based on this analysis, missed TB notification rates were 7x more than the reported notifications in the private sector.

Conclusion: We recommend a private sector-based TB surveillance system with TB screening for people who approach pharmacies for cough syrup.

Background: To support BPaL (bedaquiline [Bdq], pretomanid [Pa] and linezolid [Lzd]) rollout, countries require ongoing technical and policy support for standardized drug susceptibility testing (DST).

Methods: The Leveraging Innovation for the Faster Treatment of Tuberculosis (LIFT-TB) operational research project aimed to strengthen laboratory capacity for DST in 7 countries (the Philippines, Myanmar, Indonesia, Vietnam, Uzbekistan, Kyrgyzstan and Ukraine) through needs assessments, reagent and equipment support, quality control and training.

Results: During the project, we trained 157 professionals in phenotypic and molecular DST, enhancing quality assurance and implementation. We found there was variable DST capacity and resistance patterns.

Conclusion: Our study highlights the need for continued investment in training and infrastructure to integrate DST into routine diagnostics and to support scale-up of BPaL regimens in high TB-burden settings.

The Sub-Saharan Africa Regional Child and Adolescent TB Centre of Excellence (COE) was established in 2019 to address gaps in child and adolescent TB care in the region. The COE promotes the south-to-south exchange of best practices and innovation through virtual and in-person engagements, including webinars, workshops, and annual meetings. The COE's training efforts, including an interactive curriculum, have strengthened capacity that has increased TB detection and enhanced knowledge among health professionals.

Setting: Five districts with large coalmining workforces in Pakistan.

Objective: To assess the burden of TB among returnee coalminers (RCMs) and associated community members (ACMs) in their home districts through active case finding (ACF).

Design: This cross-sectional study (October 2020-September 2021) used portable chest X-ray (CXR) with artificial intelligence (AI) in camps and verbal screening in camps and communities. Individuals screening positive were tested with GeneXpert, and those diagnosed were initiated on TB treatment.

Results: A total of 150,242 individuals were screened, including 44% RCMs. Of these, 8.3% underwent CXR, 10% verbal screening in camps, and 81% verbal screening in communities. Symptoms were reported by 45% of RCMs and 15% of ACMs, while CXR abnormalities were comparable. TB was diagnosed in 226 RCMs and 204 ACMs, with overall prevalence per 100,000 of 341 (95% confidence interval [CI]: 296-385) and 243 (95% CI: 209-276), respectively. TB prevalence varied by screening strategy and was significantly higher among those screened with CXR: 1,156 in RCMs and 497 in ACMs.

Conclusion: AI-assisted CXR was substantially more effective than verbal screening, detecting significantly higher numbers of TB cases among RCMs and ACMs, supporting its use for targeted ACF in high-risk populations.