Public Health Action最新文献

Objective: In the ongoing India's first state-wide differentiated TB care programme in Tamil Nadu (TN-KET), adults diagnosed with drug-sensitive TB at public facilities undergo triage. The adults with severe undernutrition, respiratory insufficiency, or poor performance status are prioritised for comprehensive assessment and inpatient care. Although the programme met triage coverage targets, 11 districts failed to achieve the goal of a 30% reduction in TB death rates. This study compares aggregate triage coverage with actual coverage and evaluates the quality of programme-reported triaging data against an investigator-led audit (repeat assessments in the field) within a few weeks of diagnosis.

Design: An ecological study using routine programme data (April 2022-June 2024) was conducted for the first objective, and a cross-sectional analytical study with primary and secondary data (August 2024-February 2025) was performed for the triage audit.

Results: Among 48,905 adults with drug-sensitive TB notified, the true triage coverage was 84% against the reported triage coverage of 113%. The triage audit showed 35.7% were triage-positive, compared with 27.6% through TB SeWA (Severe TB Web Application). The mean weight and body mass index from the audit were 0.82 kg and 0.63 kg/m² lower than TB SeWA data, and oedema was unassessed in 65% of the adults with TB.

Conclusion: The districts need to address inadequate triage coverage and suboptimal quality of triaging.

Background: We tested the operational feasibility of body mass index (BMI) field charts in nutritional assessment of adult patients with tuberculosis (PwTB), which obviate calculations and provide nutritional status based on BMI and the ideal weight (BMI = 21 kg/m²).

Methods: We trained primary health care providers (HCPs) in 39 primary health centres for nutritional assessment and classification and identifying the ideal weight using BMI field charts in PwTB. Using the descriptive statistics method, we analysed the collected data and reported the nutritional status in PwTB and the uptake of the field charts among the HCPs.

Results: The median (interquartile range [IQR]) weight and BMI were 44 kg (37.0, 50.0) and 16.9 kg/m² (15.2, 18.9), respectively, in 214 PwTB, of which 146 (68.2%) patients had a BMI of <18.5 kg/m². The HCPs documented the ideal weight in 155 (72.4%) patients, which was correct in 147 (94.8%) patients. The median (IQR) weight deficit to achieve the ideal weight was 10.4 kg (7.3, 12.8) in men and 11.9 kg (7.0, 17.9) in women. For a BMI of 18.5 kg/m², the deficit was 6.4 kg (3.4, 8.5) in men and 11.3 kg (4.6, 13.6) in women.

Conclusion: The magnitude and severity of undernutrition in adult PwTB in a well-performing district of Karnataka in South India were high. A single training session successfully improved nutritional assessment and BMI field chart usage among the primary HCPs.

Background: As part of its TB control efforts, the Nigeria National TB Program has prioritised implementation of TB preventive treatment (TPT) especially among all contacts of TB patients. This study aims to assess knowledge, perceived enablers, and barriers to TPT among health care workers (HCWs) in Nigeria.

Methods: This was a cross-sectional descriptive study using mixed methods. Quantitative data were collected from 434 HCWs and analysed using SPSS version 25, and in-depth interviews were conducted on 36 purposely selected HCWs with thematic analysis.

Result: More than half of the respondents (55.7%) had good knowledge of TPT. Nurses, doctors, and other HCWs working in public tertiary institutions had better knowledge compared with other cadres. Adequate knowledge of types of TPT regimens and belief in their effectiveness were elicited as enablers, whereas barriers included suboptimal contact tracing system, TPT stock-outs, long duration of TPT, unavailability of TB infection testing before TPT, absence of transport logistics support for patients to receive TPT, and poor HCW capacity.

Conclusion: HCWs in public tertiary settings had better knowledge of TPT. Successful scale-up of TPT services requires competency building for other cadres and interventions addressing other identifiable barriers.

Background: Although the need for community-based support services as part of TB care is reaffirmed in various strategies, there are no data on the implementation progress of the recommended standardised package of community-based support services to improve TB outcomes developed by a consortium of partners in 2021.

Methods: The study describes country adaptation and initial planned implementation of the community-based packages in six countries of Eastern Europe and Central Asia - Azerbaijan; the Republic of Belarus (Belarus); the Kyrgyz Republic (Kyrgyzstan); the Republic of Moldova (Moldova); Tajikistan; and Ukraine - using programme review and qualitative data.

Results: An analysis of the package adaptation and initial implementation is presented from the perspective of the country implementers with a focus on country-specific approaches and lessons learned. The analysis framework is focused on the following specific areas: 1) adaptation practices; 2) ensuring quality and supervision of the services; and 3) securing funding. Commonalities and differences in each of these areas are analysed.

Conclusion: In all countries, standardised community-based service packages were adapted and gradually introduced to support clinical TB care. Proper costing and monitoring of the services delivered at the community levels and integrating the budgeted packages into national TB programmes are recommended to ensure sustainability.

Background: A policy of decentralised care for drug-resistant TB (DR-TB) was introduced in South Africa in 2011. We describe a trade-off between increasing coverage of services and poor quality of care, in the early phase of policy implementation.

Methods: This was a mixed methods case study, comparing implementation in KwaZulu-Natal and Western Cape provinces; with interviews and quantitative analysis of routine DR-TB programme data. We analysed qualitative data, thematically organizing findings into inputs, processes, and outputs to explore how decentralisation influenced quality of DR-TB care.

Results: Decentralisation of DR-TB care expanded access across provinces but there was wide variation in pace, planning and structural readiness. Where rapid scale-up outpaced capacity-building, weaknesses in resourcing, workforce, and clinical governance compromised quality of care. Two illustrative examples highlight that decentralisation to inadequately resourced sites resulted in morbidity to patients who did not receive effective monitoring for adverse events; and decentralising services to inadequately capacitated clinicians resulted in incorrect initiation in more complex cases and late referral of clinical complications.

Conclusions: Attempts to decentralise DR-TB treatment in the context of complex treatment algorithms and limited health system capacity resulted in trade-offs of care quality. We argue that quality of care should be an essential consideration in early implementation of health programmes.

Background: TB continues to pose significant public health challenges in high-burden regions such as Kano State, Nigeria, where private health sector engagement in TB control is notably lacking. The Social Franchising for TB Contact Investigation (SOFT) model was introduced to leverage private healthcare to increase the reach and efficacy of TB control efforts.

Methods: This nine-month project supported mapping health facilities, training of community health workers and systematic TB contact screening. The SOFT model aimed to enhance TB control by integrating private healthcare facilities and community-based organisations to improve TB yield, contact investigation and uptake of TB Preventive Therapy (TPT).

Results: The project showed a consistent increase in TB case detection, with a significant rise in index TB cases identified and their contacts screened each quarter. There was also a marked increase in the number of household contacts screened and initiated on TPT, demonstrating the model's effectiveness in enhancing TB control efforts.

Conclusion: The integration of social franchising with community and private healthcare engagement presents a scalable and innovative approach to improving TB control in high-burden settings. This model contributes significantly to global TB elimination efforts by improving detection rates and TPT uptake.

In India, tobacco products are a leading cause of preventable diseases, including cancer. Because of the health risks to children, we explored compliance and implementation of tobacco control law in relation to educational institutes (EIs). We discuss an issue of accountability by an EI in relation to compliance regarding the prohibition of tobacco vendors in close proximity to the EI. We also discuss various studies highlighting poor implementation of the law prohibiting tobacco sales near to EIs. It is our recommendation that the tobacco control law in India should be strengthened to reduce preventable diseases, including cancer.

For over a decade, trained African giant pouched rats have been employed in detecting missed pulmonary TB (PTB). However, the relationship between rat-positive results and subsequent clinical PTB or extrapulmonary TB (EPTB) has not been previously reported. This report highlights the use of rat-positivity as a predictor for PTB clinical diagnosis and treatment among presumptive TB. Treating physicians were 1.39 times more likely to clinically diagnose and treat rat-positives than rat-negatives: 12% versus 9%, respectively, odds ratio=1.39, 95% confidence interval: 1.05-1.84. No difference was observed among EPTB.

Setting: Five major coal mining districts in Balochistan, Pakistan.

Objectives: To assess burden of TB among coal miners and their associated communities and establish linkages with TB care services.

Design: A cross-sectional study was conducted to find TB cases through active case finding. The target population included people working at coal mining sites and surrounding communities residing within 10 km, including coal miners' families and other individuals. Verbal symptom screening was carried out via mobile camps and community outreach. Sputum was collected from screened positive individuals and tested for TB on GeneXpert. TB cases diagnosed were linked with TB care services.

Results: A total of 14,541 individuals including 8,149 (56%) coal miners were screened. Of the people screened, 81% were male, median age was 31 years, 2,274 (15.6%) had TB symptoms, and 34 confirmed TB cases were diagnosed. All 34 TB patients were linked to care and 32 completed treatments successfully. The estimated TB prevalence was 234 cases per 100,000 population (95% confidence interval: 150.6-316.5), with no significant difference between coal miners and associated communities.

Conclusion: Similar TB prevalence among coal miners and associated communities reflects shared vulnerability. Use of more sensitive screening tools is recommended to validate prevalence estimates in future studies.