Public Health Action最新文献

Objective: To retrospectively review TB surveillance data to detect whether there was a possible outbreak in the area and verify it in the city of Sapporo, a megalopolis with a low burden of TB.

Design: A cohort study in which TB notification rates of wards each year were compared with those for the rest of the city. If the rate was significantly higher, the notification rates by sex and age groups were further compared with those of the rest of the city.

Results: Six possible TB outbreaks were found in six wards: Chuo in 2007, Atsubetsu in 2010, Higashi in 2014, Shiroishi in 2015, Nishi in 2017, and Minami in 2018. Further analysis found that the notification rates were significantly higher in specific sex and age groups than those of the rest of the city. The city's outbreak records showed three actual outbreaks (one in Atsubetsu ward in 2010 and two in Higashi in 2014) corresponding to two events found in our analysis.

Conclusion: Our study shows that retrospectively reviewing TB surveillance data could detect possible outbreaks. Local health offices and prefectures of Japan should monitor their TB surveillance data at least monthly to detect possible outbreaks and take appropriate actions if needed.

Background: Mesothelioma is causally established to be primarily related to asbestos exposure as a risk factor. Before considering other possible causative factors for mesothelioma, a detailed exposure history is warranted, which looks at possible prior exposures to asbestos. Some exposures may be unknown to patients, may be forgotten or may not be readily available as a comprehensive tool for the clinicians dealing with mesothelioma patients.

Methods: We used the Delphi anonymous consensus technique to develop and validate a detailed, seven-sectioned, and comprehensive questionnaire that can be readily used by clinicians and researchers. Over two rounds, the experts followed a thorough and rigorous process to validate the questionnaire, including medical history along with occupational, non-occupational as well as para-occupational exposure to asbestos, and many other parameters that can be both rule in and rule out the possibility of mesothelioma. Questions have also been included to factor in other types of dust exposure for an informed differential diagnosis.

Results: We have created a readily available history-taking questionnaire validated by experts, which can be replicated for other conditions and become an essential tool for diagnosis.

Conclusion: Apart from accurate and informed diagnosis, this documentation can be valuable for epidemiological, research, policy-informing, legal and compensation related issues.

The Structured Operational Research and Training Initiative (SORT IT), implemented through the Collaborative Medical Oncology Group in India, strengthened oncology research capacity by training clinicians, expanding research into underserved regions, and fostering a sustainable mentorship culture. Using a descriptive evaluation (2014-2025), the programme documented growth in research outputs, mentoring, and dissemination through a Real-World Evidence Conference and Stats Decoded pre-conference workshop. Context-specific innovations - hybrid learning, mobile data capture, and faculty development - enhanced scalability. Case examples demonstrated translation of research into improved cancer screening and diagnostics. SORT IT contributed to evidence-informed cancer care and provides a replicable framework for other medical disciplines.

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: 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: 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: 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.