Public Health Action最新文献

Background: Post-TB patients often experience persistent lung issues that impair exercise capacity and quality of life. Although pulmonary rehabilitation is known to be effective for chronic lung diseases, its role in post-TB lung disease remains underexplored in high TB-burden settings.

Method: This prospective study (2021-2022) in Tanzania's Kilimanjaro region evaluated a 24-week, community-based pulmonary rehabilitation program led by TB survivors for adults with moderate-to-severe respiratory symptoms despite TB cure. The program included supervised exercise, breathing training, psychosocial support and smoking cessation. Outcomes measured at baseline, 12 weeks, and 24 weeks included spirometry, 6-minute walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), BMI, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9).

Results: Among 121 participants (mean age 48±8.67 years, 89.2% male), significant improvements were observed in 6MWD (420 vs. 460 meters, p < 0.001) and SGRQ scores (34.63 to 12.99, p < 0.001). Smoking history predicted SGRQ improvement. Although no changes were seen in lung function or BMI, anxiety and depression symptoms improved in those with abnormal baseline scores.

Conclusion: Community-based pulmonary rehabilitation improved symptomatic individuals' quality of life, physical capacity and mental health. Future research should refine intervention timing and evaluate long-term outcomes across diverse settings.

Clinically diagnosed TB patients (n = 335) at two facilities in Lusaka, Zambia were re-evaluated within two weeks of diagnosis. This re-evaluation included sputum Xpert Ultra testing and expert reader interpretation of the chest x-rays (CXRs) used for initial diagnosis. Repeat Xpert Ultra detected TB in just 2.6% (n=6). Of the remaining patients (n=222), expert CXR re-interpretation classified 18.0% as normal; 36.0% as abnormal, consistent with TB; and 46.0% as abnormal, not consistent with TB. These findings suggest that clinical TB is frequently over diagnosed in those without detectable CXR abnormalities and misdiagnosed in those with abnormal CXRs: these abnormalities are likely due to other respiratory conditions. Such misdiagnosis leads to unnecessary treatment, failure to treat the true underlying condition and incorrect estimates of TB burden.

Setting: Finding TB among nomads, a high-risk group, can help address the global challenge of missing TB cases. Nigeria accounts for 6.2% of the 3.1 million missing TB cases.

Objective: To describe the outcome of active TB case-finding (ACF) among nomads in Bauchi State, northeastern Nigeria.

Design: KNCV implemented ACF in eight Local Government Areas of Bauchi State from June 2020 to December 2023. Trained community volunteers screened nomads and ensured diagnostic testing of sputum samples of nomads with presumptive TB. Community volunteers helped to link those with confirmed TB to treatment.

Results: We screened 43,070 nomads (35,533 adults; 7,537 children) of which 43% were males. Presumptive TB was detected among 12,387, of whom 850 (6.9%) had active TB, including 61 children. Overall, 99% of people with active TB were put on treatment. Presumptive TB yield was higher among the nomads, but active TB yield was comparable with the general population. Nomads contributed 5% to the total number of people notified with TB from Bauchi State.

Conclusion: ACF among nomads resulted in improved TB notification and can help improve the identification of missing TB cases in Nigeria.

Background: The FAST (Find cases Actively, Separate safely and Treat effectively) TB infection control (TB-IC) strategy decreases the time-to-TB diagnosis and treatment. We examined healthcare workers' (HCW) perceptions of FAST implementation at a tertiary referral hospital in Lima, Peru.

Methods: From August 2016 to December 2019, we conducted 24 interviews and four focus groups (n = 14) with a diverse population of HCWs and other stakeholders involved throughout the TB care cascade. We used inductive analysis to identify emergent themes, used Dedoose to code transcripts accordingly, and developed a narrative using reflexive thematic analysis.

Results: We identified three emergent themes: 1) FAST impact on TB care, 2) FAST impact on TB-IC and 3) FAST impact on hospital culture. FAST was felt to improve the speed of TB screening, diagnosis and treatment. TB specialists recognized that by expediting diagnosis and treatment, FAST likely decreased transmission. Healthcare workers appreciated that FAST improved care coordination along the TB care cascade. FAST changed hospital culture related to the prioritization of TB-IC.

Conclusion: HCWs perceived that FAST, implemented by a dedicated external team, was an acceptable and effective TB-IC strategy that improved care coordination and overall TB quality of care.

Cancer cases are rising in India. However, despite attempts to make cancer a notifiable disease, the Ministry of Health in India has resisted this. Their reasoning is that cancer is not a communicable disease and does not have community spread. We highlight flaws in the logic of this argument and highlight how a legal mandate to report cases would give impetus to the decades-old National Cancer Registry Program. Robust record keeping would allow real-time epidemiological analysis and highlight those areas where priority could be given to both prevent and treat cancer.

Background: Isoniazid-resistant, rifampicin-susceptible Mycobacterium tuberculosis (Hr-TB) is the most common form of drug-resistant TB (DR-TB). We investigated the prevalence of and risk factors for Hr-TB in Ethiopia.

Methods: A cross-sectional study was conducted to determine the magnitude of Hr-TB, and to compare characteristics of persons with Hr-TB to those with multidrug-resistant TB (MDR-TB) and INH/RMP-susceptible TB identified during the National Drug Resistance Survey from 2017-2019.

Results: Among 1927 M. tuberculosis isolates recovered from persons with pulmonary TB, the prevalence of Hr-TB was 4.1% (95% CI 3.2-5.1), whereas the prevalence of MDR-TB was 1.9%. (95% CI 1.3-2.6). Unlike MDR-TB, the occurrence of Hr-TB did not differ significantly between new and previously treated TB cases (P = 0.67). The prevalence of Hr-TB cases was high in the Amhara (8.0%, 95% CI 4.8-12.5) region and Addis Ababa (7.1%, 95% CI 3.4-13.0). The proportion of Hr-TB increased with age (OR 1.02, 95% CI 1.01-1.04; P = 0.035). Compared to INH/RMP-susceptible TB, Hr-TB was more likely to harbor resistance to ethambutol, streptomycin and pyrazinamide (P < 0.0001).

Conclusions: Hr-TB is the most prevalent type of DR-TB in Ethiopia and varies among regional states. Given the lack of identifiable clinical factors associated with Hr-TB, we recommend screening all bacteriologically confirmed TB cases for INH resistance at baseline.

Setting: Hospitals in Japan with more than five TB isolation beds.

Objectives: Approximately 4,000 cases of sputum smear-positive TB were reported in 2022, who were isolated in a TB ward at least until they became sputum smear-negative. However, some recalcitrant patients are difficult to isolate because of their behaviour. This study aims to characterise recalcitrant patients with TB and determine why they left the hospitals.

Design: This was a descriptive study. We sent a self-administered questionnaire to the hospitals asking about recalcitrant inpatients with TB from April 2022 through March 2023.

Results: A total of 12 recalcitrant patients were identified, of whom 8 (66.7%) self-discharged, and the other 4 (33.3%) were discharged by the hospital. All were male with an average age of 58.9 years. The main reason why the patients were considered recalcitrant was related to psychiatric problems (41.7%), including 2 with possible dementia (16.7%). However, 3 (25.0%) patients verbally insulted or physically assaulted staff members and other patients.

Conclusion: Although the number of recalcitrant patients was small, we recommend that there should be one or two TB facilities readily available for law enforcement officials to enforce isolation.

Background: The global TB burden shows significant gender disparity with men and women facing distinct challenges in accessing comprehensive care for TB. A full understanding of the gender dimensions of the TB epidemic is crucial for appropriate policy interventions and we therefore explored gender differences in the TB service cascade in Nigeria.

Methods: A retrospective gender-based analysis of the TB care cascade was conducted covering the four-year period between 2018-2021. We obtained sex-disaggregated service utilisation data for adults (aged ≥15 years) in 14 states through the monitoring and evaluation systems of the TB control programme. Using a care cascade framework, we present numbers accessing care at each step and gaps for men and women including TB/HIV collaborative services.

Results: Overall, amongst men, 12.3 million visited health facilities, 6 million were screened for TB and 833,483 were identified as presumptive cases, of which 79% were tested for TB. For women, 12.3 million visited facilities, 6.9 million screened and 664,130 identified as presumptive cases, of which 76% were tested. Men exhibited a higher screening gap, whereas women had a higher testing gap, with variations in treatment outcomes across both genders.

Conclusion: The TB surveillance system screened more women and diagnosed more men with the disease, with significant missed opportunities and gaps along the continuum of care for both men and women. Targeted policy interventions are required to strengthen surveillance, data systems and to reduce gender inequity across the TB care cascade in Nigeria.

Background: To inform future decision-making on pandemic preparedness for COVID-19, we evaluated the acceptability and perceived feasibility of implementation strategies for COVID-19 self-testing among decision-makers in Mozambique. National and provincial directors, heads of programs and division chiefs were selected as decision-makers.

Methods: We conducted semi-structured interviews with decision-makers involved in COVID-19 diagnosis, management, and policy development. Topics included knowledge and perceptions of COVID-19, testing policies, implementation considerations, and linkage to care. Using a thematic approach, we analysed the interviews.

Results: Seventeen decision-makers were interviewed - most perceived self-testing as an acceptable strategy for early COVID-19 detection. The benefits were improved access to testing, decongesting health facilities, minimising infection risk and decreasing healthcare workers' workload. Concerns included low testing interest in the post-pandemic period, literacy barriers, affordability and equity issues, mistrust that patients might not take the test due to fear of positive results, and the healthcare system's capacity to follow up positive cases.

Conclusion: COVID-19 self-testing is feasible and acceptable to decision-makers; however, the changing epidemiology has shifted perspectives. This study highlights self-testing's value in emergencies and pandemic preparedness, enabling rapid detection and isolation of cases, thus minimising the spread of infectious diseases in vulnerable populations in Mozambique and similar contexts.

As part of the LIFT-TB project, we investigated the efficacy and safety of the BPaL regimen, while enhancing laboratory diagnostic capacity for drug-resistant-TB. Challenges include sample contamination, excessive workload, test kit shortages, unreliable results and systemic issues such as infrastructure, delayed procurement, workforce constraints and reliance on paper-based data reporting. Our study highlights the need for a system-level approach backed by strong national leadership to strengthen TB diagnostic capacity. Although countries must take ownership of laboratory system improvements, a harmonized and coordinated approach among international stakeholders is essential in specialized areas, such as external quality assurance, capacity building, and introducing innovative diagnostic technologies.