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Analysis of the Indian Government's position on the use of asbestos and its health effects. 分析印度政府对石棉的使用及其对健康的影响的立场。
IF 1.4 Pub Date : 2023-06-21 DOI: 10.5588/pha.23.0013
R Singh, A L Frank

Based on WHO guidance, all forms of asbestos are a health risk. In India, the mining of asbestos has been stopped, but chrysotile (a type of asbestos) is still imported and processed in large quantities. Chrysotile is mainly used for asbestos-cement roofing, and the manufacturers claim its use to be safe. We sought to understand the Indian Government's position on the use of asbestos. To do so, we have analysed the replies of the executive wing of the Indian Government to questions on asbestos in the Indian Parliament. This revealed that, despite a mining ban, the government has defended the import, processing and continued use of asbestos.

根据世卫组织的指导,所有形式的石棉都对健康构成威胁。在印度,石棉的开采已经停止,但温石棉(石棉的一种)仍然大量进口和加工。温石棉主要用于石棉水泥屋顶,制造商声称它的使用是安全的。我们试图了解印度政府对使用石棉的立场。为此,我们分析了印度政府行政部门对印度议会中有关石棉问题的答复。这表明,尽管有采矿禁令,政府仍为石棉的进口、加工和继续使用辩护。
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引用次数: 0
TB treatment using family members, treatment supporters and self-administered therapies in rural Papua New Guinea. 在巴布亚新几内亚农村地区,利用家庭成员、治疗支持者和自我治疗进行结核病治疗。
IF 1.4 Pub Date : 2023-06-21 DOI: 10.5588/pha.22.0062
G Kurbaniyazova, F Msibi, H Bogati, M Kal, A Sofa, E Abdi Djama, P Mozi, F Hossain, P Blasco, L Sannino

Setting: Papua New Guinea (PNG) has one of the world's highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary.

Objective: To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context.

Design: A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019-2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model.

Results: Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7-19.3), as were PEC sessions (OR 4.3, 95% CI 2.5-7.2).

Conclusion: By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals' needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.

环境:巴布亚新几内亚是世界上结核病发病率最高的国家之一。在偏远省份,由于基础设施不足和地形复杂,患者很难获得结核病治疗,因此必须采用多种有针对性的结核病治疗模式。目的:评估PNG背景下自我给予治疗(SAT)、家庭支持治疗和社区直接观察治疗(DOT)的治疗效果。设计:对2019-2020年两个地点360名患者常规收集的数据进行回顾性描述性分析。根据风险因素(依从性或默认)为所有患者分配治疗模式,并提供患者教育和咨询(PEC)、家庭咨询和交通费。对每个模型的治疗结束结果进行评估。结果:药物敏感结核病(DS-TB)的治疗成功率总体良好:SAT治疗为91.1%,家庭支持治疗为81.4%,DOT治疗为77%。SAT与有利结果密切相关(OR 5.7, 95% CI 1.7-19.3), PEC疗程也是如此(OR 4.3, 95% CI 2.5-7.2)。结论:通过在确定治疗交付模式时考虑危险因素,三组患者均获得了良好的治疗效果。针对个人需求和风险因素量身定制的多种治疗管理模式,是一种可行、有效、以患者为中心的护理模式,适用于交通不便、资源有限的环境。
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引用次数: 1
Operationalising targeted next-generation sequencing for routine diagnosis of drug-resistant TB. 用于耐药结核病常规诊断的靶向新一代测序的运作。
IF 1.4 Pub Date : 2023-06-21 DOI: 10.5588/pha.22.0041
A Iyer, Z Ndlovu, J Sharma, H Mansoor, M Bharati, S Kolan, M Morales, M Das, P Issakidis, G Ferlazzo, N Hirani, A Joshi, P Tipre, N Sutar, K England

Background: Phenotypic drug susceptibility testing (pDST) for Mycobacterium tuberculosis can take up to 8 weeks, while conventional molecular tests identify a limited set of resistance mutations. Targeted next-generation sequencing (tNGS) offers rapid results for predicting comprehensive drug resistance, and this study sought to explore its operational feasibility within a public health laboratory in Mumbai, India.

Methods: Pulmonary samples from consenting patients testing Xpert MTB-positive were tested for drug resistance by conventional methods and using tNGS. Laboratory operational and logistical implementation experiences from study team members are shared below.

Results: Of the total number of patients tested, 70% (113/161) had no history of previous TB or treatment; however, 88.2% (n = 142) had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB). There was a high concordance between resistance predictions of tNGS and pDST for most drugs, with tNGS more accurately identifying resistance overall. tNGS was integrated and adapted into the laboratory workflow; however, batching samples caused significantly longer result turnaround time, fastest at 24 days. Manual DNA extraction caused inefficiencies; thus protocol optimisations were performed. Technical expertise was required for analysis of uncharacterised mutations and interpretation of report templates. tNGS cost per sample was US$230, while for pDST this was US$119.

Conclusions: Implementation of tNGS is feasible in reference laboratories. It can rapidly identify drug resistance and should be considered as a potential alternative to pDST.

背景:结核分枝杆菌的表型药敏试验(pDST)可能需要长达8周的时间,而传统的分子试验鉴定出一组有限的耐药突变。靶向下一代测序(tNGS)为预测全面耐药性提供了快速结果,本研究试图在印度孟买的一个公共卫生实验室探索其操作可行性。方法:采用常规方法和tNGS对Xpert mtb阳性患者肺标本进行耐药检测。下面分享了研究小组成员的实验室操作和后勤实施经验。结果:在接受检测的患者总数中,70%(113/161)没有结核病史或治疗史;然而,88.2% (n = 142)患有利福平耐药/耐多药结核病(RR/MDR-TB)。对于大多数药物,tNGS和pDST的耐药预测之间存在高度一致性,tNGS总体上更准确地识别耐药。将tNGS整合并适应到实验室工作流程中;然而,批量样品导致结果周转时间明显延长,最快为24天。人工DNA提取效率低下;因此,执行了协议优化。分析无特征的突变和解释报告模板需要技术专门知识。每个样品的tNGS成本为230美元,而pDST的成本为119美元。结论:在参比实验室实施tNGS是可行的。它可以快速识别耐药性,应被视为pDST的潜在替代品。
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引用次数: 0
A micro-costing analysis of nutritional support for persons with TB and their families in India. 印度结核病患者及其家庭营养支持的微观成本分析。
IF 1.4 Pub Date : 2023-06-21 DOI: 10.5588/pha.22.0058
G Buonomo, C Acuña-Villaorduna, V Poongothai, M Dharmalingam, C Cintron, M Dauphinais, S P Babu, L M Locks, S Sarkar, P Salgame, N S Hochberg, S Lakshminaryanan, P B Narasimhan, P Sinha

Undernutrition is the leading risk factor for TB infection and death in India. We undertook a micro-costing analysis of a nutritional intervention for household contacts of people living with TB in Puducherry, India. We found that the total 6-month food cost for a family of four was USD4/day. We also identified several alternative regimens and cost-lowering strategies to encourage wider adoption of nutritional supplementation as a public health tool.

营养不良是印度结核病感染和死亡的主要风险因素。我们对印度普杜切里结核病患者家庭接触者的营养干预进行了微观成本分析。我们发现,一个四口之家6个月的总食物成本为4美元/天。我们还确定了几种替代方案和降低成本的策略,以鼓励更广泛地采用营养补充剂作为公共卫生工具。
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引用次数: 0
Integrating TB screening into house-to-house polio vaccination campaigns. 将结核病筛查纳入挨家挨户的脊髓灰质炎疫苗接种运动。
IF 1.4 Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0055
C Ugwu, U Chukwulobelu, E Okeke, C Igboekwu, A Onyima, V Ibeziako, C Ebede, U Orjiagu, V Unamba

Setting: In July 2019, the Anambra State (south-east Nigeria) TB Control Programme implemented the integration of TB case-finding with the polio vaccination campaign with the support of the WHO.

Objective: To improve TB case-finding from communities leveraging already existing polio structures.

Design: Vaccination teams were trained to ask for symptoms of TB in each household and to document details of people presumed to have TB. Community TB workers subsequently tracked those identified for subsequent sample collection. We report the numbers detected, and the proportion of wards that reported people with TB. Regression analyses were used to estimate the relationship between ward characteristics and reporting. Odds ratios (ORs) with associated 95% confidence intervals (CIs) are also reported.

Results: Of 281 people with presumptive TB, 32 were diagnosed with TB; 21% (70/330) of wards identified at least one presumptive, while 5% (18/330) of the people were identified with TB. Peri-urban slums were most likely to identify presumptives (adjusted OR [aOR] 11.52, 95% CI 1.62-81.79), while Riverine areas were most likely to identify a person with TB (aOR 3.59, 95% CI 1.16-11.01).

Conclusion: Integrating community TB case-finding into house-to-house vaccination campaigns can boost case detection. This approach proved effective in areas perennially underserved by routine healthcare services.

背景:2019年7月,在世卫组织的支持下,阿南布拉州(尼日利亚东南部)结核病控制规划将结核病病例发现与脊髓灰质炎疫苗接种运动结合起来。目的:利用现有的脊髓灰质炎结构改善社区的结核病病例发现。设计:疫苗接种小组接受了培训,询问每个家庭的结核病症状,并记录推定患有结核病的人的详细情况。社区结核病工作人员随后对确定的病例进行追踪,以便随后进行样本收集。我们报告了检测到的数字,以及报告结核病患者的病房比例。回归分析用于估计病区特征与报告之间的关系。比值比(ORs)和相关的95%置信区间(CIs)也被报道。结果:在281例推定结核病患者中,32例被诊断为结核病;21%(70/330)的病房确定了至少一种推定,而5%(18/330)的人被确定患有结核病。城市周边的贫民窟最有可能发现推定结核病患者(调整后的OR [aOR] 11.52, 95% CI 1.62-81.79),而河流地区最有可能发现结核病患者(aOR 3.59, 95% CI 1.16-11.01)。结论:将社区结核病病例发现纳入挨家挨户的疫苗接种运动可以促进病例发现。事实证明,这种做法在常规保健服务长期不足的地区是有效的。
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引用次数: 0
The use of rats to detect drug-resistant TB. 利用大鼠检测耐药结核病。
IF 1.4 Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0059
N Beyene, A L Sitotaw, E G Telila, H A Gebre, N B Alemu, R Burny, C Cox, J Soka, B Tegegn, L Wassie, K Bobosha, T Agizew

Although detection of drug-susceptible TB by Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling-trained African giant pouched rats has been known for more than a decade, the detection of drug-resistant TB (DR-TB) using rats has never been explored before. We present what we believe to be the first report on rifampicin-resistant TB (RR-TB) detected using Xpert® MTB/RIF Ultra, comparably identified by rats sniffing sputum samples from presumptive TB patients: 88% of RR-TB detected using Ultra were identified by the rats. Further evaluation of the usefulness of rats for large-scale DR-TB contact triage testing is needed, especially in low- and middle-income countries, where resources are limited.

尽管十多年前人们就已经知道用经过ontwikkeling训练的非洲巨袋大鼠检测药物敏感结核病,但以前从未探索过用大鼠检测耐药结核病(DR-TB)。我们提出了我们认为是关于使用Xpert®MTB/RIF Ultra检测到的利福平耐药结核病(RR-TB)的第一份报告,可以通过大鼠嗅闻推定结核病患者的痰样本进行比较:使用Ultra检测到的88%的RR-TB被大鼠识别出来。需要进一步评估大鼠用于大规模耐药结核病接触分诊检测的有用性,特别是在资源有限的低收入和中等收入国家。
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引用次数: 0
Local government stewardship for TB elimination in Kerala, India. 印度喀拉拉邦地方政府对消除结核病的管理。
IF 1.4 Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0037
P S Rakesh, S Nair, R Kamala, M S Manu, S K Mrithunjayan, M J Valamparampil, V Raman Kutty, R Sadanandan

Setting: The southern Indian state of Kerala has implemented 'Kerala Tuberculosis Elimination Mission' as 'People's Movement against TB' under the stewardship of local governments (LGs). The state has been certified by the Government of India for being on track to attain the UN Sustainable Development Goals related to TB elimination.

Objective: To document the role of LG stewardship in the successful implementation of the TB elimination activities in Kerala.

Design: 1) Key informant interviews with four state officials, 2) desk review of available documents, 3) in-depth interviews with seven LG leaders, three mid-level programme managers and three health department field staff.

Results: LG involvement led to the establishment of solutions based on local problems, enhanced outreach of services to the socially vulnerable individuals, improved treatment support to patients with TB, increased community ownership of TB elimination activities, reduced TB-related stigma and social determinants being addressed. Institutional mechanisms such as LG TB elimination task forces, formal guidance in planning interventions and appreciation of their performance in the form of awards were facilitators for LG involvement.

Conclusion: LG stewardship can accelerate TB elimination. A good plan for engagement and institutional mechanisms are crucial for LG involvement.

背景:印度南部喀拉拉邦在地方政府(LGs)的领导下实施了“喀拉拉邦消除结核病任务”,作为“抗击结核病的人民运动”。该邦已获得印度政府的认证,证明该邦有望实现与消除结核病有关的联合国可持续发展目标。目的:记录LG管理在喀拉拉邦成功实施结核病消除活动中的作用。设计:1)与4名州政府官员进行关键信息提供者访谈,2)对现有文件进行案头审查,3)与7名LG领导、3名中层方案管理人员和3名卫生部门现场工作人员进行深入访谈。结果:LG的参与导致了基于当地问题的解决方案的建立,加强了对社会弱势群体的服务延伸,改善了对结核病患者的治疗支持,增加了社区对结核病消除活动的所有权,减少了与结核病相关的耻辱和社会决定因素。制度机制,如LG结核病消除工作组,在规划干预措施方面的正式指导以及以奖励形式对其表现的赞赏,是LG参与的促进因素。结论:LG管理可促进结核病的消除。良好的参与计划和制度机制对LG的参与至关重要。
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引用次数: 1
Combatting emerging infectious diseases from Nipah to COVID-19 in Kerala, India. 在印度喀拉拉邦抗击从尼帕病毒到COVID-19等新发传染病。
IF 1.4 Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0024
K C Prajitha, V Babu, A Rahul, M J Valamparampil, P R Sreelakshmi, S Nair, R P Varma

Background: The state of Kerala, India, has experienced several unprecedented events in the past few years. The current study was an attempt to explore perceptions of stakeholders on how the decentralised system helped during the Nipah virus (NiV) outbreaks and COVID-19 pandemic in Kerala.

Methods: This study used a qualitative descriptive approach built on the advocacy paradigm. The stakeholders who were involved in decision-making and the representatives of local self-government who had real-time experience and had handled the challenges were identified using purposive sampling. Seven key informant interviews (KIIs) and nine in-depth interviews (IDIs) were conducted.

Results: Findings indicate that decentralisation had enabled the state to effectively deal with the outbreaks and the pandemic. The survey revealed four major themes: decision-making, engagement level, people-centric action, and difficulties. Two to four categories have emerged for each theme.

Conclusion: The study results highlight the importance of human resources and service delivery as balancing factors during public health emergencies in any developing nation with limited resources. Given that very few nations have the healthcare infrastructure and resources necessary to cater to the healthcare needs of the whole population, decentralisation should be reinforced.

背景:印度喀拉拉邦在过去几年中经历了几次前所未有的事件。目前的研究试图探索利益相关者对分散系统在尼帕病毒(NiV)爆发和喀拉拉邦COVID-19大流行期间如何提供帮助的看法。方法:本研究采用基于倡导范式的定性描述方法。通过有目的抽样确定了参与决策的利益攸关方和具有实时经验并处理过挑战的地方自治代表。进行了7次关键信息提供者访谈(KIIs)和9次深度访谈(IDIs)。结果:调查结果表明,权力下放使国家能够有效地应对疫情和大流行。调查揭示了四个主要主题:决策、参与水平、以人为本的行动和困难。每个主题都有两到四个类别。结论:研究结果突出了人力资源和服务提供在任何资源有限的发展中国家突发公共卫生事件中作为平衡因素的重要性。鉴于很少有国家拥有满足全体人口保健需求所需的保健基础设施和资源,应加强权力下放。
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引用次数: 0
Re-engineering primary healthcare in Kerala. 重新设计喀拉拉邦的初级保健。
IF 1.4 Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0033
A Krishnan, R P Varma, R Kamala, R Anju, K Vijayakumar, R Sadanandan, P K Jameela, K S Shinu, B Soman, R M Ravindran

Introduction: In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based ('Aardram') initiative. It was envisioned that the mission's implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care.

Methods: The study adopted an exploratory approach using qualitative methods: key informant interviews (n = 8), in-depth interviews (n = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema.

Results: The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of 'Aardram' primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed.

Conclusion: Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study.

导言:在可持续发展目标(SDGs)的背景下,印度喀拉拉邦将现有的初级保健中心(phc)改造为以人为本的家庭保健中心(FHCs),以提供全面的初级保健,这是一项以使命为基础的倡议(“Aardram”)的一部分。按照设想,特派团的执行和业务将利用权力下放的管理。本研究探讨分散式管理如何影响初级保健的重组。方法:本研究采用探索性研究方法,采用定性方法:关键举报人访谈(n = 8)、深度访谈(n = 20)和文献综述。主题分析是按照演绎编码进行的,出现的主题是在一个图式下组织起来的。结果:结果可以概括为五个主要主题。强有力的政治承诺,加上官僚能力,促进了“Aardram”初级保健的实施和运作。通过多部门培训形成的见解帮助地方政府作为一个团队参与和参与卫生系统,以便规划和实施干预措施。分散的管治架构使初级保健得以重新设计,调动财政资源、提供人力资源、改善基础设施,以及加强社区在各个层面的参与。所观察到的不足之处包括承诺的不一致、城市地方政府的次优参与以及可持续性和监测问题。结论:分散管理在初级保健中心的重新设计中发挥了积极作用,它被用作一个平台,通过参与式方法展示卫生治理的最佳做法。本研究强调了通过能力建设赋予地方政府权力的重要性,以应对实现初级保健可持续发展目标的挑战。
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引用次数: 2
Increase in rifampicin resistance among people previously treated for TB. 以前接受过结核病治疗的人对利福平的耐药性增加。
IF 1.4 Pub Date : 2023-03-21 DOI: 10.5588/pha.22.0047
J Izudi, F Bajunirwe, A Cattamanchi

People previously treated for TB are at a higher risk of rifampicin-resistant or multidrug-resistant TB (RR/MDR-TB). Uganda's recent RR-TB estimates were not updated, including during the COVID-19 pandemic. Using programmatic data (2012-2021), we report on the distribution and trends in RR-TB among people previously treated for bacteriologically confirmed pulmonary TB (BC-PTB) across six TB clinics in Kampala, Uganda. The RR-TB prevalence between 2012 and 2015 was 0% (95% CI 0-2.3). The prevalence rose significantly in recent years to 7.0% (95% CI 4.4-10.8) between 2016 and 2021 (P < 0.001). RR-TB is increasing among people previously treated for BC-PTB in Kampala; surveillance for RR-TB should be enhanced.

以前接受过结核病治疗的人患耐利福平或耐多药结核病(RR/MDR-TB)的风险较高。乌干达最近的耐药结核病估计数没有更新,包括在2019冠状病毒病大流行期间。利用规划数据(2012-2021年),我们报告了乌干达坎帕拉6家结核病诊所中曾接受细菌学确诊肺结核(BC-PTB)治疗的患者中耐药结核病的分布和趋势。2012年至2015年间,RR-TB患病率为0% (95% CI 0-2.3)。近年来,患病率在2016年至2021年间显著上升至7.0% (95% CI 4.4-10.8) (P < 0.001)。在坎帕拉以前接受过BC-PTB治疗的人群中,RR-TB正在增加;应加强对耐药结核病的监测。
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引用次数: 0
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