S Nyangu, M Kagujje, I Mwaba, D Luhanga, R Hambwalula, S Maliko, T Mushili, E Mwamba, Mukaba Mulai, Monde Muyoyeta
Background: Zambia has an estimated TB incidence of 319/100,000 population and a HIV prevalence of 11.1%. In 2020, only 49% of new people living with HIV (PLHIV) received TB preventive therapy (TPT) in Zambia. Misconceptions about the reliability of symptom screening and drug resistance among people who develop TB while on TPT are barriers to TPT scale-up. We determined the incidence and predictors of breakthrough TB during TPT among PLHIV in Zambia.
Method: This was a retrospective analysis of routine TPT programme data among PLHIV collected between October 2016 and October 2019 from select primary health facilities in Zambia.
Results: Of 48,581 PLHIV enrolled on TPT, 130 (0.3%) developed breakthrough TB during TPT. Of the 130, 90 client records were accessed. The median age of the breakthrough TB cases was 35 years; 68% were males. Overall, 96% of the breakthrough TB cases had been on antiretroviral therapy (ART) for ⩽3 months; 24% were symptomatic at the beginning of TPT, 22% were asymptomatic and others had missing data. Of the 130 breakthrough TB cases, 79% developed TB in the first month after TPT initiation. The median time to TB diagnosis was 10 days (IQR 4-16).
Conclusion: Breakthrough TB during TPT is rare among PHLIV on ART, and very rare after the first month of TPT initiation. It should therefore not be a barrier to TPT scale-up.
{"title":"Breakthrough TB among people living with HIV on TB preventive therapy.","authors":"S Nyangu, M Kagujje, I Mwaba, D Luhanga, R Hambwalula, S Maliko, T Mushili, E Mwamba, Mukaba Mulai, Monde Muyoyeta","doi":"10.5588/pha.22.0016","DOIUrl":"https://doi.org/10.5588/pha.22.0016","url":null,"abstract":"<p><strong>Background: </strong>Zambia has an estimated TB incidence of 319/100,000 population and a HIV prevalence of 11.1%. In 2020, only 49% of new people living with HIV (PLHIV) received TB preventive therapy (TPT) in Zambia. Misconceptions about the reliability of symptom screening and drug resistance among people who develop TB while on TPT are barriers to TPT scale-up. We determined the incidence and predictors of breakthrough TB during TPT among PLHIV in Zambia.</p><p><strong>Method: </strong>This was a retrospective analysis of routine TPT programme data among PLHIV collected between October 2016 and October 2019 from select primary health facilities in Zambia.</p><p><strong>Results: </strong>Of 48,581 PLHIV enrolled on TPT, 130 (0.3%) developed breakthrough TB during TPT. Of the 130, 90 client records were accessed. The median age of the breakthrough TB cases was 35 years; 68% were males. Overall, 96% of the breakthrough TB cases had been on antiretroviral therapy (ART) for ⩽3 months; 24% were symptomatic at the beginning of TPT, 22% were asymptomatic and others had missing data. Of the 130 breakthrough TB cases, 79% developed TB in the first month after TPT initiation. The median time to TB diagnosis was 10 days (IQR 4-16).</p><p><strong>Conclusion: </strong>Breakthrough TB during TPT is rare among PHLIV on ART, and very rare after the first month of TPT initiation. It should therefore not be a barrier to TPT scale-up.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"153-158"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716823/pdf/i2220-8372-12-4-153.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10414614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P Pal, R Bhatta, R Bhattarai, P Acharya, S Singh, A D Harries
Setting: Twenty poultry farms in five provinces of Nepal were selected for studying bacterial pathogens and their antimicrobial resistance (AMR) patterns.
Objective: To document the proportion of cloacal swabs collected from 3,230 broiler and 3,230 layer chickens from September to December 2021 that grew isolates of Escherichia coli, Enterococcus spp. and Salmonella spp. along with their AMR patterns.
Design: This was a cross-sectional descriptive study.
Results: In broiler birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 36%, 39% and 63% of swabs. In layer birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 31%, 48% and 60% of swabs. For both bird types, there was variation in bacterial prevalence between the regions. For all three bacterial isolates, the lowest antimicrobial resistance was found with amikacin. For the other nine antibiotics tested, >50% of bacterial isolates showed resistance; between 60% and 90% of isolates showed resistance to ciprofloxacin and trimethoprim-sulfamethoxazole. Multidrug resistance ranged from 45% to 46% for Salmonella spp., 37-44% for E. coli and 13-17% for Enterococcus spp.
Conclusion: This study shows that a large proportion of poultry in Nepal are infected with potentially pathogenic bacteria, and these are frequently resistant to commonly used antibiotics. Nepal urgently needs to implement corrective measures.
{"title":"Antimicrobial resistance in bacteria isolated from the poultry production system in Nepal.","authors":"P Pal, R Bhatta, R Bhattarai, P Acharya, S Singh, A D Harries","doi":"10.5588/pha.22.0014","DOIUrl":"https://doi.org/10.5588/pha.22.0014","url":null,"abstract":"<p><strong>Setting: </strong>Twenty poultry farms in five provinces of Nepal were selected for studying bacterial pathogens and their antimicrobial resistance (AMR) patterns.</p><p><strong>Objective: </strong>To document the proportion of cloacal swabs collected from 3,230 broiler and 3,230 layer chickens from September to December 2021 that grew isolates of <i>Escherichia coli</i>, <i>Enterococcus</i> spp. and <i>Salmonella</i> spp. along with their AMR patterns.</p><p><strong>Design: </strong>This was a cross-sectional descriptive study.</p><p><strong>Results: </strong>In broiler birds, <i>Enterococcus</i> spp., <i>Salmonella</i> spp. and <i>E. coli</i> were identified in respectively 36%, 39% and 63% of swabs. In layer birds, <i>Enterococcus</i> spp., <i>Salmonella</i> spp. and <i>E. coli</i> were identified in respectively 31%, 48% and 60% of swabs. For both bird types, there was variation in bacterial prevalence between the regions. For all three bacterial isolates, the lowest antimicrobial resistance was found with amikacin. For the other nine antibiotics tested, >50% of bacterial isolates showed resistance; between 60% and 90% of isolates showed resistance to ciprofloxacin and trimethoprim-sulfamethoxazole. Multidrug resistance ranged from 45% to 46% for <i>Salmonella</i> spp., 37-44% for <i>E. coli</i> and 13-17% for <i>Enterococcus</i> spp.</p><p><strong>Conclusion: </strong>This study shows that a large proportion of poultry in Nepal are infected with potentially pathogenic bacteria, and these are frequently resistant to commonly used antibiotics. Nepal urgently needs to implement corrective measures.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"165-170"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716825/pdf/i2220-8372-12-4-165.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M A Franke, L M Truß, H Wierenga, K Nordmann, A Frühauf, R Ranaivoson, Z Rampanjato, F Ranjaharinony, S Knauss, N Muller, J V Emmrich
Background: Knowledge about factors influencing access and adherence to TB care, and on the impact of the COVID-19 pandemic on TB care in resource-restricted settings is scarce. We conducted this study in Atsimo-Andrefana, a rural region in southern Madagascar where TB prevalence, poverty and food insecurity rates are high. We aimed to determine facilitators and barriers to access to and provision of TB care in rural Madagascar during the COVID-19 pandemic.
Methods: We conducted qualitative focus group discussions (FGDs) and in-depth interviews (IDIs) with patients with TB, community health workers, facility-based health workers, public health officials and non-governmental organisation staff. We analysed interviews using thematic analysis.
Results: We conducted 11 FGDs and 23 IDIs. We identified three main barriers to access and adherence to TB care: 1) stigma, 2) indirect treatment costs, and 3) food insecurity. The facilitator perceived as most influential was high health worker motivation. The effects of the COVID-19 pandemic on TB care varied between stake-holders; some health workers described delays in TB diagnosis and increased workload.
Conclusions: To improve access and adherence to TB care, both indirect treatment costs and stigma need to be reduced; undernourished patients with TB should receive food support.
{"title":"Facilitators and barriers to TB care during the COVID-19 pandemic.","authors":"M A Franke, L M Truß, H Wierenga, K Nordmann, A Frühauf, R Ranaivoson, Z Rampanjato, F Ranjaharinony, S Knauss, N Muller, J V Emmrich","doi":"10.5588/pha.22.0039","DOIUrl":"https://doi.org/10.5588/pha.22.0039","url":null,"abstract":"<p><strong>Background: </strong>Knowledge about factors influencing access and adherence to TB care, and on the impact of the COVID-19 pandemic on TB care in resource-restricted settings is scarce. We conducted this study in Atsimo-Andrefana, a rural region in southern Madagascar where TB prevalence, poverty and food insecurity rates are high. We aimed to determine facilitators and barriers to access to and provision of TB care in rural Madagascar during the COVID-19 pandemic.</p><p><strong>Methods: </strong>We conducted qualitative focus group discussions (FGDs) and in-depth interviews (IDIs) with patients with TB, community health workers, facility-based health workers, public health officials and non-governmental organisation staff. We analysed interviews using thematic analysis.</p><p><strong>Results: </strong>We conducted 11 FGDs and 23 IDIs. We identified three main barriers to access and adherence to TB care: 1) stigma, 2) indirect treatment costs, and 3) food insecurity. The facilitator perceived as most influential was high health worker motivation. The effects of the COVID-19 pandemic on TB care varied between stake-holders; some health workers described delays in TB diagnosis and increased workload.</p><p><strong>Conclusions: </strong>To improve access and adherence to TB care, both indirect treatment costs and stigma need to be reduced; undernourished patients with TB should receive food support.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"174-179"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716826/pdf/i2220-8372-12-4-174.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L de Vos, E Mazinyo, D Bezuidenhout, N Ngcelwane, D S Mandell, S H Schriger, J Daniels, A Medina-Marino
Missed opportunities for TB screening and/or passive testing in clinics continues to contribute to the number of missed cases. To understand reasons for these missed opportunities, we conducted focus group discussions with clinic-based nurses. Nurses described low indices of suspicion, prioritization of seemingly more urgent ailments and clinic operational challenges as barriers to TB screening and testing. To improve TB screening and testing in clinics, standard patients should be used to identify real-time factors that impact nurses' clinical decision-making and engage in real-time feedback and discussion with nurses to help optimize opportunities for TB screening and testing.
{"title":"Reasons for missed opportunities to screen and test for TB in healthcare facilities.","authors":"L de Vos, E Mazinyo, D Bezuidenhout, N Ngcelwane, D S Mandell, S H Schriger, J Daniels, A Medina-Marino","doi":"10.5588/pha.22.0042","DOIUrl":"10.5588/pha.22.0042","url":null,"abstract":"<p><p>Missed opportunities for TB screening and/or passive testing in clinics continues to contribute to the number of missed cases. To understand reasons for these missed opportunities, we conducted focus group discussions with clinic-based nurses. Nurses described low indices of suspicion, prioritization of seemingly more urgent ailments and clinic operational challenges as barriers to TB screening and testing. To improve TB screening and testing in clinics, standard patients should be used to identify real-time factors that impact nurses' clinical decision-making and engage in real-time feedback and discussion with nurses to help optimize opportunities for TB screening and testing.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"171-173"},"PeriodicalIF":1.3,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716824/pdf/i2220-8372-12-4-171.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9426724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Setting: Five urban TB diagnostic centres in Lusaka, Zambia.
Objective: To determine the proportion of bacteriologically confirmed pre-treatment lost to follow-up (LTFU) patients with TB found at the study settings in 2020.
Design: This was a retrospective cohort study in which the TB laboratory and treatment registers at the study sites were cross-matched.
Results: A total of 1,085 bacteriologically confirmed patients with TB were found in the laboratory TB registers at the study settings. Of these, 809 (74.6%) were males, whereas 8 (0.7%) were children, 1,005 (92.6%) were diagnosed using Xpert, 78 (7.2%) by microscopy. A total of 91 (8.4%, 95% CI 6.8-10.2) were determined to be pre-treatment LTFU. Those who had very low (14.0%, 95% CI 8.5-21.2) and low (11.8%, 95% CI 8.4-16.0) results on Xpert were respectively 3.1 (95% CI 1.6-6.0) and 2.6 (95% CI 1.4-4.8) times more likely to become pre-treatment LTFU than those who had medium (4.5%, 95% CI 2.5-7.4) results. The proportions of pre-treatment LTFU varied among the study sites from 0.7% to 16.1%.
Conclusion: Health facilities should strive to account for every patient with TB, with particular attention to those who are bacteriologically confirmed.
环境:赞比亚卢萨卡的五个城市结核病诊断中心。目的:确定2020年在研究环境中发现的细菌学证实的治疗前失访(LTFU)结核病患者的比例。设计:这是一项回顾性队列研究,研究地点的结核病实验室和治疗登记是交叉匹配的。结果:在研究设置的实验室结核病登记中共发现1,085名细菌学确诊的结核病患者。其中,809例(74.6%)为男性,8例(0.7%)为儿童,1005例(92.6%)为Xpert诊断,78例(7.2%)为显微镜诊断。共有91例(8.4%,95% CI 6.8-10.2)被确定为治疗前LTFU。Xpert结果非常低(14.0%,95% CI 8.5-21.2)和低(11.8%,95% CI 8.4-16.0)的患者成为治疗前LTFU的可能性分别是中度(4.5%,95% CI 2.5-7.4)患者的3.1倍(95% CI 1.6-6.0)和2.6倍(95% CI 1.4-4.8)。处理前LTFU的比例在研究地点从0.7%到16.1%不等。结论:卫生机构应努力对每一位结核病患者作出解释,特别注意那些经细菌学证实的患者。
{"title":"Causes of pre-treatment loss to follow-up in patients with TB.","authors":"S Daka, Y Matsuoka, M Ota, S Hirao, A Phiri","doi":"10.5588/pha.22.0051","DOIUrl":"https://doi.org/10.5588/pha.22.0051","url":null,"abstract":"<p><strong>Setting: </strong>Five urban TB diagnostic centres in Lusaka, Zambia.</p><p><strong>Objective: </strong>To determine the proportion of bacteriologically confirmed pre-treatment lost to follow-up (LTFU) patients with TB found at the study settings in 2020.</p><p><strong>Design: </strong>This was a retrospective cohort study in which the TB laboratory and treatment registers at the study sites were cross-matched.</p><p><strong>Results: </strong>A total of 1,085 bacteriologically confirmed patients with TB were found in the laboratory TB registers at the study settings. Of these, 809 (74.6%) were males, whereas 8 (0.7%) were children, 1,005 (92.6%) were diagnosed using Xpert, 78 (7.2%) by microscopy. A total of 91 (8.4%, 95% CI 6.8-10.2) were determined to be pre-treatment LTFU. Those who had very low (14.0%, 95% CI 8.5-21.2) and low (11.8%, 95% CI 8.4-16.0) results on Xpert were respectively 3.1 (95% CI 1.6-6.0) and 2.6 (95% CI 1.4-4.8) times more likely to become pre-treatment LTFU than those who had medium (4.5%, 95% CI 2.5-7.4) results. The proportions of pre-treatment LTFU varied among the study sites from 0.7% to 16.1%.</p><p><strong>Conclusion: </strong>Health facilities should strive to account for every patient with TB, with particular attention to those who are bacteriologically confirmed.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"148-152"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716822/pdf/i2220-8372-12-4-148.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10414612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Framed as "the great-equalizer," the COVID-19 pandemic has intensified pressure to adapt critical care labor and resulted in rationing by healthcare workers across the world.
Objective: To critically investigate how hospital intensive care units are critical sites of care labor and examine how rationing highlights key features of healthcare labor and its inequalities.
Methods: A practice-oriented ethnographic study was conducted in a United States academic ICU by a medical anthropologist and medical intensivists with global health expertise. The analysis drew on 57 in-depth interviews and 25 months of participant observation between 2020 and 2021.
Results: Embodied labor constitutes sites and practices of shortage or rationing along three domains: equipment and technology, labor, and emotions and energy. The resulting workers' practices of adaptation and resilience point to a potentially more robust global health labor politics based on seeing rationing as work.
Conclusion: Studies of pandemic rationing practices and critical care labor can disrupt too-simple comparative narratives of Global North/South divides. Further studies and efforts must address the toll of healthcare labor.
{"title":"The pandemic is not the great equalizer: front-line labor and rationing in COVID-19 critical care.","authors":"N Navuluri, H S Solomon, C W Hargett, P S Kussin","doi":"10.5588/pha.22.0025","DOIUrl":"https://doi.org/10.5588/pha.22.0025","url":null,"abstract":"<p><strong>Background: </strong>Framed as \"the great-equalizer,\" the COVID-19 pandemic has intensified pressure to adapt critical care labor and resulted in rationing by healthcare workers across the world.</p><p><strong>Objective: </strong>To critically investigate how hospital intensive care units are critical sites of care labor and examine how rationing highlights key features of healthcare labor and its inequalities.</p><p><strong>Methods: </strong>A practice-oriented ethnographic study was conducted in a United States academic ICU by a medical anthropologist and medical intensivists with global health expertise. The analysis drew on 57 in-depth interviews and 25 months of participant observation between 2020 and 2021.</p><p><strong>Results: </strong>Embodied labor constitutes sites and practices of shortage or rationing along three domains: equipment and technology, labor, and emotions and energy. The resulting workers' practices of adaptation and resilience point to a potentially more robust global health labor politics based on seeing rationing as work.</p><p><strong>Conclusion: </strong>Studies of pandemic rationing practices and critical care labor can disrupt too-simple comparative narratives of Global North/South divides. Further studies and efforts must address the toll of healthcare labor.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"186-190"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716820/pdf/i2220-8372-12-4-186.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D P Baloyi, M G Anthony, K A Meyerson, S Mazibuko, D Wademan, L Viljoen, H Myburgh, K du Preez, M Osman, Y Hirsch-Moverman, S Charalambous, H Hausler, A C Hesseling, G Hoddinott
Background: South Africa has one the highest TB and HIV burdens globally. TB preventive therapy (TPT) reduces the risk of TB disease and TB-related mortality in adults and children living with HIV and is indicated for use in TB-exposed HIV-negative individuals and children. TPT implementation in South Africa remains suboptimal.
Methods: We conducted a pragmatic review of TPT implementation using multiple data sources, including informant interviews (n = 134), semi-structured observations (n = 93) and TB patient folder reviews in 31 health facilities purposively selected across three high TB burden provinces. We used case descriptive analysis and thematic coding to identify barriers and facilitators to TPT implementation.
Results: TPT programme implementation was suboptimal, with inadequate monitoring even in health districts with well-functioning TB services. Health workers reported scepticism about TPT effectiveness, deprioritised TPT in practice and expressed divergent opinions about the cadres of staff responsible for implementation. Service- and facility-level barriers included ineffective contact tracing, resource shortages, lack of standardised reporting mechanisms and insufficient patient education on TPT. Patient-level barriers included socio-economic factors.
Conclusions: Improving TPT implementation will require radically simplified and more feasible systems and training for all cadres of health workers. Partnership with communities to stimulate demand driven service uptake can potentially facilitate implementation.
{"title":"Reasons for poor uptake of TB preventive therapy in South Africa.","authors":"D P Baloyi, M G Anthony, K A Meyerson, S Mazibuko, D Wademan, L Viljoen, H Myburgh, K du Preez, M Osman, Y Hirsch-Moverman, S Charalambous, H Hausler, A C Hesseling, G Hoddinott","doi":"10.5588/pha.22.0030","DOIUrl":"https://doi.org/10.5588/pha.22.0030","url":null,"abstract":"<p><strong>Background: </strong>South Africa has one the highest TB and HIV burdens globally. TB preventive therapy (TPT) reduces the risk of TB disease and TB-related mortality in adults and children living with HIV and is indicated for use in TB-exposed HIV-negative individuals and children. TPT implementation in South Africa remains suboptimal.</p><p><strong>Methods: </strong>We conducted a pragmatic review of TPT implementation using multiple data sources, including informant interviews (<i>n</i> = 134), semi-structured observations (<i>n</i> = 93) and TB patient folder reviews in 31 health facilities purposively selected across three high TB burden provinces. We used case descriptive analysis and thematic coding to identify barriers and facilitators to TPT implementation.</p><p><strong>Results: </strong>TPT programme implementation was suboptimal, with inadequate monitoring even in health districts with well-functioning TB services. Health workers reported scepticism about TPT effectiveness, deprioritised TPT in practice and expressed divergent opinions about the cadres of staff responsible for implementation. Service- and facility-level barriers included ineffective contact tracing, resource shortages, lack of standardised reporting mechanisms and insufficient patient education on TPT. Patient-level barriers included socio-economic factors.</p><p><strong>Conclusions: </strong>Improving TPT implementation will require radically simplified and more feasible systems and training for all cadres of health workers. Partnership with communities to stimulate demand driven service uptake can potentially facilitate implementation.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"159-164"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716815/pdf/i2220-8372-12-4-159.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10603095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M G Anthony, G Hoddinott, M Van Niekerk, A Mtshabe, A Pienaar, I Dewandel, C Mckenzie, P Goussard, A C Hesseling, M M van der Zalm
Background: There is a lack of holistic health-related quality of life (HRQoL) measures for young children with respiratory disease, especially in low- and middle-income countries (LMICs). We aimed to understand caregivers' perceptions of the relevance of common HRQoL domains for children with respiratory diseases, including TB.
Methods: This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of pulmonary TB. We conducted 10 semi-structured interviews to explore caregivers' perceptions of the five commonly measured HRQoL domains: physical health, social support, emotional and psychological wellbeing, and schooling. We used case descriptive analysis and thematic coding.
Results: Caregivers considered all five domains to be relevant. The socio-economic context framed their responses, with QoL requiring sufficient basic resources for children. HRQoL experiences varied according to the severity of the child's symptoms, but not between TB and non-TB illnesses. Manifestations in the psychological domain were difficult to distinguish from the emotional domain. Social support included broad support for family members, indirectly benefiting the children. Caregivers were concerned about their children's early developmental milestones and future schooling.
Conclusion: This exploratory study shows that HRQoL domains are relevant but require adaptation to be applicable for young children affected by respiratory illnesses living in LMICs.
{"title":"Caregivers' perspectives on health-related quality of life in young children with TB and respiratory illnesses.","authors":"M G Anthony, G Hoddinott, M Van Niekerk, A Mtshabe, A Pienaar, I Dewandel, C Mckenzie, P Goussard, A C Hesseling, M M van der Zalm","doi":"10.5588/pha.22.0038","DOIUrl":"https://doi.org/10.5588/pha.22.0038","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of holistic health-related quality of life (HRQoL) measures for young children with respiratory disease, especially in low- and middle-income countries (LMICs). We aimed to understand caregivers' perceptions of the relevance of common HRQoL domains for children with respiratory diseases, including TB.</p><p><strong>Methods: </strong>This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of pulmonary TB. We conducted 10 semi-structured interviews to explore caregivers' perceptions of the five commonly measured HRQoL domains: physical health, social support, emotional and psychological wellbeing, and schooling. We used case descriptive analysis and thematic coding.</p><p><strong>Results: </strong>Caregivers considered all five domains to be relevant. The socio-economic context framed their responses, with QoL requiring sufficient basic resources for children. HRQoL experiences varied according to the severity of the child's symptoms, but not between TB and non-TB illnesses. Manifestations in the psychological domain were difficult to distinguish from the emotional domain. Social support included broad support for family members, indirectly benefiting the children. Caregivers were concerned about their children's early developmental milestones and future schooling.</p><p><strong>Conclusion: </strong>This exploratory study shows that HRQoL domains are relevant but require adaptation to be applicable for young children affected by respiratory illnesses living in LMICs.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"201-205"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716816/pdf/i2220-8372-12-4-201.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10603097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Setting: Sao Tomé and Principe (STP) is a lower middle-income country in the Gulf of Guinea that has a persistent high loss of TB patients on treatment.
Objective: To investigate factors associated with patient loss to follow-up (LTFU) and to assess health worker perceptions on non-adherence.
Design: A retrospective cohort study was conducted using data from the national database. Factors associated with LTFU were investigated using univariable and multivariable logistic regression. In-depth interviews were conducted with TB health workers to identify perceived barriers for treatment completion.
Results: A total of 822 registered patients with drug-susceptible TB were included, of whom 82 (10.0%) were lost to follow-up. Male sex (adjusted OR [aOR] 1.7, 95% CI 1.0-3.0; P = 0.048), as well as living in the Mé-Zóchi and Caué Districts (aOR 2.60, 95% CI 1.58-4.26; P < 0.001) were associated with an increased odds of LTFU. The main barriers to treatment completion were related to lack of food, stigma, and lack of patient information and personal support.
Conclusion: The study indicates the need to address multiple issues related to LTFU during TB treatment. Enhanced efforts to personalise care, especially for information, nutrition and encouragement will better support patients in STP.
背景:圣多美和普林西比(STP)是几内亚湾的一个中低收入国家,接受治疗的结核病患者持续大量流失。目的:调查与患者失访(LTFU)相关的因素,并评估卫生工作者对不依从性的看法。设计:使用国家数据库的数据进行回顾性队列研究。使用单变量和多变量logistic回归研究与LTFU相关的因素。与结核病卫生工作者进行了深入访谈,以确定完成治疗的感知障碍。结果:共纳入822例登记的药敏结核患者,其中失访82例(10.0%)。男性(调整OR [aOR] 1.7, 95% CI 1.0-3.0;P = 0.048),以及居住在Mé-Zóchi和cau地区(aOR 2.60, 95% CI 1.58-4.26;P < 0.001)与LTFU发生率增加相关。完成治疗的主要障碍与缺乏食物、耻辱感、缺乏患者信息和个人支持有关。结论:该研究表明,在结核病治疗过程中需要解决与LTFU相关的多个问题。加强个性化护理的努力,特别是在信息、营养和鼓励方面,将更好地支持STP患者。
{"title":"TB treatment non-adherence in São Tomé and Príncipe.","authors":"S Bandeira, S da Trindade, M E Raguenaud, B Sousa","doi":"10.5588/pha.22.0040","DOIUrl":"https://doi.org/10.5588/pha.22.0040","url":null,"abstract":"<p><strong>Setting: </strong>Sao Tomé and Principe (STP) is a lower middle-income country in the Gulf of Guinea that has a persistent high loss of TB patients on treatment.</p><p><strong>Objective: </strong>To investigate factors associated with patient loss to follow-up (LTFU) and to assess health worker perceptions on non-adherence.</p><p><strong>Design: </strong>A retrospective cohort study was conducted using data from the national database. Factors associated with LTFU were investigated using univariable and multivariable logistic regression. In-depth interviews were conducted with TB health workers to identify perceived barriers for treatment completion.</p><p><strong>Results: </strong>A total of 822 registered patients with drug-susceptible TB were included, of whom 82 (10.0%) were lost to follow-up. Male sex (adjusted OR [aOR] 1.7, 95% CI 1.0-3.0; <i>P</i> = 0.048), as well as living in the Mé-Zóchi and Caué Districts (aOR 2.60, 95% CI 1.58-4.26; <i>P</i> < 0.001) were associated with an increased odds of LTFU. The main barriers to treatment completion were related to lack of food, stigma, and lack of patient information and personal support.</p><p><strong>Conclusion: </strong>The study indicates the need to address multiple issues related to LTFU during TB treatment. Enhanced efforts to personalise care, especially for information, nutrition and encouragement will better support patients in STP.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"195-200"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716817/pdf/i2220-8372-12-4-195.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9373216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Urakawa, A Yasukawa, Y Hoshino, M Ota, H Hatamoto, S Hirao, T Zama, Y Nagata, T Yoshiyama
Setting: Japan, an intermediate TB burden country.
Objective: To review TB-related technical enquiries received at the Research Institute of Tuberculosis, Japan, from January 2017 to December 2019.
Design: This was a cohort study.
Results: A total of 2,197 enquiries were analysed. On average, 61.0 enquiries/month (range: 42-81) were received. The enquiry rates were highest for the Yamanashi (4.65/100,000 population) and Ishikawa (4.55) Prefectures, and lowest in the Yamagata (0.46) and Tochigi (0.56) Prefectures. The main organisations the enquirers belonged to were local governments (n = 1,585, 72.1%) and healthcare facilities (n = 307, 14.0%). The enquirers were medical doctors (n = 391, 17.8%), nurses (n = 1,207, 54.9%), other healthcare professionals (n = 57, 2.6%), the general public (n = 168, 7.6%) and others/unknown (n = 374, 17.0%). The most frequent enquiries were about TB diagnosis and treatment (n = 501, 22.8%), including laboratory diagnosis (n = 88, 4.0%), TB treatment in general (n = 93, 4.2%) and management of comorbidities (n = 86, 3.9%), followed by contact investigations (n = 385, 17.5%) and TB in foreigners (n = 344, 15.7%).
Conclusion: As the most frequent enquiries were about diagnosis and treatment of TB, the health ministry of Japan should maintain a few specialised TB institutions with TB physicians to provide technical assistance.
{"title":"TB-related technical enquiries received in Japan, 2017-2019.","authors":"M Urakawa, A Yasukawa, Y Hoshino, M Ota, H Hatamoto, S Hirao, T Zama, Y Nagata, T Yoshiyama","doi":"10.5588/pha.22.0053","DOIUrl":"https://doi.org/10.5588/pha.22.0053","url":null,"abstract":"<p><strong>Setting: </strong>Japan, an intermediate TB burden country.</p><p><strong>Objective: </strong>To review TB-related technical enquiries received at the Research Institute of Tuberculosis, Japan, from January 2017 to December 2019.</p><p><strong>Design: </strong>This was a cohort study.</p><p><strong>Results: </strong>A total of 2,197 enquiries were analysed. On average, 61.0 enquiries/month (range: 42-81) were received. The enquiry rates were highest for the Yamanashi (4.65/100,000 population) and Ishikawa (4.55) Prefectures, and lowest in the Yamagata (0.46) and Tochigi (0.56) Prefectures. The main organisations the enquirers belonged to were local governments (<i>n</i> = 1,585, 72.1%) and healthcare facilities (<i>n</i> = 307, 14.0%). The enquirers were medical doctors (<i>n</i> = 391, 17.8%), nurses (<i>n</i> = 1,207, 54.9%), other healthcare professionals (<i>n</i> = 57, 2.6%), the general public (<i>n</i> = 168, 7.6%) and others/unknown (<i>n</i> = 374, 17.0%). The most frequent enquiries were about TB diagnosis and treatment (<i>n</i> = 501, 22.8%), including laboratory diagnosis (<i>n</i> = 88, 4.0%), TB treatment in general (<i>n</i> = 93, 4.2%) and management of comorbidities (<i>n</i> = 86, 3.9%), followed by contact investigations (<i>n</i> = 385, 17.5%) and TB in foreigners (<i>n</i> = 344, 15.7%).</p><p><strong>Conclusion: </strong>As the most frequent enquiries were about diagnosis and treatment of TB, the health ministry of Japan should maintain a few specialised TB institutions with TB physicians to provide technical assistance.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"12 4","pages":"206-209"},"PeriodicalIF":1.4,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716821/pdf/i2220-8372-12-4-206.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10414613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}