Pub Date : 2014-12-31DOI: 10.2174/1874279301408010008
A. Vallone
*Address correspondence to this author at the Infectious Diseases Unit, Jazzolino Hospital, piazza Fleming, 89900 Vibo Valentia, Italy; Tel/Fax: +39 0963 61219; E-mail: alfredovallone@yahoo.it until late in the evening. Doctors, nurses, and a good number of patients shared with ease their private lives in various ways and attended parties and important family events even in sad or controversial circumstances because the Sicilian society at the time was not artificial. Teams of healthcare workers and patients in the hospital related to each other in a nowadays unknown way that did not separate the clinical issues from the other spheres of the person. At times being in the hospital looked like standing in the town main square where you could meet people who were at ease because were not forced to get rid, as well as of their clothes, of their status and their condition.
{"title":"PRACTICE REFLECTION I Have Met, At Last, Rosario!","authors":"A. Vallone","doi":"10.2174/1874279301408010008","DOIUrl":"https://doi.org/10.2174/1874279301408010008","url":null,"abstract":"*Address correspondence to this author at the Infectious Diseases Unit, Jazzolino Hospital, piazza Fleming, 89900 Vibo Valentia, Italy; Tel/Fax: +39 0963 61219; E-mail: alfredovallone@yahoo.it until late in the evening. Doctors, nurses, and a good number of patients shared with ease their private lives in various ways and attended parties and important family events even in sad or controversial circumstances because the Sicilian society at the time was not artificial. Teams of healthcare workers and patients in the hospital related to each other in a nowadays unknown way that did not separate the clinical issues from the other spheres of the person. At times being in the hospital looked like standing in the town main square where you could meet people who were at ease because were not forced to get rid, as well as of their clothes, of their status and their condition.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"8 1","pages":"8-10"},"PeriodicalIF":0.0,"publicationDate":"2014-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-03-22DOI: 10.2174/1874279301307010015
S. Uzunović, A. Ibrahimagić, F. Kamberović, M. Rijnders, E. Stobberingh
Objectives: To determine the prevalence and genetic background of methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) obtained from healthy food handlers admitted to the Cantonal Public Health Institute of Zenica, Bosnia and Herzegovina, during 2007-2009. Methods: S. aureus were isolated and identified using standard microbiological methods including coagulase and catalase tests. Antibiotic susceptibility testing by disc diffusion method was performed according to the CLSI guidelines. Methicillin resistance was confirmed by the presence of the mecA gene by PCR. The genetic characterization was performed using spa-typing and BURP algorithm. Results: A total of 189 non-duplicated S. aureus isolates were collected from 13 690 nasal swabs (1.4%), of which three were MRSA (1.6%). Among 173 MSSA analyzed, 66 spa types were clustered into nine spa-CCs, four no founders, and singletons. The MSSA spa-CC015 associated with MLST CC45 was predominant, having 41 (24%) strains. All three MRSA were associated with MLST 152 (spa-CC 355/595) which was not found in MSSA isolates. MRSA-related background had 60% MSSA isolates. There were 127 (71%) MSSA and one MRSA sensitive to all antibiotic tested (the beta-lactam compounds excepted); multi-drug resistance was found in 13 (7.3%) of MSSA. Conclusion: Very low prevalence of S. aureus, as well as MRSA was noted. MSSA were more heterogeneous than MRSA. Although the number of MSSA with a genetic background common to MRSA clones was high, the prevalence of MRSA was low, and MLST CC152 of MRSA was not found among MSSA isolates suggesting that MRSA did not arise from predominant MSSA clones.
{"title":"Molecular Characterization of Methicillin-Susceptible And Methicillin- Resistant Staphylococcus aureus in Food Handlers in Bosnia and Herzegovina","authors":"S. Uzunović, A. Ibrahimagić, F. Kamberović, M. Rijnders, E. Stobberingh","doi":"10.2174/1874279301307010015","DOIUrl":"https://doi.org/10.2174/1874279301307010015","url":null,"abstract":"Objectives: To determine the prevalence and genetic background of methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) obtained from healthy food handlers admitted to the Cantonal Public Health Institute of Zenica, Bosnia and Herzegovina, during 2007-2009. Methods: S. aureus were isolated and identified using standard microbiological methods including coagulase and catalase tests. Antibiotic susceptibility testing by disc diffusion method was performed according to the CLSI guidelines. Methicillin resistance was confirmed by the presence of the mecA gene by PCR. The genetic characterization was performed using spa-typing and BURP algorithm. Results: A total of 189 non-duplicated S. aureus isolates were collected from 13 690 nasal swabs (1.4%), of which three were MRSA (1.6%). Among 173 MSSA analyzed, 66 spa types were clustered into nine spa-CCs, four no founders, and singletons. The MSSA spa-CC015 associated with MLST CC45 was predominant, having 41 (24%) strains. All three MRSA were associated with MLST 152 (spa-CC 355/595) which was not found in MSSA isolates. MRSA-related background had 60% MSSA isolates. There were 127 (71%) MSSA and one MRSA sensitive to all antibiotic tested (the beta-lactam compounds excepted); multi-drug resistance was found in 13 (7.3%) of MSSA. Conclusion: Very low prevalence of S. aureus, as well as MRSA was noted. MSSA were more heterogeneous than MRSA. Although the number of MSSA with a genetic background common to MRSA clones was high, the prevalence of MRSA was low, and MLST CC152 of MRSA was not found among MSSA isolates suggesting that MRSA did not arise from predominant MSSA clones.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2014-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-03-07DOI: 10.2174/1874279301408010001
O. Simooya, N. Sanjobo, C. Mulenga, D. Mwakazanga, F. Tailoka, Evans Betha, Lovemore Kaetano, H. Witola
Background: More than thirty years into the epidemic and at a time of declining HIV prevalence rates in many affected regions, prisoners continue to receive less protection against HIV infection compared to communities outside. This survey, the third since 1988 was conducted to assess the effectiveness of current programmes in Zambian prisons. Methods: From June 2009-June 2010, 2,244 {184 women (8.2%); 2060 men (91.8%)} prisoners in Zambia participated in a survey of HIV prevalence and risk behaviours. Risk behaviours were elicited using a pretested questionnaire whilst HIV prevalence was determined using two ELISAs and Western Blot. The survey was voluntary, anonymous and confidential. Results: Six hundred and nine (609), (27%), prisoners were found with HIV infection. This was associated with age, highest in those 35-44 years and gender, 47.3% of the women tested were positive for HIV. Other significant associations were found between HIV and tattooing, STIs and TB. Only 35 prisoners agreed to have had male to male sex (MSM) and this was not linked to HIV result. However, indirect questioning suggested much higher figures of MSM in prisons. Overall, prisoners had knowledge about HIV and over 60 % knew their HIV status. Conclusion: The HIV prevalence rate of 27% is nearly double the national average of 14%, suggesting that current inter- ventions in prisons, focused on raising awareness, are not effective. Evidence based programs targeting tattooing and MSM are needed urgently to reduce the risk of HIV infected prisoners spreading infections to their communities after release.
{"title":"Aggressive Awareness Campaigns May Not be Enough for HIV Preventionin Prisons-Studies in Zambia Suggest Time for Evidence BasedInterventions","authors":"O. Simooya, N. Sanjobo, C. Mulenga, D. Mwakazanga, F. Tailoka, Evans Betha, Lovemore Kaetano, H. Witola","doi":"10.2174/1874279301408010001","DOIUrl":"https://doi.org/10.2174/1874279301408010001","url":null,"abstract":"Background: More than thirty years into the epidemic and at a time of declining HIV prevalence rates in many affected regions, prisoners continue to receive less protection against HIV infection compared to communities outside. This survey, the third since 1988 was conducted to assess the effectiveness of current programmes in Zambian prisons. Methods: From June 2009-June 2010, 2,244 {184 women (8.2%); 2060 men (91.8%)} prisoners in Zambia participated in a survey of HIV prevalence and risk behaviours. Risk behaviours were elicited using a pretested questionnaire whilst HIV prevalence was determined using two ELISAs and Western Blot. The survey was voluntary, anonymous and confidential. Results: Six hundred and nine (609), (27%), prisoners were found with HIV infection. This was associated with age, highest in those 35-44 years and gender, 47.3% of the women tested were positive for HIV. Other significant associations were found between HIV and tattooing, STIs and TB. Only 35 prisoners agreed to have had male to male sex (MSM) and this was not linked to HIV result. However, indirect questioning suggested much higher figures of MSM in prisons. Overall, prisoners had knowledge about HIV and over 60 % knew their HIV status. Conclusion: The HIV prevalence rate of 27% is nearly double the national average of 14%, suggesting that current inter- ventions in prisons, focused on raising awareness, are not effective. Evidence based programs targeting tattooing and MSM are needed urgently to reduce the risk of HIV infected prisoners spreading infections to their communities after release.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"8 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2014-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-06-28DOI: 10.2174/1874279301307010090
A. Ansari, S. A. Alawi, M. Qahtani, A. Darwish
Outpatient parenteral antimicrobial therapy (OPAT) is an alternative method to deliver intravenous antimicrobial agents to patients requiring parenteral therapy without an overnight hospital stay. The aim of this study was to review the OPAT services, to explore patient satisfaction with the services provided, and to determine cost effectiveness. A retrospective review for the raw data collected in the OPAT clinic between February 2012 and January 2013 was included. Patients' variables including age, sex, type of infection, and service costs were analyzed with descriptive statistics. Each patient's eligibility was assessed by an infectious disease physician (ID), and a family physician. Patient's satisfaction was measured by a modified short version patient satisfaction questionnaire. Cost was calculated for each patient in the OPAT clinic and compared to the actual cost if the same patient was admitted and treated in the hospital. During the last 12 months, 101 patients, 92 adults, and nine children were treated in our OPAT clinic. Half (50%) of the patients were referred from general practitioner services and our emergency department. Ceftriaxone was the most frequently used antibiotic, prescribed to 76% of the patients. Successful cure was achieved in 97 treated patients. Patients were highly satisfied with the OPAT service with the mean rating of 4.41 SD + 0.31. Cost was reduced from $75, 000 to $30, 000 over one year. This retrospective study suggested that OPAT service is safe and potentially a cost saving approach for the health care system. OPAT service is acceptable and well tolerated among patients receiving intravenous antimicrobial agents.
{"title":"Outpatient Parenteral Antimicrobial Therapy (OPAT) in the Kingdom of Bahrain: Efficacy, Patient Satisfaction and Cost Effectiveness","authors":"A. Ansari, S. A. Alawi, M. Qahtani, A. Darwish","doi":"10.2174/1874279301307010090","DOIUrl":"https://doi.org/10.2174/1874279301307010090","url":null,"abstract":"Outpatient parenteral antimicrobial therapy (OPAT) is an alternative method to deliver intravenous antimicrobial agents to patients requiring parenteral therapy without an overnight hospital stay. The aim of this study was to review the OPAT services, to explore patient satisfaction with the services provided, and to determine cost effectiveness. A retrospective review for the raw data collected in the OPAT clinic between February 2012 and January 2013 was included. Patients' variables including age, sex, type of infection, and service costs were analyzed with descriptive statistics. Each patient's eligibility was assessed by an infectious disease physician (ID), and a family physician. Patient's satisfaction was measured by a modified short version patient satisfaction questionnaire. Cost was calculated for each patient in the OPAT clinic and compared to the actual cost if the same patient was admitted and treated in the hospital. During the last 12 months, 101 patients, 92 adults, and nine children were treated in our OPAT clinic. Half (50%) of the patients were referred from general practitioner services and our emergency department. Ceftriaxone was the most frequently used antibiotic, prescribed to 76% of the patients. Successful cure was achieved in 97 treated patients. Patients were highly satisfied with the OPAT service with the mean rating of 4.41 SD + 0.31. Cost was reduced from $75, 000 to $30, 000 over one year. This retrospective study suggested that OPAT service is safe and potentially a cost saving approach for the health care system. OPAT service is acceptable and well tolerated among patients receiving intravenous antimicrobial agents.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"90-95"},"PeriodicalIF":0.0,"publicationDate":"2013-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-05-17DOI: 10.2174/1874279301307010086
R. Buso, M. Rattazzi, M. Puato, P. Pauletto
Cervical Pott's disease is a rare clinical condition whose diagnosis is usually delayed. We report a case of lung tuberculosis (TB) and cervical Pott's disease mimicking a metastatic lung cancer. The patient presented with persistent cervical pain. Radiologic examinations showed the presence of a lytic lesion of C3 vertebral body, associated with spinal cord compression. A CT scan of the thorax showed a lung nodule highly suspicious for malignancy in the apical region of right lung upper lobe. Neurosurgical decompression was performed. Unexpectedly, histological analysis showed the presence of an inflammatory infiltrate suggestive for TB infection. The patient was immediately treated with antituberculous drugs. Atypical forms of spinal TB, such as cervical TB, can be misdiagnosed as primary or metastatic cancers and lead to delay of treatment initiation that could be fatal. Awareness of this uncommon TB presentation is important to prevent morbidity and mortality associated with spinal cord injury and disease dissemination.
{"title":"An Uncommon Presentation of Tuberculosis with Cervical Pott’s DiseaseInitially Suspected as Metastatic Lung Cancer","authors":"R. Buso, M. Rattazzi, M. Puato, P. Pauletto","doi":"10.2174/1874279301307010086","DOIUrl":"https://doi.org/10.2174/1874279301307010086","url":null,"abstract":"Cervical Pott's disease is a rare clinical condition whose diagnosis is usually delayed. We report a case of lung tuberculosis (TB) and cervical Pott's disease mimicking a metastatic lung cancer. The patient presented with persistent cervical pain. Radiologic examinations showed the presence of a lytic lesion of C3 vertebral body, associated with spinal cord compression. A CT scan of the thorax showed a lung nodule highly suspicious for malignancy in the apical region of right lung upper lobe. Neurosurgical decompression was performed. Unexpectedly, histological analysis showed the presence of an inflammatory infiltrate suggestive for TB infection. The patient was immediately treated with antituberculous drugs. Atypical forms of spinal TB, such as cervical TB, can be misdiagnosed as primary or metastatic cancers and lead to delay of treatment initiation that could be fatal. Awareness of this uncommon TB presentation is important to prevent morbidity and mortality associated with spinal cord injury and disease dissemination.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"46 1","pages":"86-89"},"PeriodicalIF":0.0,"publicationDate":"2013-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-19DOI: 10.2174/1874279301307010036
E. Tiemersma, L. V. Duc, D. N. Sy, F. Cobelens
Tuberculosis (TB) case notification rates in Vietnam have stabilized since 2000, but in 2007 were increasing among young adults. The emerging HIV epidemic only partly explains this increase. Other factors are probably involved. We aimed to assess whether rural-to-urban migration is such a factor. We conducted a case-control study at district TB units (DTUs) in Da Nang province, Vietnam, recruiting equal numbers (170) of TB patients aged 15-35 years, TB suspects of the same age in whom TB was excluded, and TB patients of 35 years and older. Risk factors for TB were assessed through interviews using pre-structured questionnaires. Among persons seeking care at DTUs, migration was not a significant risk factor for TB. Young male migrants had a lower risk of TB than other young adults (odds ratio (OR) 0.4; 95% confidence interval (95%CI) 0.03-0.64). Instead, TB was associated with male sex and a higher level of education. Compared to older TB patients, younger TB patients were more likely to be female, have a higher education level and a job involving indoor contacts with other people. Migration does not account for the increase in TB case notification rates among young adults in Vietnam. However, migration cannot be excluded as a risk factor for TB in Vietnam, because migrants may not seek diagnosis and treatment for TB at DTUs.
{"title":"Increasing Tuberculosis Notification Rates Among Young Adults are NotAssociated with Migration in Da Nang, Vietnam","authors":"E. Tiemersma, L. V. Duc, D. N. Sy, F. Cobelens","doi":"10.2174/1874279301307010036","DOIUrl":"https://doi.org/10.2174/1874279301307010036","url":null,"abstract":"Tuberculosis (TB) case notification rates in Vietnam have stabilized since 2000, but in 2007 were increasing among young adults. The emerging HIV epidemic only partly explains this increase. Other factors are probably involved. We aimed to assess whether rural-to-urban migration is such a factor. We conducted a case-control study at district TB units (DTUs) in Da Nang province, Vietnam, recruiting equal numbers (170) of TB patients aged 15-35 years, TB suspects of the same age in whom TB was excluded, and TB patients of 35 years and older. Risk factors for TB were assessed through interviews using pre-structured questionnaires. Among persons seeking care at DTUs, migration was not a significant risk factor for TB. Young male migrants had a lower risk of TB than other young adults (odds ratio (OR) 0.4; 95% confidence interval (95%CI) 0.03-0.64). Instead, TB was associated with male sex and a higher level of education. Compared to older TB patients, younger TB patients were more likely to be female, have a higher education level and a job involving indoor contacts with other people. Migration does not account for the increase in TB case notification rates among young adults in Vietnam. However, migration cannot be excluded as a risk factor for TB in Vietnam, because migrants may not seek diagnosis and treatment for TB at DTUs.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"36-46"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-19DOI: 10.2174/1874279301307010060
G. Kaliakbarova, S. Pak, N. Zhaksylykova, G. Raimova, B. Temerbekova, S. Hof
A novel patient-oriented treatment delivery program was introduced for multi-drug resistant tuberculosis (MDR-TB) patients at high risk of treatment default in East Kazakhstan region, The Republic of Kazakhstan. In parallel interventions were introduced to improve programmatic and clinical management for all MDR-TB patients. To assess the effects of the patient support program on patient default rates, we analyzed the characteristics of MDR-TB patients referred to the psychosocial support (PSS) program, treatment adherence before and during the intervention for patients referred to the patient support program. In 2010, the total numberf MDR-patients starting second-line drug MDR-TB treatment was 426. The PSS program supported 228 (53%) patients considered to be at high risk of treatment default. The program contributed to strengthening of management of all MDR-TB patients during the ambulatory, continuation phase of treatment. The proportion of drug doses taken under direct observation improved from 48% to 97%, while division of intake of second-line anti-TB drugs in 2-3 portions per day decreased from 20% in 2009 to 0%. Interruptions of anti-TB drugs for at least one day decreased from 18% to 4% among all MDR-TB patients. Among patients included in the PSS program, no treatment default was observed and only one patient missed doses of treatment.
{"title":"Psychosocial Support Improves Treatment Adherence Among MDR-TBPatients: Experience from East Kazakhstan","authors":"G. Kaliakbarova, S. Pak, N. Zhaksylykova, G. Raimova, B. Temerbekova, S. Hof","doi":"10.2174/1874279301307010060","DOIUrl":"https://doi.org/10.2174/1874279301307010060","url":null,"abstract":"A novel patient-oriented treatment delivery program was introduced for multi-drug resistant tuberculosis (MDR-TB) patients at high risk of treatment default in East Kazakhstan region, The Republic of Kazakhstan. In parallel interventions were introduced to improve programmatic and clinical management for all MDR-TB patients. To assess the effects of the patient support program on patient default rates, we analyzed the characteristics of MDR-TB patients referred to the psychosocial support (PSS) program, treatment adherence before and during the intervention for patients referred to the patient support program. In 2010, the total numberf MDR-patients starting second-line drug MDR-TB treatment was 426. The PSS program supported 228 (53%) patients considered to be at high risk of treatment default. The program contributed to strengthening of management of all MDR-TB patients during the ambulatory, continuation phase of treatment. The proportion of drug doses taken under direct observation improved from 48% to 97%, while division of intake of second-line anti-TB drugs in 2-3 portions per day decreased from 20% in 2009 to 0%. Interruptions of anti-TB drugs for at least one day decreased from 18% to 4% among all MDR-TB patients. Among patients included in the PSS program, no treatment default was observed and only one patient missed doses of treatment.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"60-64"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-19DOI: 10.2174/1874279301307010023
J. V. Gorkom, F. Mavhunga, Omer Ahmed Omer, A. Kutwa, A. Zezai, N. Ruswa, P. Dhliwayo, S. Sawadogo, B. Schreuder, Rosalia Indongo, E. Shihepo
Namibia is among the five countries worstly affected by tuberculosis (TB) with a notification rate of 465/100,000 in 2011. This paper describes how the National Tuberculosis Leprosy Program (NTLP) developed from a poorly performing TB control program in 2002 into a well performing program in 2011. The program achieved 85% treatment success for new sputum-positive patients, high coverage and performance on TB/Human Immunodeficiency Virus (HIV) collaborative program activities, and institution of Programmatic Management of Drug-Resistant Tuberculosis (PMDT) where this was absent before. Provision of significant short- and long-term technical assistance provided by KNCV Tuberculosis Foundation (KNCV) in the period 2002-2011 was catalytic in leveraging a total of U$ 80million of external funding in a stepwise approach balanced with absorption capacity, in combination with national policy review and support for its implementation on the basis of two consecutive costed national strategic plans. The technical assistance by KNCV, in partnership with other international technical agencies for specialized areas, proved to work very well in this context where Namibian human resources and funding for TB control were initially limited and the Ministry of Health and Social Services (MoHSS) welcomed extensive technical assistance.
{"title":"TB Control in Namibia 2002-2011: Progress and Technical Assistance","authors":"J. V. Gorkom, F. Mavhunga, Omer Ahmed Omer, A. Kutwa, A. Zezai, N. Ruswa, P. Dhliwayo, S. Sawadogo, B. Schreuder, Rosalia Indongo, E. Shihepo","doi":"10.2174/1874279301307010023","DOIUrl":"https://doi.org/10.2174/1874279301307010023","url":null,"abstract":"Namibia is among the five countries worstly affected by tuberculosis (TB) with a notification rate of 465/100,000 in 2011. This paper describes how the National Tuberculosis Leprosy Program (NTLP) developed from a poorly performing TB control program in 2002 into a well performing program in 2011. The program achieved 85% treatment success for new sputum-positive patients, high coverage and performance on TB/Human Immunodeficiency Virus (HIV) collaborative program activities, and institution of Programmatic Management of Drug-Resistant Tuberculosis (PMDT) where this was absent before. Provision of significant short- and long-term technical assistance provided by KNCV Tuberculosis Foundation (KNCV) in the period 2002-2011 was catalytic in leveraging a total of U$ 80million of external funding in a stepwise approach balanced with absorption capacity, in combination with national policy review and support for its implementation on the basis of two consecutive costed national strategic plans. The technical assistance by KNCV, in partnership with other international technical agencies for specialized areas, proved to work very well in this context where Namibian human resources and funding for TB control were initially limited and the Ministry of Health and Social Services (MoHSS) welcomed extensive technical assistance.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68060618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-19DOI: 10.2174/1874279301307010047
E. Mitchell, E. Pérez-Then, Ivonne Orejel-Juarez, Jeannette Báez, F. Gonzales, A. Morrobel, B. Marcelino, N. Kamp
Engagement of the private sector and community leaders are popular strategies for improving tuberculosis (TB) case detection. However the impact of engaging pharmacies and community shop keepers in TB referral varies and the best method to achieve it are unknown. To evaluate changes in referral and TB case detection following workshops and/or motivational "detailing" visits, mystery clients visited 188 pharmacies and 103 grocery stores to seek advice for chronic symptoms reflecting pulmonary TB. Most sites (89% n=255) were exposed to "detailing" and 26.8% (76) also attended 1 hour workshops designed by the National TB program and KNCV Tuberculosis Foundation (KNCV). Sites were scored pre- and post-intervention, obtaining 1 point each for a) spontaneous recognition of TB symptoms, b) acknowledgement of symptoms as possibly TB when prompted, c) referral to medical care d) not promoting drugs e) exhibiting TB health education materials on site and f) referral of mystery clients to the TB program. The TB recognition and referral scores of all exposed establishments increased by an average of 2.0 points (95%C.I. 1.9- 2.1) at post-test compared with an increase of 0.6 points (95%C.I. 0.4-.0.9) among those in the comparison group (p<0.001). Attempted sales of antibiotics and palliatives declined from 38.3% at baseline to 16.1%. After six months, 33.1% of pharmacies and 22.7% of grocery stores reported referring. Seven smear-positive TB cases were diagnosed from among 70 TB suspects referred by pharmacies, but none from among 30 suspects sent by groceries. TB investigations rose by 8.4% in the area for a six month period. The intervention is likely to have contributed to the doubling of TB case notifications over two years. A simple motivation intervention led to improvement in referral and TB case detection. The National TB program introduced interventions with pharmacies to other provinces.
{"title":"Effectiveness of Interventions to Increase Referral of Clients ExhibitingTB Symptoms by Pharmacies and Corner Stores in Santo Domingo,Dominican Republic","authors":"E. Mitchell, E. Pérez-Then, Ivonne Orejel-Juarez, Jeannette Báez, F. Gonzales, A. Morrobel, B. Marcelino, N. Kamp","doi":"10.2174/1874279301307010047","DOIUrl":"https://doi.org/10.2174/1874279301307010047","url":null,"abstract":"Engagement of the private sector and community leaders are popular strategies for improving tuberculosis (TB) case detection. However the impact of engaging pharmacies and community shop keepers in TB referral varies and the best method to achieve it are unknown. To evaluate changes in referral and TB case detection following workshops and/or motivational \"detailing\" visits, mystery clients visited 188 pharmacies and 103 grocery stores to seek advice for chronic symptoms reflecting pulmonary TB. Most sites (89% n=255) were exposed to \"detailing\" and 26.8% (76) also attended 1 hour workshops designed by the National TB program and KNCV Tuberculosis Foundation (KNCV). Sites were scored pre- and post-intervention, obtaining 1 point each for a) spontaneous recognition of TB symptoms, b) acknowledgement of symptoms as possibly TB when prompted, c) referral to medical care d) not promoting drugs e) exhibiting TB health education materials on site and f) referral of mystery clients to the TB program. The TB recognition and referral scores of all exposed establishments increased by an average of 2.0 points (95%C.I. 1.9- 2.1) at post-test compared with an increase of 0.6 points (95%C.I. 0.4-.0.9) among those in the comparison group (p<0.001). Attempted sales of antibiotics and palliatives declined from 38.3% at baseline to 16.1%. After six months, 33.1% of pharmacies and 22.7% of grocery stores reported referring. Seven smear-positive TB cases were diagnosed from among 70 TB suspects referred by pharmacies, but none from among 30 suspects sent by groceries. TB investigations rose by 8.4% in the area for a six month period. The intervention is likely to have contributed to the doubling of TB case notifications over two years. A simple motivation intervention led to improvement in referral and TB case detection. The National TB program introduced interventions with pharmacies to other provinces.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"36 1","pages":"47-53"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-19DOI: 10.2174/1874279301307010072
E. Mitchell, C. Colvin, E. Klinkenberg, M. Heus, Joseph Sitenei
The dearth of trained personnel to implement TB/HIV services led to substantial investment in human resources and technical assistance in Kenya. Between 1999 and 2006 the staff of the TB program almost doubled. Increases in quantity of TB services occurred, but the impact on quality was unclear. Analysis of nationally representative data from the 2004 Kenya Service Provisions Assessment (KSPA) of 1,332 TB and/or HIV service providers within 440 public and private health facilities was conducted to compare performance of TB duties between those with and without TB and/or HIV training. Although the TB-HIV workforce was disproportionately female (56.9%), participation in training was less common among women of all cadres (OR 0.41 95%CI .22-.78). After controlling for structural and organizational factors, training in TB diagnosis was strongly associated with performance of smear microscopy (aOR 3.4 95%CI 1.6-7.3). Mid-level health workers were less likely than doctors to rely on smear microscopy for diagnosis (aOR 0.4 95%CI 0.2-0.6). Training was associated with direct observation of treatment (D.O.T) (aOR 3.3 CI 1.3-8.9). Other factors positively associated with performance of D.O.T included receipt of supportive supervision (aOR 3.2 CI 2.0-5.0) and an adequate TB drug supply (aOR1.2 95%CI 1.1-1.4). Barriers included non-alignment with the national directly observed short course policy program (DOTS) (aOR.0.2 95%CI 0.1-0.7) and working where high volumes of smear microscopy were performed (aOR 0.7 95%CI 0.5-1.0). Investments in capacity building including technical assistance during the 2000-2003 period were associated with performance of smear microscopy and directly observed therapy in 2004. However health system factors also influence performance.
{"title":"Return on Investments in Technical Assistance for TB Capacity Building?Factors Influencing Kenyan Health Workers' Performance of TB Skills","authors":"E. Mitchell, C. Colvin, E. Klinkenberg, M. Heus, Joseph Sitenei","doi":"10.2174/1874279301307010072","DOIUrl":"https://doi.org/10.2174/1874279301307010072","url":null,"abstract":"The dearth of trained personnel to implement TB/HIV services led to substantial investment in human resources and technical assistance in Kenya. Between 1999 and 2006 the staff of the TB program almost doubled. Increases in quantity of TB services occurred, but the impact on quality was unclear. Analysis of nationally representative data from the 2004 Kenya Service Provisions Assessment (KSPA) of 1,332 TB and/or HIV service providers within 440 public and private health facilities was conducted to compare performance of TB duties between those with and without TB and/or HIV training. Although the TB-HIV workforce was disproportionately female (56.9%), participation in training was less common among women of all cadres (OR 0.41 95%CI .22-.78). After controlling for structural and organizational factors, training in TB diagnosis was strongly associated with performance of smear microscopy (aOR 3.4 95%CI 1.6-7.3). Mid-level health workers were less likely than doctors to rely on smear microscopy for diagnosis (aOR 0.4 95%CI 0.2-0.6). Training was associated with direct observation of treatment (D.O.T) (aOR 3.3 CI 1.3-8.9). Other factors positively associated with performance of D.O.T included receipt of supportive supervision (aOR 3.2 CI 2.0-5.0) and an adequate TB drug supply (aOR1.2 95%CI 1.1-1.4). Barriers included non-alignment with the national directly observed short course policy program (DOTS) (aOR.0.2 95%CI 0.1-0.7) and working where high volumes of smear microscopy were performed (aOR 0.7 95%CI 0.5-1.0). Investments in capacity building including technical assistance during the 2000-2003 period were associated with performance of smear microscopy and directly observed therapy in 2004. However health system factors also influence performance.","PeriodicalId":88330,"journal":{"name":"The open infectious diseases journal","volume":"7 1","pages":"72-85"},"PeriodicalIF":0.0,"publicationDate":"2013-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68061527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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