National TB elimination programme - What has changed

Management of tuberculosis patients and the role of forensic medicine in COVID-19 pandemic

Tuberculosis and Coronaviral disease-19 had a global impact in 2020 and still predominating, both infectious diseases similar to the lethal pandemics spread in one route, likely airborne transmission, the infected person could spread to healthy people. However, tuberculosis slightly varies from COVID-19. Though the primordial disease of the tuberculosis epidemic has had a vast impact on this society, besides the COVID-19 pandemic with other co-morbidities, conditions faced numerous complications. This review exemplified the impact of two lethal diseases in changing patient care, diagnostic issues, and forensic sciences roles. The diagnosis of tuberculosis with a massive concern due to standard testing methods, leading to inaccuracy, sensitivity, and prolonged time consumption. In addition, unavailability of testing kits, equipment failure, over-crowd in hospitals and fewer healthcare workers, a prolonged testing period, and finally, anxiety about COVID-19. Also, the contribution of forensic sciences in the autopsy of the exact cause of infectious diseases is crucial. Likewise, during this pandemic, there has been a drastic reduction in tuberculosis incidence in high-burden countries and a synergistic effect of both diseases. So, this review summarized the overall burden of tuberculosis management during COVID-19 and followed the guidelines of various nations' healthcare authorities to mitigate the consequences of tuberculosis diagnosis and prognosis during the pandemic.

Nationwide surveys of awareness of tuberculosis in India uncover a gender gap in tuberculosis awareness

BACKGROUND

Tuberculosis remains a major challenge in India, with an estimated 2.69 million cases each year. Although men are more affected than women, gender differences and related factors affect awareness of tuberculosis and thus impact tuberculosis diagnosis and access to treatment. Understanding the gender-specific needs and complexities when diagnosing and treating tuberculosis is essential to manage cases in India.

METHODS

We undertook a comparative study using data from three National Family and Health Surveys (NFHS), specifically NFHS-3, NFHS-4 and NFHS-5. We investigated the prevalence and gender disparity in awareness about tuberculosis, and associated factors, using regression analysis.

RESULTS

Most men and women surveyed are between the ages of 15 and 19. Across the surveys, the proportion of men and women who are unaware of spreading of tuberculosis decreases from 44.9% during NFHS 3 to 29.6% during NFHS 5. However, the prevalence ratio of men to women with no knowledge about modes of transmission of Tuberculosis increases from 0.92 during NFHS 3 to 0.98 during NFHS 5. Higher odds with younger age (NFHS 5, aOR: 1.07 (1.01-1.13)) and rural residency (NFHS 5, aOR: 1.12 (1.06-1.18)), and lower odds with unmarried marital status (NFHS 5, aOR: 0.92 (0.86-0.98)) are noteworthy associations. Women and men have differences in knowledge.

CONCLUSIONS

Gender disparity associated with awareness about tuberculosis in India is observed across all three nationwide surveys. Being aged fifteen to nineteen years and residing in rural area are risk factors. Being unmarried is a protective factor for women, but not for men.

Augmenting Radiological Diagnostics with AI for Tuberculosis and COVID-19 Disease Detection: Deep Learning Detection of Chest Radiographs

In this research, we introduce a network that can identify pneumonia, COVID-19, and tuberculosis using X-ray images of patients' chests. The study emphasizes tuberculosis, COVID-19, and healthy lung conditions, discussing how advanced neural networks, like VGG16 and ResNet50, can improve the detection of lung issues from images. To prepare the images for the model's input requirements, we enhanced them through data augmentation techniques for training purposes. We evaluated the model's performance by analyzing the precision, recall, and F1 scores across training, validation, and testing datasets. The results show that the ResNet50 model outperformed VGG16 with accuracy and resilience. It displayed superior ROC AUC values in both validation and test scenarios. Particularly impressive were ResNet50's precision and recall rates, nearing 0.99 for all conditions in the test set. On the hand, VGG16 also performed well during testing-detecting tuberculosis with a precision of 0.99 and a recall of 0.93. Our study highlights the performance of our deep learning method by showcasing the effectiveness of ResNet50 over traditional approaches like VGG16. This progress utilizes methods to enhance classification accuracy by augmenting data and balancing them. This positions our approach as an advancement in using state-of-the-art deep learning applications in imaging. By enhancing the accuracy and reliability of diagnosing ailments such as COVID-19 and tuberculosis, our models have the potential to transform care and treatment strategies, highlighting their role in clinical diagnostics.

Sex-based differences in TB treatment compliance: A mediating factor for sputum conversion among newly diagnosed pulmonary TB patients in Chennai, South India

Background

Tuberculosis (TB) remains a global health concern, particularly in India, which carries a significant portion of the global burden. The role of sex as a determinant of health is increasingly recognized, impacting various aspects of TB, including treatment compliance and outcomes. This study aimed to determine the mediating role of treatment compliance in the relationship between sex and sputum conversion in newly diagnosed pulmonary TB patients in Chennai, South India.

Methods

We conducted a retrospective cohort study among patients newly diagnosed for TB at ESIC Medical College & PGIMSR between April 2020 and April 2022. A causal mediation analysis was performed to identify the direct and indirect effects of sex on sputum conversion via the mediator, treatment compliance. We employed logistic regression models and the "paramed" package for the analysis, with bootstrapping technique for examining the significance of indirect and direct effects.

Results

The Marginal Total Effect (MTE) suggested that females were more likely to have sputum positivity compared to males (OR: 6.77; p = 0.003). Direct effect of being female increased the odds of sputum positivity at the end of the intensive phase (OR: 3.42; p = 0.03). The indirect effect of being female via treatment compliance significantly increased the odds of sputum positivity at the end of the intensive phase (OR: 1.98; p = 0.03).

Conclusion

The study provides evidence that treatment compliance significantly mediates the relationship between sex and sputum conversion in TB patients, highlighting the necessity to consider gendered dimensions of health in TB control strategies.

Prevalence, Clinical Characteristics and Determinants of Unsuccessful Treatment Outcomes Among Pulmonary Tuberculosis Patients: A 5-Year Registry-Based Retrospective Cohort Study

Purpose

Despite the existence of effective medications, pulmonary tuberculosis (PTB) remains a significant global public health concern, The evaluation and feedback of national TB control programs are crucial, requiring diligent monitoring of TB treatment outcomes and analysis of the factors influencing these outcomes. This study aims to provide valuable insights into the challenges faced by TB patients, which can inform better strategies for treatment and management in the future.

Patients and Methods

We conducted a study in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia (KSA), from January 1, 2018 to December 31, 2023. The study was a registry-based retrospective cohort study. Patients' data were sourced from the National Tuberculosis Registry database of Saudi Arabia. Treatment outcomes were determined as either success or failure, considering clinical evaluation, changes in chest X-rays, and the results of subsequent sputum examinations during follow-up. To evaluate the data, SPSS version 28.0 was used.

Results

A total of 427 PTB patients participated in the study. The results show successful treatment outcomes among 88.5% of patients. Among the patients, males exhibited a higher likelihood of treatment failure as compared to females (aOR 1.3; 95%Cl 1.2-1.5, p < 0.001). Patients with positive sputum smear (aOR 1.3; 95%Cl 1.1-1.3 p < 0.00) and the presence of cough were associated with an increased risk of treatment failure (aOR1.5; 95%Cl 1.1-1.4, p < 0.001).

Conclusion

This study shows that the percentage of unsuccessful treatment outcomes is high, ie, 11.5%, due to patients' deaths and loss to follow-up. Enhanced supervision and treatment monitoring for tuberculosis patients at high risk of treatment failure can lead to improved treatment success rates in Saudi Arabia.

Navigating the infodemic: strategies and policies for promoting health literacy and effective communication

The COVID-19 pandemic, with its vast impact illustrated by 770 million confirmed cases and 6.9 million deaths as of September 21, 2023, has exposed a critical challenge: the infodemic. Effective communication and health literacy are pivotal in addressing this crisis. This article emphasizes the urgency of combating health misinformation, highlighting its tangible impact on public health and social well-being. Trustworthy sources, especially government agencies and public health officials, played a central role in shaping public behavior. Clear, accurate, and consistent messaging became vital. Health literacy, a fundamental determinant of pandemic response, empowered individuals to understand and act upon health information. Approximately 36% of adults exhibited basic or below-basic health literacy skills, emphasizing its crucial role. Improving health literacy emerged as a strategic imperative, enabling informed choices and proactive health protection. The pandemic underscores the vital role of effective communication and health literacy in combating health misinformation, fostering informed decision-making, and safeguarding public health.

The Predicted Potential Impact of COVID-19 Pandemic on Tuberculosis Epidemic in Tamil Nadu, South India

OBJECTIVE

To estimate the prevalence and incidence of TB before and during the COVID-19 pandemic in Tamil Nadu, south India.

METHODS

In the present study, the effect of COVID-19 epidemiology on the TB epidemic was assessed by the SEIR (Susceptible-Exposed-Infected-Recovered), a compartmental epidemiological model. The model input parameters on compartments of TB and incidence of COVID-19 were collected from the published literature. Based on the data collected, point prevalence and incidence of TB per 100,000 population is calculated with and without COVID-19. A prediction was conducted up to 2025, trend analysis was performed, and a trend chi-square test and chi-square test of independence were used to test the difference between the prevalence with and without COVID-19. R software 2000 (R 4.0.0) was used for analysis.

RESULTS

The TB prevalence without and with COVID-19 decreases from 289 in 2020 to 271 in 2025 and from 289 in 2020 to 269 in 2025, respectively. Similarly, the incidence of TB was decreasing from 144 in 2020 to 135 in 2025 without COVID-19 and 143 in 2020 to 134 in 2025 with COVID-19. Though the TB burden is decreasing over the years, the trend was not statistically significant (p > 0.05). With respect to the district level, the prevalence and incidence of TB with and without COVID-19 is also found to be decreasing over the years. It was also found that the difference in the prevalence and incidence of TB with and without COVID-19 was not statically significant.

CONCLUSION

The results of our study shows that there was an annual decline of around 2% from 2020 to 2025 in the trend of the prevalence and incidence of TB with and without COVID-19. Overall, there is a reduction, but it was not significant, and there is no significant effect of COVID-19 on TB in Tamil Nadu.

Serum Protein Electrophoresis Bands As Biomarkers for Drug-Sensitive Pulmonary Tuberculosis

INTRODUCTION

India has the highest cases of tuberculosis worldwide. According to WHO (2022), the incidence of tuberculosis in India is 210 per 100,000 population. Their incidence of new positive smear cases is 75 per 100,000 population per year. In tuberculosis, the level of albumin decreases while globulin increases leading to a low albumin to globulin (A/G) ratio, and electrophoresis of serum proteins are good diagnostic approach and provides essential information for monitoring treatment outcomes.

MATERIALS AND METHODS

The present study includes 50 cases of pulmonary tuberculosis and 50 age-sex-matched healthy controls. Initially, serum protein estimation and electrophoresis were performed in newly diagnosed patients and controls. All drugs were given as National Tuberculosis Elimination Programme (NTEP) guidelines and blood samples were collected at two-month, four-month, and six-month intervals, and different serum protein fractions were compared and analyzed.

RESULTS

The total serum protein was significantly lower in the cases than in the controls; 6.12±0.61 vs. 7.02±0.56 g/dL (p˂0.0020, t-value=3.12). The mean serum albumin was also significantly lower in the cases compared to the controls; 1.65±0.69 vs. 3.87±0.47g/dL (p˂0.0001, t-value=10.98). The α1 globulin started to rise after four months of treatment and at six months level was 0.262±0.32 g/dL. The level of γ globulin continuously decreases after antituberculous treatment to 1.56±0.67 gm/dL at six months.

CONCLUSION

The cause of the decrease in total protein and albumin may be due to malnutrition leading to low cellular immunity. Serum protein level and protein electrophoresis should be analyzed as routine tests in patients before, during, and after treatment. It helps us in identifying patients at risk of pulmonary tuberculosis as well prognosis of the disease. This study is a valuable guide in deciding the effective management of tuberculosis patients with drug treatment plans and appropriate dietary intake. Hence, it highlights the complex relationship that exists between poverty and disease.

Trends in Tuberculosis Mortality Across India: Improvements Despite the COVID-19 Pandemic

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has had significant health implications across the globe. India is a country that has faced a double burden of COVID-19 and tuberculosis (TB) since 2020. There is a need to understand the impacts of COVID-19 on tuberculosis control programs in India. Therefore, our study aimed to determine the changes in TB mortality across India between 2019 and 2021.

METHODS

In our study, we described trends in TB and COVID-19 cases reported across India. Next, we compared death totals for TB between 2019, 2020, and 2021 in India at the national and state level. We considered total TB deaths, as well as deaths by TB for tribal populations, and for those living with human immunodeficiency virus (HIV). Percent changes were calculated.

RESULTS

In 2020, compared to 2019, there was a 15.4% decrease in TB death totals, with 28 out of India's 36 states showing a decrease during this time period. While total deaths increased in 2021 compared to 2020, decreases did occur in 2021 compared to 2019. Deaths by TB for individuals living with HIV decreased by 16.0% across India. At a national level, there was a notable rise in TB deaths among tribal populations, though this was not universal across states.

CONCLUSION

While the majority of the world has seen an increase in new TB cases and TB deaths annually since the start of the COVID-19 pandemic, there have instead been decreases in India during this time period. More research is required to understand the factors that have led to this decrease in TB deaths. Furthermore, additional allocation of resources is required to better support vulnerable populations in states where TB death totals have increased, especially among tribal populations.