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Asmamaw G, Minwagaw T, Samuel M, Ayenew W. Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care. BMJ Open 2024; 14:e087601. [PMID: 39317501 PMCID: PMC11423718 DOI: 10.1136/bmjopen-2024-087601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024] Open
Abstract
OBJECTIVE This study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia. DESIGN Secondary data analysis of institution-based cross-sectional national survey data. SETTING Data were obtained from the 2021-2022 Ethiopian Service Provision Assessment (ESPA) survey which includes all active health facilities in Ethiopia. PARTICIPANTS This study included all health facilities that provide DM services (both diagnosis and treatment) and recently collected DM data during the 2021-2022 ESPA survey. OUTCOME MEASURES The service availability was computed as the percentage of facilities offering DM services to provide TB management. The preparedness of these facilities for managing TB was measured using three service tracer indicators (staff training and guidelines, diagnostics and essential medicines used in TB management) defined by the WHO Service Availability and Readiness Assessment Manual. The extent of preparedness was categorised as low level (<50%), moderate level (≥50% to 75%) and high level (≥75%). A descriptive statistic was employed to present the study findings. RESULTS Only 170 out of 338 facilities were reported to provide DM services across the country, with 136 (70%) also offering TB management services. Among these facilities, the majority were health centres (n=82; 60.1%), publicly owned (n=98; 72.0%), rural (n=83; 60.7%) and located in the Oromia region (n=53; 39.0%). Regarding preparedness, facilities offering DM services had an overall moderate to high preparedness for managing TB, with 47 (27.5%), 53 (31.1%) and 70 (41.3%) facilities classified as low-level, moderate-level and high-level preparedness, respectively. Specifically, these facilities were less prepared in the domains of 'trained staff and guidelines' and 'diagnostics', but had better preparedness in providing first-line TB drugs, with an overall score of 79.7%. CONCLUSIONS Although the percentage availability of TB services in facilities offering DM services and their preparedness was unsatisfactory compared with WHO standards, Ethiopia has a greater capacity to implement WHO strategies to reduce the burden of TB-DM comorbidity. However, given the high epidemiological risk and the high burden of both diseases in the country, our findings emphasise the urgent necessity to establish and implement a collaborative TB-DM care plan to integrate TB services within facilities providing DM care.
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Affiliation(s)
- Getahun Asmamaw
- Department of Pharmacy, Arba Minch University, Arba Minch, Ethiopia
| | - Tefera Minwagaw
- Department of Pharmacy, Bahir Dar University, Bahir dar, Ethiopia
| | - Mastewal Samuel
- Department of Pharmacy, Wachemo University, Hossana, Ethiopia
| | - Wondim Ayenew
- Department Social and Administrative Pharmacy, University of Gondar, Gondar, Ethiopia
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Yang M, Li P, Liu H, Zhu X, Zhu G, Zhang P, Deng G. The association between type 2 diabetes and pulmonary cavitation revealed among IGRA-positive tuberculosis patients. Front Med (Lausanne) 2023; 10:1245316. [PMID: 38126070 PMCID: PMC10731020 DOI: 10.3389/fmed.2023.1245316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
The co-occurrence of tuberculosis (TB) and diabetes mellitus (DM) presents a significant obstacle to TB eradication. Pulmonary cavitation can occur in severe cases of TB, particularly in patients with DM. From 1 May 2014 through 30 June 2019, we conducted a cross-sectional study of 1,658 smear- or culture-confirmed pulmonary TB (PTB) patients at the Second Department of Pulmonary Medicine and Tuberculosis, Shenzhen, China. A total of 861 participants who satisfied the criteria (chest CT scan for cavitation, interferon-gamma release assay (IGRA), diagnosis of diabetes mellitus), with the median age of 36.7 years, 63.6% of male, 79.7% IGRA positive, 13.8% with diabetes, and 40.8% with pulmonary cavitation, were included in the study. The association between diabetes and pulmonary cavitation was confirmed in these TB patients (adjusted OR, 2.54; 95% CI, 1.66-3.94; p < 0.001). No associations were observed between diabetes and IGRA, as well as between lung cavitary and IGRA. Based on the criteria of IGRA+/-, pulmonary cavitation+/-, and DM+/-, the further analysis with univariate and multivariate logistic regression were conducted in six subgroups. The significant association between diabetes and pulmonary cavitation was further confirmed in the IGRA+ subgroup (adjusted OR, 3.07; 95% CI, 1.86-5.16; p < 0.001) but not observed in IGRA- individuals. This observation suggests that different immunological mechanisms of pulmonary cavitary/DM may be employed in IGRA+ TB patients from IGRA- TB patients.
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Affiliation(s)
- Min Yang
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, China
| | - Pei Li
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, China
| | - Han Liu
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, China
| | - Xiaojie Zhu
- China Institute of Veterinary Drug Control, Beijing, China
| | - Guofeng Zhu
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, China
| | - Peize Zhang
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, China
| | - Guofang Deng
- Department of Pulmonary Medicine and Tuberculosis, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, China
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Meng F, Lan L, Wu G, Ren X, Yuan X, Yang M, Chen Q, Peng X, Liu D. Impact of diabetes itself and glycemic control status on tuberculosis. Front Endocrinol (Lausanne) 2023; 14:1250001. [PMID: 38027218 PMCID: PMC10663330 DOI: 10.3389/fendo.2023.1250001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To explore the impact of diabetes itself and glycemic control status on tuberculosis (TB). Methods A total of 3393 patients with TB and diabetes mellitus (DM) who were hospitalized in the Public Health Clinical Center of Chengdu from January 1, 2019, to December 31, 2021, were retrospectively included and divided into three groups according to baseline glycemic control status: two groups according to glycemic status at discharge, two groups according to cavity occurrence, three groups according to sputum results, and three groups according to lesion location. The influencing factors and the differences in cavity occurrence, sputum positivity and lesion location among different glycemic control groups or between different glycemic status groups were analyzed. Results In this TB with DM cohort, most of the subjects were male, with a male to female ratio of 4.54:1, most of them were 45-59 years old, with an average age of 57.44 ± 13.22 years old. Among them, 16.8% (569/3393) had cavities, 52.2% (1770/3393) were sputum positive, 30.4% (1030/3393) had simple intrapulmonary lesions, 68.1% (2311/3393) had both intra and extrapulmonary lesions, only 15.8% (537/3393) had good glycemic control,16.0% (542/3393) and 68.2% (2314/3393) had fair and poor glycemic control, respectively. Compared with the non-cavity group, the sputum-negative group and the extrapulmonary lesion group, the cavity group, sputum-positive group, intrapulmonary lesion group and the intra and extrapulmonary lesion group all had higher fasting plasma glucose (FPG) and glycosylated hemoglobin A 1c (HbA1c) and lower good glycemic control rates at admission (all P<0.001). Another aspect, compared with the good glycemic control group, the poor glycemic control group had a higher cavity occurrence rate, sputum positive rate, and greater proportion of intrapulmonary lesions. Moreover, FPG and HbA1c levels and poor glycemic control were significantly positively correlated with cavity occurrence, sputum positivity, and intrapulmonary lesions and were the main risk factors for TB disease progression. On the other hand, cavity occurrence, sputum positivity, and intrapulmonary lesions were also main risk factors for hyperglycemia and poor glycemic control. Conclusion Diabetes itself and glycemic control status could impact TB disease. Good glycemic control throughout the whole process is necessary for patients with TB and DM to reduce cavity occurrence and promote sputum negative conversion and lesion absorption.
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Affiliation(s)
- Fanqi Meng
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Lijuan Lan
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Guihui Wu
- Tuberculosis (TB) Department, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Xiaoxia Ren
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Xiaoyan Yuan
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Ming Yang
- Tuberculosis (TB) Department, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Qing Chen
- Tuberculosis (TB) Department, Public Health Clinic Centre of Chengdu, Chengdu, China
| | - Xiaoli Peng
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Dafeng Liu
- The First Ward of Internal Medicine, Public Health Clinic Centre of Chengdu, Chengdu, China
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Niu T, He F, Yang J, Ma C, Xu J, Sun T, Zhang X, Chen S, Ru C. The epidemiological characteristics and infection risk factors for extrapulmonary tuberculosis in patients hospitalized with pulmonary tuberculosis infection in China from 2017 to 2021. BMC Infect Dis 2023; 23:488. [PMID: 37653382 PMCID: PMC10472653 DOI: 10.1186/s12879-023-08410-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Pulmonary tuberculosis (PTB) complicated with extrapulmonary tuberculosis (EPTB) infection can aggravate the disease, but there have been few reports. METHODS Retrospective analysis was used to collect the clinical data of PTB patients with pathogen positive in a teaching hospital from 2017 to 2021. We describe the incidence, the invasive site of EPTB patients, and analyze the infection risk factors for PTB with EPTB by univariate and multivariate logistic regression models. We also compared the complications, disease burden with chi-square test and rank-sum test. RESULTS A total of 1806 PTB were included, of which 263 (14.6%) were complicated with EPTB. The common invasive sites for EPTB were neck lymph nodes (16.49%), intestines (16.13%), and meninges (10.75%). Age ≤ 40 (OR = 1.735; 95%CI [1.267-2.376]; P = 0.001), malnutrition (OR = 2.029; 95%CI [1.097-3.753]; P = 0.022), anemia (OR = 1.739; 95%CI[1.127-2.683]; P = 0.012), and osteoporosis (OR = 4.147; 95%CI [1.577-10.905]; P = 0.004) were all independent risk factors for PTB infection with EPTB. The incidence of extrathoracic hydrothorax, intestinal bacterial infection, urinary tract bacterial infection, and abdominal bacterial infection were higher in patients with PTB with EPTB. PTB with EPTB patients also had longer median hospitalization durations (19 vs. 14 days), during which time they incurred higher total costs, laboratory test costs, imaging examination costs, and drug use costs. CONCLUSION This study found important risk factors for PTB complicated with EPTB, such as age ≤ 40, malnutrition, anemia, and osteoporosis. PTB with EPTB patients have more extrapulmonary complications and higher hospitalization disease burden.
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Affiliation(s)
- Tianshui Niu
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Fei He
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Jianshe Yang
- Shanghai Research Center for Thyroid Diseases, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Chengxi Ma
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Jingyi Xu
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Tianzhi Sun
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Xin Zhang
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Shuyi Chen
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Chuhui Ru
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Adane HT, Howe RC, Wassie L, Magee MJ. Diabetes mellitus is associated with an increased risk of unsuccessful treatment outcomes among drug-susceptible tuberculosis patients in Ethiopia: A prospective health facility-based study. J Clin Tuberc Other Mycobact Dis 2023; 31:100368. [PMID: 37122611 PMCID: PMC10130346 DOI: 10.1016/j.jctube.2023.100368] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Background The impact of diabetes mellitus on tuberculosis (TB) treatment outcomes has not been well investigated in most sub-Saharan countries including Ethiopia. The current study aimed to determine the association between diabetes mellitus and unsuccessful TB treatment outcomes among drug-susceptible TB patients treated at selected health facilities in Addis Ababa, Ethiopia. Methods This health facility-based prospective cohort study was conducted at six randomly selected public health centers in Addis Ababa, from August 2020 until November 2021. Clinically diagnosed adult pulmonary and extra pulmonary TB patients were recruited at the time of treatment initiation. A multivariable logistic regression analysis was used to estimate the association between diabetes and unsuccessful TB treatment outcomes. Results Among the total 267 enrolled participants, 9.7% of patients with TB were identified to have diabetes comorbidity. Of patients with diabetes and TB, 9 (34.6%) were newly diagnosed based on glucose test results. Despite an overall high TB treatment success rate (94.0%), more than one-fourth (26.9%) of patients with diabetes had a poor TB treatment outcome (26.9%), which was remarkably higher compared to patients without diabetes (3.7%). In multivariable regression, the adjusted odds of poor TB treatment outcome among those with diabetes was 14.8 (95% CI 3.5 - 62.7) times the odds of poor outcome patients without diabetes. Conclusion Diabetes was significantly associated with increased odds of poor TB treatment outcomes among patients in Addis Ababa, Ethiopia.
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Affiliation(s)
| | | | - Liya Wassie
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Matthew J. Magee
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Departments of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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