1
|
Badoum G, Ouédraogo AR, Fiogbé AA, Kuate Kuate A, Soumana A, Diop YM, Dogo MF, Mbitikon OB, Combary A, Agodokpessi G, Affolabi D, Bisso A, Atimbada DR, Menon S, Koura KG. An Overview of the Management of Drug-Resistant Tuberculosis in Six French-Speaking African Countries from 2018 to 2022. Trop Med Infect Dis 2024; 9:176. [PMID: 39195614 PMCID: PMC11360384 DOI: 10.3390/tropicalmed9080176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
Drug-resistant tuberculosis (DR-TB) poses a significant public health challenge, particularly in resource-limited settings. The prevalence and management of DR-TB in African countries require comprehensive strategies to improve patient outcomes and control the spread of the disease. Aggregated routine data (from 2018 to 2022) on multidrug-resistant TB (MDR-TB) were collected from the National TB Programs (NTPs) from all six countries. The diagnostic capacity for MDR-TB was globally insufficient. The system for collecting and transporting samples was sometimes inoperative. A total of 2353 cases of MDR-TB were reported, with 86.4% receiving treatment. The gap between the expected number of MDR-TB cases and the number reported per country varied from 51.5% to 88.0%, depending on the year. Fifty-two extensively drug-resistant (XDR) TB cases received treatment regimens over five years, with variations across countries. All patients received free follow-up examinations, nutritional and financial support for travel expenses to the outpatient care and treatment centers. The MDR-TB treatment success rates for all regimens between 2018 and 2021 ranged from 44.4 to 90.9%, varying by country and year. The information system relied on primary tools, reporting tools, and digital solutions. Progress has been made in MDR-TB management; however, challenges persist, necessitating resources to enhance access to rapid molecular screening tests.
Collapse
Affiliation(s)
- Gisèle Badoum
- Service de Pneumologie, Centre Hospitalier et Universitaire de Yalgado Ouédraogo (CHU-YO), Ouagadougou P.O. Box 7022, Burkina Faso
- Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph Ki-Zerbo, Ouagadougou P.O. Box 7021, Burkina Faso;
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
| | - Abdoul R. Ouédraogo
- Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph Ki-Zerbo, Ouagadougou P.O. Box 7021, Burkina Faso;
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
- Service de Pneumologie, Centre Hospitalier et Universitaire de Tengandogo (CHU-T), Ouagadougou P.O. Box 104, Burkina Faso
| | - Attannon A. Fiogbé
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
- National Tuberculosis Programme, Cotonou P.O. Box 321, Benin; (G.A.); (D.A.)
- Service de Pneumologie, Centre National et Universitaire de Pneumo-Phitsiologie de Cotonou (CNHUPP/C), Cotonou P.O. Box 321, Benin
| | - Albert Kuate Kuate
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
- National Tuberculosis Programme, Yaoundé P.O. Box 15656, Cameroon;
| | - Alphazazi Soumana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
- National Tuberculosis Programme, Niamey P.O. Box 623, Niger
| | - Yacine Mar Diop
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
- National Tuberculosis Programme, Dakar P.O. Box 4024, Senegal
| | - Mohammed F. Dogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
- National Tuberculosis Programme, Lomé P.O. Box 2171, Togo
| | - Olivia B. Mbitikon
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
| | - Adjima Combary
- National Tuberculosis Programme, Ouagadougou P.O. Box 6632, Burkina Faso;
| | - Gildas Agodokpessi
- National Tuberculosis Programme, Cotonou P.O. Box 321, Benin; (G.A.); (D.A.)
- Service de Pneumologie, Centre National et Universitaire de Pneumo-Phitsiologie de Cotonou (CNHUPP/C), Cotonou P.O. Box 321, Benin
| | - Dissou Affolabi
- National Tuberculosis Programme, Cotonou P.O. Box 321, Benin; (G.A.); (D.A.)
| | - Annie Bisso
- National Tuberculosis Programme, Yaoundé P.O. Box 15656, Cameroon;
| | - Dona R. Atimbada
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
| | - Sonia Menon
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
- Epitech Research, 1160 Auderghem, Belgium
| | - Kobto G. Koura
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (A.K.K.); (A.S.); (Y.M.D.); (M.F.D.); (O.B.M.); (D.R.A.); (S.M.)
- UMR261 MERIT, Université Paris Cité, IRD, 75006 Paris, France
| |
Collapse
|
2
|
Pape S, Karki SJ, Heinsohn T, Brandes I, Dierks ML, Lange B. Tuberculosis case fatality is higher in male than female patients in Europe: a systematic review and meta-analysis. Infection 2024:10.1007/s15010-024-02206-z. [PMID: 38521839 DOI: 10.1007/s15010-024-02206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/02/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Epidemiological TB data indicate differences in infection prevalence, progression rates, and clinical disease incidence between sexes. In contrast, evidence on sex-specific differential (post) TB case fatality in Europe has not been synthesized systematically. METHODS We searched electronic databases and grey literature up to December 2020 for studies reporting sex-stratified TB death data for Europe. The JBI critical appraisal tools served for bias risk assessment and subgroup analyses for studying heterogeneity. Random-effects models meta-analyses enabled estimating pooled relative risks of sex-associated TB fatality. Considering associations of comorbidities and risk factors on fatality differences, we applied relative risk meta-regression. RESULTS Based on 17,400 records screened, 117 studies entered quantitative analyses. Seventy-five studies providing absolute participant data with moderate quality and limited sex stratification reported 33 to 235,000 TB cases and 7 to 27,108 deaths. The pooled male-to-female TB fatality risk ratio was 1.4 [1.3-1.5]. Heterogeneity was high between studies and subgroups. Study time, concurrent comorbidities (e.g., HIV, diabetes, cancers), and mean participant ages showed no effect modification. We identified higher male TB fatality in studies with higher homelessness (coefficient 3.18, 95% CI [-0.59 to 6.94], p-value 0.10) and lower migrants proportion (coefficient - 0.24, 95% CI [- 0.5 to 0.04], p-value 0.09). CONCLUSION We found 30-50% higher TB case fatality for males in Europe. Except for homelessness, migration, and a trend for some comorbidities, assessing effect modification could not reduce our meta-analysis' high heterogeneity. Public health authorities should take heed of this higher risk of dying in male patients' treatment services.
Collapse
Affiliation(s)
- Stephanie Pape
- Institute for Epidemiology, Social Medicine and Health Systems, Hannover Medical School, Hannover, Germany.
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.
| | - Sudip Jung Karki
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- Faculty of Medicine, Université Toulouse III Paul Sabatier, Toulouse, Occitanie, France
| | - Torben Heinsohn
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Iris Brandes
- Institute for Epidemiology, Social Medicine and Health Systems, Hannover Medical School, Hannover, Germany
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems, Hannover Medical School, Hannover, Germany
| | - Berit Lange
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
| |
Collapse
|
3
|
Seytre B, Amalaman DM, Diaby M, Sansan KÉ, Coulibaly M, Yoro B. [Tuberculosis communication challenges in Ivory Coast]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2021; Vol. 33:415-423. [PMID: 35485090 DOI: 10.3917/spub.213.0415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The objective of this socio-anthropological study was to establish a foundation for communication recommendations with the potential to increase the demand for tuberculosis (TB) screening in Ivory Coast. The study therefore focused on perceptions of TB likely to be influenced via communication campaigns. METHOD The study design included a qualitative approach, with semi-structured interviews of 54 persons and 28 focus groups each comprised of 8 persons, as well as a quantitative approach, with a questionnaire distributed to 400 respondents. The study was undertaken in Abidjan, Bouaké, Korhogo and San Pédro, Ivory Coast. RESULTS Amongst the results, this study showed that the population has a robust understanding of the existence and severity of TB and a good understanding of TB symptoms. There is little confidence in traditional medicine to treat TB and there is an awareness that TB can be treated by modern medicine and medications. On the other hand, only half of the population knew that TB treatment is free-of-charge, which could be a contributing factor to patients not seeking treatment. For the vast majority of respondents, there is an association between TB and HIV or AIDS. Fears related to this association are likely to present a significant obstacle to seeking treatment in cases of presumed TB. CONCLUSION Based on these findings, we think it is essential to reinforce communication around the availability of free treatment for TB, and to disassociate TB from HIV in communication and awareness-raising tools both for TB and for HIV.
Collapse
|
4
|
[Epidemiological and evolutionary profile of tuberculosis under the influence og HIV]. Rev Mal Respir 2021; 39:1-7. [PMID: 34756503 DOI: 10.1016/j.rmr.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 09/05/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We conducted this study to understand the impact of HIV infection on the epidemiology of tuberculosis (TB) in an outpatient care center. PATIENTS AND METHODS This is a retrospective and comparative study between subjects infected or not infected with HIV, using TB case notification data registered from October 2017 to September 2019 in the intermediate care facility (CDT) of the University Hospital of Libreville. Comparisons were made by bivariate analysis; proportions were compared using the Chi2 or the Fisher Exact test. Variables of significant interest were included in a binary logistic regression model for multivariate analysis. RESULTS Prevalence of HIV infection was 30.4%. Average age was 35.2 years with extremes at 15 and 83 years. In the results of the multivariate analysis, female patients were more frequently infected with HIV (p=0.002; OR=1.960, 95% CI [1.275 - 3.015]) and HIV infection was associated with a reduction in the proportion of PTB (+) (p=0.001; OR=0.483, 95% CI [0.311 - 0.752]). HIV infection was also associated with an increased proportion of new cases (P=0.007; OR=2.987, 95% CI [1.353 - 6.597]), EPT (p<0.001; OR=1.084, 95% CI [1.054 - 1.131] and an unfavorable therapeutic outcome (p=0.016; OR=2.744, 95% CI [1.208 - 6.233]). CONCLUSION TB/HIV co-infection remains high. It continues to negatively impact outpatient management of TB.
Collapse
|
5
|
Owolabi OA, Jallow AO, Jallow M, Sowe G, Jallow R, Genekah MD, Donkor S, Wurrie A, Kampmann B, Sutherland J, Togun T. Delay in the diagnosis of pulmonary tuberculosis in The Gambia, West Africa: A cross-sectional study. Int J Infect Dis 2020; 101:102-106. [PMID: 32949776 PMCID: PMC7493728 DOI: 10.1016/j.ijid.2020.09.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To investigate the pattern of tuberculosis (TB) care initiation and risk factors for TB diagnostic delay in The Gambia. METHODS In this cross-sectional study, adult patients diagnosed with pulmonary TB (pTB) in public facilities in the Greater Banjul Area of The Gambia were consecutively recruited from October 2016 to March 2017. Diagnostic delay was defined as >21 days from the onset of at least one symptom suggestive of pTB to diagnosis. Logistic regression analyses were used to investigate risk factors for diagnostic delay. RESULTS Overall, 216 pTB patients were included in the study; the median (Interquartile Range (IQR)) age was 30 (23-39) years and 167 (77%) were male patients. Of the 216 patients, 110 (50.9%) of them initiated care-seeking in the formal and informal private sector and 181/216 (83.8%) had TB diagnostic delay. The median (IQR) duration from the onset of symptoms to TB diagnosis was 34 (28-56) days. Age groups 18-29 years (aOR 3.2; 95% CI 1.2-8.8 [p = 0.02]) and 30-49 years (aOR 5.1; 95% CI 1.6-16.2 [p = 0.006]) and being employed (aOR 4.2; 95% CI 1.7-10.5 [p = 0.002]) were independent risk factors for TB diagnostic delay. CONCLUSION There is considerable TB diagnostic delay in The Gambia, and this is likely to be worsened by the COVID-19 pandemic.
Collapse
Affiliation(s)
- Olumuyiwa A Owolabi
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia
| | - Alpha O Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia
| | - Momodou Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia
| | - Gambia Sowe
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia
| | - Rohey Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia
| | - Monica D Genekah
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia
| | - Simon Donkor
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia
| | - Alieu Wurrie
- The Gambia National Leprosy and Tuberculosis Control Programme (NLTBCP), Kanifing Municipal, Serrekunda, Gambia
| | - Beate Kampmann
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia; The Vaccine Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, United Kingdom
| | - Jayne Sutherland
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia
| | - Toyin Togun
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Atlantic Boulevard, Fajara, Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, United Kingdom.
| |
Collapse
|
6
|
Peri AM, Bernasconi DP, Galizzi N, Matteelli A, Codecasa L, Giorgio V, Di Biagio A, Franzetti F, Cingolani A, Gori A, Lapadula G. Determinants of patient and health care services delays for tuberculosis diagnosis in Italy: a cross-sectional observational study. BMC Infect Dis 2018; 18:690. [PMID: 30572830 PMCID: PMC6302482 DOI: 10.1186/s12879-018-3609-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Prompt diagnosis of active tuberculosis (TB) has paramount importance to reduce TB morbidity and mortality and to prevent the spread of Mycobacterium tuberculosis. Few studies so far have assessed the diagnostic delay of TB and its risk factors in low-incidence countries. Methods We present a cross-sectional multicentre observational study enrolling all consecutive patients diagnosed with TB in seven referral centres in Italy. Information on demographic and clinical characteristics, health-seeking trajectories and patients’ knowledge and awareness of TB were collected. Diagnostic delay was assessed as patient-related (time between symptoms onset and presentation to care) and healthcare-related (time between presentation to care and TB diagnosis). Factors associated with patient-related and healthcare-related delays in the highest tertile were explored using uni- and multivariate logistic regression analyses. Results We enrolled 137 patients, between June 2011 and May 2012. The median diagnostic delay was 66 days (Interquartile Range [IQR] 31–146). Patient-related and healthcare-related delay were 14.5 days (IQR 0–54) and 31 days (IQR: 7.25–85), respectively. Using multivariable analysis, patients living in Italy for < 5 years were more likely to have longer patient-related delay (> 3 weeks) than those living in Italy for > 5 years (Odds Ratio [OR] 3.47; 95% Confidence Interval [CI] 1.09–11.01). The most common self-reported reasons to delay presentation to care were the mild nature of symptoms (82%) and a good self-perceived health (76%). About a quarter (26%) of patients had wrong beliefs and little knowledge of TB, although this was not associated with longer diagnostic delay. Regarding healthcare-related delay, multivariate analysis showed that extra-pulmonary TB (OR 4.3; 95% CI 1.4–13.8) and first contact with general practitioner (OR 5.1; 95% CI 1.8–14.5) were both independently associated with higher risk of healthcare-related delay > 10 weeks. Conclusions In this study, TB was diagnosed with a remarkable delay, mainly attributable to the healthcare services. Delay was higher in patients with extra-pulmonary disease and in those first assessed by general practitioners. We suggest the need to improve knowledge and raise awareness about TB not only in the general population but also among medical providers. Furthermore, specific programs to improve access to care should be designed for recent immigrants, at significantly high risk of patient-related delay. Trial registration The study protocol was registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT01390987. Study start date: June 2011. Electronic supplementary material The online version of this article (10.1186/s12879-018-3609-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna Maria Peri
- Division of Infectious Diseases, "San Gerardo" Hospital, Via GB Pergolesi 33, Monza, Italy. .,Infectious Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Davide Paolo Bernasconi
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Nadia Galizzi
- "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Alberto Matteelli
- Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV and TB elimination, University of Brescia, Brescia, Italy
| | - Luigi Codecasa
- Regional TB Reference Centre, "Villa Marelli" Institute, Niguarda Hospital, Milan, Italy
| | | | - Antonio Di Biagio
- Infectious Diseases Department, IRCCS AOU San Martino-IST, Genova, Italy
| | | | | | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giuseppe Lapadula
- Division of Infectious Diseases, "San Gerardo" Hospital, Via GB Pergolesi 33, Monza, Italy
| |
Collapse
|
7
|
Li T, Zhang H, Shewade HD, Soe KT, Wang L, Du X. Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China. BMC Health Serv Res 2018; 18:786. [PMID: 30340489 PMCID: PMC6194607 DOI: 10.1186/s12913-018-3583-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 09/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background Early diagnosis and treatment is vital for effective tuberculosis (TB) management especially among migrant populations who are a vulnerable group. We aimed to study factors associated with delay before registration at country level among registered migrant TB patients in China (2014–15) who were transferred out (during treatment) through web-based TB information management system (TBIMS). Methods This was a cross sectional study involving review of TBIMS data. Delays (in days) were classified as follows: patient delay (from symptom onset to first doctor visit), health system delay (from first doctor visit to treatment initiation, divided into health system diagnosis and treatment delay before and after date of diagnosis respectively), diagnosis delay (from symptom onset to diagnosis) and total delay (from symptom onset to treatment initiation). Linear regression was used to build a predictive model (forward stepwise) for the socio-demographic, clinical and health system related factors associated with delay: one model for each type of delay. Delays were log transformed and included in the model. Results The median (IQR) patient delay, health system delay and total delay was 16 (6, 34), two (0, 6) and 22 (11, 41) days respectively. Factors associated with long patient, diagnosis and total delay were: female gender, age ≥ 65 years, sputum smear positive pulmonary TB and registration at referral hospital. Treatment initiation delay was significantly higher among those registered in referral hospitals, unemployed and previously treated. Among migrant patients having permanent residence out of province, health system diagnosis delay was significantly higher while treatment initiation delay after diagnosis was significantly lower when compared to patients having permanent residence within the prefecture. Conclusion Among migrant population with TB, patient delay contributed to the total delay. The factors identified including the need for improved coordination between referral hospitals and national programme have to be addressed if China has to end TB. Electronic supplementary material The online version of this article (10.1186/s12913-018-3583-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tao Li
- National Center for Tuberculosis Control and Prevention, China CDC, No. 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, China CDC, No. 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asian Office, Delhi, India
| | - Kyaw Thu Soe
- Department of Medical Research (PyinOoLwin Branch), Ministry of Health and Sports, PyinOoLwin, Myanmar
| | - Lixia Wang
- National Center for Tuberculosis Control and Prevention, China CDC, No. 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Xin Du
- National Center for Tuberculosis Control and Prevention, China CDC, No. 155 Changbai Road, Changping District, Beijing, 102206, China.
| |
Collapse
|
8
|
Kombila UD, Ndiaye EHM, Fafa Cisse M, Diouf NF, Sagne JM, Dia S, Kone S, Kane YD, Toure NO. [Therapeutic itinerary and radiological features of positive microscopy tuberculosis patients at Centre Hospitalier National Universitaire de Fann (CHNUF), Dakar]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:240-245. [PMID: 29029771 DOI: 10.1016/j.pneumo.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 07/18/2017] [Accepted: 08/19/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The long diagnostic delay is responsible for the extension of radiological lesions and spread of TB in the community. These radiological lesions can leave significant scars responsible for respiratory disability. OBJECTIVE The aim of the study is to characterize radiologic features according to tuberculosis diagnostic delay. METHODS We conducted a prospective cross-sectional study, about 66 patients with positive sputum. RESULTS The average diagnostic delay was 16 (±15) weeks; whether 22 (±14.1) weeks in the female gender versus 14.6 (±14.3) weeks in the male gender (P=0.10). The first care use was respectively health centers (62.1%), drugstores (51.9%), and traditional medicine (28.7%). Only 27.2% of patients used the marabouts care. Bilateral radiographic abnormalities in bivariate analysis were associated with consultation at the health center (66.7% versus 33.3%; P<0.031), as is the extension of the lesions (70.2% versus 29.8% RP=1.66 [1.05 to 2.91]; P<0.03). Lake of knowledge of the symptoms of TB was associated with the use of marabouts care (12.5% versus 87.5; PR=0.35 [0.11 to 1.08], P<0.04). CONCLUSION These results should prompt consideration in an emergency, appropriate control interventions, advocacy, patient information and medical personnel on the reality of tuberculosis to prevent its spread often causing respiratory disability with radological effects.
Collapse
Affiliation(s)
- U D Kombila
- Service de pneumologie, centre hospitalier universitaire de Libreville, 3(e) arrondissement, BP 2228, Libreville, Gabon.
| | - E H M Ndiaye
- Service de pneumologie, centre hospitalier national universitaire de Fann, avenue Cheikh Anta Diop, Fann, Dakar, Sénégal
| | - M Fafa Cisse
- Service de pneumologie, centre hospitalier national universitaire de Fann, avenue Cheikh Anta Diop, Fann, Dakar, Sénégal
| | - N F Diouf
- Service de pneumologie, centre hospitalier national universitaire de Fann, avenue Cheikh Anta Diop, Fann, Dakar, Sénégal
| | - J M Sagne
- Service de pneumologie, centre hospitalier national universitaire de Fann, avenue Cheikh Anta Diop, Fann, Dakar, Sénégal
| | - S Dia
- Service de pneumologie, centre hospitalier national universitaire de Fann, avenue Cheikh Anta Diop, Fann, Dakar, Sénégal
| | - S Kone
- Service de pneumologie, centre hospitalier national universitaire de Fann, avenue Cheikh Anta Diop, Fann, Dakar, Sénégal
| | - Y D Kane
- Service de pneumologie, centre hospitalier national universitaire de Fann, avenue Cheikh Anta Diop, Fann, Dakar, Sénégal
| | - N O Toure
- Service de pneumologie, centre hospitalier national universitaire de Fann, avenue Cheikh Anta Diop, Fann, Dakar, Sénégal
| |
Collapse
|
9
|
Inadequate critical appraisal of studies in systematic reviews of time to diagnosis. J Clin Epidemiol 2016; 78:43-51. [DOI: 10.1016/j.jclinepi.2016.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/02/2016] [Accepted: 03/21/2016] [Indexed: 01/07/2023]
|
10
|
Registration and management of community patients with tuberculosis in north-west China. Public Health 2015; 129:1585-90. [PMID: 26506453 DOI: 10.1016/j.puhe.2015.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 07/14/2015] [Accepted: 09/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To describe the registration, management and characteristics of patients with tuberculosis (TB) in north-west China, and investigate whether patients with TB were diagnosed and treated in a timely manner. STUDY DESIGN Health-facility-based retrospective data were collected from district patient registers and case reports for all patients with TB registered from January 2009 to December 2011 in Xinjiang Uygur Autonomous Region, north-west China. METHODS Patient characteristics and clinical data were collected from the national TB epidemic reporting system using standardized case reporting forms for diagnosis, treatment and outcome. Data were collected and entered by trained health staff in the regional TB clinics. RESULTS In total, data for 20,396 patients with TB were collected; of these, 78.5% were farmers. The age peaks were 20-44 years and 60-74 years. Average health-seeking and diagnostic delays were 32 days and two days, respectively. More than half (54.7%) of the patients with smear-negative TB were diagnosed by chest x-ray. Moreover, 94.3% of patients with TB were treated successfully. From 2009 to 2011, the health-seeking delay decreased significantly (P < 0.05), and the diagnostic delay increased significantly (P < 0.05). A significant decreasing trend in smear-positive TB was observed (P < 0.05), along with an increasing trend in treatment success (P < 0.05). CONCLUSIONS In north-west China, there is a need to focus on key high-risk populations for prevention and control of TB, such as those aged 20-44 years and 60-74 years, males and farmers. Delays in diagnosis and treatment have a negative effect on cure rates and make it more difficult to control the propagation of TB.
Collapse
|
11
|
Massey PD, Asugeni R, Wakageni J, Kekeubata E, Maena'aadi J, Laete'esafi J, Waneagea J, Asugeni V, MacLaren D, Speare R. Steps on a journey to TB control in Solomon Islands: a cross-sectional, mixed methods pre-post evaluation of a local language DVD. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:1. [PMID: 25644087 PMCID: PMC4320437 DOI: 10.1186/s12914-015-0041-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/15/2015] [Indexed: 12/05/2022]
Abstract
Background In Solomon Islands many people with Tuberculosis (TB) have challenges in accessing services because of socio-cultural, geographic and health service reasons, resulting in delays in TB treatment and low detection rates. The purpose of this project was to (i) develop a local language audio-visual resource (DVD) about TB (ii) share this resource with people in remote villages and (iii) evaluate the process and outcomes. Methods The project involved the development and evaluation of a DVD in local Kwaio language. The DVD included five short videos based on the Australian Respiratory Council TB Education Flipchart. The DVD also included short videos of: traditional music/chanting (ai’imae); drama that presented an allegory of TB; and a short documentary on the redevelopment of the local TB Ward. A mixed-methods approach evaluated changes in TB knowledge and investigated the impact of the DVD. Results The DVD was recorded and produced in March–June 2013 and screened in 41 villages and hamlets. The pre-post DVD survey was completed by 64% (255/400) of people who viewed the DVD in the villages. Pre-DVD survey responses showed a moderate to high knowledge about TB signs, symptoms and treatment but 76/255 (30%) stated TB was caused by sorcery and 85/255 (33%) incorrectly stated that TB medication should be stopped when a patient feels better. The post-DVD survey showed a significant increase in people in coastal villages reporting (i) a 3-week cough would trigger a medical assessment and (ii) TB is mainly spread through the air. Statements that TB is not caused by sorcery increased post-DVD in both coastal and mountain villages, however belief in sorcery in mountain villages remained high at 20/70 (29%). Conclusions The local DVD resource was developed within local cultural understandings and oral traditions of Kwaio people. Using modern but accessible DVD technology generated a lot of interest about the disease and the stories. The project evaluation indicates that current delays in seeking treatment may be more due to socio-cultural and health service factors than awareness of the disease. Therefore the development of TB services, including TB education, which are culturally sensitive, remains important.
Collapse
Affiliation(s)
- Peter D Massey
- Hunter New England Population Health, 470 Peel St, Locked bag 9783, Tamworth, NEMSC, 2348, Australia. .,University of New England, Armidale, Australia.
| | - Rowena Asugeni
- Atoifi Adventist Hospital, Malaita, Solomon Islands. .,James Cook University, Brisbane, Queensland, Australia.
| | | | | | | | | | | | | | | | - Richard Speare
- James Cook University, Brisbane, Queensland, Australia. .,Tropical Health Solutions, Townsville, Australia.
| |
Collapse
|
12
|
Viney KA, Johnson P, Tagaro M, Fanai S, Linh NN, Kelly P, Harley D, Sleigh A. Tuberculosis patients' knowledge and beliefs about tuberculosis: a mixed methods study from the Pacific Island nation of Vanuatu. BMC Public Health 2014; 14:467. [PMID: 24885057 PMCID: PMC4033676 DOI: 10.1186/1471-2458-14-467] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 05/06/2014] [Indexed: 11/19/2022] Open
Abstract
Background The setting for this study was the Pacific island nation of Vanuatu, an archipelago of 82 islands, located in the South Pacific Ocean. Our objective was to assess the knowledge, attitudes and practices of tuberculosis (TB) patients towards TB. Methods This was a descriptive study using qualitative and quantitative methods. Quantitative analysis was based on the responses provided to closed questions, and we present frequencies to describe the TB patients’ knowledge, attitudes and practice relating to TB. Qualitative analysis was based on open questions permitting fuller explanations. We used thematic analysis and developed a posteriori inductive categories to draw conclusions. Results Thirty five TB patients were interviewed; 22 (63%) were male. They attributed TB to cigarettes, kava, alcohol, contaminated food, sharing eating utensils and “kastom” (the local term for the traditional way of life, but also for sorcery). Most (94%) did not attribute TB to a bacterial cause. However, almost all TB patients (89%) thought that TB was best treated at a hospital with antibiotics. Three quarters (74%) experienced stigma after their TB diagnosis. Seeking health care from a traditional healer was common; 54% of TB patients stated that they would first consult a traditional healer for any illness. When seeking a diagnosis for signs and symptoms of TB, 34% first consulted a traditional healer. Patients cited cost, distance and beliefs about TB causation as reasons for first consulting a traditional healer or going to the hospital. Of the TB patients who consulted a traditional healer first, there was an average of two weeks delay before they consulted the health service. In some cases, however, the delay was up to six years. Conclusion The majority of the TB patients interviewed did not attribute TB to a bacterial cause. Consulting a traditional healer for health care, including while seeking a diagnosis for TB symptoms, was common and may have delayed diagnosis. People require better information about TB to correct commonly held misperceptions about the disease. Traditional healers could also be engaged with the national TB programme, in order to refer people with signs and symptoms of TB to the nearest health service.
Collapse
Affiliation(s)
- Kerri A Viney
- Secretariat of the Pacific Community, BP D5, 98848, Noumea Cedex, New Caledonia.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Ngangro NN, Ngarhounoum D, Ngangro MN, Rangar N, Siriwardana MG, des Fontaines VH, Chauvin P. Pulmonary tuberculosis diagnostic delays in Chad: a multicenter, hospital-based survey in Ndjamena and Moundou. BMC Public Health 2012; 12:513. [PMID: 22776241 PMCID: PMC3519715 DOI: 10.1186/1471-2458-12-513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 06/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis remains one of the leading causes of morbidity and mortality in low-resource countries. One contagious patient can infect 10 to 20 contacts in these settings. Delays in diagnosing TB therefore contribute to the spread of the disease and sustain the epidemic. Objectives The aim of this study was to assess delays in diagnosing tuberculosis and the factors associated with these delays in the public hospitals in Moundou and Ndjamena, Chad. Methods A structured questionnaire was administered to 286 new tuberculosis patients to evaluate patient delay (time from the onset of symptoms to the first formal or informal care), health-care system delay (time from the first health care to tuberculosis treatment) and total delay (sum of the patient and system delays). Logistic regression was used to identify risk factors associated with long diagnostic delays (defined as greater than the median). Results and discussion The median [interquartile range] patient delay, system delay and total delay were 15 [7–30], 36 [19–65] and 57.5 [33–95] days, respectively. Low economic status (aOR [adjusted odds ratio] =2.38 [1.08-5.25]), not being referred to a health service (aOR = 1.75 [1.02- 3.02]) and a secondary level education (aOR = 0.33 [0.12-0.92]) were associated with a long patient delay. Risk factors for a long system delay were a low level of education (aOR = 4.71 [1.34-16.51]) and the belief that traditional medicine and informal care can cure TB (aOR = 5.46 [2.37-12.60]). Conclusion Targeted strengthening of the health-care system, including improving patient access, addressing deficiencies in health-related human resources, and improving laboratory networks and linkages as well as community mobilization will make for better outcomes in tuberculosis diagnosis.
Collapse
|