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Yuan Y, Jin J, Bi X, Geng H, Li S, Zhou C. Gender-Specific Association Between Perceived Stigma Toward Tuberculosis and Acceptance of Preventive Treatment Among College Students With Latent Tuberculosis Infection: Cross-Sectional Analysis. JMIR Public Health Surveill 2023; 9:e43972. [PMID: 37314847 DOI: 10.2196/43972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND With the increasing enrollment scale of colleges, the number of students on campus has risen sharply in China. The number of students with tuberculosis (TB) and rifampicin-resistant TB in colleges has increased significantly. Preventive treatment of latent tuberculosis infection (LTBI) is an important means for TB prevention and control in colleges. At present, the acceptance of LTBI treatment among college students remains unclear. In addition, evidence shows stigma may be one of the key factors affecting acceptance of LTBI treatment. To date, there is little direct evidence on the gender-specific association between perceived stigma toward TB and acceptance of LTBI treatment among college students. OBJECTIVE This study aimed to describe the acceptance of LTBI treatment among college students in an eastern province of China to explore the association between perceived stigma toward TB and acceptance of LTBI treatment and to examine the moderating effect of gender on the association. METHODS Data were derived from the project on the evaluation of LTBI treatment and its effectiveness among college students in Shandong, China. In total, 1547 college students were included in the analysis. We considered covariates at the individual and family levels. Multilevel mixed-effects logistic regression was used to examine the moderating role of gender and also explore the association between perceived stigma toward TB and acceptance of LTBI treatment. RESULTS The acceptance rate of LTBI treatment among the diagnosed college students was 46.7% (n=723). The proportion of female students (n=361, 51.5%) accepting LTBI treatment was higher than that of male students (n=362, 42.8%; P=.001). There was an interaction between perceived stigma toward TB and gender (OR 0.93, 95% CI 0.87-1.00; P=.06). Among college students with LTBI, perceived stigma toward TB was positively associated with acceptance of preventive treatment (OR 1.03, 95% CI 1.00-1.08, P=.05). Perceived stigma toward TB was positively associated with accepting LTBI treatment only among male students (OR 1.07, 95% CI 1.02-1.12; P=.005). CONCLUSIONS The acceptance rate of preventive treatment among college students with LTBI was low. Contrary to our expectations, perceived stigma toward TB was positively associated with acceptance of preventive treatment. Gender moderated this association; high perceived stigma toward TB was associated with acceptance of preventive treatment only in male gender. Gender-specific strategies are effective in improving the acceptability of LTBI treatment in colleges.
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Affiliation(s)
- Yemin Yuan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jin Jin
- Department of Prevention and Control, Shandong Public Health Clinical Center, Jinan, China
| | - Xiuli Bi
- Department of Prevention and Control, Shandong Public Health Clinical Center, Jinan, China
| | - Hong Geng
- Department of Prevention and Control, Shandong Public Health Clinical Center, Jinan, China
| | - Shixue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
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Oladimeji O, Atiba BP, Anyiam FE, Odugbemi BA, Afolaranmi T, Zoakah AI, Horsburgh CR. Gender and Drug-Resistant Tuberculosis in Nigeria. Trop Med Infect Dis 2023; 8:104. [PMID: 36828520 PMCID: PMC9964483 DOI: 10.3390/tropicalmed8020104] [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: 01/07/2023] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
We conducted a retrospective study of 2555 DR-TB patients admitted to treatment between 2010 and 2016 in six geopolitical zones in Nigeria. We characterized the gender distribution of DR-TB cases and the association between demographics and clinical data, such as age, treatment category, number of previous TB treatment cycles, and geopolitical zone, with gender. The independent effects of being a male or female DR-TB patient were determined using bivariate and multivariate analyzes with statistical significance of p < 0.05 and a 95% confidence interval. Records from a total of 2555 DR-TB patients were examined for the study. A majority were male (66.9%), largest age-group was 30-39 years old (35.8%), most had MDR-TB (61.4%), were HIV-negative (76.6%), and previously treated for TB (77.1%). The southwest treatment zone had the highest proportion of DR-TB patients (36.9%), and most DR-TB diagnoses occurred in 2016 (36.9%). On bivariate analysis, age, HIV status, treatment zone, and clinical patient group in DR-TB were significantly associated with male gender. On multivariate analysis, males aged 20-29 years (AOR: 0.19, 95% CI: 0.33-0.59, p = 0.001) and HIV-positive males (AOR: 0.44, 95% CI: 0.33-0.59, p = 0.001) had lower likelihood of MDR-TB as males in the south-south treatment zone (AOR: 1.88, 95% CI: 1.23-2.85, p = 0.03), and being male and aged ≥60 years (AOR: 2.19, 95% CI: 1.05-4.54, p = 0.036) increased the probability of DR-TB. The older male population from south-southern Nigeria and women of childbearing age had lower incidence of DR-TB than men of the same age. Tailored interventions to reduce HIV and DR-TB prevalence in the general population, particularly among women of childbearing potential, and treatment support for young and older men are relevant strategies to reduce DR-TB in Nigeria.
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Affiliation(s)
- Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5117, South Africa
- Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, Jos 2064, Nigeria
| | - Bamidele Paul Atiba
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa
| | - Felix Emeka Anyiam
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa
| | - Babatunde A. Odugbemi
- Departments of Community Health & Primary Health Care, Lagos State University College of Medicine, Ikeja 102212, Nigeria
| | - Tolulope Afolaranmi
- Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, Jos 2064, Nigeria
| | - Ayuba Ibrahim Zoakah
- Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, Jos 2064, Nigeria
| | - C. Robert Horsburgh
- Section of Infectious Diseases, Boston Medical Center, Boston, MA 02118, USA
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA 02118, USA
- Department of Global Health, School of Public Health, Boston University, Boston, MA 02118, USA
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Dabitao D, Bishai WR. Sex and Gender Differences in Tuberculosis Pathogenesis and Treatment Outcomes. Curr Top Microbiol Immunol 2023; 441:139-183. [PMID: 37695428 DOI: 10.1007/978-3-031-35139-6_6] [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] [Indexed: 09/12/2023]
Abstract
Tuberculosis remains a daunting public health concern in many countries of the world. A consistent observation in the global epidemiology of tuberculosis is an excess of cases of active pulmonary tuberculosis among males compared with females. Data from both humans and animals also suggest that males are more susceptible than females to develop active pulmonary disease. Similarly, male sex has been associated with poor treatment outcomes. Despite this growing body of evidence, little is known about the mechanisms driving sex bias in tuberculosis disease. Two dominant hypotheses have been proposed to explain the predominance of active pulmonary tuberculosis among males. The first is based on the contribution of biological factors, such as sex hormones and genetic factors, on host immunity during tuberculosis. The second is focused on non-biological factors such as smoking, professional exposure, and health-seeking behaviors, known to be influenced by gender. In this chapter, we review the literature regarding these two prevailing hypotheses by presenting human but also experimental animal studies. In addition, we presented studies aiming at examining the impact of sex and gender on other clinical forms of tuberculosis such as latent tuberculosis infection and extrapulmonary tuberculosis, which both appear to have their own specificities in relation to sex. We also highlighted potential intersections between sex and gender in the context of tuberculosis and shared future directions that could guide in elucidating mechanisms of sex-based differences in tuberculosis pathogenesis and treatment outcomes.
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Affiliation(s)
- Djeneba Dabitao
- Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University Clinical Research Center (UCRC), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - William R Bishai
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
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Chidambaram V, Tun NL, Majella MG, Ruelas Castillo J, Ayeh SK, Kumar A, Neupane P, Sivakumar RK, Win EP, Abbey EJ, Wang S, Zimmerman A, Blanck J, Gupte A, Wang JY, Karakousis PC. Male Sex Is Associated With Worse Microbiological and Clinical Outcomes Following Tuberculosis Treatment: A Retrospective Cohort Study, a Systematic Review of the Literature, and Meta-analysis. Clin Infect Dis 2021; 73:1580-1588. [PMID: 34100919 PMCID: PMC8563313 DOI: 10.1093/cid/ciab527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Although the incidence of tuberculosis is higher in men than in women, the relationship of sex with tuberculosis treatment outcomes has not been adequately studied. METHODS We performed a retrospective cohort study and a systematic review and meta-analysis of observational studies during the last 10 years to assess sex differences in clinical and microbiological outcomes in tuberculosis. RESULTS In our cohort of 2894 Taiwanese patients with drug-susceptible pulmonary tuberculosis (1975 male and 919 female), male patients had higher adjusted hazards of 9-month mortality due to all causes (hazard ratio, 1.43 [95% confidence interval (CI), 1.03-1.98]) and infections (1.70 [1.09-2.64]) and higher adjusted odds of 2-month sputum culture positivity (odds ratio [OR], 1.56 [95% CI, 1.05-2.33]) compared with female patients. Smear positivity at 2 months did not differ significantly (OR, 1.27 [95% CI, .71-2.27]) between the sexes. Among 7896 articles retrieved, 398 were included in our systematic review describing a total of 3 957 216 patients. The odds of all-cause mortality were higher in men than in women in the pooled unadjusted (OR, 1.26 [95% CI, 1.19-1.34]) and adjusted (1.31 [1.18-1.45]) analyses. Men had higher pooled odds of sputum culture (OR, 1.44 [95% CI, 1.14-1.81]) and sputum smear (1.58 [1.41-1.77]) positivity, both at the end of the intensive phase and on completion of treatment. CONCLUSIONS Our retrospective cohort showed that male patients with tuberculosis have higher 9-month all-cause and infection-related mortality, with higher 2-month sputum culture positivity after adjustment for confounding factors. In our meta-analysis, male patients showed higher all-cause and tuberculosis-related mortality and higher sputum culture and smear positivity rates during and after tuberculosis treatment.
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Affiliation(s)
- Vignesh Chidambaram
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nyan Lynn Tun
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marie Gilbert Majella
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jennie Ruelas Castillo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Samuel K Ayeh
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Pranita Neupane
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ranjith Kumar Sivakumar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Ei Phyo Win
- Department of Pathology, Yangon Children’s Hospital, Yangon, Myanmar
| | - Enoch J Abbey
- Division of Endocrinology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Siqing Wang
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Alyssa Zimmerman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jaime Blanck
- Welch Medical Library, Johns Hopkins University, Baltimore, Maryland, USA
| | - Akshay Gupte
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Petros C Karakousis
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Schoenbaechler V, Guilavogui Y, Onivogui S, Hébélamou J, Mugglin C, Furrer H, Henzen C, Bavogui EK, Kolié C, Zoumanigui P, Béavogui I, Leuenberger D, Staehelin C. Rate of treatment success and associated factors in the program for drug-susceptible tuberculosis in the Forest Region, Republic of Guinea, 2010-2017: A real-world retrospective observational cohort study. Int J Infect Dis 2021; 110:6-14. [PMID: 34118429 DOI: 10.1016/j.ijid.2021.06.014] [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: 04/06/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To analyze the treatment success rate (TSR = sum of cured or treatment completed) in the tuberculosis (TB) program for drug-susceptible TB (DS-TB) at the "Centre Hospitalier Régional Spécialisé" in Macenta, Forest Region, Republic of Guinea. METHODS This cohort study included patients who started treatment for DS-TB between 2010 and 2017. Data collection was part of the documentation for the national TB program. Descriptive analysis was applied to determine the TSR in various patient groups. Further, logistic regression was performed to determine factors influencing the TSR in new and relapsed cases versus all other previously treated cases. A subgroup analysis for only microbiologically confirmed pulmonary TB was added. RESULTS The study included 3969 patients. The TSR increased from 68.3% in 2010 to 80.8% in 2017 (p < 0.001). Mortality (11.2%) mainly occurred in early treatment months, while loss to follow-up (5.9%) increased towards later treatment months. Risk factors for low TSR were advanced age, positive HIV status, long travel distances (>100 km) to the clinic, and late treatment refill. CONCLUSION The TSR in the Forest Region of Guinea remained below the WHO goal of 90%. Reaching this target remains a challenge in rural areas with high early mortality and increased risk of loss to follow-up.
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Affiliation(s)
- Valérie Schoenbaechler
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Yakpazouo Guilavogui
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea
| | - Sosso Onivogui
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea
| | - Jean Hébélamou
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea
| | - Catrina Mugglin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Corina Henzen
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Esther Kolou Bavogui
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea
| | - Cécé Kolié
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea
| | - Pévé Zoumanigui
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea
| | - Ismaël Béavogui
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea
| | - David Leuenberger
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea.
| | - Cornelia Staehelin
- Centre Hospitalier Régional Spécialisé, Quartier Fassankoni, Commune Urbaine Macenta, Région N'Zérékoré, Région Forestière, Republic of Guinea; Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Izudi J, Tamwesigire IK, Bajunirwe F. Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study. BMC Public Health 2020; 20:501. [PMID: 32295549 PMCID: PMC7161267 DOI: 10.1186/s12889-020-08646-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high dual tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda. Methods We constructed a retrospective cohort of persons with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we ran a modified Poisson regression analysis to determine factors independently associated with treatment success and mortality rates. Results We retrieved 1123 records for persons with BC-PTB and the treatment outcomes were distributed as follows: 477(42.5%) cured, 323 (28.0%) treatment completed, 17(1.5%) treatment failed, 81(7.2%) died, 89(7.9%) lost to follow-up, and 136(12.1%) not evaluated. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had treatment outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82–0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81–0.97), or male sex (aRR, 0.92; 95% CI, 0.87–0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95–6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74–4.92), year of enrollment into treatment after 2015 (aRR, 0.80; 95% CI, 0.66–0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13–0.50). Conclusions Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality rate is high. HIV infection and older age reduce chances of treatment success, and increase mortality rate. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success rate and reduce mortality rate.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda.
| | - Imelda K Tamwesigire
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda
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Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019; 14:e0226507. [PMID: 31881023 PMCID: PMC6934297 DOI: 10.1371/journal.pone.0226507] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
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Affiliation(s)
- Ninfa Marlen Chaves Torres
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Medicine, Nueva Granada Military University, Bogotá, D.C., Colombia
| | | | | | - María Belen Arriaga
- Gonzalo Moniz Institute, Gonzalo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
| | - Eduardo Martins Netto
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
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Rahimi BA, Rahimy N, Mukaka M, Ahmadi Q, Hayat MS, Wasiq AW. Determinants of treatment failure among tuberculosis patients in Kandahar City, Afghanistan: A 5-year retrospective cohort study. Int J Mycobacteriol 2019; 8:359-365. [PMID: 31793506 DOI: 10.4103/ijmy.ijmy_142_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tuberculosis (TB) is a preventable and treatable chronic disease. Afghanistan is among the high-TB-burden countries. The aim of this study is to find the determinants of treatment failure among TB patients in Kandahar City, Afghanistan. Methods This was a retrospective cohort study conducted in Kandahar City during a period of 5 years (August 2014-July 2019). For data analysis; descriptive statistics, Chi-square test, and logistic regression were used. Results Among 1416 TB patients, 894/1416 (63.1%) had pulmonary TB (PTB), whereas 522/1416 (36.9%) had extrapulmonary TB (EPTB). Mean age in these patients was 34.7 years while most of them were females in PTB (530/894 [59.3%]) and EPTB (340/522 [65.1%]) patients. Sputum smear was positive in 618/860 (71.9%) and 16/404 (4%) of PTB and EPTB patients, respectively. TB treatment failure was more in PTB (56/894 [6.3%]) than EPTB (4/522 [0.8%]). Chi-square test of TB cases showed that statistically significant determinants that may cause the treatment failure were re-treatment cases (crude odds ratio [COR] 7.7, P < 0.001), absence of fever (COR 5.2, P < 0.001), absence of cough (COR 1.7, P = 0.004), living in rural areas (COR 1.4, P = 0.035), and no weight loss (COR 1.3, P = 0.033). Binary logistic regression of the statistically significant variables revealed only absence of fever (adjusted odds ratio 6.0, P < 0.001) as the risk factor for treatment failure in TB patients. Conclusion TB is still a major threat for Kandahar City. Low treatment success rate and increased number of defaulted cases are the major threats.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Paediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Najeebullah Rahimy
- Department of Histopathology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mavuto Mukaka
- Department of Clinical Trials Support Group, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Qudratullah Ahmadi
- Department of Surgery, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Sami Hayat
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Abdul Wahed Wasiq
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
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The burdens of tuberculosis on patients with malignancy: incidence, mortality and relapse. Sci Rep 2019; 9:11901. [PMID: 31417132 PMCID: PMC6695428 DOI: 10.1038/s41598-019-48395-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/02/2019] [Indexed: 12/28/2022] Open
Abstract
Population with malignancy is growing worldwide; however, its tuberculosis (TB) burden including remains unclear regarding incidence, mortality, and relapse. We retrieved information and identified patients with malignancy and TB between 2000 and 2015 from the Taiwanese National Health Insurance reimbursement datasets, Taiwan cancer registry and death registration. We analyzed the incidence of new TB in patients with malignancy and their mortality as well as TB recurrence. During study period, we reviewed 1,105,009 patients after exclusion and among them, 19,906 had newly diagnosed TB. The TB incidence in cancer patients divided all TB events increased annually, from 3% in 2000 to 13% in 2015. The standard incidence rates (SIR) were highest in cancer of respiratory tract (5.45), hematology (3.70) and then head and neck area (2.58). The mortality directly due to TB was defined as 0.83% and all-cause mortality were approximately 10.5% at 3 months and 20.56% at 12 months. After completing TB treatment, recurrence was diagnosed in 626 (3.14%), and 1001 (5.03%) patients within the first and the first two years, respectively. In conclusion, the incidence of TB in patients with malignancy increase yearly as well as its proportion within overall cases. The twelve-month all-cause mortality during TB and the two-year recurrence are as high as 20.56% and 5.03%, respectively. It indicates the importance of this population in future TB control, especially for those with malignancy of respiratory tract, and hematology as well as head and neck area.
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Pradipta IS, van’t Boveneind-Vrubleuskaya N, Akkerman OW, Alffenaar JWC, Hak E. Treatment outcomes of drug-resistant tuberculosis in the Netherlands, 2005-2015. Antimicrob Resist Infect Control 2019; 8:115. [PMID: 31338162 PMCID: PMC6626402 DOI: 10.1186/s13756-019-0561-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Since in low incidence TB countries population migration and complex treatment of drug-resistant tuberculosis (DR-TB) patients are major issues, we aimed to analyse patient risk factors associated with the incidence of poor outcome of TB treatment among DR-TB patients in the Netherlands. Methods This retrospective cohort study included adult patients with confirmed DR-TB treated from 2005 to 2015. We obtained data from a nationwide exhaustive registry of tuberculosis patients in the Netherlands. Predictors for unsuccessful TB treatment (defaulted and failed treatment) and TB-associated mortality were analysed using multivariate logistic regression. Results Among 10,303 registered TB patients, 545 patients with DR-TB were analysed. Six types of DR-TB were identified from the included patients, i.e. isoniazid mono- or poly-resistance (68%); rifampicin mono- or poly-resistance (3.1%); pyrazinamide mono-resistance (8.3%); ethambutol mono-resistance (0.1%); multidrug-resistance (18.9%); and extensively drug-resistance (0.7%). The majority of patients were foreign-born (86%) and newly diagnosed TB (89%) patients. The cumulative incidence of unsuccessful treatment and mortality were 5 and 1%, respectively. Among all DR-TB cases, patients with Multi Drug-Resistant Tuberculosis (MDR-TB) (OR 4.43; 95%CI 1.70-11.60) were more likely to have unsuccessful treatment, while miliary and central nervous system TB (OR 15.60; 95%CI 2.18-111.52) may also be predictors for TB mortality. Additionally, patients with substance abuse and homelessness tend to have unsuccessful treatment. Conclusions In recent years, we identified a low incidence of DR-TB as well as the poor outcome of DR-TB treatment. The majority of cases were primary drug-resistant and foreign-born. To further improve treatment outcome, special attention should be given to the high-risk DR-TB patients.
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Affiliation(s)
- Ivan S. Pradipta
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, - Epidemiology & - Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jawa Barat, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - Natasha van’t Boveneind-Vrubleuskaya
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Groningen, the Netherlands
- Department of Public Health Tuberculosis Control, Metropolitan Public Health Services , the Hague, the Netherlands
| | - Onno W. Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Tuberculosis Centre Beatrixoord, University Medical Centre Groningen, University of Groningen, Haren, the Netherlands
| | - Jan-Willem C. Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Groningen, the Netherlands
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, Australia
- Westmead Hospital, Sydney, Australia
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, - Epidemiology & - Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
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Predictors of Tuberculosis outcomes amongst drug sensitive patients in Boteti sub-district, Botswana, 2015-2017. Indian J Tuberc 2019; 67:79-86. [PMID: 32192622 DOI: 10.1016/j.ijtb.2019.04.014] [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: 03/07/2019] [Accepted: 04/29/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The. Boteti sub-district in Botswana has a high TB notification rate of 356 per 100 000 population in 2013, a Treatment completion rate of 55%, 13% cure rate, and 4% defaulter rate in 2014. The high TB notification and defaulter rates with lower cure and treatment success rates in this sub-district relative to the country, are indicative of certain determinants that may be hampering TB control. The aim of this study was to determine the factors associated drug sensitive TB treatment outcomes. METHODS A retrospective cohort study was conducted amongst all the new-smear positive adult pulmonary TB patients who registered and/or completed the treatment period at the six selected health-care centres in Boteti sub-district, between 1 January 2015 and 31 January 2017. An interviewer-administered questionnaire in the patient's language of choice- Setswana or English was utilised for data collection. Adjusted risk ratios (ARR) and their respective 95% confidence intervals (95% CI) were used for expressing associations. RESULTS Fifty-eight (56.9%) patients were successfully cured compared to 44 (43.1%) who successfully completed treatment. Patients that attended the clinics by foot (ARR 3.38) (P < 0.05), females (ARR: 1.25) and HIV negative patients (ARR: 1.20) were more likely to achieve TB cure. Patients that attended the facility with a vehicle were 2.12 (P < 0.000), a primary school and above education (ARR: 1.59), travelled less than 5 km (ARR: 1.05) and less than 38 years of age (ARR:1.02) were more likely to complete TB treatment. CONCLUSION A comprehensive health promotion approach based on the Ottawa charter principles to should be developed and implemented.
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Tuberculosis Treatment Outcomes and Associated Factors among TB Patients Attending Public Hospitals in Harar Town, Eastern Ethiopia: A Five-Year Retrospective Study. Tuberc Res Treat 2019; 2019:1503219. [PMID: 31057963 PMCID: PMC6463571 DOI: 10.1155/2019/1503219] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/22/2019] [Accepted: 02/21/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Tuberculosis remains a major public health threat throughout the world particularly in developing countries. Evaluating the treatment outcome of tuberculosis and identifying the associated factors should be an integral part of tuberculosis treatment. Objectives The aim of this study was to assess the treatment outcome of tuberculosis and its associated factors among TB patients in the TB clinics of Harar public hospitals, Eastern Ethiopia, 2017. Methods A retrospective document review was conducted in two public hospitals of Harar town, located 516 km east of Addis Ababa. A systematic random sampling technique was used to select the document of TB patients who were registered in the hospitals from 1st of January, 2011, to 30th of December, 2015. The data were collected using a pretested structured data extraction format. SPSS Version 21 for window was used for data processing. Bivariate and multivariate analysis with 95% confidence interval was employed in order to infer the associations between TB treatment outcome and potential predictor variables. Results One thousand two hundred thirty-six registered TB patients' documents were reviewed. Of these, 59.8% were male, 94.2% were urban dwellers, 97% were new cases, 61.2% were presented with pulmonary TB, and 22.8% were HIV positive. Regarding the treatment outcome, 30.4% were cured, 62.1% completed their treatment, 3.9% died, 2.4% were defaulted, and the remaining 1.2% had failed treatment. The overall rate of the treatment success among the patients was 92.5%. In the present study, being female (AOR = 1.89, 95% CI: 1.14 - 3.14), having pretreatment weight of 20 – 29 kg (AOR = 11.03, 95% CI: 1.66 - 73.35), being HIV negative (AOR = 6.50, 95% CI: 3.95 - 10.71), and being new TB patient (AOR = 3.22 95% CI: 1.10 - 9.47) were factors independently associated with successful treatment outcome. On the other hand, being in the age group 54 – 64 years (AOR =10.41, 95% CI: 1.86 - 58.30) and age greater than 65 years (AOR =24.41, 95% CI: 4.19 - 142.33) was associated with unsuccessful TB treatment outcome. Conclusion In the current study, the rate of successful TB treatment outcome was acceptable. This rate should be maintained and further improved by designing appropriate monitoring strategies.
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Katoto PDMC, Murhula A, Kayembe-Kitenge T, Lawin H, Bisimwa BC, Cirhambiza JP, Musafiri E, Birembano F, Kashongwe Z, Kirenga B, Mfinanga S, Mortimer K, De Boever P, Nawrot TS, Nachega JB, Nemery B. Household Air Pollution Is Associated with Chronic Cough but Not Hemoptysis after Completion of Pulmonary Tuberculosis Treatment in Adults, Rural Eastern Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2563. [PMID: 30445808 PMCID: PMC6265859 DOI: 10.3390/ijerph15112563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors living in 13 remote health zones with high TB burden in the South Kivu province of the Democratic Republic of Congo (DRC). Trained community and health-care workers administered a validated questionnaire. In a multivariate logistic regression, chronic cough was independently associated with HAP (adjusted odds ratios (aOR) 2.10, 95% CI: 1.10⁻4.00) and PTB treatment >6 months (aOR 3.80, 95% CI: 1.62⁻8.96). Among women, chronic cough was associated with cooking ≥3 h daily (aOR 2.74, 95% CI: 1.25⁻6.07) and with HAP (aOR 3.93, 95% CI: 1.15⁻13.43). Independent predictors of hemoptysis were PTB retreatment (aOR 3.04, 95% CI: 1.04⁻5.09) and ignorance of treatment outcome (aOR 2.24, 95% CI: 1.09⁻4.58) but not HAP (aOR 1.86, 95% CI: 0.61⁻5.62). Exposure to HAP proved a major risk factor for chronic cough in PTB survivors, especially in women. This factor is amenable to intervention.
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Affiliation(s)
- Patrick D M C Katoto
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 300 Leuven, Belgium.
- Department of Internal Medicine and Prof Lurhuma Biomedical Research Laboratory, Mycobacterium Unit, Faculty of Medicine, Catholic University of Bukavu, 02BP, Bukavu, Congo.
| | - Aime Murhula
- Department of Internal Medicine and Prof Lurhuma Biomedical Research Laboratory, Mycobacterium Unit, Faculty of Medicine, Catholic University of Bukavu, 02BP, Bukavu, Congo.
| | - Tony Kayembe-Kitenge
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 300 Leuven, Belgium.
- Unit of Toxicology and Environment, University hospital of Lubumbashi, School of Public Health Faculty of Medicine, Lubumbashi 1825BP, Congo.
| | - Herve Lawin
- Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey-Calavi (UAC), Cotonou 03BP0490, Benin.
| | - Bertin C Bisimwa
- Department of Internal Medicine and Prof Lurhuma Biomedical Research Laboratory, Mycobacterium Unit, Faculty of Medicine, Catholic University of Bukavu, 02BP, Bukavu, Congo.
- Département de Biologie médicale, Institut Supérieur des Techniques Médicales (ISTM) Bukavu, BP 3036, Bukavu, Congo.
| | - Jean Paul Cirhambiza
- National TB Program, Provincial and national Anti-Leprosy and TB Coordination, BP. 1899, Bukavu, Dem. Congo.
| | - Eric Musafiri
- National TB Program, Provincial and national Anti-Leprosy and TB Coordination, BP. 1899, Bukavu, Dem. Congo.
| | - Freddy Birembano
- National TB Program, Provincial and national Anti-Leprosy and TB Coordination, BP. 1899, Bukavu, Dem. Congo.
| | - Zacharie Kashongwe
- National TB Program, Provincial and national Anti-Leprosy and TB Coordination, BP. 1899, Bukavu, Dem. Congo.
| | - Bruce Kirenga
- Department of Pulmonary Medicine and Lung Institute, Makerere University, PB 7072, Kampala, Uganda.
| | - Sayoki Mfinanga
- National Institute for Medical Research Muhimbili Medical Research Centre, PB 65001, Dar es Salaam, Tanzania.
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Agoralaan, building D, 3590, Diepenbeek, Belgium.
- Health Unit, Flemish Institute for Technological Research (VITO), Vlasmeer7, 2400 Mol, Belgium.
| | - Tim S Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 300 Leuven, Belgium.
- Centre for Environmental Sciences, Hasselt University, Agoralaan, building D, 3590, Diepenbeek, Belgium.
| | - Jean B Nachega
- Department of Medicine and Center for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, 8000, Francie Van Zijl Drive, PB 241, Cape Town, South Africa.
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, MD, USA.
- Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, 15210, PA, USA.
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, 300 Leuven, Belgium.
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Meka AO, Chukwu JN, Nwafor CC, Oshi DC, Madichie NO, Ekeke N, Anyim MC, Alphonsus C, Mbah O, Uzoukwa GC, Njoku M, Ntana K, Ukwaja KN. Diagnosis delay and duration of hospitalisation of patients with Buruli ulcer in Nigeria. Trans R Soc Trop Med Hyg 2016; 110:502-509. [PMID: 27777282 DOI: 10.1093/trstmh/trw065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong duration of management, and impose avoidable additional costs on patients and health providers. We investigated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria. METHODS This was a prospective cohort study of patients with Buruli ulcer who were identified from a community-based survey. Data on the patients' clinical profile, delays in diagnosis and duration of hospitalisation were prospectively collected. RESULTS Of 145 patients notified, 125 (86.2%) were confirmed by one or more laboratory tests (81.4% by PCR). The median age of the patients was 20 years, 88 (60.7%) were >15years old and 85 (58.6%) were females. In addition, 137 (94.5%) were new cases, 119 (82.1%) presented with ulcers and 110 (75.9%) had lower limb lesions. The mean time delay to diagnosis was 50.6 (±101.9) weeks. The mean duration of hospitalisation was 108 (±60) days. Determinants of time delay to diagnosis were higher disease category (p=0.001) and laboratory confirmation of disease (p=0.02). Determinants of longer hospitalisation were; multiple lesions (p=0.035), and having functional limitation at diagnosis and undertaking surgery (p=0.003). CONCLUSIONS Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria.
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Affiliation(s)
- Anthony O Meka
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Joseph N Chukwu
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Charles C Nwafor
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Daniel C Oshi
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Nelson O Madichie
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Ngozi Ekeke
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Moses C Anyim
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Chukwuka Alphonsus
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Obinna Mbah
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Glory C Uzoukwa
- Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria
| | - Martin Njoku
- St Benedict's Tuberculosis & Leprosy Rehabilitation Hospital, Ogoja, Cross River State, Nigeria
| | - Kentigern Ntana
- St Benedict's Tuberculosis & Leprosy Rehabilitation Hospital, Ogoja, Cross River State, Nigeria
| | - Kingsley N Ukwaja
- Department of Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria
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