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Pathak D, Vasishtha G, Mohanty SK. Association of multidimensional poverty and tuberculosis in India. BMC Public Health 2021; 21:2065. [PMID: 34763696 PMCID: PMC8582202 DOI: 10.1186/s12889-021-12149-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 11/01/2021] [Indexed: 11/15/2022] Open
Abstract
Background Reduction of multidimensional poverty and tuberculosis are priority development agenda worldwide. The SDGs aims to eradicate poverty in all forms (SDG 1.2) and to end tuberculosis (SDG 3.3.2) by 2030. While poverty is increasingly being measured across multiple domains, reduction of tuberculosis has been an integral part of public health programmes. Though literature suggests a higher prevalence of tuberculosis among the economically poor, no attempt has been made to understand the association between multidimensional poverty and tuberculosis in India. The objective of this paper is to examine the association of multidimensional poverty and tuberculosis in India. Methods The unit data from the National Family Health Survey-4, conducted in 2015–16 covering 628,900 households and 2,869,043 individuals across 36 states and union territories of India was used in the analysis. The survey collected information on the self-reported tuberculosis infection of each member of a sample household at the time of the survey. Multidimensional poverty was measured in the domains of education, health, and standard of living, with a set of 10 indicators. The prevalence of tuberculosis was estimated among the multidimensional poor and non-poor populations across the states of India. A binary logistic regression model was used to understand the association of tuberculosis and multidimensional poverty. Results Results suggest that about 29.3% population of India was multidimensional poor and that the multidimensional poverty index was 0.128. The prevalence of tuberculosis among the multidimensional poor was 480 (95% CI: 464–496) per 100,000 population compared to 250 (95% CI: 238–262) among the multidimensional non-poor. The prevalence of tuberculosis among the multidimensional poor was the highest in the state of Kerala (1590) and the lowest in the state of Himachal Pradesh (220). Our findings suggest a significantly higher prevalence of tuberculosis among the multidimensional poor compared to the multidimensional non-poor in most of the states in India. The odds of having tuberculosis among the multidimensional poor were 1.82 times higher (95% CI, 1.73–1.90) compared to the non-poor. Age, sex, smoking, crowded living conditions, caste, religion, and place of residence are significant socio-demographic risk factors of tuberculosis. Conclusion The prevalence of tuberculosis is significantly higher among the multidimensional poor compared to the multidimensional non-poor in India.
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Affiliation(s)
- Dimpal Pathak
- Assam Medical College & Hospital Dibrugarh, Barbari, Assam, India
| | - Guru Vasishtha
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India.
| | - Sanjay K Mohanty
- Department of Development Studies, International Institute for Population Sciences, Mumbai, India
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Zweig PJ. Everyday hazards and vulnerabilities amongst backyard dwellers: A case study of Vredendal North, Matzikama Municipality, South Africa. JAMBA (POTCHEFSTROOM, SOUTH AFRICA) 2015; 7:210. [PMID: 38633846 PMCID: PMC11021872 DOI: 10.4102/jamba.v7i1.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/19/2015] [Indexed: 04/19/2024]
Abstract
The populations of many small towns in South Africa continue to expand unmatched by parallel economic growth, entrenching high levels of poverty. The town of Vredendal, located close to the national route between Namibia and Cape Town in South Africa, is a West Coast development node and an emergent industrial and processing area that continues to attract an influx of people seeking economic opportunities. This is challenging the capacity of the local municipality, which has a waiting list for state-provided low-cost housing units, whilst the provision of adequate infrastructure to meet growing local need is also a developmental concern. In the suburb of Vredendal North this has resulted in the proliferation of unplanned informal dwellings in the backyards of formalised low-cost housing areas. Largely overlooked by urban researchers, little is known or understood about small town backyard populations. This prompted a brief study of Vredendal North backyard dwellers commissioned by the local municipality to identify their everyday hazards and livelihood vulnerabilities to inform future development planning. A community workshop identified critical development needs and suggested that backyard dwellers in small towns experience similar living conditions and hazards to those in the cities, although underlain by some unique differences.
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Affiliation(s)
- Patricia J Zweig
- Department of Geography & Environmental Studies, Stellenbosch University, South Africa
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Crofts JP, Gelb D, Andrews N, Delpech V, Watson JM, Abubakar I. Investigating tuberculosis trends in England. Public Health 2008; 122:1302-10. [PMID: 18672258 DOI: 10.1016/j.puhe.2008.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 12/07/2007] [Accepted: 04/16/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the factors associated with the increasing incidence of tuberculosis in England. DESIGN Prospective national surveillance study. METHODS Measurement of relative trends in demographic, clinical and microbiological characteristics of tuberculosis cases reported in England between 1999 and 2003. RESULTS Between 1999 and 2003, the number of tuberculosis cases reported in England increased by 19% from 5539 to 6608. Significant increases in tuberculosis cases were seen in the non-UK-born population who were recent entrants to the UK (arrival less than 5 years prior to diagnosis) relative to cases in the UK-born population, both in London [1.08; 95% confidence interval (CI) 1.02-1.14] and outside London (1.22; 95% CI 1.16-1.28). Cases of tuberculosis co-infected with human immunodeficiency virus (HIV) increased significantly both in London (1.19; 95% CI 1.12-1.27) and outside London (1.22; 95% CI 1.12-1.33) relative to cases not known to be co-infected with HIV. Small increases in the number of cases living in less-deprived areas were observed relative to those in the most-deprived areas (1.11; 95% CI 1.02-1.21) in London. The number of cases of isoniazid-resistant (1.09; 95% CI 1.02-1.16) and multi-drug-resistant tuberculosis (1.22; 95% CI 1.02-1.45) increased relative to drug-susceptible cases in London. CONCLUSIONS Tuberculosis remains strongly associated with deprivation, but no real change in the distribution of tuberculosis cases by deprivation was observed over the study period. The proportion of tuberculosis cases co-infected with HIV has increased, but migration explains most of the recent trends in tuberculosis in England. Measures that target latent tuberculosis infection could have an increased role to play alongside measures against active disease in reducing the incidence of tuberculosis in the UK.
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Affiliation(s)
- J P Crofts
- Respiratory Diseases Department, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK
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Riley AJ, Harding G, Underwood MR, Carter YH. Homelessness: a problem for primary care? Br J Gen Pract 2003; 53:473-9. [PMID: 12939894 PMCID: PMC1314623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Homelessness is a social problem that affects all facets of contemporary society. This paper discusses the concept of homelessness in terms of its historical context and the dominance of the pervasive 'victim blaming' ideologies, which, together with the worldwide economic changes that have contributed to a fiscal crisis of the state, and the resultant policies and circumstances, have led to an increase in the number of 'new homeless' people. This paper attempts to challenge the dominant political discourse on homelessness. The widespread healthcare problems and heterogeneity of homeless people have a particular impact on health services, with many homeless people inappropriately accessing local accident and emergency (A&E) departments because of barriers inhibiting adequate access to primary care. A number of primary care schemes have been successfully implemented to enable the homeless to have better access to appropriate care. However, there is no consistency in the level of services around the United Kingdom (UK), and innovations in service are not widespread and by their nature they are ad hoc. Despite the successes of such schemes, many homeless people still access health care inappropriately. Until homeless people are fully integrated into primary care the situation will not change. The question remains, how can appropriate access be established? A start can be made by building on some of the positive work that is already being done in primary care, but in reality general practitioners (GPs) will be 'swimming against the tide' unless a more integrated policy approach is adopted to tackle homelessness.
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Affiliation(s)
- Anthony J Riley
- Centre for Health Informatics and Multiprofessional Education, Royal Free and University College Medical School, London, University College London, Fourth Floor, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW.
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Leung CC, Yew WW, Chan CK, Chau CH, Tam CM, Lam CW, Tam WO, Lau KS, Liu WT. Tuberculosis in older people: a retrospective and comparative study from Hong Kong. J Am Geriatr Soc 2002; 50:1219-26. [PMID: 12133016 DOI: 10.1046/j.1532-5415.2002.50308.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare tuberculosis (TB) in older and younger patients. DESIGN A retrospective and comparative observational study. SETTING Four chest clinics and two chest hospitals in Hong Kong. PARTICIPANTS All notifications from the participating hospitals and clinics in 1996 were extracted from the TB notification registry. The characteristics of patients aged 65 and older were compared with a one-in-three random sampling of those aged 16 to 64. MEASUREMENTS Demographic, clinical, radiological, and laboratory data of the two groups were compared alongside treatment and outcomes. RESULTS Older people with TB were more likely to be male, to smoke, to have had TB previously, to have coexisting medical diseases, to be socioeconomically disadvantaged, and to weigh less than younger people with TB. Dyspnea, weight loss, and malaise were more common, whereas extrathoracic lymph node enlargement was less common. Chest radiograph showed more extensive disease and lower zone involvement. Positive tuberculin test was present in only 61.9%. Sputum bacteriology was more likely to be positive. There was a longer delay in presentation and commencement of treatment, and 77.2% required at least one admission. Adverse effects of treatment, notably hepatic dysfunction, occurred more commonly. Fluoroquinolones appeared well tolerated. Only 72.5% of the older people were cured or completed their treatment. Mortality was 16%. Age of 65 and older, comorbidity, socioeconomic disadvantage, moderate-extensive disease, positive sputum smear, and poor adherence were factors independently associated with unfavorable outcomes (P <.001 to P = .01; odds ratios = 1.61-27.02). CONCLUSION Substantial differences were found between older and younger TB patients. Many of these were associated with unfavorable outcome. Increased awareness in disease recognition and better medical and social support are therefore needed in addressing the growing problem of TB in older people.
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Affiliation(s)
- Chi C Leung
- Tuberculosis and Chest Service, Department of Health, Hong Kong, China.
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Marjanovic Z, Tuppin P, Herrmann JL, Bayol G, Toledano C, Farge D. Tuberculosis in patients with and without primary health coverage. Eur J Intern Med 2002; 13:180-184. [PMID: 12020625 DOI: 10.1016/s0953-6205(02)00013-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND: The aim of this study was to determine whether tuberculosis (TB) treatment and follow-up is a feasible option for patients without primary health coverage when free access to health care and drug delivery is provided on an outpatient basis. METHODS: We conducted a retrospective analysis of patient characteristics, treatment modalities, and evolution up to 9 months of follow-up at Saint-Louis Hospital, Paris, France. RESULTS: TB patients without (n=44) compared to those with (n=49) primary health coverage at diagnosis tended to be younger and more frequently homeless (P<0.05) or had illegal status (P<0.001). They had similar TB presentation when starting treatment, but required free drug delivery more often (74 vs. 21%, P<0.001). After the same duration of follow-up, patients considered as cured or as having completed treatment (52.3 vs. 51%), dead (2.3 vs. 8.2%), still under treatment (13.2 vs. 6.1%), or lost to follow-up (31.8 vs. 34.7%) were similar in both groups. At the end of the follow-up period, 43% of the patients without primary health coverage had managed to obtain 70% or 100% free medical aid or social security. CONCLUSIONS: Free access to health care and drug delivery is worthwhile in TB patients without primary health coverage since it permits the same clinical results as in TB patients with primary health coverage. However, efforts should be made to improve the management and follow-up of TB patients and to lower the number of patients lost to follow-up, whatever their social status.
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Affiliation(s)
- Zora Marjanovic
- Service de Médecine Interne, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Cedex 10, Paris, France
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Rose AMC, Sinka K, Watson JM, Mortimer JY, Charlett A. An estimate of the contribution of HIV infection to the recent rise in tuberculosis in England and Wales. Thorax 2002; 57:442-5. [PMID: 11978923 PMCID: PMC1746328 DOI: 10.1136/thorax.57.5.442] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The number of patients with tuberculosis has been increasing slowly in England and Wales since the late 1980s. HIV infection has been a contributory factor to increases in tuberculosis in a number of comparable industrialised countries. This study investigated the extent of tuberculosis and HIV co-infection in England and Wales in 1993 and 1998, and estimated its contribution to the increase in tuberculosis observed during this period. METHODS Patients aged 16-54 years old at diagnosis on the 1993 and 1998 National Tuberculosis Survey databases were matched with those on the HIV/AIDS patient database. A coded process maintained patient confidentiality. Primary outcome measures were the increase between 1993 and 1998 in the numbers with both infections reported and an estimate of the proportion of the increase in tuberculosis during this period attributable to HIV co-infection. RESULTS In 1993 61 (2.2%) tuberculosis patients aged 16-54 years matched with patients reported to the HIV database, increasing to 112 (3.3%) in 1998 (p=0.08; OR 1.35; 95% CI 0.97 to 1.87). Patients co-infected with HIV contributed an estimated 8.5% of the increase in number of tuberculosis patients between 1993 and 1998 nationwide (11% in London). In both years prevalence of co-infection was greatest in London and in patients of white and black African ethnic groups. CONCLUSIONS In 1998 the number of tuberculosis patients co-infected with HIV in England and Wales, though still small, had nearly doubled since 1993, with most of the increase occurring in London. As HIV infection may be undiagnosed in patients with tuberculosis, and tuberculosis may be unreported in patients with diagnosed HIV infection, the true extent of co-infection will have been underestimated by this study. In addition, constraints in coded matching make it inevitable that some reported co-infections are missed. Routine HIV testing of all patients with tuberculosis should now be considered, particularly in patients of white or black African ethnic origin under 55 years of age.
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Affiliation(s)
- A M C Rose
- Respiratory Division, PHLS Communicable Disease Surveillance Centre, London NW9 5EQ, UK
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Bhutto AM, Solangi A, Khaskhely NM, Arakaki H, Nonaka S. Clinical and epidemiological observations of cutaneous tuberculosis in Larkana, Pakistan. Int J Dermatol 2002; 41:159-65. [PMID: 12010341 DOI: 10.1046/j.1365-4362.2002.01440.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cutaneous tuberculosis is widespread in Pakistan but has not been fully documented. This study was conducted to determine the clinical pattern, nature and existence of the disease in Larkana, Sindh province, Pakistan. METHODS We are reporting 153 cases of patients with cutaneous tuberculosis who visited our department from 1996 to 1999. All cases were diagnosed at the clinic, and the biopsies were examined for histopathological evidence. The patients received three antituberculous treatments during a 9 month course. RESULTS Clinically, 63 (41.2%) cases of lupus vulgaris, 54 (35.3%) of scrofuloderma, 29 (19.59%) of lupus verrucosa cutis, six (3.92%) of tuberculosis cutis orificialis and one (0.64%) case of disseminated cutaneous tuberculosis were observed in our department from 1996 to 1999. All patients were aged between 3 and 50 years and had experienced the present complaints for 1 to 12 years. Sixty-nine (45.1%) cases were children aged under 10 years, 50 cases (37.25%) were aged between 10 and 20 years, and 27 cases (17.65%) were aged over 20 years. There was no considerable ratio difference of the disease between male and female patients. Histopathologically, all the specimens showed chronic granulomatous changes; the majority was infiltrated with epitheloid cells, langhans giant cells, plasma cells and other inflammatory cells, such as lymphocytes, eosinophils and neutrophils in ulcerated lesions. Increased numbers of mast cells were seen in upper and lower dermis in two-thirds of the specimens. Caseating necrosis was visible in half of the specimens while Ziehl-Neelsen stain was negative in all the sections. CONCLUSIONS The observed number of patients was moderately large, thus indicating a high incidence of cutaneous tuberculosis in Larkana. Lupus vulgaris, a form of cutaneous tuberculosis, was widespread in this area and prevalent in adults, while scrofuloderma was prevalent in children. Moreover, the existing rate of the disease was higher in children aged under 10 years and lower in adults. This indicates that children are more prone to this disease than adults.
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Affiliation(s)
- Abdul Manan Bhutto
- Department of Dermatology, Chandka Medical College, Doctors' Colony, VIP Road, Larkana Sindh, Pakistan.
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Abstract
Tuberculous otitis media can provide a diagnostic challenge even to the most astute and experienced clinician. The rarity of the condition and its propensity to masquerade as commoner otological conditions further delays diagnosis and treatment. We present the case of a 22-year-old female who presented with chronic aural discharge, unilateral hearing loss and recurrent hemifacial paralysis. The paper highlights the difficulty in diagnosis and stresses the need for a high index of suspicion in cases resistant to the common methods of treatment.
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Affiliation(s)
- R K Bhalla
- Department of Otolaryngology, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
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Resistencia a los fármacos antituberculosos en España. Evolución e influencia del virus de la inmunodeficiencia humana. Med Clin (Barc) 2001. [DOI: 10.1016/s0025-7753(01)72013-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Glynn JR, Warndorff DK, Malema SS, Mwinuka V, Pönnighaus JM, Crampin AC, Fine PE. Tuberculosis: associations with HIV and socioeconomic status in rural Malawi. Trans R Soc Trop Med Hyg 2000; 94:500-3. [PMID: 11132374 DOI: 10.1016/s0035-9203(00)90065-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Tuberculosis (TB) is associated with human immunodeficiency virus (HIV) infection, increasing age and male sex, but less is known about other risk factors in developing countries. As part of the Karonga Prevention Study in northern Malawi, we conducted a retrospective cohort study in the general population to assess risk factors for the development of TB. Individuals were identified in 1986-89 and TB cases diagnosed up to 1996 were included. TB was confirmed in 62/11,059 (0.56%) HIV negative individuals and 7/182 (3.9%) HIV positive individuals (relative risk 7.1, 95% confidence interval 3.2-15.7). This association was little altered by adjustment for age, sex or socioeconomic factors. The risk of TB was higher in those aged over 30 years than in younger individuals, in men than in women, in those engaged in occupations other than farming than in subsistence farmers, in those living in households with burnt brick dwellings than in those with less well built dwellings, and in those with some schooling than in those with none. These associations persisted after adjusting for age, sex, HIV status and population density. The absolute risks of TB were low in this study due to the passive follow-up and strict diagnostic criteria. The relative risk with HIV was of a similar magnitude to that measured elsewhere. Increased risks of TB with age and in men are expected. Associations with measures of higher socioeconomic status were unexpected. They may reflect a greater likelihood of diagnosis in this group.
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Affiliation(s)
- J R Glynn
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Hawker JI, Bakhshi SS, Ali S, Farrington CP. Ecological analysis of ethnic differences in relation between tuberculosis and poverty. BMJ (CLINICAL RESEARCH ED.) 1999; 319:1031-4. [PMID: 10521193 PMCID: PMC28253 DOI: 10.1136/bmj.319.7216.1031] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the effect of ethnicity on the relation between tuberculosis and deprivation. DESIGN Retrospective ecological study comparing incidence of tuberculosis in white and south Asian residents of the 39 electoral wards in Birmingham with ethnic specific indices of deprivation. SETTING Birmingham, 1989-93. SUBJECTS 1516 notified cases of tuberculosis. MAIN OUTCOME MEASURES Rates of tuberculosis and measures of deprivation. RESULTS Univariate analysis showed significant associations of tuberculosis rates for the whole population with several indices of deprivation (P<0.01) and with the proportion of the population of south Asian origin (P<0.01). All deprivation covariates were positively associated with each other but on multiple regression, higher level of overcrowding was independently associated with tuberculosis rates. For the white population, overcrowding was associated with tuberculosis rates independently of other variables (P=0.0036). No relation with deprivation was found for the south Asian population in either single or multivariable analyses. CONCLUSIONS Poverty is significantly associated with tuberculosis in the white population, but no such relation exists for those of Asian ethnicity. These findings suggest that causal factors, and therefore potential interventions, will also differ by ethnic group.
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Affiliation(s)
- J I Hawker
- Public Health Laboratory Service Communicable Disease Surveillance Centre, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS.
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Abstract
BACKGROUND The prevalence of tuberculosis, especially extrapulmonary tuberculosis, is increasing worldwide. Because information on the outcome of pregnancy among women with extrapulmonary tuberculosis is limited, we studied the course of pregnancy and labor and the perinatal outcome in these women and their infants. METHODS From 1983 to 1993, we followed 33 pregnant women who had extrapulmonary tuberculosis (12 with tuberculous lymphadenitis and 9 with intestinal, 7 with skeletal, 2 with renal, 2 with meningeal, and 1 with endometrial tuberculosis) through their deliveries. Of the 33, 29 received antituberculosis treatment during pregnancy. The antenatal complications, intrapartum events, and perinatal outcomes were compared with those among 132 healthy pregnant women without tuberculosis who were matched for age, parity, and socioeconomic status. RESULTS Tuberculous lymphadenitis did not affect the course of pregnancy or labor or the perinatal outcome. However, as compared with the control women, the 21 women with tubercular involvement of other extrapulmonary sites had higher rates of antenatal hospitalization (24 percent vs. 2 percent, P< 0.001), infants with low Apgar scores (< or =6) soon after birth (19 percent vs. 3 percent, P=0.01), and low-birth-weight (<2500 g) infants (33 percent vs. 11 percent, P=0.01). CONCLUSIONS Extrapulmonary tuberculosis that is confined to the lymph nodes has no effect on obstetrical outcomes, but tuberculosis at other extrapulmonary sites does adversely affect the outcome of pregnancy.
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Affiliation(s)
- N Jana
- Department of Obstetrics and Gynaecology, Memorial Hospital, Darlington, United Kingdom
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Bonington A, Harden S, Anderson S, Wall R, Davidson RN. HIV-testing study of immigrants with pulmonary tuberculosis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1998; 29:461-3. [PMID: 9435032 DOI: 10.3109/00365549709011854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The increasing prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV), particularly in Africa and Asia, led us to investigate the prevalence of HIV infection in immigrants with pulmonary TB at the time of arrival in the UK. We performed anonymous HIV testing of stored sera from 39/65 immigrants referred to our unit between January 1991 and December 1994, who had culture-positive pulmonary TB. None of the 39 patients tested was positive for either HIV-1 or HIV-2, and the characteristics of the 26 patients for whom no serum was available were similar to those of the tested group. Despite the need to consider concomitant HIV infection in any patient with TB, particularly those from an area of HIV endemnicity, the present data do not suggest that recently arrived refugees, asylum seekers, immigrants or long-term visitors to the UK constitute a group in whom dual infection of HIV and Mycobacterium tuberculosis is common.
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Affiliation(s)
- A Bonington
- Department of Infection and Tropical Medicine, Imperial College School of Medicine, Harrow, Middlesex, UK
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Bakhshi SS, Hawker J, Ali S. The epidemiology of tuberculosis by ethnic group in Birmingham and its implications for future trends in tuberculosis in the UK. ETHNICITY & HEALTH 1997; 2:147-53. [PMID: 9426979 DOI: 10.1080/13557858.1997.9961823] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To describe the epidemiology of tuberculosis (TB) in Birmingham, UK, by ethnic group and to assess the implications of the findings for future trends in TB in the UK. METHODS Retrospective review of records of all patients notified with TB in Birmingham during 1989-1994. RESULTS The decline in TB notifications in Birmingham halted and then reversed in 1987-1992. Trends in overall notifications were mainly influenced by trends in cases of Asian origin. Crude notification rates in 1989-1994 are 17 times higher in Asian than Caucasian residents (p < 0.01). Rates in African Caribbean residents are also statistically significantly higher than in Caucasians (p < 0.01) but significantly lower than in Asians. Crude rates for Asian people born abroad are 4.1 times higher than for Asians born in the UK (p < 0.01) but only 3.8% of Asian patients had been resident in the UK for less than 1 year. The group accounting for the highest number of cases were female Asians aged 20-29, followed by male Asians of the same age. Age-specific rates show that incidence increases with age in both Asian and white groups, with a small peak in 20-29-year-old Asians. TB is uncommon in all Caucasian age-groups under 50 years of age (less than 1 per 10,000) but is relatively common in all Asian age-groups over 15 years of age (over 10 per 10,000). CONCLUSIONS The different epidemiology of TB in the Caucasian and Asian populations in the UK suggests that from about the second decade of the next century, TB in the UK will almost be entirely a problem of ethnic minorities and that even if new infection was eliminated now in Asian people, cases due to reactivation would continue to occur until the third quarter of the next century.
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Affiliation(s)
- S S Bakhshi
- Communicable Disease Unit, Birmingham Health Authority, UK
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Abstract
Tuberculosis has been a disease of human beings for thousands of years. In recent times it has waxed to become the feared White Plague of the eighteenth and nineteenth centuries and waned under the impact of effective chemotherapy until its elimination seemed possible by the early twenty-first century. The resurgence of tuberculosis in the past 10 to 15 years, caused by unanticipated events such as the appearance of the human immunodeficiency virus and deteriorating social conditions, also brought with it the problem of multiple drug resistance. Control measures such as tuberculin skin testing, perhaps somewhat forgotten when tuberculosis seemed to be a disease of the past, again became first-line defenses against spread of the disease. Environmental controls must be well understood and used effectively. Diagnosis of tuberculosis requires knowledge of the strengths and shortcomings of the various diagnostic methods and experience in their use. Practitioners are cautioned to remember that no diagnostic method, by itself, can be relied on to confirm or rule out tuberculosis. Well-tested diagnostic methods of chest radiograph, tuberculin skin testing, smear, and culture have been recently supplemented by rapid diagnostic tests based on amplification of bacterial RNA and DNA. More invasive diagnostic methods are sometimes required to diagnose extrapulmonary disease. Two-drug up to seven-drug therapy may be indicated for a case of tuberculosis, depending on evidence of the presence of multiple drug resistance. Duration of treatment can range from 6 to 12 months, also depending on identification of drug-sensitive or drug-resistant organisms. Failure of compliance can be a significant problem in patients who are homeless, or drug abusers, or who for various reasons cannot or will not complete a course of therapy. Directly observed therapy is strongly recommended for these patients, and for assistance in its administration the physician must cooperate with the local or state health department. The health department also must be notified whenever a case of tuberculosis is identified.
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Affiliation(s)
- L J McDermott
- Allegheny University of the Health Sciences, Philadelphia, Pennsylvania, USA
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Affiliation(s)
- J Popay
- Public Health Research and Resource Centre, University of Salford
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Abstract
Tuberculosis has been the subject of much concern in recent years. Notifications have increased, inadequacies in surveillance revealed, and policies for BCG immunisation and screening of immigrants questioned. Until recently the disease was given low priority in the United Kingdom. There is no overall strategic framework for tackling tuberculosis, and fears have been expressed about the future of local tuberculosis control programmes in the new market economy of the NHS. An action plan for tuberculosis within the context of a national programme is urgently required. Only then will a major impact on the incidence of the disease be seen.
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Affiliation(s)
- M R Evans
- Department of Public Health Medicine, South Glamorgan Health Authority, Cardiff, Wales
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