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Monaiar LR, D'Avila KG, Soccol EB, Santos AK, de Braga RSL, Filho FFD, Silva DR. Impact of COVID-19 Pandemic on Tuberculosis and Latent Tuberculosis Infection Diagnosis in Healthcare Workers. J Occup Environ Med 2024; 66:659-661. [PMID: 38664957 DOI: 10.1097/jom.0000000000003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
OBJECTIVE The aim of the study is to compare the prevalence of latent tuberculosis infection and tuberculosis (TB) in the prepandemic period (2017-2019) with the pandemic period (2020-2022), in a group of healthcare workers (HCWs). METHODS This is a retrospective study. Data on TB diagnosis was retrieved from the hospital information system database. All HCWs who underwent tuberculin skin test (TST) from January 2017 to December 2022 were included in the study. RESULTS In the prepandemic period (2017-2019), 163 HCWs out of 710 were TST positive (22.9%), and in the pandemic period (2020-2022), 85 HCWs out of 449 were TST positive (18.9%) ( P = 0.11). There were 10 HCWs diagnosed with TB in the prepandemic period (incidence: 41.7/100,000) and 2 in the pandemic period (incidence: 8.3/100,000) ( P < 0.0001). CONCLUSIONS This study showed that TB incidence was reduced during the pandemic period in HCWs. TST positivity was also reduced, though not statistically significant.
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Affiliation(s)
- Luciana Rott Monaiar
- From the Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil (L.R.M., K.G.D'A., E.B.S., F.F.D.F., D.R.S.); Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil (L.R.M., K.G.D'A., E.B.S., F.F.D.F., D.R.S.); and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil (A.K.S., R.S.L.d.B., D.R.S.)
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Gunsaru V, Henrion MYR, McQuaid CF. The impact of the COVID-19 pandemic on tuberculosis treatment outcomes in 49 high burden countries. BMC Med 2024; 22:312. [PMID: 39075546 PMCID: PMC11288071 DOI: 10.1186/s12916-024-03532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted tuberculosis (TB) health services, including treatment support and access to drugs, as patients were not able to access health facilities. While the effect of this disruption on treatment outcomes has been studied in isolated treatment centres, cities and provinces, the impact of the pandemic on TB treatment outcomes at a country and regional level has not been evaluated. METHODS We used treatment outcomes for new and relapse TB cases reported to the World Health Organization (WHO) from 49 high TB, TB/HIV and drug-resistant TB burden countries from 2012 to 2019. We developed multinomial logistic regression models for trends in TB treatment success, failure, death and loss to follow up. We predicted TB treatment outcomes for 2020 and 2021, comparing these to observations, by computing ratios between observed and predicted probabilities. We aggregated these risk ratios (RR) for six WHO-defined regions using random-effects meta-analysis. RESULTS Across 49 countries and four TB treatment outcomes, 17 (out of 196) country-outcome pairs in 2020 and 21 in 2021 had evidence of systematic differences between observed and predicted TB treatment outcome probabilities. Regionally, only four (out of 24) region-outcome pairs had evidence of systematic differences in 2020 and four in 2021, where the European region accounted for four of these in total. Globally, there was evidence of systematic differences in treatment failure in both 2020 (RR: 1.14, 95%CI: 1.01-1.28, p = 0.0381) and 2021 (RR: 1.36, 95%CI: 1.03-1.78, p = 0.0277), deaths in 2020 (RR: 1.08, 95%CI: 1.03-1.13, p = 0.0010) and losses to follow up in 2020 (RR: 0.91, 95%CI: 0.86-0.97, p = 0.0059). CONCLUSIONS While for some countries and regions there were significant differences between observed and predicted treatment outcomes probabilities, there was insufficient evidence globally to identify systematic differences between observed and expected TB treatment outcome probabilities because of COVID-19-associated disruptions in general. However, larger numbers of treatment failures and deaths on treatment than expected were observed globally, suggesting a need for further investigation.
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Affiliation(s)
| | - Marc Y R Henrion
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - C Finn McQuaid
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Marco MH, Ahmedov S, Castro KG. The global impact of COVID-19 on tuberculosis: A thematic scoping review, 2020-2023. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003043. [PMID: 38959278 PMCID: PMC11221697 DOI: 10.1371/journal.pgph.0003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND This thematic scoping review of publications sought to understand the global impact of COVID-19 on tuberculosis (TB), interpret the scope of resonating themes, and offer policy recommendations to stimulate TB recovery and future pandemic preparedness. DATA SOURCES Publications were captured from three search engines, PubMed, EBSCO, and Google Scholar, and applicable websites written in English from January 1, 2020, to April 30, 2023. STUDY SELECTION Our scoping review was limited to publications detailing the impact of COVID-19 on TB. Original research, reviews, letters, and editorials describing the deleterious and harmful--yet sometimes positive--impact of COVID-19 (sole exposure) on TB (sole outcome) were included. The objective was to methodically categorize the impacts into themes through a comprehensive review of selected studies to provide significant health policy guidance. DATA EXTRACTION Two authors independently screened citations and full texts, while the third arbitrated when consensus was not met. All three performed data extraction. DATA SYNTHESIS/RESULTS Of 1,755 screened publications, 176 (10%) covering 39 countries over 41 months met the inclusion criteria. By independently using a data extraction instrument, the three authors identified ten principal themes from each publication. These themes were later finalized through a consensus decision. The themes encompassed TB's care cascade, patient-centered care, psychosocial issues, and health services: 1) case-finding and notification (n = 45; 26%); 2) diagnosis and laboratory systems (n = 19; 10.7%) 3) prevention, treatment, and care (n = 22; 12.2%); 4) telemedicine/telehealth (n = 12; 6.8%); 5) social determinants of health (n = 14; 8%); 6) airborne infection prevention and control (n = 8; 4.6%); 7) health system strengthening (n = 22; 13%); 8) mental health (n = 13; 7.4%); 9) stigma (n = 11; 6.3%); and 10) health education (n = 10; 5.7%). LIMITATIONS Heterogeneity of publications within themes. CONCLUSIONS We identified ten globally generalizable themes of COVID-19's impact on TB. The impact and lessons learned from the themed analysis propelled us to draft public health policy recommendations to direct evidence-informed guidance that strengthens comprehensive global responses, recovery for TB, and future airborne pandemic preparedness.
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Affiliation(s)
- Michael H. Marco
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Global Health Technical Assistance and Mission Support, Vienna, Virginia, United States of America
| | - Sevim Ahmedov
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Kenneth G. Castro
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Rollins School of Public Health, School of Medicine, Emory/Georgia TB Research Advancement Center, Atlanta, Georgia, United States of America
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Gebreegziabher SB, Ashuro AA, Kumssa TH, Teferi MY, Alemayue EA, Datiko DG, Yimer SA, Shagre MB. Tuberculosis preventive treatment uptake among people living with HIV during COVID-19 period in Addis Ababa, Ethiopia: a retrospective data review. BMC Infect Dis 2024; 24:499. [PMID: 38760665 PMCID: PMC11100166 DOI: 10.1186/s12879-024-09403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Screening for tuberculosis (TB) and providing TB preventive treatment (TPT) along with antiretroviral therapy is key components of human immune deficiency virus (HIV) care. The uptake of TPT during the coronavirus disease 2019 (COVID-19) period has not been adequately assessed in Addis Ababa City Administration. This study aimed at assessing TPT uptake status among People living with HIV (PLHIV) newly initiated on antiretroviral therapy during the COVID-19 period at all public hospitals of Addis Ababa City Administration, Ethiopia. METHODS A retrospective data review was conducted from April-July 2022. Routine District Health Information System 2 database was reviewed for the period from April 2020-March 2022. Proportion and mean with standard deviation were computed. Logistic regression analysis was conducted to assess factors associated with TPT completion. A p-value of < 0.05 was considered statistically significant. RESULTS A total of 1,069 PLHIV, aged 18 years and above were newly initiated on antiretroviral therapy, and of these 1,059 (99.1%) underwent screening for TB symptoms. Nine hundred twelve (86.1%) were negative for TB symptoms. Overall, 78.8% (719) of cases who were negative for TB symptoms were initiated on TPT, and of these 70.5% and 22.8% were completed and discontinued TPT, respectively. Of 719 cases who were initiated on TPT, 334 (46.5%) and 385 (53.5%) were initiated on isoniazid plus rifapentine weekly for three months and Isoniazid preventive therapy daily for six months, respectively. PLHIV who were initiated on isoniazid plus rifapentine weekly for three months were more likely to complete TPT (adjusted odds ratio [AOR],1.68; 95% confidence interval [CI], 1.01, 2.79) compared to those who were initiated on Isoniazid preventive therapy daily for six months. CONCLUSION While the proportion of PLHIV screened for TB was high, TPT uptake was low and far below the national target of achieving 90% TPT coverage. Overall a considerable proportion of cases discontinued TPT in this study. Further strengthening of the programmatic management of latent TB infection among PLHIV is needed. Therefore, efforts should be made by the Addis Ababa City Administration Health Bureau authorities and program managers to strengthen the initiation and completion of TPT among PLHIV in public hospitals.
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Affiliation(s)
| | | | | | | | | | - Daniel Gemechu Datiko
- USAID Eliminate TB Project Health Programs Group Management Sciences for Health, Addis Ababa, Ethiopia
| | - Solomon Abebe Yimer
- Vaccine Research and Development Department, Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
- Faculty of Medicine, Unit for Genome Dynamics, University of Oslo, Oslo, Norway
| | - Mulatu Biru Shagre
- USAID Eliminate TB Project KNCV Tuberculosis Foundation-Ethiopia, Addis Ababa, Ethiopia
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Mashuri YA, Boettiger D, Wahyuningtias SD, Negara SNS, Subronto YW, Liverani M, Wulandari LPL, Ahmad RA, Thabrany H, Fardousi N, Kaldor J, Probandari A, Wiseman V. "I pity the TB patient": a mixed methods study assessing the impact of the COVID-19 pandemic on TB services in two major Indonesian cities and distilling lessons for the future. BMJ Glob Health 2024; 9:e014943. [PMID: 38760026 PMCID: PMC11103193 DOI: 10.1136/bmjgh-2023-014943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/20/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION In Indonesia, a country with around 280 million people and the second-highest tuberculosis (TB) incidence rate in the world, the impact of the COVID-19 pandemic on TB care needs careful assessment so that future response strategies can be strengthened. We conducted a study comparing TB testing and treatment rates before and during the first 2 years of the COVID-19 pandemic in Indonesia, and the reasons for any disruptions to care. METHODS We conducted retrospective secondary data analysis and qualitative interviews in Yogyakarta and Bandung, Indonesia. Routine data on TB testing and treatment were sourced from the national TB information system operated by the Indonesian Ministry of Health. TB testing and treatment outcomes were compared between two time periods: pre-COVID (2018-19); and during COVID-19 (2020-21). In-depth interviews were conducted with patients and health workers to explore their experiences in accessing and providing TB services during the pandemic. RESULTS There was a 45% (21 937/39 962) reduction in the number of patients tested for TB during the pandemic compared with pre-COVID-19, while the proportion of TB tests returning a positive result increased from 12% (4733/39 962) to 50% (10 945/21 937). The proportion of TB patients completing treatment increased by 2.6% during the pandemic, yet the proportion cured and the number of patients successfully treated both decreased (by 7% and 4.4%, respectively). Our qualitative interviews highlighted several factors influencing TB service access and delivery, including fear of being diagnosed with COVID-19 during TB-related clinic visits, fear of COVID-19 exposure among patients and health workers, healthcare facilities prioritising COVID-19 over other services, and mandatory mobility restrictions affecting both patients and health workers. CONCLUSION The COVID-19 pandemic impacted TB testing and treatment outcomes in Bandung and Yogyakarta. Policymakers should consider these findings in designing strategies to ensure TB services are maintained and supported during future health crises.
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Affiliation(s)
- Yusuf Ari Mashuri
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - David Boettiger
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Siska Dian Wahyuningtias
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Srila Nirmithya Salita Negara
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yanri Wijayanti Subronto
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Riris Andono Ahmad
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Biostatistics, Epidemiology, and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Nasser Fardousi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ari Probandari
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Rajotiya S, Mishra S, Singh AK, Debnath S, Raj P, Singh P, Bareth H, Nakash P, Sharma A, Singh M, Nathiya D, Joshi N, Tomar BS. Burden of COVID-19 pandemic on tuberculosis hospitalisation patterns at a tertiary care hospital in Rajasthan, India: a retrospective analysis. BMJ Open 2024; 14:e080623. [PMID: 38702079 PMCID: PMC11086464 DOI: 10.1136/bmjopen-2023-080623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/06/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the burden of the COVID-19 pandemic on tuberculosis (TB) trends, patient demographics, disease types and hospitalisation duration within the Respiratory Medicine Department over three distinct phases: pre-COVID-19, COVID-19 and post-COVID-19. DESIGN Retrospective analysis using electronic medical records of patients with TB admitted between June 2018 and June 2023 was done to explore the impact of COVID-19 on patients with TB. The study employed a meticulous segmentation into pre-COVID-19, COVID-19 and post-COVID-19 eras. SETTING National Institute of Medical Science Hospital in Jaipur, Rajasthan, India. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome includes patients admitted to the Respiratory Medicine Department of the hospital and secondary outcome involves the duration of hospital stay. RESULTS The study encompassed 1845 subjects across the three eras, revealing a reduction in TB incidence during the post-COVID-19 era compared with the pre-COVID-19 period (p<0.01). Substantial demographic shifts were observed, with 5.2% decline in TB incidence among males in the post-COVID-19 era (n=529) compared with the pre-COVID-19 era (n=606). Despite the decrease, overall TB incidence remained significantly higher in males (n=1460) than females (n=385), with consistently elevated rates in rural (65.8%) as compared with the urban areas (34.2%). Extended hospital stays were noted in the post-COVID-19 era compared with the pre-COVID-19 era (p<0.01). CONCLUSION The study underscores the influence of the COVID-19 pandemic on the TB landscape and hospitalisation dynamics. Notably, patient burden of TB declined during the COVID-19 era, with a decline in the post-COVID-19 era compared with the pre-COVID-19 era. Prolonged hospitalisation in the post-COVID-19 period indicates the need for adaptive healthcare strategies and the formulation of public health policies in a post-pandemic context. These findings contribute to a comprehensive understanding of the evolving TB scenario, emphasising the necessity for tailored healthcare approaches in the aftermath of a global health crisis.
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Affiliation(s)
- Sumit Rajotiya
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Shivang Mishra
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Anurag Kumar Singh
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Sourav Debnath
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Preeti Raj
- Department of Public health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pratima Singh
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Hemant Bareth
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Prashant Nakash
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
| | - Anupama Sharma
- Department of Biochemistry, NIMS University, Jaipur, Rajasthan, India
| | - Mahaveer Singh
- Department of Endocrinology, NIMS University, Jaipur, Rajasthan, India
| | - Deepak Nathiya
- Department of Pharmacy Practice, NIMS University, Jaipur, Rajasthan, India
- Department of Clinical Studies, Fourth Hospital of Yulin (Xingyuan), Yulin, Shaanxi, China
- Department of Clinical Sciences, Shenmu Hospital, Shenmu, Shaanxi, China
| | - Nalin Joshi
- Department of Respiratory Medicine, NIMS University, Jaipur, Rajasthan, India
| | - Balvir Singh Tomar
- Department of Clinical Studies, Fourth Hospital of Yulin (Xingyuan), Yulin, Shaanxi, China
- Department of Clinical Sciences, Shenmu Hospital, Shenmu, Shaanxi, China
- Institute of Gastroenterology, Hepatology & Transplant, NIMS University, Jaipur, Rajasthan, India
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Bbuye M, Muyanja SZ, Sekitoleko I, Padalkar R, Robertson N, Helwig M, Hopkinson D, Siddharthan T, Jackson P. Patient level barriers to accessing TB care services during the COVID-19 pandemic in Uganda, a mixed methods study. BMC Health Serv Res 2024; 24:52. [PMID: 38200524 PMCID: PMC10782633 DOI: 10.1186/s12913-023-10513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Lockdown measure has been utilized widely to mitigate COVID-19 pandemic transmission and recently during the 2022 Sudan Ebola Virus Disease outbreak in Uganda. These have setback effects on the continuity of essential health services such as tuberculosis (TB) care, reversing progress made in the fight against tuberculosis (TB) over the past decade. We set out to understand patient-reported barriers to accessing TB care services during the COVID-19 pandemic in Uganda. METHODS Mixed methods study involving review of medical records of TB patients who received TB care from January to September 2020. We used quantitative and qualitative methods including phone questionnaires and in-depth interviews. We carried out descriptive statistics, a chi-square test and conducted a thematic analysis. RESULTS We carried out phone interviews with 672 participants. The majority (60%) were male and with an average of 35 years (SD:11). A significantly higher proportion of patients reported a barrier to TB care access during the COVID-19 lockdown than pre-lockdown (79.9% vs. 68.1% p = 0.027). We carried out in-depth interviews with 28 participants (54% (15/28): male). Barriers experienced by these participants included lack of a means of transport to reach the health facility, lack of money to pay the transport fares, long distances to the facility, fear of COVID-19 infection, stigma due to overlap between TB and COVID-19 symptoms, and few health care workers available during the lockdown period. CONCLUSION Lockdown measures instituted to mitigate the transmission of COVID1-19 affected access to TB care services in Uganda. Uganda is at risk of future emerging and re-emerging diseases of epidemic potential. Therefore, there should be measures to ensure the continuity of essential services such as tuberculosis care during the implementation of future epidemic response interventions such as a lockdown.
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Affiliation(s)
- Mudarshiru Bbuye
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Stella Zawedde Muyanja
- Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Roma Padalkar
- Hackensack University Medical Center, New Jersey, USA
| | - Nicole Robertson
- Hackensack University Medical Center, New Jersey, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Madeline Helwig
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Dennis Hopkinson
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, USA
- Division of Pulmonary and Critical Care, Duke University, Durham, NC, USA
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Peter Jackson
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, USA
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Feasey HRA, Khundi M, Soko RN, Bottomley C, Chiume L, Burchett HED, Nliwasa M, Twabi HH, Mpunga JA, MacPherson P, Corbett EL. Impact of active case-finding for tuberculosis on case-notifications in Blantyre, Malawi: A community-based cluster-randomised trial (SCALE). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002683. [PMID: 38051717 PMCID: PMC10697577 DOI: 10.1371/journal.pgph.0002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
Active case-finding (ACF) for tuberculosis can help find the "missing millions" with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively implemented following 2014 estimates of ~1,000 per 100,000 adults with undiagnosed TB. Following a pre-intervention prevalence survey (May 2019 to March 2020), constrained randomisation allocated neighbourhoods to either door-to-door ACF (sputum microscopy for reported cough >2 weeks) or standard-of-care (SOC). Implementation was interrupted by COVID-19. Cluster-level bacteriologically-confirmed case-notification rate (CNR) ratio within 91 days of ACF was our redefined primary outcome; comparison between arms used Poisson regression with random effects. Secondary outcomes were 91-day CNR ratios comparing all tuberculosis registrations and all non-ACF registrations. Interrupted time series (ITS) analysis of CNRs in the SOC arm examined prevalence survey impact. (ISRCTN11400592). 72 clusters served by 10 study-supported tuberculosis registration centres were randomised to ACF (261,244 adults, 58,944 person-years follow-up) or SOC (256,713 adults, 52,805 person-years). Of 1,192 ACF participants, 13 (1.09%) were smear-positive. Within 91 days, 113 (42 bacteriologically-confirmed) and 108 (33 bacteriologically-confirmed) tuberculosis patients were identified as ACF or SOC cluster residents, respectively. There was no difference by arm, with adjusted 91-day CNR ratios 1.12 (95% CI: 0.61-2.07) for bacteriologically-confirmed tuberculosis; 0.93 (95% CI: 0.68-1.28) for all tuberculosis registrations; and 0.86 (95%CI: 0.63-1.16) for non-ACF (routinely) diagnosed. Of 7,905 ACF and 7,992 SOC pre-intervention survey participants, 12 (0.15%) and 17 (0.21%), respectively, had culture/Xpert-confirmed tuberculosis. ITS analysis showed no survey impact on SOC CNRs. Despite residual undiagnosed tuberculosis of 150 per 100,000 population, there was no increase in tuberculosis notifications from this previously successful approach targeting symptomatic disease, likely due to previous TB ACF and rapid declines in TB burden. In such settings, future ACF should focus on targeted outreach and demand creation, alongside optimised facility-based screening. Trial Registration: ISRCTN11400592.
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Affiliation(s)
| | - McEwen Khundi
- African Institute for Development Policy, Lilongwe, Malawi
| | - Rebecca Nzawa Soko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Lingstone Chiume
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Marriott Nliwasa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hussein H. Twabi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Silva BPMD, Almeida ASD, Sérgio MGDM, Gatto TC, Carasek VP, Yamamura M. Drug-Resistant Tuberculosis and COVID-19: A Scoping Review on a New Threat to Antimicrobial Resistance. Rev Bras Enferm 2023; 76Suppl 1:e20220803. [PMID: 38055430 DOI: 10.1590/0034-7167-2022-0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/14/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To assess the impact of COVID-19 on the morbidity and mortality associated with drug-resistant tuberculosis (DR-TB). METHODS A comprehensive review of articles published in international databases since December 2019 was conducted. The findings are presented in a narrative format, supplemented with tables, diagrams, and a map created using ArcGIS software. RESULTS Thirty-five studies were selected, highlighting the significant consequences of COVID-19 on TB and DR-TB treatment progress. Four main thematic areas were identified: Clinical and epidemiological aspects of the interaction between COVID-19 and DR-TB; Management of physical resources and the team; Challenges and circumstances; Perspectives and possibilities. CONCLUSIONS This study revealed that the COVID-19 pandemic significantly negatively impacted the control of long-standing diseases like TB, particularly in the context of morbidity and mortality related to DR-TB.
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Affiliation(s)
| | | | | | | | | | - Mellina Yamamura
- Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
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Prakoso DA, Istiono W, Mahendradhata Y, Arini M. Acceptability and feasibility of tuberculosis-diabetes mellitus screening implementation in private primary care clinics in Yogyakarta, Indonesia: a qualitative study. BMC Public Health 2023; 23:1908. [PMID: 37789310 PMCID: PMC10546762 DOI: 10.1186/s12889-023-16840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The relationship between Tuberculosis (TB) and Diabetes Mellitus (DM) is intricate and intertwined, posing significant global health challenges. In addition, the increasing prevalence of DM worldwide raises concerns regarding the potential resurgence of tuberculosis. The implementation of tuberculosis prevention strategies is of the utmost importance, especially in countries like Indonesia that encounter a dual burden of TB and DM. The significance of TB screening in private primary care settings for patients with diabetes cannot be overstated. Implementing TB screening protocols in private primary care settings can assist in identifying diabetic patients with tuberculosis. Therefore, this study aims to explore the acceptability and feasibility of tuberculosis-diabetes mellitus screening implementation in private primary care clinics. METHODS We conducted implementation research with an exploratory qualitative design. Fifteen healthcare professionals from five private primary health care clinics in Yogyakarta, Indonesia, participated in five focus groups. The discussions were audio recorded, transcribed verbatim, and thematically analyzed. As part of the feasibility assessment, surveys were conducted in each clinic. We conducted a thematic analysis in accordance with the theoretical framework of acceptability and the feasibility assessment. RESULTS We identified that most private primary care clinics deemed the implementation of TB screening in DM patients acceptable and practicable. We revealed that the majority of diabetes patients enthusiastically accepted TB-DM screening services. In addition, we found that the healthcare professionals at the clinic are aware of the nature of the intervention and demonstrates a positive attitude despite a subtle burden. The stigma associated with COVID-19 has emerged as a new implementation barrier, joining TB stigma, lack of resources, and regulatory issues. We identify concealed and tiered screening as a potential method for enhancing the implementation of TB-DM screening. CONCLUSIONS The implementation of TB screening in DM patients in private primary care clinics had the potential to be acceptable and feasible. To achieve a successful implementation, consideration should be given to supporting factors, hindering factors, and strategies to improve TB screening in DM patients.
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Affiliation(s)
- Denny Anggoro Prakoso
- Doctoral Program of Medical and Health Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Wahyudi Istiono
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yodi Mahendradhata
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Merita Arini
- Master of Hospital Administration, Postgraduate Program, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
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11
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Gonete TZ, Asseffa NA, Gashu KD, Tilahun B, Angaw DA, Jisso M, Tamiso A, Alemayehu A, Fikre R, Abdisa B, Sime H, Yesuf EA, Umer A, Kebede M, Mohammed H, Yazie B, Gurmu KK, Endehabtu BF. Communicable and Non-communicable Diseases Diagnosis and Treatment Service Availability at Primary Health Care Units During COVID-19 Outbreak in Ethiopia. Ethiop J Health Sci 2023; 33:95-104. [PMID: 38352666 PMCID: PMC10859742 DOI: 10.4314/ejhs.v33i2.3s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 02/16/2024] Open
Abstract
Background Non-communicable diseases (NCDs) pose a substantial global health challenge, resulting in an annual death toll of over 15 million individuals aged 30 to 69. Ethiopia, categorized as COVID-19 vulnerable, grapples with NCD treatment challenges. This study aims to assess disease service availability at primary health units in Ethiopia during the pandemic. Methods A facility-based cross-sectional study was conducted from October to December 2021 across regions, encompassing 452 facilities: 92 health centers, 16 primary hospitals, 344 health posts, and 43 districts. Facility selection, based on consultation with regional health bureaus, included high, medium, and low performing establishments. The study employed the WHO tool for COVID-19 capacity assessment and evaluated services for various diseases using descriptive analysis. Results Results reveal service disruptions in the past year: hospitals (55.6%), health centers (21.7%), districts (30.2%), and health posts (17.4%). Main reasons were equipment shortages (42%), lack of skilled personnel (24%), and insufficient infection prevention supplies (18.8%). While tuberculosis treatment was fully available in 23% of health posts and malaria services in 65.7%, some health centers lacked HIV/AIDS, cardiovascular, mental health, and cervical cancer services. Most communicable and non-communicable disease diagnoses and treatments were fully accessible at primary hospitals, except for cervical cancer (56.3%) and mental health (62.5%) services. Conclusion Significant gaps exist in expected services at primary health units. Improving disease care accessibility necessitates strengthening the supply chain, resource management, capacity building, and monitoring systems.
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Affiliation(s)
- Tajebew Zayede Gonete
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Gonder, Ethiopia
| | | | - Kassahun Dessie Gashu
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Gonder, Ethiopia
| | - Binyam Tilahun
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Gonder, Ethiopia
| | - Dessies Abebaw Angaw
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Gonder, Ethiopia
| | - Meskerem Jisso
- Hawassa University, College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Alemu Tamiso
- Hawassa University, College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Akalewold Alemayehu
- Hawassa University, College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Rekiku Fikre
- Hawassa University, College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Biru Abdisa
- Jimma University, Institute of Health, Jimma, Ethiopia
| | - Habtamu Sime
- Jimma University, Institute of Health, Jimma, Ethiopia
| | | | - Abdurezak Umer
- Dire Dawa University, College of Medicine and Health Sciences, Dire Dawa, Ethiopia
| | - Mesfin Kebede
- Dire Dawa University, College of Medicine and Health Sciences, Dire Dawa, Ethiopia
| | - Hussen Mohammed
- Dire Dawa University, College of Medicine and Health Sciences, Dire Dawa, Ethiopia
| | - Bekele Yazie
- Dire Dawa University, College of Medicine and Health Sciences, Dire Dawa, Ethiopia
| | - Kassu Ketema Gurmu
- World Health Organization Country Office for Ethiopia, Universal Health Coverage/Life Course, Health System Strengthening Team, Addis Ababa, Ethiopia
| | - Berhanu Fikadie Endehabtu
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Gonder, Ethiopia
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12
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Tilahun M, Wegayehu T, Wondale B, Gebresilase TT, Gebreyohannes T, Tekola A, Alemu M, Neway S, Adnew B, Nassir MF, Kassahun Y, Aseffa A, Bobosha K. Phenotypic and genotypic drug susceptibility patterns of Mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Central and Southern Ethiopia. PLoS One 2023; 18:e0285063. [PMID: 37682820 PMCID: PMC10491001 DOI: 10.1371/journal.pone.0285063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION The persistence of tuberculosis (TB) infection in some patients after treatment has highlighted the importance of drug susceptibility testing (DST). This study aimed to determine the drug susceptibility patterns of Mycobacterium tuberculosis (M. tuberculosis) isolates from pulmonary TB (PTB) patients in Central and Southern Ethiopia. METHODS A health institution-based cross-sectional study was conducted between July 2021 and April 2022. Sputum samples were collected from newly diagnosed smear microscopy and/or Xpert MTB/RIF-positive PTB patients. The samples were processed and cultivated in Lowenstein-Jensen (LJ) pyruvate and glycerol medium. M. tuberculosis isolates were identified using polymerase chain reaction (PCR) based region of difference 9 (RD9) deletion typing. Phenotypic DST patterns of the isolates were characterized using the BACTEC MGIT™ 960 instrument with SIRE kit. Isoniazid (INH) and Rifampicin (RIF) resistant M. tuberculosis isolates were identified using the GenoType® MTBDRplus assay. RESULTS Sputum samples were collected from 350 PTB patients, 315 (90%) of which were culture-positive, and phenotypic and genotypic DST were determined for 266 and 261 isolates, respectively. Due to invalid results and missing data, 6% (16/266) of the isolates were excluded, while 94% (250/266) were included in the paired analysis. According to the findings, 14.4% (36/250) of the isolates tested positive for resistance to at least one anti-TB drug. Gene mutations were observed only in the rpoB and katG gene loci, indicating RIF and high-level INH resistance. The GenoType® MTBDRplus assay has a sensitivity of 42% and a specificity of 100% in detecting INH-resistant M. tuberculosis isolates, with a kappa value of 0.56 (95%CI: 0.36-0.76) compared to the BACTEC MGIT™ DST. The overall discordance between the two methods was 5.6% (14/250) for INH alone and 0% for RIF resistance and MDR-TB (resistance to both INH and RIF) detection. CONCLUSION This study reveals a higher prevalence of phenotypic and genotypic discordant INH-resistant M. tuberculosis isolates in the study area. The use of whole-genome sequencing (WGS) is essential for gaining a comprehensive understanding of these discrepancies within INH-resistant M. tuberculosis strains.
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Affiliation(s)
- Melaku Tilahun
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Teklu Wegayehu
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Biniam Wondale
- Department of Biology, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia
| | | | | | - Abraham Tekola
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Mekdes Alemu
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Sebsib Neway
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Bethlehem Adnew
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | - Yonas Kassahun
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
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13
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Bekele D, Aragie S, Alene KA, Dejene T, Warkaye S, Mezemir M, Abdena D, Kebebew T, Botore A, Mekonen G, Gutema G, Dufera B, Gemede K, Kenate B, Gobena D, Alemu B, Hailemariam D, Muleta D, Siu GKH, Tafess K. Spatiotemporal Distribution of Tuberculosis in the Oromia Region of Ethiopia: A Hotspot Analysis. Trop Med Infect Dis 2023; 8:437. [PMID: 37755898 PMCID: PMC10536582 DOI: 10.3390/tropicalmed8090437] [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: 07/28/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
Tuberculosis (TB) is a major public health concern in low- and middle-income countries including Ethiopia. This study aimed to assess the spatiotemporal distribution of TB and identify TB risk factors in Ethiopia's Oromia region. Descriptive and spatiotemporal analyses were conducted. Bayesian spatiotemporal modeling was used to identify covariates that accounted for variability in TB and its spatiotemporal distribution. A total of 206,278 new pulmonary TB cases were reported in the Oromia region between 2018 and 2022, with the lowest annual TB case notification (96.93 per 100,000 population) reported in 2020 (i.e., during the COVID-19 pandemic) and the highest TB case notification (106.19 per 100,000 population) reported in 2019. Substantial spatiotemporal variations in the distribution of notified TB case notifications were observed at zonal and district levels with most of the hotspot areas detected in the northern and southern parts of the region. The spatiotemporal distribution of notified TB incidence was positively associated with different ecological variables including temperature (β = 0.142; 95% credible interval (CrI): 0.070, 0.215), wind speed (β = -0.140; 95% CrI: -0.212, -0.068), health service coverage (β = 0.426; 95% CrI: 0.347, 0.505), and population density (β = 0.491; 95% CrI: 0.390, 0.594). The findings of this study indicated that preventive measures considering socio-demographic and health system factors can be targeted to high-risk areas for effective control of TB in the Oromia region. Further studies are needed to develop effective strategies for reducing the burden of TB in hotspot areas.
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Affiliation(s)
- Dereje Bekele
- Communicable and Non-Communicable Diseases Prevention and Control Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (D.A.); (G.M.); (K.G.); (B.A.); (D.H.)
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (S.A.); (G.G.); (B.D.)
| | - Solomon Aragie
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (S.A.); (G.G.); (B.D.)
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Team, Telethon Kids Institute, Perth, WA 6009, Australia;
- School of Public Health, Faculty of Public Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Tariku Dejene
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia;
| | - Samson Warkaye
- Ethiopian Public Health Institute, National Data Management Center for Health, Addis Ababa P.O. Box 1242, Ethiopia;
| | - Melat Mezemir
- Health Promotion and Diseases Prevention Directorate, Addis Ababa City Administration Health Bureau, Addis Ababa P.O. Box 30738, Ethiopia;
| | - Dereje Abdena
- Communicable and Non-Communicable Diseases Prevention and Control Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (D.A.); (G.M.); (K.G.); (B.A.); (D.H.)
| | - Tesfaye Kebebew
- Public Health Emergency Management, Research, and Blood Bank Service Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (T.K.); (A.B.); (B.K.); (D.G.); (D.M.)
| | - Abera Botore
- Public Health Emergency Management, Research, and Blood Bank Service Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (T.K.); (A.B.); (B.K.); (D.G.); (D.M.)
| | - Geremew Mekonen
- Communicable and Non-Communicable Diseases Prevention and Control Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (D.A.); (G.M.); (K.G.); (B.A.); (D.H.)
| | - Gadissa Gutema
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (S.A.); (G.G.); (B.D.)
- National HIV/AIDS and TB Research Directorate, Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Boja Dufera
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; (S.A.); (G.G.); (B.D.)
- Bacterial, Parasitic, and Zoonotic Research Directorate, Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Kolato Gemede
- Communicable and Non-Communicable Diseases Prevention and Control Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (D.A.); (G.M.); (K.G.); (B.A.); (D.H.)
| | - Birhanu Kenate
- Public Health Emergency Management, Research, and Blood Bank Service Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (T.K.); (A.B.); (B.K.); (D.G.); (D.M.)
| | - Dabesa Gobena
- Public Health Emergency Management, Research, and Blood Bank Service Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (T.K.); (A.B.); (B.K.); (D.G.); (D.M.)
| | - Bizuneh Alemu
- Communicable and Non-Communicable Diseases Prevention and Control Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (D.A.); (G.M.); (K.G.); (B.A.); (D.H.)
| | - Dagnachew Hailemariam
- Communicable and Non-Communicable Diseases Prevention and Control Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (D.A.); (G.M.); (K.G.); (B.A.); (D.H.)
| | - Daba Muleta
- Public Health Emergency Management, Research, and Blood Bank Service Directorate, Oromia Region Health Bureau, Addis Ababa P.O. Box 24341, Ethiopia; (T.K.); (A.B.); (B.K.); (D.G.); (D.M.)
| | - Gilman Kit Hang Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong;
| | - Ketema Tafess
- Department of Applied Biology, School of Applied Natural Science, Adama Science and Technology University, Adama P.O. Box 1888, Ethiopia;
- Institute of Pharmaceutical Science, Adama Science and Technology University, Adama P.O. Box 1888, Ethiopia
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14
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Ledesma JR, Basting A, Chu HT, Ma J, Zhang M, Vongpradith A, Novotney A, Dalos J, Zheng P, Murray CJL, Kyu HH. Global-, Regional-, and National-Level Impacts of the COVID-19 Pandemic on Tuberculosis Diagnoses, 2020-2021. Microorganisms 2023; 11:2191. [PMID: 37764035 PMCID: PMC10536333 DOI: 10.3390/microorganisms11092191] [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: 07/31/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Evaluating cross-country variability on the impact of the COVID-19 pandemic on tuberculosis (TB) may provide urgent inputs to control programs as countries recover from the pandemic. We compared expected TB notifications, modeled using trends in annual TB notifications from 2013-2019, with observed TB notifications to compute the observed to expected (OE) ratios for 170 countries. We applied the least absolute shrinkage and selection operator (LASSO) method to identify the covariates, out of 27 pandemic- and tuberculosis-relevant variables, that had the strongest explanatory power for log OE ratios. The COVID-19 pandemic was associated with a 1.55 million (95% CI: 1.26-1.85, 21.0% [17.5-24.6%]) decrease in TB diagnoses in 2020 and a 1.28 million (0.90-1.76, 16.6% [12.1-21.2%]) decrease in 2021 at a global level. India, Indonesia, the Philippines, and China contributed the most to the global declines for both years, while sub-Saharan Africa achieved pre-pandemic levels by 2021 (OE ratio = 1.02 [0.99-1.05]). Age-stratified analyses revealed that the ≥ 65-year-old age group experienced greater relative declines in TB diagnoses compared with the under 65-year-old age group in 2020 (RR = 0.88 [0.81-0.96]) and 2021 (RR = 0.88 [0.79-0.98]) globally. Covariates found to be associated with all-age OE ratios in 2020 were age-standardized smoking prevalence in 2019 (β = 0.973 [0.957-990]), school closures (β = 0.988 [0.977-0.998]), stay-at-home orders (β = 0.993 [0.985-1.00]), SARS-CoV-2 infection rate (β = 0.991 [0.987-0.996]), and proportion of population ≥65 years (β = 0.971 [0.944-0.999]). Further research is needed to clarify the extent to which the observed declines in TB diagnoses were attributable to disruptions in health services, decreases in TB transmission, and COVID-19 mortality among TB patients.
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Affiliation(s)
- Jorge R. Ledesma
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02912, USA
| | - Ann Basting
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Huong T. Chu
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Jianing Ma
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, 1800 Cannon Drive, Columbus, OH 43210, USA;
| | - Meixin Zhang
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Avina Vongpradith
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Amanda Novotney
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Jeremy Dalos
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Hmwe H. Kyu
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; (J.R.L.); (A.B.); (H.T.C.); (M.Z.); (A.V.); (A.N.); (J.D.); (P.Z.); (C.J.L.M.)
- Department of Health Metrics Sciences, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA
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15
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Katende B, Bresser M, Kamele M, Chere L, Tlahali M, Erhardt RM, Muhairwe J, Ayakaka I, Glass TR, Ruhwald M, van Ginneken B, Murphy K, de Vos M, Amstutz A, Mareka M, Mooko SM, Reither K, González Fernández L. Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001488. [PMID: 37531333 PMCID: PMC10395971 DOI: 10.1371/journal.pgph.0001488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Abstract
The surge of the COVID-19 pandemic challenged health services globally, and in Lesotho, the HIV and tuberculosis (TB) services were similarly affected. Integrated, multi-disease diagnostic services were proposed solutions to mitigate these disruptions. We describe and evaluate the effect of an integrated, hospital-based COVID-19, TB and HIV screening and diagnostic model in two rural districts in Lesotho, during the period between December 2020 and August 2022. Adults, hospital staff, and children above 5 years attending two hospitals were pre-screened for COVID-19 and TB symptoms. After a positive pre-screening, participants were offered to enroll in a service model that included clinical evaluation, chest radiography, SARS-CoV-2, TB, and HIV testing. Participants diagnosed with COVID-19, TB, or HIV were contacted after 28 days to evaluate their health status and linkage to HIV and/or TB care services. Of the 179160 participants pre-screened, 6623(3.7%) pre-screened positive, and 4371(66%) were enrolled in this service model. Of the total 458 diagnoses, only 17 happened in children. One positive rapid antigen test for SARS-CoV-2 was found per 11 participants enrolled, one Xpert-positive TB case was diagnosed per 85 people enrolled, and 1 new HIV diagnosis was done per 182 people enrolled. Of the 321(82.9%) participants contacted after 28 days of diagnosis, 304(94.7%) reported to be healthy. Of the individuals that were newly diagnosed with HIV or TB, 18/24(75.0%) and 46/51(90.1%) started treatment within 28 days of the diagnosis. This screening and diagnostic model successfully maintained same-day, integrated COVID-19, TB, and HIV testing services, despite frequent disruptions caused by the surge of COVID-19 waves, healthcare seeking patterns, and the volatile context (social measures, travel restrictions, population lockdowns). There were positive effects in avoiding diagnostic delays and ensuring linkage to services, however, diagnostic yields for adults and children were low. To inform future preparedness plans, research will need to identify essential health interventions and how to optimize them along each phase of the emergency response.
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Affiliation(s)
| | - Moniek Bresser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Lebohang Chere
- Butha-Buthe District Health Management Team, Butha-Buthe, Ministry of Health Lesotho, Maseru, Lesotho
| | - Mosa Tlahali
- Mokhotlong District Health Management Team, Mokhotlong, Ministry of Health Lesotho, Maseru, Lesotho
| | - Rahel Milena Erhardt
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Irene Ayakaka
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | - Tracy R Glass
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Morten Ruhwald
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Radboud UMC, Nijmegen, The Netherlands
| | - Keelin Murphy
- Diagnostic Image Analysis Group, Radboud UMC, Nijmegen, The Netherlands
| | | | - Alain Amstutz
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mathabo Mareka
- National Reference Laboratory, Ministry of Health of Lesotho, Maseru, Lesotho
| | | | - Klaus Reither
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Lucia González Fernández
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Division Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- SolidarMed, Partnerships for Health, Lucerne, Switzerland
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Chippaux JP. COVID-19 impacts on healthcare access in sub-Saharan Africa: an overview. J Venom Anim Toxins Incl Trop Dis 2023; 29:e20230002. [PMID: 37405230 PMCID: PMC10317188 DOI: 10.1590/1678-9199-jvatitd-2023-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
This overview aimed to describe the situation of healthcare access in sub-Saharan Africa, excluding South Africa, during the COVID-19 pandemic. A PubMed® search from March 31, 2020, to August 15, 2022, selected 116 articles. Healthcare access and consequences of COVID-19 were assessed based on comparisons with months before its onset or an identical season in previous years. A general reduction of healthcare delivery, associated with the decline of care quality, and closure of many specialty services were reported. The impact was heterogeneous in space and time, with an increase in urban areas at the beginning of the pandemic (March-June 2020). The return to normalcy was gradual from the 3rd quarter of 2020 until the end of 2021. The impact of COVID-19 on the health system and its use was attributed to (a) conjunctural factors resulting from government actions to mitigate the spread of the epidemic (containment, transportation restrictions, closures of businesses, and places of entertainment or worship); (b) structural factors related to the disruption of public and private facilities and institutions, in particular, the health system; and (c) individual factors linked to the increase in costs, impoverishment of the population, and fear of contamination or stigmatization, which discouraged patients from going to health centers. They have caused considerable socio-economic damage. Several studies emphasized some adaptability of the healthcare offer and resilience of the healthcare system, despite its unpreparedness, which explained a return to normal activities as early as 2022 while the COVID-19 epidemic persisted. There appears to be a strong disproportion between the moderate incidence and severity of COVID-19 in sub-Saharan Africa, and the dramatic impact on healthcare access. Several articles make recommendations for lowering the socioeconomic consequences of future epidemics to ensure better management of health issues.
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Affiliation(s)
- Jean-Philippe Chippaux
- Paris Cité University, Research Institute for Development, Mother and child in tropical environment: pathogens, health system and epidemiological transition, Paris, France
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Coutinho I, Alves LC, Werneck GL, Trajman A. The impact of the COVID-19 pandemic in tuberculosis preventive treatment in Brazil: a retrospective cohort study using secondary data. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100444. [PMID: 36818594 PMCID: PMC9917585 DOI: 10.1016/j.lana.2023.100444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 02/12/2023]
Abstract
Background Disruptions in tuberculosis services have been reported around the world since the emergence of the COVID-19 pandemic. However, the pandemic's effect on tuberculosis preventive treatment (TPT) has been poorly explored. We compared TPT-notified prescriptions and outcomes before and during the pandemic in Brazil. Methods Retrospective cohort using secondary data from the Brazilian TPT information system in five cities with over 1000 notifications. The number of TPT prescriptions was analysed from 6 months after healthcare workers' training, in 2018, to July 2021. The proportion of TPT outcomes by the date of treatment initiation was analysed up to the end of 2020, as most outcomes of TPT started in 2021 were still unknown in July 2021. Joinpoint regression was used to evaluate trends. Findings 14,014 TPT prescriptions were included, most from São Paulo (8032) and Rio de Janeiro (3187). Compared to the same epidemiological weeks in 2019, the number of TPT prescribed in 2020 increased in Rio de Janeiro (82%) and São Paulo (14%) and decreased in Recife (65%), Fortaleza (31%) and Manaus (44%). In 2021, however, there was a 93% reduction in TPT prescriptions in all cities. The proportion of completed TPT remained constant (median = 74%). Interpretation The COVID-19 pandemic in Brazil was associated with a dramatic decrease in TPT prescriptions in 2021. Treatment adherence remained constant, suggesting that health services were able to keep people on treatment but did not perform well in providing opportunities for people to enter care. Efforts are needed to expand access to TPT. Funding Brazilian Ministry of Science, Technology and Innovation, CNPq.
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Affiliation(s)
- Iane Coutinho
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Layana Costa Alves
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Bahia, Brazil
| | - Guilherme Loureiro Werneck
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anete Trajman
- Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- McGill TB International Centre, McGill University, Montreal, Quebec, Canada
- Corresponding author. Rua Macedo Sobrinho 74/203, Humaitá, Rio de Janeiro, RJ, Brazil.
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Chippaux JP. [Impact of COVID-19 on public health in sub-Saharan Africa]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2023; 207:150-164. [PMID: 36628105 PMCID: PMC9816877 DOI: 10.1016/j.banm.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/27/2022] [Indexed: 01/09/2023]
Abstract
Objective This work aimed to assess the impact of COVID-19 on healthcare supply in sub-Saharan Africa except South Africa. Method A search through PubMed® between April 2020 and August 2022 selected 135 articles. The impact of COVID-19 was assessed on comparisons with the months prior to the onset of COVID-19 or an identical season in previous years. Results The decline of health services, associated with a reduction in their quality, and the closure of specialized health units have been reported. Many control programs and public health interventions have been interrupted, with the risk of an increase of the corresponding diseases. Social disorganization has generated mental health issues among the population, including health personnel. The impact was heterogeneous in space and time. The main causes were attributed to containment measures (transport restrictions, trade closures) and the lack of human and material resources. The increase in costs, in addition to the impoverishment of the population, and the fear of being contaminated or stigmatized have discouraged patients from going to health centres. The studies mention the gradual return to normal after the first epidemic wave and the resilience of the healthcare system. Conclusion Several articles make recommendations aimed at reducing the impact of future epidemics: support for community workers, training of health workers and reorganization of services to improve the reception and care of patients, technological innovations (use of telephones, drones, etc.) and better information monitoring.
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Masina HV, Lin IF, Chien LY. The Impact of the COVID-19 Pandemic on Tuberculosis Case Notification and Treatment Outcomes in Eswatini. Int J Public Health 2022; 67:1605225. [PMID: 36387290 PMCID: PMC9643149 DOI: 10.3389/ijph.2022.1605225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: We investigated the impact of COVID-19 on tuberculosis (TB) case notification and treatment outcomes in Eswatini. Methods: A comparative retrospective cohort study was conducted using TB data from eight facilities. An interrupted time series analysis, using segmented Poisson regression was done to assess the impact of COVID-19 on TB case notification comparing period before (December 2018-February 2020, n = 1,560) and during the pandemic (March 2020–May 2021, n = 840). Case notification was defined as number of TB cases registered in the TB treatment register. Treatment outcomes was result assigned to patients at the end of treatment according to WHO rules. Results: There was a significant decrease in TB case notification (IRR 0.71, 95% CI: 0.60–0.83) and a significant increase in death rate among registrants during the pandemic (21.3%) compared to pre-pandemic (10.8%, p < 0.01). Logistic regression indicated higher odds of unfavorable outcomes (death, lost-to-follow-up, and not evaluated) during the pandemic than pre-pandemic (aOR 2.91, 95% CI: 2.17–3.89). Conclusion: COVID-19 negatively impacted TB services in Eswatini. Eswatini should invest in strategies to safe-guard the health system against similar pandemics.
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Affiliation(s)
| | - I-Feng Lin
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Li-Yin Chien,
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Sotgiu G, Mondoni M. TB/Covid-19: An Underestimated Risk? Arch Bronconeumol 2022; 58:742-743. [PMID: 35908987 PMCID: PMC9305372 DOI: 10.1016/j.arbres.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022]
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Chimsimbe M, Mucheto P, Juru TP, Chadambuka A, Govha E, Gombe NT, Tshimanga M. An evaluation of childhood tuberculosis program in Chegutu District, Zimbabwe, 2020: a descriptive cross-sectional study. BMC Health Serv Res 2022; 22:500. [PMID: 35421993 PMCID: PMC9008389 DOI: 10.1186/s12913-022-07918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. METHODS We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. RESULTS The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW's negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. CONCLUSION The childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.
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Affiliation(s)
- Memory Chimsimbe
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Pride Mucheto
- Department of Oral Health, University of Zimbabwe, Harare, Zimbabwe
| | - Tsitsi Patience Juru
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Addmore Chadambuka
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
- Zimbabwe Field Epidemiology Training Program, 3-68 Kaguvi Building, Corner 4th/Central Avenue, Harare, Zimbabwe
| | - Emmanuel Govha
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Notion Tafara Gombe
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
- African Field Epidemiology Network, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
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22
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Asemahagn MA. Missed Tuberculosis Investigations and Associated Factors in Patients with Symptoms Indicative of Tuberculosis at Public Health Institutions in Northwest Ethiopia: The Application of a Negative Binomial Model. Infect Drug Resist 2022; 15:1947-1956. [PMID: 35469307 PMCID: PMC9034845 DOI: 10.2147/idr.s355247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis (TB) remains one of the top health problems in Ethiopia, and over one-third of estimated TB cases remain undetected. This study examined the magnitude and factors of missed opportunities for TB investigation at public health facilities in Northwest Ethiopia. Methods A facility-based cross-sectional study was conducted among 412 adult patients with TB symptoms from 34 randomly selected public health facilities. Data on socio-demographics, TB symptoms, and clinical status were collected by an exit interview. A patient was considered missed for TB investigation if he/she had at least one symptom suggestive of TB but did not receive a sputum smear and/or x-ray evaluation to rule out TB. We computed descriptive and analytical statistics using SPSS version 26. A negative binomial regression analysis was used to identify factors associated with missed opportunities for TB investigation. Statistical significance was determined at a p-value less than 0.05. Results A total of 412 presumptive TB patients, 235 (57%) females and 247 (60%) rural dwellers were interviewed. The mean age of respondents was 35 ± 8 years and 228 (55.3%) were from health centers. Over two-thirds, 284 (69%) were new patients, 62 (15%) were HIV positive and 78 (19%) had diabetes mellitus (DM). Fifty patients with symptoms suggestive of TB did not receive sputum evaluation services. Inability to read and write, having DM, having normal body mass index and facility type they visited were significant factors to missing opportunities to get TB investigations. Conclusion A significant number of patients with symptoms suggestive of TB were missed for sputum evaluation to rule out TB. Education level, comorbidity, nutritional status and type of facility patients attended were factors of missing opportunities for TB investigation. Thus, improving quality of TB diagnosis, screening TB among all types of patients, and paying attention to screen illiterate people are crucial to avoid missing potential TB cases.
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Affiliation(s)
- Mulusew Andualem Asemahagn
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Correspondence: Mulusew Andualem Asemahagn, Email
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