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Kerkhoff AD, Mwamba C, Pry JM, Kagujje M, Nyangu S, Mateyo K, Sanjase N, Chilukutu L, Christopoulos KA, Muyoyeta M, Sharma A. A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001372. [PMID: 37327200 DOI: 10.1371/journal.pgph.0001372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/16/2023] [Indexed: 06/18/2023]
Abstract
Men and women with undiagnosed tuberculosis (TB) in high burden countries may have differential factors influencing their healthcare seeking behaviors and access to TB services, which can result in delayed diagnoses and increase TB-related morbidity and mortality. A convergent, parallel, mixed-methods study design was used to explore and evaluate TB care engagement among adults (≥18 years) with newly diagnosed, microbiologically-confirmed TB attending three public health facilities in Lusaka, Zambia. Quantitative structured surveys characterized the TB care pathway (time to initial care-seeking, diagnosis, and treatment initiation) and collected information on factors influencing care engagement. Multinomial multivariable logistic regression was used to determine predicted probabilities of TB health-seeking behaviors and determinants of care engagement. Qualitative in-depth interviews (IDIs; n = 20) were conducted and analyzed using a hybrid approach to identify barriers and facilitators to TB care engagement by gender. Overall, 400 TB patients completed a structured survey, of which 275 (68.8%) and 125 (31.3%) were men and women, respectively. Men were more likely to be unmarried (39.3% and 27.2%), have a higher median daily income (50 and 30 Zambian Kwacha [ZMW]), alcohol use disorder (70.9% [AUDIT-C score ≥4] and 31.2% [AUDIT-C score ≥3]), and a history of smoking (63.3% and 8.8%), while women were more likely to be religious (96.8% and 70.8%) and living with HIV (70.4% and 36.0%). After adjusting for potential confounders, the probability of delayed health-seeking ≥4 weeks after symptom onset did not differ significantly by gender (44.0% and 36.2%, p = 0.14). While the top reasons for delayed healthcare-seeking were largely similar by gender, men were more likely to report initially perceiving their symptoms as not being serious (94.8% and 78.7%, p = 0.032), while women were more likely to report not knowing the symptoms of TB before their diagnosis (89.5% and 74.4%; p = 0.007) and having a prior bad healthcare experience (26.4% and 9.9%; p = 0.036). Notably, women had a higher probability of receiving TB diagnosis ≥2 weeks after initial healthcare seeking (56.5% and 41.0%, p = 0.007). While men and women reported similar acceptability of health-information sources, they emphasized different trusted messengers. Also, men had a higher adjusted probability of stating that no one influenced their health-related decision making (37.9% and 28.3%, p = 0.001). In IDIs, men recommended TB testing sites at convenient community locations, while women endorsed an incentivized, peer-based, case-finding approach. Sensitization and TB testing strategies at bars and churches were highlighted as promising approaches to reach men and women, respectively. This mixed-methods study found important differences between men and women with TB in Zambia. These differences suggest the need for gender-tailored TB health promotion, including addressing harmful alcohol use and smoking among men, and sensitizing HCWs to prolonged delays in TB diagnosis among women, and also using gender-specific approaches as part of community-based, active case-finding strategies to improve TB diagnosis in high burden settings.
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Affiliation(s)
- Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Division of Epidemiology, University of California Davis, Davis, California, United States of America
| | - Mary Kagujje
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sarah Nyangu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kondwelani Mateyo
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Nsala Sanjase
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, United States of America
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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de Lucena LA, Dantas GBDS, Carneiro TV, Lacerda HG. Factors Associated with the Abandonment of Tuberculosis Treatment in Brazil: A Systematic Review. Rev Soc Bras Med Trop 2023; 56:S0037-86822023000100301. [PMID: 36700598 PMCID: PMC9870282 DOI: 10.1590/0037-8682-0155-2022] [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: 04/25/2022] [Accepted: 10/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis. In Brazil, TB is a public health problem, and the treatment dropout rate contributes to it. METHODS This systematic review investigated the factors associated with TB treatment dropout in Brazil using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The databases used were Bireme, Scopus, PubMed, Medline, Pan-American Health Organization (PAHO), and Latin-American and Caribbean Literature on Health Sciences (LILACS). The search was conducted on May 16, 2021. Nine articles were reviewed, and all were published within the last 5 years in English, Spanish, or Portuguese. RESULTS The sample sizes in the studies ranged from 148 to 77,212 individuals, and the studies enrolled only adult patients (aged 18-59 years) in Brazil. Evidence suggests that the significant risk factors associated with TB treatment dropout are male sex, black race/ethnicity, age between 19 and 49 years, human immunodeficiency virus (HIV) co-infection, low education (<8 years), use of alcohol and illicit drugs, and unsupervised treatment. This study's limitations were the small number of articles published on this topic with stronger study designs, use of secondary data sources in most articles, and a moderate to high risk of bias in most papers. CONCLUSIONS There was a significant association between abandonment of TB treatment and HIV/acquired immunodeficiency syndrome co-infection; socioeconomic factors (low education and homelessness); use of alcohol, tobacco, and illicit drugs; and failure to use directly observed treatment. These results can guide more efficient measures to prevent dropout.
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Affiliation(s)
| | | | | | - Hênio Godeiro Lacerda
- Universidade Federal do Rio Grande do Norte, Departamento de Infectologia, Natal, RN, Brasil
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Barrios-Rivera E, Bastidas-Santacruz HE, Ramirez-Bernate CA, Vasilieva O. A synthesized model of tuberculosis transmission featuring treatment abandonment. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:10882-10914. [PMID: 36124574 DOI: 10.3934/mbe.2022509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this paper, we propose and justify a synthesized version of the tuberculosis transmission model featuring treatment abandonment. In contrast to other models that account for the treatment abandonment, our model has only four state variables or classes (susceptible, latent, infectious, and treated), while people abandoning treatment are not gathered into an additional class. The proposed model retains the core properties that are highly desirable in epidemiological modeling. Namely, the disease transmission dynamics is characterized by the basic reproduction number $ \mathscr{R}_0 $, a threshold value that determines the number of possible steady states and their stability properties. It is shown that the disease-free equilibrium is globally asymptotically stable (GAS) only if $ \mathscr{R}_0 < 1 $, while a strictly positive endemic equilibrium exists and is GAS only if $ \mathscr{R}_0 > 1. $ Analysis of the dependence of $ \mathscr{R}_0 $ on the treatment abandonment rate shows that a reduction of the treatment abandonment rate has a positive effect on the disease incidence and results in avoiding disease-related fatalities.
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Affiliation(s)
- Edwin Barrios-Rivera
- Department of Mathematics, Universidad del Valle, Calle 13 No. 100-00, Cali 760032, Colombia
| | | | | | - Olga Vasilieva
- Department of Mathematics, Universidad del Valle, Calle 13 No. 100-00, Cali 760032, Colombia
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Wang HR, Han C, Wang JL, Zhang YA, Wang MS. Risk Factor for Retreatment Episode on Admission Among TB Patients With Schizophrenia. Front Psychiatry 2021; 12:793470. [PMID: 34955934 PMCID: PMC8695840 DOI: 10.3389/fpsyt.2021.793470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical characteristics of patients with tuberculosis (TB) and schizophrenia remain largely unknown. Furthermore, TB retreatment is associated with a poor outcome. Hence, we aimed to address the risk factors of TB retreatment in schizophrenia patients in this retrospective cohort. Methods: Between March 2005 and August 2020, patients diagnosed with schizophrenia and TB were included in the study. Patient characteristics, such as demographics, medical history, underlying diseases, symptoms, outcome, and lab examinations, were collected from medical records using a structured questionnaire. TB retreatment was defined as treatment failures and relapses. Subsequently, multivariate logistic regression was performed using variables selected based on prior findings as well as factors found to be associated with a retreatment episode in univariate analyses (p < 0.1). Results: A total of 113 TB patients with schizophrenia were included. Of them, 94 (83.2%) patients were classified as initial treatment group, and 19 (16.8%) were classified as retreatment group. The mean age was 53.0 ± 23.2 years, and males accounted for 61.9% of all cases. Multivariate analysis revealed that continuous antipsychotics treatment (OR = 0.226, 95% CI: 0.074, 0.693; p = 0.009) and extra-pulmonary TB (OR = 0.249, 95% CI: 0.080, 0.783; p = 0.017) were associated with the retreatment in TB patients with schizophrenia. Conclusion: Retreatment is a significant concern for TB patients with schizophrenia. To improve the current dilemma, continuous antipsychotics treatment is required, and increasing awareness of schizophrenia would reduce the disease burden.
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Affiliation(s)
- Hai-Rong Wang
- Department of Outpatient, Shandong Mental Health Center, Jinan, China
| | - Chao Han
- Department of Outpatient, Shandong Mental Health Center, Jinan, China
| | - Jun-Li Wang
- Department of Lab Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Yan-An Zhang
- Department of Cardiovascular Surgery, Shandong Public Health Clinical Center, Cheeloo College of Medicine, Shandong University, Jinan, China.,Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China
| | - Mao-Shui Wang
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China.,Department of Lab Medicine, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Lab Medicine, Shandong Public Health Clinical Center, Cheeloo College of Medicine, Shandong University, Jinan, China
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Shirzad-Aski H, Hamidi N, Sohrabi A, Abbasi A, Golsha R, Movahedi J. Incidence, risk factors and clinical characteristics of extra-pulmonary tuberculosis patients: a ten-year study in the North of Iran. Trop Med Int Health 2020; 25:1131-1139. [PMID: 32501638 DOI: 10.1111/tmi.13452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the incidence of extra-pulmonary tuberculosis (EPTB) and examine the risk factors and the clinical features of the disease over a ten-year period. METHODS Retrospective study of records of patients who were followed and registered in the TB registry programme in the health district of Gorgan, Iran from January 1, 2008, through December 31, 2017. RESULTS Among 2280 TB records, 609 (26.71%) were EPTB. They were mostly female patients (53.7%) and residents in rural areas (56.5%) with a mean age of 40.55 years [±16]. The average age of female patients (37.55 years [±16.99]) was lower than of male patients (44.07 years [±20.59]). The median of the incidence rate was 7.5 per 100 000 inhabitants for EPTB; biopsy and pathology were the best methods for the detection of EPTB. The most frequent forms of EPTB were lymphatic TB (193/609 = 31.7%) and pleural TB (158/609 = 25.9%). In most cases (245/609 = 40.2%), one to three months elapsed between occurrence of symptoms and final confirmation of EPTB. The outcome of EPTB was weaker than of pulmonary TB (PTB). CONCLUSION Our most important finding was the increasing incidence of EPTB, which shows the importance of attention to this disease. Lymph node and pleural tissue were the most commonly infected tissues. Skeletal TB presents a challenge in the diagnosis and treatment of EPTB.
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Affiliation(s)
| | - Niloofar Hamidi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ahmad Sohrabi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdollah Abbasi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roghieh Golsha
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Jamileh Movahedi
- Tuberculosis laboratory of Health Care Center, Golestan University of Medical Sciences, Gorgan, Iran
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Izudi J, Tamwesigire IK, Bajunirwe F. Treatment success and mortality among adults with tuberculosis in rural eastern Uganda: a retrospective cohort study. BMC Public Health 2020; 20:501. [PMID: 32295549 PMCID: PMC7161267 DOI: 10.1186/s12889-020-08646-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Successful treatment of tuberculosis leads to clinical and public health benefits such as reduction in transmission, complications, and mortality among patients. However, data are limited on treatment outcomes and the associated factors among persons with bacteriologically confirmed pulmonary (BC-PTB) in rural areas of high dual tuberculosis and Human Immunodeficiency Virus (HIV) burden countries such as Uganda. We investigated factors associated with successful treatment of tuberculosis and mortality among adult persons with BC-PTB in rural eastern Uganda. Methods We constructed a retrospective cohort of persons with BC-PTB from a routine tuberculosis clinic database in eastern Uganda. We performed bivariate and multivariate analysis. Using a 5% level of significance, we ran a modified Poisson regression analysis to determine factors independently associated with treatment success and mortality rates. Results We retrieved 1123 records for persons with BC-PTB and the treatment outcomes were distributed as follows: 477(42.5%) cured, 323 (28.0%) treatment completed, 17(1.5%) treatment failed, 81(7.2%) died, 89(7.9%) lost to follow-up, and 136(12.1%) not evaluated. Overall, 800 (81.1%) of the 987 persons with BC-PTB that had treatment outcome, were successfully treated. Successful treatment of tuberculosis was less likely to occur among those with HIV infection (Adjusted risk ratio (aRR), 0.88; 95% Confidence Interval (CI), 0.82–0.95), older than 50 years (aRR, 0.89; 95% CI, 0.81–0.97), or male sex (aRR, 0.92; 95% CI, 0.87–0.98). Mortality was associated with HIV infection (aRR, 4.48; 95% CI, 2.95–6.79), older than 50 years (aRR, 2.93; 95% CI, 1.74–4.92), year of enrollment into treatment after 2015 (aRR, 0.80; 95% CI, 0.66–0.97), and Community-Based Directly Observed Therapy Short Course (aRR, 0.26; 95% CI, 0.13–0.50). Conclusions Treatment success rate among adult persons with BC-PTB in rural eastern Uganda is suboptimal and mortality rate is high. HIV infection and older age reduce chances of treatment success, and increase mortality rate. Older and HIV infected persons with BC-PTB will require special consideration to optimize treatment success rate and reduce mortality rate.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda.
| | - Imelda K Tamwesigire
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda
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de Lima LMM, de Sá LR, Dos Santos Macambira AFU, de Almeida Nogueira J, de Toledo Vianna RP, de Moraes RM. A new combination rule for Spatial Decision Support Systems for epidemiology. Int J Health Geogr 2019; 18:25. [PMID: 31706302 PMCID: PMC6842522 DOI: 10.1186/s12942-019-0187-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/24/2019] [Indexed: 01/04/2023] Open
Abstract
Background Decision making in the health area usually involves several factors, options and data. In addition, it should take into account technological, social and spatial aspects, among others. Decision making methodologies need to address this set of information , and there is a small group of them with focus on epidemiological purposes, in particular Spatial Decision Support Systems (SDSS). Methods Makes uses a Multiple Criteria Decision Making (MCDM) method as a combining rule of results from a set of SDSS, where each one of them analyzes specific aspects of a complex problem. Specifically, each geo-object of the geographic region is processed, according to its own spatial information, by an SDSS using spatial and non-spatial data, inferential statistics and spatial and spatio-temporal analysis, which are then grouped together by a fuzzy rule-based system that will produce a georeferenced map. This means that, each SDSS provides an initial evaluation for each variable of the problem. The results are combined by the weighted linear combination (WLC) as a criterion in a MCDM problem, producing a final decision map about the priority levels for fight against a disease. In fact, the WLC works as a combining rule for those initial evaluations in a weighted manner, more than a MCDM, i.e., it combines those initial evaluations in order to build the final decision map. Results An example of using this new approach with real epidemiological data of tuberculosis in a Brazilian municipality is provided. As a result, the new approach provides a final map with four priority levels: “non-priority”, “non-priority tendency”, “priority tendency” and “priority”, for the fight against diseases. Conclusion The new approach may help public managers in the planning and direction of health actions, in the reorganization of public services, especially with regard to their levels of priorities.
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Affiliation(s)
- Luciana Moura Mendes de Lima
- Graduate Program in Decision Models and Health, Department of Statistics, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
| | - Laísa Ribeiro de Sá
- Graduate Program in Decision Models and Health, Department of Statistics, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
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Khan AH, Sulaiman SAS, Laghari M, Hassali MA, Muttalif AR, Bhatti Z, Ming LC, Talpur BA. Treatment outcomes and risk factors of extra-pulmonary tuberculosis in patients with co-morbidities. BMC Infect Dis 2019; 19:691. [PMID: 31382889 PMCID: PMC6683549 DOI: 10.1186/s12879-019-4312-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/24/2019] [Indexed: 01/06/2023] Open
Abstract
Background Extra-pulmonary tuberculosis (EPTB) represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aims of the study include evaluation of socio-demographic factors, clinical manifestations, co-morbidities among patients with EPTB and their treatment outcomes. Methods A retrospective study was conducted to recognize the epidemiology facts of EPTB. Individual data for EPTB patients were collected from TB registers, laboratory TB registers, treatment cards and TB medical personal files into a standardized study questionnaire. Crude (COR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined to assess the risk factors for EPTB and unsuccessful treatment outcomes. Results There were 1222 EPTB patients presenting 13.1% of all TB cases during 2006–2008. Pleural effusion and lymph node TB were the most frequent types and accounted for 45.1% of all EPTB cases among study participants. Treatment success rate was 67.6%. The best treatment completion rates were found in children ≤15 years (0.478 [0.231–1.028]; p = 0.05). On multivariate analysis, age group 56–65 years (1.658 [1.157–2.376]; p = 0.006), relapse cases (7.078 [1.585–31.613]; p = 0.010), EPTB-DM (1.773 [1.165–2.698]; p = 0.008), patients with no formal (2.266 [1.254–4.095]; p = 0.001) and secondary level of education (1.889 [1.085–3.288]; p = 0.025) were recorded as statistically positive significant risk factors for unsuccessful treatment outcomes. Patients at the risk of EPTB were more likely to be females (1.524 [1.311–1.746]; p < 0.001), Malays (1.251 [1.056–1.482]; p = 0.010) and Indians (1.450 [1.142–1.842]; p = 0.002), TB-HIV (3.215 [2.347–4.405]; p < 0.001), EPDM-HIV (4.361 [1.657–11.474]; p = 0.003), EPTB-HIV-HEP (4.083 [2.785–5.987]; p < 0.001), those living in urban areas (1.272 [1.109–1.459]; p = 0.001) and no formal education (1.361 [1.018–1.820]; p = 0.037). Conclusion The findings of this study extend the knowledge of EPTB epidemiology and highlight the need for improved EPTB detection in Malaysia, especially in subpopulations with high risk for EPTB and unsuccessful treatment outcomes.
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Affiliation(s)
- Amer Hayat Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Madeeha Laghari
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.,Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Abdul Razak Muttalif
- Department of Respiratory Medicine, Penang General Hospital, George Town, Penang, Malaysia
| | - Zohra Bhatti
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Long Chiau Ming
- School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia.,Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Bandeh Ali Talpur
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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Sarvi F, Moghimbeigi A, Mahjub H, Nasehi M, Khodadost M. Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data. Epidemiol Health 2019; 41:e2019032. [PMID: 31319655 PMCID: PMC6713850 DOI: 10.4178/epih.e2019032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/09/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran. METHODS This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages. RESULTS The risk of mortality from TB was found to increase with the unemployment rate (β^=0.02), illiteracy (β^=0.04), household density per residential unit (β^=1.29), distance between the center of the county and the provincial capital (β^=0.03), and urbanization (β^=0.81). The following other risk factors for TB mortality were identified: diabetes (β^=0.02), human immunodeficiency virus infection (β^=0.04), infection with TB in the most recent 2 years (β^=0.07), injection drug use (β^=0.07), long-term corticosteroid use (β^=0.09), malignant diseases (β^=0.09), chronic kidney disease (β^=0.32), gastrectomy (β^=0.50), chronic malnutrition (β^=0.38), and a body mass index more than 10% under the ideal weight (β^=0.01). However, silicosis had no effect. CONCLUSIONS The results of this study provide useful information on risk factors for mortality from TB.
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Affiliation(s)
- Fatemeh Sarvi
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moghimbeigi
- Modeling of Noncommunicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Mahjub
- Research Center for Health Sciences, Department of Biostatistics, Faculty of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahshid Nasehi
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Khodadost
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kibuule D, Verbeeck RK, Nunurai R, Mavhunga F, Ene E, Godman B, Rennie TW. Predictors of tuberculosis treatment success under the DOTS program in Namibia. Expert Rev Respir Med 2018; 12:979-987. [PMID: 30198358 DOI: 10.1080/17476348.2018.1520637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Optimal treatment success rates are critical to end tuberculosis in Namibia. Despite the scale-up of high quality directly observed therapy short-course strategy (DOTS) in Namibia, treatment success falls short of the global target of 90%. The objective of this study was to ascertain the predictors of treatment success rates under DOTS in Namibia to provide future direction. METHODS A nation-wide comparative analysis of predictors of treatment success was undertaken. Tuberculosis cases in the electronic tuberculosis register were retrospectively reviewed over a 10-year period, 2004-2016. The patient, programmatic, clinical, and treatment predictors of treatment success were determined by multivariate logistic regression modeling using R software. RESULTS 104,603 TB cases were registered at 300 DOTS sites in 37 districts. The 10-year period treatment success rate was 80%, and varied by region (77.2%-89.2%). The patient's sex and age were not significant predictors. The independent predictors for treatment success as were: Region of DOTS implementation (p=0.001), type of directly observed treatment (DOT) supporter (p<0.001), sputum conversion at 2 months (p=0.013), DOT regimen (p<0.001), cotrimoxazole prophylaxis (p=0.002), and HIV co-infection (p=0.001). CONCLUSION Targeted programmatic, clinical and treatment interventions are required to enhance DOTS treatment success in Namibia. These are now ongoing.
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Affiliation(s)
- Dan Kibuule
- a School of Pharmacy, Faculty of Health Sciences , University of Namibia , Windhoek , Namibia
| | - Roger K Verbeeck
- a School of Pharmacy, Faculty of Health Sciences , University of Namibia , Windhoek , Namibia
| | - Ruswa Nunurai
- b Ministry of Health and Social Services , National Tuberculosis and Leprosy Programme , Windhoek , Namibia
| | - Farai Mavhunga
- b Ministry of Health and Social Services , National Tuberculosis and Leprosy Programme , Windhoek , Namibia
| | - Ette Ene
- c Anioxis Corporation , Massachusetts , USA
| | - Brian Godman
- d Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Timothy W Rennie
- a School of Pharmacy, Faculty of Health Sciences , University of Namibia , Windhoek , Namibia
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Olaleye A, Beke A. Determinants of Survival of Patients with Tuberculosis in Developing Countries. Tuberculosis (Edinb) 2018. [DOI: 10.5772/intechopen.75890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Predictors of In-Hospital Mortality among Patients with Pulmonary Tuberculosis: A Systematic Review and Meta-analysis. Sci Rep 2018; 8:7230. [PMID: 29740001 PMCID: PMC5940698 DOI: 10.1038/s41598-018-25409-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/13/2018] [Indexed: 11/08/2022] Open
Abstract
Background: There is uncertainty regarding which factors are associated with in-hospital mortality among patients with pulmonary TB (PTB). The aim of this systematic review and meta-analysis is to identify predictors of in-hospital mortality among patients with PTB. Methods: We searched MEDLINE, EMBASE, and Global Health, for cohort and case-control studies that reported risk factors for in-hospital mortality in PTB. We pooled all factors that were assessed for an association, and presented relative associations as pooled odds ratios (ORs). Results: We identified 2,969 records, of which we retrieved 51 in full text; 11 cohort studies that evaluated 5,468 patients proved eligible. Moderate quality evidence suggested an association with co-morbid malignancy and in-hospital mortality (OR 1.85; 95% CI 1.01–3.40). Low quality evidence showed no association with positive sputum smear (OR 0.99; 95% CI 0.40–2.48), or male sex (OR 1.09, 95% CI 0.84–1.41), and very low quality evidence showed no association with diabetes mellitus (OR 1.31, 95% IC 0.38–4.46), and previous TB infection (OR 2.66, 95% CI 0.48–14.87). Conclusion: Co-morbid malignancy was associated with increased risk of in-hospital death among pulmonary TB patients. There is insufficient evidence to confirm positive sputum smear, male sex, diabetes mellitus, and previous TB infection as predictors of in-hospital mortality in TB patients.
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Kuehne A, Hauer B, Brodhun B, Haas W, Fiebig L. Find and treat or find and lose? Tuberculosis treatment outcomes among screened newly arrived asylum seekers in Germany 2002 to 2014. Euro Surveill 2018; 23:17-00042. [PMID: 29560856 PMCID: PMC5861592 DOI: 10.2807/1560-7917.es.2018.23.11.17-00042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 11/12/2017] [Indexed: 11/20/2022] Open
Abstract
BackgroundGermany has a low tuberculosis (TB) incidence. A relevant and increasing proportion of TB cases is diagnosed among asylum seekers upon screening. Aim: We aimed to assess whether cases identified by screening asylum seekers had equally successful and completely reported treatment outcomes as cases diagnosed by passive case finding and contact tracing in the general population. Methods: We analysed characteristics and treatment outcomes of pulmonary TB cases notified in Germany between 2002 and 2014, stratified by mode of case finding. We performed three multivariable analyses with different dependent variables: Model A: successful vs all other outcomes, Model B: successful vs documented non-successful clinical outcome and Model C: known outcome vs lost to follow-up. Results: TB treatment success was highest among cases identified by contact tracing (87%; 3,139/3,591), followed by passive case finding (74%; 28,804/39,019) and by screening asylum seekers (60%; 884/1,474). Cases identified by screening asylum seekers had 2.4 times higher odds of not having a successful treatment outcome as opposed to all other outcomes (A), 1.4 times higher odds of not having a successful treatment outcome as opposed to known non-successful outcomes (B) and 2.3 times higher odds of loss to follow-up (C) than cases identified by passive case finding. Conclusion: Screened asylum seekers had poorer treatment outcomes and were more often lost to follow-up. Linking patients to treatment facilities and investigating potential barriers to treatment completion are needed to secure screening benefits for asylum seekers and communities.
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Affiliation(s)
- Anna Kuehne
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
- Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany affiliated to the European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden
| | - Barbara Hauer
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
| | - Bonita Brodhun
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
| | - Walter Haas
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
| | - Lena Fiebig
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
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Mundra A, Deshmukh PR, Dawale A. Magnitude and determinants of adverse treatment outcomes among tuberculosis patients registered under Revised National Tuberculosis Control Program in a Tuberculosis Unit, Wardha, Central India: A record-based cohort study. J Epidemiol Glob Health 2017; 7:111-118. [PMID: 28315657 PMCID: PMC7320429 DOI: 10.1016/j.jegh.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Deaths, defaults, relapses, and treatment failures have made the control of TB difficult across the globe. METHODOLOGY This study is a record-based follow-up of a cohort of patients registered under Revised National Tuberculosis Control Program in the year 2014 in Wardha Tuberculosis Unit, India. Data was collected from the records available at the District Tuberculosis Office. RESULTS Data of 510 patients was analyzed. The sputum conversion rate was 88%. The overall treatment success rate was 81.9%, and rates of any adverse outcome, deaths, defaults, failure, and shift to Category IV regimen were 32.60/100 person years at risk (PYAR), 16.88/100 PYAR, 11.12/100 PYAR, 3.45/100 PYAR, and 1.15/100 PYAR, respectively. The median times for the above outcomes were 81days, 110days, 66days, 118days, and 237days, respectively. The cumulative probability of occurrence at 6months of any adverse outcome, deaths, default, failure, and shift to Category IV regimen was 0.145, 0.056, 0.088, 0.002, and 0.004, respectively. On multivariate analysis, the determinant of any adverse outcome was age >45years, whereas extrapulmonary disease was protective. The hazard of defaulting was also significantly higher in male patients and those aged >45years. CONCLUSION Appropriate interventions and program implementation to reduce the adverse treatment outcomes and interruptions will help in improving program performance.
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Affiliation(s)
- Anuj Mundra
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India.
| | - Pradeep R Deshmukh
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India
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30 Years Retrospective Review of Tuberculosis Cases in a Tuberculosis Dispensary in Bursa/Nilufer, Turkey (1985-2014): Changes of Epidemics . Mediterr J Hematol Infect Dis 2016; 8:e2016059. [PMID: 27872739 PMCID: PMC5111538 DOI: 10.4084/mjhid.2016.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/23/2016] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe the epidemiological and clinical aspects of patients who applied to the Bursa Nilufer Tuberculosis Dispensary by investigating the trends in epidemics over three decades. METHOD In this retrospective observational study, the records of all tuberculosis cases (1630 patients) treated in the last 30 years (1985-2014) at the Bursa Nilufer Tuberculosis Dispensary were examined and statistically analyzed. RESULTS Males comprised 65.2% of the patients. The ages of the patients ranged from 1 to 87 years, and the mean age was 37.4 (95% CI: 36.6-38.2). Among the cases, 86.7% were new infections and 74.1% were pulmonary tuberculosis. In the last decade, the education level, the percentage of patients who had received a BCG vaccination, the proportion of women and active employees among them increased (p<0.05), while it decreased among men (p<0.05). Clinical symptoms accompanying TB such as weakness, anorexia, weight loss, and cough, decreased to a statistically significant degree (p<0.05). In the last decade, the mortality rate was 3.6% and increased compared with previous decades (p<0.05). Mortality was higher among patients who were elderly, male, did not have a BCG scar or had a chronic disease (p<0.05). CONCLUSION This study adds information about the change of TB epidemics in Turkey in the last 30 years. Further studies are needed to determine the risk factors associated with tuberculosis mortality and to evaluate the effectiveness control programs of this disease.
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van’t Boveneind-Vrubleuskaya N, Daskapan A, Kosterink JGW, van der Werf TS, van den Hof S, Alffenaar JWC. Predictors of Prolonged TB Treatment in a Dutch Outpatient Setting. PLoS One 2016; 11:e0166030. [PMID: 27832142 PMCID: PMC5104463 DOI: 10.1371/journal.pone.0166030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/21/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Standard treatment duration for drug-susceptible tuberculosis (TB) treatment is 6 months. Treatment duration is often extended—and for various different reasons. The aim of this study was to determine the prevalence and to assess risk factors associated with extended TB treatment. Methods A cross-sectional study was conducted. Data including demographic, clinical, radiological and microbiological information from the Netherlands TB Register (NTR) of 90 patients with smear and culture positive pulmonary TB of the region Haaglanden, The Netherlands, was eligible for analysis. Results Treatment was extended to ≥ 200 days by 46 (51%) patients. Extended TB treatment was associated with a higher frequency of symptoms, presumed to be due to adverse drug reactions (ADR; OR 2.39 95% CI: 1.01–5.69), drug-induced liver injury (DILI) (OR: 13.51; 95% CI: 1.66–109.82) and longer than 2 month smear and culture conversion rate (OR: 11.00; 95% CI: 1.24–97.96 and OR: 8.56; 95% CI: 1.53–47.96). In the multivariable logistic analysis, development of DILI emerged as the single statistically strong risk factor necessitating extension of TB treatment. Conclusion This finding will need further confirmation in a prospective study, exploring the possible mutual role of pharmacokinetic and pharmacogenetic determinants of DILI among TB patients.
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Affiliation(s)
- Natasha van’t Boveneind-Vrubleuskaya
- Department of Public Health TB Control, Metropolitan Public Health Service, The Hague, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- * E-mail:
| | - Alper Daskapan
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Jos G. W. Kosterink
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Tjip S. van der Werf
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jan-Willem C. Alffenaar
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
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