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Miles JR, Lu P, Bai S, Aguillón-Durán GP, Rodríguez-Herrera JE, Gunn BM, Restrepo BI, Lu LL. Antigen specificity shapes antibody functions in tuberculosis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.03.597169. [PMID: 38895452 PMCID: PMC11185737 DOI: 10.1101/2024.06.03.597169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Tuberculosis (TB) is the number one infectious disease cause of death worldwide in part due to an incomplete understanding of immunity. Emerging data highlight antibody functions as correlates of protection and disease across human TB. However, little is known about how antibody functions impact Mycobacterium tuberculosis (Mtb), the causative agent. Here, we use antigen specificity to understand how antibodies mediate host-Mtb interactions. We focus on Mtb cell wall and ESAT-6 & CFP-10, critical bacterial structural and secreted virulence proteins. In polyclonal IgG from TB patients, we observe that antigen specificity alters IgG subclass and glycosylation that drives Fc receptor binding and effector functions. Through in vitro models of Mtb macrophage infection we find that Mtb cell wall IgG3, sialic acid, and fucose increase opsonophagocytosis of extracellular Mtb and bacterial burden, suggesting that some polyclonal IgG enhance disease. In contrast, ESAT-6 & CFP-10 IgG1 inhibits intracellular Mtb, suggesting that antibodies targeting secreted virulence factors are protective. We test this hypothesis by generating a mAb that reacts to ESAT-6 & CFP-10 and show that it alone inhibits intracellular Mtb. Understanding which antigens elicit antibody mediated disease enhancement and or protection will be critical in appreciating the many roles for antibodies in TB.
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Affiliation(s)
- Joshua R Miles
- UT Southwestern Medical Center, Department of Immunology
| | - Pei Lu
- UT Southwestern Medical Center, Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine
| | - Shuangyi Bai
- Paul G. Allen School of Global Health, College of Veterinary Medicine, Washington State University
| | - Genesis P Aguillón-Durán
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA
| | - Javier E Rodríguez-Herrera
- Departamento Estatal de Micobacteriosis, Secretaría de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370, Tamaulipas, México
| | - Bronwyn M Gunn
- Paul G. Allen School of Global Health, College of Veterinary Medicine, Washington State University
| | - Blanca I Restrepo
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville campus, Brownsville, TX, USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, USA
- I.CARE and Population Health, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Lenette L Lu
- UT Southwestern Medical Center, Department of Immunology
- UT Southwestern Medical Center, Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine
- Parkland Health
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Bailey SL, Floyd S, Cheeba-Lengwe M, Maluzi K, Chiwele-Kangololo K, Kaluba-Milimo D, Amofa-Sekyi M, Yudkin JS, Godfrey-Faussett P, Ayles H. The Effect of HIV on the Association of Hyperglycaemia and Active Tuberculosis in Zambia, a Case-Control Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00236-2. [PMID: 38713341 DOI: 10.1007/s44197-024-00236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To determine if HIV modifies the association between hyperglycaemia and active tuberculosis in Lusaka, Zambia. METHODS A case-control study among newly-diagnosed adult tuberculosis cases and population controls in three areas of Lusaka. Hyperglycaemia is determined by random blood glucose (RBG) concentration measured at the time of recruitment; active tuberculosis disease by clinical diagnosis, and HIV status by serological result. Multivariable logistic regression is used to explore the primary association and effect modification by HIV. RESULTS The prevalence of RBG concentration ≥ 11.1 mmol/L among 3843 tuberculosis cases was 1.4% and among 6977 controls was 1.5%. Overall, the adjusted odds ratio of active tuberculosis was 1.60 (95% CI 0.91-2.82) comparing those with RBG concentration ≥ 11.1- < 11.1 mmol/L. The corresponding adjusted odds ratio among those with and without HIV was 5.47 (95% CI 1.29-23.21) and 1.17 (95% CI 0.61-2.27) respectively; p-value for effect modification by HIV = 0.042. On subgroup analysis, the adjusted odds ratio of smear/Xpert-positive tuberculosis was 2.97 (95% CI 1.49-5.90) comparing RBG concentration ≥ 11.1- < 11.1 mmol/L. CONCLUSIONS Overall, no evidence of association between hyperglycaemia and active tuberculosis was found, though among those with HIV and/or smear/Xpert-positive tuberculosis there was evidence of association. Differentiation of hyperglycaemia caused by diabetes mellitus and stress-induced hyperglycaemia secondary to tuberculosis infection is important for a better understanding of these findings.
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Affiliation(s)
- Sarah Lou Bailey
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
- Zambart, Lusaka, Zambia.
| | - Sian Floyd
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - John S Yudkin
- Division of Medicine, University College London, London, UK
| | - Peter Godfrey-Faussett
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
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Kibirige D, Andia-Biraro I, Olum R, Adakun S, Zawedde-Muyanja S, Sekaggya-Wiltshire C, Kimuli I. Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population. BMC Infect Dis 2024; 24:242. [PMID: 38389045 PMCID: PMC10885501 DOI: 10.1186/s12879-024-09111-8] [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: 05/20/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity. METHODS In this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used. RESULTS A total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27-42) years, 19.2 (17.6-21.3) kg/m2, and 6.1 (5.5-7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9-18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35-7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10-0.74, p = 0.01). CONCLUSION TB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.
- Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis ward, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
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Gizamba JM, Davies J, Africa C, Choo-Kang C, Goedecke JH, Madlala H, Lambert EV, Rae DE, Myer L, Luke A, Dugas LR. Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:861. [PMID: 38062372 PMCID: PMC10704741 DOI: 10.1186/s12879-023-08736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa. METHODS In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran's Q statistic. RESULTS We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022. CONCLUSIONS These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting.
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Affiliation(s)
- Jacob M Gizamba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Jess Davies
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Chad Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Candice Choo-Kang
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Julia H Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Hlengiwe Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Estelle V Lambert
- Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dale E Rae
- Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amy Luke
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Lara R Dugas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
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Xu G, Hu X, Lian Y, Li X. Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:813. [PMID: 37986146 PMCID: PMC10662654 DOI: 10.1186/s12879-023-08765-0] [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: 11/16/2022] [Accepted: 10/29/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Both tuberculosis (TB) and diabetes mellitus (DM) are major public health problems threatening global health. TB patients with DM have a higher bacterial burden and affect the absorption and metabolism for anti-TB drugs. Drug-resistant TB (DR-TB) with DM make control TB more difficult. METHODS This study was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. We searched PubMed, Excerpta Medica Database (EMBASE), Web of Science, ScienceDirect and Cochrance Library for literature published in English until July 2022. Papers were limited to those reporting the association between DM and treatment outcomes among DR-TB and multidrug-resistant TB (MDR-TB) patients. The strength of association was presented as odds ratios (ORs) and their 95% confidence intervals (CIs) using the fixed-effects or random-effects models. This study was registered with PROSPERO, number CRD: 42,022,350,214. RESULTS A total of twenty-five studies involving 16,905 DR-TB participants were included in the meta-analysis, of which 10,124 (59.89%) participants were MDR-TB patients, and 1,952 (11.54%) had DM history. In DR-TB patients, the pooled OR was 1.56 (95% CI: 1.24-1.96) for unsuccessful outcomes, 0.64 (95% CI: 0.44-0.94) for cured treatment outcomes, 0.63 (95% CI: 0.46-0.86) for completed treatment outcomes, and 1.28 (95% CI: 1.03-1.58) for treatment failure. Among MDR-TB patients, the pooled OR was 1.57 (95% CI: 1.20-2.04) for unsuccessful treatment outcomes, 0.55 (95% CI: 0.35-0.87) for cured treatment outcomes, 0.66 (95% CI: 0.46-0.93) for treatment completed treatment outcomes and 1.37 (95% CI: 1.08-1.75) for treatment failure. CONCLUSION DM is a risk factor for adverse outcomes of DR-TB or MDR-TB patients. Controlling hyperglycemia may contribute to the favorite prognosis of TB. Our findings support the importance for diagnosing DM in DR-TB /MDR-TB, and it is needed to control glucose and therapeutic monitoring during the treatment of DR-TB /MDR-TB patients.
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Affiliation(s)
- Guisheng Xu
- Department of Preventive Medicine, Public Health Administration College, Jiangsu Health Vocational College, 69 Huang-shanling Road, Pukou District, Nanjing, Jiangsu Province, 211800, China.
- Department of Hygiene, Luhe District Center for Disease Control and Prevention, 8 Meteorological Road, Luhe District, Nanjing, Jiangsu Province, 211500, China.
| | - Xiaojiang Hu
- Department of Preventive Medicine, Public Health Administration College, Jiangsu Health Vocational College, 69 Huang-shanling Road, Pukou District, Nanjing, Jiangsu Province, 211800, China
| | - Yanshu Lian
- Department of Health Management and Medical Nutrition, Public Health Administration College, Jiangsu Health Vocational College, 69 Huang-shanling Road, Pukou District, Nanjing, Jiangsu Province, 211800, China
| | - Xiuting Li
- Department of Preventive Medicine, Public Health Administration College, Jiangsu Health Vocational College, 69 Huang-shanling Road, Pukou District, Nanjing, Jiangsu Province, 211800, China
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Aging with HIV: Increased Risk of HIV Comorbidities in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042359. [PMID: 35206544 PMCID: PMC8872228 DOI: 10.3390/ijerph19042359] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 12/10/2022]
Abstract
With improved access to antiretroviral treatment (ART), adults with HIV live longer to reach older age. The number of older adults living with HIV is increasing steadily, giving rise to a new population of interest in HIV research and for invigorated considerations in health service delivery and policy. We analysed the profile of comorbidities in older people (50 years and older) living with HIV in South Africa. We conducted a secondary analysis of all individuals over 15 years who tested HIV positive in the Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017. We conducted multivariate logistic regression to determine the factors associated with having HIV comorbidity using Stata 15.0 software. We entered 3755 people living with HIV into the analysis, of whom 18.3% (n = 688) were 50 years or older. Older adults had four times greater odds (OR = 4.7 (3.1-7.0)) of having an HIV comorbidity compared to younger adults. Being female (OR = 1.6 (1.1-2.4)) and living in an urban area (OR = 2.6 (1.8-3.7)) increased the odds of HIV comorbidity. Older adults with HIV require comprehensive health care to deal with multimorbidity, to maximise the benefits gained by advances in HIV therapies.
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7
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Arriaga MB, Araújo-Pereira M, Barreto-Duarte B, Sales C, Miguez-Pinto JP, Nogueira EB, Nogueira BMF, Rocha MS, Souza AB, Benjamin A, de Oliveira JG, Moreira ASR, Queiroz ATL, Rodrigues MMS, Spener-Gomes R, Figueiredo MC, Durovni B, Cavalcante S, Lapa-e-Silva JR, Kristki AL, Cordeiro-Santos M, Sterling TR, Rolla VC, Andrade BB. Prevalence and Clinical Profiling of Dysglycemia and HIV Infection in Persons With Pulmonary Tuberculosis in Brazil. Front Med (Lausanne) 2022; 8:804173. [PMID: 35127760 PMCID: PMC8814308 DOI: 10.3389/fmed.2021.804173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are scarce data on the prevalence and disease presentation of HIV in patients with tuberculosis (TB) and dysglycemia (diabetes [DM] and prediabetes [PDM]), especially in TB-endemic countries. METHODS We assessed the baseline epidemiological and clinical characteristics of patients with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort in Brazil (RePORT-Brazil) during 2015-2019. Dysglycemia was defined by elevated glycated hemoglobin and stratified as PDM or DM. Additionally, we used data from TB cases obtained through the Brazilian National Notifiable Diseases Information System (SINAN), during 2015-2019. In SINAN, diagnosis of diabetes was based on self-report. Logistic regression models were performed to test independent associations between HIV, dysglycemia status, and other baseline characteristics in both cohorts. RESULTS In the RePORT-Brazil cohort, the prevalence of DM and of PDM was 23.7 and 37.8%, respectively. Furthermore, the prevalence of HIV was 21.4% in the group of persons with TB-dysglycemia and 20.5% in that of patients with TBDM. In the SINAN cohort, the prevalence of DM was 9.2%, and among the TBDM group the prevalence of HIV was 4.1%. Logistic regressions demonstrated that aging was independently associated with PDM or DM in both the RePORT-Brazil and SINAN cohorts. In RePORT-Brazil, illicit drug use was associated with PDM, whereas a higher body mass index (BMI) was associated with DM occurrence. Of note, HIV was not associated with an increased risk of PDM or DM in patients with pulmonary TB in both cohorts. Moreover, in both cohorts, the TBDM-HIV group presented with a lower proportion of positive sputum smear and a higher frequency of tobacco and alcohol users. CONCLUSION There is a high prevalence of dysglycemia in patients with pulmonary TB in Brazil, regardless of the HIV status. This reinforces the idea that DM should be systematically screened in persons with TB. Presence of HIV does not substantially impact clinical presentation in persons with TBDM, although it is associated with more frequent use of recreational drugs and smear negative sputum samples during TB screening.
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Affiliation(s)
- María B. Arriaga
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Beatriz Barreto-Duarte
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Escola de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil,Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caio Sales
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Escola de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
| | - João Pedro Miguez-Pinto
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Escola de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
| | - Evelyn B. Nogueira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Escola de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
| | - Betânia M. F. Nogueira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil,Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
| | - Michael S. Rocha
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil,Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Alexandra B. Souza
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Aline Benjamin
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | | | - Adriana S. R. Moreira
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Artur T. L. Queiroz
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Moreno M. S. Rodrigues
- Laboratório de Análise e Visualização de Dados, Fundação Oswaldo Cruz, Porto Velho, Brazil
| | - Renata Spener-Gomes
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Marina C. Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Betina Durovni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - José R. Lapa-e-Silva
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil,Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Afrânio L. Kristki
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil,Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil,Faculdade de Medicina, Universidade Nilton Lins, Manaus, Brazil
| | - Timothy R. Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Valeria C. Rolla
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Bruno B. Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil,Escola de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil,Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States,*Correspondence: Bruno B. Andrade
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Parvin D, Mosa ASM, Knight L, Schatz EJ. Development of a Tablet Computer Application for HIV Testing and Risk History Calendar for Use With Older Africans. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:671747. [DOI: 10.3389/frph.2021.671747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Life history calendars (LHCs) are able to capture large-scale retrospective quantitative data, which can be utilized to learn about transitions of behavior change over time. The Testing and Risk History Calendar (TRHC) is a version of life history calendar (LHC) which correlates critical social, sexual and health variables with the timing of HIV testing. In order to fulfill the need for time-bound data regarding HIV testing and risk of older persons in South Africa, a pilot of the TRHC was performed using a paper fold-out grid format. Though the TRHC study in this format was effective as older persons were able to recall details about their HIV testing and risk contexts, the interview process was tedious as data were collected manually. Development of a tablet application for TRHC study will improve data quality and make data entry and collection more automated. This paper presents the development of the TRHC application prototype in order to collect TRHC data electronically and provides a platform for efficient large-scale life history calendar data collection.
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Lotter N, Lahri S, van Hoving D. The burden of diabetic emergencies on the resuscitation area of a district-level public hospital in Cape Town. Afr J Emerg Med 2021; 11:416-421. [PMID: 34703733 PMCID: PMC8524109 DOI: 10.1016/j.afjem.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/12/2021] [Accepted: 05/21/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Diabetes and its complications continue to cause a daunting and growing concern on resource-limited environments. There is a paucity of data relating to the care of diabetic emergencies in the emergency centres of entry-level hospitals in Africa. The aim of this study was to describe the burden of diabetic emergencies presenting to the emergency centre of an urban district-level hospital in Cape Town, South Africa. METHODS The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for patients presenting with a diabetic emergency within a 24-week randomly selected period. The database was supplemented by a retrospective chart review to include additional variables for participants with diabetic ketoacidosis (DKA), uncomplicated hyperglycaemia, severe hypoglycaemia and hyperosmolar hyperglycaemic state (HHS). Summary statistics are presented of all variables. RESULTS The prevalence of all diabetic emergencies was 8.1% (197/2424) (DKA n = 96, 48.7%; uncomplicated hyperglycaemia n = 45, 22.8%; severe hypoglycaemia n = 44, 22.3%; HHS n = 12, 6%). The median age was 48 years, with those presenting with DKA being substantially younger (36 years). A likely precipitant was identified in 175 (88%) patients; infection was the most common precipitant (n = 79, 40.1%). Acute kidney injury occurred in 80 (40.6%) cases. The median length of stay in the resuscitation area was 13 h (IQR 7.2-24) and 101 (51.3%) participants represented with a diabetic- related emergency within six months of the study period. The overall mortality rate was 5% (n = 10). CONCLUSION This study highlights the high burden of diabetic emergencies on the provision of acute care at a district-level hospital. The high prevalence of diabetic emergencies (8%) consisted of DKA (48.7%), uncomplicated hyperglycaemia (22.8%), severe hypoglycaemia (22.3%), and HHS (6%). The high infection rate (40%) and the high percentage of patients returning with a diabetic emergency (51%) could be indicative of the need for improved community-based diabetic programmes.
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10
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Hango E, Amakali K, Shilunga A, Kibuule D, Godman B, Kalemeera F. Assessing smoking cessation services and pharmacotherapy in Namibia; findings and implications for future policy initiatives. Expert Rev Pharmacoecon Outcomes Res 2021; 22:699-710. [PMID: 34720025 DOI: 10.1080/14737167.2022.2000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND : Tobacco smoking is a considerable barrier to reducing morbidity and mortality associated with non-communicable diseases (NCDs). However, few studies in sub-Saharan Africa have explored access to smoking cessation programs including smoking cessation pharmacotherapy (SCP). This needs to be addressed given the growing burden of NCDs across sub-Saharan Africa including Namibia. METHODS : Multi-facility cross sectional survey among physicians in both public and private sectors in Namibia. RESULTS : Of the 106 physicians recruited, 69% practiced in public health facilities and 92% were non-smokers. 67% offer smoking cessation services, with 64% of these offering SCP. This was mainly nicotine replacement therapy (53%) and bupropion SR (41%). Overall, all physicians had a low knowledge score of SCP (<50%). The mean knowledge score though was 77% lower among physicians in public versus private sectors (OR=0.23, 95%CI: 0.14-0.35, p<0.001). Principal barriers to prescribing SCP were inadequate knowledge and/or lack of smoking cessation guidelines. This is not surprising with SCP medicines not currently listed within the public medicine list in Namibia. CONCLUSION : Despite good attitudes towards SCP, there are concerns with physicians' knowledge and practices especially in the public sector. There is an urgent need to address this and integrate services to reduce NCDs in Namibia.
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Affiliation(s)
- Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
| | - Kristofina Amakali
- School of Nursing, Faculty of Health Sciences, University of Namibia, Namibia
| | - Anna Shilunga
- School of Public Health, Faculty of Health Sciences, University of Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
| | - Brian Godman
- Strathchlyde Institute of Pharmacy and Biomedical Science, Strathclyde University, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Namibia
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11
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Kubiak RW, Kratz M, Motala AA, Galagan S, Govere S, Brown ER, Moosa MYS, Drain PK. Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study. BMC Infect Dis 2021; 21:789. [PMID: 34376173 PMCID: PMC8353828 DOI: 10.1186/s12879-021-06473-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND HIV clinical care programs in high burden settings are uniquely positioned to facilitate diabetes diagnosis, which is a major challenge. However, in sub-Saharan Africa, data on the burden of diabetes among people living with HIV (PLHIV) and its impact on HIV outcomes is sparse. METHODS We enrolled adults presenting for HIV testing at an outpatient clinic in Durban. Those who tested positive for HIV-infection were screened for diabetes using a point-of-care hemoglobin A1c (HbA1c) test. We used log-binomial, Poisson, and Cox proportional hazard models adjusting for confounders to estimate the relationship of diabetes (HbA1c ≥ 6.5%) with the outcomes of HIV viral suppression (< 50 copies/mL) 4-8 months after antiretroviral therapy initiation, retention in care, hospitalization, tuberculosis, and death over 12 months. RESULTS Among 1369 PLHIV, 0.5% (n = 7) reported a prior diabetes diagnosis, 20.6% (95% CI 18.5-22.8%, n = 282) screened positive for pre-diabetes (HbA1c 5.7-6.4%) and 3.5% (95% CI 2.7-4.6%, n = 48) for diabetes. The number needed to screen to identify one new PLHIV with diabetes was 46.5 persons overall and 36.5 restricting to those with BMI ≥ 25 kg/m2. Compared to PLHIV without diabetes, the risk of study outcomes among those with diabetes was not statistically significant, although the adjusted hazard of death was 1.79 (95% CI 0.41-7.87). CONCLUSIONS Diabetes and pre-diabetes were common among adults testing positive for HIV and associated with death. Clinic-based diabetes screening could be targeted to higher risk groups and may improve HIV treatment outcomes.
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Affiliation(s)
- Rachel W Kubiak
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA.
| | - Mario Kratz
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Sean Galagan
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Elisabeth R Brown
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
| | - Paul K Drain
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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12
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Thapa S, Bista A, Subedi P, Adhikari A, Pokharel S. Tuberculosis among Patients Admitted to the Department of Medicine of a Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:531-536. [PMID: 34508414 PMCID: PMC8369550 DOI: 10.31729/jnma.5938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Tuberculosis has high burden in developing countries like Nepal. This study aims to determine the prevalence of tuberculosis among patients admitted in the department of medicine of a tertiary hospital. Methods: A descriptive cross-sectional study of all the patients admitted to the tertiary care hospital from 1st January 2017 to 31st December 2019 was done. Ethical approval was obtained from Institutional Review Committee (Ref: drs2006181387). Convenience sampling method was used. A descriptive analysis of demographic, clinical and laboratory profile of patients was made using Microsoft Excel version 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 6829 patients admitted to the department of medicine, 209 (3.06%) (2.65-3.47 at 95% CI) patients were diagnosed with tuberculosis. Among them, 147 (70.33%) were males and the mean age was 49.77 years. Pulmonary and extra-pulmonary tuberculosis were present in 153 (73.20%) and 56 (26.79%) patients, respectively. Bacteriological confirmation was limited to 107 (70%) of pulmonary tuberculosis and 3 (5%) of extrapulmonary tuberculosis. Fever was the commonest presentation in 166 (79.42%) followed by cough in 164 (78.46%), anorexia in 108 (51.67%), weight loss 104 (49.76%), and others. Conclusions: The study showed that the prevalence of tuberculosis among admitted patients was higher than national prevalence.
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Affiliation(s)
- Suman Thapa
- Department of Medicine, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Anupam Bista
- Department of Medicine, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Prashant Subedi
- Department of Medicine, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Aaradhana Adhikari
- Center for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Sunil Pokharel
- Center for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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13
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Pheiffer C, Pillay-van Wyk V, Turawa E, Levitt N, Kengne AP, Bradshaw D. Prevalence of Type 2 Diabetes in South Africa: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115868. [PMID: 34070714 PMCID: PMC8199430 DOI: 10.3390/ijerph18115868] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023]
Abstract
Synthesis of existing prevalence data using rigorous systematic review methods is considered an effective strategy to generate representative and robust prevalence figures to inform health planning and policy. The purpose of this systematic review was to identify, collate, and synthesise all studies reporting the prevalence of total and newly diagnosed type 2 diabetes (T2DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in South Africa. Four databases, PubMed, Scopus, Web of Science, and African Index Medicus were searched for articles published between January 1997 and June 2020. A total of 1886 articles were identified, of which 11 were included in the meta-analysis. The pooled prevalence in individuals 25 years and older was 15.25% (11.07–19.95%) for T2DM, 9.59% (5.82–14.17%) for IGT, 3.55% (0.38–9.61%) for IFG, and 8.29% (4.97–12.34%) for newly diagnosed T2DM. Although our pooled estimate may be imprecise due to significant heterogeneity across studies with regard to population group, age, gender, setting, diagnostic test, and study design, we provide evidence that the burden of glucose intolerance in South Africa is high. These factors contribute to the paucity of representative T2DM prevalence data. There is a need for well-designed epidemiological studies that use best-practice and standardised methods to assess prevalence.
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Affiliation(s)
- Carmen Pheiffer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa
- Division of Medical Physiology, University of Stellenbosch, Tygerberg 7505, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria 0001, South Africa
- Correspondence: ; Tel.: +27-21-938-0292
| | - Victoria Pillay-van Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (V.P.-v.W.); (E.T.); (D.B.)
| | - Eunice Turawa
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (V.P.-v.W.); (E.T.); (D.B.)
| | - Naomi Levitt
- Department of Medicine, Division of Endocrinology, University of Cape Town, Observatory 7925, South Africa;
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa;
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (V.P.-v.W.); (E.T.); (D.B.)
- School of Public Health and Family Medicine, University of Cape Town, Observatory 7925, South Africa
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14
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Harling G, Gómez-Olivé FX, Tlouyamma J, Mutevedzi T, Kabudula CW, Mahlako R, Singh U, Ohene-Kwofie D, Buckland R, Ndagurwa P, Gareta D, Gunda R, Mngomezulu T, Nxumalo S, Wong EB, Kahn K, Siedner MJ, Maimela E, Tollman S, Collinson M, Herbst K. Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study. JMIR Public Health Surveill 2021; 7:e26073. [PMID: 33827046 PMCID: PMC8121138 DOI: 10.2196/26073] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In March 2020, South Africa implemented strict nonpharmaceutical interventions (NPIs) to contain the spread of COVID-19. Over the subsequent 5 months, NPI policies were eased in stages according to a national strategy. COVID-19 spread throughout the country heterogeneously; the disease reached rural areas by July and case numbers peaked from July to August. A second COVID-19 wave began in late 2020. Data on the impact of NPI policies on social and economic well-being and access to health care are limited. OBJECTIVE We aimed to determine how rural residents in three South African provinces changed their behaviors during the first COVID-19 epidemic wave. METHODS The South African Population Research Infrastructure Network nodes in the Mpumalanga (Agincourt), KwaZulu-Natal, (Africa Health Research Institute) and Limpopo (Dikgale-Mamabolo-Mothiba) provinces conducted up to 14 rounds of longitudinal telephone surveys among randomly sampled households from rural and periurban surveillance populations every 2-3 weeks. Interviews included questions on the following topics: COVID-19-related knowledge and behaviors, the health and economic impacts of NPIs, and mental health. We analyzed how responses varied based on NPI stringency and household sociodemographics. RESULTS In total, 5120 households completed 23,095 interviews between April and December 2020. Respondents' self-reported satisfaction with their COVID-19-related knowledge and face mask use rapidly rose to 85% and 95%, respectively, by August. As selected NPIs were eased, the amount of travel increased, economic losses were reduced, and the prevalence of anxiety and depression symptoms fell. When the number of COVID-19 cases spiked at one node in July, the amount of travel dropped rapidly and the rate of missed daily medications doubled. Households where more adults received government-funded old-age pensions reported concerns about economic matters and medication access less often. CONCLUSIONS South Africans complied with stringent, COVID-19-related NPIs despite the threat of substantial social, economic, and health repercussions. Government-supported social welfare programs appeared to buffer interruptions in income and health care access during local outbreaks. Epidemic control policies must be balanced against the broader well-being of people in resource-limited settings and designed with parallel support systems when such policies threaten peoples' income and access to basic services.
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Affiliation(s)
- Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana
| | - Joseph Tlouyamma
- Dikgale-Mamabolo-Mothiba Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
- Department of Computer Science, School of Mathematical and Computer Sciences, Faculty of Science and Agriculture, University of Limpopo, Mankweng, South Africa
| | - Tinofa Mutevedzi
- Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Johannesburg, South Africa
| | - Chodziwadziwa Whiteson Kabudula
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruth Mahlako
- Dikgale-Mamabolo-Mothiba Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
| | - Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Daniel Ohene-Kwofie
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rose Buckland
- Institute for Global Health, University College London, London, United Kingdom
| | - Pedzisai Ndagurwa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, University of Alabama, Birmingham, Birmingham, AL, United States
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Harvard Medical School and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, United States
| | - Eric Maimela
- Dikgale-Mamabolo-Mothiba Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
- Department of Public Health, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana
| | - Mark Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Johannesburg, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Johannesburg, South Africa
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15
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Tamuhla T, Dave JA, Raubenheimer P, Tiffin N. Diabetes in a TB and HIV-endemic South African population: Analysis of a virtual cohort using routine health data. PLoS One 2021; 16:e0251303. [PMID: 33961671 PMCID: PMC8104376 DOI: 10.1371/journal.pone.0251303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It is widely accepted that people living with diabetes (PLWD) are at increased risk of infectious disease, yet there is a paucity of epidemiology studies on the relationship between diabetes and infectious disease in SSA. In a region with a high burden of infectious disease, this has serious consequences for PLWD. METHODS AND FINDINGS Using routinely collected longitudinal health data, we describe the epidemiology of diabetes in a large virtual cohort of PLWD who have a high burden of HIV and TB, from the Khayelitsha subdistrict in the Western Cape Province in South Africa. We described the relationship between previous TB, newly diagnosed TB disease and HIV infection on diabetes using HbA1c results as an outcome measure. The study population was predominately female (67%), 13% had a history of active TB disease and 18% were HIV positive. The HIV positive group had diabetes ascertained at a significantly younger age (46 years c.f. 53 years respectively, p<0.001) and in general had increased HbA1c values over time after their HIV diagnosis, when compared to the HIV-negative group. There was no evidence of TB disease influencing the trajectory of glycaemic control in the long term, but diabetes patients who developed active TB had higher mortality than those without TB (12.4% vs 6.7% p-value < 0.001). HIV and diabetes are both chronic diseases whose long-term management includes drug therapy, however, only 52.8% of the study population with an HIV-diabetes comorbidity had a record of diabetes treatment. In addition, the data suggest overall poor glycaemic control in the study population with only 24.5% of the participants having an HbA1c <7% at baseline despite 85% of the study population being on diabetes treatment. CONCLUSION The epidemiologic findings in this exploratory study highlight the need for further research into diabetes outcomes in a high TB and HIV burden setting and demonstrate that routine health data are a valuable resource for understanding disease epidemiology in the general population.
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Affiliation(s)
- Tsaone Tamuhla
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joel A. Dave
- Division of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, South Africa
| | - Peter Raubenheimer
- Division of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, South Africa
| | - Nicki Tiffin
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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16
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Kubjane M, Berkowitz N, Goliath R, Levitt NS, Wilkinson RJ, Oni T. Tuberculosis, Human Immunodeficiency Virus, and the Association With Transient Hyperglycemia in Periurban South Africa. Clin Infect Dis 2021; 71:1080-1088. [PMID: 31557282 PMCID: PMC7428387 DOI: 10.1093/cid/ciz928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022] Open
Abstract
Background Diabetes mellitus (DM) increases tuberculosis (TB) risk. We assessed the prevalence of hyperglycemia (DM and impaired glucose regulation [IGR]) in persons with TB and the association between hyperglycemia and TB at enrollment and 3 months after TB treatment in the context of human immunodeficiency virus (HIV) infection. Methods Adults presenting at a Cape Town TB clinic were enrolled. TB cases were defined by South African guidelines, while non-TB participants were those who presented with respiratory symptoms, negative TB tests, and resolution of symptoms 3 months later without TB treatment. HIV status was ascertained through medical records or HIV testing. All participants were screened for DM using glycated hemoglobin and fasting plasma glucose at TB treatment and after 3 months. The association between TB and DM was assessed. Results Overall DM prevalence was 11.9% (95% confidence interval [CI], 9.1%–15.4%) at enrollment and 9.3% (95% CI, 6.4%–13%) at follow-up; IGR prevalence was 46.9% (95% CI, 42.2%–51.8%) and 21.5% (95% CI, 16.9%–26.3%) at enrollment and follow-up. TB/DM association was significant at enrollment (odds ratio [OR], 2.41 [95% CI, 1.3–4.3]) and follow-up (OR, 3.3 [95% CI, 1.5–7.3]), whereas TB/IGR association was only positive at enrollment (OR, 2.3 [95% CI, 1.6–3.3]). The TB/DM association was significant at enrollment in both new and preexisting DM, but only persisted at follow-up in preexisting DM in patients with HIV-1 infection. Conclusions Our study demonstrated high prevalence of transient hyperglycemia and a significant TB/DM and TB/IGR association at enrollment in newly diagnosed DM, but persistent hyperglycemia and TB/DM association in patients with HIV-1 infection and preexisting DM, despite TB therapy.
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Affiliation(s)
- Mmamapudi Kubjane
- Division of Public Health Medicine, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Natacha Berkowitz
- Division of Public Health Medicine, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Naomi S Levitt
- Division of Diabetes and Endocrinology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa and Chronic Disease Initiative for Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory, South Africa.,The Francis Crick Institute, London, United Kingdom.,Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Tolu Oni
- Division of Public Health Medicine, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory, South Africa.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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17
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Araia ZZ, Mesfin AB, Mebrahtu AH, Tewelde AG, Osman R, Tuumzghi HA. Diabetes Mellitus and Its Associated Factors in Tuberculosis Patients in Maekel Region, Eritrea: Analytical Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:515-523. [PMID: 33568928 PMCID: PMC7869713 DOI: 10.2147/dmso.s293557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Both diabetes mellitus (DM) and tuberculosis (TB) are among the leading causes of morbidity and mortality in Eritrea. TB-DM comorbidity is known to complicate TB care, control and prevention. However, systematically studied epidemiological data on TB-DM comorbidity and its associated risk factors are lacking in this country. OBJECTIVE This study aimed to assess the prevalence of DM and its associated factors among TB patients in the Maekel region, Eritrea. METHODS Analytical cross-sectional study was conducted in eleven TB diagnostic and treatment sites. Pretested data extraction tool was used to collect data from medical records. Prevalence data were analysed using frequencies, proportions and median. To determine DM risk factors, univariable and multivariable logistic regression analysis was done with 95% CI and p value < 0.05 considered significant. RESULTS Out of total eligible (1134) TB cases, DM prevalence was 9.88%. Age and BMI were identified as independent risk factors for DM among TB patients. Higher odds of DM were found among TB patients aged 45-54 (aOR: 4.85[1.39-16.94], p= 0.013) and those ≥55 (aOR: 6.99[2.12-23.04], p= 0.001). TB cases with normal BMI were two times more likely to have DM (aOR: 2.00[1.23-3.26], p= 0.005) compared to those underweight. CONCLUSION The prevalence of DM among TB cases observed in this study is high, a clarion call to scale up current efforts to integrate TB-DM services within routine care. Furthermore, age and BMI were identified as independent risk factors for DM in TB cases, pointing to the need to pay attention to age and BMI status when managing this co-morbidity.
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Affiliation(s)
- Zenawi Zeramariam Araia
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
- Correspondence: Zenawi Zeramariam Araia National TB and Leprosy Control Program, Communicable Diseases Control Division, Ministry of Health, Asmara, EritreaTel +291-1-122129 Email
| | | | - Amanuel Hadgu Mebrahtu
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
| | | | - Randa Osman
- Orrota College of Medicine and Health Sciences, Asmara, Eritrea
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18
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Harling G, Gómez-Olivé FX, Tlouyamma J, Mutevedzi T, Kabudula CW, Mahlako R, Singh U, Ohene-Kwofie D, Buckland R, Ndagurwa P, Gareta D, Gunda R, Mngomezulu T, Nxumalo S, Wong EB, Kahn K, Siedner MJ, Maimela E, Tollman S, Collinson M, Herbst K. Protective behaviours and secondary harms from non-pharmaceutical interventions during the COVID-19 epidemic in South Africa: a multisite prospective longitudinal study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33200146 PMCID: PMC7668759 DOI: 10.1101/2020.11.12.20230136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: In March 2020 South Africa implemented strict non-pharmaceutical interventions (NPIs) to contain Covid-19. Over the subsequent five months NPIs were eased in stages according to national strategy. Covid-19 spread throughout the country heterogeneously, reaching rural areas by July and peaking in July-August. Data on the impact of NPI policies on social and economic wellbeing and access to healthcare is limited. We therefore analysed how rural residents of three South African provinces changed their behaviour during the first epidemic wave. Methods: The South African Population Research Infrastructure Network (SAPRIN) nodes in Mpumalanga (Agincourt), KwaZulu-Natal (AHRI) and Limpopo (DIMAMO) provinces conducted longitudinal telephone surveys among randomly sampled households from rural and peri-urban surveillance populations every 2-3 weeks. Interviews included questions on: Covid-19 knowledge and behaviours; health and economic impact of NPIs; and mental health. Results: 2262 households completed 10,966 interviews between April and August 2020. By August, self-reported satisfaction with Covid-19 knowledge had risen from 48% to 85% and facemask use to over 95%. As selected NPIs were eased mobility increased, and economic losses and anxiety and depression symptoms fell. When Covid-19 cases spiked at one node in July, movement dropped rapidly, and missed daily medication rates doubled. Economic concerns and mental health symptoms were lower in households receiving a greater number of government-funded old-age pensions. Conclusions: South Africans reported complying with stringent Covid-19 NPIs despite the threat of substantial social, economic and health repercussions. Government-supported social welfare programmes appeared to buffer interruptions in income and healthcare access during local outbreaks. Epidemic control policies must be balanced against impacts on wellbeing in resource-limited settings and designed with parallel support systems where they threaten income and basic service access.
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Affiliation(s)
- Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Institute for Global Health, University College London, London, United Kingdom.,Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joseph Tlouyamma
- DIMAMO Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa.,Faculty of Science and Agriculture, School of Mathematical and Computer Sciences, Department of Computer Science, University of Limpopo, Limpopo, South Africa
| | - Tinofa Mutevedzi
- DSI-MRC South African Population Research Infrastructure Network, South Africa
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruth Mahlako
- DIMAMO Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa
| | - Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Daniel Ohene-Kwofie
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rose Buckland
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Pedzisai Ndagurwa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Harvard Medical School and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Eric Maimela
- DIMAMO Population Health Research Centre, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa.,Department of Public Health, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Mark Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,DSI-MRC South African Population Research Infrastructure Network, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,DSI-MRC South African Population Research Infrastructure Network, South Africa
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19
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Haines HM, Meyer JC, Summers RS, Godman BB. Knowledge, attitudes and practices of health care professionals towards adverse drug reaction reporting in public sector primary health care facilities in a South African district. Eur J Clin Pharmacol 2020; 76:991-1001. [PMID: 32296857 PMCID: PMC7306046 DOI: 10.1007/s00228-020-02862-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/26/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Adverse drug reactions (ADRs) have an appreciable impact on patients' health. Little is known however about ADR reporting in ambulatory care environments especially in low- and middle-income countries. Consequently, our aim was to determine knowledge, attitudes and practices (KAP) among health care professionals (HCPs) towards ADR reporting in primary health care (PHC) facilities in South Africa. The findings will be used to direct future activities. METHODS Descriptive, cross-sectional design using quantitative methodology among 8 public sector community health care centres and 40 PHC clinics in the Tshwane Health District, Gauteng Province. A self-administered questionnaire was distributed to 218 HCPs, including all key groups. RESULTS A total of 200 responses were received (91.7%). Although an appropriate attitude towards ADR reporting existed, the actual frequency of ADR reporting was low (16.0%). Of the respondents, 60.5% did not know how to report, where to report or when to report an ADR and 51.5% said the level of their clinical knowledge made it difficult to decide whether or not an ADR had occurred. Over 97.5% stated they should be reporting ADRs with 89% feeling that ADR reporting is a professional obligation and over 70% that ADR reporting should be compulsory. When results were combined, the overall mean score in terms of positive or preferred practices for ADR reporting was 24.6% with pharmacists having the highest scores. CONCLUSION Under-reporting of ADRs with gaps in KAP was evident. There is a serious and urgent need for education and training of HCPs on ADR reporting in South Africa.
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Affiliation(s)
- H. M. Haines
- Tshwane Regional Pharmacy, Tshwane, South Africa
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, 0208 South Africa
| | - J. C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, 0208 South Africa
| | - R. S. Summers
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, 0208 South Africa
| | - B. B. Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, 0208 South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE UK
- Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool, UK
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20
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Gbadamosi MA, Tlou B. Prevalence of abnormal glucose metabolism among adults attending an outpatient department at a tertiary referral hospital in Swaziland: a cross-sectional study. BMC Public Health 2020; 20:392. [PMID: 32216759 PMCID: PMC7098143 DOI: 10.1186/s12889-020-08489-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The exact prevalence of type 2 diabetes mellitus (T2DM) and pre-diabetes in Swaziland remains unknown. Estimates suggest that the prevalence rate of type 2 diabetes mellitus is between 2.5 and 6.0% in Swaziland. The disparity in these estimates is due to a lack of quality data but the prevalence of diabetes is increasing in Swaziland. This study estimates the prevalence of type 2 diabetes mellitus and pre-diabetes among patients in a tertiary hospital in Manzini, Swaziland. METHODS A cross-sectional observational survey was used to estimate the crude and age-adjusted prevalence rates of diabetes and pre-diabetes (impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)) in the Manzini regional referral hospital of Swaziland. Diabetes was defined as a fasting blood glucose (FBG) ≥ 7.0 mmol/L (126 mg/dL) and pre-diabetes was defined as an FBG of 6.1-6.9 mmol/L (110-125 mg/dL) and an FBG < 7.0 mmol/L (< 126 mg/dL), respectively for IFG and IGT. A random sample of 385 participants was used. Data analysis was done using SPSS version 26 and the level of statistical significance was set at α < 0.05. RESULTS The crude prevalence of type 2 diabetes mellitus and pre-diabetes was 7.3% [95% CI 4.9-10.3] and 6.5% [95% CI 4.2-9.4], respectively, with clear gender differences in the prevalence of diabetes (men 1.6% vs women 5.7%, p = 0.001). On the other hand, significantly more men (3.6%) had pre-diabetes than women (2.9%) (p = 0.004). The overall age-adjusted prevalence rates of type 2 diabetes mellitus and pre-diabetes were 3.9 and 3.8%, respectively. Among the diabetic group, 3 (10.7%) had known T2DM, whereas 25 (89.3%) were newly diagnosed during the study. Advancing age, gender, raised blood pressure, abnormal body mass index, and wealth index were significant risk factors for T2DM or prediabetes. CONCLUSION The prevalence of type 2 diabetes mellitus among adult outpatients in the Raleigh Fitkin Memorial hospital was higher than previously reported in the health facility in Manzini; suggesting the need for routine T2DM screening at outpatient departments.
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Affiliation(s)
- Mojeed Akorede Gbadamosi
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Boikhutso Tlou
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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21
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Watermeyer J, Hume V, Seabi T, Pauly B. “It’s got its own life, and you can’t contain it”: A qualitative study of patient and health professional experiences of diabetes care. J Clin Nurs 2019; 29:240-250. [DOI: 10.1111/jocn.15086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/30/2019] [Accepted: 10/17/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Jennifer Watermeyer
- Health Communication Research Unit School of Human and Community Development University of the Witwatersrand Johannesburg South Africa
| | - Victoria Hume
- Health Communication Research Unit School of Human and Community Development University of the Witwatersrand Johannesburg South Africa
- Wits Institute for Social and Economic Research Johannesburg South Africa
| | - Tshegofatso Seabi
- Health Communication Research Unit School of Human and Community Development University of the Witwatersrand Johannesburg South Africa
- MRC/Wits Population Health and Health Transition Research Unit (Agincourt) Johannesburg South Africa
| | - Bruno Pauly
- Chris Hani Baragwanath Academic Hospital Internal Medicine Diabetes Clinic Johannesburg South Africa
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22
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Kalyesubula R, Mutyaba I, Rabin T, Andia-Biraro I, Alupo P, Kimuli I, Nabirye S, Kagimu M, Mayanja-Kizza H, Rastegar A, Kamya MR. Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study. PLoS One 2019; 14:e0216060. [PMID: 31086371 PMCID: PMC6516645 DOI: 10.1371/journal.pone.0216060] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa suffers from a dual burden of infectious and non-communicable diseases. There is limited data on causes and trends of admission and death among patients on the medical wards. Understanding the major drivers of morbidity and mortality would help inform health systems improvements. We determined the causes and trends of admission and mortality among patients admitted to Mulago Hospital, Kampala, Uganda. METHODS AND RESULTS The medical record data base of patients admitted to Mulago Hospital adult medical wards from January 2011 to December 2014 were queried. A detailed history, physical examination and investigations were completed to confirm the diagnosis and identify comorbidities. Any histopathologic diagnoses were made by hematoxylin and eosin tissue staining. We identified the 10 commonest causes of hospitalization, and used Poisson regression to generate annual percentage change to describe the trends in causes of hospitalization. Survival was calculated from the date of admission to the date of death or date of discharge. Cox survival analysis was used to identify factors associate with in-hospital mortality. We used a statistical significance level of p<0.05. A total of 50,624 patients were hospitalized with a median age of 38 (range 13-122) years and 51.7% females. Majority of patients (72%) had an NCD condition as the primary reason for admission. Specific leading causes of morbidity were HIV/AIDS in 30% patients, hypertension in 14%, tuberculosis (TB) in 12%), non-TB pneumonia in11%) and heart failure in 9.3%. There was decline in the proportion of hospitalization due to malaria, TB and pneumonia with an annual percentage change (apc) of -20% to -6% (all p<0.03) with an increase in proportions of admissions due to chronic kidney disease, hypertension, stroke and cancer, with apc 13.4% to 24%(p<0.001). Overall, 8,637(17.1%) died during hospitalization with the highest case fatality rates from non-TB pneumonia (28.8%), TB (27.1%), stroke (26.8%), cancer (26.1%) and HIV/AIDS (25%). HIV-status, age above 50yrs and being male were associated with increased risk of death among patients with infections. CONCLUSION Admissions and case fatality rates for both infectious and non-infectious diseases were high, with declining trends in infectious diseases and a rising trend in NCDs. Health care systems in sub-Saharan region need to prepare to deal with dual burden of disease.
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Affiliation(s)
- Robert Kalyesubula
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Innocent Mutyaba
- Department of Medicine, Uganda Cancer Institute, Kampala, Uganda
| | - Tracy Rabin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patricia Alupo
- Department of Medicine, Makerere Lung Institute, Kampala, Uganda
| | - Ivan Kimuli
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stella Nabirye
- Directorate of Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - Magid Kagimu
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Harriet Mayanja-Kizza
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Asghar Rastegar
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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23
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Sane Schepisi M, Navarra A, Altet Gomez MN, Dudnyk A, Dyrhol-Riise AM, Esteban J, Giorgetti PF, Gualano G, Guglielmetti L, Heyckendorf J, Kaluzhenina A, Lange B, Lange C, Manika K, Miah J, Nanovic Z, Pontali E, Prego MR, Solovic I, Tiberi S, Palmieri F, Girardi E. Burden and Characteristics of the Comorbidity Tuberculosis-Diabetes in Europe: TBnet Prevalence Survey and Case-Control Study. Open Forum Infect Dis 2018; 6:ofy337. [PMID: 30697572 PMCID: PMC6330516 DOI: 10.1093/ofid/ofy337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe. Methods We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007–2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine. Results Among 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients’ median ages ranged from 36 to 49 years, and all centers had >60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM. Conclusions Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.
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Affiliation(s)
- Monica Sane Schepisi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
| | - Assunta Navarra
- Clinical Epidemiology Unit, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
| | - M Nieves Altet Gomez
- Unidad de Tratamiento Directamente Observado de la Tuberculosis "Servicios Clínicos," Barcelona, Spain
| | - Andrii Dudnyk
- Tuberculosis, Clinical Immunology & Allergy Department, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Anne Margarita Dyrhol-Riise
- Department of Infectious Diseases, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Department of Clinical Science, University of Bergen, Norway
| | - Jaime Esteban
- Departamento de Microbiología Clínica, Fundación Jiménez Díaz, Madrid, Spain
| | - Pier Francesco Giorgetti
- Clinica di Malattie Infettive e Tropicali, A. O. Spedali Civili di Brescia e Università di Brescia, Brescia, Italy
| | - Gina Gualano
- Clinical Department, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
| | - Lorenzo Guglielmetti
- Sanatorium, Centre Hospitalier de Bligny Briis-sous-Forges, Paris, France.,APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Unité 1135, Team E13 (Bactériologie), CR7 INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Jan Heyckendorf
- Research Center Borstel. German Center for Infection Research (DZIF), Borstel, Germany
| | - Anna Kaluzhenina
- Department of Phthisiopulmonology, Volgograd State Medical University, Volgograd, Russian Federation
| | - Berit Lange
- Infectious Disease Division, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Center for Chronic Immunodeficiency, Faculty of Medicine, Medical Center, University of Freiburg, Germany
| | - Christoph Lange
- Research Center Borstel. German Center for Infection Research (DZIF), Borstel, Germany
| | - Katerina Manika
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Jalal Miah
- Division of Infection, Barts Health NHS Trust, London, United Kingdom
| | - Zorica Nanovic
- Institute of Lung Diseases and Tuberculosis - Skopje, Institute of Lung Diseases and Tuberculosis - Skopje, Skopje, FYROM (Macedonia)
| | - Emanuele Pontali
- Divisione di Malattie Infettive, Ospedale Galliera - Genova, Genova, Italy
| | - Monica Rios Prego
- Enfermedades Infecciosas, Medicina Interna, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Simon Tiberi
- Division of Infection, Barts Health NHS Trust, London, United Kingdom
| | - Fabrizio Palmieri
- Clinical Department, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy
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Wamai RG, Kengne AP, Levitt N. Non-communicable diseases surveillance: overview of magnitude and determinants in Kenya from STEPwise approach survey of 2015. BMC Public Health 2018; 18:1224. [PMID: 30400841 PMCID: PMC6218983 DOI: 10.1186/s12889-018-6051-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Richard G Wamai
- Integrated Initiative for Global Health, Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA USA
| | - Andre Pascal Kengne
- Non Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape South Africa
| | - Naomi Levitt
- Diabetic Medicine and Endocrinology, University of Cape Town, J47/86 Old Main Building Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Chronic Disease Initiative for Africa (CDIA), University of Capetown, J47/86 Old Main Building Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
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25
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Manderson L, Levine S. Southward Focused: Medical Anthropology in South Africa. AMERICAN ANTHROPOLOGIST 2018. [DOI: 10.1111/aman.13097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lenore Manderson
- University of the Witwatersrand; South Africa, and Brown University USA
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26
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George JA, Erasmus RT. Haemoglobin A1c or Glycated Albumin for Diagnosis and Monitoring Diabetes: An African Perspective. Indian J Clin Biochem 2018; 33:255-261. [PMID: 30072824 DOI: 10.1007/s12291-018-0755-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/24/2018] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus (DM) has reached epidemic proportions across the globe with the largest increases seen in sub-Saharan Africa. Those that are diagnosed are largely poorly controlled. This review summarizes the limitations of the use of glycated haemoglobin (HBA1c) in Africa and current knowledge on the utility of glycated albumin and fructosamine in African patients. The diagnosis and monitoring of DM in African patients may be compromised by associated conditions like sickle cell anaemia, chronic kidney disease and HIV infection. Glycated albumin reflects short term glycaemia and is not affected by many conditions that alter HbA1c. It can be measured enzymatically, and this review discusses methods for analysis, and discusses the advantages and limitations in specific situations with an emphasis on conditions that also affect HbA1c.
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Affiliation(s)
- J A George
- 1Department of Chemical Pathology, National Health Laboratory Services and University of Witwatersrand, Johannesburg, South Africa
| | - R T Erasmus
- 2Department of Chemical Pathology, National Health Laboratory Services and University of Stellenbosch, Stellenbosch, South Africa
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Moreira J, Castro R, Lamas C, Ribeiro S, Grinsztejn B, Veloso VG. Hyperglycemia during tuberculosis treatment increases morbidity and mortality in a contemporary cohort of HIV-infected patients in Rio de Janeiro, Brazil. Int J Infect Dis 2017; 69:11-19. [PMID: 29253707 DOI: 10.1016/j.ijid.2017.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/12/2017] [Accepted: 12/07/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hyperglycemia occurs in tuberculosis (TB), but the long-term impact is unknown. We estimated the prevalence of hyperglycemia and compared the TB treatment outcomes and 1-year mortality rate according to the glycemic status noted during TB treatment. METHODS We conducted a retrospective cohort analysis of adult patients who had TB and HIV coinfection and started receiving TB treatment at the Instituto Nacional de Infectologia Evandro Chagas, Brazil, between 2010-2015. Diabetes Mellitus (DM) and hyperglycemia were defined according to the American Diabetes Association. After excluding for known DM at baseline, the proportion of participants who developed new-onset DM after TB treatment was assessed. TB outcome was classified as successful or adverse (i.e., treatment failure, abandonment, and death). Kaplan-Meier survival curves were compared by the log-rank test based on the glycemic status of patients. Multivariate Cox regression models were used to assess the association between hyperglycemia and 1-year mortality. Two-sided p values <0.05 were considered statistically significant. RESULTS We identified 414 euglycemic patients (87.5%), 49 hyperglycemic patients (10.3%), and 10 patients with known DM (2.1%). Diabetic patients were older compared to the euglycemic and hyperglycemic patients (47.9 vs. 37 vs. 39.7 years, respectively, p=0.001). Diabetic patients frequently had cavitation on chest image compared to hyperglycemic and euglycemic patients (50% vs. 23.4% vs. 15.3%, p=0.007, respectively). Hyperglycemic patients had more new-onset DM at follow-up compared to euglycemic (22 vs. 1; p<0001). Hyperglycemia was associated with adverse outcomes (71.4% vs. 24.6%, p<0.0001) compared to euglycemia. Crude 1-year mortality was significantly higher in patients with hyperglycemia compared with euglycemia (48.9% vs. 7.9%; unadjusted HR: 5.79 (3.74-8.96)). In the adjusted Cox models, hyperglycemia remained a significant factor for increased 1-year mortality (adjusted HR: 3.72 (2.17-6.38)]. CONCLUSIONS Hyperglycemia frequently occurs in HIV-infected patients who commence TB treatment, and it increases the risks of adverse TB outcomes and 1-year mortality. Glucose testing during TB treatment detects patients at risk of adverse outcomes.
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Affiliation(s)
- José Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.
| | - Rodolfo Castro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Instituto de Saúde Coletiva, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Cristiane Lamas
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil; Universidade do Grande Rio (Unigranrio), Rio de Janeiro, Brazil
| | - Sayonara Ribeiro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Valdiléa G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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