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Yi Y, Sun M, Chen X, Pan Y, Lu J, Yu Y, Dou X, Zhou L. Prejudice and determinants regarding tuberculosis patients among medical students in Dalian, Northeast China: a cross-sectional study. Front Public Health 2024; 11:1292333. [PMID: 38269378 PMCID: PMC10806168 DOI: 10.3389/fpubh.2023.1292333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Background Health workers play a central role in global tuberculosis (TB) elimination efforts. If medical students have prejudiced attitudes toward TB patients, this may make it difficult for them to provide effective health care to TB patients in their future roles as health workers. There is currently no research on prejudice toward TB patients among medical students in China. This study aimed to explore the current status of medical students' prejudice against patients with TB and its associated predictors. Methods We conducted a cross-sectional questionnaire survey among medical students at a medical university in Dalian, Liaoning Province, Northeast China. Multiple logistic regression analysis was employed to determine the predictive factors of medical students' prejudice against patients with TB. Results More than half (57.23%) of the medical students held prejudices against individuals with TB. Multivariate logistic regression analysis revealed that not receiving TB health education (OR: 2.12, 95% CI: 1.35-3.32), not knowing a person with TB (OR: 2.52, 95% CI: 1.39-4.56), and fear of TB/TB patients (OR: 6.79, 95% CI: 4.36-10.56) were identified as risk factors for medical students' prejudice against TB patients. Conversely, residing in rural areas (OR: 0.60, 95% CI: 0.38-0.95), agreeableness (OR: 0.82, 95% CI: 0.73-0.92) and emotional stability (OR: 0.90, 95% CI: 0.81-1.00) in the Big Five personality traits, and a better understanding of TB knowledge (OR: 0.58, 95% CI: 0.38-0.89) were identified as protective factors. Conclusion In China, a considerable number of medical students still exhibit prejudice against patients with TB. Targeted interventions, such as incorporating TB health education into the core curriculum of medical students, and enhance their agreeableness and emotional stability, are still needed. Furthermore, greater focus should be placed on medical students from urban backgrounds or those who harbor fear or do not know a person with TB.
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Affiliation(s)
| | | | | | | | | | | | | | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, Liaoning, China
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Madebo M, Balta B, Daka D. Knowledge, attitude and practice on prevention and control of pulmonary tuberculosis index cases family in Shebedino District, Sidama Region, Ethiopia. Heliyon 2023; 9:e20565. [PMID: 37818014 PMCID: PMC10560778 DOI: 10.1016/j.heliyon.2023.e20565] [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: 05/28/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Tuberculosis is a leading cause of death, despite being a largely curable and preventable disease. The goals of TB control are to reduce infection transmission, morbidity, and mortality until TB cannot be a threat to public health any longer while preventing drug resistance. Assessing KAP on TB control and prevention among family members is more essential, and taking action based on the result can break the transmission of TB infection. Methods From August to September 2022, a community-based cross-sectional study method was used. A total of 422 participants were selected from a list of sample frames who were family members of PTB patients who had used anti-TB medication in the previous 12 months prior to the study period using a systematic random sampling method. SPSS version 25 software was used to analyze the data. Bivariate and multivariate analyses were used to determine variables related to KAP on TB prevention and control. A variable with p-values less than 0.25 was included in the multivariable logistic regression model to find independent determinant factors. In the multivariate logistic regression, variables with p-values ≤0.05 were identified as statistically significant. Result A total of 414 family members responded to the survey questionnaire. The average knowledge score on TB was 17.11 ± 6.34. The majority (51.9%) of respondents had a good knowledge of TB cases. One-third of those polled had an unfavorable attitude towards PTB prevention, with a mean score of 3.16 ± 1.78 and 55.1% had good practice in preventing tuberculosis. Marital status (AOR = 1.7, 95% CI: 1.5-2.5) was an independent predictor of knowledge. Practice level is independently affected by occupation (AOR = 3.9; 95% CI = (1.7-8.7)) and health education on PTB (AOR = 2.4; 95% CI = (1.6-3.9). Conclusion Knowledge, attitudes, and preventive practices about tuberculosis were not satisfactory when compared to several national and international studies. It is necessary to strengthen the program for health education and awareness-building on PTB.
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Affiliation(s)
| | - Bargude Balta
- Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
| | - Deresse Daka
- Hawassa University College of Medicine and Health Science, Hawassa, Ethiopia
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Alshahrani NS, Kayal M, Alahmad Almshhad H, Dirar Q, AlKattan W, Shibl A, Ouban A. The Risk of Latent Tuberculosis Infection Among Healthcare Workers at a General Hospital in Bisha, the Kingdom of Saudi Arabia. Cureus 2023; 15:e40561. [PMID: 37465781 PMCID: PMC10351446 DOI: 10.7759/cureus.40561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Background and objective Tuberculosis (TB) is a global health issue, often preceded by a latent tuberculosis infection (LTBI) in individuals. Significant global and local efforts have recently been directed toward this infection, focusing on TB control and eradication. This study aimed to assess the magnitude of LTBI among healthcare workers (HCWs) in the Kingdom of Saudi Arabia, by evaluating its prevalence and associated risk factors. Methods An analytical cross-sectional study was conducted among HCWs at the King Abdullah Hospital (KAH), from January to August 2018, by using two surveys: the first one involved data related to HCW demographics and the tuberculin skin test (TST) readings, and the second involved a questionnaire that assessed LTBI risk factors. Results Out of the total 561 HCWs who participated in the study, 66 had an induration reading of more than 10 mm in TST. Many factors were associated with LTBI cases, but multivariate analysis showed that age, gender, and nationality were statistically significant risk factors. Conclusion Given the nature of their work, HCWs are at a greater risk of TB and LTBI. At the same time, HCWs are uniquely positioned to play a crucial role in halting the spread of TB. Gaps in preventive measures may result in the increased spread of TB. Our study assessed risk factors associated with the increased risk of LTBI and proposed possible ways of addressing them.
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Affiliation(s)
- Naif S Alshahrani
- Immunology and Microbiology, Alfaisal University College of Medicine, Riyadh, SAU
| | - Malik Kayal
- Anatomical Sciences, Alfaisal University College of Medicine, Riyadh, SAU
| | | | - Qais Dirar
- Immunology and Microbiology, Alfaisal University College of Medicine, Riyadh, SAU
| | - Wael AlKattan
- Surgery, Alfaisal University College of Medicine, Riyadh, SAU
| | - Atef Shibl
- Immunology and Microbiology, Alfaisal University College of Medicine, Riyadh, SAU
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Mahmud S, Mohsin M, Irfan SH, Muyeed A, Islam A. Knowledge, attitude, practices, and determinants of them toward tuberculosis among social media users in Bangladesh: A cross-sectional study. PLoS One 2022; 17:e0275344. [PMID: 36219607 PMCID: PMC9553051 DOI: 10.1371/journal.pone.0275344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Tuberculosis (TB) is an infectious disease that causes thousands of deaths in Bangladesh. Bangladesh is one of the 30 high TB burden countries. In this study, we aimed to assess the knowledge, practices, and attitude toward TB, and to determine the factors associated with them among people who have internet access in Bangladesh. Design, Setting, and Participant: A web-based anonymous cross-sectional survey was conducted from May 20 to August 10, 2021, among people (age> = 18 years) who have internet access in Bangladesh. A comprehensive consent statement was included at the beginning of the survey and informed consent was taken. OUTCOME MEASURES This study's outcomes of interest were respondents' adequate knowledge, good practices, and positive attitudes toward TB and were coded binarily. The association between respondents' socio-demographic factors and knowledge, attitude, and practices toward TB was inspected using the Chi-square test and Multivariable logistic regression model. RESULTS Among 1,180 respondents, 58.64% were males, and 62.37% were married. The majority of the participants (78.28%) were aged between 18 to 44 years. Overall adequate knowledge, favorable attitudes, and good practices about TB were found respectively in 47.8%, 44.75%, and 31.19% of the people with internet access in Bangladesh. Almost the same sets of associated factors were found to influence adequate knowledge, favorable attitudes, and good practices toward TB among social media users in Bangladesh. Males, young, unmarried, social media users with higher education, and urban social media users were more likely to have adequate knowledge, favorable attitudes, and good practices toward TB. CONCLUSION Policymakers need to design programs and interventions to improve knowledge, attitudes, and practices toward TB in Bangladesh with a particular focus on females, young and older people, people who live in rural areas, and illiterate/less educated people. Social media can be a powerful medium for disseminating scientific facts on TB and other diseases.
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Affiliation(s)
- Sultan Mahmud
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR’B), Dhaka, Bangladesh
| | - Md Mohsin
- Department of Applied Statistics, Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
| | - Saddam Hossain Irfan
- Department of Applied Statistics, Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Abdul Muyeed
- Department of Statistics, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Ariful Islam
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
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Katana GG, Ngari M, Maina T, Sanga D, Abdullahi OA. Tuberculosis poor treatment outcomes and its determinants in Kilifi County, Kenya: a retrospective cohort study from 2012 to 2019. Arch Public Health 2022; 80:48. [PMID: 35123570 PMCID: PMC8818215 DOI: 10.1186/s13690-022-00807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis (TB) is one of the leading causes of deaths in Africa, monitoring its treatment outcome is essential to evaluate treatment effectiveness. The study aimed to evaluate proportion of poor TB treatment outcomes (PTO) and its determinants during six-months of treatment at Kilifi County, Kenya. Methods We conducted a retrospective analysis of data from the TB surveillance system (TIBU) in Kilifi County, Kenya from 2012 to 2019. The outcome of interest was PTO (lost-to-follow-up (LTFU), death, transferred out, treatment failure, drug resistance) or successful treatment (cured or completed treatment). We performed time-stratified (at three months follow-up) survival regression analyses accounting for sub-county heterogeneity to determine factors associated with PTO. Results We included 14,706 TB patients, their median (IQR) age was 37
(28–50) years and 8,791 (60%) were males. A total of 13,389 (91%) were on first line anti-TB treatment (2RHZE/4RH), 4,242 (29%) were HIV infected and 192 (1.3%) had other underlying medical conditions. During 78,882 person-months of follow-up, 2,408 (16%) patients had PTO: 1,074 (7.3%) deaths, 776 (5.3%) LTFU, 415 (2.8%) transferred out, 103 (0.7%) treatment failure and 30 (0.2%) multidrug resistance. The proportion of poor outcome increased from 7.9% in 2012 peaking at 2018 (22.8%) and slightly declining to 20% in 2019 (trend test P = 0.03). Over two-thirds 1,734 (72%) poor outcomes occurred within first three months of follow-up. In the first three months of TB treatment, overweight ((aHR 0.85 (95%CI 0.73–0.98), HIV infected not on ARVS (aHR 1.72 (95% CI 1.28–2.30)) and year of starting treatment were associated with PTO. However, in the last three months of treatment, elderly age ≥50 years (aHR 1.26 (95%CI 1.02–1.55), a retreatment patient (aHR 1.57 (95%CI 1.28–1.93), HIV infected not on ARVs (aHR 2.56 (95%CI 1.39–4.72), other underlying medical conditions (aHR 2.24 (95%CI 1.41–3.54)) and year of starting treatment were positively associated with PTO while being a female (aHR 0.83 (95%CI 0.70–0.97)) was negatively associated with PTO. Conclusions Over two-thirds of poor outcomes occur in the first three months of TB treatment, therefore greater efforts are needed during this phase. Interventions targeting HIV infected and other underlying medical conditions, the elderly and retreated patients provide an opportunity to improve TB treatment outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00807-4.
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Bergman A, Farley JE, Agarwalla V, Relf M. Reframing Intersectional Stigma for a South African Context Integrating Tuberculosis, HIV and Poverty Stigmas. J Assoc Nurses AIDS Care 2022; 33:22-32. [PMID: 34939985 DOI: 10.1097/jnc.0000000000000296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Intersectionality is closely intertwined with Black feminism within the context of the United States. As a result, intersectionality is often overlooked in non-Western contexts where racial homogeneity may reduce some of the impact of race on marginalization. This article will look at intersectional stigma from the South African context using the tuberculosis/HIV (TB/HIV) treatment environment in South Africa to exemplify intersectionality's versatility as an analytic method outside of the United States. We will use colonial history and contemporary research to reframe intersectionality considering a new set of stigmatized identities, including HIV stigma, TB stigma, and poverty stigma, to create a situation-specific framework adapted from a model by Bulent Turan and colleagues.
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Affiliation(s)
- Alanna Bergman
- Alanna Bergman, MSN, AGNP-BC, AAHIVS, is a PhD Student, Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA. Jason E. Farley, PhD, MPH, ANP-BC, AACRN, FAAN, FAANP, is a Professor at Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA. Vidisha Agarwalla, MA, is a Social Design Associate, Johns Hopkins University in the PROMOTE Center, Baltimore, Maryland, USA. Michael Relf, PhD, RN, AACRN, ACNS-BC, CNE, ANEF, FAAN, is the Associate Dean, Global and Community Health Affairs, Duke University, School of Nursing, Durham, North Carolina, USA
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Oladele DA, Idigbe IE, Ekama SO, Gbajabiamila T, Ohihoin AG, David AN, Ezechi OC, Odunukwe NN, Salako BL. "Their place is beyond the town's border": A qualitative exploration of stigma associated with tuberculosis in rural and urban areas of Lagos, Nigeria. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1789-1798. [PMID: 33491866 DOI: 10.1111/hsc.13287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/21/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
Tuberculosis (TB) remains a major public health challenge in Nigeria with a minimum yield of various TB control efforts due to sociocultural determinants of health including TB-associated stigma. Therefore, to achieve the Sustainable Development Goal targets for TB control, an understanding and reduction in TB-associated stigma is necessary. The study aims to explore the perspective of community members and investigate the possible ways of mitigating TB-associated stigma in rural and urban areas in Lagos State, Nigeria. Eight focus group discussions (FGD) were conducted among eight homogenous groups of participants living in the community in rural and urban areas of Lagos state who were stratified by gender, between July and November 2017. Analysis of data was done using the modified grounded theory. A total of 86 participants took part in the FGDs. There were various stigmatising behaviours towards people infected with TB in rural and urban communities studied. This includes: Not willing to eat with people suffering from TB, withdrawal from TB patients in social gatherings, verbal abuse of TB patients and refusing to visit their houses because of their illness. There were also misconceptions about the cause of TB in our study which includes spiritual attack, ingestion of cat hair and inhalation of dust. However, participants in the study believed that mitigating the effect of TB-associated stigma will require adequate community education on TB, provision of financial and emotional support to the patients, as well as the involvement of community leaders in TB control activities and stigma reduction interventions. TB-associated stigma exists in rural and urban communities, with a lack of appropriate knowledge of TB and fear of infection as a major determinant in rural and urban areas respectively. Health education and sensitisation about TB, with community leaders as champions could help to mitigate the effect of TB-associated stigma.
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Affiliation(s)
- David A Oladele
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ifeoma E Idigbe
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Sabdat O Ekama
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Titilola Gbajabiamila
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Aigbe G Ohihoin
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Agatha N David
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Oliver C Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Nkiruka N Odunukwe
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Babatunde L Salako
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
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Estifanos TM, Hui C, Tesfai AW, Teklu ME, Ghebrehiwet MA, Embaye KS, Andegiorgish AK. Predictors of HIV/AIDS comprehensive knowledge and acceptance attitude towards people living with HIV/AIDS among unmarried young females in Uganda: a cross-sectional study. BMC Womens Health 2021; 21:37. [PMID: 33499860 PMCID: PMC7836492 DOI: 10.1186/s12905-021-01176-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/12/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Youth in general and young females, in particular, remain at the center of HIV/AIDS epidemic. To avoid and prevent HIV infection, comprehensive knowledge as well as correct understanding of transmission and prevention strategies are crucial. Thus, the aim of this study is to explore the predictors of comprehensive knowledge on HIV/AIDS and accepting attitude towards PLWHIV. METHODS A cross-sectional study was conducted using data from the 2016 Uganda Demographic Health Survey. A two-stage probability sampling method was applied and data were collected using a standard questionnaire. Of the total 8674 women aged 15-49 years, 1971 eligible women aged 15-24 years were included in this analysis. Data analysis was done using SPSS version 23. A Chi-square test followed by logistic regression analysis was used to explore the relationship between specific explanatory variables and outcome variables. The results were reported using odds ratios with 95% confidence interval. P value less than 0.05 was considered as statistically significant. RESULTS Overall, 99.3% of the unmarried women aged 15-24 years were aware of HIV/AIDS, but only 51.9% had comprehensive knowledge on HIV/AIDS. Around 70% of the respondents were aware that "using condoms every time when having sex" and "having only one faithful uninfected partner" can prevent HIV transmission. About 68% of the unmarried women rejected at least two common local misconceptions about HIV/AIDS. An alarmingly small (20.6%) proportion of the respondents had a positive acceptance attitude towards PLWHIV. All variables were significantly associated with having comprehensive knowledge on HIV/AIDS in the unadjusted logistic regression analysis. After adjustment, older age (20-24 years), being educated, wealthier, and ever been tested for HIV/AIDS became predictors of adequate comprehensive HIV/AIDS knowledge. Moreover, respondents with adequate comprehensive knowledge of HIV/AIDS were more likely (OR 1.64, 95% CI 1.30-2.08) to have a positive acceptance attitude towards PLWHIV than their counterparts. CONCLUSION Our study demonstrated a remarkably high level of awareness about HIV/AIDS among study participants, but the knowledge and positive acceptance attitude towards PLWHIV were not encouraging. Thus, endeavors to expand and strengthen educational campaigns on HIV/AIDS in communities, health facilities, and schools are highly recommended. Attention should particularly focus on young-aged and disadvantaged women with low educational level, poor socioeconomic status and those who have never been tested for HIV/AIDS.
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Affiliation(s)
- Tesfaldet Mekonnen Estifanos
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| | - Chen Hui
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Afewerki Weldezgi Tesfai
- Department of Statistics, College of Science, Eritrea Institute of Technology, Mai Nefhi, Eritrea
| | | | - Matiwos Araya Ghebrehiwet
- Department of Pathology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Kidane Siele Embaye
- Department of Pathology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Amanuel Kidane Andegiorgish
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, People's Republic of China
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Angelo AT, Geltore TE, Asega T. Knowledge, Attitude, and Practices Towards Tuberculosis Among Clients Visiting Tepi General Hospital Outpatient Departments, 2019. Infect Drug Resist 2020; 13:4559-4568. [PMID: 33376362 PMCID: PMC7762442 DOI: 10.2147/idr.s287288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis, which is an infectious disease, is one of the leading causes of morbidity and mortality in developing countries. Ethiopia is facing high tuberculosis burdens. Even if it is preventable and curable, individuals' KAP towards the disease is one of the bottlenecks in decreasing the disease burdens. TGH, located in the Sheka zone, is one of the remote areas and the KAP towards TB is unknown. Therefore, the current study was undertaken in TGH to assess the KAP towards TB. Materials and Methods A cross-sectional study was conducted among 415 randomly selected participants. A structured questionnaire was used to collect the data by a face-to-face interview from May 23 to June 23/2019. Data were entered into Epidata 3.1 and exported to SPSS version 21 for descriptive analysis. Results A total of 345 (83%) respondents have heard about TB, while 76 (18%) respondents said persistence productive cough as symptoms of tuberculosis. Only 9.9% of participants mentioned bacteria as the cause of the diseases and 170 (41%) considered that the transmission is via air droplets. The majority (70%) of participants responded that its transmission is not preventable and overall 236 (56.9%) had high overall knowledge about TB. Thirty percent of the respondents considered that TB is serious to the area while 29% considered TB is not very serious for them. Fifty-three percent of the participants were having a favorable attitude towards tuberculosis. The majority (85%) did not cover their mouth while coughing, while 79.5% did not screen for tuberculosis and 82% of participants have not received any health education about TB. Overall, 44.6% practiced TB prevention. Conclusion The majority of the study participants had high overall knowledge and positive attitude towards tuberculosis prevention, which are not seen in the practice of tuberculosis. Effective educational programs should be implemented to overcome the problem.
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Affiliation(s)
| | | | - Tagay Asega
- Nursing Department, Tepi General Hospital, Tepi, Ethiopia
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Mohammedhussein M, Hajure M, Shifa JE, Hassen TA. Perceived stigma among patient with pulmonary tuberculosis at public health facilities in southwest Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0243433. [PMID: 33290413 PMCID: PMC7731994 DOI: 10.1371/journal.pone.0243433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Although tuberculosis (TB) related stigma has a significant impact on the diagnosis, patient adherence with treatment, and recovery from the disease, there is limited evidence from Ethiopia regarding perceived stigma among patient with pulmonary tuberculosis (PTB).The purpose of this study was to assess perceived stigma and associated factors among patient with PTB on treatment in southwest Ethiopia. METHODS Institution-based cross-sectional study was conducted from April to May 2019 among 410 patient with PTB. Data were collected by using the perceived tuberculosis stigma scale. Epi data v3.1 and SPSSv23 were used for data entry and analysis. Multivariable logistic regression models were fitted to identify factors associated with perceived stigma. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULT Prevalence of perceived stigma among patient with Pulmonary tuberculosis was 57.1% (95% CI: 52.2, 61.7). Poor social support (AOR = 2.41; 95% CI: 1.06, 5.48), above a month duration of illness (AOR = 2.48; 95% CI: 1.33, 4.64), high perceived stress (AOR = 1.95; 95% CI:1.09, 3.49), current khat use (AOR = 1.88; 95% CI:1.05, 3.37), and presence of depression (AOR = 8.18; 95% CI:4.40, 15.22) were significantly associated with perceived stigma. Patient with HIV co-infection were 5.67 times (AOR = 5.67; 95% CI: 2.32, 13.87) more likely to have Perceived stigma than their counterparts. CONCLUSION TB related stigma was reported by more than half of the study participant. Stigma reduction measures are needed to lower TB related stigma perceived by the patient, the level of distress associated with it, and to promote the psychological wellbeing of patient with TB.
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Affiliation(s)
- Mustefa Mohammedhussein
- Department of Psychiatry, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, Ethiopia
| | - Mohammedamin Hajure
- Department of Psychiatry, Faculty of Public Health and Medical Sciences, Mettu University, Mettu, Ethiopia
| | - Jemal Ebrahim Shifa
- Department of Psychiatry, School of Health Sciences, Mada Walabu University, Shashemene campus, Shashemene, Ethiopia
| | - Tahir Ahmed Hassen
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Nutor JJ, Slaughter-Acey JC, Marquez SP, DiMaria-Ghalili RA, Momplaisir F, Oladimeji KE, Jemmott LS. Impact of attitudes and beliefs on antiretroviral treatment adherence intention among HIV-positive pregnant and breastfeeding women in Zambia. BMC Public Health 2020; 20:1410. [PMID: 32938415 PMCID: PMC7495861 DOI: 10.1186/s12889-020-09505-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia. METHODS We recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART. RESULTS Intention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps < .05). In addition, strong intention to adhere to ART differed by urban (69%) and rural (31%) place of residence (P ≤ .01). In adjusted models, women in the weak adherence intention group were more likely to be older, have less knowledge about HIV transmission, and have a more negative attitude toward ART (PR 0.74; 95% CI 0.67-0.82). Behavioral belief about ART, however, was significant in unadjusted model (PR 0.85; 95% CI 0.76-0.94) but not significant after adjusting for covariates such as age, knowledge of transmission, and district locality. CONCLUSION Compared to behavioral beliefs, attitudes about ART were more influential for intention to adhere. This knowledge will help inform effective and appropriate ART counseling for pregnant and breastfeeding women at different points along their ART time course.
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Affiliation(s)
- Jerry John Nutor
- Family Health Care Nursing Department, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA, 94143-0608, USA.
| | - Jaime C Slaughter-Acey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Shannon P Marquez
- Undergraduate Global Engagement, Columbia University, New York City, NY, 110027, USA
| | | | - Florence Momplaisir
- Department of Medicine, Hospital of University of the Pennsylvania, Philadelphia, PA, 19102, USA
| | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, Alice, Eastern Cape, South Africa
| | - Loretta S Jemmott
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, 19104, USA
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12
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Getting the message across: Characterizing a need to bridge public health messaging for tuberculosis across a rural/urban and CHW/traditional healer divide in Madagascar (A review). SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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13
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Agu IC, Mbachu CO, Okeke C, Eze I, Agu C, Ezenwaka U, Ezumah N, Onwujekwe O. Misconceptions about transmission, symptoms and prevention of HIV/AIDS among adolescents in Ebonyi state, South-east Nigeria. BMC Res Notes 2020; 13:244. [PMID: 32410689 PMCID: PMC7227299 DOI: 10.1186/s13104-020-05086-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/08/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives Nigeria has the second largest number of adolescents and young people living with HIV/AIDS in the world. Misconceptions about HIV/AIDS contribute to spread of HIV, and constrain uptake of preventive services. This paper explored misconceptions about HIV/AIDS among adolescents in south-east Nigeria. A qualitative study was conducted in six urban and rural local government areas of Ebonyi state. Data were collected through twelve focus group discussions (FGD) with unmarried adolescents aged 13–18 who were either attending school or out-of-school. The FGDs were conducted using a pre-tested topic guide. Data were coded manually and analyzed using a thematic framework approach. Results There are persistent misconceptions about transmission of HIV/AIDS through mosquito bites and sharing of personal belongings. Some adolescents had inaccurate notions that a HIV infected person could be identified through changes in physical features such as abdominal swelling and longer fingernails. A few of them also reported that HIV could be treated with antibiotics. These misconceptions were expressed by both male and female adolescents. Adolescents have some mistaken beliefs about HIV/AIDS which constrain them from taking necessary preventive measures. Hence, the need to target adolescents with health education interventions on HIV/AIDS.
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Affiliation(s)
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Chinyere Okeke
- Health Policy Research Group, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Irene Eze
- Health Policy Research Group, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Chibuike Agu
- Health Policy Research Group, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Uchenna Ezenwaka
- Health Policy Research Group, University of Nigeria, Enugu, Nigeria.,Department of Health Administration and Management, University of Nigeria, Enugu, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, University of Nigeria, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria, Enugu, Nigeria.,Department of Health Administration and Management, University of Nigeria, Enugu, Nigeria
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14
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Wondimu W, Dube L, Kabeta T. Factors Affecting Survival Rates Among Adult TB/HIV Co-Infected Patients in Mizan Tepi University Teaching Hospital, South West Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:157-164. [PMID: 32368156 PMCID: PMC7185339 DOI: 10.2147/hiv.s242756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/07/2020] [Indexed: 11/23/2022]
Abstract
Background Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection was responsible for approximately 300,000 deaths worldwide in 2017. Despite this burden of death, factors associated with the survival of TB-HIV co-infected patients were not adequately studied; and some of the existing evidences are inconsistent. This study was aimed to identify factors associated with survival rates of TB/HIV co-infected patients. Methods The current study was a retrospective analysis of data extracted from 364 TB/HIV co-infected patients treated at Mizan Tepi University Teaching Hospital, Ethiopia, during the years 2007-2017. Time to event was measured from the date of TB treatment initiation till death, loss to follow-up or completion of treatment. Since the event was death, patients lost from follow-up and those on follow-up were considered as censored. Using Cox-regression, the 95% CI of hazard ratio (HR) and P-value <0.05 were used to identify the significant variables in multivariable analysis. Results All the 364 patients were followed up for 1654 person-months. There were 83 (22.8%) deaths and the majority, 38 (45.8%), were occurring within the first two months of anti-TB treatment initiation. The overall incidence rate and median survival time were 5.02 per 100 person-months (95% CI: 4.05, 6.22) and 10 months, respectively. Not using CPT (adjusted hazard ratio [AHR] =1.72; P=0.023), bedridden functional status (AHR=2.55; P=0.007), not disclosing HIV status (AHR=4.03; P<0.001) and CD4 < 200 cells/mm3 (AHR=6.05; P<0.001) were factors associated with survival rates of TB/HIV co-infected patients. Conclusion Our finding signals that care and attention should be given to the victims of these synergistic diseases. There is room to improve the survival of the patients if those with low CD4 count and bedridden functional status are closely monitored; and if CPT is promptly initiated with encouraging HIV status disclosure.
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Affiliation(s)
- Wondimagegn Wondimu
- Mizan Tepi University, College of Health Science, Department of Public Health, Mizan Aman, Ethiopia
| | - Lamessa Dube
- Jimma University, Faculty of Public Health, Department of Epidemiology, Jimma, Ethiopia
| | - Teshome Kabeta
- Jimma University, Faculty of Public Health, Department of Epidemiology, Jimma, Ethiopia
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15
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Datiko DG, Habte D, Jerene D, Suarez P. Knowledge, attitudes, and practices related to TB among the general population of Ethiopia: Findings from a national cross-sectional survey. PLoS One 2019; 14:e0224196. [PMID: 31658300 PMCID: PMC6816561 DOI: 10.1371/journal.pone.0224196] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 10/08/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Ethiopia is among the high-burden countries for tuberculosis (TB), TB/HIV, and drug-resistant TB. The aim of this nationwide study was to better understand TB-related knowledge, attitudes, and practices (KAPs) and generate evidence for policy and decision-making. MATERIALS AND METHODS We conducted a cross-sectional TB KAP survey in seven regions and two city administrations of Ethiopia. Eighty kebeles (wards) and 40 health centers were randomly selected for the study. Using systematic sampling, 22 households and 11 TB patients were enrolled from each selected village and health center, respectively. Variables with a value of p = < 0.25 were included in the model for logistic regression analysis. RESULTS Of 3,503 participants, 884 (24.4%), 836 (24.1%), and 1,783 (51.5%) were TB patients, families of TB patients, and the general population, respectively. The mean age was 34.3 years, and 50% were women. Forty-six percent were heads of households, 32.1% were illiterate, 20.3% were farmers, and 19.8% were from the lowest quintile. The majority (95.5%) had heard about TB, but only 25.8% knew that TB is caused by bacteria. Cough or sneezing was reported as the commonest means of TB transmission. The majority (85.3%) knew that TB could be cured. Men, better-educated people, and TB patients and their families have higher knowledge scores. Of 2,483 participants, 96% reported that they would go to public health facilities if they developed TB symptoms. DISCUSSION Most Ethiopians have a high level of awareness about TB and seek care in public health facilities, and communities are generally supportive. Inadequate knowledge about TB transmission, limited engagement of community health workers, and low preference for using community health workers were the key challenges. CONCLUSIONS Given misconceptions about TB's causes, low preference for use of community health workers, and inadequate engagement, targeted health education interventions are required to improve TB services.
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Affiliation(s)
- Daniel G Datiko
- Challenge TB and Management Sciences for Health, Addis Ababa, Ethiopia
| | - Dereje Habte
- Challenge TB and Management Sciences for Health, Addis Ababa, Ethiopia
| | - Degu Jerene
- Challenge TB and Management Sciences for Health, Addis Ababa, Ethiopia
| | - Pedro Suarez
- Management Sciences for Health, Infectious Diseases Cluster, Arlington, Virginia, United States of America
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16
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Yaya S, Ghose B, Udenigwe O, Shah V, Hudani A, Ekholuenetale M. Knowledge and attitude of HIV/AIDS among women in Nigeria: a cross-sectional study. Eur J Public Health 2019; 29:111-117. [PMID: 30053009 DOI: 10.1093/eurpub/cky131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) epidemic is one of the world's most serious public health and social problems. Promoting knowledge and attitude towards HIV/AIDS is a key strategy to control the prevalence of this growing epidemic. This study aimed to measure knowledge and attitude about HIV/AIDS along with the factors of association Nigerian women. Methods This is a cross-sectional study based on data from the 2013 Demographic Health Survey (DHS) conducted among community dwelling women in Nigeria. A set of 13 questions was identified relevant to knowledge and attitude about HIV/AIDS. Each correct answer was scored as 1 and wrong answer as '0'. Normality of the variables was examined using Shapiro-Wilks tests. The socioeconomic and community factors associated with HIV/AIDS knowledge and attitude were examined by linear regression with dummy variables model. Results Means score (SD) on knowledge of transmission was 6.4 (2.0) and that for attitude was 2.1 (1.2). In the regression models, knowledge and attitude of HIV/AIDS were positively associated with survey years and respondents' age; geographical region was significantly associated with HIV/AIDS knowledge and attitude; rural respondents had significant reduction in knowledge [Exp(B)=0.86; 95% confidence interval (CI)=0.83-0.89] and positive attitude to HIV/AIDS [Exp(B)=0.91; 95% CI=0.89-0.93] compared with the urban counterpart, respectively. Conclusion Findings of the present study suggested that women's knowledge and attitude about HIV/AIDS in Nigeria needs more attention to attain the global target to end its epidemics and other communicable diseases by 2030.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Bishwajit Ghose
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Vaibhav Shah
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Alzahra Hudani
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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17
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Stošić MB, Simić DM, Babić DD, Ristić L, Kuruc V. HIV prevalence, knowledge and self-perceived risk of HIV infection among tuberculosis patients in Serbia. Cent Eur J Public Health 2019; 27:99-105. [PMID: 31241283 DOI: 10.21101/cejph.a4950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/07/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the seroprevalence of HIV infection among TB patients, knowledge, self-perceived risks and testing practices related to HIV. METHODS We performed cross-sectional study from 10 May to 15 July 2011. Cluster sampling method was used to select 27 hospitals where 289 TB patients were consecutively recruited. Descriptive statistics and multivariable logistic regression methods were used to identify the factors associated with correct comprehensive knowledge of HIV/AIDS. RESULTS HIV prevalence among TB patients was 0.3%. Only 25.2% of the respondents presented comprehensive correct knowledge of HIV/AIDS. The percentage of correct answers to all questions related to knowledge about HIV/AIDS increases with educational status (χ2 = 5.42; p < 0.05) and decreases with the age of respondents (χ2 = 8.53; p > 0.05). The independent predictors of correct comprehensive knowledge were living without partner (OR = 4.45; CI = 1.59-12.95) and self-awareness of HIV risk (OR = 4.43; CI = 1.20-16.52). CONCLUSION HIV prevalence among TB patients is higher than among general population in Serbia. The level of comprehensive correct knowledge of HIV/AIDS is low. There is a need for continuous implementation of public health strategy to successfully manage HIV and HIV/TB co-infection in Serbia.
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Affiliation(s)
- Maja B Stošić
- Department for HIV infection, STIs, Viral Hepatitis and TB, Public Health Institute of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Danijela M Simić
- Department for HIV infection, STIs, Viral Hepatitis and TB, Public Health Institute of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Dragan D Babić
- Institute of Medical Statistics and Informatics, School of Medicine, Belgrade, Serbia
| | - Lidija Ristić
- Clinic for Pulmonary Disease, Clinical Centre of Nis, Nis, Serbia
| | - Vesna Kuruc
- Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
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18
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Heath K, Byard RW. Tuberculosis-related stigma contributing to a 'hidden' disease at autopsy. MEDICINE, SCIENCE, AND THE LAW 2019; 59:135-138. [PMID: 31081464 DOI: 10.1177/0025802419849350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 29-year-old African immigrant to Australia was found dead in bed. She had no known medical history, except for recent weight loss and hip/leg pain. Autopsy examination revealed extensive tuberculous consolidation with widespread cavitation of the lungs, with multiple caseating granulomas containing large numbers of acid fast bacilli on histology. Similar granulomas were also present in lymph nodes of the porta hepatis, mediastinum and pulmonary hilum, and within the liver, spleen and mesentery. Mycobacterial polymerase chain reaction analysis confirmed tuberculous infection. Her serum was negative for human immunodeficiency virus infection. Death was due to disseminated tuberculosis. In many parts of Africa, there are negative cultural associations attached to tuberculosis, which often leads to a delay in diagnosis. The case demonstrates the extent of active disease that may be uncovered at autopsy in decedents from societies where tuberculosis is stigmatised and therefore concealed. It also emphasises the risk of infection for forensic workers.
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Affiliation(s)
- Karen Heath
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Australia
| | - Roger W Byard
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Australia
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19
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Deribew A, Biadgilign S, Deribe K, Dejene T, Tessema GA, Melaku YA, Lakew Y, Amare AT, Bekele T, Abera SF, Dessalegn M, Kumsa A, Assefa Y, Glenn SD, Frank T, Carter A, Misganaw A, Wang H. The Burden of HIV/AIDS in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study. Ethiop J Health Sci 2019; 29:859-868. [PMID: 30700953 PMCID: PMC6341438 DOI: 10.4314/ejhs.v29i1.7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background The burden of HIV/AIDS in Ethiopia has not been comprehensively assessed over the last two decades. In this study, we used the 2016 Global Burden of Diseases, Injuries and Risk factors (GBD) data to analyze the incidence, prevalence, mortality and Disability-adjusted Life Years Lost (DALY) rates of Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV/AIDS) in Ethiopia over the last 26 years. Methods The GBD 2016 used a wide range of data source for Ethiopia such as verbal autopsy (VA), surveys, reports of the Federal Ministry of Health and the United Nations (UN) and published scientific articles. The modified United Nations Programme on HIV/AIDS (UNAIDS) Spectrum model was used to estimate the incidence and mortality rates for HIV/AIDS. Results In 2016, an estimated 36,990 new HIV infections (95% uncertainty interval [UI]: 8775-80262), 670,906 prevalent HIV cases (95% UI: 568,268–798,970) and 19,999 HIV deaths (95% UI: 16426-24412) occurred in Ethiopia. The HIV/AIDS incidence rate peaked in 1995 and declined by 6.3% annually for both sexes with a total reduction of 77% between 1990 and 2016. The annualized HIV/AIDS mortality rate reduction during 1990 to 2016 for both sexes was 0.4%. Conclusions Ethiopia has achieved the 50% reduction of the incidence rate of HIV/AIDS based on the Millennium Development Goals (MDGs) target. However, the decline in HIV/AIDS mortality rate has been comparatively slow. The country should strengthen the HIV/AIDS detection and treatment programs at community level to achieve its targets during the Sustainable Development Program (SDGs)-era.
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Affiliation(s)
- Amare Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia Hospital.,Nutrition International, Ethiopia
| | | | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK.,School of Medicine, Addis Ababa University, Ethiopia
| | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gizachew Assefa Tessema
- School of Public Health, University of Adelaide, Adelaide, Australia.,Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yohannes Adama Melaku
- School of Public Health, Mekelle University, Mekelle, Ethiopia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Yihune Lakew
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Azmeraw T Amare
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Tolessa Bekele
- Department of Public Health, College of Medicine and Health Sciences, Madda Walabu University, Ethiopia
| | - Semaw F Abera
- School of Public Health, Mekelle University, Mekelle, Ethiopia.,Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Ethiopia.,Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany
| | | | | | - Yibeltal Assefa
- University of Queensland, School of Public Health, Australia
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington
| | - Tahvi Frank
- Institute of Health Metrics and Evaluation, University of Washington
| | - Austin Carter
- Institute of Health Metrics and Evaluation, University of Washington
| | - Awoke Misganaw
- Institute of Health Metrics and Evaluation, University of Washington
| | - Haidong Wang
- Institute of Health Metrics and Evaluation, University of Washington
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20
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Nouvet E, Knoblauch AM, Passe I, Andriamiadanarivo A, Ravelona M, Ainanomena Ramtariharisoa F, Razafimdriana K, Wright PC, McKinney J, Small PM, Rakotosamimanana N, Grandjean Lapierre S. Perceptions of drones, digital adherence monitoring technologies and educational videos for tuberculosis control in remote Madagascar: a mixed-method study protocol. BMJ Open 2019; 9:e028073. [PMID: 31076475 PMCID: PMC6528021 DOI: 10.1136/bmjopen-2018-028073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/22/2019] [Accepted: 03/04/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Poor road and communication infrastructure pose major challenges to tuberculosis (TB) control in many regions of the world. TB surveillance and patient support often fall to community health workers (CHWs) who may lack the time or knowledge needed for this work. To meet the End TB Strategy goal of reducing TB incidence by 90% by 2035, the WHO calls for intensified research and innovation including the rapid uptake of new tools, interventions and strategies. Technologies that 'leapfrog' infrastructure challenges and support CHWs in TB control responsibilities have the potential to dramatically change TB outcomes in remote regions. Such technologies may strengthen TB control activities within challenged national tuberculosis treatment and control programmes (NTPs), and be adapted to address other public health challenges. The deployment of innovative technologies needs to be differentially adapted to context-specific factors. The Drone Observed Therapy System (DrOTS) project was launched in Madagascar in 2017 and integrates a bundle of innovative technologies including drones, digital adherence monitoring technology and mobile device-based educational videos to support TB control. METHODS AND ANALYSIS This mixed-methods study gathers and analyses cultural perceptions of the DrOTS project among key stakeholders: patients, community members, CHWs, village chiefs and NTP-DrOTS mobile health teams. Data from questionnaires, semistructured interviews, focus group discussions (FGD) and ethnographic observation gathered from June 2018 to June 2019 are thematically analysed and compared to identify patterns and singularities in how DrOTS stakeholders perceive and interact with DrOTS technologies, its enrolment processes, objectives and team. ETHICS AND DISSEMINATION Ethics approval was obtained from the National Bioethics Research Committee of Madagascar and Stony Brook University institutional review board. Study results will be submitted for peer-reviewed publication. In Madagascar, results will be presented in person to Ministry and other Malagasy decision-makers through the Institut Pasteur de Madagascar. PATIENT AND PUBLIC INVOLVEMENT This study is designed to foreground the voices of patients and potential patients in the DrOTS programme. CHW participants in this study also supported the design of study information sessions and recruitment strategies. One member of the mobile health team provided detailed input on the wording and content of FGD and interview guides. Study findings will be presented via a report in French and Malagasy to CHW, mobile health team and other village-level participants who have email/internet access.
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Affiliation(s)
- Elysée Nouvet
- School of Health Studies, Western University, London, Ontario, Canada
| | - Astrid M Knoblauch
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- Mycobacteria Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ian Passe
- Global Health Institute, Stony Brook University, Stony Brook, New York, NY, USA
| | | | | | | | | | - Patricia C Wright
- Global Health Institute, Stony Brook University, Stony Brook, New York, NY, USA
- Health Department, Center Valbio, Ranomafana, Madagascar
| | - Jesse McKinney
- Global Health Institute, Stony Brook University, Stony Brook, New York, NY, USA
- Health Department, Center Valbio, Ranomafana, Madagascar
| | - Peter M Small
- Global Health Institute, Stony Brook University, Stony Brook, New York, NY, USA
| | | | - Simon Grandjean Lapierre
- Mycobacteria Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Immunopathology, Centre de recherche du CHUM, Montreal, Quebec, Canada
- Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montréal, Québec, Canada
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21
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Deribew A, Deribe K, Dejene T, Tessema GA, Melaku YA, Lakew Y, Amare AT, Bekele T, Abera SF, Dessalegn M, Kumsa A, Assefa Y, Kyu H, Glenn SD, Misganaw A, Biadgilign S. Tuberculosis Burden in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study. Ethiop J Health Sci 2019; 28:519-528. [PMID: 30607066 PMCID: PMC6308773 DOI: 10.4314/ejhs.v28i5.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background The burden of Tuberculosis (TB) has not been comprehensively evaluated over the last 25 years in Ethiopia. In this study, we used the 2016 Global Burden of Diseases, Injuries and Risk Factors (GBD) data to analyze the incidence, prevalence and mortality rates of tuberculosis (TB) in Ethiopia over the last 26 years. Methods The GBD 2016 is a mathematical modeling using different data source for Ethiopia such as verbal autopsy (VA), prevalence surveys and annual case notifications. Age and sex specific causes of death for TB were estimated using the Cause of Death Ensemble Modeling (CODEm). We used the available data such as annual notifications and prevalence surveys as an input to estimate incidence and prevalence rates respectively using DisMod-MR 2.1, a Bayesian meta-regression tool. Results In 2016, we estimated 219,186 (95%UI: 182,977–265,292) new, 151,602 (95% UI: 126,054–180,976) prevalent TB cases and 48,910(95% UI: 40,310–58,195) TB deaths. The age-standardized TB incidence rate decreased from 201.6/100,000 to 88.5/100,000 (with a total decline of 56%) between 1990 to 2016. Similarly, the age-standardized TB mortality rate declined from 393.8/100,000 to 100/100,000 between 1990 and 2016(with a total decline of 75%). Conclusions Ethiopia has achieved the 50% reduction of most of the Millennium Development Goals (MDGs) targets related to TB. However, the decline of TB incidence and prevalence rates has been comparatively slow. The country should strengthen the TB case detection and treatment programs at community level to achieve its targets during the Sustainable Development Program (SDGs)-era.
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Affiliation(s)
- Amare Deribew
- St. Paul Hospital Millennium Medical College, Ethiopia.,Nutrition International, Ethiopia
| | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Brighton, UK.,School of Medicine, Addis Ababa University, Ethiopia
| | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Ethiopia
| | - Gizachew Assefa Tessema
- School of Public Health, University of Adelaide, Adelaide, Australia.,Department of Reproductive Health, Institute of Public Health, University of Gondar, Ethiopia
| | - Yohannes Adama Melaku
- School of Public Health, Mekelle University, Ethiopia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | | | - Azmeraw T Amare
- College of Medicine and Health Sciences, Bahir Dar University, Ethiopia.,Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Tolessa Bekele
- College of Medicine and Health Sciences, Madda Walabu University, Ethiopia
| | - Semaw F Abera
- School of Public Health, Mekelle University, Ethiopia.,Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Ethiopia.,Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany
| | | | | | - Yibeltal Assefa
- University of Queensland, School of Public Health, Australia
| | - Hmwe Kyu
- Institute of Health Metrics and Evaluation, University of Washington
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington
| | - Awoke Misganaw
- Institute of Health Metrics and Evaluation, University of Washington
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Deribew A, Biadgilign S, Berhanu D, Defar A, Deribe K, Tekle E, Asheber K, Dejene T. Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia. BMC Health Serv Res 2018; 18:535. [PMID: 29996821 PMCID: PMC6042210 DOI: 10.1186/s12913-018-3347-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022] Open
Abstract
Background There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas.
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Affiliation(s)
- Amare Deribew
- St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia. .,Nutrition International, Addis Ababa, Ethiopia.
| | - Sibhatu Biadgilign
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Della Berhanu
- London School of Hygiene and Tropical Medicine, London, UK.,Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Atkure Defar
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK.,Collage of Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Tekle
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
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23
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Sikalengo G, Hella J, Mhimbira F, Rutaihwa LK, Bani F, Ndege R, Sasamalo M, Kamwela L, Said K, Mhalu G, Mlacha Y, Hatz C, Knopp S, Gagneux S, Reither K, Utzinger J, Tanner M, Letang E, Weisser M, Fenner L. Distinct clinical characteristics and helminth co-infections in adult tuberculosis patients from urban compared to rural Tanzania. Infect Dis Poverty 2018; 7:24. [PMID: 29580279 PMCID: PMC5868052 DOI: 10.1186/s40249-018-0404-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/12/2018] [Indexed: 12/25/2022] Open
Abstract
Background Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis (TB). We comparatively studied epidemiological features of TB and helminth co-infections in adult patients from rural and urban settings of Tanzania. Methods Adult patients (≥ 18 years) with microbiologically confirmed pulmonary TB were consecutively enrolled into two cohorts in Dar es Salaam, with ~ 4.4 million inhabitants (urban), and Ifakara in the sparsely populated Kilombero District with ~ 400 000 inhabitants (rural). Clinical data were obtained at recruitment. Stool and urine samples were subjected to diagnose helminthiases using Kato-Katz, Baermann, urine filtration, and circulating cathodic antigen tests. Differences between groups were assessed by χ2, Fisher’s exact, and Wilcoxon rank sum tests. Logistic regression models were used to determine associations. Results Between August 2015 and February 2017, 668 patients were enrolled, 460 (68.9%) at the urban and 208 (31.1%) at the rural site. Median patient age was 35 years (interquartile range [IQR]: 27–41.5 years), and 454 (68%) were males. Patients from the rural setting were older (median age 37 years vs. 34 years, P = 0.003), had a lower median body mass index (17.5 kg/m2 vs. 18.5 kg/m2, P < 0.001), a higher proportion of recurrent TB cases (9% vs. 1%, P < 0.001), and in HIV/TB co-infected patients a lower median CD4 cell counts (147 cells/μl vs. 249 cells/μl, P = 0.02) compared to those from urban Tanzania. There was no significant difference in frequencies of HIV infection, diabetes mellitus, and haemoglobin concentration levels between the two settings. The overall prevalence of helminth co-infections was 22.9% (95% confidence interval [CI]: 20.4–27.0%). The significantly higher prevalence of helminth infections at the urban site (25.7% vs. 17.3%, P = 0.018) was predominantly driven by Strongyloides stercoralis (17.0% vs. 4.8%, P < 0.001) and Schistosoma mansoni infection (4.1% vs. 16.4%, P < 0.001). Recurrent TB was associated with living in a rural setting (adjusted odds ratio [aOR]: 3.97, 95% CI: 1.16–13.67) and increasing age (aOR: 1.06, 95% CI: 1.02–1.10). Conclusions Clinical characteristics and helminth co-infections pattern differ in TB patients in urban and rural Tanzania. The differences underline the need for setting-specific, tailored public health interventions to improve clinical management of TB and comorbidities. Electronic supplementary material The online version of this article (10.1186/s40249-018-0404-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jerry Hella
- Ifakara Health Institute, Dar es Salaam, Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Francis Mhimbira
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Liliana K Rutaihwa
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Farida Bani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Robert Ndege
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mohamed Sasamalo
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Khadija Said
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Yeromin Mlacha
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sébastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Emilio Letang
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Maja Weisser
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Lukas Fenner
- Ifakara Health Institute, Dar es Salaam, Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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24
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Mindu C, López-Varela E, Alonso-Menendez Y, Mausse Y, Augusto OJ, Gondo K, Múñoz J, Sacarlal J, García-Basteiro AL, Alonso PL, Munguambe K. Caretakers' perspectives of paediatric TB and implications for care-seeking behaviours in Southern Mozambique. PLoS One 2017; 12:e0182213. [PMID: 28910284 PMCID: PMC5598920 DOI: 10.1371/journal.pone.0182213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 07/12/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains an important public health concern, especially in poorly resourced settings. TB diagnosis is challenging, particularly for children, who are the most vulnerable to its' impacts. Lack of knowledge and awareness of the disease compromises prompt diagnosis and treatment compliance. OBJECTIVE To gain insights regarding caretakers' knowledge of the aetiology and prevention of paediatric TB in southern Mozambique, to describe their care-seeking behaviours and to assess the acceptability of diagnostic procedures. METHODS A total of 35 caretakers were interviewed, all of which had children with TB compatible symptoms. Eleven were caretakers of children diagnosed with TB at the health facility, 11 of children for whom TB was excluded as a diagnosis at the health facility and 13 of children with TB compatible symptoms identified in the community. The first two groups took part in a TB incidence study, while the third group did not. All underwent the same semi-structured interviews, the results of which were analysed and compared using content analysis. RESULTS Even when confronted with signs suggestive of TB, most caretakers never suspected it or misinterpreted the signs, even among caretakers with TB and TB contacts. There was limited knowledge of TB, except among those undergoing treatment. The transgression of social norms was often presented as an explanation for TB in parallel to medically sound causes. The use of traditional care for prevention is widespread, but it varied for treatment purposes. TB diagnostic procedures were considered painful but were unanimously tolerated. CONCLUSIONS AND SIGNIFICANCE Misconceptions of paediatric TB, associated complex care-seeking itineraries and negative feelings of the diagnostic procedures may result in delays, low adherence and lost to follow-up, which needs to be addressed by adequately framed health promotion approaches.
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Affiliation(s)
- Carolina Mindu
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
| | - Elisa López-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- ISGlobal, Barcelona Global Health Institute, Hospital Clınic – Universitat de Barcelona, Barcelona, Spain
| | | | - Yolanda Mausse
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
| | | | - Kizito Gondo
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
| | - Jose Múñoz
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- ISGlobal, Barcelona Global Health Institute, Hospital Clınic – Universitat de Barcelona, Barcelona, Spain
| | - Jahit Sacarlal
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Alberto L. García-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- ISGlobal, Barcelona Global Health Institute, Hospital Clınic – Universitat de Barcelona, Barcelona, Spain
- Amsterdam Institute for Global Health and Development (AIGHD), Academic Medical Center, Amsterdam, The Netherlands
| | - Pedro L. Alonso
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- ISGlobal, Barcelona Global Health Institute, Hospital Clınic – Universitat de Barcelona, Barcelona, Spain
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
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25
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Zein RA, Suhariadi F, Hendriani W. Estimating the effect of lay knowledge and prior contact with pulmonary TB patients, on health-belief model in a high-risk pulmonary TB transmission population. Psychol Res Behav Manag 2017; 10:187-194. [PMID: 28790871 PMCID: PMC5488811 DOI: 10.2147/prbm.s134034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The research aimed to investigate the effect of lay knowledge of pulmonary tuberculosis (TB) and prior contact with pulmonary TB patients on a health-belief model (HBM) as well as to identify the social determinants that affect lay knowledge. Methods Survey research design was conducted, where participants were required to fill in a questionnaire, which measured HBM and lay knowledge of pulmonary TB. Research participants were 500 residents of Semampir, Asemrowo, Bubutan, Pabean Cantian, and Simokerto districts, where the risk of pulmonary TB transmission is higher than other districts in Surabaya. Results Being a female, older in age, and having prior contact with pulmonary TB patients significantly increase the likelihood of having a higher level of lay knowledge. Lay knowledge is a substantial determinant to estimate belief in the effectiveness of health behavior and personal health threat. Prior contact with pulmonary TB patients is able to explain the belief in the effectiveness of a health behavior, yet fails to estimate participants’ belief in the personal health threat. Conclusion Health authorities should prioritize males and young people as their main target groups in a pulmonary TB awareness campaign. The campaign should be able to reconstruct people’s misconception about pulmonary TB, thereby bringing around the health-risk perception so that it is not solely focused on improving lay knowledge.
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Affiliation(s)
- Rizqy Amelia Zein
- Crisis and Community Development Centre, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia.,Department of Personality and Social Psychology, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
| | - Fendy Suhariadi
- Crisis and Community Development Centre, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
| | - Wiwin Hendriani
- Crisis and Community Development Centre, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
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26
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Sima BT, Belachew T, Abebe F. Knowledge, attitude and perceived stigma towards tuberculosis among pastoralists; Do they differ from sedentary communities? A comparative cross-sectional study. PLoS One 2017; 12:e0181032. [PMID: 28715439 PMCID: PMC5513437 DOI: 10.1371/journal.pone.0181032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ethiopia is ninth among the world high tuberculosis (TB) burden countries, pastoralists being the most affected population. However, there is no published report whether the behavior related to TB are different between pastoralist and the sedentary communities. Therefore, the main aim of this study is to assess the pastoralist community knowledge, attitude and perceived stigma towards tuberculosis and their health care seeking behavior in comparison to the neighboring sedentary communities and this may help to plan TB control interventions specifically for the pastoralist communities. METHOD A community-based cross-sectional survey was carried out from September 2014 to January 2015, among 337 individuals from pastoralist and 247 from the sedentary community of Kereyu district. Data were collected using structured questionnaires. Three focus group discussions were used to collect qualitative data, one with men and the other with women in the pastoralist and one with men in the sedentary groups. Data were analyzed using Statistical Software for Social Science, SPSS V 22 and STATA. RESULTS A Lower proportion of pastoralists mentioned bacilli (bacteria) as the cause of PTB compared to the sedentary group (63.9% vs. 81.0%, p<0.01), respectively. However, witchcraft was reported as the causes of TB by a higher proportion of pastoralists than the sedentary group (53.6% vs.23.5%, p<0.01), respectively. Similarly, a lower proportion of pastoralists indicated PTB is preventable compared to the sedentary group (95.8% vs. 99.6%, p<0.01), respectively. Moreover, majority of the pastoralists mentioned that most people would reject a TB patient in their community compared to the sedentary group (39.9% vs. 8.9%, p<0.001), respectively, and the pastoralists expressed that they would be ashamed/embarrassed if they had TB 68% vs.36.4%, p<0.001), respectively. CONCLUSION The finding indicates that there is a lower awareness about TB, a negative attitude towards TB patients and a higher perceived stigma among pastoralists compared to their neighbor sedentary population. Strategic health communications pertinent to the pastoralists way of life should be planned and implemented to improve the awareness gap about tuberculosis.
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Affiliation(s)
- Bezawit Temesgen Sima
- Public Health and Medical College, Jimma University, Jimma, Ethiopia
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- * E-mail:
| | - Tefera Belachew
- Public Health and Medical College, Jimma University, Jimma, Ethiopia
| | - Fekadu Abebe
- Department of Community Medicine and Global Health, Institute for Health and Society, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
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27
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Nathavitharana RR, Bond P, Dramowski A, Kotze K, Lederer P, Oxley I, Peters JA, Rossouw C, van der Westhuizen HM, Willems B, Ting TX, von Delft A, von Delft D, Duarte R, Nardell E, Zumla A. Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis. Presse Med 2017; 46:e53-e62. [PMID: 28256382 DOI: 10.1016/j.lpm.2017.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/04/2017] [Accepted: 01/17/2017] [Indexed: 11/29/2022] Open
Abstract
Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.
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Affiliation(s)
- Ruvandhi R Nathavitharana
- TB Proof, Cape Town, South Africa; Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, MA 02215, USA.
| | | | - Angela Dramowski
- TB Proof, Cape Town, South Africa; Paediatric Infectious Diseases, Stellenbosch University, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Koot Kotze
- TB Proof, Cape Town, South Africa; East London Hospital Complex, East London, South Africa
| | - Philip Lederer
- TB Proof, Cape Town, South Africa; Massachusetts General Hospital, Division of Infectious Diseases, , Boston, MA 02215, USA
| | - Ingrid Oxley
- Nelson Mandela Metropolitan University, Dietetics Division, , Port Elizabeth, South Africa
| | - Jurgens A Peters
- TB Proof, Cape Town, South Africa; London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Clinical Research Department, London, UK
| | | | | | - Bart Willems
- TB Proof, Cape Town, South Africa; Stellenbosch University, Division of Community Health, Faculty of Medicine and Health Sciences, , Cape Town, South Africa
| | - Tiong Xun Ting
- TB Proof, Cape Town, South Africa; Clinical Research Center, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Arne von Delft
- TB Proof, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, 7925 Observatory, South Africa
| | | | - Raquel Duarte
- Institute of Public Health, Porto University, EpiUnit, Portugal; Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Edward Nardell
- Brigham and Women's Hospital, Division of Global Health and Social Medicine, 02115 Boston, MA, USA
| | - Alimuddin Zumla
- TB Proof, Cape Town, South Africa; University College London, and NIHR Biomedical Research Centre, University College London Hospital, Division of Infection and Immunity, London, UK
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28
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O’Dwyer G, Lino V, Rodrigues N, Kramer M, Reis I, Frossard V, Vianna E, Elias L, Estellita-Lins CE. Illness Experience in a Very Low Income/Poor District of Rio de Janeiro, Brazil: Tuberculosis, Medication Adherence and Common Mental Disorders. Health (London) 2017. [DOI: 10.4236/health.2017.93038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Masoudnia E. Public perceptions about HIV/AIDS and discriminatory attitudes toward people living with acquired immunodeficiency syndrome in Iran. SAHARA J 2016; 12:116-22. [PMID: 26726933 DOI: 10.1080/17290376.2015.1123644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Negative and discriminatory attitudes towards people living with HIV/AIDS (PLWHA) are one of the biggest experienced challenges by people suffering from HIV, and these attitudes have been regarded as a serious threat to the fundamental rights of all infected people who are affected or associated with this disease in Iran. This study aimed to determine the relationship between public perception about HIV/AIDS and discriminatory attitudes toward PLWHA . The present study was conducted using a descriptive and survey design. Data were collected from 450 patients (236 male and 214 female) in Tehran and Yazd cities. The research instruments were modified HIV-related knowledge/attitude and perception questions about PLWHA, and discriminatory attitudes toward PLWHA. The results showed that prevalence of discriminatory attitudes toward PLWHA in the studied population was 60.0%. There was a significant negative correlation between citizens' awareness about HIV/AIDS, HIV-related attitudes, negative perception toward people with HIV/AIDS symptoms and their discriminatory attitudes toward PLWHA (p < .01). The hierarchical multiple regression analysis showed that components of public perception about HIV/AIDS explained for 23.7% of the variance of discriminatory attitudes toward PLWHA. Negative public perceptions about HIV/AIDS in Iran associated with discriminatory attitudes toward PLWHA and cultural beliefs in Iran tend to stigmatize and discriminate against the LWHA.
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Affiliation(s)
- Ebrahim Masoudnia
- a PhD, is an Associate Professor affiliated to Medical Sociology, Department of Sociology, Faculty of Humanities , University of Guilan , P.O. Box 1841, Rasht , Iran
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30
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von Delft A, Dramowski A, Khosa C, Kotze K, Lederer P, Mosidi T, Peters JA, Smith J, van der Westhuizen HM, von Delft D, Willems B, Bates M, Craig G, Maeurer M, Marais BJ, Mwaba P, Nunes EA, Nyirenda T, Oliver M, Zumla A. Why healthcare workers are sick of TB. Int J Infect Dis 2016; 32:147-51. [PMID: 25809771 DOI: 10.1016/j.ijid.2014.12.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
Abstract
Dr Thato Mosidi never expected to be diagnosed with tuberculosis (TB), despite widely prevalent exposure and very limited infection control measures. The life-threatening diagnosis of primary extensively drug-resistant TB (XDR-TB) came as an even greater shock. The inconvenient truth is that, rather than being protected, Dr Mosidi and thousands of her healthcare colleagues are at an increased risk of TB and especially drug-resistant TB. In this viewpoint paper we debunk the widely held false belief that healthcare workers are somehow immune to TB disease (TB-proof) and explore some of the key factors contributing to the pervasive stigmatization and subsequent non-disclosure of occupational TB. Our front-line workers are some of the first to suffer the consequences of a progressively more resistant and fatal TB epidemic, and urgent interventions are needed to ensure the safety and continued availability of these precious healthcare resources. These include the rapid development and scale-up of improved diagnostic and treatment options, strengthened infection control measures, and focused interventions to tackle stigma and discrimination in all its forms. We call our colleagues to action to protect themselves and those they care for.
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Affiliation(s)
- Arne von Delft
- TB Proof; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925, South Africa.
| | - Angela Dramowski
- TB Proof; Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Celso Khosa
- TB Proof; Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Koot Kotze
- TB Proof; Division of Community Health, Stellenbosch University, Cape Town, South Africa
| | - Philip Lederer
- TB Proof; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thato Mosidi
- TB Proof; Wits Health Consortium, Respiratory and Meningeal Pathogens Unit, Johannesburg, South Africa
| | | | - Jonathan Smith
- TB Proof; Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA; Visual Epidemiology, New Haven, Connecticut, USA
| | | | | | - Bart Willems
- TB Proof; Division of Community Health, Stellenbosch University, Cape Town, South Africa
| | - Matthew Bates
- UNZA-UCLMS Project, University Teaching Hospital, Lusaka, Zambia
| | - Gill Craig
- Senior Lecturer, City University London, London, UK
| | | | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia
| | - Peter Mwaba
- UNZA-UCLMS Project, University Teaching Hospital, Lusaka, Zambia
| | | | - Thomas Nyirenda
- European and Developing Countries Clinical Trials Partnership (EDCTP), Cape Town, South Africa
| | - Matt Oliver
- UK All Party Parliamentary Group on Global TB, London, UK
| | - Alimuddin Zumla
- TB Proof; Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, at University College London Hospital, London, UK
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Almeida CPBD, Skupien EC, Silva DR. Health care seeking behavior and patient delay in tuberculosis diagnosis. CAD SAUDE PUBLICA 2015; 31:321-30. [PMID: 25760166 DOI: 10.1590/0102-311x00195413] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 09/04/2014] [Indexed: 11/22/2022] Open
Abstract
Delays in diagnosis of TB cases are major impeding factors in the control of TB. The objectives of this study were to describe the health care seeking behavior of TB patients, assessing patient delay and the number of health care facilities visited before the start of TB treatment. A cross-sectional study was carried out with adult patients with pulmonary TB presenting to two TB facilities to start treatment. We found a median patient delay of 20 days. The factors associated negatively with patient delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom. We also demonstrated that 44.8% of patients incorrectly reported the mode of transmission of TB. In addition, the local of first attendance was an emergency room of public hospitals in 37.3% of patients. We demonstrated that the median patient delay in TB diagnosis in two TB services in a region with a high prevalence of TB was 20 days, and the protective factors associated with this delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom.
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Rakotosamimanana S, Mandrosovololona V, Rakotonirina J, Ramamonjisoa J, Ranjalahy JR, Randremanana RV, Rakotomanana F. Spatial analysis of pulmonary tuberculosis in Antananarivo Madagascar: tuberculosis-related knowledge, attitude and practice. PLoS One 2014; 9:e110471. [PMID: 25386655 PMCID: PMC4227641 DOI: 10.1371/journal.pone.0110471] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction Tuberculosis infection may remain latent, but the disease is nevertheless a serious public health issue. Various epidemiological studies on pulmonary tuberculosis have considered the spatial component and taken it into account, revealing the tendency of this disease to cluster in particular locations. The aim was to assess the contribution of Knowledge Attitude and Practice (KAP) to the distribution of tuberculosis and to provide information for the improvement of the National Tuberculosis Program. Methods We investigated the role of KAP to distribution patterns of pulmonary tuberculosis in Antananarivo. First, we performed spatial scanning of tuberculosis aggregation among permanent cases resident in Antananarivo Urban Township using the Kulldorff method, and then we carried out a quantitative study on KAP, involving TB patients. The KAP study in the population was based on qualitative methods with focus groups. Results The disease still clusters in the same districts identified in the previous study. The principal cluster covered 22 neighborhoods. Most of them are part of the first district. A secondary cluster was found, involving 18 neighborhoods in the sixth district and two neighborhoods in the fifth. The relative risk was respectively 1.7 (p<10−6) in the principal cluster and 1.6 (p<10−3) in the secondary cluster. Our study showed that more was known about TB symptoms than about the duration of the disease or free treatment. Knowledge about TB was limited to that acquired at school or from relatives with TB. The attitude and practices of patients and the population in general indicated that there is still a stigma attached to tuberculosis. Conclusion This type of survey can be conducted in remote zones where the tuberculosis-related KAP of the TB patients and the general population is less known or not documented; the findings could be used to adapt control measures to the local particularities.
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Affiliation(s)
- Sitraka Rakotosamimanana
- Département de géographie, Faculté des Lettres et Sciences humaines, Université d′ Antananarivo, Antananarivo, Madagascar
| | | | - Julio Rakotonirina
- Institut National de Santé Publique et Communautaire, Antananarivo, Madagascar
- Etablissement Universitaire de Soins de Santé Publique d′Analakely, Antananarivo, Madagascar
| | - Joselyne Ramamonjisoa
- Département de géographie, Faculté des Lettres et Sciences humaines, Université d′ Antananarivo, Antananarivo, Madagascar
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Tuberculosis in Antananarivo Renivohitra district of Madagascar: communication challenges. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Natad A, Moser K, Maiden J, Kim SC. Positive Tuberculosis Blood Test as a Predictor of Health Status Among HIV-Infected Persons. Clin Nurs Res 2014; 25:100-12. [PMID: 25147333 DOI: 10.1177/1054773814547045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This cross-sectional study explored tuberculosis (TB) knowledge, attitudes, practice, and TB interferon-gamma release assay (IGRA) results as the predictor of self-reported poor mental and physical health among HIV-infected persons attending a sexually transmitted diseases clinic (N = 111). The participants correctly responded to only 56.6% of the TB knowledge questions. Most had positive attitudes and would not be ashamed of TB diagnosis. The TB practice was suboptimal with only half having been tested for TB within the past 2 years. Eight percent of the participants had positive IGRA (n = 9). Simultaneous multiple regression models showed that positive IGRA, an indicator of latent TB infection, was the only significant predictor of both poor mental health (p = .006) and physical health days (p = .016). IGRA screening and treatment of latent TB infection in HIV-infected persons could potentially improve their mental and physical health status in addition to reducing the TB reactivation rate.
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Affiliation(s)
| | - Kathleen Moser
- County of San Diego, TB & Refugee Health Branch, San Diego, CA, USA
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Tolossa D, Medhin G, Legesse M. Community knowledge, attitude, and practices towards tuberculosis in Shinile town, Somali regional state, eastern Ethiopia: a cross-sectional study. BMC Public Health 2014; 14:804. [PMID: 25099209 PMCID: PMC4133079 DOI: 10.1186/1471-2458-14-804] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/29/2014] [Indexed: 11/12/2022] Open
Abstract
Background Though tuberculosis (TB) is preventable and curable, its global burden remains enormous. Similarly, TB is one of the major public health problems in Ethiopia, particularly in geographically isolated areas like Shinile town. The people in Shinile town, Somali Regional State of Ethiopia, are underserved in all forms of health care and suffer from high burden of TB. Low level of knowledge about TB could affect the health-seeking behavior of patients and sustain the transmission of the disease within the community. Therefore, the current study was undertaken in Shinile town with the objective of assessing communities’ knowledge, attitude and practices towards TB. Methods Community-based cross-sectional survey, involving 410 randomly selected individuals, was conducted in Shinile town from January to May, 2013. Data were analyzed using STATA V.11. Logistic regression technique was used to determine the association between socio-demographic characteristics and communities’ knowledge of TB. Results While 94.9% of the respondents said that they ever heard about TB, only 22.9% knew that TB is caused by bacteria. Eighty percent have awareness that TB can be transmitted from a patient to another person and 79.3% know that transmission of TB can be preventable. Persistence cough (72.4%) was the most commonly stated symptom of TB and modern drugs used in health institutions (68.1%) was the preferred choice of treatment. Two hundred and ninety one respondents (71.0%) said that they would seek treatment at health facility if they realized that they had symptoms related to TB. Two hundred and twenty seven respondents (55.4%) considered TB as a very serious disease and 284 (69.3%) would experience fear if they themselves had TB. Individuals with educational level of grade 8 up to grade 12 had increased odds of having good level of overall TB knowledge compared to illiterate individuals (OR = 2.3; 95% CI: 1.2 to 4.6). Conclusion The communities in Shinile town have basic awareness about TB which is not translated into the knowledge about the cause of the disease. Therefore, health education directed towards bringing a significant change in the knowledge of TB must be stepped-up within the TB control program. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-804) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Tolossa
- Department of Medical Laboratory Technology, Jig-jiga Health Sciences College, P,O, Box 504, Jig-jiga, Ethiopia.
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Mishra SR, Adhikari S, Khanal V. Role of mass media on knowledge generation and countering misconceptions about tuberculosis transmission in Nepal. Asian Pac J Trop Biomed 2014. [DOI: 10.12980/apjtb.4.2014apjtb-2014-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gender-related barriers and delays in accessing tuberculosis diagnostic and treatment services: a systematic review of qualitative studies. Tuberc Res Treat 2014; 2014:215059. [PMID: 24900921 PMCID: PMC4037602 DOI: 10.1155/2014/215059] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/10/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified “inductive coding” system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services.
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Barriers and delays in tuberculosis diagnosis and treatment services: does gender matter? Tuberc Res Treat 2014; 2014:461935. [PMID: 24876956 PMCID: PMC4020203 DOI: 10.1155/2014/461935] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Tuberculosis (TB) remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men.
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Wynne A, Richter S, Jhangri GS, Alibhai A, Rubaale T, Kipp W. Tuberculosis and human immunodeficiency virus: exploring stigma in a community in western Uganda. AIDS Care 2014; 26:940-6. [PMID: 24521055 DOI: 10.1080/09540121.2014.882488] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The threat of tuberculosis (TB) in Uganda cannot be considered in isolation from the HIV/AIDS epidemic. Stigma contributes to delays in seeking treatment and poor adherence for both TB and HIV patients. This study aims to assess and describe stigma and predictors of stigma related to TB and HIV in the population of western Uganda. This was a cross-sectional mixed methods study. A survey was administered to 360 individuals, randomly selected from one district in western Uganda. Participants were classified as low/high stigma based on weighted scores built from survey questions. Logistic regression was used to determine significant predictors for high stigma. Six focus groups were conducted to inform survey findings; themes were developed using content analysis. Twenty-six per cent of respondents were found to have stigmatising attitudes towards HIV and 47% towards TB. Multivariate logistic regression models included age, sex, marital status, education, residence and having a friend with HIV/TB. Those who had an HIV-positive friend were less likely to have high HIV stigma (OR: 0.41, 95% CI: 0.23-0.72). Those with secondary education or more were half as likely to have high TB stigma (OR: 0.50, 95% CI: 0.27-0.91). Focus group participants felt that "normalisation" of HIV has contributed to reduced HIV stigma, but there is still a fear of being recognised at the HIV clinic. TB stigma causes patients to remain silent instead of seeking care. Fear of TB is driven by the assumption that "TB means HIV". Declining HIV stigma is encouraging but more effort needs to be made to improve confidentiality. TB stigma is high and is likely affecting care seeking behaviour; TB awareness campaigns should be a priority and emphasise the treatability and curability of TB, regardless of HIV status.
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Affiliation(s)
- Ashley Wynne
- a School of Public Health , University of Alberta , Edmonton , AB , Canada
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Amo-Adjei J, Kumi-Kyereme A. Myths and misconceptions about tuberculosis transmission in Ghana. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:38. [PMID: 24028419 PMCID: PMC3847526 DOI: 10.1186/1472-698x-13-38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 09/11/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Myths and misconceptions about TB can serve as a barrier to efforts at reducing stigmatisation of people infected and affected by the disease. Understanding such drivers of myths and misconceptions is important for improving information, education and communication (IEC) efforts of national control and preventive interventions. This study therefore assesses the influence of interaction of spatial, socioeconomic and demographic characteristics on myths and misconceptions. METHODS Data was drawn from male (N = 4,546) and female (N = 4,916) files of the 2008 Ghana Demographic and Health Survey. A myth and misconception variable was created from five-related constructs with internal consistency score of r = 0. 8802 for males (inter-item correlation: 0.5951) and for females, r = 0. 0.9312 (inter-item correlation: 0.7303). The Pearson Chi-square was used to test the bivariate relationship between the independent variables and the dependent variable. Logistic regression was subsequently used to explore the factors determining myths and misconceptions of TB transmission. RESULTS Majority of Ghanaians (males: 66.75%; females: 66.13%) did not hold myths and misconceptions about TB transmission. Females resident in the Upper East (aOR = 0.31, CI = 0.17-0.55) and Upper West (aOR = 0.41, CI = 0.24-0.69) and males resident in the Northern (aOR = 0.23, CI = 0.13-0.39) and the Greater Accra (aOR = 0.25, CI = 0.16-0.39) regions were independently associated with no misconceptions about TB transmission. Significant differences were also found in education, ethnicity and age. CONCLUSION That spatial and other socioeconomic difference exists in myths and misconceptions suggest the need for spatial, socioeconomic and demographic segmentations in IEC on TB. This holds potentials for reaching out to those who are in critical need of information and education on the transmission processes of TB.
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Affiliation(s)
- Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
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Doherty AM, Kelly J, McDonald C, O'Dywer AM, Keane J, Cooney J. A review of the interplay between tuberculosis and mental health. Gen Hosp Psychiatry 2013; 35:398-406. [PMID: 23660587 DOI: 10.1016/j.genhosppsych.2013.03.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/18/2013] [Accepted: 03/26/2013] [Indexed: 01/05/2023]
Abstract
AIMS Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/substance abuse and migrant status leading to frequent comorbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness. METHODS A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. In total 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data. RESULTS Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses, such as depression, may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects and some medications such as rifampicin may reduce the effective doses of anti-psychotics y their enzyme induction actions. Treatment with agents such as cycloserine has been associated with depression, and there have been reported cases of psychosis with most anti-tuberculous agents. Mental illness and substance abuse may also affect compliance with treatment, with attendant public health concerns. CONCLUSIONS As a result of the common co-morbidity of mental illness and tuberculosis, it is probable that physicians will encounter previously undiagnosed mental illness among patients with tuberculosis. Similarly, psychiatrists are likely to meet tuberculosis among their patients. It is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.
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Jesmin SS, Chaudhuri S, Abdullah S. Educating women for HIV prevention: does exposure to mass media make them more knowledgeable? Health Care Women Int 2013; 34:303-31. [PMID: 23394327 DOI: 10.1080/07399332.2012.736571] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mass media is an important vehicle for health promotion in developing countries. In Bangladesh multiple media campaigns are being carried out to educate people about HIV/AIDS. We examined the extent of HIV/AIDS knowledge and the association of exposure to mass media among women in Bangladesh. The Bangladesh Demographic and Health Survey (BDHS) provides data for this article. We found that media exposure (combined index of television, radio, and newspaper) was a highly significant predictor of women's knowledge about HIV and AIDS. Other significant predictors of HIV knowledge include women's education, age, employment, and urban residence.
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Affiliation(s)
- Syeda S Jesmin
- Department of Sociology and Psychology, Division of Liberal Arts and Life Sciences, University of North Texas at Dallas, Dallas, TX 75241, USA.
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Wynne A, Jhangri GS, Richter S, Alibhai A, Rubaale T, Kipp W. Tuberculosis in the era of infection with the human immunodeficiency virus: assessment and comparison of community knowledge of both infections in rural Uganda. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2012; 12:36. [PMID: 23254144 PMCID: PMC3541975 DOI: 10.1186/1472-698x-12-36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 12/11/2012] [Indexed: 07/14/2023]
Abstract
UNLABELLED BACKGROUND In Uganda, despite a significant public health burden of tuberculosis (TB) in the context of high human immunodeficiency virus (HIV) prevalence, little is known about community knowledge of TB. The purpose of this study was to assess and compare knowledge about TB and HIV in the general population of western Uganda and to examine common knowledge gaps and misconceptions. METHODS We implemented a multi-stage survey design to randomly survey 360 participants from one district in western Uganda. Weighted summary knowledge scores for TB and HIV were calculated and multiple linear regression (with knowledge score as the dependant variable) was used to determine significant predictors. Six focus group discussions were conducted to supplement survey findings. RESULTS Mean (SD) HIV knowledge score was 58 (12) and TB knowledge score was 33 (15), both scores out of 100. The TB knowledge score was statistically significantly (p < 0.001) lower. Multivariate regression models included age, sex, marital status, education, residence, and having a friend with HIV/TB as independent variables. TB knowledge was predicted by rural residence (coefficient = -6.27, 95% CI: -11.7 to -0.8), and age ≥45 years (coefficient = 7.45, 95% CI: 0.3-14.6). HIV knowledge was only predicted by higher education (coefficient = 0.94, 95%CI: 0.3-1.6). Focus group participants mentioned various beliefs in the aetiology of TB including sharing cups, alcohol consumption, smoking, air pollution, and HIV. Some respondents believed that TB was not curable. CONCLUSION TB knowledge is low and many misconceptions about TB exist: these should be targeted through health education programs. Both TB and HIV-infection knowledge gaps could be better addressed through an integrated health education program on both infections, whereby TB program managers include HIV information and vice versa.
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Affiliation(s)
- Ashley Wynne
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Gian S Jhangri
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Solina Richter
- Faculty of Nursing, University of Alberta, 5-269 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Arif Alibhai
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Tom Rubaale
- Health Department, Kabarole District Administration, Fort Portal, Uganda
| | - Walter Kipp
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, Alberta, T6G 1C9, Canada
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Dante A, Rizzi L, Ianderca B, Palese A. Why do university students not choose a nursing degree at matriculation? An Italian cross-sectional study. Int Nurs Rev 2012; 60:129-35. [DOI: 10.1111/j.1466-7657.2012.01037.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Dante
- School of Nursing; Trieste University
| | | | - B. Ianderca
- Azienda per i Servizi Sanitari n. 1; Trieste
| | - A. Palese
- School of Nursing; Udine University; Italy
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Sendagire I, Schim Van der Loeff M, Kambugu A, Konde-Lule J, Cobelens F. Urban movement and alcohol intake strongly predict defaulting from tuberculosis treatment: an operational study. PLoS One 2012; 7:e35908. [PMID: 22567119 PMCID: PMC3342307 DOI: 10.1371/journal.pone.0035908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 03/23/2012] [Indexed: 11/30/2022] Open
Abstract
Background High levels of defaulting from treatment challenge tuberculosis control in many African cities. We assessed defaulting from tuberculosis treatment in an African urban setting. Methods An observational study among adult patients with smear-positive pulmonary tuberculosis receiving treatment at urban primary care clinics in Kampala, Uganda. Defaulting was defined as having missed two consecutive monthly clinic visits while not being reported to have died or continued treatment elsewhere. Defaulting patients were actively followed-up and interviewed. We assessed proportions of patients abandoning treatment with and without the information obtained through active follow-up and we examined associated factors through multivariable logistic regression. Results Between April 2007 and April 2008, 270 adults aged ≥15 years were included; 54 patients (20%) were recorded as treatment defaulters. On active follow-up vital status was established of 28/54 (52%) patients. Of these, 19 (68%) had completely stopped treatment, one (4%) had died and eight (29%) had continued treatment elsewhere. Extrapolating this to all defaulters meant that 14% rather than 20% of all patients had truly abandoned treatment. Daily consumption of alcohol, recorded at the start of treatment, predicted defaulting (adjusted odds ratio [ORadj] 4.4, 95%CI 1.8–13.5), as did change of residence during treatment (ORadj 8.7, 95%CI 1.8–41.5); 32% of patients abandoning treatment had changed residence. Conclusions A high proportion of tuberculosis patients in primary care clinics in Kampala abandon treatment. Assessing change of residence during scheduled clinic appointments may serve as an early warning signal that the patient may default and needs adherence counseling.
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Affiliation(s)
- Ibrahim Sendagire
- Directorate of Health, Kampala Capital City Authority, Kampala, Uganda
| | - Maarten Schim Van der Loeff
- Center for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
- Department of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Andrew Kambugu
- Infectious Diseases Institute, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Konde-Lule
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Frank Cobelens
- Department of Global Health, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- * E-mail:
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Análisis sociodemográfico y espacial de la transmisión de la tuberculosis en la ciudad de Armenia (Colombia). INFECTIO 2012. [DOI: 10.1016/s0123-9392(12)70005-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gebremariam MK, Bjune GA, Frich JC. Lay beliefs of TB and TB/HIV co-infection in Addis Ababa, Ethiopia: a qualitative study. BMC Res Notes 2011; 4:277. [PMID: 21813004 PMCID: PMC3161876 DOI: 10.1186/1756-0500-4-277] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 08/03/2011] [Indexed: 11/19/2022] Open
Abstract
Background Knowledge about lay beliefs of etiology, transmission and treatment of TB, and lay perceptions of the relationship between TB and HIV is important for understanding patients' health seeking behavior and adherence to treatment. We conducted a study to explore lay beliefs about TB and TB/HIV co-infection in Addis Ababa, Ethiopia. Findings We conducted a qualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients in Addis-Ababa, Ethiopia. We found that a predominant lay belief was that TB was caused by exposure to cold. Excessive sun exposure, exposure to mud, smoking, alcohol, khat and inadequate food intake were also reported as causes for TB. Such beliefs initially led to self-treatment. The majority of patients were aware of an association between TB and HIV. Some reported that TB could transform into HIV, while others said that the body could be weakened by HIV and become more susceptible to illnesses such as TB. Some patients classified TB as either HIV-related or non-HIV-related, and weight loss was a hallmark for HIV-related TB. The majority of patients believed that people in the community knew that there was an association between TB and HIV, and some feared that this would predispose them to HIV-related stigma. Conclusion There is a need for culturally sensitive information and educational efforts to address misperceptions about TB and HIV. Health professionals should provide information about causes and treatment of TB and HIV to co-infected patients.
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Affiliation(s)
- Mekdes K Gebremariam
- Section for International Health, Institute of Health and Society, University of Oslo, PO Box 1130, Blindern, NO-0318 Oslo, Norway.
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