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Wang S, Cao H. The dynamics of tuberculosis transmission model with different genders. JOURNAL OF BIOLOGICAL DYNAMICS 2024; 18:2394665. [PMID: 39238481 DOI: 10.1080/17513758.2024.2394665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/15/2024] [Indexed: 09/07/2024]
Abstract
The dynamics of tuberculosis transmission model with different genders are to be established and studied. The basic regeneration numbers R 0 = R F + R M are to be defined, where R F and R M to be the basic reproduction number of tuberculosis transmission in female and male populations, respectively. The existence and global stability of the disease-free equilibrium was discussed when R 0 < 1 . The global dynamic behaviours of the corresponding limit system under some conditions are to be provided, including the existence, uniqueness, and global stability of the disease-free equilibrium and endemic equilibrium. The numerical simulation shows that the endemic equilibrium may be unique and stable when R 0 > 1 , and the system will undergo Hopf bifurcation based on some parameter values. Finally, we applied this model to analyse the transmission of tuberculosis in China, estimated the incidence of tuberculosis in China in 2035, and gave the conclusion that controlling the incidence of tuberculosis in male populations could better reduce the incidence of tuberculosis in China.
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Affiliation(s)
- Si Wang
- School of Mathematics and Data Science, Shaanxi University of Science and Technology, Xi'an, People's Republic of China
| | - Hui Cao
- School of Mathematics and Data Science, Shaanxi University of Science and Technology, Xi'an, People's Republic of China
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Muttamba W, Omongot S, Najjingo I, Nuwarinda R, Buregyeya E, Del Barrio MO, Morgan R, Kirenga B, Ssali S. Using intersectional gender analysis to identify challenges in tuberculosis care at four health care facilities in Uganda. Infect Dis Poverty 2024; 13:2. [PMID: 38178248 PMCID: PMC10768122 DOI: 10.1186/s40249-023-01171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) care could be considered as a continuum from symptom recognition, decision to seek care, diagnosis, treatment initiation and treatment completion, with care along the continuum influenced by several factors. Gender dimensions could influence TB care, and indeed, more men than women are diagnosed with TB each year. The study was done to identify social stratifiers that intersect with gender to influence TB care. METHODS A cross-sectional qualitative study was done at four health facilities in 3 districts in central Uganda between October 2020 and December 2020. Data was collected from patients seeking a diagnosis or on TB treatment through focus group discussions and key informant interviews. Key themes around gender guided by a gender and intersectionality lens were developed and thereafter thematic content analysis was done. RESULTS Women have increased vulnerability to TB due to bio mass exposure through roles like cooking. Women have increased access to health care services as they interface with the health care system frequently given their role as child bearers and child care givers. Men have a duty to provide for their families and this most often is prioritised over healthcare seeking, and together with belief that they are powerful beings leads to poor healthcare seeking habits and delays in healthcare seeking. Decisions on when and where to seek care were not straightforward for women, who most often rely on their husbands/partners to make decisions. CONCLUSIONS Men and women experience challenges to TB care, and that these challenges are deeply rooted in roles assigned to them and further compounded by masculinity. These challenges need to be addressed through intersectional gender responsive interventions if TB control is to be improved.
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Affiliation(s)
- Winters Muttamba
- Makerere University Lung Institute, Makerere University, Kampala, Uganda.
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St. Andrews, UK.
| | - Samson Omongot
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | - Irene Najjingo
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | | | | | - Mariam Otmani Del Barrio
- UNICEF, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
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Rui JR, Du Y. The more the better? How social support predicted perceived barriers to tuberculosis treatment across groups of different socioeconomic statuses. PATIENT EDUCATION AND COUNSELING 2023; 115:107874. [PMID: 37393682 DOI: 10.1016/j.pec.2023.107874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Social support can lower perceived barriers to medical treatment, but this relationship may vary in groups of different socioeconomic statuses (SES). This study examined whether different types of social support predicted different types of perceived barriers to tuberculosis (TB) treatment and whether these relationships varied across different levels of SES. METHOD A paper-pencil survey covering 12 cities in Guangdong, China (N = 1386) was conducted in December 2020, which measured demographics, three types of perceived social support (informational, instrumental, and emotional) and barriers to TB treatment (cognitive, instrumental, and psychological). RESULTS Informational support and instrumental support were negatively related to cognitive barriers and instrumental barriers. These relationships were stronger among more educated individuals and urban residents. However, emotional support predicted psychological barrier positively, and this relationship was stronger among less educated individuals and rural residents. CONCLUSION High SES groups benefit more from individual-level support. Thus, there is a gap of social support, which reveals the power nature of social support exchanges. PRACTICE IMPLICATIONS TB campaigns need provide support for low SES groups to compensate for their insufficient support. Campaigns need provide information about disease management and the legal and financial support for TB patients, and change tuberculosis-related norms.
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Affiliation(s)
- Jian Raymond Rui
- Department of New Media and Communication, South China University of Technology, 382 Waihuan East Rd, Guangzhou, China, 510006; Center for Public Health Risk Surveillance and Information Communication in Guangdong Province.
| | - Yuetong Du
- Department of New Media and Communication, South China University of Technology, 382 Waihuan East Rd, Guangzhou, China, 510006
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Yuen CM, Millones AK, Acosta D, Torres I, Farroñay S, Jimenez J, Lecca L. Person-centered strategies for delivering TB diagnostic services in Lima, Peru. Public Health Action 2023; 13:112-116. [PMID: 37736576 PMCID: PMC10446665 DOI: 10.5588/pha.23.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 09/23/2023] Open
Abstract
SETTING Lima, Peru. OBJECTIVE To close the gap in TB diagnosis, TB diagnostic services must match care-seeking preferences. We sought to identify preferred strategies for delivering TB diagnostic services and to determine whether preferences differ among demographic groups. DESIGN During May 2022-January 2023, we recruited adults who recently initiated treatment for pulmonary TB. We used an object-case best-worst scaling instrument to assess the desirability of nine hypothetical strategies for delivering TB diagnostic services. A t-test was used to assess differences in preference scores between groups. RESULTS Among 150 participants, the strategies with the highest preference scores were an integrated mobile unit offering screening for multiple conditions, expedited attention at the health center, and home-based screening. These were strongly preferred by 42%, 25%, and 27% of participants, respectively, and 80% of participants strongly preferred at least one of the three. Expedited attention at the health center scored more highly among people who experienced >2 months delay in TB diagnosis compared to those who experienced a more rapid diagnosis (0.37 ± 0.06 vs. 0.17 ± 0.06; P = 0.031). CONCLUSION Providing person-centered TB diagnostic services at diverse access points could help reach different populations, which could promote early diagnosis and help close the diagnosis gap.
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Affiliation(s)
- C M Yuen
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - D Acosta
- Socios En Salud Sucursal Peru, Lima, Peru
| | - I Torres
- Socios En Salud Sucursal Peru, Lima, Peru
| | - S Farroñay
- Socios En Salud Sucursal Peru, Lima, Peru
| | - J Jimenez
- Socios En Salud Sucursal Peru, Lima, Peru
| | - L Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Socios En Salud Sucursal Peru, Lima, Peru
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Popovic I, Soares Magalhães RJ, Yang Y, Yang S, Yang B, Dong G, Wei X, Fox GJ, Hammer MS, Martin RV, van Donkelaar A, Ge E, Marks GB, Knibbs LD. Effects of long-term ambient air pollution exposure on township-level pulmonary tuberculosis notification rates during 2005-2017 in Ningxia, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 317:120718. [PMID: 36435281 DOI: 10.1016/j.envpol.2022.120718] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 06/16/2023]
Abstract
Studies examining long-term effects of ambient air pollution exposure, measured as annual averages, on pulmonary tuberculosis (TB) incidence are scarce, particularly in endemic, rural settings. We performed a small-area study in Ningxia Hui Autonomous Region (NHAR), a high TB-burden area in rural China, using township-level (n = 358 non-overlapping townships) annual TB notification data (2005-2017). We aimed to determine if annual average concentrations of ambient air pollution (particulate matter <2·5 μm [PM2·5], nitrogen dioxide [NO2] ozone [O3]) were associated with TB notification rates (as a proxy for incidence). Air pollution effects on TB notification rates at township-level were estimated as incidence rate ratios (IRR), fitted using a generalised estimating equation (GEE) adjusted for covariates (age, sex, occupation, education, ethnicity, remoteness [urban or rural], household crowding and solid fuel use). A total of 38,942 TB notifications were reported in NHAR between 2005 and 2017. The mean annual TB notification rate was 67 (standard deviation [SD]; 7) per 100,000 people. Median concentrations of PM2·5, NO2, and O3 were 42 μg/m3 (interquartile range [IQR]; 38-48 μg/m3), 15 ppb (IQR; 12-16 ppb), and 56 ppb (IQR; 56-57 ppb), respectively. In single pollutant models, adjusted for covariates, an interquartile range (IQR) increase (10 μg/m3) in PM2·5 was significantly associated with higher TB notification rates (IRR: 1∙35; 95% CI: 1·25-1·48). Comparable effects on notifications of TB were observed for increases in NO2 exposure (IRR: 1·20 per IQR (4 ppb) increase; 95% CI: 1·08-1·31). Ground-level ozone was not associated with TB notification rate in any models. The observed effects were consistent over time, in multi-pollutant models, and appeared robust to additional adjustment for indicators of household crowding, solid fuel use and remoteness. More rigorous study designs are needed to understand if improving air quality has population-level benefits on TB disease incidence in endemic settings.
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Affiliation(s)
- Igor Popovic
- Faculty of Medicine, School of Public Health, University of Queensland, Herston, 4006, Australia; UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton, 4343, Australia.
| | - Ricardo J Soares Magalhães
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton, 4343, Australia; Children's Health and Environment Program, UQ Children's Health Research Center, The University of Queensland, South Brisbane, 4101, Australia
| | - Yurong Yang
- Department of Pathogenic Biology & Medical Immunology, School of Basic Medical Science, Ningxia Medical University, Yinchuan, 750004, China
| | - Shukun Yang
- Department of Radiology, The Second Affiliated Hospital of Ningxia Medical University, The First People's Hospital in Yinchuan, Yinchuan, 750004, China
| | - Boyi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510085, China
| | - Guanghui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510085, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Greg J Fox
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Melanie S Hammer
- Department of Energy, Environmental, and Chemical Engineering, Washington University, St Louis, 63130, United States
| | - Randall V Martin
- Department of Energy, Environmental, and Chemical Engineering, Washington University, St Louis, 63130, United States; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 3J5, Canada
| | - Aaron van Donkelaar
- Department of Energy, Environmental, and Chemical Engineering, Washington University, St Louis, 63130, United States; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 3J5, Canada
| | - Erjia Ge
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Liverpool, 2170, Australia; Woolcock Institute of Medical Research, Glebe, 2037, Australia
| | - Luke D Knibbs
- Public Health Unit, Sydney Local Health District, Camperdown, 2050, Australia; Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, 2006, Australia
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Abu-Humaidan AHA, Tarazi A, Hamadneh Y, Al-leimon A, Al-leimon O, Aljahalin M, Ahmad F, Awajan D, Alaridah N. Knowledge, attitudes, and practices toward tuberculosis among Jordanian university students. Front Public Health 2022; 10:1055037. [PMID: 36478722 PMCID: PMC9719926 DOI: 10.3389/fpubh.2022.1055037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Tuberculosis (TB) is one of the leading causes of death from infectious diseases worldwide with numerous undiagnosed and untreated cases, emphasizing the need for TB awareness to minimize transmission and initiate early treatment. Data regarding the knowledge, attitudes, and practices (KAP) toward TB among Jordanians is lacking but requires attention given the massive migration spells to Jordan from neighboring countries in the past decade. Methods A descriptive cross-sectional study was conducted from May to June 2022. An online questionnaire was developed following World Health Organization (WHO) recommendations for TB KAP surveys and was distributed to Jordanian university students. The questionnaire documented sociodemographic data and measured participants' KAP toward TB. Descriptive and analytic statistics were used to report KAP levels and highlight relevant sociodemographic factors associated with better KAP. Results 602 participants completed the survey; most were females (60.8%), in their first 3 years of school (84.4%), and from a healthcare field of study (57.0%). The knowledge section median score was 27 out of 51. Knowledge gaps in TB treatment, and to a lesser extent, TB transmission routes were identified. The attitudes section median score was 6 out of 9, attitudes were generally positive toward TB patients with no indication of a social stigma. The practice section median score was 6 out of 8, most participants would take the correct measures if they suspected being infected, yet around 41.0% were not confident that masks are important in preventing airborne diseases. Students in healthcare specialties had significantly better KAP scores and identifying as a smoker was associated with a lower practice score. Conclusion Although university students displayed satisfactory KAP scores, the focus should be aimed at informing students from non-healthcare fields on TB transmission routes, treatment options, and the role of masks in preventing disease transmission.
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Affiliation(s)
- Anas H. A. Abu-Humaidan
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan,*Correspondence: Anas H. A. Abu-Humaidan
| | - Alaa Tarazi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Yazan Hamadneh
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | | | - Fatima Ahmad
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Dima Awajan
- Department of Clinical Pharmacy and Therapeutics, Applied Science Private University, Amman, Jordan
| | - Nader Alaridah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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Al Khalili S, Al Yaquobi F, Al Abri B, Al Thuhli K, Al Marshoudi S, Al Rawahi B, Al-Abri S. Assessing Oman's knowledge, attitude and practice regarding tuberculosis: a cross-sectional study that calls for action. Int J Infect Dis 2022; 124 Suppl 1:S4-S11. [PMID: 35697196 DOI: 10.1016/j.ijid.2022.06.002] [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: 02/01/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a major public health issue. Elimination mandates collaboration between decision makers, practitioners and the community. Few studies address the knowledge, attitude and practice (KAP) from countries with low incidence. AIM Assess KAP regarding TB in Oman. METHOD A cross-sectional survey based on validated questionnaire conducted via phone on randomly selected participants. RESULTS A total of 1048 participants completed the questionnaire. Males accounted for 63% (n=664) of respondents, Omanis 76% (n=796) and 18-39-year-olds 50% (n=527). The overall knowledge was fair (53%), overall attitude scored good and fair (46%) equally and a good score (78%) for overall practice. While female gender associated with higher knowledge (53.9%, n=201), males showed higher attitude and practice, (48.5%, n=322) and (80.3%, n=533) respectively. Omani nationality correlated with higher knowledge (49.1%, n= 391) and attitude (46.9%, n=373) whereas non-Omani nationality correlated with higher practice (85.3%, n=214). Literacy was associated with higher knowledge (73.3%, n=11) and attitude (60%, n=9). CONCLUSION Despite efforts by the Ministry of Health, more must be done to raise TB knowledge to encourage preferable attitudes and practice. Interventions to improve KAP are required to speed up disease reduction rate. Utilization of different resources, especially digital platforms, for knowledge dissemination should consider community diversity, including the presence of expatriates.
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Affiliation(s)
- Sulien Al Khalili
- Directorate General for Disease Surveillance and Control, Ministry of Health, P.O. Box 393, 100, Muscat, Oman.
| | - Fatma Al Yaquobi
- Directorate General for Disease Surveillance and Control, Ministry of Health, P.O. Box 393, 100, Muscat, Oman.
| | - Bader Al Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, P.O. Box 393, 100, Muscat, Oman.
| | - Khalsa Al Thuhli
- Directorate General for Disease Surveillance and Control, Ministry of Health, P.O. Box 393, 100, Muscat, Oman.
| | - Sabria Al Marshoudi
- Directorate General for Disease Surveillance and Control, Ministry of Health, P.O. Box 393, 100, Muscat, Oman.
| | - Bader Al Rawahi
- Directorate General for Disease Surveillance and Control, Ministry of Health, P.O. Box 393, 100, Muscat, Oman.
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, P.O. Box 393, 100, Muscat, Oman.
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Grigoryan Z, McPherson R, Harutyunyan T, Truzyan N, Sahakyan S. Factors Influencing Treatment Adherence Among Drug-Sensitive Tuberculosis (DS-TB) Patients in Armenia: A Qualitative Study. Patient Prefer Adherence 2022; 16:2399-2408. [PMID: 36072915 PMCID: PMC9444026 DOI: 10.2147/ppa.s370520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Despite the availability of effective treatment, tuberculosis (TB) is still one of the leading causes of mortality around the globe. Poor adherence to treatment challenges TB management both globally and locally. Proper adherence to treatment contributes to successful outcomes and prevents the development of drug-resistant forms of TB. Patients and Methods We conducted a qualitative study to identify and describe the factors that facilitated treatment adherence among drug-sensitive TB (DS-TB) patients in Armenia. Sixteen in-depth interviews (IDIs) with former DS-TB patients, two IDIs with family members of former DS-TB patients, and a focus group discussion with healthcare providers who manage DS-TB patients were conducted. The educational and ecological assessment component of the PRECEDE-PROCEED model was applied as a conceptual framework to guide the interview content and data analysis. Results Former patients' awareness of TB and its treatment, beliefs about TB, trust in TB healthcare providers, and a sense of responsibility were the most common factors that predisposed them to complete the treatment. Support received from providers, family, and friends, a desire to avoid TB-associated stigma, and good tolerance of TB medications were the main reinforcing factors. Enabling factors included a relatively simple regimen of TB treatment and accessibility and affordability of TB services. Conclusion The findings of the study provide new perspectives on factors that facilitate adherence to long-term therapies, such as TB. Interventions that aim to invoke a patient's sense of responsibility and positive beliefs about TB as well as engage families might promote the successful completion of treatment.
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Affiliation(s)
- Zaruhi Grigoryan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Robert McPherson
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Tsovinar Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Nune Truzyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
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Gender Differences in Factors Associated with the Total Delay in Treatment of Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Selangor, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106258. [PMID: 35627796 PMCID: PMC9140698 DOI: 10.3390/ijerph19106258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022]
Abstract
Background: Gender plays a significant role in health-care-seeking behavior for many diseases. Delays in seeking treatment, diagnosis, and treatment for pulmonary tuberculosis (pTB) may increase the risk of transmission in the community and lead to poorer treatment outcomes and mortality. This study explores the differences in factors associated with the total delay in treatment of male and female pTB patients in Selangor, Malaysia. Methods: A cross-sectional study was conducted from January 2017 to December 2017. Newly diagnosed pTB patients (≥18 years) were recruited from selected government health clinics and hospitals in Selangor during the specified study period. An interviewer-administered questionnaire was used to collect information on sociodemographic characteristics, lifestyle, knowledge about pTB, stigma, distance to the nearest health facility, and chronology of pTB symptom onset, diagnosis, and treatment. The total delay was measured as the length of time between the onset of pTB symptoms to treatment initiation. Factors significantly associated with a longer total delay among men and women were identified using binary logistic regression. Results: A total of 732 patients (61.5% men, 38.5% women) were enrolled in the study. The median total delay was 60 days. Men who have weight loss as a symptom (AOR: 1.63, 95%CI: 1.10–2.41) and are employed (1.89, 1.15–3.11) were more likely to have a longer total delay, while those who know others who have had pTB (0.64, 0.43–0.96) were less likely to have a longer total delay. On the other hand, among women, having a stigma towards TB (0.52, 0.32–0.84) and obtaining a pTB diagnosis at the first medical consultation (0.48, 0.29–0.79) were associated with a shorter total delay. Conclusion: Factors associated with the total delay in pTB treatment were different for male and female pTB patients. Increasing awareness of pTB symptoms and the importance of seeking early medical consultation and a prompt diagnosis among the general public may reduce total delay in pTB treatment.
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Ji H, Xu J, Wu R, Chen X, Lv X, Liu H, Duan Y, Sun M, Pan Y, Chen Y, Lu X, Zhou L. Cut-off Points of Treatment Delay to Predict Poor Outcomes Among New Pulmonary Tuberculosis Cases in Dalian, China: A Cohort Study. Infect Drug Resist 2022; 14:5521-5530. [PMID: 34984007 PMCID: PMC8702986 DOI: 10.2147/idr.s346375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Despite increasing literature on the association between treatment delay and outcomes, cut-off point (1 month or median) selection in almost all studies for treatment delay is too subjective. This study explored more scientific cut-off points of treatment delay for poor treatment outcomes and death at the clinical level. Patients and Methods A total of 18,100 newly confirmed pulmonary tuberculosis (TB) cases in Dalian, China were used in the final analysis. A 3-knotted restricted cubic spline (RCS) fitted for Cox proportional hazard regression models is used to analyse the effects of cut-off points of treatment delay on incident poor treatment outcomes. To explore the moderating effects of age, gender and diabetes, we added the interaction terms of these moderating variables and treatment delay to Cox proportional hazard regression models. Results The median time of treatment initiation was 30 days (IQR: 14–59 days). The risk of incident poor treatment outcomes increased when the time was greater than cut-off point 1 (53 days; adjusted HR: 1.26; 95% CI: 1.00–1.60) of treatment delay, and the risk of incident death events increased when the time was greater than cut-off point 2 (103 days; adjusted HR: 1.56; 95% CI: 1.00–2.44) of delay. In addition, treatment delay was associated with an increased risk of incident poor treatment outcomes and death, and older age, male sex, and diabetes may increase the risk of treatment delay for poor outcomes. Conclusion This study is the first to identify scientific cut-off points of treatment delay for poor treatment outcomes and death, and this method of exploration should be popularized. In addition, the knowledge of tuberculosis must be spread to every adult. Moreover, the tuberculosis diagnosis level of community level health workers should be enhanced.
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Affiliation(s)
- Haoqiang Ji
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Jia Xu
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Xu Chen
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Xintong Lv
- Office of Epidemic Surveillance, Dalian Tuberculosis Hospital, Dalian, Liaoning, People's Republic of China
| | - Hongyu Liu
- Office of Epidemic Surveillance, Dalian Tuberculosis Hospital, Dalian, Liaoning, People's Republic of China
| | - Yuxin Duan
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Meng Sun
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Yuanping Pan
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Yunting Chen
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Xiwei Lu
- Office of Epidemic Surveillance, Dalian Tuberculosis Hospital, Dalian, Liaoning, People's Republic of China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, 116044, People's Republic of China
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Bohlbro AS, Mendes AM, Sifna A, Patsche CB, Gomes V, Wejse C, Rudolf F. Assessing gender differences among presumed and diagnosed patients with pulmonary TB: observations from Guinea-Bissau. Trans R Soc Trop Med Hyg 2021; 115:1273-1281. [PMID: 34542154 DOI: 10.1093/trstmh/trab145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/15/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Globally, more males than females are diagnosed with pulmonary TB (PTB); however, the cause of this gender disparity remains unknown. We aimed to assess gender differences in an observational cohort of patients with presumed PTB (prePTB) at the Bandim Health Project, Guinea-Bissau. METHODS Adult patients with signs and symptoms suggestive of PTB seeking medical care were invited to participate and were referred to comprehensive diagnostic work-up. RESULTS We included 2020 patients with prePTB; 54.6% were female. Females were younger than males and more often infected with HIV. More male patients with prePTB were diagnosed with PTB and the proportion of smear-positive cases was greater among males. There was no gender difference in loss to follow-up during the diagnostic process. Of 219 patients with PTB, 205 started treatment, with no difference between genders regarding pretreatment loss to follow-up or treatment outcome. CONCLUSIONS More women sought help for symptoms indicative of PTB, yet more men were diagnosed. Women did not have more clinically severe disease at presentation, did not drop out of diagnostic procedures more frequently and did not experience a worse outcome than men. This suggests that the gender gap in PTB is unlikely to be due solely to differences in care-seeking behaviour or diagnostic procedures in our setting.
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Affiliation(s)
- Anders Solitander Bohlbro
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | | | - Armando Sifna
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
| | - Cecilie Blenstrup Patsche
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.,GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Victor Gomes
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
| | - Christian Wejse
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Frauke Rudolf
- Ban dim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Wang Y, Feng J, Zhang J, Shen X, Lei Z, Zhu Y, Meng X, Di H, Xia W, Lu Z, Guo Y, Yuan Q, Wang X, Gan Y. Willingness to seek medical care for tuberculosis and associated factors among the elderly population in Shenzhen: a cross-sectional study. BMJ Open 2021; 11:e051291. [PMID: 34548361 PMCID: PMC8458307 DOI: 10.1136/bmjopen-2021-051291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study was aimed to assess the willingness of elderly people to seek medical care for tuberculosis (TB) and the associated influencing factors. DESIGN A cross-sectional study. SETTING A multistage random survey was conducted in Bao'an District of Shenzhen in China. PARTICIPANTS A total of 1200 elderly people aged 65 or above were recruited for the study and completed a structured questionnaire between September and October 2019. MAIN OUTCOME MEASURES Descriptive and binary logistic stepwise regression analyses were conducted to analyse the characteristics of elderly individuals, their willingness to seek medical care for TB and associated factors. RESULTS Among the final 1123 respondents, 943 (84.0%) were willing to seek medical care if they discovered suspicious TB symptoms. Binary logistic stepwise regression analysis indicated that respondents whose family annual income per capita was 50 000-100 000¥ (OR=2.56, 95% CI: 1.44 to 4.54, p<0.01) and who had positive attitudes (≥3 scores: OR=3.10, 95% CI: 1.90 to 5.05, p<0.01) or practices (≥4 scores: OR=3.13, 95% CI: 1.82 to 5.39, p<0.01) towards TB were more willing to seek medical care for TB. CONCLUSIONS Willingness to seek medical care for TB in the elderly population can be improved according to the determinants.
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Affiliation(s)
- Yunxia Wang
- Dapartment of Tuberculosis Prevention and Control, Shenzhen Bao'an Centre for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Jing Feng
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Juanjuan Zhang
- Dapartment of Tuberculosis Prevention and Control, Shenzhen Bao'an Centre for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Xin Shen
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Zihui Lei
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Yi Zhu
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Xin Meng
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Hongkun Di
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Wenqi Xia
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Yanfang Guo
- Dapartment of Tuberculosis Prevention and Control, Shenzhen Bao'an Centre for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Qing Yuan
- Dapartment of Tuberculosis Prevention and Control, Shenzhen Bao'an Centre for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Xiaojun Wang
- Office of Tuberculosis Control and Management, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
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Boah M, Kpordoxah MR, Adokiya MN. Self-reported gender differentials in the knowledge of tuberculosis transmission and curative possibility using national representative data in Ghana. PLoS One 2021; 16:e0254499. [PMID: 34252131 PMCID: PMC8274842 DOI: 10.1371/journal.pone.0254499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Health-seeking behaviour, stigma, and discrimination towards people affected by tuberculosis (TB) are influenced by awareness of the disease. Gender differentials in the diagnosis and treatment of TB have been reported in other settings of the world. However, little is known about the gender differences in the knowledge of TB transmission and curative possibility in Ghana. Methods The analysed data were a weighted sample of 9,396 women aged 15–49 years and 4,388 men aged 15–59 years, obtained from the 2014 Ghana Demographic and Health Survey. The dependent variable, correct knowledge regarding TB transmission and cure was derived from questions on the transmission of the disease and the possibility of a cure. A design-based multivariate logistic regression model in Stata 13.0/SE was used to identify the correlates of reporting correct knowledge. Results Overall, the mean knowledge score was 6.1±0.9 (maximum = 7). Of the 13,784 respondents, 45.7% (95% CI: 44.0–47.3) reported correct knowledge regarding TB transmission and cure. Men had significantly higher knowledge than women (50.9% versus 43.2%). Misconceptions, including TB transmitted through sharing utensils (13.3%), food (6.9%), touching a person with TB (4.5%), sexual contact (4.1%), and mosquito bites (0.4%) were noted. About 30% (33% women and 25% men) of the total sample would keep the information secret when a household member is affected with TB. In the adjusted analysis, age, gender, education, region, place of residence, wealth quintile, frequency of reading newspaper/magazine, listening to the radio, and watching television were significantly associated with reporting correct knowledge. Conclusions There was low knowledge regarding TB transmission and cure. Misconceptions regarding the transmission of TB prevailed among the participants. Gender differential in knowledge was observed. Comparatively, females were less likely to be aware of TB and report correct knowledge regarding TB transmission but were more likely to conceal information when a household member was affected by the disease.
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Affiliation(s)
- Michael Boah
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
- * E-mail:
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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Literacy on tuberculosis in paediatric population and their caregivers. The importance of an outpatient tuberculosis centre. Pulmonology 2021; 27:469-471. [PMID: 33685848 DOI: 10.1016/j.pulmoe.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
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Negash H, Legese H, Adhanom G, Mardu F, Tesfay K, Gebreslasie Gebremeskel S, Berhe B. Six Years Trend Analysis of Tuberculosis in Northwestern Tigrai, Ethiopia; 2019: A Retrospective Study. Infect Drug Resist 2020; 13:643-649. [PMID: 32158240 PMCID: PMC7047984 DOI: 10.2147/idr.s239717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ethiopia is one of the 22 high tuberculosis burden countries. In our country. there are limited published data to show the trend analysis of tuberculosis. Hence, we designed this trend analysis to fill the information gap in our study area. Institutional based retrospective cross-sectional study was employed from 2013 to 2018 to determine the trend analysis of tuberculosis among tuberculosis presumptive clients in Northwestern Tigrai. We have used a standard checklist to extract the data. There were some missing data from the logbooks which are then excluded from the analysis. RESULTS A total of 7793 tuberculosis presumptive clients were requested for laboratory diagnosis of which about 7639 results had a valid result for X-pert MTB/Rif assay. The overall detection rate of tuberculosis was found to be 9.9% (756/7639). Of the total tuberculosis cases, 8.7 % (66/756) were rifampicin-resistant. The trend of tuberculosis across the six years was fluctuating with a declining trend in the recent three years. HIV infection and being presumptive to drug resistance were associated with tuberculosis detection. CONCLUSION Although there was a cumulative declining trend of tuberculosis within the last six years, prevention and control strategies still need to be improved to achieve the stop tuberculosis strategy. To create a world free of tuberculosis, there should be quality service provision regarding tuberculosis case detection and treatment.
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Affiliation(s)
- Hadush Negash
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Haftom Legese
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Gebre Adhanom
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Fitsum Mardu
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Kebede Tesfay
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Senait Gebreslasie Gebremeskel
- Unit of Pediatrics and Child Health, Department of Midwifery, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
| | - Brhane Berhe
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Tigrai, Ethiopia
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Wang W, Wang F, Peng Y, Liu K, Chen X, Chai C, Wang X, Chen B. Factors Associated with Health-Seeking Preference Among People Who Were Supposed to Cough for More Than 2 Weeks: A Cross-Sectional Study in Southeast China. Patient Prefer Adherence 2020; 14:1173-1183. [PMID: 32764890 PMCID: PMC7372003 DOI: 10.2147/ppa.s257722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The health-seeking preference of people with a cough >2 weeks had not been extensively researched in southeast China. The study aimed to explore factors associated with health-seeking preference, which could provide more evidence to improve individuals' appropriate health-seeking behavior. MATERIALS AND METHODS From October 2018 to December 2018, this cross-sectional study was conducted in Zhejiang, China. A questionnaire was used to collect information on sociodemographic characteristics, knowledge of tuberculosis (TB), and health-seeking preference. The chi-square test and multivariable logistic regression were performed to evaluate factors associated with health-seeking preference. RESULTS Of the 7174 participants, 3321 (46.3%) were men, 6148 (85.7%) were married, and 6013 (83.8%) knew about TB. Appropriate health-seeking preference was reported by 6229 (86.8%) participants. Respondents knowing about TB were more likely to seek appropriate care than those did not (89.6% vs 72.4%, p<0.001). Of the 6013 participants knowing about TB, respondents with higher scores on five key items of TB knowledge were more likely to get appropriate health-seeking preference. About 805 (96.6%) participants with 5 scores on TB knowledge had appropriate care preference. Only 97 (72.4%) participants with a score of 0 reported an appropriate preference. Multivariable logistic regression showed residence, marital status, education level, occupation, and awareness of TB knowledge were predictors of appropriate health-seeking preference. Compared to participants with a score of 0 on five TB key knowledge, participants with a score of 5 were 8.57 times more likely to have appropriate health-seeking preference (95% confidence interval [CI]: 4.97-14.78), followed by a score of 4 (odds ratio [OR]=5.99, 95% CI, 3.23-8.03); 3 (OR=3.74, 95% CI, 2.44-5.74); 2 (OR=1.99, 95% CI, 1.30-3.02) and 1 (OR=1.17, 95% CI, 0.76-1.80). CONCLUSION Participants with little knowledge of TB had a low level of appropriate health-seeking preference. Appropriate health-seeking preference of the participants improved with increased key knowledge level of TB.
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Affiliation(s)
- Wei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Fei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Ying Peng
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Xinyi Chen
- Department of Preventive Medicine, Epidemiology and Health Statistics, School of Medicine, Ningbo University, Ningbo315211, People’s Republic of China
| | - Chengliang Chai
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Xiaomeng Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
| | - Bin Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou310051, People’s Republic of China
- Correspondence: Bin Chen; Xiaomeng Wang Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399, Binsheng Road, Binjiang District, Hangzhzou, Zhejiang Province310051, People’s Republic of China Tel/Fax +86 571 8711 5183; Tel +86 571 8711 5181Fax +86 571 8711 5189 Email ;
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Public Awareness of Tuberculosis in Southeast China: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214290. [PMID: 31694232 PMCID: PMC6862559 DOI: 10.3390/ijerph16214290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
Few provinces in China have recently conducted population-based surveys on tuberculosis (TB) awareness at the provincial level. Hence, we conducted a population-based, cross-sectional study to evaluate the level of awareness of TB knowledge among residents of Zhejiang Province, China from October 2018 to December 2018. A total of 7174 individuals were randomly selected to participate in this survey. The rate of awareness of key information on TB was found to be 48.0%. The study’s participants exhibited a good understanding of the transmission route (80.8%), curable outcome (78.3%), and designated treatment sites (67.0%) of TB. The rate of awareness of suspicious TB symptoms (36.1%) and the relief policy on diagnosis and first-line therapeutic drugs (38.0%) were found to be relatively low among the respondents. People living in rural areas, those who were less educated, and students all showed a low level of awareness of key knowledge about TB. In conclusion, residents in Zhejiang Province generally lacked key information about TB, which is not conducive to the early detection and treatment of TB. Corresponding efforts should be made for different groups of people to achieve favorable effects on the prevention and control of TB.
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Lin Y, Dlodlo RA, Shu Q, Lin H, Huang Q, Meng X, Zeng X, Chen Y, Xiao L. Outcomes of a smoking cessation intervention at follow-up after 5 years among tuberculosis patients in China. Tob Induc Dis 2019; 17:69. [PMID: 31582957 PMCID: PMC6770632 DOI: 10.18332/tid/111539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/09/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smoking cessation should be part of tuberculosis (TB) treatment, but a cessation service is not available as part of a routine TB service in most low- and middle-income countries. WHO and The International Union Against Tuberculosis and Lung Disease (The Union) issued a guideline and China implemented a pilot project 5 years ago. This study aimed to determine changes in smoking status among TB patients at 5 years after completion of anti-TB treatment to observe long-term outcome of a smoking cessation project whose baseline characteristics were associated with a relapse of smoking behavior. METHODS A prospective longitudinal study was conducted 5 years after completion of anti-TB treatment to assess changes in patient smoking status against individual baseline data that were entered into a database at the time of TB registration. The patients were tracked by trained village doctors and validated by township health staff. Their smoking status was assessed and entered into the database and analysed. RESULTS Of the 800 TB patients registered at baseline, 650 (81.2%) were tracked. Ninety-one (11.4%) patients died and 59 (7.4%) were lost to follow-up. The rates of remaining non-smoking after 5 years were 82.0%, 63.0%, 49.6%, 43.5% and 30.0%, respectively for non-smokers, ex-smokers, current smokers who received cessation intervention, recent quitters, and current smokers not on a cessation intervention. The odds of smoking relapse were significantly higher for those aged ≥65 years (p=0.003) and registered in Xingguo County (p=0.025). CONCLUSIONS Findings from this study confirmed that non-smokers, ex-smokers and current smokers who received cessation intervention at baseline maintained higher non-smoking rates compared with those who did not receive the intervention. To prevent relapse, intensive cessation support should be given to TB patients aged ≥65 years. TB programme managers need to ensure integration and provision of smoking cessation advice and smoke-free policy in routine TB services.
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Affiliation(s)
- Yan Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Riitta A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Qi Shu
- Jinshan District Center for Disease Control and Prevention, Shanghai, China
| | - Haoxiang Lin
- School of Public Health, Peking University, Beijing, China.,Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China
| | - Qin Huang
- Jiangxi Provincial Institute of Tuberculosis Control and Prevention, Nanchang, China
| | - Xu Meng
- Ganzhou City Center for Disease Control and Prevention, Ganzhou, China
| | - Xianglin Zeng
- Ningdu County Tuberculosis Dispensary, Ningdu, China
| | - Yongming Chen
- Xingguo County Tuberculosis Dispensary, Xingguo, China
| | - Lixin Xiao
- Xingguo County Tuberculosis Dispensary, Xingguo, China
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Abstract
Gender inequality has severe consequences on public health in terms of delay in diagnosis of pulmonary tuberculosis (PTB). In order to explore gender-related differences in diagnosis delay, a cross-sectional study of 10 686 patients diagnosed with PTB in Yulin from 1 January 2009 to 31 December 2014 was conducted. Diagnosis delay was categorised into ‘short delay’ and ‘long delay’ by four commonly used cut-off points of 14, 30, 60 and 90 days. Logistic regression analysis was used to analyse gender differences in diagnostic delay. Stratified analyses by smear results, age, urban/rural were performed to examine whether the effect persisted across the strata. The median delay was 31 days (interquartile range 13–65). Diagnostic delay in females at cut-off points of 14, 30, 60 and 90 days had odds ratios (OR) of 0.99 (95% CI 0.91–1.09), 1.09 (95% CI 1.01–1.18), 1.15 (95% CI 1.05–1.26) and 1.18 (95% CI 1.06–1.31), respectively, compared with males. Stratified analysis showed that females were associated with increased risk of longer delay among those aged 30–60 years, smear positive and living in the rural areas (P < 0.05). The female-to-male OR increased along with increased delay time. Further inquiry into the underlying reasons for gender differences should be urgently addressed to improve the current situation.
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Badane AA, Dedefo MG, Genamo ES, Bekele NA. Knowledge and Healthcare Seeking Behavior of Tuberculosis Patients attending Gimbi General Hospital, West Ethiopia. Ethiop J Health Sci 2019; 28:529-538. [PMID: 30607067 PMCID: PMC6308772 DOI: 10.4314/ejhs.v28i5.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Tuberculosis (TB) now ranks alongside HIV (Human Immunodeficiency Virus) as a leading cause of death worldwide. Globally, 9.6 million people were estimated to have fallen ill with TB in 2014. The aim of this study is to assess the knowledge and healthcare seeking behaviour of tuberculosis patents in Gimbi General Hospital, West Ethiopia. Methods A cross sectional study was conducted among tuberculosis patients from March 8 to April 30, 2015. The data collection method was face-to-face interview through structured standard questionnaire. To identify the factors associated with knowledge about TB and healthcare seeking behavior, backward logistic regression analysis was used. Results Of the 138 TB patients, 85(61.6%) had good knowledge about TB while 53(38.4%) had poor knowledge about TB. On multivariable logistic analysis, poor knowledge about TB was more likely to occur among TB patients in intensive treatment phase (Adjusted odds ratio (AOR)=4.1, 95% CI= 1.7–9.6, p=0.001). Conclusion TB patients had good knowledge on signs and symptoms of TB, transmission of TB and healthcare seeking behaviour of TB, but their knowledge on the cause of TB, treatment of TB and prevention of TB were not adequate. This study also revealed that the health careseeking behaviour of TB patients were good.
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Determinants of Health Care-Seeking Delay among Tuberculosis Patients in Rural Area of Central China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091998. [PMID: 30217043 PMCID: PMC6164791 DOI: 10.3390/ijerph15091998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022]
Abstract
Background The prevalence of tuberculosis (TB) in low and middle-income countries is a significant public health and social concern. TB is a common infectious disease caused by the Mycobacterium tuberculosis infection, which has a widespread infection rate. Health care-seeking delay maybe one of the most important neglected risk factors for the spread of TB. Objectives The aim of this study was to understand the situation of health care-seeking delay among rural tuberculosis patients in Hubei Province, and explore its risk factors. Methods A total of 1408 rural tuberculosis patients were surveyed using a standard structured questionnaire in three cities of Hubei Province during the past two years. Results For the 1408cases of pulmonary tuberculosis, 39.70% of them were health care-seeking delayed. Logistic regressions indicate that the Han nationality, farming careers, the over 45 min walk to the township’s hospital, and awareness of the national TB free treatment policy, were significantly associated with higher odds of a delay in care seeking. Conclusions The prevalence of health care-seeking delay among tuberculosis patients was high in rural areas. It is essential to take comprehensive targeted interventions to reduce care-seeking delay.
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Chen S, Burström B, Sparring V, Qian D. Vertical integrated service model: an educational intervention for chronic disease management and its effects in rural China - a study protocol. BMC Health Serv Res 2018; 18:567. [PMID: 30029653 PMCID: PMC6053730 DOI: 10.1186/s12913-018-3355-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/04/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic diseases are becoming a huge threat to the Chinese health system. Although the New Round of Medical Reform aims to improve this, the chronic disease management in rural China is still worrying as it relies highly on hospital care instead of primary care. The vertical integrated care model has proven to be effective for chronic disease patients in many high-income countries, while few studies have been conducted in China. In this project, vertical integrated care will be applied to optimize the care of patients with type 2 diabetes mellitus (T2DM) and primary hypertension in rural China, and to shift the care from hospital to primary care. METHODS An educational intervention was conducted in three pilot counties in Jiangsu province, a high-income province in southeast China. The intervention was based on the model of vertical integrated care between the three-levels of healthcare institutions. In the pilot counties, 22 townships were included (11 in the intervention and control groups, respectively). Service teams assembled by the local health bureaus implemented the intervention which provides services for both patients and healthcare professionals. Questionnaire interviews (n = 4259) and medical records were used to collect patient data (physiological measures, health-related quality of life, satisfaction with care). Data from healthcare professionals (n = 282) was gathered through questionnaires and in-depth interviews (knowledge about chronic diseases, general procedure of diagnosing and registering, chronic disease management situation, perceptions of chronic disease treatment and prevention). Baseline data were collected before the start of the intervention in Nov 2015, follow-up data in Oct-Nov 2016, and final data completed in Jul-Aug 2017. DISCUSSION The intervention has been conducted smoothly and gotten support from patients, healthcare institutions and local health authorities. The research team anticipates that the vertical integrated model will improve patients' health, satisfaction with care, and their understanding of their chronic disease. We also anticipate that healthcare professionals can acquire more information about chronic diseases and improve their strategy for providing good quality care for patients. TRIAL REGISTRATION ISRCTN13319989 Registration date: 4th April, 2017.
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Affiliation(s)
- Shaofan Chen
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Health Outcomes and Economic Evaluation Research Group, SE-17177 Stockholm, Sweden
- Karolinska Institutet, Equity and Health Policy Research Group, Department of Public Health Services, SE-17177 Stockholm, Sweden
| | - Bo Burström
- Karolinska Institutet, Equity and Health Policy Research Group, Department of Public Health Services, SE-17177 Stockholm, Sweden
- Stockholm County Council, Centre for Epidemiology and Community Medicine, P.O. Box 45436, SE-10431 Stockholm, Sweden
- Center for Health Policy Studies, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 China
| | - Vibeke Sparring
- Karolinska Institutet, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, SE-17177 Stockholm, Sweden
| | - Dongfu Qian
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 China
- Creative Health Policy Research Group, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166 China
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Lin Y, Enarson DA, Du J, Dlodlo RA, Chiang CY, Rusen ID. Risk factors for unfavourable treatment outcome among new smear-positive pulmonary tuberculosis cases in China. Public Health Action 2017; 7:299-303. [PMID: 29584792 DOI: 10.5588/pha.17.0056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Three projects of the Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB. Objectives: To assess unfavourable treatment outcomes (UTOs), including failure, died, loss to follow-up (LTFU), transferred out and unknown outcome, and to identify risk factors associated with UTOs. Design: This was a cross-sectional study using routine programme data. Results: Of 30 277 new smear-positive tuberculosis (TB) patients, 4261 (14.1%) had UTOs: 2048 (6.8%) LTFU, 1418 (4.7%) transferred out, 390 (1.3%) died, 340 (1.1%) failed and 65 (0.2%) had an unknown outcome. Risk factors for LTFU (including LTFU, transfer out and unknown outcome) were residing in Anhui, age > 55 years, service delay > 10 days, patient delay < 30 days, directly observed treatment (DOT) provided by a family member or others and unknown DOT provider. The outcome of 'died' was associated with residing in Shaanxi, age > 55 years, male sex, patient delay > 30 days and unknown DOT provider. 'Failed' was associated with having unlimited access to health services, patient delay of >30 days and unknown DOT provider. Conclusion: This study highlights the predominance of lost patients among UTOs. Patients with family members or other non-medical DOT providers or unknown DOT providers had a high risk of a UTO. There is an urgent need to address these service-related factors.
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Affiliation(s)
- Y Lin
- International Union Against Tuberculosis and Lung Disease (The Union), Beijing, China.,The Union, Paris, France
| | | | - J Du
- Beijing Chest Hospital, Capital Medical University, Beijing, China.,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
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Hutchison C, Khan MS, Yoong J, Lin X, Coker RJ. Financial barriers and coping strategies: a qualitative study of accessing multidrug-resistant tuberculosis and tuberculosis care in Yunnan, China. BMC Public Health 2017; 17:221. [PMID: 28222724 PMCID: PMC5320743 DOI: 10.1186/s12889-017-4089-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and multidrug-resistance tuberculosis (MDR-TB) pose serious challenges to global health, particularly in China, which has the second highest case burden in the world. Disparities in access to care for the poorest, rural TB patients may be exacerbated for MDR-TB patients, although this has not been investigated widely. We examine whether certain patient groups experience different barriers to accessing TB services, whether there are added challenges for patients with MDR-TB, and how patients and health providers cope in Yunnan, a mountainous province in China with a largely rural population and high TB burden. METHODS Using a qualitative study design, we conducted five focus group discussions and 47 in-depth interviews with purposively sampled TB and MDR-TB patients and healthcare providers in Mandarin, between August 2014 and May 2015. Field-notes and interview transcripts were analysed via a combination of open and thematic coding. RESULTS Patients and healthcare providers consistently cited financial constraints as the most common barriers to accessing care. Rural residents, farmers and ethnic minorities were the most vulnerable to these barriers, and patients with MDR-TB reported a higher financial burden owing to the centralisation and longer duration of treatment. Support in the form of free or subsidised treatment and medical insurance, was deemed essential but inadequate for alleviating financial barriers to patients. Most patients coped by selling their assets or borrowing money from family members, which often strained relationships. Notably, some healthcare providers themselves reported making financial and other contributions to assist patients, but recognised these practices as unsustainable. CONCLUSIONS Financial constraints were identified by TB and MDR-TB patients and health care professionals as the most pervasive barrier to care. Barriers appeared to be magnified for ethnic minorities and patients coming from rural areas, especially those with MDR-TB. To reduce financial barriers and improve treatment outcomes, there is a need for further research into the total costs of seeking and accessing TB and MDR-TB care. This will enable better assessment and targeting of appropriate financial support for identified vulnerable groups and geographic development of relevant services.
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Affiliation(s)
- C Hutchison
- London School of Hygiene and Tropical Medicine, London, UK
| | - M S Khan
- London School of Hygiene and Tropical Medicine, London, UK.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - J Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Centre for Economic and Social Research, University of Southern California, Los Angeles, USA
| | - X Lin
- Yunnan Center for Disease Control and Prevention, Kunming, China.
| | - R J Coker
- London School of Hygiene and Tropical Medicine, London, UK.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
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25
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Vanaja K, Banu R, Reddy L, Kumar PC, Srinivas C, Rajani T, Navyashree, Shekar HS. A study on knowledge and awareness about tuberculosis in senior school children in Bangalore, India. Indian J Tuberc 2016; 63:192-198. [PMID: 27865242 DOI: 10.1016/j.ijtb.2015.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/07/2015] [Accepted: 07/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (M. tuberculosis), commonly affecting the lungs. All health care professionals including the pharmacists provide a valuable public health role in promoting community awareness of TB particularly in reducing stigma attached to TB. Thus, creating awareness at a community level could play a vital role in control and prevention of TB. OBJECTIVES To determine whether educational intervention would affect the level of TB awareness among students of selected schools and pre-university colleges (PUCs) in Bangalore urban and Bangalore rural regions. METHODOLOGY The present study was conducted among the students of 8th, 9th, 10th and PUC in Bangalore rural and urban jurisdiction (n=2635). A questionnaire was designed in English and Kannada language, consisting of 20 questions with multiple-choice answers. A 30-minute visual health education was given on TB in English, followed by general pictorial presentation, and the data were collected as pre-test and post-test. RESULTS Data collected from 2635 participants during pre- and post-education session revealed that mean score improved from 8.77±2.59 to 14.95±1.99. Impact of the education session showed a significant knowledge improvement about TB from 1.59% (pre-education) to 49.67% (post-education). CONCLUSION The present study clearly demonstrated that a simple, 30-minute health education session did have a positive impact on knowledge and awareness about TB among school children as observed with increase in mean knowledge score from pre-test to post-test, indicating that empowerment of students could guide the community on various aspects of TB.
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Affiliation(s)
- K Vanaja
- Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, 24th Cross, 22nd Main, BDA Complex, BSK 2nd Stage, Bangalore 560070, India.
| | - Reshma Banu
- Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, 24th Cross, 22nd Main, BDA Complex, BSK 2nd Stage, Bangalore 560070, India
| | - Lokeshwar Reddy
- Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, 24th Cross, 22nd Main, BDA Complex, BSK 2nd Stage, Bangalore 560070, India
| | - P Chethan Kumar
- Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, 24th Cross, 22nd Main, BDA Complex, BSK 2nd Stage, Bangalore 560070, India
| | - Chaitra Srinivas
- Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, 24th Cross, 22nd Main, BDA Complex, BSK 2nd Stage, Bangalore 560070, India
| | - T Rajani
- Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, 24th Cross, 22nd Main, BDA Complex, BSK 2nd Stage, Bangalore 560070, India
| | - Navyashree
- Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, 24th Cross, 22nd Main, BDA Complex, BSK 2nd Stage, Bangalore 560070, India
| | - H S Shekar
- Department of Pharmacy Practice, Visveswarapura Institute of Pharmaceutical Sciences, 24th Cross, 22nd Main, BDA Complex, BSK 2nd Stage, Bangalore 560070, India
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Health Care Seeking Behavior of Persons with Acute Chagas Disease in Rural Argentina: A Qualitative View. J Trop Med 2016; 2016:4561951. [PMID: 27829843 PMCID: PMC5088329 DOI: 10.1155/2016/4561951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/28/2016] [Indexed: 02/01/2023] Open
Abstract
Chagas disease (CD) is a tropical parasitic disease largely underdiagnosed and mostly asymptomatic affecting marginalized rural populations. Argentina regularly reports acute cases of CD, mostly young individuals under 14 years old. There is a void of knowledge of health care seeking behavior in subjects experiencing a CD acute condition. Early treatment of the acute case is crucial to limit subsequent development of disease. The article explores how the health outcome of persons with acute CD may be conditioned by their health care seeking behavior. The study, with a qualitative approach, was carried out in rural areas of Santiago del Estero Province, a high risk endemic region for vector transmission of CD. Narratives of 25 in-depth interviews carried out in 2005 and 2006 are analyzed identifying patterns of health care seeking behavior followed by acute cases. Through the retrospective recall of paths for diagnoses, weaknesses of disease information, knowledge at the household level, and underperformance at the provincial health care system level are detected. The misdiagnoses were a major factor in delaying a health care response. The study results expose lost opportunities for the health care system to effectively record CD acute cases.
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Using Survival Analysis to Identify Risk Factors for Treatment Interruption among New and Retreatment Tuberculosis Patients in Kenya. PLoS One 2016; 11:e0164172. [PMID: 27706230 PMCID: PMC5051722 DOI: 10.1371/journal.pone.0164172] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022] Open
Abstract
Despite high tuberculosis (TB) treatment success rate, treatment adherence is one of the major obstacles to tuberculosis control in Kenya. Our objective was to identify patient-related factors that were associated with time to TB treatment interruption and the geographic distribution of the risk of treatment interruption by county. Data of new and retreatment patients registered in TIBU, a Kenyan national case-based electronic data recording system, between 2013 and 2014 was obtained. Kaplan-Meier curves and log rank tests were used to assess the adherence patterns. Mixed-effects Cox proportional hazards modeling was used for multivariate analysis. Records from 90,170 patients were included in the study. The cumulative incidence of treatment interruption was 4.5% for new patients, and 8.5% for retreatment patients. The risk of treatment interruption was highest during the intensive phase of treatment. Having previously been lost to follow-up was the greatest independent risk factor for treatment interruption (HR: 4.79 [3.99, 5.75]), followed by being HIV-positive not on ART (HR: 1.96 [1.70, 2.26]) and TB relapse (HR: 1.70 [1.44, 2.00]). Male and underweight patients had high risks of treatment interruption (HR: 1.46 [1.35, 1.58]; 1.11 [1.03, 1.20], respectively). High rates of treatment interruption were observed in counties in the central part of Kenya while counties in the northeast had the lowest risk of treatment interruption. A better understanding of treatment interruption risk factors is necessary to improve adherence to treatment. Interventions should focus on patients during the intensive phase, patients who have previously been lost to follow-up, and promotion of integrated TB and HIV services among public and private facilities.
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28
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Burtscher D, Van den Bergh R, Toktosunov U, Angmo N, Samieva N, Rocillo Arechaga EP. "My Favourite Day Is Sunday": Community Perceptions of (Drug-Resistant) Tuberculosis and Ambulatory Tuberculosis Care in Kara Suu District, Osh Province, Kyrgyzstan. PLoS One 2016; 11:e0152283. [PMID: 27019454 PMCID: PMC4809488 DOI: 10.1371/journal.pone.0152283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/12/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Kyrgyzstan is one of the 27 high multidrug-resistant tuberculosis (MDR-TB) burden countries listed by the WHO. In 2012, Médecins Sans Frontières (MSF) started a drug-resistant tuberculosis (DR-TB) project in Kara Suu District. A qualitative study was undertaken to understand the perception of TB and DR-TB in order to improve the effectiveness and acceptance of the MSF intervention and to support advocacy strategies for an ambulatory model of care. METHODS This paper reports findings from 63 interviews with patients, caregivers, health care providers and members of communities. Data was analysed using a qualitative content analysis. Validation was ensured by triangulation and a 'thick' description of the research context, and by presenting deviant cases. RESULTS Findings show that the general population interprets TB as the 'lungs having a cold' or as a 'family disease' rather than as an infectious illness. From their perspective, individuals facing poor living conditions are more likely to get TB than wealthier people. Vulnerable groups such as drug and alcohol users, homeless persons, ethnic minorities and young women face barriers in accessing health care. As also reported in other publications, TB is highly stigmatised and possible side effects of the long treatment course are seen as unbearable; therefore, people only turn to public health care quite late. Most patients prefer ambulatory treatment because of the much needed emotional support from their social environment, which positively impacts treatment concordance. Health care providers favour inpatient treatment only for a better monitoring of side effects. Health staff increasingly acknowledges the central role they play in supporting DR-TB patients, and the importance of assuming a more empathic attitude. CONCLUSIONS Health promotion activities should aim at improving knowledge on TB and DR-TB, reducing stigma, and fostering the inclusion of vulnerable populations. Health seeking delays and adherence problems will be countered by further implementation of shortened treatment regimens. An ambulatory model of care is proposed when convenient for the patient; hospitalisation is favoured only when seen as more appropriate for the respective individual.
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Affiliation(s)
- Doris Burtscher
- Médecins Sans Frontières, Vienna Evaluation Unit, Vienna, Austria
| | | | | | - Nilza Angmo
- Médecins Sans Frontières, Bishkek, Kyrgyzstan
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Chen CC, Chiang CY, Pan SC, Wang JY, Lin HH. Health system delay among patients with tuberculosis in Taiwan: 2003-2010. BMC Infect Dis 2015; 15:491. [PMID: 26527404 PMCID: PMC4629405 DOI: 10.1186/s12879-015-1228-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/19/2015] [Indexed: 11/30/2022] Open
Abstract
Background Taiwan has integrated the previous vertical tuberculosis (TB) control system into the general health care system. With the phase out of the specialized TB care system and the declining TB incidence, it is likely that clinical workers become less familiar with the presentation of TB, resulting in delay in TB diagnosis and treatment. Methods We used the detailed information of health care visits in the Taiwan National Health Insurance database to analyze the temporal pattern of the health system delay (HSD) among 3,117 patients with TB between 2003 and 2010. Results The median HSD was 29 days (interquartile range 5–73 days), and the median delay increased from 26 days in 2003 to 33.5 days in 2008, thereafter slightly decreased to 32 days in 2010. Patient factors associated with a longer HSD included: aged 45–64 and ≧65 years (as compared to aged <30 years); females (as compared to males); an initial visit as an outpatient (as compared to an inpatient). Provider factors were an initial visit to a provider not specialized in TB (as compared to a TB-related provider), to a primary care clinic or to a medical center (as compared to a district hospital), and in Central region, Northern region, KaoPing region, Southern region and Taipei region (as compared to in Eastern region). Longer distances from the point of initial visit to that of treatment were associated with longer HSD. Patients who switched among different levels or different types of medical care services during their illness exhibited the longest HSD. Conclusions In countries where the TB care systems are being restructured from a vertical to a horizontal system, it is critical to monitor HSD and be aware of its increase. The potential increase in the HSD from 2003 to 2008 observed in this study is concerning and the decline of HSD after 2008 might be attributed to the launch of contact investigation. Our results call for actions to improve the efficiency of TB diagnosis in the health care system and to increase the awareness of TB among physicians and the general public. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1228-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chien-Chou Chen
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chen-Yuan Chiang
- Department of Lung Health and NCDs, International Union Against Tuberculosis and Lung Disease, Paris, France. .,Division of Pulmonary Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. .,Department of Internal Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Sung-Ching Pan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
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Lin Y, Enarson DA, Chiang CY, Rusen ID, Qiu LX, Kan XH, Yuan YL, Du J, Zhang TH, Li Y, Li XF, Du CT, Zhang LX. Patient delay in the diagnosis and treatment of tuberculosis in China: findings of case detection projects. Public Health Action 2015; 5:65-9. [PMID: 26400603 DOI: 10.5588/pha.14.0066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE 1) To assess patient delay among new smear-positive pulmonary tuberculosis (PTB) patients in accessing health services in seven FIDELIS (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) projects from 2003 to 2008 in China; 2) to compare treatment delay by province; and 3) to assess factors associated with delay. METHOD Records of new smear-positive PTB patients were reviewed. Data sources were the consultation book, laboratory register, patient record, treatment card and the PWLAHS (people with limited access to health services) evaluation form. Data were collected using a standard questionnaire, cross-checked by staff from the sites and by the International Union Against Tuberculosis and Lung Disease (The Union) and analysed by The Union. RESULTS Of the 75 401 new smear-positive PTB patients included in the study, 63-89% were PWLAHS. The average gross domestic product of the project sites and at national level were respectively US$557 and US$998. The median patient delay was 93 days (range 68-128). Delays were longer among females, older patients, rural residents and PWLAHS. Delayed access to health services was significantly associated with a greater number of symptoms. CONCLUSION Patient delay in accessing health care in China was lengthy; TB care and control needs to be improved.
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Affiliation(s)
- Y Lin
- International Union Against Tuberculosis and Lung Disease (The Union), Beijing, China
| | | | | | | | - L-X Qiu
- Jiangxi Provincial Tuberculosis Institute, Nanchang, China
| | - X-H Kan
- Anhui Provincial Tuberculosis Institute, Hefei, China
| | - Y-L Yuan
- Jilin Provincial Tuberculosis Institute, Changchun, China
| | - J Du
- Beijing Tuberculosis and Thoracic Tumour Research Institute, Beijing, China
| | - T-H Zhang
- Shaanxi Provincial Tuberculosis Institute, Xian, China
| | - Y Li
- Guizhou Provincial Tuberculosis Institute, Guiyang, China
| | - X-F Li
- Xianyang Center for Disease Control and Prevention, Xianyang, China
| | - C-T Du
- Chongqing Tuberculosis Institute, Chongqing, China
| | - L-X Zhang
- International Union Against Tuberculosis and Lung Disease (The Union), Beijing, China
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Abstract
Tuberculosis (TB) researchers and clinicians, by virtue of the social disease they study, are drawn into an engagement with ways of understanding illness that extend beyond the strictly biomedical model. Primers on social science concepts directly relevant to TB, however, are lacking. The particularities of TB disease mean that certain social science concepts are more relevant than others. Concepts such as structural violence can seem complicated and off-putting. Other concepts, such as gender, can seem so familiar that they are left relatively unexplored. An intimate familiarity with the social dimensions of disease is valuable, particularly for infectious diseases, because the social model is an important complement to the biomedical model. This review article offers an important introduction to a selection of concepts directly relevant to TB from health sociology, medical anthropology and social cognitive theory. The article has pedagogical utility and also serves as a useful refresher for those researchers already engaged in this genre of work. The conceptual tools of health sociology, medical anthropology and social cognitive theory offer insightful ways to examine the social, historical and cultural dimensions of public health. By recognizing cultural experience as a central force shaping human interactions with the world, TB researchers and clinicians develop a more nuanced consideration of how health, illness and medical treatment are understood, interpreted and confronted.
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Ma E, Ren L, Wang W, Takahashi H, Wagatsuma Y, Ren Y, Gao F, Gao F, Wang W, Bi L. Demographic and socioeconomic disparity in knowledge about tuberculosis in Inner Mongolia, China. J Epidemiol 2015; 25:312-20. [PMID: 25797599 PMCID: PMC4375286 DOI: 10.2188/jea.je20140033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study is to evaluate the awareness status, attitudes, and care-seeking behaviors concerning tuberculosis (TB) and associated factors among the public in Inner Mongolia, China. Methods A five-stage sampling was conducted, in which counties as the primary survey units and towns, villages, and households as sub-survey units were selected progressively. A standardized questionnaire was used to collect TB information. Complex survey analysis methods, including the procedures of survey frequency and survey logistic regression, were applied for analysis of TB knowledge and associated factors. The sample was weighted by survey design, non-respondent, and post-stratification adjustment. Results Among 10 581 respondents, awareness that TB is an infectious disease was 86.7%. Knowing that a cough lasting ≥3 weeks is suggestive of TB was 26.9%. Knowledge about TB dispensaries in county administrative areas was reported by 68.3% of respondents, and knowledge about the free TB detection/treatment policy was reported by 57.5% of respondents. About 52.5% of participants would stigmatize TB patients. Compared with the majority Han ethnic group, Mongolians and other minorities were 1.52–2.18 times more likely to know about TB curability, TB symptoms, the free detection/treatment policy, and TB dispensaries’ locations, but were less likely to know about the TB transmission mode (odds ratio, 0.74; 95% confidence interval, 0.65–0.84). The main sources of TB information were TV (65.6%) and other persons (47.2%). In the past year, 19.7% of TB knowledge was from acquaintances, and 16.1% was from TB institutes. Conclusions Improvement in knowledge about TB risk (symptoms and transmission), the free treatment policy, and facilities is necessary and should be provided through effective multimedia for different target populations.
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Affiliation(s)
- Enbo Ma
- University of Tsukuba Faculty of Medicine
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Emami H, Modarressi T, Najmi K, Radmand G, Monjazebi F, Tabarsi P, Richter J. Psychological Symptoms Before and After a 14-Day Initial Inpatient Treatment in Tuberculosis Patients Compared with Their Primary Caregivers and Healthy Controls. TANAFFOS 2015; 14:182-92. [PMID: 26858764 PMCID: PMC4745187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Tuberculosis (TB) is one of the most challenging public health burdens in the world. Recent research demonstrated high prevalence of mental disorders in TB patients and their caregivers. The purpose of this study was to assess mental health of TB patients and their caregivers in Iran before and after a two-week inpatient treatment and to determine the prevalence of psychological problems in these groups. MATERIALS AND METHODS A standardized questionnaire (SCL-90) was used to assess psychological symptoms in 146 hospitalized TB patients and their caregivers (n=89). Furthermore, the scores of both target groups were compared with those of a group of healthy individuals (n=85). RESULTS The mean scores before the start of the initial treatment of the patients were significantly lower for paranoid ideation (P=0.038) and hostility (P= 0.046), and the scores of depression (P=0.046) and somatization (P=0.001) were significantly higher than those of the healthy individuals. The patients scored significantly higher than the caregivers on depression (0.047) and somatization (P< 0.001), whereas the caregivers scored higher than the healthy individuals on paranoid ideation (P= 0.044) and hostility (P= 0.034). Multiple linear regression showed that age, educational level and marital status were factors affecting the mental health of TB patients and their caregivers. The variance in psychological symptoms of the patients was between 10% (paranoid ideation) and 27% (hostility) of the variance in the symptoms of their caregivers. CONCLUSION Tuberculosis control and treatment programs should not only address issues like continued respiratory symptoms, but should also focus on mental health in TB patients and their caregivers.
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Affiliation(s)
- Habib Emami
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Kosar Najmi
- Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnar Radmand
- Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Monjazebi
- Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Monjazebi F, Address: Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences Tehran, Iran
| | - Jörg Richter
- Department of Psychology, University of Hull, UK
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Chowdhury MRK, Rahman MS, Mondal MNI, Sayem A, Billah B. Social Impact of Stigma Regarding Tuberculosis Hindering Adherence to Treatment: A Cross Sectional Study Involving Tuberculosis Patients in Rajshahi City, Bangladesh. Jpn J Infect Dis 2015; 68:461-6. [DOI: 10.7883/yoken.jjid.2014.522] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Md Rocky Khan Chowdhury
- Department of Population Science and Human Resource Development, University of Rajshahi
- Department of Public Health, First Capital University of Bangladesh
| | | | | | - Abu Sayem
- Divisional Consultant, Rajshahi Division, National Tuberculosis Control Program (NTP), Directorate General of Health Service (DGHS)
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University
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Paz-Soldan VA, Alban RE, Dimos Jones C, Powell AR, Oberhelman RA. Patient Reported Delays in Seeking Treatment for Tuberculosis among Adult and Pediatric TB Patients and TB Patients Co-Infected with HIV in Lima, Peru: A Qualitative Study. Front Public Health 2014; 2:281. [PMID: 25566523 PMCID: PMC4273630 DOI: 10.3389/fpubh.2014.00281] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/02/2014] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) remains a significant public health challenge worldwide, and particularly in Peru with one of the highest incidence rates in Latin America. TB patient behavior has a direct influence on whether a patient will receive timely diagnosis and successful treatment of their illness. OBJECTIVES The objective was to understand the complex factors that can impact TB patient health seeking behavior. METHODS In-depth interviews were conducted with adult and parents of pediatric patients receiving TB treatment (n = 43), within that group a sub-group was also co-infected with HIV (n = 11). RESULTS Almost all of the study participants recognized delays in seeking either their child's or their own diagnosis of their TB symptoms. The principal reasons for treatment-seeking delays were lack of knowledge and confusion of TB symptoms, fear and embarrassment of receiving a TB diagnosis, and a patient tendency to self-medicate prior to seeking formal medical attention. CONCLUSION Health promotion activities that target patient delays have the potential to improve individual patient outcomes and mitigate the spread of TB at a community level.
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Affiliation(s)
- Valerie A Paz-Soldan
- Tulane University School of Public Health and Tropical Medicine , New Orleans, LA , USA ; Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Rebecca E Alban
- Tulane University School of Public Health and Tropical Medicine , New Orleans, LA , USA
| | - Christy Dimos Jones
- Tulane University School of Public Health and Tropical Medicine , New Orleans, LA , USA
| | - Amy R Powell
- Tulane University School of Public Health and Tropical Medicine , New Orleans, LA , USA
| | - Richard A Oberhelman
- Tulane University School of Public Health and Tropical Medicine , New Orleans, LA , USA
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Dangisso MH, Datiko DG, Lindtjørn B. Trends of tuberculosis case notification and treatment outcomes in the Sidama Zone, southern Ethiopia: ten-year retrospective trend analysis in urban-rural settings. PLoS One 2014; 9:e114225. [PMID: 25460363 PMCID: PMC4252125 DOI: 10.1371/journal.pone.0114225] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 11/05/2014] [Indexed: 11/18/2022] Open
Abstract
Background Ethiopia is one of the high tuberculosis (TB) burden countries. An analysis of trends and differentials in case notifications and treatment outcomes of TB may help improve our understanding of the performance of TB control services. Methods A retrospective trend analysis of TB cases was conducted in the Sidama Zone in southern Ethiopia. We registered all TB cases diagnosed and treated during 2003–2012 from all health facilities in the Sidama Zone, and analysed trends of TB case notification rates and treatment outcomes. Results The smear positive (PTB+) case notification rate (CNR) increased from 55 (95% CI 52.5–58.4) to 111 (95% CI 107.4–114.4) per 105 people. The CNRs of PTB+ in people older than 45 years increased by fourfold, while the mortality of cases during treatment declined from 11% to 3% for smear negative (PTB-) (X2trend, P<0.001) and from 5% to 2% for PTB+ (X2trend, P<0.001). The treatment success was higher in rural areas (AOR 1.11; CI 95%: 1.03–1.2), less for PTB- (AOR 0.86; CI 95%: 0.80–0.92) and higher for extra-pulmonary TB (AOR 1.10; CI 95%: 1.02–1.19) compared to PTB+. A higher lost-to-follow up was observed in men (AOR 1.15; CI 95%: 1.06–1.24) and among PTB- cases (AOR 1.14; CI 95%: 1.03–1.25). More deaths occurred in PTB-cases (AOR 1.65; 95% CI: 1.44–1.90) and among cases older than 65 years (AOR 3.86; CI 95%: 2.94–5.10). Lastly, retreatment cases had a higher mortality than new cases (6% vs 3%). Conclusion Over the past decade TB CNRs and treatment outcomes improved, whereas the disparities of disease burden by gender and place of residence reduced and mortality declined. Strategies should be devised to address higher risk groups for poor treatment outcomes.
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Affiliation(s)
- Mesay Hailu Dangisso
- Center for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Sidama Zone Health Department, Hawassa, Ethiopia
- * E-mail:
| | - Daniel Gemechu Datiko
- Hawassa University, Hawassa, Ethiopia
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bernt Lindtjørn
- Center for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Mondal MNI, Nazrul HM, Chowdhury MRK, Howard J. Socio-demographic factors affecting knowledge level of Tuberculosis patients in Rajshahi City, Bangladesh. Afr Health Sci 2014; 14:855-65. [PMID: 25834494 DOI: 10.4314/ahs.v14i4.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Tuberculosis (TB) control program in Bangladesh is still unsatisfactory due to insufficient knowledge and stigma about TB. Patients with low knowledge may be at higher risk of experiencing delays in diagnosis and appropriate treatment. OBJECTIVES The aims of this study were to identify the knowledge levels of TB and investigate the factors associated with knowledge level among the TB patients in Bangladesh. METHODS A cross-sectional study was conducted at Rajshahi City, Bangladesh. A total of 384 TB patients were interviewed through a pretested, structured questionnaire using purposive sampling techniques. Logistic regression analysis was used to evaluate the effects of selected socio-demographic factors on TB knowledge level. RESULTS The results revealed that pulmonary TB patients had greater knowledge than that of extra-pulmonary patients, and that sex, age, educational status and TB type were significantly associated with knowledge level. CONCLUSIONS In general, males and young adults, ages 21-35, had greater awareness about transmission and prevention of TB than females and adults over 35. Individuals with higher education and urban area patients were comparatively better informed about TB infection. Patients with greater knowledge about TB were also less likely to experience delays in seeking treatment.
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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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Agho KE, Hall J, Ewald B. Determinants of the knowledge of and attitude towards tuberculosis in Nigeria. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2014; 32:520-538. [PMID: 25395915 PMCID: PMC4221458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Globally, Nigeria had the fourth highest incidence of tuberculosis (TB) cases in 2009. Datasets of the 2008 Nigeria Demographic and Health Survey (NDHS) were used for examining factors associated with respondents' knowledge of and attitude towards TB in Nigeria. With the same age-group of males and females, the sample included 47,193 respondents aged 15-49 years. Factors associated with the knowledge of and attitude towards TB were examined against a set of individual-, household- and community-level variables, using multiple binary logistic regression analyses. Respondents who reported having ever heard of TB was 74.7%. Of those who ever heard of TB, 76.9% believed that TB can be cured, and 19.6% would want a family member's TB to be kept secret. Of those who ever heard of TB, 63.1% believed that TB was spread from person to person through the air by coughing or sneezing. Multivariate analysis indicated that the probability of having poor knowledge of and negative attitude towards TB was consistently significant among the poorest household (lowest wealth quintile), geopolitical regions (North Central), respondents with no schooling, non-working respondents, youngest age-group (15-19 years), and rural areas [adjusted odds ratios (AOR)=0.76, 95% CI 0.66-0.86 for respondents who had ever heard of TB; AOR=0.89, 95% CI 0.80-0.99 for respondents who had ever heard of TB and believed that TB can be cured; AOR=0.83, 95% CI 0.73-0.94 for those who had ever heard of TB and concealed the fact that a family member had TB; and AOR=0.88, 95% CI 0.78-0.99 for those who had ever heard of TB and believed TB was spread from person to person through the air by coughing or sneezing]. Efforts to improve the knowledge of and attitude towards TB in Nigeria should focus on the youngest age-group (15-19 years), the poorest households, and respondents with no schooling. Improving the knowledge and attitude of these groups of individuals may result in an increase in the number of people who will seek early treatment.
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Affiliation(s)
- K E Agho
- School of Science and Health, University of Western Sydney, NSW, Australia
| | - J Hall
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, NSW, Australia
| | - B Ewald
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, NSW, Australia
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Bam K, Bhatt LP, Thapa R, Dossajee HK, Angdembe MR. Illness perception of tuberculosis (TB) and health seeking practice among urban slum residents of Bangladesh: a qualitative study. BMC Res Notes 2014; 7:572. [PMID: 25163889 PMCID: PMC4156634 DOI: 10.1186/1756-0500-7-572] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background Combating tuberculosis (TB) in urban slums is more complex than in rural areas due to reasons such as over-crowding, unhygienic living conditions and poverty. This study aimed to assess illness perception of TB and identify barriers and facilitators for health seeking practice among the residents of Badda slum, Dhaka, Bangladesh. Methods The Badda slum was purposively selected. Convenience sampling was carried out to select participants aged 18 years and above. Twenty two in-depth interviews, two key informants’ interviews and participatory rapid appraisal (PRA) were conducted. Data were analyzed manually by using defined a priori codes and color coding of the quotes in data matrix table. Results TB was commonly recognized as Jokkha (pulmonary TB), Sas rog (disease associated to breathing) followed by TB. More females than males had knowledge about TB related illness. Very few perceived of being at risk of TB despite the high risk behavior and environment. Prime barriers for health seeking practice of TB were cost along with other barriers like prevailing stigma on TB, lack of information on service sites and unavailability of accompanying person. Training and orientation to community organizations and people, awareness on TB and free treatment through advertisements/media, community level diagnostic and home based care were identified as the facilitators for the health seeking practice of TB. Conclusions Perceptions of TB and knowledge associated with the disease shape the health seeking practice, therefore promotion of media awareness campaign, targeting the people of urban slums for reducing misconceptions and promotion of home based service is needed to encourage health seeking practice in the future.
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Affiliation(s)
- Kiran Bam
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
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Kigozi NG, Chikobvu P, Heunis JC, van der Merwe S. A Retrospective Analysis of Two-Month Sputum Smear Non-Conversion in New Sputum Smear Positive Tuberculosis Patients in the Free State Province, South Africa. J Public Health Afr 2014; 5:324. [PMID: 28299125 PMCID: PMC5345412 DOI: 10.4081/jphia.2014.324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 02/12/2014] [Accepted: 02/19/2014] [Indexed: 11/22/2022] Open
Abstract
Little is known about the drivers of two-month sputum smear non-conversion in the South African context. Our study sought to determine these factors in new sputum smear positive tuberculosis (TB) patients in South Africa’s Free State Province. A retrospective record review was conducted for all TB patients on treatment between 2003 and 2009. Two-month sputum smear non-conversion was defined by a positive sputum smear result. Data was subjected to univariate, bivariate and regression analyses. Generalized linear regression models were used to estimate the risk for two-month sputum smear non-conversion. Age, pre-treatment sputum smear grading, HIV status and TB disease classification influenced two-month sputum smear non-conversion. Significant associations were thus established between health systems, microbiological, clinical and demographic factors, and two-month sputum smear non-conversion. This study provides program managers with evidence to support the development of more tailored TB care.
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Affiliation(s)
- Nanteza Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State , Bloemfontein, South Africa
| | - Perpetual Chikobvu
- Department of Community Health, University of the Free State, Bloemfontein, South Africa; Free State Department of Health, Bloemfontein, South Africa
| | - James Christoffel Heunis
- Centre for Health Systems Research & Development, University of the Free State , Bloemfontein, South Africa
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Patients’ Satisfaction With Tuberculosis Services of Directly Observed Therapy Programs in the Gezira State of Sudan. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2014. [DOI: 10.5812/archcid.18062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liang Y, Li S. Landless female peasants living in resettlement residential areas in China have poorer quality of life than males: results from a household study in the Yangtze River Delta region. Health Qual Life Outcomes 2014; 12:71. [PMID: 24884618 PMCID: PMC4041916 DOI: 10.1186/1477-7525-12-71] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Urbanization has accelerated in China, and a large amount of arable land has been transformed into urban land. Moreover, the number of landless peasants has continually increased. Peasants lose not only their land, but also a series of rights and interests related with land. The problems of landless peasants have been long-standing; however, only a few studies have examined their health or quality of life (QOL). This paper assesses the QOL of landless peasants in the Yangtze River Delta (YRD) region, analyzes gender differences, and explores health inequity. Methods Data are derived from household samples in six resettlement residential areas of three cities (Nanjing, Hangzhou, and Yangzhou) in the YRD region (N = 1,500; the effective rate = 82.4%). This study uses the short version of World Health Organization Quality of Life questionnaire (WHOQOL-BREF) scale to measure the QOL of landless peasants, and performs confirmatory factor analysis (CFA) and analyze gender differences in QOL on the basis of CFA. Results and conclusion First, we use Analysis of Variance and Non-parametric Tests to test if the differences of mean value of testing generals have statistical significances. Results shows significant differences occur between the impacts of different genders on the four domains of QOL (physical health, psychological health, social relationships, and environment). The internal reliability of the WHOQOL-BREF scale is good (Cronbach’s alpha > 0.8), and the four domains of QOL are connected with each other. Second, scores in each QOL domain are commonly low, whereas the scores of females are much lower, indicating a poorer QOL than that of males. Third, results of the CFA of the QOL domains and their related observed variables indicate a good model fit. Fourth, results imply that the order of importance of the four domains (psychological health (males = 26.74%, females = 27.17%); social relationships (males = 26.23%, females = 25.35%); environment (males = 25.70%, females = 24.40%); and physical health (males = 21.33%, females = 23.08%)) affecting QOL from high to low is the same for landless male and female peasants, whereas the proportion of importance is different between genders. The results highlight the importance of government intervention to improve the QOL of Chinese landless peasants, ultimately reducing health inequity.
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Affiliation(s)
- Ying Liang
- Department of Social Work and Social Policy, School of Social and Behavioral Sciences, Nanjing University, Nanjing 210023, Jiangsu province, People's Republic of China.
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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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Senbeto M, Tadesse S, Tadesse T, Melesse T. Appropriate health-seeking behavior and associated factors among people who had cough for at least two weeks in northwest Ethiopia: a population-based cross-sectional study. BMC Public Health 2013; 13:1222. [PMID: 24359115 PMCID: PMC3890638 DOI: 10.1186/1471-2458-13-1222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 12/18/2013] [Indexed: 11/22/2022] Open
Abstract
Background Tuberculosis remains the major debilitating public health problem in Ethiopia. However, studies to understand the patients’ perspectives on the illness and their health-seeking behavior have been few in the country. In this study, we seek to investigate the magnitude of appropriate health-seeking behavior and factors associated with tuberculosis among people who had cough for at least two weeks. Methods A population-based cross-sectional study was conducted from July to October 2012 in Dabat, northwest Ethiopia. All people aged ≥15 years and had cough for at least two weeks were included in the study. Data collected by using a pre-tested and structured questionnaire were entered and cleaned using the Epi Info version 2002 statistical software. The statistical Package for the Social Sciences Version 16.0 was also employed for descriptive and logistics regression analysis. Results Out of the 25,701 people aged ≥15 years surveyed, the proportion of people who had cough for at least two weeks was reported to be 843(3.3%). Appropriate health-seeking behavior towards tuberculosis was reported by 674(80.0%) of them. Factors significantly associated with health-seeking behavior for tuberculosis were being female [AOR: 0.56, 95%CI: (0.39-0.79)], high monthly real per capita income [AOR: 1.66, 95%CI: (1.15-2.38)], large family size [AOR: 0.50, 95%CI: (0.35-0.72)], and use of traditional-healing practices [AOR: 13.27, 95%CI: (9.10-25.41)]. Conclusion This study showed that the magnitude of appropriate health-seeking behavior during the event of chronic cough was high. However, this doesn’t mean that there will be no need for further strengthening of the intervention activities as significant proportions of the study communities still demonstrate inappropriate health-seeking behavior. So tuberculosis control programs need to emphasize factors, such as sex, family size, socioeconomic inequalities, and traditional-healing practices in resource-poor settings.
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Affiliation(s)
| | - Sebsibe Tadesse
- Institute of Public Health, the University of Gondar, Gondar, Ethiopia.
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Tadesse S. Agreement between physicians and the InterVA-4 model in assigning causes of death: the role of recall period and characteristics specific to the deceased and the respondent. Arch Public Health 2013; 71:28. [PMID: 24196159 PMCID: PMC4130515 DOI: 10.1186/2049-3258-71-28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 10/14/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In the absence of routine death registration, the InterVA model is a new methodology being used as a physician alternative method to interpret verbal autopsy (VA) data in resource-poor settings. However, various studies indicate that there are significant discrepancies between the two approaches in assigning causes of deaths. This study evaluated the role of recall period and characteristics that were specific to the deceased and the respondent in affecting the level of agreement between the approaches. METHODS A population-based cross-sectional study was conducted from March to April, 2012. All adults aged ≥14 years and died between 01 January, 2010, and 15 February, 2012, were included in the study. Data were collected by using a pre-tested and modified WHO designed verbal autopsy questionnaire. The verbal autopsy interviews were reviewed by the InterVA-4 model and the physicians. Cohen's kappa statistic with 95% CI was applied to compare the strength of the agreement between the model and the physician review. RESULTS A total of 408 VA interviews were successfully completed and reviewed by the InterVA model and the physicians. Both approaches showed an overall agreement in 294 (72.1%) of the cases [kappa = 0.48, 95% CI: 0.42 - 0.60]. The level of agreement between the approaches was low [kappa ≤0.40] when the deceased was female, 50 and above years old, single, illiterate, rural dweller, belonged to a family of 1-4 people living together, and died at home. This was also true when the recall period was ≤1 year, and the respondent was a relative other than parent/marital partner, lived with the deceased, and had medical information. CONCLUSION This study identified important variables affecting the strength of agreement between the InterVA-4 model and the physician in assigning causes of death. The results are believed to significantly contribute to the process of identifying the actual underlying causes of deaths in the population, and may thus serve to promote informed health policy decisions in resource-poor settings.
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Affiliation(s)
- Sebsibe Tadesse
- Institute of Public Health, the University of Gondar, Gondar, Ethiopia
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Bati J, Legesse M, Medhin G. Community's knowledge, attitudes and practices about tuberculosis in Itang Special District, Gambella Region, South Western Ethiopia. BMC Public Health 2013; 13:734. [PMID: 23924362 PMCID: PMC3750843 DOI: 10.1186/1471-2458-13-734] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 07/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) is one of the primary public health problems in developing countries. HIV/AIDS, poverty, undernutrition, over-crowded living conditions and lack of knowledge about the disease have been known to increase the risk of spreading the bacteria and the risk of developing the disease. The objective of this study was to assess the level of TB knowledge, attitudes and practices of rural communities of Itang Special District of the Gambella Regional State of Ethiopia. Methods Between November 2011 and January 2012, a community-based cross sectional study was carried out in a randomly selected rural kebeles (i.e. the smallest administrative units) of Itang communities. The study participants were interviewed using pre-tested questionnaire. The overall knowledge, attitudes and practices of the study participants were assessed using the mean score of each outcome as a cut-off value. Having a score above the mean on each of the three target outcomes was equated with having a good level of knowledge, or having favorable attitude and good practices towards TB. Results Out of 422 study participants (58.5% males and 41.5% females) only 3.3% mentioned bacteria/germ as a cause of pulmonary TB (PTB) and 9.9% mentioned cough for at least two weeks as the sign of TB. Taking the mean knowledge score as the cut-off value, 57.6% (95% CI: 52.7% to 62.3%) of the study participants had good level of knowledge about TB, 40.8% (95% CI: 36.0% to 45.6%) had favorable attitude towards TB and 45.9% (95% CI: 41.1% to 50.9%) had good practices. Female participants were less likely to have good level of knowledge [adjusted odds ratio (AOR) = 0.33, 95% CI, 0.21 to 0.51, p < 0.001], less likely to have favorable attitude (AOR = 0.23, 95% CI, 0.14 to 0.37) and less likely to have good practices (AOR = 0.37, 95% CI, 0.24 to 0.57, p < 0.001) compared to male participants. Conclusion Majority of the study participants had no correct information about the causative agent of TB and the main symptom of PTB. Moreover, low level of overall knowledge, attitudes and practices about TB was associated with female participants. Hence, TB control strategy in the present study area should include community awareness raising component.
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Affiliation(s)
- Jango Bati
- Gambella Teachers Education and Health Science College, Gambella, Ethiopia
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Sreeramareddy CT, Harsha Kumar HN, Arokiasamy JT. Prevalence of self-reported tuberculosis, knowledge about tuberculosis transmission and its determinants among adults in India: results from a nation-wide cross-sectional household survey. BMC Infect Dis 2013; 13:16. [PMID: 23324535 PMCID: PMC3551631 DOI: 10.1186/1471-2334-13-16] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 01/14/2013] [Indexed: 12/05/2022] Open
Abstract
Background Knowledge about symptoms and transmission of tuberculosis determines health seeking behavior and helps in prevention of tuberculosis transmission in the community. Such data is useful for policy makers to formulate information, education and communication strategies for tuberculosis control. Methods A secondary data analysis of India demographic and health survey, 2005/6 was carried out. Questions about self-reported tuberculosis, transmission and curability of tuberculosis were analysed. Correct knowledge (without misconceptions) about tuberculosis transmission was used as a dependant variable and the explanatory variables tested were: demographic data, education, wealth quintiles, frequency of exposure to media and the curability of tuberculosis. Determinants of correct knowledge without misconceptions were tested by univariate and multivariate analyses using national weighting factor to adjust for complex sampling design. Results A total of 109,070 households (response rate of 93.5%) and 198,718 participants (response rate of 91.6%) completed the survey. The samples of men and women interviewed were 74,360 and 124,358 respectively. Prevalence rate of self-reported tuberculosis was 445 per 100,000 usual household residents and 4.60 per 1,000 participants. The number of respondents who had “heard of an illness called tuberculosis” was 177,423 (89.3%). Of these 47,487 (26.8%) participants did not know and 55.5% knew about the correct mode of tuberculosis transmission i.e. “Through the air when coughing or sneezing”. The common misconceptions about transmission were “Through food” (32.4%), “Sharing utensils” (18.2%), and “Touching a person with tuberculosis” (12.3%). Only 52,617 (29.7%) participants had correct knowledge without misconceptions. Being male (aOR 1.17, 95% CIs 1.14, 1.21), being a Hindu (aOR 1.20, 95% CIs 1.14, 1.26) or Muslim (aOR 1.26, 95% CIs 1.18, 1.34), listening to radio (aOR 1.08, 95% CIs 1.04, 1.13) and “Tuberculosis can be cured” (aOR 1.47, 95% CIs 1.41, 1.53) were associated with correct knowledge without misconceptions. Conclusions Knowledge about tuberculosis transmission is very poor and misconceptions still exist. Among the traditional mass media, the frequency of listening to radio was associated with correct knowledge about tuberculosis transmission. Strategies to deliver information, education and communication campaigns could be improved.
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Affiliation(s)
- Chandrashekhar T Sreeramareddy
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Sungai Long, Malaysia.
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Yang YR, McManus DP, Gray DJ, Wang XL, Yang SK, Ross AG, Williams GM, Ellis MK. Evaluation of the tuberculosis programme in Ningxia Hui Autonomous region, the People's Republic of China: a retrospective case study. BMC Public Health 2012; 12:1110. [PMID: 23259484 PMCID: PMC3543161 DOI: 10.1186/1471-2458-12-1110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 12/19/2012] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis is a devastating disease due to its rapid transmission and high rate of mortality. Ningxia Hui Autonomous Region (NHAR), located in the North-west, is one of the poorest provinces in China and national surveys have shown TB has been hyper endemic in NHAR for several decades. As no active surveys had been undertaken since the initiation of the DOTS control program across all of NHAR. Methods A retrospective study was undertaken of all clinical records of TB patients registered from January 2005 to September 2009. Poisson regression was performed to investigate the change in incidence over time and accounted for age, sex and county. Length of time on treatment, disease severity and patient delay were assessed by county. Results More than 30% of patients had been on treatment for over 12 months and 10% for over 3 years, reflecting drug-resistance or failure of DOTS. More than 93% of patients had grade III disease at time of diagnosis and >15% of patients had severe disease grade IV-V in some NHAR counties. Further, 8.8% of patients were not diagnosed for over 6 months from the onset of symptoms; this was as high as 20% in some counties. The reported incidence of TB is most likely grossly underestimated and the data indicate TB is a major public health concern in NHAR. Conclusions It is clear that active surveillance is necessary to determine the full extent of the burden of TB in NHAR. New control and treatment strategies for TB are required that increase awareness in the health-care system and at the individual and community level.
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Affiliation(s)
- Yu Rong Yang
- Ningxia Medical University, Ningxia Hui Autonomous Region, Ningxia, the People’s Republic of China
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Arora N, Vadrevu R, Chandrasekhar A, Gupta A. Low tuberculosis knowledge among HIV-infected patients in a high HIV prevalence region within southeast India. J Int Assoc Provid AIDS Care 2012; 12:84-9. [PMID: 23060464 DOI: 10.1177/1545109712461553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
SETTING A private multispecialty hospital in Kakinada, Andhra Pradesh, India. METHODS A survey of knowledge, attitudes, and perceptions adapted from a pretested questionnaire was administered to 128 HIV-infected adults, from July to August 2008. RESULTS A total of 31% had not heard of tuberculosis (TB), with 15 (38%) currently receiving anti-TB therapy or had received it in the past. Of those familiar with TB, 70% could not list a method by which it was spread. Low education attainment, female sex, and less frequent television exposure were associated with low TB literacy. CONCLUSIONS HIV-infected patients in southeast India have poor knowledge of TB and the methods by which it is spread. Scale-up of patient-directed educational programs is necessary to help control TB in India.
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Affiliation(s)
- Nick Arora
- University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
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