Difficulties in tuberculosis infection control in a general hospital of Vietnam: a knowledge, attitude, and practice survey and screening for latent tuberculosis infection among health professionals

Identification of the health education targeted susceptible population of tuberculosis in Ningxia, Northwest China

Knowledge, Attitude, and Practice (KAP) survey, as an effective measure tool, is of practical significance for identifying the susceptible population in high-incidence regions of tuberculosis (TB). We aim to identify the health education targeted susceptible population of TB and discuss the acting pathway of KAP in Ningxia. A multistage random sampling method was used to conduct a face-to-face questionnaire survey for residents. The latent class analysis (LCA) model was used to classify susceptible populations of TB, and the structural equation modeling (SEM) model was also employed to investigate the interaction mechanisms of KAP (mediation analysis). We further applied the ordered logistic regression model to explore the associated factors. A total of 973 residents were enrolled, 70.6% were male, aged from 16 to 89. The LCA analysis demonstrated that 3 categories of susceptible populations of TB ("overall good", "positive attitude" and "overall poor") have optimal goodness of fit (BIC = 7889.5, Entropy = 0.923). SEM model indicated that the attitude plays a significant mediation effect from knowledge to practice toward TB (an indirect effect of 0.038, and a direct effect of 0.138). The ordered logistic regression results found that age, sex, marital status, education level, occupation, family income, self-perceived health status, having a family member or friend with TB, and knowing the DOTS strategy were significantly associated with classifications of KAP level towards TB. Based on the LCA model, we accurately classified the susceptible population of TB into 3 groups with different degrees of KAP. We found that TB attitude plays a mediating role between knowledge and practice. Therefore, we should pay more attention and carry out targeted health education in the community to these populations with overall poor KAP towards TB, and develop effective strategies and measures to realize the End TB Plan.

Impact of Nursing Interventions on Hospital Readmissions in Patients With Pulmonary Tuberculosis: A Quasi-Experimental Study

PURPOSE

Our study aimed to evaluate the effectiveness of the nursing care program on the incidence and rate of 28-day hospital readmissions among pulmonary tuberculosis (TB) patients.

METHODS

We conducted a quasi-experimental study using a historical control (usual care) group. Patients diagnosed with pulmonary TB who received nursing interventions between January 28, 2021, and May 31, 2021, were categorized as an intervention group, whereas historical controls were selected from January 1, 2020, to December 31, 2020. The primary outcomes were the incidence and rates of hospital readmissions within 28 days due to TB-related complications. The secondary outcome was the change in knowledge and self-care behavior scores at discharge and 28 days postdischarge. Cox models were used to assess the intervention's impact on the incidence of hospital readmission. Rates of readmission were compared by the Poisson model. Both Cox and Poisson models were adjusted for age, sex, sputum smears at diagnosis, serum albumin level, and diabetes mellitus at baseline.

RESULTS

Among 104 pulmonary TB patients included in the analysis (68 were in a historical control group and 36 were in an intervention group), 20 patients were readmitted due to TB-related complications. We found that our nursing care program resulted in a significant reduction in the incidence (adjusted hazard ratio was 0.16 [95% CI 0.03, 0.87]) and the rate of hospital readmissions (adjusted incidence rate ratio was 0.22 [95% CI 0.06, 0.85]). Furthermore, nursing interventions significantly improved knowledge and self-care behavior scores with significant score retention at 28 days postdischarge.

CONCLUSIONS

The nursing care program can significantly decrease the incidence and rate of 28-day hospital readmission and improve knowledge and self-care behavior scores in pulmonary TB patients.

Optimising diagnosis and treatment of tuberculosis infection in community and primary care settings in two urban provinces of Viet Nam: a cohort study

OBJECTIVES

To end tuberculosis (TB), the vast reservoir of 1.7-2.3 billion TB infections (TBIs) must be addressed, but achieving global TB preventive therapy (TPT) targets seems unlikely. This study assessed the feasibility of using interferon-γ release assays (IGRAs) at lower healthcare levels and the comparative performance of 3-month and 9-month daily TPT regimens (3HR/9H).

DESIGN, SETTING, PARTICIPANTS AND INTERVENTION

This cohort study was implemented in two provinces of Viet Nam from May 2019 to September 2020. Participants included household contacts (HHCs), vulnerable community members and healthcare workers (HCWs) recruited at community-based TB screening events or HHC investigations at primary care centres, who were followed up throughout TPT.

PRIMARY AND SECONDARY OUTCOMES

We constructed TBI care cascades describing indeterminate and positivity rates to assess feasibility, and initiation and completion rates to assess performance. We fitted mixed-effects logistic and stratified Cox models to identify factors associated with IGRA positivity and loss to follow-up (LTFU).

RESULTS

Among 5837 participants, the indeterminate rate was 0.8%, and 30.7% were IGRA positive. TPT initiation and completion rates were 63.3% (3HR=61.2% vs 9H=63.6%; p=0.147) and 80.6% (3HR=85.7% vs 9H=80.0%; p=0.522), respectively. Being male (adjusted OR=1.51; 95% CI: 1.28 to 1.78; p<0.001), aged 45-59 years (1.30; 1.05 to 1.60; p=0.018) and exhibiting TB-related abnormalities on X-ray (2.23; 1.38 to 3.61; p=0.001) were associated with positive IGRA results. Risk of IGRA positivity was lower in periurban districts (0.55; 0.36 to 0.85; p=0.007), aged <15 years (0.18; 0.13 to 0.26; p<0.001), aged 15-29 years (0.56; 0.42 to 0.75; p<0.001) and HCWs (0.34; 0.24 to 0.48; p<0.001). The 3HR regimen (adjusted HR=3.83; 1.49 to 9.84; p=0.005) and HCWs (1.38; 1.25 to 1.53; p<0.001) showed higher hazards of LTFU.

CONCLUSION

Providing IGRAs at lower healthcare levels is feasible and along with shorter regimens may expand access and uptake towards meeting TPT targets, but scale-up may require complementary advocacy and education for beneficiaries and providers.

Knowledge, Attitudes, and Practices Survey among Nursing Care Workers Involved in Caring for Older Adults during the Early Stage of the COVID-19 Pandemic in Japan

BACKGROUND

As Japan undergoes population aging, nursing care workers play an important role in supporting older adults in the community, which has been particularly critical during COVID-19 pandemic. However, the knowledge, attitudes, and practices (KAP) among nursing care workers regarding COVID-19 have not been fully elucidated.

METHODS

A self-administered questionnaire survey was conducted in June 2020 among 481 nursing care workers in the nursing care facilities in Aichi, Japan. We assessed COVID-19-related KAP scores of nursing care workers, and compared them by age, sex, and years of experience.

RESULTS

A total of 481 nursing care workers responded to the survey. Out of a maximum of 10 points, the mean (standard deviations) knowledge, attitude, and practice scores were 6.86 (1.45), 7.11 (1.42), and 7.40 (1.89), respectively. Comparisons between the KAP scores revealed significantly higher knowledge scores among older workers (p < 0.001) and significantly higher knowledge scores (p = 0.002) and practice scores (p = 0.033) among workers with more than 20 years of working experience.

CONCLUSIONS

The findings revealed that older age and a longer duration of experience were associated with higher COVID-19-related knowledge and practice scores. To better support older adults, it is essential to improve the education system for care workers and to provide environments for delivering necessary information rapidly.

Knowledge, attitudes, and practices regarding COVID-19 among pharmacists partnering with community residents: A national survey in Japan

BACKGROUND

Community pharmacists play an important role in reducing COVID-19-related secondary health problems. However, the knowledge, attitudes, and practices (KAP) regarding COVID-19 among pharmacists in Japan have not yet been elucidated.

METHODS

We conducted a web-based questionnaire survey among 1,137 pharmacists working in health support pharmacies (HSPs) in Japan. These pharmacists are responsible for providing health consultations to community residents. We assessed COVID-19-related KAP among pharmacists and compared the results for two age groups: ≤49 years and ≥50 years. We used multiple regression analysis to examine which factors influence KAP scores regarding COVID-19.

RESULTS

From among the 2,141 HSPs in Japan, a total of 1,137 pharmacists, each representing a different HSP, responded to the survey. The results indicated that since the beginning of the COVID-19 pandemic, pharmacists have been providing consultations about COVID-19 to local residents, covering topics such as "Effective infection prevention methods" (60.6%) and "What the COVID-19 pandemic would be" (48.8%). Importantly, 73.5% of the pharmacists felt they "did not have enough information about COVID-19." The main information resources about COVID-19 were Internet (91.2%) and television (78.9%). Across all respondents, the mean knowledge score (4.17/10) was lower than the mean scores for attitudes (7.26/10) and practices (5.79/10). Multiple regression analysis showed that having enough information about COVID-19 was a factor strongly associated with total KAP scores (p<0.001; 95% confidence interval, -1.344 to -0.540).

CONCLUSIONS

Pharmacists working in community pharmacies provide residents with information related to COVID-19. In this role as a health partner, these pharmacists need a way to strengthen and expand their knowledge, and moreover, their ability to support community residents. Learning more about the available academic and scientific information, as well as having access to accurate epidemiological information, can offer a means of reaching these goals.

Tuberculosis and Public Health Care Workers: Infection Prevention and Control Practices and Associated Factors Among Governmental Health Centers and Hospitals in Wolaita Zone, Southern Ethiopia

Purpose

Institutional settings, including health care facilities, have been identified to be at high risk of tuberculosis (TB) transmissions. But no study has been conducted in hospitals and health centers concurrently in Wolaita Zone, Southern Ethiopia. Therefore, the aim of this study was to assess tuberculosis infection prevention and control (TBIPC) practices and associated factors among public health care workers in Wolaita Zone, Southern Ethiopia.

Material and Methods

A facility-based cross-sectional quantitative study supplemented with qualitative interview and observation was conducted in 16 sampled governmental health facilities in Wolaita Zone, Southern Ethiopia, from 25 July 2020 to 25 August 2020. A multistage sampling technique was used to select 748 health care workers, while purposive sampling was used to identify participants for the qualitative study.

Results

The proportion of proper TBIPC practices was 44.78%. Years of service (AOR=4.182, 95% CI: 2.024–8.639), working in a TB clinic (AOR=4.009, 95% CI: 1.311–12.261), working in an anti-retroviral therapy clinic (AOR=2.796, 95% CI: 1.009–7.743), TB-related training (AOR=0.024, 95% CI: 11.483–34.92), availability of personal protective equipment (AOR=1.712, 95% CI: 1.057–2.776), good knowledge of TBIPC measures (AOR=2.66, 95% CI: 1.119–4.196), and positive attitude (AOR=2.011, 95% CI: 1.242–3.255) were significantly associated with proper TBIPC practices.

Conclusion and Recommendation

The proportion of proper TBIPC practices among public health care workers was low in the study area. For better intervention, further studies could focus on experimental research into possible factors that are responsible for TBIPC practices in health care facilities in the study area.

Latent tuberculosis infection in medical students in the Northeast of Mexico

Background

Medical students are considered to be personnel with a high level of risk for developing latent tuberculosis infection (LTBI). One possible reason is lack of knowledge about the transmission, prevention, and biosafety standards for tuberculosis disease.

Objective

This research aimed to determine the rate of LTBI among medical students studying in a private School of Medicine in Monterrey, Mexico.

Methods

In this cross-sectional study, we obtained blood samples from 174 medical students. LTBI was diagnosed using the QuantiFERON®-TB Gold Plus test. The prevalence of LTBI was compared with the socio-demographic data of the students and their level of knowledge and use of personal protective equipment (PPE).

Results

The proportion of LTBI in the students was 20.6%. Medical students in their first few years of medical school had a lower prevalence of LTBI than students in their final years of medical school. Additionally, students with a low level of knowledge on LTBI and low use of proper PPE had a higher prevalence of LTBI.

Conclusions

In a School of Medicine in Monterrey, Mexico, the proportion of medical students with LTBI was low but the proportion increased in advanced students. Students who demonstrated adequate knowledge and use of respiratory protective masks had lower prevalence rates for LTBI.