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Aguiar A, Abreu M, Duarte R. Healthcare professionals perspectives on tuberculosis barriers in Portuguese prisons-a qualitative study. J Public Health (Oxf) 2024; 46:e389-e399. [PMID: 38710659 DOI: 10.1093/pubmed/fdae065] [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: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a significant public health concern, particularly within prison settings, where the confluence of adverse health factors and high-risk behaviors contribute to a heightened risk of transmission. This study delves into the perspectives of medical doctors, regarding the implementation of the 2014 TB protocol in Portugal. METHODS The study has a qualitative, descriptive design. Individual semi-structured interviews with medical doctors from TB outpatient centers in Porto and Lisbon were used for data collection. For the analysis thematic analysis method was used. RESULTS The study population comprised 21 medical doctors with the majority being female (61.9%) and 57.1% specializing in pulmonology. The results indicate varied perceptions of the protocol's usefulness, with positive impacts on coordination reported by some participants. Improved communication and evolving collaboration between TB outpatient centers and prisons were highlighted, although challenges in contact tracing and resource constraints were acknowledged. The study also sheds light on the role of nurses in patient education. CONCLUSION Despite overall positive perceptions, challenges such as sustaining therapy post-symptomatic improvement and delays in diagnostic methods were identified. The findings underscore the importance of continuous collaboration between prisons and TB control programs to address challenges, improve disease control and prevent TB transmission.
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Affiliation(s)
- Ana Aguiar
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Estudo das Populações, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Mariana Abreu
- Unidade de Saúde Pública de Gaia, Agrupamento de Centros de Saúde do Grande Porto VII-Gaia, Vila Nova de Gaia, Portugal
| | - Raquel Duarte
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Estudo das Populações, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
- INSA-Instituto de Saúde Pública Doutor Ricardo Jorge-INSA Porto, 4000-053 Porto, Portugal
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Kebede Bizuneh F, Tsegaye D, Negese Gemeda B, Kebede Bizuneh T. Proportion of active tuberculosis among HIV-infected children after antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003528. [PMID: 39093892 PMCID: PMC11296650 DOI: 10.1371/journal.pgph.0003528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
Despite effectiveness of antiretroviral therapy in reducing mortality of opportunistic infections among HIV infected children, however tuberculosis (TB) remains a significant cause for morbidity and attributed for one in every three deaths. HIV-infected children face disproportionate death risk during co-infection of TB due to their young age and miniatures immunity makes them more vulnerable. In Ethiopia, there is lack of aggregated data TB and HIV mortality in HIV infected children. We conducted an extensive systematic review of literature using Preferred Reporting of Systematic Review and Meta-Analysis (PRISMA) guideline. Five electronic databases were used mainly Scopus, PubMed, Medline, Web of Science, and Google scholar for articles searching. The pooled proportion of TB was estimated using a weighted inverse variance random-effects meta-regression using STATA version-17. Heterogeneity of the articles was evaluated using Cochran's Q test and I2 statistic. Subgroup analysis, sensitivity test, and Egger's regression were conducted for publication bias. This met-analysis is registered in Prospero-CRD42024502038. In the final met-analysis report, 13 out of 1221 articles were included and presented. During screening of 6668 HIV-infected children for active TB occurrence, 834 cases were reported after ART was initiated. The pooled proportion of active TB among HIV infected children was found 12.07% (95% CI: 10.71-13.41). In subgroup analysis, the Oromia region had 15.6% (95%CI: 10.2-20.6) TB burden, followed by southern Ethiopia 12.8% (95%CI: 10.03-15.67). During meta-regression, missed isoniazid Preventive therapy (IPT) (OR: 2.28), missed contrimoxazole preventive therapy (OR: 4.26), WHO stage III&IV (OR: 2.27), and level of Hgb ≤ 10gm/dl (OR = 3.11.7) were predictors for active TB. The systematic review found a higher proportion of active TB in HIV-infected children in Ethiopia compared to estimated rates in end TB strategy. To prevent premature death during co-infection, implement effective TB screening and cases tracing strategies in each follow up is needed.
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Affiliation(s)
| | - Dejen Tsegaye
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Favril L, Rich JD, Hard J, Fazel S. Mental and physical health morbidity among people in prisons: an umbrella review. Lancet Public Health 2024; 9:e250-e260. [PMID: 38553144 DOI: 10.1016/s2468-2667(24)00023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. METHODS In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827. FINDINGS Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9-12·8) for major depression, 9·8% (6·8-13·2) for post-traumatic stress disorder, and 3·7% (3·2-4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0-26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5-46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0-20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects. INTERPRETATION People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health. FUNDING Research Foundation-Flanders, Wellcome Trust, National Institutes of Health.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Josiah D Rich
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
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Bishara H, Weiler-Ravell D, Saffouri A, Green M. The Challenges of Tuberculosis Management beyond Professional Competence: Insights from Tuberculosis Outbreaks among Ethiopian Immigrants in Israel. Trop Med Infect Dis 2024; 9:29. [PMID: 38393118 PMCID: PMC10892168 DOI: 10.3390/tropicalmed9020029] [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: 11/27/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Controlling tuberculosis (TB) among immigrants from high-incidence countries presents a public health concern as well as a medical challenge. In this article, we investigate a TB outbreak in a community of people of Jewish descent who emigrated from Ethiopia to Israel (Israeli Ethiopians) that started in June 2022. The index case was a 20-year-old female who had recently immigrated to Israel with her family. Her pre-immigration tuberculin skin test was positive. After excluding active TB, treatment with daily isoniazid for latent TB (LTB) was started shortly after her arrival. A year later, she was diagnosed with smear-positive, culture-positive, pulmonary TB. Investigation of 83 contacts revealed five additional patients with active TB, and three of whom were members were of her household. In this article, we report the current TB outbreak, review previously published TB outbreaks involving Israeli Ethiopians, analyze the factors that triggered each of these outbreaks, and discuss the challenges that face the Israeli TB control program in an era of declining TB incidence and diminishing resources available for TB control.
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Affiliation(s)
- Hashem Bishara
- Tuberculosis Clinic and Pulmonary Division, Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel
| | - Daniel Weiler-Ravell
- Pulmonary Division and Tuberculosis Clinic, Carmel Medical Center, Haifa 3498838, Israel;
| | - Amer Saffouri
- Tuberculosis Clinic and Internal Medicine, Nazareth Hospital, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel;
| | - Manfred Green
- School of Public Health, Faculty of Social Welfare and Health Science, University of Haifa, Haifa 3498838, Israel;
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Genet A, Girma A. Magnitude, associated risk factors, and trend comparisons of identified tuberculosis types among prisons in Ethiopia: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e1789. [PMID: 38186928 PMCID: PMC10766876 DOI: 10.1002/hsr2.1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Tuberculosis (TB) remained a major public health threat, particularly in developing countries with vulnerable groups, particularly prison inmates. A systematic review and meta-analysis of individual studies with varying prevalence rates were performed to identify risk factors associated with the recent magnitude of TB among prisoners. Methods A systematic search of research articles on the magnitude and risk factors of TB among prisoners in Ethiopia was conducted in registers, databases, and other sources. Cochran's Q, inverse variance (I 2), sensitivity analysis, funnel plot, Begg's, and Egger's regression tests were used to check heterogeneity and publication bias. A random-effects model was used to calculate the pooled burden of TB among prisoners. Results The total national prevalence of TB among prisoners was 9.84% (95% confidence interval [CI]: 7.16-12.52). According to the subgroup analysis, the highest prevalence was observed in patients infected by latent TB (51.20%), the Southern nations, nationalities and people's region (SNNPR) (29.63%), studies conducted in ≤200 (17.50%) sample sizes, and from 2017 to 2022 (11.49%) study periods. TB infection among prisoners was significantly associated with a history of contact with TB patients (adjusted odds ratio [AOR] = 2.75; 95% CI: 0.98-4.52), coughing for ≥2 weeks (AOR = 0.08; 95% CI: -0.16-0.33), being incarcerated in overcrowded cells with poor ventilation (AOR = 0.39; 95% CI: -0.01-0.78), and increasing with the duration of imprisonment (AOR = 1.29; 95% CI: -0.39-2.97]. Conclusion Expectably high TB magnitude is found among prison inmates in Ethiopia. Duration of incarceration, coughing, ventilation of the cell, and contact with TB patients were all predictors of TB among prisoners. The management of TB requires early diagnosis, adequate medication, and the implementation of preventative and control measures suitable for prison inmates.
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Affiliation(s)
- Amere Genet
- Department of Biology, College of Natural and Computational ScienceMekdela Amba UniversityTulu AwuliyaEthiopia
| | - Abayeneh Girma
- Department of Biology, College of Natural and Computational ScienceMekdela Amba UniversityTulu AwuliyaEthiopia
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Litvinjenko S, Magwood O, Wu S, Wei X. Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews. THE LANCET. INFECTIOUS DISEASES 2023; 23:1395-1407. [PMID: 37696278 PMCID: PMC10665202 DOI: 10.1016/s1473-3099(23)00372-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Tuberculosis is a communicable disease of public health concern that inequitably impacts the most vulnerable populations worldwide. Vulnerable populations are those with a high risk for tuberculosis disease and whose disadvantaged or marginalised socioeconomic position limits their access to the health system. We conducted an overview of reviews that aimed to assess the burden (ie, prevalence and incidence) of tuberculosis disease among 12 vulnerable populations globally. METHODS We did an overview of reviews using a systematic search in MEDLINE, Embase, and the Cochrane Database for Systematic Reviews for articles published in English, French, and Chinese, from Jan 1, 2010 to March 8, 2023. We did an initial search on Oct 28, 2021, and updated our search on March 8, 2023. We included systematic and scoping reviews reporting on the prevalence or incidence of active tuberculosis among 12 vulnerable populations. Evidence gaps were supplemented with primary or secondary database studies. Study characteristics and outcome data related to tuberculosis burden were tabulated, including prevalence ratios and incidence rate ratios, and evidence was synthesised narratively. This trial is registered with PROSPERO (CRD42022324421). FINDINGS We screened 13 169 citations and included 44 publications (23 reviews and 21 primary or database studies) in the final synthesis. The comprehensiveness and methodological quality of the evidence differed across population groups. Prevalence of more than 1000 cases per 100 000 were reported in all vulnerable populations. On the basis of pooled estimates, prevalence ratios were often more than 25 among people experiencing homelessness, incarcerated populations, refugees, asylum seekers, and people living with HIV compared with the general population. Incidence was infrequently reported, with the best-available incidence rate ratios documented for people who were incarcerated. There was scarce evidence specific to miners, nomadic populations, sex workers, men who have sex with men, and transgender individuals. INTERPRETATION The burden of tuberculosis is substantially higher among vulnerable populations than general populations, suggesting a need for improved integration of these groups, including dedicated efforts for their identification, targeted screening and prevention measures, as well as treatment support. FUNDING WHO.
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Affiliation(s)
- Stefan Litvinjenko
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, ON, Canada; Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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