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Wang L, Xu C, Hu M, Wang J, Qiao J, Chen W, Zhu Q, Wang Z. Modeling tuberculosis transmission flow in China, 2010-2012. BMC Infect Dis 2024; 24:784. [PMID: 39103752 DOI: 10.1186/s12879-024-09649-7] [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: 12/05/2022] [Accepted: 07/23/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND China has the third largest number of TB cases in the world, and the average annual floating population in China is more than 200 million, the increasing floating population across regions has a tremendous potential for spreading infectious diseases, however, the role of increasing massive floating population in tuberculosis transmission is yet unclear in China. METHODS 29,667 tuberculosis flow data were derived from the new smear-positive pulmonary tuberculosis cases in China. Spatial variation of TB transmission was measured by geodetector q-statistic and spatial interaction model was used to model the tuberculosis flow and the regional socioeconomic factors. RESULTS Tuberculosis transmission flow presented spatial heterogeneity. The Pearl River Delta in southern China and the Yangtze River Delta along China's east coast presented as the largest destination and concentration areas of tuberculosis inflows. Socioeconomic factors were determinants of tuberculosis flow. Some impact factors showed different spatial associations with tuberculosis transmission flow. A 10% increase in per capita GDP was associated with 10.2% in 2010 or 2.1% in 2012 decrease in tuberculosis outflows from the provinces of origin, and 1.2% in 2010 or 0.5% increase in tuberculosis inflows to the destinations and 18.9% increase in intraprovincial flow in 2012. Per capita net income of rural households and per capita disposable income of urban households were positively associated with tuberculosis flows. A 10% increase in per capita net income corresponded to 14.0% in 2010 or 3.6% in 2012 increase in outflows from the origin, 44.2% in 2010 or 12.8% increase in inflows to the destinations and 47.9% increase in intraprovincial flows in 2012. Tuberculosis incidence had positive impacts on tuberculosis flows. A 10% increase in the number of tuberculosis cases corresponded to 2.2% in 2010 or 1.1% in 2012 increase in tuberculosis inflows to the destinations, 5.2% in 2010 or 2.0% in 2012 increase in outflows from the origins, 11.5% in 2010 or 2.2% in 2012 increase in intraprovincial flows. CONCLUSIONS Tuberculosis flows had clear spatial stratified heterogeneity and spatial autocorrelation, regional socio-economic characteristics had diverse and statistically significant effects on tuberculosis flows in the origin and destination, and income factor played an important role among the determinants.
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Affiliation(s)
- Li Wang
- College of Geography and Environmental Science, Henan University, KaiFeng, 475001, China
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, Ministry of Education, KaiFeng, 475001, China
| | - Chengdong Xu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Science and Natural Resource Research, Chinese Academy of Sciences, Beijing, 100101, China
| | - Maogui Hu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Science and Natural Resource Research, Chinese Academy of Sciences, Beijing, 100101, China
| | - Jinfeng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Science and Natural Resource Research, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Jiajun Qiao
- College of Geography and Environmental Science, Henan University, KaiFeng, 475001, China.
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, Ministry of Education, KaiFeng, 475001, China.
| | - Wei Chen
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Qiankun Zhu
- College of Geography and Environmental Science, Henan University, KaiFeng, 475001, China
| | - Zhipeng Wang
- College of Geography and Environmental Science, Henan University, KaiFeng, 475001, China
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2
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Barreto-Duarte B, Villalva-Serra K, Miguez-Pinto JP, Araújo-Pereira M, Campos VMS, Rosier G, Nogueira BMF, Queiroz ATL, Rolla VC, Cordeiro-Santos M, Kritski AL, Martinez L, Rebeiro PF, Sterling TR, Rodrigues MM, Andrade BB. Retreatment and Anti-tuberculosis Therapy Outcomes in Brazil Between 2015 and 2022: A Nationwide Study. Open Forum Infect Dis 2024; 11:ofae416. [PMID: 39100532 PMCID: PMC11297487 DOI: 10.1093/ofid/ofae416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
Background Adherence to anti-tuberculosis treatment (ATT) in Brazil remains a challenge in achieving the goals set by the World Health Organization (WHO). Patients who are lost to follow-up during treatment pose a significant public health problem. This study aimed to investigate the factors associated with unfavorable ATT outcomes among those undergoing retreatment in Brazil. Methods We conducted an observational study of patients aged ≥18 years with tuberculosis (TB) reported to the Brazilian National Notifiable Disease Information System between 2015 and 2022. Clinical and epidemiologic variables were compared between the study groups (new cases and retreatment). Regression models identified variables associated with unfavorable outcomes. Results Among 743 823 reported TB cases in the study period, 555 632 cases were eligible, consisting of 462 061 new cases and 93 571 undergoing retreatments (44 642 recurrent and 48 929 retreatments after loss to follow-up [RLTFU]). RLTFU (odds ratio [OR], 3.96 [95% confidence interval {CI}, 3.83-4.1]) was a significant risk factor for any type of unfavorable ATT. Furthermore, RLTFU (OR, 4.93 [95% CI, 4.76-5.11]) was the main risk factor for subsequent LTFU. For death, aside from advanced age, living with HIV (OR, 6.28 [95% CI, 6.03-6.54]) was the top risk factor. Conclusions Retreatment is a substantial risk factor for unfavorable ATT outcomes, especially after LTFU. The rates of treatment success in RLTFU are distant from the WHO End TB Strategy targets throughout Brazil. These findings underscore the need for targeted interventions to improve treatment adherence and outcomes in persons who experience RLTFU.
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Affiliation(s)
- Beatriz Barreto-Duarte
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
- Programa Pós-graduação de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, Brazil
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Klauss Villalva-Serra
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - João P Miguez-Pinto
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Mariana Araújo-Pereira
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, Brazil
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Vanessa M S Campos
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Gabriela Rosier
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Betânia M F Nogueira
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Artur T L Queiroz
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Valeria C Rolla
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcelo Cordeiro-Santos
- Department of Tuberculosis, Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Faculdade de Medicina, Universidade Nilton Lins, Manaus, Brazil
| | - Afrânio L Kritski
- Programa Pós-graduação de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Peter F Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Moreno M Rodrigues
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Laboratório de Análise e Visualização de Dados, Fundação Oswaldo Cruz, Porto Velho, Brazil
| | - Bruno B Andrade
- Curso de Medicina, Universidade Salvador, Salvador, Brazil
- Programa Pós-graduação de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Institute for Research in Priority Populations, Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, Brazil
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Bush A, Byrnes CA, Chan KC, Chang AB, Ferreira JC, Holden KA, Lovinsky-Desir S, Redding G, Singh V, Sinha IP, Zar HJ. Social determinants of respiratory health from birth: still of concern in the 21st century? Eur Respir Rev 2024; 33:230222. [PMID: 38599675 PMCID: PMC11004769 DOI: 10.1183/16000617.0222-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/20/2024] [Indexed: 04/12/2024] Open
Abstract
Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.
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Affiliation(s)
- Andrew Bush
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Catherine A Byrnes
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Starship Children's Health and Kidz First Hospital, Auckland, New Zealand
| | - Kate C Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne B Chang
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane and Menzies School of Health Research, Darwin, Australia
| | - Juliana C Ferreira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karl A Holden
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics and Environmental Health Sciences, Columbia University Medical Center, New York, NY, USA
| | - Gregory Redding
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Kim MK, Bhattacharya J, Bhattacharya J. Is income inequality linked to infectious disease prevalence? A hypothesis-generating study using tuberculosis. Soc Sci Med 2024; 345:116639. [PMID: 38364719 DOI: 10.1016/j.socscimed.2024.116639] [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: 08/13/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
We study the association between infectious disease incidence and income inequality. We hypothesize that random social mixing in an income-unequal society brings into contact a) susceptible and infected poor and b) the infected-poor and the susceptible-rich, raising infectious disease incidence. We analyzed publicly available, country-level panel data for a large cross-section of countries between 1995 and 2013 to examine whether countries with elevated levels of income inequality have higher rates of pulmonary Tuberculosis (TB) incidence per capita. A "negative control" using anemia and diabetes (both non-communicable diseases and hence impervious to the hypothesized mechanism) is also applied. We find that high levels of income inequality are positively associated with tuberculosis incidence. All else equal, countries with income-Gini coefficients 10% apart show a statistically significant 4% difference in tuberculosis incidence. Income inequality had a null effect on the negative controls. Our cross-country regression results suggest that income inequality may create conditions where TB spreads more easily, and policy action to reduce income inequities could directly contribute to a reduced TB burden.
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Sveinbjornsdottir GM, Kamowa D, Katundu PN, Gizurarson S. Compliance and illiteracy when treating tuberculosis. Int Health 2024; 16:126-128. [PMID: 37655852 PMCID: PMC10759289 DOI: 10.1093/inthealth/ihad077] [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: 11/09/2022] [Revised: 05/26/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
According to Centers for Disease Control and Prevention, one-fourth of the worlds' population was infected with tuberculosis (TB) in 2017. It is estimated that globally, more than 1 billion woken are infected with TB. The treatment of TB is limited to follow the treatment schedule. A small pause in taking the meds, forgetting the meds for a day or two etc will result in relapse of the disease. Unfortunately, illiteracy is associated with poor compliance and understanding of the importance of following the treatment protocol. In 2015, it was estimated that about 11% of the world's population over 15 y were illiterate. Where two-thirds were women. This is even worse in sub-Saharan Africa, where 34.7% of all adults above 15 y were illiterate in 2019.
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Affiliation(s)
- Gudlaug Maria Sveinbjornsdottir
- Hananja ehf, Aflagrandi 7, 107 Reykjavik, Iceland
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, 107 Reykjavik, Iceland
| | - Dina Kamowa
- Pharmacy Department, Kamuzu University of Health Sciences, Blantyre 3, Malawi
| | | | - Sveinbjorn Gizurarson
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, 107 Reykjavik, Iceland
- Pharmacy Department, Kamuzu University of Health Sciences, Blantyre 3, Malawi
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Taal AT, Barreto JG, Santos de Sousa GD, da Rocha AM, Lima Ferreira NN, Menezes da Silva JA, Hinders DC, van Brakel WH, Richardus JH, Blok DJ. The geographical distribution and socioeconomic risk factors of COVID-19, tuberculosis and leprosy in Fortaleza, Brazil. BMC Infect Dis 2023; 23:662. [PMID: 37853318 PMCID: PMC10585722 DOI: 10.1186/s12879-023-08627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Fortaleza (Brazil) is high endemic for coronavirus disease 2019 (COVID-19), tuberculosis (TB) and leprosy. These three diseases share respiratory droplets through coughing or sneezing as the main mode of transmission but differ in incubation time, with COVID-19 having a short and leprosy a long incubation time. Consequently, contacts of a patient are at higher risk of infection and developing these diseases. There might be scope for combined preventive measures, but a better understanding of the geographical distribution and relevant socioeconomic risk factors of the three diseases is needed first. This study aims to describe the geographic distribution of COVID-19, TB and leprosy incidence and to identify common socioeconomic risk factors. METHODS The total number of new cases of COVID-19, TB and leprosy, as well as socioeconomic and demographic variables, were retrieved from official registers. The geographical distribution of COVID-19, TB and leprosy rates per neighbourhood was visualised in Quantum GIS, and spatial autocorrelation was measured with Moran's I in GeoDa. A spatial regression model was applied to understand the association between COVID-19, TB, leprosy rates, and socioeconomic factors. RESULTS COVID-19 and TB showed a more homogenous distribution, whereas leprosy is located more in the south and west of Fortaleza. One neighbourhood (Pedras) in the southeast was identified as high endemic for all three diseases. Literacy was a socioeconomic risk factor for all three diseases: a high literacy rate increases the risk of COVID-19, and a low literacy rate (i.e., illiteracy) increases the risk of TB and leprosy. In addition, high income was associated with COVID-19, while low income with TB. CONCLUSIONS Despite the similar mode of transmission, COVID-19, TB and leprosy show a different distribution of cases in Fortaleza. In addition, associated risk factors are related to wealth in COVID-19 and to poverty in TB and leprosy. These findings may support policymakers in developing (partially combined) primary and secondary prevention considering the efficient use of resources.
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Affiliation(s)
- A T Taal
- NLR, Amsterdam, The Netherlands.
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | - J H Richardus
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D J Blok
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Sales ACDS, Lopes LA, Vale MCDS, Costa MF, Lima JVDS, Silva JGMD, Ferreira BSDC, Nascimento VAD, Flor SEDS, Sousa ELCD, Paz BKB, Garcia RADS, Sousa EMD, Santos AFD, Silva LCND, Zagmignan A. Clinical Features, Biochemical Parameters, and Treatment Adherence of Individuals Who Started the Treatment for Active Pulmonary Tuberculosis during the Pandemic Period. J Clin Med 2023; 12:4843. [PMID: 37510958 PMCID: PMC10381187 DOI: 10.3390/jcm12144843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/30/2023] Open
Abstract
This descriptive prospective study investigated the clinical features and treatment adherence of individuals who started the treatment for Pulmonary tuberculosis (TB) during the COVID-19 pandemic in São Luís. Thirty-six TB patients and thirty-five age/sex-matched individuals were recruited between January 2021 and January 2022. The clinical features, sociodemographic information, and serum were obtained at the diagnosis time. Adherence to treatment and adverse reactions were investigated monthly. The most common symptoms in TB patients were cough (91.6%) and fever (83.3%). All TB patients had elevated pre-therapy levels of CRP and reduced HDL: 88.9% presented hypocalcemia and 47.2% showed elevated ALP and GGT. TB patients showed higher levels of ALT, AST, ALP, GGT, CRP, amylase, and triglycerides than the comparison group (p < 0.05), while the calcium levels were reduced (p < 0.0001). TB patients with anti-SARS-CoV-2-IgG antibodies (seroprevalence of 66.7%) presented higher values of amylase and lower CRP levels (p < 0.05). Most patients (~70%) reported at least one adverse drug reaction, mainly pruritus and nausea. The treatment abandonment rate was 19.2%. In conclusion, TB patients showed elevated pre-therapy levels of CRP, low levels of HDL, and hypocalcemia. Liver and pancreatic functions were also compromised in several patients before the therapy. The treatment non-adherence rate observed was similar to other studies performed before the pandemic period.
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Affiliation(s)
- Amanda Caroline de Souza Sales
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
- Laboratory of Clinical Analysis (LABORCEUMA), CEUMA University, São Luís 65075-120, MA, Brazil
| | - Larissa Araújo Lopes
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
| | | | - Mayara Ferreira Costa
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
| | - João Victor de Souza Lima
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
| | | | | | | | | | | | | | | | - Eduardo Martins de Sousa
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Health and Services Management, CEUMA University, São Luís 65075-120, MA, Brazil
- Laboratory of Immunology and Microbiology of Respiratory Infections, CEUMA University, São Luís 65075-120, MA, Brazil
| | | | - Luís Cláudio Nascimento da Silva
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
| | - Adrielle Zagmignan
- Laboratory of Microbial Pathogenesis, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Microbial Biology, CEUMA University, São Luís 65075-120, MA, Brazil
- Postgraduate Program in Health and Services Management, CEUMA University, São Luís 65075-120, MA, Brazil
- Departament of Nutrition, CEUMA University, São Luís 65075-120, MA, Brazil
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Gao Z, Liu Q, Deng Q, Kong L, Liu Y. Growth and anemia among children with tuberculosis infection at different sites in Southwest China. Front Pediatr 2023; 11:1188704. [PMID: 37397155 PMCID: PMC10309554 DOI: 10.3389/fped.2023.1188704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives To explore the effects of tuberculosis (TB) infection at different sites on anthropometric indicators, malnutrition and anemia incidence in children in Southwest China. Methods From January 2012 to December 2021, a total of 368 children aged 1 month to 16 years were enrolled. According to the sites of TB infection, they were divided into three groups: tuberculous meningitis (T group), tuberculous meningitis complicated withpulmonary tuberculosis (TP group), and tuberculous meningitis complicated with pulmonary tuberculosis and abdominal tuberculosis (TPA group). Data on weight, height, nutritional risk, blood biochemical indicators and basic descriptions were collected within 48 h after admission. Results The body mass index-for-age z score (BAZ), height-for-age z score (HAZ), and concentrations of hemoglobin (Hb) and albumin (ALB) decreased in the following order: T group, TP group, and TPA group. The prevalence of malnutrition was the highest in the TPA group (69.5%, 82/118) and 10-to 16-year-old group (72.4%, 63/87). Children aged 0.5-2 years exhibited the highest anemia prevalence of 70.6% (48/68) among the four age groups.The TPA group had the highest incidence of anemia (70.5%, 67/95) compared to T group and TP group.Compared with the treatment group, the abandonment group had a lower BAZ, HAZ and levels of HB and ALB, a higher rate of severe malnutrition, and higher nutritional risk scores. Children who had a low BAZ [odds ratio (OR) = 1.98], nutritional risk (OR = 0.56) and anemia (OR = 1.02) were less likely to obtain treatment with their guardians' support. Conclusions Children with tuberculous meningitis were at risk for growth disorders and anemia, especially when complicated with pulmonary tuberculosis and abdominal tuberculosis. The prevalence of anemia and malnutrition was the highest among patients aged 1 month to 2 years and 10-16 years, respectively. Nutritional status was one of the causes of abandoning treatment.
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Affiliation(s)
- Zhongmin Gao
- Department of Nutrition, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Quanbo Liu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Deng
- Department of Nutrition, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Kong
- Department of Nutrition, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yongfang Liu
- Department of Nutrition, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
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9
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Costa GF, Garcez JCD, Marcos W, Ferreira ALDS, Andrade JAA, Rodrigues YC, Lima LNGC, Conceição EC, Lima KVB. Factors Associated with Tuberculosis Outcome in a Hyperendemic City in the North of Brazil. Healthcare (Basel) 2023; 11:healthcare11040508. [PMID: 36833042 PMCID: PMC9957009 DOI: 10.3390/healthcare11040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023] Open
Abstract
Ananindeua city, State of Pará, North of Brazil, is a hyperendemic area for tuberculosis (TB), with a cure rate below the recommendation by the Brazilian Ministry of Health. We aimed to describe: (I) the TB incidence coefficient of Ananindeua municipality comparatively against Brazilian data; (II) TB treatment outcomes; (III) to compare the socioeconomic and epidemiological characteristics of abandonment versus cure outcome; and (IV) to evaluate the risk factors associated with TB treatment abandonment in Ananindeua city, from 2017 to 2021. This is a retrospective, descriptive, and cross-sectional epidemiological study which used secondary TB entries. Data were analyzed by linear regression, descriptive statistics, and associations were made using the Chi-square test and G-test, followed by univariate and multivariate logistic regression analyses. Cure rates ranged from 28.7% to 70.1%, abandonment between 7.3% and 11.8%, deaths from the disease ranged from 0% to 1.6%, and drug-resistant tuberculosis (TB-DR) rates had frequencies from 0% to 0.9%. Patient transfer rates to other municipalities were between 4.9% and 12.5%. The multivariate analysis showed that alcohol is almost 2 times more likely to lead an individual to abandon treatment and use of illicit drugs was almost 3 times more likely. Individuals between 20 and 59 years of age were also more likely to abandon treatment almost twice as often. Finally, data obtained in the present report is of great relevance to strengthen epidemiological surveillance and minimize possible discrepancies between the information systems and the reality of public health in high endemicity areas.
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Affiliation(s)
- Gabriel Fazzi Costa
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
- Correspondence: (G.F.C.); (K.V.B.L.); Tel.: +55-91-3214-2116 (K.V.B.L.)
| | - Juliana Conceição Dias Garcez
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
| | - Weber Marcos
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
| | - Ana Lúcia da Silva Ferreira
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
| | | | - Yan Corrêa Rodrigues
- Program in Epidemiology and Health Surveillance (PPGEVS), Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil
| | - Luana Nepomuceno Gondim Costa Lima
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health of Brazil, Ananindeua 67030-000, PA, Brazil
| | - Emilyn Costa Conceição
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch 7602, South Africa
| | - Karla Valéria Batista Lima
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Belém 66087-662, PA, Brazil
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health of Brazil, Ananindeua 67030-000, PA, Brazil
- Correspondence: (G.F.C.); (K.V.B.L.); Tel.: +55-91-3214-2116 (K.V.B.L.)
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Ali MM, Weldegebreal F, Kabew G, Urgesa K. Rifampicin resistant Mycobacterium tuberculosis and associated factors among presumptive pulmonary tuberculosis patients in Mogadishu, Somalia. SAGE Open Med 2023; 11:20503121221148603. [PMID: 36643204 PMCID: PMC9834785 DOI: 10.1177/20503121221148603] [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: 01/18/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Background Multi-drug resistant Mycobacterium tuberculosis is a growing public health problem in developing countries including Somalia. Although, the prevalence of multi-drug resistant tuberculosis among new and retreated cases is high, data on GeneXpert- Mycobacterium tuberculosis/rifampicin-resistant assay, which is a surrogate marker for multidrug resistance, is not well explored in Mogadishu. Objectives To determine the prevalence of rifampicin-resistant Mycobacterium tuberculosis and its associated factors among presumptive pulmonary tuberculosis patients visiting tuberculosis centers in Mogadishu, Somalia. Methods A multicenter cross-sectional study was conducted in three tuberculosis treatment centers from March 12 to April 30, 2021. Laboratory professionals collected sputum sample consecutively from presumptive pulmonary tuberculosis participants and performed a GeneXpert assay to determine the rifampicin resistance. Socio-demographic and clinical data were collected using structured questionnaire. Logistic regression analyses were performed to assess factors associated with rifampicin resistance using an adjusted odds ratio at a 95% confidence interval. Statistical significance was considered at a p-value of less than 0.05. Results A total of 370 presumptive tuberculosis suspects were included; of whom 58.4% were females and the mean age of the participants was 44.3 ± 14 years. Mycobacterium tuberculosis was detected in 63 (17%) (95% confidence interval = 13.2-20.8) suspects. Of these the prevalence of rifampicin-resistant Mycobacterium tuberculosis was 35% (95% confidence interval = 30.2-39.8). Anti-tuberculosis treatment history (adjusted odds ratio = 4.1; 95% confidence interval = 1.91-6.75), monthly income less than $100 USD (adjusted odds ratio = 2.2; 95% confidence interval = 1.77-5.98) and being diagnosed with Asthma (adjusted odds ratio = 2.63; 95% confidence interval = 1.3-7.3) were significantly associated with rifampicin-resistant tuberculosis. Conclusion A considerable proportion of rifampicin-resistant tuberculosis is reported in these study settings. The strong association between multidrug resistance tuberculosis and patients' retreatment history of tuberculosis, low income, and co-morbidity with asthma highlights the need for more efforts in tuberculosis treatment and monitoring programs to limit the emergence of multi-drug resistant strain in the study areas.
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Affiliation(s)
- Mohamed Muhumed Ali
- College of Health and Medical Sciences
of Daha International University, Mogadishu, Somalia
| | - Fitsum Weldegebreal
- Department of Medical Laboratory
Sciences College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
| | - Getachew Kabew
- Department of Medical Laboratory
Sciences College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
| | - Kedir Urgesa
- Department of Medical Laboratory
Sciences College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia,Kedir Urgesa, Department of Medical
Laboratory Sciences College of Health and Medical Sciences, Haramaya University,
Harar, Oromia 235, Ethiopia.
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Monique OPPERMAN, Ilse DUPREEZ. FACTORS CONTRIBUTING TO PULMONARY TB TREATMENT LOST TO FOLLOW-UP IN DEVELOPING COUNTRIES: AN OVERVIEW. Afr J Infect Dis 2022; 17:60-73. [PMID: 36756489 PMCID: PMC9885020 DOI: 10.21010/ajidv17i1.6] [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: 08/16/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Despite the available treatment options, pulmonary tuberculosis (TB) remains a leading cause of disease-related deaths worldwide. Treatment non-adherence/lost to follow-up (LTFU), particularly in developing countries, is a continuous concern. LTFU prolongs TB infectiousness and contributes to TB treatment failure, relapse, and death. Furthermore, LTFU also delays global TB eradication by promoting TB spread and drug-resistant TB strain development.[1] The purpose of this paper is to give an overview of the commonly observed risk factors associated with TB treatment LTFU in developing countries. Materials and Methods A literature survey was done of studies published in the past decade, which evaluated the risk factors for LTFU in TB patients, specifically in developing countries. Furthermore, some prospective TB treatment adherence initiatives and the feasibility of these initiatives within developing countries were assessed.[3]. Results Several variables, including socio-demographic, patient-related, TB disease and other health-related-factors, healthcare and system determinants, as well as treatment-related factors, were identified to increase the risk of TB treatment LTFU. More recently applied adherence interventions in developing countries, show potential for implementation on a larger scale. Conclusion Successful TB treatment is contingent on treatment adherence, and by addressing these persisting LTFU risk factors, treatment adherence in developing countries may be improved.
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Affiliation(s)
- OPPERMAN, Monique
- Human Metabolomics, North-West University (Potchefstroom Campus), Private Bag x6001, Box 269, Potchefstroom, South Africa, 2531
| | - DU PREEZ, Ilse
- Human Metabolomics, North-West University (Potchefstroom Campus), Private Bag x6001, Box 269, Potchefstroom, South Africa, 2531,Corresponding Author’s E-Mail:
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Sousa GJB, Lourenço VDO, Mendes CCDS, Vasconcelos MND, Maranhão TA, Pereira MLD. Spatiotemporal pattern and factors related to childhood tuberculosis. Rev Gaucha Enferm 2022; 43:e20210270. [DOI: 10.1590/1983-1447.2022.20210270.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/14/2022] [Indexed: 11/06/2022] Open
Abstract
ABSTRACT Aim: To identify the spatiotemporal pattern of childhood tuberculosis and the sociodemographic factors related to it. Method: This is an ecological study, which used the municipalities of the state of Ceará as units of analysis. The Notifiable Diseases Information System was used as a data source from January 2001 to December 2017. It was conducted a descriptive analysis of the characteristics of the cases, the temporal and spatial pattern of the incidence of the disease and regression with sociodemographic indicators. Results: An average incidence of 3.48 cases/100 thousand inhabitants was identified, with a reduction of 5.7% during the period 2003-2017 (p<0.001). The following were related to childhood tuberculosis: proportion of the population in households with piped water (β=0.05), proportion of the population in households with density >2 (β=0.09) and number of female heads of household with children under 15 years of age (β=0.0003). Conclusion: Indicators of housing conditions and vulnerability were related to childhood tuberculosis.
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Sousa GJB, Lourenço VDO, Mendes CCDS, Vasconcelos MND, Maranhão TA, Pereira MLD. Padrão espaço-temporal e fatores relacionados à tuberculose na infância. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210270.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RESUMO Objetivo: Identificar o padrão espaço-temporal da tuberculose na infância e os fatores sociodemográficos a ela relacionados. Método: Estudo ecológico, que utilizou como unidades de análise os municípios do estado do Ceará. Utilizou-se como fonte de dados o Sistema de Informação de Agravos de Notificação durante janeiro de 2001 a dezembro de 2017. Realizou-se análise descritiva das características dos casos, do padrão temporal e espacial da incidência da doença e regressão com indicadores sociodemográficos. Resultados: Identificou-se incidência média de 3,48 casos/100 mil hab., com redução de 5,7% de durante o período de 2003-2017 (p<0,001). Foram relacionados à tuberculose na infância: proporção da população em domicílios com água encanada (β=0,05), proporção da população em domicílios com densidade >2 (β=0,09) e número de mulheres chefes de família e com filhos menores de 15 anos (β=0,0003). Conclusão: Indicadores de condições de moradia e vulnerabilidade foram relacionados a tuberculose na infância.
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Prado Junior JC, Medronho RDA. Spatial analysis of tuberculosis cure in primary care in Rio de Janeiro, Brazil. BMC Public Health 2021; 21:1841. [PMID: 34641849 PMCID: PMC8507316 DOI: 10.1186/s12889-021-11834-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Tuberculosis (TB) presents a high burden of disease and is considered a global emergency by the World Health Organization (WHO), as the leading cause of death from infectious disease in adults. TB incidence is related directly to access to health services and socioeconomic determinants and inequality. Providing primary care settings can lead to improved access, shorter waiting times for patients, and enhanced TB case detection. The article aims to identify the spatial and temporal risk areas for TB and the relationship between TB cure and primary healthcare coverage from 2012 to 2014 in Rio de Janeiro, Brazil. Methods A cross-sectional study was conducted in Rio de Janeiro, Brazil. All cases of TB reported to the Information System on Diseases of Notification (SINAN) from 2012 to 2014 were included. Socioeconomic variables from the 2010 Brazilian national census were also added. Socioeconomic variables were selected from multivariate analysis using principal factors analysis. Spatial association was verified with generalized additive model (GAM). It was possible to identify areas at higher risk of failure to cure TB. Results TB rates showed strong positive spatial autocorrelation. TB cure rate varied according to schooling (individuals with complete secondary schooling had higher cure rates than illiterate individuals; OR 1.72, 95% CI 1.30–2.29), alcohol consumption (OR 0.47, 95% CI 0.35–0.64), contact investigation (OR 2.00, 95% CI 1.56–2.57), positive HIV serology (OR 0.31, 95% CI 0.23–0.42), and census tracts with higher elderly rates (OR 9.39, 95% CI 1.03–85.26). Individuals who had been covered by primary healthcare (PHC) for 35 to 41 months had 1.64 higher odds of cure, compared to those with no PHC coverage (95% CI 1.07–2.51). Conclusion A comprehensive risk map was developed, allowing public health interventions. Spatial analysis allowed identifying areas with lower odds of TB cure in the city of Rio de Janeiro. TB cure was associated statistically with time of coverage by primary healthcare. TB cure rate also varied according to sociodemographic factors like schooling, alcohol abuse, and population density. This methodology can be generalized to other areas and/or other public health problems. Highlights We studied standardized municipal TB cure rates in an area of social inequality in Brazil. TB rates showed strong positive spatial autocorrelation. Higher rates were associated with population density and socioeconomic conditions. Illiterate individuals were less likely to achieve TB cure. TB cure was less likely in individuals with HIV and alcohol abuse. TB cure was greater in areas with high primary healthcare coverage.
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Affiliation(s)
- José Carlos Prado Junior
- Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Avenida Brasil 4036, 10° andar, Prédio da Expansão, Manguinhos, Rio de Janeiro, RJ, 21040-361, Brazil
| | - Roberto de Andrade Medronho
- Instituto de Estudos em Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco, 255, 6° andar, Rio de Janeiro, RJ, 21941-913, Brazil.
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Spatio-temporal variation in tuberculosis incidence and risk factors for the disease in a region of unbalanced socio-economic development. BMC Public Health 2021; 21:1817. [PMID: 34627189 PMCID: PMC8501584 DOI: 10.1186/s12889-021-11833-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/22/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Previous research pointed to a close relationship between the incidence of tuberculosis (TB) in aging populations and socio-economic conditions, however there has been lack of studies focused on a region of unbalanced socio-economic development. The aim of this paper is to explore the spatio-temporal variation in TB incidence and examine risk determinants of the disease among aging populations in a typical region. METHODS Data on TB-registered cases between 2009 and 2014, in addition to social-economic factors, were collected for each district/county in Beijing, Tianjin and Hebei, a region characterized by an aging population and disparities in social-economic development. A Bayesian space-time hierarchy model (BSTHM) was used to reveal spatio-temporal variation in the incidence of TB among the elderly in this region between 2009 to 2014. GeoDetector was applied to measure the determinant power (q statistic) of risk factors for TB among the elderly. RESULTS The incidence of TB among the elderly exhibited geographical spatial heterogeneity, with a higher incidence in underdeveloped rural areas compared with that in urban areas. Hotspots of TB incidence risk among the elderly were mostly located in north-eastern and southern areas in the study region, far from metropolitan areas. Areas with low risk were distributed mainly in the Beijing-Tianjin metropolitan areas. Social-economic factors had a non-linear influence on elderly TB incidence, with the dominant factors among rural populations being income (q = 0.20) and medical conditions (q = 0.17). These factors had a non-linear interactive effect on the incidence of TB among the elderly, with medical conditions and the level of economic development having the strongest effect (q = 0.54). CONCLUSIONS The findings explain spatio-temporal variation in TB incidence and risk determinants of elderly TB in the presence of disparities in social-economic development. High-risk zones were located mainly in rural areas, far from metropolitan centres. Medical conditions and the economic development level were significantly associated with elderly TB incidence, and these factors had a non-linear interactive effect on elderly TB incidence. The findings can help to optimize the allocation of health resources and to control TB transmission in the aging population in this region.
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Chenciner L, Annerstedt KS, Pescarini JM, Wingfield T. Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study. Lancet Glob Health 2021; 9:e1380-e1390. [PMID: 34534486 DOI: 10.1016/s2214-109x(21)00300-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Tuberculosis elimination strategies in Brazil might neglect adolescents and young adults aged 10-24 years, hampering tuberculosis control. However, little is known about factors associated with tuberculosis treatment outcomes in this underserved group. In this study, we aimed to investigate social and health factors associated with unfavourable treatment outcomes in young people with tuberculosis in Brazil. METHODS A national retrospective cohort study was done using data from Sistema de Informação de Agravos de Notificação (SINAN), the national tuberculosis registry in Brazil. People aged 10-24 years (young people) with tuberculosis registered in SINAN between Jan 1, 2015, and Dec 31, 2018, were included. Unfavourable outcomes were defined as loss to follow-up, treatment failure, and death. Favourable outcome was defined as treatment success. Multiple logistic regression models estimated the association between social and health factors and tuberculosis treatment outcomes. FINDINGS 67 360 young people with tuberculosis were notified to SINAN, and we included 41 870 young people in our study. 7024 (17%) of the 41 870 included individuals had unfavourable treatment outcomes. Young people who received government cash transfers were less likely to have an unfavourable outcome (adjusted odds ratio 0·83, 95% CI 0·70-0·99). Homelessness (3·03, 2·07-4·42), HIV (2·89, 2·45-3·40), and illicit drug use (2·22, 1·93-2·55) were the main factors associated with unfavourable treatment outcome. INTERPRETATION In this national cohort of young people with tuberculosis in Brazil, tuberculosis treatment success rates were lower than WHO End TB Strategy targets, with almost a fifth of participants experiencing unfavourable treatment outcomes. Homelessness, HIV, and illicit drug use were the main factors associated with unfavourable outcome. In Brazil, strategies are required to support this underserved group to ensure favourable tuberculosis treatment outcomes. FUNDING Wellcome Trust, UK Medical Research Council, and UK Foreign Commonwealth and Development Office.
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Affiliation(s)
- Louisa Chenciner
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden.
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden
| | - Julia M Pescarini
- Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Wingfield
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden; Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Sousa GJB, Maranhão TA, Leitão TDMJS, Souza JTD, Moreira TMM, Pereira MLD. Prevalence and associated factors of tuberculosis treatment abandonment. Rev Esc Enferm USP 2021; 55:e03767. [PMID: 34320115 DOI: 10.1590/s1980-220x2020039203767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of tuberculosis treatment abandonment and its associated factors. METHOD Cross-sectional study which used cases of tuberculosis in the System of Information on Notification Aggravations (Sistema de Informação de Agravos de Notificação) from 2001 to 2017 in Ceará state. This study included 74,006 cases and the outcome was the closing situation "treatment abandonment". A multivariate analysis was performed to estimate the association between the variables with abandonment. RESULTS Throughout the period, the abandonment rate was 12.54%. A higher abandonment prevalence was verified among people who live in the urban zone (PR = 2.45; 95%CI: 2.20-2.74), who are readmitted after abandonment (PR = 2.84; 95%CI: 2.68-3.01), among those notified as recurrent (PR = 1.22; 95%CI: 1.10-1.35) and among drinkers (PR = 1.50; 95%CI: 1.42-1.58). Those who were sputum smear-positive (PR = 1.11; 95%CI: 1.03-1.19) or for whom sputum smear was unperformed (PR = 1.30; 95%CI: 1.20-1.40), coinfection (PR = 2.04; CI95%: 1.89-2.21) and who were not submitted to serology (PR = 1.62; 95%CI: 1.53-1.71) have also a higher prevalence of tuberculosis treatment abandonment. CONCLUSION Tuberculosis treatment abandonment is associated to biological and social factors, habits, and health service structure.
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Affiliation(s)
- George Jó Bezerra Sousa
- Universidade Estadual do Ceará, Programa de Pós-graduação Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brasil
| | | | | | | | | | - Maria Lúcia Duarte Pereira
- Universidade Estadual do Ceará, Programa de Pós-graduação Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brasil
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Sousa GGDSD, Pascoal LM, Costa ACPDJ, Santos FS, Santos LHD, Arcêncio RA, Santos Neto M. Trend and factors associated with Tuberculosis-Diabetes Mellitus comorbidity in a Northeastern Brazilian municipality. Rev Bras Enferm 2021; 74:e20201238. [PMID: 34259732 DOI: 10.1590/0034-7167-2020-1238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the trend and factors associated with Tuberculosis-Diabetes Mellitus comorbidity in Imperatriz, Maranhão. METHODS epidemiological temporal-series study, conducted in a Northeastern Brazilian municipality. The population consisted of Tuberculosis cases with Diabetes Mellitus-associated aggravation notified in the Notifiable Diseases Information System (SINAN) between 2009 and 2018. We determined the prevalence and trend of comorbidity using Prais-Winsten regressions and to identify associated factors employed Poisson regression. RESULTS prevalence ranged from 3.23% in 2014 to 19.51% in 2018, with a mean of 11.5% for the period, showing an increasing trend. Age groups 30 to 59 years and ≥ 60 years, education < 8 years, and clinical form of pulmonary Tuberculosis were risk factors for comorbidity. CONCLUSIONS The increasing trend of comorbidity and its associated factors alert us to the need to improve customer service at all levels of health care.
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Chitwood MH, Pelissari DM, Drummond Marques da Silva G, Bartholomay P, Rocha MS, Sanchez M, Arakaki-Sanchez D, Glaziou P, Cohen T, Castro MC, Menzies NA. Bayesian evidence synthesis to estimate subnational TB incidence: An application in Brazil. Epidemics 2021; 35:100443. [PMID: 33676092 PMCID: PMC8252152 DOI: 10.1016/j.epidem.2021.100443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Evidence on local disease burden and the completeness of case detection represent important information for TB control programs. We present a new method for estimating subnational TB incidence and the fraction of individuals with incident TB who are diagnosed and treated in Brazil. METHODS We compiled data on TB notifications and TB-related mortality in Brazil and specified an analytic model approximating incidence as the number of individuals exiting untreated active disease (sum of treatment initiation, death before treatment, and self-cure). We employed a Bayesian inference approach to synthesize data and adjust for known sources of bias. We estimated TB incidence and the fraction of cases treated, for each Brazilian state and the Federal District over 2008-2017. FINDINGS For 2017, TB incidence was estimated as 41.5 (95 % interval: 40.7, 42.5) per 100 000 nationally, and ranged from 11.7-88.3 per 100 000 across states. The fraction of cases treated was estimated as 91.9 % (89.6 %, 93.7 %) nationally and ranged 86.0 %-94.8 % across states, with an estimated 6.9 (5.3, 9.2) thousand cases going untreated in 2017. Over 2008-2017, incidence declined at an average annual rate of 1.4 % (1.1 %, 1.9 %) nationally, and -1.1%-4.2 % across states. Over this period there was a 0.5 % (0.2 %, 0.9 %) average annual increase in the fraction of incident TB cases treated. INTERPRETATION Time-series estimates of TB burden and the fraction of cases treated can be derived from routinely-collected data and used to understand variation in TB outcomes and trends.
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Affiliation(s)
- Melanie H Chitwood
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven CT 06510 United States.
| | - Daniele M Pelissari
- Chronic and Airborne Disease Surveillance Coordination, Ministry of Health, SRTVN Qd. 701, Via W5 Norte, Lote D, Ed. PO 700, Brasília Brazil
| | - Gabriela Drummond Marques da Silva
- Chronic and Airborne Disease Surveillance Coordination, Ministry of Health, SRTVN Qd. 701, Via W5 Norte, Lote D, Ed. PO 700, Brasília Brazil
| | - Patricia Bartholomay
- Chronic and Airborne Disease Surveillance Coordination, Ministry of Health, SRTVN Qd. 701, Via W5 Norte, Lote D, Ed. PO 700, Brasília Brazil
| | - Marli Souza Rocha
- Chronic and Airborne Disease Surveillance Coordination, Ministry of Health, SRTVN Qd. 701, Via W5 Norte, Lote D, Ed. PO 700, Brasília Brazil
| | - Mauro Sanchez
- Department of Tropical Medicine, University of Brasília, Campus Universitário Darcy Ribeiro, s/n Asa Norte, Brasília Brazil
| | - Denise Arakaki-Sanchez
- Chronic and Airborne Disease Surveillance Coordination, Ministry of Health, SRTVN Qd. 701, Via W5 Norte, Lote D, Ed. PO 700, Brasília Brazil
| | | | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven CT 06510 United States
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston MA, 02115 United States
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston MA, 02115 United States
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Bezerra WDSP, Lemos EF, do Prado TN, Kayano LT, Zacarin de Souza S, Chaves CEV, Paniago AMM, de Souza AS, de Oliveira SMDVL. Risk Stratification and Factors Associated with Abandonment of Tuberculosis Treatment in a Secondary Referral Unit. Patient Prefer Adherence 2020; 14:2389-2397. [PMID: 33299305 PMCID: PMC7721312 DOI: 10.2147/ppa.s266475] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/25/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To study the factors associated with the risk of discontinuing active tuberculosis treatment among patients in an outpatient referral unit and to analyze the association between patients' abandonment risk score and their odds of discontinuing the treatment. PATIENTS AND METHODS In this cohort study, tuberculosis patients were prospectively followed up from June 2012 through July 2019 at a secondary tuberculosis referral unit in Mato Grosso do Sul, Brazil. At initial consultation, patients were interviewed using a standardized questionnaire and were assigned a score for the risk of treatment abandonment by the nurse. Univariate and multivariate analyses were performed using logistic regression. RESULTS One hundred and forty-eight patients were included in the study, of which 65.0% (96/148) were male. Their mean age was 43.3 ± 14.8 years (range: 18-89 years). Smoking, drug use, repeated admissions, and a high abandonment risk score were the variables associated with the highest risk of discontinuing the treatment. The rate of tuberculosis and human immunodeficiency virus coinfection was 37.2%. The overall rate of global treatment abandonment was 10.8% (95% confidence interval [CI]: 6.1-16.2). Upon stratification of patients that abandoned by the risk score, 22.9% (8/35) of the ones that abandoned had a high risk, 10.9% (6/55) had an intermediate risk, and 3.5% (2/58) had a low risk of treatment abandonment. In multivariate analysis, the factors associated with abandoning the treatment were smoking [adjusted odds ratio (aOR) = 4.91 (95% CI: 1.08, 22.32)] and undergoing retreatment (aOR) = 3.66 (95% CI: 1.04, 12 88). CONCLUSION Smoking and undergoing retreatment were independent risk factors for tuberculosis treatment abandonment in this center. Risk stratification can help prioritize the strengthening of treatment adherence among patients at higher risk of abandoning treatment in referral units.
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Affiliation(s)
- Wanessa da Silva Peres Bezerra
- Postgraduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Everton Ferreira Lemos
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Larissa Taemy Kayano
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Stefany Zacarin de Souza
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Cláudia Elizabeth Volpe Chaves
- Postgraduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Maria Aparecida Pedrossian University Hospital, EBSERH, Campo Grande, Mato Grosso do Sul, Brazil
| | - Anamaria Mello Miranda Paniago
- Postgraduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Maria Aparecida Pedrossian University Hospital, EBSERH, Campo Grande, Mato Grosso do Sul, Brazil
| | - Albert Schiaveto de Souza
- Biosciences Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Postgraduate Program in Family Health, Biosciences Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Sandra Maria do Valle Leone de Oliveira
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Maria Aparecida Pedrossian University Hospital, EBSERH, Campo Grande, Mato Grosso do Sul, Brazil
- Postgraduate Program in Family Health, Biosciences Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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Hokino Yamaguti V, Alves D, Charters Lopes Rijo RP, Brandão Miyoshi NS, Ruffino-Netto A. Development of CART model for prediction of tuberculosis treatment loss to follow up in the state of São Paulo, Brazil: A case-control study. Int J Med Inform 2020; 141:104198. [PMID: 32574924 DOI: 10.1016/j.ijmedinf.2020.104198] [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: 12/19/2019] [Revised: 04/03/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tuberculosis is the leading cause of infectious disease-related death, surpassing even the immunodeficiency virus. Treatment loss to follow up and irregular medication use contribute to persistent morbidity and mortality. This increases bacillus drug resistance and has a negative impact on disease control. OBJECTIVE This study aims to develop a computational model that predicts the loss to follow up treatment in tuberculosis patients, thereby increasing treatment adherence and cure, reducing efforts regarding treatment relapses and decreasing disease spread. METHODS This is a case-controlled study. Included in the data set were 103,846 tuberculosis cases from the state of São Paulo. They were collected using the TBWEB, an information system used as a tuberculosis treatment monitor, containing samples from 2006 to 2016. This set was later resampled into 6 segments with a 1-1 ratio. This ratio was used to avoid any bias during the model construction. RESULTS The Classification and Regression Trees were used as the prediction model. Training and test sets accounted for 70% in the former and 30% in the latter of the tuberculosis cases. The model displayed an accuracy of 0.76, F-measure of 0.77, sensitivity of 0.80 and specificity of 0.71. The model emphasizes the relationship between several variables that had been identified in previous studies as related to patient cure or loss to follow up treatment in tuberculosis patients. CONCLUSION It was possible to construct a predictive model for loss to follow up treatment in tuberculosis patients using Classification and Regression Trees. Although the fact that the ideal predictive ability was not achieved, it seems reasonable to propose the use of Classification and Regression Trees models to predict likelihood of treatment follow up to support healthcare professionals in minimising the loss to follow up.
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Affiliation(s)
- Verena Hokino Yamaguti
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil.
| | - Domingos Alves
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil; Center for Research in Health Technologies and Services (CINTESIS), University of Porto, Porto, Portugal.
| | - Rui Pedro Charters Lopes Rijo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil; School of Technology and Management, Polytechnic Institute of Leiria, Leiria, Portugal; Institute for Systems and Computers Engineering (INESCC), Coimbra, Portugal; Center for Research in Health Technologies and Services (CINTESIS), University of Porto, Porto, Portugal.
| | | | - Antônio Ruffino-Netto
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil.
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Campelo TA, Lima LNC, Lima KVB, Silva CS, da Conceição ML, Barreto JAP, Mota APP, Sancho SDO, Frota CC. Molecular characterization of pre-extensive drug resistant Mycobacterium tuberculosis in Northeast Brazil. Rev Inst Med Trop Sao Paulo 2020; 62:e4. [PMID: 32049255 PMCID: PMC7014566 DOI: 10.1590/s1678-9946202062004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
In Fortaleza, the capital of Ceara State, Brazil, the detection rate of tuberculosis (TB) in 2018 was 65.5/100,000 inhabitants with a cure rate of 59.1%, which is higher than the country average. This study investigated the risk factors associated with drug-resistant tuberculosis (DR-TB) and identified the drug-resistance phenotype and resistance-conferring mutations. The geographic distribution of DR-TB in Fortaleza, Brazil, was also determined. From March 2017 to February 2018, 41 DR-TB isolates and 69 drug-susceptible pulmonary TB isolates were obtained from patients seen at a referral hospital in Fortaleza, Brazil. Samples were subjected to phenotypic and genetic analysis of resistance; the spatial distribution of the participants was also analyzed. Primary resistance was high (50.9%) among participants. The following risk factors for DR were identified: being female ( p = 0.03), having diabetes ( p < 0.01), history of previous TB disease ( p < 0.01), and the number of intra-domiciliary contacts ( p < 0.01). Analysis by multiplex allele-specific polymerase chain reaction detected mutations in the genes katG (65.8%) , rpoB (43.9%), inhA promoter (14.6%), and gyrA (9.8%). Sequencing identified mutations in the the genes katG (75.6%), inhA promoter (19.5%), rpoB (85.4%), and gyrA (100%). There was no mutation in the rrs gene. Spatial analysis showed DR-TB isolates distributed in areas of low socioeconomic status in the city of Fortaleza. Our results emphasized the importance of detecting resistance to TB drugs. The resistance found in the gene gyrA is of concern due to the high number of pre-extensive DR-TB cases in Fortaleza.
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Affiliation(s)
- Thales Alves Campelo
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
| | - Luana Nepomuceno Costa Lima
- Instituto Evandro Chagas , Seção de Bacteriologia e Micologia, Ananindeua , Pará , Brazil
- Universidade do Estado do Pará , Programa de Pós-Graduação em Biologia Parasitária na Amazônia , Belém , Pará , Brazil
| | - Karla Valéria Batista Lima
- Instituto Evandro Chagas , Seção de Bacteriologia e Micologia, Ananindeua , Pará , Brazil
- Universidade do Estado do Pará , Programa de Pós-Graduação em Biologia Parasitária na Amazônia , Belém , Pará , Brazil
| | - Caroliny Soares Silva
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
| | - Marília Lima da Conceição
- Universidade do Estado do Pará , Programa de Pós-Graduação em Biologia Parasitária na Amazônia , Belém , Pará , Brazil
| | | | - Aquiles Paulino Peres Mota
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
| | - Soraya de Oliveira Sancho
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
| | - Cristiane Cunha Frota
- Universidade Federal do Ceará , Faculdade de Medicina, Departamento de Patologia e Medicina Legal , Fortaleza , Ceará , Brazil
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de Lima LMM, de Sá LR, Dos Santos Macambira AFU, de Almeida Nogueira J, de Toledo Vianna RP, de Moraes RM. A new combination rule for Spatial Decision Support Systems for epidemiology. Int J Health Geogr 2019; 18:25. [PMID: 31706302 PMCID: PMC6842522 DOI: 10.1186/s12942-019-0187-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/24/2019] [Indexed: 01/04/2023] Open
Abstract
Background Decision making in the health area usually involves several factors, options and data. In addition, it should take into account technological, social and spatial aspects, among others. Decision making methodologies need to address this set of information , and there is a small group of them with focus on epidemiological purposes, in particular Spatial Decision Support Systems (SDSS). Methods Makes uses a Multiple Criteria Decision Making (MCDM) method as a combining rule of results from a set of SDSS, where each one of them analyzes specific aspects of a complex problem. Specifically, each geo-object of the geographic region is processed, according to its own spatial information, by an SDSS using spatial and non-spatial data, inferential statistics and spatial and spatio-temporal analysis, which are then grouped together by a fuzzy rule-based system that will produce a georeferenced map. This means that, each SDSS provides an initial evaluation for each variable of the problem. The results are combined by the weighted linear combination (WLC) as a criterion in a MCDM problem, producing a final decision map about the priority levels for fight against a disease. In fact, the WLC works as a combining rule for those initial evaluations in a weighted manner, more than a MCDM, i.e., it combines those initial evaluations in order to build the final decision map. Results An example of using this new approach with real epidemiological data of tuberculosis in a Brazilian municipality is provided. As a result, the new approach provides a final map with four priority levels: “non-priority”, “non-priority tendency”, “priority tendency” and “priority”, for the fight against diseases. Conclusion The new approach may help public managers in the planning and direction of health actions, in the reorganization of public services, especially with regard to their levels of priorities.
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Affiliation(s)
- Luciana Moura Mendes de Lima
- Graduate Program in Decision Models and Health, Department of Statistics, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
| | - Laísa Ribeiro de Sá
- Graduate Program in Decision Models and Health, Department of Statistics, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
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Brand ÉM, Rossetto M, Calvo KDS, Winkler GB, da Silva DAR, Hentges B, Machado FV, Duarte ERM, da Silva LC, Vasques SC, Teixeira LB. Factors associated with directly observed treatment in tuberculosis/HIV coinfection cases in Porto Alegre, 2009-2013: A retrospective cohort. PLoS One 2019; 14:e0222786. [PMID: 31577812 PMCID: PMC6774507 DOI: 10.1371/journal.pone.0222786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/07/2019] [Indexed: 11/20/2022] Open
Abstract
Background TB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil. Methods A retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT. Results 2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08–1.54), cases of relapse (OR = 1.33; 95% CI = 1.03–1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20–1.83), transfer (OR = 2.04; 95% CI = 1.40–2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24–2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16–1.67), and mental disorders (OR = 1.83; 95% CI = 1.38–2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%. Conclusions There was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy.
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Affiliation(s)
- Évelin Maria Brand
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maíra Rossetto
- Department of Medicine, Universidade Federal da Fronteira Sul, Chapecó, Santa Catarina, Brazil
| | - Karen da Silva Calvo
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gerson Barreto Winkler
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daila Alena Raenck da Silva
- Department of Professional Assistance and Guidance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Hentges
- Department of Social Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Frederico Viana Machado
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Erica Rosalba Mallmann Duarte
- Department of Professional Assistance and Guidance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Cardoso da Silva
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Samantha Correa Vasques
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciana Barcellos Teixeira
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
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25
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Lima SVMA, dos Santos AD, Duque AM, de Oliveira Goes MA, da Silva Peixoto MV, da Conceição Araújo D, Ribeiro CJN, Santos MB, de Araújo KCGM, Nunes MAP. Spatial and temporal analysis of tuberculosis in an area of social inequality in Northeast Brazil. BMC Public Health 2019; 19:873. [PMID: 31272437 PMCID: PMC6610860 DOI: 10.1186/s12889-019-7224-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/21/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is a disease known worldwide for its vulnerability factors, magnitude and mortality. The objective of the study was to analyze the spatial and temporal dynamics of TB in the area of social inequality in northeast Brazil between the years 2001 and 2016. METHODS An ecological time series study with the use of spatial analysis techniques was carried out from 2001 to 2016. The units of analysis were the 75 municipalities in the state of Sergipe. Data from the Notification of Injury Information System were used. For the construction of the maps, the cartographic base of the state of Sergipe, obtained at the Instituto Brasileiro de Geografia e Estatística, was used. Georeferenced data were analysed using TerraView 4.2.2 software (Instituto Nacional de Pesquisas Espaciais) and QGis 2.18.2 (Open Source Geospatial Foundation). Spatial analyses included the empirical Bayesian model and the global and local Moran indices. The time trend analyses were performed by the software Joinpoint Regression, Version 4.5.0.1, with the variables of sex, age, cure and abandonment. RESULTS There was an increasing trend of tuberculosis cases in patients under 20 years old and 20-39 years old, especially in males. Cured cases showed a decreasing trend, and cases of treatment withdrawal were stationary. A spatial dependence was observed in almost all analysed territories but with different concentrations. Significant spatial correlations with the formation of clusters in the southeast and northeast of the state were observed. The probability of illness among municipalities was determined not to occur in a random way. CONCLUSION The identification of risk areas and priority groups can help health planning by refining the focus of attention to tuberculosis control. Understanding the epidemiological, spatial and temporal dynamics of tuberculosis can allow for improved targeting of strategies for disease prevention and control.
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Affiliation(s)
| | - Allan Dantas dos Santos
- Nursing Department, Federal University of Sergipe, Avenida Universitária Marcelo Deda Chagas, 330, Lagarto, SE 49.400-000 Brazil
| | - Andrezza Marques Duque
- Program in Health Sciences, Federal University of Sergipe, Brazil Cláudio Batista, s/n, Cidade Nova, Aracaju, SE 49060-108 Brazil
| | - Marco Aurélio de Oliveira Goes
- Program in Health Sciences, Federal University of Sergipe, Brazil Cláudio Batista, s/n, Cidade Nova, Aracaju, SE 49060-108 Brazil
| | - Marcus Valerius da Silva Peixoto
- Program in Health Sciences, Federal University of Sergipe, Brazil Cláudio Batista, s/n, Cidade Nova, Aracaju, SE 49060-108 Brazil
| | - Damião da Conceição Araújo
- Program in Health Sciences, Federal University of Sergipe, Brazil Cláudio Batista, s/n, Cidade Nova, Aracaju, SE 49060-108 Brazil
| | - Caíque Jordan Nunes Ribeiro
- Program in Health Sciences, Federal University of Sergipe, Brazil Cláudio Batista, s/n, Cidade Nova, Aracaju, SE 49060-108 Brazil
| | - Márcio Bezerra Santos
- Department of Health education, Federal University of Sergipe, Avenida Universitária Marcelo Deda Chagas 330, Lagarto, SE 49.400-000 Brazil
| | | | - Marco Antônio Prado Nunes
- Program in Health Sciences, Federal University of Sergipe, Brazil Cláudio Batista, s/n, Cidade Nova, Aracaju, SE 49060-108 Brazil
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MacCormack-Gelles B, Lima Neto AS, Sousa GS, Nascimento OJ, Machado MMT, Wilson ME, Castro MC. Epidemiological characteristics and determinants of dengue transmission during epidemic and non-epidemic years in Fortaleza, Brazil: 2011-2015. PLoS Negl Trop Dis 2018; 12:e0006990. [PMID: 30507968 PMCID: PMC6292645 DOI: 10.1371/journal.pntd.0006990] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 12/13/2018] [Accepted: 11/12/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND After being eliminated during the 1950s, dengue reemerged in Brazil in the 1980s. Since then, incidence of the disease has increased, as serotypes move within and between cities. The co-circulation of multiple serotypes contributes to cycles of epidemic and interepidemic years, and a seasonal pattern of transmission is observed annually. Little is known regarding possible differences in the epidemiology of dengue under epidemic and interepidemic scenarios. This study addresses this gap and aims to assess the epidemiological characteristics and determinants of epidemic and interepidemic dengue transmission, utilizing data from the 5th largest city in Brazil (Fortaleza), at fine spatial and temporal scales. METHODS/PRINCIPAL FINDINGS Longitudinal models of monthly rates of confirmed dengue cases were used to estimate the differential contribution of contextual factors to dengue transmission in Fortaleza between 2011 and 2015. Models were stratified by annual climatological schedules and periods of interepidemic and epidemic transmission, controlling for social, economic, structural, entomological, and environmental factors. Results revealed distinct seasonal patterns between interepidemic and epidemic years, with persistent transmission after June in interepidemic years. Dengue was strongly associated with violence across strata, and with poverty and irregular garbage collection during periods of low transmission, but not with other indicators of public service provision or structural deprivation. Scrapyards and sites associated with tire storage were linked to incidence differentially between seasons, with the strongest associations during transitional precipitation periods. Hierarchical clustering analysis suggests that the dengue burden concentrates in the southern periphery of the city, particularly during periods of minimal transmission. CONCLUSIONS/SIGNIFICANCE Our findings have direct programmatic implications. Vector control operations must be sustained after June even in non-epidemic years. More specifically, scrapyards and sites associated with tires (strongly associated with incidence during periods of minimal transmission), require sustained entomological surveillance, particularly during interepidemic intervals and in the urban periphery. Intersectoral collaborations that address urban violence are critical for facilitating the regular activities of vector control agents.
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Affiliation(s)
- Benjamin MacCormack-Gelles
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Antonio S. Lima Neto
- Fortaleza Municipal Health Secretariat (SMS-Fortaleza), Fortaleza, Ceará, Brazil
- University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
| | - Geziel S. Sousa
- Fortaleza Municipal Health Secretariat (SMS-Fortaleza), Fortaleza, Ceará, Brazil
| | - Osmar J. Nascimento
- Fortaleza Municipal Health Secretariat (SMS-Fortaleza), Fortaleza, Ceará, Brazil
| | | | - Mary E. Wilson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Stosic M, Vukovic D, Babic D, Antonijevic G, Foley KL, Vujcic I, Grujicic SS. Risk factors for multidrug-resistant tuberculosis among tuberculosis patients in Serbia: a case-control study. BMC Public Health 2018; 18:1114. [PMID: 30208864 PMCID: PMC6134722 DOI: 10.1186/s12889-018-6021-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/06/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Multidrug resistant (MDR) tuberculosis (TB) represents TB which is simultaneous resistant to at least rifampicin (R) and isoniazid (H). Identifying inadequate therapy as the main cause of this form of the disease and explaining the factors leading to its occurrence, numerous social determinants that affect the risk of developing resistance are highlighted. The objectives of the study was to identify independent factors of MDR-TB among tuberculosis patients. METHODS Case-control study was conducted from 1st September 2009 to 1st June 2014 in 31 healthcare institutions in Serbia where MDR-TB and TB patients were treated. TB patients infected with MDR- M. tuberculosis and non MDR- M. tuberculosis strain were considered as cases and controls, respectively. Cases and controls were matched by the date of hospitalization. The data was collected using structured questionnaire with face to face interview. Bivariate and multivariable logistic regression analysis (MLRA) were used to identify determinants associated with MDR-TB. RESULTS A total of 124 respondents, 31 cases and 93 controls were participated in the study. MLRA identified six significant independent risk factors for the occurrence of MDR-TB as follows: monthly income of the family (Odds ratio (OR) = 3.71; 95% Confidence Interval (CI) = 1.22-11.28), defaulting from treatment (OR = 3.33; 95% CI = 1.14-9.09), stigma associated with TB (OR = 2.97; 95% CI = 1.18-7.45), subjective feeling of sadness (OR = 4.05; 95% CI = 1.69-9.70), use of sedatives (OR = 2.79; 95% CI = 1.02-7.65) and chronic obstructive pulmonary disease (OR = 4.51; 95% CI = 1.07-18.96). CONCLUSION In order to reduce burden of drug resistance, strategies of controlling MDR-TB in Serbia should emphasize multi-sectorial actions, addressing health care and social needs of TB patients.
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Affiliation(s)
- Maja Stosic
- Department of HIV/AIDS, STIs, Viral Hepatitis and TB, Public Health Institute of Serbia, "Dr Milan Jovanovic Batut", Dr Subotica 5, Belgrade, 11000, Serbia
| | - Dejana Vukovic
- Institute of Social Medicine, Faculty of Medicine, Belgrade University, Dr Subotica 9, Belgrade, 11000, Serbia
| | - Dragan Babic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, Belgrade University, Dr Subotica 9, Belgrade, 11000, Serbia
| | - Gordana Antonijevic
- Special Hospital for Lung Diseases, "Ozren"Ozrenska bb, Sokobanja, 18230, Serbia
| | - Kristie L Foley
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Isidora Vujcic
- Institute of Epidemiology, Faculty of Medicine, Belgrade University, Visegradska 26, Belgrade, 11000, Serbia
| | - Sandra Sipetic Grujicic
- Institute of Epidemiology, Faculty of Medicine, Belgrade University, Visegradska 26, Belgrade, 11000, Serbia.
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Pelissari DM, Diaz-Quijano FA. Impact of alcohol disorder and the use of illicit drugs on tuberculosis treatment outcomes: a retrospective cohort study. Arch Public Health 2018; 76:45. [PMID: 30009021 PMCID: PMC6042349 DOI: 10.1186/s13690-018-0287-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol and illicit drugs are associated with the discontinuation of tuberculosis (TB) treatment and can compromise the immune system. We estimated the impact of alcohol disorder and the use of illicit drug on TB treatment outcomes, considering the interaction of both substances in patients from São Paulo state, Brazil. METHODS This is a retrospective cohort of patients diagnosed with TB from 2011 to 2015. We estimated the relative risk (RR) of an unsuccessful outcome associated with alcohol disorder, use of illicit drugs and their interaction using a multiple regression model. We used the adjusted RR to estimate the population attributable fraction. RESULTS Out of a total 77,212 TB patients, 22.2% used at least one of the substances of interest during treatment, while 17% presented an unsuccessful outcome of TB treatment. Compared with no exposure to any substance, alcohol disorder alone (adjusted RR: 1.48; 95% CI: 1.4-1.56), drug use alone (adjusted RR: 2.1; 95% CI: 1.98-2.21) and exposure to both substances (adjusted RR: 2.09; 95% CI: 1.97-2.21) were all associated with a higher risk of an unsuccessful outcome. The adjusted RR of an unsuccessful outcome for people exposed to both substances was 32.7% (95% CI: 26.8-38.2%) and 15.8% (95% CI: 11.5-20.1%) lower than expected on the multiplicative and additive scales respectively. Among all TB patients, 15.8% (95% CI: 15-16.5%) of unsuccessful outcomes was attributable to those exposures. CONCLUSIONS We identified a negative interaction between alcohol disorder and the use of illicit drugs on TB treatment outcomes. Despite this, interventions to reduce substance use in TB patients could have a meaningful contribution to preventing unsuccessful treatment outcomes.
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Affiliation(s)
- Daniele M. Pelissari
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, 01246-904 Brazil
| | - Fredi A. Diaz-Quijano
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, 01246-904 Brazil
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