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Villarreal EG, Ramos-Barrera E, Estrada-Mendizabal RJ, Treviño-Valdez PD, Tamez-Rivera O. Pediatric tuberculosis in Mexico: A retrospective analysis of 100 patients. J Clin Tuberc Other Mycobact Dis 2024; 36:100441. [PMID: 38699149 PMCID: PMC11061342 DOI: 10.1016/j.jctube.2024.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Background Analyzing the epidemiology and clinical manifestations of pediatric tuberculosis in endemic regions is crucial to meet the goal of ending tuberculosis. The objective was to assess the various clinical scenarios of tuberculosis in a large pediatric cohort in Mexico. Methods This retrospective study from a pediatric referral center in Mexico included patients diagnosed with tuberculosis from 2012 to 2021. We analyzed clinical data and diagnostic study results, including demographic characteristics, underlying medical conditions, BCG vaccination, clinical presentation, imaging findings, microbiologic data, treatment, and clinical outcomes. Basic descriptive statistics and Chi-squared analysis were performed to summarize the metadata of pediatric patients with different clinical presentations of tuberculosis and evaluate their association with mortality, respectively. Results A total of 100 patients were included with a mean age of 7.76 years ± 1.49 years. The most prevalent clinical presentation was pulmonary tuberculosis (n = 51). Only 51 patients were immunized with Bacillus Calmette-Guérin vaccine. The most commons symptoms were fever, cough and weight loss. Among patients with meningeal tuberculosis (n = 14), the most common clinical signs were seizures, fever, and vomiting. Cure was achieved in 52 patients, 12 patients died, and 36 continue in treatment. Clinical presentation of tuberculosis (p-value = 0.009) and immunodeficiency (p-value = 0.015) were significantly associated with mortality. Conclusions Increasing the visibility of tuberculosis is imperative to end this disease. We report relevant clinical data of a large pediatric tuberculosis cohort, stratified by the different forms of disease. A high index of suspicion of tuberculosis is required for a timely diagnosis and treatment initiation, particularly among immunocompromised individuals, in whom mortality is higher.
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Affiliation(s)
- Enrique G. Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Morones Prieto 3000, Monterrey, N.L. 64710, Mexico
- Department of Pediatrics, Secretaría de Salud del Gobierno del Estado de Nuevo León, Hospital Regional de Alta Especialidad Materno Infantil de Monterrey, Ave. San Rafael 450, Guadalupe, N.L. 67140, Mexico
| | - Emilia Ramos-Barrera
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Morones Prieto 3000, Monterrey, N.L. 64710, Mexico
| | - Ricardo J. Estrada-Mendizabal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Morones Prieto 3000, Monterrey, N.L. 64710, Mexico
| | - Pablo D. Treviño-Valdez
- Department of Pediatrics, Secretaría de Salud del Gobierno del Estado de Nuevo León, Hospital Regional de Alta Especialidad Materno Infantil de Monterrey, Ave. San Rafael 450, Guadalupe, N.L. 67140, Mexico
| | - Oscar Tamez-Rivera
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Morones Prieto 3000, Monterrey, N.L. 64710, Mexico
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Ksoo R, Barman H, De M, Lynser D, Duwarah SG, Lyngdoh C. Clinical Profile of Pediatric Tuberculosis in a Tertiary Hospital in Northeast India: A Retrospective Analysis. Cureus 2023; 15:e38660. [PMID: 37288235 PMCID: PMC10243406 DOI: 10.7759/cureus.38660] [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] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
Context Tuberculosis (TB) is India's major public health problem. The profile of childhood TB in the northeast region of India is still limited. Aim To analyze the clinical, radiological, and bacteriological profiles of children with TB at a tertiary health care facility. Materials and methods A three years retrospective descriptive analysis of children admitted to a tertiary centre with TB before the introduction of cartridge-based nucleic acid amplification test (CBNAAT) for testing. Children below 18 years who were admitted from 2012 to 2014 and were diagnosed with TB were included. Relevant data were extracted in a predesigned format and entered into a Microsoft Excel sheet. Descriptive statistic was used for analysis. The results of variables are given in proportions and means and a Chi-square test was done for the test of significance using Epi-info tools. The study was done after getting ethical approval from the institute. Results A total of 150 children were included in the analysis with a Male: Female ratio of 1.1:1. A majority of the cases were under five years (n=46) and 11 to 15 years old (n=45) with a mean age of 9.3 ± 4.4 years. Fever was a common presentation (70%). Disseminated TB was seen in 31.3%, isolated central nervous system (CNS) TB was found in 30.6%, and all CNS TB with dissemination was found in 46 cases (40.7%) making extra-pulmonary TB a common finding in our study (83.3%). Isolated pulmonary TB was seen in 16.7% and total pulmonary cases along with dissemination was seen in 60 cases (40%). A bacteriological diagnosis was made in 23%. Overall mortality was 9.3%, out of which mortality in CNS TB was 13% with a p-value of 0.004 as compared to mortality other than CNS TB which was significant and mortality in under-five years was significant with a p-value of 0.001. Conclusions Pulmonary and extra-pulmonary were both causes of admission in the pediatric age group. We found that extra-pulmonary TB was the most common cause of admission in children, with CNS manifestation and disseminated TB, being the most common presentations and significant mortality was seen in under-five years and in children diagnosed with CNS TB.
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Affiliation(s)
- Rosina Ksoo
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Himesh Barman
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Manisha De
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Donboklang Lynser
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Sourabh G Duwarah
- Paediatrics and Neonatology, Akanksha and Ayursundra Hospital, Guwahati, IND
| | - Clarissa Lyngdoh
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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da Costa FBP, Ramos ACV, Berra TZ, Alves YM, Silva RVDS, Crispim JDA, dos Santos MS, Nanque AR, Teibo TKA, Arcêncio RA. Spatial Distribution and Temporal Trend of Childhood Tuberculosis in Brazil. Trop Med Infect Dis 2022; 8:tropicalmed8010012. [PMID: 36668919 PMCID: PMC9865747 DOI: 10.3390/tropicalmed8010012] [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: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Tuberculosis (TB) in children presents specificities in its diagnosis, which makes it prone to underreporting: therefore, the disease in this group is still a serious public health problem in several countries. We aimed to analyze the spatial distribution and temporal trend of childhood TB in Brazil. An ecological study with time series, spatial analysis, and description of cases in Brazil between 2010-2021 was conducted. A total of 1,054,263 TB cases were reported in the period, with 30,001 (2.8%) in children. The yearly average was 2,500 cases, with a trend toward an increase in the incidence rate in 2018 and 2019 and a decline in 2020. Children under 5 years old represented 38.2% of cases, 5.2% were indigenous, and 424 children (1.4%) died. Sputum culture was performed for 18.4% of pulmonary TB. The incidence rates were higher in municipalities in the north and midwest regions, with high occurrence locations (hot spots), especially on borders with other countries. There was a reduction in childhood TB in 2020, possibly related to the COVID-19 pandemic. Strategies are needed for the identification and monitoring of childhood TB, with reinforcement of professional training for assistance and control, especially in the most vulnerable locations and groups.
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Mendes MDS, Oliveira ALSD, Pimentel LMLM, Figueiredo TMRMD, Schindler HC. Spatial analysis of tuberculosis in children under 15 years of age and socioeconomic risk: an ecological study in Paraíba, Brazil, 2007-2016. ACTA ACUST UNITED AC 2021; 30:e20201038. [PMID: 34378653 DOI: 10.1590/s1679-49742021000300006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/05/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze spatial distribution of tuberculosis in individuals under 15 years old and socioeconomic factors in Paraíba, Brazil, 2007-2016. METHODS This was an ecological study based on data from the Notifiable Health Conditions Information System (SINAN), taking each municipality to be a unit of analysis. Spatial distribution of incidence was performed, the local empirical Bayesian method and Moran's I were applied. Socioeconomic data were crossed-checked to identify areas of social prosperity. RESULTS 426 cases were notified, with average incidence of 4.5/100,000 inhabitants. Moran's I was 0.59 (p=0.010). The Moran Map revealed concentration of cases in children under 15 in 38 high priority municipalities, in clusters with high-high and low-low patterns, in the east and northwest of the state, coinciding with areas of low social prosperity. CONCLUSION There were clusters with greater tuberculosis transmission, indicating priority areas for addressing tuberculosis.
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Berra TZ, Bruce ATI, Alves YM, Ramos ACV, Giacomet CL, Arcêncio RA. Impact of the GeneXpert® MTB/RIF rapid molecular test on tuberculosis detection: temporal trends and vulnerable territories. Rev Lat Am Enfermagem 2021; 29:e3441. [PMID: 34287540 PMCID: PMC8294793 DOI: 10.1590/1518.8345.4412.3441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE to assess the impact of the GeneXpert® MTB/RIF rapid molecular test on tuberculosis detection, to analyze the temporal trend of the event and to identify vulnerable territories in a Brazilian municipality. METHOD an ecological study carried out in Ribeirão Preto, São Paulo, Brazil, a municipality considered a priority in tuberculosis control due to the high number of cases. To classify the temporal trend, the Prais-Winsten method and the Interrupted Time Series were used to identify changes in the disease incidence. Kernel intensity analysis was applied to identify vulnerable areas. RESULTS the temporal trend of tuberculosis decreased by 18.1%/year and by 6.9%/year for children under 15 years old. The North District decreased by 6.67%/year and the East District increased by 17.5%/year in the incidence of tuberculosis. Resistant tuberculosis, after the implementation of the Rapid Molecular Test, increased by 0.6% per year. The South and West Districts showed a higher density of cases, with a range from 45 to 79 tuberculosis cases per square kilometer (km2). CONCLUSION although resistant tuberculosis is not a problem in the scenario, the study showed an increase in its incidence, which puts it on alert. The use of spatial analysis enabled the identification of priority areas, putting them in evidence for health surveillance actions.
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Affiliation(s)
- Thaís Zamboni Berra
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Fundação de Amparo à Pesquisa do Estado de
São Paulo (FAPESP), Brazil
| | - Alexandre Tadashi Inomata Bruce
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq), Brazil
| | - Yan Mathias Alves
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
| | - Antônio Carlos Vieira Ramos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
| | - Clóvis Luciano Giacomet
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
| | - Ricardo Alexandre Arcêncio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
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Childhood tuberculosis in a reference children's hospital after admission of refugees. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.848937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kunciw SE, de la Cruz EC. Incidental Finding of Tuberculosis During Evaluation for Delayed Wound Healing. Mil Med 2021; 186:e457-e460. [PMID: 33007072 DOI: 10.1093/milmed/usaa366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/10/2020] [Accepted: 09/10/2020] [Indexed: 11/14/2022] Open
Abstract
Cutaneous tuberculosis (TB) is an uncommon form of extrapulmonary TB that can be difficult to diagnose. The following case is about a 14-year-old female who was experiencing delayed wound healing after an incision and drainage of a chest wall abscess. A computed tomography scan of her chest obtained 2 months after the procedure revealed pulmonary findings consistent with TB. An acid-fast bacilli culture was obtained from the wound after the computed tomography scan was performed and was positive for Mycobacterium tuberculosis 8 weeks later. Although TB is relatively uncommon in the United States, it is more prevalent in the Republic of Korea where the patient lives and was evaluated. This case serves to illustrate the long history of challenges the military medical community has faced with TB and to remind providers to be cognizant about local common diseases when serving overseas and include these diagnoses in their differentials.
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Affiliation(s)
- Sabrina E Kunciw
- Department of Family Medicine and Department of Surgery, Brian D. Allgood Army Community Hospital, U.S. Army Garrison Humphreys, 549th Hospital Center Unit #15245, APO, AP, 96271-5245, South Korea
| | - Eric C de la Cruz
- Department of Family Medicine and Department of Surgery, Brian D. Allgood Army Community Hospital, U.S. Army Garrison Humphreys, 549th Hospital Center Unit #15245, APO, AP, 96271-5245, South Korea
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ETİZ P, ALTUNSU AT. Pediatrik pulmoner tüberküloz olgularının epidemiyolojik özellikleri ve tedavi sonuçları. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.780991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Alves YM, Berra TZ, Alves LS, de Assis IS, Arcoverde MAM, Ramos ACV, Arroyo LH, Campoy LT, Bruce ATI, Dos Santos FL, Souza LLL, de Almeida Crispim J, Arcêncio RA. Risk areas for tuberculosis among children and their inequalities in a city from Southeast Brazil. BMC Pediatr 2020; 20:462. [PMID: 33023517 PMCID: PMC7541251 DOI: 10.1186/s12887-020-02364-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
Background The objective of the study was to identify areas of risk for the appearance of tuberculosis in children and their association with social inequalities in a municipality in southeastern Brazil. Methods Ecological study conducted in Ribeirão Preto, Brazil. To identify areas of spatial risk for tuberculosis in children, we used spatial scanning statistics. To analyze the association of cases of childhood tuberculosis with social vulnerability, we used the Social Vulnerability Index of São Paulo, and four explanatory statistical models were listed. Results There were 96 cases of childhood tuberculosis, of which 90 were geocoded through a process of converting addresses to geographic coordinates. A risk area was identified in the municipality, where children under 15 years old have 3.14 times greater risk of contracting tuberculosis than those living outside this area. The variables identified as risk factors were: number of private and collective households, proportion of children aged 0 to 5 years in the population, proportion of households without per capita income, and the proportion of private households with monthly nominal incomes of up to one quarter of wage minimums. The variables identified as protection factors were the proportion of women under the age of 30 years responsible for the household under and women responsible for the household with an average income over BRL 2344. Conclusion The study showed areas of risk for the occurrence of tuberculosis in children. The study is in line with the End TB Strategy and the 2030 Agenda, which aim to support strategic actions and, therefore, save the lives of children through the systematic, intensified, and comprehensive identification of children with tuberculosis respiratory symptoms in the community.
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Affiliation(s)
- Yan Mathias Alves
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil.
| | - Thaís Zamboni Berra
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Luana Seles Alves
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | | | | | - Antonio Carlos Vieira Ramos
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Luiz Henrique Arroyo
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Laura Terenciani Campoy
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Alexandre Tadashi Inomata Bruce
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Felipe Lima Dos Santos
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Ludmilla Leidianne Limirio Souza
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Juliane de Almeida Crispim
- Inter-institutional Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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André SR, Nogueira LMV, Rodrigues ILA, Cunha TND, Palha PF, Santos CBD. Tuberculosis associated with the living conditions in an endemic municipality in the North of Brazil. Rev Lat Am Enfermagem 2020; 28:e3343. [PMID: 32876291 PMCID: PMC7458573 DOI: 10.1590/1518-8345.3223.3343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/29/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: to analyze the association between the occurrence of new tuberculosis cases and the Adapted Living Condition Index, and to describe the spatial distribution in an endemic municipality. Method: this is an analytical and ecological study that was developed from new cases in residents of an endemic municipality in the North Region of Brazil. The data were obtained from the Notifiable Diseases Information System and from the 2010 Demographic Census. The Adapted Living Conditions Index was obtained by factor analysis and its association with the occurrence of the disease was analyzed by means of the chi-square test. The type I error was set at 0.05. Kernel estimation was used to describe the density of tuberculosis in each census sector. Results: the incidence coefficient was 97.5/100,000 inhabitants. The data showed a statistically significant association between the number of cases and socioeconomic class, with the fact that belonging to the highest economic class reduces the chance of the disease occurring. The thematic maps showed that tuberculosis was distributed in a heterogeneous way with a concentration in the Southern region of the municipality. Conclusion: tuberculosis, associated with precarious living conditions, reinforces the importance of discussion on social determinants in the health-disease process to subsidize equitable health actions in risk areas, upon a context of vulnerability.
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Affiliation(s)
- Suzana Rosa André
- Departamento de Enfermagem Comunitária, Escola da Enfermagem Magalhães Barata, Universidade do Estado do Pará, Belém, PA, Brazil
| | - Laura Maria Vidal Nogueira
- Departamento de Enfermagem Comunitária, Escola da Enfermagem Magalhães Barata, Universidade do Estado do Pará, Belém, PA, Brazil
| | - Ivaneide Leal Ataíde Rodrigues
- Departamento de Enfermagem Comunitária, Escola da Enfermagem Magalhães Barata, Universidade do Estado do Pará, Belém, PA, Brazil
| | - Tarcísio Neves da Cunha
- Programa Nacional de Cooperação Acadêmica da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), MICROARS Consultoria e Projetos, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Fredemir Palha
- PAHO/WHO Collaborating Centre at Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Claudia Benedita Dos Santos
- PAHO/WHO Collaborating Centre at Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Berra TZ, Assis ISD, Arroyo LH, Arcoverde MAM, Alves JD, Campoy LT, Alves LS, Crispim JDA, Bruce ATI, Alves YM, Lima Dos Santos F, da Costa Uchôa SA, Fiorati RC, Lapão L, Arcêncio RA. Social determinants of deaths from pneumonia and tuberculosis in children in Brazil: an ecological study. BMJ Open 2020; 10:e034074. [PMID: 32819980 PMCID: PMC7443304 DOI: 10.1136/bmjopen-2019-034074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants. METHODS Ecological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil's electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified. RESULTS A total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Família Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25). CONCLUSIONS The results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.
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Affiliation(s)
- Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | | | - Luiz Henrique Arroyo
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | | | - Josilene Dália Alves
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Laura Terenciani Campoy
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Luana Seles Alves
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | | | | | - Yan Mathias Alves
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Felipe Lima Dos Santos
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | | | - Regina Celia Fiorati
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Luis Lapão
- International Public Health and Biostatistics, Universidade Nova de Lisboa, Lisboa, Portugal
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Santos BA, Cruz RPDS, Lima SVMA, Santos ADD, Duque AM, Araújo KCGMD, Nunes MAP. [Tuberculosis among children and adolescents: an epidemiological and spatial analysis in the state of Sergipe, Brazil, 2001-2017]. CIENCIA & SAUDE COLETIVA 2020; 25:2939-2948. [PMID: 32785531 DOI: 10.1590/1413-81232020258.25692018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/30/2018] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis continues to be of the most frequent diseases in the world and one of the main causes of morbidity and mortality. Data from the World Health Organization indicate that Brazil accounts for 75% of global cases involving children. The study aims to analyze the epidemiological and spatial pattern of tuberculosis in children and adolescents in the state of Sergipe during the period from 2001 to 2017. This is an ecological, temporal series study using secondary data. The categorical variables were summarized in simple and absolute frequency. In the spatial analysis the Bayesian method for rate smoothing and the Moran index were used to evaluate spatial autocorrelation. Trend analysis was performed using the Joinpoint regression model. The mean incidence rate was 5.9, with a predominance of 15 to 19 years of age (76.4%) and a steady trend, but with a positive annual variation in both sexes. Tuberculosis in children and adolescents has significant spatial dependence in the north and northeast regions. The knowledge of the epidemiological situation of tuberculosis over the years provides subsidies for the targeting of resources in risk areas and new strategies for prevention and control of the disease among children and adolescents.
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Affiliation(s)
- Beatriz Almeida Santos
- Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem, Universidade Federal de Sergipe. Av. Governador Marcelo Deda, Centro. 49400-000 Lagarto SE Brasil.
| | - Rosieli Pereira Dos Santos Cruz
- Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem, Universidade Federal de Sergipe. Av. Governador Marcelo Deda, Centro. 49400-000 Lagarto SE Brasil.
| | - Shirley Verônica Melo Almeida Lima
- Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem, Universidade Federal de Sergipe. Av. Governador Marcelo Deda, Centro. 49400-000 Lagarto SE Brasil.
| | - Allan Dantas Dos Santos
- Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem, Universidade Federal de Sergipe. Av. Governador Marcelo Deda, Centro. 49400-000 Lagarto SE Brasil.
| | - Andrezza Marques Duque
- Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem, Universidade Federal de Sergipe. Av. Governador Marcelo Deda, Centro. 49400-000 Lagarto SE Brasil.
| | - Karina Conceição Gomes Machado de Araújo
- Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem, Universidade Federal de Sergipe. Av. Governador Marcelo Deda, Centro. 49400-000 Lagarto SE Brasil.
| | - Marco Antônio Prado Nunes
- Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem, Universidade Federal de Sergipe. Av. Governador Marcelo Deda, Centro. 49400-000 Lagarto SE Brasil.
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Gupta N, Kashyap B, Dewan P, Hyanki P, Singh NP. Clinical Spectrum of Pediatric Tuberculosis: A Microbiological Correlation from a Tertiary Care Center. J Trop Pediatr 2019; 65:130-138. [PMID: 29846733 DOI: 10.1093/tropej/fmy026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM AND OBJECTIVES The paucibacillary nature of pediatric tuberculosis (TB) makes diagnosis difficult. The aim of the study was to correlate the clinical spectrum of pediatric TB with microbiological diagnosis. MATERIALS AND METHODS Specimens from clinically suspected pediatric TB cases were subjected to Ziehl-Neelsen staining, culture on Lowenstein-Jensen medium and cartridge-based nucleic acid amplification test (CB-NAAT) for TB. RESULTS Pulmonary TB was the predominant form affecting 36 of 62 (58%) patients. Tubercular meningitis was the commonest form of extrapulmonary type and affected 13 of 26 (50%) children. Microbiological diagnosis by any of the above methods could be established in 35 (56.45%) cases. While 33 of 36 (92%) patients diagnosed with pulmonary TB had radiological findings, of which only 25 (76%) could be microbiologically confirmed, only 24 of 31 (77%) patients with extrapulmonary symptoms had radiological evidence and microbiological confirmation could be achieved in 4 (17%) of these. CONCLUSION An integrated approach of diagnosis, including clinical-radiological, microbiological and immunological evidence should be stressed on.
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Affiliation(s)
- Neha Gupta
- Department of microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, Delhi, India
| | - Bineeta Kashyap
- Department of microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, Delhi, India
| | - Pooja Dewan
- Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, Delhi, India
| | - Puneeta Hyanki
- CMO I/C DOTS Center, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, Delhi, India
| | - N P Singh
- Department of microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, Delhi, India
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