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Sindato EM, Mlwati A, Swai SS, Kajogoo VD. Postmortem for Intensified Missed Tuberculosis Case Finding in High Human Immunodeficiency Virus and Tuberculosis-burdened Settings in Sub-Saharan Africa among Adults' Population: Systematic Review and Meta-analysis. Int J Mycobacteriol 2024; 13:126-132. [PMID: 38916381 DOI: 10.4103/ijmy.ijmy_41_24] [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: 03/04/2024] [Accepted: 05/18/2024] [Indexed: 06/26/2024] Open
Abstract
Tuberculosis (TB) is the leading infectious cause of mortality in sub-Saharan Africa (SSA); the high prevalence of TB in this region is due to human immunodeficiency virus (HIV)-coinfection. Despite the advent of modalities to diagnose TB, undiagnosed TB-related deaths among HIV-infected patients remain significantly high. This systematic review aims at characterizing missed TB cases from postmortem studies. This review informs on the burden of TB missed diagnosis and highlights the need of improving TB case-finding strategies, especially among the high-risk groups and early TB therapy initiation to keeping in with the World Health Organization's end TB strategy. We searched PubMed, Cochrane, Web of Science, and African journals online for studies that looked into missed TB cases following postmortem using the following key terms: postmortem, TB diagnosis, and HIV; we included cross-sectional and cohorts from 1980 in the English language that were carried out in SSA among adults' population. Authors used the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for reporting, the quality of the included studies was assessed using the Newcastle-Ottawa Scale for observational studies, and STATA 17.0 software was used for analysis. This study was registered in the International Prospective Register of Systematic Reviews with registration number CRD42024507515. The combined prevalence of postmortem missed TB diagnosis among the 6025 participants was 27.13% (95% confidence interval [CI] =14.52-41.89), with a high level of heterogeneity at 98.65% (P < 0.001). The prevalence varied significantly across the included studies, ranging from 1.21% (95% CI = 0.93-1.59) in the general population to 66.67% (95% CI = 50.98-79.37) in people living with HIV (PLWHIV). This current literature suggests that SSA is a region with a high prevalence of missed TB cases but with significant variations between countries. In addition, this study confirms a high number of missed TB infections within the PLWHIV. These results highlight the immediate need for targeted screening and diagnosis strategies and relevant policies.
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Affiliation(s)
- Emmanuel M Sindato
- Department of Internal Medicine, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
| | - Abdallah Mlwati
- Department of Internal Medicine, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
- Department of Chest Diseases, Alexandria University, Egypt
| | - Sylivia Sarah Swai
- Department of Demand Planning, Global Health Supply Chain-Technical Assistance Project, Dar-es-Salaam, Tanzania
| | - Violet Dismas Kajogoo
- Department of Clinical Trials, Tanzania Diabetes Association, Dar-es-Salaam, Tanzania
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Abraham Y, Manyazewal T, Amdemariam Z, Petros H, Ayenadis F, Mekonen H, Workneh F. Facilitators and barriers to implementing chest radiography in tuberculosis systematic screening of clinically high-risk groups in Ethiopia: A qualitative study. SAGE Open Med 2024; 12:20503121241233232. [PMID: 38379811 PMCID: PMC10878208 DOI: 10.1177/20503121241233232] [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: 08/05/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Background Chest X-ray has been included in national tuberculosis screening algorithms as a sensitive tuberculosis screening tool among high-risk groups. However, the implementation was influenced by multiple factors. We aimed to explore facilitators and barriers to implementing chest X-ray in systematic tuberculosis screening of clinically high-risk groups in Addis Ababa, Ethiopia. Methods We conducted face-to-face, in-depth interviews with purposively selected participants at tertiary-level hospitals and a tuberculosis program coordinator at the Ethiopian Ministry of Health, who coordinates chest X-ray-guided systematic tuberculosis screening. A framework analysis was conducted using the consolidated framework for implementation research. Results We identified 11 constructs that influenced the implementation of the chest X-ray intervention. Facilitators included the relative sensitivity of chest X-ray over symptom-based screening, its potential integration into existing systems, technological advancements in the area, policies and laws supporting the screening intervention, and the quality of the evidence of the screening intervention. Barriers included implementation complexity, high costs of the intervention, knowledge gaps among healthcare providers, training gaps, low priority for chest X-ray screening at the healthcare facility level, and a lack of external support from the Ministry of Health and stakeholders. Conclusion This study identified contextual factors that influence the implementation of chest X-ray guided systematic tuberculosis screening among clinically high-risk groups that healthcare facilities and health ministries may use for decision-making. Addressing the barriers identified by the study would help to improve the implementation of chest X-rays for improved tuberculosis case detection and prompt treatment in clinically high-risk groups.
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Affiliation(s)
- Yishak Abraham
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Hezkiel Petros
- International Center for AIDS Care and Treatment Programs, Addis Ababa, Ethiopia
| | - Firehiwot Ayenadis
- Addis Ababa Burn, Emergency, and Trauma Hospital, St. Paul’s Hospital Millennium Medical Collage, Addis Ababa, Ethiopia
| | - Hana Mekonen
- Zewditu Memorial Hospital, Addis Ababa, Ethiopia
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Usmael K, Manyazewal T, Mohammed H, Yimer G, Oljira L, Roba KT, Hailemariam T, Adjeme T, Tesfaye D, Bisrat H, Ngadaya E, Woldeamanuel Y. Patterns of childhood tuberculosis diagnosis in Ethiopia: A multicenter cross-sectional study. RESEARCH SQUARE 2023:rs.3.rs-3758745. [PMID: 38234744 PMCID: PMC10793511 DOI: 10.21203/rs.3.rs-3758745/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Children share 12% of the global 10 million people infected with tuberculosis (TB) each year. Closing case detection gap in children remains difficult, with 56% of all children and 65% under-five with TB missed each year. We aimed to assess the patterns of childhood TB diagnosis and underlying determinants in Ethiopia when different TB diagnostic platforms are applied. Methods A multi-site, cross-sectional study was carried out in Ethiopia as part of the larger EXIT-TB study - evidence-based multiple focused integrated intensified TB screening package. Outpatient children aged ≤ 15 with cough of any duration seeking care at four healthcare facilities in Ethiopia were enrolled consecutively. Participants underwent sputum Xpert MTB/RIF and/or smear microscopy and posteroanterior chest X-ray (CXR), and their clinical and sociodemographic data were captured using a structured questionnaire. Data were analyzed using Stata version 23. Multiple regression model was computed to determine the factors that influence TB case detection, with a 95% confidence interval (CI) and p < 0.05 taken as statistically significant. Results A total of 438 children were enrolled. Of these, 399 had CXR examination of which 55 (13.8%) were suggestive of TB, 270 had Xpert MTB/RIF testing of which 32 (11.9%) were positive, and AFB smear microscopy was done for 51 children of which 2 (3.9%) were positive. Febrile children were more likely to be diagnosed with pulmonary TB than those without fever [aPR = 1.3, 95% CI (1.1-1.4)], and those with a TB contact history were more likely to be diagnosed with pulmonary TB than those with no such contacts [aPR = 1.2, 95% CI (1.1-1.3)]. Children from rural residences were more likely to be diagnosed with TB than those from urban residences [aPR = 1.3, 95% CI (1.1-1.5)]. Conclusion The findings showed that clinical diagnosis remains an important method of TB diagnosis in children and the preferred choice to avert underdiagnosis. A more sensitive TB diagnostic method for children was symptom screening, followed by CXR and Xpert MTB/RIF assay or smear microscopy. Hence, an algorithm that combines clinical, CXR, and microbiological confirmatory tests can improve the rate of pulmonary TB diagnosis in children till more accurate and cost-effective diagnostic tools are accessible. Fever, weight loss, and TB contact history are highly associated with TB positivity rates in children.
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Hailemariam T, Yimer G, Mohammed H, Bisrat H, Ajeme T, Belina M, Oljira L, Roba KT, Belay F, Andrias T, Ngadaya E, Manyazewal T. Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study. J Clin Tuberc Other Mycobact Dis 2023; 32:100383. [PMID: 37389013 PMCID: PMC10302112 DOI: 10.1016/j.jctube.2023.100383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Background Tuberculosis (TB) prevalence is increasing among women of reproductive age (WRA) in sub-Saharan Africa, yet undiagnosed and untreated cases remain rather high with serious health and socio-economic consequences. We aimed to assess the prevalence and predictors of TB in WRA seeking health care for acute respiratory symptoms. Methods We consecutively enrolled outpatient WRA with acute respiratory symptoms seeking care at four healthcare facilities in Ethiopia between July 2019 and December 2020. Data on sociodemographic characteristics and clinical information were collected using a structured questionnaire administered by trained nurses. Posteroanterior chest X-ray was performed in non-pregnant WRA and interpreted independently by two radiologists. Sputum samples were collected from all patients and tested for pulmonary TB using Xpert MTB/RIF and/or smear microscopy. Predictors of bacteriologically confirmed TB cases were determined using binary logistic regression, with clinically relevant variables included in the final Firth's multivariate-penalized logistic regression model. Results We enrolled 577 participants, of whom 95 (16%) were pregnant, 67 (12%) were living with HIV, 512 (89%) had cough of less than 2 weeks, and 56 (12%) had chest-x-ray findings suggestive of TB. The Overall prevalence of TB was 3% (95% CI: 1.8%-4.7%) with no significant difference observed between patient groups categorized by duration of cough or HIV serostatus (P-value = 0.9999). In multivariable analysis, TB-suggestive CXR abnormality (AOR 18.83 [95% CI, 6.20-57.18]) and history of weight loss (AOR 3.91 [95% CI, 1.25-12.29]) were associated with bacteriologically-confirmed TB cases. Conclusions We found a high TB prevalence among low-risk women of reproductive age with acute respiratory symptoms. Routine CXR may improve early case detection and thereby TB treatment outcomes.
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Affiliation(s)
- Tesfahunegn Hailemariam
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Center for Global Genomics and Health Equity, Department of Genetics, Perelman School of Medicine, University of Pennsylvania, USA
| | - Hussen Mohammed
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Haileleul Bisrat
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Tigist Ajeme
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Merga Belina
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekadu Belay
- Wachemo University, College of Medicine and Health Sciences, Department of Pediatrics and Child Health, Hossana, Ethiopia
| | | | - Esther Ngadaya
- National Institute for Medical Research, Muhimbili Research Centre, Dar es Saalam, Tanzania
| | - Tsegahun Manyazewal
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
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Madybaeva D, Duishekeeva A, Meteliuk A, Kulzhabaeva A, Kadyrov A, Shumskaia N, Kumar AMV. "Together against Tuberculosis": Cascade of Care of Patients Referred by the Private Health Care Providers in the Kyrgyz Republic. Trop Med Infect Dis 2023; 8:316. [PMID: 37368734 PMCID: PMC10304244 DOI: 10.3390/tropicalmed8060316] [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: 05/11/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Until 2021, in the Kyrgyz Republic, tuberculosis (TB) was diagnosed and treated only in the public sector. With funding support of the STOP-TB partnership, the private providers in four regions of the country and Bishkek city were mapped, trained and incentivized to screen for and identify presumptive TB patients and refer them to the public facilities for diagnosis and treatment. In this study, we describe the cascade of care of such patients. This was a cohort study involving secondary analysis of routine data. Of 79,352 patients screened during February 2021-March 2022, 2511 (3%) had presumptive TB, of whom 903 (36%) were not tested for TB [pre-diagnostic loss to follow-up]. A total of 323 (13%) patients were diagnosed with TB, of whom, 42 (13%) were not started on treatment [pre-treatment loss to follow-up]. Among 257 patients eligible for outcome assessment, 197 (77%) had treatment success, 29 (11%) were lost-to-follow-up, 13 (5%) died, 4 (2%) had treatment failure and 14 (5%) were not evaluated. While this donor-funded, pioneering initiative was successful in engaging the private sector, we recommend that the national TB programme scales up the initiative nationally with dedicated budgets, activities and plans to monitor progress. Qualitative research is urgently needed to understand the reasons for the gaps in the care cascade.
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Affiliation(s)
- Dinara Madybaeva
- Public Foundation “AFEW KG”, 14 JalArtis, 103, Bishkek 720047, Kyrgyzstan;
| | - Aiymgul Duishekeeva
- Public Foundation “KNCV KG”, 121 Dzhantoshev St., Bishkek 720020, Kyrgyzstan; (A.D.); (A.K.)
- Department of Phthisiology, Kyrgyz State Medical Academy, 92 Akhunbaev St., Bishkek 720020, Kyrgyzstan
| | - Anna Meteliuk
- International Charitable Foundation Alliance for Public Health, 03150 Kyiv, Ukraine;
| | - Aizat Kulzhabaeva
- Public Foundation “KNCV KG”, 121 Dzhantoshev St., Bishkek 720020, Kyrgyzstan; (A.D.); (A.K.)
- Department of Public Health, Kyrgyz State Medical Academy, 92 Akhunbaev St., Bishkek 720020, Kyrgyzstan
| | - Abdullaat Kadyrov
- National Center for Phthisiology of MoH Kyrgyzstan, Ahunbaev St., 90a, Bishkek 720064, Kyrgyzstan;
| | - Natalia Shumskaia
- Public Foundation “AFEW KG”, 14 JalArtis, 103, Bishkek 720047, Kyrgyzstan;
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France;
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Karnataka, Mangalore 575018, India
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Lokhande L, Malhotra AG, Vishwakarma SP, Shankar P, Singh J, Khurana AK, Maurya AK, Singh S. Diagnosis of tuberculous pleural effusion in a tertiary care hospital of central India: The role of xpert Mycobacterium tuberculosis/rifampicin. Int J Mycobacteriol 2023; 12:162-167. [PMID: 37338478 DOI: 10.4103/ijmy.ijmy_96_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Background In India, 15%-20% of tuberculosis (TB) cases are categorized as extra-pulmonary TB, and tuberculous pleural effusion (TPE) is the second-most common type after tuberculous lymphadenitis. However, the paucibacillary nature of TPE makes its diagnosis challenging. As a result, relying on empirical anti-TB treatment (ATT) based on clinical diagnosis becomes necessary for achieving the best possible diagnostic outcome. The study aims to determine the diagnostic utility of Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) for the detection of TB in TPE in high incidence setting of Central India. Methods The study enrolled 321 patients who had exudative pleural effusion detected through radiological testing and were suspected of having TB. The medical procedure of thoracentesis was conducted to collect the pleural fluid, which was then subjected to both the Ziehl-Neelsen staining and Xpert MTB/RIF test. The patients who showed improvement after receiving anti-tuberculosis treatment (ATT) were considered the composite reference standard. Results The sensitivity of smear microscopy was found to be 10.19%, while that of the Xpert MTB/RIF method was 25.93% when compared to the composite reference standard. The accuracy of clinical diagnosis was measured using receiver operating characteristics based on clinical symptoms, and it was found to be 0.858 (area under the curve). Conclusions The study shows that Xpert MTB/RIF has significant value in diagnosing TPE, despite its low sensitivity of 25.93%. Clinical diagnosis based on symptoms was relatively accurate, but relying on symptoms alone is not enough. Using multiple diagnostic tools, including Xpert MTB/RIF, is crucial for accurate diagnosis. Xpert MTB/RIF has excellent specificity and can detect RIF resistance. Its quick results make it useful in situations where a rapid diagnosis is necessary. While it should not be the only diagnostic tool, it has a valuable role in diagnosing TPE.
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Affiliation(s)
- Leena Lokhande
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anvita Gupta Malhotra
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Prem Shankar
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Jitendra Singh
- Department of Translational Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Alkesh K Khurana
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anand Kumar Maurya
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sarman Singh
- Department of Microbiology, All India Institute of Medical Sciences; MEDSER, Indian Institute of Science Education and Research, Bhopal, Madhya Pradesh, India
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Lee I, Kang S, Chin B, Joh JS, Jeong I, Kim J, Kim J, Lee JY. Predictive Factors and Clinical Impacts of Delayed Isolation of Tuberculosis during Hospital Admission. J Clin Med 2023; 12:jcm12041361. [PMID: 36835896 PMCID: PMC9966369 DOI: 10.3390/jcm12041361] [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: 01/05/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Delayed isolation of tuberculosis (TB) can cause unexpected exposure of healthcare workers (HCWs). This study identified the predictive factors and clinical impact of delayed isolation. We retrospectively reviewed the electronic medical records of index patients and HCWs who underwent contact investigation after TB exposure during hospitalization at the National Medical Center, between January 2018 and July 2021. Among the 25 index patients, 23 (92.0%) were diagnosed with TB based on the molecular assay, and 18 (72.0%) had a negative acid-fast bacilli smear. Sixteen (64.0%) patients were hospitalized via the emergency room, and 18 (72.0%) were admitted to a non-pulmonology/infectious disease department. According to the patterns of delayed isolation, patients were classified into five categories. Among 157 close-contact events in 125 HCWs, 75 (47.8%) occurred in Category A. Twenty-five (20%) HCWs had multiple TB exposures (n = 57 events), of whom 37 (64.9%) belonged to Category A (missed during emergency situations). After contact tracing, latent TB infection was diagnosed in one (1.2%) HCW in Category A, who was exposed during intubation. Delayed isolation and TB exposure mostly occurred during pre-admission in emergency situations. Effective TB screening and infection control are necessary to protect HCWs, especially those who routinely contact new patients in high-risk departments.
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Affiliation(s)
- Inhan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Soyoung Kang
- Department of Infection Control and Prevention, National Medical Center, Seoul 04564, Republic of Korea
| | - Bumsik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Joon-Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Ina Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Junghyun Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea
| | - Joohae Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
| | - Ji Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea
- Correspondence:
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Jiang Y, Luo L, Gui M, Liu L, Lin Y, Deng G, Chen J, Zhang P. Duration and Determinants of Delayed Diagnosis with Tuberculosis in Shenzhen, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2022; 15:1473-1481. [PMID: 35937967 PMCID: PMC9346302 DOI: 10.2147/rmhp.s367998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Early diagnosis and timely treatment of tuberculosis are critical for disease control and management. However, diagnostic delay remains severe around the world. We aim to evaluate the duration and factors associated with diagnostic delay of tuberculosis in Shenzhen, China. Methods We conducted a face-to-face interview to collect the whole care-seeking process of patients diagnosed with active TB in Shenzhen, China, from April 1 to September 30, 2021. The duration from symptom onset to confirmed diagnosis was recorded. The risk factors of diagnostic delay were identified by binary stepwise logistic regression analysis. Results Among 288 confirmed TB cases, 170 (59.0%) were delayed diagnosis. The median diagnostic delay was 39.5 days. Median patient delay was 23 days and health system delay was 7 days. Income ≤315USD/month (OR = 2.97 [95% CI: 1.15–7.69]), cough (OR = 3.00 [95% CI: 1.16–7.76]), weight loss (OR = 15.59 [95% CI: 1.85–131.56]), use of traditional Chinese Medicine (OR = 5.03 [95% CI: 1.04–24.31]) and over-the-counter cough syrup (OR = 2.73 [95% CI: 1.10–6.76]) were significant risk factors for patient delay. Fever (OR = 0.13[95% CI: 0.04–0.48]) and hemoptysis (OR = 0.06 [95% CI0.01–0.30]) were protective factors for patient delay. Cough (OR = 2.85 [95% CI: 1.49–5.49]) and availability of chest X-ray (OR = 0.21[CI: 0.11–0.39]) were factors associated with health system delay. Conclusion Delayed diagnosis of tuberculosis remains an unresolved problem. Patients with low income, self-treatment with over-the-counter medicine and accepting TCM suffered from a higher risk of patient delay. It is important to give more help to the vulnerable people and strengthen tuberculosis knowledge among primary health providers. Keeping all health providers alert to TB symptoms can facilitate earlier TB diagnosis and better disease control.
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Affiliation(s)
- Youli Jiang
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Lan Luo
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Min Gui
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Linlin Liu
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Yi Lin
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Guofang Deng
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Jingfang Chen
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Correspondence: Jingfang Chen; Peize Zhang, Email ;
| | - Peize Zhang
- Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, People’s Republic of China
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Kajogoo VD, Twebaze C, Said B, Tesfahunei HA, Charlie L, Getachew E. Post tuberculosis chronic lung disease in tuberculosis HIV coinfected and non-HIV individuals in Sub-Saharan Africa: A systematic review and meta-analysis. Int J Mycobacteriol 2022; 11:139-144. [PMID: 35775545 DOI: 10.4103/ijmy.ijmy_66_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Post tuberculosis (TB) sequelae are faced by many individuals who survive TB. The most common of all is post-TB chronic lung disease (CLD) and pulmonary impairment. We reviewed studies that estimated the prevalence of post-TB CLD in patients with TB only and those with TB-HIV coinfection. Methods Searched Google scholar, PubMed, African journals online, Embase, and Cochrane Central Register of Clinical Trials from the year 2000 to 01 March 2022 for all designs of studies that examined the impact of post on lung impairment or damage. The protocol was registered in PROSPERO, ID: chronic respiratory disease 42022304628. Results Three hundred and thirty-six studies were identified and five studies were identified through other sources, four were finally in the meta-analysis with a total of 4382 enrolled participants. All the studies had a low risk of bias; The prevalence of CLD between the TB HIV coinfection and those with TB only was of no statistical significance between the three of the four studies - new statement: the prevalence of CLD in the TB-HIV coinfected group when compared to the group of participants with TB only was not statistically significant in the study. This was seen in three of the four studies. One study was in favor of the high prevalence of CLD in HIV coinfection participants (relative risk [RR] = 0.75 [0.61-0.89] with 95% confidence interval [0.61-0.89]). Conclusions Post-TB lung disease is still a burden that needs advocation and an increase of awareness is necessary from the health-care level to the communities and societies, especially in regions of high prevalence. Development of guidelines for health-care workers to aid the management of individuals, multi-disciplinary advocacy is necessary for those whom prevention is not too late.
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Affiliation(s)
| | - Calleb Twebaze
- Department of Research, MCT- Clinical Research Organisation, Kampala, Uganda
| | - Bibie Said
- Department of Research, Kibong'oto National Tuberculosis Hospital, Kilimanjaro, Tanzania
| | | | - Loveness Charlie
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Bisrat H, Manyazewal T, Mohammed H, Shikur B, Yimer G. Validity of InterVA model versus physician review of verbal autopsy for tracking tuberculosis-related mortality in Ethiopia. BMC Infect Dis 2022; 22:200. [PMID: 35232392 PMCID: PMC8886901 DOI: 10.1186/s12879-022-07193-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In most African countries where a legitimate vital registration system is lacking, physicians often review verbal autopsy (VA) data to determine the cause of death, while there are concerns about the routine practicality, accuracy, and reliability of this procedure. In Ethiopia where the burden of tuberculosis (TB) remains unacceptably high, reliable VA data are needed to guide intervention strategies. This study aimed to validate the InterVA model against the physician VA in tracking TB-related mortality in Ethiopia. METHODS From a sample of deaths in Addis Ababa, Ethiopia, VAs were conducted on TB-related mortality, physician-certified verbal autopsy (PCVA) through multiple steps to ascertain the causes of death. InterVA model was used to interpret the causes of death. Estimates of TB-related deaths between physician reviews and the InterVA model were compared using Cohen's Kappa (k), Receiver-operator characteristic (ROC) curve analysis, sensitivity, and specificity to compare agreement between PCVA and InterVA. RESULTS A total of 8952 completed PCVA were used. The InterVA model had an optimal likelihood cut-off point sensitivity of 0.64 (95% CI: 59.0-69.0) and specificity of 0.95 (95% CI: 94.9-95.8). The area under the ROC curve was 0.79 (95% CI: 0.78-0.81). The level of agreement between physician reviews and the InterVA model to identifying TB-related mortality was moderate (k = 0.59, 95% CI: 0.57-0.61). CONCLUSION The InterVA model is a viable alternative to physician review for tracking TB-related causes of death in Ethiopia. From a public health perspective, InterVA helps to analyze the underlying causes of TB-related deaths cost-effectively using routine survey data and translate to policies and strategies in resource-constrained countries.
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Affiliation(s)
- Haileleuel Bisrat
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Hussen Mohammed
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Bilal Shikur
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Getachew E, Woldeamanuel Y, Manyazewal T. Capacity and Readiness Assessment of Healthcare Facilities for Digital Health Interventions Against Tuberculosis and HIV in Addis Ababa, Ethiopia. Front Digit Health 2022; 4:821390. [PMID: 35295619 PMCID: PMC8918491 DOI: 10.3389/fdgth.2022.821390] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background There is a high level of concern that low-income countries lack the capacity and readiness to effectively adopt, implement, and scale up digital health interventions (DHIs). We aimed to assess the infrastructure and human resource capacity and readiness of healthcare facilities to adopt and implement any new DHI for tuberculosis (TB) and HIV care and treatment in Addis Ababa, Ethiopia. Method We carried out a cross-sectional, mixed-methods study in 14 public healthcare facilities that provide TB and HIV care and treatment services. Providers' perceived readiness to adopt and implement digital health was assessed using a self-administered questionnaire designed based on an adapted eHealth readiness assessment model that covers six domains: core readiness, organizational cultural readiness, value proposition readiness, technological readiness, regulatory policy readiness, and operational resource readiness. The infrastructure and human resource capacity were assessed on-site using a tool adapted from the Technology Infrastructure Checklist. Internal consistency was assessed using Cronbach's alpha, and the significant relationship between the composite variables was assessed using Pearson's correlation coefficients (r). Result We assessed 14 facilities on-site and surveyed 60 TB and HIV healthcare providers. According to Cronbach's alpha test, all the six technology acceptance domains had a value of >0.8, suggesting a strong interrelatedness between the measuring items. The correlation between technological readiness and operational resource readiness was significant (r = 0.8). The providers perceived their work environment as good enough in electronic data protection, while more efforts are needed in planning, training, adapting, and implementing digital health. Of the 14 facilities, 64.3% lack the plan to establish a functional local area network, and 43% lack skilled staff on payroll to provide maintenance of computers and other digital technologies. Conclusion Like many developing countries, there was a modest infrastructure and human resource capacity and readiness of public healthcare facilities in Addis Ababa, Ethiopia, to nurture and strengthen DHIs across the TB and HIV cascades of care. Technological and operational resource readiness, including funding and a Well-trained workforce, are essential for successful implementation and use of digital health against the two infectious diseases of global importance in such settings.
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Affiliation(s)
- Emnet Getachew
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mohammed H, Oljira L, Roba KT, Ngadaya E, Manyazewal T, Ajeme T, Mnyambwa NP, Fekadu A, Yimer G. Tuberculosis Prevalence and Predictors Among Health Care-Seeking People Screened for Cough of Any Duration in Ethiopia: A Multicenter Cross-Sectional Study. Front Public Health 2022; 9:805726. [PMID: 35282420 PMCID: PMC8914016 DOI: 10.3389/fpubh.2021.805726] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) remains a major cause of morbidity and mortality in sub-Saharan Africa. This high burden is mainly attributed to low case detection and delayed diagnosis. We aimed to determine the prevalence and predictors of TB among health care-seeking people screened for cough of any duration in Ethiopia. Methods In this multicenter cross-sectional study, we screened 195,713 (81.2%) for cough of any duration. We recruited a sample of 1,853 presumptive TB (PTB) cases and assigned them into three groups: group I with cough ≥2 weeks, group II with cough of <2 weeks, and group III pregnant women, patients on antiretroviral therapy, and patients with diabetes. The first two groups underwent chest radiograph (CXR) followed by sputum Xpert MTB/RIF assay or smear microscopy. The third group was exempted from CXR but underwent sputum Xpert MTB/RIF assay or smear microscopy. TB prevalence was calculated across the groups and TB predictors were analyzed using modified Poisson regression to compute adjusted prevalence ratio (aPR) with a 95% confidence interval (CI). Results The overall prevalence of PTB was 16.7% (309/1853). Of the positive cases, 81.2% (251/309) were in group I (cough ≥2 weeks), 14.2% (44/309) in group II (cough of <2), and 4.5% (14/309) in group III (CXR exempted). PTB predictors were age group of 25-34 [aPR = 2.0 (95% CI 1.3-2.8)], history of weight loss [aPR = 1.2 (95% CI 1.1-1.3)], and TB suggestive CXRs [aPR = 41.1 (95% CI 23.2-72.8)]. Conclusion The prevalence of confirmed PTB among routine outpatients was high, and this included those with a low duration of cough who can serve as a source of infection. Screening all patients at outpatient departments who passively report any cough irrespective of duration is important to increase TB case finding and reduce TB transmission and mortality.
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Affiliation(s)
- Hussen Mohammed
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tigest Ajeme
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nicholaus P. Mnyambwa
- Muhimbili Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Getnet Yimer
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ohio State Global One Health Initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
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