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Ojo OO, Nadarajah S, Kebe M. Integer time series models for tuberculosis in Africa. Sci Rep 2023; 13:11443. [PMID: 37454188 PMCID: PMC10349835 DOI: 10.1038/s41598-023-38707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
Tuberculosis, an airborne disease, is the deadliest human infectious disease caused by one single agent. The African region is among the most affected and most burdensome area in terms of tuberculosis cases. In this paper, we modeled the number of new cases of tuberculosis for 2000-2021 by integer time series. For each African country, we fitted twenty different models and selected the model that best fitted the data. The twenty models were mostly based on the number of new cases following either the Poisson or negative binomial distribution with the rate parameter allowed to vary linearly or quadratically with respect to year. The best fitted models were used to give predictions for 2022-2031.
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Affiliation(s)
- Oluwadare O Ojo
- Department of Statistics, Federal University of Technology, Akure, Nigeria
| | - Saralees Nadarajah
- Department of Mathematics, University of Manchester, Manchester, M13 9PL, UK.
| | - Malick Kebe
- Department of Mathematics, Howard University, Washington, DC, 20059, USA
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Brooks MB, Malik A, Khan S, Ahmed JF, Siddiqui S, Jaswal M, Saleem S, Amanullah F, Becerra MC, Hussain H. Predictors of unsuccessful tuberculosis treatment outcomes in children from a prospective cohort study in Pakistan. J Glob Health 2021; 11:04011. [PMID: 33692895 PMCID: PMC7916443 DOI: 10.7189/jogh.11.04011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Every year, about 239 000 children die from tuberculosis (TB), despite availability of highly effective regimens. Few studies have evaluated predictors for poor treatment outcomes in children treated for TB. Methods We assessed predictors of unsuccessful TB treatment outcomes in a prospective cohort of children diagnosed by an intensified TB patient-finding intervention at four facilities in Pakistan between 2014 and 2016. A case of TB disease was determined through either bacteriologic confirmation of disease or a clinical diagnosis. To estimate characteristics predictive of experiencing an unsuccessful treatment outcome, we used a multi-level model with a modified Poisson approach, accounting for clustering at the facility level. We report estimated relative risks (RR) and 95% confidence intervals (CI). Results During the study period, 1404 children less than 15 years old were initiated on treatment for drug-susceptible TB. In total, 709 (50.5%) were 0-4, 406 (28.9%) were 5-9 years, and 289 (20.6%) were 10-14 years old; 614 (43.7%) were female; and of the 1377 children assessed for malnourishment, 1161 (84.3%) were malnourished. A total of 1322 (94.2%) children experienced a successful treatment outcome, 14 (1.0%) children transferred out to a different facility, and 68 (4.8%) children experienced an unsuccessful treatment outcome: 14 (1.0%) died, 20 (1.4%) failed treatment, and 34 (2.4%) were lost to follow-up. After adjustment for age group, sex, and malnutrition status, we identified increased risk of unsuccessful treatment outcome in children presenting with fever (RR = 2.56, 95% CI = 1.02-6.44; P = 0.05) or an abdominal examination suggestive of TB disease (RR = 2.34, 95% CI = 1.20-4.58; P = 0.01), and a decreased risk in children who initiated treatment at a rural facility (RR = 0.05, 95% CI = 0.00-0.74; P = 0.03). Conclusions More than 94% of children experienced successful treatment outcomes. We identified individual-, facility-, and clinical-factors predictive of experiencing unsuccessful treatment outcomes. Children with fevers and abdominal findings suggestive of TB disease should be tested for TB and followed closely throughout treatment to ensure necessary support for successful completion of treatment.
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Affiliation(s)
- Meredith B Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amyn Malik
- Global Health Directorate, Indus Health Network, Karachi, Pakistan.,Yale Institute for Global Health, New Haven, Connecticut, USA.,Interactive Research and Development Global, Singapore
| | - Salman Khan
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Junaid F Ahmed
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Sara Siddiqui
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Maria Jaswal
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Saniya Saleem
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | | | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Awaluddin SM, Ismail N, Zakaria Y, Yasin SM, Razali A, Mutalip MHA, Lodz NA, Musa KI, Kusnin F, Aris T. Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years. BMC Public Health 2020; 20:1903. [PMID: 33302908 PMCID: PMC7731774 DOI: 10.1186/s12889-020-10005-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Tuberculosis (TB) among children remains a significant public health problem in many parts of the world. The objective of this study was to describe the characteristics of TB patients and to determine the predictors of treatment success among children in Malaysia. Methods Secondary data from MyTB version 2.1, a national database, were analysed using R version 3.6.1. Descriptive analysis and multivariable logistic regression were conducted to identify treatment success and its determinants. Results In total, 3630 cases of TB cases were registered among children in Malaysia between 2013 and 2017. The overall treatment success rate was 87.1% in 2013 and plateaued between 90.1 and 91.4% from 2014 to 2017. TB treatment success was positively associated with being a Malaysian citizen (aOR = 3.43; 95% CI = 2.47, 4.75), being a child with BCG scars (aOR = 1.93; 95% CI = 1.39, 2.68), and being in the older age group (aOR = 1.06; 95% CI = 1.03, 1.09). Having HIV co-infection (aOR = 0.31; 95% CI = 0.16, 0.63), undergoing treatment in public hospitals (aOR = 0.38; 95% CI =0.25, 0.58), having chest X-ray findings of advanced lesion (aOR = 0.48; 95% CI = 0.33, 0.69), having EPTB (aOR = 0.58; 95% CI = 0.41, 0.82) and having sputum-positive PTB (aOR = 0.58; 95% CI = 0.43, 0.79) were negatively associated with TB treatment success among children. Conclusions The overall success rate of treatment among children with TB in Malaysia has achieved the target of 90% since 2014 and remained plateaued until 2017. The socio-demographic characteristics of children, place of treatment, and TB disease profile were associated with the likelihood of TB treatment success among children. The treatment success rate can be increased by strengthening contact tracing activities and promoting early identification targeting the youngest children and non-Malaysian children.
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Affiliation(s)
- S Maria Awaluddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.,Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Nurhuda Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
| | - Yuslina Zakaria
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Siti Munira Yasin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Asmah Razali
- Sector of TB/Leprosy, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mohd Hatta Abdul Mutalip
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Noor Aliza Lodz
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Faridah Kusnin
- Selangor Health State Department, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Tahir Aris
- Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
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Hamid M, Brooks MB, Madhani F, Ali H, Naseer MJ, Becerra M, Amanullah F. Risk factors for unsuccessful tuberculosis treatment outcomes in children. PLoS One 2019; 14:e0222776. [PMID: 31553758 PMCID: PMC6760830 DOI: 10.1371/journal.pone.0222776] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Pakistan has a high pediatric burden of tuberculosis, but few studies describe the treatment experience of children with tuberculosis in Pakistan. We sought to identify risk factors for unsuccessful treatment outcomes in children with drug-susceptible tuberculosis identified in eight hospitals in Karachi, Pakistan. DESIGN We conducted a retrospective cohort study among children (<15 years old) treated with first-line anti-tuberculosis drugs for presumed or confirmed drug-susceptible tuberculosis between 2016 and 2017. We assessed risk factors for experiencing an unsuccessful treatment outcome through multivariable logistic regression analysis. RESULTS In total, 1,665 children initiated tuberculosis treatment, including 916 (55.0%) identified through intensified case finding. Unsuccessful treatment outcomes were experienced by 197 (11.8%) children, comprising 27 (1.6%) deaths, 16 (1.0%) treatment failures, and 154 (9.3%) lost to follow-up. An additional 47 (2.8%) children had outcomes not evaluable. In multivariable analysis, children 0-4 years old (OR: 1.80, 95% CI: 1.07-3.04), males (OR: 1.48, 95% CI: 1.04, 2.11), and those with bacteriologic confirmation of disease (OR: 3.39, 95% CI: 1.98, 5.80) had increased odds of experiencing an unsuccessful treatment outcome. CONCLUSION Our findings suggest a need to deploy strategies to identify children earlier in the disease process and point to the need for interventions tailored for young children once treatment is initiated.
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Affiliation(s)
- Meherunissa Hamid
- Global Health Directorate, The Indus Health Network, Karachi, Sindh, Pakistan
- * E-mail:
| | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Falak Madhani
- Global Health Directorate, The Indus Health Network, Karachi, Sindh, Pakistan
| | - Hassan Ali
- Global Health Directorate, The Indus Health Network, Karachi, Sindh, Pakistan
| | | | | | - Mercedes Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Farhana Amanullah
- Global Health Directorate, The Indus Health Network, Karachi, Sindh, Pakistan
- Department of Pediatrics, The Indus Hospital, Karachi, Sindh, Pakistan
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