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Oiwoh SO, Adebayo O, Kanmodi KK, Agbogidi J, Ojo OF, Ogunsuji O, Oyabambi AO, Wachinou AP. Profile and Correlates of Sleep Quality and Obstructive Sleep Apnoea among Young Persons in Ibadan, Southwestern Nigeria. West Afr J Med 2024; 41:183-190. [PMID: 38581697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND Sleep breathing disorders (SDB), especially obstructive sleep apnoea (OSA), are poorly studied in the young population. This study aimed to determine the prevalence of OSA and its associated risk factors among young persons. METHODS A cross-sectional study design was used, and participants aged 16-35 years were recruited from five tertiary institutions in Ibadan, South Western, Nigeria. The study used a structured questionnaire, stadiometer, weighing scale, tape measure, and digital blood pressure machine to collect data. Patient Health Questionnaire (PHQ 9), Generalized Anxiety Disorder-7(GAD-7), and Pittsburgh sleep quality index (PSQI) were used to assess depression, anxiety, and sleep quality respectively. To assess the risk of OSA, we used both the STOP-Bang questionnaire and the NOSAS score. The Statistical Package for the Social Sciences version 23 was used to analyse the data, and statistical significance was set at <0.05. RESULTS A total of 354 participants were included in this report with a mean age of 21.2±3.5 years. The female: male ratio was 1.9:1. The mean ±standard deviation of PSQI, GAD-7 score and PHQ-9 were 2.2±1.1, 12.4±5.1 and 15.0±5.4 respectively. The following percentages of participants were found to be at low, intermediate, and high risk for OSA: 94.1%, 5.6%, and 0.3%, respectively. This study showed that age and GAD-7 score were independently associated with the PSQI score while age, body mass index, neck cuff size and PHQ-9 score for OSA score. CONCLUSION There is a burden of OSA among this population of young people; and modifying anthropometric and psychosocial factors can help mitigate the risk of OSA outcomes.
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Affiliation(s)
- S O Oiwoh
- Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - O Adebayo
- Department of Medicine, University College Hospital, Ibadan, Nigeria. , Tel: +2348033744279
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - K K Kanmodi
- Cephas Health Research Initiative Inc, Ibadan, Nigeria
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - J Agbogidi
- Clinical Programme Team, University Hospital Southampton (UHS) NHS Foundation Trust, United Kingdom
| | - O F Ojo
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - O Ogunsuji
- Department of Periodontology & Community Dentistry, University College Hospital, Ibadan, Nigeria
| | - A O Oyabambi
- Department of Physiology, University of Ilorin, Ilorin, Nigeria
| | - A P Wachinou
- .School of Health Sciences University of Abomey-Calavi, Cotonou, Benin Republic
- National Hospital for Tuberculosis & Pulmonary Diseases, Cotonou, Benin Republic
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Abbew ET, Lorent N, Mesic A, Wachinou AP, Obiri-Yeboah D, Decroo T, Rigouts L, Lynen L. Challenges and knowledge gaps in the management of non-tuberculous mycobacterial pulmonary disease in sub-Saharan African countries with a high tuberculosis burden: a scoping review. BMJ Open 2024; 14:e078818. [PMID: 38238184 PMCID: PMC10806640 DOI: 10.1136/bmjopen-2023-078818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION In sub-Saharan African (SSA) countries endemic for tuberculosis (TB), previous TB is a significant risk factor for non-tuberculous mycobacterial pulmonary disease (NTM-PD). The deployment of GeneXpert MTB/RIF in pulmonary TB diagnostic work-up regularly identifies symptomatic patients with a positive smear microscopy but negative GeneXpert, indicative of NTM presence. This scoping review outlines recent evidence for NTM-PD diagnosis and management in SSA. OBJECTIVE The review's objective was to outline the risk factors, available diagnostics, management options and outcomes of NTM-PD in high-burden TB settings in SSA using the population-concept-context framework. DESIGN AND DATA SOURCES We searched existing literature from PubMed, Web of Science, African Journals Online, Google Scholar and grey literature. Studies published between January 2005 and December 2022 were retained. Data were extracted into Rayyan software and Mendeley and summarised using Excel. RESULTS We identified 785 potential articles, of which 105 were included in the full-text review, with 7 papers retained. Included articles used international criteria for diagnosing NTM-PD. Multiple papers were excluded due to non-application of the criteria, suggesting challenging application in the SSA setting. Identified risk factors include previous TB, smoking and mining. Most commonly, chest radiography and not CT was used for the radiological diagnosis of PD, which may miss early changes related to NTM-PD. Molecular methods for NTM species identification were employed in research settings, usually at referral centres, but were unavailable for routine care. Most studies did not report a standardised approach to treatment and they were not offered treatment for the specific disease, marking a lack of guidance in treatment decision-making. When treatment was provided, the outcome was often not reported due to the lack of implementation of standardised outcome definitions. CONCLUSIONS These outlined challenges present a unique opportunity for researchers to undertake further studies in NTM-PD and proffer solutions more applicable to SSA.
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Affiliation(s)
- Elizabeth Tabitha Abbew
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
- Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Central, Ghana
- Biomedical Sciences, University of Antwerp, Antwerp, Antwerpen, Belgium
| | - Natalie Lorent
- Respiratory Diseases, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Chronic Diseases and Metabolism, BREATHE Laboratory, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Anita Mesic
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Dorcas Obiri-Yeboah
- Microbiology and Immunology, University of Cape Coast School of Medical Sciences, Cape Coast, Central, Ghana
| | - Tom Decroo
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Leen Rigouts
- Biomedical Sciences, University of Antwerp, Antwerp, Antwerpen, Belgium
- Biomedical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lutgarde Lynen
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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Wachinou AP, Fiogbe AA, Totah T, Salanon E, Solelhac GM, Berger M, Haba-Rubio J, Amidou S, Agodokpessi G, Houinato D, Heinzer R. EVALUATION OF A MODIFIED EPWORTH SLEEPINESS SCALE TO RELIABLY ASSESS EXCESSIVE DAYTIME SLEEPINESS IN LOW-INCOME COUNTRIES: RESULTS FROM THE BENIN SOCIETY AND SLEEP (BESAS) STUDY. West Afr J Med 2023; 40:S39-S40. [PMID: 38071478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background The Epworth Sleepiness Scale (ESS) is a tool widely used to assess excessive daytime sleepiness. Unfortunately, it is not reliable in low-income countries where situations such as reading a book, watching TV or driving a car are not common. The aim of this study was thus to assess the performance of a modified version of the Epworth scale in a low-income country. Methods We used data from the Benin Society and Sleep (BeSAS) study where the ESS and a modified ESS (mESS) were administered to participants. In the mESS, questions four questions over eight were redesigned to reflect common living situations in Benin. The internal coherence of the mESS was assessed using the Cronbach alpha coefficient (CAC). The discriminatory ability of the scale was assessed by comparing the mean scores according to reported sleep quality, insomnia complaints and apnea-hypopnea index (AHI). Results A total of 2909 participants were recruited, 1129 were male (38.9%) with a mean age (SD) of 44.7 (14.5) y. Overall, 52.4% (1526) completed all the mESS questions while 453 (15.6%) completed the standard ESS. The CAC of the mES was 0.86 showing good internal coherence. Concerning the discriminatory ability, mean scores for mESS were 7.8 for participants with ISI < 8 vs 9.2 for participants with ISI≥8 (p<0.001), 7.8 for participants withPSQI<5 vs 8.3 for participants with PSQI≥5 (p=0.03). No difference was found when comparing the participants participants using different cut-offs of AHI (15 and 30). Conclusion The mES is more reliable than ES in the Beninese population. mESS shows good internal coherence and differentiates between insomniacs vs non-insomniacs and between good and poor sleepers. Although the mES is not a perfect score, it appears more relevant in the Benin population than the original Epworth scale but needs further validation/improvement in other low-income countries.
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Affiliation(s)
- A P Wachinou
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin.
- National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health. Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - A A Fiogbe
- National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin
| | - T Totah
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health. Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - E Salanon
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health. Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | - M Berger
- Center of Investigation and Research on Sleep, Lausanne, Switzerland
| | - J Haba-Rubio
- Center of Investigation and Research on Sleep, Lausanne, Switzerland
| | - S Amidou
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health. Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - G Agodokpessi
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin.
- National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin
| | - D Houinato
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin.
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health. Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - R Heinzer
- Center of Investigation and Research on Sleep, Lausanne, Switzerland
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Wachinou AP, Fiogbe AA, Totah T, Salanon E, Solelhac G, Berger M, Haba-Rubio J, Amidou S, Agodokpessi G, Houinato D, Heinzer R. PERFORMANCE OF SIX SCREENING SCORES FOR OBSTRUCTIVE SLEEP APNOEA IN AN AFRICAN POPULATION. West Afr J Med 2023; 40:S38-S39. [PMID: 38071469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Introduction A screening tool for obstructive sleep apnoea (OSA) is useful in low-income countries where it may be difficult to access sleep recordings. The objective of this study was to assess the performance of six screening scores compared with objective sleep recording in an African population sample. Methods This analysis is based on the "Benin Sleep and Society" (BeSAS) populational study in which respiratory polygraphy (PG) was performed using a type III device and OSA screening questionnaires (STOP, STOP-Bang, Berlin, NOSAS [≥ 8 and ≥ 5), No-Apnea, GOAL) were administered to participants. PG-defined OSA severity categories were defined according to the apnoea-hypopnoea index (AHI): mild (AHI 5 to <15/h), moderate (AHI 15 to <30/h) or severe (AHI≥30/h), and these were compared to score findings. Results A total of 1810 subjects (mean age 45.4±14.6 years; 57.3% women) were included. For moderate to severe OSA, the area under the receiving operating characteristic (ROC) curve was greatest for GOAL and No-Apnea (0.70), followed by NoSAS5 (0.69). The highest sensitivity values were for NoSAS5 (0.73), No-Apnea (0.72), and GOAL (0.69), while NoSAS8 had the highest specificity (0.91), followed by Berlin (0.88) and GOAL (0.71). All scores performed poorly with respect to the positive predictive value (PPV), which was highest with NoSAS8 (0.38). Conclusion: This study provides the first comparison of the performance of screening scores for OSA in an African population. Although still low, PPV was highest with NoSAS8. Hence, NoSAS8 would be the screening method of choice for OSA in resource-constrained settings where formal sleep recordings are not accessible.
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Affiliation(s)
- A P Wachinou
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - A A Fiogbe
- National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin
| | - T Totah
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - E Salanon
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - G Solelhac
- Center of Investigation and Research on Sleep, Lausanne, Switzerland
| | - M Berger
- Center of Investigation and Research on Sleep, Lausanne, Switzerland
| | - J Haba-Rubio
- Center of Investigation and Research on Sleep, Lausanne, Switzerland
| | - S Amidou
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - G Agodokpessi
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin
| | - D Houinato
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- Laboratory of Epidemiology of Chronic and Neurologic Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - R Heinzer
- Center of Investigation and Research on Sleep, Lausanne, Switzerland
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Fiogbé A, Toukoui P, Wachinou AP, Alovokpinhou F, Séfou F, Hada AA, Vinassé P, Takin R, Agodokpessi G. [Early onset of small cell carcinom of the lung in a young patient in Benin]. Rev Mal Respir 2022; 39:791-794. [PMID: 36088182 DOI: 10.1016/j.rmr.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022]
Abstract
Context Bronchial cancer in a person under 30 years of age is quite rare. It generally occurs after 40 years of age following heavy smoking intoxication. We report a clinical case illustrating the early onset of a small cell lung carcinoma in young heavy smoker. CASE REPORT: A 30-year-old patient, current smoker for about 10 years (15 packs/year), consulted for a cough with haemoptotic sputum. Clinical and paraclinical examinations diagnosed small cell carcinoma of the right lung with some controlatéral metastatic nodules. . He was classified as stage T2bN2M1a. Unfortunately, due to lack of financial accessibility to suitable chemotherapy, the patient died after one month. CONCLUSION: Early-onset of bronchial carcinoma in young smokers calls for strengthened control of teenage tobacco use, especially in Africa, where the phenomenon has been taking on alarming proportions.
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Affiliation(s)
- A Fiogbé
- Centre national hospitalier et universitaire de pneumo-phtisiologie de Cotonou (CNHU/PPC), 02 BP 8229, Cotonou, Bénin.
| | - P Toukoui
- Centre national hospitalier et universitaire de pneumo-phtisiologie de Cotonou (CNHU/PPC), 02 BP 8229, Cotonou, Bénin
| | - A P Wachinou
- Centre national hospitalier et universitaire de pneumo-phtisiologie de Cotonou (CNHU/PPC), 02 BP 8229, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey Calavi, Abomey Calavi, Bénin
| | - F Alovokpinhou
- Centre national hospitalier et universitaire de pneumo-phtisiologie de Cotonou (CNHU/PPC), 02 BP 8229, Cotonou, Bénin
| | - F Séfou
- Centre national hospitalier et universitaire de pneumo-phtisiologie de Cotonou (CNHU/PPC), 02 BP 8229, Cotonou, Bénin
| | - A A Hada
- Centre national hospitalier et universitaire de pneumo-phtisiologie de Cotonou (CNHU/PPC), 02 BP 8229, Cotonou, Bénin
| | - P Vinassé
- Centre national hospitalier et universitaire de pneumo-phtisiologie de Cotonou (CNHU/PPC), 02 BP 8229, Cotonou, Bénin
| | - R Takin
- Centre hospitalier de Troyes, Troyes, France
| | - G Agodokpessi
- Centre national hospitalier et universitaire de pneumo-phtisiologie de Cotonou (CNHU/PPC), 02 BP 8229, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey Calavi, Abomey Calavi, Bénin
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Wachinou AP, Houehanou C, Ade S, Totah T, Berger M, Solelhac G, Amidou S, Fiogbe AA, Alovokpinhou F, Lacroix P, Preux PM, Marques-Vidal P, Agodokpessi G, Houinato D, Heinzer R. Prevalence of sleep-disordered breathing in an African general population: The Benin Society and Sleep (BeSAS) study. Lancet Respir Med 2022; 10:831-839. [PMID: 35405141 DOI: 10.1016/s2213-2600(22)00046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Data on the prevalence of sleep-disordered breathing (SDB) in the African general population are scarce, and a better understanding is urgently needed. Our study aimed to objectively determine the prevalence of, and factors associated with, SDB in a large sample in Benin, west Africa. METHODS In the Benin Society and Sleep (BeSAS) cross-sectional study, participants aged 25 years and older were recruited from both urban and rural areas. Rural participants were recruited from Tanve, a village located 200 km north of Cotonou, and urban participants were recruited from Cotonou. The participants underwent respiratory polygraphy at home using a type-3 device that measures airflow through a nasal pressure sensor, respiratory effort (thoracic movement), and pulse oximetry. Clinical and morphometric data were also collected. SDB severity categories were defined according to the apnoea-hypopnoea index (AHI), with mild-to-severe SDB (AHI ≥5/h), moderate-to-severe SDB (AHI ≥15/h), and severe SDB (AHI ≥30/h). FINDINGS The study was completed from April 4, 2018 to Jan 15, 2021. Of 2909 participants recruited in the BeSAS study, 2168 (74·5%) underwent respiratory polygraphy. For the 1810 participants with complete polygraphic data (mean age 46 years, SD 15; 1163 [64·2%] women), the prevalence of mild-to-severe SDB (AHI ≥5/h) was 43·2% (95% CI 40·9-45·5), of moderate-to-severe SDB (AHI ≥15/h) was 11·6% (10·2-13·1), and of severe SDB (AHI ≥30/h) was 2·7% (2·0-3·5). Factors independently associated with SDB were advanced age, male sex, large neck circumference, abdominal obesity, overweight or obesity, and snoring. After multivariable adjustment, severe SDB was independently associated with hypertension in women (odds ratio 3·99, 95% CI 1·04-15·33; ptrend=0·044), but not in men (odds ratio 0·67, 0·22-2·05; Ptrend=0·63). INTERPRETATION The BeSAS study provides the first large-scale objective evaluation of SDB prevalence and associated factors in Africa. The high prevalence of SDB identified should stimulate the development of public health policies to prevent and treat this condition in African countries. FUNDING Ligue Pulmonaire Vaudoise, Switzerland.
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Affiliation(s)
- Ablo Prudence Wachinou
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin; National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin.
| | - Corinne Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin; National School of Public Health, University of Parakou, Parakou, Benin
| | - Serge Ade
- Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Terence Totah
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin
| | - Mathieu Berger
- Centre of Investigation and Research on Sleep, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Geoffroy Solelhac
- Centre of Investigation and Research on Sleep, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Salmane Amidou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin
| | | | | | - Philipe Lacroix
- Inserm U1094, University Hospital of Limoges-Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, University Hospital of Limoges-Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pedro Marques-Vidal
- Department of Internal Medicine, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Gildas Agodokpessi
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin
| | - Dismand Houinato
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; Laboratory of Epidemiology of Chronic and Neurological Diseases, Cotonou, Benin
| | - Raphael Heinzer
- Centre of Investigation and Research on Sleep, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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Dhana A, Hamada Y, Kengne AP, Kerkhoff AD, Rangaka MX, Kredo T, Baddeley A, Miller C, Singh S, Hanifa Y, Grant AD, Fielding K, Affolabi D, Merle CS, Wachinou AP, Yoon C, Cattamanchi A, Hoffmann CJ, Martinson N, Mbu ET, Sander MS, Balcha TT, Skogmar S, Reeve BWP, Theron G, Ndlangalavu G, Modi S, Cavanaugh J, Swindells S, Chaisson RE, Ahmad Khan F, Howard AA, Wood R, Thit SS, Kyi MM, Hanson J, Drain PK, Shapiro AE, Kufa T, Churchyard G, Nguyen DT, Graviss EA, Bjerrum S, Johansen IS, Gersh JK, Horne DJ, LaCourse SM, Al-Darraji HAA, Kamarulzaman A, Kempker RR, Tukvadze N, Barr DA, Meintjes G, Maartens G. Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis. Lancet Infect Dis 2022; 22:507-518. [PMID: 34800394 PMCID: PMC8942858 DOI: 10.1016/s1473-3099(21)00387-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/24/2021] [Accepted: 06/21/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The WHO-recommended tuberculosis screening and diagnostic algorithm in ambulatory people living with HIV is a four-symptom screen (known as the WHO-recommended four symptom screen [W4SS]) followed by a WHO-recommended molecular rapid diagnostic test (eg Xpert MTB/RIF [hereafter referred to as Xpert]) if W4SS is positive. To inform updated WHO guidelines, we aimed to assess the diagnostic accuracy of alternative screening tests and strategies for tuberculosis in this population. METHODS In this systematic review and individual participant data meta-analysis, we updated a search of PubMed (MEDLINE), Embase, the Cochrane Library, and conference abstracts for publications from Jan 1, 2011, to March 12, 2018, done in a previous systematic review to include the period up to Aug 2, 2019. We screened the reference lists of identified pieces and contacted experts in the field. We included prospective cross-sectional, observational studies and randomised trials among adult and adolescent (age ≥10 years) ambulatory people living with HIV, irrespective of signs and symptoms of tuberculosis. We extracted study-level data using a standardised data extraction form, and we requested individual participant data from study authors. We aimed to compare the W4SS with alternative screening tests and strategies and the WHO-recommended algorithm (ie, W4SS followed by Xpert) with Xpert for all in terms of diagnostic accuracy (sensitivity and specificity), overall and in key subgroups (eg, by antiretroviral therapy [ART] status). The reference standard was culture. This study is registered with PROSPERO, CRD42020155895. FINDINGS We identified 25 studies, and obtained data from 22 studies (including 15 666 participants; 4347 [27·7%] of 15 663 participants with data were on ART). W4SS sensitivity was 82% (95% CI 72-89) and specificity was 42% (29-57). C-reactive protein (≥10 mg/L) had similar sensitivity to (77% [61-88]), but higher specificity (74% [61-83]; n=3571) than, W4SS. Cough (lasting ≥2 weeks), haemoglobin (<10 g/dL), body-mass index (<18·5 kg/m2), and lymphadenopathy had high specificities (80-90%) but low sensitivities (29-43%). The WHO-recommended algorithm had a sensitivity of 58% (50-66) and a specificity of 99% (98-100); Xpert for all had a sensitivity of 68% (57-76) and a specificity of 99% (98-99). In the one study that assessed both, the sensitivity of sputum Xpert Ultra was higher than sputum Xpert (73% [62-81] vs 57% [47-67]) and specificities were similar (98% [96-98] vs 99% [98-100]). Among outpatients on ART (4309 [99·1%] of 4347 people on ART), W4SS sensitivity was 53% (35-71) and specificity was 71% (51-85). In this population, a parallel strategy (two tests done at the same time) of W4SS with any chest x-ray abnormality had higher sensitivity (89% [70-97]) and lower specificity (33% [17-54]; n=2670) than W4SS alone; at a tuberculosis prevalence of 5%, this strategy would require 379 more rapid diagnostic tests per 1000 people living with HIV than W4SS but detect 18 more tuberculosis cases. Among outpatients not on ART (11 160 [71·8%] of 15 541 outpatients), W4SS sensitivity was 85% (76-91) and specificity was 37% (25-51). C-reactive protein (≥10 mg/L) alone had a similar sensitivity to (83% [79-86]), but higher specificity (67% [60-73]; n=3187) than, W4SS and a sequential strategy (both test positive) of W4SS then C-reactive protein (≥5 mg/L) had a similar sensitivity to (84% [75-90]), but higher specificity than (64% [57-71]; n=3187), W4SS alone; at 10% tuberculosis prevalence, these strategies would require 272 and 244 fewer rapid diagnostic tests per 1000 people living with HIV than W4SS but miss two and one more tuberculosis cases, respectively. INTERPRETATION C-reactive protein reduces the need for further rapid diagnostic tests without compromising sensitivity and has been included in the updated WHO tuberculosis screening guidelines. However, C-reactive protein data were scarce for outpatients on ART, necessitating future research regarding the utility of C-reactive protein in this group. Chest x-ray can be useful in outpatients on ART when combined with W4SS. The WHO-recommended algorithm has suboptimal sensitivity; Xpert for all offers slight sensitivity gains and would have major resource implications. FUNDING World Health Organization.
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Affiliation(s)
- Ashar Dhana
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Yohhei Hamada
- Centre for International Cooperation and Global Tuberculosis Information, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Institute for Global Health, University College London, London, UK
| | - Andre P Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA
| | - Molebogeng X Rangaka
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Institute for Global Health, University College London, London, UK
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Annabel Baddeley
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Cecily Miller
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Satvinder Singh
- Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland
| | - Yasmeen Hanifa
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Corinne S Merle
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland
| | | | - Christina Yoon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Center for Tuberculosis, University of California, San Francisco, CA, USA
| | - Adithya Cattamanchi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Center for Tuberculosis, University of California, San Francisco, CA, USA
| | | | - Neil Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Johns Hopkins University Center for Tuberculosis Research, Baltimore, MD, USA
| | | | | | - Taye T Balcha
- Clinical Infection Medicine, Lund University, Malmö, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sten Skogmar
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Byron W P Reeve
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Gcobisa Ndlangalavu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Surbhi Modi
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Richard E Chaisson
- Johns Hopkins University Center for Tuberculosis Research, Baltimore, MD, USA
| | - Faiz Ahmad Khan
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Andrea A Howard
- ICAP at Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robin Wood
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Swe Swe Thit
- Department of Medicine, University of Medicine 2, Yangon, Yangon Division, Myanmar
| | - Mar Mar Kyi
- Department of Medicine, University of Medicine 2, Yangon, Yangon Division, Myanmar
| | - Josh Hanson
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Paul K Drain
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Adrienne E Shapiro
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tendesayi Kufa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Gavin Churchyard
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; The Aurum Institute, Parktown, South Africa
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Stephanie Bjerrum
- Department of Clinical Research, Infectious Diseases, University of Southern Denmark, Odense, Denmark
| | - Isik S Johansen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - David J Horne
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Sylvia M LaCourse
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Global Health, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
| | | | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Russell R Kempker
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - David A Barr
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Graeme Meintjes
- Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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8
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Wachinou AP, Fiogbé AA, Adè S, Yemoa A, Esse M, Houéto S, Agodokpessi G, Affolabi D. Remote Supervision of Basic Management Units for Tuberculosis Care During Covid-19 Period: An Innovative Experience from Benin Republic. West Afr J Med 2021; Vol. 38:958-962. [PMID: 34855334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Contingency measures taken by governments with movement restrictions during the COVID-19 pandemic may create difficulties in conducting some field activities for TB control especially the supervision of Basic Management Units (BMUs). We described in this paper an innovative initiative to conduct remote supervision (Esupervision) using Information and Communication Technology tools. SETTING AND METHOD This initiative was conducted in Benin Republic. To carry out the activity, we used smartphone, WhatsApp® for messaging, CamScanner for scanning (both free applications); and internet connection. BMUs were asked to scan their reports and all necessary documents and sent them by WhatsApp® after scanning. On the day planned for the supervision, the supervisors of each section (clinic, laboratory, food delivery supervision) calls the BMUs health professionals via WhatsApp® video to conduct the activity according to the National Tuberculosis Programme guidelines. RESULTS Overall, all the main objectives of a supervision were achieved despite some difficulties mainly related to the quality of internet connection. The reports from the different sections were validated for each BMU. For the laboratory activities, general aspects as well as the stock of reagents were evaluated; microcopy fields with an ordinary microscope were visualized. The management of tuberculosis patients was assessed by visualizing the results of bacteriological exams, treatment records, and stocks of medicines. CONCLUSION Even though, this activity will probably not replace the traditional face-to-face supervision, it could be used in settings where movements are restricted for several reasons including COVID-19 pandemic, conflicts and natural disasters.
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Affiliation(s)
- A P Wachinou
- School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- National Tuberculosis Programme of Benin, Cotonou, Benin
| | - A A Fiogbé
- National Tuberculosis Programme of Benin, Cotonou, Benin
| | - S Adè
- Faculty of Medicine, University of Parakou
| | - A Yemoa
- School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- National Tuberculosis Programme of Benin, Cotonou, Benin
| | - M Esse
- National Tuberculosis Programme of Benin, Cotonou, Benin
| | - S Houéto
- National Tuberculosis Programme of Benin, Cotonou, Benin
| | - G Agodokpessi
- School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- National Tuberculosis Programme of Benin, Cotonou, Benin
| | - D Affolabi
- School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- National Tuberculosis Programme of Benin, Cotonou, Benin
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9
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Massou F, Fandohan M, Wachinou AP, Agbla SC, Agodokpessi G, Rigouts L, de Jong BC, Affolabi D. Spot specimen testing with GeneXpert MTB/RIF results compared to morning specimen in a programmatic setting in Cotonou, Benin. BMC Infect Dis 2021; 21:979. [PMID: 34544371 PMCID: PMC8454072 DOI: 10.1186/s12879-021-06676-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The diagnosis of tuberculosis (TB) using smear microscopy has been based on testing two specimens: one spot and one early morning sputa. Recently, the World Health Organization (WHO) has recommended to replace, whenever possible, microscopy with GeneXpert® MTB/RIF performed on a single specimen. However, as the bacterial load is higher in early morning specimens than in spot specimens, one could expect lower sensitivity of GeneXpert® MTB/RIF performed only on spot specimens. In this study, we compared results of GeneXpert® MTB/RIF on spot specimens versus early morning specimens, under programmatic conditions in Cotonou, Benin. METHODS From June to September 2018, all sputa received from presumptive TB patients at the Supranational Reference Laboratory for Tuberculosis of Cotonou were included in the study. From each patient, two specimens were collected (one spot and one early morning) and GeneXpert® MTB/RIF was performed on both specimens. RESULTS In total, 886 participants were included in the study, of whom 737 provided both sputa and 149 (16.8%) gave only the spot specimen. For the 737 participants who provided both sputa, GeneXpert® MTB/RIF was positive for both specimens in 152 participants; for three participants GeneXpert® MTB/RIF was positive on spot specimen but negative on morning specimen while for another three, the test was positive on morning specimen but negative on spot specimen. The overall percentage of agreement was excellent (99.2%) with a positive and negative percent agreement greater than 98%. CONCLUSION For TB diagnosis under programmatic conditions in Cotonou, GeneXpert® MTB/RIF in spot specimens gave similar results with the test in morning specimens. Performing GeneXpert® MTB/RIF in both specimens did not significantly increase the number of cases detected. To avoid losing patients from the diagnostic cascade, it is preferable to test sputa produced at the time of the first visit at the health center.
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Affiliation(s)
- Faridath Massou
- National Tuberculosis Program, NTP, Cotonou, Benin.
- Supranational Reference Laboratory for Tuberculosis of Cotonou, Cotonou, Benin.
| | | | | | - Schadrac Christin Agbla
- London School of Hygien and Tropical Medicine, London, UK
- University of Liverpool, Liverpool, UK
| | | | - Leen Rigouts
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Dissou Affolabi
- National Tuberculosis Program, NTP, Cotonou, Benin
- Supranational Reference Laboratory for Tuberculosis of Cotonou, Cotonou, Benin
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10
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Lamontagne F, Stegemann M, Agarwal A, Agoritsas T, Siemieniuk R, Rochwerg B, Bartoszko J, Askie L, Macdonald H, Al-Maslamani M, Amin W, Da Silva ARA, Barragan FAJ, Bausch FJ, Burhan E, Cecconi M, Chacko B, Chanda D, Dat VQ, Du B, Geduld H, Gee P, Haider M, Nerina H, Hashimi M, Jehan F, Hui D, Hunt BJ, Ismail M, Kabra S, Kanda S, Kawano-Dourado L, Kim YJ, Kissoon N, Krishna S, Kwizera A, Lisboa T, Leo YS, Mahaka I, Hela M, Migliori GB, Mino G, Nsutebu E, Pshenichnaya N, Qadir N, Ranganathan SS, Sabzwari S, Sarin R, Shankar-Hari M, Sharland M, Shen Y, Souza JP, Tshokey T, Ugarte S, Uyeki T, Venkatapuram S, Wachinou AP, Wijewickrama A, Vuyiseka D, Preller J, Brignardello-Petersen R, Kum E, Qasim A, Zeraatkar D, Owen A, Guyatt G, Lytvyn L, Jacobs M, Vandvik PO, Diaz J. A living WHO guideline on drugs to prevent covid-19. BMJ 2021; 372:n526. [PMID: 33649077 DOI: 10.1136/bmj.n526] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CLINICAL QUESTION What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. RECOMMENDATION The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). HOW THIS GUIDELINE WAS CREATED This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. UNDERSTANDING THE NEW RECOMMENDATION The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. UPDATES This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. READERS NOTE This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.
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Affiliation(s)
- François Lamontagne
- Université de Sherbrooke, Centre de recherche due CHU de Sherbrooke, Sherbrooke, Quebec, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Miriam Stegemann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Berlin, Germany
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Arnav Agarwal
- Division of General Internal Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Thomas Agoritsas
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Jessica Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Lisa Askie
- World Health Organization, Geneva, Switzerland
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Helen Macdonald
- The BMJ, London, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
| | | | - Wagdy Amin
- Ministry of Health and Population, Cairo, Egypt
| | | | | | | | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Binila Chacko
- Division of Critical Care Medicine at Christian Medical College, Vellore, India
| | - Duncan Chanda
- Adult Infectious Disease Centre, University Teaching Hospital, Lusaka, Zambia
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
| | - Heike Geduld
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | | | | | - David Hui
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Sushil Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Leticia Kawano-Dourado
- Pulmonary Division, Heart Institute (InCor)- HCFMUSP, Medical School, University of Sao Paulo, São Paulo, Brazil and Research Institute, Hospital do Coração (HCor), São Paulo, Brazil
| | - Yae-Jean Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Niranjan Kissoon
- Department of Paediatrics and Emergency Medicine, University of British Columbia, Vancouver, Canada
| | | | - Arthur Kwizera
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Yee-Sin Leo
- National Center for Infectious Diseases, Singapore
| | | | - Manai Hela
- Emergency Medical Services, Faculty of Medicine, Tunis, Tunisia
| | | | | | | | | | - Nida Qadir
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | | | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | | | - Yinzhong Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | | | - Sebastian Ugarte
- Faculty of Medicine Andres Bello University, Indisa Clinic, Santiago, Chile
| | - Tim Uyeki
- Influenza Division, Centers for Disease Control and Prevention, USA
| | | | | | | | | | - Jacobus Preller
- World Health Organization, Geneva, Switzerland
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Elena Kum
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Anila Qasim
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Andrew Owen
- University of Liverpool, Liverpool, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Michael Jacobs
- Royal Free London NHS Foundation Trust, London, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Health Economics and Health Management, Institute for Health and Society, University of Oslo, Oslo, Norway
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
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11
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Wachinou AP, Ade S, Ndour Mbaye M, Bah B, Baldé N, Gninkoun J, Bekou W, Sarr M, Bah Sow O, Affolabi D, Merle C. Tuberculosis prevalence and associated factors among persons with diabetes mellitus after intensified case finding in three West African countries. Multidiscip Respir Med 2021; 16:783. [PMID: 34557300 PMCID: PMC8404526 DOI: 10.4081/mrm.2021.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background To determine the prevalence of tuberculosis (TB) and associated factors in persons with diabetes mellitus (DM) in Benin, Guinea and Senegal. Patients and Method A cross-sectional study was conducted in the largest DM center in each country. Participants systematically underwent clinical screening and chest radiography. Participants who were symptomatic or with abnormal radiography underwent bacteriological investigations (sputum smear, Xpert MTB/RIF and culture) on sputum. Participants with no TB at enrolment were re-examined for TB six months later. Logistic regression was performed to identify factors associated with TB. Results There were 5,870 DM patients: 1,881 (32.0%) in Benin, 1,912 (32.6%) in Guinea and 2,077 (35.4%) in Senegal. Out of these, 114 had bacteriologically-confirmed TB, giving a pooled prevalence of 1.9% (95%CI=1.6-2.3). TB prevalence was 0.5% (95%CI=0.3-1.0), 2.4% (95%CI=1.8-3.2) and 2.8% (95%CI=2.2-3.6), respectively, in Benin, Guinea and Senegal. Factors associated with an increased odds of TB diagnosis were a usual residence in Guinea (aOR=2.62;95%CI=1.19-5.77; p=0.016) or in Senegal (aOR=3.73;95%CI=1.85-7.51; p<0.001), the age group of 35-49 years (aOR=2.30;95%CI=1.11-4.79; p=0.025), underweight (aOR=7.34;95%CI=4.65-11.57; p<0.001) and close contact with a TB case (aOR=2.27;95%CI=1.37-3.76; p=0.002). Obesity was associated with lower odds of TB (aOR=0.20; 95%CI=0.06-0.65; p=0.008). Conclusion TB is prevalent among DM patients in Benin, Guinea and Senegal and higher than among the general population. The findings support the need for intensified case finding in DM patients in order to ensure systematic early detection of TB during the routine consultation process.
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Affiliation(s)
- Ablo Prudence Wachinou
- Faculty of School of Medicine, University of Abomey-Calavi, Cotonou, Benin.,National Tuberculosis Programme of Benin, Cotonou, Benin
| | - Serge Ade
- National Tuberculosis Programme of Benin, Cotonou, Benin.,Faculty of Medicine, University of Parakou, Parakou, Benin
| | | | - Boubacar Bah
- Service de Pneumophtisiologie, Centre National Hospitalier Ignace Deen, Conakry, Guinea
| | - Naby Baldé
- Service d'endocrinologie, Centre Hospitalier Universitaire Donka, Conakry, Guinea
| | - Jules Gninkoun
- Faculty of School of Medicine, University of Abomey-Calavi, Cotonou, Benin
| | - Wilfried Bekou
- National Tuberculosis Programme of Benin, Cotonou, Benin
| | - Marie Sarr
- National Tuberculosis Programme of Senegal, Dakar, Senegal
| | - Oumou Bah Sow
- Service de Pneumophtisiologie, Centre National Hospitalier Ignace Deen, Conakry, Guinea
| | - Dissou Affolabi
- Faculty of School of Medicine, University of Abomey-Calavi, Cotonou, Benin.,National Tuberculosis Programme of Benin, Cotonou, Benin
| | - Corinne Merle
- Tropical Disease Research Special Programme, World Health Organization, Geneva, Switzerland.,London School of Hygiene and Tropical Medicine, LSHTM, London, UK
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12
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Sanni S, Wachinou AP, Merle CSC, Bekou KW, Esse M, Gossa S, Gomina K, Baba-Moussa L, Affolabi D. Hepatic Safety of High-Dose Rifampicin for Tuberculosis Treatment in TB/HIV Co-infected Patients: A Randomized Clinical Trial. Arch Pharm Pract 2021. [DOI: 10.51847/plywkp28yd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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13
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Wachinou AP, Agodokpessi G, Agbodande A, Affolabi D, Esse M, Adjibode O, Anagonou S. [Tuberculosis in older persons in African setting: Epidemiological, diagnostic and evolutive features]. Rev Pneumol Clin 2018; 74:444-451. [PMID: 30279016 DOI: 10.1016/j.pneumo.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/21/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the epidemiological, diagnostic and evolutives features of tuberculosis (TB) in older subjects in Benin. PATIENTS AND METHODS This was a retrospective cohort study of adults TB patients (age≥15 years) who were notified at all the Basic Management Units (BMU) in Benin from January 1st, 2013 to December 31st. Older subjects (age≥60 years) were compared to those less than 60 years named young subjects. The threshold of significance was set at 5%. RESULTS The analysis was carried out on 6531 cases adults cases notified during the period. 601 (9.2%) were 60 years old or above. The case notification rate (CNR) in elders was more than twice the CNR in young people (68 cases vs. 31 cases per 100,000 population). Older subjects were less often infected with HIV (9.3%) than young's (16.7%), P<0.0001. In new bacteriologically confirmed pulmonary TB negative for HIV, unfavorable treatment outcomes were more frequent in older subjects than in young subjects with more deaths (7.5% vs. 3.0%). On the other hand, in bacteriological confirmed TB seropositive for HIV and all the other cases, treatment outcomes were comparable between the two groups. CONCLUSION The high CNR and the high death rate in older subjects should plead for a specific care for an adapted management of TB case in this group.
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Affiliation(s)
- A P Wachinou
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin.
| | - G Agodokpessi
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
| | - A Agbodande
- Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin; Service de médecine interne, Centre national hospitalier universitaire Hubert K. Maga (CNHU-HKM), Cotonou, Bénin
| | - D Affolabi
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
| | - M Esse
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin
| | - O Adjibode
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin
| | - S Anagonou
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
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Dovonou CA, Amidou SA, Kpangon AA, Traoré YA, Godjedo TPM, Satondji AJ, Wachinou AP, Issa-Djibril FM, Fourn L, Zannou DM, Gandaho P. [Prevalence of hepatitis B in people infected with HIV in Parakou in Benin]. Pan Afr Med J 2015; 20:125. [PMID: 26097629 PMCID: PMC4462550 DOI: 10.11604/pamj.2015.20.125.6061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/24/2015] [Indexed: 12/14/2022] Open
Abstract
Introduction La co-infection avec l'hépatite B est l'un des défis majeurs de la prise en charge du VIH depuis l'amélioration de l'accès aux antirétroviraux en Afrique. La présente étude visait à estimer la prévalence de l'hépatite B chez les personnes séropositives au VIH à Parakou et décrire les facteurs associés. Méthodes Il s'agit d'une étude transversale menée de Mai 2011 à Juin 2012 dans le service de Médecine du CHU de Parakou. Ont été inclus tous les adultes séropositifs au VIH vus en consultation ou hospitalisés. Les données ont été collectées par interviews et dépouillement de dossiers médicaux. L'antigène HBs a été recherché par un test rapide et l'ALAT a été dosé. L'analyse des données a été faite avec le logiciel EpiInfo 3.5.1. Les proportions ont été comparées grâce au test de Chi-deux ou au test de Fisher au seuil de significativité de 5%. Un modèle de régression logistique multivariable a permis d'expliquer la prévalence de l'hépatite B. Résultats Sur les 744 sujets inclus on a dénombré 555 femmes. L’âge moyen était de 35,5 + 10,1 ans. La prévalence de l'hépatite B a été estimée à 16,9% (IC95: 14,3%-19,9%). Cette prévalence était plus élevée chez les sujets originaires du Borgou/Alibori et ceux au stade 4 de l'OMS. Conclusion La prévalence de la co-infection VIH/VHB au CHU Parakou est élevée. Le dispositif national de prise en charge et de prévention de l'hépatite B chez les personnes séropositives au VIH doit être renforcé.
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Affiliation(s)
- Comlan Albert Dovonou
- Service de Médecine Interne, CHU de Parakou ; Département de Médecine et spécialités médicales de la Faculté de Médecine de l'Université de Parakou
| | - Salimanou Ariyoh Amidou
- Service de Médecine Interne, CHU de Parakou ; Centre d'Information de Prospectives et de Conseils sur les IST/VIH/Sida, Parakou
| | | | | | | | | | | | | | - Léonard Fourn
- Département de Santé Publique, Faculté des Sciences de la Santé Cotonou
| | | | - Prosper Gandaho
- Département de Médecine et spécialités médicales de la Faculté de Médecine de l'Université de Parakou ; Service de Psychiatrie, CHU de Parakou
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Agodokpessi G, Ade G, Dovoedo N, Ade S, Wachinou AP, Fayomi B, Gninafon M. [Sensitisation profile to airborne allergens of patients followed for asthma in Cotonou, Benin. A cross-sectional study using prick-tests]. Rev Mal Respir 2014; 32:930-5. [PMID: 25480388 DOI: 10.1016/j.rmr.2014.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 09/22/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE The sensitisation profile to airborne allergens of asthma patients followed in Benin is not known. PATIENTS AND METHODS A descriptive cross-sectional study was conducted from April to June 2013 at the hospital reference centre. A prick-test was performed in all adults with asthma consulting during this period. The standardized allergenic extracts tested were: mites (Dermatophagoides pteronyssinus [DP], Dermatophagoides farinae [DF] and Blomia tropicalis [BT]), cockroaches, 5 different grasses, Alternaria, dogs and cats. The test was positive when the diameter of the wheal was more than half that of the positive control and/or when the diameter of the wheal was ≥3mm than the negative control. RESULTS Of the 253 asthmatics tested, 247 (97.6%) had at least one positive skin reaction. The average age was 44 years, the sex ratio was 0.81. Sensitization to mites was the most frequent (99.6%), followed by cockroaches (71.3%), 5 grasses (71.3%), Alternaria (71%), dog (68%) and cat (63.6%). The average number of sensitivities was 5±2. CONCLUSION Asthmatics monitored in Cotonou have multiple sensitisations dominated by mites.
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Affiliation(s)
- G Agodokpessi
- Centre national hospitalier de pneumo-phtisiologie, 01 BP 321, Cotonou, Bénin; Faculté des sciences de la santé de Cotonou, Cotonou, Bénin.
| | - G Ade
- Centre national hospitalier de pneumo-phtisiologie, 01 BP 321, Cotonou, Bénin; Faculté des sciences de la santé de Cotonou, Cotonou, Bénin
| | - N Dovoedo
- Centre national hospitalier de pneumo-phtisiologie, 01 BP 321, Cotonou, Bénin; Faculté des sciences de la santé de Cotonou, Cotonou, Bénin
| | - S Ade
- Centre national hospitalier de pneumo-phtisiologie, 01 BP 321, Cotonou, Bénin
| | - A P Wachinou
- Centre national hospitalier de pneumo-phtisiologie, 01 BP 321, Cotonou, Bénin
| | - B Fayomi
- Unité de recherche en santé au travail et environnement, département de santé publique, Cotonou, Bénin; Faculté des sciences de la santé de Cotonou, Cotonou, Bénin
| | - M Gninafon
- Centre national hospitalier de pneumo-phtisiologie, 01 BP 321, Cotonou, Bénin; Faculté des sciences de la santé de Cotonou, Cotonou, Bénin
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Agodokpessi G, Ade G, Mbatchou Ngahane BH, Ade S, Wachinou AP, Bohissou F, Gninafon M. [Evaluation of tuberculous patients' management when re-treated in Cotonou, Benin]. Rev Mal Respir 2013; 30:774-9. [PMID: 24267768 DOI: 10.1016/j.rmr.2013.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 03/17/2013] [Indexed: 10/26/2022]
Abstract
Retreatment of tuberculosis is the leading risk factor for drug resistance if the management is not adequate and complete. The objective of this study was to evaluate the management of cases of retreatment in Cotonou. This was a retrospective, descriptive cross type which covered a period of 5 years. Outcomes of retreatment cases were compared against those for new cases that were registered during the same period. We analyzed the cases of 389 retreatment patients and 4542 new cases. The success rates of treatment were generally satisfactory (80% vs. 86%, P=0.0001). Of adverse outcomes, the rate of loss of sight of was 12% versus 7%, P=0.26, the rate was 23% for cases of occasions. The failure rate was low and similar in both populations (2%). The retreatment regimen for patients with TB in Cotonou appears to give generally satisfactory results. The high loss to follow-up in case of retreatment means that a personalized therapeutic approach for such patients is needed in general and in particular in the case of defaulters.
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Affiliation(s)
- G Agodokpessi
- Centre national hospitalier de pneumo-phtisiologie, 01 BP 321, Cotonou, Bénin; Faculté des sciences de la santé de Cotonou, Cotonou, Bénin.
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Adjoh KS, Watéba MI, Fiogbé AA, Adambounou AS, Gbadamassi AG, Efalou PJ, Boukari M, Awanou GB, Wachinou AP, Kounta C, Dagnra A, Tidjani O. [Becoming new pulmonary tuberculosis patients with sputum smear-positive at the end of second month of anti tubercular treatment in Lome]. Mali Med 2013; 28:32-36. [PMID: 30049152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIMS To determine the frequency of the new smear-positive pulmonary tuberculosis patients at the end of the second month of anti-tuberculosis treatment and to analyze the outcomes of their treatment. PATIENTS AND METHOD It was a retrospective comparative study from January 2006 to June 2008, based on the analysis of the records and treatment cards from the diagnosis and treatment centers of Lome. New sputum smear-positive tuberculosis patients at the end of the second month (smear positive 2 months) constituted the study population. A comparison group consisted of the new tuberculosis patients with sputum smear-negative at the end of the second month (negative smear 2 months). RESULTS The proportion of sputum smear-positive at 2 months was 5.34% (163/3050). Cure and failure rates were respectively 69.3% and 17.2% for smear-positive 2 months versus 79.1% and 3.7% for control group. The death rate was similar in both groups (3% and 3.7%). CONCLUSION The smear positive 2 month's patients have a high risk of failure and must receive special attention during their follow-up to improve the results of treatment.
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Affiliation(s)
- K S Adjoh
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - M I Watéba
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - A A Fiogbé
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - A S Adambounou
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - A G Gbadamassi
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - P J Efalou
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - M Boukari
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - G B Awanou
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - A P Wachinou
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - C Kounta
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
| | - A Dagnra
- Laboratoire national de référence de mycobactériologie
| | - O Tidjani
- Service de Pneumo-phtisiologie et de Maladies Infectieuses, Centre Hospitalier Universitaire Sylvanus Olympio de Lomé-Togo
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Agodokpessi G, Ade G, Ade S, Wachinou AP, Affolabi D, Anagonou S, Gninafon M. Management of tuberculosis and HIV co-infection in Cotonou, Benin. Med Mal Infect 2012; 42:561-6. [PMID: 23044083 DOI: 10.1016/j.medmal.2012.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/17/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The authors had for aim to assess the management of tuberculosis and HIV co-infection in Cotonou, Benin. PATIENTS AND METHODS We made a cross-sectional, retrospective, and descriptive study comparing the clinical presentation and outcome of patients with tuberculosis and HIV co-infection versus patients with tuberculosis alone, all managed at the National Pneumophtisiology Center in Cotonou, Benin, in 2009. RESULTS The rate of HIV screening in TB patients was 99%. One thousand and eighty-six TB patients were included and 259 were HIV positive. The mean age of co-infected patients was 36 years, versus 34 for TB mono-infected patients. The sex ratio among co-infected was 1.15 versus 2.25 among TB patients. Positive pulmonary sputum was less frequent with co-infection. Two hundred and fifty-seven over 259 patients were treated with cotrimoxazole. One hundred and eighty-five over 234 (79.05%) had CD4 counts<350. Eighty-five (46%) of the 185 patients with CD4<350, were given antiretroviral therapy. Treatment success rate was lower for co-infected (75%) than for patients with TB alone (86%), and death rates were higher in co-infected patients (10% vs. 3%). CONCLUSION High death rate and high rate of lost to follow-up are arguments for systematic antiretroviral treatment of co-infected patients. Early screening for TB and HIV, and reviewing the current national recommendations, as well as an increased governmental effort to provide medicines to all patients in need of ARV are mandatory.
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Affiliation(s)
- G Agodokpessi
- Centre National Hospitalier de Pneumophtisiologie, 01 BP 321 Cotonou, Benin.
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