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Koesoemadinata RC, McAllister SM, Soetedjo NNM, Santoso P, Dewi NF, Permana H, Ruslami R, Alisjahbana B, Critchley JA, Dockrell HM, Hill PC, van Crevel R. Diabetes characteristics and long-term management needs in diabetic TB patients. Int J Tuberc Lung Dis 2023; 27:113-120. [PMID: 36853103 DOI: 10.5588/ijtld.22.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND: Diabetes mellitus (DM) is common among patients with TB. We assessed DM characteristics and long-term needs of DM-TB patients after completing TB treatment.METHODS: Newly diagnosed TB patients with DM were recruited for screening in a randomised clinical trial evaluating a simple algorithm to improve glycaemic control during TB treatment. DM characteristics, lifestyle and medication were compared before and after TB treatment and 6 months later. Risk of cardiovascular disease (CVD), albuminuria and neuropathy were assessed after TB treatment.RESULTS: Of 218 TB-DM patients identified, 170 (78%) were followed up. Half were males, the mean age was 53 years, 26.5% were newly diagnosed DM. High glycated haemoglobin at TB diagnosis (median 11.2%) decreased during TB treatment (to 7.4% with intensified management and 8.4% with standard care), but this effect was lost 6 months later (9.3%). Hypertension and dyslipidemia contributed to a high 10-year CVD risk (32.9% at month 6 and 35.5% at month 12). Neuropathy (33.8%) and albuminuria (61.3%) were common. After TB treatment, few patients used CVD-mitigating drugs.CONCLUSION: DM in TB-DM patients is characterised by poor glycaemic control, high CVD risk, and nephropathy. TB treatment provides opportunities for better DM management, but effort is needed to improve long-term care.
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Affiliation(s)
- R C Koesoemadinata
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S M McAllister
- Centre for International Health, Division of Health Sciences, University of Otago Medical School, Dunedin, New Zealand
| | - N N M Soetedjo
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P Santoso
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - N F Dewi
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - H Permana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R Ruslami
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - B Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - J A Critchley
- Population Health Research Institute, St George´s University of London, London, UK
| | - H M Dockrell
- Faculty of Infectious and Tropical Diseases and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - P C Hill
- Centre for International Health, Division of Health Sciences, University of Otago Medical School, Dunedin, New Zealand
| | - R van Crevel
- Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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2
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Apriani L, Koesoemadinata RC, Bastos ML, Wulandari DA, Santoso P, Alisjahbana B, Rutherford ME, Hill PC, Benedetti A, Menzies D, Ruslami R. Implementing the 4R and 9H regimens for TB preventive treatment in Indonesia. Int J Tuberc Lung Dis 2022; 26:103-110. [PMID: 35086621 PMCID: PMC8802562 DOI: 10.5588/ijtld.21.0318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACK GROUND: The implementation of tuberculosis preventive treatment (TPT) is challenging especially in resource-limited settings. As part of a Phase 3 trial on TPT, we described our experience with the use of rifampicin for 4 months (4R) and isoniazid for 9 months (9H) in Indonesia. METHODS: In 2011–2017, children and adults with latent TB infection were randomised to either 4R or 9H and followed until 16 months after randomisation for children and 28 months for adults. The primary outcome was the treatment completion rate. Secondary outcomes were Grade 3–5 adverse events (AEs), active TB occurrence, and health costs. RESULTS: A total of 157 children and 860 adults were enrolled. The 4R treatment completion rate was significantly higher than that of 9H (78.7% vs. 65.5%), for a rate difference of 13.2% (95% CI 7.1–19.2). No Grade 3–5 AEs were reported in children; in adults, it was lower in 4R (0.4%) compared to 9H (2.8%). The incidence of active TB was lower with 4R than with 9H (0.09/100 person-year vs. 0.36/100 person-year) (rate difference: −0.36/100 person-year). The total cost per patient was lower for the 4R regimen than for the 9H regimen (USD151.9 vs. USD179.4 in adults and USD152.9 vs. USD206.5 in children) CONCLUSIONS: Completion and efficacy rates for 4R were better than for 9H. Compared to 9H, 4R was cheaper in all age groups, safer in adults and equally safe in children. The Indonesian TB program could benefit from these benefits of the 4R regimen.
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Affiliation(s)
- L Apriani
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - R C Koesoemadinata
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - M L Bastos
- Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - D A Wulandari
- Department of Child Health, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P Santoso
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - B Alisjahbana
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - M E Rutherford
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Otago, New Zealand
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Otago, New Zealand
| | - A Benedetti
- Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, Departments of Epidemiology, Biostatistics and Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - D Menzies
- Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, Departments of Epidemiology, Biostatistics and Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - R Ruslami
- TB Working Group, Infectious Disease Research Center, Universitas Padjadjaran, Bandung, Indonesia, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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3
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Koesoemadinata RC, McAllister SM, Soetedjo NNM, Santoso P, Ruslami R, Damayanti H, Rahmadika N, Alisjahbana B, van Crevel R, Hill PC. Educational counselling of patients with combined TB and diabetes mellitus: a randomised trial. Public Health Action 2021; 11:202-208. [PMID: 34956849 DOI: 10.5588/pha.21.0064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Newly diagnosed pulmonary TB with diabetes mellitus (DM) comorbidity attending clinics in Bandung City, Indonesia. OBJECTIVE To describe the effect of educational counselling on patients' knowledge about TB (transmission, treatment, risk factors) and DM (symptoms, treatment, complications, healthy lifestyle), adherence to medication, and to assess characteristics associated with knowledge. DESIGN All patients received counselling and were then randomised to either structured education on TB-DM, combined with clinical monitoring and medication adjustment (intervention arm), or routine care (control arm). Knowledge and adherence were assessed using a questionnaire. RESULTS Baseline and 6-month questionnaires were available for 108 of 150 patients randomised (60/76 in the intervention arm and 48/74 in the control arm). Patients knew less about DM than about TB. There was no significant difference in the proportion with knowledge improvement at 6 months, both for TB (difference of differences 14%; P = 0.20) or for DM (10%; P = 0.39) between arms. Intervention arm patients were more likely to adhere to taking DM medication, with fewer patients reporting ever missing oral DM drugs than those in the control arm (23% vs. 48%; P = 0.03). Higher education level was associated with good knowledge of both TB and DM. CONCLUSIONS Structured education did not clearly improve patients' knowledge. It was associated with better adherence to DM medication, but this could not be attributed to education alone. More efforts are needed to improve patients' knowledge, especially regarding DM.
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Affiliation(s)
- R C Koesoemadinata
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S M McAllister
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - N N M Soetedjo
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P Santoso
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R Ruslami
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - H Damayanti
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - N Rahmadika
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - B Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R van Crevel
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P C Hill
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
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4
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Bastos ML, Oxlade O, Benedetti A, Fregonese F, Valiquette C, Lira SCC, Carvalho-Cordeiro D, Cavalcante JR, Faerstein E, Albuquerque MFM, Cordeiro-Santos M, Hill PC, Menzies D, Trajman A. A public health approach to increase treatment of latent TB among household contacts in Brazil. Int J Tuberc Lung Dis 2021; 24:1000-1008. [PMID: 33126931 DOI: 10.5588/ijtld.19.0728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities.METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician.RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI - 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial.DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.
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Affiliation(s)
- M L Bastos
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Respiratory Epidemiology & Clinical Research Unit
| | | | - A Benedetti
- Respiratory Epidemiology & Clinical Research Unit, Departments of Epidemiology, Biostatistics & Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - F Fregonese
- Respiratory Epidemiology & Clinical Research Unit
| | - C Valiquette
- Respiratory Epidemiology & Clinical Research Unit
| | - S C C Lira
- Recife Municipal Health Secretariat, Recife, PE, Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Pernambuco, Recife, PE
| | - D Carvalho-Cordeiro
- Manaus Municipal Health Secretariat, Manaus, AM, Programa de Pós-gradução em Enfermagem, Universidade Federal do Amazonas, Manaus, AM
| | - J R Cavalcante
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - E Faerstein
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - M Cordeiro-Santos
- Tropical Medicine Post-Graduation Program, Amazonas State University, Manaus, AM, Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, AM, Brazil
| | - P C Hill
- Centre for International Health, Otago Medical School, University of Otago, Otago, New Zealand
| | - D Menzies
- Respiratory Epidemiology & Clinical Research Unit, McGill International TB Centre, Departments of Epidemiology, Biostatistics & Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - A Trajman
- McGill International TB Centre, Internal Medicine Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Primary Health Care Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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5
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van Crevel R, Andia-Biraro I, Ntinginya NE, Chamba N, Critchley J, Te Brake L, Kibirige D, Manyama CK, Kilonzo K, Pennington M, Sharples K, Hill PC. Response to IJTLD article, "Having diabetes and being underweight in Asia: a potent risk factor for tuberculosis". Int J Tuberc Lung Dis 2020; 24:632-633. [PMID: 32552998 DOI: 10.5588/ijtld.20.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - I Andia-Biraro
- Makerere University, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) & London School of Hygiene and Tropical Medicine (LSHTM), Kampala, Uganda
| | - N E Ntinginya
- National Institute for Medical Research (NIMR) Tanzania, Male, Tanzania
| | - N Chamba
- Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | | | - L Te Brake
- Radboudumc (RUMC), Nijmegen, Netherlands
| | | | - C K Manyama
- NIMR Mbeya Medical Research Centre, Mbeya, Tanzania
| | - K Kilonzo
- Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | | | - K Sharples
- University of Otago, Otago, New Zealand, ,
| | - P C Hill
- University of Otago, Otago, New Zealand, ,
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6
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Handel A, Martinez L, Sekandi JN, Bellan SE, Zhu L, Chen C, Liu Q, Donkor S, Sutherland J, Hill PC, Gilman RH, Grandjean L, Whalen CC. Evidence for supercoughers in an analysis of six tuberculosis cohorts from China, Peru, The Gambia and Uganda. Int J Tuberc Lung Dis 2020; 23:1286-1292. [PMID: 31931913 DOI: 10.5588/ijtld.18.0819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: It is very difficult to observe tuberculosis (TB) transmission chains and thus, identify superspreaders. We investigate cough duration as a proxy measure of transmission to assess the presence of potential TB superspreaders.DESIGN: We analyzed six studies from China, Peru, The Gambia and Uganda, and determined the distribution of cough duration and compared it with several theoretical distributions. To determine factors associated with cough duration, we used linear regression and boosted regression trees to examine the predictive power of patient, clinical and environmental characteristics.RESULTS: We found within-study heterogeneity in cough duration and strong similarities across studies. Approximately 20% of patients contributed 50% of total cough days, and around 50% of patients contributed 80% of total cough days. The cough duration distribution suggested an initially increasing, and subsequently, decreasing hazard of diagnosis. While some of the exposure variables showed statistically significant associations with cough duration, none of them had a strong effect. Multivariate analyses of different model types did not produce a model that had good predictive power.CONCLUSION: We found consistent evidence for the presence of supercoughers, but no characteristics predictive of such individuals.
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Affiliation(s)
- A Handel
- Department of Epidemiology and Biostatistics, and Health Informatics Institute and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - L Martinez
- Department of Epidemiology and Biostatistics, and Health Informatics Institute and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - J N Sekandi
- Department of Epidemiology and Biostatistics, and Health Informatics Institute and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - S E Bellan
- Department of Epidemiology and Biostatistics, and Health Informatics Institute and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - L Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, People's Republic of China
| | - C Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, People's Republic of China
| | - Q Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, People's Republic of China
| | - S Donkor
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - J Sutherland
- Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - P C Hill
- Centre for International Health, School of Medicine, University of Otago, Dunedin, New Zealand
| | - R H Gilman
- Universidad Peruana Cayetano Heredia, Lima, Peru, Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | - L Grandjean
- Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Centre for Clinical Tropical Medicine, Imperial College London, London, Institute of Child Health, University College London, London, UK
| | - C C Whalen
- Department of Epidemiology and Biostatistics, and Health Informatics Institute and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
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7
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Nadiah Z, Koesoemadinata RC, McAllister SM, Putriyani G, Chaidir L, Ruslami R, Santoso P, Hill PC, van Crevel R, Alisjahbana B. Early chest X-ray in persons with presumptive tuberculosis increases Xpert® MTB/RIF diagnostic yield and efficiency. Public Health Action 2020; 10:17-20. [PMID: 32368519 DOI: 10.5588/pha.19.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/22/2019] [Accepted: 11/04/2019] [Indexed: 11/10/2022] Open
Abstract
Adult presumptive tuberculosis (TB) patients (n = 1690) were screened for TB using a questionnaire, chest X-ray (CXR) and sputum microscopy for acid-fast bacilli (AFB); Mycobacterium tuberculosis culture was performed for 74% of the patients and Xpert® MTB/RIF was done for 17.2%. Among patients recruited, 943 (55.8%) were diagnosed with TB, of whom 870 (92.3%) were bacteriologically confirmed and 73 (7.7%) were clinically diagnosed on the basis of CXR. Using CXR prior to culture or Xpert testing reduces the number needed to screen from 7.6 to 5.0. Using CXR to triage for culture or Xpert testing reduces the number of missed cases and increases the efficiency of culture and Xpert testing.
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Affiliation(s)
- Z Nadiah
- Undergraduate Programme, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - R C Koesoemadinata
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Indonesian Society for Clinical Microbiology, Bandung City, Indonesia
| | - S M McAllister
- Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand
| | - G Putriyani
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - L Chaidir
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Indonesian Society for Clinical Microbiology, Bandung City, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - R Ruslami
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - P Santoso
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P C Hill
- Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand
| | - R van Crevel
- Department of Internal Medicine and Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B Alisjahbana
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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8
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Viney K, Bissell K, Hill PC. Building operational research capacity in Papua New Guinea and the Pacific Islands. Public Health Action 2019; 9:S3. [PMID: 31579643 DOI: 10.5588/pha.19.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- K Viney
- Research School of Population Health, Australian National University, Canberra, Australia.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - K Bissell
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - P C Hill
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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9
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Abstract
Optimal management of combined tuberculosis (TB) and diabetes (DM) is important but challenging in terms of achieving good disease outcomes and avoiding toxicity, drug interactions and other challenges. DM management during anti-tuberculosis treatment, aimed at improving TB treatment outcomes and reducing DM-related morbidity and mortality, consists of glycaemic control and measures to reduce the risk of cardiovascular disease. Metformin, the glucose-lowering drug of choice for TB patients, has no meaningful interaction with rifampicin (RMP), and may reduce TB mortality. Insulin is effective for severe hyperglycaemia, but has several disadvantages that limit its use in TB patients. Cardiovascular risk assessment should be considered in TB-DM patients to guide management in terms of counselling and prescription of antihypertensive, lipid-lowering and anti-platelet treatment. With regard to anti-tuberculosis treatment, DM is associated with an increased risk of drug resistance, lower exposure to anti-tuberculosis drugs, treatment failure and recurrent TB. Patients therefore need careful assessment before, during and possibly after anti-tuberculosis treatment. Although no studies have been performed, anti-tuberculosis treatment may also have to be prolonged or intensified in terms of regimen or drug dosage if DM is present. With regard to service delivery, combined treatment should probably be administered, supervised and monitored as much as possible in a TB clinic. Local circumstances and severity of DM will guide the need for referral of patients to specialised DM care, and continuation of DM care after completion of anti-tuberculosis treatment. More data are also needed for the management of TB-DM patients with human immunodeficiency virus co-infection.
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Affiliation(s)
- R van Crevel
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - R Koesoemadinata
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, Faculty of Medicine, University of Otago, Dunedin, New Zealand
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, London School of Hygiene & Tropical Medicine, London, UK
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10
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Koesoemadinata RC, Kranzer K, Livia R, Susilawati N, Annisa J, Soetedjo NNM, Ruslami R, Philipsen R, van Ginneken B, Soetikno RD, van Crevel R, Alisjahbana B, Hill PC. Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus. Int J Tuberc Lung Dis 2019; 22:1088-1094. [PMID: 30092877 DOI: 10.5588/ijtld.17.0827] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a significant risk factor for tuberculosis (TB). We evaluated the performance of computer-aided detection for tuberculosis (CAD4TB) in people living with diabetes mellitus (PLWD) in Indonesia. METHODS PLWD underwent symptom screening and chest X-ray (CXR); sputum was examined in those with positive symptoms and/or CXR. Digital CXRs were scored using CAD4TB and analysed retrospectively using clinical and microbiological diagnosis as a reference. The area under the receiver operator curve (AUC) of CAD4TB scores was determined, and an optimal threshold score established. Agreement between CAD4TB and the radiologist's reading was determined. RESULTS Among 346 included PLWD, seven (2.0%) had microbiologically confirmed and two (0.6%) had clinically diagnosed TB. The highest agreement of CAD4TB with radiologist reading was achieved using a threshold score of 70 (κ = 0.41, P < 0.001). The AUC for CAD4TB was 0.89 (95%CI 0.73-1.00). A threshold score of 65 for CAD4TB resulted in a sensitivity, specificity, positive predictive value and negative predictive value of respectively 88.9% (95%CI 51.8-99.7), 88.5% (95%CI 84.6-91.7), 17.0% (95%CI 7.6-30.8) and 99.6% (95%CI 98.2-100). With this threshold, 48 (13.9%) individuals needed microbiological examination and no microbiologically confirmed cases were missed. CONCLUSIONS CAD4TB has potential as a triage tool for TB screening in PLWD, thereby significantly reducing the need for microbiological examination.
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Affiliation(s)
- R. C. Koesoemadinata
- Infectious Disease Research Centre, Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - K. Kranzer
- London School of Hygiene & Tropical Medicine, London, UK, National and Supranational Reference Laboratory, Research Centre Borstel, Germany
| | - R. Livia
- Infectious Disease Research Centre
| | | | | | - N. N. M. Soetedjo
- Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R. Ruslami
- Infectious Disease Research Centre, Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - R. Philipsen
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - B. van Ginneken
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R. D. Soetikno
- Department of Radiology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R. van Crevel
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - B. Alisjahbana
- Infectious Disease Research Centre, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P. C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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11
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Huangfu P, Laurence YV, Alisjahbana B, Ugarte-Gil C, Riza AL, Walzl G, Ruslami R, Moore DAJ, Ioana M, McAllister S, Ronacher K, Koesoemadinata RC, Grint D, Kerry S, Coronel J, Malherbe ST, Griffiths U, Dockrell HM, Hill PC, van Crevel R, Pearson F, Critchley JA. Point of care HbA 1c level for diabetes mellitus management and its accuracy among tuberculosis patients: a study in four countries. Int J Tuberc Lung Dis 2019; 23:283-292. [PMID: 30871659 DOI: 10.5588/ijtld.18.0359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is common among tuberculosis (TB) patients and often undiagnosed or poorly controlled. We compared point of care (POC) with laboratory glycated haemoglobin (HbA1c) testing among newly diagnosed TB patients to assess POC test accuracy, safety and acceptability in settings in which immediate access to DM services may be difficult. METHODS We measured POC and accredited laboratory HbA1c (using high-performance liquid chromatography) in 1942 TB patients aged 18 years recruited from Peru, Romania, Indonesia and South Africa. We calculated overall agreement and individual variation (mean ± 2 standard deviations) stratified by country, age, sex, body mass index (BMI), HbA1c level and comorbidities (anaemia, human immunodeficiency virus [HIV]). We used an error grid approach to identify disagreement that could raise significant concerns. RESULTS Overall mean POC HbA1c values were modestly higher than laboratory HbA1c levels by 0.1% units (95%CI 0.1-0.2); however, there was a substantial discrepancy for those with severe anaemia (1.1% HbA1c, 95%CI 0.7-1.5). For 89.6% of 1942 patients, both values indicated the same DM status (no DM, HbA1c <6.5%) or had acceptable deviation (relative difference <6%). Individual agreement was variable, with POC values up to 1.8% units higher or 1.6% lower. For a minority, use of POC HbA1c alone could result in error leading to potential overtreatment (n = 40, 2.1%) or undertreatment (n = 1, 0.1%). The remainder had moderate disagreement, which was less likely to influence clinical decisions. CONCLUSION POC HbA1c is pragmatic and sufficiently accurate to screen for hyperglycaemia and DM risk among TB patients.
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Affiliation(s)
- P Huangfu
- Population Health Research Institute, St George's University of London, London
| | - Y V Laurence
- Department of Global Health and Development, Faculty of Public Health and Policy, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - B Alisjahbana
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - C Ugarte-Gil
- Facultad de Medicina Alberto Hurtado and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - A-L Riza
- Human Genomics Laboratory, Universitatea de Medicina si Farmacie din Craiova, Romania, Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Walzl
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Tygerberg, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - D A J Moore
- Facultad de Medicina Alberto Hurtado and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - M Ioana
- Human Genomics Laboratory, Universitatea de Medicina si Farmacie din Craiova, Romania, Dolj Regional Centre of Medical Genetics, Emergency County Clinical Hospital Craiova, Romania
| | - S McAllister
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - K Ronacher
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Tygerberg, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Mater Medical Research, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - R C Koesoemadinata
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - D Grint
- Population Health Research Institute, St George's University of London, London
| | - S Kerry
- Population Health Research Institute, St George's University of London, London
| | - J Coronel
- Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia Lima, Peru
| | - S T Malherbe
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Tygerberg, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - U Griffiths
- Department of Global Health and Development, Faculty of Public Health and Policy
| | - H M Dockrell
- Department of Immunology & Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - P C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - R van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F Pearson
- Population Health Research Institute, St George's University of London, London
| | - J A Critchley
- Population Health Research Institute, St George's University of London, London
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12
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Koeken VACM, Verrall AJ, Netea MG, Hill PC, van Crevel R. Trained innate immunity and resistance to Mycobacterium tuberculosis infection. Clin Microbiol Infect 2019; 25:1468-1472. [PMID: 30807849 DOI: 10.1016/j.cmi.2019.02.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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: 11/15/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some individuals, even when heavily exposed to an infectious tuberculosis patient, develop neither active nor latent tuberculosis infection (LTBI). This 'early clearance' of Mycobacterium tuberculosis is associated with a history of bacillus Calmette-Guérin (BCG) vaccination. As BCG vaccination can boost innate immune responses through a process termed 'trained immunity', we hypothesize that BCG-induced trained innate immunity contributes to early clearance of M. tuberculosis. OBJECTIVES We describe the epidemiological evidence and biological concepts of early clearance and trained immunity, and the possible relation between these two processes through BCG vaccination. SOURCES Relevant data from published reports up to November 2018 were examined in the conduct of this review. CONTENT Several observational studies and one recent randomized trial support the concept that boosting innate immunity contributes to protection against M. tuberculosis infection, with BCG vaccination providing approximately 50% protection. The molecular mechanisms mediating early clearance remain largely unknown, but we propose that trained immunity, characterized by epigenetic and metabolic reprogramming of innate immune cells such as monocytes or macrophages, is at least partially responsible for eliminating the mycobacteria and inducing early clearance. IMPLICATIONS Future studies should examine if BCG revaccination increases early clearance of M. tuberculosis through induction of trained immunity. Epigenetic or metabolic modulation may further boost BCG-induced trained innate immunity to promote tuberculosis prevention. New tuberculosis vaccine candidates should also be examined for their capacity to improve protection against M. tuberculosis infection and induce trained immunity.
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Affiliation(s)
- V A C M Koeken
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - A J Verrall
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - M G Netea
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands; Department for Genomics & Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - R van Crevel
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands.
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13
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Egere U, Togun T, Sillah A, Mendy F, Otu J, Hoelscher M, Heinrich N, Hill PC, Kampmann B. Identifying children with tuberculosis among household contacts in The Gambia. Int J Tuberc Lung Dis 2018; 21:46-52. [PMID: 28157464 DOI: 10.5588/ijtld.16.0289] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Greater Banjul Area of the Gambia. OBJECTIVES To identify co-prevalent tuberculosis (TB) among child contacts of adults with smear-positive TB. DESIGN Child contacts aged <15 years in the immediate household and compound were prospectively enrolled and evaluated for TB disease using screening questionnaires and the tuberculin skin test (TST). Symptomatic and/or TST-positive (10 mm) contacts were further investigated. RESULTS Of 4042 child contacts who underwent symptom screening and TST, 3339 (82.6%) were diagnosed as TB-exposed but not infected, 639 (15.8%) were latently infected and 64 (1.6%) had co-prevalent TB. Of the 64 TB cases, 50 (78.1%) were from within the immediate household of the index case, and 14 (21.9%) from within the same compound. Of the 27 asymptomatic but TST-positive children diagnosed with TB, 7 were microbiologically confirmed. The median age of the TB cases was 4.4 years (interquartile range 1.9-6.9); 53.1% were aged <5 years. Of the 4042 child contacts, 206 (5%) slept in the same bed as the index case; 28.1% of all TB cases occurred in this group. Symptom screening alone would have detected only 57.8% of the co-prevalent cases. CONCLUSION In our community setting, if contact tracing is restricted to symptom screening and immediate households only, nearly half of all co-prevalent TB disease in child contacts would be missed.
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Affiliation(s)
- U Egere
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - T Togun
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - A Sillah
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia
| | - F Mendy
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia
| | - J Otu
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia
| | - M Hoelscher
- Center for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, German Center for Infection Research, Munich Partner Site, Munich, Germany
| | - N Heinrich
- Center for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, German Center for Infection Research, Munich Partner Site, Munich, Germany
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - B Kampmann
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit-The Gambia, Banjul, The Gambia; Centre for International Child Health, Academic Department of Paediatrics, St Mary's Campus, Imperial College London, London, UK
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14
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McAllister S, Wiem Lestari B, Sujatmiko B, Siregar A, Sihaloho ED, Fathania D, Dewi NF, Koesoemadinata RC, Hill PC, Alisjahbana B. Feasibility of two active case finding approaches for detection of tuberculosis in Bandung City, Indonesia. Public Health Action 2017; 7:206-211. [PMID: 29226096 DOI: 10.5588/pha.17.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 03/24/2017] [Accepted: 05/06/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: A community health clinic catchment area in the eastern part of Bandung City, Indonesia. Objective: To evaluate the feasibility of two different screening interventions using community health workers (CHWs) in detecting tuberculosis (TB) cases. Design: This was a feasibility study of 1) house-to-house TB symptom screening of five randomly selected 'neighbourhoods' in the catchment area, and 2) selected screening of household contacts of TB index patients and their neighbouring households. Acceptability was assessed through focus group discussions with key stakeholders. Results: Of 5100 individuals screened in randomly selected neighbourhoods, 48 (0.9%) reported symptoms, of whom 38 provided sputum samples; no positive TB was found. No TB cases were found among the 88 household contacts or the 423 neighbourhood contacts. With training, regular support and supervision from research staff and local community health centre staff, CHWs were able to undertake screening effectively, and almost all householders were willing to participate. Conclusion: The use of CHWs for TB screening could be integrated into routine practice relatively easily in Indonesia. The effectiveness of this would need further exploration, particularly with the use of improved diagnostics such as chest X-ray and sputum culture.
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Affiliation(s)
- S McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - B Wiem Lestari
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - B Sujatmiko
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - A Siregar
- Centre for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - E D Sihaloho
- Centre for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - D Fathania
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - N F Dewi
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - R C Koesoemadinata
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - B Alisjahbana
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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15
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Egere U, Sillah A, Togun T, Kandeh S, Cole F, Jallow A, Able-Thomas A, Hoelscher M, Heinrich N, Hill PC, Kampmann B. Isoniazid preventive treatment among child contacts of adults with smear-positive tuberculosis in The Gambia. Public Health Action 2016; 6:226-231. [PMID: 28123958 DOI: 10.5588/pha.16.0073] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: Greater Banjul area of The Gambia. Objectives: To evaluate uptake, adherence and completion of treatment among tuberculosis (TB) exposed children in The Gambia when isoniazid preventive treatment (IPT) is delivered at home Design: Child (age <5 years) contacts of adults with smear-positive TB were prospectively enrolled. Following symptom screening, tuberculin skin testing and clinical evaluation where indicated, those without disease were placed on daily isoniazid, provided monthly at home. Adherence was assessed by pill counts and IsoScreen™ urine test. Results: Of 404 contacts aged <5 years, 368 (91.1%) were offered IPT. Of the 328 (89.4%) for whom consent was received and who commenced IPT, 18 (5.5%) dropped out and 310 (94.5%) remained on IPT to the end of the 6-month regimen. Altogether, 255/328 children (77.7%, 95%CI 73.2-82.2) completed all 6 months, with good adherence. The IsoScreen test was positive in 85.3% (435/510) of all tests among those defined as having good adherence by pill count and in 16% (8/50) of those defined as having poor adherence (P < 0.001). A cascade of care analysis showed an overall completion rate with good adherence of 61% for all child contacts. Conclusion: Home-delivered IPT among child contacts of adults with smear-positive TB in The Gambia achieved verifiable high uptake and adherence rates. System rather than patient factors are likely to determine the success of IPT at national level.
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Affiliation(s)
- U Egere
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - A Sillah
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - T Togun
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia ; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - S Kandeh
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - F Cole
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia
| | - A Jallow
- National Leprosy and Tuberculosis Control Programme, Kanifing, The Gambia
| | - A Able-Thomas
- National Leprosy and Tuberculosis Control Programme, Kanifing, The Gambia
| | - M Hoelscher
- Centre for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - N Heinrich
- Centre for International Health, Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - P C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - B Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit-The Gambia, Banjul, The Gambia ; Centre for International Child Health, Academic Department of Paediatrics, Imperial College London, London, UK
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16
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Howie SRC, Schellenberg J, Chimah O, Ideh RC, Ebruke BE, Oluwalana C, Mackenzie G, Jallow M, Njie M, Donkor S, Dionisio KL, Goldberg G, Fornace K, Bottomley C, Hill PC, Grant CC, Corrah T, Prentice AM, Ezzati M, Greenwood BM, Smith PG, Adegbola RA, Mulholland K. Childhood pneumonia and crowding, bed-sharing and nutrition: a case-control study from The Gambia. Int J Tuberc Lung Dis 2016; 20:1405-1415. [PMID: 27725055 PMCID: PMC5019143 DOI: 10.5588/ijtld.15.0993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/19/2016] [Indexed: 12/03/2022] Open
Abstract
SETTING Greater Banjul and Upper River Regions, The Gambia. OBJECTIVE To investigate tractable social, environmental and nutritional risk factors for childhood pneumonia. DESIGN A case-control study examining the association of crowding, household air pollution (HAP) and nutritional factors with pneumonia was undertaken in children aged 2-59 months: 458 children with severe pneumonia, defined according to the modified WHO criteria, were compared with 322 children with non-severe pneumonia, and these groups were compared to 801 neighbourhood controls. Controls were matched by age, sex, area and season. RESULTS Strong evidence was found of an association between bed-sharing with someone with a cough and severe pneumonia (adjusted OR [aOR] 5.1, 95%CI 3.2-8.2, P < 0.001) and non-severe pneumonia (aOR 7.3, 95%CI 4.1-13.1, P < 0.001), with 18% of severe cases estimated to be attributable to this risk factor. Malnutrition and pneumonia had clear evidence of association, which was strongest between severe malnutrition and severe pneumonia (aOR 8.7, 95%CI 4.2-17.8, P < 0.001). No association was found between pneumonia and individual carbon monoxide exposure as a measure of HAP. CONCLUSION Bed-sharing with someone with a cough is an important risk factor for severe pneumonia, and potentially tractable to intervention, while malnutrition remains an important tractable determinant.
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Affiliation(s)
- S R C Howie
- Medical Research Council Unit, Fajara, The Gambia; Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, Centre for International Health, University of Otago, Dunedin, New Zealand
| | - J Schellenberg
- London School of Hygiene & Tropical Medicine, London, UK
| | - O Chimah
- Medical Research Council Unit, Fajara, The Gambia
| | - R C Ideh
- Medical Research Council Unit, Fajara, The Gambia; Child Health Department, University of Benin, Teaching Hospital, Benin City, Nigeria
| | - B E Ebruke
- Medical Research Council Unit, Fajara, The Gambia
| | - C Oluwalana
- Medical Research Council Unit, Fajara, The Gambia
| | - G Mackenzie
- Medical Research Council Unit, Fajara, The Gambia
| | - M Jallow
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - M Njie
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - S Donkor
- Medical Research Council Unit, Fajara, The Gambia
| | - K L Dionisio
- Harvard School of Public Health, Department of Global Health and Population, Boston, and Harvard School of Public Health, Department of Environmental Health, Boston, Massachusetts, USA; National Exposure Research Laboratory, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - G Goldberg
- MRC-Public Health England Centre for Environment and Health, Imperial College London, London, UK
| | - K Fornace
- Medical Research Council Unit, Fajara, The Gambia, London School of Hygiene & Tropical Medicine, London, UK
| | - C Bottomley
- London School of Hygiene & Tropical Medicine, London, UK
| | - P C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - C C Grant
- Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, New Zealand
| | - T Corrah
- Medical Research Council Unit, Fajara, The Gambia
| | - A M Prentice
- Medical Research Council Unit, Fajara, The Gambia, London School of Hygiene & Tropical Medicine, London, UK
| | - M Ezzati
- Medical Research Council (MRC) Human Nutrition Research, Cambridge, UK
| | - B M Greenwood
- London School of Hygiene & Tropical Medicine, London, UK
| | - P G Smith
- London School of Hygiene & Tropical Medicine, London, UK
| | - R A Adegbola
- Medical Research Council Unit, Fajara, The Gambia, GlaxoSmithKline Vaccines, Wavre, Belgium
| | - K Mulholland
- London School of Hygiene & Tropical Medicine, London, UK, Harvard School of Public Health, Department of Global Health and Population, Boston, and Harvard School of Public Health, Department of Environmental Health, Boston, Massachusetts, USA
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17
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Togun TO, Egere U, Sillah AK, Ayorinde A, Mendy F, Tientcheu L, Otu J, Antonio M, Sutherland J, Hill PC, Kampmann B. Contribution of Xpert® MTB/RIF to the diagnosis of pulmonary tuberculosis among TB-exposed children in The Gambia. Int J Tuberc Lung Dis 2016; 19:1091-7, i-ii. [PMID: 26260831 DOI: 10.5588/ijtld.15.0228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Greater Banjul Area, The Gambia. OBJECTIVE To conduct a pragmatic evaluation of the Xpert(®) MTB/RIF assay in the diagnosis of tuberculosis (TB) among child contacts. DESIGN In this prospective study, one induced sputum sample was obtained from TB contacts aged <15 years and tested using fluorescent microscopy, culture and Xpert. The diagnostic accuracy of the microbiological tests was evaluated against culture and 'all TB diagnosis and treatment' as separate reference standards. RESULTS Using culture as a reference standard, Xpert was positive for Mycobacterium tuberculosis in 6/14 culture-positive and 6/473 culture-negative children, giving a sensitivity and specificity of respectively 42.9% (95%CI 17.7-71.1) and 98.7% (95%CI 97.2-99.5). With 'all TB diagnosis and treatment' as a composite reference standard, combined Xpert and culture tests were positive for M. tuberculosis in 20/62 children with TB disease (32.3%, 95%CI 20.9-45.3), which was comparable to the yield from microscopy, culture and Xpert combined (33.9%, 95%CI 22.3-47.0), but significantly higher than individual yields from each test. CONCLUSION The sensitivity of Xpert is low in actively traced child contacts, but a combination of Xpert and mycobacterial culture has incremental benefits for the bacteriological confirmation of TB disease.
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Affiliation(s)
- T O Togun
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - U Egere
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - A K Sillah
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - A Ayorinde
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - F Mendy
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - L Tientcheu
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - J Otu
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - M Antonio
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - J Sutherland
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - P C Hill
- Centre for International Health and the Otago International Health Research Network, Department of Preventive and Social Medicine, University of Otago School of Medicine, Dunedin, New Zealand
| | - B Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia; Academic Department of Paediatrics, St Mary's campus, Imperial College London, London, UK
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Menon S, Stansfield SH, Walsh M, Hope E, Isaia L, Righarts AA, Niupulusu T, Temese SVA, Iosefa-Siitia L, Auvaa L, Tapelu SA, Motu MF, Suaalii-Sauni T, Timms P, Hill PC, Huston WM. Sero-epidemiological assessment of Chlamydia trachomatis infection and sub-fertility in Samoan women. BMC Infect Dis 2016; 16:175. [PMID: 27102989 PMCID: PMC4839085 DOI: 10.1186/s12879-016-1508-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 10/08/2015] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background In our recent village-based cross-sectional study, the prevalence of nucleic acid amplification technique (NAAT) diagnosed Chlamydia trachomatis (CT) in sexually active Samoan women was very high (36 %), and test positivity was associated with sub-fertility. We conducted a serological and epidemiological analysis in these participants to identify if serological data can provide further insight into the potential contribution of CT to sub-fertility in this population. Methods Serological prediction of CT associated sub-fertility was conducted using a series of commercial tests. The correlation between fertility or sub-fertility, behavioral factors, and serologically predicted CT associated sub-fertility was determined. Results A positive antibody reaction against the Chlamydia Major Outer Membrane Protein (MOMP) was significantly associated with sub-fertility, with 50 % of infertile women being positive. Serum IgG and IgA antibodies against MOMP correlated with current infection measured by urine NAAT, suggesting longer term infections are common in this population. Chlamydia pneumoniae antibodies were frequently detected in this population (84 %), and unexpectedly, were significantly associated with sub-fertility. Conclusions The high prevalence of chlamydial infection and of positive chlamydial sub-fertility results suggests that CT is an important and frequent contributory factor to sub-fertility in this population.
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Affiliation(s)
- S Menon
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - S H Stansfield
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - M Walsh
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - E Hope
- National University of Samoa, Apia, Samoa
| | - L Isaia
- National Health Service Laboratory Division, Apia, Samoa
| | - A A Righarts
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - T Niupulusu
- Samoa Family Health Association, Apia, Samoa
| | - S V A Temese
- Centre for Samoan Studies, National University of Samoa, Apia, Samoa
| | | | - L Auvaa
- National University of Samoa, Apia, Samoa
| | | | - M F Motu
- Samoa National Council of Churches, Apia, Samoa
| | | | - P Timms
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Australia
| | - P C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - W M Huston
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. .,School of Life Sciences, Faculty of Science, University of Technology Sydney, Broadway, Sydney, NSW, Australia. .,School of Life Sciences, University of Technology Sydney, PO BOX 123, Broadway, Sydney, NSW, 2007, Australia.
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Usuf E, Bojang A, Hill PC, Bottomley C, Greenwood B, Roca A. Nasopharyngeal colonization of Gambian infants by Staphylococcus aureus and Streptococcus pneumoniae before the introduction of pneumococcal conjugate vaccines. New Microbes New Infect 2015; 10:13-8. [PMID: 26909154 PMCID: PMC4733216 DOI: 10.1016/j.nmni.2015.12.002] [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: 09/29/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022] Open
Abstract
Staphylococcus aureus and Streptococcus pneumoniae commonly colonize the upper respiratory tract and can cause invasive disease. Several studies suggest an inverse relationship between these two bacteria in the nasopharynx. This association is of particular concern as the introduction of pneumococcal conjugate vaccines (PCVs) that affect pneumococcal nasopharyngeal carriage become widespread. A cohort of children in rural Gambia were recruited at birth and followed for 1 year, before the introduction of PCV into the routine immunization program. Nasopharyngeal swabs were taken immediately after birth, every 2 weeks for the first 6 months and then every other month. The presence of S. aureus and S. pneumoniae was determined using conventional microbiologic methods. Prevalence of S. aureus carriage was 71.6% at birth, decreasing with age to reach a plateau at approximately 20% between 10 to 20 weeks of age. Carriage with any S. pneumoniae increased during the first 10 weeks of life to peak at approximately 90%, mostly of PCV13 serotypes. Although in the crude analysis S. aureus carriage was inversely associated with carriage of any S. pneumoniae and PCV13 serotypes, after adjusting by age and season, there was a positive association with any carriage (odds ratio 1.32; 95% confidence interval 1.07-1.64; p 0.009) and no association with carriage of PCV13 serotypes (odds ratio 0.99; 95% confidence interval 0.70-1.41; p 0.973). Among Gambian infants, S. aureus and S. pneumoniae are not inversely associated in nasopharyngeal carriage after adjustment for age. Further carriage studies following the introduction of PCV are needed to better understand the relationship between the two bacteria.
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Affiliation(s)
- E Usuf
- Disease Control and Elimination, MRC Unit The Gambia, Fajara, Gambia
| | - A Bojang
- Disease Control and Elimination, MRC Unit The Gambia, Fajara, Gambia
| | - P C Hill
- Centre for International Health, University of Otago, New Zealand
| | - C Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - B Greenwood
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - A Roca
- Disease Control and Elimination, MRC Unit The Gambia, Fajara, Gambia; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Harries AD, Marais B, Kool B, Ram S, Kumar AMV, Gounder S, Viney K, Brostrom R, Roseveare C, Bissell K, Reid AJ, Zachariah R, Hill PC. Mentorship for operational research capacity building: hands-on or hands-off? Public Health Action 2015; 4:S56-8. [PMID: 26477290 DOI: 10.5588/pha.13.0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/29/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022] Open
Abstract
Mentorship is a key feature of operational research training courses run by the International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières. During the recent South Pacific paper writing module, the faculty discussed 'hands-on' mentorship (direct technical assistance) vs. 'hands-off' mentorship (technical advice). This article explores the advantages and disadvantages of each approach. Our collective experience indicates that 'hands-on' mentorship is a valuable learning experience for the participant and a rewarding experience for the mentor. This approach increases the likelihood of successful course completion, including publishing a well written paper. However, mentors must allow participants to lead and take ownership of the paper, in keeping with a first author position.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - B Marais
- The Sydney Emerging Infections and Biosecurity Institute, University of Sydney, Sydney, NSW, Australia
| | - B Kool
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - A M V Kumar
- The Union South-East Asia Regional Office, New Delhi, India
| | - S Gounder
- National Tuberculosis Programme, Ministry of Health, Suva, Fiji
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - R Brostrom
- Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia, USA
| | - C Roseveare
- Department of Statistics, Regional Public Health, Lower Hutt, New Zealand
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A J Reid
- Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - R Zachariah
- Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - P C Hill
- Centre for International Health, The University of Otago, Dunedin, New Zealand
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Itogo N, Hill PC, Bissell K, Harries AD, Viney K, Gounder S. Tuberculosis notifications, characteristics and treatment outcomes: urban vs. rural Solomon Islands, 2000-2011. Public Health Action 2015; 4:S25-8. [PMID: 26477283 DOI: 10.5588/pha.13.0078] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING All provincial tuberculosis (TB) management units in the Solomon Islands. OBJECTIVE To compare TB notifications, characteristics and treatment outcomes in urban vs. rural areas. DESIGN A retrospective descriptive cohort study involving record review and data extraction from provincial TB and laboratory registers and treatment charts from 2000 to 2011. RESULTS Of 4137 TB cases notified, 1364 (33%) were from urban and 3227 (67%) from rural areas. Notification rates per year of study were consistently higher in urban areas (104-150 per 100 000 population) than in rural areas (49-70/100 000). Cases in rural areas were more likely to have smear-negative pulmonary TB and less likely to have extra-pulmonary TB (P < 0.001). TB cases in rural areas were more likely to die from TB than those from urban areas (3.2% vs. 5.9%). In contrast, TB cases in rural areas were less likely to default (2.8% vs. 1.8%). CONCLUSION TB notification rates were much higher in urban than in rural areas in the Solomon Islands. Rural patients are more likely to die from the disease but are slightly less likely to default. Further research is required to explore the possibility of under-reporting in rural areas and to improve treatment outcomes.
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Affiliation(s)
- N Itogo
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - P C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K Viney
- Secretariat of the Pacific Community, Nouméa, New Caledonia
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Tairea K, Kool B, Harries AD, Bissell K, Gounder S, Hill PC, Avare T, Fariu R. Characteristics of government workers and association with diabetes and hypertension in the Cook Islands. Public Health Action 2014; 4:S34-8. [PMID: 26477285 DOI: 10.5588/pha.13.0077] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Twenty government departments in Rarotonga, Cook Islands. OBJECTIVE To determine the characteristics, presence of selected non-communicable disease (NCD) risk factors and prevalence of diabetes mellitus (DM) and hypertension among government workers who participated in 'wellness checks' in 2012. DESIGN Cross-sectional study involving analysis of survey data. RESULTS Of 598 employees, 70% were aged 25-54 years and 55% were female. Two thirds were obese (body mass index ⩾30 kg/m(2)), and 76% had low levels of fruit and vegetable consumption. Of 50 (8.4%) participants diagnosed with DM (random blood glucose ⩾11 mmol/l, fasting ⩾7 mmol/l), 30 were self-reported and 20 were based on blood glucose. Of the 206 (34.4%) diagnosed with hypertension (systolic ⩾140 and/or diastolic ⩾90), 71 were self-reported and 135 were based on blood pressure measurements. Obesity was associated with hypertension (OR 2.79, 95%CI 1.4-5.4), but not with DM. No relationship was observed between fruit and vegetable consumption and presence or absence of DM or hypertension. CONCLUSION This study identified a high prevalence of obesity and hypertension among government employees in the Cook Islands, risk factors that are associated with NCDs such as DM and cardiovascular disease. 'Wellness checks' pave the way for interventions in workplace settings to prevent and better manage these diseases through early diagnosis, risk management, treatment and supportive public health policies.
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Affiliation(s)
- K Tairea
- Ministry of Health, Rarotonga, Cook Islands
| | - B Kool
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - K Bissell
- School of Population Health, The University of Auckland, Auckland, New Zealand ; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S Gounder
- National Tuberculosis Programme, Ministry of Health, Suva, Fiji
| | - P C Hill
- Centre for International Health, The University of Otago, Dunedin, New Zealand
| | - T Avare
- Ministry of Health, Rarotonga, Cook Islands
| | - R Fariu
- Ministry of Health, Rarotonga, Cook Islands
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Fonua L, Bissell K, Vivili P, Gounder S, Hill PC. Sputum smear microscopy referral rates and turnaround time in the Tonga Islands. Public Health Action 2014; 4:S29-33. [PMID: 26477284 DOI: 10.5588/pha.13.0087] [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: 09/22/2013] [Accepted: 11/08/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING The National Tuberculosis Programme and the National Reference Laboratory, located on the main island of Tonga, Tongatapu, and three district hospital laboratories located on the outer islands. OBJECTIVES To compare Tongatapu with Tonga's outer islands with respect to sputum referral rates, numbers of samples per patient, sample quality, test results and time from sending sample to obtaining results and from obtaining results to treatment initiation. DESIGN Retrospective study involving record review of laboratory and TB treatment registers in Tonga's four hospitals from 2003 to 2012. RESULTS Of 3078 sputum samples submitted, 71.7% were of good quality. Sputum referral rates on Tongatupu were nearly twice as high as those on the outer islands (353 vs. 180 per 100 000 population). The mean smear turnaround times on Tongatapu and the outer islands were respectively 4.02 and 4.11 days. Of 83 positive cases, 91.2% were treated within a day in Tongatapu compared with 80% in the outer islands. CONCLUSIONS Referral rates for sputum smear testing differed in the main and the outer islands in Tonga, but turnaround times did not. Records of sputum quality and dates had limitations, necessitating interventions with TB-specific laboratory guidelines and registers. Further research is required to understand the differences in referral rates.
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Affiliation(s)
- L Fonua
- Ministry of Health, Nuku'alofa, Tonga
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, University of Auckland, Auckland, New Zealand
| | - P Vivili
- Ministry of Health, Nuku'alofa, Tonga
| | | | - P C Hill
- Centre for International Health, Faculty of Medicine, University of Otago, Dunedin, New Zealand
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White MJ, Tacconelli A, Chen JS, Wejse C, Hill PC, Gomes VF, Velez-Edwards DR, Østergaard LJ, Hu T, Moore JH, Novelli G, Scott WK, Williams SM, Sirugo G. Epiregulin (EREG) and human V-ATPase (TCIRG1): genetic variation, ethnicity and pulmonary tuberculosis susceptibility in Guinea-Bissau and The Gambia. Genes Immun 2014; 15:370-7. [PMID: 24898387 DOI: 10.1038/gene.2014.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 02/07/2023]
Abstract
We analyzed two West African samples (Guinea-Bissau: n=289 cases and 322 controls; The Gambia: n=240 cases and 248 controls) to evaluate single-nucleotide polymorphisms (SNPs) in Epiregulin (EREG) and V-ATPase (T-cell immune regulator 1 (TCIRG1)) using single and multilocus analyses to determine whether previously described associations with pulmonary tuberculosis (PTB) in Vietnamese and Italians would replicate in African populations. We did not detect any significant single locus or haplotype associations in either sample. We also performed exploratory pairwise interaction analyses using Visualization of Statistical Epistasis Networks (ViSEN), a novel method to detect only interactions among multiple variables, to elucidate possible interaction effects between SNPs and demographic factors. Although we found no strong evidence of marginal effects, there were several significant pairwise interactions that were identified in either the Guinea-Bissau or the Gambian samples, two of which replicated across populations. Our results indicate that the effects of EREG and TCIRG1 variants on PTB susceptibility, to the extent that they exist, are dependent on gene-gene interactions in West African populations as detected with ViSEN. In addition, epistatic effects are likely to be influenced by inter- and intra-population differences in genetic or environmental context and/or the mycobacterial lineages causing disease.
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Affiliation(s)
- M J White
- 1] Center for Human Genetics Research, Vanderbilt University, Nashville, TN, USA [2] Department of Genetics and Institute of Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH, USA
| | - A Tacconelli
- Centro di Ricerca, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - J S Chen
- Department of Genetics and Institute of Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH, USA
| | - C Wejse
- 1] Bandim Health Project, Danish Epidemiology Science Centre and Statens Serum Institute, Bissau, Guinea-Bissau [2] Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark [3] Center for Global Health, School of Public Health, Aarhus University, Skejby, Denmark
| | - P C Hill
- 1] Centre for International Health, University of Otago School of Medicine, Dunedin, New Zealand [2] MRC Laboratories, Fajara, The Gambia
| | - V F Gomes
- Bandim Health Project, Danish Epidemiology Science Centre and Statens Serum Institute, Bissau, Guinea-Bissau
| | - D R Velez-Edwards
- 1] Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN, USA [2] Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN, USA [3] Center for Human Genetics Research, Vanderbilt University, Nashville, TN, USA [4] Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN, USA
| | - L J Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - T Hu
- Department of Genetics and Institute of Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH, USA
| | - J H Moore
- Department of Genetics and Institute of Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH, USA
| | - G Novelli
- 1] Centro di Ricerca, Ospedale San Pietro Fatebenefratelli, Rome, Italy [2] Dipartimento di Biomedicina e Prevenzione, Sezione di Genetica, Università di Roma 'Tor Vergata', Rome, Italy
| | - W K Scott
- Dr John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S M Williams
- Department of Genetics and Institute of Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH, USA
| | - G Sirugo
- Centro di Ricerca, Ospedale San Pietro Fatebenefratelli, Rome, Italy
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Rutherford ME, Hill PC, Maharani W, Sampurno H, Ruslami R. Risk factors for treatment default among adult tuberculosis patients in Indonesia. Int J Tuberc Lung Dis 2014; 17:1304-9. [PMID: 24025382 DOI: 10.5588/ijtld.13.0084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Defaulting from anti-tuberculosis treatment hinders tuberculosis (TB) control. OBJECTIVE To identify potential defaulters. DESIGN We conducted a cohort study in newly diagnosed Indonesian TB patients. We administered a questionnaire, prospectively identified defaulters (discontinued treatment ≥ 2 weeks) and assessed risk factors using Cox's regression. RESULTS Of 249 patients, 39 (16%) defaulted, 61% in the first 2 months. Default was associated with liver disease (HR 3.40, 95%CI 1.02-11.78), chest pain (HR 2.25, 95%CI 1.06-4.77), night sweats (HR 1.98, 95%CI 1.03-3.79), characteristics of the head of the household (self-employed, HR 2.47, 95%CI 1.15-5.34; patient's mother, HR 7.72, 95%CI 1.66-35.88), household wealth (HR 4.24, 95%CI 1.12-16.09), walking to clinic (HR 4.53, 95%CI 1.39-14.71), being unaccompanied at diagnosis (HR 30.49, 95%CI 7.55-123.07) or when collecting medication (HR 3.34, 95%CI 1.24-8.98) and low level of satisfaction with the clinic (HR 3.85, 95%CI 1.17-12.62) or doctors (HR 2.45, 95%CI 1.18-5.10). Health insurance (HR 0.24, 95%CI 0.07-0.74) and paying for diagnosis (HR 0.14, 95%CI 0.04-0.48) were protective. CONCLUSION Defaulting is common and occurs early. Interventions that improve clinic services, strengthen patient support and increase insurance coverage may reduce default in Indonesia.
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Affiliation(s)
- M E Rutherford
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; Health Research Unit, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
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Rutherford ME, Hill PC, Maharani W, Apriani L, Sampurno H, van Crevel R, Ruslami R. Risk factors for Mycobacterium tuberculosis infection in Indonesian children living with a sputum smear-positive case. Int J Tuberc Lung Dis 2013; 16:1594-9. [PMID: 23131256 DOI: 10.5588/ijtld.12.0389] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING AND OBJECTIVES Young children living with infectious tuberculosis (TB) cases are at high risk of infection and disease, and screening is recommended. This is rarely conducted in resource-limited settings. Identifying children most at risk of infection may be useful for setting practical screening policies. DESIGN Child contacts of smear-positive adult TB patients were invited for Mycobacterium tuberculosis infection and disease screening by symptoms, tuberculin skin test (TST), QuantiFERON-TB Gold In-Tube assay (QFT-GIT) and chest X-ray. Risk factors for infection were collected using a questionnaire and were calculated separately for TST, for QFT-GIT and for both tests combined. RESULTS Of 304 screened children 145/302 (48%) were positive using TST, 152/299 (51%) by QFT-GIT and 180/304 (59%) were positive using either or both tests. Positivity for both tests was associated with index case infectivity (acid-fast bacilli [AFB] 3+ vs. AFB 1+: TST OR 2.93, 95%CI 1.59-5.39; QFT-GIT OR 2.28, 95%CI 1.06-4.90) and exposure (child contact's parent is the index case: TST OR 7.04, 95%CI 2.23-22.28; QFT-GIT OR 4.30, 95%CI 1.48-12.45). CONCLUSION M. tuberculosis infection according to either test was high, supporting screening and preventive treatment. Children of smear-positive TB cases who accompany their parents to the clinic should be prioritised for immediate screening.
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Affiliation(s)
- M E Rutherford
- Centre for International Health, University of Otago, Dunedin, New Zealand.
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Rutherford ME, Nataprawira M, Yulita I, Apriani L, Maharani W, van Crevel R, Hill PC, Alisjahbana B. QuantiFERON®-TB Gold In-Tube assay vs. tuberculin skin test in Indonesian children living with a tuberculosis case. Int J Tuberc Lung Dis 2012; 16:496-502. [PMID: 22325792 DOI: 10.5588/ijtld.11.0491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING AND OBJECTIVES The tuberculin skin test (TST) has limitations in diagnosing latent tuberculosis (TB) infection (LTBI). Interferon-gamma release assays may improve diagnostic accuracy. We compared QuantiFERON®-TB Gold In-Tube (QFT-GIT) and TST in Indonesian children. DESIGN Children aged from 6 months to 9 years exposed to a TB case at household and neighbourhood levels were recruited. The children underwent QFT-GIT and TST. Test responsiveness was assessed according to an exposure gradient. RESULTS A total of 299 household-exposed and 72 neighbourhood-exposed children were analysed. Overall, respectively 46% and 41% were positive using QFT-GIT and the TST. Test positivity increased with exposure (QFT-GIT P value for trend <0.001, and TST P < 0.001); however, only QFT-GIT responded significantly to a 'within-household' gradient. The TST was less likely to be positive than the QFT-GIT in neighbourhood-exposed children (P = 0.05). BCG-vaccinated children were less likely to be QFT-GIT-positive, while older children were more likely to be QFT-GIT-positive. Both tests had increasing positivity with increasing smear grade. CONCLUSION QFT-GIT performed similarly to the TST in Indonesian children living with an infectious TB case. Test accuracy was not compromised by young age or BCG vaccination. Our findings suggest that QFT-GIT offers little advantage over the TST in this population. High rates of LTBI diagnosed in household-exposed children by both tests support preventive therapy.
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Affiliation(s)
- M E Rutherford
- Centre for International Health, University of Otago, Dunedin, New Zealand.
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Roca A, Bottomley C, Hill PC, Bojang A, Egere U, Antonio M, Darboe O, Greenwood BM, Adegbola RA. Effect of age and vaccination with a pneumococcal conjugate vaccine on the density of pneumococcal nasopharyngeal carriage. Clin Infect Dis 2012; 55:816-24. [PMID: 22700830 PMCID: PMC3423933 DOI: 10.1093/cid/cis554] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study evaluated the impact of age and pneumococcal vaccination on the density of pneumococcal nasopharyngeal carriage. Among colonized individuals, density decreased with increasing age. Time-trends analysis revealed that pneumococcal vaccination appeared to lower the density of nasopharyngeal carriage. Background. This study evaluated the impact of age and pneumococcal vaccination on the density of pneumococcal nasopharyngeal carriage. Methods. A cluster-randomized trial was conducted in rural Gambia. In 11 villages (the vaccine group), all residents received 7-valent pneumococcal conjugate vaccine (PCV-7), while in another 10 villages (the control group), only children <30 months old or born during the study period received PCV-7. Cross-sectional surveys (CSSs) were conducted to collect nasopharyngeal swabs before vaccination (baseline CSS) and 4, 12, and 22 months after vaccination. Pneumococcal density was defined using a semiquantitative classification (range, 1–4) among colonized individuals. An age-trend analysis of density was conducted using data from the baseline CSS. Mean pneumococcal density was compared in CSSs conducted before and after vaccination. Results. Mean bacterial density among colonized individuals in the baseline CSS was 2.57 for vaccine-type (VT) and non–vaccine-type (NVT) pneumococci; it decreased with age (P < .001 for VT and NVT). There was a decrease in the density of VT carriage following vaccination in individuals older than 5 years (from 2.44 to 1.88; P = .001) and in younger individuals (from 2.57 to 2.11; P = .070) in the vaccinated villages. Similar decreases in density were observed with NVT within vaccinated and control villages. No significant differences were found between vaccinated and control villages in the postvaccination comparisons for either VT or NVT. Conclusions. A high density of carriage among young subjects might partly explain why children are more efficient than adults in pneumococcal transmission. PCV-7 vaccination lowered the density of VT and of NVT pneumococcal carriage in the before-after vaccination analysis. Clinical Trials Registration. ISRCTN51695599.
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Affiliation(s)
- A Roca
- Medical Research Council Unit, Gambia.
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Chan CM, Corso PJ, Sun X, Hill PC, Shorr AF. Evaluating the role for the optical density in the diagnosis of heparin-induced thrombocytopenia following cardiac surgery. Thromb Haemost 2011; 106:934-8. [PMID: 21947303 DOI: 10.1160/th11-04-0273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/22/2011] [Indexed: 11/05/2022]
Abstract
The poor accuracy of the enzyme immune assay (EIA) contributes to the diagnostic challenge of heparin-induced thrombocytopenia (HIT) following cardiac surgery. We sought to determine if adjusting the threshold optical density (OD) defining a positive EIA improves the test's accuracy in subjects with an OD>0.40. We retrospectively analysed the results from both EIA and confirmatory serotonin release assays (SRAs) in cardiac surgery patients with EIA OD of >0.4. Employing the SRA as the standard, we compared the area under the receiver-operating characteristic (AUROC) curves of various OD measurements for identifying HIT. We examined baseline clinical variables associated with a positive SRA in the setting of a positive HIT EIA (OD >0.4). We then used logistic regression to identify baseline clinical variables independently associated with a positive SRA given a positive EIA. The cohort included 99 subjects with positive EIAs and 35% had positive SRAs. An OD>0.40 had moderate utility as a screening test for a positive SRA (AUROC: 0.68; 95% CI: 0.55-0.80). Increasing the OD threshold did not improve the HIT EIA's screening utility. Clinical variables independently associated with a positive SRA if the EIA were positive included female gender, absence of diabetes, and use of cardiopulmonary bypass. A relatively modest elevation in the OD measurement, when it is already known to be greater than 0.4, does not reliably exclude the potential for a positive SRA in this setting.
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Affiliation(s)
- C M Chan
- Washington Hospital Center, Washington, DC 20010, USA
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Abstract
Capillary rise on a tapered cylindrical rod creates a static axisymmetric meniscus that quantitatively attracts buoyant particles into a single microscopic field of view, providing a new method for small particle microscopy. This approach simplifies the visualization of micrometre-sized particles, such as pollen and parasite eggs, and has potential utility in remote location monitoring and clinical diagnosis.
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Affiliation(s)
- S J Sowerby
- Department of Biochemistry, University of Otago, Dunedin, New Zealand.
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Touray K, Adetifa IM, Jallow A, Rigby J, Jeffries D, Cheung YB, Donkor S, Adegbola RA, Hill PC. Spatial analysis of tuberculosis in an urban west African setting: is there evidence of clustering? Trop Med Int Health 2010; 15:664-72. [PMID: 20406427 DOI: 10.1111/j.1365-3156.2010.02533.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. METHODS In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents. RESULTS Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. CONCLUSIONS There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.
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Affiliation(s)
- K Touray
- Bacterial Diseases Programme, MRC Laboratories, Banjul, The Gambia.
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Hill SE, Njie O, Sanneh M, Jallow M, Peel D, Njie M, Weber M, Hill PC, Adegbola RA, Howie SRC. Oxygen for treatment of severe pneumonia in The Gambia, West Africa: a situational analysis. Int J Tuberc Lung Dis 2009; 13:587-593. [PMID: 19383191] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
SETTING Health facilities in The Gambia, West Africa. OBJECTIVES Oxygen treatment is vital in pneumonia, the leading cause of death in children globally. There are shortages of oxygen in developing countries, but little information is available on the extent of the problem. We assessed national oxygen availability and use in The Gambia, a sub-Saharan African country. METHODS A government-led team visited 12 health facilities in The Gambia. A modified World Health Organization assessment tool was used to determine oxygen requirements, current provision and capacity to support effective oxygen use. RESULTS Eleven of the 12 facilities managed severe pneumonia. Oxygen was reliable in three facilities. Requirement and supply were often mismatched. Both oxygen concentrators and oxygen cylinders were used. Suboptimal electricity and maintenance made using concentrators difficult, while logistical problems and cost hampered cylinder use. Children were usually triaged by trained nurses who reported lack of training in oxygen use. Oxygen was given typically by nasal prongs; pulse oximetry was available in two facilities. CONCLUSIONS National data showed that oxygen availability did not meet needs in most Gambian health facilities. Remedial options must be carefully assessed for real costs, reliability and site-by-site usability. Training is needed to support oxygen use and equipment maintenance.
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Affiliation(s)
- S E Hill
- Department of Public Health, University of Otago, Wellington, New Zealand
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Pai M, Joshi R, Dogra S, Zwerling AA, Gajalakshmi D, Goswami K, Reddy MVR, Kalantri A, Hill PC, Menzies D, Hopewell PC. T-cell assay conversions and reversions among household contacts of tuberculosis patients in rural India. Int J Tuberc Lung Dis 2009; 13:84-92. [PMID: 19105884 PMCID: PMC2951989] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Interferon-gamma assays (IGRAs) are alternatives to the tuberculin skin test (TST), but IGRA conversions and reversions are not well understood. In a pilot study, we determined conversions and reversions using QuantiFERON-TB Gold In-Tube((R)) (QFT) among household contacts of TB cases, and evaluated the effect of using various definitions and criteria for conversions. DESIGN In a cohort of 250 contacts in India, 46% were TST-positive at baseline and 54% were QFT-positive. We re-tested this cohort after 12 months. Conversion rates were estimated using several definitions. RESULTS Of the 250 contacts, 205 (82%) underwent repeat testing. Among 85 contacts with baseline TST-negative/QFT-negative results, TST conversion rates ranged between 7.5% and 13.8%, and QFT conversion rates ranged between 11.8% and 21.2%, depending on the definitions used. Among 109 contacts who were QFT-positive at baseline, seven (6.4%) had QFT reversions. QFT reversions were most likely when the baseline TST was negative and QFT results were just above the diagnostic cut-off. CONCLUSIONS QFT conversions and reversions occurred among contacts of TB cases. Conversion rates seemed to vary, depending on the test and definitions used for conversions. These findings need to be verified in larger studies in various settings.
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Affiliation(s)
- M Pai
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
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Adetifa IMO, Hill PC, Jeffries DJ, Jackson-Sillah D, Ibanga HB, Bah G, Donkor S, Corrah T, Adegbola RA. Haematological values from a Gambian cohort--possible reference range for a West African population. Int J Lab Hematol 2008; 31:615-22. [PMID: 18631172 DOI: 10.1111/j.1751-553x.2008.01087.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to establish haematological reference ranges for the West African subregion using a Gambian cohort. We analysed full blood counts from 1279 subjects aged > or =1 year. Anthropometric and body composition measurements were performed. Haematological mean values, medians and 90% reference values were calculated and related to malnutrition in children and thinness and/or obesity in adults. Haemoglobin (Hb) and mean corpuscular volume (MCV) significantly increased with age (P < 0.00001). There were gender-related changes in Hb from 15 years of age (P = 0.001) and for MCV only in adults (P = 0.0002). Hb was significantly reduced in underweight and stunted children (P = 0.0001 and 0.0002, respectively) but was unaffected by thinness or obesity in adults. White blood cell (WBC) and platelet counts were highest under 5 years and declined significantly with age (P < 0.0001 and 0.0001). While, there were no gender-related differences with WBC, there were higher WBC counts in underweight (P = 0.0001) and stunted (P < 0.0001) children. Adult females had significantly higher mean platelet counts compared with males (P = 0.006). The mean and median values of haematological parameters in The Gambia are similar to other standards but the 90% reference range for each parameter encompasses lower values when compared with Western standards.
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Affiliation(s)
- I M O Adetifa
- Bacterial Diseases Programme, Medical Research Council (UK) Laboratories, The Gambia.
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Olesen R, Wejse C, Velez DR, Bisseye C, Sodemann M, Aaby P, Rabna P, Worwui A, Chapman H, Diatta M, Adegbola RA, Hill PC, Østergaard L, Williams SM, Sirugo G. DC-SIGN (CD209), pentraxin 3 and vitamin D receptor gene variants associate with pulmonary tuberculosis risk in West Africans. Genes Immun 2007; 8:456-67. [PMID: 17611589 DOI: 10.1038/sj.gene.6364410] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated the role of DC-SIGN (CD209), long pentraxin 3 (PTX3) and vitamin D receptor (VDR) gene single nucleotide polymorphisms (SNPs) in susceptibility to pulmonary tuberculosis (TB) in 321 TB cases and 347 healthy controls from Guinea-Bissau. Five additional, functionally relevant SNPs within toll-like receptors (TLRs) 2, 4 and 9 were typed but found, when polymorphic, not to affect host vulnerability to pulmonary TB. We did not replicate an association between SNPs in the DC-SIGN promoter and TB. However, we found that two polymorphisms, one in DC-SIGN and one in VDR, were associated in a nonadditive model with disease risk when analyzed in combination with ethnicity (P=0.03 for DC-SIGN and P=0.003 for VDR). In addition, PTX3 haplotype frequencies significantly differed in cases compared to controls and a protective effect was found in association with a specific haplotype (OR 0.78, 95% CI 0.63-0.98). Our findings support previous data showing that VDR SNPs modulate the risk for TB in West Africans and suggest that variation within DC-SIGN and PTX3 also affect the disease outcome.
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Affiliation(s)
- R Olesen
- MRC Laboratories, Banjul, The Gambia
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Burl S, Hill PC, Jeffries DJ, Holland MJ, Fox A, Lugos MD, Adegbola RA, Rook GA, Zumla A, McAdam KPWJ, Brookes RH. FOXP3 gene expression in a tuberculosis case contact study. Clin Exp Immunol 2007; 149:117-22. [PMID: 17465993 PMCID: PMC1942016 DOI: 10.1111/j.1365-2249.2007.03399.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Regulatory T lymphocytes (T(regs)) that express FOXP3 are involved in the beneficial attenuation of immunopathology, but are also implicated in down-regulation of protective responses to infection. Their role in tuberculosis (TB) is unknown. We classified 1272 healthy TB contacts according to their tuberculin skin test (TST) and interferon (IFN)-gamma enzyme-linked immunospot (ELISPOT) results and 128 TB cases, and studied the expression of FOXP3 and interleukin (IL)-10 in blood samples. Compared to the uninfected contact group (TST(-), ELISPOT(-)), we observed higher levels of FOXP3 mRNA in blood from TB patients (< 0.001), but IL-10 expression was slightly lower (P = 0.04). In contrast, FOXP3 expression levels were significantly lower (P = 0.001) in the recently infected contacts (TST(+), ELISPOT(+)) but there was no difference for IL-10 (P = 0.74). We hypothesize that during early/subclinical TB, most of which will become latent, FOXP3(+) T(regs) may be sequestered in the lungs, but when TB becomes progressive, FOXP3 reappears at increased levels in the periphery. While these findings do not reveal the role, beneficial or harmful, of T(regs) in TB, they emphasize the probable importance of these cells.
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Affiliation(s)
- S Burl
- Tuberculosis Division, Bacterial Diseases Programme, Medical Research Council (UK) Unit, Banjul, The Gambia, West Africa
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de Jong BC, Hill PC, Aiken A, Jeffries DJ, Onipede A, Small PM, Adegbola RA, Corrah TP. Clinical presentation and outcome of tuberculosis patients infected by M. africanum versus M. tuberculosis. Int J Tuberc Lung Dis 2007; 11:450-6. [PMID: 17394693] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
SETTING A tuberculosis (TB) case contact study in the Gambia. OBJECTIVE To test whether Mycobacterium africanum, which has lost around 68 kb compared with M. tuberculosis sensu stricto, causes less severe TB disease. DESIGN We genotyped mycobacterial isolates and compared clinical and radiological characteristics as well as outcome data of M. africanum-infected TB patients with those infected with M. tuberculosis. RESULTS Of 317 index cases, 301 had a mycobacterial isolate available, 290 of which had an interpretable spoligotype pattern. Of these, 110 isolates (38%) were M. africanum and 180 (62%) were M. tuberculosis. M. africanum cases had lower body mass indices (17 vs. 17.45 for M. tuberculosis-infected patients, P = 0.029) and their radiographic disease was more extensive (96% vs. 89% had at least moderately severe radiographic changes, P = 0.031). Outcome on treatment was similar (2.8% of human immunodeficiency virus [HIV] negative M. africanum patients died on treatment vs. 3.0% of M. tuberculosis patients, P = 0.95). CONCLUSION M. africanum causes sputum smear-positive tuberculosis disease that is at least as severe as that caused by M. tuberculosis sensu stricto. Further clinical comparisons may be helpful in smear-negative patients and HIV-TB co-infected patients, and to identify whether there is any difference in time to develop disease.
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Affiliation(s)
- B C de Jong
- Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, The Gambia.
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38
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Adetifa IMO, Brookes R, Lugos MD, de Jong BC, Antonio M, Adegbola RA, Hill PC. Rising ELISPOT count prior to the onset of symptoms of full-blown tuberculosis disease. Int J Tuberc Lung Dis 2007; 11:350-2. [PMID: 17352104] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
The relationship between the T-cell response to mycobacterial antigens and the likelihood of progression to disease has not been defined. We report a rapidly rising ELISPOT count in a 55-year-old man with evidence of Mycobacterium tuberculosis infection prior to the onset of symptoms of disease. This case illustrates the possible utility of quantitative changes in the ELISPOT count in predicting progression from M. tuberculosis infection to disease.
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Affiliation(s)
- I M O Adetifa
- Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, The Gambia.
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Jeffries DJ, Hill PC, Fox A, Lugos M, Jackson-Sillah DJ, Adegbola RA, Brookes RH. Identifying ELISPOT and skin test cut-offs for diagnosis of Mycobacterium tuberculosis infection in The Gambia. Int J Tuberc Lung Dis 2006; 10:192-8. [PMID: 16499260] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
SETTING An urban area, The Gambia. OBJECTIVE To identify ELISPOT and PPD skin test cut-offs, targeting sensitivity and specificity equivalence. DESIGN Tuberculosis cases >5 years of age and their household contacts underwent ELISPOT, HIV and PPD skin tests. Cases and contacts sleeping in a different house were used to estimate sensitivity and specificity, providing two planes for estimating cut-offs. Specificity was adjusted for infection from previous exposure using a multivariate discrimination algorithm. RESULTS The point on the line of intersection of the planes that maximised sensitivity and specificity equivalence occurred at 4 spots (95% confidence interval [CI] 3.5-5, multiplier=0 ) for CFP-10 and 5.5 spots (4.5-8, multiplier=0 for ESAT-6), yielding a sensitivity and specificity of 76% for both antigens. Combining ESAT-6 and CFP-10 using an 'or' statement yielded a maximum equivalence sensitivity and specificity of 76.5% at 6 spots for ESAT-6 and 11.5 spots for CFP-10. For the PPD skin test sensitivity and specificity, an equivalence of 78% occurred at 11 mm induration (9-13 mm). CONCLUSION An ELISPOT cut-off for ESAT-6 or CFP-10 could be set at 4-8 spot forming units (20-40 spots per million), with little benefit from combining the results. A cut-off of 9-13 mm for the PPD skin test is reasonable when comparing with the ELISPOT.
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Affiliation(s)
- D J Jeffries
- Medical Research Council Labs, Bacterial Diseases Programme, Banjul, The Gambia
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Hill PC, Stevens W, Hill S, Bah J, Donkor SA, Jallow A, Lienhardt C. Risk factors for defaulting from tuberculosis treatment: a prospective cohort study of 301 cases in the Gambia. Int J Tuberc Lung Dis 2005; 9:1349-54. [PMID: 16466057] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
SETTING An urban tuberculosis (TB) clinic, The Gambia. OBJECTIVE To identify patient characteristics associated with increased rates of defaulting from treatment, specifically knowledge and cost factors amenable to intervention. DESIGN Prospective cohort study of TB cases at least 15 years of age commencing treatment, interviewed by semi-structured questionnaire and followed for attendance at thrice-weekly directly observed treatment (DOT). RESULTS Of 301 patients, 76 (25.2%) defaulted from treatment and 25 did not return for treatment. The defaulting rate was higher among those who said they were uncertain that their treatment would work (HR 3.64; 95%CI 1.42-9.31, P = 0.007) and among those who incurred significant time or money costs travelling to receive treatment (HR 2.67; 95%CI 1.05-6.81; P = 0.04). These factors had differing effects with respect to time: uncertainty over treatment success was important in the first 90 days of treatment, while increased cost of travelling to the clinic was important after 90 days. CONCLUSION In The Gambia, risk groups for defaulting can be recognised at the start of treatment and are at highest risk at different times. Home-based self-administration of medications after 3 months of DOT should be considered as confidence in treatment success rises, and the costs of travelling to receive treatment start to take their toll.
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Affiliation(s)
- P C Hill
- Department of Tuberculosis, Medical Research Council Laboratories, Banjul, The Gambia.
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Martin M, Brookes L, Cham A, Sowe DM, Khan S, Thomas DR, Hill PC. Tuberculosis education in an endemic setting: application of participatory methods to video development in The Gambia. Int J Tuberc Lung Dis 2005; 9:550-5. [PMID: 15875928] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVE To produce an educational video for tuberculosis (TB) awareness in The Gambia using participatory methods and integrated formative evaluation. METHODS A steering group was formed of key people working in TB research, health education, the health service and the media. They developed a script and commissioned local production of the video in three local languages and English. A formative participatory evaluation of the project was conducted using document review, attendance at rehearsals and semi-structured interviews. A pilot version of the video was evaluated through focus groups in Banjul and remote villages. Data were analysed using a general inductive approach. RESULTS Five major themes emerged from evaluation of the project participatory process: collaboration, knowledge sharing, networking, ownership and a common desire to sustain the project goals for video dissemination. The video was well received and described as informative, entertaining and professional. Audiences were able to identify the key messages, prevailing attitudes about TB were challenged, and many participants expressed a desire to act on their new knowledge. CONCLUSION A participatory approach to the development of a video in The Gambia proved to be empowering to local participants and led to the production of a resource well received by Gambian people.
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Affiliation(s)
- M Martin
- School of Population Health, University of Auckland, Auckland, New Zealand
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Harper ME, Hill PC, Bah AH, Manneh K, McAdam KPWJ, Lienhardt C. Traditional healers participate in tuberculosis control in The Gambia. Int J Tuberc Lung Dis 2004; 8:1266-8. [PMID: 15527161] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
SETTING Twenty-three Gambian villages. OBJECTIVE To evaluate the feasibility of involving traditional healers in tuberculosis diagnosis and treatment in The Gambia. DESIGN Twenty-eight traditional healers were educated in the recognition of signs and symptoms of tuberculosis and indications for referral. They administered medications to confirmed cases, and were revisited after 1 year to assess knowledge retention. RESULTS Over 6 months, the traditional healers referred 66 suspects, from whom eight cases were diagnosed. All were successfully treated. Twenty-three of 24 traditional healers re-interviewed retained appropriate knowledge; 16 continued to refer suspects. CONCLUSIONS Traditional healers can play a positive role in tuberculosis control.
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Affiliation(s)
- M E Harper
- Department of Tuberculosis, Medical Research Council Laboratories, Banjul, Western Division, The Gambia
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Jeffries DJ, Donkor S, Brookes RH, Fox A, Hill PC. Design and implementation of relational databases relevant to the diverse needs of a tuberculosis case contact study in the Gambia. Int J Tuberc Lung Dis 2004; 8:1095-9. [PMID: 15455594] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
The data requirements of a large multidisciplinary tuberculosis case contact study are complex. We describe an ACCESS-based relational database system that meets our rigorous requirements for data entry and validation, while being user-friendly, flexible, exportable, and easy to install on a network or stand alone system. This includes the development of a double data entry package for epidemiology and laboratory data, semi-automated entry of ELISPOT data directly from the plate reader, and a suite of new programmes for the manipulation and integration of flow cytometry data. The double entered epidemiology and immunology databases are combined into a separate database, providing a near-real-time analysis of immuno-epidemiological data, allowing important trends to be identified early and major decisions about the study to be made and acted on. This dynamic data management model is portable and can easily be applied to other studies.
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Affiliation(s)
- D J Jeffries
- Tuberculosis Research Group, Medical Research Council Laboratories, Banjul, The Gambia
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Eastwood SV, Hill PC. A gender-focused qualitative study of barriers to accessing tuberculosis treatment in The Gambia, West Africa. Int J Tuberc Lung Dis 2004; 8:70-5. [PMID: 14974748] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
SETTING The Medical Research Council unit in Fajara, The Gambia. OBJECTIVE To explore gender differences in care seeking behaviour, access to treatment, and knowledge and perceptions about tuberculosis. DESIGN Fifteen government health workers were interviewed to define the scope of the issues involved, then 15 male and 15 female tuberculosis patients were interviewed. Qualitative semi-structured questionnaires were used in health worker and patient interviews. Data were analysed using the thematic framework method. The main themes were compared between male and female patients. RESULTS Patients often initially consulted traditional healers and pharmacies. Women used traditional healers more, probably because of stronger traditional beliefs, time constraints and increased confidentiality. Regardless of sex, most patients acknowledged problems affording the transport costs to access treatment. Health workers and patients highlighted negative perceptions of tuberculosis. Lack of knowledge about tuberculosis and stigma were widely reported, and were worst in female patients. CONCLUSIONS Tuberculosis is a stigmatised disease in The Gambia, particularly in women, and its management is associated with access problems. Health education is required to provide basic knowledge about the disease and to reduce stigma, and further decentralisation of tuberculosis services is needed to improve access.
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Affiliation(s)
- S V Eastwood
- Department of Medicine, University of Birmingham, Birmingham, United Kingdom
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Rathman G, Sillah J, Hill PC, Murray JF, Adegbola R, Corrah T, Lienhardt C, McAdam KPWJ. Clinical and radiological presentation of 340 adults with smear-positive tuberculosis in The Gambia. Int J Tuberc Lung Dis 2003; 7:942-7. [PMID: 14552563] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
SETTING Four clinics in The Gambia. OBJECTIVE To document clinical and radiographic presentations of sputum smear-positive tuberculosis in adults. DESIGN Newly diagnosed acid-fast bacilli (AFB) smear, culture-positive tuberculosis patients aged > or = 15 years were interviewed and examined, and underwent tuberculin skin testing, HIV testing and chest X-ray reviewed by a chest physician using set criteria. RESULTS Of 340 patients enrolled (median age 29 years; males 73%), 8.3% were HIV-positive. One-third reported haemoptysis, > 90% reported weight loss and fever, and wasting was the most common sign (69%). Crepitations were the most frequent auscultatory finding (41%). The most common radiological lesion was a patchy infiltrate (> 90%). Cavitation was present in 206 patients (60.6%), most frequently occurred in the upper lung fields, was associated with increasing bacterial load in the sputum, and was less prevalent in HIV-positive patients (45% vs. 62%; P = 0.07). Auscultatory and chest X-ray findings matched only one-third of the time. CONCLUSION In our setting, wasting is the most common clinical sign of sputum smear-positive tuberculosis. Auscultatory findings correlate poorly with radiological abnormalities. Cavitation is associated with increasing bacterial load in the sputum, and is therefore a strong indicator for early treatment.
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Affiliation(s)
- G Rathman
- University of Minnesota, Department of Medicine, Minneapolis, Minnesota, USA
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Stamou SC, Hill PC, Sample GA, Snider E, Pfister AJ, Lowery RC, Corso PJ. Prevention of atrial fibrillation after cardiac surgery: the significance of postoperative oral amiodarone. Chest 2001; 120:1936-41. [PMID: 11742925 DOI: 10.1378/chest.120.6.1936] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Atrial fibrillation (AF) is a common occurrence after cardiac surgery (10 to 53%) that contributes to increased length of stay and hospital cost. Recent evidence suggests that treatment with amiodarone may provide safe and effective prophylaxis against AF in many patients undergoing cardiac operations. This study sought to investigate whether oral amiodarone administered postoperatively would reduce the incidence of postoperative AF. DESIGN Prospective nonrandomized cohort study. PATIENTS AND PARTICIPANTS In this prospective study, 1,196 consecutive patients who underwent various open-heart procedures with cardiopulmonary bypass between July 1999 and February 2000 received oral amiodarone, 400 mg bid, from the transfer to the cardiovascular recovery room until the day of hospital discharge, or up to 7 days postoperatively. The incidence of AF in this group of patients was compared with a group of 1,246 patients who underwent cardiac surgery with cardiopulmonary bypass in the preceding 8-month period (November 1998 to June 1999) at the same institution without receiving amiodarone postoperatively. SETTING Tertiary health-care center. MEASUREMENT AND RESULTS AF developed in 294 patients (25%) in amiodarone-treated group and in 385 patients (31%) in the control group (p = 0.001). In multivariate logistic regression analysis, oral amiodarone treatment emerged as an independent predictor of lower risk of AF (odds ratio, 0.7; 95%; 95% confidence interval, 0.6 to 0.9; p = 0.002) and shorter hospital length of stay (odds ratio, 0.8; 95% confidence interval, 0.5 to 0.9; p = 0.006). CONCLUSIONS Postoperative oral amiodarone treatment is a safe and effective regimen associated with a reduced incidence of new-onset AF and decreased length of hospital stay. Prospective randomized trials are needed to evaluate the benefits of amiodarone treatment relative to its side effect profiles.
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Affiliation(s)
- S C Stamou
- Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center and MedStar Research Institute, Washington, DC 20010, USA
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Hill PC, Rogers K, McKinney WP, Morris AJ, Holland DJ. Antifungal susceptibilities of Candida sp. in New Zealand. N Z Med J 2001; 114:528-9. [PMID: 11795573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Hill PC, Wong CG, Voss LM, Taylor SL, Pottumarthy S, Drinkovic D, Morris AJ. Prospective study of 125 cases of Staphylococcus aureus bacteremia in children in New Zealand. Pediatr Infect Dis J 2001; 20:868-73. [PMID: 11734766 DOI: 10.1097/00006454-200109000-00009] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Staphylococcus aureus bacteremia is a common complication of S. aureus infection. There are few pediatric studies defining the incidence and associated morbidity and mortality of S. aureus bacteremia and no such New Zealand studies. We conducted a prospective study of S. aureus bacteremia in children in New Zealand. METHODS From July 1, 1996 to December 31, 1998, we included all children < 16 years of age with S. aureus bacteremia in Auckland and Christchurch. Relevant information regarding patient demographics, clinical course and outcome and laboratory results was recorded. RESULTS One hundred twenty-five cases of true S. aureus bacteremia were identified. There were 4 deaths within 30 days of the onset of bacteremia. Fourteen (11%) of the children were < 1 month of age. Maori children (relative risk, 2.0; 95% confidence interval, 1.3 to 3.2) were twice as likely and Pacific Island children (relative risk, 2.5; 95% confidence interval, 1.6 to 3.8) 2.5 times as likely as white children to acquire S. aureus bacteremia. The peak incidence of S. aureus bacteremia was observed in Pacific Island children < 1 year of age (105 cases/100,000 children/year). Twenty-seven percent of cases were related to intravenous catheters. Seventy percent of cases were community-acquired. Ninety-eight percent of non-catheter-related cases in children > 1 month of age were community-acquired. There was a low rate of methicillin resistance (6%). CONCLUSIONS S. aureus bacteremia is largely community-acquired in children in New Zealand and is more common in Pacific Island and Maori populations. Although there is a low associated mortality, a significant number are potentially preventable cases secondary to intravenous catheters.
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Affiliation(s)
- P C Hill
- Department of Clinical Microbiology, Auckland Hospital, New Zealand
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Stamou SC, Hill PC, Dangas G, Pfister AJ, Boyce SW, Dullum MK, Bafi AS, Corso PJ. Stroke after coronary artery bypass: incidence, predictors, and clinical outcome. Stroke 2001; 32:1508-13. [PMID: 11441193 DOI: 10.1161/01.str.32.7.1508] [Citation(s) in RCA: 220] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Early postoperative stroke is a serious adverse event after coronary artery bypass grafting (CABG). This study sought to investigate risk factors, prevalence, and prognostic implications of postoperative stroke in patients undergoing CABG. METHODS We investigated the predictors of postoperative stroke (n=333, 2%) in 16 528 consecutive patients who underwent CABG between September 1989 and June 1999 in our institution. Predictors of postoperative stroke were identified by logistic regression analysis. RESULTS Among the preoperative and postoperative factors, significant correlates of stroke included (1) chronic renal insufficiency (P<0.001), (2) recent myocardial infarction (P=0.01), (3) previous cerebrovascular accident (P<0.001), (4) carotid artery disease (P<0.001), (5) hypertension (P<0.001), (6) diabetes (P=0.001), (7) age >75 years (P=0.008), (8) moderate/severe left ventricular dysfunction (P=0.01), (9) low cardiac output syndrome (P<0.001), and (10) atrial fibrillation (P<0.001). Postoperative stroke was associated with longer postoperative stay (11+/-4 versus 7+/-3 days for patients without stroke, P<0.001) and with higher in-hospital mortality (14% versus 2.7% for patients without stroke; P<0.001). CONCLUSIONS Stroke after CABG is associated with high short-term morbidity and mortality. Increased stroke risk can be predicted by preoperative and postoperative clinical factors.
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Affiliation(s)
- S C Stamou
- Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, Washington, DC, USA.
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Hill PC, Birch M, Chambers S, Drinkovic D, Ellis-Pegler RB, Everts R, Murdoch D, Pottumarthy S, Roberts SA, Swager C, Taylor SL, Thomas MG, Wong CG, Morris AJ. Prospective study of 424 cases of Staphylococcus aureus bacteraemia: determination of factors affecting incidence and mortality. Intern Med J 2001. [DOI: 10.1111/j.1444-0903.2001.00029.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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