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Thekkur P, Thiagesan R, Nair D, Karunakaran N, Khogali M, Zachariah R, Dar Berger S, Satyanarayana S, Kumar AMV, Bochner AF, McClelland A, Ananthakrishnan R, Harries AD. Using timeliness metrics for household contact tracing and TB preventive therapy in the private sector, India. Int J Tuberc Lung Dis 2024; 28:122-139. [PMID: 38454186 DOI: 10.5588/ijtld.23.0285] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Although screening of household contacts (HHCs) of TB patients and provision of TB preventive therapy (TPT) is a key intervention to end the TB epidemic, their implementation globally is dismal. We assessed whether introducing a '7-1-7' timeliness metric was workable for implementing HHC screening among index patients with pulmonary TB diagnosed by private providers in Chennai, India, between November 2022 and March 2023.METHODS This was an explanatory mixed-methods study (quantitative-cohort and qualitative-descriptive).RESULTS There were 263 index patients with 556 HHCs. In 90% of index patients, HHCs were line-listed within 7 days of anti-TB treatment initiation. Screening outcomes were ascertained in 48% of HHCs within 1 day of line-listing. Start of anti-TB treatment, TPT or a decision to receive neither was achieved in 57% of HHC within 7 days of screening. Overall, 24% of screened HHCs in the '7-1-7' period started TPT compared with 16% in a historical control (P < 0.01). Barriers to achieving '7-1-7' included HHC reluctance for evaluation or TPT, refusal of private providers to prescribe TPT and reliance on facility-based screening of HHCs instead of home visits by health workers for screening.CONCLUSIONS Introduction of a timeliness metric is a workable intervention that adds structure to HHC screening and timely management..
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Affiliation(s)
- P Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - R Thiagesan
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - D Nair
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - N Karunakaran
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - M Khogali
- Institute of Public Health, College of Medicine and Health Sciences, University of the United Arab Emirates, Al Ain, UAE
| | - R Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | - S Dar Berger
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | | | | | - R Ananthakrishnan
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Chavan VV, Dalal A, Nagaraja S, Thekkur P, Mansoor H, Meneguim A, Paryani R, Singh P, Kalon S, Das M, Ferlazzo G, Isaakidis P. Correction: Ambulatory management of pre- and extensively drug resistant tuberculosis patients with imipenem delivered through port-a-cath: A mixed methods study on treatment outcomes and challenges. PLoS One 2024; 19:e0299477. [PMID: 38381762 PMCID: PMC10880953 DOI: 10.1371/journal.pone.0299477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0234651.].
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Alvi Y, Philip S, Anand T, Chinnakali P, Islam F, Singla N, Thekkur P, Khanna A, Vashishat BK. Situation Analysis of Early Implementation of Programmatic Management of Tuberculosis Preventive Treatment among Household Contacts of Pulmonary TB Patients in Delhi, India. Trop Med Infect Dis 2024; 9:24. [PMID: 38251221 PMCID: PMC10818279 DOI: 10.3390/tropicalmed9010024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Tuberculosis Preventive Treatment (TPT) is a powerful tool for preventing the TB infection from developing into active TB disease, and has recently been expanded to all household contacts of TB cases in India. This study employs a mixed-methods approach to conduct a situational analysis of the initial phase of TPT implementation among household contacts of pulmonary TB patients in three districts of Delhi, India. It was completed using a checklist based assessments, care cascade data, and qualitative analysis. Our observations indicated that organizational structure and planning were established, but implementation of TPT was suboptimal with issues in drug availability and procurement, budget, human resources, and training. Awareness and motivation, and shorter regimen, telephonic assessment, and collaboration with NGOs emerged as enablers. Apprehension about taking TPT, erratic drug supply, long duration of treatment, side effects, overburden, large population, INH resistance, data entry issues, and private provider reluctance emerged as barriers. The study revealed potential solutions for optimizing TPT implementation. It is evident that, while progress has been made in TPT implementation, there is room for improvement and refinement across various domains.
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Affiliation(s)
- Yasir Alvi
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi 110062, India;
| | - Sairu Philip
- Department of Community Medicine, Government Medical College, Kottayam 686008, India;
| | - Tanu Anand
- Scientist E, Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, New Delhi 110029, India;
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India;
| | - Farzana Islam
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi 110062, India;
| | - Neeta Singla
- Department of Training, National Institute of TB & Respiratory Disease, New Delhi 110030, India;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75006 Paris, France;
| | | | - BK Vashishat
- State TB Cell, Gulabi Bagh, New Delhi 110007, India;
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Mahajan P, Soundappan K, Singla N, Mehta K, Nuken A, Thekkur P, Nair D, Rattan S, Thakur C, Sachdeva KS, Kalottee B. Test and Treat Model for Tuberculosis Preventive Treatment among Household Contacts of Pulmonary Tuberculosis Patients in Selected Districts of Maharashtra: A Mixed-Methods Study on Care Cascade, Timeliness, and Early Implementation Challenges. Trop Med Infect Dis 2023; 9:7. [PMID: 38251204 PMCID: PMC10818418 DOI: 10.3390/tropicalmed9010007] [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: 10/30/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Tuberculosis preventive treatment (TPT) is an important intervention in preventing infection and reducing TB incidence among household contacts (HHCs). A mixed-methods study was conducted to assess the "Test and Treat" model of TPT care cascade among HHCs aged ≥5 years of pulmonary tuberculosis (PTB) patients (bacteriologically/clinically confirmed) being provided TPT care under Project Axshya Plus implemented in Maharashtra (India). A quantitative phase cohort study based on record review and qualitative interviews to understand the challenges and solutions in the TPT care cascade were used. Of the total 4181 index patients, 14,172 HHCs were screened, of whom 36 (0.3%) HHCs were diagnosed with tuberculosis. Among 14,133 eligible HHCs, 10,777 (76.3%) underwent an IGRA test. Of them, 2468 (22.9%) tested positive for IGRA and were suggested for chest X-ray. Of the eligible 2353 HHCs, 2159 (91.7%) were started on TPT, of whom 1958 (90.6%) completed the treatment. The median time between treatment initiation of index PTB patient and (a) HHC screening was 31 days; (b) TPT initiation was 64 days. The challenges in and suggested solutions for improving the TPT care cascade linked to subthemes were tuberculosis infection testing, chest X-ray, human resources, awareness and engagement, accessibility to healthcare facilities, TPT drugs, follow-up, and assessment. A systematic monitoring and time-based evaluation of TPT cascade care delivery followed by prompt corrective actions/interventions could be a crucial strategy for its effective implementation and for the prevention of tuberculosis.
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Affiliation(s)
- Palak Mahajan
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Kathirvel Soundappan
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Neeta Singla
- National Institute of TB & Respiratory Disease, New Delhi 110030, India;
| | - Kedar Mehta
- Department of Community Medicine, Gujarat Medical Education & Search Society Medical College, Vadodara 390021, India;
| | - Amenla Nuken
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (P.T.); (D.N.)
| | - Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (P.T.); (D.N.)
| | - Sampan Rattan
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Chaturanand Thakur
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Kuldeep Singh Sachdeva
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
| | - Bharati Kalottee
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India; (A.N.); (S.R.); (C.T.); (K.S.S.); (B.K.)
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Jamil B, Nair D, Thekkur P, Laeeq N, Adil A, Khogali M, Zachariah R, Dar Berger S, Satyanarayana S, Kumar AMV, Bochner A, McClelland A, Fatima R, Harries AD. Feasibility, enablers and challenges of using timeliness metrics for household contact tracing and TB preventive therapy in Pakistan. PLoS One 2023; 18:e0295580. [PMID: 38079438 PMCID: PMC10712885 DOI: 10.1371/journal.pone.0295580] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Screening household contacts of TB patients and providing TB preventive therapy (TPT) is a key intervention to end the TB epidemic. Global and timely implementation of TPT in household contacts, however, is dismal. We adapted the 7-1-7 timeliness metric designed to evaluate and respond to infectious disease outbreaks or pandemics, and assessed the feasibility, enablers and challenges of implementing this metric for screening and management of household contacts of index patients with bacteriologically-confirmed pulmonary TB in Karachi city, Pakistan. METHODS We conducted an explanatory mixed methods study with a quantitative component (cohort design) followed by a qualitative component (descriptive design with focus group discussions). RESULTS From January-June 2023, 92% of 450 index patients had their household contacts line-listed within seven days of initiating anti-TB treatment ("first 7"). In 84% of 1342 household contacts, screening outcomes were ascertained within one day of line-listing ("next 1"). In 35% of 256 household contacts eligible for further evaluation by a medical officer (aged ≤5 years or with chest symptoms), anti-tuberculosis treatment, TPT or a decision for no drugs was made within seven days of symptom screening ("second 7"). The principal reason for not starting anti-tuberculosis treatment or TPT was failure to consult a medical officer: only 129(50%) of 256 contacts consulted a medical officer. Reasons for poor performance in the "second 7" component included travel costs to see a medical officer, loss of daily earnings and fear of a TB diagnosis. Field staff reported that timeliness metrics motivated them to take prompt action in household contact screening and TPT provision and they suggested these be included in national guidelines. CONCLUSIONS Field staff found "7-1-7" timeliness metrics to be feasible and useful. Integration of these metrics into national guidelines could improve timeliness of diagnosis, treatment and prevention of TB within households of index patients.
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Affiliation(s)
- Bushra Jamil
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Neelofar Laeeq
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Anum Adil
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Khogali
- Institute of Public Health (IPH), College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Rony Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank, World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
| | - Selma Dar Berger
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore, India
| | - Aaron Bochner
- Resolve to Save Lives, New York City, New York, United States of America
| | - Amanda McClelland
- Resolve to Save Lives, New York City, New York, United States of America
| | - Razia Fatima
- Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
| | - Anthony D. Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Samudyatha UC, Soundappan K, Ramaswamy G, Mehta K, Kumar C, Jagadeesh M, Prasanna Kamath BT, Singla N, Thekkur P. Outcomes and Challenges in the Programmatic Implementation of Tuberculosis Preventive Therapy among Household Contacts of Pulmonary TB Patients: A Mixed-Methods Study from a Rural District of Karnataka, India. Trop Med Infect Dis 2023; 8:512. [PMID: 38133444 PMCID: PMC10748199 DOI: 10.3390/tropicalmed8120512] [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: 10/25/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
The National TB Elimination Programme (NTEP) of India is implementing tuberculosis preventive treatment (TPT) for all household contacts (HHCs) of pulmonary tuberculosis patients (index patients) aged <5 years and those HHCs aged >5 years with TB infection (TBI). We conducted an explanatory mixed-methods study among index patients registered in the Kolar district, Karnataka during April-December 2022, to assess the TPT cascade and explore the early implementation challenges for TPT provision. Of the 301 index patients, contact tracing home visits were made in 247 (82.1%) instances; a major challenge was index patients' resistance to home visits fearing stigma, especially among those receiving care from the private sector. Of the 838 HHCs, 765 (91.3%) were screened for TB; the challenges included a lack of clarity on HHC definition and the non-availability of HHCs during house visits. Only 400 (57.8%) of the 692 eligible HHCs underwent an IGRA test for TBI; the challenges included a shortage of IGRA testing logistics and the perceived low risk among HHCs. As HHCs were unaware of their IGRA results, a number of HHCs actually eligible for TPT could not be determined. Among the 83 HHCs advised of the TPT, 81 (98%) initiated treatment, of whom 63 (77%) completed treatment. Though TPT initiation and completion rates are appreciable, the NTEP needs to urgently address the challenges in contact identification and IGRA testing.
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Affiliation(s)
- U. C. Samudyatha
- Department of Community Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar 563101, India;
| | - Kathirvel Soundappan
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Gomathi Ramaswamy
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad 508126, India;
| | - Kedar Mehta
- Department of Community Medicine, GMERS Medical College, Gotri, Vadodara 390021, India;
| | - Chandan Kumar
- District Health Office, Kolar 536101, India; (C.K.); (M.J.)
| | - M. Jagadeesh
- District Health Office, Kolar 536101, India; (C.K.); (M.J.)
| | - B. T. Prasanna Kamath
- Department of Community Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar 563101, India;
| | - Neeta Singla
- National Institute for Tuberculosis Research and Respiratory Diseases, New Delhi 110030, India;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France;
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Conteh TA, Thomas F, Abiri OT, Komeh JP, Kanu A, Kanu JS, Fofanah BD, Thekkur P, Zachariah R. Quality of Reporting of Adverse Drug Reactions to Antimicrobials Improved Following Operational Research: A before-and-after Study in Sierra Leone (2017-2023). Trop Med Infect Dis 2023; 8:470. [PMID: 37888598 PMCID: PMC10610728 DOI: 10.3390/tropicalmed8100470] [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: 07/04/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
Background: The quality of pharmacovigilance data is important for guiding medicine safety and clinical practice. In baseline and follow-up studies after introducing interventions to improve the quality of reporting of Individual Case Safety Reports (ICSRs) in Sierra Leone, we compared (a) timeliness and completeness of reporting and (b) patient outcomes classified as 'recovering'. Methods: Baseline (January 2017-December 2021) and follow-up (June 2022-April 2023) studies of ICSRs in the national pharmacovigilance database. Interventions introduced following recommendations from the baseline study included: updating standard operating procedures and guidelines, setting performance targets follow-up of patient outcomes, and training. Results: There were 566 ICSRs in the baseline study and 59 in the follow-up study. Timelines (reporting < 30 days) improved by five-fold (10% at baseline to 47% in follow-up). For the completeness of variables in ICSRs (desired threshold ≥ 90%),this was 44% at baseline and increased to 80% in the follow-up study. 'Recovering' outcomes reduced from 36% (baseline study) to 3% (follow-up study, p < 0.001). Conclusions: Significant improvements in timeliness, completeness, and validation of ICSRs were observed following operational research in Sierra Leone. While enhancing pharmacovigilance and patient safety, this study highlights the important synergistic role operational research can play in improving monitoring and evaluation systems.
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Affiliation(s)
- Thomas A. Conteh
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Ministry of Health, Freetown 047235, Sierra Leone; (F.T.); (O.T.A.); (J.P.K.); (A.K.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 047235, Sierra Leone
| | - Fawzi Thomas
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Ministry of Health, Freetown 047235, Sierra Leone; (F.T.); (O.T.A.); (J.P.K.); (A.K.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 047235, Sierra Leone
| | - Onome T. Abiri
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Ministry of Health, Freetown 047235, Sierra Leone; (F.T.); (O.T.A.); (J.P.K.); (A.K.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 047235, Sierra Leone
| | - James P. Komeh
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Ministry of Health, Freetown 047235, Sierra Leone; (F.T.); (O.T.A.); (J.P.K.); (A.K.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 047235, Sierra Leone
| | - Abdulai Kanu
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Ministry of Health, Freetown 047235, Sierra Leone; (F.T.); (O.T.A.); (J.P.K.); (A.K.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 047235, Sierra Leone
| | - Joseph Sam Kanu
- National Disease Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown 047235, Sierra Leone;
| | | | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), 1211 Geneva, Switzerland;
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Boakye-Yiadom E, Najjemba R, Thekkur P, Labi AK, Gil-Cuesta J, Asafo-Adjei K, Mensah P, van Boetzelaer E, Jessani NS, Orish VN. Use and Quality of Blood Cultures for the Diagnosis of Bloodstream Infections: A Cross-Sectional Study in the Ho Teaching Hospital, Ghana, 2019-2021. Int J Environ Res Public Health 2023; 20:6631. [PMID: 37681771 PMCID: PMC10487590 DOI: 10.3390/ijerph20176631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/22/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Blood Culture and Drug Susceptibility Testing (CDST) remains vital for the diagnosis and management of bloodstream infections (BSIs). While the Ghana National Standard Treatment Guidelines require CDST to be performed in each case of suspected or clinically diagnosed BSI, these are poorly adhered to in the Ho Teaching Hospital (HTH). This study used secondary medical and laboratory records to describe blood CDST requests by clinicians and the quality of CDST processes for the diagnosis of BSI among patients admitted to HTH from 2019 to 2021. Of 4278 patients, 33% were infants. Pneumonia and neonatal sepsis cases were 40% and 22%, respectively. Only 8% (351/4278) had blood CDST requested. Of 94% (329/351) blood CDST processed and reported, only 7% (22/329) were culture-positive, with likely contaminants being recovered from 16% (52/329) of the specimens. The duration from admission to request was 2 days (IQR: 0-5), and Further qualitative studies must be conducted to understand the reasons for low blood CDST utilisation among clinicians and the patient outcomes. Targeted interventions are required to enhance the utilisation of blood CDST by clinicians and the quality of laboratory processes.
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Affiliation(s)
- Emily Boakye-Yiadom
- Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho PMB 31, Volta Region, Ghana;
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | | | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France;
| | - Appiah-Korang Labi
- Ghana Country Office, World Health Organization, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana;
| | - Julita Gil-Cuesta
- Luxembourg Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières, Rue Arbre Benit 46, 1050 Brussels, Belgium;
| | - Karikari Asafo-Adjei
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | - Prosper Mensah
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | - Elburg van Boetzelaer
- Luxembourg Operational Research Unit, Médecins Sans Frontières, 68 Rue de Gasperich, L-1617 Luxembourg, Luxembourg;
| | - Nasreen S. Jessani
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Tygerburg 7505, South Africa;
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Verner Ndudri Orish
- Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho PMB 31, Volta Region, Ghana;
- Sickle Cell Disease Unit, Department of Internal Medicine, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana
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Shauer D, Petrosyan O, Gemilyan M, Kamau EM, Thekkur P, Goncharova O, Gulmira K, Kyrbashov B, Istamov K, Kadyrov M, Wilkinson E. Quality of Electronic TB Register Data Compared with Paper-Based Records in the Kyrgyz Republic. Trop Med Infect Dis 2023; 8:416. [PMID: 37624354 PMCID: PMC10458876 DOI: 10.3390/tropicalmed8080416] [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: 05/25/2023] [Revised: 08/12/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
This study evaluated the effectiveness of an electronic system for managing individuals with drug-sensitive pulmonary tuberculosis in the Kyrgyz Republic. This cohort study used programmatic data. The study included people registered on the paper-based system in 2019 and 302 people registered on both the electronic and the paper-based systems between June 2021 and May 2022. The data from the 302 individuals were used to assess the completeness of each form of record and the concordance of the electronic record with the paper-based system. This study showed that for most variables, the completeness and concordance were 85.3-93.0% and were lowest for nonmandatory fields such as medication side effects (26.8% vs. 13.6%). No significant difference was observed in the time taken from symptom onset to diagnosis and treatment initiation between the two systems. However, the electronic system had a significantly higher percentage of subjects who initiated treatment on the day of diagnosis (80.3% vs. 57.1%). The proportion with successful outcomes was similar in both groups, but the electronic system had a significantly lower proportion of individuals with outcomes that were not evaluated or recorded (4.8% vs. 14.3%, p < 0.001). This study highlights the potential advantages and gaps associated with implementing an electronic TB register system for improving records.
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Affiliation(s)
- Daniil Shauer
- National Center for Tuberculosis, Ministry of Health, Bishkek 720000, Kyrgyzstan; (O.G.); (K.G.); (B.K.); (M.K.)
| | - Ofelya Petrosyan
- TB Research and Prevention Center, Yerevan 0014, Armenia; (O.P.); (M.G.)
| | - Manik Gemilyan
- TB Research and Prevention Center, Yerevan 0014, Armenia; (O.P.); (M.G.)
- Department of Gastroenterology, Yerevan State Medical University, Yerevan 0025, Armenia
| | - Edward M. Kamau
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) World Health Organization, 1211 Geneva, Switzerland;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France;
| | - Olga Goncharova
- National Center for Tuberculosis, Ministry of Health, Bishkek 720000, Kyrgyzstan; (O.G.); (K.G.); (B.K.); (M.K.)
| | - Kalmambetova Gulmira
- National Center for Tuberculosis, Ministry of Health, Bishkek 720000, Kyrgyzstan; (O.G.); (K.G.); (B.K.); (M.K.)
| | - Bolot Kyrbashov
- National Center for Tuberculosis, Ministry of Health, Bishkek 720000, Kyrgyzstan; (O.G.); (K.G.); (B.K.); (M.K.)
| | - Kylychbek Istamov
- School of Medicine, Osh State University, Osh City 723500, Kyrgyzstan;
| | - Meder Kadyrov
- National Center for Tuberculosis, Ministry of Health, Bishkek 720000, Kyrgyzstan; (O.G.); (K.G.); (B.K.); (M.K.)
| | - Ewan Wilkinson
- The Institute of Medicine, University of Chester, Chester CH14BJ, UK;
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10
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Margao S, Fofanah BD, Thekkur P, Kallon C, Ngauja RE, Kamara IF, Kamara RZ, Tengbe SM, Moiwo M, Musoke R, Fullah M, Kanu JS, Lakoh S, Kpagoi SSTK, Kamara KN, Thomas F, Mannah MT, Katawera V, Zachariah R. Improvement in Infection Prevention and Control Performance Following Operational Research in Sierra Leone: A Before (2021) and After (2023) Study. Trop Med Infect Dis 2023; 8:376. [PMID: 37505672 PMCID: PMC10383112 DOI: 10.3390/tropicalmed8070376] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) is crucial to limit health care-associated infections and antimicrobial resistance. An operational research study conducted in Sierra Leone in 2021 reported sub-optimal IPC performance and provided actionable recommendations for improvement. METHODS This was a before-and-after study involving the national IPC unit and all twelve district-level secondary public hospitals. IPC performance in 2021 (before) and in 2023 (after) was assessed using standardized World Health Organization checklists. IPC performance was graded as: inadequate (0-25%), basic (25.1-50%), intermediate (50.1-75%), and advanced (75.1-100%). RESULTS The overall IPC performance in the national IPC unit moved from intermediate (58%) to advanced (78%), with improvements in all six core components. Four out of six components achieved advanced levels when compared to the 2021 levels. The median score for hospitals moved from basic (50%) to intermediate (59%), with improvements in six of eight components. Three of four gaps identified in 2021 at the national IPC unit and four of seven at hospitals had been addressed by 2023. CONCLUSIONS The study highlights the role of operational research in informing actions that improved IPC performance. There is a need to embed operational research as part of the routine monitoring of IPC programs.
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Affiliation(s)
- Senesie Margao
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Christiana Kallon
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Ramatu Elizabeth Ngauja
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Rugiatu Zainab Kamara
- US Centre for Disease Control and Prevention Country Office, Freetown 00232, Sierra Leone;
| | - Sia Morenike Tengbe
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Matilda Moiwo
- Republic of Sierra Leone Armed Forces, HIV/AIDS/TB Control Program Coordinator, 34th Military Hospital, Wilberforce, Western Area Urban 00232, Sierra Leone;
| | - Robert Musoke
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Mary Fullah
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Satta Sylvia T. K. Kpagoi
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Kadijatu Nabie Kamara
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Fawzi Thomas
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Freetown 047235, Sierra Leone
| | - Margaret Titty Mannah
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Victoria Katawera
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), 1211 Geneva, Switzerland;
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11
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Harries AD, Lin Y, Thekkur P, Nair D, Chakaya J, Dongo JP, Luzze H, Chimzizi R, Mubanga A, Timire C, Kavenga F, Satyanarayana S, Kumar AMV, Khogali M, Zachariah R. Why TB programmes should assess for comorbidities, determinants and disability at the start and end of TB treatment. Int J Tuberc Lung Dis 2023; 27:495-498. [PMID: 37353872 DOI: 10.5588/ijtld.23.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Thekkur
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - D Nair
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - J Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Respiratory Society of Kenya, Nairobi, Kenya
| | - J P Dongo
- The Union-Uganda Office, Kampala, Uganda
| | - H Luzze
- National Leprosy and Tuberculosis Programme, Ministry of Health, Kampala, Uganda
| | - R Chimzizi
- Ministry of Health/USAID STAR Project, Lusaka, Zambia
| | - A Mubanga
- National Tuberculosis Programme, Ministry of Health, Lusaka, Zambia
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - F Kavenga
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - M Khogali
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - R Zachariah
- Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
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12
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Liu Y, Lin Y, Sun Y, Thekkur P, Cheng C, Li Y, Shi Y, Jiang J, Liao J, Nie C, Sun W, Liang C, Zhang X, Liu S, Ma Y, Berger SD, Satyanarayana S, Kumar AMV, Khogali M, Zachariah R, Golub JE, Li L, Harries AD. Managing Comorbidities, Determinants and Disability at Start and End of TB Treatment under Routine Program Conditions in China. Trop Med Infect Dis 2023; 8:341. [PMID: 37505637 PMCID: PMC10383887 DOI: 10.3390/tropicalmed8070341] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
Many patients with tuberculosis (TB) have comorbidities, risk determinants and disability that co-exist at diagnosis, during and after TB treatment. We conducted an observational cohort study in 11 health facilities in China to assess under routine program conditions (i) the burden of these problems at the start and end of TB treatment and (ii) whether referral mechanisms for further care were functional. There were 603 patients registered with drug-susceptible TB who started TB treatment: 84% were symptomatic, 14% had diabetes, 14% had high blood pressure, 19% smoked cigarettes, 10% drank excess alcohol and in 45% the 6 min walking test (6MWT) was abnormal. Five patients were identified with mental health disorders. There were 586 (97%) patients who successfully completed TB treatment six months later. Of these, 18% were still symptomatic, 12% had diabetes (the remainder with diabetes failed to complete treatment), 5% had high blood pressure, 5% smoked cigarettes, 1% drank excess alcohol and 25% had an abnormal 6MWT. Referral mechanisms for the care of comorbidities and determinants worked well except for mental health and pulmonary rehabilitation for disability. There is need for more programmatic-related studies in other countries to build the evidence base for care of TB-related conditions and disability.
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Affiliation(s)
- Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, No. 9 Beiguan Ave, Tongzhou, Beijing 101149, China; (Y.L.); (Y.S.); (L.L.)
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
| | - Yuxian Sun
- Beijing Chest Hospital, Capital Medical University, No. 9 Beiguan Ave, Tongzhou, Beijing 101149, China; (Y.L.); (Y.S.); (L.L.)
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
- The Union South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Changhao Cheng
- Wuhan Pulmonary Hospital, No. 28 Baofengyilu, Qiaokou, Wuhan 430000, China;
| | - Yuecui Li
- The First People’s Hospital of Yongkang, No. 599 Jinshan West Road, Yongkang 321300, China;
| | - Yunzhen Shi
- Dongyang People’s Hospital, No. 60 Wuning West Road, Dongyang 322100, China;
| | - Jun Jiang
- The Third People’s Hospital of Yichang City, No. 32 Gangyaolu, Yichang 443000, China;
| | - Jiong Liao
- The People’s Hospital of Laiban, No. 159 Pangudadao, Laiban 546100, China;
| | - Chuangui Nie
- Xiangyang Institute of Tuberculosis Control and Prevention, No. 20 Xinhuala, Xiangyang 441000, China;
| | - Wenyan Sun
- Ezhou Third Hospital, No. 16 Minxin West Road, Ezhou 436000, China;
| | - Chengyuan Liang
- Baise City People’s Hospital, No. 8 Chengxianglu, Youjiang, Baise 533000, China;
| | - Xiaojuan Zhang
- Zhongwei People’s Hospital, Gulouxijie, Zhongwei 755000, China;
| | - Sang Liu
- Guangxi Chest Hospital, No. 8 Yangjiaoshanlu, Yufeng, Liuzhou 545000, China;
| | - Yan Ma
- The People’s Hospital of Tongxin, Xueyuanlu, Tongxi, Yuhaizhen 751100, China;
| | - Selma Dar Berger
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
- The Union South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
- The Union South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore 575018, India
| | - Mohammed Khogali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 17666, United Arab Emirates;
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), Avenue Appia 20, 1211 Geneva, Switzerland;
| | - Jonathan E. Golub
- Johns Hopkins Center for Tuberculosis, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Liang Li
- Beijing Chest Hospital, Capital Medical University, No. 9 Beiguan Ave, Tongzhou, Beijing 101149, China; (Y.L.); (Y.S.); (L.L.)
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (Y.L.); (P.T.); (S.D.B.); (S.S.); (A.M.V.K.)
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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13
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Zachariah R, Goncharova O, Kamarli C, Bazikov T, Ahmedov S, Osmonaliev K, Harries AD, Davtyan H, Thekkur P, Kalmambetova G, Kadyrov A. Strengthening the Operational Research Capacity of National Tuberculosis Control Programs: Necessity or Luxury? Trop Med Infect Dis 2023; 8:339. [PMID: 37505635 PMCID: PMC10384202 DOI: 10.3390/tropicalmed8070339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
'How to get research into practice: first get practice into research [...].
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Affiliation(s)
- Rony Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank, World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), 20, Avenue Appia, CH-1211 Geneva, Switzerland
| | - Olga Goncharova
- National Center of Phthisiology, Bishkek 720000, Kyrgyzstan; (O.G.); (A.K.)
| | - Chynara Kamarli
- United States Agency for International Development, 171 Prospect Mira, Bishkek 720016, Kyrgyzstan; (C.K.); (T.B.)
| | - Timur Bazikov
- United States Agency for International Development, 171 Prospect Mira, Bishkek 720016, Kyrgyzstan; (C.K.); (T.B.)
| | - Sevim Ahmedov
- United States Agency for International Development, TB/HIV, Prevention and M&E Team Lead, Bureau for Global Health, TB Division, Washington, DC 20024, USA;
| | | | - Anthony D. Harries
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (A.D.H.); (P.T.)
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hayk Davtyan
- Tuberculosis Research and Prevention Center NGO, Yerevan 0014, Armenia;
| | - Pruthu Thekkur
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (A.D.H.); (P.T.)
| | - Gulmira Kalmambetova
- Department of Strategic Development and International Cooperation, TB National Reference Laboratory, 90a Akhunbaeva Str., Bishkek 720075, Kyrgyzstan;
| | - Abdullaat Kadyrov
- National Center of Phthisiology, Bishkek 720000, Kyrgyzstan; (O.G.); (A.K.)
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14
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Kadyrov M, Thekkur P, Geliukh E, Sargsyan A, Goncharova O, Kulzhabaeva A, Kadyrov A, Khogali M, Harries AD, Kadyrov A. Contact Tracing and Tuberculosis Preventive Therapy for Household Child Contacts of Pulmonary Tuberculosis Patients in the Kyrgyz Republic: How Well Are We Doing? Trop Med Infect Dis 2023; 8:332. [PMID: 37505628 PMCID: PMC10386269 DOI: 10.3390/tropicalmed8070332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Early identification, screening and investigation for tuberculosis (TB), and provision of TB preventive therapy (TPT), reduces risk of TB among child household contacts of pulmonary TB patients (index patients). A cohort study was conducted to describe the care cascade and timeliness of contact tracing and TPT initiation among child household contacts (aged < 15 years) of index patients initiated on TB treatment in Bishkek, the Kyrgyz Republic during October 2021-September 2022. In the register, information on the number of child household contacts was available for 153 (18%) of 873 index patients. Of 297 child household contacts identified, data were available for 285, of whom 261 (92%) were screened for TB. More than 50% were screened after 1 month of the index patient initiating TB treatment. TB was diagnosed in 23/285 (9%, 95% CI: 6-13%) children. Of 238 TB-free children, 130 (55%) were eligible for TPT. Of the latter, 64 (49%) were initiated on TPT, of whom 52 (81%) completed TPT. While TPT completion was excellent, there was deficiency in contact identification, timely screening and TPT initiation. Thus, healthcare providers should diligently request and record details of child household contacts, adhere to contact tracing timelines and counsel caregivers regarding TPT.
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Affiliation(s)
- Meder Kadyrov
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France
| | - Evgenia Geliukh
- International Charitable Foundation "Alliance for Public Health", 01601 Kiev, Ukraine
| | - Aelita Sargsyan
- Tuberculosis Research and Prevention Centre (TBRPC), Yerevan 0014, Armenia
| | - Olga Goncharova
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
| | | | - Asel Kadyrov
- Primary Healthcare Centre #1, Bishkek 720000, Kyrgyzstan
| | - Mohammed Khogali
- Institute of Public Health (IPH), College of Medicine and health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 15551, United Arab Emirates
| | - Anthony D Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Abdullaat Kadyrov
- National Centre of Phthisiology, Ministry of Health, Bishkek 720000, Kyrgyzstan
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15
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Saavedra JC, Fonseca D, Abrahamyan A, Thekkur P, Timire C, Reyes J, Zachariah R, Agudelo LG. Bloodstream infections and antibiotic resistance at a regional hospital, Colombia, 2019-2021. Rev Panam Salud Publica 2023; 47:e18. [PMID: 37082533 PMCID: PMC10105591 DOI: 10.26633/rpsp.2023.18] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 04/22/2023] Open
Abstract
Objectives To assess antibiotic susceptibility of World Health Organization (WHO) priority bacteria (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus, and Streptococcus pneumoniae) in blood cultures at the Orinoquía regional hospital in Colombia. Methods This was cross-sectional study using routine laboratory data for the period 2019-2021. Data on blood samples from patients suspected of a bloodstream infection were examined. We determined: the total number of blood cultures done and the proportion with culture yield; the characteristics of patients with priority bacteria; and the type of bacteria isolated and antibiotic resistance patterns. Results Of 25 469 blood cultures done, 1628 (6%) yielded bacteria; 774 (48%) of these bacteria were WHO priority pathogens. Most of the priority bacteria isolated (558; 72%) were gram-negative and 216 (28%) were gram-positive organisms. Most patients with priority bacteria (666; 86%) were hospitalized in wards other than the intensive care unit, 427 (55%) were male, and 321 (42%) were ≥ 60 years of age. Of the 216 gram-positive bacteria isolated, 205 (95%) were Staphylococcus aureus. Of the 558 gram-negative priority bacteria isolated, the three most common were Escherichia coli (34%), Klebsiella pneumoniae (28%), and Acinetobacter baumannii (20%). The highest resistance of Staphylococcus aureus was to oxacillin (41%). For gram-negative bacteria, resistance to antibiotics ranged from 4% (amikacin) to 72% (ampicillin). Conclusions Bacterial yield from blood cultures was low and could be improved. WHO priority bacteria were found in all hospital wards. This calls for rigorous infection prevention and control standards and continued surveillance of antibiotic resistance.
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Affiliation(s)
- Julio C. Saavedra
- Regional hospital of OrinoquiaYopalColombiaRegional hospital of Orinoquia, Yopal, Colombia.
| | - Deisy Fonseca
- Regional hospital of OrinoquiaYopalColombiaRegional hospital of Orinoquia, Yopal, Colombia.
| | - Arpine Abrahamyan
- Tuberculosis Research and Prevention CenterYerevanArmeniaTuberculosis Research and Prevention Center, Yerevan, Armenia.
| | - Pruthu Thekkur
- Centre for Operational ResearchInternational Union Against Tuberculosis and Lung DiseaseSouth-East Asia OfficeNew DelhiIndiaCentre for Operational Research, International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India.
| | - Collins Timire
- International Union Against Tuberculosis and Lung DiseaseParisFranceInternational Union Against Tuberculosis and Lung Disease, Paris, France.
| | - Jorge Reyes
- Central University of EcuadorQuitoEcuadorCentral University of Ecuador, Quito, Ecuador.
| | - Rony Zachariah
- UNICEF, UNDP, World BankWHO Special Programme for Research and Training in Tropical DiseasesGenevaSwitzerlandUNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland.
| | - Lorena G. Agudelo
- Regional hospital of OrinoquiaYopalColombiaRegional hospital of Orinoquia, Yopal, Colombia.
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Nair D, Thekkur P, Fernando M, Kumar AMV, Satyanarayana S, Chandraratne N, Chandrasiri A, Attygalle DE, Higashi H, Bandara J, Berger SD, Harries AD. Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study. Healthcare (Basel) 2023; 11:healthcare11020202. [PMID: 36673570 PMCID: PMC9859051 DOI: 10.3390/healthcare11020202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0-23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.
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Affiliation(s)
- Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- Correspondence:
| | - Manoj Fernando
- Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Anuradhapura 50300, Sri Lanka
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union-South East Asia (USEA) Office, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore 575018, India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union-South East Asia (USEA) Office, New Delhi 110016, India
| | - Nadeeka Chandraratne
- The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka
| | - Amila Chandrasiri
- The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka
| | | | | | - Jayasundara Bandara
- Project Management Unit, Primary Health Care System Strengthening Project (PSSP), Colombo 00300, Sri Lanka
| | - Selma Dar Berger
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Anthony D. Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Amancha G, Celis Y, Irazabal J, Falconi M, Villacis K, Thekkur P, Nair D, Perez F, Verdonck K. High levels of antimicrobial resistance in Escherichia coli and Salmonella from poultry in Ecuador. Rev Panam Salud Publica 2023; 47:e15. [PMID: 37082534 PMCID: PMC10105606 DOI: 10.26633/rpsp.2023.15] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/12/2022] [Indexed: 04/22/2023] Open
Abstract
Objective To describe antimicrobial resistance profiles of Escherichia coli and Salmonella spp. isolated from chicken carcasses and the antimicrobials commonly used in animals in Ecuador and provide information on antimicrobial resistance patterns for implementing evidence-based corrective measures. Methods Meat samples were collected from chicken carcasses in 199 slaughterhouses across Ecuador as part of a national pilot study for monitoring antimicrobial resistance in agricultural sources in 2019. Samples were tested for E. coli and Salmonella spp. Sensitivity to 10 critically important and three highly important antimicrobials (from a human health perspective) was assessed. The country report submitted to the World Organization for Animal Health was accessed to extract the quantity of antimicrobials produced or imported for use in animals. Results Of 383 samples, E. coli was isolated from 148 (39%) and Salmonella spp. from 20 (5%) samples. Ninety percent of the isolates were resistant to at least one critically important antimicrobial. Resistance was highest to erythromycin (E. coli 76%; Salmonella spp. 85%) and tetracycline (E. coli 71%; Salmonella spp. 90%). Critically or highly important antimicrobials (colistin, tetracycline, trimethoprim/sulfamethoxazole) formed the bulk (87%) of antimicrobials used in animals as per the World Organization for Animal Health report. Conclusions High prevalence of antimicrobial resistance in poultry in Ecuador calls for the development of guidelines and regulations on the use of antimicrobials and for engagement with livestock producers. The existing surveillance system needs to be strengthened to improve the monitoring of antimicrobial use and evolving resistance patterns.
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Affiliation(s)
- Geovanna Amancha
- Agency for Plant and Animal Health Regulation and Control (Agrocalidad)QuitoEcuadorAgency for Plant and Animal Health Regulation and Control (Agrocalidad), Quito, Ecuador
- Geovanna Amancha,
| | - Yamile Celis
- Pan American Health OrganizationBogotáColombiaPan American Health Organization, Bogotá, Colombia
| | - Jorge Irazabal
- Agency for Plant and Animal Health Regulation and Control (Agrocalidad)QuitoEcuadorAgency for Plant and Animal Health Regulation and Control (Agrocalidad), Quito, Ecuador
| | - Mercy Falconi
- Agency for Plant and Animal Health Regulation and Control (Agrocalidad)QuitoEcuadorAgency for Plant and Animal Health Regulation and Control (Agrocalidad), Quito, Ecuador
| | - Karla Villacis
- Agency for Plant and Animal Health Regulation and Control (Agrocalidad)QuitoEcuadorAgency for Plant and Animal Health Regulation and Control (Agrocalidad), Quito, Ecuador
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung DiseaseParisFranceInternational Union Against Tuberculosis and Lung Disease, Paris, France
| | - Divya Nair
- International Union Against Tuberculosis and Lung DiseaseParisFranceInternational Union Against Tuberculosis and Lung Disease, Paris, France
| | - Freddy Perez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
- Federal University of Health Sciences of Porto AlegrePorto AlegreBrazilFederal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Kristien Verdonck
- Institute of Tropical MedicineAntwerpBelgiumInstitute of Tropical Medicine, Antwerp, Belgium
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Lopez M, Martinez A, Celis Bustos Y, Thekkur P, Nair D, Verdonck K, Perez F. Antibiotic consumption in secondary and tertiary hospitals in Colombia: national surveillance from 2018-2020. Rev Panam Salud Publica 2023; 47:e63. [PMID: 37082536 PMCID: PMC10100593 DOI: 10.26633/rpsp.2023.63] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/21/2022] [Indexed: 04/22/2023] Open
Abstract
Objective To assess the compliance in secondary and tertiary level hospitals with monthly reporting of antibiotic consumption to the Colombian National Public Health Surveillance System (SIVIGILA-INS), and to describe reported antibiotic consumption during 2018-2020. Methods This study involved a secondary analysis of antibiotic consumption data reported to SIVIGILA-INS. Frequency of hospital reporting was assessed and compared against expected reports, disaggregated by intensive care units (ICU)/non-ICU wards and geographical regions. Consumption was expressed as defined daily dose (DDD) per 100 occupied beds for seven antibiotics. Results More than 70% of hospitals reported antibiotic consumption at least once in each of the three years (79% in ICU and 71% in non-ICU wards). Of these, ICU monthly reporting was complete (12 monthly reports per year) for 59% in the period 2018-2019 but only 4% in 2020. Non-ICU reporting was complete for 52% in 2019 and for 2% in 2020. Most regions had an overall decrease in reporting in 2020. Analysis of antibiotic consumption showed an increase for piperacillin/tazobactam, ertapenem, and cefepime from 2019 to 2020. Conclusions There were gaps in the consistency and frequency of reporting. Efforts are needed to improve compliance with monthly reporting, which declined in 2020, possibly due to the COVID-19 pandemic. Non-compliance on reporting and data quality issues should be addressed with the hospitals to enable valid interpretation of antibiotic consumption trends.
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Affiliation(s)
- Mónica Lopez
- Ministry of Health and Social ProtectionBogotáColombiaMinistry of Health and Social Protection, Bogotá, Colombia
- Mónica Lopez,
| | - Adriana Martinez
- Ministry of Health and Social ProtectionBogotáColombiaMinistry of Health and Social Protection, Bogotá, Colombia
| | - Yamile Celis Bustos
- Pan American Health OrganizationBogotáColombiaPan American Health Organization, Bogotá, Colombia
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung DiseaseParisFranceInternational Union Against Tuberculosis and Lung Disease, Paris, France
| | - Divya Nair
- International Union Against Tuberculosis and Lung DiseaseParisFranceInternational Union Against Tuberculosis and Lung Disease, Paris, France
| | - Kristien Verdonck
- Institute of Tropical MedicineAntwerpBelgiumInstitute of Tropical Medicine, Antwerp, Belgium
| | - Freddy Perez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
- Federal University of Health Sciences of Porto AlegrePorto AlegreBrazilFederal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Corredor SM, Abrahamyan A, Thekkur P, Reyes J, Celis Y, Cuellar C, Zachariah R. High level of infection prevention and control in surveyed hospitals in Colombia, 2021. Rev Panam Salud Publica 2023; 47:e70. [PMID: 37089786 PMCID: PMC10120385 DOI: 10.26633/rpsp.2023.70] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 04/25/2023] Open
Abstract
Objective This study aimed to determine the performance of infection prevention and control (IPC) programs in eight core components in level 2 and level 3 hospitals across all provinces in Colombia. Methods This cross-sectional study used self-assessed IPC performance data voluntarily reported by hospitals to the Ministry of Health and Social Protection during 2021. Each of the eight core components of the World Health Organization's checklist in the Infection Prevention and Control Assessment Framework contributes a maximum score of 100, and the overall IPC performance score is the sum of these component scores. IPC performance is graded according to the overall score as inadequate (0-200), basic (201-400), intermediate (401-600) or advanced (601-800). Results Of the 441 level 2 and level 3 hospitals, 267 (61%) reported their IPC performance. The median (interquartile range [IQR]) overall IPC score was 672 (IQR: 578-715). Of the 267 hospitals reporting, 187 (70%) achieved an advanced level of IPC. The median overall IPC score was significantly higher in private hospitals (690, IQR: 598-725) than in public hospitals (629, IQR: 538-683) (P < 0.001). Among the core components, scores were highest for the category assessing IPC guidelines (median score: 97.5) and lowest for the category assessing workload, staffing and bed occupancy (median score: 70). Median overall IPC scores varied across the provinces (P < 0.001). Conclusions This countrywide assessment showed that 70% of surveyed hospitals achieved a self-reported advanced level of IPC performance, which reflects progress in building health system resilience. Since only 61% of eligible hospitals participated, an important next step is to ensure the participation of all hospitals in future assessments.
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Affiliation(s)
- Sandra Milena Corredor
- Ministry of Health and Social ProtectionBogotáColombiaMinistry of Health and Social Protection, Bogotá, Colombia
- Sandra Milena Corredor,
| | - Arpine Abrahamyan
- Tuberculosis Research and Prevention CenterYerevanArmeniaTuberculosis Research and Prevention Center, Yerevan, Armenia
| | - Pruthu Thekkur
- Center for Operational ResearchInternational Union Against Tuberculosis and Lung DiseaseParisFranceCenter for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Jorge Reyes
- Central University of EcuadorQuitoEcuadorCentral University of Ecuador, Quito, Ecuador
| | - Yamile Celis
- Communicable Diseases and Environmental Determinants of Health DepartmentPan American Health OrganizationBogotáColombiaCommunicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Bogotá, Colombia
| | - Claudia Cuellar
- Ministry of Health and Social ProtectionBogotáColombiaMinistry of Health and Social Protection, Bogotá, Colombia
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical DiseasesGenevaSwitzerlandSpecial Programme for Research and Training in Tropical Diseases, Geneva, Switzerland
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Mandal SK, Neupane J, Kumar AMV, Davtyan H, Thekkur P, Jayaram A, Chalise BS, Rawal M, Paudel M, Baral B, Shah RK, Maharjan K, Shrestha S, Bhandari L, K.C. N, Gautam N, Sunny AK, Thakur N, Subeedee KC, Mandal SK, Bastola A. Audit of Clinical Care Received by COVID-19 Patients Treated at a Tertiary Care Hospital of Nepal in 2021. Trop Med Infect Dis 2022; 7:tropicalmed7110381. [PMID: 36422932 PMCID: PMC9698854 DOI: 10.3390/tropicalmed7110381] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Like the world over, Nepal was also hard hit by the second wave of COVID-19. We audited the clinical care provided to COVID-19 patients admitted from April to June 2021 in a tertiary care hospital of Nepal. This was a cohort study using routinely collected hospital data. There were 620 patients, and most (458, 74%) had severe illness. The majority (600, 97%) of the patients were eligible for admission as per national guidelines. Laboratory tests helping to predict the outcome of COVID-19, such as D-dimer and C-reactive protein, were missing in about 25% of patients. Nearly all (>95%) patients with severe disease received corticosteroids, anticoagulants and oxygen. The use of remdesivir was low (22%). About 70% of the patients received antibiotics. Hospital exit outcomes of most (>95%) patients with mild and moderate illness were favorable (alive and discharged). Among patients with severe illness, about 25% died and 4% were critically ill, needing further referral. This is the first study from Nepal to audit and document COVID-19 clinical care provision in a tertiary care hospital, thus filling the evidence gap in this area from resource-limited settings. Adherence to admission guidelines was excellent. Laboratory testing, access to essential drugs and data management needs to be improved.
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Affiliation(s)
- Shrawan Kumar Mandal
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
- Correspondence: ; Tel.: +977-9841597341
| | - Jenish Neupane
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, The National Capital Territory of Delhi, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangaluru 575018, Karnataka, India
| | - Hayk Davtyan
- Tuberculosis Research and Prevention Center, NGO, Yerevan 0014, Armenia
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, The National Capital Territory of Delhi, India
| | - Anup Jayaram
- Manipal Institute of Virology, Manipal, Academy of Higher Education, Manipal, Udupi 576104, Karnataka, India
| | - Bimal Sharma Chalise
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Manisha Rawal
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Manu Paudel
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Bishwodip Baral
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Rajesh Kumar Shah
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Kijan Maharjan
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Sanjay Shrestha
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Lilanath Bhandari
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Nisha K.C.
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | - Nabaraj Gautam
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
| | | | - Nishant Thakur
- Epidemiology and Disease Control Division, Kathmandu 44600, Nepal
| | | | | | - Anup Bastola
- Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Government of Nepal, Kathmandu 44600, Nepal
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Zachariah R, Abrahamyan A, Rust S, Thekkur P, Khogali M, Kumar AMV, Davtyan H, Satyanarayana S, Shewade HD, Delamou A, Zolfo M, Hermans V, Berger SD, Reid A, Aseffa A, Dongre AR, Harries AD, Reeder JC. Quality, Equity and Partnerships in Mixed Methods and Qualitative Research during Seven Years of Implementing the Structured Operational Research and Training Initiative in 18 Countries. Trop Med Infect Dis 2022; 7:tropicalmed7100305. [PMID: 36288046 PMCID: PMC9610844 DOI: 10.3390/tropicalmed7100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Qualitative studies are often inadequately reported, making it difficult to judge their appropriateness for decision making in public health. We assessed the publication characteristics and quality of reporting of qualitative and mixed-method studies from the Structured Operational Research and Training Initiative (SORT IT), a global partnership for operational research capacity building. Methods: A cross-sectional analysis of publications to assess the qualitative component using an adapted version of the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: In 67 publications involving 18 countries, 32 journals and 13 public health themes, 55 were mixed-methods studies and 12 were qualitative studies. First authorship from low-and-middle-income (LMIC) countries was present in 64 (96%), LMIC last authorship in 55 (82%), and female first authorship in 30 (45%). The mean LMIC institutions represented per publication was five (range 1–11). Sixty-three (94%) publications were open access. Reporting quality was graded as ‘good’ to ‘excellent’ in 60 (89%) publications, ‘fair’ in five (8%) and ‘poor’ in two (3%). Conclusion: Most SORT IT publications adhered to COREQ standards, while supporting gender equity in authorship and the promotion of LMIC research leadership. SORT IT plays an important role in ensuring quality of evidence for decision making to improve public health.
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Affiliation(s)
- Rony Zachariah
- UNICEF, UNDP, World Bank, WHO, Special Programme for Research and Training in Tropical Diseases (TDR), CH-1211 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-791-4367
| | - Arpine Abrahamyan
- Tuberculosis Research and Prevention Center NGO (TB-RPC), Yerevan 0014, Armenia
| | - Stefanie Rust
- Local Health Authority, District of Diepholz, 49356 Diepholz, Germany
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Mohammed Khogali
- UNICEF, UNDP, World Bank, WHO, Special Programme for Research and Training in Tropical Diseases (TDR), CH-1211 Geneva, Switzerland
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union South-East Asia Office, C6, Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to Be University), Deralakatte, Mangaluru 575018, India
| | - Hayk Davtyan
- Tuberculosis Research and Prevention Center NGO (TB-RPC), Yerevan 0014, Armenia
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Hemant D. Shewade
- Division of Health Systems Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai, Tamil Nadu 600077, India
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry 1147, Guinea
| | - Maria Zolfo
- Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Veerle Hermans
- Médecins Sans Frontières, Operational Centre Brussels, LuxOR, 1617 Luxembourg, Luxembourg
| | - Selma Dar Berger
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Anthony Reid
- Médecins Sans Frontières, Operational Centre Brussels, LuxOR, 1617 Luxembourg, Luxembourg
| | - Abraham Aseffa
- UNICEF, UNDP, World Bank, WHO, Special Programme for Research and Training in Tropical Diseases (TDR), CH-1211 Geneva, Switzerland
| | - Amol R. Dongre
- Pramukhswami Medical College (PSMC), Karamsad 388325, India
| | - Anthony D. Harries
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - John C. Reeder
- UNICEF, UNDP, World Bank, WHO, Special Programme for Research and Training in Tropical Diseases (TDR), CH-1211 Geneva, Switzerland
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Owusu H, Thekkur P, Ashubwe-Jalemba J, Hedidor GK, Corquaye O, Aggor A, Steele-Dadzie A, Ankrah D. Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019-2021. Int J Environ Res Public Health 2022; 19:12413. [PMID: 36231716 PMCID: PMC9566282 DOI: 10.3390/ijerph191912413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
Increasing trends in antimicrobial resistance among uropathogens call for rational use of empirical antibiotics for managing uncomplicated urinary tract infections (UTIs). In Ghana, standard treatment guidelines (STGs) for UTI recommend oral ciprofloxacin or cefuroxime for 5-7 days in females and 10-14 days in males. We conducted a cross-sectional audit using electronic medical records (EMR) to assess compliance to the STGs among adults (≥18 years) with uncomplicated UTIs diagnosed in a primary health facility between October 2019 and October 2021. Among 3717 patients, 71% were females and all had complete prescription details in the EMR. Of all the patients, 83% were prescribed empirical antibiotics, of whom 88% received oral ciprofloxacin or cefuroxime. Only 68% were prescribed antibiotics for the correct duration, which was significantly lower among males (10%) compared to females (90%). Among patients who received antibiotics, 60% were prescribed in line with the STGs. The results call for feedback to physicians about poor compliance to STGs with duration of antibiotic prescribed. Recommendations on 10-14 days duration of antibiotics for males needs to be reassessed and necessary amendments to STGs can be made. Leveraging the well-established EMR system, a real-time audit-feedback mechanism can be instituted to improve compliance with STGs.
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Affiliation(s)
- Helena Owusu
- Pharmacy Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union South-East Asia Office (The USEA), New Delhi 110016, India
| | | | - George Kwesi Hedidor
- World Health Organization Country Office, Roman Ridge, Accra P.O. Box MB142, Ghana
| | - Oksana Corquaye
- Pharmacy Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
| | - Asiwome Aggor
- Pharmacy Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
| | - Allen Steele-Dadzie
- Polyclinic/Family Medicine Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
| | - Daniel Ankrah
- Pharmacy Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
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Koju P, Shrestha R, Shrestha A, Tamrakar S, Rai A, Shrestha P, Madhup SK, Katuwal N, Shrestha A, Shrestha A, Shrestha S, K.C S, Karki P, Tamang P, Thekkur P, Shakya Shrestha S. Antimicrobial Resistance in E. coli Isolated from Chicken Cecum Samples and Factors Contributing to Antimicrobial Resistance in Nepal. Trop Med Infect Dis 2022; 7:tropicalmed7090249. [PMID: 36136660 PMCID: PMC9504632 DOI: 10.3390/tropicalmed7090249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Microorganisms with antimicrobial resistance (AMR) are prevalent among humans and animals, and also found in the environment. Though organisms with AMR can spread to humans via food from animal sources, the burden of AMR in food-producing animals remains largely unknown. Thus, we assessed the resistance pattern among Escherichia coli isolated from chicken cecum samples and explored issues contributing to AMR in animals in the Dhulikhel Municipality of Nepal. We conducted a mixed-methods study, comprising a cross-sectional quantitative component, with collection of chicken cecal samples from slaughter houses/shops. In addition, a descriptive qualitative component was undertaken, with a focus group discussion and key informant interviews among stakeholders involved in animal husbandry. Of the 190 chicken cecum samples collected, 170 (89%) were subjected to culture and drug sensitivity testing, of which E. coli was isolated from 159 (94%) samples. Of the 159 isolates, 113 (71%) had resistance to ≥3 antimicrobial class. Resistance to tetracycline (86%) and ciprofloxacin (66%) were most prevalent. Overuse of antimicrobials, easy availability of antimicrobials, and lack of awareness among farmers about AMR were major issues contributing to AMR. The high prevalence of resistance among E. coli in chicken cecal samples calls for rational use of antimicrobials, educating farmers, and multi-sectoral coordination.
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Affiliation(s)
- Pramesh Koju
- Pharmacovigilance Unit, Dhulikhel Hospital, Dhulikhel 45210, Nepal
- Department of Public Health and Community Programs, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Rajeev Shrestha
- Pharmacovigilance Unit, Dhulikhel Hospital, Dhulikhel 45210, Nepal
- Department of Pharmacology, School of Medical Sciences, Kathmandu University, Dhulikhel 45210, Nepal
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Abha Shrestha
- Department of Public Health and Community Programs, Dhulikhel Hospital, Dhulikhel 45210, Nepal
- Department of Community Medicine, School of Medical Sciences, Kathmandu University, Dhulikhel 45210, Nepal
| | - Sudichhya Tamrakar
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Anisha Rai
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Priyanka Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu 41825, Nepal
| | | | - Nishan Katuwal
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Archana Shrestha
- Department of Public Health and Community Programs, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Akina Shrestha
- Department of Public Health and Community Programs, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Sunaina Shrestha
- Department of Microbiology, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Sandip K.C
- Health Unit, Dhulikhel Municipality, Dhulikhel 45210, Nepal
| | - Prashamsa Karki
- Department of Microbiology, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Pooja Tamang
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75000 Paris, France
| | - Sony Shakya Shrestha
- Pharmacovigilance Unit, Dhulikhel Hospital, Dhulikhel 45210, Nepal
- Department of Pharmacology, School of Medical Sciences, Kathmandu University, Dhulikhel 45210, Nepal
- Correspondence: ; Tel.: +977-9841276045
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Maroof M, Faizi N, Thekkur P, Raj S, Goel S. Is the rule of halves in hypertension valid uniformly across India? A cross-sectional analysis of national family health survey-4 data. Indian J Public Health 2022; 66:269-275. [PMID: 36149103 DOI: 10.4103/ijph.ijph_2143_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Hypertension is widely prevalent across India. The rule of halves is commonly used to describe the attrition and gaps in the care cascade of hypertension management across detection, availing treatment, and having controlled blood pressure (BP) on treatment. Objectives Using nationally representative data, we aimed to assess the rule of halves in hypertension management in different states of India and across sociodemographic, health system, and personal factors. Methods A descriptive analysis of secondary data from the National Family Health Survey-4 was conducted. We included 770,662 individuals (112,122 men and 658,540 nonpregnant women) of 15-49 years of age. The proportion of individuals not aware of hypertension status among those with high BP, known hypertensives not availing of treatment, and uncontrolled BP among those on treatment were expressed as percentage with a 95% confidence interval (CI). Results Of those with high BP, 48.5% (95% CI: 47.8%-49.3%) were not aware of their hypertensive status. Among known hypertensives, 72% (95% CI: 71.2%-72.8%) had not availed treatment for hypertension. Among those on treatment, 39.8% (95% CI: 38.7%-40.9%) had uncontrolled hypertension. Conclusion The rule of halves of India shows that the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke has made relatively good progress with the detection of hypertension and achieving BP control among those on treatment. However, with three-fourth of known hypertensives not availing treatment, more dividends from the detection of hypertension efforts could be realized. The program needs to especially focus on ensuring the treatment for those detected with hypertension.
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Affiliation(s)
- Mohd Maroof
- Assistant Professor, Department of Community Medicine, Rani Durgavati Medical College, Banda, Uttar Pradesh, India
| | - Nafis Faizi
- Assistant Professor, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Pruthu Thekkur
- Senior Operational Research Fellow, Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Sonika Raj
- Public Health Masters Program, School of Medicine, University of Limerick, Limerick, Ireland
| | - Sonu Goel
- Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Fofanah BD, Abrahamyan A, Maruta A, Kallon C, Thekkur P, Kamara IF, Njuguna CK, Squire JS, Kanu JS, Bah AJ, Lakoh S, Kamara D, Hermans V, Zachariah R. Achieving Minimum Standards for Infection Prevention and Control in Sierra Leone: Urgent Need for a Quantum Leap in Progress in the COVID-19 Era! Int J Environ Res Public Health 2022; 19:5642. [PMID: 35565037 PMCID: PMC9102022 DOI: 10.3390/ijerph19095642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Good Infection prevention and control (IPC) is vital for tackling antimicrobial resistance and limiting health care-associated infections. We compared IPC performance before (2019) and during the COVID-19 (2021) era at the national IPC unit and all regional (4) and district hospitals (8) in Sierra Leone. METHODS Cross-sectional assessments using standardized World Health Organizations IPC checklists. IPC performance scores were graded as inadequate = 0-25%, basic = 25.1-50%, intermediate = 50.1-75%, and advanced = 75.1-100%. RESULTS Overall performance improved from 'basic' to 'intermediate' at the national IPC unit (41% in 2019 to 58% in 2021) and at regional hospitals (37% in 2019 to 54% in 2021) but remained 'basic' at district hospitals (37% in 2019 to 50% in 2021). Priority gaps at the national IPC unit included lack of: a dedicated IPC budget, monitoring the effectiveness of IPC trainings and health care-associated infection surveillance. Gaps at hospitals included no assessment of hospital staffing needs, inadequate infrastructure for IPC and lack of a well-defined monitoring plan with clear goals, targets and activities. CONCLUSION Although there is encouraging progress in IPC performance, it is slower than desired in light of the COVID-19 pandemic. There is urgent need to mobilize political will, leadership and resources and make a quantum leap forward.
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Affiliation(s)
- Bobson Derrick Fofanah
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Arpine Abrahamyan
- Tuberculosis Research and Prevention Center (TBRPC), Yerevan 0014, Armenia;
| | - Anna Maruta
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Christiana Kallon
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Charles Kuria Njuguna
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - James Sylvester Squire
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (J.S.S.); (J.S.K.)
| | - Joseph Sam Kanu
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (J.S.S.); (J.S.K.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
| | - Abdulai Jawo Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
- Institute of Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown 00232, Sierra Leone
| | - Dauda Kamara
- Water, Sanitation, and Hygiene (WASH) Program, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone;
| | - Veerle Hermans
- Médecins Sans Frontières, Operational Centre Brussels, 68, Rue de Gasperich, 1617 Luxembourg, Belgium;
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), Avenue Appia 20, 1211 Geneva, Switzerland;
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Thomas F, Abiri OT, Komeh JP, Conteh TA, Bah AJ, Kanu JS, Terry R, Abrahamyan A, Thekkur P, Zachariah R. Inconsistent Country-Wide Reporting of Adverse Drug Reactions to Antimicrobials in Sierra Leone (2017-2021): A Wake-Up Call to Improve Reporting. Int J Environ Res Public Health 2022; 19:ijerph19063264. [PMID: 35328953 PMCID: PMC8952810 DOI: 10.3390/ijerph19063264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 01/25/2023]
Abstract
Background: Monitoring of adverse drug reactions (ADRs) to antimicrobials is important, as they can cause life-threatening illness, permanent disabilities, and death. We assessed country-wide ADR reporting on antimicrobials and their outcomes. Methods: A cross-sectional study was conducted using individual case safety reports (ICSRs) entered into the national pharmacovigilance database (VigiFlow) during 2017−2021. Results: Of 566 ICSRs, inconsistent reporting was seen, with the highest reporting in 2017 and 2019 (mass drug campaigns for deworming), zero reporting in 2018 (reasons unknown), and only a handful in 2020 and 2021 (since COVID-19). Of 566 ICSRs, 90% were for antiparasitics (actively reported during mass campaigns), while the rest (passive reporting from health facilities) included 8% antibiotics, 7% antivirals, and 0.2% antifungals. In total, 90% of the reports took >30 days to be entered (median = 165; range 2−420 days), while 44% had <75% of all variables filled in (desired target = 100%). There were 10 serious ADRs, 18 drug withdrawals, and 60% of ADRs affected the gastrointestinal system. The patient outcomes (N-566) were: recovered (59.5%), recovering (35.5%), not recovered (1.4%), death (0.2%), and unknown (3.4%). There was no final ascertainment of ‘recovering’ outcomes. Conclusions: ADR reporting is inconsistent, with delays and incomplete data. This is a wake-up call for introducing active reporting and setting performance targets.
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Affiliation(s)
- Fawzi Thomas
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Freetown 02717, Sierra Leone; (O.T.A.); (J.P.K.); (T.A.C.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 02717, Sierra Leone; (A.J.B.); (J.S.K.)
- Correspondence: ; Tel.: +23-27946-0264
| | - Onome T. Abiri
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Freetown 02717, Sierra Leone; (O.T.A.); (J.P.K.); (T.A.C.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 02717, Sierra Leone; (A.J.B.); (J.S.K.)
| | - James P. Komeh
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Freetown 02717, Sierra Leone; (O.T.A.); (J.P.K.); (T.A.C.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 02717, Sierra Leone; (A.J.B.); (J.S.K.)
| | - Thomas A. Conteh
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Freetown 02717, Sierra Leone; (O.T.A.); (J.P.K.); (T.A.C.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 02717, Sierra Leone; (A.J.B.); (J.S.K.)
| | - Abdulai Jawo Bah
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 02717, Sierra Leone; (A.J.B.); (J.S.K.)
- Institute of Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Joseph Sam Kanu
- College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown 02717, Sierra Leone; (A.J.B.); (J.S.K.)
- National Disease Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown 02717, Sierra Leone
| | - Robert Terry
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), 1211 Geneva, Switzerland; (R.T.); (R.Z.)
| | - Arpine Abrahamyan
- Tuberculosis Research and Prevention NGO (TB-RPC), Yerevan 0014, Armenia;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), 1211 Geneva, Switzerland; (R.T.); (R.Z.)
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Shakya S, Edwards J, Gupte HA, Shrestha S, Shakya BM, Parajuli K, Kattel HP, Shrestha PS, Ghimire R, Thekkur P. High multidrug resistance in urinary tract infections in a tertiary hospital, Kathmandu, Nepal. Public Health Action 2021; 11:24-31. [PMID: 34778012 PMCID: PMC8575380 DOI: 10.5588/pha.21.0035] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
SETTING: Tribhuvan University Teaching Tertiary Care Hospital, Kathmandu, Nepal, May–October 2019. OBJECTIVE: 1) To describe the bacteriological profile, 2) to identify the antimicrobial resistance (AMR) pattern, and 3) to find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing. DESIGN: This was a hospital-based, cross-sectional study using routine laboratory records. RESULTS: Among 11,776 urine samples, 16% (1,865/11,776) were culture-positive, predominantly caused by Escherichia coli (1,159/1,865; 62%). We found a high prevalence of resistance to at least one antibiotic (1,573/1,865; 84%) and MDR (1,000/1,865; 54%). Resistance to commonly used antibiotics for urinary tract infections (UTIs) such as ceftazidime, levofloxacin, cefepime and ampicillin was high. Patients aged ⩾60 years (adjusted prevalence ratio [aPR] 1.6, 95% CI 1.4–1.7) were more likely to have culture positivity. Patients with age ⩾45 years (45–59 years: aPR 1.5, 95% CI 1.3–1.7; ⩾60 years: aPR 1.4, 95% CI 1.2–1.6), male sex (aPR 1.3, 95% CI 1.2–1.5) and from inpatient settings (aPR 1.4, 95% CI 1.2–1.7) had significantly higher prevalence of MDR. CONCLUSION: Urine samples from a tertiary hospital showed high prevalence of E. coli and MDR to routinely used antibiotics, especially among inpatients. Regular surveillance and application of updated antibiograms are crucial to monitor the AMR situation in Nepal.
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Affiliation(s)
- S Shakya
- Central Department of Public Health, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - J Edwards
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - H A Gupte
- Narotam Sekhsaria Foundation, Mumbai, India
| | - S Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu, Nepal
| | - B M Shakya
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - K Parajuli
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - H P Kattel
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - P S Shrestha
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - R Ghimire
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - P Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
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Ghimire R, Gupte HA, Shrestha S, Thekkur P, Kharel S, Kattel HP, Shrestha PS, Poudel N, Shakya S, Parajuli S, Mudvari A, Edwards J. High drug resistance among Gram-negative bacteria in sputum samples from an intensive care unit in Nepal. Public Health Action 2021; 11:64-69. [PMID: 34778018 PMCID: PMC8575379 DOI: 10.5588/pha.21.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Tribhuvan University Teaching Hospital, Kathmandu, Nepal. OBJECTIVES 1) To report the number and proportion of Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas (PABS) species among intensive care unit (ICU) patients with sputum culture; and 2) to assess antimicrobial resistance patterns, demographic and clinical characteristics associated with resistance to at least one antibiotic and ICU discharge outcomes among those patients with PABS species admitted to hospital between 14 April 2018 and 13 April 2019. DESIGN This was a hospital-based, cross-sectional study using secondary data. RESULTS Of 166 who underwent sputum culture, 104 (63%) had bacterial growth, of which, 67 (64%) showed PABS species. Of the positive cultures, Pseudomonas, Acinetobacter, Burkholderia and Stenotrophomonas were present in respectively 32 (30.7%), 31 (29.8%), 1 (1%) and 3 (2.8%). Pseudomonas showed a high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). Acinetobacter was largely resistant to cefepime (95%), imipenem (92%) and levofloxacin (86%). Of the 67 with PABS infection, 32 (48%) died. CONCLUSION The study showed a high prevalence of Pseudomonas and Acinetobacter and the emergence of Stenotrophomonas in sputum culture samples of ICU patients. This highlights the need for monitoring PABS and associated resistance patterns to reduce mortality in ICU patients.
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Affiliation(s)
- R Ghimire
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - H A Gupte
- Narotam Sekhsaria Foundation, Mumbai, India
| | - S Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu, Nepal
| | - P Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
| | - S Kharel
- International Friendship Children's Hospital, Kathmandu, Nepal
| | - H P Kattel
- Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - P S Shrestha
- Department of Anaesthesiology and Critical Care, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - N Poudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - S Shakya
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - S Parajuli
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - A Mudvari
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - J Edwards
- Department of Global Health, University of Washington, Seattle, WA, USA
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Ulaganeethi R, Dorairajan G, Ramaswamy G, Thekkur P, Olickal JJ, Rajkumari N, Kumar Saya G. 'I was scared I will end up in another abortion': a mixed-methods study assessing the impact of COVID-19 pandemic and lockdown on the antenatal care of pregnant women in Puducherry, South India. Fam Pract 2021; 38:i23-i29. [PMID: 34169960 PMCID: PMC8344696 DOI: 10.1093/fampra/cmab042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March-31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic. OBJECTIVE To assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron-folic acid (IFA) supplements and challenges in availing health services during the period of lockdown. METHODS A concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period. RESULTS Out of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6-49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7-49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9-14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care. CONCLUSIONS Two out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period.
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Affiliation(s)
- Revathi Ulaganeethi
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gowri Dorairajan
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gomathi Ramaswamy
- Department of Preventive and Social Medicine, All India Institute of medical Sciences, Bibinagar, Hyderabad, India
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nonika Rajkumari
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kabir S, Rahman SMM, Ahmed S, Islam MS, Banu RS, Shewade HD, Thekkur P, Anwar S, Banu NA, Nasrin R, Uddin MKM, Choudhury S, Ahmed S, Paul KK, Khatun R, Chisti MJ, Banu S. Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children. Clin Infect Dis 2021; 73:226-234. [PMID: 32421765 PMCID: PMC8521743 DOI: 10.1093/cid/ciaa583] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background The World Health Organization recommends the Xpert MTB/RIF Ultra assay for diagnosing pulmonary tuberculosis (PTB) in children. Though stool is a potential alternative to respiratory specimens among children, the diagnostic performance of Xpert Ultra on stool is unknown. Thus, we assessed the diagnostic performance of Xpert Ultra on stool to diagnose PTB in children. Methods We conducted a cross-sectional study among consecutively recruited children (< 15 years of age) with presumptive PTB admitted in 4 tertiary care hospitals in Dhaka, Bangladesh, between January 2018 and April 2019. Single induced sputum and stool specimens were subjected to culture, Xpert, and Xpert Ultra. We considered children as bacteriologically confirmed on induced sputum if any test performed on induced sputum was positive for Mycobacterium tuberculosis and bacteriologically confirmed if M. tuberculosis was detected on either induced sputum or stool. Results Of 447 children, 29 (6.5%) were bacteriologically confirmed on induced sputum and 72 (16.1%) were bacteriologically confirmed. With “bacteriologically confirmed on induced sputum” as a reference, the sensitivity and specificity of Xpert Ultra on stool were 58.6% and 88.1%, respectively. Xpert on stool had sensitivity and specificity of 37.9% and 100.0%, respectively. Among bacteriologically confirmed children, Xpert Ultra on stool was positive in 60 (83.3%), of whom 48 (80.0%) had “trace call.” Conclusions In children, Xpert Ultra on stool has better sensitivity but lesser specificity than Xpert. A high proportion of Xpert Ultra assays positive on stool had trace call. Future longitudinal studies on clinical evolution are required to provide insight on the management of children with trace call.
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Affiliation(s)
- Senjuti Kabir
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - S M Mazidur Rahman
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Shakil Ahmed
- Department of Paediatrics, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
| | - Md Shamiul Islam
- Mycobacterium Disease Control, TB-Leprosy & ASP (AIDS STD Program), Directorate General of Health Services, Dhaka, Bangladesh.,National Tuberculosis Control Program, Dhaka, Bangladesh
| | | | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South East Asia Office, New Delhi, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South East Asia Office, New Delhi, India
| | - Sayeeda Anwar
- Department of Paediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Nazneen Akhter Banu
- Department of Paediatrics, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Rumana Nasrin
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | | | - Sabrina Choudhury
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Shahriar Ahmed
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Kishor Kumar Paul
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.,Kirby Institute, University of New South Wales, Kensington, Australia
| | - Razia Khatun
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | | | - Sayera Banu
- Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
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Majella MG, Thekkur P, Kumar AM, Chinnakali P, Saka VK, Roy G. Effect of mobile voice calls on treatment initiation among patients diagnosed with tuberculosis in a tertiary care hospital of Puducherry: A randomized controlled trial. J Postgrad Med 2021; 67:205-212. [PMID: 34169923 PMCID: PMC8706537 DOI: 10.4103/jpgm.jpgm_1105_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective In India, about one third of tuberculosis (TB) patients diagnosed at tertiary hospitals are missed during a referral to peripheral health institutes for treatment. To address this, we assessed whether mobile voice call reminders to TB patients after diagnosis at a tertiary hospital decrease the proportion of "pretreatment loss to follow-up" (PTLFU), compared with the conventional paper-based referral. Design A two-group parallel-arm randomized controlled trial was conducted. Setting The study was conducted in a tertiary care hospital at Puducherry, South India. Participants All newly diagnosed TB patients, both pulmonary and extrapulmonary, who were referred for treatment from the selected tertiary care hospital and possessed a mobile phone were eligible to participate. The participants were enrolled between March 2015 and June 2016 and were randomized to study groups using the block randomization with allocation concealment. Intervention The participants in the intervention arm received standardized mobile voice calls reminding them to register for anti-TB treatment on the second and seventh day after referral in addition to the conventional paper-based referral received by the control group. Primary outcomes Patients not started on anti-TB treatment within 14 days of referral were considered as PTLFU. The outcome of PTLFU was ascertained through phone calls made on the 14th day after referral. The intention-to-treat analysis was used, and the proportion of PTLFU in the study groups and the risk difference with 95% confidence interval (CI) were calculated. Results Of the 393 patients assessed for eligibility, 310 were randomized to the intervention (n = 155) and control (n = 155) arms. In the intervention arm, 14 (9%) out of 155 were PTLFU compared with 28 (18%) of the 155 patients in the control arm. The absolute risk difference was 9% (95% CI [1.5, 16.6], P = 0.01). Conclusion Mobile voice call reminder to patients is a feasible intervention and can reduce PTLFU among referred TB patients.
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Affiliation(s)
- M G Majella
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - P Thekkur
- Department of Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A M Kumar
- Department of Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - P Chinnakali
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - V K Saka
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - G Roy
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
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Prasad BM, Tripathy JP, Thekkur P, Muraleedharan VR. Insights from national survey on household expenditure for primary healthcare services availed through informal healthcare providers. J Family Med Prim Care 2021; 10:1912-1916. [PMID: 34195124 PMCID: PMC8208194 DOI: 10.4103/jfmpc.jfmpc_2274_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: Ensuring accessible and affordable primary healthcare services of optimal quality is a core component of universal health coverage (UHC). Though a substantial percentage of population avail healthcare services from informal healthcare providers (IHPs) in rural India, the information regarding the extent of out-of-pocket (OOP) expenditure during such encounters is limited. Method: The study analyzed publicly available data of 75th National Sample Survey (NSS) to understand the household expenditure pattern on availing service from IHPs. OOP expenditure for services availed from IHPs were extracted from main data sets and analyzed for both out-patient care and hospitalization. The OOP was summarized across the five wealth quintiles based on monthly per capita expenditure (MPCE) and disease groupings derived from the ailments recorded during the survey. Results: In total, 721 households accessed IHPs as part of out-patient consultation for infectious disease (67%). Households from rural areas (78%), households belonging to backward groups (75%), households from the poorest quintile and women (52%) access the services of IHPs. The median OOP for all services was INR 240 (IQR 120–600) and more than 90% of total OOP is accounted for medical expenditure. Conclusion: The programs need to define healthcare packages to engage IHPs to increase the reach and reduce OOP expenditure on households.
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Affiliation(s)
- Banuru Muralidhara Prasad
- Tuberculosis and Communicable Disease, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Jaya Prasad Tripathy
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Pruthu Thekkur
- Tuberculosis and Communicable Disease, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - V R Muraleedharan
- Humanities and Social Science Department, Indian Institute of Technology - Madras, Chennai, Tamil Nadu, India
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Namugambe JS, Delamou A, Moses F, Ali E, Hermans V, Takarinda K, Thekkur P, Nanyonga SM, Koroma Z, Mwoga JN, Akello H, Imi M, Kitutu FE. National Antimicrobial Consumption: Analysis of Central Warehouses Supplies to In-Patient Care Health Facilities from 2017 to 2019 in Uganda. Trop Med Infect Dis 2021; 6:83. [PMID: 34069434 PMCID: PMC8163196 DOI: 10.3390/tropicalmed6020083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.
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Affiliation(s)
- Juliet Sanyu Namugambe
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, P.O. Box 1410 Mbarara, Uganda
| | - Alexandre Delamou
- Africa Centre of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), University Gamal Abdel Nasser, Conakry, PB: 4099 Maferinyah, Guinea;
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099 Maferinyah, Guinea
| | - Francis Moses
- Ministry of Health and Sanitation, 00232 Freetown, Sierra Leone; (F.M.); (Z.K.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, 00232 Freetown, Sierra Leone
| | - Engy Ali
- Médecins Sans Frontières–Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg De Manstraat 6, 2100 Deurne, Brussels, Belgium; (E.A.); (V.H.)
| | - Veerle Hermans
- Médecins Sans Frontières–Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg De Manstraat 6, 2100 Deurne, Brussels, Belgium; (E.A.); (V.H.)
| | - Kudakwashe Takarinda
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (K.T.); (P.T.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (K.T.); (P.T.)
| | - Stella Maris Nanyonga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, P.O. Box 7072 Kampala, Uganda;
| | - Zikan Koroma
- Ministry of Health and Sanitation, 00232 Freetown, Sierra Leone; (F.M.); (Z.K.)
| | - Joseph Ngobi Mwoga
- World Health Organisation County Office, P.O. Box 24578 Kampala, Uganda;
| | - Harriet Akello
- Ministry of Health Uganda, P.O. Box 7272 Kampala, Uganda;
| | - Monica Imi
- Enabel, The Belgian Development Agency, P.O. Box 40131 Kampala, Uganda;
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, Pharmacy Department, School of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda;
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Mbithi I, Thekkur P, Chakaya JM, Onyango E, Owiti P, Njeri NC, Kumar AM, Satyanarayana S, Shewade HD, Khogali M, Zachariah R, Rusen ID, Berger SD, Harries AD. Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya. Trop Med Infect Dis 2021; 6:tropicalmed6020074. [PMID: 34068615 PMCID: PMC8163186 DOI: 10.3390/tropicalmed6020074] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/10/2023] Open
Abstract
There was concern that the COVID-19 pandemic would adversely affect TB and HIV programme services in Kenya. We set up real-time monthly surveillance of TB and HIV activities in 18 health facilities in Nairobi so that interventions could be implemented to counteract anticipated declining trends. Aggregate data were collected and reported monthly to programme heads during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data collected during the pre-COVID period (March 2019–February 2020). During the COVID-19 period, there was an overall decrease in people with presumptive pulmonary TB (31.2%), diagnosed and registered with TB (28.0%) and in those tested for HIV (50.5%). Interventions to improve TB case detection and HIV testing were implemented from August 2020 and were associated with improvements in all parameters during the second six months of the COVID-19 period. During the COVID-19 period, there were small increases in TB treatment success (65.0% to 67.0%) and referral of HIV-positive persons to antiretroviral therapy (91.2% to 92.9%): this was more apparent in the second six months after interventions were implemented. Programmatic interventions were associated with improved case detection and treatment outcomes during the COVID-19 period, suggesting that monthly real-time surveillance is useful during unprecedented events.
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Affiliation(s)
- Irene Mbithi
- Respiratory Society of Kenya, Regent Court, Block A Suite A6 Hurlingham, Argwings Khodhek Road, Nairobi P.O. Box 43844-00100, Kenya; (I.M.); (J.M.C.)
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (P.T.); (A.M.V.K.); (S.S.); (H.D.S.); (S.D.B.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Jeremiah Muhwa Chakaya
- Respiratory Society of Kenya, Regent Court, Block A Suite A6 Hurlingham, Argwings Khodhek Road, Nairobi P.O. Box 43844-00100, Kenya; (I.M.); (J.M.C.)
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi P.O. Box 43844-00100, Kenya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Elizabeth Onyango
- Division of National TB, Leprosy and Lung Disease Programme, Ministry of Health, Afya House, Cathedral Road, Nairobi P.O. Box 30016-00100, Kenya; (E.O.); (P.O.)
| | - Philip Owiti
- Division of National TB, Leprosy and Lung Disease Programme, Ministry of Health, Afya House, Cathedral Road, Nairobi P.O. Box 30016-00100, Kenya; (E.O.); (P.O.)
| | - Ngugi Catherine Njeri
- National AIDS and STDs Control Programme, Ministry of Health, Afya House, Cathedral Road, Nairobi P.O. Box 30016-00100, Kenya;
| | - Ajay M.V. Kumar
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (P.T.); (A.M.V.K.); (S.S.); (H.D.S.); (S.D.B.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, India
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (P.T.); (A.M.V.K.); (S.S.); (H.D.S.); (S.D.B.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Hemant D. Shewade
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (P.T.); (A.M.V.K.); (S.S.); (H.D.S.); (S.D.B.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Mohammed Khogali
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland; (M.K.); (R.Z.)
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland; (M.K.); (R.Z.)
| | - I. D. Rusen
- Vital Strategies, 100 Broadway 4th Floor, New York, NY 10005, USA;
| | - Selma Dar Berger
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (P.T.); (A.M.V.K.); (S.S.); (H.D.S.); (S.D.B.)
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (P.T.); (A.M.V.K.); (S.S.); (H.D.S.); (S.D.B.)
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Correspondence: ; Tel.: +44-(0)-1962-714-297
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Opollo MS, Otim TC, Kizito W, Thekkur P, Kumar AMV, Kitutu FE, Kisame R, Zolfo M. Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done. Trop Med Infect Dis 2021; 6:tropicalmed6020069. [PMID: 34062871 PMCID: PMC8167580 DOI: 10.3390/tropicalmed6020069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/17/2022] Open
Abstract
Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobial-resistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, cross-sectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.
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Affiliation(s)
- Marc Sam Opollo
- Department of Public Health, Faculty of Health Sciences, Lira University, 1035 Lira, Uganda;
- Correspondence: ; Tel.: +256-772-900-834
| | - Tom Charles Otim
- Department of Public Health, Faculty of Health Sciences, Lira University, 1035 Lira, Uganda;
| | - Walter Kizito
- Médecins Sans Frontières, MSF-B, 1050 Brussels, Belgium;
| | - Pruthu Thekkur
- International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France; (P.T.); (A.M.V.K.)
| | - Ajay M. V. Kumar
- International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France; (P.T.); (A.M.V.K.)
- The Union South-East Asia Office, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, Pharmacy Department, Makerere University School of Health Sciences, 10217 Kampala, Uganda;
| | - Rogers Kisame
- Infectious Diseases Institute, Makerere University, 10217 Kampala, Uganda;
| | - Maria Zolfo
- Institute of Tropical Medicine, 2000 Antwerp, Belgium;
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Oo NAT, Edwards JK, Pyakurel P, Thekkur P, Maung TM, Aye NSS, Nwe HM. Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019. Trop Med Infect Dis 2021; 6:tropicalmed6020062. [PMID: 33924746 PMCID: PMC8167801 DOI: 10.3390/tropicalmed6020062] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022] Open
Abstract
Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in two tertiary care hospitals in Yangon, Myanmar, 2017–2019. This was a cross sectional study utilizing a standardized electronic database and paper-based records. Bacteriological profiles and associated factors were analyzed with descriptive statistics and Poisson Regression. Of those with suspected sepsis, 42% were bacteriologically confirmed and 74% of confirmed sepsis was resistant to at least first-line antibiotics. Neonates with late onset sepsis (LOS) (aPR: 1.2 (95% CI: 1.1–1.4, p = 0.008)) were more likely to have bacteriologically confirmed sepsis (45%) versus early onset sepsis (38%). Gram-negative organisms were most commonly isolated (63%), associated with multidrug-resistant organisms and with a high case-fatality rate (64%). These findings suggest that enhanced national guidance regarding infection control and prevention, antibiotic stewardship, and first-line antibiotic choices need to be provided. The link between LOS with infection and prevention protocols needs to be further explored in this context to decrease sepsis risk, neonatal mortality, and reduce further antimicrobial resistance.
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Affiliation(s)
- Nan Aye Thida Oo
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar;
- Correspondence: ; Tel.: +95-9-5126148
| | - Jeffrey K. Edwards
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
| | - Prajjwal Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan 56700, Nepal;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 68 Boulevard Saint Michel, 75006 Paris, France;
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar;
| | - Nant San San Aye
- Neonatal Intensive Care Unit, Central Women Hospital, Yangon 11121, Myanmar;
| | - Hla Myat Nwe
- Department of Neonatology, Yangon Children Hospital, Yangon 11191, Myanmar;
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Harries AD, Kumar AMV, Satyanarayana S, Thekkur P, Lin Y, Dlodlo RA, Brigden G. TB and COVID-19: measuring key risk factors that affect treatment outcomes. Int J Tuberc Lung Dis 2021; 25:329-331. [PMID: 33762081 DOI: 10.5588/ijtld.21.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi
| | - P Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union, South-East Asia Office, New Delhi
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - G Brigden
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
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Wang N, Guo L, Shewade HD, Thekkur P, Zhang H, Yuan YL, Wang XM, Wang XL, Sun MM, Huang F, Zhao YL. Effect of using electronic medication monitors on tuberculosis treatment outcomes in China: a longitudinal ecological study. Infect Dis Poverty 2021; 10:29. [PMID: 33731213 PMCID: PMC7967105 DOI: 10.1186/s40249-021-00818-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/10/2020] [Accepted: 03/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background In China, an indigenously developed electronic medication monitor (EMM) was designed and used in 138 counties from three provinces. Previous studies showed positive results on accuracy, effectiveness, acceptability, and feasibility, but also found some ineffective implementations. In this paper, we assessed the effect of implementation of EMMs on treatment outcomes. Methods The longitudinal ecological method was used at the county level with aggregate secondary programmatic data. All the notified TB cases in 138 counties were involved in this study from April 2017 to June 2019, and rifampicin-resistant cases were excluded. We fitted a multilevel model to assess the relative change in the quarterly treatment success rate with increasing quarterly EMM coverage rate, in which a mixed effects maximum likelihood regression using random intercept model was applied, by adjusting for seasonal trends, population size, sociodemographic and clinical characteristics, and clustering within counties. Results Among all 69 678 notified TB cases, the treatment success rate was slightly increased from 93.5% [95% confidence interval (CI): 93.0–94.0] in second quarter of 2018 to 94.9% (95% CI: 94.4–95.4) in second quarter of 2019 after implementing EMMs. There was a statistically significant effect between quarterly EMM coverage and treatment success rate after adjusting for potential confounders (P = 0.0036), increasing 10% of EMM coverage rate will lead to 0.2% treatment success rate augment. Besides, an increase of 10% of elderly or bacteriologically confirmed TB will lead to a decrease of 0.4% and 0.9% of the treatment success rate. Conclusions Under programmatic settings, we found a statistically significant effect between increasing coverage of EMM and treatment success rate at the county level. More prospective studies are needed to confirm the effect of using EMM on TB treatment outcomes. We suggest performing operational research on EMMs that provides real-time data under programmatic conditions in the future. ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00818-3.
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Affiliation(s)
- Ni Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lei Guo
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan-Li Yuan
- Jilin Research Institute of Tuberculosis Control, Changchun, China
| | - Xiao-Meng Wang
- Zhejiang Province Center Disease Control and Prevention, Hangzhou, China
| | - Xiao-Lin Wang
- The Fourth People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Miao-Miao Sun
- Program for Appropriate Technology in Health(PATH), China Program, Shanghai, China
| | - Fei Huang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Yan-Lin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Venugopal V, Thekkur P, Selvaraj K, Sahu SK. Injury and its associated factors among residents of an urban slum during the festival month in South India: A community-based survey. J Family Med Prim Care 2021; 9:6041-6045. [PMID: 33681038 PMCID: PMC7928127 DOI: 10.4103/jfmpc.jfmpc_1105_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Injury morbidity and mortality have been steadily increasing in both developed and developing countries including India. The current study tried to assess the incidence of injury and identify the risk factors associated with injuries during the festival month in a selected urban area in Puducherry. Methods It is a community-based cross-sectional survey conducted among the residents in the urban field practice area of a medical college in Puducherry. Participants were interviewed using a pretested questionnaire. Information on the incidence of injury and its associated factors were collected. Data were entered in EpiData and analyzed using Stata. Generalized linear models with Poisson distribution were used to identify the risk factors associated with the injuries. Results Overall, 1380 participants from two selected clusters were interviewed. The incidence rate of injuries was 5.2% (95% CI: 4.0-6.4). In adjusted analysis male (RR 1.96, 95% CI: 1.15-3.37) and student (RR 2.91, 95% CI: 1.13-7.54) were independently associated with having an injury. Most of the injuries were unintentional and accidental. Conclusion The reported incidence of at least one injury was 52 per 1000 population per month and the majority were accidental in nature. It was higher during the festival week. Public health strategies at the primary healthcare level targeting adult males and school children will be effective in the reduction and prevention of injury.
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Affiliation(s)
- Vinayagamoorthy Venugopal
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry, India
| | - Pruthu Thekkur
- International Union Against Lung Diseases, New Delhi, India
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Swaroop K Sahu
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medicine and Research (JIPMER), Puducherry, India
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Sharma V, Thekkur P, Naik PR, Saha BK, Agrawal N, Dinda MK, Parthiban S, Dey A, Poojar B, Shamanewadi AN, Satyanarayana S. Treatment success rates among tuberculosis patients notified from the private sector in West Bengal, India. Monaldi Arch Chest Dis 2021; 91. [PMID: 33550792 DOI: 10.4081/monaldi.2021.1555] [Citation(s) in RCA: 1] [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: 08/08/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022] Open
Abstract
In India, an estimated 50% of tuberculosis (TB) patients are diagnosed and managed by private providers (PPs). However, there is limited information on treatment outcomes among those treated by PPs largely because of a lack of systems for patient follow-up and documentation of the outcomes. Tuberculosis Health Action Learning Initiative (THALI) project implemented in six districts of West Bengal, supported PPs in managing TB patients and systematically documented the TB treatment outcomes of such patients. This provided us an opportunity to describe the treatment outcomes and assess factors associated with 'unsuccessful outcomes' among TB patients notified by PPs from January to April 2018. This was a retrospective cohort study using routinely collected data. During the study reference period, 2347 patients were notified from 389 PPs. The patient's mean (SD) age was 39.9 (17.2) years and 61% were males. Of the total, about 86% had pulmonary TB, 95% were new cases, and 23% were microbiologically confirmed (either on sputum smear microscopy or Xpert assay). Among 2347 patients, 19% received free drugs from the National Tuberculosis Program (NTP) under the supervision of PPs while the rest purchased anti-TB drugs from the private pharmacies. The 'successful outcomes' (cured and treatment completed) were seen in 86.1% (95% confidence interval (CI), 84.6%-87.4%) patients and 8.6% were 'not evaluated'. The patients who received free NTP drugs (adjusted relative risk-4.0 (95% CI: 3.1-5.0)) had a higher risk of 'unsuccessful outcomes' than those who availed of drugs from private pharmacies. The high 'successful outcomes' among TB patients treated by PPs are promising. However, higher 'unsuccessful outcomes' among patients on free NTP drugs need to be explored, and suitable corrective actions have to be taken.
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Affiliation(s)
- Vivek Sharma
- John Snow India (JSI), Tuberculosis Health Action and Learning Initiative (THALI), West Bengal.
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris.
| | - Poonam R Naik
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore.
| | | | - Niraj Agrawal
- John Snow India (JSI), Tuberculosis Health Action and Learning Initiative (THALI), New Delhi.
| | - Milan K Dinda
- World Health Partners, Tuberculosis Health Action and Learning Initiative (THALI), West Bengal.
| | - S Parthiban
- World Health Partners, Tuberculosis Health Action and Learning Initiative (THALI), West Bengal.
| | - Abhijit Dey
- World Health Partners, Tuberculosis Health Action and Learning Initiative (THALI), West Bengal.
| | - Basavaraj Poojar
- Department of Pharmacology, Kasturba Medical College, Mangalore.
| | - Amrita N Shamanewadi
- Department of Community Medicine, MVJ Medical College and Research Hospital (MVJMCRH), Dandupalya, Hoskote, Bengaluru rural.
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris.
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Reddy MM, Thekkur P, Ramya N, Kamath PBT, Shastri SG, Kumar RBN, Chinnakali P, Nirgude AS, Rangaraju C, Somashekar N, Kumar AMV. To start or to complete? - Challenges in implementing tuberculosis preventive therapy among people living with HIV: a mixed-methods study from Karnataka, India. Glob Health Action 2021; 13:1704540. [PMID: 31937200 PMCID: PMC7006687 DOI: 10.1080/16549716.2019.1704540] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Isoniazid preventive therapy (IPT) has been shown to reduce the risk of tuberculosis (TB) among people living with HIV (PLHIV). In 2017, India began a nationwide roll-out of IPT, but there is a lack of evidence on the implementation and the challenges. Objectives: Among PLHIV newly initiated on antiretroviral therapy (ART) from January 2017 to June 2018, to: (i) assess the proportion who started and completed IPT and (ii) explore reasons for non-initiation and non-completion from health-care providers’ and patients’ perspectives. Methods: An explanatory mixed-methods study was conducted in two selected districts of Karnataka, South India. A quantitative phase (cohort analysis of routinely collected program data) was followed by a qualitative phase involving thematic analysis of in-depth interviews with providers (n = 22) and patients (n = 8). Results: Of the 4020 included PLHIV, 3780 (94%) were eligible for IPT, of whom, 1496 (40%, 95% CI: 38%-41%) were initiated on IPT. Among those initiated, 423 (28.3%) were still on IPT at the time of analysis. Among 1073 patients with declared IPT outcomes 870 (81%, 95% CI: 79%-83%) had completed the six-month course of IPT. The main reason for IPT non-initiation and non-completion was frequent drug stock-outs. This required health-care providers to restrict IPT initiation in selected patient subgroups and earmark six-monthly courses for each patient to ensure that, once started, treatment was not interrupted. The other reasons for non-completion were adverse drug effects and loss to follow-up. Conclusion: The combined picture of ‘low IPT initiation and high completion’ seen in our study mirrors findings from other countries. Drug stock-out was the key challenge, which obliged health-care providers to prioritize ‘IPT completion’ over ‘IPT initiation’. There is an urgent need to improve the procurement and supply chain management of isoniazid.
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Affiliation(s)
- Mahendra M Reddy
- Department of Community Medicine, Sri Devaraj Urs Medical College (SDUMC), Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, India
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
| | - Nagesh Ramya
- Department of Community Medicine, Sri Devaraj Urs Medical College (SDUMC), Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, India
| | - Prasanna B T Kamath
- Department of Community Medicine, Sri Devaraj Urs Medical College (SDUMC), Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, India
| | - Suresh G Shastri
- Department of Health and Family Welfare Services, State Tuberculosis Cell, Bengaluru, India
| | - Ravi B N Kumar
- Department of Health and Family Welfare Services, National AIDS Control Organization (NACO), New Delhi, India.,Department of Health and Family Welfare Services, Karnataka AIDS Prevention Society (KSAPS), Bengaluru, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Abhay S Nirgude
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | | | | | - Ajay M V Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India.,Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
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Kumar AM, Harries AD, Satyanarayana S, Thekkur P, Shewade HD, Zachariah R. What is operational research and how can national tuberculosis programmes in low- and middle-income countries use it to end TB? Indian J Tuberc 2020; 67:S23-S32. [PMID: 33308668 DOI: 10.1016/j.ijtb.2020.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Abstract
Despite considerable progress over the years, tuberculosis (TB) still remains the top cause of death among the infectious diseases and has devastating socio-economic consequences for people in low- and middle-income countries. To add to this, the emergence of the COVID-19 pandemic has worsened delivery of TB care across the globe. As a global community, we have committed to end the TB epidemic by 2030. The World Health Organization has framed a strategy to achieve this goal which consists of three pillars namely i) integrated patient-centred care and prevention, ii) bold policies and systems and iii) intensified research and innovation. An analysis of the performance of national tuberculosis programmes (NTPs) across the globe against the ten priority indicators recommended for monitoring the end TB strategy show that there are huge gaps at every step in the cascade of care of TB patients. In our view, these gaps reflect suboptimal implementation of existing strategies known to be efficacious and operational research (OR) is one of the best available tools to plug the gaps. In this paper, we define what operational research is and how it differs from other kinds of research. We also share our views and experiences about how operational research can be used by NTPs to identify implementation gaps and their reasons, and develop and test possible solutions - which are then integrated to make changes to policy and practice and eventually improve programme outcomes. OR can be defined as research into interventions, strategies and tools which produces practical useable knowledge that can be used to enhance the quality, coverage, effectiveness and efficiency of disease control programmes, health services or health systems in which the research is conducted. The key steps in integrating operational research in the NTPs include: i) securing political commitment reflected by inclusion of OR in the national strategic plans of NTPs and earmarked funding, ii) having a critical mass of dedicated and trained human resources in OR within the NTP, iii) setting research priorities and steering the direction of research in the country, iv) using output-oriented models of capacity building such as the Structured Operational Research Training Initiative (SORT IT) model and building communities of practice, v) harnessing existing capacity in the country by forging partnerships with academia, vi) NTP-led nationwide, multicentre OR studies, vii) providing access to anonymized patient and programme surveillance data, vii) creating a forum for evidence dissemination and fostering policy change and ix) monitoring and accountability. In conclusion, ending the TB epidemic will not be possible without new tools (diagnostics, drugs, vaccines) and a multi-sectoral response involving stakeholders beyond the health ministry, including private providers, patients and communities. However, timely conduct of operational research to fine-tune programme implementation and ensuring proper deployment of new tools will be equally crucial to maximize the effectiveness and efficiency of interventions and ultimately contribute towards ending TB.
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Affiliation(s)
- Ajay Mv Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India; Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangalore, India.
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene and Tropical Medicine, London, UK
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Hemant D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union South-East Asia Office, New Delhi, India
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Geneva, Switzerland
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Wang N, Shewade HD, Thekkur P, Zhang H, Yuan Y, Wang X, Wang X, Sun M, Huang F. Do electronic medication monitors improve tuberculosis treatment outcomes? Programmatic experience from China. PLoS One 2020; 15:e0242112. [PMID: 33166361 PMCID: PMC7652336 DOI: 10.1371/journal.pone.0242112] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
Background In China, an indigenously developed electronic medication monitor (EMM) was used. EMM recorded each time the device was opened (no real time data), offering an indirect measure of tuberculosis treatment adherence. Previous study in China showed that the EMM uptake was satisfactory, missing adherence data were common in the information management system (25%) and shift to directly observed therapy (DOT) based on poor adherence documented by EMMs were seldom. Objectives Among people with tuberculosis notified in 30 counties (July-December 2018) where EMM supported self-administered therapy (SAT) was suggested to all eligible (no communication impairment, ambulatory), we assessed the relative differences in unfavourable outcomes and deaths among those started on EMM at baseline (within first month of diagnosis) when compared to SAT alone. Methods This was a cohort study using secondary data. We employed an intention to treat analysis, and used modified Poisson regression with robust variance estimates to assess the association. Results Of 1810 eligible people, 1047 used EMM at baseline and of them, 216 (20.1%) stopped using EMM midway. Of 763 people who did not use EMM at baseline, 267 (35.0%) started using EMM later during the treatment. Among those who started using EMM at baseline, 6.3% [95% CI: 4.9, 8.0] had unfavourable outcomes compared to 6.7% [95% CI: 5.1, 8.8] among those who did not (p = 0.746). Lesser deaths were observed in people who started EMM at baseline when compared to those who did not: 2.5% [95% CI: 1.7, 3.7] versus 3.5% [95% CI: 2.4, 5.2], p = 0.191. The lack of association remained after adjusting for potential confounders (occupation, TB classification and TB category). Conclusion Under programmatic settings, we did not find significant differences in the outcomes. Optimization of EMMs by shifting to DOT when indicated, addressing the issue of missing data and ensuring continuous use is required.
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Affiliation(s)
- Ni Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hemant Deepak Shewade
- International Union against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South East Asia Office, New Delhi, India
| | - Pruthu Thekkur
- International Union against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South East Asia Office, New Delhi, India
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanli Yuan
- Jilin Research Institute of Tuberculosis Control, Changchun, China
| | - Xiaomeng Wang
- Zhejiang province Center Disease Control and Prevention, Hangzhou, China
| | - Xiaolin Wang
- The Fourth People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | | | - Fei Huang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
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Rohit A, Kumar AMV, Thekkur P, Shastri SG, Kumar RBN, Nirgude AS, Reddy MM, Ravichandra C, Somashekar N, Balu PS. Does provision of cash incentive to HIV-infected tuberculosis patients improve the treatment success in programme settings? A cohort study from South India. J Family Med Prim Care 2020; 9:3955-3964. [PMID: 33110793 PMCID: PMC7586600 DOI: 10.4103/jfmpc.jfmpc_474_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/25/2020] [Accepted: 06/10/2020] [Indexed: 11/04/2022] Open
Abstract
Background In April 2018, the Government of India launched 'Nikshay Poshan Yojana' (NPY), a cash assistance scheme (500 Indian rupees [~8 USD] per month) intended to provide nutritional support and improve treatment outcomes among tuberculosis (TB) patients. Objective To compare the treatment outcomes of HIV-infected TB patients initiated on first-line anti-TB treatment in five selected districts of Karnataka, India before (April-September 2017) and after (April-September 2018) implementation of NPY. Methods This was a cohort study using secondary data routinely collected by the national TB and HIV programmes. Results A total of 630 patients were initiated on ATT before NPY and 591 patients after NPY implementation. Of the latter, 464 (78.5%, 95% CI: 75.0%-81.8%) received at least one installment of cash incentive. Among those received, the median (inter-quartile range) duration between treatment initiation and receipt of first installment was 74 days (41-165) and only 16% received within the first month of treatment. In 117 (25.2%) patients, the first installment was received after declaration of their treatment outcome. Treatment success (cured and treatment completed) in 'before NPY' cohort was 69.2% (95% CI: 65.6%-72.8%), while it was 65.0% (95% CI: 61.2%-68.8%) in 'after NPY' cohort. On adjusted analysis using modified Poisson regression we did not find a statistically significant association between NPY and unsuccessful treatment outcomes (adjusted relative risk-1.1, 95% CI: 0.9-1.3). Conclusion Contrary to our hypothesis and previous evidence from systematic reviews, we did not find an association between NPY and improved treatment outcomes.
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Affiliation(s)
- Amuje Rohit
- Department of Community Medicine, JJM Medical College, Davanagere, Karnataka, India
| | - Ajay M V Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India.,Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University), Mangaluru, Karnataka, India
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
| | - Suresh G Shastri
- Department of Health and Family Welfare Services, State Tuberculosis Cell, Bangalore, Karnataka, India
| | - Ravi B N Kumar
- Department of Health and Family Welfare Services, National AIDS Control Organization (NACO), New Delhi, India.,Department of Health and Family Welfare Services, Karnataka State AIDS Prevention Society (KSAPS), Bangalore, Karnataka, India
| | - Abhay S Nirgude
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University), Mangaluru, Karnataka, India
| | - Mahendra M Reddy
- Department of Community Medicine, Sri Devaraj Urs Medical College (SDUMC), Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar, Karnataka, India
| | | | | | - P S Balu
- Department of Community Medicine, JJM Medical College, Davanagere, Karnataka, India
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Harries AD, dar Berger S, Satyanarayana S, Thekkur P, Kumar AMV. Testing wastewater to detect severe acute respiratory syndrome coronavirus 2 in communities. Trans R Soc Trop Med Hyg 2020; 114:782-783. [PMID: 32780856 PMCID: PMC7454889 DOI: 10.1093/trstmh/traa066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/21/2020] [Indexed: 01/25/2023] Open
Abstract
Research groups around the world are starting to analyse whether wastewater surveillance is a useful tool to monitor the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in communities. Reported studies from the Netherlands, USA, Australia and France have demonstrated that SARS-CoV-2 can be detected and quantified in wastewater, allowing the total number of community infections to be estimated as well as monitoring whether the virus has returned to a community after elimination. Further work is required to improve the quantification of virus, to better detect the virus at low levels and to ensure wastewater samples are representative of the community under surveillance.
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Affiliation(s)
- Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Selma dar Berger
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, Paris, France
- International Union Against Tuberculosis and Lung Disease, South-east Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, Paris, France
- International Union Against Tuberculosis and Lung Disease, South-east Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France
- International Union Against Tuberculosis and Lung Disease, South-east Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, India
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Ramakrishnan J, Sarkar S, Chinnakali P, Lakshminarayanan S, Sahu SK, Reshma A, Knudsen S, Das M, Thekkur P, Venugopal V, Hochberg NS, Salgame P, Horsburgh CR, Ellner J, Roy G. Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study. Indian J Tuberc 2020; 68:32-39. [PMID: 33641849 DOI: 10.1016/j.ijtb.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/04/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Identifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of 'Zero Deaths' by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years. STUDY DESIGN We performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis). SETTING Revised TB Control Program (RNTCP) in three districts of South India. PARTICIPANTS The cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014-2018 in three districts of southern India. Information on death was collected at homes by trained project staff. PRIMARY OUTCOME MEASURES We calculated 'all-cause mortality' during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI. RESULTS The mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0-5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24-4.15), male gender (RR 3.98; 95% CI: 1.25-12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07-3.87), tobacco use (RR 1.87; 95%CI: 1.05-3.36) and severe anaemia (RR 3.53: 95%CI: 1.34-9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts. CONCLUSION Though deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.
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Affiliation(s)
- Jayalakshmy Ramakrishnan
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Sonali Sarkar
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
| | - Palanivel Chinnakali
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Subitha Lakshminarayanan
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Swaroop Kumar Sahu
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ayiraveetil Reshma
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Selby Knudsen
- Boston University School of Public Health, Boston, MA, USA
| | | | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; The Union-South East Asia Office, New Delhi, India
| | - Vinayagamoorthy Venugopal
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Natasha S Hochberg
- Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - C Robert Horsburgh
- Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Gautam Roy
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Manyame-Murwira B, Takarinda KC, Thekkur P, Payera B, Mutunzi H, Simbi R, Siziba N, Sibanda E, Banana C, Muleya N, Makombe E, Jongwe PL, Bhebhe R, Mangwanya D, Dzangare J, Mudzengerere FH, Timire C, Wekiya E, Sandy C. Prevalence, risk factors and treatment outcomes of isoniazid resistant TB in Bulawayo city, Zimbabwe: A cohort study. J Infect Dev Ctries 2020; 14:893-900. [PMID: 32903234 PMCID: PMC8655986 DOI: 10.3855/jidc.12319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: The isoniazid-resistant TB poses a threat to TB control efforts. Zimbabwe, one of the high TB burden countries, has not explored the burden of isoniazid resistant TB. Hence among all bacteriologically-confirmed TB patients diagnosed in Bulawayo City during March 2017 and December 2018, we aimed to assess the proportion with isoniazid resistant TB and associated factors. Also, we aimed to describe the TB treatment outcomes. Methodology: A cohort study involving routinely collected data by the National TB Reference Laboratory (NTBRL) in Bulawayo City and National TB programme of Zimbabwe. The percentage with 95% confidence interval (CI) was used to express the proportion with isoniazid-resistant TB. The modified Poisson regression was used to assess the association of demographic and clinical characteristics with isoniazid mono-resistant TB. Results: Of 2160 bacteriologically-confirmed TB patients, 1612 (74.6%) had their sputum received at the NTBRL and 743 (46.1%) had culture growth. Among those with culture growth, 34 (4.6%, 95% CI: 3.5–6.7) had isoniazid mono-resistant TB, 25 (3.3%, 95% CI: 2.2–4.9) had MDR-TB. Thus, 59 (7.9%, 95% CI: 6.1–10.1) had isoniazid-resistant TB. Children < 15 years had a higher prevalence of isoniazid mono-resistant TB (aPR= 3.93; 95% CI: 1.24–12.45). Among those with rifampicin sensitive TB, patients with isoniazid-sensitive TB had higher favourable treatment outcomes compared to those with isoniazid-resistant TB (86.3% versus 75.5%, p = 0.039). Conclusions: The prevalence of isoniazid-resistant TB was low compared to neighbouring countries with high burden of TB-HIV. However, Zimbabwe should consider reviewing treatment guidelines for isoniazid mono-resistant TB due to the observed poor treatment outcomes.
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Affiliation(s)
- Barbara Manyame-Murwira
- National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe.
| | | | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
| | - Bright Payera
- National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe.
| | - Herbert Mutunzi
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Raiva Simbi
- Department of Laboratory Services, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Nicholas Siziba
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Edwin Sibanda
- Department of Health, Bulawayo City Council, Zimbabwe.
| | | | - Norbert Muleya
- Department of Environmental Health Services, Ministry of Health and Childcare, Matebeleland South, Zimbabwe.
| | - Evidence Makombe
- Department of laboratory Services, Ministry of Health and Childcare, Midlands Province, Zimbabwe.
| | - Paula Littia Jongwe
- National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe.
| | - Regina Bhebhe
- National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe.
| | - Douglas Mangwanya
- Department of Laboratory Services, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Janet Dzangare
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
| | | | - Collins Timire
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Enock Wekiya
- WHO Supra National Reference Laboratory/National Tuberculosis Reference Laboratory, Uganda.
| | - Charles Sandy
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
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Zachariah R, Dar Berger S, Thekkur P, Khogali M, Davtyan K, Kumar AMV, Satyanarayana S, Moses F, Aslanyan G, Aseffa A, Harries AD, Reeder JC. Investing in Operational Research Capacity Building for Front-Line Health Workers Strengthens Countries' Resilience to Tackling the COVID-19 Pandemic. Trop Med Infect Dis 2020; 5:tropicalmed5030118. [PMID: 32708821 PMCID: PMC7558759 DOI: 10.3390/tropicalmed5030118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Introduction. The Structured Operational Research and Training IniTiative (SORT IT) supports countries to build operational research capacity for improving public health. We assessed whether health workers trained through SORT IT were (1) contributing to the COVID-19 pandemic response and if so, (2) map where and how they were applying their SORT IT skills. (2) Methods. An online questionnaire survey of SORT IT alumni trained between 2009 and 2019. (3) Results. Of 895 SORT IT alumni from 93 countries, 652 (73%) responded to the survey and 417 were contributing to the COVID-19 response in 72 countries. Of those contributing, 307 (74%) were applying their SORT IT skills to tackle the pandemic in 60 countries and six continents including Africa, Asia, Europe, South Pacific and North/South America. Skills were applied to all the pillars of the emergency response with the highest proportions of alumni applying their skills in data generation/analysis/reporting (56%), situation analysis (55%) and surveillance (41%). Skills were also being used to mitigate the health system effects of COVID-19 on other diseases (27%) and in conducting research (26%). (4) Conclusion. Investing in people and in research training ahead of public health emergencies generates downstream dividends by strengthening health system resilience for tackling pandemics. It also strengthens human resources for health and the integration of research within health systems.
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Affiliation(s)
- Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Disease (TDR), 1211 Geneva, Switzerland; (M.K.); (G.A.); (A.A.); (J.C.R.)
- Correspondence: ; Tel.: +41-79-72-88-488
| | - Selma Dar Berger
- Center for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France; (S.D.B.); (P.T.); (A.M.V.K.); (A.D.H.)
| | - Pruthu Thekkur
- Center for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France; (S.D.B.); (P.T.); (A.M.V.K.); (A.D.H.)
- Center for Operational Research, The Union South-East Asia (USEA), New Delhi 110016, India;
| | - Mohammed Khogali
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Disease (TDR), 1211 Geneva, Switzerland; (M.K.); (G.A.); (A.A.); (J.C.R.)
| | - Karapet Davtyan
- Country Health Policies and Systems, World Health Organization Regional Office for Europe, 2100 Copenhagen, Denmark;
| | - Ajay M. V. Kumar
- Center for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France; (S.D.B.); (P.T.); (A.M.V.K.); (A.D.H.)
- Center for Operational Research, The Union South-East Asia (USEA), New Delhi 110016, India;
- Community Medicine, Yenepoya Medical College (Deemed to Be University), Yenepoya, Mangalore 575018, India
| | - Srinath Satyanarayana
- Center for Operational Research, The Union South-East Asia (USEA), New Delhi 110016, India;
| | - Francis Moses
- Reproductive Health and Family Planning Program, Ministry of Health and Sanitation, Freetown 23222, Sierra Leone;
| | - Garry Aslanyan
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Disease (TDR), 1211 Geneva, Switzerland; (M.K.); (G.A.); (A.A.); (J.C.R.)
| | - Abraham Aseffa
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Disease (TDR), 1211 Geneva, Switzerland; (M.K.); (G.A.); (A.A.); (J.C.R.)
| | - Anthony D. Harries
- Center for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France; (S.D.B.); (P.T.); (A.M.V.K.); (A.D.H.)
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1 7HT, UK
| | - John C. Reeder
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Disease (TDR), 1211 Geneva, Switzerland; (M.K.); (G.A.); (A.A.); (J.C.R.)
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49
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Chavan VV, Dalal A, Nagaraja S, Thekkur P, Mansoor H, Meneguim A, Paryani R, Singh P, Kalon S, Das M, Ferlazzo G, Isaakidis P. Ambulatory management of pre- and extensively drug resistant tuberculosis patients with imipenem delivered through port-a-cath: A mixed methods study on treatment outcomes and challenges. PLoS One 2020; 15:e0234651. [PMID: 32544174 PMCID: PMC7297304 DOI: 10.1371/journal.pone.0234651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Imipenem, an intravenous antibiotic is recommended for use in drug resistant tuberculosis (DR-TB) when an effective regimen with combination of other second line drugs is not possible. Though the treatment success rates with carbapenems are promising, the twice daily injection of Imipenem usually requires patients to be hospitalized. The Médecins Sans Frontières independent clinic in Mumbai, India implemented ambulatory and home based management of patients receiving Imipenem through the use of port-a-cath. OBJECTIVE We aimed to describe the adverse events and treatment outcomes of ambulatory pre- and XDR-TB patients initiated on imipenem through port-a-cath between January 2015 and June 2018 and to explore the challenges with this regimen as perceived by healthcare providers and patients. METHODS A convergent mixed methods study with quantitative (longitudinal descriptive study using the routine data) and qualitative (descriptive study) part conducted concurrently. For the quantitative component, all XDR-TB and pre-XDR-TB initiated on imipenem containing regimen during January 2015-June 2018 were included. For qualitative component, interviews were carried out including patients who initiated on imipenem (n = 5) and healthcare providers (n = 7) involved in providing treatment. Treatment outcomes, culture conversion and adverse events during treatment were described. Thematic analysis was carried out for qualitative component. RESULTS Of the 70 patients included, the mean age was 28.1 (standard deviation: 11.2) years and 36 (51.4%) were females. Fifty one (72.9%) had XDR-TB. All patients were resistant to fluoroquinilone, levofloxacin. Vomiting was reported by 55 (78.6%) patients and at least one episode of QTC prolongation (more than 500 msec by Fredrecia method) was detected in 25 (35.7%). Port-a-cath block and infection was seen in 11 (15.7%) and 20 (28.6%) patients respectively. Favourable outcomes were seen in 43 (61.4%) patients. Mortality was seen in 22 (31.4%) patients, 2 (2.9%) were lost-to-follow-up and 3 (4.3%) were declared as treatment failure. The overarching theme of the qualitative analysis was: Challenges in delivering Imipenem via port-a-cath device in ambulatory care. Major challenges identified were difficulties in adhering to drug dose timelines, vomiting, restricted mobility due to port-a-cath, paucity of infection control and space constraints at patients' home for optimal care. CONCLUSION Administration of imipenem was feasible through port-a-cath. Though outcomes with ambulatory based imipenem containing regimens were promising, there were several challenges in providing care. The feasibility of infusion at day care facilities needs to explored to overcome challenges in infusion at patients home.
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Affiliation(s)
| | | | | | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Diseases, Paris, France
- The Union South East Asia Office, New Delhi, India
| | - Homa Mansoor
- Médecins Sans Frontières/Doctors Without Borders, Mumbai, India
| | | | - Roma Paryani
- Médecins Sans Frontières/Doctors Without Borders, Mumbai, India
| | - Pramila Singh
- Médecins Sans Frontières/Doctors Without Borders, Mumbai, India
| | - Stobdan Kalon
- Médecins Sans Frontières/Doctors Without Borders, Mumbai, India
| | - Mrinalini Das
- Médecins Sans Frontières/Doctors Without Borders, Mumbai, India
| | - Gabriella Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Petros Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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50
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Makoni TM, Thekkur P, Takarinda KC, Xaba S, Ncube G, Zwangobani N, Samuelson J, Mangombe A, Mabaya S, Tapera T, Matambo R, Ameyan W, Mugurungi O. Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study. BMJ Open 2020; 10:e033035. [PMID: 32371506 PMCID: PMC7223012 DOI: 10.1136/bmjopen-2019-033035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES WHO recommended strengthening the linkages between various HIV prevention programmes and adolescent sexual reproductive health (ASRH) services. The Smart-LyncAges project piloted in Bulawayo city and Mt Darwin district of Zimbabwe established a referral system to link the voluntary medical male circumcision (VMMC) clients to ASRH services provided at youth centres. Since its inception in 2016, there has been no assessment of the performance of the referral system. Thus, we aimed to assess the proportion of young (10-24 years) VMMC clients getting 'successfully linked' to ASRH services and factors associated with 'not being linked'. DESIGN This was a cohort study using routinely collected secondary data. SETTING All three VMMC clinics of Mt Darwin district and Bulawayo province. PRIMARY OUTCOME MEASURES The proportion of 'successfully linked' was summarised as the percentage with a 95% CI. Adjusted relative risks (aRR) using a generalised linear model was calculated as a measure of association between client characteristics and 'not being linked'. RESULTS Of 1773 young people registered for VMMC services, 1478 (83%) were referred for ASRH services as they had not registered for ASRH previously. Of those referred for ASRH services, the mean (SD) age of study participants was 13.7 (4.3) years and 427 (28.9%) were out of school. Of the referred, 463 (31.3%, 95% CI: 30.0 to 33.8) were 'successfully linked' to ASRH services and the median (IQR) duration for linkage was 6 (0-56) days. On adjusted analysis, receiving referral from Bulawayo circumcision clinic (aRR: 1.5 (95% CI: 1.3 to 1.7)) and undergoing circumcision at outreach sites (aRR: 1.2 (95% CI: 1.1 to 1.3)) were associated with 'not being linked' to ASRH services. CONCLUSION Linkage to ASRH services from VMMC is feasible as one-third VMMC clients were successfully linked. However, there is need to explore reasons for not accessing ASRH services and take corrective actions to improve the linkages.
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Affiliation(s)
- Talent M Makoni
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Harare, Zimbabwe
- World Health Organization Regional Office for Africa, Harare, Harare, Zimbabwe
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
- Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
| | | | | | - Getrude Ncube
- Ministry of Health and Child Care, Harare, Harare, Zimbabwe
| | | | | | | | - Simbarashe Mabaya
- World Health Organization Regional Office for Africa, Harare, Harare, Zimbabwe
| | - Talent Tapera
- Ministry of Health and Child Care, Harare, Harare, Zimbabwe
| | | | - Wole Ameyan
- World Health Organization, Geneve, GE, Switzerland
| | - Owen Mugurungi
- Ministry of Health and Child Care, Harare, Harare, Zimbabwe
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