The problem of Tuberculosis (TB) and Human Immune Deficiency Virus (HIV) co-infection becomes vital when it is seen in the context of under developed countries like Pakistan. Pakistan ranks 5th high burden countries f...The problem of Tuberculosis (TB) and Human Immune Deficiency Virus (HIV) co-infection becomes vital when it is seen in the context of under developed countries like Pakistan. Pakistan ranks 5th high burden countries for drug-susceptible and 6th among drug-resistant TB patients [1]. Objectives of the study were to assess the prevalence of TB-HIV Co-infection at the designated Sentinel Sites across Pakistan. A cross-sectional study is based on retrospective record review of routinely maintained TB program data at all 17 designated sentinel sites of TB Control Program from 2013-15. Among the screened TB patients 145 (0.66%) were found HIV reactive. The prevalence of HIV was higher (1.02%) in extra-pulmonary and male TB patients (1.23 %) as compared to pulmonary (0.55%) and female patients (0.09%). Scale up TB surveillance activities, integrating TB-HIV care services, active case finding among key affected populations will have a positive impact on TB-HIV co-infection and disease control.展开更多
To improve childhood Tuberculosis management, the National Tuberculosis Program implemented a package of interventions Hospital DOTS linkages (HDL) in 2015 in 144 tertiary and secondary care hospitals across Pakistan....To improve childhood Tuberculosis management, the National Tuberculosis Program implemented a package of interventions Hospital DOTS linkages (HDL) in 2015 in 144 tertiary and secondary care hospitals across Pakistan. This included systematic engagement of hospital administration and all specialist doctors, staff training and regular facility-based review meetings. HDL was associated with 35% increase in childhood TB notifications in 2015 (versus 2014) in HDL sites as compared to 16% increase in non-HDL sites. The increase was seen across provinces, age-groups and sexes, but did not correlate with presence of Xpert MTB/RIF®?or “screeners” (health workers deployed to screen children for TB).展开更多
To identify missing childhood Tuberculosis (TB) cases, “screeners” (hospital-based health workers trained to screen accompanying contacts of TB patients for symptoms) were introduced in eight tertiary care hospitals...To identify missing childhood Tuberculosis (TB) cases, “screeners” (hospital-based health workers trained to screen accompanying contacts of TB patients for symptoms) were introduced in eight tertiary care hospitals of Sindh, Pakistan in 2013. There was a 55% increase in childhood TB notifications in 2014 compared to 2012 in facilities with screeners (n = 8) compared to 40% increase in facilities without screeners (n = 22). This apparent association disappeared when stratified by presence of “trained pediatrician” whose introduction was associated with a massive increase in notifications while transfer was associated with a marked decrease. In conclusion, screeners were not associated with increase in pediatric TB case notifications.展开更多
Tuberculosis (TB) is a chronic disease caused by mycobacterium tuberculosis and transmitted from person to person, through inhalation of droplet nuclei aerosolized by coughing of an infected person. It reach...Tuberculosis (TB) is a chronic disease caused by mycobacterium tuberculosis and transmitted from person to person, through inhalation of droplet nuclei aerosolized by coughing of an infected person. It reached epidemic proportions in Europe and North America during the 18th and 19th centuries. The incubation period is 2 - 6 weeks and the control has been complicated with emergence of HIV and drug-resistant TB. In 1993, World Health Organization (WHO) declared TB a global emergency. However, despite the concerted effort of National TB control programs, adoption and implementation of Stop TB strategy, TB has remained a major public health challenge with high mortality rate, especially in developing countries. Methodology: This is a descriptive study, evaluated using the positivist/quantitative approach. The study was conducted at FederalMedical Centre Umuahia, a tertiary specialist hospital with comprehensive TB/HIV treatment services. All the presumptive drug-resistant TB cases and symptomatic PLHIV were screened for HIV and their sputum specimens were tested for tuberculosis using the Gene xpert and the Ziehl- Neelsen technique for detecting Acid Fast bacilli. A pretested structured questionnaire was used tocollect the demographic data and other essential data from the presumptive TB and laboratory registers such as total number of TB presumptive cases registered HIV status, AFB status and rifampicin status within the study period. Result: A total of 493 presumptive TB cases were screened in the study, 49.9% were HIV positive while 50.05% were HIV negative. More so, 77.85% of thescreened cases were AFB negative and 22.15% were AFB positive. Moreover, 11% of the TB/HIV co-infected patients were rifampicin positive. Interestingly among the 493 cases screened with gene xpert machine, 3.6% were rifampicin positive. Furthermore, 3.6% of the HIV negative cases were rifampicin positive while 1.6% of the HIV positive cases were rifampicin positive. Discussion: The data depict lower rifampicin resistance among HIV positive cases than HIV negative cases. The implication for public health professionals is to intensify equitable and unbiased search for resistant TB cases among smear negative and positive cases.展开更多
Tuberculosis (TB) is a chronic disease that has impacted negatively on human history. The biology of the mycobacterium tuberculosis is complicated and has affected the control as well as elimination of the disease. Ni...Tuberculosis (TB) is a chronic disease that has impacted negatively on human history. The biology of the mycobacterium tuberculosis is complicated and has affected the control as well as elimination of the disease. Nigeria is one of the countries with high incidence and prevalence of TB. The late and low case detection has been a major problem with National TB control program, caused by passive case finding strategy practiced by the country. A shift from the passive and active case search has been recommended for detection of missing cases of TB and improved program performance. The proximity of TB contact is a major determinant of disease transmission. However, maximizing early case detection and prompt treatment of notified cases is very useful in (TB) control especially in high burden countries. The tracking of TB contacts provides a good platform for early diagnosis, educating the household on TB disease and infection control as well as breaking the chain of transmission. The objective of the study is to ascertain effectiveness of contact tracing on Tuberculosis case detection. The study is a retrospective quasi experimental with quantitative arm. The study was conducted in Abia State, one of the South Eastern States of Nigeria. A pre-tested questionnaire was used for data collection and analyzed with SPSS. A total of 168 and 162 index cases of TB were recruited for both intervention and control facilities. The 168 index TB cases yielded 301 TB contacts. The result revealed 55% contact/index ratio, presumptive TB yield of 130 (43.2%) and TB yield of 68 (22.6%). The cases registered in the State increased from 336 to 417 and p value = 0.001, while presumptive TB and BCG vaccination were major predictors. The study shows that tracing contact of index TB cases is an effective and complementary method of finding undetected cases of TB.展开更多
This case report presents a 63-year-old male patient with a history of TB 20 years prior, who developed chronic cor pulmonale, right heart failure, and eventually died. The report emphasizes the serious long-term effe...This case report presents a 63-year-old male patient with a history of TB 20 years prior, who developed chronic cor pulmonale, right heart failure, and eventually died. The report emphasizes the serious long-term effects of post-TB sequelae, highlighting diagnostic challenges, clinical progression, and management strategies. The case report addresses a significant and often overlooked aspect of TB management: the long-term complications following TB treatment, known as post-TB sequelae.展开更多
Background:As part of the WHO End TB strategy,national tuberculosis(TB)programs increasingly aim to engage all private and public TB care providers.Engagement of communities,civil society organizations and public and ...Background:As part of the WHO End TB strategy,national tuberculosis(TB)programs increasingly aim to engage all private and public TB care providers.Engagement of communities,civil society organizations and public and private care provider is the second pillar of the End TB strategy.In Myanmar,this entails the public-public and public-private mix(PPM)approach.The public-public mix refers to public hospital TB services,with reporting to the national TB program(NTP).The public-private mix refers to private general practitioners providing TB services including TB diagnosis,treatment and reporting to NTP.The aim of this study was to assess whether PPM activities can be scaled-up nationally and can be sustained over time.Methods:Using 2007-2014 aggregated program data,we collected information from NTP and non-NTP actors on 1)the number of TB cases detected and their relative contribution to the national case load;2)the type of TB cases detected;3)their treatment outcomes.Results:The total number of TB cases detected per year nationally increased from 133,547 in 2007 to 142,587 in 2014.The contribution of private practitioners increased from 11%in 2007 to 18%in 2014,and from 1.8%to 4.6%for public hospitals.The NTP contribution decreased from 87%in 2007 to 77%in 2014.A similar pattern was seen in the number of new smear(+)TB cases(31%of all TB cases)and retreatment cases,which represented 7.8%of all TB cases.For new smear(+)TB cases,adverse outcomes were more common in public hospitals,with more patients dying,lost to follow up or not having their treatment outcome evaluated.Patients treated by private practitioners were more frequently lost to follow up(8%).Adverse treatment outcomes in retreatment cases were particularly common(59%)in public hospitals for various reasons,predominantly due to patients dying(26%)or not being evaluated(10%).In private clinics,treatment failure tended to be more common(8%).Conclusions:The contribution of non-NTP actors to TB detection at the national level increased over time,with the largest contribution by private practitioners involved in PPM.Treatment outcomes were fair.Our findings confirm the role of PPM in national TB programs.To achieve the End TB targets,further expansion of PPM to engage all public and private medical facilities should be targeted.展开更多
文摘The problem of Tuberculosis (TB) and Human Immune Deficiency Virus (HIV) co-infection becomes vital when it is seen in the context of under developed countries like Pakistan. Pakistan ranks 5th high burden countries for drug-susceptible and 6th among drug-resistant TB patients [1]. Objectives of the study were to assess the prevalence of TB-HIV Co-infection at the designated Sentinel Sites across Pakistan. A cross-sectional study is based on retrospective record review of routinely maintained TB program data at all 17 designated sentinel sites of TB Control Program from 2013-15. Among the screened TB patients 145 (0.66%) were found HIV reactive. The prevalence of HIV was higher (1.02%) in extra-pulmonary and male TB patients (1.23 %) as compared to pulmonary (0.55%) and female patients (0.09%). Scale up TB surveillance activities, integrating TB-HIV care services, active case finding among key affected populations will have a positive impact on TB-HIV co-infection and disease control.
文摘To improve childhood Tuberculosis management, the National Tuberculosis Program implemented a package of interventions Hospital DOTS linkages (HDL) in 2015 in 144 tertiary and secondary care hospitals across Pakistan. This included systematic engagement of hospital administration and all specialist doctors, staff training and regular facility-based review meetings. HDL was associated with 35% increase in childhood TB notifications in 2015 (versus 2014) in HDL sites as compared to 16% increase in non-HDL sites. The increase was seen across provinces, age-groups and sexes, but did not correlate with presence of Xpert MTB/RIF®?or “screeners” (health workers deployed to screen children for TB).
文摘To identify missing childhood Tuberculosis (TB) cases, “screeners” (hospital-based health workers trained to screen accompanying contacts of TB patients for symptoms) were introduced in eight tertiary care hospitals of Sindh, Pakistan in 2013. There was a 55% increase in childhood TB notifications in 2014 compared to 2012 in facilities with screeners (n = 8) compared to 40% increase in facilities without screeners (n = 22). This apparent association disappeared when stratified by presence of “trained pediatrician” whose introduction was associated with a massive increase in notifications while transfer was associated with a marked decrease. In conclusion, screeners were not associated with increase in pediatric TB case notifications.
文摘Tuberculosis (TB) is a chronic disease caused by mycobacterium tuberculosis and transmitted from person to person, through inhalation of droplet nuclei aerosolized by coughing of an infected person. It reached epidemic proportions in Europe and North America during the 18th and 19th centuries. The incubation period is 2 - 6 weeks and the control has been complicated with emergence of HIV and drug-resistant TB. In 1993, World Health Organization (WHO) declared TB a global emergency. However, despite the concerted effort of National TB control programs, adoption and implementation of Stop TB strategy, TB has remained a major public health challenge with high mortality rate, especially in developing countries. Methodology: This is a descriptive study, evaluated using the positivist/quantitative approach. The study was conducted at FederalMedical Centre Umuahia, a tertiary specialist hospital with comprehensive TB/HIV treatment services. All the presumptive drug-resistant TB cases and symptomatic PLHIV were screened for HIV and their sputum specimens were tested for tuberculosis using the Gene xpert and the Ziehl- Neelsen technique for detecting Acid Fast bacilli. A pretested structured questionnaire was used tocollect the demographic data and other essential data from the presumptive TB and laboratory registers such as total number of TB presumptive cases registered HIV status, AFB status and rifampicin status within the study period. Result: A total of 493 presumptive TB cases were screened in the study, 49.9% were HIV positive while 50.05% were HIV negative. More so, 77.85% of thescreened cases were AFB negative and 22.15% were AFB positive. Moreover, 11% of the TB/HIV co-infected patients were rifampicin positive. Interestingly among the 493 cases screened with gene xpert machine, 3.6% were rifampicin positive. Furthermore, 3.6% of the HIV negative cases were rifampicin positive while 1.6% of the HIV positive cases were rifampicin positive. Discussion: The data depict lower rifampicin resistance among HIV positive cases than HIV negative cases. The implication for public health professionals is to intensify equitable and unbiased search for resistant TB cases among smear negative and positive cases.
文摘Tuberculosis (TB) is a chronic disease that has impacted negatively on human history. The biology of the mycobacterium tuberculosis is complicated and has affected the control as well as elimination of the disease. Nigeria is one of the countries with high incidence and prevalence of TB. The late and low case detection has been a major problem with National TB control program, caused by passive case finding strategy practiced by the country. A shift from the passive and active case search has been recommended for detection of missing cases of TB and improved program performance. The proximity of TB contact is a major determinant of disease transmission. However, maximizing early case detection and prompt treatment of notified cases is very useful in (TB) control especially in high burden countries. The tracking of TB contacts provides a good platform for early diagnosis, educating the household on TB disease and infection control as well as breaking the chain of transmission. The objective of the study is to ascertain effectiveness of contact tracing on Tuberculosis case detection. The study is a retrospective quasi experimental with quantitative arm. The study was conducted in Abia State, one of the South Eastern States of Nigeria. A pre-tested questionnaire was used for data collection and analyzed with SPSS. A total of 168 and 162 index cases of TB were recruited for both intervention and control facilities. The 168 index TB cases yielded 301 TB contacts. The result revealed 55% contact/index ratio, presumptive TB yield of 130 (43.2%) and TB yield of 68 (22.6%). The cases registered in the State increased from 336 to 417 and p value = 0.001, while presumptive TB and BCG vaccination were major predictors. The study shows that tracing contact of index TB cases is an effective and complementary method of finding undetected cases of TB.
文摘This case report presents a 63-year-old male patient with a history of TB 20 years prior, who developed chronic cor pulmonale, right heart failure, and eventually died. The report emphasizes the serious long-term effects of post-TB sequelae, highlighting diagnostic challenges, clinical progression, and management strategies. The case report addresses a significant and often overlooked aspect of TB management: the long-term complications following TB treatment, known as post-TB sequelae.
基金The program was funded by WHO/TDR Impact grant to two TDR alumni from DMR.The funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript.
文摘Background:As part of the WHO End TB strategy,national tuberculosis(TB)programs increasingly aim to engage all private and public TB care providers.Engagement of communities,civil society organizations and public and private care provider is the second pillar of the End TB strategy.In Myanmar,this entails the public-public and public-private mix(PPM)approach.The public-public mix refers to public hospital TB services,with reporting to the national TB program(NTP).The public-private mix refers to private general practitioners providing TB services including TB diagnosis,treatment and reporting to NTP.The aim of this study was to assess whether PPM activities can be scaled-up nationally and can be sustained over time.Methods:Using 2007-2014 aggregated program data,we collected information from NTP and non-NTP actors on 1)the number of TB cases detected and their relative contribution to the national case load;2)the type of TB cases detected;3)their treatment outcomes.Results:The total number of TB cases detected per year nationally increased from 133,547 in 2007 to 142,587 in 2014.The contribution of private practitioners increased from 11%in 2007 to 18%in 2014,and from 1.8%to 4.6%for public hospitals.The NTP contribution decreased from 87%in 2007 to 77%in 2014.A similar pattern was seen in the number of new smear(+)TB cases(31%of all TB cases)and retreatment cases,which represented 7.8%of all TB cases.For new smear(+)TB cases,adverse outcomes were more common in public hospitals,with more patients dying,lost to follow up or not having their treatment outcome evaluated.Patients treated by private practitioners were more frequently lost to follow up(8%).Adverse treatment outcomes in retreatment cases were particularly common(59%)in public hospitals for various reasons,predominantly due to patients dying(26%)or not being evaluated(10%).In private clinics,treatment failure tended to be more common(8%).Conclusions:The contribution of non-NTP actors to TB detection at the national level increased over time,with the largest contribution by private practitioners involved in PPM.Treatment outcomes were fair.Our findings confirm the role of PPM in national TB programs.To achieve the End TB targets,further expansion of PPM to engage all public and private medical facilities should be targeted.
