Management of rifampicin-resistant tuberculosis in conflict-affected areas: The case of Iraq.

Since December 2019, the World Health Organization (WHO) has encouraged National Tuberculosis Programs to deprioritize the use of injectable-containing regimens and roll-out all-oral bedaquiline-containing regimens for rifampicin-resistant tuberculosis (RR-TB) treatment. Consequently, Iraq gradually replaced the injectable-containing regimen with an all-oral regimen, including bedaquiline. To assess treatment enrolment and outcomes of both regimens during a transitioning phase in Iraq, where health system services are recovering from decades of war, we conducted a nationwide retrospective cohort study using routinely collected programmatic data for patients enrolled between 2019-2021. We describe treatment enrolment and use logistic regression to identify predictors of unfavorable treatment outcomes (failure, death, or lost to follow-up), including regimen type. Nationwide, a total of 301 RR-TB patients started treatment, of whom 167 concluded treatment. The proportion of patients enrolled on the all-oral regimen increased from 53.2% (50/94) in 2020, to 75.5% (80/106) in 2021. Successful treatment was achieved in 82.1% (32/39) and 63.3% (81/128), for all-oral and injectable-containing regimens respectively. Moreover, the proportion of lost to follow-up was lower among those treated with the all-oral versus the long injectable-containing regimen; respectively 2.6% (1/39) versus 17.9% (23/128: p = 0.02). Unfavorable treatment outcome was associated with male gender (aOR 2.12, 95%CI:1.02-4.43) and age <15 years (vs 30-49 years, aOR 5.80, 95%CI:1.30-25.86). Regimen type (aOR 2.37, 95%CI: 0.91-6.13) was not significantly associated with having an unfavorable treatment outcome. In Iraq, the use of bedaquiline-containing all-oral regimen resulted in a high treatment success and reduced lost to follow-up.

Primary Health-Care Staff Barriers to Immunization.

BACKGROUND: Missed opportunities for immunization (MOI) is considered as the most important preventable reason for underimmunization. Health-care workers stand beyond more than half the children's missed opportunities due to gaps in their knowledge, attitudes, and practices (KAP) regarding immunization. OBJECTIVES: This study assessed immunization staff at primary health-care centers in Baghdad/Al-Karkh for KAP that may lead to MOI. MATERIALS AND METHODS: KAP survey was conducted on field immunization service providers at primary health-care centers in Baghdad/Al-Karkh. Barriers are considered to present whenever scores found <80 in any of KAP. Data were collected using a self-administered structured questionnaire analyzed by SPSS 24. RESULTS: Among 217 respondent health professionals, 69 (31.8%) were physicians and 148 (68.2%) were nurses. The studied sample got mean scores for KAP of 84.7 ± 11.4, 71.1 ± 22.7, and 74.8 ± 20.3, respectively. Physicians had higher mean knowledge score compared to nurses (P < 0.05). Both physicians and nurses got mean scores below 80 for both attitudes and practices. CONCLUSION: Attitudes and practices in both physicians and nurses need to be improved to avoid MOI.