The yield of community-based tuberculosis and HIV among key populations in hotspot settings of Ethiopia: A cross-sectional implementation study.

OBJECTIVE: To determine the yield of tuberculosis (TB) and the prevalence of Human Immuno-deficiency virus (HIV) among key populations in the selected hotspot towns of Ethiopia. METHODS: We undertook a cross-sectional implementation research during August 2017-January 2018. Trained TB focal persons and health extension workers (HEWs) identified female sex workers (FSWs), health care workers (HCWs), prison inmates, homeless, internally displaced people (IDPs), internal migratory workers (IMWs) and residents in missionary charities as key and vulnerable popuaiton. They carried out health education on the importance of TB screening and HIV testing prior to recruitment of the study participants. Symptomatic TB screening and HIV testing was done. The yield of TB was computed per 100,000 background key population. RESULTS: A total of 1878 vulnerable people were screened, out of which 726 (38.7%) presumptive TB cases and 87 (4.6%) TB cases were identified. The yield of TB was 1519 (95% CI: 1218.1-1869.9). The highest proportion (19.5%) and yield of TB case (6,286 (95% CI: 3980.8-9362.3)) was among HCWs. The prevalence of HIV infection was 6%, 67 out of 1,111 tested. IMWs and FSWs represented 49.3% (33) and 28.4% (13) of the HIV infections, respectively. There was a statistically significant association of active TB cases with previous history of TB (Adjusted Odds Ratio (AOR): 11 95% CI, 4.06-29.81), HIV infection (AOR: 7.7 95% CI, 2.24-26.40), and being a HCW (AOR: 2.42 95% CI, 1.09-5.34). CONCLUSIONS: The prevalence of TB in key populations was nine times higher than 164/100,000 national estimated prevalence rate. The prevalence of HIV was five times higher than 1.15% of the national survey. The highest yield of TB was among the HCWs and the high HIV burden was detected among the FSWs and IMWs. These suggest a community and health facility based integrated and enhanced case finding approaches for TB and HIV in hotspot settings.

The dynamics of tuberculosis in response to 10 years of intensive control effort in Peru.

Improved tuberculosis (TB) case detection and cure rates are expected to accelerate the decline in incidence of TB and to reduce TB-associated deaths. Time series analyses of case reports in Peru showed that the per capita TB incidence rate was probably steady before 1991. Case reports increased between 1990 and 1992 as a result of improved case detection. Although diagnostic efforts have continued to increase since 1993, the incidence of new pulmonary TB cases has declined in every department of the country, with a national rate of decline > or =5.8% per year (range, 1.9%-9.7%). This elevated rate of decline suggests that 27% (19%-34%) of cases (158,000) and 70% (63%-77%) of deaths (91,000) among smear-positive patients were averted between 1991 and 2000. This is the first demonstration that a significant number of TB cases can be prevented through intensive short-course chemotherapy in a high-burden country.

Meningoencefalitis bacteriana en pediatría / Bacterial meningoencephalitis in pediatrics

La menigoencefalitis bacteriana es una patología que ha aumentado su incidencia en los últimos años. Se ha realizado un estudio prospectivo, previa elaboración de un protocolo para determinar la incidencia de esta patología, germen causal, clínica tratamiento, secuelas y mortalidad. En el Servicio de Pediatría del Hospital Central SSFP, durante el período de 1985-1988 se hospitalizaron 3604 pacientes, de los cuales 670 (18.5%) correspondieron a la Unidad de Cuidados Intensivos Pediátricos, diagnosticándose dentro del segundo grupo 20 casos de meningoencefalitis bacteriana, lo que equivalen al 2.9% de los pacientes intensivos. De los 20 casos analizados, se aislaron ocho de Neisseria meningitidis seis casos con Heamophyllus influenzae, uno con E. coli y en cinco no se aisló germen causal. En el grupo estudiado: 16 pacientes fueron de sexo masculino, 4 de sexo femenino. El grupo etario más afectado fue el de lactantes (40%). Entre los síntomas y signos comunes estuvieron: fiebre, vómitos, irritebilidad y signos meníngeos. El tratamiento antibiótico fue doble y la mortalidad alcanzó el 15% de los casos estudiados. Se enfatiza la necesidad de un diagnóstico etiológico rápido y el inicio de un tratamiento adecuado y oportuno para evitar secuelas posteriores y disminuir la mortalidad por esta patología