Clinical and Imaging Characteristics of Smear Negative Pulmonary Tuberculosis Patients: A Comparative Study.

Background: Prevalence surveys in Ethiopia indicate smear negative pulmonary tuberculosis (SNPTB) taking the major share of the overall TB burden. It has also been a diagnostic dilemma worldwide leading to diagnostic delays and difficulty in monitoring treatment outcomes. This study determines and compares the clinical and imaging findings in SNPTB and smear positive PTB (SPPTB). Methodology. A case-control study was conducted on 313 PTB (173 SNPTB) patients. Data and sputum samples were collected from consented patients. Smear microscopy, GeneXpert, and culture analyses were performed on sputum samples. Data were analyzed using Stata version 17; a P value < 0.05 was considered statistically significant. Results: Of the 173 SNPTB patients, 42% were culture positive with discordances between test results reported by health facilities and Armauer Hansen Research Institute laboratory using concentrated smear microscopy. A previous history of TB and fewer cavitary lesions were significantly associated with SNPTB. Conclusions: Though overall clinical presentations of SNPTB patients resemble those seen in SPPTB patients, a prior history of TB was strongly associated with SNPTB. Subject to further investigations, the relatively higher discrepancies seen in TB diagnoses reflect the posed diagnostic challenges in SNPTB patients, as a higher proportion of these patients are also seen in Ethiopia.

Socio-historical representations of a disease: a study of posters from campaigns against Hansen's disease during the second half of the twentieth century. / Representações sócio-históricas de uma doença: um estudo sobre cartazes de campanhas para o combate à hanseníase na segunda metade do século XX.

This article analyzes the use of iconographic sources in the context of educational campaigns to combat Hansen's disease from a socio-historical perspective at four points in time: the 1950s, 1960s, 1980s, and 1990s. Four posters are analyzed to identify the elements (textual, visual or graphic) used to develop discourse on this disease and those it affected and transformations and permanences in this discourse, as well as to verify how they became part of a narrative of institutional memory linked to public health in the state of São Paulo. These were produced by various public health institutions and are part of the Health Campaign Poster Collection held by the Emílio Ribas Public Health Museum.

Este artigo analisa o uso de fontes iconográficas no contexto das campanhas educativas para o combate à hanseníase numa perspectiva sócio-histórica em quatro momentos: décadas de 1950, 1960, 1980 e 1990. São analisados quatro cartazes para identificar os elementos (textuais, visuais ou gráficos) utilizados para elaborar um discurso sobre a doença e os doentes; suas transformações discursivas e permanências, além de verificar como se tornaram parte de uma narrativa de memória institucional ligada à saúde pública paulista. As fontes estudadas fazem parte da coleção Cartazes de Campanhas de Saúde, cujos itens foram produzidos por diversas instituições ligadas à saúde pública e integram o acervo do Museu de Saúde Pública Emílio Ribas.

Efficiency and equity of bed utilization in China's health institutions: based on the rank-sum ratio method.

OBJECTIVE: The study aimed to analyze the efficiency and equity of bed utilization in Please check if the section headings are assigned to appropriate levels.China's healthcare institutions and to compare and analyze the overall health resource utilization efficiency in recent years and some specific utilization conditions in 2021, to provide empirical experience for the allocation of health care resources in epidemic China. METHODS: To compare and analyze the overall health resource utilization efficiency of the whole country with that of the East, middle, and West in 2021, and to analyze the bed utilization efficiency of different types of healthcare institutions in China and the bed utilization efficiency of various types of specialist hospitals in the country in 2021 by using the rank-sum ratio method. RESULTS: In 2021, the bed utilization rate of China's health institutions was 69.82%, and the number of bed turnover times was 27.65 times; the bed utilization rate of hospitals was 74.6%, and the number of bed turnover times was 26.08 times. The number of hospital bed turnovers was highest in the western region, lowest in the central region, and close to the national average in the eastern region. The average length of stay for discharged patients was the highest in the central region, the lowest in the eastern region, and the same as the national average in the western region. The analysis of rank-sum ratio method shows that among different types of health institutions' bed utilization efficiency (r = 0.935, P = 0.000), general hospitals and traditional Chinese medicine hospitals have the best bed utilization rate, and the bed utilization rate of community health service centers (stations) needs to be improved; while among various types of specialized hospitals' bed utilization efficiency (r = 0.959, P = 0.000), oncology hospitals, thoracic hospitals, and hematology hospitals, children's hospitals have high bed utilization efficiency; leprosy hospitals, cosmetic hospitals, and stomatology hospitals have low bed utilization efficiency. Health technicians per 1,000 population are highest in the western region, lowest in the central region, and lower in the eastern region than in the western region but slightly higher than the national average. The number of beds in health institutions per 1,000 population is the highest in the central region, the lowest in the eastern region, and slightly lower in the northwest than in the central region but higher than the national average. CONCLUSION: China's investment in health funding in the field of health care has been on the rise in recent years. However, there still exists the situation of uneven investment in health expenses and inconsistent medical efficiency among regions. And change such a status quo can be further improved in terms of government, capital, human resources, technology, information system, and so on.

Leprosy (Hansen's disease): An Update and Review.

Leprosy (Hansen's disease) is caused by infection with bacilli of the Mycobacterium leprae complex. It is considered an exotic and rare diagnosis in Missouri. Past leprosy patients diagnosed locally have typically acquired it in areas of the world where leprosy is endemic. However, a recent case in a native Missourian that appears to be locally acquired suggests that leprosy may now be endemic in Missouri, possibly due to the expanded range of its zoonotic vector, the nine-banded armadillo. Health care providers in Missouri should be aware of how leprosy manifests and suspected cases referred to centers such as ours for evaluation and early institution of appropriate treatment.

Social Reproduction as a methodological perspective for contextualized analysis of living and health conditions. / A Reprodução Social como perspectiva metodológica para análise contextualizada das condições de vida e de saúde.

This article aims to discuss the use of Social Reproduction, proposed by Juan Samaja, in the analysis of living and health conditions in a context of an sustanaible development reserve in the Brazilian Amazon. This study uses a comprehensive approach to Social Reproduction processes that comprise the network of hierarchically organized structures using the analysis of social interactions of narrated and observable events, applied to the data matrix. The Ecological Reproduction of life in the riverside forest is negatively expressed in bio-communal life, as the strategic actions provided by the Political, Economic and Cultural Reproductions, that is, the environmental policy actions, do not value the local way of life. The deficient access to social goods and services, including health care, from the Political and Techno-Economic Reproductions, has an impact on the material basis of the Bio-Communal Reproduction, whose outcome is high frequency of disease complaints and workplace accidents, such as infectious gastroenteritis, malaria, tuberculosis, leprosy, and poisoning by venomous animals. Ensuring access to social goods and services, in particular health care, is essential for improving resilience to the forest adversities. In conclusion, the social reproduction data matrix helped understand the processes of Social Reproduction that are part of the hierarchically organized structures, whose interactions shaped the living and health conditions of the riverside population analyzed in this study.

Este artigo objetiva discutir o uso da categoria Reprodução Social, proposta por Juan Samaja, na análise sobre condições de vida e de saúde em um contexto de uma unidade de conservação ambiental da Amazônia brasileira. Trata-se de um estudo de abordagem compreensiva sobre os processos da reprodução social que integram a rede de determinação hierarquicamente organizada por meio da análise de interações sociais dos acontecimentos narrados e observáveis, aplicados a matriz de dados. A Reprodução Ecológica da vida na floresta dos ribeirinhos é expressa negativamente na vida biocomunal, pois as estratégias de ação propiciadas pelas Reproduções Política, Econômica e Cultural, ou seja, as ações da política ambiental, não valorizam o modo de vida local. O deficitário acesso aos bens e serviços sociais, incluindo a atenção à saúde, provenientes das Reproduções Política e Tecnoeconômica, repercutem na base material da Reprodução Biocomunal, cujo desfecho são elevadas frequências de queixas de doença e de acidentes de trabalho, como gastroenterites infecciosas, malária, tuberculose, hanseníase e intoxicação por animais peçonhentos. Garantir o acesso aos bens e serviços sociais, em especial à saúde, são imprescindíveis para uma maior resiliência às adversidades da floresta. Conclui-se, então, que a matriz de dados da Reprodução Social possibilitou compreender os processos da reprodução social que integram a rede de determinação hierarquicamente organizada, cujas interações modelaram as condições de vida e de saúde dos ribeirinhos.

Este artículo tiene como objetivo discutir el uso de la categoría Reproducción Social, propuesta por Juan Samaja, en el análisis sobre condiciones de vida y de salud en un contexto de una unidad de conservación ambiental de la Amazonía brasileña. Se trata de un estudio de enfoque integral sobre los procesos de la reproducción social que integran la red de determinación jerárquicamente organizada por medio del análisis de interacciones sociales de los acontecimientos narrados y observables, aplicados a la matriz de datos. La Reproducción Ecológica de la vida en los bosques ribereños es expresada negativamente en la vida biocomunal, pues las estrategias de acción propiciadas por las Reproducciones Política, Económica y Cultural, es decir, las acciones de la política ambiental, no valoran el modo de vida local. El deficiente acceso a los bienes y servicios sociales, incluida la atención a la salud, procedentes de las Reproducciones Política y Tecnoeconómica, repercuten en la base material de la Reproducción Biocomunal, cuyo desenlace son elevadas frecuencias de quejas de enfermedad y de accidentes de trabajo, como gastroenteritis infecciosas, malaria, tuberculosis, lepra e intoxicación por animales venenosos. Garantizar el acceso a los bienes y servicios sociales, especialmente la atención a la salud, es esencial para una mayor resistencia a las adversidades del bosque. Se concluye, entonces, que la matriz de datos de la Reproducción Social permitió comprender los procesos de la reproducción social que integran la red de determinación jerárquicamente organizada, cuyas interacciones modelaron las condiciones de vida y salud de los ribereños.

Delayed detection of leprosy cases: A systematic review of healthcare-related factors.

BACKGROUND: In new leprosy cases, grade 2 disability (G2D) is still a public health burden worldwide. It is often associated with the delayed leprosy diagnoses that healthcare systems should play a crucial role in preventing. The aim of this systematic review was to identify healthcare factors related to delays in case detection in leprosy. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a guideline in this research. The study protocol was registered in the PROSPERO (International Prospective Register of Systematic Reviews) with reference code CRD42020189274. Data was collected from five electronic databases: Embase, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. RESULTS: After applying the selection criteria for original empirical studies, and after removing duplicates, we included 20 papers from 4313 records. They had been conducted in ten countries and published between January 1, 2000, and January 31, 2021. We identified three categories of healthcare factors related to delayed case. 1) Structural factors, such as i) financial and logistic issues, and geographical circumstances (which we classified as barriers); ii) Health service organization and management including the level of decentralization (classified as facilitators). 2) Health service factors, such as problems or shortages involving referral centers, healthcare personnel, and case-detection methods. 3) Intermediate factors, such as misdiagnosis, higher numbers of consultations before diagnosis, and inappropriate healthcare services visited by people with leprosy. CONCLUSIONS: Delays in leprosy case detection are due mainly to misdiagnosis. It is crucial to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services.

Use of healthcare services during the COVID-19 pandemic in urban Ethiopia: evidence from retrospective health facility survey data.

OBJECTIVES: In recent years, Ethiopia has made enormous strides in enhancing access to healthcare, especially, maternal and child healthcare. With the onset and spread of COVID-19, the attention of the healthcare system has pivoted to handling the disease, potentially at the cost of other healthcare needs. This paper explores whether this shift has come at the cost of non-Covid related healthcare, especially the use of maternal and child health (MCH) services. SETTING: Data covering a 24-month period are drawn from 59 health centres and 29 public hospitals located in urban Ethiopia. PRIMARY AND SECONDARY OUTCOMES MEASURES: The primary outcome measures are the use of MCH services including family planning, antenatal and postnatal care, abortion care, delivery and immunisation. The secondary outcome measures are the use of health services by adults including antiretroviral therapy (ART), tuberculosis (TB) and leprosy and dental services RESULTS: There is a sharp reduction in the use of both inpatient (20%-27%, p<0.001) and outpatient (27%-34%, p<0.001) care, particularly in Addis Ababa, which has been most acutely affected by the virus. This decline does not come at the cost of MCH services. The use of several MCH components (skilled birth attendant deliveries, immunisation, postnatal care) remains unaffected throughout the period while others (family planning services, antenatal care) experience a decline (8%-17%) in the immediate aftermath but recover soon after. CONCLUSION: Concerns about the crowding out of MCH services due to the focus on COVID-19 are unfounded. Proactive measures taken by the government and healthcare facilities to ring-fence the use of essential healthcare services have mitigated service disruptions. The results underline the resilience and agility displayed by one of the world's most resource-constrained healthcare systems. Further research on the approaches used to mitigate disruptions is needed.

Cost of TB services in healthcare facilities in Kenya (No 3).

BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and within the National TB, Leprosy and Lung Disease Program (NTLD-P). We aimed to estimate the unit costs of TB services for budgeting by NTLD-P, and allocative efficiency analyses for future National Strategic Plan (NSP) costing.METHODS: We estimated costs of all TB interventions in a sample of 20 public and private health facilities from eight counties. We calculated national-level unit costs from a health provider´s perspective using bottom-up (BU) and top-down (TD) approaches for the financial year 2017-2018 using Microsoft Excel and STATA v16.RESULTS: The mean unit cost for passive case-finding (PCF) was respectively US$38 and US$60 using the BU and TD approaches. The unit BU and TD costs of a 6-month first-line treatment (FLT) course, including monitoring tests, was respectively US$135 and US$160, while those for adult drug-resistant TB (DR-TB) treatment was respectively US$3,230.28 and US$3,926.52 for the 9-month short regimen. Intervention costs highlighted variations between BU and TD approaches. Overall, TD costs were higher than BU, as these are able to capture more costs due to inefficiency (breaks/downtime/leave).CONCLUSION: The activity-based TB unit costs form a comprehensive cost database, and the costing process has built-in capacity within the NTLD-P and international TB research networks, which will inform future TB budgeting processes.

Adherence to the MDR-TB intensive phase treatment protocol amongst individuals followed up at central and peripheral health care facilities in Uganda - a descriptive study.

BACKGROUND: Following initiation of MDR-TB treatment, patients have a choice to receive follow up DOT supervision at either the central initiating facility or at a peripheral facility. OBJECTIVES: We describe the adherence patterns of MDR-TB patients undergoing DOT supervision at the two health facility categories during intensive phase of treatment. METHODS: We used a retrospective cohort of patients initiated on MDR TB treatment at Mulago National Referral Hospital between 2014 and 2016. We extracted data from the National Tuberculosis and Leprosy Program records and analysed these using STATA V14. RESULT: Majority (84.01%) of the patients received their DOT supervision from the peripheral facilities. Males made up 62.1% of patients, and 91.2% had had their household contacts screened for MDR-TB. 26.5% of the patients on peripheral DOT supervision had good adherence to treatment protocol compared to 0% among patients on central initiating health facility DOT supervision. Among the patients with good adherence, 24.1% had contacts screened for MDR-TB as compared to 3.6% with poor adherence. CONCLUSION: More patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settingsMore patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settings.

Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural eastern Uganda.

BACKGROUND: Optimally performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors associated with the low and high TSR across four districts in rural eastern Uganda. METHODS: We interviewed District TB and Leprosy Supervisors, Laboratory focal persons, and health facility TB focal persons from four districts in eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes. RESULTS: The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and prioritization of better management of people with TB. The barriers common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities, and a poor implementation of community-based directly observed therapy short course. CONCLUSION: This study shows that several factors are associated with the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.

Stigma in health facilities: why it matters and how we can change it.

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

[A case series of pure neural leprosy in patients diagnosed in a specialized center for the control of Hansen's disease in Colombia].

Pure neural leprosy, defined as a peripheral neuropathy in which the patient has no skin lesions, is difficult to diagnose. Its verification by bacteriological index and histopathology is not possible in the majority of the patients.We describe four cases of pure neural leprosy diagnosed by clinical criteria. The clinical outcome of three of the patients after specific treatment was satisfactory, while the other one developed progressive neural damage despite the therapy. All patients were treated in a specialized center for the management and control of Hansen's disease in the municipality of Contratación, Santander, Colombia.

Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016.

BACKGROUND: Buruli ulcer (BU), a necrotizing skin infection caused by Mycobacterium ulcerans is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana. METHOD/PRINCIPAL FINDINGS: Pathological samples were collected from BU lesions and transported either through courier services or by car directly to the laboratory. Samples were processed and analysed by IS2404 PCR, culture and Ziehl-Neelsen staining for detection of acid-fast bacilli. From 2008 to 2016, we analysed by PCR, 2,287 samples of 2,203 cases from seventy-five health facilities in seven regions of Ghana (Ashanti, Brong Ahafo, Central, Eastern, Greater Accra, Northern and Volta). The mean annual positivity rate was 46.2% and ranged between 14.6% and 76.2%. The yearly positivity rates from 2008 to 2016 were 52.3%, 76.2%, 56.7%, 53.8%, 41.2%, 41.5%, 22.9%, 28.5% and 14.6% respectively. Of the 1,020 confirmed cases, the ratio of female to male was 518 and 502 respectively. Patients who were 15 years of age and below accounted for 39.8% of all cases. The median age was 20 years (IQR = 10-43). Ulcerative lesions were 69.2%, nodule (9.6%), plaque (2.9%), oedema (2.5%), osteomyelitis (1.1%), ulcer/oedema (9.5%) and ulcer/plaque (5.2%). Lesions frequently occurred on the lower limbs (57%) followed by the upper limbs (38%), the neck and head (3%) and the least found on the abdomen (2%). CONCLUSIONS/SIGNIFICANCE: Our findings show a decline in microbiological confirmed rates over the years and therefore call for intensive education on case recognition to prevent over-diagnosis as BU cases decline.

A case series of pure neural leprosy in patients diagnosed in a specialized center for the control of Hansen's disease in Colombia / Serie de casos de lepra neural pura en pacientes diagnosticados en un centro especializado en el control de la enfermedad de Hansen en Colombia

Abstract Pure neural leprosy, defined as a peripheral neuropathy in which the patient has no skin lesions, is difficult to diagnose. Its verification by bacteriological index and histopathology is not possible in the majority of the patients. We describe four cases of pure neural leprosy diagnosed by clinical criteria. The clinical outcome of three of the patients after specific treatment was satisfactory, while the other one developed progressive neural damage despite the therapy. All patients were treated in a specialized center for the management and control of Hansen's disease in the municipality of Contratación, Santander, Colombia.

Resumen La lepra neural pura se presenta como una neuropatía periférica sin presencia de lesiones cutáneas. La verificación del diagnóstico mediante el índice bacilary la histopatología, no es posible en la mayoría de los pacientes. Se describen cuatro casos de lepra neural pura diagnosticados por clínica; la evolución de tres de los pacientes que recibieron tratamiento específico fue satisfactoria, en tanto que la otra paciente presentó deterioro progresivo a pesar de las medidas terapéuticas. Todos los pacientes fueron atendidos en un centro especializado en el manejo y control de la enfermedad de Hansen, ubicado en el municipio de Contratación, Santander, Colombia.

Performance of general health workers in leprosy control activities at public health facilities in Amhara and Oromia States, Ethiopia.

BACKGROUND: Leprosy is a chronic infectious disease of public health importance and one of the leading causes of permanent physical disability. Nevertheless, the drop in prevalence following multidrug therapy has resulted in the neglect of leprosy. The annual incidence of leprosy has remained the same in Ethiopia since decades with more than 76% of the reported new cases coming from Oromia and Amhara Regional States. This study was aimed to assess the knowledge, attitude and skill of general health workers in leprosy control activities at public health facilities in Oromia and Amhara Regional States. METHODS: A cross-sectional study was conducted from September 2011 to February 2012 at different public health facilities in selected eight zones in Oromia and Amhara Regional States. A multistage sampling method was used to obtain representative samples. High and low endemic zones for leprosy were included in the study in both regional states. Data were collected from general health workers through a structured self-administered questionnaire and at on-site assessment of their performance. Baseline socio-demographic data, health workers' attitude towards leprosy and their knowledge and skill in the management of leprosy were assessed. Bloom's cut off point was used to describe the knowledge and practical skills of the respondents while Likert's scale was used for attitude assessment. RESULT: A total of 601 general health workers responsible for leprosy control activities at public health facilities were included in knowledge and attitude assessment and 83 of them were subjected to practical evaluation, with on-site observation of how they handle leprosy patients. These included medical doctors (4%), health officers and nurses with Bachelor degree in Science (27%), clinical nurses with diploma (66%) and health assistants (2.8%). The median age of the respondents was 26.0 years and females made up of 45%. Generally the knowledge and skills of the respondents were found to be poor while attitude towards leprosy was positive for the majority of the respondents. The result showed that 519 (86.3%) had poor knowledge. Overall 155 (25.8%) of the respondents had positive attitude towards leprosy while 205 (34.1%) had intermediate (mixed) attitude and 241 (40.1%) had negative attitude to the disease. Among 83 respondents assessed for diagnosis of leprosy only 15(18.0%) diagnosed leprosy correctly. Variation in knowledge and attitude indicated a significant difference (p < 0.05) among different health institutions, professions, gender, in-service training and years of experience. CONCLUSION: The current finding underlines that although leprosy control activities are integrated to the general health services in the country, the knowledge and skills of leprosy diagnosis, treatment and management by health workers was unsatisfactory. Hence, attention should be given to develop training strategies that can improve health worker knowledge and promote better leprosy management at public health facilities. This could be achieved through pre-service and in-service training and giving adequate emphasis to leprosy related practical work and continuous follow- up.

Strengthening the Tuberculosis Specimen Referral Network in Uganda: The Role of Public-Private Partnerships.

BACKGROUND: Diagnosis of multidrug-resistant tuberculosis and prompt initiation of effective treatment rely on access to rapid and reliable drug-susceptibility testing. Efficient specimen transport systems and appropriate training on specimen referral contribute to optimal and timely access to tuberculosis diagnostic services. METHODS: With support and technical assistance from a public-private partnership (PPP) between Becton Dickinson and the US President's Emergency Plan for AIDS Relief, the Uganda National TB Reference Laboratory (NTRL) and National TB and Leprosy Program redesigned the tuberculosis specimen transport network and trained healthcare workers with the goal of improving multidrug-resistant tuberculosis detection. RESULTS: Between 2008 and 2011, the PPP mapped 93% of health facilities and trained 724 healthcare and postal staff members covering 72% of districts. Strengthening the tuberculosis specimen referral system increased referrals from presumptive multidrug-resistant tuberculosis cases by >10-fold, with 94% of specimens reaching the NTRL within the established target transport time. CONCLUSIONS: This study demonstrates the potential of PPP collaborations with ministries of health to positively influence patient care by strengthening laboratory systems through increased access to drug-susceptibility testing in Uganda. Ongoing efforts to integrate specimen transport networks will maximize resources and improve patient management.

Health concerns of Micronesian peoples.

Several states in the United States have been experiencing an influx of migrants from an area of the world that most people have only heard of when learning about the atomic bomb and World War II. This area is the former U.S. Trust Territory of Pacific Islands now called the Freely Associated States. At the end of World War II, the United States took possession of many of these islands and in 1948, the United States formally took over administration of the Marshalls, the Carolines, Palau, and the Northern Marianas islands. Collectively this area is known as Micronesia. Micronesians come from areas that have high prevalence of several communicable diseases and there is growing concern that Micronesian immigrants may enable the spread of infectious disease to the United States from Asia. Data concerning Hansen's disease and tuberculosis support this claim. According to data from the Hawai'i State Department of Health, a 5-year trend examining new cases of tuberculosis in Hawai'i identified that 65 out of 77 new cases came from the Freely Associated States of Micronesia. Presented is an overview of the health concerns and health status of the people from the Federated States of Micronesia.

Filantropia, poder público e combate à lepra (1920-1945) / Philanthropy, government, and the fight against leprosy (1920-1945)

Durante a Primeira República (1889-1930), a criação das Sociedades de Assistência aos Lázaros e Defesa Contra a Lepra, na década de 1920, foi um marco nas relações entre as entidades assistenciais e os poderes públicos. Inicialmente aquelas entidades mantiveram autonomia decisória, mas suas diretrizes mudaram quando estabeleceram relações mais próximas com a política de combate à lepra, após a criação do Ministério da Educação e Saúde Pública, em 1930, no âmbito das reformas implementadas a partir de então, e, especialmente, durante a prolongada gestão de Gustavo Capanema à frente daquele ministério (1934-1945).

The 1920s creation of Sociedades de Assistência aos Lázaros e Defesa Contra a Lepra under Brazil's First Republic (1889-1930) represented a milestone in relations between assistance organizations and the government. Although these organizations were at first autonomous decision-makers, their guidelines changed after they established closer relations with the government, which enacted reforms in policies to fight leprosy following the 1930 creation of the Ministry of Education and Public Health, especially during the long tenure of Minister Gustavo Capanema (1934-1945).