Tuberculosis in South Asian communities in the UK: a systematic review of the literature.

BACKGROUND: Rates of tuberculosis (TB) in UK South Asian communities are up to 17 times higher than in white British groups. Latent infection in new migrants provides only a partial explanation. We undertook a systematic review of the literature to establish existing knowledge about TB in South Asian communities. METHODS: We undertook a search for literature relating to TB and its management in South Asian communities in the UK. Articles initially identified were screened for relevance. A narrative review of relevant articles was then conducted. RESULTS: We found 18 relevant articles. Associated risk factors for TB included poverty, deprivation, return visits to the Indian subcontinent, history of close contact with a case, gender, religion, possible dietary factors such as Vitamin D deficiency, duration of stay in the UK and country of birth. However, the evidence for these factors was often conflicting or weak, and suggests that commonly proposed hypotheses may not provide robust explanations for the higher rates of diagnosis. CONCLUSIONS: Migration patterns and the demographic profile of the South Asian communities are constantly changing. Further research into the determinants of TB infection in these communities in the UK is urgently needed to inform the commissioning of TB health services.

The economic benefits of increasing kangaroo skin-to-skin care and breastfeeding in neonatal units: analysis of a pragmatic intervention in clinical practice.

BACKGROUND: A number of significant recent research studies have used techniques of economic modelling to demonstrate the potential benefits of increasing breastfeeding rates in the UK overall, and specifically in neonatal care. This paper complements this growing body of evidence by presenting an economic analysis of data from an actual intervention, the 'Getting It Right From the Start' programme, which took place in the north of the UK during 2011-12, with the aim of increasing breastfeeding and kangaroo skin-to-skin care rates in neonatal units. METHODS: 'Getting It Right from the Start' was a pragmatic, multifaceted programme of change delivered under the auspices of the regional Health Innovation and Education Cluster, of which 17 were established in the UK in 2010. It engaged with 18 neonatal units in two Neonatal Networks with the aim of increasing kangaroo skin-to-skin care and breastfeeding rates. As part of the evaluation of the programme, we conducted an economic study comparing the overall costs and benefits of the intervention. RESULTS: Overall, the economic analysis demonstrated that for every £1 invested in the intervention to increase kangaroo skin-to-skin care and breastfeeding rates, between £4.00 and £13.82 of benefit was generated. This was spread across different healthcare settings and the timescale for the realisation of benefits will vary. The increases in kangaroo skin-to-skin care generated the greatest cost savings, with potential cost savings ranging between £668,000 (minimum cost assumptions) to more than £2 m (maximum cost assumptions). Increases in breastfeeding associated with the project generated between £68,486 and £582,432. The majority of the cost savings generated were associated with reductions in cases of gastroenteritis and necrotising enterocolitis. CONCLUSION: This was one of the first economic evaluations of an actual intervention to increase breastfeeding and kangaroo skin-to-skin care in neonatal units. It complements the existing economic models by demonstrating that a real intervention in clinical practice was both cost effective as well as clinically beneficial. Future interventions with similar methodology should be supported and considered likely to generate significant cost savings compared to outlay. Economic evaluation should be more frequently included in studies of practical interventions in clinical settings to increase breastfeeding.