ABSTRACT
GeneXpert® Edge (GX-Edge) is a new point-of-care platform not yet tested in the field. In this proof-of-concept study conducted for the diagnosis of tuberculosis in communities living alongside two large rivers of the Brazilian Amazon, we demonstrate that GX-Edge implemented in boats to offer onsite testing is a feasible strategy to investigate potentially devastating diseases such as tuberculosis in difficult-to-reach populations, such as riverside communities.
Subject(s)
Molecular Diagnostic Techniques/methods , Point-of-Care Systems , Tuberculosis/diagnosis , Brazil , Delivery of Health Care , Feasibility Studies , HumansABSTRACT
[This corrects the article DOI: 10.1371/journal.pone.0218359.].
ABSTRACT
OBJECTIVES: Estimate TB mortality rates, catalogue multiple causes on death certificates in which TB was reported and identify predictors of TB from reporting on death certificates in the State of Amazonas, Brazil, based on a multiple cause of death approach. METHODS: The death records of residents in the Amazonas state between 2006-2014 were analyzed and separated into three categories: TB not reported on the death certificate (TBNoR), TB reported as the underlying cause of death (TBUC) and TB reported as an associated cause of death (TBAC). Age standardized annual mortality rates for TBUC, TBAC and with TB reported (TBUC plus TBAC) were estimated for the State of Amazonas using the direct standardization method and World Health Organization 2000-2025 standard population. Mortality odds ratios (OR) for reporting of TBUC and TBAC were estimated using multinomial logistic regression. RESULTS: Age standardized annual TBUC and TBAC mortality rates ranged between 5.9-7.8/105 and 2.7-4.0/105, respectively. TBUC was associated with being a resident in the State capital (OR = 0.66), of female gender (OR = 0.87), having an education level of 8 to 11, or 12 or more school years (OR = 0.67 and 0.50 respectively), non-white race/skin color (OR = 1.38) and place of death reported as in the State capital (OR = 1.69). TBAC was related to the triennium in which death occurred (OR = 1.21 and 1.22 for the years 2009-2011 and 2012-2014 respectively), age (OR = 36.1 and 16.5 for ages 15-39 and 40-64 years respectively) and when death occurred in the State capital (OR = 5.8). CONCLUSIONS: TBUC was predominantly associated with predictors of unfavorable socioeconomic conditions and health care access constraints, whereas TBAC was mainly related to ages which were typical of high HIV disease incidence.
Subject(s)
Cause of Death , HIV Infections/mortality , Tuberculosis/mortality , Adolescent , Adult , Brazil/epidemiology , Comorbidity , Death Certificates , Female , HIV Infections/epidemiology , HIV Infections/physiopathology , Humans , Male , Middle Aged , Tuberculosis/epidemiology , Tuberculosis/physiopathology , Young AdultABSTRACT
OBJECTIVE: To analyse the temporal and spatial distribution as well as the environmental and socioeconomic factors associated with cutaneous leishmaniasis incidence in the state of Amazonas, Brazil from 2007 to 2015. METHODS: Spatial and temporal distribution was evaluated from sequential thematic maps of the mean incidence rates of the disease. A negative binomial regression analysis was performed to evaluate the association of the factors studied with the mean incidence rate of ACL. RESULTS: The average proportion of deforestation was negatively associated with the average incidence rate of cutaneous leishmaniasis in municipalities (ß = -2.178; P = 0.019; 95%CI -3.996, -0.361), and the health system performance index (effectiveness) (ß = -0.852; P = 0.008; 95%CI -1.481, -0.225). Conversely, the municipal human development index (MHDI) was a factor positively related to the average incidence among the municipalities (ß = 7.728; P = 0.003; 95%CI 2.716, 12.738). CONCLUSION: Our study shows the important impact of socioeconomic and environmental factors on ACL incidence in the Amazonas State.
OBJECTIF: Analyser la distribution temporelle et spatiale ainsi que les facteurs environnementaux et socioéconomiques associés à l'incidence de la leishmaniose cutanée dans l'Etat de l'Amazonas, au Brésil, de 2007 à 2015. MÉTHODES: La distribution spatiale et temporelle a été évaluée à partir de cartes thématiques séquentielles des taux d'incidence moyens de la maladie. Une analyse de régression binomiale négative a été réalisée pour évaluer l'association des facteurs étudiés avec le taux d'incidence moyen de la LCA. RÉSULTATS: La proportion moyenne de déforestation était négativement associée au taux d'incidence moyen de la leishmaniose cutanée dans les municipalités (ß = -2,178; p = 0,019; IC95%: -3,996 à -0,361) et à l'indice de performance du système de santé (efficacité) (ß = -0,852; p = 0,008; IC95%: -1,481 à -0,225). Par contre, l'indice de développement humain municipal (IDHM) était un facteur positivement lié à l'incidence moyenne dans les municipalités (ß = 7,728; p = 0,003; IC95%: 2,716 à 12,738). CONCLUSION: Notre étude montre l'impact important des facteurs socioéconomiques et environnementaux sur l'incidence de la LCA dans l'Etat d'Amazonas.
