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1.
Pan Afr Med J ; 33: 31, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31384346

RESUMO

Tuberculosis (TB) is endemic in the Central African Republic (CAR) with an incidence rate of 391 per 100,000 population in 2015. This study aims to analyze current epidemiological and clinical features of TB at the Hôpital de l'Amitié in the Central African Republic. We conducted an analytic retrospective study of patients hospitalized in the Department of Medicine at the Hôpital de l'Amitié from 15 April 2010 to 14 October 2011. Data were collected using a questionnaire and then analyzed with Epi info software 3.5.3. Chi-square test was used to compare proportions, using a threshold significance level of 5%. The study included 220 patients, of whom 128 were women (58.18%). The average age of patients was 35.69± 10.65 years. In 42.70% of cases, patients had no professional activity. Prevalence of tuberculosis in hospital was 10.99%. On average, 12 cases of TB were recorded each month. Most common clinical signs included: chronic cough (71.81%), fever (96.82%), alteration of the general state (91.36%) and pulmonary condensation syndrome (63.64%). The diseases most commonly associated with tuberculosis were HIV/AIDS (73.36%), malaria (48.63%) and anemia (31.81%). The mean time between symptom onset and diagnosis was 37.65 days. Mortality rate was 18.63%. TB/HIV co-infection and neuromeningeal TB were associated with a high mortality rate (p < 0.05). Tuberculosis is a common disease in Bangui and it is often associated with HIV infection. Prognosis is poor in the case of neuromeningeal involvement. Prevention and routine monitoring in HIV infected patients may contribute to reduce the extent and severity of TB.


Assuntos
Infecções por HIV/epidemiologia , Hospitalização , Tuberculose Meníngea/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Anemia/epidemiologia , República Centro-Africana/epidemiologia , Coinfecção , Feminino , Humanos , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Tuberculose/diagnóstico , Tuberculose/mortalidade , Tuberculose Meníngea/mortalidade , Adulto Jovem
2.
J Glob Health ; 9(1): 010423, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263546

RESUMO

Background: Tuberculosis (TB) is a major global health burden, which has been inadequately addressed. This study aims to analyze different patterns and gaps of care along the care cascade across countries and to develop a model to examine the relationship between performance of tuberculosis programmes in high and low burden countries along the tuberculosis care cascade and tuberculosis disease burden. Methods: We used the World Health Organization's Global TB Database for the year 2016 to construct tuberculosis care cascade consisting of four steps: incidence, diagnosed, treatment started and treatment completed. Based on the constructed care cascades, we analyzed the relationship between health system performance indicators and tuberculosis cascades performance: diagnosed rate, treatment started rate, and treatment completed rate. Results: There are wide differences in access to diagnosis and treatment between high-burden countries and non-high-burden countries. The largest gap was found between incidence and diagnosed rate, with 65% of diagnosed rate for high burden countries and 80% of diagnosed rate for non-high burden countries. We found variations in care performance among high-burden countries. We found a negative relationship between the population health indicators related to the mortality rate and TB care cascade performance. There was a positive relationship between immunization coverage rate and antenatal care indicators and TB care cascade performance. Conclusions: Well-functioning tuberculosis care cascades and effective health systems are important for the successful management of tuberculosis. While improving screening performance is essential for tuberculosis control especially for high-burden countries, resource should be allocated to improve health system performance, which is weak in high-burden countries. Performance of TB programmes across care cascade could be used as a useful tracer to measure performance of health systems.


Assuntos
Assistência à Saúde/organização & administração , Saúde Global/estatística & dados numéricos , Tuberculose/prevenção & controle , Bases de Dados como Assunto , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Incidência , Modelos Organizacionais , Avaliação de Programas e Projetos de Saúde , Tuberculose/epidemiologia , Organização Mundial da Saúde
3.
Pan Afr Med J ; 32: 159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31308862

RESUMO

Introduction: Focus has been put on strengthening surveillance systems in high tuberculosis (TB) burden countries, like Zambia, however inadequate information on factors associated with unfavourable TB treatment outcomes is generated from the system. We determined the proportion of tuberculosis treatment outcomes and their associated factors. Methods: We defined unfavourable outcome as death, lost-to-follow-up, treatment-failure, or not-evaluated and favourable outcome as a patient cured or completed-treatment. We purposively selected a 1st level hospital, an urban-clinic and a peri-urban clinic. We abstracted data from TB treatment registers at these three health facilities, for all TB cases on treatment from 1st January to 31st December, 2015. We calculated proportions of treatment outcomes and analysed associations between unfavourable outcome and factors such as age, HIV status, health facility, and patient type, using univariate logistics regression. We used multivariable stepwise logistic regression to control for confounding and reported the adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results: We included a total of 1,724 registered TB patients, from one urban clinic 694 (40%), a 1st Level Hospital 654 (38%), and one peri-urban-clinic 276 (22%). Of the total patients, 43% had unfavourable outcomes. Of the total unfavourable outcomes, were recorded as treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not evaluated (29%). The odds of unfavourable outcome were higher among patients > 59 years (AOR=2.9, 95%CI: 1.44-5.79), relapses (AOR=1.65, 95%CI: 1.15-2.38), patients who sought treatment at the urban clinic (AOR=1.76, 95%CI:1.27-2.42) and TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11-2.19). Conclusion: Unfavourable TB treatment outcomes were high in the selected facilities. We recommend special attention to TB patients who are > 59 years old, TB relapses and TB / HIV co-infected. The national TB programme should strengthen close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.


Assuntos
Antituberculosos/uso terapêutico , Programas Nacionais de Saúde/organização & administração , Vigilância da População , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Coinfecção/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Perda de Seguimento , Masculino , Pessoa de Meia-Idade , Falha de Tratamento , Resultado do Tratamento , Tuberculose/epidemiologia , Adulto Jovem , Zâmbia/epidemiologia
4.
Epidemiol Health ; 41: e2019028, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319659

RESUMO

OBJECTIVES: Tuberculosis (TB) is common in children with human immunodeficiency virus (HIV), but its effect on the survival of HIV-infected children is not well understood. Therefore, the aim of this study was to assess the incidence and predictors of active TB among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia. METHODS: A retrospective study was conducted over 5 years using a checklist to gather data from 428 randomly selected pediatric patient charts. The checklist was adapted from the standardized antiretroviral therapy (ART) follow-up form currently used by the institution's ART clinic. Data were analyzed by bivariate and multivariable analysis using Cox regression proportional hazards models, as appropriate. Survival was calculated and compared using the Kaplan-Meier and log-rank tests. RESULTS: Of the 466 charts reviewed, 428 patient records were included in the analysis. A total of 67 new TB cases were observed during the follow-up period. Hence, the incidence rate in this cohort was found to be 6.03 per 100 child-years of observation. A baseline hemoglobin level <10 g/dL (adjusted hazard ratio [aHR], 7.04; 95% confidence interval [CI], 1.03 to 48.15), moderate wasting (aHR, 2.86; 95% CI, 1.02 to 7.99), and not receiving isoniazid preventive therapy (aHR, 8.23; 95% CI, 2.11 to 32.06) were among the independent predictors of TB occurrence. CONCLUSIONS: The incidence of TB was high, particularly in pre-ART patients receiving chronic care for HIV. Close followup of HIV-positive children is crucial to protect them against the development of TB. Initiating isoniazid preventive therapy, averting malnutrition, and managing anemia are also of significant importance.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Isoniazida/uso terapêutico , Masculino , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Tuberculose/prevenção & controle
5.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 1088-1095, jul.-set. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005471

RESUMO

Objetivo: Analisar o perfil e identificar os fatores associados à tuberculose em idosos no Maranhão no período de 2010 a 2015. Métodos: Estudo transversal analítico com os casos de tuberculose em idosos no estado do Maranhão. Foram utilizados dados secundários do SINAN, disponíveis no Datasus. Para identificar as associações entre o desfecho (tuberculose em idosos) e as variáveis independentes, utilizou-se a regressão de Poisson. Resultados: Após o ajuste do modelo, a escolaridade < 8 anos de estudo, ter encerramento por não cura, exame anti HIV não realizado e ter diabetes apresentaram­se como fatores que aumenta a chance da ocorrência de tuberculose em idosos. As demais variáveis apresentaram-se como fator protetor. Conclusão: Foi observada alta prevalência de tuberculose em idosos no estado (16,6%). Há necessidade de se adotarem estratégias de acompanhamento dessa clientela


Objective: To analyze the profile and identify the factors associated with tuberculosis in the elderly in Maranhão from 2010 to 2015. Methods: An analytical cross-sectional study with cases of tuberculosis in the elderly in the State of Maranhão. Secondary data from SINAN, available on Datasus, were used. To identify the associations between the outcome (tuberculosis in the elderly) and the independent variables, Poisson regression was used. Results: After adjustment of the model, schooling < 8 years of study, closure due to non-cure, unrecovered HIV test and diabetes had a factor that increases the chance of tuberculosis occurring in the elderly. The other variables were presented as protective factor. Conclusion: A high prevalence of tuberculosis in the elderly was observed in the State (16.6%). There is a need to adopt strategies to follow up this clientele


Objetivo: Analizar el perfil e identificar los factores asociados a la tuberculosis em ancianos en Maranhão en el período de 2010 a 2015. Métodos: Estudio transversal analítico con los casos de tuberculosis en ancianos en el Estado de Maranhão. Se utilizaron datos secundarios del SINAN, disponibles en Datasus. Para identificar las asociaciones entre el desenlace (tuberculosis en ancianos) y las variables independientes se utilizó la regresión de Poisson. Resultados: Después del ajuste del modelo la escolaridad < 8 años de estudio, tener cierre por no cura, examen anti VIH no realizado y tener diabetes se presentaron como factor que aumenta la probabilidad de la ocurrencia de tuberculosis en ancianos. Las demás variables se presentaron como factor protector. Conlusión: Se observó una alta prevalencia de tuberculosis en ancianos en el Estado (16,6%). Hay necesidad de adoptar estrategias de acompañamiento de esa clientela


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Idoso/estatística & dados numéricos , Saúde do Idoso , Serviços de Saúde para Idosos
6.
N Engl J Med ; 381(3): 219-229, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31314966

RESUMO

BACKGROUND: Universal antiretroviral therapy (ART) with annual population testing and a multidisease, patient-centered strategy could reduce new human immunodeficiency virus (HIV) infections and improve community health. METHODS: We randomly assigned 32 rural communities in Uganda and Kenya to baseline HIV and multidisease testing and national guideline-restricted ART (control group) or to baseline testing plus annual testing, eligibility for universal ART, and patient-centered care (intervention group). The primary end point was the cumulative incidence of HIV infection at 3 years. Secondary end points included viral suppression, death, tuberculosis, hypertension control, and the change in the annual incidence of HIV infection (which was evaluated in the intervention group only). RESULTS: A total of 150,395 persons were included in the analyses. Population-level viral suppression among 15,399 HIV-infected persons was 42% at baseline and was higher in the intervention group than in the control group at 3 years (79% vs. 68%; relative prevalence, 1.15; 95% confidence interval [CI], 1.11 to 1.20). The annual incidence of HIV infection in the intervention group decreased by 32% over 3 years (from 0.43 to 0.31 cases per 100 person-years; relative rate, 0.68; 95% CI, 0.56 to 0.84). However, the 3-year cumulative incidence (704 incident HIV infections) did not differ significantly between the intervention group and the control group (0.77% and 0.81%, respectively; relative risk, 0.95; 95% CI, 0.77 to 1.17). Among HIV-infected persons, the risk of death by year 3 was 3% in the intervention group and 4% in the control group (0.99 vs. 1.29 deaths per 100 person-years; relative risk, 0.77; 95% CI, 0.64 to 0.93). The risk of HIV-associated tuberculosis or death by year 3 among HIV-infected persons was 4% in the intervention group and 5% in the control group (1.19 vs. 1.50 events per 100 person-years; relative risk, 0.79; 95% CI, 0.67 to 0.94). At 3 years, 47% of adults with hypertension in the intervention group and 37% in the control group had hypertension control (relative prevalence, 1.26; 95% CI, 1.15 to 1.39). CONCLUSIONS: Universal HIV treatment did not result in a significantly lower incidence of HIV infection than standard care, probably owing to the availability of comprehensive baseline HIV testing and the rapid expansion of ART eligibility in the control group. (Funded by the National Institutes of Health and others; SEARCH ClinicalTrials.gov number, NCT01864603.).


Assuntos
Antirretrovirais/uso terapêutico , Serviços de Saúde Comunitária , Infecções por HIV/tratamento farmacológico , Administração Massiva de Medicamentos , Programas de Rastreamento , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Incidência , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Prevalência , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Uganda/epidemiologia , Carga Viral , Adulto Jovem
7.
Pan Afr Med J ; 32: 60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223352

RESUMO

Introduction: Nigeria is among six countries responsible for the majority of tuberculosis (TB) cases in the world. The Nigerian government has emphasized community-based case finding to increase detection of TB. This process requires efforts to improve knowledge, attitudes and practices (KAP) of TB, particularly in the poorest of communities. This study presents data from a KAP survey administered in two underserved Nigerian communities. Methods: a structured survey was administered by trained interviewers among adult residents in two slum communities in Lagos, Nigeria. Participants were selected through multistage random sampling. KAP scores were computed and the predictors of higher scores were assessed. Results: a total of 504 respondents were surveyed. The mean KAP scores were relatively low: 9.8 ± 7.1 for knowledge (out of a maximum 34), 5.3 ± 3.4 for attitude (maximum = 10), and 5.2 ± 1.5 for practice (maximum = 7). The predictors of good knowledge were increasing age, post secondary education and professional occupation. The predictors of positive attitude were post secondary education and good TB knowledge. Good knowledge was a predictor of good practice. Conclusion: our findings underscore the need to improve the education about TB in underserved communities. Improving KAP scores will ultimately lead to higher rates of TB detection and treatment.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Áreas de Pobreza , Tuberculose/diagnóstico , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Ocupações/estatística & dados numéricos , Inquéritos e Questionários , Tuberculose/epidemiologia , Adulto Jovem
8.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 633-637, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238610

RESUMO

Objective: Autoregressive integrated moving average (ARIMA) model was used to predict the incidence of tuberculosis in China from 2018 to 2019, providing references for the prevention and control of pulmonary tuberculosis. Methods: The monthly incidence data of tuberculosis in China were collected from January 2005 to December 2017. R 3.4.4 software was used to establish the ARIMA model, based on the monthly incidence data of tuberculosis from January 2005 to June 2017. Both predicted and actual data from July to December 2017 were compared to verify the effectiveness of this model, and the number of tuberculosis cases in 2018-2019 also predicted. Results: From 2005 to 2017, a total of 13 022 675 cases of tuberculosis were reported, the number of pulmonary tuberculosis patients in 2017 was 33.68% lower than that in 2005, and the seasonal character was obvious, with the incidence in winter and spring was higher than that in other seasons. According to the incidence data from 2005 to 2017, we established the model of ARIMA (0,1,2)(0,1,0)(12). The relative error between the predicted and actual values of July to December 2017 fitted by the model ranged from 1.67% to 6.80%, and the predicted number of patients in 2018 and 2019 were 789 509 and 760 165 respectively. Conclusion: The ARIMA (0, 1, 2)(0, 1, 0)(12) model well predicted the incidence of tuberculosis, thus can be used for short-term prediction and dynamic analysis of tuberculosis in China, with good application value.


Assuntos
Modelos Estatísticos , Tuberculose/epidemiologia , China/epidemiologia , Previsões , Humanos , Incidência , Software , Tuberculose/diagnóstico
9.
Cent Eur J Public Health ; 27(2): 99-105, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31241283

RESUMO

OBJECTIVE: The aim of the study was to estimate the seroprevalence of HIV infection among TB patients, knowledge, self-perceived risks and testing practices related to HIV. METHODS: We performed cross-sectional study from 10 May to 15 July 2011. Cluster sampling method was used to select 27 hospitals where 289 TB patients were consecutively recruited. Descriptive statistics and multivariable logistic regression methods were used to identify the factors associated with correct comprehensive knowledge of HIV/AIDS. RESULTS: HIV prevalence among TB patients was 0.3%. Only 25.2% of the respondents presented comprehensive correct knowledge of HIV/AIDS. The percentage of correct answers to all questions related to knowledge about HIV/AIDS increases with educational status (χ2 = 5.42; p < 0.05) and decreases with the age of respondents (χ2 = 8.53; p > 0.05). The independent predictors of correct comprehensive knowledge were living without partner (OR = 4.45; CI = 1.59-12.95) and self-awareness of HIV risk (OR = 4.43; CI = 1.20-16.52). CONCLUSION: HIV prevalence among TB patients is higher than among general population in Serbia. The level of comprehensive correct knowledge of HIV/AIDS is low. There is a need for continuous implementation of public health strategy to successfully manage HIV and HIV/TB co-infection in Serbia.


Assuntos
Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Tuberculose/epidemiologia , Adulto , Distribuição por Idade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sérvia/epidemiologia , Estudos Soroepidemiológicos , Adulto Jovem
11.
Nat Commun ; 10(1): 2480, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171791

RESUMO

Global stakeholders including the World Health Organization rely on predictive models for developing strategies and setting targets for tuberculosis care and control programs. Failure to account for variation in individual risk leads to substantial biases that impair data interpretation and policy decisions. Anticipated impediments to estimating heterogeneity for each parameter are discouraging despite considerable technical progress in recent years. Here we identify acquisition of infection as the single process where heterogeneity most fundamentally impacts model outputs, due to selection imposed by dynamic forces of infection. We introduce concrete metrics of risk inequality, demonstrate their utility in mathematical models, and pack the information into a risk inequality coefficient (RIC) which can be calculated and reported by national tuberculosis programs for use in policy development and modeling.


Assuntos
Política de Saúde , Risco , Tuberculose/epidemiologia , Brasil/epidemiologia , Disparidades nos Níveis de Saúde , Humanos , Modelos Teóricos , Formulação de Políticas , Portugal/epidemiologia , Medição de Risco , Vietnã/epidemiologia , Organização Mundial da Saúde
12.
BMC Infect Dis ; 19(1): 556, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238885

RESUMO

BACKGROUND: In recent decades, Mycobacterium tuberculosis with the RDRio genotype, frequently isolated from tuberculosis patients in Rio de Janeiro, has become part of the Latin American - Mediterranean (LAM) family and has been associated with multidrug-resistant tuberculosis (MDR-TB). The aim of this study was to investigate the frequency of M. tuberculosis RDRio in the state of Minas Gerais, Brazil, and its relationship with MDR-TB. METHODS: For convenience, 172 susceptible and 63 MDR M. tuberculosis isolates were taken from pulmonary samples from patients diagnosed between January 2007 and December 2011. The DNA extracted from these isolates was analyzed by spoligotyping, PCR-RFLP to characterize fbpC103/Ag85C103, multiplex PCR to detect RDRio and RD174, and MIRU-VNTR 24 loci. RESULTS: Among the 235 isolates, the RDRio pattern was identified in 122 (51.9%) isolates (IC 0.45-0.58), with 100 (42.5%) wild-type and 13 (5.5%) mixed pattern isolates, whereas RD174 was identified in 93 of the 122 RDRio positive samples (76.3%). The LAM family and the LAM9 lineage were the most frequently identified among the isolates in this study. Among the 63 MDR isolates, 41 (65.1%) were RDRio and 28 (44.4%) RD174. CONCLUSION: The association of both deletions with MDR proved to be statistically significant, corroborating the few reports that have associated RDRio with MDR.


Assuntos
Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Técnicas de Tipagem Bacteriana , Brasil/epidemiologia , Farmacorresistência Bacteriana Múltipla/genética , Frequência do Gene , Estudos de Associação Genética , Genótipo , Humanos , Testes de Sensibilidade Microbiana , Repetições Minissatélites , Reação em Cadeia da Polimerase/métodos , Polimorfismo de Fragmento de Restrição , Polimorfismo de Nucleotídeo Único , Tuberculose/epidemiologia , Tuberculose/microbiologia
13.
Rev. méd. Urug ; 35(2): 102-112, jun. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-999579

RESUMO

Introducción y objetivo: la tuberculosis (TB) es una de las principales causas de mortalidad a nivel mundial con tendencia al estancamiento en su control, situación a la que no es ajena Venezuela, y particularmente el estado Carabobo con importantes cifras de enfermedades respiratorias. El objetivo de este trabajo fue describir las características clínico-epidemiológicas de la TB ocurrida durante un año en el estado Carabobo. Método: estudio descriptivo, de campo y retrospectivo. Resultados: fueron en total 712 casos de TB pulmonar y 15 de TB extrapulmonar, mayoritariamente del municipio Valencia del estado Carabobo con afectación fundamental del sexo masculino (76% y 67%, respectivamente), además 67% de los afectados con la forma pulmonar se encuentran en edad económicamente productiva así como 53% de los pacientes con la variante extrapulmonar, siendo la meníngea la variante extrapulmonar de mayor frecuencia. Asimismo, 16,1% de los pacientes con TB pulmonar tenían privación de libertad. Los afectados con TB tienen en mayor proporción como factor de riesgo la ingesta de alcohol y como patología sobreagregada la desnutrición. Los afectados con TB pulmonar muestran la sintomatología clásica con patrón radiológico bilateral cavitario de TB secundaria. Conclusiones: la tasa de morbilidad por TB en 2017 muestra importante alza para el estado Carabobo, contraria a la tendencia mundial al descenso. Este trabajo se constituye en una puesta al día en la caracterización clínica-epidemiológica de la TB en el estado Carabobo con el objeto de aportar a los organismos oficiales información para la toma de decisiones sanitarias en el efectivo control de esta enfermedad.


Introduction: tuberculosis (TB) is one of the main causes of mortality worldwide with a tendency to stagnation in its control. Venezuela follows the global tendency, and in particular the state of Carabobo, which accounts for significant numbers of respiratory diseases. Objective: to describe the clinical-epidemiological characteristics of TB that occurred during one year in the state of Carabobo. Method: descriptive, field and retrospective study. Results: A total of 712 cases of pulmonary TB and 15 cases of extrapulmonary TB were part of the study, most of them in the municipality of Valencia of the state of Carabobo, with fundamental involvement of the male gender (76% and 67% respectively), and 67% of the patients affected being economically productive, as well as 53% of the patients with the extrapulmonary variant, being the meningeal the extrapulmonary variant of greater frequency. Likewise, 16.1% of patients with pulmonary TB were deprived of their liberty. Those affected with TB have a higher risk of alcohol intake as a risk factor and malnutrition as an added pathology. Those affected with pulmonary TB show the classic symptomatology with a bilateral cavitary radiological pattern of secondary TB. Conclusions: the TB morbidity rate in 2017 shows an important increase for the Carabobo state, contrary to the global tendency to decrease, and this study constitutes an update on the clinical-epidemiological characterization of TB in the state of Carabobo with the purpose of providing official organizations with information for making health decisions for the effective control of this disease.


Introdução e objetivo: a tuberculose (TB) é uma das principais causas de mortalidade no mundo, com tendência à estagnação no seu controle, uma situação que não é alheia na Venezuela, e particularmente no estado de Carabobo com um número significativo de doenças respiratórias. O objetivo deste trabalho é descrever as características clínico-epidemiológicas da TB ocorridas durante um ano no estado de Carabobo. Método: estudo descritivo, de campo e retrospectivo. Resultados: foram registrados 712 casos de tuberculose pulmonar e 15 extrapulmonar principalmente no município de Valencia em Carabobo com maior incidência em pacientes do sexo masculino (76% e 67%, respectivamente); mais de 67% dos pacientes com a forma pulmonar estavam em idades economicamente produtivas, bem como 53% dos pacientes com a variante extrapulmonar, sendo a variante meníngea extrapulmonar a de maior frequência. 16,1% dos pacientes com TB pulmonar estavam privados de liberdade. Uma maior proporção dos pacientes afetados pela tuberculose apresenta como fator de risco a ingestão de álcool e de desnutrição como patologia adicional. Os acometidos por TB pulmonar apresentam a sintomatologia clássica com padrão radiológico cavitário bilateral de TB secundária. Conclusões: a taxa de morbidade por TB em 2017 mostrou um aumento relevante no estado de Carabobo, oposta a tendência mundial de redução; este trabalho apresenta uma atualização sobre as características clínicas e epidemiológicas da tuberculose no estado de Carabobo com o objetivo de fornecer às organizações oficiais informação para a tomada de decisões sanitárias para o controle efetivo dessa doença.


Assuntos
Humanos , Tuberculose/mortalidade , Tuberculose/epidemiologia , Venezuela
14.
MMWR Morb Mortal Wkly Rep ; 68(19): 439-443, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31099768

RESUMO

The 2005 CDC guidelines for preventing Mycobacterium tuberculosis transmission in health care settings include recommendations for baseline tuberculosis (TB) screening of all U.S. health care personnel and annual testing for health care personnel working in medium-risk settings or settings with potential for ongoing transmission (1). Using evidence from a systematic review conducted by a National Tuberculosis Controllers Association (NTCA)-CDC work group, and following methods adapted from the Guide to Community Preventive Services (2,3), the 2005 CDC recommendations for testing U.S. health care personnel have been updated and now include 1) TB screening with an individual risk assessment and symptom evaluation at baseline (preplacement); 2) TB testing with an interferon-gamma release assay (IGRA) or a tuberculin skin test (TST) for persons without documented prior TB disease or latent TB infection (LTBI); 3) no routine serial TB testing at any interval after baseline in the absence of a known exposure or ongoing transmission; 4) encouragement of treatment for all health care personnel with untreated LTBI, unless treatment is contraindicated; 5) annual symptom screening for health care personnel with untreated LTBI; and 6) annual TB education of all health care personnel.


Assuntos
Pessoal de Saúde , Programas de Rastreamento , Mycobacterium tuberculosis , Tuberculose/prevenção & controle , Centers for Disease Control and Prevention (U.S.) , Humanos , Testes de Liberação de Interferon-gama , Tuberculose Latente/epidemiologia , Tuberculose Latente/prevenção & controle , Medição de Risco , Revisão Sistemática como Assunto , Teste Tuberculínico , Tuberculose/epidemiologia , Tuberculose/transmissão , Estados Unidos/epidemiologia
15.
BMC Infect Dis ; 19(1): 379, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053104

RESUMO

BACKGROUND: The incidence of tuberculosis (TB) remains high worldwide. Current strategies will not eradicate TB by 2035; instead, by 2182 is more likely. Therefore, it is urgent that new risk factors be identified. METHODS: An ecological study was conducted in 340 prefectures in China from 2005 to 2015. The spatial distribution of TB incidence was shown by clustering and hotspot analysis. The relationship between the distribution patterns and six meteorological factors was evaluated by the geographically weighted regression (GWR) model. RESULTS: During the 11 years of the study period, TB incidence was persistently low in the east and high in the west. Local coefficients from the GWR model showed a positive correlation between TB incidence and yearly average rainfall (AR) but a negative correlation with other meteorological factors. Average relative humidity (ARH) was negatively correlated with the incidence of TB in all prefectures (p < 0.05). CONCLUSION: Meteorological factors may play an important role in the prevention and control of TB.


Assuntos
Clima , Tuberculose/epidemiologia , China/epidemiologia , Análise por Conglomerados , Humanos , Incidência , Fatores de Risco , Tuberculose/diagnóstico
16.
BMC Infect Dis ; 19(1): 405, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077133

RESUMO

BACKGROUND: Tuberculosis (TB) and HIV makeup a deadly synergy of infectious disease, and the combined effect is apparent in resource limited countries like Ethiopia. Previous studies have demonstrated inconsistent results about the protective effect of isoniazid preventive therapy (IPT) on active TB incidence among HIV positive patients receiving ART. Therefore, the aim of this meta-analysis was, first, to determine the protective effect of IPT on active tuberculosis incidence, and second, to assess the pooled incidence of active TB among HIV positive patients taking ART with and without IPT intervention in Ethiopia. METHODS: PubMed, Google scholar and Cochran library databases were searched from April 1 to 30, 2018. Two independent authors explored and assessed studies for eligibility, and extracted data based on predefined criteria. Studies that reported TB incidence among HIV positive patients taking ART in Ethiopia with and without IPT concomitant intervention, and with a clear stratified data on the incidence of TB based on the duration of IPT intervention were selected. A random effects model was used to estimate risk ratios and the pooled incident TB with the respective 95% confidence intervals. RESULTS: We identified 7 suitable studies in this analysis. Accordingly, IPT reduced the risk of TB incidence by 74%, risk ratio (RR) 0.26 (95% CI; 0.16-0.43%), compared to no IPT group. Moreover, IPT for 12 months reduced incident TB by 91% (RR: 0.09, 95% CI: 0.04 to 0.21), whereas 6 months IPT averted TB incidence by 63% (RR: 0.37, 95% CI: 0.26 to 0.52). The overall pooled incident TB among HIV infected patients receiving ART was 10.30% (95% CI; 7.57-13.02%). Specifically, incident TB among study cohorts with and without IPT was 3.79% (95% CI; 2.03-5.55%) and 16.32% (95% CI; 11.57-21.06%) respectively. CONCLUSION: IPT reduced the risk of incident TB among HIV positive patients receiving ART in Ethiopian settings. Moreover, the duration of IPT intervention has effect on its protective role. Thus, scaling up the isoniazid preventive therapy program and its strict compliance is necessary to avert HIV fueled tuberculosis. STUDY PROTOCOL REGISTRATION: CRD42018090804.


Assuntos
Terapia Antirretroviral de Alta Atividade , Antituberculosos/uso terapêutico , Infecções por HIV/complicações , Isoniazida/uso terapêutico , Tuberculose/prevenção & controle , Estudos de Coortes , Etiópia/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Recursos em Saúde , Humanos , Incidência , Razão de Chances , Cooperação do Paciente , Serviços Preventivos de Saúde , Tuberculose/epidemiologia
17.
BMC Infect Dis ; 19(1): 365, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039734

RESUMO

BACKGROUND: Tuberculosis (TB) is an important public health issue worldwide. However, evidence concerning the impact of environmental factors on TB is sparse. We performed a retrospective analysis to determine the spatiotemporal trends and geographic variations of, and the factors associated with, the TB prevalence in Inner Mongolia. METHODS: We performed a retrospective analysis of the epidemiology of TB. A Bayesian spatiotemporal model was used to investigate the spatiotemporal distribution and trends of the TB prevalence. A spatial panel data model was used to identify factors associated with the TB prevalence in the 101 counties of Inner Mongolia, using county-level aggregated data collected by the Inner Mongolia Center for Disease Control and Prevention. RESULTS: From January 2010 to December 2014, 79,466 (6.36‱) incident TB cases were recorded. The TB prevalence ranged from 4.97‱ (12,515/25,167,547) in 2014 to 7.49‱ (18,406/ 24,578,678) in 2010; the majority of TB cases were in males, and in those aged 46-60 years; by occupation, farmers and herdsmen were the most frequently affected. The Bayesian spatiotemporal model showed that the overall TB prevalence decreased linearly from 2010 to 2014 and occupation-stratified analyses yielded similar results, corroborating the reliability of the findings. The decrease of TB prevalence in the central-western and eastern regions was more rapid than that in the overall TB prevalence. A spatial correlation analysis showed spatial clustering of the TB prevalence from 2011 to 2014 (Moran's index > 0, P < 0.05); in the spatial panel data model, rural residence, birth rate, number of beds, population density, precipitation, air pressure, and sunshine duration were associated with the TB prevalence. CONCLUSIONS: The overall TB prevalence in Inner Mongolia decreased from 2010 to 2014; however, the incidence of TB was high throughout this period. The TB prevalence was influenced by a spatiotemporal interaction effect and was associated with epidemiological, healthcare, and environmental factors.


Assuntos
Tuberculose/diagnóstico , Teorema de Bayes , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Densidade Demográfica , Prevalência , Estudos Retrospectivos , Análise Espacial , Tuberculose/epidemiologia , Tempo (Meteorologia)
18.
Public Health ; 171: 50-56, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31100694

RESUMO

OBJECTIVES: A well-functioning disease surveillance system is essential for effective control of diseases. Therefore, conducting evaluation studies on the performance of disease surveillance systems is necessary. This study was conducted to evaluate the performance of the Iranian syndrome-based surveillance system for tuberculosis (TB) in rural areas of Fars, the third largest province located in southern Iran. STUDY DESIGN: This was an evaluation study. METHODS: Two independent sources of information (data from a population-based survey and data from the surveillance system) were used in this evaluation. A group of trained female nurses used a specially designed interview-administered questionnaire to obtain data on the health status of family members from mothers or other adult women in rural houses. Subsequently, the nurses obtained data from individuals who reported a history of TB during a specified period and defined whether the patients presented themselves to a rural or urban health centre or clinic. RESULTS: A total of 48,771 individuals participated in this study. Of 156 cases who reported a history of TB, 137 (87.82%) presented themselves to at least one medical care provider seeking diagnosis and treatment services. Of patients who visited a health or medical centre, only 18 (13.14%) were reported to the highest level of the surveillance system. Accordingly, the rates of underascertainment and underreporting of the Iranian surveillance system for TB were 12.18% and 86.86%, respectively. Moreover, underascertainment was significantly higher for men (19.40%) than for women (6.74%). The mean time between the date at which TB was noticed and the date of diagnosis was 56.24 days, which was longer for men (79.29 days) than for women (40.10 days). The highest and lowest levels of underreporting were observed for private general practitioners (100%) and the health centres run by the government (87%), respectively. CONCLUSION: The quality of the communicable disease surveillance system for TB in Iran is facing important challenges, including underascertainment, underreporting and timeliness, in addition to different types of bias. Informing the general population and health workforce about TB and the importance of timely diagnosis is a good approach to improve the performance of Iran's national communicable disease surveillance system.


Assuntos
Notificação de Doenças/normas , Vigilância da População , Tuberculose/epidemiologia , Adulto , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Fatores de Tempo
19.
BMC Infect Dis ; 19(1): 474, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138129

RESUMO

BACKGROUND: Tuberculosis (TB) is the leading cause of death from an infectious disease in Ethiopia, killing more than 30 thousand people every year. This study aimed to determine whether the rates of poor TB treatment outcome varied geographically across Ethiopia at district and zone levels and whether such variability was associated with socioeconomic, behavioural, health care access, or climatic conditions. METHODS: A geospatial analysis was conducted using national TB data reported to the health management information system (HMIS), for the period 2015-2017. The prevalence of poor TB treatment outcomes was calculated by dividing the sum of treatment failure, death and loss to follow-up by the total number of TB patients. Binomial logistic regression models were computed and a spatial analysis was performed using a Bayesian framework. Estimates of parameters were generated using Markov chain Monte Carlo (MCMC) simulation. Geographic clustering was assessed using the Getis-Ord Gi* statistic, and global and local Moran's I statistics. RESULTS: A total of 223,244 TB patients were reported from 722 districts in Ethiopia during the study period. Of these, 63,556 (28.5%) were cured, 139,633 (62.4%) completed treatment, 6716 (3.0%) died, 1459 (0.7%) had treatment failure, and 12,200 (5.5%) were lost to follow-up. The overall prevalence of a poor TB treatment outcome was 9.0% (range, 1-58%). Hot-spots and clustering of poor TB treatment outcomes were detected in districts near the international borders in Afar, Gambelia, and Somali regions and cold spots were detected in Oromia and Amhara regions. Spatial clustering of poor TB treatment outcomes was positively associated with the proportion of the population with low wealth index (OR: 1.01; 95%CI: 1.0, 1.01), the proportion of the population with poor knowledge about TB (OR: 1.02; 95%CI: 1.01, 1.03), and higher annual mean temperature per degree Celsius (OR: 1.15; 95% CI: 1.08, 1.21). CONCLUSIONS: This study showed significant spatial variation in poor TB treatment outcomes in Ethiopia that was related to underlying socioeconomic status, knowledge about TB, and climatic conditions. Clinical and public health interventions should be targeted in hot spot areas to reduce poor TB treatment outcomes and to achieve the national End-TB Strategy targets.


Assuntos
Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Teorema de Bayes , Análise por Conglomerados , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Método de Monte Carlo , Prevalência , Fatores Socioeconômicos , Análise Espacial , Resultado do Tratamento
20.
BMC Public Health ; 19(1): 446, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035984

RESUMO

BACKGROUND: Childhood tuberculosis (TB) diagnoses often lack microbiologic confirmation and require empiric treatment. Barriers to empiric treatment include concern for poor outcomes and adverse effects. We thus determined the outcomes of empiric TB treatment from a retrospective cohort of children at a national referral hospital in Kampala, Uganda from 2010 to 2015. METHODS: Children were diagnosed clinically and followed through treatment. Demographics, clinical data, outcome and any adverse events were extracted from patient charts. A favorable outcome was defined as a child completing treatment with clinical improvement. We performed logistic regression to assess factors associated with loss to follow up and death. RESULTS: Of 516 children, median age was 36 months (IQR 15-73), 55% (95% CI 51-60%) were male, and HIV prevalence was 6% (95% CI 4-9%). The majority (n = 422, 82, 95% CI 78-85%) had a favorable outcome, with no adverse events that required treatment discontinuation. The most common unfavorable outcomes were loss to follow-up (57/94, 61%) and death (35/94, 37%; overall mortality 7%). In regression analysis, loss to follow up was associated with age 10-14 years (OR 2.38, 95% CI 1.15-4.93, p = 0.02), HIV positivity (OR 3.35, 95% CI 1.41-7.92, p = 0.01), hospitalization (OR 4.14, 95% CI 2.08-8.25, p < 0.001), and living outside of Kampala (OR 2.64, 95% CI 1.47-4.71, p = 0.001). Death was associated with hospitalization (OR 4.57, 95% CI 2.0-10.46, p < 0.001), severe malnutrition (OR 2.98, 95% CI 1.07-8.27, p = 0.04), baseline hepatomegaly (OR 4.11, 95% CI 2.09-8.09, p < 0.001), and living outside of Kampala (OR 2.41, 95% CI 1.17-4.96, p = 0.02). CONCLUSIONS: Empiric treatment of child TB was effective and safe, but treatment success remained below the 90% target. Addressing co-morbidities and improving retention in care may reduce unfavorable outcomes.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Adolescente , Fatores Etários , Criança , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Masculino , Prevalência , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose/mortalidade , Uganda/epidemiologia
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