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Applying tuberculosis management time to measure the tuberculosis infectious pool at a local level in Ethiopia

Infectious Diseases of Poverty 2017年第1期6卷 1392-1400页

作者： Senedu Bekele Gebreegziabher gunnar aksel bjune Solomon Abebe Yimer Amhara Regional State Health Bureau Bahir DarEthiopia Department of Community Medicine Institute of Health and SocietyUniversity of OsloOsloNorway Oslo University Hospital OsloNorway Department of Bacteriology and Immunology Division of Infectious Disease ControlNorwegian Institute of Public HealthOsloNorway

Background:Measuring the size of the infectious pool of tuberculosis(TB)is essential to understand the burden and monitor trends of TB control program performance.This study applied the concept of TB management time to estimate and compare the size of the TB infectious pool between 2009 and 2014 in West Gojjam Zone of Amhara Region,Ethiopia.Methods:New sputum smear-positive and smear-negative pulmonary TB(PTB)and retreatment cases who attended 30 randomly selected public health facilities in West Gojjam Zone from October 2013 to October 2014 were consecutively enrolled in the study.In order to determine the infectious period,the TB management time(number of days from the onset of cough until start of anti-TB treatment)was computed for each patient category.The number of undiagnosed TB cases was estimated and hence the TB management time for the undiagnosed category was calculated.The total size of the TB infectious pool during the study period for the study zone was estimated as the annual number of infectious person days.Results:New smear-positive and smear-negative PTB cases contributed 25,050 and 12,931 infectious person days per year to the TB infectious pool,respectively.The retreatment and presently undiagnosed cases contributed 8840 and 34,310 infectious person days per year,respectively.The total size of the TB infectious pool in West Gojjam Zone during the study period was estimated at 81,131 infectious person days per year or 3405 infectious person days per 100,000 population per year.Compared to a similar study done in 2009 in the study area,the current study showed reduction of the TB infectious pool by 244,279 infectious person days.Conclusions:TB management time is a simple and practical tool that may help to estimate and compare the changes in the size of the TB infectious pool at local level.It may also be used as an indicator to monitor the changes in TB control program performance.

关键词： Tuberculosis TB management time Infectious pool West Gojjam zone Ethiopia

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Diabetes mellitus is associated with increased mortality during tuberculosis treatment:a prospective cohort study among tuberculosis patients in SouthEastern Amahra Region,Ethiopia

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Infectious Diseases of Poverty 2016年第1期5卷 198-207页

作者： Mahteme Haile Workneh gunnar aksel bjune Solomon Abebe Yimer Institute of Health and Society Faculty of MedicineUniversity of OsloOsloNorway Amhara Regional State Health Bureau Bahir-DarEthiopia Department of Microbiology Oslo University HospitalOsloNorway Department of Bacteriology and Immunology Norwegian Institute of Public HealthOsloNorway

Background:There is growing evidence suggesting that diabetes mellitus(DM)affects disease presentation and treatment outcome in tuberculosis(TB)patients.This study aimed at investigating the role of DM on clinical presentations and treatment outcomes among newly diagnosed TB patients.Methods:A prospective cohort study was conducted in South-Eastern Amhara Region,Ethiopia from September 2013 till March 2015.Study subjects were consecutively recruited from 44 randomly selected health facilities in the study area.Participants were categorized into two patient groups,namely,patients with TB and DM(TBDM)and TB patients without DM(TBNDM).Findings on clinical presentations and treatment outcomes were compared between the two patient groups.Cox proportional hazard regression analysis was applied to identify factors associated with death.Results:Out of 1314 TB patients enrolled in the study,109(8.3%)had coexisting DM.TBDM comorbidity[adjusted hazard ratio(AHR)3.96;95%confidence interval(C.I.)(1.76–8.89)],and TB coinfection with human immunodeficiency virus(HIV)[AHR 2.59;95%C.I.(1.21–5.59)]were associated with increased death.TBDM and TBNDM patients did not show significant difference in clinical symptoms at baseline and during anti-TB treatment period.However,at the 2nd month of treatment,TBDM patients were more symptomatic compared to patients in the TBNDM group.Conclusions:The study showed that DM is associated with increased death during TB treatment.DM has no association with clinical presentation of TB except at the end of the intensive phase treatment.Routine screening of TB patients for DM is recommended for early diagnosis and treatment of patients with TBDM comorbidity.

关键词： Tuberculosis Diabetes mellitus Association Symptoms Treatment outcome Amhara Region Ethiopia

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Routine diagnosis of intestinal tuberculosis and Crohn's disease in Southern India

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World Journal of Gastroenterology 2014年第17期20卷 5017-5024页

作者： Geir Larsson Thrivikrama Shenoy Ramalingom Ramasubramanian Leena Kondarappassery Balakumaran Milada Cvancarova Smstuen gunnar aksel bjune Bjφrn Allan Moum Department of Medicine Unger-Vetlesen InstituteLovisenberg Diaconal HospitalNO-0440 OsloNorway Population Health and Research Institute Medical College POTrivandrum 695011KeralaIndia Thoothukudi Government Medical College Thoothukudi 628002Tamil NaduIndia Department of Biostatistics Institute of Basic Medical SciencesFaculty of MedicineUniversity of OsloNO-0318 OsloNorway Institute of Health and Society Faculty of MedicineUniversity of OsloNO-0318 OsloNorway Department of Gastroenterology and Hepatology Institute of Clinical MedicineOslo University Hospital UllevlNO-0424 OsloNorway

AIM:To investigate whether routinely measured clinical variables could aid in differentiating intestinal tuberculosis(ITB)from Crohn’s disease(CD).METHODS:ITB and CD patients were prospectively included at four South Indian medical centres from October 2009 to July 2012.Routine investigations included case history,physical examination,blood biochemistry,ileocolonoscopy and histopathological examination of biopsies.Patients were followed-up after 2 and 6 mo of treatment.The diagnosis of ITB or CD was re-evaluated after 2 mo of antituberculous chemotherapy or immune suppressive therapy respectively,based on improvement in signs,symptoms and laboratory variables.This study was considered to be an exploratory analysis.Clinical,endoscopic and histopathological features recorded at the time of inclusion were subject to univariate analyses.Disease variables with sufficient number of recordings and P<0.05 were entered into logistic regression models,adjusted for known confounders.Finally,we calculated the odds ratios with respective confidence intervals for variables associated with either ITB or CD.RESULTS:This study included 38 ITB and 37 CD patients.Overall,ITB patients had the lowest body mass index(19.6 vs 22.7,P=0.01)and more commonly reported weight loss(73%vs 38%,P<0.01),watery diarrhoea(64%vs 33%,P=0.01)and rural domicile(58%vs 35%,P<0.05).Endoscopy typically showed mucosal nodularity(17/31 vs 2/37,P<0.01)and histopathology more frequently showed granulomas(10/30vs 2/35,P<0.01).The CD patients more frequently reported malaise(87%vs 64%,P=0.03),nausea(84%vs 56%,P=0.01),pain in the right lower abdominal quadrant on examination(90%vs 54%,P<0.01)and urban domicile(65%vs 42%,P<0.05).In CD,endoscopy typically showed involvement of multiple intestinal segments(27/37 vs 9/31,P<0.01).Using logistic regression analysis we found weight loss and nodularity of the mucosa were independently associated with ITB,with adjusted odds ratios of 8.6(95%CI:2.1-35.6)and 18.9(95%CI:3.5-102.8)respectively.Right lower abdominal quadrant

关键词： Diagnosis Differential Tuberculosis Gastrointestin

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脊柱手术后患者外科手术部位感染及相关危险因素（英文）

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中国感染控制杂志 2017年第1期16卷 16-22页

作者：王建聪卢晓燕 gunnar aksel bjune Hanne Merete Eriksen 挪威奥斯陆大学医学院健康与社会研究所社区医学与全球健康系挪威奥斯陆0450 广州中医药大学附属东莞市中医院广东东莞523000 挪威公共卫生研究所传染病流行病学系挪威奥斯陆0403

目的外科手术部位感染(SSI)是脊柱手术后常见的并发症之一,与感染发病率增高,治疗时间延长,医疗费用增加,患者预后效果不良有着密不可分的关系。本研究的目的是探索某教学医院患者进行脊柱手术后发生SSI的现状与其相关危险因素。方法采... 详细信息

目的外科手术部位感染(SSI)是脊柱手术后常见的并发症之一,与感染发病率增高,治疗时间延长,医疗费用增加,患者预后效果不良有着密不可分的关系。本研究的目的是探索某教学医院患者进行脊柱手术后发生SSI的现状与其相关危险因素。方法采用前瞻性队列研究方法,对2014年6月26日-11月30日该院所有脊柱手术患者进行目标性监测,以美国疾病控制与预防中心(CDC)颁布的指南作为SSI的诊断依据,通过床旁调查与出院后的检查发现SSI病例,使用标准化的数据收集脊柱手术患者术前,术中及术后资料。结果 2014年6月26日—11月30日共监测192例脊柱手术患者,其中7例(3.6%)发生了SSI。通过双变量分析的方法发现切口类型(污染/感染切口)、外科引流、输血与增加SSI风险的密切相关。在192例脊柱手术患者中,120例(62.5%)给予静脉使用预防性抗菌药物,使用周期为2.2(1~9)d,139例(72.4%)使用中成药。结论该研究有助于了解该教学医院脊柱手术后患者SSI发病率,亦为今后进行脊柱手术后患者发生SSI的研究提供有价值的信息。

关键词：外科手术部位感染脊柱手术医院感染危险因素中成药

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Tuberculosis Case Notification and Treatment Outcomes in West Gojjam Zone, Northwest Ethiopia: A Five-Year Retrospective Study

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Journal of Tuberculosis Research 2016年第1期4卷 23-33页

作者： Senedu B. Gebreegziabher Solomon A. Yimer gunnar A. bjune Amhara Regional State Health Bureau Bahir Dar Ethiopia Department of Community Medicine Institute of Health and Society University of Oslo Oslo Norway Oslo University Hospital Oslo Norway Department of Bacteriology and Immunology Division of Infectious Disease Control Norwegian Institute of Public Health Oslo Norway

Introduction: Tuberculosis (TB) is a major public health concern in Ethiopia. Analysis of TB case notification and treatment outcomes is crucial to understand the TB control program performance. The current study was carried out to assess trends of TB case notifications, treatment success rate and factors associated with unsuccessful treatment outcome among TB patients in West Gojjam Zone of Amhara Region, Ethiopia. Method: A retrospective cohort study was conducted in West Gojjam Zone. Demographic and clinical data were reviewed for all TB patients registered between July 2007 and June 2012 at 30 randomly selected public health facilities of the study zone. In addition, annual case notification reports of the study zone were used to analyze trends in TB case notifications. Logistic regression analysis was used to assess the association between potential predictor variables and unsuccessful treatment outcomes. Results: Tuberculosis case notification for all forms of TB decreased from 203/100,000 population in 2007 to 155/100,000 population in 2012. Among patients whose treatment outcomes were evaluated, 94.4% were successfully treated, 0.3% had treatment failure, 1.5% defaulted and 3.7% died. In multivariate analysis, the odds of unsuccessful treatment outcome was higher among retreatment cases than new cases (adjusted OR, 3.44;95% CI: 1.92, 6.19). HIV co-infected cases were more likely to have unsuccessful treatment outcome compared to HIV negatives (adjusted OR, 2.68;95% CI: 1.92, 3.72). Conclusion: Tuberculosis case notification rates showed a decreasing trend between 2007 and 2012. The treatment success rate exceeded the 90% treatment success rate target as set by the WHO. Special attention is required for patients with high risk of unsuccessful treatment outcome. Therefore, retreatment cases, and HIV positive cases need strict follow up throughout their treatment period.

关键词： Tuberculosis Case Notification Treatment Outcome Ethiopia

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Re-Assessing Tuberculin Skin Test (TST) for the Diagnosis of Tuberculosis (TB) among African Migrants in Western Europe and USA

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Journal of Tuberculosis Research 2014年第1期2卷 4-15页

作者： Kebede C. Shero Mengistu Legesse Girmay Medhin Mulugeta Belay gunnar bjune Fekadu Abebe Addis Ababa University (AAU) Aklilu Lemma Institute of Pathobiology (ALIPB) Addis Ababa Ethiopia University of Oslo Faculty of Medicine Institute of Health and Society Department of Community Medicine Oslo Norway

Background: Tuberculin skin test (TST)—is widely used for screening tuberculosis TB in migrants from high endemic countries of Africa and Asia. However, the cut-off point for clinical TB and Mtb infection is not well established in TB endemic countries of sub-Saharan Africa. In this study we compared the size of TST induration in smear positive pulmonary TB (PTB) patients, their house-hold contacts and community controls in high endemic setting in Ethiopia. Methods: In a health facility-based cross-sectional study, smear positive PTB patients were recruited. Their household contacts traced, and community controls were recruited from neighbourhoods. Sputum sample collected from patients were examined using smear microscopy. Participants were also tested by TST and QuantiFERON? -TB Gold In–Tube test (QFTGIT). Results: From a total of 224 study participants, skin test induration data were available for 48 PTB patients, 88 household contacts and 75 community controls. All 48 patients, 64 (72.2%) of the household contacts and 35 (46.7%) of the community controls had skin test induration ≥ 10 mm. Moreover, 44 (91.7%) PTB patients, 58 (65.9%) of the household contacts and 26 (34.7%) of the community controls had skin test induration ≥ 15 mm, respectively. The mean size of TST induration was significantly higher in TB patients (18.1mm) compared to that of household contacts (13.6 mm) and community controls (7.9 mm) (pMtb

关键词： Tuberculosis TST Diagnosis IGRA Migrant Ethiopia HIV

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