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Responding to Emerging Epidemics and Disasters in Asia in ASIA:Enhancing Linkages for Global Health Security

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Effectiveness of Contact Tracing of Index Tuberculosis Cases in Nigeria

北京论坛（2005）文明的和谐与共同繁荣——全球化视野...

作者： W.K.patrick Secretary General APACPH john A Burns School of Medicine University of Hawaii

The ability to control infections effectively through immunization and antibiotics had reduced alertness until recent dangerous viral epidemics exposed serious gaps and vulnerability without vaccines or anti-viral therapy to protect *** reemergence of diseases in more virulent and drug resistant forms have strained resources of countries showing marked health *** appearance of new diseases with capacity to spread quickly and undetected across national boundaries has created a new awareness of how interconnected and dependent people and nations are for global health *** has magnified socio-economic and ecological dynamics to make borders more porous and rapid for disease *** has reduced margins of safety and effective response times to contain *** challenge is for co-operative surveillance and other mechanisms for data sharing instantly or at least quickly among all those at immediate *** is therefore essential to build expertise and trust for joint *** and timely decisions to safeguard health in the region will determine the outcome of the next pandemic:its early containment or tragic spread. Otherwise we all *** later we act the more we will *** walls can save us from pandemics. Not even the Great Wall.

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Advances in Infectious Diseases 2018年第4期8卷 173-199页

作者： Okorie Onuka Ikpeazu Okezie john Ahukanna Chukwudi Okebaram patrick Dakum Aderonke Agbaje Vivian Ibeziako Gidado Mustapha Nkem Chukwueme Emperor Ubochioma Amarachi Okorie Nwafor Charles Chux Anago TB Control Program Ministry of Health Abia State Nigeria Abia State Government House Umuahia Abia State Nigeria Ministry of Health Abia State Nigeria Department of Pharmacology and Therapeutics Abia State University Uturu Nigeria Institute of Human Virology Abuja Nigeria KNCV Abuja Nigeria National TB Control Program Abuja Nigeria School of Midwifery Ministry of Health Umuahia Nigeria GLRA Enugu Enugu Nigeria Clinton Health Access Initiative Abuja Nigeria

Tuberculosis (TB) is a chronic disease that has impacted negatively on human history. The biology of the mycobacterium tuberculosis is complicated and has affected the control as well as elimination of the disease. Nigeria is one of the countries with high incidence and prevalence of TB. The late and low case detection has been a major problem with National TB control program, caused by passive case finding strategy practiced by the country. A shift from the passive and active case search has been recommended for detection of missing cases of TB and improved program performance. The proximity of TB contact is a major determinant of disease transmission. However, maximizing early case detection and prompt treatment of notified cases is very useful in (TB) control especially in high burden countries. The tracking of TB contacts provides a good platform for early diagnosis, educating the household on TB disease and infection control as well as breaking the chain of transmission. The objective of the study is to ascertain effectiveness of contact tracing on Tuberculosis case detection. The study is a retrospective quasi experimental with quantitative arm. The study was conducted in Abia State, one of the South Eastern States of Nigeria. A pre-tested questionnaire was used for data collection and analyzed with SPSS. A total of 168 and 162 index cases of TB were recruited for both intervention and control facilities. The 168 index TB cases yielded 301 TB contacts. The result revealed 55% contact/index ratio, presumptive TB yield of 130 (43.2%) and TB yield of 68 (22.6%). The cases registered in the State increased from 336 to 417 and p value = 0.001, while presumptive TB and BCG vaccination were major predictors. The study shows that tracing contact of index TB cases is an effective and complementary method of finding undetected cases of TB.

关键词： Contact tracing Index TB cases

A Case Study of Multi Drug-Resistant Tuberculosis (MDR-TB), HIV and Diabetes Mellitus (Dm) Comorbidity: Triple Pathology;Challenges and Prospects

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Advances in Infectious Diseases 2017年第3期7卷 70-79页

作者： Okorie Onuka john Ahukanna Chukwudi Okebaram patrick Dakum Aderonke Agbaje Vivian Ibeziako Gidado Mustapha Nkem Chukwueme Chux Anago Emperor Ubochioma Amarachi Okorie Odume Bethrand Nwafor Charles Abia State Ministry of Health Umuahia Nigeria Department of Pharmacology Abia State University Okigwe Nigeria Institute of Human Virology Abuja Nigeria Challenge KNCV Abuja Nigeria Clinton Health Access Initiative Abuja Nigeria National Tuberculosis and Leprosy Control Program Abuja Nigeria School of Midwifery Umuahia Nigeria Department of Family Medicine National Hospital Abuja Nigeria German Leprosy and Tuberculosis Relief Association Enugu Nigeria

Tuberculosis (TB), diabetes mellitus and HIV co-morbidity is a rare and interrelated health condition with associated high morbidity and mortality especially in developing countries with high prevalence of TB. It has become an emerging concern to epidemiologists and TB control programs due to complexities in its control and management. Managing MDR-TB, DM and HIV comorbidity is challenging, with risk of unfavorable outcome;consequently, close monitoring is necessary. Individuals with weak immunity resulting from diseases such as uncontrolled Diabetes Mellitus (DM) and HIV have a higher risk of developing TB or progression from latent to active TB. We present a 65-year old known diabetic patient who presented to Royal Cross Hospital Ugwueke Abia State, Nigeria with a one-year history of recurrent productive cough with associated night sweats, low grade fever and marked weight loss. A diagnosis of drug-resistant TB with DM/HIV co-morbidity was made and co-managed by experts from the respective clinics and the State TB control program. The patient was declared cured (7 months consecutive negative cultures each taken 30 days apart) after completing 20 months of conventional MDR-TB treatment. The patient showed remarkable clinical improvement including weight gain, good diabetic control and significant increase in CD4 (700 cells). Managing MDR-TB patients with diabetes and HIV is challenging, however, appropriate treatment, psychosocial support, adequate blood sugar control as well as monthly monitoring of patients with requisite investigations are vital in achieving good treatment outcome.

关键词： Co-Morbidity-Diabetes-Multi Drug Resistant TB and HIV

Asia Pacific Universities and Health Leadership in Challenging Times

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Violence on Health Professionals: Experience of the Obstetrics &Gynecology and Pediatrics Departments at the University Teaching Hospital of Bouake;, Cote d’Ivoire

北京论坛（2006）文明的和谐与共同繁荣—对人类文明方...

作者： Walter K.patrick Secretary General Asia Pacific Academic Consortium for Public Health(APACPH)Global Health & MedicineJohn A Burns School of MedicineUniversity of Hawaii

Universities reflect the challenges,social realities and aspirations of people at various periods in their *** recent times,"Ivory Tower"isolation has been gradually replaced by collective"Knowledge Solutions"to meet common global threats such as AIDS,SARS,the Asian Tsunami and the not so invisible epidemics such as *** health and medicine that arose from charitable roots of missionary medicine and traditional medical systems have evolved in the post colonial era to promote values of health as a human *** though this ideal is enshrined in many national constitutions,economic and technological limitations have led to serious disparities in health *** have a vital role in creating the consciousness and leadership to close those gaps in health care made more critical in disasters and *** national crises challenge universities to enhance research,training leadership and advocacy in response and *** paper will also briefly review trends in globalization of knowledge that have created networks and partnerships to address these global crises of disasters and pandemics.

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Open Journal of Pediatrics 2018年第1期8卷 8-18页

作者： Kouadio Vincent Asse Richard Azagoh-Kouadio Kouassi Christian Yao Koko Aude Aka-Tanoh Christelle Avi Kossonou Roland Yeboua john patrick Yenan Mocket Adolphe Ehouman Yacouba Doumbia Kouie Jeannot Plo Paediatric Ward of University and Teaching Hospital of Bouake BouakeCote d’Ivoire Paediatric Ward of University and Teaching Hospital of Treichville AbidjanCote d’Ivoire Olopam Pharma and Research&Development AbidjanCote d’Ivoire Obstetrics and Gynecoology Ward of University and Teaching Hospital of Bouake BouakeCote d’Ivoire

Introduction: Violence in hospital is a major Public Health issue. In Cote d’Ivoire, acts of violence against health professionals exist and may sometimes take a dramatic turn. Objective: To research the causes of this violence for the purpose to prevent them. Materials and Methods: This is a cross-sectional, descriptive study conducted in the Obstetrics & Gynecology and Pediatrics departments at the University Teaching Hospital of Bouaké from 26 January 2016 to 24 February 2016. It included 129 health workers who gave their consent. The data collection was done through individual interviews followed by a focus group according to the socio-professional category. Results: Out of 129 health professionals included, 100 were a victim of violence i.e. a frequency of 77.5%. Most of the violence occurred during “on-call hours” (55.8%) in the emergency units (34.8%). The violence was verbal (52.5%), physical (28.6%), moral and psychological (11.6%), theft (7.3%). The aggression was mainly related to patient’s care (32.1%), visiting hours (26%) and the low level of understanding of the person (16.5%). The victim’s immediate feelings were dominated by frustration (26.7%), discouragement (21.3%) and insecurity (18.3%). The victims received a medical assistance in 9% of cases. To prevent this violence, the staff mainly offered to raise awareness about violence (27.6%) and the respect for hospital staff (25%). Conclusion: Violence against health professionals is common and has negative impacts on staff and hospital activity. Its prevention requires a holistic approach centered on awareness. Keywords: Violence, Hospital, Pediatrics, Staff, Cote d’Ivoire.

关键词： Violence Hospital Pediatrics Staff Cote d’Ivoire

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解析约翰·斯图亚特·穆勒《功利主义》

解析约翰·斯图亚特·穆勒《功利主义》

2019年

作者： patrick Tom，Sander Werkhoven

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学会放弃

经理人 2007年第5期 82-83页

作者： john T.Horn Dan P.Lovallo S.patrick Viguerie

当通用汽车在1985年推出土星汽车时，这种新型汽车迅速被消费者接受。但好景不长，土星汽车在1994达到高峰后，便陷入下滑的局面。通用立即对该部门进行了重组，取消了它的部分自主权。然而就在2004年，通用毅然决定再次投入30亿美元，... 详细信息

当通用汽车在1985年推出土星汽车时，这种新型汽车迅速被消费者接受。但好景不长，土星汽车在1994达到高峰后，便陷入下滑的局面。通用立即对该部门进行了重组，取消了它的部分自主权。然而就在2004年，通用毅然决定再次投入30亿美元，准备为土星重新注入活力。但结果却是：土星仍然没有给通用带来任何切实的利润。

关键词：通用汽车放弃学会消费者自主权

Multidrug-Resistant Tuberculosis in the Democratic Republic of Congo: Analysis of Continuous Surveillance Data from 2007 to 2016

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Journal of Tuberculosis Research 2019年第1期7卷 25-44页

作者： Serge Bisuta-Fueza Jean Marie Kayembe-Ntumba Marie-Jose Kabedi-Bajani Pascale Mulomba Sabwe Hippolyte Situakibanza-Nani Tuma Jean-Pierre Simelo Ernest Sumaili-Kiswaya john Ditekemena-Dinanga patrick Kayembe-Kalambayi Pneumology Unit University Hospital of Kinshasa University of Kinshasa Kinshasa Democratic Republic of Congo Department of Microbiology Medical Biology Department University of Kinshasa Kinshasa Democratic Republic of Congo National Tuberculosis Program Ministry of Public Health Kinshasa Democratic Republic of Congo Infectious Diseases Unit Department of Internal Medicine University of Kinshasa Kinshasa Democratic Republic of Congo Physiology Unit Department of Internal Medicine University of Kinshasa Kinshasa Democratic Republic of Congo Department of Community Health Kinshasa School of Public Health University of Kinshasa Kinshasa Democratic Republic of Congo Department of Epidemiology & Biostatistics Kinshasa School of Public Health University of Kinshasa Kinshasa Democratic Republic of Congo

Background: For countries with limited resources such as the Democratic Republic of the Congo (DRC), the diagnosis of Multidrug-resistant tuberculosis (MDR-TB) is still insufficient. The MDR-TB identification is done primarily among at-risk groups. The knowledge of the true extent of the MDR-TB remains a major challenge. This study tries to determine the proportion of MDR-TB in each group of presumptive MDR-TB patients and to identify some associated factors. Methods: This is an analysis of the DRC surveillance between 2007 and 2016. The proportions were expressed in Percentage. The logistic regression permits to identify the associated factors with the RR-/MDR-TB with adjusted Odds-ratio and 95% CI. Significance defined as p ≤ 0.05. Results: Overall, 83% (5407/6512) of the MDR-TB presumptive cases had each a TB test. 86.5% (4676/5407) had each a culture and drug sensitive testing (DST) on solid medium, and 24.3% (1312/5407) had performed an Xpert MTB/RIF test. The proportion of those with at least one first-line drug resistance was 59.3% [95% CI 57.2 - 61.4] among which 50.1%, [95% CI 47.9 - 52.3] for the isoniazid, 45.6% [95% CI 43.4 - 47.8] for the rifampicin, 49.9% [95% CI 47.8 - 52.1] for ethambutol and 35.8% [95% CI 33.7 - 37.9] for streptomycin. The confirmation of MDR-TB was 42.8% [95% CI 38.4 - 47.8]. Combining both tests, the proportion of RR-/MDR-TB was 49.6% [95% CI 47.9 - 51.4] for all presumptives. This proportion was 60.0% for failures, 40.7% for relapses and 34.7% for defaulters. Associated factors with the diagnosis of MDR-TB were: aged less than 35 years;prior treatment failure;defaulters;the delay between the collection of sputum and the test completion. Conclusion: The proportion of RR-/MDR-TB among the presumptives has been higher than those estimated generally. The National tuberculosis programme (NTP) should improve patient follow-up to reduce TB treatment failures and defaulting. Moreover, while increasing the use of molecular tests, they sho

关键词： Multidrug-Resistant Tuberculosis Resistance to Rifampicin Factors Associated DR Congo

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