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Validation of the clinical tuberculosis screening algorithm used in Nigerian national tuberculosis control programme for screening people living with HIV

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Health 2013年第11期5卷 1737-1741页

作者： Emmanuel N. Aguwa Chika N. Onwasigwe Joseph N. Chukwu Daniel C. Oshi Charles C. Nwafor Babatunde I. Omotowo Anne C. Ndu Anthony O. Meka Osa-Eloka C. Ekwueme Nwachukwu C. Ugwunna Moses C. Anyim Department of Community Medicine University of Nigeria Nsukka Nigeria Department of Community Medicine University of Nigeria Nsukka Nigeria German leprosy and tuberculosis Relief Association Enugu Nigeria

Background: In high HIV prevalence, tuberculosis diagnosis is challenging. Some countries hence use clinical algorithms to screen for tuberculosis in People Living with HIV (PLHIV). Objectives: The aim of the study was to validate the national algorithm for clinical tuberculosis screening of persons living with HIV who attend comprehensive HIV clinics. Methods: A cross-sectional study of PLHIV who presented with cough of at least 2 weeks duration between 2009 and 2011 at St Patrick’s Hospital, Ebonyi State, Nigeria. Sputum smear microscopy for acid fast bacilli was obtained from the participants. Results: Three hundred and twelve PLHIV were studied: 146 (46.8%) males and 166 (53.2%) females. Only 55 (17.6%) of the participants had smear positive pulmonary tuberculosis. Weight loss (c2 = 2.33;P = 0.127), hemoptysis (c2 = 0.03;P = 0.864), night sweats (c2 = 1.52;P = 0.218), fever (c2 = 3.49;P = 0.06), anorexia (c2 = 0.49;P = 0.484), chest pain (c2 = 2.48;P = 0.115), breathlessness (c2 = 0.63;P = 0.426) were not significant in PLHWA with/without pulmonary tuberculosis. Cough, fever, night sweat and weight loss combined gave a sensitivity of 97.0%, specificity of 10.9%, negative predictive value (NPV) of 93.3% and positive predictive value (PPV) of 21.8%. Conclusion: Findings suggest that though national screening algorithm is a valid tool to screen for tuberculosis in PLHIV, it will lead to many false positive results.

关键词： HIV tuberculosis PLHIV Screening Tool Validation

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Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam,Tanzania

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Infectious Diseases of Poverty 2017年第1期6卷 548-557页

作者： Khadija Said Jerry Hella Grace Mhalu Mary Chiryankubi Edward Masika Thomas Maroa Francis Mhimbira Neema Kapalata Lukas Fenner Ifakara Health Institute Bagamoyo Research and Training Centre(BRTC)P O Box 74BagamoyoTanzania Swiss Tropical and Public Health Institute Socinstrasse 574002 BaselSwitzerland University of Basel Petersplatz 14003 BaselSwitzerland national tuberculosis and leprosy programme Dar es SalaamTanzania Institute of Social and Preventive Medicine University of BernBernSwitzerland

Background:Tanzania is among the 30 countries with the highest tuberculosis(TB)*** TB has a long infectious period,early diagnosis is not only important for reducing transmission,but also for improving treatment *** assessed diagnostic delay and associated factors among infectious TB ***:We interviewed new smear-positive adult pulmonary TB patients enrolled in an ongoing TB cohort study in Dar es Salaam,Tanzania,between November 2013 and June *** patients were interviewed to collect information on socio-demographics,socio-economic status,health-seeking behaviour,and residential *** categorized diagnostic delay into≤3 or>3 *** used logistic regression models to identify risk factors for diagnostic delay,presented as crude(OR)and adjusted Odds Ratios(aOR).We also assessed association between geographical distance(incremental increase of 500 meters between household and the nearest pharmacy)with binary ***:We analysed 513 patients with a median age of 34 years(interquartile range 27-41);353(69%)were ***,444(87%)reported seeking care from health care providers prior to TB diagnosis,of whom 211(48%)sought care>2 *** six(1%)visited traditional healers before TB *** delay was positively associated with absence of chest pain(aOR=7.97,95%confidence intervals[CI]:3.15-20.19;P<0.001),and presence of hemoptysis(aOR=25.37,95%CI:11.15-57.74;P<0.001)and negatively associated with use of medication prior to TB diagnosis(aOR=0.31,95%CI:0.14-0.71;P=0.01).Age,sex,HIV status,education level,household income,and visiting health care facilities(HCFs)were not associated with diagnostic *** living far from pharmacies were less likely to visit a HCF(incremental increase of distance versus visit to any facility:OR=0.51,95%CI:0.28-0.96;P=0.037).Conclusions:TB diagnostic delay was common in Dar es Salaam,and was more likely among patients without prior use of medication and presenting with

关键词： Tanzania tuberculosis Diagnostic delay Health-seeking Geographic information system Pharmacy Transmission

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tuberculosis in Children Living amongst Adults with tuberculosis at the tuberculosis and leprosy Referral Hospital, Eku, Nigeria

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Journal of tuberculosis Research 2015年第3期3卷 80-89页

作者： Atana Uket Ewa Dominic Fabian Essiet Samuel John Umejei Monu Department of Paediatrics University of Calabar/Teaching Hospital Calabar Nigeria Formerly Department of Haematology Baptist Hospital Eku Nigeria Formerly Delta State Tuberculosis and Leprosy Control Program/Tuberculosis and Leprosy Referral Hospital Eku Nigeria

Background: tuberculosis (tb) causes significant morbidity and mortality worldwide. In Nigeria, the exact prevalence is not known but a progressive increase of the disease has been observed, with “epidemic states” reported in certain clusters. Even with the newer diagnostic tests for tb, diagnostic difficulties still occur. As a result, several diagnostic criteria have been adopted to aid the diagnosis of tuberculosis in these children. The main objective of this study was to identify Tb in children who were either living with adults who have Tb or in the environment of adults with Tb. Methodology: This was a prospective cross-sectional study conducted in Eku and Oria communities in Ethiope East Local Government Area of Delta State. Eku housed the tuberculosis and leprosy Referral Hospital where adults with tb were admitted in the first two months of their treatment. 128 children under 19 years of age were studied over a 3-month period. After obtaining relevant information from every child, a full physical examination and certain laboratory investigations were done. Results: There were 68 males and 60 females. The prevalence of Tb was 68% in those children living among adults with tb within the hospital and 50.6% in those living in the environment or community (p = 0.05). The prevalence of Tb in Bacille Calmette Guerin (BCG) immunized children was 66.2% as against 46.7% in those not vaccinated. Twenty-six of the infected children (57.8%) had only pulmonary disease while 45.7% had affectation of 2 or more organs. The positive predictive values of elevated erythrocyte sedimented rate (ESR), elevated white blood cells (WBC) count and positive gastric aspirates (GA) in diagnosing tb were 60.3%, 70.5% and 0% respectively, while that of abnormal chest X-ray (CXR) and positive Mantoux reaction were 93.6% and 93.7% respectively. Conclusion: The alarming prevalence of tb in these children was not surprising considering their contacts with the tb patients and was representati

关键词： tuberculosis Case Finding Positive Predictive Values Contacts

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Strategic Engagement of Private Facilities to Increase Public-Private Mix (PPM) Contribution to Nigeria tuberculosis Case Notification

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Journal of tuberculosis Research 2022年第3期10卷 99-110页

作者： Obioma Chijioke-Akaniro Emperor Ubochioma Amos Omoniyi Oluwafunmilayo Omosebi Olawumi Olarewaju Mary Etolue Sunday Asuke Elias Aniwada Anyaele Uwaezuoke Ndubuisi Victor Ombeka Aderonke Agbaje Adebola Lawanson Chukwuma Anyaike national tuberculosis Leprosy and Buruli Ulcer Control Programme (NTBLCP) FCT Nigeria World Health Organisation (WHO) FCT Nigeria Bingham University Karu Nigeria University of Nigeria Nsukka Nigeria Institute of Human Virology Nigeria FCT Nigeria

Introduction: Finding the missing tuberculosis (TB) cases remains the single most important priority for TB control in Nigeria. Between 66% - 92% of all cases of respiratory diseases including those with symptoms suggestive of TB are first seen byprivate health providers. Dependable, quality surveillance systems and notification are key roles in health services delivery, particularly as it is related to TB control. However, poor notification has been a challenge. This study was to assess the contribution of the public private mix (PPM) to Nigeria tuberculosis national case notification. Methods: It was a national cross-sectional study. Data were extracted from the national database and reviewed. Private facilities were engaged in 2017 and assessed over 2018-2020. Interventions included: enrolling private practitioners (Private-For-Profit, Faith Based Organization, Private Medicine Vendors and Community Pharmacists), engaging a private standalone Laboratory for Gene Xpert testing within the network of private facilities, use of Mobile App for easy screening and reporting, instituting a HUB and spoke, and incentives to private providers for participating. Each private provider had a customized approach. Trend analysis was performed using Cochran-Armitage χ2 test for linear trends. Level of significance was at a p value of Results: Total case notification increased from 104,904 cases in 2017 to 138,591 in 2020. There were 2.0% increase in 2018, 13.0% in 2019 and 15.0% in 2020 (p control efforts in Nigeria using a variety of approaches resulting in improved TB notification is possible. The national TB programme should engage all private practitioners such that each practitioner

关键词： Strategic Engagement Public-Private Mix Case Notification tuberculosis Nigeria

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Patients direct costs to undergo TB diagnosis

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Infectious Diseases of Poverty 2016年第1期5卷 221-229页

作者： Rachel M.Anderson de Cuevas Lovett Lawson Najla Al-Sonboli Nasher Al-Aghbari Isabel Arbide Jeevan B.Sherchand Emenyonu E.Nnamdi Abraham Aseffa Mohammed A.Yassin Saddiq T.Abdurrahman Joshua Obasanya Oladimeji Olanrewaju Daniel Datiko Sally J.Theobald Andrew Ramsay S.Bertel Squire Luis E.Cuevas Liverpool School of Tropical Medicine Pembroke PlaceLiverpool L35QAUK Zankli Medical Center AbujaNigeria Bingham University Nassarawa StateAbujaNigeria Medical Faculty Sana’a UniversitySana’aYemen national tuberculosis Institute Sana’aYemen Bushullo Major Health Centre AwassaEthiopia Tribhuvan University Institute of Medicine KathmanduNepal Armauer Hansen Research Institute Addis AbabaEthiopia The Global Fund to Fight AIDS Tuberculosis and MalariaGenevaSwitzerland Federal Capital Territory tuberculosis and leprosy control programme AbujaNigeria Nigeria tuberculosis and leprosy control programme AbujaNigeria REACH Ethiopia HawassaEthiopia UNICEF/UNDP/World Bank/WHO Special programme for Research and Training in Tropical Diseases World Health OrganizationGenevaSwitzerland

Background:A major impediment to the treatment of TB is a diagnostic process that requires multiple *** of patient costs associated with diagnosis use different protocols and are not ***:We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for *** of 2225 adults attending smear-microscopy centres in Nigeria,Nepal,Ethiopia and ***>18 years with cough>2 weeks were enrolled *** costs were quantified using structured *** with costs>75^(th) quartile were considered to have high expenditure(cases)and compared with patients with costs<75^(th) quartile to identify factors associated with high ***:The most significant expenses were due to clinic fees and *** participants attended the centres with *** expenditure was associated with attending with company,residing in rural areas/other towns and ***:The costs incurred by patients are substantial and share common patterns across *** user fees,transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic *** locations with limited resources,support could be prioritised for those most at risk of high expenditure;those who are illiterate,attend the service with company and rural residents.

关键词： tuberculosis Costs Access to healthcare Ethiopia Nepal Nigeria Yemen

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Reduction patterns of Japanese encephalitis incidence following vaccine introduction into long-term expanded program on immunization in Yunnan Province,China

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Infectious Diseases of Poverty 2019年第6期8卷 84-91页

作者： Xiao-Ting Hu Qiong-Fen Li Chao Ma Zhi-Xian Zhao Li-Fang He Ting-Ting Tang Wen Yu Philip Owiti Expand ed Program on Immunization Yunnan Center for Disease Control and PreventionNO.158 DongSi StreetXiShan DistrictKunming CityYunnan ProvinceChina national Immunization Program Chinese Center for Disease Control and Prevention27 Nanwei RoadXicheng DistrictBeijingChina The International Union Against tuberculosis and Lung Disease ParisFrance The national tuberculosis Leprosy and Lung Disease ProgramNairobiKenya

Background:Japanese encephalitis(JE)is a leading cause of childhood viral encephalitis both at global level and in *** is recommended as a key strategy to control *** China most JE cases have been reported in southwest provinces,which include *** this study,we quantify the epidemiological shift of JE in Yunnan Province from 2005 to 2017,covering before and after the introduction of JE vaccination into routine Expanded Program on Immunization(EPI)in ***:We used routinely collected data in the case-based JE surveillance system from 2005 through 2017 in *** were reported from hospital and county-level Centers for Disease control in line with the national JE Surveillance *** data were extracted,analysed and presented in appropriate *** coverage was estimated from actual JE doses administered and new births for each ***:A total 4780 JE cases(3077 laboratory-confirmed,1266 clinical and 437 suspected)were reported in the study *** of JE(per 100000 population)increased from 0.95 in 2005 to 1.69 in *** increase in vaccination coverage,incidence rates decreased steadily from 1.16 in 2009 to 0.17 in ***,seasonality remained similar across the years,peaking in ***(bordering Myanmar and Laos),Dehong(bordering Myanmar),and Zhaotong(an inland prefecture)had the highest incidence rates of 2.3,1.9,and 1.6,respectively.97%of all cases were among local *** vaccination coverage increased(and incidence decreased),proportion of JE cases among children20 years old increased from 12 to 48%.There were a large number of JE cases with unknown treatment outcomes,especially in the earlier years of the surveillance ***:The 13-year JE surveillance data in Yunnan Province showed dramatic decrease of total incidence and a shift from children to *** vaccinati

关键词： Vaccination program Incidence Surveillance system Epidemiology Operational research

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The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients

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Infectious Diseases of Poverty 2019年第4期8卷 101-101页

作者： Yan-Jiao Xin Li Xiang Jun-Nan Jiang Henry Lucas Sheng-Lan Tang Fei Huang 不详 national Center for tuberculosis control and Prevention China CDCBeijingChina

Background:tuberculosis(TB)is still a major public health problem in *** scale up TB control,an innovative programme entitled the'China-Gates Foundation Collaboration on TB control in China was initiated in *** the second phase of the project,a policy of increased reimbursement rates under the New Cooperative Medical Scheme(NCMS)was *** this paper,we aim to explore how this reform affects the financial burden on TB patients through comparison with baseline ***:In two cross-sectional surveys,quantitative data were collected before(January 2010 to December 2012)and after(April 2014 to June 2015)the intervention in the existing NCMS routine data *** on all 313 TB inpatients,among which 117 inpatients in the project was *** data collection included 11 focus group *** main indicators,non-reimbursable expenses rate(NER),effective reimbursement rate(ERR),and out-of-pocket payment(OOP)as a percentage of per capita household income,were used to measure the impact of intervention by comprising post-intervention data with baseline *** quantitative data were analysed by descriptive analysis and non-parametric tests(Mann-Whitney U test)using SPSS 22.0,and qualitative data were subjected to thematic framework analysis using ***:The nominal reimbursement rates for inpatient care were no less than 80%for services within the *** inpatient expenses greatly increased,with an average growth rate of 11.3%.For all TB inpatients,the ERR for inpatient care increased from 52 to 66%.Compared with inpatients outside the project,for inpatients covered by the new policy,the ERR was higher(78%),and OOP showed a sharper *** addition,their financial burden decreased ***:Although the nominal reimbursement rates for inpatient care of TB patients greatly increased under the new reimbursement policy,inpatient OOP expenditure was still a major financial problem for pat

关键词： tuberculosis New cooperative medical scheme Financial burden China

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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

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Safety of Blood Maintained in Zimbabwe: Low Transfusion Transmissible Infections among Blood Donors

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Journal of Biosciences and Medicines 2020年第7期8卷 35-43页

作者： David Zezai Palanivel Chinnakali Riitta A. Dlodlo Hamufare D. Mugauri Philip Owiti Menard Mutenherwa George Mavunganidze Lucy M. Marowa Tonderai Mapako national Blood Service Zimbabwe (NBSZ) Harare Zimbabwe Department of Preventive and Social Medicine Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Puducherry India International Union against tuberculosis and Lung Disease Paris France Ministry of Health and Child Care AIDS and TB Unit Harare Zimbabwe national tuberculosis Leprosy and Lung Disease Programme Ministry of Health Nairobi Kenya

Background: Low level of transfusion transmissible infections (TTIs) is an indicator of a well-performing blood donor program. Aim: The study was designed to estimate the prevalence of TTIs and to evaluate the demographic characteristics of reactive and non-reactive blood donors in Zimbabwe in 2018. Methods: A cross-sectional study was conducted using routinely available data from January to December 2018 in five branches of national Blood Service Zimbabwe (NBSZ). After initial screening for high-risk behavior with a questionnaire, weight, blood pressure and hemoglobin level, eligible donors were invited for blood donation. The following laboratory tests for TTIs were done: antibodies and antigen tests for human immunodeficiency virus 1 and 2 (HIV 1/2), tests for the surface antigen of hepatitis B virus (HBV), testing for hepatitis C virus (HCV) antibody and antibodies for treponema pallidum. Information on age, gender, NBSZ branch, marital status, occupation, donor type (first time/repeat) and TTIs test results were extracted from the NBSZ electronic database (e-Delphyn blood bank software). Results: Out of a sample of 1586 blood donors, thirteen (0.81%) were reactive to at least one TTI marker;five (0.32%) were reactive for human immunodeficiency virus, seven (0.44%) for hepatitis B and one (0.06%) for syphilis. There were no samples with co-infection and hepatitis C virus markers. The prevalence of TTIs was highest in the 31 - 45 years age group (2.3%) and among first-time blood donors (4.7%). The prevalence of all TTI was low with the highest prevalence of 0.44% for the hepatitis B virus. Conclusion: Continued concerted efforts will help to maintain satisfactory blood safety in Zimbabwe.

关键词： Transfusion Transmissible Infections Blood Donors Hepatitis Human Immunodeficiency Virus SORT IT

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Buruli ulcer in Nigeria:results of a pilot case study in three rural districts

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Infectious Diseases of Poverty 2016年第1期5卷 328-336页

作者： Kingsley N.Ukwaja Anthony O.Meka Alphonsus Chukwuka Kingsley B.Asiedu Kristina L.Huber Miriam Eddyani Joseph N.Chukwu Moses C.Anyim Charles C.Nwafor Daniel C.Oshi Nelson O.Madichie Ngozi Ekeke Martin Njoku Kentigern Ntana Department of Medicine Federal Teaching HospitalFMC RdAbakalikiEbonyi StateNigeria Medical Department German Leprosy and TB Relief AssociationEnuguEnugu StateNigeria St Benedict’s tuberculosis and leprosy Rehabilitation Hospital OgojaCross River StateNigeria Global Buruli Ulcer Initiative Department of Control of Neglected Tropical DiseasesWorld Health OrganizationGenevaSwitzerland Department of Infectious Diseases and Tropical Medicine University HospitalLudwig-Maximilians UniversityMunichGermany Mycobacteriology Unit Department of MicrobiologyInstitute of Tropical MedicineAntwerpBelgium

Background:Buruli ulcer(BU),also known as Mycobacterium ulcerans disease,is the third most common mycobacterial disease *** BU disease has been diagnosed among Nigerians in neighbouring West African countries,data on the burden of the disease in Nigeria itself are *** study aimed to assess the magnitude and epidemiology of BU in the South South region of ***:We conducted a cross-sectional survey in the Ogoja territory(comprising 31 communities).We undertook sensitisation programmes centred on BU in 10 of the *** were asked to identify community members with long-standing ulcers,who were then invited for *** also contacted traditional healers to refer their clients who had non-healing *** suspected cases had a full clinical evaluation and laboratory *** cases were given treatment in a referral hospital in the ***:We diagnosed 41 clinical BU cases;36(87.8%)of which were confirmed by quantitative polymerase chain reaction(qPCR).These 36 PCR-confirmed cases were diagnosed in a total population of 192,169 ***,the estimated crude prevalence of BU was 18.7 per 100,000 population,varying from 6.0 to 41.4 per 100,000 in the districts *** majority(66.7%)of the cases were *** 92%of the BU lesions were located on the patients’*** differences were observed between the sexes in terms of the location of the *** age of the patients ranged from four to 60 years,with a median age of 17 *** 35(100%)patients who consented to treatment completed chemotherapy as *** the treated cases,29(82.9%)needed and received *** cases healed,but 29(82.9%)had some limitations in *** with limitations in movement occurred in 18/19(94.7%)and 8/10(80.0%)of patients with lesions>15 cm(Category III)and 6–15 cm in diameter(Category II),*** median duration of treatment was 130(87–164)days for children and

关键词： Buruli ulcer Mycobacterium ulcerans Epidemiology Case finding Endemicity Ogoja Cross River State Nigeria

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