Households experiencing catastrophic costs due to tuberculosis in Uganda : magnitude and cost drivers

Funding: This survey was funded by CDC (grant number 3U2GGH001180-03S1) toWHO, a USAID Uganda WHO Grant (PIO grant AID-617-10-17-00001) and alsofunding from Doctors with Africa, CUAMM.Background: Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers. Methods: A cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2 weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities. Results: Of the 1178 respondents, 62.7% were male, 44.7% were aged 15-34 years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food. Conclusion: Despite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs.Publisher PDFPeer reviewe

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Summary Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019.

BACKGROUND: Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS: On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION: As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

DATA SHARING STATEMENT : The IPD database is stored within the UCL Data Repository and can be shared subject to the approval of the corresponding authors of the original studies.BACKGROUND Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. METHODS In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and selfreported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). FINDINGS We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. INTERPRETATION Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB.http://www.thelancet.comam2024Medical MicrobiologySDG-03:Good heatlh and well-bein

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Tobacco smoking clusters in households affected by tuberculosis in an individual participant data meta-analysis of national tuberculosis prevalence surveys: Time for household-wide interventions?

Tuberculosis (TB) and non-communicable diseases (NCD) share predisposing risk factors. TB-associated NCD might cluster within households affected with TB requiring shared prevention and care strategies. We conducted an individual participant data meta-analysis of national TB prevalence surveys to determine whether NCD cluster in members of households with TB. We identified eligible surveys that reported at least one NCD or NCD risk factor through the archive maintained by the World Health Organization and searching in Medline and Embase from 1 January 2000 to 10 August 2021, which was updated on 23 March 2023. We compared the prevalence of NCD and their risk factors between people who do not have TB living in households with at least one person with TB (members of households with TB), and members of households without TB. We included 16 surveys (n = 740,815) from Asia and Africa. In a multivariable model adjusted for age and gender, the odds of smoking was higher among members of households with TB (adjusted odds ratio (aOR) 1.23; 95% CI: 1.11–1.38), compared with members of households without TB. The analysis did not find a significant difference in the prevalence of alcohol drinking, diabetes, hypertension, or BMI between members of households with and without TB. Studies evaluating household-wide interventions for smoking to reduce its dual impact on TB and NCD may be warranted. Systematically screening for NCD using objective diagnostic methods is needed to understand the actual burden of NCD and inform comprehensive interventions

ECOLOGICAL ECONOMICS IN THE AGE OF 4IR: SPOTLIGHT ON SUSTAINABILITY INITIATIVES IN THE GLOBAL SOUTH

The study presents an overview of ecological Economics in the Age of 4IR with spotlight on Sustainability Initiatives in the Global South. This study delves into the intersection of ecological economics, the Fourth Industrial Revolution (4IR), and sustainable development initiatives in the Global South. It explores the environmental implications of key 4IR technologies, analyzes economic shifts associated with the digital age, and investigates sustainability initiatives in the Global South. The study highlights successful projects in renewable energy, circular economy practices, and biodiversity conservation, showcasing the region's commitment to ecological and economic sustainability. Challenges and opportunities are discussed, emphasizing the role of inclusive innovation and global cooperation in shaping a future that harmonizes technological advancements with environmental well-being. The study concludes by underscoring the importance of the Global South in influencing a sustainable trajectory in the age of the 4IR. Keywords:  Ecological; Economics; 4IR; Sustainability; Global South

ENTREPRENEURIAL STRATEGIES FOR AI STARTUPS: NAVIGATING MARKET AND INVESTMENT CHALLENGES

This paper delves into the dynamic and evolving world of AI startups, examining the unique challenges and opportunities they face in the current market and investment landscape. The study's primary aim is to dissect the intersection of entrepreneurship and artificial intelligence, offering a nuanced understanding of how AI startups evolve, adapt, and succeed in a rapidly changing environment. The scope of the paper encompasses a thorough exploration of the AI startup ecosystem, focusing on strategic planning, market dynamics, and investment realities. It provides an in-depth analysis of the evolution of AI startups, from their inception to current trends, and investigates the impact of strategic alliances, regulatory challenges, and ethical considerations on these burgeoning enterprises. The methodology employed is a comprehensive literature review, synthesizing insights from various academic sources to construct a well-rounded view of the AI startup landscape. Key findings reveal that AI startups must navigate a complex array of challenges, including rapidly evolving technology, competitive market dynamics, and a shifting regulatory landscape. The study highlights the importance of innovative business models, strategic partnerships, and a keen understanding of regulatory and ethical issues in driving the success of AI startups. Conclusively, the paper recommends that AI startups adopt agile, innovative strategies, balancing technological advancement with ethical and regulatory compliance. It underscores the need for continuous adaptation and strategic foresight in the face of technological and market changes. This study serves as a valuable resource for entrepreneurs, investors, and policymakers in the AI domain, offering insights and guidance for navigating the multifaceted challenges of AI entrepreneurship. Keywords: AI Startups, Market Dynamics, Investment Challenges, Strategic Planning, Technological Innovation

EVALUATING THE EFFICACY OF TECHNOLOGY INCUBATION CENTRES IN FOSTERING ENTREPRENEURSHIP: CASE STUDIES FROM THE GLOBAL SOUT

This study conducts a comprehensive evaluation of the effectiveness of Technology Incubation Centres (TICs) in nurturing entrepreneurship, focusing on case studies from diverse regions of the Global South. With the growing emphasis on innovation and technology-driven economic development, TICs have emerged as vital entities in fostering entrepreneurial ecosystems. The research employs a mixed-methods approach, combining quantitative analysis and qualitative case studies. The quantitative aspect involves assessing key performance indicators, including startup success rates, job creation, and financial sustainability of TICs. Qualitative investigations delve into the nuanced experiences of entrepreneurs, exploring the support mechanisms provided by TICs, challenges faced, and the overall impact on their ventures. The case studies span various contexts within the Global South, encompassing regions with differing economic, social, and cultural landscapes. By examining TICs in diverse settings, the study aims to draw insights into the contextual factors influencing the efficacy of incubation programs and their relevance in different entrepreneurial ecosystems. Preliminary findings suggest a correlation between the success of TICs and factors such as effective mentorship, access to funding, and collaborative networks. However, challenges such as resource constraints, regulatory hurdles, and variations in local market dynamics pose significant barriers to the optimal functioning of TICs. The study contributes to the existing literature by offering a nuanced understanding of the role and impact of TICs in the Global South. Findings will inform policymakers, entrepreneurs, and stakeholders about the specific contextual considerations that influence the efficacy of TICs, ultimately aiding in the refinement of strategies to enhance entrepreneurship and innovation in emerging economies. As the Global South increasingly positions itself as a hub for technological innovation, this research provides timely insights into the evolving landscape of entrepreneurial support structures, offering practical implications for the future development of TICs and fostering a conducive environment for sustained entrepreneurial growth. Keywords: Technology Incubation Centres, Entrepreneurship, Global South, Case Studies, Innovation, Economic Development

CYBERSECURITY AWARENESS AND EDUCATION PROGRAMS: A REVIEW OF EMPLOYEE ENGAGEMENT AND ACCOUNTABILITY

As organizations continue to grapple with the escalating threat landscape of cyber-attacks, the imperative to fortify their cybersecurity defenses becomes increasingly paramount. This review delves into the critical realm of cybersecurity awareness and education programs, focusing on the pivotal factors of employee engagement and accountability. The effectiveness of these programs in cultivating a cyber-resilient workforce is scrutinized through an extensive examination of existing literature, empirical studies, and industry practices. The review begins by exploring the foundational elements of cybersecurity awareness programs, elucidating the significance of imparting knowledge and instilling a culture of vigilance among employees. It examines the diverse methodologies employed in these programs, ranging from interactive workshops and simulated phishing exercises to online modules and gamified learning platforms. A comparative analysis of these approaches sheds light on their respective strengths and limitations. A central theme of this review revolves around the nexus between employee engagement and cybersecurity resilience. It delves into the psychological and behavioral aspects of engagement, assessing how motivational factors and tailored learning experiences contribute to heightened cybersecurity awareness. The impact of organizational culture and leadership support on fostering a sense of responsibility among employees is also explored, emphasizing the need for a holistic approach that transcends mere compliance. Furthermore, the review investigates the role of accountability in sustaining the efficacy of cybersecurity initiatives. It examines the mechanisms employed by organizations to enforce adherence to security policies and protocols, emphasizing the role of robust monitoring systems, clear communication channels, and consequence management. Case studies and real-world examples are integrated to illustrate instances of successful accountability frameworks and their influence on overall cybersecurity posture. This review synthesizes key findings and identifies emerging trends in cybersecurity awareness and education programs, with a particular focus on optimizing employee engagement and fostering a culture of accountability. The insights gleaned from this analysis provide a roadmap for organizations seeking to fortify their defenses against evolving cyber threats by cultivating a vigilant and proactive workforce. Keywords: Cybersecurity, Education, Cyber threat, Employee engagement, Accountability