Determinants of Survival of Patients with Tuberculosis in Developing Countries

Tuberculosis (TB), a major disease of public health importance, continues to cause significant morbidity and mortality to populations around the world. In 2016, it accounted for 1.7 million deaths worldwide. While the mortality rate among patients undergoing TB treatment has been declining over the years, TB death rates remains high in developing countries. This chapter discusses the epidemiology of TB mortality, the pathogenesis of TB highlighting susceptibility to mortality, and the interaction of factors which determine an individual’s risk to death on account of TB. Furthermore, the chapter proposes the need for a strategic research agenda on reduction of TB burden, focusing on the factors that enable or impede political will towards translating knowledge into effective action

Assessing the effect of indoor residual spraying (IRS) on malaria morbidity in Northern Uganda: a before and after study

BACKGROUND : Indoor residual spraying (IRS) is known to reduce malaria transmission. In northern Uganda, a high endemic area, IRS has been implemented since 2006. Limited data however, exists on the effect of IRS on the malaria burden. This study sought to assess the effect of IRS on malaria morbidity in the high intensity area of northern Uganda. Retrospective routine data from ten health facilities in three districts which had received at least five rounds of IRS in northern Uganda was analysed. The primary outcome of interest was malaria morbidity, measured by the slide positivity rate (SPR). Descriptive statistics were used to describe the malaria morbidity stratified by age and sex. The average change in the malaria morbidity, measured by the SPR was assessed according to time, measured as calendar months. A fixed-effects linear regression model was used which included a polynomial function of time and controlled for malaria seasonality and variations between districts/facilities. RESULTS : The total out-patient department attendance in the ten health facilities for the study period was 2,779,246, of which 736,034 (26.5%) malaria cases were diagnosed with 374,826 (50.9%) cases of under 5 years and an overall SPR of 37.5%. The percentage point (p.p.) changes in SPR according to time measured as calendar months following IRS, revealed a decreasing trend in malaria morbidity in the first 3 months following each round of IRS. The highest percentage point decrease in the SPR was observed in the second month following IRS (9.5 p.p., CI −17.85 to −1.16, p = 0.026), among patients above 5 years. The SPR decline however waned by the fourth month following IRS, with an increase in the SPR of 8.4 p.p. at district level by the sixth month, p = 0.510. CONCLUSION : The study results show that IRS was associated with a significant reduction in malaria morbidity in northern Uganda in the first 3 months following IRS. The malaria reduction however waned by the fourth month following IRS.Additional file 1. Details of indoor residual spraying rounds.Measure Evaluation under the post graduate programme at the University of Pretoria.http://www.malariajournal.comam2017School of Health Systems and Public Health (SHSPH

A cross-sectional survey on the lifestyle and health-seeking behaviour of Basotho patients with diabetes

OBJECTIVES: The objectives of the study were to determine the level of practice of a healthy lifestyle, to assess the health education provided to patients with diabetes and to determine the prevalence of obesity among Basotho patients with diabetes. DESIGN: A cross-sectional study enrolled 192 patients between November 2004 and July 2005. Descriptive statistics on demographic, socio-economic and lifestyle data were computed. Weight, waist circumference and hip circumference measurements were taken to compute body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR). SETTING AND SUBJECTS: Patients with diabetes attending three hospitals in Lesotho were recruited in the study. OUTCOME MEASURES: These included obesity indices, the quality and quantity of physical exercises, the quality and quantity of provided health education and the frequency with which the subjects sought medical help. RESULTS: The participants’ mean age was 54.73 years. The prevalence of smoking (14.6%) was higher than that of drinking (9.4%). Only 20.8% of the participants participated in recommended physical exercise. Most participants (95%) consulted their physicians on a regular basis. The Health Education Quantity Index was very low: 49.9%. The prevalence of obesity measured by BMI, WHpR and WHtR was 67.7%, 69.8% and 95.3% respectively. CONCLUSION: The practice of a healthy lifestyle was suboptimal, but help-seeking behaviour was satisfactory among participants. It is recommended that health education and the promotion of a healthy lifestyle are encouraged, that diabetes education is rendered by accredited educators or healthcare providers trained in communicating health messages, and that the fight against obesity is made a priority.www.safpj.co.zaam201

Survival of smear-positive multidrug resistant tuberculosis patients in Witbank, South Africa : a retrospective cohort study

BACKGROUND : A retrospective cohort study was carried out to compare the survival between smear-positive patients and smear-negative multidrug resistant tuberculosis (MDR-TB) patients hospitalised in a specialised TB hospital in Witbank, South Africa. METHODS : A review of medical records of MDR-TB patients treated from 2001 to 2010 was carried out. Survival time was measured from a patient's date of hospitalisation to the date when the patient died, was last treated at the hospital or the end of the study (whichever came first). All patients who were alive until the end of the study period or lost to follow-up were censored and those who died were considered as failures. Survival patterns were estimated using Kaplan Meier plots, log rank tests and life tables. Cox proportional hazards regression analyses were also conducted. RESULTS : The mean age of the 442 MDR-TB patients in the study was 37.7 ± 11.2 years. The incidence rates of mortality were 13.4 and 43.9 per 1000 person-months for smear-negative and smear-positive MDR-TB patients, respectively. Cox proportional hazard regression showed that the predictors of death among MDR-TB patients include HIV co-infection (adjusted Hazard Rate, aHR = 1.89, 95% CI = 1.02-3.52), old age (above 60 years) (aHR = 2.05, 95% CI = 1.04-3.60) and smear positivity at diagnosis (aHR = 3.29, 95% CI = 2.39-4.64). CONCLUSION : The study showed that the probability of survival during the treatment is reduced in MDR-TB patients, who are smear-positive, HIV positive or older than 60 years. Special care should be given to these patients to improve survival.http://www.tandfonline.com/loi/infd202017-06-30hb2016School of Health Systems and Public Health (SHSPH

Predictors of drug sensitive tuberculosis treatment outcomes among hospitalized patients in South Africa : a multinomial logit model

No abstract available.The Research Committee of the School of Health Systems and Public Health, University of Pretoriahttp://www.tandfonline.com/loi/infd20hj2018School of Health Systems and Public Health (SHSPH

Effectiveness of community participation in tuberculosis control

Background: The global prominence of Tuberculosis (TB) as a public health issue has seen various multi-stakeholder interventions adopted to meet this challenge. In low resource settings where health systems are hardly coping, community participation has emerged as a pivotal measure for successful programming. This study sought to determine the best approach of integrating community interventions for TB control. Methodology: The study evaluated the records of the 3110 new TB patients registered in three Local Service Areas (LSA’s), from quarter 1 2004 to quarter 4 2005. In a quasi-experimental study design, the performance of respective LSA’s was compared over time; taking cognizance of the community project in one of the LSA’s. Further analysis was done to establish the influential determinants of treatment success. Results: Bacteriological coverage, smear conversion and treatment success rates dropped in the interventional LSA, while the control LSA’s remained consistent. The defaulter rates dropped in all LSA’s, while the proportion of unevaluated cases increased in the interventional LSA. However, patients registered in the clinics had better chance of successful treatment outcome (OR 10.8, 95% CI 8.03-14.3) compared to their hospital counterparts. Conclusion: Community participation by itself is not adequate to improve the performance of a TB control program. Enhancement of the program’s technical and organizational capacity is crucial, prior to engaging purely community interventions. Failure to observe this logical relationship would ultimately result in suboptimal performance. Therefore, the process of entrusting communities with more responsibility in TB control should be gradual and take cognizance of the various health system factors

Multi-drug-resistant tuberculosis clusters in Mpumalanga province, South Africa, 2013–2016 : a spatial analysis

OBJECTIVE : To identify spatial clusters with unusually high levels of MDR-TB, which are highly unlikely to have arisen by chance in Mpumalanga Province, South Africa. METHODS : Home addresses of all MDR-TB patients were collected from four MDR-TB facilities from 2013 to 2016. We mapped all addresses, linking them to the nearest ward with population estimates. A spatial analysis was conducted using kernel density in ArcGIS to estimate and map the distribution of the disease and used Gertis-Ord Gi to test for significant clustering. RESULTS : A total of 4065 MDR-TB patients were mapped. Ten significant clusters (p-value <0.05) were found across the province in six sub-districts: Mbombela, Nkomazi, Emalahleni, Govan Mbeki, Lekwa and Mkhondo. Mbombela has the highest number of significant clusters. The central region did not have any MDR-TB clusters. CONCLUSION : There is clear evidence of MDR-TB clustering in Mpumalanga. This calls for concentrated TB prevention efforts and proper allocation of resources. Further investigations are needed to identify MDR-TB predictors.http://www.wileyonlinelibrary.com/journal/tmihj2022School of Health Systems and Public Health (SHSPH

Predictors of survival among HIV-positive children on ART in Swaziland

The objective of the study was to determine predictors of survival among HIV-positive children (<15 years) in Swaziland. A retrospective cohort analysis of medical records for 4 167 children living with HIV who were initiated on antiretroviral therapy (ART) between 2004 and 2008, and followed up until 2014 was conducted in clinical settings at 36 health facilities. The Kaplan Meier Estimator, signed-ranks test, and the Cox proportional hazards regression model were applied to determine survival probabilities, significant difference among stratified survival functions and adjusted hazard ratios respectively. The results reveal that the median survival time for children was 78 months (95% CI: 77–79). Children who were initiated early on ART had higher survival probability over time (HR: 0.35 [95% CI: 0.21–0.57], p < 0.001) compared to those whose ART initiation was delayed. Children within the age group of <1 years had higher hazard (HR = 1.55 [95% CI: 1.16–2.08], p < 0.001) of death than children within the age group of 1–14 years. Children who were nourished had 88% lower hazard of death (HR: 0.12 [95% CI: 0.07–0.19], p < 0.001) than severely malnourished children. The study demonstrates that ART paediatric services are effective in increasing survival among HIV infected children and early initiated children have high survival probability. Active tuberculosis (TB), malnutrition, and delayed ART initiation remain predictors of poor survival among children living with HIV.http://www.tandfonline.com/loi/raar20am2018School of Health Systems and Public Health (SHSPH

Methodology and baseline results from the evaluation of a sexuality education activity in Mpumalanga and KwaZulu-Natal, South Africa

In South Africa, adolescents and young adults (ages 15–24) are at risk of HIV, sexually transmitted infections, and unintended pregnancies. Recently, the Department of Basic Education has revised its sexuality education content and teaching strategies (using scripted lessons plans) as part of its life orientation curriculum. This paper presents the methodology and baseline results from the evaluation of the scripted lesson plans and supporting activities. A rigorous cluster-level randomized design with random assignment of schools as clusters is used for the evaluation. Baseline results from grade 8 female and male learners and grade 10 female learners demonstrate that learners are at risk of HIV and early and unintended pregnancies. Multivariable analyses demonstrate that household-level food insecurity and living with an HIV-positive person are associated with sexual experience and pregnancy experience. Implications are discussed for strengthening the current life orientation program for future scale-up by the government of South Africa.The U.S. Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004.http://www.guilford.com/journals/AIDS-Education-and-Prevention/Francisco-Sy/089995462019-10-01hj2018School of Health Systems and Public Health (SHSPH