Training of front-line health workers for tuberculosis control: Lessons from Nigeria and Kyrgyzstan

Efficient human resources development is vital for facilitating tuberculosis control in developing countries, and appropriate training of front-line staff is an important component of this process. Africa and Central Asia are over-represented in global tuberculosis statistics. Although the African region contributes only about 11% of the world population, it accounts for at least 25% of annual TB notifications, a proportion that continues to increase due to poor case management and the adverse impact of HIV/AIDS. Central Asia's estimated current average tuberculosis prevalence rate of 240/100 000 is significantly higher than the global average of 217/100 000. With increased resources currently becoming available for countries in Africa and Central Asia to improve tuberculosis control, it is important to highlight context-specific training benchmarks, and propose how human resources deficiencies may be addressed, in part, through efficient (re)training of frontline tuberculosis workers. This article compares the quality, quantity and distribution of tuberculosis physicians, laboratory staff, community health workers and nurses in Nigeria and Kyrgyzstan, and highlights implications for (re)training tuberculosis workers in developing countries

The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review

<p>Abstract</p> <p>Background</p> <p>In 2004, tuberculosis (TB) was responsible for 2.5% of global mortality (among men 3.1%; among women 1.8%) and 2.2% of global burden of disease (men 2.7%; women 1.7%). The present work portrays accumulated evidence on the association between alcohol consumption and TB with the aim to clarify the nature of the relationship.</p> <p>Methods</p> <p>A systematic review of existing scientific data on the association between alcohol consumption and TB, and on studies relevant for clarification of causality was undertaken.</p> <p>Results</p> <p>There is a strong association between heavy alcohol use/alcohol use disorders (AUD) and TB. A meta-analysis on the risk of TB for these factors yielded a pooled relative risk of 2.94 (95% CI: 1.89-4.59). Numerous studies show pathogenic impact of alcohol on the immune system causing susceptibility to TB among heavy drinkers. In addition, there are potential social pathways linking AUD and TB. Heavy alcohol use strongly influences both the incidence and the outcome of the disease and was found to be linked to altered pharmacokinetics of medicines used in treatment of TB, social marginalization and drift, higher rate of re-infection, higher rate of treatment defaults and development of drug-resistant forms of TB. Based on the available data, about 10% of the TB cases globally were estimated to be attributable to alcohol.</p> <p>Conclusion</p> <p>The epidemiological and other evidence presented indicates that heavy alcohol use/AUD constitute a risk factor for incidence and re-infection of TB. Consequences for prevention and clinical interventions are discussed.</p

Prevalence of CCHF Virus in Ticks and People and Public Awareness in Zhambyl Region, Kazakhstan

ObjectiveAs part of CDC’s Global Disease Detection work, in conjunction with Zhambyl Region Department of Health, we conducted a tick survey and human seroprevalence Knowledge, Attitudes, and Practices (KAP) survey of livestock-owning households in Zhambyl to assess CCHF seroprevalence and risk factors.IntroductionCrimean Congo Hemorrhagic Fever (CCHF) virus is a tick-borne pathogen that causes severe disease in people, with a distribution that extends from central Asia to southern Africa. In addition to tick bites, contact with bodily fluids from viremic livestock or from symptomatic humans are risk factors for infection. From 2000 to 2013, 73 cases of CCHF were reported in Zhambyl Region, Kazakhstan. CCHF virus is categorized as an “especially dangerous pathogen” in Kazakhstan and CCHF is prioritized for surveillance and treatment. Little is known about the seroprevalence of infection by CCHF virus in Zhambyl in ticks or people, and knowledge of risk factors for transmission of CCHF virus among at-risk populations is believed to be low.MethodsRural villages were classified as “endemic” or “non-endemic”, where endemic areas reported ≥1 CCHF case or a CCHF virus-positive tick in the past 5 years. In each group, 15 villages were chosen by population proportional to livestock population size. Livestock-owning households (n=969) were selected randomly from veterinary registries. One adult was randomly selected per house and ticks were collected from one randomly selected sheep or cow over 1 year of age per house. Data were weighted accounting for design and analyzed in R.ResultsKAP surveys were completed for 950 people (98%); of those, 923 (97%) submitted blood for ELISA testing using Vector-Best Kits. Median age of human respondents was 46 years (range: 19 – 90); 54% were male. Three individuals were anti-CCHF IgM positive, 12 anti-CCHF IgG positive and two positive for both. Weighted seroprevalence of CCHF in Zhambyl was 1.6% (95% CI: 0.9, 3.0). In endemic villages, seroprevalence was 1.8% (95% CI: 1.0, 3.0), compared to 1.2% (95% CI: 0.4, 4.0) in non-endemic villages. Of the 17 seropositive for CCHF, median age was 54 years; 58% were male. None reported previous CCHF diagnosis or illness with fever and hemorrhaging in the past five years. None reported high-risk tick exposure in the past four months. Controlling for age and sex, milking animals, an activity in which 40.3% of the population had engaged, was associated with infection in Poisson regression (OR: 2.53, 95% CI: 1.27, 4.81). Of respondents who had heard of CCHF (n=791), 99.8% knew transmission was caused by a tick bite; few identified contact with animal blood (8.2%) or tick crushing (20.8%) as potential causes. Of the five seropositive by IgM, four participated in at least one of the following activities in the last four months: milking (n=3), birthing (n=2), shearing and slaughtering (n=1). One reported experiencing an illness with joint pain within the past four months. Three were from non-endemic villages.Entomologists inspected 465 cows and 528 sheep for ticks. Ticks were found on 61.5% (95% CI: 48.1, 73.2) of cows (n=254) and 46.3% (95% CI: 24.3, 69.8) of sheep (n=264). Ticks were grouped into pools by animal source and species. Over ninety-seven percent of the tick pools were from the family Ixoidadae, with the remaining from family Argasidae. The genus Hyalomma accounted for 65.8% of tick pools, Rhipicephalus for 31.8%, Ornithodoros for 2.4%, and Argas for 0.5%. Pools contained an average of 4.5 ticks (range: 1 – 26). Ticks were stored live at 4°C for up to 24 hours before being crushed and extracts tested for CCHF virus by PCR and Antigen testing. Of the 155 pools tested, seven (2.4%, 95% CI: 1.1, 5.0) were positive for CCHF virus by either PCR (n=5) and/or antigen testing (n=4). A CCHF virus-positive tick was found on 1.4% (95% CI: 0.4, 4.8) of all sheep and 4.8% (95% CI: 2.3, 10.0) of all cows. All CCHF virus-positive ticks were hard ticks of family Ixodidae, belonging to either genus Hyalomma (n=5) or Rhipicephalus (n=2). Two pools were from non-endemic villages.ConclusionsPresence of CCHF virus-positive ticks and CCHF-seropositive humans in non-endemic areas may suggest a wider range of virus circulation. These findings will be used to inform and target public health messaging

Hazardous and Harmful Alcohol Use and Associated Factors in Tuberculosis Public Primary Care Patients in South Africa

The aim of this study was to assess the prevalence of hazardous and harmful alcohol use and associated factors among patients with tuberculosis in South Africa. In a cross-sectional survey new tuberculosis (TB) and TB retreatment patients were consecutively screened using the Alcohol Use Disorder Identification Test (AUDIT) within one month of anti-tuberculosis treatment. The sample included 4,900 (54.5% men and women 45.5%) tuberculosis patients from 42 primary care clinics in three districts. Results indicate that, overall 23.2% of the patients were hazardous or harmful alcohol drinkers, 31.8% of men and 13.0% of women were found to be hazardous drinkers, and 9.3% of men and 3.4% of women meet criteria for probable alcohol dependence (harmful drinking) as defined by the AUDIT. Men had significantly higher AUDIT scores than women. In multivariable analyses it was found that among men poor perceived health status, tobacco use, psychological distress, being a TB retreatment patient and not being on antiretroviral therapy (ART), and among women lower education, tobacco use and being a TB retreatment patient were associated with hazardous or harmful alcohol use. The study found a high prevalence of hazardous or harmful alcohol use among tuberculosis primary care patients. This calls for screening and brief intervention and a comprehensive alcohol treatment programme as a key component of TB management in South Africa

Crimean-Congo Hemorrhagic Fever, Kazakhstan, 2009–2010

We evaluated Crimean-Congo hemorrhagic fever (CCHF) surveillance data from southern Kazakhstan during 2009–2010 and found both spatial and temporal association between reported tick bites and CCHF cases. Public health measures should center on preventing tick bites, increasing awareness of CCHF signs and symptoms, and adopting hospital infection control practices