A Triage System For The Early Detection Of Chronic Cough Among TB Suspects Attending A Hospital In Banda Aceh, Indonesia

Background and Aims: One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with TB. In the hospital, people with symptoms compatible with TB have an opportunity to get proper diagnosis and treatment. Yet this opportunity is often missed. We hypothesize that a respiratory triage system recommended by WHO for prevention of the spread of respiratory infection at the outpatient department, can be improved to enhance early detection of TB. With this hypothesis an inter- vention study was conducted at Zainal Abidin Hospital. The objective of this intervention study was to compare the proportion of patients with cough >2 weeks, offered sputum test and TB case detection rate before versus after a respiratory triage system introduced. Methods: Before-and-after interventional study. Intervention; training of health personnel and setting up a respiratory triage system, to detect patients with >2 weeks cough and offering sputum test for acid-fast bacilli. Data from “exit poll” and central laboratory were compared before vs after the triage set up. Results: After the intervention, sampled patients who visited the hospital were more likely to be asked on >2 weeks cough (85.3% vs17.9%). In the whole samples (99.2% vs 64.7%) among them have >2 weeks cough patients. For TB detection, the changes were 39 positive results from 220 AFB tests of 61,871 outpatients to 55 positive from 365 AFB tests among 53,056 outpatients. The rates of sputum testing and TB case detection increased from 3.5 to 6.8 per 1,000 (OR=1.9, 95% CI=1.6-2.3) and 6.3 to 10.4 per 10,000 (OR=1.7, 95% CI=1.1-2.6) respectively. Conclusions: Respiratory triage can significantly increase TB detection rate

Effectiveness of Space Spraying on the Transmission of Dengue/Dengue Hemorrhagic Fever (DF/DHF) in an Urban Area of Southern Thailand

Timely and extensive space spraying has been widely used to prevent the spread of dengue fever/dengue hemorrhagic fever (DF/DHF). Field evaluations on its effectiveness have been rarely reported. This study aimed to evaluate the timeliness, coverage, and effectiveness of space spraying for DF/DHF control using a geographic information system (GIS). Longitudinal monitoring of DF/DHF cases and spray activities in Songkhla municipality was done between May 2006 and April 2007. After a case was detected, subsequent cases occurring within a 100 meter radius of the index case's house and between 16–35 days of onset were considered as potential secondary cases. During the study period, 140 cases of DF/DHF were detected. Of these, 25 were identified as secondary infections from 20 index cases. Where a secondary infection occurred, the mean attack rate was 2.7 per 1,000 population. Two significant predictors for being a secondary case were both related to the house of the index case, namely, absence of window screens and being constructed with corrugated iron sheets. Our findings suggest that space spraying in the study area was inadequate and often failed to prevent secondary cases of DF/DHF. Control programs should target houses constructed with corrugated iron sheets

Association of ABO Blood Group Phenotype and Allele Frequency with Chikungunya Fever

Background. The objective of this study was to investigate the association of the ABO blood group phenotype and allele frequency with CHIK fever. Methods. A rural community survey in Southern Thailand was conducted in August and September 2010. A total of 506 villagers were enrolled. Cases were defined as individuals having anti-CHIK IgG by hemagglutination ≥1 : 10. Results. There were 314 cases (62.1%) with CHIK seropositivity. Females were less likely to have positive anti-CHIK IgG with odds ratio (OR) (95% CI) of 0.63 (0.43, 0.93). All samples tested were Rh positive. Distribution of CHIK seropositivity versus seronegativity (P value) in A, B, AB, and O blood groups was 80 versus 46 (0.003), 80 versus 48 (0.005), 24 versus 20 (0.55), and 130 versus 78 (<0.001), respectively. However, chi-square test between ABO and CHIK infection showed no statistical significance P=0.76. Comparison of the ABO blood group allele frequency between CHIK seropositivity and seronegativity was not statistically significant. Conclusion. This finding demonstrated no association of the ABO blood group phenotypes and allele frequencies with CHIK infection

The economic burden of overseas medical treatment: a cross sectional study of Maldivian medical travelers.

BACKGROUND: Access to tertiary care is a problem common to many small states, especially island ones. Although medical treatment overseas (MTO) may result in cost savings to high income countries, it can be a relatively high cost for low and middle income source countries. The purpose of this study was to estimate the costs of overseas medical treatment incurred by the households of medical travelers from Maldives and assess the burden of medical treatment overseas on the government and on households. METHODS: A survey was conducted of inbound Maldivian medical travelers who traveled during the period June - December 2013. Participants were stratified by the source of funds used for treatment abroad. Three hundred and forty four government-subsidized and 471 privately funded Maldivians were interviewed. Self-reported data on the utilization and expenses incurred during the last visit abroad, including both expenses covered by the government and borne by the household, were collected using a researcher administered structured questionnaire. RESULTS: The median per capita total cost of a medical travel episode amounted to $1,470. Forty eight percent of the cost was spent on travel. Twenty six percent was spent on direct medical costs, which were markedly higher among patients subsidized by the government than self-funded patients (p = <0.001). The two highest areas of spending for public funds were neoplasms and diseases of the circulatory system in contrast to diseases of the musculoskeletal system and nervous system for privately funded patients. Medical treatment overseas imposed a considerable burden on households as 43$68.9 million was spent to obtain treatment for Maldivians in overseas health facilities ($204 per capita), representing 4.8% of the country's GDP. CONCLUSIONS: Overseas medical treatment represents a substantial economic burden to the Maldives in terms of lost consumer spending in the local economy and catastrophic health spending by households. Geographical inequality in access to public funds for MTO and the disproportionate travel cost borne by travelers from rural areas need to be addressed in the existing Universal Health Care programme to minimize the burden of MTO. Increased investment to create more capacity in the domestic health infrastructure either through government, private or by foreign direct investment can help divert the outflow on MTO

Can clot size and stenotic degree predict perfusion defects on conventional computed tomographic pulmonary angiography in diagnoses of pulmonary embolism?

Purpose: To evaluate clot size and stenotic degree on conventional computed tomographic pulmonary angiography (CTPA) with perfusion defect. Material and Methods: Fifty-two pulmonary embolism (PE) patients with 144 PE locations underwent dual-energy CTPA with an iodine distribution map. Each PE location was rated as to whether there was a perfusion defect. Clot size, stenotic degree, and other associated PE findings were evaluated. These findings were then correlated with whether the perfusion defect was present. Results: There were no associations between demographics, clinical characteristics, anatomical data, and perfusion defect. The median iodine concentration ratio was 0.11. Imaging interpretation by 2 thoracic radiologists had excellent agreement. The clot size and stenotic degree in PE were significant predictors of perfusion defect on conventional CTPA. Lesions with higher degrees of stenosis had higher percentages of perfusion defect. The generalized estimating equation (GEE) logistic regression confirmed that clot size and stenotic degree could predict PE perfusion defects on conventional CTPA. Conclusions: The 2 significant predictors of perfusion defect were occluded vessels in both small and large branches together, or complete occlusion of the pulmonary artery

Financial Barrier against Access to Diagnostic Procedures among Enteric Fever Suspects in Highly-endemic Areas of China

There is currently no public financial system that fully covers enteric fever suspects in China. This study aimed at documenting the level of access to definitive diagnostic procedures, especially haemoculture, for these patients and examining the effect of health insurance on access to such care. A hospital-based cross-sectional study was conducted in six counties of Yunnan province, using a structured questionnaire and data extraction from medical records. In total, 714 subjects were recruited. Chi-square test and logistic regression were employed for analysis of data. The majority of the subjects were young adults (52%) and farmers (55%) from low-income families (49%). Only 407 (57%) could afford haemoculture routinely advised by their doctors. Of these, 123 (30%) had haemoculture positive for Salmonella Typhi. After adjustment for income, not getting haemoculture was marginally associated with percentage of reimbursement from the insurance (p value for trend=0.047). Illiteracy was also an independent risk factor for this outcome. The poor coverage of haemoculture for patients suspected of having enteric fever in this endemic area was due to financial barrier. The current health-insurance system inadequately relieved the problem. Further financial reform to help patients suspected with enteric fever is required

The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China

Abstract Background: The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes. Methods: A cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview. Results: NRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household’s capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment. Conclusion: The coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved

Financial Barrier against Access to Diagnostic Procedures among Enteric Fever Suspects in Highly-endemic Areas of China

There is currently no public financial system that fully covers enteric fever suspects in China. This study aimed at documenting the level of access to definitive diagnostic procedures, especially haemoculture, for these patients and examining the effect of health insurance on access to such care. A hospital-based cross-sectional study was conducted in six counties of Yunnan province, using a structured questionnaire and data extraction from medical records. In total, 714 subjects were recruited. Chi-square test and logistic regression were employed for analysis of data. The majority of the subjects were young adults (52%) and farmers (55%) from low-income families (49%). Only 407 (57%) could afford haemoculture routinely advised by their doctors. Of these, 123 (30%) had haemoculture positive for Salmonella Typhi. After adjustment for income, not getting haemoculture was marginally associated with percentage of reimbursement from the insurance (p value for trend=0.047). Illiteracy was also an independent risk factor for this outcome. The poor coverage of haemoculture for patients suspected of having enteric fever in this endemic area was due to financial barrier. The current health-insurance system inadequately relieved the problem. Further financial reform to help patients suspected with enteric fever is required