Adaptation of the Tool to Estimate Patient Costs Questionnaire into Indonesian Context for Tuberculosis-affected Households

Background: Indonesia is the second-highest country for tuberculosis (TB) incidence worldwide. Hence, it urgently requires improvements and innovations beyond the strategies that are currently being implemented throughout the country. One fundamental step in monitoring its progress is by preparing a validated tool to measure total patient costs and catastrophic total costs. The World Health Organization (WHO) recommends using a version of the generic questionnaire that has been adapted to the local cultural context in order to interpret findings correctly. This study is aimed to adapt the Tool to Estimate Patient Costs questionnaire into the Indonesian context, which measures total costs and catastrophic total costs for tuberculosis-affected households. Methods: the tool was adapted using best-practice guidelines. On the basis of a pre-test performed in a previous study (referred to as Phase 1 Study), we refined the adaptation process by comparing it with the generic tool introduced by the WHO. We also held an expert committee review and performed pre-testing by interviewing 30 TB patients. After pre-testing, the tool was provided with complete explanation sheets for finalization. Results: seventy-two major changes were made during the adaptation process including changing the answer choices to match the Indonesian context, refining the flow of questions, deleting questions, changing some words and restoring original questions that had been changed in Phase 1 Study. Participants indicated that most questions were clear and easy to understand. To address recall difficulties by the participants, we made some adaptations to obtain data that might be missing, such as tracking data to medical records, developing a proxy of costs and guiding interviewers to ask for a specific value when participants were uncertain about the estimated market value of property they had sold. Conclusion: the adapted Tool to Estimate Patient Costs in Bahasa Indonesia is comprehensive and ready for use in future studies on TB-related catastrophic costs and is suitable for monitoring progress to achieve the target of the End TB Strategy

Sensitivity and specificity of single IgA and IgG antibody concentrations for early diagnosis of pertussis in adults: an evaluation for outbreak management in public health practice

Background: An accurate, practical laboratory test is needed to confirm clinical diagnosis of pertussis in adults during the first 3 symptomatic weeks, when treatment is effective and transmission can be interrupted. Methods: The sensitivity and specificity of single IgA and IgG levels were assessed in a cohort study of a pertussis epidemic in 99 adults in a closed community. Sensitivities were assessed in the sera of 46 laboratory confirmed clinical pertussis cases during the first 3 weeks. Specificities were calculated in sera of 35 asymptomatic controls without clinical symptoms or laboratory confirmed infections from the same community (internal contro

Sensitivity and specificity of methods of classification of leprosy without use of skin-smear examination

A 12-month cohort of 2664 new leprosy cases in Bangladesh has been analyzed to provide information about the sensitivity and specificity of two different methods of classifying leprosy into paucibacillary (PB) and multibacillary (MB), if the results of skin-smear examination are not taken into account. The two methods are: 1) a procedure based on counting skin lesions recommended by the World Health Organization (WHO) (&lt;6 skin lesions = PB, ≥6 skin lesions = MB); and 2) the 'Bangladesh method' (&lt;10 skin and nerve lesions = PB, ≥10 skin and nerve lesions = MB). In the latter system, any degree of nerve enlargement is taken to be a nerve lesion. The WHO method was found to be 89% sensitive and 88% specific at detecting smear-positive MB cases from among the cohort; the Bangladesh system, 92% sensitive and 88.6% specific. The WHO method did not detect 18 smear-positive cases as MN; the Bangladesh method left 13 smear-positive cases unclassified as MB. Several of these 'missed' (false-negative) cases had a high bacterial index. The WHO system of classifying leprosy cases as MB is simple to apply and has a reasonable balance between sensitivity and specificity. However, it must be recognized that the system will lead to a small but significant number of skin-smear-positive MB cases being treated with a PB treatment regimen.</p

Sensitivity and specificity of single IgA and IgG antibody concentrations for early diagnosis of pertussis in adults: an evaluation for outbreak management in public health practice

Background: An accurate, practical laboratory test is needed to confirm clinical diagnosis of pertussis in adults during the first 3 symptomatic weeks, when treatment is effective and transmission can be interrupted. Methods: The sensitivity and specificity of single IgA and IgG levels were assessed in a cohort study of a pertussis epidemic in 99 adults in a closed community. Sensitivities were assessed in the sera of 46 laboratory confirmed clinical pertussis cases during the first 3 weeks. Specificities were calculated in sera of 35 asymptomatic controls without clinical symptoms or laboratory confirmed infections from the same community (internal contro

Sensitivity and specificity of methods of classification of leprosy without use of skin-smear examination

A 12-month cohort of 2664 new leprosy cases in Bangladesh has been analyzed to provide information about the sensitivity and specificity of two different methods of classifying leprosy into paucibacillary (PB) and multibacillary (MB), if the results of skin-smear examination are not taken into account. The two methods are: 1) a procedure based on counting skin lesions recommended by the World Health Organization (WHO) (&lt;6 skin lesions = PB, ≥6 skin lesions = MB); and 2) the 'Bangladesh method' (&lt;10 skin and nerve lesions = PB, ≥10 skin and nerve lesions = MB). In the latter system, any degree of nerve enlargement is taken to be a nerve lesion. The WHO method was found to be 89% sensitive and 88% specific at detecting smear-positive MB cases from among the cohort; the Bangladesh system, 92% sensitive and 88.6% specific. The WHO method did not detect 18 smear-positive cases as MN; the Bangladesh method left 13 smear-positive cases unclassified as MB. Several of these 'missed' (false-negative) cases had a high bacterial index. The WHO system of classifying leprosy cases as MB is simple to apply and has a reasonable balance between sensitivity and specificity. However, it must be recognized that the system will lead to a small but significant number of skin-smear-positive MB cases being treated with a PB treatment regimen.</p

Interventions for erythema nodosum leprosum (Protocol)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effects of any therapy or treatment used in the management of ENL.<br/

Interventions for erythema nodosum leprosum (Protocol)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effects of any therapy or treatment used in the management of ENL.<br/

Close contacts with leprosy in newly diagnosed leprosy patients in a high and low endemic area:Comparison between Bangladesh and Thailand

Background: As part of a larger study of the role of close contacts in the transmission of M. leprae, we explored whether the proportion of newly detected cases with a family history of leprosy differs with different incidence rates of leprosy in a population. Methods: Retrospective analysis was performed of contacts of all new leprosy patients diagnosed during a 10-yr period in well-established leprosy control programs in Thailand and Bangladesh. By our definition, a contact group consisted of the new case and of past and present cases who were relatives and in-laws of the new case. For a new case, the nearest index case was defined on the basis of time of onset of symptoms for the cases in the contact group, in combination with the level of closeness of contact between these cases and the new case. Three contact levels were distinguished. In Bangladesh these levels were defined as 'kitchen contact'; 'house contact'; and 'non-house contact'. In Thailand comparable levels were defined as 'house contact'; 'compound contact'; and 'neighbor contact'. Results: In Bangladesh 1333, and in Thailand 129 new patients were included. The average new case detection rate over 10 yrs was 50 per 100,000 general population per year in Bangladesh, and 1.5 per 100,000 in Thailand. In the high endemic area 25% of newly detected cases were known to belong to a contact group and were not the index case of this group, whereas in the low endemic area 62% of newly detected cases had these characteristics. The distribution of the nearest index cases over the three contact levels was comparable in both areas. Just over half of the nearest index cases were found within the immediate family unit ('kitchen' in Bangladesh; 'house' in Thailand). Conclusion: The results indicate that in a low endemic area a higher proportion of newly detected leprosy cases have a family history of leprosy compared to a high endemic area. Different contact levels and their relative risks to contract leprosy need to be established more precisely. In high endemic situations the circle of contacts that should be surveyed may need to be wider than currently practiced.</p

Close contacts with leprosy in newly diagnosed leprosy patients in a high and low endemic area:Comparison between Bangladesh and Thailand

Background: As part of a larger study of the role of close contacts in the transmission of M. leprae, we explored whether the proportion of newly detected cases with a family history of leprosy differs with different incidence rates of leprosy in a population. Methods: Retrospective analysis was performed of contacts of all new leprosy patients diagnosed during a 10-yr period in well-established leprosy control programs in Thailand and Bangladesh. By our definition, a contact group consisted of the new case and of past and present cases who were relatives and in-laws of the new case. For a new case, the nearest index case was defined on the basis of time of onset of symptoms for the cases in the contact group, in combination with the level of closeness of contact between these cases and the new case. Three contact levels were distinguished. In Bangladesh these levels were defined as 'kitchen contact'; 'house contact'; and 'non-house contact'. In Thailand comparable levels were defined as 'house contact'; 'compound contact'; and 'neighbor contact'. Results: In Bangladesh 1333, and in Thailand 129 new patients were included. The average new case detection rate over 10 yrs was 50 per 100,000 general population per year in Bangladesh, and 1.5 per 100,000 in Thailand. In the high endemic area 25% of newly detected cases were known to belong to a contact group and were not the index case of this group, whereas in the low endemic area 62% of newly detected cases had these characteristics. The distribution of the nearest index cases over the three contact levels was comparable in both areas. Just over half of the nearest index cases were found within the immediate family unit ('kitchen' in Bangladesh; 'house' in Thailand). Conclusion: The results indicate that in a low endemic area a higher proportion of newly detected leprosy cases have a family history of leprosy compared to a high endemic area. Different contact levels and their relative risks to contract leprosy need to be established more precisely. In high endemic situations the circle of contacts that should be surveyed may need to be wider than currently practiced.</p

Interventions for erythema nodosum leprosum:A Cochrane review

Introduction: Treatment for erythema nodosum leprosum (ENL), an immunological complication of leprosy, is diverse. We undertook a systematic review as it was not clear which treatments were most beneficial. Methods: We did a systematic search to identify randomised controlled trials (RCTs) comparing treatment with placebo, no treatment or another therapy. Two authors assessed quality and checked data. Results: We included 13 studies involving 445 participants. These trials assessed: betamethasone, thalidomide, pentoxifylline, clofazimine, indomethacin and levamisole. The quality of the trials was generally poor and no results could be pooled due to the treatments being so heterogeneous. Treatment with thalidomide showed a significant benefit compared to aspirin (RR 2.43; 95% CI 1.28 to 4.59). Clofazimine treatment was superior to prednisolone (more treatment successes; RR 3.67; 95% CI 1.36 to 9.91) and thalidomide (fewer recurrences; RR 0.08; 95% CI 0.01, 0.56). Minor adverse events were significantly lower in participants on a low dose thalidomide regimen compared to a high dose thalidomide regimen (RR 0.46; 95% CI 0.23 to 0.93). Significantly more minor adverse events were reported in participants taking clofazimine compared with prednisolone (RR 1.92; 95% CI 1.10 to 3.35). None of the studies assessed quality of life or economic outcomes. Conclusion: There is some evidence of benefit for thalidomide and clofazimine, but generally we did not find clear benefits for interventions in the management of ENL.</p