Tuberculosis (TB)Progress toward Millennium Development Goals (MDGS) and DOTS in Who Eastern Mediterranean Region (EMR)

Tuberculosis (TB) is an airborne infection. Though effective anti-TB drugs have been available for more than 50 years, over one-third of the world’s population is exposed to TB bacterium; deaths due to TB infection occur at high frequency every day worldwide. Today, drug-resistant TB, TB/HIV co-morbidity and poor health infrastructure are major challenges worldwide, particularly in less developed countries. The primary objective of the study was to assess the progress of TB control programs in twenty-two Eastern Mediterranean Region countries toward Millennium Development Goals (MDGs) including implementation of the Directly Observed Treatment, Short-course (DOTS). Also, the study was designed to explore TB/HIV co-morbidity and to assess some factors potentially associated with TB progress in the region. Secondary data, obtained from the World Health Organization, World Bank, and World Resource Institute on line databases were used. Paired samples t-test and bivariate correlation were conducted. Between 1990 and 2005, TB incidence had decreased 9%, TB prevalence had decreased 37% (statistically significant) and TB mortality had decreased 28%; nevertheless, MDG targets were not met. TB/HIV co-morbidity increased in the region especially in HIV-high burden countries. Though DOTS population coverage was increased to 94% in 2005, DOTS new smear-positive case detection rate was 61% (target 70%) and DOTS treatment success was 80% (target 85%). Thus, the 1991 Stop TB Partnership targets were not met. In spite of the progress of TB control programs in the EMR, MDGs and DOTs targets of 2005 were not obtained. Further efforts such as allocation of more resources, strengthening of TB surveillance systems, extension of drug-resistant TB and TB/HIV collaborative programs, and TB research are required to achieve MDGs by 2015 and to fully implement the new Stop TB Strategy in the region

A pilot with computer-assisted psychosocial risk –assessment for refugees

<p>Abstract</p> <p>Background</p> <p>Refugees experience multiple health and social needs. This requires an integrated approach to care in the countries of resettlement, including Canada. Perhaps, interactive eHealth tools could build bridges between medical and social care in a timely manner. The authors developed and piloted a multi-risk Computer-assisted Psychosocial Risk Assessment (CaPRA) tool for Afghan refugees visiting a community health center. The iPad based CaPRA survey was completed by the patients in their own language before seeing the medical practitioner. The computer then generated individualized feedback for the patient and provider with suggestions about available services.</p> <p>Methods</p> <p>A pilot randomized trial was conducted with adult Afghan refugees who could read Dari/Farsi or English language. Consenting patients were randomly assigned to the CaPRA (intervention) or usual care (control) group. All patients completed a paper-pencil exit survey. The primary outcome was patient intention to see a psychosocial counselor. The secondary outcomes were patient acceptance of the tool and visit satisfaction.</p> <p>Results</p> <p>Out of 199 approached patients, 64 were eligible and 50 consented and one withdrew (CaPRA = 25; usual care = 24). On average, participants were 37.6 years of age and had lived 3.4 years in Canada. Seventy-two percent of participants in CaPRA group had intention to visit a psychosocial counselor, compared to 46 % in usual care group [<it>X</it>^<it>2</it> (1)=3.47, <it>p</it> = 0.06]. On a 5-point scale, CaPRA group participants agreed with the benefits of the tool (mean = 4) and were ‘unsure’ about possible barriers to interact with the clinicians (mean = 2.8) or to privacy of information (mean = 2.8) in CaPRA mediated visits. On a 5-point scale, the two groups were alike in patient satisfaction (mean = 4.3).</p> <p>Conclusion</p> <p>The studied eHealth tool offers a promising model to integrate medical and social care to address the health and settlement needs of refugees. The tool’s potential is discussed in relation to implications for healthcare practice. The study should be replicated with a larger sample to generalize the results while controlling for potential confounders.</p