Sex-differences in socioeconomic status and health-seeking behaviour among tuberculosis patients in transitional Albania in 2012-2013

Aim: There is little scientific evidence about the main determinants of sex discrepancies in tuberculosis rates in Albania. The aim of this study was to assess the sex-differences in socioeconomic characteristics, knowledge and attitudes about tuberculosis and access to health care among tuberculosis patients in Albania, a transitional country in the Western Balkans.Methods: Our analysis involved all the new cases of pulmonary tuberculosis diagnosed in Albania during the period June 2012 – June 2013 (N=197; 69% males; overall mean age: 44±19 years). The recording and reporting system of tuberculosis cases was performed according to the WHO and EuroTB Surveillance guidelines. Information on socioeconomic characteristics of the patients, knowledge and attitudes about tuberculosis and access to health care was also collected. Logistic regression was used to assess the correlates of sex-differences among tuberculosis patients.Results: In multivariable-adjusted models, female sex was positively related to unemployment (OR=3.7, 95%CI=1.8-7.7), bad living conditions (OR=3.0, 95%CI=1.4-6.5), a longer distance to health care facility (OR=3.0, 95%CI=1.4-6.3), a lower level of knowledge about tuberculosis (OR=3.1, 95%CI=1.3-7.1) and a higher level of stigma against tuberculosis (OR=3.6, 95%CI=1.6-7.9).Conclusion: Our study informs about selected correlates of sex-differences in tuberculosis rates in post-communist Albania. Future studies should more vigorously explore determinants of sex-differences in tuberculosis rates in countries of the Western Balkans

Sex-differences in socioeconomic status and health-seeking behaviour among tuberculosis patients in transitional Albania in 2012-2013

Aim: There is little scientific evidence about the main determinants of sex discrepancies in tuberculosis rates in Albania. The aim of this study was to assess the sex-differences in socioeconomic characteristics, knowledge and attitudes about tuberculosis and access to health care among tuberculosis patients in Albania, a transitional country in the Western Balkans. Methods: Our analysis involved all the new cases of pulmonary tuberculosis diagnosed in Albania during the period June 2012 – June 2013 (N=197; 69% males; overall mean age: 44±19 years). The recording and reporting system of tuberculosis cases was performed according to the WHO and EuroTB Surveillance guidelines. Information on socioeconomic characteristics of the patients, knowledge and attitudes about tuberculosis and access to health care was also collected. Logistic regression was used to assess the correlates of sex-differences among tuberculosis patients. Results: In multivariable-adjusted models, female sex was positively related to unemployment (OR=3.7, 95%CI=1.8-7.7), bad living conditions (OR=3.0, 95%CI=1.4-6.5), a longer distance to health care facility (OR=3.0, 95%CI=1.4-6.3), a lower level of knowledge about tuberculosis (OR=3.1, 95%CI=1.3-7.1) and a higher level of stigma against tuberculosis (OR=3.6, 95%CI=1.6-7.9). Conclusion: Our study informs about selected correlates of sex-differences in tuberculosis rates in post-communist Albania. Future studies should more vigorously explore determinants of sex-differences in tuberculosis rates in countries of the Western Balkans

DISTRIBUȚIA CAZURILOR DE TUBERCULOZĂ ÎN ALBANIA, PERIOADA 2012-2013

CONTEXT: BACKGROUND: The information about current trends of tuberculosis in Albanian speaking countries is limited. Our aim was to describe the distribution of tuberculosis in Albania, a former communist country in Southeastern Europe. METHODS: This study included all new cases of pulmonary tuberculosis diagnosed in Albania during the period June 2012 – June 2013 (N=197; overall mean age: 43.8±19 years). The recording and reporting system was performed according to the WHO and EuroTB Surveillance guidelines. Socio-demographic characteristics included age, gender, residence, marital status, employment status, educational attainment and income level. In addition, data on selected risk factors were collected including smoking status, excessive alcohol consumption, presence of a separate kitchen in the house and distance to health care facility.    RESULTS: There were 136 (69%) male and 61 (31%) female cases. About 20% of the cases were 15-24 years old, whereas19% were ≥65 years old. About 45% of the patients were residing in urban areas. The unemployment rate was particularly high (43%) and only 29% had completed at least nine years of formal schooling. The overall prevalence of smoking was 21%. Only 27% of the patients reported a separate kitchen at their respective homes, whereas 23% had a distance >20 km from their health care facilities. CONCLUSION: Our study offers useful evidence which could inform health professionals, policymakers and decision-makers about the occurrence and distribution of tuberculosis cases in post-communist Albania, a country in the Western Balkans which is still struggling in its transition towards a market-oriented system.         Keywords: Albania, case detection rate, incidence, pulmonary tuberculosis.  CONTEXT: Informațiile cu privire la trendul actual al tuberculozei în rândul albanezilor sunt limitate. Scopul nostru a fost de a descrie distribuția tuberculozei în Albania, o țară fost comunistă din SE Europei. METODE: Acest studiu a inclus toate cazurile de tuberculoză pulmonară diagnosticate în Albania în perioada iunie 2012- iunie 2013 (N=197; media de vârstă: 43,8±19 ani). Sistemul de înregistrare și raportare a fost setat să performeze conform ghidurilor OMS și  a Rețelei Europene de Supraveghere a Tuberculozei. Caracteristicile socio-demografice au inclus vârsta, sexul, mediul de rezidență, statusul marital, angajarea, nivelul de educație, venit. Suplimentar, au fost colectate date despre factorii de risc incluzând fumatul, consumul în exces de alcool, prezența unei bucătării separate și distanța până la unitatea medicală. REZULTATE: Lotul de cazuri a cuprins 136 (69%) bărbați și 61 (31%) femei. Aproximativ 20% dintre cazuri au avut vârsta între 15-24 ani, iar 19% au avut 65 de ani și peste. Aproximativ 45% dintre pacienți locuiesc în mediul urban. Rata de șomaj a fost, în mod particular, înaltă (43%) și doar 29% au terminat 9 ani de școlarizare. Prevalența globală a fumatului a fost de 21%. Doar 27% dintre pacienți au raportat bucătărie separată în locul unde locuiau, iar 23% au raportat o distanță mai mare de 20km față de unitatea medicală. CONCLUZII: Studiul nostru oferă evidențe despre apariția și distribuția tuberculozei, utile pentru informarea profesioniștilor în sănătate, decidenți și politicieni implicați în procesul de luare a deciziilor în Albania, o țară post comunistă din V-Balcanilor, ce se străduiește să traverseze perioada de tranziție către un sistem orientat pe economia de piață.   Cuvinte cheie: Albania, rata de detectare a bolii, incidența, tbc pulmonary. &nbsp

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Background Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it difficult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the first structured survey on the occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in European hospitals. Methods National expert laboratories recruited hospitals with diagnostic capacities, who collected the first ten carbapenem non-susceptible clinical isolates of K pneumoniae or E coli and ten susceptible same-species comparator isolates and pertinent patient and hospital information. Isolates and data were relayed back to national expert laboratories, which made laboratory-substantiated information available for central analysis. Findings Between Nov 1, 2013, and April 30, 2014, 455 sentinel hospitals in 36 countries submitted 2703 clinical isolates (2301 [85%] Kpneurnoniae and 402 (15%) Ecoli). 850 (37%) of 2301 Kpneumoniae samples and 77 (19%) of 402 Ecoli samples were carbapenemase (KPC, NDM, OXA-48-like, or VIM) producers. The ratio of K pneumoniae to E coli was 11:1.1.3 patients per 10000 hospital admissions had positive clinical specimens. Prevalence differed greatly, with the highest rates in Mediterranean and Balkan countries. Carbapenemase-producing K pneumoniae isolates showed high resistance to last-line antibiotics. Interpretation This initiative shows an encouraging commitment by all participants, and suggests that challenges in the establishment of a continent-wide enhanced sentinel surveillance for carbapenemase-producing Entero-bacteriaeceae can be overcome. Strengthening infection control efforts in hospitals is crucial for controlling spread through local and national health care networks

Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread

Public health interventions to control the current epidemic of carbapenem-resistant Klebsiella pneumoniae rely on a comprehensive understanding of its emergence and spread over a wide range of geographical scales. We analysed the genome sequences and epidemiological data of >1,700 K. pneumoniae samples isolated from patients in 244 hospitals in 32 countries during the European Survey of Carbapenemase-Producing Enterobacteriaceae. We demonstrate that carbapenemase acquisition is the main cause of carbapenem resistance and that it occurred across diverse phylogenetic backgrounds. However, 477 of 682 (69.9%) carbapenemase-positive isolates are concentrated in four clonal lineages, sequence types 11,15,101, 258/512 and their derivatives. Combined analysis of the genetic and geographic distances between isolates with different beta-lactam resistance determinants suggests that the propensity of K. pneumoniae to spread in hospital environments correlates with the degree of resistance and that carbapenemase-positive isolates have the highest transmissibility. Indeed, we found that over half of the hospitals that contributed carbapenemase-positive isolates probably experienced within-hospital transmission, and interhospital spread is far more frequent within, rather than between, countries. Finally, we propose a value of 21 for the number of single nucleotide polymorphisms that optimizes the discrimination of hospital clusters and detail the international spread of the successful epidemic lineage, ST258/512

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Background Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it difficult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the first structured survey on the occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in European hospitals. Methods National expert laboratories recruited hospitals with diagnostic capacities, who collected the first ten carbapenem non-susceptible clinical isolates of K pneumoniae or E coli and ten susceptible same-species comparator isolates and pertinent patient and hospital information. Isolates and data were relayed back to national expert laboratories, which made laboratory-substantiated information available for central analysis. Findings Between Nov 1, 2013, and April 30, 2014, 455 sentinel hospitals in 36 countries submitted 2703 clinical isolates (2301 [85%] Kpneurnoniae and 402 (15%) Ecoli). 850 (37%) of 2301 Kpneumoniae samples and 77 (19%) of 402 Ecoli samples were carbapenemase (KPC, NDM, OXA-48-like, or VIM) producers. The ratio of K pneumoniae to E coli was 11:1.1.3 patients per 10000 hospital admissions had positive clinical specimens. Prevalence differed greatly, with the highest rates in Mediterranean and Balkan countries. Carbapenemase-producing K pneumoniae isolates showed high resistance to last-line antibiotics. Interpretation This initiative shows an encouraging commitment by all participants, and suggests that challenges in the establishment of a continent-wide enhanced sentinel surveillance for carbapenemase-producing Entero-bacteriaeceae can be overcome. Strengthening infection control efforts in hospitals is crucial for controlling spread through local and national health care networks