The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study

BACKGROUND: Although historically tuberculosis (TB) has been associated with poverty, few analytical studies from developing countries have tried to: 1. assess the relative impact of poverty on TB after the emergence of HIV; 2. explore the causal mechanism underlying this association; and 3. estimate how many cases of TB could be prevented by improving household socioeconomic position (SEP). METHODS AND FINDINGS: We undertook a case-control study nested within a population-based TB and HIV prevalence survey conducted in 2005-2006 in two Zambian communities. Cases were defined as persons (15+ years of age) culture positive for M. tuberculosis. Controls were randomly drawn from the TB-free participants enrolled in the prevalence survey. We developed a composite index of household SEP combining variables accounting for four different domains of household SEP. The analysis of the mediation pathway between household SEP and TB was driven by a pre-defined conceptual framework. Adjusted Population Attributable Fractions (aPAF) were estimated. Prevalent TB was significantly associated with lower household SEP [aOR = 6.2, 95%CI: 2.0-19.2 and aOR = 3.4, 95%CI: 1.8-7.6 respectively for low and medium household SEP compared to high]. Other risk factors for prevalent TB included having a diet poor in proteins [aOR = 3.1, 95%CI: 1.1-8.7], being HIV positive [aOR = 3.1, 95%CI: 1.7-5.8], not BCG vaccinated [aOR = 7.7, 95%CI: 2.8-20.8], and having a history of migration [aOR = 5.2, 95%CI: 2.7-10.2]. These associations were not confounded by household SEP. The association between household SEP and TB appeared to be mediated by inadequate consumption of protein food. Approximately the same proportion of cases could be attributed to this variable and HIV infection (aPAF = 42% and 36%, respectively). CONCLUSIONS: While the fight against HIV remains central for TB control, interventions addressing low household SEP and, especially food availability, may contribute to strengthen our control efforts

Tuberculose no Brasil: construção de um sistema de vigilância de base territorial Tuberculosis in Brazil: construction of a territorially based surveillance system

OBJETIVO: Analisar a ocorrência da tuberculose, identificando variáveis definidoras de situações coletivas de risco que determinam sua distribuição espacial, como subsídio à implantação de um sistema de vigilância de base territorial para controle da tuberculose. MÉTODOS: Estudo ecológico realizado no período 1996-2000, em Olinda, município da região metropolitana do Recife, PE. A mediana do número de casos de tuberculose, notificados por setor censitário, serviu como ponto de corte para caracterização das áreas de alta e baixa transmissão. Um modelo de regressão logística, utilizando essa variável resposta, permitiu estimar as "odds-ratio" de algumas variáveis socioeconômicas do Censo Demográfico de 2000 e de outras co-variáveis relacionadas com a transmissão da doença. RESULTADOS: A tuberculose em Olinda apresentou altas taxas de incidência no período (média de 111 casos por 100.000 habitantes). Verificou-se que são significativamente associadas à ocorrência da tuberculose, as variáveis: média de moradores por domicílio (OR=2,2; IC 95%: 1,3; 3,6); existência de famílias com mais de um caso no período (OR=5,1; IC 95%: 2,3; 11,3); e presença de casos de retratamento (OR=6,8; IC 95%: 2,7; 17,1). Setores censitários com a ocorrência desses dois últimos eventos concentraram 45% do total de casos do período, representando apenas 28% da população do município. CONCLUSÕES: Duas das três variáveis explicativas associadas a maiores taxas de incidência da doença são informações que devem ser monitorizadas, em nível local, pelo sistema de vigilância da tuberculose. O simples mapeamento de casos de retratamento e de domicílios com ocorrência de repetidos casos, permitiria refinar o foco de atenção em micro-áreas prioritárias para intervenções intensivas, como forma de enfrentar o problema da tuberculose.<br>OBJECTIVE: To analyze the occurrence of tuberculosis and to identify variables that define situations of collective risk that determine the spatial distribution of the disease, as backing for implementing a territory-based surveillance system for tuberculosis control. METHODS: This was an ecological study performed in Olinda, a municipality in the metropolitan region of Recife, State of Pernambuco, between 1996 and 2000. The median number of notified tuberculosis cases in each census tract served as the cutoff point for characterizing areas of high and low transmission. A logistic regression model using this response variable allowed odds ratios for some socioeconomic variables from the 2000 demographic census and other covariates related to the transmission of the disease to be estimated. RESULTS: Tuberculosis in Olinda presented high incidence rates during the study period (average of 111 cases per 100,000 inhabitants). Significant associations with the occurrence of tuberculosis were found for the variables of average number of inhabitants per household (OR=2.2; 95% CI: 1.3; 3.6); existence of families with more than one case during the study period (OR=5.1; 95% CI: 2.3; 11.3); and presence of cases of retreatment (OR=6.8; 95% CI: 2.7; 17.1). The census tract where the latter two events occurred accounted for 45% of the total number of cases during the study period, while representing only 28% of the population of Olinda. CONCLUSIONS: The two explanatory covariates that were strongly associated with higher incidence rates of the disease are events that need to be carefully monitored at a local level by the tuberculosis surveillance system. Simply by mapping out retreatment cases and households with more than one case, attention could be focused on small areas with high priority for intensive intervention, thus facing up to the tuberculosis problem

Contributions from the systematic review of economic evaluations: the case of childhood hepatitis A vaccination in Brazil.

The aim of this study was to present the contributions of the systematic review of economic evaluations to the development of a national study on childhood hepatitis A vaccination. A literature review was performed in EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO and LILACS from 1995 to 2010. Most of the studies (8 of 10) showed favorable cost-effectiveness results. Sensitivity analysis indicated that the most important parameters for the results were cost of the vaccine, hepatitis A incidence, and medical costs of the disease. Variability was observed in methodological characteristics and estimates of key variables among the 10 studies reviewed. It is not possible to generalize results or transfer epidemiological estimates of resource utilization and costs associated with hepatitis A to the local context. Systematic review of economic evaluation studies of hepatitis A vaccine demonstrated the need for a national analysis and provided input for the development of a new decision-making model for Brazil

Fauna de flebotomíneos (Diptera: Psychodidae) de uma reserva de campina no Estado do Amazonas, e sua importância epidemiológica Phlebotomine fauna (Diptera: Psychodidae) in a campina reserve in the State of Amazonas, and its epidemiological importance

INTRODUÇÃO: No Brasil, a maior diversidade de flebotomíneos é encontrada na Região Amazônica, principalmente em floresta primária de terra-firme. No entanto, sua fauna ainda é pouco conhecida em outros ecossistemas desta região. MÉTODOS: a fim de conhecer a fauna de flebotomíneos de outro ecossistema amazônico, coletas com armadilhas de luz CDC foram realizadas em uma área de campina/campinarana na zona periurbana da Cidade de Manaus. RESULTADOS: foram capturados 814 flebotomíneos de 26 espécies, sendo as mais abundantes: Lutzomyia flaviscutellata (64,5%); Lutzomyia georgii (14%); Lutzomyia olmeca nociva (8,1%); Lutzomyia furcata (3,2%); Lutzomyia monstruosa (1,3%); Lutzomyia umbratilis (1,1%) outros (7,8%). CONCLUSÕES: Campina/campinarana revelou-se de grande importância epidemiológica devido a elevada abundância de Lutzomyia flaviscutellata e Lutzomyia olmeca nociva, ambas vetoras de Leishmania (Leishmania) amazonensis. Com base nestas informações, será possível traçar metas para estudos parasitológicos e conscientizar pesquisadores e estudantes, que mantém constante exposição nesta área realizando trabalhos de pesquisa, sobre o possível risco de contaminação por Leishmania.<br>INTRODUCTION: In Brazil, the largest diversity of phlebotomines is found in the Amazon region, particularly in undisturbed terra-firma forest. However, the phlebotomine fauna in other ecosystems of this region is still not well known. METHODS: In order to investigate the phlebotomine fauna of another Amazon ecosystem, collections were made using CDC light traps in the campina/campinarana ecosystems in the periurban zone of the city of Manaus. RESULTS: Eight hundred and fourteen phlebotomines of 26 species were captured, of which the most abundant were: Lutzomyia flaviscutellata (64.5%); Lutzomyia georgii (14%); Lutzomyia olmeca nociva (8.1%); Lutzomyia furcata (3.2%); Lutzomyia monstruosa (1.3%); Lutzomyia umbratilis (1.1%); and others (7.8%). CONCLUSIONS: The campina/campinarana ecosystems showed great epidemiological importance because of the high abundance of Lutzomyia flaviscutellata and Lutzomyia olmeca nociva, which are both vectors of Leishmania (Leishmania) amazonensis. Based on this information, it will be possible to outline goals for parasitological studies and raise awareness among researchers and students who are constantly exposed in these areas while conducting research work, regarding the possible risk of contamination by Leishmania

ZikaPLAN: addressing the knowledge gaps and working towards a research preparedness network in the Americas

Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN`s mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network