Abstract
BackgroundGlobally, tuberculosis (TB) lasts a major public health concern. Using feasible strategies to estimate TB infectious periods is crucial. The aim of this study was to determine the magnitude of TB infectious period and associated factors in East Gojjam zone.MethodsAn institution-based prospective study was conducted among 348 pulmonary TB (PTB) cases between December 2017 and December 2018. TB cases were recruited from all health facilities located in Hulet Eju Enesie, Enebse Sarmider, Debay Tilatgen, Dejen, Debre-Markos town administration, and Machakel districts. Data were collected through an exit interview using a structured questionnaire and analyzed by IBM SPSS version25. The TB infectious period of each patient category was determined using the TB management time and sputum smear conversion time. The sum of the infectious period of each patient category gave the infectious pool of the study area. A multivariable logistic regression analysis was used to identify factors associated with the magnitude of TB infectious period.ResultsOf the total participated PTB cases, 209(60%) were male, 226(65%) aged < 30 years, 205(59%) were from the rural settings, and 77 (22%) had comorbidities. The magnitude of the TB infectious pool in the study area was 78,031 infectious person-days. The undiagnosed TB cases (44,895 days), smear-positive (14,625 days) and smear-negative (12,995 days) were major contributors to the infectious pool. The overall average median TB management time was 142.4 days (IQR, 98–238 days). Similarly, the average sputum smear conversion time of PTB cases (new and repeat) was 46 days. Residence, knowledge, form of TB, smoking, alcohol history, distance from the facility, comorbidity history and stigma were statistically significant factors TB infectious period (p-value< 0.05).ConclusionsThe magnitude of the TB infectious pool is high even if it is lower than the findings of previous studies. This might be an indicator of poor access to TB services, service delays, low community awareness, impaired facility readiness, and poor transportation. Improving personal awareness and behavior, timely management of commodities, and using the TB management time in TB control are crucial to improving TB control activities.
Highlights
Tuberculosis (TB) lasts a major public health concern
To compute the median TB management time of relapse cases, we considered two-time intervals; the time interval between the first onset of cough to the first treatment initiation and the time interval between the reoccurrence of cough to the start of re-treatment
Socio-demographic characteristics A total of 348 pulmonary TB (PTB) patients were included in the analysis, where more than half, 209 (60%), 226 (65%), and 205 (59%)) of them were males, under 35 years, and from the rural settings, respectively
Summary
Tuberculosis (TB) lasts a major public health concern. Using feasible strategies to estimate TB infectious periods is crucial. The emergence of multidrug-resistant TB (MDR-TB) [11,12,13], limited diagnostics [6,7,8, 10, 12], low TB case detection and monitoring [14, 15], poor data quality [6, 14, 15], high prevalence of comorbidities [10, 16,17,18,19], poor socioeconomic status [19,20,21], personal behavior [6, 22], and poor service quality [2, 23,24,25,26] are challenges of TB control programs These may contribute to increased TB incidence and lengthy infectious period, which results in disease complications and high TB transmission [7, 14, 15, 27, 28]
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