Global Incidence Of Tuberculosis Research Articles

Estimating the epidemiological and economic impact of providing nutritional care for tuberculosis-affected households across India: a modelling study.

Approximately 20% of global tuberculosis incidence is attributable to undernutrition, increasing to more than a third in India. Targeting nutritional interventions to tuberculosis-affected households is a policy priority, but understanding of epidemiological and economic impacts is limited. We aimed to estimate the population-level epidemiological and economic effect of such an intervention. We used a previously published, age-stratified, compartmental transmission model of tuberculosis in India, and incorporated explicit BMI strata linked to disease progression and treatment outcomes. We used results from a recent trial of an intervention in which nutritional support in the form of food baskets was provided to people initiating tuberculosis treatment and to their household contacts (1200 kcal for patients and 750 kcal for contacts) to inform estimates of the impact and costs of nutritional support. We estimated the numbers of cases of tuberculosis disease and deaths due to tuberculosis disease that could be averted from 2023 to 2035 under the intervention scenario. Compared with a baseline with no nutritional intervention, at 50% coverage of adults on tuberculosis treatment and their households (around 23% of households affected by incident tuberculosis in India), providing the nutritional support intervention could prevent 361 200 (95% uncertainty interval 318 000-437 700) tuberculosis deaths and 880 700 (802 700-974 900) disease episodes from 2023 to 2035. This would be equivalent to averting approximately 4·6% (4·2-5·5) tuberculosis deaths and 2·2% (2·1-2·4) tuberculosis episodes. The additional health system cost would be US$1349 million (1221-1492), with an incremental cost-effectiveness ratio of $167 (147-187) per disability-adjusted life-year averted. The median number of households needed to treat to prevent one tuberculosis death was 24·4 and to prevent one tuberculosis case was 10·0. A nutritional intervention for tuberculosis-affected households could avert a substantial amount of tuberculosis disease and death in India, and would be highly likely to be cost-effective on the basis of the tuberculosis-specific benefits alone. None. For the Bangla and Hindi translations of the abstract see Supplementary Materials section.

Effectiveness of Systematic Screening and Treatment of Tuberculosis in Prison in Thailand.

The global incidence of tuberculosis (TB) in prison is 5 to 70 times greater than that in the general population. The systematic screening and treatment of TB in prison benefit TB control and treatment outcomes. However, no study has supported this in Thailand. Here, we evaluated the effectiveness of long-term, continuous, systematic screening for TB control. We conducted a retrospective study in Suratthani Central Prison, Thailand, using annual TB screening from 2016 to 2020. A positive TB screening was defined as having any TB symptoms or chest radiography abnormality. We collected sputum smear and Xpert® Mycobacterium tuberculosis/rifampicin (MTB/RIF) results from those inmates with positive screening results. Bacteriologically confirmed TB was defined as a positive sputum smear or M. tuberculosis detected by Xpert assay. Inmates with clinically diagnosed TB were also eligible for this study. Those inmates diagnosed with active TB were sent to an isolation zone in prison and received anti-TB medicine using directly observed therapy and were monitored by pulmonologists during the treatment course via telemedicine. Of 18,965 TB screening events, 175 patients were diagnosed with TB. The 5-year prevalence was 922 per 100,000 inmates. The relative reduction in TB prevalence was 60.5% from 2016 to 2020. Overall, 94.3% of TB patients were successfully treated (sum of patients cured and treatment completed). Three TB patients died during the 5-year study period. All occurred in 2016. The systematic screening and treatment of TB in inmates effectively reduced the prevalence and mortality in Suratthani Central Prison. The success rate of treatment in this prison has been consistently high.

Pulmonary and Hepatic Tuberculosis in a Single Individual

Tuberculosis (TB) is a contagious bacterial infection caused by the Mycobacterium tuberculosis bacterium. It primarily affects the lungs but can also target other parts of the body, known as extra pulmonary tuberculosis (EPTB). TB spreads through the air when an infected person coughs, sneezes, or talks.[1] Asia bears a significant burden of TB cases worldwide, accounting for approximately 60% of the global TB incidence. The region's large population, varying health systems, and socioeconomic factors contribute to this high prevalence. Countries like India, China, Indonesia, and Bangladesh have particularly high TB rates.[1,2] India has the highest number of TB cases globally, making it a major concern for public health. Factors such as poverty, overcrowding, inadequate healthcare infrastructure, and limited access to diagnostics and treatment contribute to the high prevalence. The Indian government has implemented various initiatives to combat TB and improve prevention, diagnosis, and treatment services.[3] Despite the rapid decline in tuberculosis (TB) prevalence globally following the introduction of anti-TB medications in the 1940s, recent years have witnessed a resurgence in TB incidence rates. This resurgence can be attributed to various factors including governmental complacency, inadequate public health interventions, HIV coinfection, intravenous drug abuse, multidrug resistance, and an increasing number of immunocompromised individuals.[1] As a consequence, hepatic tuberculosis, which is part of disseminated tuberculosis, has been observed in 50-80% of cases, reflecting the growing prevalence of TB. Hepatic TB often presents challenges in clinical diagnosis due to its atypical symptoms and imaging findings, leading to potential misdiagnosis and delayed treatment initiation.[2-3] Through our literature review, it became apparent that the majority of existing studies are comprised of case reports, highlighting a lack of comprehensive understanding in diagnosing and treating hepatic tuberculosis.[4] An immunocompromised host refers to an individual with a weakened immune system, making them more susceptible to infections and diseases. This can result from conditions such as HIV/AIDS, chemotherapy, organ transplantation, or certain medications that suppress the immune response.[5] Immunocompromised individuals face a higher risk of contracting TB due to their weakened immune defenses. The risk of developing active TB disease is significantly increased in this population. Timely diagnosis and appropriate management are crucial to prevent serious complications and mortality.[5] In immunocompromised hosts, TB can manifest in various extra pulmonary sites outside the lungs. Common sites of EPTB involvement include the lymph nodes, bones and joints, central nervous system, genitourinary system, gastrointestinal tract, and skin. Prompt recognition and appropriate treatment are essential to prevent complications and morbidity associated with EPTB.[6] By understanding the prevalence of TB in Asia and India, the impact on immunocompromised individuals, the definition of disseminated TB, and the sites of EPTB in immunocompromised hosts, we can better address and manage this public health issue. Increased awareness, early diagnosis, and effective treatment strategies are crucial in reducing the burden of TB and improving patient outcomes.[7]

Optimizing the cascade of prevention to protect people from tuberculosis: A potential game changer for reducing global tuberculosis incidence.

The provision of tuberculosis preventive treatment is one of the critical interventions to reduce tuberculosis incidence and ultimately eliminate the disease, yet we still miss appropriate tools for an impactful intervention and treatment coverage remains low. We used recent data, epidemiological estimates, and research findings to analyze the challenges of each step of the cascade of tuberculosis prevention that currently delay the strategy implementation. We addressed research gaps and implementation bottlenecks that withhold key actions in tuberculosis case finding, testing for tuberculosis infection, provision of preventive treatment with safer, shorter regimens and supporting people to complete their treatment. Empowering communities to generate demand for preventive therapy and other prevention services in a holistic manner and providing adequate financial support to sustain implementation are essential requirements. The adoption of an effective, universal monitoring and evaluation system is a prerequisite to provide general and granular insight, and to steer progress of the tuberculosis infection strategy at global and local level.

Risk factors for Tuberculosis in children at labuang baji hospital and center for community pulmonary health Makassar in 2023

Efforts to achieve the Sustainable Development Goals (SDGs) include eradicating the global tuberculosis (TB) epidemic by 2030. In 2020, the global TB incidence rate stood at 121 per 100,000 people, with 1.1 million children succumbing to the disease worldwide. Indonesia alone recorded 42,187 pediatric TB cases in 2021, emphasizing the urgency of addressing this public health concern.A recent observational study in Makassar City focused on children aged 0-14, revealing 380 cases in 2022, notably concentrated in Labuang Baji Regional Hospital, Tajuddin Chalid Hospital, and Community Center for Lung Health Makassar. Developing countries, where children under 15 constitute 40-50% of the population, witness around 500,000 pediatric TB cases annually, leading to severe morbidity and mortality, especially in those under 14. May to July 2023, researchers conducted a case-control study involving 114 children. The study revealed that malnutrition (with an odds ratio of 2.614 and a 95% confidence interval of 1.133-6.085) and a history of TB contact (with an odds ratio of 7.84 and a 95% confidence interval of 2.932-22.319) emerged as noteworthy risk factors for pediatric TB. Notably, economic status, residential density, BCG vaccination status, and exposure to smokers showed no significant impact on the prevalence of the disease.The study advocates consistent screening of adult TB patients' family contacts to trace potential cases in children. Future research should explore the feasibility of TB transmission among children. Tackling malnutrition and strengthening contact tracing initiatives are imperative to curbing pediatric TB, aligning with global goals for a TB-free world by 2030.

Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021

Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990-2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5-14 years, 6·29% (5·05 to 7·70) in those aged 15-49 years, 5·72% (4·02 to 7·39) in those aged 50-69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5-14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15-49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50-69 years, and a 3·29% (-5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (-713 to 2180) fewer deaths. Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. Bill & Melinda Gates Foundation.

Global Burden of Tuberculosis in Adolescents and Young Adults: 1990-2019.

Tuberculosis (TB) is a major health threat in adolescents and young adults. However, its burden in this population remains unclear. This study aimed to assess TB burden and changing trends in individuals aged 10 to 24 years from 1990 to 2019. All data were obtained from the Global Burden of Disease Study 2019. We calculated the percentage of relative changes in incident cases, deaths, and disability-adjusted life years (DALYs). The temporal trends of the incidence, mortality, and DALYs were assessed using estimated annual percentage changes (EAPCs). At global level, TB incidence (per 100 000 population) decreased from 144.12 in 1990 to 97.56 in 2019, with average 1.28% (95% confidence interval [CI]: 1.36%-1.19%) of decline per year. Similar decreasing trends occurred across sex, age, sociodemographic index regions, and in most Global Burden of Disease study regions and countries. TB incidence in female adolescents decreased faster than that in male. However, there was an increasing trend in the incidence of extensively drug-resistant TB (EAPC = 11.23, 95% CI: 8.22-14.33) and multidrug-resistant TB without extensive drug resistance (EAPC = 3.28, 95% CI: 1.73-4.86). South Africa had the highest increase in TB incidence (EAPC = 3.51, 95% CI: 3.11-3.92). Global TB incidence, mortality, and DALYs in adolescents and young adults decreased from 1990 to 2019. However, the incidence of drug-resistant TB increased. TB remains a threat in adolescents and young adults worldwide, especially in low- and middle-income countries.

Global, regional and national trends in tuberculosis incidence and main risk factors: a study using data from 2000 to 2021

BackgroundDespite the significant progress over the years, Tuberculosis remains a major public health concern and a danger to global health. This study aimed to analyze the spatial and temporal characteristics of the incidence of tuberculosis and its risk factors and to predict future trends in the incidence of Tuberculosis.MethodsThis study used secondary data on tuberculosis incidence and tuberculosis risk factor data from 209 countries and regions worldwide between 2000 and 2021 for analysis. Specifically, this study analyses the spatial autocorrelation of Tuberculosis incidence from 2000 to 2021 by calculating Moran’s I and identified risk factors for Tuberculosis incidence by multiple stepwise linear regression analysis. We also used the Autoregressive Integrated Moving Average model to predict the trend of Tuberculosis incidence to 2030. This study used ArcGIS Pro, Geoda and R studio 4.2.2 for analysis.ResultsThe study found the global incidence of Tuberculosis and its spatial autocorrelation trends from 2000 to 2021 showed a general downward trend, but its spatial autocorrelation trends remained significant (Moran’s I = 0.465, P < 0.001). The risk factors for Tuberculosis incidence are also geographically specific. Low literacy rate was identified as the most pervasive and profound risk factor for Tuberculosis.ConclusionsThis study shows the global spatial and temporal status of Tuberculosis incidence and risk factors. Although the incidence of Tuberculosis and Moran’s Index of Tuberculosis are both declining, there are still differences in Tuberculosis risk factors across countries and regions. Even though literacy rate is the leading risk factor affecting the largest number of countries and regions, there are still many countries and regions where gender (male) is the leading risk factor. In addition, at the current rate of decline in Tuberculosis incidence, the World Health Organization’s goal of ending the Tuberculosis pandemic by 2030 will be difficult to achieve. Targeted preventive interventions, such as health education and regular screening of Tuberculosis-prone populations are needed if we are to achieve the goal. The results of this study will help policymakers to identify high-risk groups based on differences in TB risk factors in different areas, rationalize the allocation of healthcare resources, and provide timely health education, so as to formulate more effective Tuberculosis prevention and control policies.

Epidemiological features and temporal trends of HIV-negative tuberculosis burden from 1990 to 2019: a retrospective analysis based on the Global Burden of Disease Study 2019

ObjectiveThis study aimed to analyse the burden and temporal trends of tuberculosis (TB) incidence and mortality globally, as well as the association between mortality-to-incidence ratio (MIR) and Socio-Demographic Index (SDI).DesignA...

Geographical evolutionary pathway of global tuberculosis incidence trends

BackgroundsTuberculosis (TB) remains a serious public health and human development problem, especially in developing countries. Despite the effectiveness of directly observed therapy, short course programs in reducing transmission and progression of TB, poverty reduction and socioeconomic development remain crucial factors in decreasing TB incidence. However, the geographical pathway on the planet is not yet clear.ObjectivesThis study was to reconstruct the geographical evolutionary process of TB in 173 countries and territories from 2010 to 2019 to analyze the socioeconomic determinants that impact the global TB epidemic. In addition, the TB incidence in 2030 was predicted.MethodsThis study analyses TB incidence data from 173 countries and territories between 2010 and 2019. The Geotree model would be used to reconstruct the geographical evolutionary process of TB, which provides a simplified schema for geo-visualizing the trajectories of TB incidence and their socioeconomic drivers. Additionally, to estimate the future TB incidence in 2030, a multilevel model was utilized in conjunction with the hierarchical nature of the Geotree based on a stratified heterogeneity analysis.ResultsGlobal TB incidence was found to be associated with the country type and development stages. Between 2010 and 2019, the average TB incidence rate in 173 countries and territories was -27.48%, with marked spatially stratified heterogeneity by country type and development stage. Low-income and lower-middle-income countries were most vulnerable to TB. Upper-middle-income countries experienced a faster decline in TB incidence than high-income countries, and TB incidence generally decreased as the development stage increased, except for the lower-middle development stage in 2019.The highest average rate of decline in TB incidence was observed in the upper-middle development stage of high-income countries, with a reduction of 45.24%. Meanwhile, 37 high-income countries in the high development stage demonstrated an average rate of change of -13.93%. Socioeconomic determinants, including gross domestic product per capita, urbanization rate, and sociodemographic index, were found to inhibit TB incidence. Based on current trends, the predicted average global TB incidence in 2030 is 91.581 per 100,000 population.ConclusionsThe trajectories of the global TB incidence have been reconstructed to formulate targeted public health responses. To eliminate TB, countries at similar development stage can draw on the experiences of countries at higher development stages that are tailored to their unique characteristics. By learning from successful TB control strategies, countries can take strategic steps toward eradicating TB and improving public health outcomes.

Clinical and economic burden of drug-susceptible tuberculosis in Indonesia: national trends 2017–19

The global incidence of tuberculosis is decreasing, yet it remains high in Indonesia. The Indonesian National Tuberculosis Program facilitates mandatory notification, which enables early detection and treatment, minimises complications, prevents transmission, and decreases deaths. This study aimed to assess the characteristics, trends, and economic burden of notified drug-susceptible tuberculosis cases registered in this system from 2017 to 2019. We performed a multiyear cross-sectional study focusing on drug-susceptible tuberculosis notified cases, incidence, geographical tuberculosis case distribution, treatment outcomes, and costs in Indonesia using data from Sistem Informasi Tuberkulosis (2017-19). The settings were Indonesian health-care facilities that provide tuberculosis control programmes and services. Eligible patients were those who were diagnosed with drug-susceptible tuberculosis and notified to Sistem Informasi Tuberkulosis. Between 2017 and 2019, notified cases increased from 429 219 to 523 614 individuals, corresponding to an increase in incidence from 167 cases per 100 000 to 196 cases per 100 000. In 2019, more than 250 cases per 100 000 inhabitants were notified in Jakarta, North Sulawesi, Gorontalo, and Papua. Treatment success rate increased from 363 098 (84·60%) of 429 219 in 2017 to 452 966 (86·51%) of 523 614 in 2019, with a relatively stable mortality, changing from 3·15% to 3·05%. HIV status was increasingly confirmed, with unknown status decreasing from 66·21% to 43·68%. The costs of visits and monitoring and drug regimens were relatively stable, with total direct medical costs slightly increasing from US$39·40 to $40·40 per case. Progress was made on drug-susceptible tuberculosis management in Indonesia. However, further intensified efforts, including case-finding, optimising diagnosis, and cost-effective tuberculosis management are required if Indonesia is to achieve the 2025 WHO End Tuberculosis Strategy target incidence of fewer than 55 cases per 100 000 people. These data are an important starting point for understanding drug-susceptible tuberculosis dynamics in Indonesia and optimising its management. Directorate General of Higher Education; Ministry of Education, Culture, Research, and Technology of the Republic of Indonesia.

The importance for tuberculosis of mitigating economic crises

The importance for tuberculosis of mitigating economic crises

Tuberculosis diagnostics to reduce HIV-associated mortality

Tuberculosis (TB) was declared a global emergency in 1993 by the World health Organization (WHO), with global and African regional TB incidence rates driven by the HIV epidemic. Much of this burden lay in health facilities in sub-Saharan Africa, with post-mortem studies showing almost half of fatal TB goes undiagnosed, reflecting a failure in the approach to TB diagnostics. HIV-associated TB is often under the clinical radar, and this paper describes strategies to improve TB diagnostics to expedite treatment, reduce the amount of undiagnosed disease and ultimately reduce mortality. Through studies assessing the diagnostic accuracy and yield of new, rapid TB diagnostics, including the Xpert MTB/RIF nucleic acid amplification and urinary lipoarabinomannan (LAM) lateral flow assays, and clinical trials to measure impact on mortality and clinically relevant outcomes, this paper describes how TB diagnostics can reduce HIV-associated morbidity and mortality. With improved TB diagnostics in the pipeline, the future of urine-LAM assays for TB are also discussed.

Threat from Mycobacterium orygis-associated tuberculosis in south Asia

South Asia is a hotspot of tuberculosis with an estimated annual incidence of 3·7 million cases, accounting for 37% of the global tuberculosis incidence in 2019.1 The southeast Asia region, which includes south Asia, has a high burden from zoonotic tuberculosis, with an estimated 43 000 (31·76%) new cases in 2016; however, as the causative agent of this zoonotic tuberculosis has not been fully defined, the true incidence could be underestimated.2 Reports of tuberculosis caused by Mycobacterium orygis in animals and humans in south Asia, and the discovery of M orygis in south Asian migrants, highlights an overlooked threat from M orygis in south Asia and beyond.

"Better to Die Than Take These Medicines": A Community-Based Qualitative Study on the Determinants of Treatment Loss-to-Follow-Up in Tuberculosis Patients in District Faridabad, Haryana, India.

IntroductionIndia is the biggest contributor to the global incidence of tuberculosis (TB). A major reason behind the persistently high incidence of TB in India is treatment loss-to-follow-up (LTFU). The consequences of LTFU include continuous transmission to uninfected individuals, drug resistance, and a higher rate of death in incompletely treated patients. It is a significant hurdle to making India ‘TB-Free’ by 2025. Hence, we conducted a community-based qualitative study to understand the determinants of treatment of LTFU in TB patients in the Faridabad district of Haryana, India. MethodologyWe enrolled TB patients who had completed treatment as well as those who had been LTFU. We also enrolled National Tuberculosis Elimination Programme (NTEP) functionaries, healthcare providers, family members, and community members. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted to understand stakeholders’ perceptions of reasons for LTFU. The grounded theory approach was used with inductive analysis. Data were triangulated from stakeholders’ interviews. Themes and sub-themes were identified. A Health Belief Model for TB treatment completion was developed.ResultsFifty-eight IDIs and four FGDs were conducted between May-June 2018. The major themes influencing the treatment of LTFU which emerged from the analyses were - the role of external motivators, regular use of alcohol, lack of/or inappropriate knowledge related to treatment, lack of family support, and side effects of anti-tubercular drugs, and a poor experience with the health system. Stigma was not found to be a major determinant - in the few cases that it affected treatment, it spurred treatment completion rather than LTFU.“I completed the course with great difficulty. Then they started it again! […] I said-Sorry, sir, I can’t go through this again. It’s better to die once than to die a thousand deaths.” - Fifty-one-year-old male patient who was lost-to-follow-up on re-treatment.DiscussionThis study was a comprehensive multi-stakeholder qualitative undertaking to identify the determinants of LTFU. Our qualitative approach explained the associations between LTFU and certain factors (e.g.: alcohol use, side effects, etc.) found in previous quantitative studies. The strength of this study was that we ensured participation by patients as well as all district-level stakeholders from the national health programme, which no previous qualitative study on the treatment LTFU in India had achieved. The entire qualitative analysis was done manually and in Hindi (the language in which interviews were conducted). Hence, no data were lost in translation. The limitation was that its findings were specific to the study area and study population, as is the case with all qualitative studies.ConclusionAll healthcare providers should be sensitised to the determinants of treatment LTFU, so that they can pay special attention to at-risk patients and take appropriate steps to prevent LTFU. For instance, patients with a pattern of regular alcohol use should be counselled and may be referred to deaddiction centres, with the continuum of care maintained. The journey from tuberculosis diagnosis to treatment completion is often extremely traumatic for the patient. The onus to successfully complete treatment lies not with the patient alone, but with the health system as well.

Rifampicin Induced Deep Vein Thrombosis: A Case Report

Rifampicin is an established and effective antibiotic and is the gold standard in the treatment of tuberculosis (TB). Its use is reserved for serious bacterial infections, such as active and latent leprosy. Tuberculosis is the most prevalent infectious disease worldwide as well as in India. Therefore, despite recent progress tuberculosis remains an important global public health problem. According to WHO, TB statistic 2020, the global incidence of TB was 15.6 million and in India, it was 5.6 million. In India, most of the antituberculosis regimens under the Revised National Tuberculosis Control Programme (RNTCP) are rifampicin-based. Deep Vein Thrombosis events are a rare side effect of rifampicin, which has been reported in a few parts of the world. Here we report a case of a male patient with pulmonary tuberculosis initiated on ATT drug regimen presented with deep vein thrombosis due to rifampicin.

The Global Incidence of Tuberculosis in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis Based on Data Collected from 1,548,774 Patients

The Global Incidence of Tuberculosis in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis Based on Data Collected from 1,548,774 Patients

The Global Incidence of Tuberculosis in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis Based on Data Collected from 1,548,774 Patients

The Global Incidence of Tuberculosis in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis Based on Data Collected from 1,548,774 Patients

Pediatric tuberculosis in Iran: a review of 10-years study in an Iranian referral hospital.

Introduction:Reductions in global tuberculosis incidence are considered as one of the End TB Strategy goal. The diagnosis of tuberculosis (TB) in children is challenging due to insufficient specimen material and the scarcity of bacilli in specimens. The purpose of this study was to evaluate the prevalence, characteristics, clinical profiles, laboratory findings and treatment outcomes of children infected with TB in an Iranian referral hospital during a 10-years period.Methods:This study was a retrospective analysis of the medical records of 90 children (≤15 years) with a diagnosis of tuberculosis who were admitted to Children’s Medical Center Hospital, Tehran, Iran, between March 2006 and March 2016. The patients’ information such as demographic, clinical manifestations, laboratory, radiological and histological tests results, and treatment outcomes were extracted from medical records and were analyzed.Results:The total prevalence of TB was about 56.6 per 100,000 admitted patients. Most of the patients were between 5 to 12 yearsTwenty-two percent had the history of TB in their family. Underlying diseases were identified in 30 cases (33%). Thirty-four cases (38%) had pulmonary TB (PTB), 35 cases (39%) had extrapulmonary TB (EPTB), while disseminated TB (DTB) was found in 21 cases (23%). Distribution of DTB in males was higher than in females (36% vs. 6%). In patients < 1 year, DTB was the most frequent type (48 %); however, in patients > 1 year both PTB and EPTB had similar distributions (42%) and were more frequent than DTB (16%). In overall, a mortality of 10% was reported.Conclusions:The total prevalence rate of TB in our study was 56.6 per 100,000 admitted patients. Since the mortality rate was higher in infants, children with DTB and children with underlying diseases, early detection and treatment of these patients will help to reduce the mortality rate of TB disease. (www.actabiomedica.it)

A Cross-sectional Study on Knowledge, Section Attitude, and Practice Regarding Notification of Tuberculosis Patients by Private Practitioners of Urban Chennai, India

Introduction: India accounts for one-fourth of global incidence of Tuberculosis (TB) with 2.79 million estimated cases annually. To improve and intensify case finding, the Government of India declared TB a notifiable disease in May 2012. It is now mandatory that all public and private health providers notify TB cases to the designated public health authorities. To facilitate notification, the central government has created a web-based, case-based notification system called NIKSHAY. Notification also provides support to the private sector in adherence to standards of TB care which helps in the monitoring of the patients, contact screening and adherence to the treatment. Aim: To assess the knowledge, opinion and barriers regarding TB notification and its processes amongst private practitioners offering TB services. Materials and Methods: This was a cross-sectional study with both analytical and descriptive components which was conducted on the private practitioners of urban Chennai for a period of three months from April 2021 to June 2021. Study was done on a convenient sample of 150 private practitioners in Urban Chennai. Any registered medical practitioner with a bachelor degree in medicine (MBBS) with private practice in Urban Chennai with a minimum of 1 year practice was included in the study. The knowledge, attitude and practice of notification of TB among private practitioners and other proportions were summarised into percentages and 95% confidence intervals were calculated. The categorical data was analysed by Chisquare (χ2 ) test. Strength of associations was assessed through odds ratio and 95% confidence intervals. Tha analysis of the data was done using Statistical Package for Social Sciences (SPSS) version 28.0.1.1. Results: Amongst the total sample of 150 study participants, 90% had said that TB notification was mandatory, of whom 80% said that they had prior sensitisation on the notification procedures. Only 46% were aware of the honorarium given after notification. Attitude of the study participants towards notification though 100% of the study participants agreed that TB notification was necessary, while 56.7% said that government should do more towards the sensitisation of the notification procedures. Only 5.3% of the study participants had initiated treatment on their own and 4% had started treatment based on clinical suspicion Nikshay registration was more among those whose duration of practice was more than or equal to 5 years (p=0.03), those who had prior sensitisation on TB notification procedures (p&lt;0.001), those who had TB patients in their Outpatient Department (OPD) (p&lt;0.001), and among those who were aware of the honorarium given for notification (p&lt;0.001). Conclusion: Nikshay registration was significantly more among those who had prior sensitisation and those who were aware about the honorarium that they will receive after notifying. This shows that simple awareness creation can significantly increase the Nikshay registration thereby increasing the TB notification.