Number Of Tuberculosis Patients Research Articles

HIV INFECTION AMONG PATIENTS WITH TUBERCULOSIS IN MOSCOW

The study is devoted to the evaluation of the impact of the spread of HIV infection on the epidemiological indicators of tuberculosis in a megacity. Based on information from the registers of the tuberculosis monitoring system in Moscow for 2014-2015. A comparative analysis of indicators for patients with tuberculosis was conducted with the presence and absence of co-infected HIV infection. The results showed that among patients with tuberculosis combined with HIV infection, patients from the city’s permanent population, from the age group of 31-40 years old, non-working, injecting drug users are much more likely than other TB patients. The number of tuberculosis patients who died of HIV infection, in comparison with the number of patients who died from tuberculosis, accounted for more than a third of the total number of tuberculosis-related deaths. Thus, when assessing the epidemiological situation of tuberculosis, it is necessary to take into account the significant contribution of HIV infection to the values of the main indicators and their dynamics.

Frequency of Smear-Negative Tuberculosis in Northwest Iran.

Microscopic smear examination is the most common test in tuberculosis (TB) detection. It is, however, not strong enough to identify TB in the majority of afflicted individuals; thus, a significant number of TB patients are smear negative and capable of transmitting the infection. The aim of this study was to evaluate the rate of smear-negative TB in northwest Iran. In this cross-sectional study, 329 TB-confirmed patients were evaluated through culture up to March 1, 2015, in northwest Iran. The demographic and clinical features of the smear-negative and smear-positive TB patients were compared. The χ2 test was used to compare the frequency of the variables. All the statistical analyses were conducted using SPSS, version 16 (Chicago, IL, USA). Seventy-five cases were smear negative and 254 were smear positive. Smokers, asthmatics, and extra-pulmonary TB patients were primarily among the smear-negative cases. The rate of mortality was also relatively higher among the smear-negative TB patients. Totally, 22.8% of the TB cases in northwest Iran were smear negative, with a relatively higher rate of mortality than those with positive smears. A delay in these patients' return to TB diagnosis and treatment centers increases the chance of transmission to others. This is a very sensitive issue in centers where there is no equipment for TB cultivation. Thus, it is essential to equip centers without TB cultivation facilities and to use appropriate diagnostic techniques in centers with those facilities to help rapidly detect smear-negative cases.

Alcohol intervention strategy among tuberculosis patients: a pilot study from South India.

Alcohol dependence has been a major cause of treatment non-adherence in tuberculosis (TB) management. There is an urgent need to develop a feasible, acceptable alcohol intervention programme to ensure treatment completion. Four of the 10 Chennai Corporation zones in Chennai, South India, were randomly selected: two each for the experimental and control arms of the study. TB patients registered from August 2013 to January 2014 with the Revised National Tuberculosis Control Programme were assessed using the Alcohol Use Disorder Identification Test (AUDIT) scale. The intervention consisted of four individual counselling sessions at months 0, 2, 4 and 6 conducted by highly trained interventionists. Of 872 TB patients, 298 (31%) were found to have alcohol use disorders. The numbers of TB patients in the experimental and control arms were respectively 113 (38%) and 185 (62%). The proportion of patients with favourable treatment outcomes was higher in the intervention than in the control group (87% vs. 62%, P = 0.04). Overall adherence to anti-tuberculosis treatment was significantly higher in the intervention group (P = 0.02). Study findings suggest that alcohol interventions could be effective in ensuring favourable TB treatment outcomes and adherence. This calls for a large cluster randomised trial for greater generalisability. Tested alcohol-intervention strategies should be recommended to promote treatment adherence among TB patients who consume alcohol.

Risk factors of pulmonary tuberculosis among diabetes mellitus patients in Denpasar City

Background and Purpose: Tuberculosis (TB) is more common in developing countries, including Indonesia. Denpasar City contributes the most on the total number of TB patients in Bali Province. There is evidence on increased burden of diabetes mellitus (DM) patients with TB comorbidity. This study aims to examine risk factors of TB among DM patients.Method: A case control study was conducted in Denpasar City. A total of 135 samples, 45 cases and 90 control, were recruited to participate in the study. Cases were DM patients with TB comorbidity and were taken from patients register between 2013 to 2015. Control were DM patients without TB comorbidity and were taken from Bali Province screening operational study. Data were collected using interviews, observations, measurements and document review. Data were analysed using bivariate analysis and multivariate with logistic regression model.Results: Demographic characteristics between cases and controls were comparable in sex and family income but not comparable in age groups, education, domicile, and employment. Risk factors of TB among DM patients were house density (AOR=36.11; 95%CI: 5.0-259.9), undernutrition (AOR=24.76; 95%CI: 3.7-162.3), inadequate glycemic control (AOR=12.64; 95%CI: 2.4-66.2), and being employed (AOR=10.55; 95%CI: 1.2-92.7). TB infection among DM patients were associated with aged<60 years (AOR=7.47; 95%CI: 1.2-44.3) and being male (AOR=5.42 ;95%CI: 1.2-24.0). TB Co-infection among DM patients were also associated with low education level (AOR=6.96; 95%CI: 1.0-48.6), contact with TB patients (AOR=5.84; 95%CI: 0.7-46.6) and inadequate house ventilation (AOR=2.92; 95%CI: 0.6-13.1).Conclusion: Socio-demographic characteristic, physical environments of the house and clinical conditions are risk factors of TB among DM patiens.

Tuberculosis in Jayapura: Human Security Threat in International Relations Perspective

The concept of human security defines the purpose of human to be free from poverty, free from terror and free from disease. This paper aims to provide an overview of the infectious disease, tuberculosis (TB), as one of the threats to human security in the city of Jayapura. The method used to assess this study is qualitative research method that describes and illustrates findings in the form of data and figures about the disease both by elaborating primary data collection through interviews with staffs and patients in government-funded health care as well as through secondary data libraries, books, journals and the Internet. The results from this study depict that from 2013 to 2015 the number of tuberculosis patients who reported themselves and get treatment and medication in Jayapura city through public health centres had both increased and decreased significantly. This is due to several reasons i.e. the presence of doctors in the health centres that handled the cases, the rise of patients’ awareness on the treatments, the availability of drugs for TB patients in clinics and assistance facilitating by USAID in Papua under the auspice of WHO. In the perspective of international relations, the increasing spread of tuberculosis in Jayapura has become the serious threat to human security and this requires crucial intervention of multi-stakeholders including local government through its health department covering the issue of the availability of accessible health centres, doctors and drugs for tuberculosis treatment. This also includes the promotion and raising awareness for local community relating to TB testing and maintaining one’s healthy environment.

Serious fungal infections in the Philippines

The Philippines is a low middle-income, tropical country in Southeast Asia. Infectious diseases remain the main causes of morbidity, including tuberculosis. AIDS/HIV prevalence is still low at <1%, but is rapidly increasing. Fungal disease surveillance has not been done, and its burden has never been estimated. This becomes more important as the population of immunocompromised patients increases, drawn from patients with AIDS, TB, malignancies, and autoimmune diseases requiring chronic steroid use. Using the methodology of the LIFE program (www.LIFE-worldwide.org), estimates were derived from data gathered from WHO, UNAIDS, Philippine Health Statistics 2011, Philippine Dermatological Society Health Information System database, HIV/AIDS and ART registry of the Philippines, epidemiological studies such as The TREAT Asia HIV Observational Database 2005, and personal communication. Aspergillosis and candidiasis were the top causes of fungal infections in the Philippines. Chronic pulmonary aspergillosis (CPA), drawn from the number of tuberculosis patients, affects 77,172 people. Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) frequencies, which were derived from the number of asthmatic patients, affect 121,113 and 159,869 respectively. Recurrent vulvovaginal candidiasis (RVVC) affects 1,481,899 women. Other estimates were cryptococcal meningitis 84, Pneumocystis pneumonia 391, oral candidiasis 3,467, esophageal candidiasis 1,522 (all in HIV-infected people), invasive aspergillosis (IA) 3,085, candidemia 1,968, candida peritonitis 246, mucormycosis 20, fungal keratitis 358, tinea capitis 846 and mycetoma 97 annually. A total of 1,852,137 (1.9% of population) are afflicted with a serious fungal infection. Epidemiological studies are needed to validate these estimates, facilitating appropriate medical care of patients and proper prioritization of limited resources.

Tuberculosis among COPD Patients in Guba City, Azerbaijan

Chronic obstructive pulmonary disease (COPD) retains their relevance. It is necessary to take into account that growth in the number of patients with lung diseases. In addition, there is a growth in the number of tuberculosis patients. According to the criteria of the Ministry of Health, patients with COPD are at risk.

A study on anti-tubercular drug-induced adverse reactions in South Indian district tuberculosis center

Background: An adverse drug reaction (ADR) is any response to a drug which is noxious and unintended occurs at doses normally used in man for prophylaxis, diagnosis or therapy of disease or the modification of physiological function, anti-tubercular drugs can cause ADR and involving almost all systems in the body including the gastrointestinal (GI) tract, liver, skin, nervous system, and eyes. Methods: A prospective observational study was conducted on tuberculosis (TB) patient. The suspected drug identified for ADRs and the type, nature, severity of reaction were recorded. A total of 239 patients were enrolled in the study. The patient was monitored the suspected ADRs were recorded and assessed for causality and severity. Results: Out of 239 patients, 60 (25.11%) developed one and more than one ADR. A maximum number of tubercular patients were in age group of 21-40 years (44.4%). The majority of patients were males (69%). Incidence of ADRs based on affected organ was GI system disorders (30.33%), skin and appendages disorders (23.62%), central and peripheral nervous system disorders (15.28%), musculo-skeletal system disorders and liver and biliary disorder (9.72% each), hearing disorder (5.55%), and visual disorder accounts of (2.78%). Conclusion: TB still becomes worldwide health problem not only on developing country but also in the developed country even the number of TB patients most large in the developing country. The importance of developing strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely.

Treatment Failure in Tuberculosis Patient: The Role of Smoking Habit

Indonesia faces high burden of Tuberculosis (TB) each year. At the same time, smoking is considered to be common, especially in men. A number of TB patients, who receive standard regimen of TB therapy, would not easily give up on smoking, despite extensive advices from healthcare providers. This report aims to show evidence whether cigarette smoking increases the rate of treatment failure of standard anti-TB regiment in patients with pulmonary TB. Systematic search was done in two databases: Medline ® and Scopus. Cohort studies were selected as appropriate study design to answer a prognosis question. Two cohort studies are found to be relevant with this report. Treatment failures upon standard regimen of TB therapy are 6.9% and 1.7% in both studies. Smoking habit has been demonstrated to increase the likelihood of treatment failure with OR 2.37 (95% CI: 1.24 – 4.54) and 7.489 (95% CI: 0.93 – 60.30). In conclusion, treatment failure in standard TB therapy is small. Smoking habit increases the treatment failure of standard anti-TB regiment in patients with pulmonary TB.

A study of 9 cases of cervical tuberculous lymphadenitis with the diagnosis of cervical tuberculous lymphadenitis

The incidence of tuberculosis patients is high in Japan compared with the other developed countries. The ratio of extrapulmonary tuberculosis patients, for example cervical tuberculous lymphadenitis, tends to increase. In otolaryngology, the number of tuberculosis patients (especially those with cervical tuberculous lymphadenitis) is high and followed by pleuritis patients in extrapulmonary tuberculosis. Although otolaryngologists often diagnose extrapulmonary tuberculosis, it is difficult for them to diagnose appropriately because of various clinical features. Thus, we examined and presented the clinical history of 9 cases of tuberculosis patients in our Otolaryngology department and added a review of the related literature. We diagnosed 9 patients as having cervical tuberculous lymphadenitis from April 2002 to December 2012. They were 30 to 90 years old (mean 57.9 years old), and the male/female ratio was 3 : 6. Five cases were diagnosed as the abscess types and 4 were the swelling types based on the imaging analysis of cervical tuberculous lymphadenitis. Four cases showed multiple lymphadenopathy and 5 showed a solitary involvement. Five sputum and 7 gastric fluid cultures were all negative, whereas 4 QuantiFERON tests were all positive. Fine-needle aspiration cytology was performed in 8 patients, and epithelioid cells were seen in 4 cases. Because tuberculosis presents various clinical features, if we obtained the atypical findings from those patients, it is important in the first instance to suspect tuberculosis. Based on the viewpoint for preventing the spread of infection, we should perform cellular analysis using ultrasound-guided fine needle aspiration after sufficient assessment of the spreading risk by sputum, gastric fluid culture and TB-PCR and QuantiFERON tests, and if a diagnosis remains difficult, the lymph node open biopsy need to be considered.

Managing tuberculosis in patients with diabetes mellitus: why we care and what we know

As the global prevalence of diabetes mellitus (DM) increases, especially in low-to-middle income countries where tuberculosis (TB) remains endemic, we will encounter a growing number of TB patients with DM. This is a major concern for TB control programs, clinicians and patients alike because DM patients are at an increased risk of TB and are more likely to face poor TB treatment outcomes, including treatment failure, relapse and even death. Priority should be placed on early detection of both diseases through active screening, monitoring of adherence to medications for both diseases, and integration of TB and DM management strategies that would facilitate the provision of more comprehensive services that TB patients with DM require.

Amendment of tuberculosis prevention law and prospect of tuberculosis control program

Amendment of tuberculosis prevention law and prospect of tuberculosis control program

The clinical features for tuberculosis in compromised hosts

We investigated the clinical features and measures for tuberculosis with diabetes mellitus, AIDS, gastrectomy, malignant tumor, or receiving anti-tumor necrosis factor-alpha. In these days, tuberculosis patients with diabetes mellitus are increasing. Their tuberculosis is often found in advanced cases and the periods of symptomatics are short. In short, in tuberculosis with diabetes mellitus, the progress of tuberculosis is fast. Japanese patients of tuberculosis with AIDS are frequent in mid-life and increasing. Extra-pulmonary tuberculosis including disseminated tuberculosis is frequent with patients of AIDS. The prognosis of them is improved with the spread of HAART treatment. The most frequent occasion for gastrectomy is gastric cancer and the prognosis is good. Many of them are thin and malnutrition. The prognosis of tuberculosis with malignant tumor is bad, especially with lung cancer and malignant lymphoma. People receiving infliximab, an antitumor necrosis factor-alpha, are frequent to have onset of tuberculosis. Particularly, extra-pulmonary tuberculosis, including disseminated tuberculosis are often. Tuberculin reaction before receiving infliximab are weak. No one, receiving chemoprophylaxis, has onset of tuberculosis. When the rate of chemoprophylaxis increases, the number of tuberculosis patients decreases. Immunocompromised hosts need to be examined periodical or extraordinary when they had symptoms of tuberculosis to discover the onset of tuberculosis. To prevent the onset of tuberculosis, patients who previously infected tuberculosis should receive active chemoprophylaxis regardless of their age.

Family physicians understanding about Mantoux test: A survey from a high endemic TB country

BackgroundTuberculosis is a global health emergency and is a big challenge to diagnose and manage it. Family physicians being first contact health persons should be well competent to diagnose and manage the patients with tuberculosis.AimsThis study was aimed to assess the level of understanding about Mantoux Test amongst Family Physicians in Karachi, Pakistan and to determine the difference of level of understanding by gender and number of tuberculosis patients seen in a month.MethodsA cross sectional survey was conducted among 200 Family Physicians working in Karachi; the largest city and economic hub of Pakistan. Family Physicians who attended Continuous Medical Education sessions were approached after taking consent. Pre-tested, self administered questionnaire was filled consisting of: basic demographic characteristics, questions regarding knowledge about Mantoux Test, its application and interpretation. Data of 159 questionnaires was analyzed for percentages, as rest were incomplete. Chi square test was used to calculate the difference of understanding levels between various groups.ResultsAlmost two thirds of respondents were males and above 35 years of age. Majority of Family Physicians were private practitioners and seeing more than five tuberculosis patients per month. Overall, a big gap was identified about the knowledge of Mantoux Test among study participants. Only 18.8% of Family Physicians secured Excellent (≥ 80% correct responses). This poor level of understanding was almost equally distributed in all comparative groups (Male = 20.8% versus Female = 15.9%; p - 0.69) and (Seen < 5 tuberculosis patients per month = 18.6% versus seen ≥ 5 tuberculosis patients per month = 19.3%; p - 0.32). A huge majority of Family Physicians (92%) however, showed keen interest in obtaining further knowledge regarding Mantoux Test and amongst them 72% suggested Continued Medical Education sessions as preferable mode of updating themselves.ConclusionOur study revealed an overall major deficit in understanding and interpretation of Mantoux Test amongst Family Physicians which needs to be addressed. Continues Medical Education sessions for Family Physicians should be organized in regular basis for upgrading their knowledge in this regards.

Implementing a community-based tuberculosis programme in the Omaheke region of Namibia: nurses’ perceived challenges

Tuberculosis (TB) is a resurgent disease in many regions of the world, including Namibia, fuelled by poor TB control&#x0D; programmes, human immunodeficiency virus (HIV) and poverty. The purpose of this survey was to identify nurses’ perceived challenges in implementing a community-based TB programme in the Omaheke region of Namibia. Structured interviews were conducted with 40 nurses involved in providing TB treatment and care in the Omaheke region. Patient-related challenges which hampered TB treatment included alcohol and drug abuse, poverty and stigma. Lack of transport for nurses to do community-based TB work, centralised TB services and patients’ lack of transport were access-related challenges. Knowledge-related challenges involved a lack of TB knowledge by both nurses and community members. The HIV pandemic has increased the number of TB patients and increased nurses’ workloads, aggravating the burden of TB as a resurgent disease in this region. Decentralisation of TB care to community and family levels would be necessary to reduce the number of people with active TB in the community, and to enhance the TB cure rates, in the Omaheke region of Namibia. In order to implement a successful communitybased TB programme, the patient-related, access-related and knowledge-related challenges, perceived by the&#x0D; nurses, need to be addressed effectively.&#x0D; &#x0D; Opsomming&#x0D; Tuberkulose (TB) is ‘n siekte wat herrys in baie dele van die wêreld, insluitende Namibië, en wat aangevuur word deur swak TB-beheerprogramme, menslike immuniteitsgebreksvirus (MIV) en armoede. Die doel van die opname was om waargenome uitdagings van verpleegkundiges te identifiseer tydens die implementering van ‘n gemeenskapsgebaseerde TB-program in die Omaheke-streek van Namibië. Gestruktureerde onderhoude is met 40 verpleegkundiges gevoer wat gemoeid was met TB-behandeling en -versorging in die Omaheke-streek. Pasiëntverwante uitdagings wat TB-behandeling nadelig beïnvloed, sluit alkohol- en dwelmmisbruik asook armoede en stigma in. ‘n Gebrek aan vervoer vir verpleegkundiges om gemeenskapsgebaseerde TB-werk te doen, die sentralisasie van TB-dienste en pasiënte se gebrek aan vervoer was die toegangsverwante uitdagings. Kennisverwante uitdagings het die gebrek aan TB-kennis van beide verpleegkundiges en gemeenskapslede ingesluit. Die MIVpandemie het die aantal TB-pasiënte vermeerder en verpleegkundiges se werksladings verhoog, wat die las van TB as ‘n herrysende siekte in die streek vererger het. Desentralisasie van TB-sorg tot op gemeenskaps- en gesinsvlak sal nodig wees om die getal mense met aktiewe TB in die gemeenskap te verminder, en om die TB-geneeskoerse in die Omaheke-streek van Namibië te verbeter. Ten einde ‘n suksesvolle gemeeskapsge-baseerde TB-program te implementeer, moet die pasiënt-, toegangs- en kennisverwante uitdagings, soos deur die verpleegkundiges waargeneem, effektief oorkom word.

Suttons’s Law: Local Immunodiagnosis of Tuberculosis

Recently, important advances have been made in the immunodiagnosis of tuberculosis. New T cell interferon-gamma release assays (TIGRA) are more specific and more sensitive than the tuberculin skin test (TST) for the diagnosis of Mycobacterium tuberculosis (MTB) infection. However, like the TST, TIGRA are unable to distinguish between active tuberculosis (TB), latent TB infection (LTBI) and treated TB if performed on blood mononuclear cells alone. In active TB, MTB-specific T cells are actively recruited to the site of infection and can rapidly be identified in extrasanguinous fluids, such as pleural effusions, ascites, cerebrospinal fluid, and in bronchoalveolar lavages. This review summarizes recent findings comparing systemic and local immune responses against MTB. Although bacteriological and histological methods have the highest specificity for TB in terms of diagnosing active TB and the number of TB patients in whom extrapulmonary TIGRAs have been evaluated is still limited, a comparison of local and systemic MTB-specific immune responses is a promising technique to rapidly distinguish active TB from latent MTB infection in routine clinical practice.

Tuberculosis en la comarca del Bajo Deba (Guipúzcoa) en el período 1995-2006

Within the Multicenter Project on Tuberculosis Research performed in Spain in 1996-1997, the Bajo Deba Area reported the highest incidence of tuberculosis in the Basque Country. We analyzed the clinical and epidemiological characteristics of the tuberculosis population diagnosed in our area during the period of 1995 to 2006. Ambispective, observational study. A total of 584 patients were diagnosed with tuberculosis. The disease affected the respiratory tract in 509 cases and other sites in 75 cases. The mean annual incidence rate of tuberculosis was 64.5 cases per 100 000 inhabitants (91.6 in 1995-1998; 34.9 in 2003-2006). The mean annual incidence rate of smear-positive patients was 20.7 cases per 100 000 inhabitants (33.8 in 1995-1998; 12.9 in 2003-2006). The 15 to 24-year-old group was the most highly affected during the period of 1995 to 1998 (mean annual incidence rate 199.4 cases per 100 000); in contrast, the > 75-year-old group was the most highly affected during the period of 2003 to 2006 (121.1 cases per 100 000 inhabitants). Fifty-three patients were co-infected by HIV (9%) (yearly mean of 11.6% in 1995-1998 and 7% in 2003-2006). Löwenstein culture was positive in 431 cases (73.8%). Resistance to isoniazid was detected in 1.4% out of a total of 287 strains tested, and multidrug resistance was not observed. Nine patients were immigrants (1.5%). Treatment completion was greater in our area (505 patients, 86.4%), as compared to that recorded in the Guipuzcoa province during the same period (1956 of 2525 patients, 77.5%) (P < .01). The Bajo Deba Area presented a high incidence of tuberculosis in the 1995 to 2006 period. Epidemiological trends showed a progressive decrease in the number of tuberculosis patients, with a shift from younger to older persons as the most highly affected age group. The impact of drug resistance and immigration was negligible on tuberculosis rates. The percentage of microbiologically confirmed cases was high. Treatment completion was satisfactory.

Erythrocyte sedimentation rate may be an indicator for screening of tuberculosis patients for underlying HIV infection, particularly in resource-poor settings: an experience from India.

Sir,India has been experiencing the most serious publichealth challenge caused by HIV epidemic since its first detection in 1986 (1). The country has an estimated 4.58 million HIV-infected individuals (2). Prevalence data on HIV infection collected from various parts of the country indicate its spread from urban to rural areas and from high risk to general population (3). Because of continued HIV transmission in the community for the last many years, the country is witnessing several opportunistic infections associated with HIV infection, of which tuberculosis (TB) is the most prominent.Early detection and effective treatment with regular follow-up until complete recovery is the most important strategy to control the spread of tuberculosis in the community. India needs special attention to control TB as the country harbours a large number of TB patients and many of whom are associated with HIV infection. The effects of HIV on TB include: (a) More transmission of TB bacteria in the community, (b) TB progresses faster in HIV-infected people, and (c) TB in HIV-positive people is more likely to be fatal if diagnosed late or left untreated (4).Unfortunately, the HIV status of a sizable number of tuberculosis patients detected by the local physicians remains unknown due to the shortage of HIV testing facilities. The present study, conducted at the National Institute of Cholera and Enteric Diseases (ICMR), Kolkata, India, was aimed at finding a positive predictive factor in tuberculosis patients, particularly in resource-poor settings, so that underlying HIV could be detected to a great extent using minimum diagnostic resources.Data of routine investigations of 34 pulmonary tuberculosis patients associated with HIV infection, diagnosed during July-December 2003, were reviewed. The routine investigations included total count (TC), differential count (DC), haemoglobin (Hb), erythrocyte sedimentation rate (ESR), and mode of diagnosis. The data were compared with data from a similar group of pulmonary tuberculosis patients (n=25), who were detected during the same time but not associated with HIV infection.There was not much difference in basic investigations between these two groups, except in ESR values. Most tuberculosis patients with HIV infection had a much lower ESR value compared to the control group. The mean and median values of ESR, respectively, were 38.5 mm per hour and 30.0 mm per hour among patients with HIV infection (n=34) compared to 102 mm per hour and 108 mm per hour among those without HIV infection (n=25).Table 1 shows the relationship between TB with or without HIV infection and ESR status, and Table 2 shows the age distribution of TB subjects of both the groups. …

A flare-up of tuberculosis due to war in Congo Brazzaville.

Congo Brazzaville, a country with a population of 3 million, experienced a period of war from 1997 to 1999. Before this time the annual increase in numbers of tuberculosis cases was on average 20%; in 2000 it was 84%. This situation had a considerable impact on the activities of the National Tuberculosis Programme. Before the war the diagnostic and treatment centres had notified nearly 100% of new cases of tuberculosis; in 2000 this had dropped to 76.19%, whereas the number of tuberculosis patients had almost doubled, from 5125 in 1999 to 9436 in 2000. New cases of smear-positive pulmonary tuberculosis represent 45% of cases, in comparison with an average of 55% before the war, and extrapulmonary tuberculosis 30% versus 21% before the war. The relapse rate has not changed significantly, by approximately 2%, while the default rate has risen significantly, from 20% to about 26%. The rates of new smear-positive tuberculosis cases who are cured or have completed treatment remain unchanged (70%), while the mortality rate dropped after the war from 6% to 1.23%. The war led to an increase in rates of tuberculosis, particularly in the two main cities, Brazzaville and Pointe-Noire, to which refugees had fled from the rural areas. This resulted in an excessive workload for the health workers. Sustained financial support is needed to reduce tuberculosis transmission in the Congo population.

Linking private and public sectors in tuberculosis treatment in Kathmandu Valley, Nepal.

Tuberculosis (TB) is a major public health problem and the world's foremost cause of death from a single infectious agent. Despite the increasing number of TB patients who seek help in the private sector, there are few practical examples of how to create a public/private linkage of TB services. The paper presents a pilot service-linkage project between the public and private sector in TB control in Kathmandu Valley, Nepal. The study documents and examines the process of the service-linkage project through the undertaking of a longitudinal analytical case study. A detailed description of the project from formulation to a short-term evaluation is given. The analysis relates the activities and early outcomes of the service-linkage project to the context, characteristics and interactions of the organizations involved. The study reveals that although the involved organizations initially agreed on the objective of the service-linkage project, differences in capacity, motivation, environment and needs had implications for the implementation and short-term success of the project. The public sector, despite the will, did not have the structure or resources to engage with the private sector. The private sector lacked interest in public health aspects of TB treatment and trust in the public sector. The study points to two different organizations that have the potential capacities to act as mediators between the public and private sectors: international research institutions and non-governmental organizations.