Tuberculosis In Ghana Research Articles

Evaluation of treatment outcomes among adult patients diagnosed with tuberculosis in Ghana: A 10 year retrospective review

ObjectivesThe study determined tuberculosis (TB) treatment outcomes in Southern Ghana from 2012 to 2021. MethodsA retrospective analysis of service data on TB cases was conducted. Treatment success was defined as TB cure or completion of treatment course, whereas unsuccessful outcomes was defined as death, failure of treatment and lost to follow up. Bivariate and multivariate logistic regression was used to determine factors associated with treatment outcomes. ResultsA total of 4106 adult TB cases were reported with a median age of 41 (interquartile range 32-52) years. Of these, 93.1% (n = 3823) were newly diagnosed. The treatment success rate declined from 71.0% in 2012 to 55.7% in 2021 (ktau-b = −0.56, P = 0.0318). Clinically diagnosed TB and extra-pulmonary TB had 7.0% (adjusted prevalence ratio [aPR]: 0.93, 95% confidence interval [CI]: 0.88-1.00) and 24.0% (aPR: 0.76, 95% CI: 0.69-0.84) respectively, less successful treatment outcome compared to pulmonary TB patients. HIV negative status was associated with 22% higher successful treatment outcome compared with being HIV positive (aPR: 1.22, 95% CI: 1.12-1.33). ConclusionTuberculosis treatment success rate declined over the period. There is a need for the TB Control Programme to review the national and sub-national TB data to ascertain poor performing TB treatment sites to identify and address context specific challenges with treatment interventions and system inadequacies to improve treatment success rates.

Evaluating the Impact of the GeneXpert Technique on Case Detection and Management of Tuberculosis in Ghana

Background: Rapid and more sensitive diagnostic assays have seen substantial investment globally intending to improve Tuberculosis (TB) diagnosis towards treatment. This study evaluated the impact of the GeneXpert intervention on TB case detection and management in Ghana.
 Methods: The study made use of an interrupted time series design. Data from Ghana’s District Health Information Management System (DHIMS II) was used to evaluate the impact of the intervention. A cross-section of DHIMS II data was analyzed repeatedly using 2017 and 2022 as baseline and end lines, respectively. Descriptive analysis and interrupted time series models were used.
 Results: No immediate impact was observed on bacteriologically confirmed TB, however, 5 years following the intervention, the number of bacteriologically confirmed TB cases increased by an average of 562 cases per year (step and ramp (coefficients of pre- and post-intervention ) variables being -278.5 (95% (CI): -1118.3, 561.3) and 561.9 (95% CI: 352.3, 771.6), respectively. The cure rate decreased on average by 32.8% at the onset (step coefficient of -32.8 (95% CI: 40.5 – 25.0), however, there were no significant changes in the pre-and post-intervention cure rates (ramp coefficient = 1.5 (95% CI: -4.0, 7.0). Subsequently, the treatment completed rate increased sharply in the year of implementation but did not significantly differ from the pre-and post-intervention period (step and ramp coefficients were 29.4% (95% CI: 27.0, 31.9) and 1.5% (95% CI: -1.8, 0.4). Moreover, the intervention did not have a significant sudden or gradual impact on adverse treatment outcomes; step and ramp coefficients were 3.0% (95% CI: -4.5, 10.6) and 0.2% (95% CI: -5.1, 5.5)
 Conclusions: While bacteriologically diagnosed TB cases improved during the implementation period, clinical outcomes were not significantly impacted. To achieve recommended global targets, there is a need to address treatment follow-up challenges and enhance monitoring as part of addressing implementation challenges.

Genetic diversity and drug resistance profiles of Mycobacterium tuberculosis complex isolates from patients with extrapulmonary tuberculosis in Ghana and their associated host immune responses

ObjectivesThis study sought to determine the genetic diversity and drug resistance profiles of Mycobacterium tuberculosis complex (MTBC) isolates from extrapulmonary tuberculosis (EPTB) patients in Ghana, and their associated immune responses. MethodsSpoligotyping was performed on 102 MTBC isolates from EPTB patients. Lineages/sub-lineages were assigned by comparing spoligotyping patterns primarily with the SITVIT2 database and subsequently with the TB-Lineage online tool for unknown isolates in SITVIT2. Drug susceptibility testing was performed using MGIT (BD BACTEC 960), Lowenstein-Jensen media (indirect proportion method), and GenoType MTBDRplus/MTBDRsl assays. Differential cytokine levels in the serum of 20 EPTB patients infected with MTBC lineage 4 were determined using the Luminex multiplex immunoassay. ResultsAround 95% (97/102) of isolates were Mycobacterium tuberculosis, predominantly lineage 4 (95%; 92/97). Of the lineage 4 isolates, the majority were sub-lineage Cameroon (37%, 34/92). Prevalence was significantly higher in the 15–34 years age group among EPTB patients infected with lineage 4 strains (p = 0.024). Fifteen isolates were resistant to at least one anti-TB drug tested. Decreased levels of IL-1β, IL-17A, and IFN-α were observed in individuals infected with Cameroon sub-lineages compared with other lineage 4 sub-lineages. ConclusionsOur study confirms Cameroon (SIT61) as the most common spoligotype causing human EPTB in Ghana, and that it is associated with decreased serum IL-1β, IL-17A, and IFN-α.

Variable Number Tandem Repeat Profiling of Mycobacterium ulcerans Reveals New Genotypes in Buruli Ulcer Endemic Communities in Ghana and Côte d'Ivoire.

Buruli ulcer (BU), a necrotic skin disease caused by Mycobacterium ulcerans, is mainly prevalent in West Africa, but cases have also been reported in other tropical parts of the world. It is the second most common mycobacterial disease after tuberculosis in Ghana and Côte d’Ivoire. Heterogeneity among M. ulcerans from different geographical locations has not been clearly elucidated, and some studies seem to suggest genetic differences between M. ulcerans in humans and in the environment. This study aimed at identifying genetic differences among M. ulcerans strains between two BU endemic countries: Ghana and Côte d’Ivoire. Clinical samples consisting of swabs, fine needle aspirates, and tissue biopsies of suspected BU lesions and environmental samples (e.g., water, biofilms from plants, soil, and detrital material) were analyzed. BU cases were confirmed via acid fast staining and PCR targeting the 16S rRNA, IS2404, IS2606, and ER domain genes present on M. ulcerans. Heterogeneity among M. ulcerans was determined through VNTR profiling targeting 10 loci. Eleven M. ulcerans genotypes were identified within the clinical samples in both Ghana and Côte d’Ivoire, whiles six M. ulcerans genotypes were found among the environmental samples. Clinical M. ulcerans genotypes C, D, F, and G were common in both countries. Genotype E was unique among the Ghanaian samples, whiles genotypes A, Z, J, and K were unique to the Ivorian samples. Environmental isolates were found to be more conserved compared with the clinical isolates. Genotype W was observed only among the Ghanaian environmental samples. Genotype D was found to be prominent in both clinical and environmental samples, suggesting evidence of possible transmission of M. ulcerans from the environment, particularly water bodies and biofilms from aquatic plants, to humans through open lesions on the skin.

Evaluation of a loop-mediated amplification test for rapid diagnosis of tuberculosis in Ghana

Evaluation of a loop-mediated amplification test for rapid diagnosis of tuberculosis in Ghana

Spatio-temporal characteristics of Tuberculosis in Ghana

Background: The number of Tuberculosis (TB) cases or deaths is declining, however, the rate of decline is not adequate to meet the World Health Organization's (WHO's) mitigation. TB remains a public health problem in Ghana with a significant economic and health burden on its citizens and health care system. Consequently, there is a need for further studies about the disease aimed at accelerating the rate of decline in cases. Methods: The spatio-temporal characteristics of TB in Ghana using Bayesian spatial and spatio-temporal regression models was analysed in this study. Data were obtained from Ghana National Tuberculosis Programme (NTP) for the 10 regions of Ghana, collected over a six-year period. The study also examines some baseline predictors of TB infections to ascertain their effects on the TB risk across the ten regions in Ghana. Results: Hot-spots of TB cases are observed in the Upper East, Upper West, Volta, Western, and Central regions and low risk in the Northern, Ashanti, Greater Accra, Brong Ahafo, Eastern and Western regions. The results indicated a clustering of risk between neighboring regions. TB cure rate, TB success rate, knowledge about TB, awareness that TB is airborne, HIV prevalence, percentage of literacy, and high income are important predictors of detection for this disease across the ten regions of Ghana. Conclusion: Most regions in Ghana have similar TB risks. A substantial reduction in TB cases requires measures that will increase detection, success and cure rates, awareness, knowledge about how this disease spreads as well adequate health facilities with easy access.

The burden of drug resistance tuberculosis in Ghana; results of the First National Survey

Resistance to Tuberculosis drugs has become a major threat to the control of tuberculosis (TB) globally. We conducted the first nation-wide drug resistance survey to investigate the level and pattern of resistance to first-line TB drugs among newly and previously treated sputum smear-positive TB cases. We also evaluated associations between potential risk factors and TB drug resistance. Using the World Health Organization (WHO) guidelines on conducting national TB surveys, we selected study participants from 33 health facilities from across the country, grouped into 29 clusters, and included them into the survey. Between April 2016 and June 2017, a total of 927 patients (859 new and 68 previously treated) were enrolled in the survey. Mycobacterium tuberculosis complex (MTBC) isolates were successfully cultured from 598 (65.5%) patient samples and underwent DST, 550 from newly diagnosed and 48 from previously treated patients. The proportion of patients who showed resistance to any of the TB drugs tested was 25.2% (95% CI; 21.8–28.9). The most frequent resistance was to Streptomycin (STR) (12.3%), followed by Isoniazid (INH) (10.4%), with Rifampicin (RIF), showing the least resistance of 2.4%. Resistance to Isoniazid and Rifampicin (multi-drug resistance) was found in 19 (3.2%; 95% CI: 1.9–4.9) isolates. Prevalence of multidrug resistance was 7 (1.3%; 95% CI: 0.5–2.6) among newly diagnosed and 12 (25.0%; 95% CI: 13.6–39.6) among previously treated patients. At both univariate and multivariate analysis, MDR-TB was positively associated with previous history of TB treatment (OR = 5.09, 95% CI: 1.75–14.75, p = 0.003); (OR = 5.41, 95% CI: 1.69–17.30, p = 0.004). The higher levels of MDR-TB and overall resistance to any TB drug among previously treated patients raises concerns about adherence to treatment. This calls for strengthening existing TB programme measures to ensure a system for adequately testing and monitoring TB drug resistance.

Genomic epidemiological analysis identifies high relapse among individuals with recurring tuberculosis and provides evidence of recent household-related transmission of tuberculosis in Ghana

ObjectiveTo retrospectively investigate the cause of recurring tuberculosis (rcTB) among participants with pulmonary TB recruited from a prospective population-based study conducted between July 2012 and December 2015. MethodsMycobacterium tuberculosis complex isolates obtained from rcTB cases were characterized by standard mycobacterial genotyping tools, whole-genome sequencing, and phylogenetic analysis carried out to assess strain relatedness. ResultsThe majority (58.3%, 21/36) of study participants with rcTB episodes had TB recurrence within 12 months post treatment. TB strains with isoniazid (INH) resistance were found in 19.4% (7/36) of participants at the primary episode, of which 29% (2/7) were also rifampicin-resistant. On TB recurrence, an INH-resistant strain was found in a larger proportion of participants, 27.8% (10/36), of which 40% (4/10) were MDR-TB strains. rcTB was attributed to relapse (same strain) in 75.0% (27/36) of participants and 25.0% (9/36) to re-infection. ConclusionOur findings indicate that previous unresolved infectiondue to inadequate treatment, may be the major cause of rcTB.

Microbiology of secondary infections in Buruli ulcer lesions; implications for therapeutic interventions

BackgroundBuruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans and is the second most common mycobacterial disease after tuberculosis in Ghana and Côte d’Ivoire. M. ulcerans produces mycolactone, an immunosuppressant macrolide toxin, responsible for the characteristic painless nature of the infection. Secondary infection of ulcers before, during and after treatment has been associated with delayed wound healing and resistance to streptomycin and rifampicin. However, not much is known of the bacteria causing these infections as well as antimicrobial drugs for treating the secondary microorganism. This study sought to identify secondary microbial infections in BU lesions and to determine their levels of antibiotic resistance due to the prolonged antibiotic therapy required for Buruli ulcer.ResultsSwabs from fifty-one suspected BU cases were sampled in the Amansie Central District from St. Peters Hospital (Jacobu) and through an active case surveillance. Forty of the samples were M. ulcerans (BU) positive. Secondary bacteria were identified in all sampled lesions (N = 51). The predominant bacteria identified in both BU and Non-BU groups were Staphylococci spp and Bacilli spp. The most diverse secondary bacteria were detected among BU patients who were not yet on antibiotic treatment. Fungal species identified were Candida spp, Penicillium spp and Trichodema spp. Selected secondary bacteria isolates were all susceptible to clarithromycin and amikacin among both BU and Non-BU patients. Majority, however, had high resistance to streptomycin.ConclusionsMicroorganisms other than M. ulcerans colonize and proliferate on BU lesions. Secondary microorganisms of BU wounds were mainly Staphylococcus spp, Bacillus spp and Pseudomonas spp. These secondary microorganisms were less predominant in BU patients under treatment compared to those without treatment. The delay in healing that are experienced by some BU patients could be as a result of these bacteria and fungi colonizing and proliferating in BU lesions. Clarithromycin and amikacin are likely suitable drugs for clearance of secondary infection of Buruli ulcer.

Community beliefs about tuberculosis in Ghana: Implications for the end tuberculosis global agenda

Globally, the agenda is to end tuberculosis (TB) by 2030. The emic (local) perspective about causes, signs and symptoms, and management of the disease has implications in service utilization and he...

Space-time analysis and mapping of prevalence rate of tuberculosis in Ghana

BackgroundGlobal fight against tuberculosis (TB) has received increasing attention over the years. However, the disease remains one of the top-most global health problems, especially in Sub-Saharan Africa and Ghana. AimsThis paper examined geographical (regional) and seasonal distribution of TB cases providing relative risk of TB exposure in Ghana and step by step procedure to perform the analysis. Methods and materialWe modelled reported TB cases between 2015 and 2018 using wavelet analysis and applied maximum covariance analysis (MCA) to determine regional and seasonal patterns and the risk of TB exposure in Ghana. This study is based on the old administrative regions of Ghana. ResultsMore TB cases were recorded in the Greater Accra and Ashanti regions and less cases in the rest of the regions. There is significant increase in the number of TB cases from 2015 to 2018. High number of TB cases is observed in the dry season relative to the rainy season. There is high variability in TB prevalence with high prevalence moving towards the Southern part of Ghana. ConclusionThe study highlights that TB cases is clustered in space and time and that even at small spatial scale, differences in prevalence can be substantial. The prevelance of TB exposure is higher in the dry season relative to the rainy season. Hence, enough resources should be timely provided during the dry season as well as intensifying preventive strategies to control the spread of the disease.

An IL7RA exon 5 polymorphism is associated with impaired IL-7Rα splicing and protection against tuberculosis in Ghana

Functional interleukin-7 receptor α-chain (IL-7Rα) genetic variants, which affect alternative splicing and expression of the soluble IL-7Rα, are associated with susceptibility to autoimmunity. We previously described aberrant IL-7Rα expression and impaired IL-7-mediated T-cell functions in tuberculosis patients. In the present study, we investigated a possible role of IL7RA gene variants. Six exonic IL7RA polymorphisms were genotyped and two minor alleles were found at lower frequencies in tuberculosis patients as compared to healthy contacts from Ghana (rs11567764, p = 0.002; rs1494558, p = 0.01). The rs11567764 polymorphism tags an IL7RA haplotype exclusively found in African populations and was predicted to affect splicing of exon 5. Reduced mRNA expression of the Δexon_5-6 variant was found in T-cells from carriers of the protective rs11567764 allele. Although we were not able to demonstrate the causative effect of rs11567764, our findings suggested functional implications of genetic variants on IL-7Rα splicing and with potential impact on T-cell protection against tuberculosis.

Isolation and characterization of nontuberculous mycobacteria from patients with pulmonary tuberculosis in Ghana.

Nontuberculous mycobacterial (NTM) species are assuming public health importance in pulmonary diseases; they are increasingly being isolated, and importantly, most NTMs do not respond to routine tuberculosis (TB) drugs. This study aimed to identify NTMs isolated from pulmonary TB cases and also determine their susceptibility to streptomycin (STR), isoniazid (INH), and rifampicin (RIF). A total of 1755 mycobacterial isolates, obtained between August 2012 and July 2014, from 2036 smear-positive pulmonary cases were identified using polymerase chain reaction amplification of IS6110, and hsp65 gene sequencing analysis. Drug susceptibility testing (DST) was then performed for the identified NTMs against STR, INH, and RIF using microplate Alamar blue assay. The results were analyzed against patients' biodata for statistical associations. Of the 1755 analyzed isolates, we identified 43 (2.5%) NTMs, which included 18 (41.9%) Mycobacterium intracellulare, 13 (30.2%) Mycobacterium avium subs. paratuberculosis, 5 (11.3%) Mycobacterium abscessus, 3 (7.0%) each of Mycobacterium mucogenicum and Mycobacterium colombiense, and 1 (2.3%) Mycobacterium simiae. Patients infected with NTMs (52.0%) were more likely to be human immunodeficiency virus-positive (P = 0.001, odds ratio = 6.6, 95% confidence interval = 2.7-16.2) than those infected with M. tuberculosis complex (5.8%). All the 43 (100%) NTMs were resistant to INH, whereas 32 (74%) and 19 (44%) were resistant to RIF and STR, respectively. Furthermore, 16 (37.2%) NTMs were resistant to all three drugs, 20 were resistant to INH and RIF, and 3 were resistant to STR and INH. All the M. abscessus isolates were resistant to all the three drugs, whereas all the M. avium isolates were resistant to INH and RIF, but only three were resistant to STR. Among the M. intracellulare isolates, 8, 18, and 15 isolates were resistant to STR, INH, and RIF, respectively. The observed high-resistance level to INH and RIF supports the need for rapid species identification and DST of nonresponding TB cases before retreatment.

Antimycobacterial and cytotoxic activity of selected medicinal plant extracts

Ethnopharmacological relevanceTuberculosis (TB) caused by Mycobacterium tuberculosis remains an ongoing threat to human health. Several medicinal plants are used traditionally to treat tuberculosis in Ghana. The current study was designed to investigate the antimycobacterial activity and cytotoxicity of crude extracts from five selected medicinal plants. Material and methodsThe microplate alamar blue assay (MABA) was used for antimycobacterial studies while the CellTiter 96® AQueous Assay, which is composed of solutions of a novel tetrazolium compound [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt; MTS] and an electron coupling reagent (phenazine methosulfate) PMS, was used for cytotoxic studies. Correlation coefficients were used to compare the activity of crude extracts against nonpathogenic strains and the pathogenic Mycobacterium tuberculosis subsp.tuberculosis. ResultsResults of the MIC determinations indicated that all the crude extracts were active on all the three tested mycobacterial strains. Minimum inhibitory concentration values as low as 156.3µg/mL against M. tuberculosis; Strain H37Ra (ATCC® 25,177™) were recorded from the leaves of Solanum torvum Sw. (Solanaceae). Cytotoxicity of the extracts varied, and the leaves from S. torvum had the most promising selectivity index. Activity against M. tuberculosis; Strain H37Ra was the best predictor of activity against pathogenic Mycobacterium tuberculosis subsp.tuberculosis (correlation coefficient=0.8). ConclusionThe overall results of the present study provide supportive data on the use of some medicinal plants for tuberculosis treatment. The leaves of Solanum torvum are a potential source of anti-TB natural products and deserve further investigations to develop novel anti-TB agents against sensitive and drug resistant strains of M. tuberculosis.

WITHDRAWN: Herbalists, traditional healers and pharmacists: a view of the tuberculosis in Ghana

WITHDRAWN: Herbalists, traditional healers and pharmacists: a view of the tuberculosis in Ghana

Herbalists, traditional healers and pharmacists: a view of the tuberculosis in Ghana

This paper is the result of a visit by Brazilian researchers to Ghana, with the aim of improving understanding of the relationship between traditional healers and conventional health practices, specifically in relation to tuberculosis. Through this exploratory visit, this group of researchers promoted by the Edital Pro Africa (CNPq) had an opportunity to learn about, reflect on, and discuss the different social, economic and cultural realities and contexts that have led to the different health conditions and forms of healthcare in Ghana. Besides the direct relationship between the social and economic conditions of the country and the health of its population, it was also concluded that there is a clear distancing, in the Ghanaian reality, between the traditional healers and the conventional system, in terms of culture and modes of operation, each constituting isolated systems with little or no collaboration between them.The visit enabled us to see the difficulties involved in managing TB, including diagnosis, treatment, monitoring and co-infection with HIV. The majority of patients with TB only go to hospital after several attempts at self-medication, due to the non-specificity of the principal symptoms, and also to the trust in the traditional medicine. Initiatives to encourage research into medicinal plants in Ghana are seeking partnerships with developed countries, but not always with clear or secure national interests. For the traditional healers, there are high hopes that the information gathered by researchers from the local universities, on the plants and traditional methods they use, will result in affirmation and recognition of their practices, but they complain strongly that they receive no feedback on the research carried out.

Views of health service providers on obstacles to tuberculosis control in Ghana

BackgroundAlthough Ghana does not fall into the category of those countries which have a high burden of tuberculosis (TB), the disease does present considerable economic and health limitations to individuals infected with, and affected by, the disease, as well as to the health system in general. Despite this fact, insufficient studies have been done on the key barriers to controlling the disease. This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers.MethodsIn-depth interviews were conducted with frontline health workers involved in TB control in the country. Participants were purposively selected from a pool of national and regional, and district and facility level coordinators of the National Tuberculosis Control Programme (NTP). One key informant was also selected from an international non-governmental organisation (NGO) involved in TB-related activities in Ghana. Observations were utilised to complement the study. Data were analysed inductively.ResultsRespondents identified the following as being constraints to TB control: clinical complication, bottlenecks in funding administration, quality of physical infrastructure, competition for attention and funding, unsatisfactory coordination between TB and HIV control programmes, a poor public-private partnership, and weak monitoring and evaluation of interventions.ConclusionsThis paper provides evidence of some key barriers to TB control. The barriers, as reported, were generally health system-based. Although this list of barriers is not exhaustive, it would be useful to take them into account when planning for TB control, thus adopting a more rounded approach to TB management in the country. As well as that, further studies should be done to explore patients’ views on health service-related barriers to TB control.

Diagnosis of tuberculosis in Ghana: The role of laboratory training

The laboratory is considered the cornerstone of tuberculosis (TB) control programme. International review of Ghana's programme in the late nineties identified the laboratory services as the weakest component. Sputum smear microscopy (SSM) being the main method of diagnosing pulmonary TB in Ghana, the training objectives were to: (i) strengthen the knowledge and skills of laboratory personnel on SSM (ii) impart necessary techniques in biosafety and (iii) introduce a Quality Assurance (QA) system in order to strengthen SSM services. Personnel were selected for training during a nationwide situation analysis of SSM centres in 2000/2001. Four training sessions on SSM/QA were held between 2001/2004. A total of 80 personnel were trained: 10 regional TB coordinators and 70 laboratory personnel. The participants upon return to their respective regions also organized training within their districts. This approach resulted in another 100 district TB coordinators and 200 laboratory personnel being trained. Improvement in smear preparation, staining and reading ability of the participants were observed during the post-test and subsequent visit to their respective laboratories. The training has led to strengthening of TB laboratory services in the country and has contributed to increase in case detection from 10,745 in 2000 to 11,827 in 2004 and 14,022 in 2008. It was observed during the post-training follow-up and quarterly supervision visits that morale of the personnel was high. Continuous training and re-training of laboratory personnel on SSM and QA at regular intervals do play an important role for effective and efficient TB control programme.

Identification of Intrinsic Airway Acidification in Pulmonary Tuberculosis

Exhaled breath condensate acidification reflects the presence of airway acidification. Mycobacterium tuberculosis is an organism particularly sensitive to acidity. We aimed to determine if there is evidence of airway acidification in a cross section of patients with active tuberculosis.We enrolled 51 subjects with active tuberculosis in Ghana and Thailand, and compared them to control subjects. We collected exhaled breath condensate, and assayed for pH after gas standardization.Exhaled breath condensate pH from the control group revealed a median of 7.9 (7.7 - 8.0, n = 21), significantly higher than the active pulmonary tuberculosis patients who had a median pH of 7.4 (7.0 - 7.7; n = 51; p=0.002). Presence or absence of antibiotic therapy did not affect EBC pH values.These exhaled breath condensate data support the theory that airways become acidic in active tuberculosis infection. This may be a mechanism of immune response and pathology not previously considered.

‘We are afraid of them’: Attitudes and behaviours of community members towards tuberculosis in Ghana and implications for TB control efforts

One major set back to the success of TB control globally is the stigma attached to the disease in most societies. This article explores community's understanding of, and attitudes and behaviours towards TB and examines the implications for disease control efforts. Individual in-depth interviews and focus groups were held with community members and the generated data analysed using Grounded Theory techniques and procedures. At the core of feelings towards TB in the community is the fear of infection leading to imposition of socio-physical distance and participatory restrictions on those suffering from the disease. Because of fear of infection, most of the community members were of the view that TB patients should not be part of the society and said they will not marry a TB patient or encourage any family member to enter such a relationship. They also pointed out that TB patients should not sell in the community and would not be allowed to represent them at any public function because they can infect others. Whenever it becomes unavoidable for the community members to interact with someone with TB, they indicated that they would cover their mouth with a handkerchief, turn their head or sit in the opposite direction of the wind from the TB patient to avoid inhaling the air. When a TB patient joins the community members at any function, he/she is expected to abide by certain ‘codes of conduct’. The stigmatising attitudes and behaviours of the community members towards the disease and its sufferers may lead individuals with very obvious signs and symptoms of TB to attribute it to other non-stigmatising conditions or hide the diagnosis from others as well as default from treatment.