Tuberculosis In sub-Saharan Africa Research Articles

Surveillance of multidrug-resistant tuberculosis in sub-Saharan Africa through wastewater-based epidemiology

The spread of multidrug-resistant tuberculosis (MDR-TB) is a serious public health issue, particularly in developing nations. The current methods of monitoring drug-resistant TB (DR-TB) using clinical diagnoses and hospital records are insufficient due to limited healthcare access and underreporting. This study proposes using Wastewater-Based Epidemiology (WBE) to monitor DR-TB in six African countries (Ghana, Nigeria, Kenya, Uganda, Cameroon, and South Africa) and examines the impact of treated wastewater on the spread of TB drug-resistant genes in the environment. Using droplet-digital polymerase chain reaction (ddPCR), the study evaluated untreated and treated wastewater samples in selected African countries for TB surveillance. There was a statistically significant difference in concentrations of genes conferring resistance to TB drugs in wastewater samples from the selected countries (p-value<0.05); South African samples exhibited the highest concentrations of 4.3(±2,77), 4.8(±2.96), 4.4(±3,10) and 4.7(±3,39) log copies/ml for genes conferring resistance to first-line TB drugs (katG, rpoB, embB and pncA respectively) in untreated wastewater. This may be attributed to the higher prevalence of TB/MDR-TB in SA compared to other African countries. Interestingly, genes conferring resistance to second-line TB drugs such as delamanid (ddn gene) and bedaquiline (atpE gene) were detected in relatively high concentrations (4.8(±3,67 and 3.2(±2,31 log copies/ml for ddn and atpE respectively) in countries, such as Cameroon, where these drugs are not part of the MDR-TB treatment regimens, perhaps due to migration or the unapproved use of these drugs in the country. The gene encoding resistance to streptomycin (rrs gene) was abundant in all countries, perhaps due to the common use of this antibiotic for infections other than TB. These results highlight the need for additional surveillance and monitoring, such as WBE, to gather data at a community level. Combining WBE with the One Health strategy and current TB surveillance systems can help prevent the spread of DR-TB in populations.

Active Screening for Tuberculosis in Sub-Saharan Africa: The Case of Mosques in the District of Bamako (Mali)

Introduction: In 2016, tuberculosis (TB) was the ninth leading cause of death worldwide and the leading cause of death due to a single infectious agent (WHO Tuberculosis Report, African Region 2016). At Mali's last census, carried out in 2009, the country's resident or legal population stood at 14,528,662, with an annual growth rate of 3.6% since 2009. The District of Bamako accounts for more than half of the urban population, i.e. 55.3% (RGPH 2009, p. 19). Mali is a highly tuberculosis-endemic country, with an estimated incidence of 56 cases per 100,000 inhabitants in 2016 (Incidence of tuberculosis in the world, World Bank link). This means that the country expects to have at least 10,000 cases of tuberculosis (TB) every year. Objective: To carry out active screening for cases of tuberculosis in places of worship in a developing country in sub-Saharan Africa. Methodology: This was a prospective cross-sectional study of active screening for TB in religious settings. We carried out systematic sampling in 02 mosques in each health district of the District of Bamako, i.e. a total of 12 mosques over a period of 03 days per commune. During the campaign period, our sample size was 1,092 participants. The campaign was preceded by a social mobilisation session with the faithful of these mosques. Results: Our study included 1,092 participants with a ratio of 1.5 in favour of men, i.e. 60.16%. The age range was 15 to 65 years and over, with the elderly being the most representative. We had 18 positive cases, representing 1.64%, the majority of whom were women (55.56%, 0.8 in favour of women). Among the positive cases, young people were more represented, with an age range of 15-24 years, representing 27.77%. In addition to the positive cases, there were 1,074 chronic coughers with negative bacilloscopy (98.35%).

Increased Mortality in HIV Infected Individuals with Tuberculosis: A Retrospective Cohort Study, Addis Ababa, Ethiopia.

BackgroundTuberculosis is one of the commonest coinfections and leading causes of death among people living with HIV in resource-limited countries. There is limited evidence on the short- and long-term mortality rate in people receiving antiretroviral therapy and coinfected by tuberculosis in sub-Saharan Africa, where the burden of coinfection is highest.PurposeThis study aimed to compare mortality among HIV positives with and without tuberculosis coinfection receiving antiretroviral therapy in Addis Ababa, Ethiopia.MethodsHIV positives’ medical records were reviewed between 2011 to 2018 and identified 7038 HIV-positive adults enrolled for antiretroviral therapy in Addis Ababa. The outcome of interest for this study was death. A parametric Gompertz regression model was applied to compare mortality between HIV with tuberculosis coinfection versus HIV without tuberculosis.ResultsOverall, 1123 (15.96%, 95% CI: 15.11–16.83%) individuals with HIV had tuberculosis coinfection at antiretroviral therapy enrollment. After adjusting for age, sex, education, marital status, cotrimoxazole therapy, body mass index, baseline CD4 cell count, and year in ART enrollment, HIV positives with tuberculosis coinfection had more than twice a higher overall mortality risk than HIV positives without tuberculosis coinfection (AHR: 2.53; 95% CI 1.63–3.91, p < 0.001).ConclusionThis large retrospective cohort study reveals significantly higher mortality in HIV and tuberculosis coinfected group. This suggests the need for enhanced utility of integrated HIV and tuberculosis health services in sub-Saharan Africa where tuberculosis prevalence is highest.

Tuberculosis risk among people with diabetes mellitus in Sub-Saharan Africa: A systematic review.

ObjectivesPeople with diabetes mellitus (DM) have a higher tuberculosis (TB) risk, but the evidence from sub‐Saharan Africa (SSA) was scarce until recently and not included in earlier global summaries. Therefore, this systematic review aims to determine the risk of active TB disease among people with DM in SSA and whether HIV alters this association.MethodsMedline, Embase, CINAHL, Web of Science, Global Health and African Index Medicus were searched between January 1980 and February 2021. Cohort, case‐control and cross‐sectional studies from SSA, which assessed the association between DM and active TB, were included if adjusted for age. Two researchers independently assessed titles, abstracts, full texts, extracted data and assessed the risk of bias. Estimates for the association between DM and TB were summarised using a random effects meta‐analysis. PROSPERO: CRD42021241743.ResultsNine eligible studies were identified, which reported on 110,905 people from 5 countries. Individual study odds ratios (OR) of the TB–DM association ranged from 0.88 (95% CI 0.17–4.58) to 10.7 (95% CI 4.5–26). The pooled OR was 2.77 (95% CI 1.90–4.05). High heterogeneity was reduced in sensitivity analysis (from I 2 = 57% to I 2 = 6.9%), by excluding one study which ascertained DM by HbA1c. Risk of bias varied widely between studies, especially concerning the way in which DM status was determined.ConclusionsThere is a strong positive association between DM and active TB in SSA. More research is needed to determine whether HIV, a key risk factor for TB in SSA, modifies this relationship.

Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

BackgroundMany patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not...

The Global Macroeconomic Burden of Burn Injuries

PURPOSE: The objective of this study was to quantify the global macroeconomic burden of injuries inflicted by fire, heat, and hot substances. BACKGROUND: Over nine million people suffer from thermal injuries annually across the world. Among those injured, 90% of mortality occurs in low- and middle-income countries (LMICs). The economic impact of the morbidity and mortality incurred as a result of such injuries remains unclear. Quantifying the financial impact of these injuries can educate government and non-governmental organization funding initiatives designed to increase access to care. METHODS: Data on incidence, mortality, and disability adjusted life years (DALYs) from injuries caused by fire, heat, and hot substances were collected from the Global Burden of Disease Study 2019. The global macroeconomic burden of burns in the form of welfare lost was calculated by multiplying GDP per capita and DALYs for 190 individual countries. Gross domestic product (GDP) per capita adjusted for purchasing power parity (PPP) data were collected from the World Development Indicator Database. Temporal trends from 2009 to 2019 were evaluated with a specific focus on sub-Saharan Africa and South Asia. RESULTS: In 2019, the incidence of burns was 1.2 million in South Asia and 1.3 million in sub-Saharan Africa compared with 0.5 million cases in the United States. Mortality rates were higher in both South Asia (2.6 per 100 patients) and sub-Saharan Africa (1.8 per 100 patients) than in the United States (0.7 per 100 patients). Between 2009 and 2019, the incidence of burns increased by 3.1% in sub-Saharan Africa and decreased by 4.0% in South Asia. Burn-related mortality decreased between 2009 and 2019 in both sub-Saharan Africa (20.0%) and South Asia (8.6%). Lifetime burden of disease due to burn injuries was 1,617,220 DALYs for sub-Saharan Africa and 1,876,506 DALYs for South Asia. In 2019, 11.7 billion USD in South Asia and 6.1 billion USD in sub-Saharan Africa were lost due to burns. This was equivalent to 0.10% and 0.15% of GDP, respectively. Welfare losses due to burns as a share of GDP within specific South Asian economies were 0.12% for India, 0.04% for Nepal, 0.09% for Pakistan, 0.07% for Bhutan, and 0.06% for Bangladesh. Welfare losses were highest in Papua New Guinea, equivalent to 0.63% of GDP. CONCLUSIONS: While mortality rates due to burns are decreasing over time, the impact on GDP remains significant; the impact on GDP exceeds that due to cervical cancer and HIV in South Asia and tuberculosis in sub-Saharan Africa. Temporal trends indicate that progress has been made in the treatment of burns in these regions. Additional resources, including intensive care units, skin banks, and hospital beds, may enhance care for patients with more severe burns and address the magnitude of injuries each year. In the setting of rising incidence, efforts designed to prevent burn injuries in the form of education are required. To convince governments to fund such initiatives in resource-limited environments, demonstrating the financial impact of burn injuries on a population level is one approach.

Evaluation of Host Serum Protein Biomarkers of Tuberculosis in sub-Saharan Africa.

Accurate and affordable point-of-care diagnostics for tuberculosis (TB) are needed. Host serum protein signatures have been derived for use in primary care settings, however validation of these in secondary care settings is lacking. We evaluated serum protein biomarkers discovered in primary care cohorts from Africa reapplied to patients from secondary care. In this nested case-control study, concentrations of 22 proteins were quantified in sera from 292 patients from Malawi and South Africa who presented predominantly to secondary care. Recruitment was based upon intention of local clinicians to test for TB. The case definition for TB was culture positivity for Mycobacterium tuberculosis; and for other diseases (OD) a confirmed alternative diagnosis. Equal numbers of TB and OD patients were selected. Within each group, there were equal numbers with and without HIV and from each site. Patients were split into training and test sets for biosignature discovery. A nine-protein signature to distinguish TB from OD was discovered comprising fibrinogen, alpha-2-macroglobulin, CRP, MMP-9, transthyretin, complement factor H, IFN-gamma, IP-10, and TNF-alpha. This signature had an area under the receiver operating characteristic curve in the training set of 90% (95% CI 86–95%), and, after adjusting the cut-off for increased sensitivity, a sensitivity and specificity in the test set of 92% (95% CI 80–98%) and 71% (95% CI 56–84%), respectively. The best single biomarker was complement factor H [area under the receiver operating characteristic curve 70% (95% CI 64–76%)]. Biosignatures consisting of host serum proteins may function as point-of-care screening tests for TB in African hospitals. Complement factor H is identified as a new biomarker for such signatures.

Magnitude of depression and associated factors among patients with tuberculosis in sub-Saharan Africa: A systematic review and meta-analysis.

• This systematic review and meta-analysis reported the prevalence of depression and risk factors among tuberculosis patients in Sub-Saharan Africa. • This review revealed that more than one-third of tuberculosis patients in sub-Saharan countries had comorbid depression • Multi drug resistant tuberculosis treatment, intensive phase of the treatment and having a comorbid chronic illness were associated factors of depression. • Routine screening and integrated management of comorbid depression among patients with Tuberculosis are important to be considered by clinicians. : Depression in tuberculosis patients escalates the risk of adverse health outcomes. Despite its serious complications, limited evidence regarding the magnitude of comorbidity and determinants of depression among patients with tuberculosis is available in Africa. : This systematic review and meta-analysis was followed Preferred Reporting Items for Systematic Review and Meta-Analysis 2009 guideline. International databases such as were searched. Meta-analysis was conducted using STATA version 14 software. Quality of studies was assessed by using the Newcastle-Ottawa Scale criteria. The random effects model was used to estimate the pooled prevalence of depression at 95% confidence interval level. : This review includes a total of 19 articles with 4391 participants. The pooled prevalence of depression among patients with tuberculosis was 39.42%. Comorbid chronic illnesses, multi-drug resistance treatment, and being on intensive phase of treatment were significant factors associated with depression in patients with tuberculosis. : This systematic review and meta-analysis revealed that more than one-third of patients with tuberculosis in sub-Saharan countries had comorbid depression. Usual screening and integrating the management of depression in patients with tuberculosis by clinicians is critical in reducing its effect. Researchers might study furtherly the emotional consequence of tuberculosis by considering affecting factors. : Selection bias was observed as we were only able to review English-language studies. We got studies only from nine countries among 54 countries of the region, and some of the studies used small sample size, could reduce the representativeness of the findings. The prevalence estimation of this systematic review and meta-analysis was also influenced by studies variation in tool preferences to measure depression among tuberculosis patients.

Histoplasmosis overlapping with HIV and tuberculosis in sub-Saharan Africa: challenges and research priorities.

Histoplasmosis, tuberculosis and HIV are all highly prevalent in sub-Saharan Africa (SSA). Co-occurrence of two or more of these infections has been reported in several populations of patients, especially those with advanced HIV infection where these opportunistic infections contribute to a significant morbidity and mortality. With a high burden of pulmonary tuberculosis (PTB) secondary to HIV in SSA, histoplasmosis is commonly misdiagnosed as smear-negative PTB in HIV patients due to similar clinical and radiological presentations. This is also partly the result of the lack of trained clinical and laboratory personnel to make a definite diagnosis of histoplasmosis. There is a low index of clinical suspicion for histoplasmosis, and cases are mostly discovered accidently and documented through case reports and case series. Similarly, the high cost and lack of fungal diagnostics in most SSA countries makes it difficult to make a diagnosis. There is a need to build local capacity for mycology so that patients are managed to improve on the index of clinical suspicion and diagnostic capabilities. Moreover, simple accurate point-of-care diagnostic tests and first-line antifungal treatment for histoplasmosis are not available in many SSA countries. This review describes the existence of co-infections of histoplasmosis, tuberculosis and HIV in SSA, highlighting the challenges and research priorities.

A systematic review of adrenal insufficiency among patients with pulmonary tuberculosis in Sub-Saharan Africa.

Tuberculosis (TB) is a disease of public health importance globally. The incidence of pulmonary TB is rising in sub-Saharan Africa. Bilateral adrenal destruction and the use of medications such as rifampicin are possible mechanisms by which TB cause adrenal insufficiency. Failure to promptly recognize adrenal insufficiency may lead to a medical crisis causing death. This systematic review aimed to identify the frequency of adrenal insufficiency, the clinical presentation and its predictors in patients with pulmonary TB in sub-Saharan Africa. The study was a systematic review. Medical databases and the grey literature were searched. Literature search and studies selection were done following the PRISMA guidelines. The total sample size was 809. The frequency of adrenal insufficiency among patients with pulmonary TB in sub-Saharan Africa was 0.9%-59.8%. Patients with adrenal insufficiency had symptoms such as nausea, vomiting, darkening of the skin, salt craving, and weight loss. Other symptoms were dry, itchy skin, abdominal pain, and muscle pain. The predictors of adrenal insufficiency among patients with pulmonary TB in sub-Saharan Africa were low blood pressure, low blood glucose, presence of multidrug-resistant TB, and low CD4 count. Other predictors were abdominal pain and generalized skin hyperpigmentation. The frequency of adrenal insufficiency in patients with pulmonary TB can be as high as 50%. The presence of low blood pressure, low blood glucose, multidrug-resistant TB, and generalized skin hyperpigmentation is a pointer to the possibility of adrenal insufficiency in these patients.

Discordant line probe genotypic testing vs culture-based drug susceptibility phenotypic testing in TB endemic KwaZulu-Natal: Impact on bedside clinical decision making

The recommendations for Mycobacterium tuberculosis drug susceptibility testing include both phenotypic and genotypic methods. This concurrent use of differing testing platforms has created an emerging challenge of discordant results, creating a diagnostic dilemma for the laboratorians as well as attending clinicians. We undertook a retrospective study to determine the prevalence of discordant results between the MTBDRplus line probe assay and solid culture-based drug susceptibility testing for rifampicin and isoniazid. The analysis was conducted for the period January 2013 and December 2015 at the Inkosi Albert Luthuli Central Hospital. Rifampicin and isoniazid resistance testing data were “paired” on 8273 isolates for culture-based drug susceptibility testing and line probe assay. The latter method showed high sensitivity and specificity of 93% and 95% respectively for isoniazid testing. For rifampicin testing, sensitivity and specificity were 95% and 75%. Overall, discordance was 14.6% for rifampicin and 7.2% for isoniazid. This report is not intended to determine superiority of one method over another. It is merely to show that discordance does exist between different methods of testing. Given the burden of HIV and Tuberculosis in Sub-Saharan Africa, these findings have clinical significance and huge public health implications. Clinicians should understand the limitations of phenotypic testing methods.

Barriers to and enablers of uptake of and adherence to antiretroviral therapy in the context of integrated HIV and tuberculosis treatment among adults in sub-Saharan Africa: a protocol for a systematic literature review

IntroductionThe scale-up of integrated Human Immunodeficiency Virus (HIV) and tuberculosis (TB) treatment has been an important intervention to curb the burden of HIV and TB co-infection worldwide. Uptake of and...

Risk score for predicting mortality including urine lipoarabinomannan detection in hospital inpatients with HIV-associated tuberculosis in sub-Saharan Africa: Derivation and external validation cohort study.

BackgroundThe prevalence of and mortality from HIV-associated tuberculosis (HIV/TB) in hospital inpatients in Africa remains unacceptably high. Currently, there is a lack of tools to identify those at high risk of early mortality who may benefit from adjunctive interventions. We therefore aimed to develop and validate a simple clinical risk score to predict mortality in high-burden, low-resource settings.Methods and findingsA cohort of HIV-positive adults with laboratory-confirmed TB from the STAMP TB screening trial (Malawi and South Africa) was used to derive a clinical risk score using multivariable predictive modelling, considering factors at hospital admission (including urine lipoarabinomannan [LAM] detection) thought to be associated with 2-month mortality. Performance was evaluated internally and then externally validated using independent cohorts from 2 other studies (LAM-RCT and a Médecins Sans Frontières [MSF] cohort) from South Africa, Zambia, Zimbabwe, Tanzania, and Kenya. The derivation cohort included 315 patients enrolled from October 2015 and September 2017. Their median age was 36 years (IQR 30–43), 45.4% were female, median CD4 cell count at admission was 76 cells/μl (IQR 23–206), and 80.2% (210/262) of those who knew they were HIV-positive at hospital admission were taking antiretroviral therapy (ART). Two-month mortality was 30% (94/315), and mortality was associated with the following factors included in the score: age 55 years or older, male sex, being ART experienced, having severe anaemia (haemoglobin < 80 g/l), being unable to walk unaided, and having a positive urinary Determine TB LAM Ag test (Alere). The score identified patients with a 46.4% (95% CI 37.8%–55.2%) mortality risk in the high-risk group compared to 12.5% (95% CI 5.7%–25.4%) in the low-risk group (p < 0.001). The odds ratio (OR) for mortality was 6.1 (95% CI 2.4–15.2) in high-risk patients compared to low-risk patients (p < 0.001). Discrimination (c-statistic 0.70, 95% CI 0.63–0.76) and calibration (Hosmer-Lemeshow statistic, p = 0.78) were good in the derivation cohort, and similar in the external validation cohort (complete cases n = 372, c-statistic 0.68 [95% CI 0.61–0.74]). The validation cohort included 644 patients between January 2013 and August 2015. Median age was 36 years, 48.9% were female, and median CD4 count at admission was 61 (IQR 21–145). OR for mortality was 5.3 (95% CI 2.2–9.5) for high compared to low-risk patients (complete cases n = 372, p < 0.001). The score also predicted patients at higher risk of death both pre- and post-discharge. A simplified score (any 3 or more of the predictors) performed equally well. The main limitations of the scores were their imperfect accuracy, the need for access to urine LAM testing, modest study size, and not measuring all potential predictors of mortality (e.g., tuberculosis drug resistance).ConclusionsThis risk score is capable of identifying patients who could benefit from enhanced clinical care, follow-up, and/or adjunctive interventions, although further prospective validation studies are necessary. Given the scale of HIV/TB morbidity and mortality in African hospitals, better prognostic tools along with interventions could contribute towards global targets to reduce tuberculosis mortality.

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study.

BackgroundPatients with suspected tuberculosis are often overtreated with antituberculosis drugs. We evaluated the diagnostic value of the focused assessment with sonography for HIV-associated tuberculosis (FASH) in rural Tanzania.MethodsIn a prospective cohort study, the frequency of FASH signs was compared between patients with confirmed tuberculosis and those without tuberculosis. Clinical and laboratory examination, chest x-ray, Xpert MTB/RIF assay, and culture from sputum, sterile body fluids, lymph node aspirates, and Xpert MTB/RIF urine assay was done.ResultsOf 191 analyzed patients with a 6-month follow-up, 52.4% tested positive for human immunodeficiency virus, 21.5% had clinically suspected pulmonary tuberculosis, 3.7% had extrapulmonary tuberculosis, and 74.9% had extrapulmonary and pulmonary tuberculosis. Tuberculosis was microbiologically confirmed in 57.6%, probable in 13.1%, and excluded in 29.3%. Ten of eleven patients with splenic or hepatic hypoechogenic lesions had confirmed tuberculosis. In a univariate model, abdominal lymphadenopathy was significantly associated with confirmed tuberculosis. Pleural- and pericardial effusion, ascites, and thickened ileum wall lacked significant association. In a multiple regression model, abnormal chest x-ray (odds ratio [OR] = 6.19; 95% confidence interval [CI], 1.96–19.6; P < .002), ≥1 FASH-sign (OR = 3.33; 95% CI, 1.21–9.12; P = .019), and body temperature (OR = 2.48; 95% CI, 1.52–5.03; P = .001 per °C increase) remained associated with tuberculosis. A combination of ≥1 FASH sign, abnormal chest x-ray, and temperature ≥37.5°C had 99.1% sensitivity (95% CI, 94.9–99.9), 35.2% specificity (95% CI, 22.7–49.4), and a positive and negative predictive value of 75.2% (95% CI, 71.3–78.7) and 95.0% (95% CI, 72.3–99.3).ConclusionsThe absence of FASH signs combined with a normal chest x-ray and body temperature <37.5°C might exclude tuberculosis.

Protocol for systematic review and meta-analysis of treatment success rate among adult patients with tuberculosis in sub-Saharan Africa

IntroductionTuberculosis (TB) is a leading cause of mortality globally. Despite being curable, treatment success rates (TSRs) among adult patients with bacteriologically confirmed pulmonary TB (BC-PTB) in sub-Saharan Africa (SSA) differ...

Childhood Tuberculosis in Sub-saharan Africa

Objective: Tuberculosis remains a public health problem in Burkina Faso and sub-Saharan Africa.The purpose of this study was to describe epidemiological, clinical and para-clinical aspects of childhood tuberculosis in sub-saharan hospital settings. Methods: It was a cross-sectional study of new cases of tuberculosis diagnosed between 1st January 2016 and 31st December 2016 in the pediatric department of Bobo-Dioulasso University Hospital (Burkina Faso). Results: The study included twenty eight (28) children with an average age of 8.3 years. The main part of patients (60.7%) came from socio-economic disadvantaged backgrounds. BCG immunization coverage was 92.9%; a contagion history was found in 42.9% of cases. Malnutrition was present in 82.1% and the combination HIV / tuberculosis were 17.8%. Pulmonary tuberculosis was the most frequent clinical form (50%). Sputum was positive in 2 children. Nodes location (35.7%) was the main extrapulmonary form. Conclusions: Pulmonary tuberculosis in children is common in sub-saharan Africa. National free care processing policy is welcome but a strengthening of diagnostic capacity will allow an optimal management of the child life infection.

The problem of resistance in Mycobacterium tuberculosis may be underestimated in Africa.

The true burden of tuberculosis (TB) and particularly multidrug-resistant (MDR) TB in Sub-Saharan Africa has remained underestimated. We investigated drug susceptibility profile and genetic diversity of Mycobacterium tuberculosis isolates collected from confirmed tuberculosis patients in Ibadan, southwestern Nigeria. We confirmed that from 74 randomly selected Mycobacterium tuberculosis isolates available for drug susceptibility testing in Ibadan, in 2011, 13.5% of them were MDR-TB. This figure is obviously above the national and World Health Organization figures.

Tackling tuberculosis in sub-Saharan Africa: EDCTP achievements and the road ahead.

The European and Developing Countries Clinical Trials Partnership (EDCTP) was established in 2003 to accelerate the development of medical interventions for tuberculosis (TB), human immunodeficiency virus (HIV) and malaria, with a particular focus on Phase II and III clinical trials. Between 2003 and 2015, the first EDCTP programme committed €65.6 million to research on TB and TB-HIV co-infection. The programme made a significant contribution to the first three elements of the DOTS TB control strategy, which mobilised European and African funding for TB-related research and generated important evidence on TB diagnostics and treatment regimens. As well as informing the development of international policy on TB diagnosis and treatment, the programme also significantly enhanced the capacity of countries in sub-Saharan Africa to undertake clinical trials and associated clinical research. The lessons learned from the first EDCTP programme have informed the development of a second, expanded EDCTP programme, EDCTP2, which was launched in 2014, and is due to run until 2024. One key lesson is the need for continued partnerships to fight the global threat of TB.

Trends in prevalence of multi drug resistant tuberculosis in sub-Saharan Africa: A systematic review and meta-analysis.

BackgroundMultidrug resistant tuberculosis (MDR-TB), is an emerging public health problem in sub-Saharan Africa (SSA). This study aims to determine the trends in prevalence of MDR-TB among new TB cases in sub-Saharan Africa over two decades.MethodsWe searched electronic data bases and accessed all prevalence studies of MDR-TB within SSA between 2007 and 2017. We determined pooled prevalence estimates using random effects models and determined trends using meta-regression.ResultsResults: We identified 915 studies satisfying inclusion criteria. Cumulatively, studies reported on MDR-TB culture of 34,652 persons. The pooled prevalence of MDR-TB in new cases was 2.1% (95% CI; 1.7–2.5%). There was a non-significant decline in prevalence by 0.12% per year.ConclusionWe found a low prevalence estimate of MDR-TB, and a slight temporal decline over the study period. There is a need for continuous MDR-TB surveillance among patients with TB.

A patchy model for the transmission dynamics of tuberculosis in sub-Saharan Africa.

Tuberculosis (TB) spreads through contact between a susceptible person and smear positive pulmonary TB case (TPM+). The spread of TB is highly dependent on people migration between cities or regions that may have different contact rates and different environmental parameters, leading to different disease spread speed in the population. In this work, a metapopulation model, i.e., networks of populations connected by migratory flows, which overcomes the assumption of homogeneous mixing between different regions was constructed. The TB model was combined to a simple demographic structure for the population living in a multi-patch environment (cities, towns, regions or countries). The model consist of a system of differential equations coupling TB epidemic at different strength and mobility between the patches. Constant recruitment rate, slow and fast progression to the disease, effective chemoprophylaxis, diagnostic and treatment are taken into account to make the model including the reality of people in the sub-Saharan African countries. The basic reproduction number (mathcal {R}_0) was computed and it was demonstrated that the disease-free equilibrium is globally asymptotically stable if mathcal {R}_0 < 1. When mathcal {R}_0 > 1, the disease-free equilibrium is unstable and there exists one endemic equilibrium. Moreover, the impact of increasing migration rate between patches on the TB spread was quantified using numerical implementation of the model. Using an example on 15 inter-connected patches on the same road, we demonstrated that most people was most likely to get infected if the disease starts in a patch in the middle than in border patches.