Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data / 한국역학회지

OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran. METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages. RESULTS: The risk of mortality from TB was found to increase with the unemployment rate (β

Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data / 한국역학회지

OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran.METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages.RESULTS: The risk of mortality from TB was found to increase with the unemployment rate (β

Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data / 한국역학회지

OBJECTIVES@#Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran.@*METHODS@#This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages.@*RESULTS@#The risk of mortality from TB was found to increase with the unemployment rate (β

Prevalence of latent tuberculosis infection among tuberculosis laboratory workers in Iran / 한국역학회지

OBJECTIVES: The risk of transmission of Mycobacterium tuberculosis from patients to health care workers (HCWs) is a neglected problem in many countries, including Iran. The aim of this study was to estimate the prevalence of latent tuberculosis (TB) infection (LTBI) among TB laboratory staff in Iran, and to elucidate the risk factors associated with LTBI.METHODS: All TB laboratory staff (689 individuals) employed in the TB laboratories of 50 Iranian universities of medical sciences and a random sample consisting of 317 low-risk HCWs were included in this cross-sectional study. Participants with tuberculin skin test indurations of 10 mm or more were considered to have an LTBI.RESULTS: The prevalence of LTBI among TB laboratory staff and low-risk HCWs was 24.83% (95% confidence interval [CI], 21.31 to 27.74%) and 14.82% (95% CI, 11.31 to 19.20%), respectively. No active TB cases were found in either group. After adjusting for potential confounders, TB laboratory staff were more likely to have an LTBI than low-risk HCWs (prevalence odds ratio, 2.06; 95% CI, 1.35 to 3.17).CONCLUSIONS: This study showed that LTBI are an occupational health problem among TB laboratory staff in Iran. This study reinforces the need to design and implement simple, effective, and affordable TB infection control programs in TB laboratories in Iran.

Prevalence of latent tuberculosis infection among tuberculosis laboratory workers in Iran / 한국역학회지

OBJECTIVES: The risk of transmission of Mycobacterium tuberculosis from patients to health care workers (HCWs) is a neglected problem in many countries, including Iran. The aim of this study was to estimate the prevalence of latent tuberculosis (TB) infection (LTBI) among TB laboratory staff in Iran, and to elucidate the risk factors associated with LTBI. METHODS: All TB laboratory staff (689 individuals) employed in the TB laboratories of 50 Iranian universities of medical sciences and a random sample consisting of 317 low-risk HCWs were included in this cross-sectional study. Participants with tuberculin skin test indurations of 10 mm or more were considered to have an LTBI. RESULTS: The prevalence of LTBI among TB laboratory staff and low-risk HCWs was 24.83% (95% confidence interval [CI], 21.31 to 27.74%) and 14.82% (95% CI, 11.31 to 19.20%), respectively. No active TB cases were found in either group. After adjusting for potential confounders, TB laboratory staff were more likely to have an LTBI than low-risk HCWs (prevalence odds ratio, 2.06; 95% CI, 1.35 to 3.17). CONCLUSIONS: This study showed that LTBI are an occupational health problem among TB laboratory staff in Iran. This study reinforces the need to design and implement simple, effective, and affordable TB infection control programs in TB laboratories in Iran.

Comparison of the tuberculin skin test and the QuantiFERON-TB Gold test in detecting latent tuberculosis in health care workers in Iran / 한국역학회지

OBJECTIVES: The tuberculin skin test (TST) and the QuantiFERON-TB Gold test (QFT) are used to identify latent tuberculosis infections (LTBIs). The aim of this study was to determine the agreement between these two tests among health care workers in Iran. METHODS: This cross-sectional study included 177 tuberculosis (TB) laboratory staff and 67 non-TB staff. TST indurations of 10 mm or more were considered positive. The Student's t-test and the chi-square test were used to compare the mean score and proportion of variables between the TB laboratory staff and the non-TB laboratory staff. Kappa statistics were used to evaluate the agreement between these tests, and logistic regression was used to assess the risk factors associated with positive results for each test. RESULTS: The prevalence of LTBIs according to both the QFT and the TST was 17% (95% confidence interval [CI], 12% to 21%) and 16% (95% CI, 11% to 21%), respectively. The agreement between the QFT and the TST was 77.46%, with a kappa of 0.19 (95% CI, 0.04 to 0.34). CONCLUSIONS: Although the prevalence of LTBI based on the QFT and the TST was not significantly different, the kappa statistic was low between these two tests for the detection of LTBIs.

Does tuberculosis have a seasonal pattern among migrant population entering Iran?

There are few quantitative documents about the seasonal incidence of tuberculosis [TB] among immigrant populations. Concerning the significant role of recognizing seasonal changes of TB in improving the TB control program, this study determines the trend and seasonal temporal changes of TB among immigrants entering Iran. In this longitudinal study, data from the Iranian TB register Program [from 2005 to 2011] was used. The aggregated number of monthly and seasonal TB cases was obtained by adding the daily counts. Data was analyzed by Chi-square, Independent T-test, ANOVA, and Poisson regression using Stata 11 and SPSS 20 software. Among 74,155 registered patients with TB, 14.3% [10,587] were non-Iranian who had immigrated to Iran from 29 different countries. The highest aggregated number of seasonal and monthly incidence of TB in immigrants was observed in spring [2824, P= 0.007] and in May [1037, P< 0.001]. The number of non-Iranian patients with TB increased significantly over the years [beta= 0.016, P= 0.001]. This study shows that immigrants constitute a significant portion of TB patients recorded in Iran and this trend is increasing. Also, the peak incidence of this disease is the second month of the spring

Inequality of leprosy disability in Iran, clinical or socio-economic inequality: an extended concentration index decomposition approach

Despite significant reduction in global disease prevalence, leprosy still has a high rate of disability while its determinants are unfair and many of them are amendable. The objective of this study was to measure inequality of disability in leprosy in Iran. This was a cross-sectional study [2006-2007] on all living people affected by leprosy registered in W. Azerbaijan province health center, Western North of Iran. The outcome of the study was the socio-economic inequality considering presence or absence of grade 2 disability [G2D] based on the WHO classifications. An extended concentration index decomposition approach was used for analysis. Among 452 cases, 65.3% were male and 67% were affected by the multi bacillary type. Overall G2D was 65.3%. The estimated Concentration Index was -0.0782, showing presence of pro-poor socio-economic inequality of G2D, while extended CI estimation [v = 5] was -0.163. Achievement index with coefficiently = 5] revealed that G2D mean was 16% more than classic mean in the poorest group. The result of decomposition of the existing inequality revealed that, some of the determinants such as receiving mono-therapy, education, urbanization, and bacillus calmette ; guerin [BCG] vaccination had shared contribution [67.4%, 61.8%, 59.2%, and 57.5% respectively]. This study provided new perspective for the health j system to leprosy control considering the significant gap between; rich and poor [inequality] regarding G2D disability, and its effective elements in socio-economic strata. Some effective actions can be considered to reduce the scale of existing inequality

Pattern of reported tuberculosis cases in Iran 2009-2010

Cooperation of all health sectors and early diagnosis of the disease are the key factors for controlling tuberculosis. This study assesses the patterns of reported tuberculosis cases in Iran. This was a cross sectional study. Tuberculosis cases were defined according to World Health Organization and Iran's national TB guidelines. Final data were prepared for analysis using SPSS16 software. Public hospitals, public and private outpatient clinics reported 4111 [39.1%], 3007 [28.6%] and 2839 [27%] cases of TB, respectively. The highest number of reported TB cases was from the public healthcare system. One third of TB cases were reported by private outpatient clinics. It is essential to make a plan such as public-private mix model in Iran. Because of high coverage of private physicians in our country and even in rural areas, it is quite necessary to involve private system in tuberculosis program

What is the share of the country's researches in Iran's national tuberculosis guideline?

Appraisal of clinical guideline, especially at the national level, has two potential benefits; one is the improvement of quality of care and the second is assessing the impact of researches on an applied setting. On the other hand, Tuberculosis [TB] is a major infectious disease which has national guideline in many countries. The present study was performed to assess sources of information and level of evidence in Iran's national TB guideline. This could explore the impact of national researches on day by day practice in the health system. A list of main "recommendations" of the guideline was explored. Then, in cases that the cited study for any decision was available, the type of study and its evidence level was specified using a standard tool. In addition, the source of information [national/international] was determined. In other cases that no any specific citation was found, the data source of the recommendation was determined by the senior experts in the Center for Communicable Disease Control. Fifteen [48.3%] recommendations of the national guideline, out of 31 reviewed, had clearly cited at least one study. There was just one single national study which was utilized as the basis for the recommendations. All other sources were international guidelines, mainly World Health Organization's, and or international researches. While, the methodology of the guideline development was not clear enough appropriately; the share of national researches in development of the national guideline was insignificant