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Background:Re-evaluation of the epidemiological profile of tuberculosis (TB) patients can help to eliminate the number of cases. This study was aimed to analyse the association of socio-demographic profile with type of TB among patients attending a rural DOTS centrein central Kerala.Methods: A cross sectional study was conducted among TB patients at a rural DOTS clinic in central Kerala during January 2020-June 2021. Various socio-demographic parameters such as age, gender and socio-economic status and comorbidities of patients with pulmonary and extrapulmonary TB were retrieved from the DOTS register. The data was analyzed.Results: A total of 241 patients (134 males and 107 females) were enrolled. In general, age group 41-60 years showed maximum incidence (p=0.0283). Lower middle (32.7%) and middle class (36.5%) strata constituted the majority of burden (p=0.9091). The distribution of cases was not associated to occupation (p=0.06). Extrapulmonary form (55%) was found to be predominant with very poor awareness (p=0.06). A significant delay of at least 1-3 months in recognizing the symptoms and thus the clinical diagnosis particularly in extrapulmonary cases was found. Diabetes mellitus was the most frequent comorbidity in TB patients.Conclusions: The prevalence was most common in age group 41-60 years without any association to occupation. Since the diabetes mellitus is the most frequent comorbidity in TB patients, early screening will make an effective management. Society oriented awareness programme about the extrapulmonary TB is inevitable
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Background: Tuberculosis (TB) remains a major public health concern despite being a curable and preventable disease. The treatment of TB using a cocktail of drugs over a period of six months under the directly observed treatment short-course strategy has led to a reduction in cases but is plagued by some challenges that leads to unsuccessful or poor outcomes, which can ultimately result in spread of infections, development of drug resistance and increase in morbidity and mortality. The objectives of this study are to determine outcomes of TB treatment in Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria and the factors that may be associated with the outcomes. Methodology: This was a retrospective study using the medical records of patients who were registered for TB treatment over a five-year period between 2016 to 2020. Data from TB registers including demographic and relevant clinical information, and treatment outcomes, were extracted into a structured data extraction format, and analysed with SPSS version 21.0 software package. Univariate and bivariate analyses were conducted, and Chi square test was used to determine association between TB outcomes and independent variables at 95% confidence interval and p<0.05 was considered as the significant value. Results: Records of 1,313 patients were studied, 744 (56.7%) were males while 569 (43.3%) were females. The age range of the patients was ≤ 1 year - 96 years, with a mean age of 30±16.7 years. Most were pulmonary TB cases (88.8%, n=1,166), newly diagnosed (95.5%, n=1254), and human immunodeficiency virus (HIV) negative at the time of TB diagnosis (63.7%, n=837). Eight hundred and seven (61.5%) patients had successful treatment, and 34% (n=446) had unsuccessful outcomes made of 'loss to follow-up' 25.8% (n=339), deaths 7.8% (n=102) and treatment failure 0.4% (n=5), while 2.3% (n=30) were transferred out and 2.3% (n=30) removed from TB register. Treatment success rate was significantly higher in patients with pulmonary TB (p=0.0024), residents in Lafia LGA (p=0.0005), those treated in 2016 (p=0.0006) and bacteriologically confirmed cases (p<0.0001), while death rate was significantly lower among patients who were HIV-negative at the time of TB diagnosis (p<0.0001). Conclusion: TB treatment success rate in this study fell short of the WHO average rate. High rates of 'loss to followup' and deaths in this study is a wake-up call to all stakeholders in the facility and the State to put in place measures to reduce poor outcomes of TB treatment.
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Tuberculosis , Patient Compliance , Treatment Outcome , Medication Adherence , Health FacilitiesABSTRACT
Background: Ending the tuberculosis (TB) epidemic by 2030 is among the health targets of the sustainable development goals. Side effects to anti-TB drugs are common and may lead to reduced compliance to treatment. These adverse effects must be recognized early to reduce associated morbidity and mortality. Objective of this study was to determine the adverse drug reactions (ADR) to anti-tubercular therapy among patients visiting directly observed treatment, short-course (DOTS) centre MIMS, Mandya.Methods: A cross sectional study was conducted at DOTS Centre MIMS, Mandya. TB patients registered at DOTS Centre during the year 2018 were selected for the study. Verbal informed consent was taken from the TB patients and interviewed using pretested semi-structured questionnaire. Data analysis was done using descriptive statistics and chi square test.Results: Among the study population (n=90), 67 (74.4%) experienced ADR among which 47.7% took treatment for ADR and the remaining 52.3% patients were given reassurance. In this study, gastrointestinal manifestations (42.3%) were the most common adverse drug reaction (ADR). Of the TB patients who experienced ADR, 9.0% of them had interrupted ATT, however they completed full course of ATT.Conclusions: A considerable number of TB patients taking ATT experience ADRs and some of them may have to interrupt treatment. However, they need to be counselled or supervised with caution to complete their course of treatment to reduce the chances of treatment default and also reduce the occurrence of drug resistance.
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Introduction: Microbiologically confirmed pulmonarytuberculosis patients under Revised National TuberculosisControl Programme (RNTCP) are treated with a 6-monthshort-course chemotherapy (SCC) regimen irrespectiveof co-morbid conditions. The aim of present study was todetermine the time taken for SSC conversion with standardcurrent treatment with anti-tubercular drugs and analysis ofrisk factors if any delaying it. We undertook this prospectivestudy to compare sputum conversion rates (smear) at the endof intensive phase (IP) of Category regimen.Material and methods: was a prospective study which wasconducted for a period of eleven months from August 2018 toJune 2019 at Department of Respiratory Medicine, K.N ChestHospital, S.N Medical College, Jodhpur Rajasthan India.Patients visiting Department of Respiratory medicine and whowere diagnosed as pulmonary tuberculosis by sputum smearexamination were included in study.Result: Sputum smear-positive patients are infectious to closecontacts as well as to community as they continue to expelbacilli for a variable period of time after initiation of DOTSregimen. Most patients undergo sputum conversion by theend of 3rd month. Patients who have predominant cavitatorydisease in radiology, high smear grading before treatment, aprior history of DS/DR tuberculosis are more likely to havedelayed sputum smear conversion.Conclusion: There need to mandate DST at the starting ofDOTS in line with latest RNTCP guidelines to prevent thedevelopment of MDR strains and failures. Also there is astrong need to constitute strong infection control measures tillpatients are labelled as noninfectious.
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Background: Tuberculosis is among the most important causes of death from a single infectious agent and a major public health problem causing an enormous burden of disease and economic impact especially in the developing countries. Pulmonary tuberculosis is the most common form of tuberculosis causing >85% of all tuberculosis cases. The smear conversion rate is an operational indicator for the directly observed treatment short course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP) in India.Methods: A longitudinal study was conducted in DMC, RRMCH, in the first two quarters of the year 2013 i.e., from January 1st to June 31st of the year 2013. All 130 adult category I (new) sputum smear positive cases that attended DMC, and registered under RNTCP constituted the sample for the study. Data was collected by interview method by using pre-tested, semi-structured questionnaire. Data was analyzed using SPSS version 20.0.Results: Majority of the study subjects was >50 years, Hindus, illiterates, belonged to nuclear family from rural area belonged to upper lower socio-economic class. The overall sputum smear conversion rate is 92.4%. Lower sputum smear conversion rate was observed in the following risk factors like the male gender, smoking, diabetes, initial high pre-treatment smear grading and poor drug compliance.Conclusions: The overall sputum conversion rate at the end of two months of intensive phase under (DOTS) chemotherapy in 118 sputum smear positive (cat I) new pulmonary tuberculosis patients in Designated Microscopy and Treatment Centre (DMC) Rajarajeswari Medical College and Hospital was 92.4%.
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Background: Tuberculosis (TB) is one of the most infectious diseases if not treated properly it may lead to mortality. The directly observed treatment, short course (DOTS) therapy is the choice of the treatment of TB. Objectives: The objectives of the study were (1) to determine the factors influencing compliance of persons with TB to DOTS, (2) to evaluate the effectiveness of an awareness program on knowledge and compliance to DOTS among persons with TB, (3) to find the association between pre-test level of knowledge with selected sociodemographic variables, and (4) to find the association between pre-test level of compliance to DOTS with selected sociodemographic variables. Materials and Methods: An evaluative approach with one group pre-test and post-test design was used as a research design in the study. 50 participants were selected as a sample using purposive sampling technique. The data were collected using structured knowledge questionnaire and compliance checklist through interview schedule Results: The study result showed that the mean post-test knowledge score (17.32 ± 1.58) was higher than the mean pre-test knowledge score (10.80 ± 2.05) and “t” value is 27.22 at P < 0.05. Similarly, the mean post-test compliance score (8.92 + 0.72) was higher than the mean pre-test compliance score (6.00 ± 1.05) and “t” value is 9.369 at P < 0.05. The sociodemographic variable such as age and educational status was significantly associated with pre-test knowledge score (χ² = 5.993, P < 0.05, and χ² = 11.49, P < 0.05), respectively, and gender was significantly associated with pre-test compliance score (χ² = 4.482, P < 0.05). The main reason for noncompliance to DOTS therapy was difficult to take multiple drugs for a long period and data showed that family support (29.55%) was highly influencing to comply with DOTS therapy. Conclusion: The awareness program was highly effective in increasing knowledge among TB person and compliance to DOTS therapy. Therefore, the knowledge and compliance of the TB person to DOTS therapy can be further improved by providing on-going awareness programs.
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Background: Studies have shown that the prevalence of psychiatric disorders, particularly depression, is high among tuberculosis (TB) patients, and may adversely affect treatment compliance. A person suffering from TB can develop depression in due course of time owing to a number of factors, namely the long duration of treatment for TB, stigmatization faced by the patient due to the disease and lack of family support to name a few. Objectives: The present study aimed to determine the prevalence of depression and its correlates among TB patients enrolled at a Directly Observed Treatment Short-course (DOTS) center in a rural area of Delhi. Methods: The study was a DOTS center-based, cross-sectional study, among 106 patients of pulmonary and extrapulmonary TB, above 18 years of age. An interviewer-administered questionnaire in Hindi was used to collect basic sociodemographic data and the Patient Health Questionnaire (PHQ)-9 was used for detecting depression. Those with a score of 10 or more were considered to be suffering from depression. Data analysis was done using SPSS licensed version 20. Chi-square was used to test for association between qualitative variables, and a P < 0.05 was considered statistically significant. Results: A total of 106 patients participated in the study, of which 61 (57.5%) were males. The median age was 30 years (inter-quartile range 24� years). Depression was found to be present in 25 (23.6%) participants. A higher proportion of patients with depression were unemployed currently, and also belonged to middle or lower class (P < 0.05). Depression was not found to be associated with religion, gender, marital status, HIV status, presence of diabetes, DOTS category nor with the phase of treatment. Conclusion: Depression among TB patients is common, affecting almost one in four TB patients. Physicians and DOTS providers should have a high index of suspicion for depression when assessing TB patients.
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@#<p><strong>OBJECTIVE:</strong> This was an evaluation of the effectiveness of the technical assistance package for the Pharmacy DOTS Initiative (PDI) in the Philippines.</p><p><strong>METHODOLOGY:</strong> Five pre-identified implementation sites were included in the evaluation. A survey was conducted to ascertain pharmacies currently implementing PDI and the number of TB presumptive cases referred by these pharmacies. Data abstraction was performed to determine the change in the number of TB cases seen by local TB programs after its implementation.</p><p><strong>RESULTS:</strong> Findings revealed that the proportion of pharmacies actively referring presumptive TB patients is not significantly lower than 60% (p=0.1892). Furthermore, results showed that the average monthly referrals were not statistically lower than 20 clients per month (p=0.9159). Nevertheless, interrupted time series analysis found no statistically significant immediate effects (p=0.516) and long-term effects (p=0.3673) on the total number of new TB cases identified after the PDI was implemented in the year 2014.</p><p><strong>CONCLUSION:</strong> The PDI was able to achieve outputs related to pharmacy engagement and referral of TB presumptive clients. However, the PDI was unsuccessful in increasing the actual number of TB presumptive cases seen by local TB programs in its implementation sites.</p>
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Tuberculosis , PhilippinesABSTRACT
Background: TB cases detected in Nigeria are still far below WHO target of 70% despite adoption of DOTS strategy since 1994 with subsequent expansion of treatment to primary health centers where diagnosis and treatment is done mainly by general health care workers. However, the extent of adherence to standard guideline by such cadre is unknown. Aims & Objective: This study aimed at assessing the knowledge on TB diagnosis and treatment by PHC workers in Osun and Oyo States. Material and Methods: A cross-sectional descriptive study was conducted among 280 general health care workers in 23 health care facilities selected using multistage sampling technique. Interviewed was done with a pre-tested selfadministered questionnaire in November, 2007. Results: Majority of the respondents (41%) are Community health extension workers i.e115 (41.1%) while 76 (27.1%) are nurses and 37 (13.2%) pharmacists. Knowledge on TB causation and mode of transmission was found to be relatively high as about 200 (71.4%) correctly describe TB as a microbial infection and about 216 (77.1%) knew airborne route as mode of transmission. When asked to define DOTS, 62.5% of the health workers gave a correct definition with only 109 (38.9%) abled to list the 4 main drugs given during intensive phase of treatment. In addition, about half of the respondents (52.5%) knew that treatment last for 8 months. Conclusion: The findings in this study several knowledge gaps on directly observed treatment short course therapy among healthcare providers. Multiple strategies are required to improve health care workers' knowledge and practice of Tuberculosis control.
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Background: Extra pulmonary TB (EPTB) including tuberculous lymphadenitis is becoming more common probably due to human immuno deficiency virus (HIV) co-infection. While children do experience a high TB related morbidity and mortality, management of TB in children is challenging. The present study was designed to study the treatment outcome of DOTS strategy for pediatric tuberculous lymphadenitis. Objective: To study the efficacy of DOTS strategy for pediatric lymphhnode tuberculosis. Methods: Retrospective analysis of 669 children of lymphnode tuberculosis treated with DOTS strategy over 9½ years. Results: Mean age was 9.8 years with significantly more girls (61.3%) than boys (38.7%) {c2=34.08, P< 0.001 (S)}. Most of the patients were in the age group of 11-14 years (48.0%) followed by 6-10 years(34.5%) and 0-5 years(17.5%) respectively. Cervical tuberculous lymphadenitis (88.2%) was the commonest form for all ages followed by axillary lymphadenitis in 3.3%. TB of other sites was seen in only 57 (8.5%) cases. Out of total 622 (93%) cases of lymphnode TB where fine needle aspiration and/ or excisional biopsy was done, it was positive (84.2%) and negative (15.6%) respectively for AFB/ cytology, while it could not be done in 47 patients due to inaccessible sites. Category I, II and III was started on 15.4%, 7.5% and 77.1% patients respectively. Overall, treatment completion rate was 94.9% and the default rate was 2.2% with a failure rate of 2.5%. Death rate was 0.3%. Conclusion: The study confirms the efficacy of DOTS strategy for pediatric TB lymphadenitis
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A significant proportion of global tuberculosis (TB) caseload is contributed by children. Management of pediatric TB especially EPTB is challenging. The present study was designed to study demographic, clinical profile and treatment outcome of DOTS strategy for pediatric tubercular pleurisy. Aim: To study the efficacy of DOTS strategy. Methods: Retrospective analysis of 106 TB pleurisy children treated with DOTS Results: Mean age was 10.8 years (median age 12.2 years) with more females (51.9%) than males (48.1%)c1 2=0.15; P= 0.698 (NS). In the age group of 0-5, 6-10 and 11-14 years, there were 15.1%, 30.2% and 54.7% patients respectively. Fever was the commonest symptom (98.1%) followed by cough (77.4%) and chest pain (55.7%). History of contact could be elicited only in 2/3rd of cases unilateral effusion (61.3%) was commonest, followed by empyema (22.6%), massive effusion and broncho-pleural fistula each in 13.2% cases respectively. Bilateral effusion was seen in 3.8% cases only. Conventional methods (mantoux, radiograph, ultrasound, pleural aspiration) and minimal invasive surgical techniques, percutaneous pleural biopsy were done to arrive at the diagnosis. Diagnosis was made by X-ray Chest in 92.5%, exudative pleural fluid (100%) predominantly lymphocytic in 85.8%, positive AFB smear and culture in 4.7 and 5.7% cases respectively. Category I, II and III was started on 35.9%, 2.8% and 61.3% patients respectively. Overall treatment completion rate was 94.3%, 4.7% default rate, 0.9% failure rate and no deaths. Conclusion: The study confirms early detection by simple tests and ensuring complete treatment using DOTS strategy.
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Background : Tuberculosis is a disease with a high case fatality of 4.65%. Objectives : To describe the survival pattern of patients on Directly Observed Treatment-Short course (DOTS) according to categories, age and sex of patients. Settings : Tuberculosis unit (TU) at District Tuberculosis Centre (DTC), Yavatmal, India Design : Retrospective cohort study. Materials and Methods : Data of patients registered for DOTS in the year 2004 were collected from the tuberculosis register. Statistical Analysis : Kaplan Meier plots and log rank tests to assess the survival pattern. Cox proportional hazards model for multivariate analysis. Results : A total of 716 patients were registered at the TU. The survival rates by the end of the intensive phase were 96%, 93% and 99% in categories I, II and III of DOTS, respectively. The cumulative survival rates were 93%, 88% and 96% in the three DOTS categories, respectively. There was a significant difference in the survival curves amongst the three DOTS categories (log rank statistic= 7.26, d.f..= 2, P=0 0.02) and amongst the different age groups [log rank statistic= 8.78, d.f.= 3, P= 0.012). There was no difference in the survival curves of male and female patients (log rank statistic= 0.05, d.f.= 1, P= 0.80) and according to type of disease (log rank statistic= 5.63, d.f.= 2, P= 0.05). On Cox proportional hazard analysis, age groups of 40 to 60 years [adjusted hazard ratio= 7.81 (1.002-60.87)] and above 60 years [adjusted hazard ratio= 21.54 (2.57-180.32)] were identified as significant risk factors for death. Conclusions : Age above 40 years is a significant risk factor for death in patients of tuberculosis. There was a significant difference in survival curves of the three DOTS categories and age groups.
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Adult , Directly Observed Therapy , Female , Humans , India/epidemiology , Male , Middle Aged , Survival Analysis , Survival Rate , Tuberculosis/drug therapy , Tuberculosis/mortalityABSTRACT
Objective To investigate the therapeutic efficacy of short course chemotherapy (SCC)on drug resistant tuberculosis (DR-TB) cases and related influencing socioeconomic factors. TB patients registered in local county TB dispensaries of two rural counties were followed up in Deqing and Guanyun of Eastern China, during 2004/2005. Methods Culture-positive patients (Deqing: 182, Guanyun: 217)were selected as subjects of this study. A cohort of TB patients was established at the beginning of their treatment and each patient was followed-up three times by questionnaires. Proportional method of drug susceptibility test was used to define the resistance to the 1st-line anti-TB drugs.χ2 test Kaplan-Meier method and Cox analysis were applied in multivariate analysis to investigate the negative conversion of smear positive sputum, treatment result of SCC and its socioeconomic influencing factors. Results The cure rates of multi-drug resistant TB (MDR-TB),other drug resistant TB (ODR-TB) and pan-drug susceptible TB,were 58.3%, 91.0%, 98.7% and 51.3%, 89.5%, 93.5% respectively in Deqing and Guanyun. The liver dysfunction (RR = 0.18, 95% CI:0. 04-0. 69 ) and previous treatment history (RR = 0.26,95% CI:0.07-0.93) were associated with treatment result among MDR-TB. Result on treatment in ODR-TB was influenced by previous treatment history (RR = 0.66, 95% CI:0. 44-0. 98 ) and Patient delay (＞2 weeks)(RR = 0.67, 95% CI: 0.46-0.97). Conclusion The priority in treating MDR-TB would include:managing side effect, developing the fast sensitive drug susceptibility test and modifying the treatment regimen corresponding to drug resistance.
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Background & Objectives: Extra-pulmonary tuberculosis (EPTB) cases have been treated with a daily short course chemotherapy (SCC) regimens in past. Following the success of Directly Observed Treatment-Short Course (DOTS) programme over recent years, a study was carried out to determine prevalence of EPTB, to draw comparison between annual case detection of pulmonary TB (PTB) and extra-pulmonary TB and to assess outcome of DOTS in EPTB in a patient population of Delhi. Methods: All consecutive EPTB cases of Delhi, diagnosed within LRS Institute of TB and Respiratory Diseases between January 1996 to March 2003 and subsequently given DOTS at the area DOTS Centres, constituted the study group. Results: Of overall 14185 cases, 2849 (20%) had EPTB. A significantly higher prevalence was observed in females (57%) and in young age (mean + standard deviation of 23.4 + 12.8 years). Commonest involved site was lymph node (54%). Whereas number of PTB and EPTB cases have increased over successive years, percentage of former declined significantly through 84 in 1996 to 78 in 2002 and that of latter rose significantly through 16 to 22 correspondingly. EPTB to PTB ratio changed significantly from 1:5 at start to about 1:3.5 at study-conclusion. Treatment completion was observed in 94% (1775/1885) of EPTB cases. Conclusions: Under Revised National TB Control Programme (RNTCP) employing a DOTS strategy, annual case detection has improved for both pulmonary and extra-pulmonary TB. Cure of infectious disease is likely to have resulted in a relative rise of the annual EPTB case detection. DOTS effected an acceptable treatment outcome in EPTB case management.
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In the early 1960s, the WHO developed a tuberculosis control policy whereby tuberculosis services (including regular and complete treatment of infectious cases) could be integrated into the general medical institutions distributed across a country. This control policy was deemed the best way to effectively reduce the tuberculosis problem within a community.<br><br>In late 1960s, the Philippines successfully developed a National Tuberculosis Program, based on WHO recommendations, that was integrated into the general health services. But due to inadequate management, it was not effectively implemented. The Government of the Philippines requested that the Japanese Government cooperate in improving its effectiveness. So, in 1992 JICA initiated a technical cooperation project in tuberculosis control. The total period of the project is from 1992 to 2007. During the cooperation, the project made major contributions to the introduction and expansion of WHO strategies throughout the country. Among the reasons for its success, the most important was that the Philippines had already developed a primary health care infrastructure throughout the country. In addition, the following factors should also be mentioned: 1) the strong commitment of the Philippine government in tuberculosis control, 2) the JICA project led to the coordination of other international aid agencies, 3) the Research Institute of Tuberculosis (Japan Anti-Tuberculosis Association), which has ample experience in tuberculosis research and international cooperation, was involved in the planning and operation of the project.<br><br>However, the Philippines' governance is still weak at the central, regional and provincial levels. The strengthening of their ability to administrate will be a key factor in the future success of the program.