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Screening for Severe Illness at Diagnosis Has the Potential to Prevent Early TB Deaths: Programmatic Experience From Karnataka, India.
Shewade, Hemant Deepak; Nagaraja, Sharath Burugina; Vanitha, Basavarajachar; Murthy, Hosadurga Jagadish Deepak; Bhargava, Madhavi; Singarajipura, Anil; Shastri, Suresh G; Patel, Bharatkumar Hargovandas; Davara, Kajal; Reddy, Ramesh Chandra; Kumar, Ajay M V; Bhargava, Anurag.
  • Shewade HD; ICMR-National Institute of Epidemiology, Chennai, India. hemantjipmer@gmail.com.
  • Nagaraja SB; Employees' State Insurance Corporation Medical College and PGIMSR, Bengaluru, India.
  • Vanitha B; Sri Atal Bihari Vajpayee Medical College and Research Institute, Bengaluru, India.
  • Murthy HJD; Bangalore Medical College and Research Institute, Bengaluru, India.
  • Bhargava M; Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru, India.
  • Singarajipura A; Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India.
  • Shastri SG; Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India.
  • Patel BH; Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India.
  • Davara K; Community Medicine Department, GMERS Medical College, Vadodara, India.
  • Reddy RC; Community Medicine Department, GMERS Medical College, Vadodara, India.
  • Kumar AMV; Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India.
  • Bhargava A; Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India.
Glob Health Sci Pract ; 10(4)2022 08 30.
Article in English | MEDLINE | ID: covidwho-2010495
ABSTRACT
Due to the coronavirus disease (COVID-19) pandemic and its associated response, TB deaths increased for the first time in a decade. In any potentially fatal illness, an assessment of severity is essential. This is not systematically done for adults with TB, mostly due to a lack of policy and/or limited availability of diagnostic and clinical capacity. We developed a screening tool using simple and easily measurable indicators that can be used by paramedical TB program staff to quickly identify people with severe illness. During October-November 2020 in Karnataka, India, the paramedical program staff from 16 districts screened people with TB (aged ≥15 years) notified by public facilities for "high risk of severe illness," which was defined as the presence of any of the following indicators (1) body mass index (BMI) ≤14.0 kg/m2; (2) BMI ≤16.0 kg/m2 with bilateral leg swelling; (3) respiratory rate >24/minute; (4) oxygen saturation <94%; (5) inability to stand without support. In this cohort study, we determined the incidence of program-recorded early deaths (within 2 months) and its association with high risk of severe illness. Of 3,010 people with TB, 1,529 (50.8%) were screened at diagnosis/notification, of whom 537 (35.1%) had a high risk of severe illness. There were 195 (6.5%, 95% CI=5.7, 7.4) early deaths 59 (30.2%) within a week and 100 (51.3%) within 2 weeks of treatment initiation. The incidence of early deaths was significantly higher among those with high risk of severe illness (8.9%) at diagnosis compared to those without (3.8%) [adjusted relative risk 2.36 (95% confidence interval=1.57, 3.55)]. To conclude, early deaths were especially high during the first 2 weeks and strongly associated with a high risk of severe illness at diagnosis/notification. Screening for severe illness should be explored as a potential strategy to end TB deaths.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adult / Humans Country/Region as subject: Asia Language: English Year: 2022 Document Type: Article Affiliation country: GHSP-D-21-00736

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adult / Humans Country/Region as subject: Asia Language: English Year: 2022 Document Type: Article Affiliation country: GHSP-D-21-00736