ABSTRACT
BACKGROUND: We aimed to identify challenges and to propose solutions for the implementation of tuberculosis (TB) programmes in rural Sub-Saharan Africa (SSA) by evaluating the outcomes of the TB programme in the Ancuabe district in rural Northern Mozambique. METHODS: Retrospective descriptive study of the patients included in the TB programme in 2012-2013. Follow-up was continued till June 2014. RESULTS: Three hundred nineteen patients were registered, 62.1% male, mean age 36.3 (SD 14.4), estimated case detection rate (eCDR) of 24.24%. Two hundred seventy-two were new cases, 21 transferred-in, 11 back after lost to follow-up (LTFU), 10 relapsing TB, 5 previous treatment failures. 94.4% were tested for Human immunodeficiency virus (HIV), 41.9% HIV-positive. 87.5% of the new cases were pulmonary TB (PTB), 43.4% were HIV co-infected. Initial sputum results were available in 207 cases, with 145 smear-positive (SP) cases. Outcomes of new cases: 122 (44.9%) LTFU, 55 (20.2%) cured, 43 (15.8%) treatment completed (98-36%-treatment success), 31 (11.4%) died, 19 (7%) transferred out and 2 (0.7%) failures. CONCLUSIONS: A low eCDR and high proportion of LTFU demonstrate that few patients were identified and had a low probability of complete treatment, suggesting a fragile health system. This raises the hypothesis that, probably, to improve TB health care in rural SSA, interventions should aim at improving health systems. Special attention should be given to social protection and compensation of the financial burden associated with TB.
Subject(s)
Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Rural Population , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Adult , Female , Health Services Research , Humans , Lost to Follow-Up , Male , Middle Aged , Mozambique , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: Efficacy of artemisinin derivatives alone or in combination compared to praziquantel alone for the treatment of urinary schistosomiasis in schoolchildren. METHODS: Randomized clinical trials comparing praziquantel with artemisinin derivatives in the treatment of urinary schistosomiasis in schoolchildren were included. Medline, EMBASE, LILACS, CENTRAL, African Index Medicus, and Scielo were searched. We also analyzed the abstracts of the main conferences on infectious diseases and tropical medicine during the years 2009-2011. Google Scholar and OpenSIGLE were also searched. The last search was performed in July 2012. The primary endpoint was the cure rate. The main outcome data were retrieved using a standardized form; three independent researchers (WP, HC, and SS) performed the search, retrieved data, and evaluated the risk of bias. Disagreements were resolved by discussion. Risk ratios were used and heterogeneity was evaluated. A fixed or random-effects model was used according to the results of heterogeneity testing. An intention-to-treat analysis was done. Data were analyzed using Revman 5·0·24 (Copenhagen: The Nordic Cochrane Centre). RESULTS: Seven studies were selected for full text review and only five studies were finally included. The cure rate for praziquantel was superior to that of artesunate (RR: 1·66; 95% CI: 1·18-2·33). Artesunate was not clearly superior to placebo (artesunate versus placebo, RR: 3·21; 95% CI: 0·50-20·74). Combination of artesunate with praziquantel could prove more beneficial than praziquantel alone (RR: 1·15; 95% CI: 1·01-1·31). The frequency of adverse events was equivalent for both drugs (praziquantel versus artesunate, RR: 1·11; 95% CI: 0·80-1·55). CONCLUSIONS: Our meta-analysis showed that praziquantel was significantly more effective than artesunate for the treatment of urinary schistosomiasis in schoolchildren. Artesunate at best had a marginal role in combination therapy.
