Tropical Medicine & International Health最新文献

{"title":"Implementation of isoniazid preventive therapy among children living with diagnosed pulmonary tuberculosis patients: A mixed methods study from Mumbai, India.","authors":"P A Sreevidya, Shrikala Acharya, Mayuri Umesh Raul, Aparna Prakash","doi":"10.1111/tmi.14072","DOIUrl":"10.1111/tmi.14072","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis remains a significant public health issue, particularly among children who are in close contact with tuberculosis patients. India accounts for a large proportion of global tuberculosis cases. Despite global recommendations for Isoniazid Preventive Therapy to prevent latent tuberculosis infection from progressing to active disease, the initiation and adherence to Isoniazid Preventive Therapy remain suboptimal, especially in high-burden settings. Understanding the barriers to Isoniazid Preventive Therapy implementation is crucial to improving treatment outcomes and achieving tuberculosis elimination goals.</p><p><strong>Objectives: </strong>This study aimed to quantify the uptake of isoniazid among children under 6 years who were started on Isoniazid Preventive Therapy and to identify the challenges from the perspectives of caregivers and healthcare providers.</p><p><strong>Methods: </strong>The study was conducted in a slum in Mumbai, India, from June to December 2023, using a mixed-methods design. The quantitative phase involved a house-to-house survey, covering all 96 contacts started on Isoniazid Preventive Therapy in 2022, using a semi-structured questionnaire. The qualitative phase included key informant interviews with healthcare providers and in-depth interviews with caregivers. Quantitative data were analysed using Fisher's exact test and chi-square test, while qualitative data were analysed thematically.</p><p><strong>Results: </strong>Of the 96 children, 11 (11.45%) completed therapy, with an average treatment duration of 2.5 months. Quantitative findings highlighted fear of side effects and family migration as major reasons for discontinuation. Completion of chemoprophylaxis was significantly associated with factors like male gender, support from extended family, home visits by tuberculosis health staff, and shorter travel time (under 30 min) to the tuberculosis unit. Qualitative data revealed challenges across themes of supply, staff, training, services, and adherence. Key challenges included lack of awareness, unavailability of isoniazid in syrup form, inadequate training for health workers, weak program monitoring, insufficient staffing, and fears related to tuberculosis exposure during outpatient department visits.</p><p><strong>Conclusion: </strong>Effective counselling, regular follow-ups, availability of medications in syrup form, increasing staffing based on case burden, timely training of staff, strengthening program monitoring, and ensuring infection control in tuberculosis outpatient departments are critical to achieving successful completion of isoniazid preventive therapy.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"93-98"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Host preference of Anopheles stephensi mosquitoes for blood feeding in south of Iran: Insights from Multiplex-PCR analysis.","authors":"Mohammad Ali Oshaghi, Madineh Abbasi, Ahmad Ali Hanafi-Bojd","doi":"10.1111/tmi.14076","DOIUrl":"10.1111/tmi.14076","url":null,"abstract":"<p><strong>Background: </strong>The study aims to determine the host preference for blood feeding among potential hosts of Anopheles stephensi in Iran, using the Multiplex-PCR method. An. stephensi is the primary malaria vector in urban areas of South Asia and the Middle East, including southern Iran, where approximately 30.21% of malaria cases are urban. This trend has become more evident during the recent outbreaks in Iran, driven by infections of Plasmodium falciparum, Plasmodium vivax, and as well as mixed infections. Hormozgan province, one of the most endemic areas in Iran, was selected for its critical public health significance. This study builds on the validated efficiency of Multiplex-PCR for blood meal analysis by applying it to mosquitoes in southern Iran.</p><p><strong>Methods: </strong>In 2021, mosquitoes were collected monthly from three coastal villages in Bandar Abbas county, Hormozgan province, using WHO-recommended collection methods. Blood-fed An. stephensi mosquitoes were dissected, and their stomach contents analysed via Multiplex-PCR to identify human and animal blood sources.</p><p><strong>Results: </strong>Of 77 An. stephensi samples analysed, humans were the most common host was humans (29.9%), followed by mammals (19%), dogs (2.6%), and birds (1.3%). Mixed blood meals were detected in 34% of samples, including 23% with human and other hosts. Informal observations suggest that domestic animals such as goats, sheep, and chickens are commonly present near homes in these areas.</p><p><strong>Conclusion: </strong>Approximately 50% of An. stephensi blood meals were sourced from humans, with 29% exclusively from humans and 23% from mixed hosts. Domestic animals such as goats, sheep, and chickens appear to attract mosquitoes, highlighting their potential role in malaria dynamics. Zooprophylaxis, alongside existing measures like insecticide residual spraying, insecticide-treated bed nets, and personal protection strategies, may strengthen urban malaria control. Further research on the ecological and behavioural drivers of mosquito host selection in urban settings is warranted.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"125-134"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge of local snakes, first-aid and prevention of snakebites among community health workers and community members in rural Malawi: A cross-sectional study.","authors":"Moses Banda Aron, Fabien Munyaneza, Anat Rosenthal, Luckson Dullie, Ralf Krumkamp, Enoch Ndarama, Bright Mailosi, Jürgen May, Basimenye Nhlema, Clara Sambani, Deborah Hosemann, Jade Rae, Paul Rahden, Jörg Blessmann, Benno Kreuels","doi":"10.1111/tmi.14071","DOIUrl":"10.1111/tmi.14071","url":null,"abstract":"<p><strong>Objective: </strong>Snakebite envenoming remains a public health threat in many tropical countries. While community knowledge of local snakes and snakebite first-aid and prevention are needed to reduce snakebite incidence and improve the outcomes for snakebite patients, it is poor in many communities. We assessed community health workers and community members regarding their knowledge on local snakes, snakebite first-aid and prevention in Neno district, Malawi.</p><p><strong>Methods: </strong>In November 2022, we conducted a cross-sectional survey among 312 community health workers and 379 community members in the Neno District of Malawi to assess their knowledge of snake identification, snakebite first-aid, and prevention. Different questions were asked in these sections and summarised as linear scores ranging from 0% to 100%. Scores of 0%-49%, 50%-70%, and >70% were considered inadequate, fairly adequate, and adequate, respectively. Along with data collected during knowledge assessments, the socio-demographic characteristics of participants were collected. To assess knowledge differences between community health workers and community members, Pearson's chi-square or Fisher's exact tests were used, and linear regression was calculated to investigate possible predictors of knowledge.</p><p><strong>Results: </strong>Overall, 66.6% of participants were females with a median age of 39 (IQR = 30-48) years. Of the 89% (n = 615) who agreed to view snake pictures, only 1.3% had adequate snake identification knowledge. Less than 5% (n = 33) had adequate knowledge of first aid measures, and 14.3% (n = 99) had adequate knowledge of prevention practices. Overall, less than 1% (n = 3) had adequate knowledge across the three assessment sections, with no significant difference between community health workers (n = 1, 0.3%) and community members (n = 2, 0.5%) (p > 0.949).</p><p><strong>Conclusion: </strong>Both community health workers and community members had inadequate knowledge regarding local snake species, first aid for snakebites and prevention measures. The effect of awareness campaigns and other education initiatives could be explored to help improve these gaps.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"84-92"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of knowledge, attitude and self-efficacy on Opisthorchis viverrini and cholangiocarcinoma prevention: A One Health approach in high-risk areas of Thailand.","authors":"Worathon Busabong, Nopparat Songserm, Somkiattiyos Woradet, Banchob Sripa","doi":"10.1111/tmi.14073","DOIUrl":"10.1111/tmi.14073","url":null,"abstract":"<p><strong>Objective: </strong>Opisthorchis viverrini and cholangiocarcinoma have been recognised by the World Health Organisation as critical public health concerns, particularly in northeastern Thailand, where Opisthorchis viverrini is a significant cause of cholangiocarcinoma. This study examines the factors influencing Opisthorchis viverrini and cholangiocarcinoma prevention within the One Health framework in Kanthararom District, Sisaket Province, Thailand.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 327 residents aged 20 and above, utilising a structured questionnaire to assess knowledge, attitudes, perceived self-efficacy and prevention behaviours. Data were analysed using descriptive statistics, Pearson's product-moment correlation coefficient and multiple regression analysis to identify relationships and predictors within the dataset.</p><p><strong>Results: </strong>The results showed that 53.52% of participants had moderate knowledge and attitudes towards prevention, while perceived self-efficacy was generally high. Positive correlations were found between income, knowledge, attitudes, self-efficacy and prevention behaviours. Key predictors of Opisthorchis viverrini and cholangiocarcinoma prevention behaviours included attitudes towards human health (β = 0.212), perceived self-efficacy in human health (β = 0.211), attitudes towards animal health (β = 0.205) and knowledge about human health (β = 0.138), accounting for 24.40% of the variance in prevention behaviours. These predictors were statistically significant at 0.05 (F = 25.95; p <0.001).</p><p><strong>Conclusion: </strong>The findings suggest that enhancing knowledge, attitudes and self-efficacy is crucial to improving Opisthorchis viverrini and cholangiocarcinoma prevention. This study underscores the need for integrated public health strategies incorporating human, animal and environmental health to reduce the prevalence of Opisthorchis viverrini and cholangiocarcinoma in high-risk regions.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"99-107"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective clinical performance evaluation of the Abbott Bioline HAT 2.0, a rapid diagnostic test for human African trypanosomiasis based on recombinant antigens.","authors":"Sara Tablado Alonso, Sylvain Biéler, Raquel Inocêncio da Luz, Paul Verlé, Philippe Büscher, Epco Hasker","doi":"10.1111/tmi.14077","DOIUrl":"10.1111/tmi.14077","url":null,"abstract":"<p><strong>Background: </strong>Rapid diagnostic tests for the serological detection of gambiense human African trypanosomiasis (gHAT) have been developed to overcome the limitations of the traditional screening method, CATT/T. b. gambiense. The Abbott Bioline human African trypanosomiasis (HAT) 2.0 rapid diagnostic test has recently been developed by Abbott using only recombinant antigens. The objective of this study was to evaluate its clinical sensitivity and specificity, in comparison with the other available rapid diagnostic tests and CATT.</p><p><strong>Methodology/principal findings: </strong>For this study, archived plasma samples from 150 gHAT cases and 150 endemic controls originating from Chad, Guinea, the Democratic Republic of the Congo and Uganda were analysed on the following tests: CATT/T. b. gambiense, the HAT Sero K-SeT, SD BIOLINE HAT and Abbott Bioline HAT 2.0 rapid diagnostic tests, and the immune trypanolysis test. The sensitivity and specificity of Abbott Bioline HAT 2.0 were 96.7% and 78.4%, respectively, and the sensitivity and specificity of SD BIOLINE HAT were 99.3% and 74.1%. The sensitivity and specificity of CATT were 98.7% and 89.2%. The sensitivity and specificity of HAT Sero K-SeT were 99.3% and 81.3%.</p><p><strong>Conclusions/significance: </strong>The sensitivity and specificity of the Abbott Bioline HAT 2.0 are comparable to those of its predecessors HAT Sero K-SeT and SD BIOLINE HAT. However, considering the decreasing prevalence of gHAT, a higher specificity of the tests used for screening is desirable to improve their positive predictive value.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"135-142"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of bacterial isolates and antimicrobial susceptibility patterns in external ocular infections among patients attending eye clinic at Kafrelsheikh University Hospitals.","authors":"Sally Hassan Essawy, Mohamed Ahmed ELShafie, Yasmeen Mohamed Mohamed Ghazy, Mo'men Mahmoud Saadoun, Nahla A Nosair, Hebatalla Abdelmaksoud Ahmed, Ayat Shaban Mousa El Nahal","doi":"10.1111/tmi.14075","DOIUrl":"10.1111/tmi.14075","url":null,"abstract":"<p><strong>Background: </strong>Ocular infections can harm the eye's anatomic structure on numerous levels. They are a global health issue. Endophthalmitis, a serious complication following cataract surgery, can result in substantial ocular morbidity and vision loss despite the administration of antibiotics. Bacterial ocular flora are the primary causative agents. This study aimed to assess the types of bacterial isolates on the external ocular surface and evaluate their antimicrobial susceptibility patterns in pre-operative cataract patients at Kafrelsheikh University Hospitals.</p><p><strong>Methods: </strong>This cross-sectional study enrolled 691 patients scheduled for routine cataract surgery in the Department of Ophthalmology at Kafrelsheikh University Hospitals, Egypt. Each patient underwent a comprehensive assessment of medical history, including the use of traditional medicine, past eye trauma, and any prior eye surgeries, as well as ophthalmic clinical data such as visual acuity and ocular surface disorders. Conjunctival swabs were collected and processed using standard microbiological procedures to identify bacterial isolates and their respective antimicrobial susceptibility patterns.</p><p><strong>Results: </strong>Among the 691 patients enrolled (median age 60 years, IQR 54-66), 59.8% were female. Conjunctival cultures yielded positive results in 38 cases (5.6%). The most frequently isolated organisms were Staphylococcus aureus, accounting for 52.6% of isolates, followed by Staphylococcus epidermidis at 15.8%. Notably, S. aureus demonstrated the highest resistance to erythromycin and vancomycin, with all 20 isolates showing resistance. In contrast, linezolid exhibited high efficacy, with 19 isolates showing sensitivity and only one displaying resistance.</p><p><strong>Conclusion: </strong>This study indicated that ocular conditions such as dry eye syndrome, Meibomian gland dysfunction, and scaly blepharitis are strongly associated with the prevalence of culture-confirmed ocular infections. Regarding antibiotic susceptibility, most Staphylococcus species demonstrated the greatest sensitivity to linezolid and trimethoprim/sulfamethoxazole.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"118-124"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of case detection strategies on the prognosis of tuberculosis patients in the state of São Paulo, Brazil, 2010-19: A retrospective cohort study.","authors":"José Mário Nunes da Silva, Fredi Alexander Diaz-Quijano","doi":"10.1111/tmi.14074","DOIUrl":"10.1111/tmi.14074","url":null,"abstract":"<p><strong>Background: </strong>Despite existing recommendations, there is still a scarcity of evidence on the impact of active case finding strategies versus passive case finding strategies, especially with regard to the mortality of tuberculosis patients. Therefore, our aim was to estimate the effect of case detection strategies on the prognosis of tuberculosis patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 160,384 new cases of tuberculosis patients diagnosed between 1 January 2010 and 31 August 2019 in the state of São Paulo, Brazil. We classified exposure into: passive case finding (emergency room, outpatient clinics or hospital settings) and active case finding (institutions, community or contact investigation). The primary outcome was all-cause mortality, and the secondary outcome was a composite outcome with treatment outcomes. We investigated associations using logistic regression, allowing for municipality-level random effects.</p><p><strong>Results: </strong>Compared with outpatient passive case finding, passive case finding in the emergency room and in the hospital showed higher odds of death (adjusted odds ratio [OR] 3.69; 95% CI: 3.47-3.93 and 4.47; 95% CI: 4.22-4.74, respectively) and unfavourable treatment outcomes (1.92; 95% CI: 1.84-1.99 and 2.06; 95% CI: 1.98-2.14, respectively). By contrast, patients detected through community-based active case finding and contact investigation showed lower odds of death (0.77; 95% CI: 0.61-0.97 and 0.71; 95% CI: 0.54-0.92, respectively) and unfavourable treatment outcomes (0.85; 95% CI: 0.77-0.95 and 0.82; 95% CI: 0.74-0.91, respectively).</p><p><strong>Conclusion: </strong>Community-based active case finding and contact investigation were associated with better prognosis than passive strategies in tuberculosis patients. Our results highlight the importance of strengthening active case finding as a fundamental part of mitigating the disease burden and controlling tuberculosis.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"108-117"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the effectiveness and cost-effectiveness of integrating mass drug administration for helminth control with seasonal malaria chemoprevention in Ghanaian children: Protocol for a cluster randomised controlled trial.","authors":"Muhammed O Afolabi, Dennis Adu-Gyasi, Lucy Paintain, Theresa Tawiah, Mohammed Sanni Ali, Brian Greenwood, Kwaku Poku Asante","doi":"10.1111/tmi.14062","DOIUrl":"10.1111/tmi.14062","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effectiveness and cost-effectiveness of integrating seasonal malaria chemoprevention (SMC) with mass drug administration for helminth control among school-aged children living in communities where the burden of malaria and helminths is high in Ghana, West Africa.</p><p><strong>Methods: </strong>This cluster randomised controlled trial will enrol 1200 children aged 5-10 years. Eligible children randomised to intervention clusters will receive SMC drugs (sulphadoxine-pyrimethamine plus amodiaquine) and anthelminthic drugs for soil-transmitted helminths-(albendazole), and for schistosomiasis (praziquantel), while children randomised to control clusters will receive SMC drugs alone. Pre- and post-intervention blood, urine and stool samples will be collected from children in both clusters. The effectiveness of the concomitant delivery will be determined by checking whether the combination of SMC and anthelminthic drugs prevents anaemia in the children randomised to the intervention clusters compared to the children in the control clusters. Cost analysis and cost-effectiveness of this integrated delivery approach will be determined by estimating the incremental costs and effects of co-administration of SMC drugs with mass drug administration of anthelminthic drugs compared to SMC alone, including cost savings due to cases of moderate and severe anaemia averted.</p><p><strong>Expected findings: </strong>The findings of this study will provide evidence to inform public health recommendations for an integrated control of malaria and helminths among children living in the poorest countries of the world.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"22-30"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe community-acquired pneumonia compared to severe community-acquired Acinetobacter baumannii pneumonia in Reunion Island: A retrospective study.","authors":"Giacomo Rotini, Axel de Mangou, Agathe Combe, Amelie Renou, Chloe Combe, Radj Cally, Marie Lagrange-Xelot, Nicolas Allou, Guillaume Miltgen, Charles Vidal","doi":"10.1111/tmi.14067","DOIUrl":"10.1111/tmi.14067","url":null,"abstract":"<p><p>Acinetobacter baumannii (Ab) has emerged in the last decades as a cause of community-acquired pneumonia (CAP) in tropical and subtropical regions. We previously conducted the first investigation on this topic in France with a case series of severe CAP-Ab in Reunion Island over an eight-year period. In the present work, we aim to highlight the specific aspects of CAP-Ab by comparing our case series with an historical cohort (PAC_RUN), obtained by retrospective chart review (2016-2021) of severe community-acquired pneumonia cases on Reunion Island, in which CAP-Ab was ruled out. During the study period, eight CAP-Ab cases were identified, giving an incidence of 0.1 cases per 100,000 people/year, and an incidence of 16.5 cases per 100,000 people/year for non-Ab-related CAP (n = 761). By comparing with non-Ab-related CAP, patients had more excessive alcohol use (75% vs. 25.6%, p = 0.005) and lower body mass index (21 vs. 24 kg/m², p = 0.004). Six cases (75%) of CAP-Ab occurred during the rainy season (p = 0.06). Mortality was higher (62.5% vs. 24.3%, p = 0.02) and time to death was shorter (median 2 days vs. 7, p = 0.009) in the CAP-Ab group. Bacteraemic pneumonia was strongly associated with CAP-Ab (62.5% vs. 15.7%, p = 0.004). Significant differences were found in the need for renal replacement therapy (75% vs. 17.2%, p < 0.001), catecholamine use (100% vs. 54.5%, p = 0.01) and use of invasive mechanical ventilation (100% vs. 62.7%, p = 0.03). Also, in the proportion of severe acute respiratory distress syndrome (62.5% vs. 23.2%, p = 0.02), septic shock (100% vs. 40.6%, p < 0.001), and cardiogenic shock (87.5% vs. 15.9%, p < 0.001). Compared to severe non-Ab-related CAP, severe CAP-Ab is characterised by higher mortality, associated with a high frequency of multiple organ failure. Excessive alcohol consumption and malnutrition seem to be risk factors. To improve outcomes, broader spectrum antibiotic therapy must be immediately proposed when CAP-Ab is suspected.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"43-50"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in tuberculosis control in Ethiopia: A district-level distributional modelling analysis.","authors":"Fentabil Getnet, Tom Forzy, Latera Tesfaye, Awoke Misganaw, Solomon Tessema Memirie, Shewayiref Geremew, Tezera Moshago Berheto, Naod Wendrad, Bantalem Yeshanew Yihun, Mizan Kiros Mirutse, Fasil Tsegaye, Mesay Hailu Dangisso, Stéphane Verguet","doi":"10.1111/tmi.14066","DOIUrl":"10.1111/tmi.14066","url":null,"abstract":"<p><strong>Background: </strong>Implementation studies indicate that the addition of tuberculosis diagnosis and treatment services into the community health extension workers' tasks-that is 'task-shifting'-improved case detection and treatment outcomes in Ethiopia. Given resource and operational constraints, only a limited number of areas can be targeted by an expanded task-shifting program. Therefore, we mapped the distributional disparities in tuberculosis services across regions and districts and modelled the equity pathways towards optimising national scale-up of this task-shifting intervention in Ethiopia.</p><p><strong>Methods: </strong>We used data from various sources including District Health Information Software 2; demographic, geospatial and topographic data; and previously published implementation study findings. We developed methods to integrate these datasets and to calculate the proportion of health facilities with tuberculosis services, the district population to health centre ratio, and the proportion of district population living within 2h walking distance from a health centre. Equity and disparities were then measured in terms of: tuberculosis services coverage; health centre adequacy, that is the district population served by health centres; and spatial access adequacy, that is the district population with health centre access within a two-hour walking distance. Subsequently, districts were ranked according to these measures to allow prioritisation of the health extension worker task-shifting intervention.</p><p><strong>Results: </strong>Tuberculosis services coverage varied from 54% in Afar region to 100% in Harari region, and health centre inadequacy ranged from 10% of districts in Benishangul-Gumuz to 87% in Sidama. After spatial access adjustment, health centre inadequacy ranged from 7% of districts in Sidama to 91% in Somali; and tuberculosis services inadequacy from 7% of districts in Sidama to 97% in Afar. Task-shifting implemented in inadequate districts (55% of all districts) could raise national case detection rate from 66% (currently) to 88% and treatment success rate from 93% to 99%; Benishangul-Gumuz achieving the largest increase of all regions.</p><p><strong>Conclusions: </strong>Access to effective tuberculosis services presents substantial disparities across districts in Ethiopia, due to both health system and tuberculosis-specific factors. Jointly considering both types of factors would enable prioritisation of districts where health extension workers would be most impactful.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"31-42"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}