Implementation of Management of Pulmonary Tuberculosis with the Directly Observed Treatment Short course Strategy

The purpose of this study was to describe the implementation of pulmonary TB disease management with the DOTS strategy at the Jagong Health Center, Central Aceh Regency.The implementation of Pulmonary TB Management with the DOTS (Directly Observed Treatment Shortcourse) strategy in the working area of the Jagong Health Center, Central Aceh Regency has been maximized. by facilitating and providing motivation so that patients want treatment in a complete and integrated manner, case detection can be carried out by health workers or cadres who have been given training to recognize the symptoms of pulmonary TB. The distribution of drugs is distributed to each puskesmas in Central Aceh Regency, from the Puskesmas the drugs are arranged directly by P2TB officers then given directly to the PMO or the patient himself. PMO performance has never been given special training about treatment, PMO only received direction from P2TB Pulmonary officers. Recording and reporting carried out at the Jagong Health Center includes case finding, treatment, and recovery. Suspected pulmonary TB will be recorded and then monitored until the results of the examination have been obtained. Recording and reporting will be reported every month in a meeting at the Central Aceh District Health Office. For the Central Aceh Regency government to further enhance the development and improvement of infrastructure in the health sector so that health services are more easily accessible to people in remote areas.

Study about Tuberculosis in Thailand: An approach to Treatment, GIS and Sichon Model

In this study, we seek to identify geographical areas where ongoing tuberculosis epidemiological characteristics is occurring by linking Geographic Information Systems (GIS) technology in Thailand. In addition, we seek to assess how the directly observed treatment short-course (DOTS) program improved new tuberculosis diagnosis and treatment successes in Sichon District, Nakhon Si Thammarat province, Thailand from 2014 to 2016. The assessment program included seven indicators, and the results revealed that 73 new cases of tuberculosis were admitted for treatment on average every year, with rates of risk group screening findings of 4.28, 5.23, and 6.04 %, respectively. Patients who come to the hospital for diagnosis make up most of the demographic. However, only a minor proportion of patients are identified through community-based primary screening. In the years 2013-2016, the mortality rate of TB cases is expected to rise by 10.25 %, 4.25 %, and 5.56 %, respectively. The elderly and HIV-positive patients comprise most of the TB mortality population. When completing the DOTS program at a hospital, however, the rate of success has fallen short of the targets. Furthermore, the screening technique excludes the target group. As a result, people suffering tuberculosis are reported to be slower and more susceptible to symptoms. As a result, researchers advise that the DOTS program be supported by enhancing treatment follow-up to improve the effectiveness of TB treatment and collaboration with health care worker (HCW).

Analisis Pengetahuan dan Sikap Pengawas Menelan Obat (Pmo) Terhadap Efek Samping Obat Anti Tuberkulosis dan Tinjauannya

Latar belakang : PMO adalah komponen DOTS (Directly Observed Treatment Short Course) yang bertugas untuk memantau pengobatan TBC (Tuberkulosis). Pasien TBC memiliki masalah terkait penyakit TBC dan efek samping obat anti tuberkulosis (ESOAT). Terdapat korelasi yang kuat antara tingkat pengetahuan dan sikap PMO tentang TBC dan pengobatannya dengan kepatuhan berobat pasien. Ilmu yang benar akan mendorong seorang muslim untuk beriman kepada Allah SWT, sedangkan sikap diturunkan dari pengetahuan. Seorang muslim yang memiliki pengetahuan baik akan memiliki sikap baik pula dan Allah akan meningkatkan derajatya. Penelitian ini bertujuan untuk mengetahui pengetahuan dan sikap PMO sebelum dan sesudah pelatihan tentang efek samping OAT. Metode : Dilakukan pelatihan tentang ESOAT pada 32 orang PMO. Sebelum dan sesudah pelatihan PMO diberikan kuisioner untuk menilai pengetahuan dan sikap. Hasil pre test dan post test dilakukan scoring. Setelah 2 bulan dilakukan FGD (Focus Group Discussion) untuk mengetahui ESOAT pada pasien dan bagaimana PMO mengatasinya. Analisis data dilakukan secara bivariat dan uji statistik yang digunakan adalah uji Chi Square dan T Test Paired Sample Correlations dengan tingkat kemaknaan 95%. Hasil : Pengetahuan PMO tentang ESOAT mengalami peningkatan yang bermakna (p = 0,003). Terdapat peningkatan sikap PMO tentang TBC dan ESOAT setelah pelatihan meski tidak bermakna (p = 0,187) karena scoring rerata sikap PMO sebelum pelatihan sudah baik. Hasil FGD menunjukkan bahwa PMO mampu mengenali efek samping OAT ringan dan berat dan mampu mengatasi beberapa efek samping ringan. Menuntut ilmu pengetahuan adalah wajib hukumnya. Pengetahuan yang baik akan menghasilkan sikap yang baik pula baik dalam menunaikan tugasnya sebagai PMO maupun sebagai umat muslim. Kesimpulan : Terdapat peningkatan pengetahuan dan sikap PMO mengenai efek samping OAT setelah pemberian pelatihan tentang tentang efek samping OAT.

Survival and predictors of death in tuberculosis/HIV coinfection cases in Porto Alegre, Brazil: A historical cohort from 2009 to 2013

Background Tuberculosis is a curable disease, which remains the leading cause of death among infectious diseases worldwide, and it is the leading cause of death in people living with HIV. The purpose is to examine survival and predictors of death in Tuberculosis/HIV coinfection cases from 2009 to 2013. Methods We estimated the survival of 2,417 TB/HIV coinfection cases in Porto Alegre, from diagnosis up to 85 months of follow-up. We estimated hazard ratios and survival curves. Results The adjusted risk ratio (aRR) for death, by age, hospitalization, and Directly Observed Treatment was 4.58 for new cases (95% CI: 1.14–18.4), 4.51 for recurrence (95% CI: 1.11–18.4) and 4.53 for return after abandonment (95% CI: 1.12–18.4). The average survival time was 72.56 ± 1.57 months for those who underwent Directly Observed Treatment and 62.61 ± 0.77 for those who did not. Conclusions Case classification, age, and hospitalization are predictors of death. The occurrence of Directly Observed Treatment was a protective factor that increased the probability of survival. Policies aimed at reducing the mortality of patients with TB/HIV coinfection are needed.

Co-implementing Vitamin A supplementation with Seasonal Malaria Chemoprevention in Sokoto State, Nigeria: a feasibility and acceptability study

Background Bi-annual high dose vitamin A supplements administered to children aged 6-59 months can significantly reduce child mortality, but vitamin A supplementation (VAS) coverage is low in Nigeria. The World Health Organization recommends that VAS be integrated into other public health programmes which are aimed at improving child survival. Seasonal malaria chemoprevention (SMC) provides a ready platform for VAS integration to improve health outcomes. Methods A mixed methods study design was used to assess the feasibility and acceptability of co-implementing VAS with SMC in one local government area of Sokoto state in northern Nigeria. Existing SMC implementation tools and job aids were revised and community drug distributors, experienced in SMC delivery, were trained on the determination of VAS eligibility, administration of the correct doses and identification of adverse drug reactions. SMC and VAS were delivered using a door-to-door approach. VAS and SMC coverage were calculated and the outcome of the integration was assessed using questionnaires administered to 188 and 197 households at baseline and endline respectively. The Bowen framework was used to assess feasibility through focus group discussions and key informant interviews; thematic analysis was carried out on the qualitative data. Results At endline, the proportion of children who received at least one dose of VAS in the last six months increased significantly from 2–59% (p<0.001). There were no adverse effects on the coverage of SMC delivery with 70% eligible children reached at baseline, increasing to 76% (p=0.412) at endline. There was no significant change (p=0.264) in the quality of SMC, measured by proportion of children receiving their first dose as directly observed treatment (DOT), at endline (68%) compared to baseline (54%). Study findings demonstrated acceptability among caregivers, community drug distributors, State and National healthcare officials. Conclusion This study showed that it is feasible and acceptable to integrate VAS with SMC delivery in areas of high seasonal malaria transmission such as northern Nigeria, where SMC campaigns are implemented. SMC-VAS integrated campaign can significantly increase vitamin A coverage but more research is required to demonstrate the feasibility of this integration in different settings and on a larger scale.

Association between Smoking Habit and Pulmonary Tuberculosis at Dr. Soetomo General Academic Hospita

Introduction: Smoking has been reported as one of tuberculosis (TB) risk factor. The association between smoking and TB has been proven in multiple studies, but little known about the association between smoking degree and sputum smear positive. Methods: An analytic observational study using cross-sectional design. Data of patients with pulmonary TB conducted at DOTS (Directly Observed Treatment Short course)/MDR (Multi Drug Resistance) outpatient and inpatient ward in Dr Soetomo General Hospital Surabaya from January to October 2018. The degree of smoking was measured using Brinkman Index (BI). The odds ratio (OR) and 95% confidence intervals (CI) were also estimated.Results: There were 94 patients with pulmonary TB, 56 non-smoker and 38 smoker. Light smoking (P = 0,120, OR = 0.200, 95% CI: 0.022-1.823), moderate smoking (P=0.377, OR = 1.667, 95% CI: 0.533-5.209), heavy smoking (P=0.076, OR= 0.333, 95% CI: 0.96-1.160). Moderate smoking compared to heavy smoking as a control (P=0.33, OR = 5.000, 95% CI=1.096-22.820). Conclusion: There’s no significant correlation between smoking habits and sputum smear positive, but the present study evidenced the patients with smoking habits had greater chance to get sputum smear positive than non-smokers. Patient with moderate smoking compared to heavy smoking had greater chance to get sputum smear positive.

Co-implementing Vitamin A supplementation with Seasonal Malaria Chemoprevention in Sokoto State, Nigeria: a feasibility and acceptability study

BackgroundBi-annual high dose vitamin A supplements administered to children aged 6-59 months can significantly reduce child mortality, but vitamin A supplementation (VAS) coverage is low in Nigeria. The World Health Organization recommends that VAS be integrated into other public health programmes which are aimed at improving child survival. Seasonal malaria chemoprevention (SMC) provides a ready platform for VAS integration to improve health outcomes.MethodsA mixed methods study design was used to assess the feasibility and acceptability of co-implementing VAS with SMC in one local government area of Sokoto state in northern Nigeria. Existing SMC implementation tools and job aids were revised and community drug distributors, experienced in SMC delivery, were trained on the determination of VAS eligibility, administration of the correct doses and identification of adverse drug reactions. SMC and VAS were delivered using a door-to-door approach. VAS and SMC coverage were calculated and the outcome of the integration was assessed using questionnaires administered to 188 and 197 households at baseline and endline respectively. The Bowen framework was used to assess feasibility through focus group discussions and key informant interviews; thematic analysis was carried out on the qualitative data. ResultsAt endline, the proportion of children who received at least one dose of VAS in the last six months increased significantly from 2% to 59% (p<0.001). There were no adverse effects on the coverage of SMC delivery with 70% eligible children reached at baseline, increasing to 76% (p=0.412) at endline. There was no significant change (p=0.264) in the quality of SMC, measured by proportion of children receiving their first dose as directly observed treatment (DOT), at endline (68%) compared to baseline (54%). Study findings demonstrated acceptability among caregivers, community drug distributors, State and National healthcare officials. ConclusionThis study showed that it is feasible and acceptable to integrate VAS with SMC delivery in areas of high seasonal malaria transmission such as northern Nigeria, where SMC campaigns are implemented. SMC-VAS integrated campaign can significantly increase vitamin A coverage but more research is required to demonstrate the feasibility of this integration in different settings and on a larger scale.

Study on serum zinc and copper levels in pulmonary tuberculosis patients before starting Directly Observed Treatment, Short-course

Background: Tuberculosis is a major public health concern throughout the world including Bangladesh. The prevalence of tuberculosis (TB) is increasing day by day. Around one-third of world population is infected with M. tuberculosis. Still pulmonary tuberculosis (PTB) remains one of the important causes of mortality throughout the world with economic burden. Objective: To evaluate levels of the serum zinc and serum copper in smear positive PTB patients before starting Directly Observed Treatment, Short-course (DOTs) therapy. Methods: This was a cross-sectional type of observational study. A total of 100 subjects were included in this study. Among them 50 were smear positive PTB patients denoted as case group and 50 were apparently healthy individuals denoted as control group. Biochemical tests were carried out in the department of biochemistry of Mymensingh Medical College, Mymensingh. All the statistical analyses were performed by using SPSS version 21. Results were evaluated by using Student’s t-test. Results: After careful evaluation there was significant decrease in serum zinc level along with significant increase in serum copper level among the case group when compared with the control group. The mean values of serum zinc level were 93.96±10.04 μg/dl and 72.84±7.73 μg/dl in control and case group respectively. Serum zinc level decreased significantly (p <0.001) in PTB patients. The mean values of serum copper were 111.81±21.26 μg/dl and 125.99±27.93 μg/dl in control and case group respectively. There was significant (p <0.001) rise of serum copper level in PTB patients. Mediscope 2021;8(2): 122-127

Cavities Herald Persistent Sputum Positivity

Aim: To determine the factors associated with persistent sputum positivity at the end of two months of treatment in patients presenting with (drug-susceptible) pulmonary tuberculosis at a tertiary care hospital in Karachi.Setting: A cross-sectional study was conducted at the Department of Chest Medicine (Ward 12), Jinnah Postgraduate Medical Center (JPMC), Karachi over six months.Methods:A sample of 73 consenting, newly diagnosed, smear positive drug-susceptible pulmonary tuberculosis patients was studied. Demographic (age, gender, height, weight and duration of tuberculosis, body mass index (BMI), socioeconomic, occupational, marital, educational and residential statuses) and clinical factors (chest X-ray extent and cavities, initial smear results, diabetic and smoking statuses) which may be associated with sputum non-conversion were entered in a proforma. Patients were followed up at two months of treatment with a sputum smear. Data analysis was done on SPSS-20.0.Results:Rate of sputum positivity after two months of treatment was 17.8%. None of the factors was associated with persistence of sputum positivity except for the presence of chest radiograph (CXR) cavities; which made it 5.5 times more likely that the patient would remain smear-positive at two months (p=0.035).Conclusion:The finding of CXR cavities makes it highly likely that a pulmonary tuberculosis patient may remain infectious or have an unfavourable outcome despite taking treatment for 2 months. Clinicians and national policy-makers should thus bear in mind the implications this can have with regard to disease control and pay particular attention in terms of stringent monitoring and Directly Observed Treatment Short-course (DOTS) provision.