scholarly journals Increased incarceration rates drive growing tuberculosis burden in prisons and jeopardize overall tuberculosis control in Paraguay

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Víctor Guillermo Sequera ◽  
Sarita Aguirre ◽  
Gladys Estigarribia ◽  
Matteo Cellamare ◽  
Julio Croda ◽  
...  
Keyword(s):  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
Control Program ◽  
Attributable Fraction ◽  
Control Measures ◽  
Notification Rate ◽  
Substantial Impact ◽  
Tb Control ◽  
Incarcerated Populations ◽  
Over Time

AbstractIncarcerated populations are at high-risk to develop tuberculosis (TB), however their impact on the population-level tuberculosis epidemic has been scarcely studied. We aimed to describe the burden and trends of TB among incarcerated populations over time in Paraguay, its clinical and epidemiological differences and the population attributable fraction. This is an observational, descriptive study including all TB cases notified to the National TB control Program in Paraguay during the period 2009–2018. We also used case registries of prisoners diagnosed with tuberculosis from the Minister of Justice. The population attributable fraction of TB in the community due to incarcerated cases was estimated through Levin’s formula. The characteristics of TB cases in and outside of prison were compared as well as the characteristics of TB in prisons were modified over time. During 2009–2018, 2764 (9.7%) of the 28,534 TB reported cases in Paraguay occurred in prisons. The number of prisoners in Paraguay increased from 6258 in 2009 to 14,627 in 2018 (incarceration rate, 101 to 207 per 100,000 persons) while the number of TB cases among prisoners increased by 250% (n = 192 in 2009 versus n = 480 in 2018). The annual TB notification rate among male prisoners was 3218 and 3459 per 100,000 inmates in 2009 and 2018, respectively. The percentage of all TB cases occurring among prisoners increased from 7.1% in 2009 to 14.5% in 2018. The relative risk of TB in prisons compared to community was 70.3 (95% CI, 67.7–73.1); the overall population attributable risk was 9.5%. Among the 16 penitentiary centers in the country, two of them—Tacumbú (39.0%) and Ciudad del Este (23.3%)—represent two thirds of all TB cases in prisons. TB among inmates is predominantly concentrated in those 20–34 years old (77.3% of all), twice the percentage of cases for the same age group outside of prison. Our findings show that the TB epidemic in prisons represents one of the most important challenges for TB control in Paraguay, especially in the country’s largest cities. Appropriate TB control measures among incarcerated populations are needed and may have substantial impact on the overall TB burden in the country.

scholarly journals Analyzing Policymaking for Tuberculosis Control in Nigeria

Complexity ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Nura M. R. Ahmad ◽  
Cristina Montañola-Sales ◽  
Clara Prats ◽  
Mustapha Musa ◽  
Daniel López ◽  
...  
Keyword(s):  
Treatment Effectiveness ◽  
Control Program ◽  
Case Finding ◽  
Control Measures ◽  
Active Case Finding ◽  
Notification Rate ◽  
Rapid Urbanization ◽  
Active Case ◽  
Tb Control ◽  
Using Data

Today, tuberculosis (TB) is still one of the major threats to humankind, being the first cause of death by an infectious disease worldwide. TB is a communicable chronic disease that every year affects 10 million people and kills almost 2 million people in the world. The main key factors fueling the disease are the progressive urbanization of the population and poverty-related socioeconomic factors. Moreover, the lack of effective tools for TB diagnosis, prevention, and treatment has decisively contributed to the lack of an effective model to predict TB spread. In Nigeria, the rapid urbanization along with unprecedented population growth is causing TB to be endemic. This paper proposes a mathematical model to evaluate TB burden in Nigeria by using data obtained from the local TB control program in the community. This research aims to point out effective strategies that could be used to effectively reduce TB burden and death due to TB in this country at different levels. The study shows that efforts should be oriented to more active case finding rather than increasing the treatment effectiveness only. It also reveals that the persistence of the disease is related to a large number of latently infected individuals and quantifies the lives that could be saved by increasing the notification rate using active case finding strategy. We conclude that undiagnosis is the bottleneck that needs to be overcome in addition to the incorporation, improvement, and/or strengthening of treatment management and other essential TB control measures in Nigeria.

Abstract P299: Changes in Race-Sex Specific Population Attributable Fraction for Obesity-Related Diabetes, 2001-2016

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Natalie Cameron ◽  
Megan McCabe ◽  
Lucia Petito ◽  
Norrina B Allen ◽  
Mercedes R Carnethon ◽  
...  
Keyword(s):  
Population Attributable Fraction ◽  
Population Level ◽  
Attributable Fraction ◽  
Incident Diabetes ◽  
Obesity Prevalence ◽  
Longitudinal Assessment ◽  
Prevalence Of Obesity ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Over Time

Introduction: Estimating effects of population-level increases in obesity on diabetes has important implications for public health policy. Therefore, we used the population attributable fraction (PAF) to quantify trends in the burden of obesity on incident diabetes in key sex and race/ethnicity subgroups over time. Hypothesis: PAFs for obesity attributable incident diabetes will be greatest for women, differ by race/ethnicity and increase over time. Methods: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we estimated unadjusted and adjusted hazard ratios (HRs) of obesity on incident diabetes mellitus (DM). We included non-Hispanic White (NHW), non-Hispanic Black (NHB) and Hispanic-Mexican (MA) MESA participants with available data on body mass index and key covariates and without DM at baseline. Next, we estimated the prevalence of obesity in four pooled groups of NHANES survey cycles from 2001-2016 with similar characteristics to MESA participants (age 45-80 years, NHW, NHB, and MA without cardiovascular disease). Lastly, we combined estimates from MESA and NHANES to quantify unadjusted and adjusted PAFs (adjusted for age, income, education, physical activity and diet). Leveraging the objective longitudinal assessment of incident DM in MESA and a nationally representative sample of NHANES, we estimated broadly generalizable PAF estimates over time. Results: Of 3869 MESA participants, mean age was 61 (± 10) years with 47% men, 56% NHW, 31% NHB, and 13% MA. Incidence of DM was 11% with overall adjusted HR of 2.75 (95% CI 2.26, 3.34) for obesity. Prevalence of obesity increased from 34% (32, 37) in 2001-2004 to 41% (39, 44) in 2013-2016. Overall adjusted PAFs ranged from 0.23 to 0.52 over the study period (TABLE), with greatest estimates in NHW women. Conclusions: In conclusion, over time, the proportion of diabetes due to obesity has increased across multiple subgroups of the population, further highlighting the health burden of obesity in the population.

scholarly journals Inequality in fertility rate among adolescents: evidence from Timor-Leste demographic and health surveys 2009–2016

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Sanni Yaya ◽  
Betregiorgis Zegeye ◽  
Bright Opoku Ahinkorah ◽  
Kelechi Elizabeth Oladimeji ◽  
Gebretsadik Shibre
Keyword(s):  
Adolescent Girls ◽  
Birth Rate ◽  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
Attributable Risk ◽  
Attributable Fraction ◽  
Demographic And Health Surveys ◽  
Timor Leste ◽  
Adolescent Fertility ◽  
Adolescent Birth

Abstract Background Despite a decline in global adolescent birth rate, many countries in South East Asia still experience a slower pace decline in adolescent birth rates. Timor-Leste is one of the countries in the region with the highest adolescent birth rate and huge disparities between socio-economic subgroups. Hence, this study assessed the magnitude and trends in adolescent fertility rates within different socio-demographic subgroups in Timor-Leste. Methods Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Timor-Leste Demographic and Health surveys (TLDHS) were analyzed between 2009 and 2016. We approached the inequality analysis in two steps. First, we disaggregated adolescent fertility rates by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio and Population Attributable Fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance. Results We found large socio-economic and area-based inequalities over the last 7 years. Adolescent girls who were poor (Population Attributable Fraction: -54.87, 95% CI; − 57.73, − 52.02; Population Attributable Risk: -24.25, 95% CI; − 25.51, − 22.99), uneducated (Difference: 58.69, 95% CI; 31.19, 86.18; Population Attributable Fraction: -25.83, 95% CI; − 26.93, − 24.74), from rural areas (Ratio: 2.76, 95% CI; 1.91, 3.60; Population Attributable Risk: -23.10, 95% CI; − 24.12, − 22.09) and from the Oecussi region (Population Attributable Fraction: -53.37, 95% CI; − 56.07, − 50.67; Difference: 60.49, 95% CI; 29.57, 91.41) had higher chance of having more births than those who were rich, educated, urban residents and from the Dili region, respectively. Conclusions This study identified disproportionately higher burden of teenage birth among disadvantaged adolescents who are, poor, uneducated, rural residents and those living in regions such as Oecussi, Liquica and Manufahi, respectively. Policymakers should work to prevent child marriage and early fertility to ensure continuous education, reproductive health care and livelihood opportunities for adolescent girls. Specialized interventions should also be drawn to the subpopulation that had disproportionately higher adolescent childbirth.

Tuberculosis Isolation Comparison of Written Procedures and Actual Practices in Three California Hospitals

2000 ◽  
Vol 21 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Patrice M. Sutton ◽  
Mark Nicas ◽  
Robert J. Harrison
Keyword(s):  
Healthcare Worker ◽  
Negative Pressure ◽  
Control Program ◽  
Control Measures ◽  
Work Practices ◽  
Patient Room ◽  
Hospital Policy ◽  
Patient Isolation ◽  
Tb Control ◽  
Cdc Guidelines

AbstractObjective:To evaluate implementation of healthcare worker exposure control measures for tuberculosis (TB)-patient isolation, as specified by Centers for Disease Control and Prevention (CDC) guidelines and the hospital's TB-control policy.Design:Prospective multihospital study comparing CDC guidelines and hospital policy for TB-patient isolation to once-weekly observations of TB-patient isolation practices over 14 consecutive weeks at each hospital.Setting:Three urban hospitals (two county, one private community) in counties in California with a high incidence rate of TB.Measurements:Work practices for TB-patient isolation were observed and ventilation performance of isolation rooms was assessed while patient rooms were in use for TB isolation.Results:Of 170 TB-patient rooms observed, 119 (70%) involved a patient in a designated TB isolation room, the room was under negative pressure, the door was closed, and a “respiratory precautions” sign was on the door; 32 patient-room units (19%) were not under negative pressure or not designated as negative-pressure rooms. Of 151 patient-room units mechanically capable of negative pressure at a prior point in time, 16 (11%) were not under negative pressure at the time of use. Of 67 patient-room units equipped with continuous monitoring devices, 8 (12%) involved devices that did not accurately reflect the direction of airflow. Of the 62 healthcare workers observed using a respirator for TB, 40 (65%) did not don the respirator properly.Conclusions:Implementing CDC guidelines for TB-patient isolation was feasible but imperfect in the three hospitals. Day-to-day work practices deviated from hospital policy. Prospectively quantifying the implementation of a hospital TB isolation policy while the room is in use may lead to improved estimates of risk and may help to identify and thereby prevent avoidable healthcare worker exposures to Mycobacterium tuberculosis aerosol. Auditing practices and verifying equipment performance is likely to identify unexpected problems in implementation of the TB control program.

scholarly journals Time trends, geographical, socio-economic, and gender disparities in neonatal mortality in Burundi: evidence from the demographic and health surveys, 2010–2016

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Sanni Yaya ◽  
Betregiorgis Zegeye ◽  
Bright Opoku Ahinkorah ◽  
Edward Kwabena Ameyaw ◽  
Abdul-Aziz Seidu ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Urban Areas ◽  
Economic Status ◽  
Statistical Significance ◽  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
Demographic And Health Surveys ◽  
Live Births ◽  
Urban Rural ◽  
Over Time

Abstract Background Programmatic and research agendas surrounding neonatal mortality are important to help countries attain the child health related 2030 Sustainable Development Goal (SDG). In Burundi, the Neonatal Mortality Rate (NMR) is 25 per 1000 live births. However, high quality evidence on the over time evolution of inequality in NMR is lacking. This study aims to address the knowledge gap by systematically and comprehensively investigating inequalities in NMR in Burundi with the intent to help the country attain SDG 3.2 which aims to reduce neonatal mortality to at least as low as 12 per 1000 live births by 2030. Methods The Burundi Demographic and Health Survey (BDHS) data for the periods of 2010 and 2016 were used for the analyses. The analyses were carried out using the WHO’s HEAT version 3.1 software. Five equity stratifiers: economic status, education, residence, sex and subnational region were used as benchmark for measuring NMR inequality with time over 6 years. To understand inequalities from a broader perspective, absolute and relative inequality measures, namely Difference, Population Attributable Risk (PAR), Ratio, and Population Attributable Fraction (PAF) were calculated. Statistical significance was measured by computing corresponding 95% Confidence Intervals (CIs). Results NMR in Burundi in 2010 and 2016 were 36.7 and 25.0 deaths per 1000 live births, respectively. We recorded large wealth-driven (PAR = -3.99, 95% CI; − 5.11, − 2.87, PAF = -15.95, 95% CI; − 20.42, − 11.48), education related (PAF = -6.64, 95% CI; − 13.27, − 0.02), sex based (PAR = -1.74, 95% CI; − 2.27, − 1.21, PAF = -6.97, 95% CI; − 9.09, − 4.86), urban-rural (D = 15.44, 95% CI; 7.59, 23.29, PAF = -38.78, 95% CI; − 45.24, − 32.32) and regional (PAR = -12.60, 95% CI; − 14.30, − 10.90, R = 3.05, 95% CI; 1.30, 4.80) disparity in NMR in both survey years, except that urban-rural disparity was not detected in 2016. We found both absolute and relative inequalities and significant reduction in these inequalities over time - except at the regional level, where the disparity remained constant during the study period. Conclusion Large survival advantage remains to neonates of women who are rich, educated, residents of urban areas and some regions. Females had higher chance of surviving their 28th birthday than male neonates. More extensive work is required to battle the NMR gap between different subgroups in the country.

scholarly journals Vascular risk factors and stroke risk across the life span: A population-representative study of half a million people

2022 ◽  
pp. 174749302110706
Author(s):  
Raed A Joundi ◽  
Scott B Patten ◽  
Jeanne VA Williams ◽  
Eric E Smith
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Stroke Risk ◽  
Population Attributable Fraction ◽  
Attributable Fraction ◽  
Hazard Ratio ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Younger Age ◽  
Over Time

Background: The incidence of stroke in developed countries is increasing selectively in young individuals, but whether this is secondary to traditional vascular risk factors is unknown. Methods: We used the Canadian Community Health Survey from 2000 to 2016 to create a large population-representative cohort of individuals over the age of 30 and free from prior stroke. All analyses were stratified by age decile. We linked with administrative databases to determine emergency department visits or hospitalizations for acute stroke until December 2017. We calculated time trends in risk factor prevalence (hypertension, diabetes, obesity, and smoking) using meta-regression. We used Cox proportional hazard models to evaluate the association between vascular risk factors and stroke risk, adjusted for demographic, co-morbid, and social variables. We used competing risk regression to account for deaths and calculated population-attributable fractions. In a sensitivity analysis, we excluded those with prior heart disease or cancer. Results: We included 492,400 people in the analysis with 8865 stroke events over a median follow-up time of 8.3 years. Prevalence of hypertension, diabetes, and obesity increased over time while smoking decreased. Associations of diabetes, hypertension, and obesity with stroke risk were progressively stronger at younger age (adjusted hazard ratio for diabetes was 4.47, 95% confidence interval (CI) = 1.95–10.28 at age 30–39, vs 1.21, 95% CI = 0.93–1.57 at age 80+), although the obesity association was attenuated with adjustment. Smoking was associated with higher risk of stroke without a gradient across age deciles, although had the greatest population-attributable fraction at younger age. The hazard ratio for stroke with multiple concurrent risk factors was much higher at younger age (adjusted hazard ratio for 3–4 risk factors was 8.60, 95% CI = 2.97–24.9 at age 30–39 vs 1.61, 95% CI = 0.88–2.97 at age 80+) and results were consistent when accounting for the competing risk of death and excluding those with prior heart disease or cancer. Conclusions: Diabetes and hypertension were associated with progressively elevated relative risk of stroke in younger individuals and prevalence was increasing over time. The association of obesity with stroke was not significant after adjustment for other factors. Smoking had the greatest prevalence and population-attributable fraction for stroke at younger age. Our findings assist in understanding the relationship between vascular risk factors and stroke across the life span and planning public health measures to lower stroke incidence in the young.

scholarly journals Spatial-temporal analysis of Tuberculosis in Chongqing, China 2011-2018

2020 ◽  
Author(s):  
Ya Yu ◽  
Bo Wu ◽  
Chengguo Wu ◽  
Qingya Wang ◽  
Daiyu Hu ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Temporal Analysis ◽  
Early Spring ◽  
Control Measures ◽  
Late Winter ◽  
Notification Rate ◽  
Temporal And Spatial Distribution ◽  
Tb Control ◽  
Spatial Distribution Characteristics ◽  
Spatial Temporal Analysis

Abstract Background: China is a country with a high burden of pulmonary tuberculosis (PTB). Chongqing is in the southwest of China, where the notification rate of PTB ranks tenth in China. This study analyzed the temporal and spatial distribution characteristics of PTB in Chongqing in order to improve TB control measures. Methods: A spatial-temporal analysis has been performed based on the data of PTB from 2011 to 2018, which was extracted from the National Surveillance System. The effect of TB control was measured by variation trend of pathogenic positive PTB notification rate and total TB notification rate. Time series, spatial autonomic correlation and spatial-temporal scanning methods were used to identify the temporal trends and spatial patterns at county level. Results: A total of 188,528 cases were included in this study. A downward trend was observed in PTB between 2011 and 2018 in Chongqing. The peak of PTB notification occurred in late winter and early spring annually. By calculating the value of Global Moran's I and Local Getis’s Gi*, we found that PTB was spatially clustered and some significant hot spots were detected in the southeast and northeast of Chongqing. One most likely cluster and three secondary clusters were identified by Kulldorff’s scan spatial-temporal Statistic. Conclusions: This study identified seasonal patterns and spatial-temporal clusters of PTB cases in Chongqing. Priorities should be given to southeast and northeast of Chongqing for better TB control.

scholarly journals Spatial-temporal analysis of Tuberculosis in Chongqing, China 2011-2018

2020 ◽  
Author(s):  
Ya Yu ◽  
Bo Wu ◽  
Chengguo Wu ◽  
Qingya Wang ◽  
Daiyu Hu ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Temporal Analysis ◽  
Early Spring ◽  
Control Measures ◽  
Late Winter ◽  
Notification Rate ◽  
Temporal And Spatial Distribution ◽  
Tb Control ◽  
Spatial Distribution Characteristics ◽  
Spatial Temporal Analysis

Abstract Background: China is a country with a high burden of pulmonary tuberculosis (PTB). Chongqing is in the southwest of China, where the notification rate of PTB ranks tenth in China. This study analyzed the temporal and spatial distribution characteristics of PTB in Chongqing in order to improve TB control measures.Methods: A spatial-temporal analysis has been performed based on the data of PTB from 2011 to 2018, which was extracted from the National Surveillance System. The effect of TB control was measured by variation trend of pathogenic positive PTB notification rate and total TB notification rate. Time series, spatial autonomic correlation and spatial-temporal scanning methods were used to identify the temporal trends and spatial patterns at county level.Results: A total of 188,528 cases were included in this study. A downward trend was observed in PTB between 2011 and 2018 in Chongqing. The peak of PTB notification occurred in late winter and early spring annually. By calculating the value of Global Moran's I and Local Getis’s Gi*, we found that PTB was spatially clustered and some significant hot spots were detected in the southeast and northeast of Chongqing. One most likely cluster and three secondary clusters were identified by Kulldorff’s scan spatial-temporal Statistic.Conclusions: This study identified seasonal patterns and spatial-temporal clusters of PTB cases in Chongqing. Priorities should be given to southeast and northeast of Chongqing for better TB control.

Tuberculosis Control in Health Care

1996 ◽  
Vol 17 (12) ◽  
pp. 819-827
Author(s):  
Gina Pugliese ◽  
Michael L. Tapper
Keyword(s):  
Health Care ◽  
Healthcare Delivery ◽  
Control Program ◽  
Control Measures ◽  
Tuberculosis Control ◽  
Regulatory Requirements ◽  
Tb Control ◽  
Additional Information ◽  
Basic Framework ◽  
Tb Control Program

AbstractThis article describes the basic framework for developing a tuberculosis (TB) control program. We suggest how to assess the risk of TB in a healthcare delivery setting, how to prioritize control measures based on their effectiveness, and how to meet current regulatory requirements. In addition, we discuss some problematic issues, examples of how other hospitals have confronted these issues, and where to obtain additional information on nosocomial TB.

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