Catastrophic costs due to tuberculosis in South India: comparison between active and passive case finding

2019 ◽  
Vol 114 (3) ◽  
pp. 185-192 ◽  
Author(s):  
Malaisamy Muniyandi ◽  
Beena Elizabeth Thomas ◽  
Nagarajan Karikalan ◽  
Thiruvengadam Kannan ◽  
Krishnan Rajendran ◽  
...  
Keyword(s):  
Rural Areas ◽  
Logistic Model ◽  
South India ◽  
Point Of Care ◽  
Multiple Regression Model ◽  
Case Finding ◽  
Active Case Finding ◽  
Household Level ◽  
Factors Associated ◽  
Income Status

Abstract Background To measure and compare economic burden at the household level for tuberculosis (TB) patients who were detected through active case finding (ACF) and passive case finding (PCF) in rural areas. Methods This study was conducted in the Thiruvallur district from October 2016 to March 2018. TB patients diagnosed through ACF were included in this study. For the comparison, patients diagnosed through ACF were recruited in the ratio of 1:2 from the same study area during the same period. Costs between the groups were compared and a multiple regression model was used to identify factors associated with catastrophic costs due to TB. Results Of the 336 individuals, 110 were diagnosed through ACF and 226 through PCF. A total of 29% of patients diagnosed through PCF and 9% of patients diagnosed through ACF experienced catastrophic costs due to TB. The multiple logistic model shows that catastrophic costs due to TB had a significant association with higher income status (adjusted odds ratio [aOR] 4.91 [confidence interval {CI} 2.39 to 10.08]; p<0.001), alcohol use (aOR 2.78 [CI 1.33 to 5.81]; p=0.007), private as a first point of care (aOR 3.91 [CI 2.01 to 7.60]; p<0.001) and PCF (aOR 3.68 [CI 1.62 to 8.33]; p=0.002). Conclusions Findings highlight that ACF significantly averted catastrophic costs due to TB among patients. ACF as a strategy could ensure financial protection of TB patients and limit their risk of poverty.

scholarly journals Individual-, maternal- and household-level factors associated with stunting among children aged 0–23 months in Bangladesh

2018 ◽  
Vol 22 (1) ◽  
pp. 85-94 ◽  
Author(s):  
Sabuj Kanti Mistry ◽  
Md. Belal Hossain ◽  
Fouzia Khanam ◽  
Fahmida Akter ◽  
Mahmood Parvez ◽  
...  
Keyword(s):  
Rural Areas ◽  
Random Sampling ◽  
Maternal Education ◽  
Reduction Rate ◽  
Urban Slums ◽  
Health Concern ◽  
Special Focus ◽  
Cross Sectional Survey ◽  
Household Level ◽  
Factors Associated

AbstractObjectiveChildhood stunting remains a major public health concern in Bangladesh. To accelerate the reduction rate of stunting, special focus is required during the first 23 months of a child’s life when the bulk of growth takes place. Therefore the present study explored individual-, maternal- and household-level factors associated with stunting among children under 2 years of age in Bangladesh.DesignData were collected through a nationwide cross-sectional survey conducted between October 2015 and January 2016. A two-stage cluster random sampling procedure was applied to select 11 428 households. In the first stage, 210 enumerations areas (EA) were selected with probability proportional to EA size (180 EA from rural areas, thirty EA from urban slums). In the second stage, an average of fifty-four households were selected from each EA through systematic random sampling.SettingRural areas and urban slums of Bangladesh.ParticipantsA total of 6539 children aged 0–23 months.ResultsOverall, 29·9 % of the children were stunted. After adjusting for all potential confounders in the modified Poisson regression model, child’s gender, birth weight (individual level), maternal education, age at first pregnancy, nutrition (maternal level), administrative division, place of residence, socio-economic status, food security status, access to sanitary latrine and toilet hygiene condition (household level) were significantly associated with stunting.ConclusionsThe study identified a number of potentially addressable multilevel risk factors for stunting among young children in Bangladesh that should be addressed through comprehensive multicomponent interventions.

scholarly journals Blood-based host biomarker diagnostics in active case finding for pulmonary tuberculosis: a diagnostic accuracy study

2021 ◽  
Author(s):  
Flora Martinez Figueira Moreira ◽  
Renu Verma ◽  
Paulo Cesar Pereira dos Santos ◽  
Alessandra Leite ◽  
Andrea da Silva Santos ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Screening Program ◽  
Point Of Care ◽  
Case Finding ◽  
National Council ◽  
Active Case Finding ◽  
Diagnostic Accuracy Study ◽  
Active Case ◽  
Accuracy Study ◽  
Triage Test

SummaryBackgroundThere is a need to identify scalable tuberculosis screening strategies among high burden populations. The WHO has identified a non-sputum-based triage test as a development priority.MethodsWe performed a diagnostic accuracy study of point-of-care C-reactive protein (CRP) and Xpert-MTB-Host-Response (Xpert-MTB-HR) assays in the context of a mass screening program for tuberculosis in two prisons in Brazil. Incarcerated individuals irrespective of symptoms were screened by sputum Xpert-MTB/RIF and sputum culture. CRP was quantified in serum by a point-of-care assay (iChroma-II) and a 3-gene expression score was quantified from whole blood using the Xpert-MTB-HR cartridge. We evaluated receiver operating characteristic area under the curve (AUC) and assessed specificity at 90% sensitivity and sensitivity at 70% specificity, consistent with WHO target product profile (TPP) benchmarks.FindingsTwo hundred controls controls and 100 culture- or Xpert-positive tuberculosis cases were included. Half of tuberculosis cases and 11% of controls reported any tuberculosis symptoms. AUC for CRP was 0.79 (95% CI: 0.73-0.84) and for Xpert-MTB-HR was 0.84 (95% CI: 0.79-0.89). At 90% sensitivity, Xpert-MTB-HR had significantly higher specificity (53.0%, 95% CI: 45.0-69.0%) than CRP (28.1%, 95% CI: 20.2-41.8%) (p=0.003). Among individuals with medium or high sputum Xpert semi-quantitative load, sensitivity (at 70% specificity) of CRP (90.3%, 95% CI: 74.2-98.0) and Xpert-MTB-HR (96.8%, 95% CI: 83.3-99.9%) was higher.InterpretationFor active case finding in this high tuberculosis-burden setting, CRP and Xpert-MTB-HR did not meet TPP benchmarks for a triage test. However, Xpert-MTB-HR was highly sensitive in detecting individuals with medium or high sputum bacillary burden.FundingNational Institutes of Health (R01 AI130058 and R01 AI149620) and Brazilian National Council for Scientific and Technological Development (CNPq-404182/2019-4). Xpert-MTB-HR cartridges were provided by Cepheid.

scholarly journals Enablers and Challenges in the Implementation of Active Case Findings in a Selected District of Karnataka, South India: A Qualitative Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Amrita N. Shamanewadi ◽  
Poonam R. Naik ◽  
Pruthu Thekkur ◽  
Suwarna Madhukumar ◽  
Abhay Subhashrao Nirgude ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
General Health ◽  
South India ◽  
Health Workers ◽  
Case Finding ◽  
Rural District ◽  
Health Staff ◽  
Active Case Finding ◽  
Active Case

Background. Active case finding (ACF) for tuberculosis (TB) is a promising tool to enhance early case detection among marginalized populations. As opposed to passive case finding, it involves systematically searching for TB in individuals who would not spontaneously present for care. The National TB Program (NTP) of India has initiated ACF for TB through the existing general health system since the end of 2017. However, prior to scale-up, there is need for exploring the implementation challenges and solutions to improve the efficiency of this program. Objectives. (1) To explore the enablers and challenges in the implementation of ACF for TB by NTP in the Bengaluru rural district of Karnataka, South India, and (2) to explore the perceived solutions to improve the efficiency of ACF activity. Methods. A qualitative descriptive study was conducted in the Bengaluru rural district during July 2018. In-depth interviews using purposively selected health care providers involved in active case finding (n=9) and presumptive TB patients (n=8) were conducted. Manual content analysis was conducted by two independent researchers to generate categories and themes. Results. The challenges in conduct of ACF were as follows: inadequate training of health care workers, shortage of staff, indifferent attitude of community due to stigma, lack of awareness about TB, illiteracy, inability to convince patients for sputum test, and delay in getting CBNAAT results. The field staff recommended the installation of mobile CBNAAT machine, involvement of general health staff in activity, training of health workers on counseling of patients, and issue of identity cards for community health workers/volunteers so that people recognize them. Conclusion. The health system challenges in conduct of ACF need to be addressed by training the health staff involved in activity and also improving the access to TB diagnostics.

scholarly journals Diagnostic yield of active case finding for tuberculosis and HIV at the household level in slums in Haiti

2017 ◽  
Vol 21 (11) ◽  
pp. 1140-1146 ◽  
Author(s):  
V. R. Rivera ◽  
M-A. Jean-Juste ◽  
S. C. Gluck ◽  
H. T. Reeder ◽  
J. Sainristil ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Case Finding ◽  
Active Case Finding ◽  
Household Level ◽  
Active Case

Active case finding for Tuberculosis among migrant brick kiln workers in South India

2020 ◽  
Vol 67 (1) ◽  
pp. 38-42
Author(s):  
Vanishree Shriraam ◽  
R. Srihari ◽  
T. Gayathri ◽  
Lakshmi Murali
Keyword(s):  
South India ◽  
Case Finding ◽  
Active Case Finding ◽  
Brick Kiln ◽  
Active Case

scholarly journals A Household-based analysis of domestic energy consumption for lighting in Jaipur City

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Nand Kumar ◽  
V Devadas
Keyword(s):  
Energy Consumption ◽  
Rural Areas ◽  
Urban Areas ◽  
Electricity Consumption ◽  
Household Survey ◽  
Multiple Regression Model ◽  
Consumption Pattern ◽  
Household Level ◽  
Domestic Energy ◽  
Jaipur City

India being the third largest economy of the world, more than two third of the total population lives in villages and started to consuming more quantity of energy in the recent years. Though the electricity consumption in the domestic sector has increased up to 22 per cent of the total electricity consumption, electricity consumption in villages is very less, since good number of villages in the rural system are not even electrified. In urban areas almost 90 percent of the household use electricity for lighting and just 10 percent use kerosene for the said purpose, whereas in the rural areas still more number of households use kerosene for lighting purposes. In this paper an attempt is made to analyze the domestic energy consumption for lighting in Jaipur city. Good amount of literature collected pertaining to domestic energy consumption for lighting purposes across the globe, analyzed thoroughly and presented. Further, a household survey was conducted among 684 households in Jaipur city by employing pre-tested schedule. The schedule has few variables including identification particulars, economic conditions, demographic pattern, domestic lighting appliances at the household level; and the energy consumption pattern. Further the collected data are analyzed and a multiple regression model was developed by considering the total electricity consumption as dependent variable ‘Y’ and the electrical appliances for lighting purposes, such as the number of incandescent bulbs, tube lights, CFL, and LED are considered as ‘X’ variables; and this study conclude with plausible findings and recommendations.

scholarly journals Capturing heterogeneous infectiousness in transmission dynamic models of tuberculosis: a compartmental modelling approach

2020 ◽  
Author(s):  
Yayehirad A Melsew ◽  
Romain Ragonnet ◽  
Allen C Cheng ◽  
Emma S McBryde ◽  
James M Trauer
Keyword(s):  
Dynamic Models ◽  
Deterministic Model ◽  
Point Of Care ◽  
Case Finding ◽  
Case Detection ◽  
Active Case Finding ◽  
Substantial Impact ◽  
Active Case ◽  
Equivalent Effect ◽  
Disease Episode

AbstractInfectiousness heterogeneity among individuals with tuberculosis (TB) is substantial and is likely to have a significant impact on the long-term dynamics of TB and the effectiveness of interventions. However, there is a gap in capturing heterogeneous infectiousness and evaluating its impact on the effectiveness of interventions.Informed by observed distribution of secondary infections, we constructed a deterministic model of TB transmission using ordinary differential equations. The model incorporated assumption of heterogeneous infectiousness with three levels of infectivity, namely non-spreaders, low-spreaders and super-spreaders. We evaluated the effectiveness of dynamic transmission untargeted and targeted implementation of an intervention intended to represent active case finding with a point-of-care diagnostic tool. The simulated intervention detected 20% of all TB patients who would otherwise have been missed by the health system during their disease episode and was compared across four epidemiological scenarios.Our model suggested that targeting the active case finding intervention towards super-spreaders was more effective than untargeted intervention in all setting scenarios, with more effectiveness in settings with low case detection and high transmission intensity. For instance, a targeted intervention achieved a 42.2% reduction in TB incidence, while the untargeted intervention achieved only a 20.7% reduction over 20 years, given the same number of people treated. Although the most marked impact on equilibrium TB incidence came from the rate of late reactivation, the proportion of super-spreaders and their relative infectiousness had shown substantial impact.Targeting active case-finding interventions to highly infectious cases likely to be particularly beneficial in settings where case detection is poor. Heterogeneity-related parameters had an equivalent effect to several other parameters that have been established as being very important to TB transmission dynamics.

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