Evaluation of the performance of an in-house duplex PCR assay targeting the IS6110 and rpoB genes for tuberculosis diagnosis in Cameroon

Abstract Background Tuberculosis (TB) remains a major public health concern in many low-income countries accounting for approximately two-thirds of deaths in people living with human immunodeficiency virus (HIV) infection. With prompt, accurate and appropriate treatment, almost all TB disease can be cured. The present study was to evaluate the diagnostic performance of an in-house duplex PCR (D-PCR) using IS1610 and rpoB specific primers in sputum samples from TB suspected patients. Methods A hospital-based cross-sectional study was conducted at the Limbe and Buea Regional Hospitals of the South West Region of Cameroon from June 2016 to April 2017. Sputum samples, decontaminated with hypertonic saline/sodium hydroxide solution were centrifuged and pellets processed for smear microscopy, culture and DNA extraction. Suspected inhibition was resolved by serial dilution of genomic DNA. Results were compared to culture as gold standard as well as a Composite Reference Standard (CRS). Results A total of 129 participants aged between 5 to 82 years were enrolled in to the study. The median age of the participants was 37 years (interquartile range, IQR: 27–50 years), with 54.3% being male. Forty-seven samples (36.4%) were positive by direct sputum microscopy, 49 (38%) by microscopy after concentration, 51 (39.5%) by culture and 62 (40.1%) by D-PCR. PCR inhibition was resolved in 85.7% (18/21) of the samples that had inhibition. The overall sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and area under the curve AUC) of the D-PCR was 93.5, 94, 94, 94%, 15.6, 0.005 and 89.0% respectively using CRS as reference. The sensitivities of D-PCR observed among different sample categories were 95.7, 87.5 and 87.5% for smear-and culture-positives, smear-negative/culture-positive, and clinically diagnosed cases respectively. Conclusion IS1610 and rpoB duplex PCR using relatively cheap decontamination and DNA extraction methods in addition to simple serial dilutions to resolve PCR inhibition shows high sensitivity in the diagnosis of paucibacillary tuberculosis.

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Will Households Invest in Safe Sanitation? Results from an Experimental Demand Trial in Nakuru, Kenya

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094462 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4462

Author(s):

Rachel Peletz ◽

Caroline Delaire ◽

Joan Kones ◽

Clara MacLeod ◽

Edinah Samuel ◽

...

Keyword(s):

Low Income ◽

Low Income Countries ◽

Health Concern ◽

High Quality ◽

Market Prices ◽

Price Point ◽

Improved Sanitation ◽

Sanitation Infrastructure ◽

The City ◽

Experimental Demand

Unsafe sanitation is an increasing public health concern for rapidly expanding cities in low-income countries. Understanding household demand for improved sanitation infrastructure is critical for planning effective sanitation investments. In this study, we compared the stated and revealed willingness to pay (WTP) for high-quality, pour-flush latrines among households in low-income areas in the city of Nakuru, Kenya. We found that stated WTP for high-quality, pour-flush latrines was much lower than market prices: less than 5% of households were willing to pay the full costs, which we estimated between 87,100–82,900 Kenyan Shillings (KES), or 871–829 USD. In addition, we found large discrepancies between stated and revealed WTP. For example, 90% of households stated that they would be willing to pay a discounted amount of 10,000 KES (100 USD) for a high-quality, pour-flush latrine, but only 10% of households redeemed vouchers at this price point (paid via six installment payments). Households reported that financial constraints (i.e., lack of cash, other spending priorities) were the main barriers to voucher redemption, even at highly discounted prices. Our results emphasize the importance of financial interventions that address the sizable gaps between the costs of sanitation products and customer demand among low-income populations.

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Bias in the perceived prevalence of open defecation: evidence from Bihar, India

10.31234/osf.io/szg35 ◽

2020 ◽

Author(s):

Jinyi Kuang ◽

Erik Thulin ◽

Sania Ashraf ◽

Alex Shpenev ◽

Upasak Das ◽

...

Keyword(s):

Low Income ◽

Low Income Countries ◽

Health Concern ◽

Open Defecation ◽

Behavior Change Interventions ◽

Significant Public Health Concern ◽

False Consensus ◽

Significant Public Health ◽

Consensus Bias ◽

Actual Prevalence

People often form perceptions about how prevalent a behavior is in a social group. However, these perceptions can be inaccurate and biased. While persistent undesirable practices in low-income countries have drawn global attention, evidence regarding people’s perception of how prevalent these practices are is scarce. Among those harmful practices, open defecation in India remains a significant public health concern, where it perpetuates the vicious cycle of disease and poverty. In this study, we focus on measuring the perceived prevalence of open defecation among respondents in Bihar, India. We examined the bias in perceived prevalence, which is defined as a pattern of deviation from the actual prevalence of open defecation. Results showed that respondents who defecate in the open overestimate the prevalence of open defecation, whereas those who consistently use toilets underestimate it. This finding suggests a false consensus bias in the perceived prevalence of open defecation. Scholars, policymakers, and program implementers who seek to correct misperceptions about open defecation by broadcasting real prevalence should be aware of biases in the perceived prevalence and address them in behavior change interventions.

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Availability of ENT Surgical Procedures and Medication in Low-Income Nation Hospitals: Cause for Concern in Zambia

BioMed Research International ◽

10.1155/2020/1980123 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Lufunda Lukama ◽

Chester Kalinda ◽

Warren Kuhn ◽

Colleen Aldous

Keyword(s):

Surgical Procedures ◽

Low Income ◽

Care Delivery ◽

National Policy ◽

Low Income Countries ◽

Health Concern ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Essential Drugs ◽

High Prevalence

Background. Ear, nose, and throat (ENT) diseases are an oft overlooked global health concern. Despite their high prevalence and associated morbidity and mortality, ENT diseases have remained neglected in health care delivery. In Zambia and many other low-income countries, ENT services are characterized by poor funding, unavailable surgical procedures, and erratic supply of essential drugs. Objective. To investigate ENT service provision in Zambia with regard to availability of surgical procedures and supply of essential drugs. Methods. A descriptive cross-sectional survey was conducted using a piloted structured questionnaire between 17 January 2017 and 2 January 2018. Included in the study were the 109 hospitals registered with the Ministry of Health (MoH) across the 10 provinces of Zambia. Results. Of the participating hospitals, only 5.9% (n=1) and 40% (n=2) of Second-Level Hospitals (SLH) and Third-Level Hospitals (TLH), respectively, carried out tympanoplasty, myringotomy, and grommet insertion (M+G). Frontal trephination and external ethmoidectomy were offered in 11.7% (n=2) and 40% (n=2) of SLH and TLH, respectively. While tracheostomy (39.3%, n=24), tonsillectomy (27.9%, n=17), and adenoidectomy (27.9%, n=17) were the most widely performed head and neck procedures, laryngectomy was carried out by 1 hospital. Between 14.8% (n=9) and 36.1% (n=22) of hospitals lacked antibiotic and/or antiseptic ear drops. Despite 96.7% (n=59) of the respondents acknowledging ENT as an important branch of clinical practice, only 15.3% (n=4) of the hospitals had a budget for ENT. Also, 6.6% (n=4) of the respondents thought the discipline of ENT had received enough attention. Conclusion. ENT service delivery in Zambia is limited with regard to performed surgical procedures and availability of essential drugs, necessitating urgent intervention. The findings from this study may be used to direct national policy on the improvement of provision of ENT services in Zambia.

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Child Maltreatment and associated Sociodemographic factors among Children affected by HIV/AIDS in Ghana: A Multi-Informant Perspective

10.21203/rs.3.rs-368841/v1 ◽

2021 ◽

Author(s):

Paul Narh Doku

Keyword(s):

Child Maltreatment ◽

Low Income ◽

Sociodemographic Factors ◽

Low Income Countries ◽

Health Concern ◽

Vulnerable Children ◽

Cross Sectional ◽

Orphans And Vulnerable Children ◽

Systemic Risks ◽

Hiv Aids

Abstract Background: Child maltreatment and its consequences are considered a major public health concern among children because they can cause significant physical and psychological problems. Child maltreatment is widespread but often underestimated. Surprisingly, there is hardly any data on the frequency of child maltreatment in general and particularly on orphans and vulnerable children in low-income countries. Method: This study employed cross-sectional, quantitative survey that involved 291 children aged 10–17 years in Lower Manya Krobo District, Ghana and examined their exposure to and experience of child maltreatment. The survey also examined parents/caregivers’ exposure and perpetuation of child maltreatment. Results: Some form of maltreatment within the household was reported by approximately 90% of children, and it was significantly higher among orphans and vulnerable children (OVC) as compared with comparison children. Children living with HIV/AIDS-infected parents and orphans of any type reported higher exposure to domestic violence and experienced significantly more neglect, psychological and physical abuse than the comparison children. Conclusion: The results of this survey demonstrate that maltreatment among children affected by HIV/AIDS are not rare, and that the dysfunction family conditions that they find themselves bear systemic risks for maltreatment. It is important that culturally appropriate and evidence-based interventions are implemented to address the maltreatment.

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Prevalence and Associated Risk Factors for Anaemia Among Pregnant Women Attending Ante-Natal Clinic, Eswatini

10.21203/rs.3.rs-753198/v1 ◽

2021 ◽

Author(s):

Rumbidzai Dodzo ◽

Ropo Ebenezer Ogunsakin ◽

Themba G. Ginindza

Keyword(s):

Pregnant Women ◽

Low Income ◽

Cross Sectional Study ◽

Low Income Countries ◽

Health Concern ◽

Cross Sectional ◽

Neonatal Deaths ◽

Factors Associated ◽

Anaemia In Pregnancy ◽

Associated Risk Factors

Abstract Background: Anaemia is one of the most common nutritional deficiency diseases observed globally and it affects about a third of the world’s population. Anaemia in pregnant women is a worldwide public health concern that has severe consequences for both mothers and infants, including maternal death and foetal and infant mortality. In Low-income countries (LICs), 25% of indirect maternal mortality and 30% of neonatal deaths are due to anaemia in pregnancy. Therefore, this study aimed to determine the prevalence of anaemia and assess associated factors among pregnant women attending ante-natal care (ANC) clinic in the Kingdom of Eswatini, which might help for screening, prevention and treatment of anaemia and ultimately prevent its adverse effects. Method: A total of 550 pregnant women between 15 and 49 years from three health facilities were randomly enrolled using a cross-sectional study design, from January to March 2021. Non-probability sampling approach was used to select the appropriate study unit. A face-toface interview was done using a structured questionnaire to collect data. Multiple logistic regression was performed to assess the factors associated with anaemia among the women.Results: The overall anaemia prevalence among pregnant women was 43.1% (95% CI: 38.947.3). The mild, moderate and severe cases of anaemia were 21.3% (95%CI: 17.9-24.9); 21.1% (95%CI: 17.8-24.7) and 0.7% (95%CI: 0.2-1.9), respectively. The prevalence of anaemia was high among women aged 20-24 (11.1%, 95%CI: 8.6-14.0) and 25-29years (11.1%, 95%CI: 8.6-14.0). Factors associated with anaemia included living in the urban area (OR=1.8, 95%CI: 1.19-2.72, p=0.005) and having anaemia 6 months before pregnancy (OR=4.64, 95%CI: 1.1518.71, p=0.031). Additionally, gestational age at first ANC also was positively associated with anaemia: 3rd trimester (OR=10.42, 95%CI: 4.27-25.4, p<0.001) and 2nd trimester (OR=1.62, 95%CI: 1.02-2.60, p=0.043) Conclusion: Anaemia remains prevalent among pregnant women in Eswatini. Thus, a comprehensive anaemia prevention program would be justified and could lower the country’s burden of anemia.

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Performance of RIPASA and AIR Scores in a Middle-Eastern Subset of Patients with Suspected Diagnosis of Acute Appendicitis

10.21203/rs.3.rs-93856/v1 ◽

2020 ◽

Author(s):

Mohammed Faisal ◽

Ahmed Bayoumi ◽

Ahmed Abo Bakr ◽

Marcus Edlehamre ◽

Islam Khaled

Keyword(s):

Acute Appendicitis ◽

Low Income ◽

Low Income Countries ◽

Risk Scores ◽

Predictive Values ◽

Cutoff Value ◽

Egyptian Population ◽

Cutoff Values ◽

Sensitivity Specificity ◽

Ripasa Score

Abstract Background: Early and definitive acute appendicitis (AA) diagnosis remains a great challenge in clinical practice worldwide. Currently, several risk scores are available for the clinical assessment of AA, although there are differences in their accuracy rates. The aim of the study was to assess and analyze the accuracy of the acute inflammatory response (AIR) and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scores in an Egyptian population. Methods: A series of 310 patients, 61% male with a median age of 18 years, with Rt. Iliac fossa pain were clinically evaluated for suspicion of AA. All patients were assessed using both the AIR and RIPASA scores. Following evaluation, all patients underwent appendectomy. A final diagnosis of AA was based on histopathology. Two predetermined cutoff values for the AIR score and one cutoff value for the RIPASA score was evaluated for sensitivity, specificity, and accuracy. Statistical analysis was performed using SPSS version 22. Cross tabulation was performed to assess sensitivity, specificity, positive and negative predictive values along with other tests for parametric and non-parametric variables.Results: The sensitivities of the RIPASA score cutoff value of ≥7.5 and AIR score cutoff values of >4 and >8 were 83.8%, 92.2%, and 33.1%, accordingly, while the specificities were 69.2%, 76.7%, and 84.6%, respectively. AIR score of >4 (91%) was more accurate compared to AIR score of >8 (37.4%) and RIPASA score of ≥7.5 (82.5%). Conclusion: An AIR score of >4 had better sensitivity, specificity, and accuracy compared to a RIPASA score of ≥7.5 for the Egyptian population. However, an AIR score of >8 was more specific. Therefore, an evaluation of patients in low-income countries using one of these scoring systems is highly recommended to avoids unnecessary hospitalization along in negative individuals, in addition to preventing complications in positive cases.

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Patterns of Injury and Mortality in Pediatric Patients Attending Emergency Department in a Tertiary Care Center in Eastern Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.3096 ◽

2017 ◽

Vol 56 (207) ◽

pp. 331-334 ◽

Cited By ~ 3

Author(s):

Pramendra Prasad Gupta ◽

Gyanendra Bahadur Malla ◽

Rabin Bhandari ◽

Rosan Prasad Shah Kalawar ◽

Madan Mandal

Keyword(s):

Emergency Department ◽

Low Income ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Soft Tissue Injuries ◽

Low Income Countries ◽

Health Concern ◽

Cross Sectional ◽

Pattern Of Injury

Introduction: Trauma is a major and increasing global health concern in the recent world is now the leading cause of death among people less than 18 years old. Methods: This is a retrospective cross sectional study done in Emergency Department of B.P.Koirala Institute of Health Sciences. Patients aged less than 16 years were included with history of Trauma from January 1st 2013 to 31st December 2013.The details of patient were taken from computerized medical records of the hospital. The data Demographic data, Pattern of injury, Mode of injury, Diagnosis and outcomes were tabulated in Microsoft excel. Results: Total 3958 pediatrics patient were enrolled in this study. Male: Female=3.6:1,Mean age 9.6±3.2 years, fall injury & RTAs common modes and fractures of limbs, soft tissue injuries and cut injuries were common patterns. Conclusions: Injury is a serious problem for children in Low Income countries like Nepal.

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Lifestyle transitions and the developing world: Reflections on the implications for health, well-being and wealth

Journal of Hospital Administration ◽

10.5430/jha.v3n2p70 ◽

2013 ◽

Vol 3 (2) ◽

pp. 70

Author(s):

Ufuoma John Ejughemre

Keyword(s):

Economic Growth ◽

Developing Countries ◽

Low Income ◽

Well Being ◽

Evidence Base ◽

Lifestyle Changes ◽

Low Income Countries ◽

Health Concern ◽

Negative Consequences ◽

Middle Income

Context: The past few decades witnessed significant economic growth in many developing countries of the world. These economic changes towards increasing gross domestic product (GDP) brought with it several other transitions in these countries: demographic, epidemiological, technological, and nutritional. These resulted in improving the living standards as well as life expectancy in many of these countries. However, of public health concern is the fact that these transitions paradoxically have their negative consequences on the health, well-being and wealth of the populace in these countries. Objectives: This review therefore assesses the evidence of the extent to which these changes have affected the living patterns in many developing countries and the epidemiological implications besides others issues on the populace in these countries. Methods: By using key words, the author involved a broad search of literatures on lifestyle changes, economic growth, nutrition, urbanization, smoking and alcohol, communicable and non-communicable diseases in countries termed low and middle income. Findings and conclusion: The review identified discernible evidence base about the implications of these changes on health, well-being and wealth of these nations. Accordingly, as lifestyle transitions now come to bear, it thus necessitates an all inclusive approach that will include proactive and pre-emptive interventions as well as consistent participation from governments, multilateral institutions, research-funding agencies, donors, and other players in health systems. This is because it will provide the global community with great opportunities in uniting high, middle, and low-income countries in a common purpose, given the shared interests of globalization and economic burdens worldwide.

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Sickle cell disease has emerged as a public health concern. Some drugs may conflict with curative therapies, yet they may be useful as a bridge to HSCT and gene therapy

10.31219/osf.io/6kufh ◽

2021 ◽

Author(s):

Moataz Dowaidar

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Low Income ◽

Low Income Countries ◽

Health Concern ◽

Haematopoietic Stem Cell ◽

Cell Disease ◽

Public Health Concern ◽

Disease Modifying Drugs ◽

Matched Sibling

Sickle cell disease has resurfaced as a health-care priority in high-income nations and low-income countries (LMICs). Transplantation results with haploidentical haematopoietic stem cell transplantation (HSCT) are improving, increasing the likelihood of a curative treatment for the majority of patients. The indications for HSCT and for disease-modifying drugs, for example, must be determined. There are still a few things to think about, including biomarkers for systemic vasculopathy. Some medications may compete with curative treatments, but they might potentially be an important bridge treatment to HSCT. One of the most difficult hurdles yet ahead is reaching out to general practitioners and haematologists to bridge the awareness gap about curative alternatives such as matched sibling donor HSCT so that patients and their families may be identified early.

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Staff Perspectives Toward Challenges in a Newly Established Cancer Center in Tanzania: A Qualitative Study

Journal of Global Oncology ◽

10.1200/jgo.18.00246 ◽

2019 ◽

pp. 1-8

Author(s):

Zainab Alwash ◽

Oliver Henke ◽

Furaha Serventi ◽

Eva Johanna Kantelhardt

Keyword(s):

Health Care ◽

Low Income ◽

Health Care Professionals ◽

Qualitative Content Analysis ◽

Low Income Countries ◽

Health Concern ◽

Cancer Center ◽

Health Seeking ◽

Training And Education ◽

The Government

PURPOSE Cancer is a growing public health concern in low-income countries (LICs). From 14 million new patient cases identified worldwide each year, 8 million are diagnosed in LICs. The fatality rate is 75% in LICs compared with 46% in high-income countries. Causes are low literacy levels, lack of awareness and knowledge about cancer, and limited education of health care professionals that leads to late detection and diagnosis. In Tanzania, cancer incidence will double to 60,000 in 2030. The referral hospital of Northern Tanzania established a new cancer unit in December 2016 to meet these needs. However, there is limited knowledge about perceptions of health care professionals toward cancer care in LICs. This study aims to understand attitudes and perspectives of those professionals and the treatment-related challenges in a newly established center to assist future efforts in this field. METHODS A qualitative method approach using in-depth interviews was chosen to achieve inductive conceptualization. Analysis of data was performed according to qualitative content analysis. RESULTS Eleven interviews were conducted. Five main categories were found: training and education of staff, availability of financial support, challenges in management, interests in future developments, and job satisfaction. Subcategories elaborated in more detail within the main categories. CONCLUSION Limitations in staffing, training, and education were major concerns. The importance of sustainable funding and the needed cooperation of the government with international aid were identified as key points. The involvement of different stakeholders requires guidance by health care management. Health care professionals expressed their satisfaction with the possibilities of treating cancer and the rewarding feedback from patients. Misconceptions and poor knowledge by patients were mentioned as reasons for delayed health-seeking behavior. Screening and awareness programs were seen as useful interventions.

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