scholarly journals The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Suman Chandra Gurung ◽  
Kritika Dixit ◽  
Bhola Rai ◽  
Maxine Caws ◽  
Puskar Raj Paudel ◽  
...  
Keyword(s):  
Social Protection ◽  
Case Finding ◽  
World Health ◽  
Active Case Finding ◽  
Annual Household Income ◽  
Chi Square ◽  
Active Case ◽  
Pre Treatment ◽  
Health Organization

Abstract Background The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. Methods The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. Results Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P <  0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. Conclusions ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.

scholarly journals Correction to: Role of community-based active case finding in screening tuberculosis in Yunnan province of China

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Jin-Ou Chen ◽  
Yu-Bing Qiu ◽  
Zulma Vanessa Rueda ◽  
Jing-Long Hou ◽  
Kun-Yun Lu ◽  
...  
Keyword(s):  
Yunnan Province ◽  
Case Finding ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case

scholarly journals Socio-protective effects of active case finding on catastrophic costs from tuberculosis in Ho Chi Minh City, Viet Nam: a longitudinal patient cost survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Luan Nguyen Quang Vo ◽  
Rachel Jeanette Forse ◽  
Andrew James Codlin ◽  
Ha Minh Dang ◽  
Vinh Van Truong ◽  
...  
Keyword(s):  
Social Protection ◽  
Case Finding ◽  
Ho Chi Minh City ◽  
Socioeconomic Impact ◽  
Viet Nam ◽  
Protective Effects ◽  
Active Case Finding ◽  
Intensive Phase ◽  
Patient Cost ◽  
Active Case

Abstract Background Many tuberculosis (TB) patients incur catastrophic costs. Active case finding (ACF) may have socio-protective properties that could contribute to the WHO End TB Strategy target of zero TB-affected families suffering catastrophic costs, but available evidence remains limited. This study measured catastrophic cost incurrence and socioeconomic impact of an episode of TB and compared those socioeconomic burdens in patients detected by ACF versus passive case finding (PCF). Methods This cross-sectional study fielded a longitudinal adaptation of the WHO TB patient cost survey alongside an ACF intervention from March 2018 to March 2019. The study was conducted in six intervention (ACF) districts and six comparison (PCF) districts of Ho Chi Minh City, Viet Nam. Fifty-two TB patients detected through ACF and 46 TB patients in the PCF cohort were surveyed within two weeks of treatment initiation, at the end of the intensive phase of treatment, and after treatment concluded. The survey measured income, direct and indirect costs, and socioeconomic impact based on which we calculated catastrophic cost as the primary outcome. Local currency was converted into US$ using the average exchange rates reported by OANDA for the study period (VNĐ1 = US$0.0000436, 2018–2019). We fitted logistic regressions for comparisons between the ACF and PCF cohorts as the primary exposures and used generalized estimating equations to adjust for autocorrelation. Results ACF patients were poorer than PCF patients (multidimensional poverty ratio: 16 % vs. 7 %; p = 0.033), but incurred lower median pre-treatment costs (US$18 vs. US$80; p < 0.001) and lower median total costs (US$279 vs. US$894; p < 0.001). Fewer ACF patients incurred catastrophic costs (15 % vs. 30 %) and had lower odds of catastrophic cost (aOR = 0.17; 95 % CI: [0.05, 0.67]; p = 0.011), especially during the intensive phase (OR = 0.32; 95 % CI: [0.12, 0.90]; p = 0.030). ACF patient experienced less social exclusion (OR = 0.41; 95 % CI: [0.18, 0.91]; p = 0.030), but more often resorted to financial coping mechanisms (OR = 5.12; 95 % CI: [1.73, 15.14]; p = 0.003). Conclusions ACF can be effective in reaching vulnerable populations and mitigating the socioeconomic burden of TB, and can contribute to achieving the WHO End TB Strategy goals. Nevertheless, as TB remains a catastrophic life event, social protection efforts must extend beyond ACF.

scholarly journals Active Case Finding for Improved Ebola Virus Disease Case Detection in Nimba County, Liberia, 2014/2015: Lessons Learned

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
E. Namukose ◽  
C. Bowah ◽  
I. Cole ◽  
G. Dahn ◽  
P. Nyanzee ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Health Workers ◽  
Virus Disease ◽  
Case Finding ◽  
Lessons Learned ◽  
Ebola Virus Disease ◽  
World Health ◽  
Case Detection ◽  
Active Case Finding ◽  
Active Case

Objectives. Early case detection and isolation of patients infected with highly infectious diseases are crucial in the management and control of epidemics such as Ebola Virus Disease (EVD). In this paper, we share the lessons learned from implementation of active case finding as a strategy for improved EVD case detection in Nimba County, Liberia. Methods. We adopted the World Health Organization (WHO) active surveillance strategy to identify and report suspected EVD cases, follow up contacts of confirmed cases, and report community deaths. We identified, trained, and deployed 1060 Community Health Volunteers (CHVs) in 718 communities in Nimba County. The CHVs were supervised by 142 health workers within their catchment area. The health workers were supervised by the District Health Officers (DHOs). The DHOs reported to the County Health Team (CHT) who provided supportive supervision. Data collection was based on the EVD contact tracing and active case finding forms adopted from WHO. Data analysis was based on epi-weeks. Results. The number of EVD suspected cases increased by more than 75% following the initiation of active case finding. Average duration between symptom onset and case detection reduced from between three and five days to within 24 hours. Collection of oral swabs from dead bodies increased from two to 15 within the first week of active case finding strategy implementation. Reporting of other IDSR priority diseases and conditions also improved. Conclusion. Active case finding strategy in Nimba increased suspected EVD case detection and reduced the duration between onset of symptoms and detection of cases.

scholarly journals Examining the sensitivity of the surveillance system to detect TB cases in Afghanistan

2020 ◽  
Author(s):  
Naqibullah Hamdard ◽  
Alim Atarud ◽  
Khalid Seddiq ◽  
Anwar Hanif
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
High Risk ◽  
Surveillance System ◽  
Risk Groups ◽  
Case Finding ◽  
World Health ◽  
Active Case Finding ◽  
Active Case ◽  
Primary Health

Abstract BackgroundTuberculosis (TB) remains a global public health threat. World Health Organization (WHO) End TB strategy recommends that effective TB control relies on general health systems, especially, on integrated and well-functioning PHC facilities. Despite, integration in Basic Package of Health Services (BPHS), evidence demonstrates that a large number of TB cases are not captured. 25000 TB cases are missed every year (Aloudal, 2015). 49% of individuals, recorded at health facilities as presumptive to have TB have not been screened (HMIS, 2016). This study intended to evaluate different dimensions of TB surveillance system and the Primary Health Care (PHC) facilities' role in TB active case finding. MethodsWe conducted a cross-sectional study. The study was implemented in eleven provinces of Afghanistan in from August to November 2016. The geographic and demographic representativeness determined the choice of provinces. All primary health care facilities in studied provinces equated to 870, therefore, considering a 95 % confidence interval, a sample size of 161 facilities established the sample frame. A stratified sampling strategy facilitated the selection of sampled facilities within different categories from an inclusive list of all facilities.ResultsThe study found that the overall sensitivity of TB surveillance systems in-country is 56.30 %. This means that 43.70 % of 171 TB cases had remained undetected. 43.81 % of studies facilities used at least one accepted active case finding strategy while 56.20 % implemented none. In studied areas, 83.33 % of 11 studied DHs and 69.57 % of 35 studied CHCs had a referral system for MDR-TB patients.ConclusionTo enhance sensitivity and boost case findings, it is essential to implement case-finding strategies targeted at high-risk groups in specific areas. The high-risk groups include IDPs, returnees, slum residents, prisoners, and addicts. Additionally, it is necessary to train private pharmacists and traditional healers to identify and refer individuals with TB symptoms for follow up and further evaluation at the PHC level.

scholarly journals ‘A double-edged sword’: Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities—A qualitative study based on expert interviews

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247568
Author(s):  
Olivia Biermann ◽  
Raina Klüppelberg ◽  
Knut Lönnroth ◽  
Kerri Viney ◽  
Maxine Caws ◽  
...  
Keyword(s):  
Evidence Base ◽  
Case Finding ◽  
Unintended Consequences ◽  
World Health ◽  
Active Case Finding ◽  
Perceived Benefits ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Tuberculosis Screening ◽  
Active Case

Background Active case-finding (ACF), also referred to as community-based tuberculosis screening, is a component of the World Health Organization’s End TB Strategy. ACF has potential benefits but also harms, which need to be carefully assessed when developing and implementing ACF policies. While empirical evidence on the benefits of ACF is still weak, evidence on the harms is even weaker. This study aimed to explore experts’ views on the benefits and harms of ACF for people with presumptive TB and communities. Methods This was an exploratory study. Semi-structured interviews were conducted with a purposive sample of 39 experts from international, non-governmental/non-profit organizations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide. Framework analysis was applied. Results Findings elaborated perceived benefits of ACF, including reaching vulnerable populations, reducing patient costs, helping raise awareness for tuberculosis among individuals and engaging communities, and reducing tuberculosis transmission. Perceived harms included increasing stigma and discrimination, causing false-positive diagnoses, as well as triggering other unintended consequences related to screening for tuberculosis patients, such as deportation of migrants once confirmed to have tuberculosis. Most of the perceived benefits of ACF could be linked to its objective of finding and treating persons with tuberculosis early (theme 1), while ACF was also perceived as a “double-edged sword” and could cause harms, if inappropriately designed and implemented (theme 2). The analysis underlined the importance of considering the benefits and harms of ACF throughout the screening pathway. The study provides new insights into the perceived benefits and harms of ACF from the perspectives of experts in the field. Conclusion This study highlights gaps in the evidence base surrounding ACF and can stimulate further research, debate and analysis regarding the benefits and harms of ACF to inform contextual optimization of design and implementation of ACF strategies.

scholarly journals Identifying TB hotspots through mobile X-rays in Karachi, Pakistan: spatial analysis of data from an active case-finding program

2021 ◽  
Author(s):  
Syed Mohammad Asad Zaidi ◽  
Wafa Zehra Jamal ◽  
Christina Mergenthaler ◽  
Kiran Sohail Azeemi ◽  
Nick Van Den Berge ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Spatial Autocorrelation ◽  
Case Finding ◽  
World Health ◽  
Moran’S I ◽  
X Rays ◽  
Active Case Finding ◽  
Moran's I ◽  
X Ray ◽  
Active Case

Abstract IntroductionTuberculosis (TB) is the leading cause of avoidable deaths from an infectious disease globally and a large of number of people who develop TB each year remain undiagnosed. Active case-finding has been recommended by the World Health Organization to bridge the case-detection gap for TB in high burden countries. However, concerns remain regarding their yield and cost-effectiveness. MethodsData from mobile chest X-ray (CXR) supported active case-finding community camps conducted in Karachi, Pakistan from July 2017- March 2020 was retrospectively analyzed. After a CXR screening supported by computer-aided detection, those with presumptive TB were counselled to submit a sputum sample for Xpert MTB/RIF testing. Frequency analysis was carried out at the camp-level and outcomes of interest for the spatial analyses were mycobacterium TB positivity (MTB+) and X-ray abnormality ratios. The Moran’s I statistic was used to test for spatial autocorrelation for MTB+ and abnormal X-rays within Union Councils (UCs) in Karachi. Local Indicators of Spatial Autocorrelation analyses were performed for UCs within Karachi. Point-pattern analyses were carried out utilizing GPS coordinates recorded at the camp sites and were analyzed for spatial autocorrelation using Getis Ord Star tests.ResultsA total of 1,161 (78.1%) camps yielded no MTB+ cases, 246 (16.5%) camps yielded 1 MTB+, 52 (3.5%) camps yielded 2 MTB+ and 27 (1.8%) yielded 3 or more MTB+. A total of 79 (5.3%) camps accounted for 193 (44.0%) of MTB+ cases detected. Statistically significant clustering for MTB positivity (Moran’s I: 0.09) and abnormal chest X-rays (Moran’s I: 0.36) ratios was identified within UCs in Karachi. Clustering of UCs with high MTB positivity were identified in Karachi West district. Clusters of camp locations with high MTB+ ratios were identified in Karachi South and Karachi West districts and in several locations in the north and eastern peripheries of the city. ConclusionStatistically significant spatial variation was identified in yield of bacteriologically positive TB cases and in abnormal CXR through active case-finding in Karachi. Cost-effectiveness of active case-finding programs can be improved by identifying and focusing interventions in hotspots and avoiding locations with no known TB cases reported through routine surveillance.

Drinking-Water Quality and Intestinal Infectious Diseases in a Colombian Department, 2010-2016

2020 ◽  
pp. 21-29
Author(s):  
Dora Cardona Rivas ◽  
Militza Yulain Cardona Guzmán ◽  
Olga Lucía Ocampo López
Keyword(s):  
Water Quality ◽  
Drinking Water ◽  
Infectious Diseases ◽  
Disease Burden ◽  
Social Protection ◽  
Drinking Water Quality ◽  
World Health ◽  
The Social ◽  
Etiological Agents ◽  
Health Organization

Objective: To characterize the burden of intestinal infectious diseases attributable to drinking-water quality in 27 municipalities in the central region of Colombia. Materials and methods: A time-trend ecological study. The drinking-water quality of the National Institute of Health and the Institute of Hydrology, Meteorology and Environmental Studies was identified. The disease burden was calculated based on the mortality registered in the National Department of Statistics and the records of morbidity attended by the Social Protection Integrated Information System. The etiological agents reported in morbidity records and the observation of environmental conditions in the municipalities of the study were included. The disease burden was determined according to the methodology recommended by the World Health Organization (WHO).

HUBUNGAN PENDIDIKAN DAN STATUS EKONOMI DENGAN STATUS GIZI IBU HAMIL TRIMESTER III DI PUSKESMAS SOSIAL PALEMBANG TAHUN 2012

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Tirta Anggraini Tirta Anggraini
Keyword(s):  
Nutritional Status ◽  
Pregnant Women ◽  
Health Center ◽  
Economic Status ◽  
Social Health ◽  
World Health ◽  
Third Trimester ◽  
Chi Square ◽  
Cross Sectional ◽  
Health Organization

ABSTRACT According to the World Health Organization (WHO), maternal nutritional status at the time of growth and during pregnancy can affect fetal growth and development. Based on (IDHS) survey of 2007 AKI Indonesia at 228 per 100,000 live births, although this figure is still the highest in Asia. Social health center in Palembang in 2011 the number of pregnant women with good nutritional status of 67 men (97.1%). factors that influence the nutritional status of pregnant women is the temperature of the environment, economic status, habits and views of women to food, age, education, and health status. The purpose of this study is a known relationship education and economic status with nutritional status of pregnant women in the third trimester of Social Health Center Palembang in 2012. This study uses analytic survey with cross sectional approach. The population in this study were all third trimester pregnant women who visit the health center Social Palembang in May 2012, with a sample of 30 respondents. Sampling in this study with non-random methods with techniques Accidental Sampling. Data analysis carried out univariate and bivariate statistics with Chi-Square test with significance level α = 0.05. The results showed than 30 respondents there (73.3%) of respondents that good nutritional status, higher education (76.7%), and high economic status (70.0%). The results of this study showed no significant association education and economic status with nutritional status of pregnant women in the third trimester of Social Health Center Palembang in 2012. From the results of this study, researchers hope to improve the health care workers, especially health services in Antenatal Care services pay more attention to maternal risk of poor nutritional status.   ABSTRAK Menurut World Health Organization (WHO), status gizi ibu hamil pada waktu pertumbuhan dan selama hamil dapat mempengaruhi pertumbuhan dan perkembangan janin. Berdasarkan (SDKI) survei terakhir tahun 2007 AKI Indonesia sebesar 228 per 100.000 Kelahiran Hidup, meskipun demikian angka tersebut masih tertinggi di Asia.  Di Puskesmas Sosial Palembang tahun 2011 jumlah ibu hamil yang berstatus gizi baik sebesar 67 orang (97,1%). faktor-faktor yang mempengaruhi status gizi ibu hamil adalah suhu lingkungan, status ekonomi, kebiasaan dan pandangan wanita terhadap makanan, usia, pendidikan, dan status kesehatan. Tujuan penelitian ini adalah diketahuinya hubungan pendidikan dan status ekonomi dengan status gizi ibu hamil trimester III di Puskesmas Sosial Palembang tahun 2012. Penelitian ini menggunakan metode survey analitik dengan pendekatan cross sectional. Populasi pada penelitian ini adalah semua ibu hamil trimester III yang berkunjung di Puskesmas Sosial Palembang pada bulan Mei tahun 2012, dengan jumlah sampel 30 responden. Pengambilan sampel pada penelitian ini dengan metode non random dengan teknik Accidental Sampling. Analisa data dilakukan secara univariat dan bivariat dengan uji statistik Chi-Square dengan tingkat kemaknaan α = 0,05. Hasil penelitian menunjukkan dari 30 responden terdapat (73,3%) responden yang berstatus gizi baik, pendidikan tinggi (76,7%), dan status ekonomi tinggi (70,0%). Hasil penelitian ini menunjukkan ada hubungan yang bermakna pendidikan dan status ekonomi dengan status gizi ibu hamil trimester III di Puskesmas Sosial Palembang tahun 2012. Dari hasil penelitian ini, peneliti berharap petugas pelayanan kesehatan dapat meningkatkan pelayanan kesehatan terutama dalam pelayanan Antenatal Care lebih memperhatikan kehamilan ibu yang berisiko status gizi buruk.

Sign in / Sign up

Export Citation Format

Share Document