scholarly journals Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

2019 ◽  
Author(s):  
Simon Mutembo ◽  
Jane Namangolwa Mutanga ◽  
Kebby Musokotwane ◽  
Cuthbert Kanene ◽  
Kevin Dobbin ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Rural Areas ◽  
Directly Observed Therapy ◽  
Risk Of Death ◽  
Therapy Strategy ◽  
Rural And Urban ◽  
Risk Of Mortality ◽  
Rural Settings ◽  
Mdr Tb ◽  
Urban Rural

Abstract Setting Southern province, Zambia. Background At least 13 – 20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). Objective To estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings. Methods In a retrospective cohort study, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Results Overall 3,566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% in urban and 11.3% in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow (LTFU), and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (aOR: 1.7; 95% CI: 1.2 2.7). Risk of LTFU was twice higher in rural than urban (aOR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (aOR: 1.7; 95% CI: 1.2 3.1). Conclusion Recurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and LTFU was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting.

scholarly journals Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

2019 ◽  
Author(s):  
Simon Mutembo ◽  
Jane Namangolwa Mutanga ◽  
Kebby Musokotwane ◽  
Cuthbert Kanene ◽  
Kevin Dobbin ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Rural Areas ◽  
Directly Observed Therapy ◽  
Risk Of Death ◽  
Therapy Strategy ◽  
Rural And Urban ◽  
Rural Settings ◽  
Urban Rural ◽  
Lost To Follow Up

Abstract Setting Southern province, Zambia. Background At least 13 – 20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). Objective To estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings. Methods In a retrospective cohort study, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Results Overall 3,566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1). Conclusion Recurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting.

scholarly journals Urban-Rural Disparities in Treatment Outcomes Among Recurrent TB Cases in Zambia

2019 ◽  
Author(s):  
Simon Mutembo ◽  
Jane Namangolwa Mutanga ◽  
Kebby Musokotwane ◽  
Cuthbert Kanene ◽  
Kevin Dobbin ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Rural Areas ◽  
Directly Observed Therapy ◽  
Public Health Importance ◽  
Risk Of Death ◽  
Therapy Strategy ◽  
Rural And Urban ◽  
Rural Settings ◽  
Lost To Follow Up

Abstract Background At least 13 – 20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurrent TB between different geographical settings. The objective of our study was to estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings. Methods In a retrospective cohort study conducted in southern province of Zambia, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Data was abstracted from the facility TB registers. Results Overall 3,566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Anti-retroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1). Conclusion Recurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting where heightened TB control activities are focused on areas with poor treatment outcomes.

scholarly journals Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Simon Mutembo ◽  
Jane N. Mutanga ◽  
Kebby Musokotwane ◽  
Cuthbert Kanene ◽  
Kevin Dobbin ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Rural Areas ◽  
Directly Observed Therapy ◽  
Public Health Importance ◽  
Southern Province ◽  
Risk Of Death ◽  
Therapy Strategy ◽  
Rural Settings ◽  
Lost To Follow Up

Abstract Background At least 13–20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurrent TB between different geographical settings. The objective of our study was to estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings. Methods In a retrospective cohort study conducted in southern province of Zambia, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Data was abstracted from the facility TB registers. Results Overall 3566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1). Conclusion Recurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting where heightened TB control activities are focused on areas with poor treatment outcomes.

scholarly journals A study on treatment outcomes in MDR-TB patients on long term regimen in West Godavari district

2021 ◽  
Vol 10 (3) ◽  
pp. 266
Author(s):  
Gedela Vasavi ◽  
Banerji Neerugatti ◽  
Chiranjeevi Uday Kumar ◽  
Hari Jagannadha Rao
Keyword(s):  
Treatment Outcomes ◽  
Rural Areas ◽  
Urban Areas ◽  
Chi Square ◽  
Institutional Ethics ◽  
Rural And Urban ◽  
Number Of Patients ◽  
Ethical Committee Approval ◽  
Mdr Tb ◽  
Chi Square Test

Background: MDR-TB is defined as a TB patient whose biological specimen is resistant to isoniazid and rifampicin with or without resistant to other first line drugs, based on results from quality assured laboratory. The main aim of this study was to study the treatment outcomes of longer regimen for MDR-TB patients.Methods: This is a retrospective observational cohort study. After obtaining ethical committee approval from Institutional ethics committee, data was collected from district TB centre from 2011-2016. Outcomes of a regimen is measured in terms of cured, treatment completed, number of defaulters, treatment failure, number of patients shifted to XDR-TB regimen, number of patients died for patients on longer regimen of MDR-TB. The collected data was entered in Microsoft excel 2007 and analysed using SPSS version 20 software.Results: Out of 211 patients, 167 were males and 44 were females. The total numbers of patients registered from rural areas were 123 and from urban areas were 88. The association between geographical distribution and treatment outcome was measured using Chi-square test and X2=12.1026, p=0.0005 which was significant. Out of 211 patients registered, 87 (41.2%) were cured of disease, 55 (26%) died, 2 (0.9%) patients shifted to XDR. 18 (8.5%) patients were defined as defaulters and 2 (0.9%) patients were defined as treatment failures.Conclusions: Our study findings have indicated that treatment outcomes in drug resistant TB may be influenced by rural and urban distribution.

scholarly journals Urban–rural disparity in cancer incidence in China, 2008–2012: a cross-sectional analysis of data from 36 cancer registers

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042762
Author(s):  
Shuai Yuan ◽  
Shao-Hua Xie
Keyword(s):  
Cancer Incidence ◽  
Rural Areas ◽  
Urban Areas ◽  
Incidence Rates ◽  
Cancer Type ◽  
Anatomic Site ◽  
Cross Sectional ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Urban Rural

ObjectiveThe substantial differences in socioeconomic and lifestyle exposures between urban and rural areas in China may lead to urban–rural disparity in cancer risk. This study aimed to assess the urban–rural disparity in cancer incidence in China.MethodsUsing data from 36 regional cancer registries in China in 2008–2012, we compared the age-standardised incidence rates of cancer by sex and anatomic site between rural and urban areas. We calculated the rate difference and rate ratio comparing rates in rural versus urban areas by sex and cancer type.ResultsThe incidence rate of all cancers in women was slightly lower in rural areas than in urban areas, but the total cancer rate in men was higher in rural areas than in urban areas. The incidence rates in women were higher in rural areas than in urban areas for cancers of the oesophagus, stomach, and liver and biliary passages, but lower for cancers of thyroid and breast. Men residing in rural areas had higher incidence rates for cancers of the oesophagus, stomach, and liver and biliary passages, but lower rates for prostate cancer, lip, oral cavity and pharynx cancer, and colorectal cancer.ConclusionsOur findings suggest substantial urban–rural disparity in cancer incidence in China, which varies across cancer types and the sexes. Cancer prevention strategies should be tailored for common cancers in rural and urban areas.

scholarly journals Smear Positive Tuberculosis Cases in Rajshahi District A Comparison Between Rural and Urban Areas

1970 ◽  
Vol 17 (2) ◽  
pp. 104-105
Author(s):  
W Wasim Hussain ◽  
M Azizul Haque ◽  
Laila Shamima Sharmin ◽  
ARM Saifuddin Ekram ◽  
M Fazlur Rahman
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Detection Rate ◽  
Case Finding ◽  
Sputum Smear ◽  
Case Detection Rate ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Rural Settings ◽  
The City

This study was designed to know the case finding of sputum smear positive tuberculosis in Rajshahi district and also to see whether case finding was different in urban and rural settings. Our study reveals that case finding rate of smear positive tuberculosis cases in the city corporation area and rural areas of Rajshahi district are 52% and 28% respectively. Case detection rate of total Rajshahi district was 33%. Stronger efforts are needed to reach the national target of detecting 70% new smear positive TB cases by the end of 2005.   doi: 10.3329/taj.v17i2.3456   TAJ 2004; 17(2): 104-105

Abstract 13706: Differences in the Distribution of Systolic Blood Pressure by Rural and Urban Residence

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brittain Heindl ◽  
George Howard ◽  
Elizabeth A Jackson
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Racial Differences ◽  
Rural Areas ◽  
Urban Areas ◽  
Census Bureau ◽  
Urban Group ◽  
Rural And Urban ◽  
Urban Rural ◽  
The Difference

Introduction: The incidence of stroke is higher in rural areas. Hypertension is the leading risk factor for stroke, but the difference in systolic blood pressure (SBP) for those living in rural and urban areas is unknown. Hypothesis: We hypothesized that rural residence is associated with higher SBP levels, and this difference is modified by race, sex, and United States (US) division. Methods: We analyzed 26,113 participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, recruited between 2003 and 2007. Participants were grouped based on the Rural-Urban Commuting Area (RUCA) scheme into urban, large-rural, and small-isolated rural groups. Resting SBP was measured during the initial home visit. Differences in percentiles of SBP distribution were compared using multivariate models with adjustment for age, race, sex, and US Census Bureau division. Results: Of the participants, 20,976 (80.3%) were classified as urban, 3,020 (11.6%) as large-rural, and 2,137 (8.2%) as small-isolated rural, reflecting the distribution of the population. The large-rural group had a 0.09 mmHg higher mean SBP compared to the urban group (95% CI, 0.33 to 1.52 mmHg, p = 0.0023), but the difference in SBP at the 95th percentile between these groups was 3.23 mmHg (95% CI, 1.43 to 4.73 mmHg, p = 0.0006). A similar difference was present between the small-isolated rural and urban groups at the highest percentiles. No urban-rural interaction was observed by race, sex, or US division. However, large SBP differences were present between US divisions, especially at the highest percentiles. To illustrate, SBP at the 95th percentile was 9.51 mmHg higher in the East North Central division than in the Pacific (95% CI, 6.41 to 12.61 mmHg, p < 0.0001). Conclusions: Residence in a rural area is associated with higher SBP, with larger differences at the highest percentiles of distribution. SBP differences are present between US divisions, independent of urban-rural status.

scholarly journals The rural–urban gap: differences in injury characteristics

2019 ◽  
Vol 39 (12) ◽  
pp. 317-322
Author(s):  
Felix Bang ◽  
Steven McFaull ◽  
James Cheesman ◽  
Minh T. Do
Keyword(s):  
Rural Areas ◽  
Motor Vehicle ◽  
Soft Tissue Injuries ◽  
Eye Injuries ◽  
Injury Rates ◽  
Urban Settings ◽  
Rural And Urban ◽  
Rural Settings ◽  
Severity Of Injury ◽  
The Difference

Background Injuries are among the top 10 leading causes of death in Canada. However, the types and rates of injuries vary between rural versus urban settings. Injury rates increase with rurality, particularly those related to motor vehicle collisions. Factors such as type of work, hazardous environments and longer driving distances contribute to the difference in rural and urban injury rates. Further examination of injuries comparing rural and urban settings with increased granularity in the nature of injuries and severity is needed. Methods The study population consisted of records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from between 2011 and July 2017. Rural and urban status was determined based on postal codes as defined by Canada Post. Proportionate injury ratios (PIRs) were calculated to compare rural and urban injury rates by nature and severity of injury and sex, among other factors. Results Rural injuries were more likely to involve multiple injuries (PIR = 1.66 for 3 injuries) and crush injuries (PIR = 1.72). More modestly elevated PIRs for rural settings were found for animal bites (1.14), burns (1.22), eye injuries (1.32), fractures (1.20) and muscle or soft tissue injuries (1.11). Injuries in rural areas were more severe, with a higher likelihood of cases being admitted to hospital (1.97), and they were more likely to be due to a motor vehicle collision (2.12). Conclusion The nature of injuries in rural settings differ from those in urban settings. This suggests a need to evaluate current injury prevention efforts in rural settings with the aim to close the gap between rural and urban injury rates.

scholarly journals Creating healthy and active life for the elderly in programmes conducted by rural and urban-rural communes in Poland

2020 ◽  
Author(s):  
Anna Augustynowicz ◽  
Michał Waszkiewicz ◽  
Sławomir Szopa ◽  
Mariola Borowska ◽  
Aleksandra Czerw
Keyword(s):  
Health Policy ◽  
Rural Areas ◽  
The Elderly ◽  
Analysis Data ◽  
Healthy Life ◽  
Aggregate Information ◽  
Active Life ◽  
Rural And Urban ◽  
Urban Rural ◽  
Family Activity

Abstract Background In Poland, between 1989 and 2018 the number of the elderly increased by over 3.9 million. Demographic changes justify a senior policy focussed on the longest possible social, professional and family activity of the elderly. Directions of undertaken actions should include health policy programmes aimed at creating conditions healthy and active life of the elderly. The programmes should be particularly important in rural areas as the health of rural and urban residents differs. The study presents programmes for creating conditions for a healthy and active life of the elderly run by rural and urban-rural communes in 2012–17. Methods The study was conducted on the basis of existing data analysis. Data from the summary information prepared by voivodes and provided to the Minister of Health about implemented health policy programmes were used. Data on programmes concerning a healthy and active life for the elderly conducted by rural and urban-rural communes between 2012 and 2017 were extracted from the aggregate information. Results Between 2012 and 2017, 354 programmes were implemented, the most in 2016, and the least in 2015. There were 171 000 people participating in the programmes. The total cost was USD 2 491 664. Conclusion It can be presumed that in 2016 communes implemented more diagnostic and therapeutic programmes than in 2017. A small number of programmes and a small involvement of financial resources in communes with the largest number of the elderly may indicate marginalization of the importance of an active and healthy life for the elderly.

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