scholarly journals Co-Management of Active Tuberculosis and Diabetes Mellitus Under Supervised DOTS Strategy—A Saudi Perspective

Reports ◽  
2018 ◽  
Vol 1 (3) ◽  
pp. 25
Author(s):  
Sarvath Ali ◽  
Marepalli Rao ◽  
Ahmed Sahly ◽  
Abdulazeez Alfageeh ◽  
Abdulrahman Bakari

Tuberculosis (TB) is a global public health concern, specifically in countries which have high prevalence of HIV/AIDS, malnutrition, unhygienic conditions, etc. Some evidence has been presented that diabetes mellitus (DM) is a risk factor for TB. On the other hand, among those who have DM, TB infection enhances glucose intolerance and worsens glycemic control. The combination of TB and DM, due to immuno-compromised status of DM, can delay the healing process of TB. The focus of this paper is the World Health Organization directly observed treatment, short course (DOTS) program implemented in Gazan province, Saudi Arabia, to treat TB. The data included some patients with both TB and DM. The data has been analyzed to assess how effective the DOTS program was in managing TB. It was found that DM was not a significant factor in the outcome of TB treatment. We used the same data and observed that the non-significance of DM is due to heterogeneity of patient population, Saudis and Non-Saudis. The prevalence of DM was very high among Saudis. This is understandable in view of different lifestyles. Non-Saudis are predominantly Yemenis. For Saudis, DM was indeed found to play a role in the treatment outcome of TB, after an application of a classification tree methodology on the data. This is the main focus of the paper.

Author(s):  
Calvin W. L. Ho ◽  
Tsung-Ling Lee

Abstract Recognizing that antimicrobial resistance (AMR) poses a serious threat to global public health, the World Health Organization (WHO) has adopted a Global Action Plan (GAP) at the May 2015 World Health Assembly. Underscoring that systematic misuse and overuse of drugs in human medicine and food production is a global public health concern, the GAP-AMR urges concerted efforts across governments and private sectors, including pharmaceutical industry, medical professionals, agricultural industry, among others. The GAP has a threefold aim: (1) to ensure a continuous use of effective and safe medicines for treatment and prevention of infectious diseases; (2) to encourage a responsible use of medicines; and (3) to engage countries to develop their national actions on AMR in keeping with the recommendations. While the GAP is a necessary step to enable multilateral actions, it must be supported by effective governance in order to realize the proposed aims. This chapter has a threefold purpose: (1) To identify regulatory principles embedded in key WHO documents relating to AMR and the GAP-AMR; (2) To consider the legal and regulatory actions or interventions that countries could use to strengthen their regulatory lever for AMR containment; and (3) To highlight the crucial role of the regulatory lever in enabling other levers under a whole-of-system approach. Effective AMR containment requires a clearer understanding of how the regulatory lever could be implemented or enabled within health systems, as well as how it underscores and interacts with other levers within a whole-of-system approach.


2018 ◽  
Vol 29 (9) ◽  
pp. 873-883 ◽  
Author(s):  
Reuben Granich ◽  
Somya Gupta

The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis syndemic remains a global public health threat. Separate HIV and tuberculosis (TB) global targets have been set; however, success will depend on achieving combined disease control objectives and care continua. The objective of this study was to review available policy, budgets, and data to reconceptualize TB and HIV disease control objectives by combining HIV and TB care continua. For 22 World Health Organization (WHO) TB and TB/HIV priority countries, we used 2015 data from the HIV90–90–90watch website, UNAIDS AIDSinfo, and WHO 2016 and 2017 Global TB Reports. Global resources available in TB and HIV/TB activities for 2003–2017 were collected from publicly available sources. In 22 high-burden countries, people living with HIV on antiretroviral therapy ranged from 9 to 70%; viral suppression was 38–63%. TB treatment success ranged from 71 to 94% with 14 (81% HIV/TB burden) countries above 80% TB treatment success. From 2003 to 2017, reported global international and domestic resources for HIV-associated TB and TB averaged $2.85 billion per year; the total for 2003–2017 was 43 billion dollars. Reviewing combined HIV and TB targets demonstrate disease control progress and challenges. Using an integrated HIV and TB continuum supports HIV and TB disease control efforts focused on improving both individual and public health.


Author(s):  
Bachti Alisjahbana ◽  
Susan M McAllister ◽  
Cesar Ugarte-Gil ◽  
Nicolae Mircea Panduru ◽  
Katharina Ronacher ◽  
...  

Abstract Background Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. Methods DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. Results A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. Conclusions These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sonia Menon ◽  
Rodolfo Rossi ◽  
Alfred Dusabimana ◽  
Natasha Zdraveska ◽  
Samit Bhattacharyya ◽  
...  

Abstract Background There is scarce evidence that tuberculosis (TB) can cause diabetes in those not previously known to be diabetic. Whilst the World Health Organization (WHO) recommends screening for Diabetes Mellitus (DM) at the onset of TB treatment, nevertheless, it remains to be elucidated which patients with TB-associated hyperglycemia are at higher risk for developing DM and stand to benefit from a more regular follow-up. This review aims to firstly quantify the reduction of newly detected hyperglycemia burden in TB patients who are on treatment over time; secondly, determine the burden of TB-associated hyperglycemia after follow-up, and thirdly, synthesize literature on risk factors for unresolved TB-associated hyperglycemia in previously undiagnosed individuals. Methods We searched PUBMED, EMBASE, SCOPUS, and Global Health for articles on TB-associated hyperglycemia up to September 30th, 2019. Search terms included Tuberculosis and hyperglycemia/DM, and insulin resistance. We appraised studies, extracted data, and conducted a meta-analysis to assess the change of the burden of hyperglycemia in prospective studies. The review is registered in the PROSPERO database (CRD42019118173). Results Eleven studies were included in the meta-analysis yielding a total of 677 (27,3%) of patients with newly detected hyperglycemia at baseline. The mean quality score of eligible studies using the Newcastle-Ottawa Quality Assessment Scale was 7.1 out of 9 (range 6-9). The pooled unresolved new cases of hyperglycemia at the end of follow up was 50% (95% CI: 36–64%) and the total pooled burden of hyperglycemia at 3–6 months of follow up was 11% (95% CI: 7–16%), with both estimates displaying a high heterogeneity, which remained significant after performing a sub-analysis by DM diagnostic method and 3 months of follow up. As only 2 studies explored risk factors for unresolved hyperglycemia, no meta-analysis was performed on risk factors. Conclusion Our meta-analysis showed that although in half of the patients with newly observed hyperglycemia at baseline, it remained unresolved at a follow-up of 3 to 6 months, the total burden of hyperglycemia is slightly above 10%, 3 months after initiating TB treatment. Studies are warranted to assess whether risk factors including HIV positivity, smoking, and extensive pulmonary TB disease put patients at higher risk for DM.


2020 ◽  
Vol 8 (1) ◽  
pp. 4-10
Author(s):  
Sri Sandhya K

A novel Corona virus discovered during a pneumonia outbreak in Wuhan city, China has raised a global public health concern. This virus spread across the world affecting various countries and was declared a pandemic by World Health Organization(WHO). The outbreak started in December 2019 and by first week of April 2020, 212 countries were affected with more than 1million confirmed cases with a death roll of 79,235 worldwide. This disease was named as COVID-19 and the causative agent was named as Severe Acute Respiratory Syndrome Corona Virus -2 (SARS-CoV-2) due to its genetic similarity with SARS virus. SARS-CoV-2 is transmitted by respiratory droplets and by contact. Clinical symptoms include high fever, sore throat, cough, breathlessness, progress to pneumonia, acute respiratory distress and multisystem dysfunction. Infectivity rate is high with SARSCoV2 , as a result many countries are affected. Control measures like are quarantine, lockdown, regular handwashing, social distancing have been indicated by WHO and being followed by various countries. Due unavailability of an effective vaccine and specific antiviral medication against the virus, only symptomatic treatment along with the isolation of the patient is being done


Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 432
Author(s):  
Samuel Vilar-Palomo ◽  
Manuel Pabón-Carrasco ◽  
María Luisa Gonzalez-Elena ◽  
Lucia Ramírez-Baena ◽  
Isabel Rodríguez-Gallego ◽  
...  

Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. COVID-19 is a respiratory disease produced by the coronavirus family. The World Health Organization declared the disease a pandemic on 11 March 2020. Podiatrists are in a peculiar situation regarding the COVID-19 pandemic: that of a health professional aspect and the singularity that most of them practise as self-employed workers. The aim of the study is to evaluate in a group of podiatrists, working at a national level, their knowledge, perception and degree of anxiety related to the COVID-19 pandemic via the use of a questionnaire specifically developed to this end in the initial phase of the pandemic. We employed a transversal descriptive study with 302 participants, with a purposive sampling technique. The degree of perception and knowledge of the podiatrists about COVID-19 was analysed as well as the cognitive impact of the situation of confinement. The results showed that the podiatrists perceive this situation as serious at the economic and health level, that they have a thorough knowledge of the disease and that they are in a moderate to severe percentile of anxiety. Additionally, 76.2% cancelled their usual work. The COVID-19 pandemic is negatively perceived by this group of podiatrists at the personal, professional, health and economic level, with even a state of anxiety being produced.


2001 ◽  
Vol 5 (45) ◽  
Author(s):  
B Twisselmann

The rapid spread of HIV-1 infection in Russia has serious implications for the control of tuberculosis (TB) epidemics in the country, according to the authors of a research letter published in the Lancet (1). Aggressive prevention measures must be taken quickly if a public health disaster is to be avoided. Since October 1999, the administrative district (oblast) of Orel in Russia has been the site of a project for TB control by directly observed treatment, short course (DOTS) (http://www.who.int/gtb/dots/), organised by the World Health Organization (WHO).


2013 ◽  
Vol 7 (11) ◽  
pp. 495
Author(s):  
Reviono Reviono ◽  
Endang Sutisna Sulaeman ◽  
Bhisma Murti

Tuberkulosis merupakan masalah kesehatan masyarakat yang utama di tingkat global, regional, nasional, maupun lokal. World Health Organization menggulirkan strategi directly observed treatment short course (DOTS) dan strategi stop tuberculosis partnership bertujuan untuk menjangkau semua penderita tuberkulosis. Kedua strategi tersebut masih belum mampu mencapai target case detection rate (CDR) secara konsisten. Penelitian ini bertujuan merumuskan model modal sosial dan partisipasi masyarakat dalam crude death rate. Sasaran penelitian adalah petugas tuberkulosis dan kader di 30 desa di Kabupaten Karanganyar, Jawa Tengah. Metode yang digunakan adalah survei dan studi kasus. Hasil penelitian survei menunjukkan, desa dengan modal sosial yang tinggi mempunyai  kemungkinan untuk melampaui target CDR ≥ 70%, 9 kali lebih besar daripada desa dengan modal sosial rendah. Desa dengan partisipasi masyarakat tinggi mempunyai kemungkinan 7,5 kali lebih besar daripada desa dengan partisipasi masyarakat rendah. Hasil penelitian studi kasus menunjukkan, faktor-faktor modal sosial yang berhubungan dengan CDR terdiri dari dimensi kognitif meliputi kepercayaan dan merasa mempunyai program tuberkulosis. Dimensi relasional meliputi norma sosial, penanaman jasa pribadi, kerja sama, dan komunikasi. Dimensi struktural meliputi jejaring dan persatuan. Faktor-faktor partisipasi yang berhubungan dengan CDR meliputi identifikasi kebutuhan, menggerakan sumber daya program, dan kepemimpinan.Tuberculosis is an important public health problem of global, regional, national, and local levels. World health organization launched directly observed treatment short course (DOTS) and stop tuberculosis partnership strategies aiming to reach all tuberculosis patients. Both strategies have not been able to reach the case detection rate (CDR) target consistently. This research aimed to formulate a social capital and participation model in crude death rate. The target of research was the officers of tuberculosis programs and cadres in 30 villages in Karanganyar Regency, Central Java. The method used in this research was survey and case study. The result of survey research showed that the village with high social capital had 9 times probability of surpassing CDR target ≥ 70% than the one with low social capital and 7.5 times higher than the one with low public participation. The result of case study showed that the social capital factors relating to CDR consisted of cognitive dimension encompassing trust and sense of belonging to tuberculosis program. Relational dimension encompassed social norm, personal service implantation, cooperation, and communication. Structural dimension involved public network and association. The factors of participation relating to CDR included need identification, activating the program resource, and leadership.


2021 ◽  
Vol 21 (3) ◽  
pp. 1107-1116
Author(s):  
Ezgi Dirgar ◽  
Betül Tosun ◽  
Soner Berşe ◽  
Nuran Tosun

Background: Coronavirus disease (COVID-19) has raised the global public health concern and has been declared a pan- demic by the World Health Organization. Objectives: This study was aimed to examine the clinical course and outcomes of the patients with COVID-19 in the south- eastern part of Turkey. Methods: This retrospective study was conducted on the files of 173 patients who were diagnosed with COVID-19. The “COVID-19 Case Information Form” in the patients’ medical records was used. Results: Of the patients with COVID-19, 64.2% were male and 16.2% had a chronic disease. Their mean age was 34.76±25.75 years. Cough and fatigue were the most common clinical symptoms at admission with 38.7%. The patients at the age of 65 and over were treated mostly in the intensive care unit, and the symptoms associated with the cardiovascular and nausea and vomiting were observed more often (p<0.05). Conclusions: It was found that the majority of the patients were male and there were differences between the age groups in terms of transmission route, the clinic where they were being followed-up, some symptoms, and clinical status outcome. It is recommended that multi-center, prospective, experimental, or observational studies with larger samples should be and the patients should be followed-up for longer periods. Keywords: COVID-19; coronavirus; surveillance; retrospective study.


2003 ◽  
Vol 7 (14) ◽  
Author(s):  

To mark world TB day, 24 March 2003, the World Health Organization (WHO) has published the seventh annual report on global tuberculosis (TB) control. This report aims to share information from national TB control programmes, and includes data on case notifications and treatment outcomes. It also provides analysis of plans, finances and constraints on DOTS (directly observed treatment-short course) expansion for the 22 high burden countries in order to assess progress toward global targets for case detection (70%) and treatment success (85%).


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