Covid-19 Cases Growth and Business Continuity in Indonesia: A Causality Test

The objective of this study is to examine the causality between Covid-19 cases growth and business continuity in Indonesia, thus can be formulated the post-Covid business strategies. The Covid-19 cases are modeled into ‘daily case’ and ‘active case’, while business continuity proxied with human mobility to grocery and pharmacy, also to retail and recreation. Using daily data ranging from March to December 2020, the Granger causality results show that there is a bidirectional causality between daily case and grocery-pharmacy business, whereas interestingly there is a unidirectional relationship from retail-recreation business to daily case. In active case model, author found a unidirectional causality from active case to both grocery-pharmacy and retail-recreation business. This research may be used to improve business strategy in order to maintain the business life during the Covid-19 Pandemic in Indonesia.

Outcome of Tuberculosis Case Surveillance at Kano Central Correctional Center, North-west Nigeria: A Need for Routine Active Case Findings for TB in Nigerian Correctional Centers

Aim: To demonstrate the need for routine active TB case finding in Nigerian correctional centers through a TB case surveillance intervention at the largest correctional centre in the most populous state in Nigeria by KNCV Tuberculosis Foundation Nigeria. Study Design: It was a retrospective review of public health intervention data derived from the mass TB screening of Kano central correctional centre inmates in Kano state, Nigeria. Methodology: A digital X-ray with artificial intelligence (AI) was used for mass TB screening of 1,967 consenting inmates at the Kano central correctional centre in Kano state, Nigeria, from 21st September to 2nd October 2020. Participants with CAD4TB score ≥ 60 had a GeneXpert assessment of their sputa for TB diagnosis. Where sputum production was not possible, or GeneXpert result was negative, expert clinical evaluation of the presumptive radiogram was carried out by experienced radiologist. Data from the project were extracted and analysed for this report. Proportions and means were compared with Fisher Exact test and Student t-test, respectively. A p-value of < 0.05 was considered statistically significant. Results: Overall, 1,967 inmates were screened for TB and 92 (4.7%) presumptive were identified - males (4.8%, 91/92), females (1.9%, 1/92). Out of the 92 presumptive, 21 males were diagnosed as TB cases giving a TB prevalence of 1.1% among the inmates and 22.8% among presumptive. One of the TB cases had multi-drug resistant TB. The number needed to screen (NNS) was 94. All TB cases were enrolled in treatment. Conclusion: The prevalence of TB at the Kano central correctional centre during the mass TB screening project was high. The National Tuberculosis Control Programme of Nigeria should accelerate the planned paradigm shift from passive to active case-finding for TB in Nigerian correctional centers.

Do community-based active case-finding interventions have indirect impacts on wider TB case detection and determinants of subsequent TB testing behaviour? A systematic review

Community-based active case-finding (ACF) may have important impacts on routine TB case-detection and subsequent patient-initiated diagnosis pathways, contributing “indirectly” to infectious diseases prevention and care. We investigated the impact of ACF beyond directly diagnosed patients for TB, using routine case-notification rate (CNR) ratios as a measure of indirect effect. We systematically searched for publications 01-Jan-1980 to 13-Apr-2020 reporting on community-based ACF interventions compared to a comparison group, together with review of linked manuscripts reporting knowledge, attitudes, and practices (KAP) outcomes or qualitative data on TB testing behaviour. We calculated CNR ratios of routine case-notifications (i.e. excluding cases identified directly through ACF) and compared proxy behavioural outcomes for both ACF and comparator communities. Full text manuscripts from 988 of 23,883 abstracts were screened for inclusion; 36 were eligible. Of these, 12 reported routine notification rates separately from ACF intervention-attributed rates, and one reported any proxy behavioural outcomes. Two further studies were identified from screening 1121 abstracts for linked KAP/qualitative manuscripts. 8/12 case-notification studies were considered at critical or serious risk of bias. 8/11 non-randomised studies reported bacteriologically-confirmed CNR ratios between 0.47 (95% CI:0.41–0.53) and 0.96 (95% CI:0.94–0.97), with 7/11 reporting all-form CNR ratios between 0.96 (95% CI:0.88–1.05) and 1.09 (95% CI:1.02–1.16). One high-quality randomised-controlled trial reported a ratio of 1.14 (95% CI 0.91–1.43). KAP/qualitative manuscripts provided insufficient evidence to establish the impact of ACF on subsequent TB testing behaviour. ACF interventions with routine CNR ratios >1 suggest an indirect effect on wider TB case-detection, potentially due to impact on subsequent TB testing behaviour through follow-up after a negative ACF test or increased TB knowledge. However, data on this type of impact are rarely collected. Evaluation of routine case-notification, testing and proxy behavioural outcomes in intervention and comparator communities should be included as standard methodology in future ACF campaign study designs.

Economic Evaluation of Community Tuberculosis Active Case-Finding Approaches in Cambodia: A Quasi-Experimental Study

This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective.

The impact of active case finding on transmission dynamics of tuberculosis: A modelling study

Background In the last decade, active case finding (ACF) strategies for tuberculosis (TB) have been implemented in many diverse settings, with some showing large increases in case detection and reporting at the sub-national level. There have also been several studies which seek to provide evidence for the benefits of ACF to individuals and communities in the broader context. However, there remains no quantification of the impact of ACF with regards to reducing the burden of transmission. We sought to address this knowledge gap and quantify the potential impact of active case finding on reducing transmission of TB at the national scale and further, to determine the intensification of intervention efforts required to bring the reproduction number (R0) below 1 for TB. Methods We adopt a dynamic transmission model that incorporates heterogeneity in risk to TB to assess the impact of an ACF programme (IMPACT TB) on reducing TB incidence in Vietnam and Nepal. We fit the models to country-level incidence data using a Bayesian Markov Chain Monte Carlo approach. We assess the impact of ACF using a parameter in our model, which we term the treatment success rate. Using programmatic data, we estimate how much this parameter has increased as a result of IMPACT TB in the implementation districts of Vietnam and Nepal and quantify additional efforts needed to eliminate transmission of TB in these countries by 2035. Results Extending the IMPACT TB programme to national coverage would lead to moderate decreases in TB incidence and would not be enough to interrupt transmission by 2035. Decreasing transmission sufficiently to bring the reproduction number (R0) below 1, would require a further intensification of current efforts, even at the sub-national level. Conclusions Active case finding programmes are effective in reducing TB in the short term. However, interruption of transmission in high-burden countries, like Vietnam and Nepal, will require comprehensive incremental efforts. Complementary measures to reduce progression from infection to disease, and reactivation of latent infection, are needed to meet the WHO End TB incidence targets.

What Makes Community Health Worker Models for Tuberculosis Active Case Finding Work? A Cross-Sectional Study of TB REACH Projects to Identify Success Factors for Increasing Case Notifications

Background In the field of tuberculosis (TB), Community Healthcare Workers (CHWs) have been engaged for advocacy, case detection, and patient support in a wide range of settings. Estimates predict large-sale shortfalls of healthcare workers in low- and middle-income settings by 2030 and strategies are needed to optimize the health workforce to achieve universal availability and accessibility of healthcare. In 2018, the World Health Organization (WHO) published guidelines on best practices for CHW engagement, and identified remaining knowledge gaps. Stop TB Partnership’s TB REACH initiative has supported interventions using CHWs to deliver TB care in over 30 countries, and utilized the same primary indicator to measure project impact at the population-level for all TB active case finding projects, which makes the results comparable across multiple settings. This study compiled 10 years of implementation data from the initiative’s grantee network to begin to address key knowledge gaps in CHW networks. Methods We conducted a cross-sectional study analyzing the TB REACH data repository (n=123) and primary survey responses (n=50) of project implementers. We designed a survey based on WHO guidelines to understand projects’ practices on CHW recruitment, training, activities, supervision, compensation, and sustainability. We segmented projects by TB notification impact and fitted linear random-effect regression models to identify practices associated with higher changes in notifications. Results Most projects employed CHWs for advocacy alongside case finding and holding activities. Model characteristics associated with higher project impact included incorporating e-learning in training and having the prospect of CHWs continuing their responsibilities at the close of a project. Factors that trended towards being associated with higher impact were community-based training, differentiated contracts, and non-monetary incentives. Conclusion In line with WHO guidelines, our findings emphasize that successful implementation approaches provide CHWs with comprehensive training, continuous supervision, fair compensation, and are integrated within the existing primary healthcare system. However, we encountered a great degree of heterogeneity in CHW engagement models, resulting in few practices clearly associated with higher notifications.

Passive versus Active Transport of Saharan Dust Aerosols by African Easterly Waves

Theory and modeling are combined to reveal the physical and dynamical processes that control Saharan dust transport by amplifying African easterly waves (AEWs). Two cases are examined: active transport, in which the dust is radiatively coupled to the circulation; passive transport, in which the dust is radiatively decoupled from the circulation. The theory is built around a dust conservation equation for dust-coupled AEWs in zonal-mean African easterly jets. The theory predicts that, for both the passive and active cases, the dust transports will be largest where the zonal-mean dust gradients are maximized on an AEW critical surface. Whether the dust transports are largest for the radiatively passive or radiatively active case depends on the growth rate of the AEWs, which is modulated by the dust heating. The theoretical predictions are confirmed via experiments carried out with the Weather Research and Forecasting model, which is coupled to a dust conservation equation. The experiments show that the meridional dust transports dominate in the passive case, while the vertical dust transports dominate in the active case.

Descriptive analysis of a tuberculosis outbreak from a northern Saskatchewan First Nations community—December 2018 to May 2019

Background: The tuberculosis (TB) incidence rate for northern Saskatchewan First Nations on-reserve is 1.5 higher than the national average. In December 2018 a member of one of these communities was diagnosed with 4+ smear-positive TB, spurring an outbreak investigation. Objectives: To describe the public health response to TB outbreak investigation and highlight the risk factors associated with TB transmission in northern Saskatchewan; and to highlight the relevance of social network contact investigation tool in outbreak management. Methods: Descriptive analysis included active TB cases and latent TB infection (LTBI) cases linked by contact investigation to the index case. Data were collected from active TB case files. Statistical analyses were performed and social network analysis conducted using household locations as points of contact between cases. Results: A total of eight active TB cases and 41 LTBI cases were identified as part of the outbreak between December 2018 and May 2019. Half of the cases (4/8) were 25 to 34 years old, and five were smear negative. One-third of the people with LTBI were 15 to 24 years old, and about a half tested positive to the new tuberculin skin test (TST). The commonly reported risk factors for TB and LTBI cases were alcohol use, cigarette use, marijuana use, previous TB infection and homelessness. Social network analysis indicated a relationship between increased node centrality and becoming an active case. Conclusion: Real-time social network contact investigation used in active-case finding was very successful in identifying cases, and enhanced nursing support, mobile clinics and mobile X-ray worked well as a means of confirming cases and offering treatment. TB outbreaks in northern Saskatchewan First Nations on-reserve communities are facilitated by population-specific factors. Efforts to implement context-specific interventions are paramount in managing TB outbreaks and preventing future transmission.

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

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.

Role of Mobile Technology in Multiple Sclerosis Patients' Health Education

ABSTRACT Background Many African and Asian randomized clinical trials stated that mobile health technology is helpful in health education and improvement of patients' compliance to medical treatment especially in chronic diseases like hypertension, diabetes mellitus and obesity. Objectives Mobile health applications can provide a health education method for MS patients and a tool for assessment of patients' compliance to medical treatment among MS patients of the Arabic speaking population. Patients and method Type of Study: Prospective comparative observational study, tool: android MS world App, study setting: arabic speaking communities, study duration: six months, study population: multiple sclerosis patients, sampling method: random, sample size 100 patients, 50 study group using the app, 50 control group non app users. Results In the present study, we revealed that total number of patients on the app of the studied group, 60(51.72%) were male and 56(46.28%) were female, and as regard number of active patients on the app of the studied groups, we found that 19(40.43%) were male and 28(59.57%) were female with 3cases dropped out. We analyzed patients in different Egyptian governments of the studied group, Most of our cases were from Cairo 66(69.47%), 9(9.47%) from Giza, 4(4.21%) from Damietta, 2(2.11%) from Alexandria, 2(2.11%) from Gharbia, 2(2.11%) from Qalyoubia, 2(2.11%) from Suez and 6(6.32%) from Upper Egypt. Regarding age characteristics of the studied group most of our cases in active case group and control group their age was ranged between 21—40 years 25(53.19%) and 27(54%) respectively there was statistically significant difference between study group where P &lt; 0.001. Regarding duration since diagnosis of the studied groups, the present study demonstrated that most of cases in active case group and control group their duration since diagnosis was ranged between 1—5 years 30(63.83%) and 31(62%) respectively, and there was no statistically significant difference between study groups where P = 0.949. Regarding the MS world Application questions, we found that61.70%of studied cases find that the app easy and simple touse,87.23% that app present the information in easy and simple way, 89.36% find that app provide with satisfying answers about MS, 95.74% were confident about information presented in that app, 93.62% find that app increase the knowledge about the drugs are taking for MS and 74.47% reported that app made them not to miss taking their drugs doses regularly. On the other hand, we found that 63.83% of cases saw that app help them overcome the usual fatigue symptoms they used to have with MS, 89.36% of cases saw that doctors in the app are good, 93.62% will use that app again and 95.74% will suggest that app for friends and that app also a tool for storing information about the patient making the doctor able to take a decision and cope with the patient condition. We have found that patients are easy to get answer embarrassing questions like that asking about their sexual condition and satisfaction after being diagnosed with multiple sclerosis the results of the questionnaire revealed that about 19 (40.43%) patients aren’t satisfied while the rest of patients in the active case study group 28 (59.57%) patients reported they are satisfied meaning that all patients in the active group answered the question in contrast to the control group asked through paper questionnaire the results revealed that 23 patients reported they are not satisfied and about 15 patients reported they are satisfied about it meaning that not patients in the control group answered the question with 12 patients didn’t answer the question that could add the advantage of mobile health apps in recording easily embarrassing questions rather than conventional methods. Conclusion Mobile health applications can provide a health education method for MS patients and a tool for assessment of patients' compliance to medical treatment among MS patients of the Arabic speaking population.