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Original Articles
Evaluation of the accessibility and its equity of the national public-private mix program for tuberculosis in Korea: a multilevel analysis
Hyunjin Son, Changhoon Kim
Epidemiol Health. 2023;45:e2023002.   Published online December 7, 2022
DOI: https://doi.org/10.4178/epih.e2023002
  • 2,531 View
  • 124 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
To examine the effect of individual and area-level characteristics on the probability of public-private mix (PPM) support (PPM coverage) for tuberculosis (TB).
METHODS
This study is a retrospective cohort design using TB reporting and treatment management data in Korea. We analyzed PPM coverage through multilevel logistic regression and empirical Bayesian estimation according to individual and area-level characteristics and their interaction.
RESULTS
Patients aged 0-29 years, women, of Korean nationality, treated at a general hospital, a one-time reporting, urban areas, and the lowest deprivation index (DI) showed higher PPM coverage. Due to the cross-level interaction, PPM coverage in the urban areas (slope=-0.048, p<0.001) had a higher level but a steeper negative deprivation gradient than in rural areas (slope= -0.015, p<0.001). For a general hospital, the PPM coverage in urban is high but more significantly decreased than in rural areas with the higher DI (urban: slope=-0.047, p<0.001; rural: slope=-0.031, p<0.001). For clinics and hospitals, the effect of DI did not appear in urban areas, but in rural areas, the higher the DI, the higher the PPM coverage with a slope of 0.046 (p<0.001) and 0.063 (p<0.001), respectively.
CONCLUSIONS
The PPM program created a significant disparity in PPM coverage between urban-rural areas and type of healthcare provider according to DI. Considering the high risk of TB incidence in areas with higher DI, institutional improvement and program redesign are needed to improve accessibility and equity.
Summary
Korean summary
다수준 분석을 통해 시행하여 PPM(Public-Private Mix) 사업의 주요한 평가 지표인 PPM coverage를 접근성과 형평성 관점에서 검토하였다. PPM 사업은 전반적으로 치료지원 수준을 높이는 효과가 있었지만, 도시화수준, 박탈 수준과 치료지원기관 선택의 3원 교차수준 교호작용의 결과로 지역간 PPM coverage에 지역박탈지수에 따른 큰 기울기를 가진 격차를 만들었다. 지역박탈수준이 큰 지역의 높은 결핵 발생 위험을 고려하면 효율성과 함께 형평성 수준을 향상시킬 수 있는 제도적 개선과 프로그램의 보완이 필요하다.
Key Message
This study analyzed the effect of individual and area-level characteristics on the probability of public-private mix (PPM) coverage for tuberculosis (TB) in Korea. The PPM program created a significant disparity in PPM coverage between urban-rural areas and type of healthcare provider according to deprivation index (DI). Given the high TB risk in areas with high DI, there is a need for institutional improvement and program redesign to improve accessibility and equity.
Nationwide trends in the incidence of tuberculosis among people with disabilities in Korea: a nationwide serial cross-sectional study
Jinsoo Min, So Young Kim, Jong Eun Park, Yeon Yong Kim, Jong Hyock Park
Epidemiol Health. 2022;44:e2022098.   Published online October 28, 2022
DOI: https://doi.org/10.4178/epih.e2022098
  • 2,965 View
  • 114 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Studies on the association between disabilities and tuberculosis (TB) are scarce. We aimed to assess the risk of active TB disease among people with disabilities.
METHODS
We conducted a nationwide serial cross-sectional study using national registry linkage databases from 2008 to 2017. The crude and age-standardized and sex-standardized incidence rates of TB were analyzed for each year according to the presence, type, and severity of disabilities. The crude incidence rate and odds of developing TB disease were examined with a multivariable logistic regression model using data from 2017.
RESULTS
The overall incidence of active TB decreased between 2008 and 2017. The age- and sex-standardized incidence rates of TB disease among people with disabilities were significantly higher than among those without disabilities throughout all observed years (p<0.001). As of 2017, the population with disabilities had a higher crude incidence rate of active TB disease than that without disabilities (119.9/100,000 vs. 48.5/100,000 person-years, p<0.001), regardless of sex, income level, and place of residence. Compared to those without disabilities, those with disabilities had higher odds of active TB (adjusted odds ratio [aOR], 1.19; 95% confidence interval [CI], 1.15 to 1.24). Individuals with mental disabilities (aOR, 1.51; 95% CI, 1.24 to1.84) had the highest odds of active TB incidence, followed by those with developmental disabilities (aOR, 1.30; 95% CI, 1.09 to 1.55).
CONCLUSIONS
People with disabilities are at a greater risk of developing TB disease. Active screening and care for TB cases would be beneficial for people with disabilities.
Summary
Korean summary
장애가 있는 사람은 이차적 건강 문제가 발생할 가능성이 더 높고 그들의 건강결정요인은 결핵 발생 위험 요인과 겹친다. 장애인은 비장애인에 비해 연령과 성별에 관계없이 활동성 결핵 발병률이 현저히 높았으며, 장애 유형 중 정신장애와 발달장애가 결핵에 더 취약한 것으로 나타났다. 장애인과 같이 결핵 감염 위험이 있는 취약계층을 파악하고 이들에게 결핵진단 및 항결핵치료의 어려움을 극복할 수 있도록 다학제적 지원을 제공하는 것이 중요하겠다.
Key Message
People with disabilities are more likely to develop secondary health conditions and their social determinants of health overlap with the risk factors for developing TB disease. We found that compared to people without disabilities, a markedly higher incidence of active TB disease among people with disabilities regardless of age and sex, and mental and developmental disabilities among types of disability were more prone to TB disease. It is critical to identify the vulnerable populations, such as people with disabilities, at risk of developing TB infection and provide them with multidisciplinary support to overcome any barriers during TB diagnosis and anti-TB treatment.

Citations

Citations to this article as recorded by  
  • The Korea National Disability Registration System
    Miso Kim, Wonyoung Jung, So Young Kim, Jong Hyock Park, Dong Wook Shin
    Epidemiology and Health.2023; : e2023053.     CrossRef
  • Nationwide Trends in Osteoporosis in Koreans With Disabilities From 2008 to 2017
    Ji Hyoun Kim, So Young Kim, Jong Eun Park, Hyo Jong Kim, Hyun Jeong Jeon, Yeon Yong Kim, Jong‐Hyock Park
    JBMR Plus.2023;[Epub]     CrossRef
  • Growing disparity in the prevalence of chronic obstructive pulmonary disease between people with and without disabilities: a Korean nationwide serial cross-sectional study
    Jinsoo Min, Jong Eun Park, So Young Kim, Yeon Yong Kim, Jong Hyock Park
    Scientific Reports.2023;[Epub]     CrossRef
The probability of diagnostic delays for tuberculosis and its associated risk factors in northwest Iran from 2005 to 2016: a survival analysis using tuberculosis surveillance data
Reza Ebrahimoghli, Hassan Ghobadi, Davoud Adham, Parviz Jangi, Abbas Abbasi-Ghahramanloo, Eslam Moradi-Asl
Epidemiol Health. 2022;44:e2022060.   Published online July 18, 2022
DOI: https://doi.org/10.4178/epih.e2022060
  • 5,626 View
  • 260 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Early diagnosis is essential for effective tuberculosis (TB) control programs. Therefore, this study examined the risk of delays in TB diagnosis and associated factors in Ardabil Province in northwest Iran from 2005 to 2016.
METHODS
This longitudinal retrospective cohort study was conducted using data obtained from the Iranian National Tuberculosis Control Program at the provincial level between 2005 and 2016. The total delay in diagnosis was defined as the time interval (days) between the onset of symptoms and TB diagnosis. Survival analysis was conducted to analyze the delay in diagnosis. Associated factors were identified using a Cox proportional hazards model.
RESULTS
A total of 1,367 new TB cases were identified. The 12-year median diagnostic delay was 45 days (interquartile range [IQR], 30-87). The annual median diagnostic delay decreased from 68 days (IQR, 33-131) in 2005 to 31 days (IQR, 30-62) in 2016. The probability of a delay in TB diagnosis decreased by 5.0% each year (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.04 to 1.07). Residence in a non-capital county (HR, 0.83; 95% CI, 0.74 to 0.92) and referral from the private health system (HR, 0.74%; 95% CI, 0.65 to 0.84) were significantly associated with an increased risk of delay in TB diagnosis over the 12-year study period.
CONCLUSIONS
The median delay decreased during the study period. We identified factors associated with a longer delay in TB diagnosis. These findings may be useful for further TB control plans and policies in Iran.
Summary
Key Message
A longitudinal analysis of tuberculosis surveillance data from northwest Iran showed that during the 12-year period from 2005 to 2016, a total of 1,367 tuberculosis cases were registered, of whom 942 patients had a prolonged diagnostic delay (>30 days) and the probability of a delay in tuberculosis diagnosis decreased by 5.0% each year.

Citations

Citations to this article as recorded by  
  • Assessing heterogeneity of patient and health system delay among TB in a population with internal migrants in China
    Ruoyao Sun, Zheyuan Wu, Hongyin Zhang, Jinrong Huang, Yueting Liu, Meiru Chen, Yixiao Lv, Fei Zhao, Yangyi Zhang, Minjuan Li, Jiaqi Yan, Hongbing Jiang, Yiqiang Zhan, Jimin Xu, Yanzi Xu, Jianhui Yuan, Yang Zhao, Xin Shen, Chongguang Yang
    Frontiers in Public Health.2024;[Epub]     CrossRef
Spatial analysis of tuberculosis treatment outcomes in Shanghai: implications for tuberculosis control
Jing Zhang, Xin Shen, Chongguang Yang, Yue Chen, Juntao Guo, Decheng Wang, Jun Zhang, Henry Lynn, Yi Hu, Qichao Pan, Zhijie Zhang
Epidemiol Health. 2022;44:e2022045.   Published online May 1, 2022
DOI: https://doi.org/10.4178/epih.e2022045
  • 7,068 View
  • 354 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Tuberculosis (TB) treatment outcomes are a key indicator in the assessment of TB control programs. We aimed to identify spatial factors associated with TB treatment outcomes, and to provide additional insights into TB control from a geographical perspective.
METHODS
We collected data from the electronic TB surveillance system in Shanghai, China and included pulmonary TB patients registered from January 1, 2009 to December 31, 2016. We examined the associations of physical accessibility to hospitals, an autoregression term, and random hospital effects with treatment outcomes in logistic regression models after adjusting for demographic, clinical, and treatment factors.
RESULTS
Of the 53,475 pulmonary TB patients, 49,002 (91.6%) had successful treatment outcomes. The success rate increased from 89.3% in 2009 to 94.4% in 2016. The successful treatment outcome rate varied among hospitals from 78.6% to 97.8%, and there were 12 spatial clusters of poor treatment outcomes during the 8-year study period. The best-fit model incorporated spatial factors. Both the random hospital effects and autoregression terms had significant impacts on TB treatment outcomes, ranking 6th and 10th, respectively, in terms of statistical importance among 14 factors. The number of bus stations around the home was the least important variable in the model.
CONCLUSIONS
Spatial autocorrelation and hospital effects were associated with TB treatment outcomes in Shanghai. In highly-integrated cities like Shanghai, physical accessibility was not related to treatment outcomes. Governments need to pay more attention to the mobility of patients and different success rates of treatment among hospitals.
Summary
Key Message
Tuberculosis treatment outcomes, a key indicator in the assessment of TB control programs, were associated with spatial autocorrelation and hospital effects in Shanghai; however, they were not associated with physical accessibility to hospitals.
Perspectives
Controlling the drug-resistant tuberculosis epidemic in India: challenges and implications
Aliabbas A. Husain, Andreas Kupz, Rajpal S. Kashyap
Epidemiol Health. 2021;43:e2021022.   Published online April 7, 2021
DOI: https://doi.org/10.4178/epih.e2021022
  • 11,203 View
  • 414 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
India has a higher tuberculosis (TB) burden than any other country, accounting for an estimated one-fourth of the global burden. Drug-resistant tuberculosis (DR-TB) presents a major public health problem in India. Patients with DR-TB often require profound changes in their drug regimens, which are invariably linked to poor treatment adherence and sub-optimal treatment outcomes compared to drug-sensitive TB. The challenge of addressing DR-TB is critical for India, as India contributes over 27% of global DR-TB cases. In recent decades, India has been proactive in its battle against TB, even implementing a revised National Strategic Plan to eliminate TB by 2025. However, to achieve this ambitious goal, the country will need to take a multifaceted approach with respect to its management of DR-TB. Despite concerted efforts made by the National TB Elimination Program, India faces substantial challenges with regard to DR-TB care, especially in peripheral and resource-limited endemic zones. This article describes some of the major challenges associated with mitigating the growing DR-TB epidemic in India and their implications.
Summary
Key Message
India is regarded as highest drug-resistant TB burden country accounting for estimated 27% of global cases. Challenge of addressing drug resistant TB is critical for India to achieve TB elimination targets of National TB program. Several heterogeneous factors have mediated the success of DR-TB management in India. In this article, we discuss, in brief, some of the major challenges and implications associated with reducing the growing DR-TB epidemic in India.

Citations

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  • Double trouble: compounding effects of COVID-19 pandemic and antimicrobial resistance on drug resistant TB epidemiology in India
    Aliabbas A. Husain, Rajpal Singh Kashyap
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Snapshot of Mycobacterium tuberculosis Phylogenetics from an Indian State of Arunachal Pradesh Bordering China
    Shiv kumar Rashmi Mudliar, Umay Kulsum, Syed Beenish Rufai, Mika Umpo, Moi Nyori, Sarman Singh
    Genes.2022; 13(2): 263.     CrossRef
Neglected paths of transmission of milkborne brucellosis and tuberculosis in developing countries: novel control opportunities
Arockiasamy Arun Prince Milton, Samir Das, Sandeep Ghatak
Epidemiol Health. 2020;42:e2020073.   Published online December 4, 2020
DOI: https://doi.org/10.4178/epih.e2020073
  • 8,453 View
  • 150 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Abstract
Brucellosis and tuberculosis are lingering zoonotic infections that are endemic in many developing parts of the world, with considerable economic and health costs. Although guidelines for the control of these diseases exist, we highlight neglected transmission routes of these diseases. We show that informal, door-to-door marketing of unpasteurized milk provides an important route for disease transmission through kitchen cross-contamination. Furthermore, the practice of discarding the first strippings of milk at farms needs adjustment to avoid floor and environmental contamination. Herein, we propose handling guidelines and a design for a milk stripping collection vessel. We believe that taking action to block these hitherto unrecognized transmission routes will complement existing efforts and guidelines.
Summary

Citations

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  • A review of three decades of use of the cattle brucellosis rough vaccine Brucella abortus RB51: myths and facts
    J. M. Blasco, E. Moreno, P. M. Muñoz, R. Conde-Álvarez, I. Moriyón
    BMC Veterinary Research.2023;[Epub]     CrossRef
  • Editorial: Taking a Fresh Look at Old Zoonoses, What Have We Been Missing in One Health Research and Education?
    Alessandra Scagliarini, Olli Peltoniemi, Anita Luise Michel
    Frontiers in Public Health.2022;[Epub]     CrossRef
Brief Communication
Effects of particulate air pollution on tuberculosis development in seven major cities of Korea from 2010 to 2016: methodological considerations involving long-term exposure and time lag
Honghyok Kim, Sarah Yu, Hongjo Choi
Epidemiol Health. 2020;42:e2020012.   Published online March 12, 2020
DOI: https://doi.org/10.4178/epih.e2020012
  • 10,626 View
  • 223 Download
  • 18 Web of Science
  • 16 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Epidemiological evidence of associations between ambient particulate matter (PM) and tuberculosis (TB) risk is accumulating. Two previous studies in Korea found associations between air pollution—especially sulfur dioxide (SO<sub>2</sub>)—and TB. In this study, we conducted an annual time-series cross-sectional study to assess the effect of PM with an aerodynamic diameter less than 10 μm (PM<sub>10</sub>) on TB risk in seven major cities of Korea from 2010 to 2016, taking into account time lag and long-term cumulative exposure.
METHODS
Age-standardized TB notification rates were derived using the Korea National TB Surveillance System. Annual average PM<sub>10</sub> concentrations were obtained from annual Korean air quality reports. We applied a generalized linear mixed model with unconstrained distributed lags of exposure to PM<sub>10</sub>. We adjusted for potential confounders such as age, health behaviors, and area-level characteristics.
RESULTS
Both average annual PM<sub>10</sub> concentrations and age-standardized TB notification rates decreased over time. The association between cumulative exposure to PM<sub>10</sub> and TB incidence became stronger as a longer exposure duration was considered. An increase of one standard deviation (5.63 μg/m<sup>3</sup>) in PM<sub>10</sub> exposure for six years was associated with a 1.20 (95% confidence interval, 1.17 to 1.22) times higher TB notification rate. The marginal association of exposure duration with the TB notification rate was highest at four and five years prior to TB notification. This association remained consistent even after adjusting it for exposure to SO<sub>2</sub>.
CONCLUSIONS
The findings of this study suggest that cumulative exposure to PM<sub>10</sub> may affect TB risk, with a potential lag effect.
Summary
Korean summary
국외 연구에서 미세먼지와 결핵발생의 관련성이 종종 보고되지만, 기존의 국내 연구에서는 관련성이 없는 것으로 알려져 있다. 본 연구는 미세먼지 노출의 누적효과와 결핵발생과의 시차에 주목하여 수행했다. 연구결과 미세먼지의 누적 노출 효과가 시간적 격차는 결핵발생률과 관련이 확인되었으며, 향후 연구에서도 이와 같은 방법론적 고려가 필요하겠다

Citations

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  • Associations between air pollutants and acute exacerbation of drug-resistant tuberculosis: evidence from a prospective cohort study
    Chan-Na Zhao, Zhiwei Xu, Peng Wang, Jie Liu, Rong Wang, Hai-Feng Pan, Fangjin Bao
    BMC Infectious Diseases.2024;[Epub]     CrossRef
  • Effects of long-term ambient air pollution exposure on township-level pulmonary tuberculosis notification rates during 2005–2017 in Ningxia, China
    Igor Popovic, Ricardo J. Soares Magalhães, Yurong Yang, Shukun Yang, Boyi Yang, Guanghui Dong, Xiaolin Wei, Greg J. Fox, Melanie S. Hammer, Randall V. Martin, Aaron van Donkelaar, Erjia Ge, Guy B. Marks, Luke D. Knibbs
    Environmental Pollution.2023; 317: 120718.     CrossRef
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    Jia-Wen Zhao, Xin-Qiang Wang, Zhen-Hua Li, Yi-Cheng Mao, Sun Zhang, Kai Huang, Cheng-Yang Hu, Xiu-Jun Zhang, Xiao-Hong Kan
    Environmental Science and Pollution Research.2023; 30(43): 98195.     CrossRef
  • Ambient PM2.5 exposures could increase risk of tuberculosis recurrence
    Kyung-Duk Min, Sun-Young Kim, Sung-il Cho
    Environmental Health and Preventive Medicine.2023; 28: 48.     CrossRef
  • Risk for development of active tuberculosis in patients with chronic airway disease—a systematic review of evidence
    Yohhei Hamada, Christopher J Fong, Andrew Copas, John R Hurst, Molebogeng X Rangaka
    Transactions of The Royal Society of Tropical Medicine and Hygiene.2022; 116(5): 390.     CrossRef
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    Xin-Qiang Wang, Ying-Qing Li, Cheng-Yang Hu, Kai Huang, Kun Ding, Xiao-Jing Yang, Xin Cheng, Kang-Di Zhang, Wen-Jie Yu, Jie Wang, Yong-Zhong Zhang, Zhen-tao Ding, Xiu-Jun Zhang, Xiao-Hong Kan
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    Da-Wei Wu, Yu-Cheng Cheng, Chih-Wen Wang, Chih-Hsing Hung, Pei-Shih Chen, Stephen Chu-Sung Hu, Chun-Hung Richard Lin, Szu-Chia Chen, Chao-Hung Kuo
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    Xin-Qiang Wang, Kai Huang, Xin Cheng, Cheng-Yang Hu, Kun Ding, Xiao-Jing Yang, Kang-Di Zhang, Wen-Jie Yu, Jie Wang, Ying-Qing Li, Shuang-Shuang Chen, Xiu-Jun Zhang, Xiao-Hong Kan
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Original Articles
Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data
Fatemeh Sarvi, Abbas Moghimbeigi, Hossein Mahjub, Mahshid Nasehi, Mahmoud Khodadost
Epidemiol Health. 2019;41:e2019032.   Published online July 9, 2019
DOI: https://doi.org/10.4178/epih.e2019032
  • 10,916 View
  • 246 Download
  • 1 Web of Science
AbstractAbstract PDF
Abstract
OBJECTIVES
Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran.
METHODS
This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages.
RESULTS
The risk of mortality from TB was found to increase with the unemployment rate (βˆ=0.02), illiteracy (βˆ=0.04), household density per residential unit (βˆ=1.29), distance between the center of the county and the provincial capital (βˆ=0.03), and urbanization (βˆ=0.81). The following other risk factors for TB mortality were identified: diabetes (βˆ=0.02), human immunodeficiency virus infection (βˆ=0.04), infection with TB in the most recent 2 years (βˆ=0.07), injection drug use (βˆ=0.07), long-term corticosteroid use (βˆ=0.09), malignant diseases (βˆ=0.09), chronic kidney disease (βˆ=0.32), gastrectomy (βˆ=0.50), chronic malnutrition (βˆ=0.38), and a body mass index more than 10% under the ideal weight (βˆ=0.01). However, silicosis had no effect.
CONCLUSIONS
The results of this study provide useful information on risk factors for mortality from TB.
Summary
Incidence and predictors of tuberculosis among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia: a retrospective follow-up study
Masino Tessu Beshir, Aklil Hailu Beyene, Kenean Getaneh Tlaye, Tefera Mulugeta Demelew
Epidemiol Health. 2019;41:e2019028.   Published online June 22, 2019
DOI: https://doi.org/10.4178/epih.e2019028
  • 13,637 View
  • 335 Download
  • 11 Web of Science
  • 14 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Tuberculosis (TB) is common in children with human immunodeficiency virus (HIV), but its effect on the survival of HIV-infected children is not well understood. Therefore, the aim of this study was to assess the incidence and predictors of active TB among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia.
METHODS
A retrospective study was conducted over 5 years using a checklist to gather data from 428 randomly selected pediatric patient charts. The checklist was adapted from the standardized antiretroviral therapy (ART) follow-up form currently used by the institution’s ART clinic. Data were analyzed by bivariate and multivariable analysis using Cox regression proportional hazards models, as appropriate. Survival was calculated and compared using the Kaplan-Meier and log-rank tests.
RESULTS
Of the 466 charts reviewed, 428 patient records were included in the analysis. A total of 67 new TB cases were observed during the follow-up period. Hence, the incidence rate in this cohort was found to be 6.03 per 100 child-years of observation. A baseline hemoglobin level <10 g/dL (adjusted hazard ratio [aHR], 7.04; 95% confidence interval [CI], 1.03 to 48.15), moderate wasting (aHR, 2.86; 95% CI, 1.02 to 7.99), and not receiving isoniazid preventive therapy (aHR, 8.23; 95% CI, 2.11 to 32.06) were among the independent predictors of TB occurrence.
CONCLUSIONS
The incidence of TB was high, particularly in pre-ART patients receiving chronic care for HIV. Close followup of HIV-positive children is crucial to protect them against the development of TB. Initiating isoniazid preventive therapy, averting malnutrition, and managing anemia are also of significant importance.
Summary

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Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study
Adel Hussein Elduma, Mohammad Ali Mansournia, Abbas Rahimi Foroushani, Hamdan Mustafa Hamdan Ali, Asrar M A Salam Elegail, Asma Elsony, Kourosh Holakouie-Naieni
Epidemiol Health. 2019;41:e2019014.   Published online April 20, 2019
DOI: https://doi.org/10.4178/epih.e2019014
  • 13,959 View
  • 544 Download
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  • 15 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan.
METHODS
This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test.
RESULTS
A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection.
CONCLUSIONS
Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients’ adherence to treatment, and to reduce contact with MDR-TB patients.
Summary

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Life expectancy of HIV-positive patients after diagnosis in Iran from 1986 to 2016: A retrospective cohort study at national and sub-national levels
Mohammad Mirzaei, Maryam Farhadian, Jalal Poorolajal, Parvin Afasr Kazerooni, Katayoun Tayeri, Younes Mohammadi
Epidemiol Health. 2018;40:e2018053.   Published online November 7, 2018
DOI: https://doi.org/10.4178/epih.e2018053
  • 10,207 View
  • 174 Download
  • 6 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Little is known about the life expectancy of individuals with human immunodeficiency virus (HIV) in Iran. This study therefore aimed to estimate the life expectancy of HIV-positive patients in Iran.
METHODS
In this retrospective cohort study, we extracted data from the Center for Disease Control and Prevention of the Ministry of Health and Medical Education and the Death Registration System. We included patients aged 20 years and older who had a specified date of diagnosis. We estimated life expectancy and its 95% confidence intervals (CIs) using Chiang’s methodology.
RESULTS
The overall life expectancy at the national level was 23.1 years (95% CI, 22.6 to 23.5). Life expectancy was 21.6 years (95% CI, 21.1 to 22.0) for men and 32.7 years (95% CI, 31.4 to 34.0) for women. The life expectancy of patients who did or did not receive antiretroviral therapy (ART) was 37.0 years (95% CI, 36.2 to 37.8) and 15.5 years (95% CI, 15.1 to 15.9), respectively. The life expectancy of patients with or without tuberculosis (TB) was 21.6 years (95% CI, 20.4 to 22.9) and 36.5 years (95% CI, 35.7 to 37.4), respectively.
CONCLUSIONS
The life expectancy of Iranian HIV-positive patients was found to be very low. To improve their longevity, improvements in ART coverage and the control and treatment of TB are advised.
Summary

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  • Factors related to baseline CD4 cell counts in HIV/AIDS patients: comparison of poisson, generalized poisson and negative binomial regression models
    Maryam Farhadian, Younes Mohammadi, Mohammad Mirzaei, Nasrin Shirmohammadi-Khorram
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Seasonality of tuberculosis in the Republic of Korea, 2006-2016
Eun Hee Kim, Jong-Myon Bae
Epidemiol Health. 2018;40:e2018051.   Published online October 20, 2018
DOI: https://doi.org/10.4178/epih.e2018051
  • 11,847 View
  • 187 Download
  • 12 Web of Science
  • 13 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
While the seasonality of notified tuberculosis has been identified in several populations, there is not a descriptive epidemiological study on the seasonality of tuberculosis in Korea. This study aimed to evaluate the seasonality of tuberculosis in Korea from 2006 to 2016.
METHODS
Data regarding notified cases of tuberculosis by year and month was obtained from the Infectious Diseases Surveillance Yearbook, 2017 published by the Korea Centers for Disease Control and Prevention. Seasonal decomposition was conducted using the method of structural model of time series analysis with simple moving averages.
RESULTS
While the trough season was winter from 2006 to 2016, the peak season was summer between 2006 and 2012, but shifted to spring between 2013 and 2016.
CONCLUSIONS
Notified tuberculosis in Korea also showed seasonality. It is necessary to evaluate factors related to the seasonality of tuberculosis for controlling tuberculosis.
Summary
Korean summary
2006-2016년 신고된 신환자의 연보를 근거로 결핵발생의 계절성 여부를 분석한 결과, 2006-2012년까지는 여름, 2013년이후는 봄에 발생 신고율이 높은 계절성을 확인하였다. 계절성을 야기하는 이유들을 찾아서 향후 결핵 예방에 활용할 필요가 있다.

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Editorial
Tuberculosis control in the Republic of Korea
Kyung Sook Cho
Epidemiol Health. 2018;40:e2018036.   Published online August 2, 2018
DOI: https://doi.org/10.4178/epih.e2018036
  • 17,324 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The incidence and mortality rates of tuberculosis (TB) in the Republic of Korea are 77 and 5.2 per 100,000 people, respectively (2016), which are the highest among the member countries of the Organization for Economic Cooperation and Development. Recently, the incidence of TB among teens and individuals in their 20s in the Republic of Korea decreased significantly. The decrease is largely attributed to the TB screening and contact investigation efforts targeting schools over the past few years. However, the incidence of TB among elderly individuals remains high, and it is even increasing compared to that in the past 10 years. Older individuals account for 42% of all TB cases and 82% of TB-related deaths. The success rate of TB treatment in the Republic of Korea has gradually increased due to various programs, such as control of non-compliance, insurance coverage for TB diagnosis and treatment, and TB public–private mix models. This study suggests that policy makers should focus their efforts on policies that prioritize a significant reduction in the incidence of TB based on the 2nd National Strategic Plan for Tuberculosis Control (2018–2022).
Summary
Korean summary
2016년 한국의 결핵 발생률은 인구 10만명당 77명이고, 결핵 사망률은 인구 10만명당 5.2명으로 경제협력개발기구(OECD) 회원국 중 가장 높은 수준이다. 본 연구는 지난 수 십 년간 한국의 결핵 발생률, 유병률 및 사망률의 변화 추이와 그간 한국 정부가 시행해 온 다양한 결핵 관리 정책들을 분석하고 향후 개선방안을 제시하고자 하였다.

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Perspectives
Vitamin D supplementation as a control program against latent tuberculosis infection in Korean high school students
Eun Hee Kim, Jong-Myon Bae
Epidemiol Health. 2018;40:e2018035.   Published online July 27, 2018
DOI: https://doi.org/10.4178/epih.e2018035
  • 11,612 View
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  • 4 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The prevalence of latnet Mycobacterium tuberculosis infection (LTBI) in the first-grade high school students in South Korea was 2.1%, which was the lowest level at congregated settings in 2017. For LTBI cases refusing anti-tuberculosis (TB) medication or having poor compliance, additional support should be considered. Eight systematic reviews concluded that vitamin D (VD) deficiency is a risk factor for TB. While three of four South Korean adolescents were VD deficiency, VD supplementation could be a practical remedy to protect LTBI students of refusing anti-TB medication or having poor compliance.
Summary
Korean summary
잠복결핵검진 검사 양성자이면서 항결핵제 복용을 거부하는 고1학생에 대한 사후 조치가 필요하다. 그동안의 연구결과들에 근거할 때, 잠복결핵이 활동성결핵으로의 전환을 억제하기 위해서 비타민 D 보충제의 투여를 검토해 볼 수 있다.

Citations

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  • Vitamin D and the risk of latent tuberculosis infection: a systematic review and meta-analysis
    Yan Cao, Xinjing Wang, Ping Liu, Yue Su, Haotian Yu, Jingli Du
    BMC Pulmonary Medicine.2022;[Epub]     CrossRef
  • Association of vitamin D levels and risk of latent tuberculosis in the hemodialysis population
    Shang-Yi Lin, Yi-Wen Chiu, Hui-Ru Yang, Tun-Chieh Chen, Min-Han Hsieh, Wen-Hung Wang, Yen-Hsu Chen
    Journal of Microbiology, Immunology and Infection.2021; 54(4): 680.     CrossRef
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    Bijay Maharjan, Ram Sharan Gopali, Ying Zhang
    International Journal of Biometeorology.2021; 65(10): 1579.     CrossRef
  • Tuberculosis risk is associated with genetic polymorphisms in the LRP2, CUBN, and VDR genes
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An opposing view on including high school students in a latent tuberculosis infection control program in Korea
Jong-Myon Bae
Epidemiol Health. 2017;39:e2017015.   Published online March 31, 2017
DOI: https://doi.org/10.4178/epih.e2017015
  • 14,022 View
  • 201 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The Korea Centers for Diseases Control and Prevention (KCDC) has announced a control program against latent <i>Mycobacterium tuberculosis</i> infection (LTBI), for a “TB-safe country” this year with the goal of a “TB-free Korea” by 2025. The program includes high school students as one target group; however, some school health teachers and parents have expressed their opposition to this. The 2015 World Health Organization guidelines do not recommend inclusion of asymptomatic high school students in LTBI control programs. Based on this guideline, the KCDC should consider excluding this population from the program.
Summary
Korean summary
질병관리본부는 결핵안심국가를 만들기 위하여 고등학교 1학년생을 포함한 잠복결핵감염 검사사업을 2017년 추진하기로 공고하였다. 그러나 2015년에 발표된 WHO 지침에 따르면 해당 대상자들은 검사대상자로 제시되어 있지않다. 근거중심의 보건정책 추진을 위해서 사업 대상 선정을 재검토할 필요가 있다.

Citations

Citations to this article as recorded by  
  • The cascade of care for latent tuberculosis infection in congregate settings: A national cohort analysis, Korea, 2017–2018
    Jinsoo Min, Hyung Woo Kim, Helen R. Stagg, Molebogeng X. Rangaka, Marc Lipman, Ibrahim Abubakar, Yunhee Lee, Jun-Pyo Myong, Hyunsuk Jeong, Sanghyuk Bae, Ah Young Shin, Ji Young Kang, Sung-Soon Lee, Jae Seuk Park, Hyeon Woo Yim, Ju Sang Kim
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    Doosoo Jeon
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    Eun Hee Kim, Jong-Myon Bae
    Epidemiology and Health.2018; 40: e2018035.     CrossRef
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    Jong-Myon Bae
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  • 결핵정책에 대하여
    찬병 박
    Public Health Affairs.2017; 1(1): 13.     CrossRef

Epidemiol Health : Epidemiology and Health