Abstract Important policy questions during infections disease outbreaks include: i) How effective are particular interventions?; ii) When can resource-intensive interventions be removed? We used ...mathematical modelling to address these questions during the 2017 Ebola outbreak in Likati Health Zone, Democratic Republic of the Congo (DRC). Eight cases occurred before 15 May 2017, when the Ebola Response Team (ERT; co-ordinated by the World Health Organisation and DRC Ministry of Health) was deployed to reduce transmission. We used a branching process model to estimate that, pre-ERT arrival, the reproduction number was $$R=1.49$$ R = 1.49 (95% credible interval $$({{{\mathrm{0.67,2.81}}})$$ ( 0.67, 2.81 ) ). The risk of further cases occurring without the ERT was estimated to be 0.97 (97%). However, no cases materialised, suggesting that the ERT’s measures were effective. We also estimated the risk of withdrawing the ERT in real-time. By the actual ERT withdrawal date (2 July 2017), the risk of future cases without the ERT was only 0.01, indicating that the ERT withdrawal decision was safe. We evaluated the sensitivity of our results to the estimated $$R$$ R value and considered different criteria for determining the ERT withdrawal date. This research provides an extensible modelling framework that can be used to guide decisions about when to relax interventions during future outbreaks.
To validate the SF-36 questionnaire in a Chinese population and to assess the patients' health-related quality of life (HQoL) during tuberculosis (TB) treatment.
The SF-36 (Chinese version) scores of ...102 TB cases before treatment, after the initial phase and at the end of treatment were compared with those of 103 control subjects.
The SF-36 scores were valid (internal consistency > 0.4) and reliable (Cronchbach's micro > 0.7). Before treatment, all except the role-emotional, social function and mental health scales of the TB patients were lower than those of the controls (P < 0.01); the patients' scores increased significantly during treatment (P < 0.01). In a stepwise regression model, age (P < 0.01, OR 0.95), white blood cell count (P < 0.01, OR 0.92) and number of symptoms (P < 0.05, OR 0.99) were associated with the total SF-36 score. At completion of treatment, sex (P < 0.01, OR 0.25) and haemoglobin (P < 0.05, OR 0.88) remained at the end of the model.
The SF-36 scores of TB patients are low before treatment, indicating a decline in HQoL, with physical scales most affected. However, scores increase over the course of treatment. The Chinese version of SF-36 is a reliable tool for monitoring HQoL throughout TB treatment.
Background: The World Health Organisation (WHO) Regional Office for Africa (AFRO) has developed a comprehensive capacity development programme to support the successful implementation of the ...Integrated Disease Surveillance and Response 3rd edition Technical Guidelines (IDSR). As part of the learning program, a series of asynchronous online courses are offered on OpenWHO in English, French and Portuguese. This paper describes the use of five IDSR online courses and reports on feedback received from learners on Course 1 in the English series. Methods: An online learner survey was developed, and a descriptive analysis was conducted. This paper also reports on use related empirical metadata from the OpenWHO platform. Results: Overall, learners (97%-n/N) of Course 1 IDSR English series indicated a positive perception toward their online learning experience because of the quality of course content, its organization, ease of use and relevance to their workplace needs. In addition, 88% (n/N) of learners reported that they had used their acquired knowledge at least sometimes and 54.4% (n/N) had shared their learning with others. Lastly, the quiz analyses showed an average of right answers of 78.97% for quiz 1 and 69.94% for quiz 2. Conclusion: Online learning is an essential component of a blended capacity development programme and provides cost effective, equitable and impactful learning. Learners who have a learning goal and find their needs met in courses tend to show more satisfaction and motivation to share their learning.
To determine the rate and associated factors of adult tuberculosis (TB) in the central Chinese city of Wuhan.
A retrospective descriptive study of 417 patients registered for TB treatment from 1 ...January to 31 December 2001.
The mean age of admission was 38.47 (median 35) years, with males aged 20-40 years mostly affected; 191 (45.8%) TB patients were classified as smear-positive, 221 (53%) smear-negative and for five (1.2%) the sputum results were not known. Of all admissions, 43 (10.32%) were retreatment cases and 50 (11.99%) were diagnosed as extra-pulmonary TB. All patients were treated under the DOTS strategy, with 391 (93.76%) cures, five (1.2%) treatment completed, five (1.2%) treatment failures, four (0.96%) deaths, three (0.72%) defaults and nine (2.16%) transfers out. Cure was associated with age (chi2 = 3.92, P < 0.05), but not with sex, retreatment TB, extra-pulmonary TB, type of treatment regimen, BCG status or delay in treatment (P > 0.05).
DOTS provides high TB cure rates. The reasons for the low detection rates, high retreatment rates and the increasing number of young adults affected by TB need further elucidation. For these purposes, routine human immunodeficiency virus screening and sputum culture for multidrug-resistant tuberculosis and case detection may be required.
HIV surveillance systems aim to monitor trends of HIV infection, the geographical distribution and its magnitude, and the impact of HIV. The quality of HIV surveillance is a key element in ...determining the uncertainty ranges around HIV estimates. This paper aims to assess the quality of HIV surveillance systems in low- and middle-income countries in 2009 compared with 2007.
Four dimensions related to the quality of surveillance systems are assessed: frequency and timeliness of data; appropriateness of populations; consistency of locations and groups; and representativeness of the groups. An algorithm for scoring the quality of surveillance systems was used separately for low and concentrated epidemics and for generalised epidemics.
The number of countries categorised as fully functioning in 2009 was 35, down from 40 in 2007. 47 countries were identified as partially functioning, while 56 were categorised as poorly functioning. When compared with 2007, the quality of HIV surveillance remains similar. The number of ANC sites in sub-Saharan Africa has increased over time. The number of countries with low and concentrated epidemics that do not have functioning HIV surveillance systems has increased from 53 to 56 between 2007 and 2009.
Overall, the quality of surveillance in low- and middle-income countries has remained stable. Still too many countries have poorly functioning surveillance systems. Several countries with generalised epidemics have conducted more than one population-based survey which can be used to confirm trends. In countries with concentrated or low-level epidemics, the lack of data on high-risk populations remains a challenge.
Introduction
Integration of HIV into child survival platforms is an evolving territory with multiple connotations. Most literature on integration of HIV into other health services focuses on adults; ...however promising practices for children are emerging. These include the Double Dividend (DD) framework, a new programming approach with dual goal of improving paediatric HIV care and child survival. In this commentary, the authors discuss why integrating HIV testing, treatment and care into child survival platforms is important, as well as its potential to advance progress towards global targets that call for, by 2020, 90% of children living with HIV to know their status, 90% of those diagnosed to be on treatment and 90% of those on treatment to be virally suppressed (90–90–90).
Discussion
Integration is critical in improving health outcomes and efficiency gains. In children, integration of HIV in programmes such as immunization and nutrition has been associated with an increased uptake of HIV infant testing. Integration is increasingly recognized as a case‐finding strategy for children missed from prevention of mother‐to‐child transmission programmes and as a platform for diffusing emerging technologies such as point‐of‐care diagnostics. These support progress towards the 90–90–90 targets by providing a pathway for early identification of HIV‐infected children with co‐morbidities, prompt initiation of treatment and improved survival. There are various promising practices that have demonstrated HIV outcomes; however, few have documented the benefits of integration on child survival interventions. The DD framework is well positioned to address the bidirectional impacts for both programmes.
Conclusions
Integration provides an important programmatic pathway for accelerated progress towards the 90–90–90 targets. Despite this encouraging information, there are still challenges to be addressed in order to maximize the benefits of integration.
Introduction
Nigeria has a high burden of children living with HIV and tuberculosis (TB). This article examines the magnitude of TB among children receiving antiretroviral treatment (ART), compares ...their ART outcomes with their non‐TB counterparts and argues that addressing TB among children on ART is critical for achieving the 90–90–90 targets.
Methods
This was a facility‐based, retrospective analysis of medical records of children aged <15 years who were newly initiated on ART between 2011 and 2012. Structured tools were used to collect data. STATA software was used to perform descriptive, survival and multivariate analyses.
Results
A total of 1142 children with a median age of 3.5 years from 20 selected facilities were followed for 24 months. Of these, 95.8% were assessed for TB at ART initiation and 14.7% had TB. Children on ART were more likely to have TB if they were aged 5 years or older (p<0.01) and had delayed ART initiation (p<0.05). The cotrimoxazole and isoniazid prophylaxes were provided to 87.9 and 0.8% of children, respectively. The rate of new TB cases was 3 (2.2–4.0) per 100 person‐years at six months and declined to 0.2 (0.06–1.4) per 100 person‐years at 24 months. TB infection adjusted hazard ratio (aHR): 4.3; 2.3–7.9, malnutrition (aHR: 5.1; 2.6–9.8), delayed ART initiation (aHR: 3.2; 1.5–6.7) and age less than 1 year at ART initiation (aHR: 4.0; 1.4–12.0) were associated with death. Additionally, patients with TB (aHR: 1.3; 1.1–1.6) and children below the age of 1 at ART initiation (aHR: 2.9; 1.7–5.2) were more likely to be lost to follow‐up (LFU).
Conclusions
Children on ART with TB are less likely to survive and more likely to be LFU. These risks, along with low isoniazid uptake and delayed ART initiation, present a serious challenge to achieving the 90–90–90 targets and underscore an urgent need for inclusion of childhood TB/HIV in global plans and reporting mechanisms.
A third-order G/sub m/-C Butterworth low-pass filter implementing G/sub m/-tuning and G/sub m/-switching to maximize the tuning range is described. This filter is intended to be used as a ...channel-selection/anti-aliasing filter in the analog baseband part of a zero-IF radio receiver architecture for multimode mobile communications. Its G/sub m/-switching feature allows extending the tuning range and adapting the power consumption. The filter's cutoff frequency ranges from 50 kHz to 2.2 MHz. An Input IP3 of up to +18 dBV/sub p/ is achieved, for a total worst-case power consumption of 7.3 mW for both I and Q paths, and an effective area of less than 0.5 mm/sup 2/ in a 0.25-/spl mu/m SiGe BiCMOS process. A new figure of merit is introduced for comparison of published low-pass tunable filters including noise, linearity, and tuning range.
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