BackgroundIn sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB).ObjectiveTo describe demographic, diagnostic and HIV-status characteristics of patients with EPTB in Bénin, their treatment outcomes, and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P), the proportion whose bodyweight increased during treatment.Material and FindingsThis was a retrospective cohort study with comparisons made between EPTB and new smear-positive pulmonary tuberculosis (NPTB) patients diagnosed in the country from January to December 2011. There were 383 EPTB patients (9% of all TB cases) with a mean age of 35 years, male/female ratio of 1.3 and important regional variation. There were significantly more females (p = 0.001), children <15years (p<0.001) and HIV-positive patients (p = 0.005) with EPTB compared with NPTB. Pleural effusion, spinal and lymph node tuberculosis accounted for 66% of all EPTB. Children <15 years represented 16% of cases, with lymph node disease being most common among them (p<0.001). Of 130 EPTB patients registered in CNHP-P, 7% had a confirmed bacteriological/histological diagnosis. There were 331 (86%) patients who successfully completed treatment. More patients with EPTB were lost-to-follow-up compared with NPTB (p<0.001) with all these patients from one region. The best treatment completion rates were in children <15 years (OR:3.5, 95%CI:1.0–14.8) while patients with pleural effusion and ascites had the worst outcomes. Of 72 HIV-coinfected patients, 88% were on antiretroviral therapy (ART). HIV-positive status was associated with poor outcomes while those on ART fared better. In the CNHP-P, more than 80% who completed their treatment showed an increase in bodyweight and this was more evident in HIV-positive compared with HIV-negative patients (p = 0.03).ConclusionPatients with EPTB generally do well in Bénin, although the TB Programme would benefit through more attention to accurate diagnosis and earlier start of ART in HIV-infected patients.
International Union Against Tuberculosis and Lung DiseaseHealth solutions for the poor C hronic non-communicable diseases have emerged as the next twenty-first century global epidemic and have already become the leading causes of death and disability worldwide. 1 Among these, the global burden of diabetes mellitus (DM) is immense. In 2013, an estimated 382 million people were living globally with DM, with numbers expected to rise to 592 million by 2030. 2 Most of these persons have type 2 DM, and given the association between DM and unhealthy lifestyles, such as poor diet and physical inactivity, there are more people with DM in urban than in rural areas; this divide is estimated to reach 314 million and 143 million, respectively, in 2030. In 2013, DM-related complications were a major cause of disability and reduced quality of life, and an estimated 5 million people aged 20-79 years worldwide died prematurely from the disease. 2 Although Asia is the epicentre of the DM pandemic, there is an increasing burden of disease in sub-Saharan African countries. 3 A systematic review of studies in Ethiopia from 1970 to 2011 suggested that DM prevalence in the country was about 2%, rising to 5% in persons aged 40 years in certain settings. 4 A more recent nationwide World Health Organization (WHO) STEPS survey among 2153 persons in Ethiopia found the DM prevalence to be 6.5%. 5 It is therefore important to monitor and anticipate the growing burden of DM and related complications, together with treatment outcomes, for the purpose of resource planning (i.e., the human and material resources needed to diagnose, treat and manage this disease) and to inform future control and management strategies.A previous study in two specialised hospitals in Addis Ababa documented the trend in DM admissions between 2005 and 2009, noting that admissions increased from 51 per annum to 245 over this period. 6 Up-to-date information on the indications for hospital admission, the types of DM, existing complications and hospital outcomes is important, as this will help policy makers and health care staff better understand the DM burden and associated comorbidities. In Ethiopia, where there are no community-level studies on the burden of DM, hospital data serve as a useful proxy.The aim of the present study was therefore to document indications for admission, complications and hospital outcomes of patients with DM admitted to the largest referral hospital (in Addis Ababa, Ethiopia), and compare findings between patients with type 1 and type 2 DM. Specific objectives for patients stratified by type of DM were to describe 1) demographic characteristics and indications for hospital admission, 2) existing complications and comorbidities, and 3) hospital outcomes. METHODS Study designThis was a retrospective descriptive study using medical files. SettingGeneral setting Ethiopia, located in the Horn of Africa, is the third most populated country in sub-Saharan Africa, with 80 million inhabitants, of whom 80% live in rural areas. The country has arou...
The main difference in hotspots and stopped-MDA districts was a high baseline mf prevalence. This finding indicates that the recommended 5-6 rounds annual treatment may not achieve interruption of transmission.
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