Poor tuberculosis treatment outcomes in Southern Mozambique (2011–2012)

García‐Basteiro, Alberto L.; Respeito, Durval; Augusto, Orvalho; López-Varela, Elisa; Sacoor, Charfudin; Sequera, Guillermo; Casellas, Aina; Bassat, Quique; Manhiça, Ivan; Macete, Eusébio; Cobelens, Frank; Alonso, Pedro L.

doi:10.1186/s12879-016-1534-y

Cited by 32 publications

(31 citation statements)

References 22 publications

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“…All the countries represented by these publications had adult HIV prevalences <2% in 2015 except for Mozambique, which had a 10.5% adult HIV prevalence 42 . We therefore excluded the Mozambique study 39 from the meta-analysis because the HIV prevalence among child TB patients was likely substantially higher than in the other studies. Also, not all studies were incorporated into each meta-analysis due to overlapping populations (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis

Jenkins

Yuen

Rodriguez

et al. 2017

The Lancet Infectious Diseases

201

154

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Background Case fatality ratios among children with tuberculosis disease are poorly understood, particularly among HIV-infected cases and those not receiving tuberculosis treatment. Methods We carried out a systematic review of the published literature to identify studies of population-representative samples of pediatric (<15 years old) tuberculosis cases. We used random effects meta-analysis to produce pooled estimates of case fatality ratios. We stratified our analyses by whether or not children received tuberculosis treatment, age (0–4 years, 5–14 years), and HIV status. Findings We identified 31 papers comprising 35 datasets representing 82,436 children with tuberculosis disease, of whom 9,273 died. Among children with tuberculosis from the pretreatment era, the pooled case fatality ratio was 21.9% (95% confidence interval [CI]: 18.1%, 26.4%). The pooled case fatality ratio was significantly higher among children aged 0–4 years (43.6%; 95% CI: 36.8%, 50.6%) than among children aged 5–14 years (14.9%; 95% CI: 11.5%, 19.1%). In recent studies where the majority of children had tuberculosis treatment, the pooled case fatality ratio was 0.9% (95% CI: 0.5%, 1.6%). USA surveillance data suggest a substantially higher case fatality ratio among HIV-infected children receiving TB treatment, compared with HIV-uninfected children, especially without antiretroviral treatment. Interpretation Without adequate treatment, children with tuberculosis disease, especially those under five years of age, are at high risk of death. HIV-infected children have an increased mortality risk, even when receiving tuberculosis treatment. Funding US National Institutes of Health, Janssen Global Public Health

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Section: Resultsmentioning

confidence: 99%

Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis

Jenkins

Yuen

Rodriguez

et al. 2017

The Lancet Infectious Diseases

201

154

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“…[16–18] Manhiça district has very high TB incidence and TB associated mortality rates with a low case detection rate [19, 20]. In the district there is one district hospital (Hospital Distrital da Manhiça), one rural hospital (Hospital Rural de Xinavane) and 12 peripheral primary Health Care Centres (HCC).…”

Section: Methodsmentioning

confidence: 99%

Knowledge, attitudes and practices regarding tuberculosis care among health workers in Southern Mozambique

et al. 2017

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BackgroundTuberculosis (TB) control is more likely to be achieved if the level of knowledge regarding TB is increased among health workers managing high-risk groups. No formal assessments regarding knowledge, attitudes and practises of health workers about TB have been published for Mozambique, a country facing challenges in the fight against TB, with a fragile health system and considerable work overload of health personnel. The main objective of the study was to determine the level of knowledge, identify attitudes and assess practices regarding TB care and control among health care workers of the district of Manhiça.MethodsA descriptive cross-sectional study was performed through the use of a specifically designed Knowledge, Attitudes and Practices (KAP) questionnaire in the district of Manhiça, a high tuberculosis and HIV burden rural area in Southern Mozambique. In this district, 14 health care facilities service a population of approximately 160,000 people. The questionnaire took 30–45 min to administer with external assistance not permitted. The survey contained 79 questions pertaining to four different areas: demographics, TB knowledge, attitudes and practices.ResultsThe study sample included 170 health care workers. The average knowledge score was 14.89 points (SD = 3.61) out of a total possible 26 points. Less than 30% of respondents had heard of Xpert MTB/RIF®. Seventy per cent agreed there was stigma associated with TB and 48.2% believed this stigma was greater than that associated with HIV. The average practice score was 3.2 out of 9 points (35.6%, SD = 2.4).ConclusionHealth care worker’s knowledge gaps identified in this study may result in substandard patient care. Specific deficiencies in understanding existed in terms of paediatric TB and Xpert MTB/RIF® testing. The present study provides impetus for tailored TB education among health care workers from a high TB burden rural area in Southern Mozambique.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0344-8) contains supplementary material, which is available to authorized users.

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“…Until now, very few studies on the burden of disease in the country have been published and none of them show temporal trends in relevant TB indicators. However, recent studies conducted in southern Mozambique show a high TB burden among children and people living with HIV, including high mortality [5][6][7]. To address this we evaluated how the TB incidence rates and other key TB indicators evolved from 1997-2012 in a high TB/HIV-burden area of southern Mozambique [6,8].…”

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confidence: 99%