A research report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa, in partial fulfilment of the requirements for the degree of Masters in Public Health-Social and Behaviour Change Communication.November 2012 / Aim of the study: The main aim of this study was to determine socio-demographic characteristics associated with being diagnosed with TB by a health care worker among adult males and females aged between18-49 years in Ntcheu district, Malawi. Method: This was a descriptive and analytical cross-sectional study. A total of 121 adult women and men were sampled using a three-stage simple sampling technique. The 2008 Population and Housing Census enumeration areas (EAs) were used as a sampling frame. The first stage involved simple sampling of two Traditional Authorities (TAs) out of nine (9). Stage two involved selection of ten villages in each sampled TA. The third level of sampling was a selection of six households from each selected village where the first dwelling was also sampled. A structured questionnaire was developed in English and translated into Chichewa. The questionnaire was administered by a trained interviewer at each respondent’s household. Three research assistants were employed to collect data. Results The awareness of TB was universal with every participant reporting that they had heard about TB. Of the 121 participants, more than half were male (53.7%; n=65).The median age of the respondents was 28 years (range 18-49 years) and approximately a third of the respondents (34.4%; n=31) had 1-2 children. The study found that higher education (p=0.01), higher ownership of household assets (p=0.01), higher average monthly household income (p=0.02) and higher socio-economic status of the respondents (p=0.01) were significantly associated with higher knowledge of causes of TB. It was found that education was also associated with knowledge of the transmission of TB (P=0.01). The lower the level of education the lower the knowledge level on the correct modes of TB transmission. There was also an association between knowledge of symptoms of TB and occupation (p=0.05). It was found that farmers were less likely to know symptoms of the disease compared to other forms of occupation namely: business persons, those participants who were employed and those not employed. The study found that women had significantly lower risk perceptions of the disease (p=0.01). No association was found between socio-economic and cultural factors of the respondent and self-reported TB diagnosis. Conclusion The findings of this study show that a comprehensive health promotion programme is required in order to address significant gaps on knowledge of causes of TB, transmission, symptoms and risk perceptions and other related socio-economic and cultural factors in Ntcheu district.

Introduction The association between tuberculosis (TB) and malnutrition is well known. Malnutrition also weakens the immune system increasing the chance of latent TB progressing to active disease. Nutritional interventions can help improve overall quality of life and can reduce susceptibility to opportunistic infections including all forms of Oral Candidiasis (OC) which includes: (1) pseudomembranous candidiasis (oral thrush), (2) atrophic (erythematous) candidiasis, (3) hyperplastic candidiasis, and (4) angular cheilitis. This secondary data analysis of a longitudinal follow-up study evaluates the impact of a fortified supplementary food on OC among adult TB patients over a three month period. Results At baseline, an overall prevalence of 33% of OC (27 out of 83) was found in 83 adult TB patients; (pseudo-membranous 46% (16 out of 35), erythematous 26% (9 out 35), angular chelitis 20% (7 out 35) and hyperplastic 8% (3 out of 35). Thirty five different types of OC were found in 27 of the subjects some of whom manifested with more than one type of OC. Almost 89% of these TB patients had low levels of malnutrition (8% for selenium, 55% for iron, 62% for Vit-A, 42% for albumin, 47% for Vit-D and 34% for zinc). Their p values related to OC were (p=0.64 for selenium, p=0.74 for iron, p=0.19 for Vit-A, p=1 for albumin, p=1 for Vit-D and p=0.09 for zinc) showing no statistically significant difference for malnutrition in each different type of micronutrient related to OC at baseline. However, there was a statistically significant difference in HIV status (p=0.01) related to OC among factors such as sex (p=0.34), employment status (p=0.74), ARV status (p=0.46) and wellbeing (p=0.18) at baseline. OC was statistically significant at both 2nd and 3rd visits using univariate analysis p=0.04 (95%CI 0.22 to 0.97) and p=0.00 (95%CI 0.06 to 0.43) and also multivariate analysis p=0.01(95%CI 0.17 to 0.85) and p=0.00 (95%CI 0.04 to 0.34) with reference to the 1st visit (the prevalence of OC was significantly decreased in both 2nd and 3rd visits). For different types of clinical OC, pseudomembranous candidiasis was the only type of OC that showed statistically significant difference at the 3rd visit in both univariate analysis (p= 0.01, 95%CI 0.01 to 0.46) and multivariate analysis (p= 0.00, 95%CI 0.01 to 0.38) with reference to 1st visit. Discussion and Conclusions This study found no significant association between overall micronutrient level and the presence of OC at baseline. However, micronutrient interventions to the 83 adult TB patients receiving treatment at Johannesburg city clinics located in Alexandra showed a decrease in prevalence of different types of OC in both 2nd and 3rd visits. This analysis showed encouraging results which indicated a beneficial effect of e’Pap in adult TB patients.

Tuberculosis (TB) is one of the most deadly diseases worldwide. In the United States, TB disproportionately affects foreign-born individuals, individuals living in congregate settings, people with human immunodeficiency virus, and people who use illicit drugs. In 2005, a large homeless shelter outbreak in San Joaquin County resulted in 67 individuals diagnosed with TB with links to a homeless shelter. It is hypothesized that by using bed analysis to identify contacts that have been exposed to TB during this outbreak will allow for better identification of exposed high-risk individuals than screening alone. Demographics, exposure, screening, and QuantiFERON-Tuberculosis results were analyzed using bed assignments from the homeless shelter database and data from a homeless shelter screening (HSS) program. Individuals diagnosed with active TB disease were on average more likely to be identified through bed analysis than HSS, 95.08% versus 59.02%. Utilizing both bed analysis and HSS allows for improvement of identification and continuous testing of individuals exposed to TB.

Made available in DSpace on 2011-05-04T12:36:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Introdução: Nas últimas duas décadas ampliou-se a demanda por serviços de maior complexidade tecnológica para o atendimento da tuberculose, especialmente em hospitais gerais e universitários. Em geral não há avaliação sistemática da magnitude da exposição local nas unidades hospitalares, apesar de ser considerada como doença ocupacional. Objetivo: Descrever e analisar o perfil epidemiológico da tuberculose-doença entre os pacientes atendidos no HUAP-UFF, e elaborar uma proposta de monitoramento da mensuração da doença. Métodos: Estudo descritivo e retrospectivo dos casos diagnosticados entre pacientes atendidos no HUAP-UFF no período de 2000 a 2006, construção de indicadores de morbidade e letalidade, e análise multivariada dos óbitos ocorridos entre os pacientes internados. Resultados: Foram diagnosticados 763 pacientes com tuberculose, 45,1 por cento no ambulatório, 11,1 por cento nas emergências e 43,8 por cento no setor de internação; 63,1 por cento eram do sexo masculino, com razão de 1,8 homens para cada mulher diagnosticada; a faixa etária mais atingida foi 30 a 59 anos. As formas clínicas pulmonares e extrapulmonares exclusivas foram predominantes, porém, entre os pacientes internados, verifica-se que as formas pulmonares positivas e negativas, associadas às extrapulmonares, e as pulmonares negativas exclusivas, foram mais frequentes. Nos pacientes que evoluíram para óbito a forma pulmonar foi também a mais encontrada. O tratamento foi iniciado em 41,9 por cento do total de casos e em 76 por cento dos pacientes internados. Entre os que iniciaram tratamento, 82,5 por cento utilizou o Esquema I. A presença de comorbidade foi mais prevalente entre os pacientes internados e os que evoluíram para óbito. O HUAP atua como uma referência não oficial de tuberculose para a sua região de abrangência. Conclusões: Os indicadores hospitalares e o perfil epidemiológico dos pacientes diagnosticados sugerem a necessidade de melhor organização da assistência à tuberculose na unidade e na sua região de referência e demonstraram a necessidade de definição rigorosa das medidas de biossegurança no hospital. / Background: Over the last decades the demand for higher complexity services for tuberculosis care has increased, especially in general and university hospitals. In these services, despite the fact that it is regarded as an occupational disease, often there is no systematic evaluation of the magnitude of the local exposure. Objective: To describe and analyze the epidemiological profile of tuberculosis-disease among the patients attended at HUAP, and to elaborate a monitoring proposal for measuring the disease. Methods: descriptive and retrospective study of the dignosed cases among patients attended at the HUAP-UFF for the 2000-2006 period, construction of morbidity and case-fatality and multivariate analysis of the deaths occurred among the admitted patients. Results: The tuberculosis diagnosis were made for 763 patients, 45.1% at the outpatient care, 11.1% at the emergency room and 43.8% at the admission sector; 63.1% were male, with male/female ratio of 1.8; the most affected age group was 30 to 69 years. Among the admitted patients it was observed that positive and negative pulmonary cases, associated to extra-pulmonary, and the exclusive negative pulmonary cases, were the most diagnosed. For the patients that evolved to death the pulmonary type was the most frequent as well. The treatment was started for 41.9% of the total cases and in 76% of the admitted patients. Among those who started treatment, 82.5% adopted the Scheme I. The presence of co-morbidity was more prevalent among the admitted patients and those who evolved to death. HUAP plays the role of an unofficial reference for tuberculosis in its region. Conclusions: The hospital indicators and the epidemiological profile of the diagnosed patients suggest the need for a better organization of tuberculosis care in the setting as well as its reference region and they show the need for a rigorous definition of the biosafety measures at the hospital.