Household Contact Screening Adherence among Tuberculosis Patients in Northern Ethiopia

BackgroundHousehold contacts of active tuberculosis cases are at high risk of getting tuberculosis disease. Tuberculosis detection rate among contacts of household members is high. Hence, this study investigated household contact screening adherence and associated factors among tuberculosis patients in Amhara region, Ethiopia.MethodsA cross-sectional study was conducted from April 10 - June 30, 2013 in five urban districts of Amhara region, where 418 patients receiving treatment at tuberculosis clinic were interviewed. All patients were interviewed using structured and pre-tested questionnaire. Bringing at least one household contact to TB clinic was regarded as adherent to household contacts screening. Bivariate and multiple logistic regressions were used to investigate association.ResultsThe overall adherence to household contact screening in Amhara region was 33.7%. Adherence was higher among Muslims than Christians. Adherence was high if patient took health education from Health Care Worker [AOR: 3.22, 95% CI: 1.88 to 5.51] and 2.17 times higher if patient had sufficient knowledge on tuberculosis [AOR: 2.17, 95% CI: 1.29 to 3.67] during interview. Relationship with contact was a significant [AOR: 0.4, 95% CI: 0.2 to 0.9] social related factor.ConclusionOne third of tuberculosis patients adhered to household contact screening in health facilities during their treatment course. Promoting knowledge of tuberculosis in the community and continuous health education to tuberculosis patients are recommended.     

Childhood Tuberculosis in Household Contacts of Newly Diagnosed TB Patients

Introduction

Childhood tuberculosis (TB), although estimated to account for a major proportion of the global TB disease burden, has a lower public health priority. Reliable research and surveillance data on childhood TB is limited in most regions of the world. This study was conducted to assess the burden of childhood TB among the household contacts of new TB patients in Karachi, Pakistan.

Methods

A retrospective analysis of children (<15 years) who were household contacts of new adult TB patients presenting to Marie Adelaide Leprosy Center (MALC) clinics in Karachi during the period of 2008 to 2010 was conducted.

Results

Of the household children contacts (n = 6613) screened, 317 were suspected and 121(1.8%) diagnosed with TB. These included 89 (73.6%) with pulmonary and 32 (26.4%) with extra-pulmonary disease. Smear positivity rate in pulmonary cases was 32.6%. Mean age of children diagnosed with TB was 11.7 (±2.8) years. Within the child-contacts screened, disease was found to be significantly higher among females (2.3%) in comparison to males (1.2%) (p-value <0.01). The commonest relationship of source cases to diagnosed children was the mother (n = 51, 42.1%). The source case was a female for 66.1% (n = 76) of the children.

Conclusion

A smear positivity rate of 32.6% amongst pulmonary cases suggests their potential to spread disease and emphasizes a need to review the contribution of children in transmission of TB within communities. Greater vulnerability of the female child and considerable role of mother in disease transmission highlights a need to increase focus on females in TB control programs in Pakistan.     

Parental Perceptions of their Children's Involvement with Household Pets: A Test of a Specificity Model of Nurturance

ABSTRACT

To test hypotheses derived from a specificity model of the development of children's nurturance, parents of preschool, second-grade and fifth-grade children (n=707) reported the frequency of their children's play with and care of pets as well as play and care directed to younger siblings, non-family babies, and elderly persons. Parents also reported on their children's frequency of expressed interest in animals, babies, and nurture in general. As predicted, gender differences were found for frequency of time spent with babies but not with pets. Frequency of time with pets was related to expressed interest in animals but not in babies. Children who had pets but no younger siblings were reported to spend more time with pets than were children with both pets and younger siblings. Children without pets were reported to express interest in babies more often than did pet owning children.     

野生动物与宠物

动物可分为野生动物和家养动物,越来越多的野生动物被人们当作宠物来饲养。野生动物作为宠物的危害是巨大的。野生动物对人类的危害主要包括直接攻击人类,携带病原威胁人类以及对环境设施造成的破坏。人类对野生动物的危害包括野生动物驯养繁殖、疾病传播等方面。野生动物对家养动物的危害包括直接危害和疾病危害。因此,野生动物不适合作为宠物饲养,不仅仅是因为它们原本的生活习性,对野生动物资源的破坏,更重要的是病原体可能跨越种间障碍而威胁人类的安全。     

Incidence and Prevalence of Tuberculosis among Household Contacts of Pulmonary Tuberculosis Patients in a Peri-Urban Population of South Delhi,India

Background

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is one of the leading causes of mortality and morbidity across all age groups throughout the world, especially in developing countries.

Methodology/Principal Findings

In this study, we have included 432 open index cases with their 1608 household contacts in a prospective cohort study conducted from May 2007 to March 2009. The follow-up period was 2 years. All Index cases were diagnosed on the basis of suggestive signs and symptoms and sputum being AFB positive. Among the 432 index patients, 250 (57.9%) were males and 182 (42.1%) females; with mean age of 34±14.4 yr and 26±11.1 yr, respectively. Out of 1608 household contacts, 866 (53.9%) were males and 742 (46.1%) females; with mean age of 26.5±15.8 and 26.5±16.0 yr, respectively. Of the total 432 households, 304 (70.4%) had ≤4 members and 128 (29.6%) had ≥5 members. The median size of the family was four. Of the 1608 contacts, 1206 were able to provide sputum samples, of whom 83 (6.9%) were found MTB culture positive. Household contacts belonging to adult age group were predominantly (74, 89.2%) infected as compared to the children (9, 10.8%). On screening the contact relationship status with index patients, 52 (62.7%) were first-degree relatives, 18 (34.6%) second-degree relatives and 12 (14.5%) spouses who got infected from their respective index patients. Co-prevalent and incident tuberculosis was found in 52 (4.3%) and 31 (2.6%) contacts, respectively. In incident cases, the diagnosis could be made between 4 to 24 months of follow-up, after their baseline evaluation.

Conclusion

Active household contact investigation is a powerful tool to detect and treat tuberculosis at early stages and the only method to control TB in high-TB-burden countries.     

The High Cost of Free Tuberculosis Services: Patient and Household Costs Associated with Tuberculosis Care in Ebonyi State,Nigeria

Objective

Poverty is both a cause and consequence of tuberculosis. The objective of this study is to quantify patient/household costs for an episode of tuberculosis (TB), its relationships with household impoverishment, and the strategies used to cope with the costs by TB patients in a resource-limited high TB/HIV setting.

Methods

A cross-sectional study was conducted in three rural hospitals in southeast Nigeria. Consecutive adults with newly diagnosed pulmonary TB were interviewed to determine the costs each incurred in their care-seeking pathway using a standardised questionnaire. We defined direct costs as out-of-pocket payments, and indirect costs as lost income.

Results

Of 452 patients enrolled, majority were male 55% (249), and rural residents 79% (356), with a mean age of 34 (±11.6) years. Median direct pre-diagnosis/diagnosis cost was $49 per patient. Median direct treatment cost was $36 per patient. Indirect pre-diagnostic and treatment costs were $416, or 79% of total patient costs, $528. The median total cost of TB care per household was $592; corresponding to 37% of median annual household income pre-TB. Most patients reported having to borrow money 212(47%), sell assets 42(9%), or both 144(32%) to cope with the cost of care. Following an episode of TB, household income reduced increasing the proportion of households classified as poor from 54% to 79%. Before TB illness, independent predictors of household poverty were; rural residence (adjusted odds ratio [aOR] 2.8), HIV-positive status (aOR 4.8), and care-seeking at a private facility (aOR 5.1). After TB care, independent determinants of household poverty were; younger age (≤35 years; aOR 2.4), male gender (aOR 2.1), and HIV-positive status (aOR 2.5).

Conclusion

Patient and household costs for TB care are potentially catastrophic even where services are provided free-of-charge. There is an urgent need to implement strategies for TB care that are affordable for the poor.     

宠物与生物安全

宠物伴随人类文明已有数千年的历史。随着我国经济的增长和人们生活水平的不断提高,宠物饲养已日益普遍化。宠物种类和数量不断增加的同时,宠物的生物安全问题,已经明显地威胁到生物多样性、生态环境及人类健康。本文分析了宠物的潜在生物安全隐患,探讨了宠物生物安全管理方面存在的问题并提出了宠物生物安全的应对的措施。     

城市宠物与管理

随着我国城市化进程发展、城市家庭结构变化,越来越多的城市居民将宠物视为家庭成员。城市宠物在提供陪伴和精神支持方面具有重要意义的同时,也带来了伤人、扰民、疫病传播、环境污染等社会问题。本文旨在通过阐述城市宠物管理现状,介绍国内外管理亮点,展望管理发展方向等,探讨针对城市宠物问题调整不同人群利益矛盾的方法,推动城市宠物规范管理,促进宠物业健康发展。     

宠物狂犬病及其防控

本文对狂犬病在犬、猫等宠物中的流行情况;宠物狂犬病及其危害;宠物狂犬病的预防及国外宠物狂犬病的防控经验等进行了综述,为保证宠物和人类健康、有效防控宠物狂犬病提供参考。     

宠物与人类健康

本文围绕宠物与人类健康主题,阐述了宠物对人类健康的积极作用;宠物对人类健康的负面影响,并对保障我国宠物业健康发展提出建议。     

Children and Their Pets

Abstract

This study examines the frequency of pet possession and its covariation with family variables (family size, housing conditions, parents' employment, maternal support) among elementary school children. Additionally, children's pet caring activities and their emotional relationship to pets were investigated. Subjects were 426 fourth graders (213 boys, 213 girls). Results indicate that pets are very frequently present in families, with the dog as the most common and most preferred animal. Parents' employment and maternal support do not covariate with pet possession, but housing conditions do. The child-pet relationship depends on childrens' gender, pet type and status of ownership (child vs. family). The intensity of pet caring is mainly related to pet type and ownership, whereas the quality of emotional contact depends on pet type and childrens' gender. On the background of manifold articles reporting case studies and educational, respectively clinical counseling experiences the discussion emphasizes the need for sound empirical research on the relationship between personality characteristics and pet ownership.     

宠物和宠物市场

我国自上世纪80年代中期以来逐渐形成了一个以犬、猫为代表的宠物市场。经过20多年的发展,宠物市场已经成为一个涵盖宠物养殖、宠物交易、宠物食品和用品的生产与销售、宠物医药保健、宠物赛会、宠物美容、宠物训导等内容的庞大产业。根据中国犬业协会（CNKC）的统计2004年中国犬只的交易额超过100亿元。成都市狂犬病防治办公室的统计现有已免疫的犬只超过20万只,实际犬只数量远超过这个数。加上数量同样庞大的家猫,我们推测成都市的宠物总量超过50万只。如此巨大数量的犬猫构筑了宠物市场坚实的自然基础。     

Increased Case Notification through Active Case Finding of Tuberculosis among Household and Neighbourhood Contacts in Cambodia

Background

Globally, there has been growing evidence that suggests the effectiveness of active case finding (ACF) for tuberculosis (TB) in high-risk populations. However, the evidence is still insufficient as to whether ACF increases case notification beyond what is reported in the routine passive case finding (PCF). In Cambodia, National TB Control Programme has conducted nationwide ACF with Xpert MTB/RIF that retrospectively targeted household and neighbourhood contacts alongside routine PCF. This study aims to investigate the impact of ACF on case notifications during and after the intervention period.

Methods

Using a quasi-experimental cluster randomized design with intervention and control arms, we compared TB case notification during the one-year intervention period with historical baseline cases and trend-adjusted expected cases, and estimated additional cases notified during the intervention period (separately for Year 1 and Year 2 implementation). The proportion of change in case notification was compared between intervention and control districts for Year 1. The quarterly case notification data from all intervention districts were consolidated, aligning different implementation quarters, and separately analysed to explore the additionality. The effect of the intervention on the subsequent case notification during the post-intervention period was also assessed.

Results

In Year 1, as compared to expected cases, 1467 cases of all forms (18.5%) and 330 bacteriologically-confirmed cases (9.6%) were additionally notified in intervention districts, whereas case notification in control districts decreased by 2.4% and 2.3%, respectively. In Year 2, 2737 cases of all forms (44.3%) and 793 bacteriologically-confirmed cases (38%) were additionally notified as compared to expected cases. The proportions of increase in case notifications from baseline cases and expected cases to intervention period cases were consistently higher in intervention group than in control group. The consolidated quarterly data showed sharp rises in all forms and bacteriologically-confirmed cases notified during the intervention quarter, with 64.6% and 68.4% increases (compared to baseline cases), and 46% and 52.9% increases (compared to expected cases), respectively. A cumulative reduction of case notification for five quarters after ACF reached more than -200% of additional cases.

Conclusions

The Cambodia’s ACF with Xpert MTB/RIF that retrospectively targeted household and neighbourhood contacts resulted in the substantial increase in case notification during the intervention period and reduced subsequent case notification during the post-intervention period. The applicability of retrospective contact investigation in other high-burden settings should be explored.     

A Systematic Review and Meta-Analysis of the Campylobacter spp. Prevalence and Concentration in Household Pets and Petting Zoo Animals for Use in Exposure Assessments

Animal contact is a potential transmission route for campylobacteriosis, and both domestic household pet and petting zoo exposures have been identified as potential sources of exposure. Research has typically focussed on the prevalence, concentration, and transmission of zoonoses from farm animals to humans, yet there are gaps in our understanding of these factors among animals in contact with the public who don’t live on or visit farms. This study aims to quantify, through a systematic review and meta-analysis, the prevalence and concentration of Campylobacter carriage in household pets and petting zoo animals. Four databases were accessed for the systematic review (PubMed, CAB direct, ProQuest, and Web of Science) for papers published in English from 1992–2012, and studies were included if they examined the animal population of interest, assessed prevalence or concentration with fecal, hair coat, oral, or urine exposure routes (although only articles that examined fecal routes were found), and if the research was based in Canada, USA, Europe, Australia, and New Zealand. Studies were reviewed for qualitative synthesis and meta-analysis by two reviewers, compiled into a database, and relevant studies were used to create a weighted mean prevalence value. There were insufficient data to run a meta-analysis of concentration values, a noted study limitation. The mean prevalence of Campylobacter in petting zoo animals is 6.5% based on 7 studies, and in household pets the mean is 24.7% based on 34 studies. Our estimated concentration values were: 7.65x10³cfu/g for petting zoo animals, and 2.9x10⁵cfu/g for household pets. These results indicate that Campylobacter prevalence and concentration are lower in petting zoo animals compared with household pets and that both of these animal sources have a lower prevalence compared with farm animals that do not come into contact with the public. There is a lack of studies on Campylobacter in petting zoos and/or fair animals in Canada and abroad. Within this literature, knowledge gaps were identified, and include: a lack of concentration data reported in the literature for Campylobacter spp. in animal feces, a distinction between ill and diarrheic pets in the reported studies, noted differences in shedding and concentrations for various subtypes of Campylobacter, and consistent reporting between studies.     

Pets,Networks and Well-Being

ABSTRACT

This study explores two explanations for well-being among older adults: social network analysis and human–animal relations. The data are based on a stratified probability sample of community living adults, aged 60 years and over, located in several rural communities in north-eastern Oregon. The dependent variables include three distinct measures of psychological well-being: life satisfaction, locus of control, and self-esteem. The independent variables include pet ownership and various measures of the personal network of respondents, including network structural variables (range, density, and frequency of contact) and network content variables (both instrumental and expressive). Control variables include socio-demographic characteristics and a measure of physical health. Multiple regression analysis is used to estimate the effects of the independent and control variables. Pet ownership was related to two of the well-being measures – self-esteem and locus of control – but only for men. Some methodological and theoretical implications are discussed.