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An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan

BACKGROUND: In Afghanistan, improving TB case detection remains challenging. In 2014, only half of the estimated incident TB cases were notified, and notifications have decreased since peaking in 2007. Active case finding has been increasingly considered to improve TB case notifications. While acces...

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Autores principales: Sanaie, A., Mergenthaler, C., Nasrat, A., Seddiq, M. K., Mahmoodi, S. D., Stevens, R. H., Creswell, J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049786/
https://www.ncbi.nlm.nih.gov/pubmed/27701446
http://dx.doi.org/10.1371/journal.pone.0163813
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author Sanaie, A.
Mergenthaler, C.
Nasrat, A.
Seddiq, M. K.
Mahmoodi, S. D.
Stevens, R. H.
Creswell, J.
author_facet Sanaie, A.
Mergenthaler, C.
Nasrat, A.
Seddiq, M. K.
Mahmoodi, S. D.
Stevens, R. H.
Creswell, J.
author_sort Sanaie, A.
collection PubMed
description BACKGROUND: In Afghanistan, improving TB case detection remains challenging. In 2014, only half of the estimated incident TB cases were notified, and notifications have decreased since peaking in 2007. Active case finding has been increasingly considered to improve TB case notifications. While access to health services has improved in Afghanistan, it remains poor and many people seeking health services won’t receive proper care. METHODS: From October 2011 through December 2012 we conducted three separate case finding strategies in six provinces of Afghanistan and measured impact on TB case notification. Systematically screening cough among attendees at 47 health facilities, active household contact investigation of smear-positive index TB patients, and active screening at 15 camps for internally displaced people were conducted. We collected both intervention yield and official quarterly notification data. Additional TB notifications were calculated by comparing numbers of cases notified during the intervention with those notified before the intervention, then adjusting for secular trends in notification. RESULTS: We screened 2,022,127 people for TB symptoms during the intervention, tested 59,838 with smear microscopy and detected 5,046 people with smear-positive TB. Most cases (81.7%, 4,125) were identified in health facilities while nearly 20% were found through active case finding. A 56% increase in smear-positive TB notifications was observed between the baseline and intervention periods among the 47 health facilities, where cases detected by all three strategies were notified. DISCUSSION: While most people with TB are likely to be identified through health facility screening, there are many people who remain without a proper diagnosis if outreach is not attempted. This is especially true in places like Afghanistan where access to general services is poor. Targeted active case finding can improve the number of people who are detected and treated for TB and can push towards the targets of the Stop TB Global Plan and End TB Strategy.
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spelling pubmed-50497862016-10-27 An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan Sanaie, A. Mergenthaler, C. Nasrat, A. Seddiq, M. K. Mahmoodi, S. D. Stevens, R. H. Creswell, J. PLoS One Research Article BACKGROUND: In Afghanistan, improving TB case detection remains challenging. In 2014, only half of the estimated incident TB cases were notified, and notifications have decreased since peaking in 2007. Active case finding has been increasingly considered to improve TB case notifications. While access to health services has improved in Afghanistan, it remains poor and many people seeking health services won’t receive proper care. METHODS: From October 2011 through December 2012 we conducted three separate case finding strategies in six provinces of Afghanistan and measured impact on TB case notification. Systematically screening cough among attendees at 47 health facilities, active household contact investigation of smear-positive index TB patients, and active screening at 15 camps for internally displaced people were conducted. We collected both intervention yield and official quarterly notification data. Additional TB notifications were calculated by comparing numbers of cases notified during the intervention with those notified before the intervention, then adjusting for secular trends in notification. RESULTS: We screened 2,022,127 people for TB symptoms during the intervention, tested 59,838 with smear microscopy and detected 5,046 people with smear-positive TB. Most cases (81.7%, 4,125) were identified in health facilities while nearly 20% were found through active case finding. A 56% increase in smear-positive TB notifications was observed between the baseline and intervention periods among the 47 health facilities, where cases detected by all three strategies were notified. DISCUSSION: While most people with TB are likely to be identified through health facility screening, there are many people who remain without a proper diagnosis if outreach is not attempted. This is especially true in places like Afghanistan where access to general services is poor. Targeted active case finding can improve the number of people who are detected and treated for TB and can push towards the targets of the Stop TB Global Plan and End TB Strategy. Public Library of Science 2016-10-04 /pmc/articles/PMC5049786/ /pubmed/27701446 http://dx.doi.org/10.1371/journal.pone.0163813 Text en © 2016 Sanaie et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sanaie, A.
Mergenthaler, C.
Nasrat, A.
Seddiq, M. K.
Mahmoodi, S. D.
Stevens, R. H.
Creswell, J.
An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan
title An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan
title_full An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan
title_fullStr An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan
title_full_unstemmed An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan
title_short An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan
title_sort evaluation of passive and active approaches to improve tuberculosis notifications in afghanistan
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049786/
https://www.ncbi.nlm.nih.gov/pubmed/27701446
http://dx.doi.org/10.1371/journal.pone.0163813
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