Outcomes of Community-Based Systematic Screening of Household Contacts of Patients with Multidrug-Resistant Tuberculosis in Myanmar.

نتائج الفحص المنهجي القائم على المجتمع للمخالطين المنزليين لمرضى السل المقاوم للأدوية المتعددة في ميانمار.

Luaran Penapisan Sistematis Berbasis Komunitas pada Kontak Serumah Pasien Tuberkulosis Resistan Multiobat di Myanmar.

Myanmar'da Çoklu İlaca Dirençli Tüberküloz Hastalarının Hanehalkı Temaslılarında Toplum Temelli Sistematik Tarama Sonuçları.

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ID: 75167
2019
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Abstract
Screening of household contacts of patients with multidrug-resistant tuberculosis (MDR-TB) is a crucial active TB case-finding intervention. Before 2016, this intervention had not been implemented in Myanmar, a country with a high MDR-TB burden. In 2016, a community-based screening of household contacts of MDR-TB patients using a systematic TB-screening algorithm (symptom screening and chest radiography followed by sputum smear microscopy and Xpert-MTB/RIF assays) was implemented in 33 townships in Myanmar. We assessed the implementation of this intervention, how well the screening algorithm was followed, and the yield of active TB. Data collected between April 2016 and March 2017 were analyzed using logistic and log-binomial regression. Of 620 household contacts of 210 MDR-TB patients enrolled for screening, 620 (100%) underwent TB symptom screening and 505 (81%) underwent chest radiography. Of 240 (39%) symptomatic household contacts, 71 (30%) were not further screened according to the algorithm. Children aged <15 years were less likely to follow the algorithm. Twenty-four contacts were diagnosed with active TB, including two rifampicin- resistant cases (yield of active TB = 3.9%, 95% CI: 2.3%-6.5%). The highest yield was found among children aged <5 years (10.0%, 95% CI: 3.6%-24.7%). Household contact screening should be strengthened, continued, and scaled up for all MDR-TB patients in Myanmar.
يُعد فحص المخالطين المنزليين لمرضى السل المقاوم للأدوية المتعددة (MDR-TB) تدخلاً بالغ الأهمية للكشف النشط عن حالات السل. وقبل عام 2016، لم يكن هذا التدخل قد طُبِّق في ميانمار، وهي دولة ترزح تحت عبء مرتفع من السل المقاوم للأدوية المتعددة. وفي عام 2016، نُفِّذ فحص مجتمعي للمخالطين المنزليين لمرضى السل المقاوم للأدوية المتعددة بالاعتماد على خوارزمية منهجية لفحص السل (فحص الأعراض والتصوير الشعاعي للصدر، يليهما الفحص المجهري للطاخة البلغم واختبار Xpert-MTB/RIF) في 33 بلدة في ميانمار. وقمنا بتقييم تنفيذ هذا التدخل، ومدى الالتزام بخوارزمية الفحص، ومردود الكشف عن حالات السل النشط. حُللت البيانات التي جُمعت بين أبريل 2016 ومارس 2017 باستخدام الانحدار اللوجستي والانحدار اللوغاريتمي الثنائي. ومن بين 620 مخالطاً منزلياً لـ 210 من مرضى السل المقاوم للأدوية المتعددة أُدرجوا في الفحص، خضع 620 (100%) لفحص أعراض السل وخضع 505 (81%) للتصوير الشعاعي للصدر. ومن بين 240 (39%) من المخالطين الذين ظهرت عليهم أعراض، لم يخضع 71 (30%) لفحوصات إضافية وفقاً للخوارزمية. وكان الأطفال الذين تقل أعمارهم عن 15 عاماً أقل احتمالاً لاتباع الخوارزمية. شُخِّصت إصابة أربعة وعشرين مخالطاً بالسل النشط، من بينهم حالتان مقاومتان للريفامبيسين (مردود السل النشط = 3.9%، فاصل ثقة 95%: 2.3%-6.5%). وسُجِّل أعلى مردود بين الأطفال دون سن 5 سنوات (10.0%، فاصل ثقة 95%: 3.6%-24.7%). ينبغي تعزيز فحص المخالطين المنزليين ومواصلته وتوسيع نطاقه ليشمل جميع مرضى السل المقاوم للأدوية المتعددة في ميانمار.
Skrining kontak serumah dari pasien tuberkulosis resistan ganda (MDR-TB) merupakan intervensi penemuan kasus TB aktif yang sangat krusial. Sebelum tahun 2016, intervensi ini belum diterapkan di Myanmar, sebuah negara dengan beban MDR-TB yang tinggi. Pada tahun 2016, skrining berbasis komunitas terhadap kontak serumah pasien MDR-TB yang menggunakan algoritma skrining TB sistematis (skrining gejala dan radiografi toraks yang diikuti dengan mikroskopi apusan dahak serta uji Xpert-MTB/RIF) diterapkan di 33 kotapraja di Myanmar. Kami mengevaluasi pelaksanaan intervensi ini, tingkat kepatuhan terhadap algoritma skrining, dan hasil penemuan (*yield*) kasus TB aktif. Data yang dikumpulkan antara April 2016 dan Maret 2017 dianalisis menggunakan regresi logistik dan log-binomial. Dari 620 kontak serumah dari 210 pasien MDR-TB yang diikutsertakan dalam skrining, sebanyak 620 (100%) menjalani skrining gejala TB dan 505 (81%) menjalani radiografi toraks. Dari 240 (39%) kontak serumah yang bergejala, 71 (30%) tidak diskrining lebih lanjut sesuai dengan algoritma. Anak-anak berusia <15 tahun memiliki kecenderungan lebih rendah untuk mematuhi algoritma. Dua puluh empat kontak terdiagnosis TB aktif, termasuk dua kasus resistan rifampisin (hasil penemuan TB aktif = 3,9%, IK 95%: 2,3%–6,5%). Hasil penemuan tertinggi ditemukan pada anak-anak berusia <5 tahun (10,0%, IK 95%: 3,6%–24,7%). Skrining kontak serumah harus diperkuat, dilanjutkan, dan diperluas cakupannya untuk semua pasien MDR-TB di Myanmar.
Çok ilaca dirençli tüberküloz (ÇİD-TB) hastalarının hanehalkı temaslılarının taranması, kritik bir aktif TB vaka bulma müdahalesidir. 2016 yılından önce bu müdahale, yüksek ÇİD-TB yüküne sahip bir ülke olan Myanmar'da uygulanmamıştı. 2016 yılında Myanmar'ın 33 ilçesinde, sistematik bir TB tarama algoritması (semptom taraması ve akciğer grafisini takiben balgam yayması mikroskopisi ve Xpert-MTB/RIF testleri) kullanılarak ÇİD-TB hastalarının hanehalkı temaslılarına yönelik toplum temelli bir tarama hayata geçirildi. Bu çalışmada, söz konusu müdahalenin uygulanmasını, tarama algoritmasına ne derece uyulduğunu ve aktif TB tespit verimini değerlendirdik. Nisan 2016 ile Mart 2017 arasında toplanan veriler, lojistik ve log-binomiyal regresyon modelleri kullanılarak analiz edildi. Taramaya dahil edilen 210 ÇİD-TB hastasının 620 hanehalkı temaslısının 620'sine de (%100) TB semptom taraması yapılırken, 505'ine (%81) akciğer grafisi çekildi. Semptomatik 240 (%39) hanehalkı temaslısından 71'ine (%30) algoritmaya göre ileri tarama yapılmadı. 15 yaşından küçük çocukların algoritmaya uyum gösterme olasılığı daha düşüktü. İkisi rifampisine dirençli vaka olmak üzere yirmi dört temaslıya aktif TB tanısı konuldu (aktif TB tespit verimi = %3,9, %95 GA: %2,3-%6,5). En yüksek verim 5 yaşından küçük çocuklar arasında saptandı (%10,0, %95 GA: %3,6-%24,7). Myanmar'daki tüm ÇİD-TB hastaları için hanehalkı temaslı taraması güçlendirilmeli, sürdürülmeli ve yaygınlaştırılmalıdır.
Reference Key
kyaw2019outcomestropical Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Kyaw, Nang Thu Thu;Sithu, Aung;Satyanarayana, Srinath;Kumar, Ajay M V;Thein, Saw;Thi, Aye Myat;Wai, Pyae Phyo;Lin, Yan Naing;Kyaw, Khine Wut Yee;Tun, Moe Myint Theingi;Oo, Myo Minn;Aung, Si Thu;Harries, Anthony D;
Journal Tropical medicine and infectious disease
Year 2019
DOI
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URL
Keywords
Screening operations research multidrug-resistant tuberculosis yield tb diagnosis household contact cerebrospinal fluid intracranial pressure cerebral blood flow cerebral autoregulation intracranial hypotension orthostatic headaches post-dural-puncture headaches transcranial doppler microbial community environmental microbiology microbial ecology bedrock deep biosphere deep subsurface extraterrestrial habitat analog low biomass education policy teacher quality education history educational leadership intelligence in education

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