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Journal Cover Journal of Epidemiology and Global Health
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2210-6006
   Published by Elsevier Homepage  [3177 journals]
  • Demographic, socio-economic and lifestyle determinants of under- and
           over-nutrition among Bangladeshi adult population: Results from a large
           cross-sectional study

    • Authors: Dipak K. Mitra; Sabuj Kanti Mistry; Kaosar Afsana; Mahfuzar Rahman
      Abstract: Publication date: Available online 3 April 2018
      Source:Journal of Epidemiology and Global Health
      Author(s): Dipak K. Mitra, Sabuj Kanti Mistry, Kaosar Afsana, Mahfuzar Rahman
      Bangladesh is currently going through a nutritional transition with rapid increase in overnutrition while undernutrition is still remaining prevalent. Nevertheless, population-based data on demographic, socio-economic and lifestyle factors associated with underweight and overweight among adult population is scarce. Employing a nationwide cross-sectional survey, we collected anthropometric, demographic, socio-economic, lifestyle and dietary information from 12,180 adults aged ≥35 years. Body Mass Index (BMI) was calculated using standard formula and categorized into underweight (<18.50), normal weight (18.50–22.99), and overweight (≥23.00). Multivariable multinomial logistic regression was performed to identify factors associated with underweight and overweight. Overall, prevalence of underweight and overweight was 18.1% (95% CI: 17.5–18.8) and 33.7% (95% CI: 32.9–34.6), respectively. All the demographic, socio-economic, dietary and lifestyle factors showed significant association with nutritional status in bivariate analysis. In adjusted analysis, factors showing significant positive association with underweight included female gender (ARRR-1.38, 95% CI: 1.11–1.71), older age [compared to 35–39 years age group, ARRR (95% CI) for ≥ 70 years is 2.32 (1.89–2.86), for 60–69 years is 1.62 (1.36–1.93), for 50–59 years 1.34 (1.13–1.58) and for 40–49 years 1.05 (0.87–1.15)] and smoking habit (ARRR-1.32, 95% CI: 1.14–1.52) while factors showing significant inverse association with underweight included higher household wealth [compared to lowest wealth quintile, ARRR (95% CI) for highest quintile is 0.68 (0.55–0.84), for second highest quintile 0.77 (0.65–0.91), for middle quintile 0.81 (0.69–0.94) and for second lowest quintile 0.89 (0.77–1.03)], urban residence (ARRR-0.66, 95% CI: 0.66–0.90), and more frequent meat/fish and fruits consumption (ARRR-0.76, 95% CI: 0.65–0.90). On the other hand, factors significantly associated with increased risk of overweight included female gender (ARRR-1.35, 95% CI: 1.12–1.63), higher household wealth [compared to lowest wealth quintile, ARRR (95% CI) for highest quintile is 2.27 (1.93–2.68), for second highest quintile 1.67 (1.44–1.94), for middle quintile 1.26 (1.10–1.46) and for second lowest quintile 1.07 (0.93–1.24), excess food availability [compared to food shortage, ARRR (95% CI) for excess food in the household is 1.29 (1.12–1.47) and for no shortage/no excess is 1.23 (1.09–1.38) and more frequent fruits consumption [compared to no fruits, ARRR (95% CI) for 5–7 days per week consumption is 1.61 (1.41–1.83) and for 3–4 days per week is 1.28 (1.16–1.41) and factors significantly associated with decreased risk of overweight included older age [compared to 35–39 years age group, ARRR (95% CI) for ≥ 70 years is 0.77 (0.64–0.93), for 60–69 years is 0.82 (0.71–0.94), for 50–59 years 0.91 (0.80–1.04) and for 40–49 years 1.01 (0.89–1.15)] and smoking (ARRR-0.76, 95% CI: 0.68–0.86). Both underweight and overweight are prevalent in Bangladeshi adult population. Several demographic, socio-economic, dietary and lifestyle factors are associated with underweight and overweight in Bangladesh. Population level impact of these factors should be examined to design suitable public health and nutrition interventions to address this dual challenge.

      PubDate: 2018-04-16T00:29:11Z
      DOI: 10.1016/j.jegh.2018.03.002
       
  • The impact of teachings on sexuality in Islam on HPV vaccine acceptability
           in the Middle East and North Africa region

    • Authors: Sabrine Hamdi
      Abstract: Publication date: Available online 19 February 2018
      Source:Journal of Epidemiology and Global Health
      Author(s): Sabrine Hamdi
      The human papilloma virus (HPV) vaccine is the recommended prevention strategy for viruses-related cancers, but its acceptability remains controversial, primarily because of the relationship between sexual activity and HPV infection. Countries in the Middle East and North Africa are conservative vis-à-vis sexual behaviors, where Islam shapes people’s practices including sexual health, and imposes that sex be carried out within lawful context. Many sexually transmitted infections can be prevented if the rules of Islam are unfailingly applied by Muslims in that region. However, this is not guaranteed and a noticeable shift in the sexual behavior of the youth has been detected, including a drastic increase in unofficial sexual practices, which in the long-term increase HPV incidence and its related diseases. This study examines the available epidemiological data as well as the teachings in Islam’s sacred texts and scholars’ perspectives to describe the tensions that exist in Muslim cultures around sexuality. Understanding their influence and the function of these tensions can help illuminate the factors that contribute to barriers to accepting the vaccine.

      PubDate: 2018-02-24T16:38:23Z
      DOI: 10.1016/j.jegh.2018.02.003
       
  • The predictive value of personality traits for psychological problems
           (stress, anxiety and depression): Results from a large population based
           study

    • Authors: Zeinab Alizadeh; Awat Feizi; Mehri Rejali; Hamid Afshar; Ammar Hassanzadeh Keshteli; Peyman Adibi
      Abstract: Publication date: Available online 26 November 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Zeinab Alizadeh, Awat Feizi, Mehri Rejali, Hamid Afshar, Ammar Hassanzadeh Keshteli, Peyman Adibi
      The current study aimed to determine the prognostic values of personality traits for common psychological problems in a large sample of Iranian adult. In a large sample of healthy people (n = 4763) who lived in Isfahan province; the NEO-FFI was used to assess the personality traits; depression and anxiety were assessed using the “Hospital Anxiety and Depression Scale (HADS)” also stress was measured through Persian validated version of General Health Questionnaire (GHQ-12). Receiver Operating Characteristics Curve (ROC) analysis was used as main statistical method for data analysis. ROC analysis showed neuroticism was the best predictor for all psychological problems with highest area under the curve (AUC) (95% confidence interval) for stress, 0.837 (0.837–0.851), anxiety 0.861 (0.847–0.876) and depression 0.833 (0.820–0.846) (p < .001) and the corresponding cut-off points (sensitivity, specificity), were 21.5 (77%, 66%), 22.5 (81%, 77%) and 20.5 (77%, 74%), respectively .Other personality traits were significant protective factors for being affected with psychological problems (p < .001). Similar findings were observed separately in women and men. The present study showed that the neuroticism is significant risk factor for being affected with three psychological problems while other traits are significant protective factors. Personality traits are useful indices for screening psychological problems and an effective pathway toward prevention in general population.

      PubDate: 2017-12-09T09:31:11Z
      DOI: 10.1016/j.jegh.2017.11.003
       
  • Global health diplomacy: Between global society and neo-colonialism: The
           role and meaning of “ethical lens” in performing the six leadership
           priorities

    • Authors: Michele Rubbini
      Abstract: Publication date: Available online 16 November 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Michele Rubbini
      Establishing indicators oriented towards the creation of a global society to the detriment of new forms of neo-colonialism. In the relations between Developed and Emerging Countries as part of the Global Health Diplomacy, there is a risk that the former can adopt behaviors induced by the financial needs of overcoming their crisis. The most relevant Documents by International Organizations and Articles published in the past regarding actions in this area and the forecast of economic growth in various areas of the World are considered and the hypothesis of dual scenarios that may arise from these are postulated. There are two hypothetical scenarios arising from the “six leadership priorities”: the search for a Global Society or initiating forms of neo-colonialism on the part of developed countries towards emerging ones. If the “economic lens” is to prevail then the developed Countries, would seek to charge their crisis to emerging Ones where a forthcoming significant growth has expected; if the “ethical lens” is to prevail, it will be most likely be the hypothesis of a Global Society where there is a respect of Human Rights in order to drive growth and harmonization of relations between Governments.

      PubDate: 2017-12-09T09:31:11Z
      DOI: 10.1016/j.jegh.2017.11.002
       
  • The effect of a regimen of Antifungal cream use on episodes of acute
           adenolymphangitis (ADL) among lymphedema patients: An application using
           marginal structural models

    • Authors: K.E. Mues; M. Klein; D.G. Kleinbaum; W.D. Flanders; L.M. Fox
      Abstract: Publication date: Available online 10 November 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): K.E. Mues, M. Klein, D.G. Kleinbaum, W.D. Flanders, L.M. Fox
      Episodes of adenolymphangitis (ADL) are a recurrent clinical aspect of lymphatic filariasis (LF) and a risk factor for progression of lymphedema. Inter-digital entry lesions, often found on the web spaces between the toes of those suffering from lymphedema, have been shown to contribute to the occurrence of ADL episodes. Use of antifungal cream on lesions is often promoted as a critical component of lymphedema management. Our objective was to estimate the observed effect of antifungal cream use on ADL episodes according to treatment regimen among a cohort of lymphedema patients enrolled in a morbidity management program. We estimated this effect using marginal structural models for time varying confounding. In this longitudinal study, we estimate that for every one-unit increase in the number of times one was compliant to cream use through 12 months, there was a 23% (RR = 0.77 (0.62, 0.96)) decrease in the number of ADL episodes at 18 months, however the RR’s were not statistically significant at other study time points. Traditionally adjusted models produced a non-significant RR closer to the null at all time points. This is the first study to estimate the effect of a regimen of antifungal cream on the frequency of ADL episodes. This study also highlights the importance of the consideration and proper handling of time-varying confounders in longitudinal observational studies.

      PubDate: 2017-11-10T19:49:03Z
      DOI: 10.1016/j.jegh.2017.10.009
       
  • Overweight risk and food habits in Portuguese pre-school children

    • Authors: A.M. Machado-Rodrigues; R.A. Fernandes; Maria-Raquel Silva; A. Gama; I. Mourão; H. Nogueira; V. Rosado-Marques; C. Padez
      Abstract: Publication date: Available online 6 November 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): A.M. Machado-Rodrigues, R.A. Fernandes, Maria-Raquel Silva, A. Gama, I. Mourão, H. Nogueira, V. Rosado-Marques, C. Padez
      The relationship between dietary intake and overweight-risk was assessed in 4349 children aged 3–5 years. Eating and sedentary behaviours were assessed by questionnaire. Logistic regressions were used. Children who consumed daily soft-drinks were 1.52 times more likely to be obese, and 72% more likely to be classified as overweight children.

      PubDate: 2017-11-10T19:49:03Z
      DOI: 10.1016/j.jegh.2017.10.006
       
  • Distribution and determinants of tuberculosis in the Kingdom of Saudi
           Arabia from 2005 to 2012

    • Authors: Fahad M. Almutairi; Tamara Tayeb; Raffat Alhakeem; Abdulaziz bin Saeed; Abdullah Assiri; Scott J.N. McNabb
      Abstract: Publication date: Available online 2 November 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Fahad M. Almutairi, Tamara Tayeb, Raffat Alhakeem, Abdulaziz bin Saeed, Abdullah Assiri, Scott J.N. McNabb
      Tuberculosis (TB) remains a public health threat in the Kingdom of Saudi Arabia (KSA) with many challenges that limit its prevention and control. To understand how to meet these challenges, this study calculated the TB incidence rates (IRs) in KSA from 2005 to 2012, which were stratified by nationality, sex, and administrative regions. Furthermore, laboratory capabilities were assessed by determining the proportion of laboratory-confirmed TB cases. The overall TB IRs decreased from 15.80/100,000 population in 2005 [95% confidence interval (CI)=15.29–16.31] to 13.16/100,000 population in 2012 (95% CI=12.74–13.58). The IRs were greater for males than for females from 2009 to 2012. The IRs of non-Saudis were approximately two times those of Saudis during the study period. Mecca had greater IR during the study period compared with other regions [25.13/100,000 (95% CI=24.7–25.56)]. Among non-Saudis, those from Indonesia and Yemen had the greatest proportion of TB cases (15.4% and 12.9%, respectively). Individuals <15years of age comprised 14.2% of the TB cases. Employed non-Saudis had the greatest proportion of TB (32%), followed by unemployed Saudis (22.38%). The proportion of laboratory-confirmed cases of reported TB was 57% from 2005 to 2012. For effective prevention and control, TB screening should be implemented for non-Saudi workers at ports of entry and laboratory-screening capacity for TB should be evaluated.

      PubDate: 2017-11-04T17:02:06Z
      DOI: 10.1016/j.jegh.2017.08.002
       
  • An estimation of the burden of sports injuries among African adolescents

    • Authors: Drake G. LeBrun; Julius del Rosario; John D. Kelly; Sherry M. Wren; David A. Spiegel; Nyengo Mkandawire; Richard A. Gosselin; Adam L. Kushner
      Abstract: Publication date: Available online 2 November 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Drake G. LeBrun, Julius del Rosario, John D. Kelly, Sherry M. Wren, David A. Spiegel, Nyengo Mkandawire, Richard A. Gosselin, Adam L. Kushner
      The extent to which sports injuries contribute to the burden of injury among adolescents in low- and middle-income countries (LMICs) is unknown. The goal of this study was to estimate the incidence of sports injuries among adolescents in Africa. Data from the World Health Organization Global School-Based Student Health surveys were used to estimate the annual number of African adolescents sustaining sports injuries. Gender-stratified injury rates were calculated and applied to every African country’s adolescent population to estimate country-specific and continent-wide injury totals. A total of 21,858 males and 24,691 females from 14 countries were included in the analysis. Country-specific annual sports injury rates ranged from 13.5% to 38.1% in males and 5.2% to 20.2% in females. Weighted average sports injury rates for males and females were 23.7% (95% CI 23.1%–24.2%) and 12.5% (95% CI 12.1%–12.9%), respectively. When these rates were extrapolated to the adolescent populations of the African continent, an estimated 15,477,798 (95% CI 15,085,955–15,804,333) males and 7,943,625 (95% CI 7,689,429–8,197,821) females sustained sports injuries. Our findings suggest that over 23 million African adolescents sustained sports injuries annually. Further work will help to more precisely define the burden of sports injuries in LMICs and the role that surgery can play in mitigating this burden.

      PubDate: 2017-11-04T17:02:06Z
      DOI: 10.1016/j.jegh.2017.10.010
       
  • Evaluation of the cell phone microbial contamination in dental and
           engineering schools: Effect of antibacterial spray

    • Authors: Reihaneh Hosseini Fard; Raziyeh Hosseini Fard; Mohammad Moradi; Maryam Alsadat Hashemipour
      Abstract: Publication date: Available online 27 October 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Reihaneh Hosseini Fard, Raziyeh Hosseini Fard, Mohammad Moradi, Maryam Alsadat Hashemipour
      Introduction The aim of this study was to evaluate the microbial contamination of cell phone in dental and engineering schools and also investigating the effect of an antibacterial spray. Method and Materials A questionnaire was completed by participants, including the pattern of using mobile phones and their disinfection. The number of participants was 120 students and professors in each of dental and engineering schools. Swabs from mobile phones of the participants were taken and plated on culture medium. The t-test, Chi-Square with the SPSS 11.5 program were used in data analysis. Results In total, 240 mobile phones were cultured for microorganisms, while 65.8% (n = 158) were culture-positive. One hundred percent of professors, 98% of students' dental school and 72% of professors and 62% of students of engineering, believe that mobile can serve as a source of pathogens. The most commonly cultured organisms were Staphylococcus Aureus, Escherichia coli, Enterococcus Faecalis, and Pseudomonas. The current study showed that none of the mobile phones of the professors and students of the engineering university was infected by Pseudomonas and Candida albicans. Conclusion The results of this study showed that mobile phones may act as an important source of nosocomial pathogens.

      PubDate: 2017-10-27T22:15:31Z
      DOI: 10.1016/j.jegh.2017.10.004
       
  • Prescribing patterns for acute respiratory infections in children in
           primary health care centers, Makkah Al Mukarramah, Saudi Arabia

    • Authors: M.H. Shaheen; M.I. Siddiqui; H.A. Jokhdar; A. Hassan-Hussein; M.A. Garout; S.M. Hafiz; M.M. Alshareef; A.M. Falemban; A.A. Neveen; A.A. Nermeen
      Abstract: Publication date: Available online 27 October 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): M.H. Shaheen, M.I. Siddiqui, H.A. Jokhdar, A. Hassan-Hussein, M.A. Garout, S.M. Hafiz, M.M. Alshareef, A.M. Falemban, A.A. Neveen, A.A. Nermeen
      Acute respiratory infections (ARI) are a major public health problem and one of the commonest reasons for visiting primary health care centers (PHC). In developing countries, seventy-five percent of the cases are treated with antibiotics, although the majority are caused by viral infection. Our aim was to observe the pattern of physician practices with respect to ARI, in comparison to WHO protocols and to provide recommendations for health promotion enhancement. The study was conducted in Makkah PHC centers, for 2 months. A total 14 PHC centers were randomly selected. And 908 prescriptions were obtained randomly from general practitioners (GP) and analyzed. We found that males were 522 and females were and 386. Weights were not recorded in 224 (24.7%) cases. In 87 cases (9.6%) no diagnosis was recorded. In 515 (62.34%) of cases, antibiotics were prescribed; most of these cases were of simple common cold, with antibiotics not recommended. To conclude, many physicians in Makkah are not following the WHO guidelines for Acute Respiratory Infection. Educational health programs should be conducted to sensitize the physicians regarding the appropriate method of diagnosis and rational use of antibiotics.

      PubDate: 2017-10-27T22:15:31Z
      DOI: 10.1016/j.jegh.2017.10.007
       
  • Physical activity promotion in Saudi Arabia: A critical role for
           clinicians and the health care system

    • Authors: Zahra Alahmed; Felipe Lobelo
      Abstract: Publication date: Available online 24 October 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Zahra Alahmed, Felipe Lobelo
      This work aimed to summarize the benefits of physical activity and the importance of counseling by a physician to promote physical activity in a primary health care setting in Saudi Arabia. Despite established evidence that physical activity is effective for reducing the risk of non-communicable diseases, as well as the importance and cost-effectiveness of physical activity counseling in the primary care setting, few studies have been conducted regarding physical activity counseling in Saudi Arabia.

      PubDate: 2017-10-27T22:15:31Z
      DOI: 10.1016/j.jegh.2017.10.005
       
  • Predictors of healthcare seeking delays among children with chronic
           musculoskeletal disorders in Nepal

    • Authors: Drake G. LeBrun; Divya Talwar; Tuyetnhi A. Pham; Bibek Banskota; David A. Spiegel
      Abstract: Publication date: Available online 12 October 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Drake G. LeBrun, Divya Talwar, Tuyetnhi A. Pham, Bibek Banskota, David A. Spiegel
      Background Healthcare seeking behaviors among children with musculoskeletal disorders are poorly understood. We sought to analyze healthcare seeking delays among children with chronic musculoskeletal conditions in Nepal and identify predictors of clinically significant delays. Methods A cross-sectional study was conducted at a large pediatric musculoskeletal rehabilitation center in Nepal. Baseline sociodemographic data and healthcare seeking behaviors were assessed via interviews with 75 randomly selected caregivers. Delays of at least 3 months between disease recognition and presentation to a health worker were considered clinically significant. Predictors of significant delay were assessed via multivariable logistic regression. Results Clubfoot was the most common condition seen in the study sample (N = 33; 37%). Mean and median presentation delays were 33 months and 14 months, respectively. Sixty-seven percent of children were delayed at least 3 months and 40% were delayed at least 2 years. Caregiver occupation in agriculture or unskilled labor was associated with an increased risk of delayed presentation (adjusted OR = 4.05; 95% CI: 1.36–12.09). Conclusions Children with chronic musculoskeletal disorders in Nepal face significant delays in accessing healthcare. This poses a major clinical problem as the delayed diagnosis and treatment of childhood musculoskeletal disorders can complicate management options and decrease long-term quality of life.

      PubDate: 2017-10-14T06:22:03Z
      DOI: 10.1016/j.jegh.2017.10.002
       
  • A 360-degree view of an ancient killer disease

    • Authors: Sarah E. Ahlbrand; Madhukar Pai
      Abstract: Publication date: Available online 7 October 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Sarah E. Ahlbrand, Madhukar Pai


      PubDate: 2017-10-14T06:22:03Z
      DOI: 10.1016/j.jegh.2017.10.003
       
  • Prevalence of rifampicin-resistant Mycobacterium tuberculosis among
           human-immunodeficiency-virus-seropositive patients and their treatment
           outcomes

    • Authors: C.K. Vidyaraj; A. Chitra; S. Smita; M. Muthuraj; S. Govindarajan; B. Usharani; S. Anbazhagi
      Abstract: Publication date: Available online 21 September 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): C.K. Vidyaraj, A. Chitra, S. Smita, M. Muthuraj, S. Govindarajan, B. Usharani, S. Anbazhagi
      Multidrug resistant (MDR) and extensively drug resistant tuberculosis (TB) are a threat to the TB control programs in developing countries, and the situation is worsened by the human immunodeficiency virus (HIV) pandemic. This study was performed to correlate treatment outcome with the resistance patterns in HIV-seropositive patients coinfected with pulmonary TB. Sputum specimens were collected from 1643 HIV-seropositive patients and subjected to microscopy and liquid culture for TB. The smear- and culture-positive Mycobacterium tuberculosis isolates were subjected to Genotype MTBDRplus assay version 2.0. The M. tuberculosis culture-positivity rate was 39.44% (648/1643) among the 1643 HIV-seropositive patients and the overall MDR-TB rate was 5.6% (36/648). There were 421 newly diagnosed and 227 previously treated patients, among whom, MDR-TB was associated with 2.9% and 10.57% cases, respectively. The rate of rifampicin monoresistant TB among the cases of MDR-TB was 2.31% (15/648) and the rate of combined rifampicin and isoniazid resistance was 3.24% (21/648). The cure and death rates among the 20 registered cases were 30% (6/20) and 35% (7/20), respectively. Five cases were on treatment and two cases were defaulters among the 20 registered cases. High death rate (13, 36.1%, 95% confidence interval 20.8–53.8) was observed in this study among the patients who had mutations at the 530–533 codons. The present study emphasized the prerequisite to monitor the trend of drug-resistant TB in various mutant populations in order to timely implement appropriate interventions to curb the threat of MDR-TB.

      PubDate: 2017-09-23T13:24:21Z
      DOI: 10.1016/j.jegh.2017.09.002
       
  • Characterization of SCCmec and spa types of methicillin-resistant
           Staphylococcus aureus isolates from health-care and community-acquired
           infections in Kerman, Iran

    • Authors: Yaser Fasihi; Somayeh Kiaei; Davood Kalantar-Neyestanaki
      Abstract: Publication date: Available online 30 August 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Yaser Fasihi, Somayeh Kiaei, Davood Kalantar-Neyestanaki
      Spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates is a worldwide problem. Molecular typing is a useful tool to understand MRSA epidemiology. Herein, we determined vancomycin-resistant, SCCmec and spa types among MRSA isolates recovered from healthcare and community-acquired infections in Kerman, Iran. A total of 170 S. aureus isolates were collected from different patients who were admitted to affiliated hospitals of Kerman University of Medical science. MRSA and vancomycin-resistant S. aureus (VRSA) isolates were detected by phenotypic methods. Polymerase chain reaction (PCR) technique was used for detection of mecA, vanA and vanB genes. Staphylococcal cassette chromosomemec (SCCmec) and spa typing were used for molecular typing of among MRSA isolates. Overall, 53% of isolates were considered as MRSA. Two MRSA isolates were resistant to vancomycin and vanA was detected in only one of VRSA isolates. SCCmec type III belonged to spa types t030 and t459 which they were the dominant spa types among community-associated MRSA (CA-MRSA) and healthcare-acquired MRSA (HA-MRSA) isolates. Our findings showed that the SCCmec type I and III spread from hospital settings to community, although the SCCmec type IV spread from community to healthcare systems. We have also reported VRSA isolates from hospitalized patients, therefore, appropriate policies should be enforced in order to prevent the spread of antibiotic resistance isolates in hospitals settings.

      PubDate: 2017-09-06T11:10:18Z
      DOI: 10.1016/j.jegh.2017.08.004
       
  • Prenatal care utilization in Zimbabwe: Examining the role of
           community-level factors

    • Authors: Marshall Makate; Clifton Makate
      Abstract: Publication date: Available online 24 August 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Marshall Makate, Clifton Makate
      This paper assesses the importance of community-level factors on prenatal care utilization in Zimbabwe. The analysis is performed using data from the two most recent rounds of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 2005/06 and 2010/11 linked with other community-level data. We use logistic, generalized linear regressions as well as multilevel mixed models to examine the factors associated with the frequency, timing and quality of prenatal care. Our results suggest that contraceptive prevalence, religious composition, density of nurses, health expenditures per capita and availability of government hospitals in communities are important predictors of prenatal care use in Zimbabwe. These findings have important implications for public health policy in Zimbabwe – a country with unfavorable maternal and child health outcomes.

      PubDate: 2017-08-29T09:46:29Z
      DOI: 10.1016/j.jegh.2017.08.005
       
  • ‘Before reaching the last mile’- Knowledge, attitude, practice and
           perceived barriers related to tuberculosis directly observed therapy among
           ASHA workers in Central India: A mixed method study

    • Authors: Akash Ranjan Singh; Abhijit Pakhare; Arun M. Kokane; Hemant Deepak Shewade; Ashish Chauhan; Abhishek Singh; Arti Gangwar; Prahlad Singh Thakur
      Abstract: Publication date: Available online 14 August 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Akash Ranjan Singh, Abhijit Pakhare, Arun M. Kokane, Hemant Deepak Shewade, Ashish Chauhan, Abhishek Singh, Arti Gangwar, Prahlad Singh Thakur
      Introduction Community-based direct observed treatment (DOT) providers are an important bridge for the national tuberculosis programme in India to reach the unreached. The present study has explored the knowledge, attitude, practice and barriers perceived by the community-based DOT providers. Methods Mixed–methods study design was used among 41 community-based DOT providers (Accredited Social Health Activist (ASHAs)) working in 67 villages from a primary health center in Raisen district of Madhya Pradesh, India. The cross-sectional quantitative component assessed the knowledge and practices and three focus-group discussions explored the attitude and perceived barriers related to DOT provision. Result ‘Adequate knowledge’ and ‘satisfactory practice’ related to DOT provision was seen in 14 (34%) and 13 (32%) ASHAs respectively. Only two (5%) received any amount of honorarium for completion of DOT in last 3years. The focus-group discussions revealed unfavourable attitude; inadequate training and supervision, non-payment of honorarium, issues related to assured services after referral and patient related factors as the barriers to satisfactory practice of DOT. Conclusion Study revealed inadequate knowledge and unsatisfactory practice related to DOT provision among ASHAs. Innovations addressing the perceived barriers to improve practice of DOT provision by ASHAs are urgently required.

      PubDate: 2017-08-19T08:31:12Z
      DOI: 10.1016/j.jegh.2017.07.002
       
  • Pulmonary tuberculosis in Patna, India: Durations, delays, and health care
           seeking behaviour among patients identified through household surveys

    • Authors: Nerges Mistry; Eunice Lobo; Shimoni Shah; Sheela Rangan; Yatin Dholakia
      Abstract: Publication date: Available online 10 August 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Nerges Mistry, Eunice Lobo, Shimoni Shah, Sheela Rangan, Yatin Dholakia


      PubDate: 2017-08-19T08:31:12Z
      DOI: 10.1016/j.jegh.2017.08.001
       
  • Assessment of metabolic syndrome in Kashmiri population with type 2
           diabetes employing the standard criteria’s given by WHO, NCEPATP III and
           IDF

    • Authors: Shafat Lone; Kouser Lone; Saika Khan; Rafiq Ahmed Pampori
      Abstract: Publication date: Available online 9 August 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Shafat Lone, Kouser Lone, Saika Khan, Rafiq Ahmed Pampori
      Background Around 20–25 percent of the world’s adult populations have the metabolic syndrome and they are twice as likely to die from heart attack or stroke compared with people without the syndrome. The World Health Organization proposed a definition for the metabolic syndrome in 1998 and later on NCEP ATPIII and IDF provided new definitions of this syndrome in 2001 and 2003 respectively. Very few studies have compared the different definitions to diagnose the metabolic syndrome in type two diabetics in India while as for Kashmir valley no such documented study has been carried out till date. Objective To study the prevalence of metabolic syndrome in type 2 Kashmir diabetics and to find out the degree of agreement between three different criteria given by WHO, NCEPATPIII and IDF for diagnosis of metabolic syndrome. Materials and Method A cross sectional study was conducted in one of the two tertiary care hospitals of Kashmir, India. About 1000 patients were selected and their demographic, clinical and biochemical parameters were studied after obtaining informed consent from each patient. Results Prevalance of metabolic syndrome was found to be highest(84.5%) while using WHO definition.Kappa statistic between WHO, ATP III and WHO, IDF definitions was 0.697 (95% CI 0.637-0.754) and 0.775 (95%CI 0.72–0.82) respectively while the degree of agreement between IDF and ATP III definitions was highest with kappa of 0.851 (95%CI 0.810–0.889). Conclusion Our study warrants for interventions to prevent the progression towards this syndrome among type 2 diabetics as early as the diagnosis of diabetes is made.

      PubDate: 2017-08-19T08:31:12Z
      DOI: 10.1016/j.jegh.2017.07.004
       
  • Diarrheagenic Escherichia coli infections among the children of Andaman
           Islands with special reference to pathotype distribution and clinical
           profile

    • Authors: .P Ramya Raghavan; Subarna Roy; Ramanathan Thamizhmani; Attayur Purushothaman Sugunan
      Abstract: Publication date: Available online 31 July 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): .P Ramya Raghavan, Subarna Roy, Ramanathan Thamizhmani, Attayur Purushothaman Sugunan
      Diarrhoeagenic E. coli (DEC) is one of the most common causes of diarrhoeal death in children less than five years globally. It is responsible for 30%–40% of all diarrhoeal episodes in developing countries. It is estimated that 0.12million children died of diarrhoea caused by DEC in 2011 globally. There is no baseline data on the occurrence of DEC diarrhoea in Andaman Islands, the remote islands of India. The study is particularly important as these strains are the emerging enteric pathogen in both developed and developing countries. DEC was screened from E. coli isolates obtained from diarrhoeal stool samples by multiplex PCR with specific primers using stasndard protocols. During the study period, among the 1394 stool samples collected, 95 (6.82%) patients were found infected with DEC. Of the 97 isolates from 95 patients, 68 (70.1%) were EAEC, 19 (19.6%) were EPEC and 10 (10.3%) were ETEC. Of the 19 EPEC isolates, 63.2% were atypical EPEC which is the emerging enteric pathogen among the children in developing as well as developed countries. More than 80% of the patients had watery diarrhoea and 6% of them had invasive diarrhoea. Persistent diarrhoea was also found in three infected children. This study documents the occurrence and type of DEC diarrhoea in Andaman Islands first time and highlights the significant proportions of E. coli diarrhoea being caused by EAEC and atypical EPEC strains.

      PubDate: 2017-08-08T19:51:55Z
      DOI: 10.1016/j.jegh.2017.07.003
       
  • Occupational stress, anxiety and depression among Egyptian teachers

    • Authors: Dalia Desouky; Heba Allam
      Abstract: Publication date: Available online 18 July 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Dalia Desouky, Heba Allam
      Occupational stress (OS) among teachers predispose to depression and anxiety. No study was done to assess these problems among Egyptian teachers. This study aimed to assess the prevalence of OS, depression and anxiety among Egyptian teachers. A cross sectional study was done on 568 Egyptian teachers. The respondents filled a questionnaire on personal data, and the Arabic version of the Occupational Stress Index (OSI), the Arabic validated versions of Taylor manifest anxiety scale and the Beck Depression Inventory (BDI) were used to assess OS, anxiety and depression respectively. The prevalence of OS, anxiety and depression among teachers was (100%, 67.5% and 23.2%) respectively. OS, anxiety and depression scores were significantly higher among teachers with an age more than 40years, female teachers, primary school teachers, those with inadequate salary, higher teaching experience, higher qualifications and higher workload. A significant weak positive correlation was found between OS scores and anxiety and depression scores. This study indicated the need for future researches to address risk factors of OS and mental disorders among Egyptian teachers, and the need of periodical medical evaluation of teachers and medical and psychological support for the identified cases.

      PubDate: 2017-07-23T17:41:24Z
      DOI: 10.1016/j.jegh.2017.06.002
       
  • Is Google Trends a reliable tool for digital epidemiology? Insights from
           different clinical settings

    • Authors: Gianfranco Cervellin; Ivan Comelli; Giuseppe Lippi
      Abstract: Publication date: Available online 9 June 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Gianfranco Cervellin, Ivan Comelli, Giuseppe Lippi
      Internet-derived information has been recently recognized as a valuable tool for epidemiological investigation. Google Trends, a Google Inc. portal, generates data on geographical and temporal patterns according to specified keywords. The aim of this study was to compare the reliability of Google Trends in different clinical settings, both for both common diseases with lower media coverage, and for less common diseases attracting major media coverage. We carried out a search in Google Trends using the keywords “renal colic”, “epistaxis”, and “mushroom poisoning”, selected on the basis of available and reliable epidemiological data. Besides this search, we carried out a second search for three clinical conditions (i.e., “meningitis”, “Legionella Pneumophila pneumonia”, and “Ebola fever”), which recently received major focus by the Italian media. In our analysis, no correlation was found between data captured from Google Trends and epidemiology of renal colics, epistaxis and mushroom poisoning. Only when searching for the term “mushroom” alone the Google Trends search generated a seasonal pattern which almost overlaps with the epidemiological profile, but this was probably mostly due to searches for harvesting and cooking rather than to for poisoning. The Google Trends data also failed to reflect the geographical and temporary patterns of disease for meningitis, Legionella Pneumophila pneumonia and Ebola fever. The results of our study confirm that Google Trends has modest reliability for defining the epidemiology of relatively common diseases with minor media coverage, or relatively rare diseases with higher audience. Overall, Google Trends seems to be more influenced by the media clamor than by true epidemiological burden.

      PubDate: 2017-06-13T14:09:48Z
      DOI: 10.1016/j.jegh.2017.06.001
       
  • Frequency and implications of ofloxacin resistance among previously
           treated tuberculosis patients

    • Authors: Jyoti Arora; Gavish Kumar; Ajoy Kumar Verma; Manpreet Bhalla; Ritu Singhal; Rohit Sarin; Vithal Prasad Myneedu
      Abstract: Publication date: Available online 24 May 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Jyoti Arora, Gavish Kumar, Ajoy Kumar Verma, Manpreet Bhalla, Ritu Singhal, Rohit Sarin, Vithal Prasad Myneedu


      PubDate: 2017-05-29T12:35:50Z
      DOI: 10.1016/j.jegh.2017.05.003
       
  • The prevalence and association of stress with sleep quality among medical
           students

    • Authors: Abdullah I. Almojali; Sami A. Almalki; Ali S. Alothman; Emad M. Masuadi; Meshal K. Alaqeel
      Abstract: Publication date: Available online 5 May 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Abdullah I. Almojali, Sami A. Almalki, Ali S. Alothman, Emad M. Masuadi, Meshal K. Alaqeel
      Introduction Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students. Methods This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale. Results A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (p<0.001). Logistic regression indicated that students who are not suffering from stress are less likely to have poor sleep quality (OR=0.28, p<0.001), and the risk of having poor sleep quality is almost four times higher in students whose cumulative grade point average (GPA) is less than 4.25 (OR=3.83, p=0.01). Conclusion The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students’ study skills and coping with their stressful environment.

      PubDate: 2017-05-09T20:52:37Z
      DOI: 10.1016/j.jegh.2017.04.005
       
  • Trends in lung cancer incidence in Lebanon by gender and histological type
           over the period 2005–2008

    • Authors: Sally Temraz; Maya Charafeddine; Deborah Mukherji; Ali Shamseddine
      Abstract: Publication date: Available online 29 April 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Sally Temraz, Maya Charafeddine, Deborah Mukherji, Ali Shamseddine
      Introduction Lung cancer incidence rates, overall and by histologic subtypes, vary substantially by gender and smoking. This study’s aim was to review data regarding trends in the number of cases of different lung-cancer histologies and relate these to smoking habits by gender in Lebanon. Materials and methods Lung cancer data using ICD-O, 3rd edition, from the Lebanese National Cancer Registry from 2005 to 2008 were stratified by gender for histology type for patients aged over 18years. Results Lung cancer cases among males were 2.5 times higher than those in females. The most common lung cancer histology type for males and females was adenocarcinoma for all observed years. The proportion of squamous cell carcinoma in incident cases was significantly higher in males than in females for the total period from 2005 to 2008, P=0.032, but not in individual years. The ratio of adenocarcinoma to squamous cell carcinoma in incident cases between 2005 and 2008 was 2:45 for males and 3:15 for females. Conclusion Lung cancer histology in Lebanon is following a pattern similar to that found in most countries of North America and in Europe, where adenocarcinoma is the most prevalent subtype among both males and females.

      PubDate: 2017-05-04T20:18:00Z
      DOI: 10.1016/j.jegh.2017.04.003
       
  • Determination of carbapenem resistance mechanism in clinical isolates of
           Pseudomonas aeruginosa isolated from burn patients, in Tehran, Iran

    • Authors: Akbar Mirsalehian; Davood Kalantar-Neyestanaki; Morovat Taherikalani; Fereshteh Jabalameli; Mohammad Emaneini
      Abstract: Publication date: Available online 29 April 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Akbar Mirsalehian, Davood Kalantar-Neyestanaki, Morovat Taherikalani, Fereshteh Jabalameli, Mohammad Emaneini
      Carbapenems are the most important therapeutic options that effect against serious infections caused by multidrug resistant Pseudomonas aeruginosa (MDR-PA) isolates. Carbapenems resistant isolates of P. aeruginosa are increasing worldwide. The aim of this study was to determine the carbapenem resistance mechanisms in clinical P. aeruginosa isolates from burn patients, in Tehran, Iran. A total of 53 non-duplicated isolates of carbapenem-resistant P. aeruginosa were collected from burn patients. The presence of carbapenemase genes were determined by PCR. AmpC overproducer isolates were detected by phenotypic method. The mutation and transcription level of oprD were determined by PCR-sequencing and quantitative Real-time PCR (RT-PCR), respectively. Twenty-seven (50.9%) isolates were positive for carbapenemase (bla VIM =25 and bla IMP =2) and showed high-level resistance to imipenem and meropenem. Twenty-eight isolates were AmpC overproducers. All isolates had a mutation in the oprD gene and down-regulation of oprD was found in 56.6% of MDR-PA isolates. Although the presence of carbapenemase is the common mechanism of resistant to carbapenem, but carbapenem resistance was found by oprD mutation-driven and the AmpC overproducing isolates in Tehran, Iran.

      PubDate: 2017-05-04T20:18:00Z
      DOI: 10.1016/j.jegh.2017.04.002
       
  • Investigation of OMNIgene·SPUTUM performance in delayed tuberculosis
           testing by smear, culture, and Xpert Mycobacterium tuberculosis/RIF assays
           in Uganda

    • Authors: Cassandra Kelly-Cirino; P.S. Curry
      Abstract: Publication date: Available online 13 April 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Cassandra D. Kelly-Cirino, P.S. Curry
      OMNIgene·SPUTUM (OM-S) is a sample transport reagent designed to work with all tuberculosis diagnostics while eliminating the need for cold chain. OM-S-treated sputum samples were assayed in several tests after multiday holds. Raw sputa from 100 patients underwent direct smear microscopy, were manually split and assigned to the OM-S group [OM-S added at collection (no other processing required) and tested after 0- to 5-day holds at room temperature] or standard-of-care (SOC) group (NaOH/N-acetyl l-cysteine decontamination, all tested on day of collection). Concentrated smear microscopy, Lowenstein Jensen (LJ) culture, and mycobacteria growth indicator tube (MGIT) culture were performed. For patients with negative direct smear, a second sample was split, with SOC (raw sputum) and OM-S portions (sediment) tested in the Xpert Mycobacterium tuberculosis/RIF (Xpert) assay. OM-S group and SOC group results were strongly concordant on all four tests [range, 89% (MGIT)–97% (Xpert)]. OM-S MGIT, LJ, and Xpert tests were in statistical agreement with SOC MGIT as reference. OM-S specimens had lower culture contamination rates (3% vs. 10% LJ; 2% vs. 5% MGIT) but required, on average, 5.6 additional days to become MGIT-positive. The findings suggest that samples held/transported in OM-S are compatible with smear microscopy, LJ or MGIT culture, and Xpert, and perform comparably to fresh sputum samples. Larger feasibility studies are warranted.

      PubDate: 2017-04-14T09:13:15Z
       
  • Sickle cell disease in Saudi Arabia: A challenge or not

    • Authors: Maha Mohammed Alotaibi
      Abstract: Publication date: Available online 28 February 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Maha Mohammed Alotaibi


      PubDate: 2017-03-06T04:54:24Z
      DOI: 10.1016/j.jegh.2016.12.006
       
  • Predictors of hepatitis C testing intention among African American Baby
           Boomers

    • Authors: Mohamed Rashrash; Mary Maneno; Anthony Wutoh; Earl Ettienne; Monika Daftary
      Abstract: Publication date: Available online 16 February 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Mohamed Rashrash, Mary Maneno, Anthony Wutoh, Earl Ettienne, Monika Daftary
      Baby Boomers (BBs) are responsible for three-quarters of hepatitis C (HCV) infections in the United States; however, HCV testing is distinctly underused by them. A cross-sectional study was conducted to assess the prevalence of HCV testing and to evaluate predictors of HCV testing intention among African–American BBs. The study was guided by the Health Belief Model and theory of reasoned action frameworks. Of the 137 participants included in the study, 44.8% had at least a college education; 13.9% received prior to 1992 blood transfusion. Findings related to HCV testing showed that 32.1% of the participants intended to test for HCV within 6months and 43.8% had received a previous HCV test. Significant predictors of HCV testing intention within 6months included having a blood transfusion prior to 1992 [odds ratio (OR)=8.25, 95% confidence interval (CI): 2.02–33.61], perceptions of benefits (OR=1.57, 95% CI: 1.13–2.18), severity (OR=1.39, 95% CI: 1.17–1.65), and subjective norms (OR=1.42, 95% CI: 1.12–1.79). These predictors of HCV testing intention can be used to develop future HCV testing initiatives for African–American BBs.

      PubDate: 2017-02-20T03:15:35Z
      DOI: 10.1016/j.jegh.2016.12.005
       
  • New tuberculosis estimates must motivate countries to act

    • Authors: Madhukar Pai; Ziad A. Memish
      Abstract: Publication date: Available online 14 February 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Madhukar Pai, Ziad A. Memish


      PubDate: 2017-02-20T03:15:35Z
      DOI: 10.1016/j.jegh.2017.02.001
       
  • Incidence and economic burden of acute otitis media in children aged up to
           5years in three Middle Eastern countries and Pakistan: A multinational,
           retrospective, observational study

    • Authors: Ghulam Mustafa; Amal Y. Al Aidaroos; Idris S. Al Abaidani; Kinga Meszaros; Kusuma Gopala; Mehmet Ceyhan; Mohamad Al-Tannir; Rodrigo DeAntonio; Shyam Bawikar; Johannes E. Schmidt
      Abstract: Publication date: Available online 8 February 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Ghulam Mustafa, Amal Y. Al Aidaroos, Idris S. Al Abaidani, Kinga Meszaros, Kusuma Gopala, Mehmet Ceyhan, Mohamad Al-Tannir, Rodrigo DeAntonio, Shyam Bawikar, Johannes E. Schmidt
      Epidemiological data on acute otitis media (AOM), an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children ≤5years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children (Saudi Arabia=1023, Oman=998, Pakistan=1022, Turkey=1000) were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars (USD)]. The overall incidence of AOM episodes per 1000 person–years was: Saudi Arabia, 207 [95% confidence interval (CI): 178–238]; Oman, 105 (95% CI: 85–127); Pakistan, 138 (95% CI: 116–163); and Turkey, 99 (95% CI: 79–123). The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation (SD)=93.0], Oman USD16.1 (SD=16.4), Pakistan USD22.1 (SD=20.5), and Turkey USD33.6 (SD=44.9). The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies.

      PubDate: 2017-02-14T02:43:12Z
      DOI: 10.1016/j.jegh.2016.12.004
       
  • Drug resistance detection and mutation patterns of multidrug resistant
           tuberculosis strains from children in Delhi

    • Authors: Jyoti Arora; Ritu Singhal; Manpreet Bhalla; Ajoy Verma; Niti Singh; Digamber Behera; Rohit Sarin; Vithal Prasad Myneedu
      Abstract: Publication date: Available online 7 February 2017
      Source:Journal of Epidemiology and Global Health
      Author(s): Jyoti Arora, Ritu Singhal, Manpreet Bhalla, Ajoy Verma, Niti Singh, Digamber Behera, Rohit Sarin, Vithal Prasad Myneedu
      A total of 312 sputum samples from pediatric patients presumptive of multidrug resistant tuberculosis were tested for the detection of drug resistance using the GenoTypeMTBDRplus assay. A total of 193 (61.8%) patients were smear positive and 119 (38.1%) were smear negative by Ziehl–Neelsen staining. A line probe assay was performed for 208 samples/cultures (193 smear positive samples and 15 cultures from smear negative samples). Valid results were obtained from 198 tests. Some 125/198 (63.1%) were sensitive to both rifampicin (RIF) and isoniazid (INH), while 73/198 (36.9%) were resistant to at least INH/RIF, out of which 49 (24.7%) were resistant to both INH and RIF (multidrug resistant). Children with tuberculosis are often infected by someone close to them, so strengthening of contact tracing in the program may help in early diagnosis to identify additional cases within the household. There is a need to evaluate newer diagnostic assays which have a high sensitivity in the case of smear negative samples, a need for additional samples other than sputum among young children not able to expectorate, and a need to fill the gap between estimated and reported cases under the program.

      PubDate: 2017-02-08T02:23:17Z
      DOI: 10.1016/j.jegh.2016.12.003
       
 
 
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