Background Primary health care settings and hospitals of low-and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with hig...Background Primary health care settings and hospitals of low-and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with high accu‑racy.In addition,there is a paucity of information on fever and its underlying aetiology in the adolescent and adult population in East Africa.The purpose of this study was to estimate the pooled prevalence of fever of unidentifed aetiology among adolescent and adult febrile patients seeking health care in East Africa.Methods We pursued a systematic review using readily available electronic databases(i.e.PubMed,Cumulative Index to Nursing&Allied Health Literature,Scopus,Cochrane Library and Web of Science)without language restric‑tion from inception date of the respective databases to October 31,2022.We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Identifed studies were screened for relevance.Further analyses based on pre-set eligibility criteria were carried out for fnal inclusion.Two reviewers independently screened and extracted data.Risk of study bias was assessed.Meta-analysis of the prevalence of fever of unidentifed aetiology was performed.Results We identifed 14,029 articles of which 25 were eligible for inclusion,reporting data from 8538 participants.The pooled prevalence of febrile cases with unidentifed aetiology was 64%[95%confdence interval(CI):51–77%,I 2=99.6%]among febrile adolescents and adults in East Africa.For the proportion of patients with identifed aetiol‑ogy,the studies documented bacterial pathogens(human bloodstream infections),bacterial zoonotic pathogens and arboviruses as the main non-malarial causative agents in East Africa.Conclusions Our study provides evidence that almost two-thirds of adolescent and adult febrile patients attending health care facilities in East Africa might receive inappropriate treatments due to unidentifed potential life-threat‑ening fever aetiology.Hence,we call for a comprehensive fever syndromic surveillance to broaden a consequential diferential diagnosis of syndromic fever and to considerably improve the course of patients’disease and treatment outcomes.展开更多
Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopi...Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopia,there is a national TB control programme with the goal to eliminate TB,but uneven distribution across lifestyle gradients remains a challenge.Notably,the mobile pastoralist communities in the country are disproportionately left uncovered.The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia.Main text:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and systematically reviewed articles in seven electronic databases:Excerptra Medical Database,African Journal Online,PubMed,Google Scholar,Centre for Agriculture and Bioscience International Direct,Cochrane Library and Web of Science.The databases were searched from inception to December 31,2018,with no language restriction.We screened 692 items of which 19 met our inclusion criteria.Using a meta-ethnographic method,we identified six themes:(i)pastoralism in Ethiopia;(ii)pastoralists’livelihood profile;(iii)pastoralists’service utilisation;(iv)pastoralists’knowledge and awareness on TB control services;(v)challenges of TB control in pastoral settings;and(vi)equity disparities affecting pastoralists.Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country.Conclusions:This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle.Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision.Targeting these two parameters holds promise to enhance effectiveness of an intervention.展开更多
Background:Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis(TB).We comparatively studied epidemiological features of TB and helminth co-infections ...Background:Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis(TB).We comparatively studied epidemiological features of TB and helminth co-infections in adult patients from rural and urban settings of Tanzania.Methods:Adult patients(≥18 years)with microbiologically confirmed pulmonary TB were consecutively enrolled into two cohorts in Dar es Salaam,with~4.4 million inhabitants(urban),and Ifakara in the sparsely populated Kilombero District with~400000 inhabitants(rural).Clinical data were obtained at recruitment.Stool and urine samples were subjected to diagnose helminthiases using Kato-Katz,Baermann,urine filtration,and circulating cathodic antigen tests.Differences between groups were assessed byχ2,Fisher’s exact,and Wilcoxon rank sum tests.Logistic regression models were used to determine associations.Results:Between August 2015 and February 2017,668 patients were enrolled,460(68.9%)at the urban and 208(31.1%)at the rural site.Median patient age was 35 years(interquartile range[IQR]:27-41.5 years),and 454(68%)were males.Patients from the rural setting were older(median age 37 years vs.34 years,P=0.003),had a lower median body mass index(17.5 kg/m2 vs.18.5 kg/m2,P<0.001),a higher proportion of recurrent TB cases(9%vs.1%,P<0.001),and in HIV/TB co-infected patients a lower median CD4 cell counts(147 cells/μl vs.249 cells/μl,P=0.02)compared to those from urban Tanzania.There was no significant difference in frequencies of HIV infection,diabetes mellitus,and haemoglobin concentration levels between the two settings.The overall prevalence of helminth co-infections was 22.9%(95%confidence interval[CI]:20.4-27.0%).The significantly higher prevalence of helminth infections at the urban site(25.7%vs.17.3%,P=0.018)was predominantly driven by Strongyloides stercoralis(17.0%vs.4.8%,P<0.001)and Schistosoma mansoni infection(4.1%vs.16.4%,P<0.001).Recurrent TB was associated with living in a rural setting(adjusted odds ratio[aOR]:3.97,95%CI:1.16-13.67)and increasing age(aOR:1.06,95%CI:1.02-1.10).Conclusions:Clinical characteristics and helminth co-infections pattern differ in TB patients in urban and rural Tanzania.The differences underline the need for setting-specific,tailored public health interventions to improve clinical management of TB and comorbidities.展开更多
文摘Background Primary health care settings and hospitals of low-and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with high accu‑racy.In addition,there is a paucity of information on fever and its underlying aetiology in the adolescent and adult population in East Africa.The purpose of this study was to estimate the pooled prevalence of fever of unidentifed aetiology among adolescent and adult febrile patients seeking health care in East Africa.Methods We pursued a systematic review using readily available electronic databases(i.e.PubMed,Cumulative Index to Nursing&Allied Health Literature,Scopus,Cochrane Library and Web of Science)without language restric‑tion from inception date of the respective databases to October 31,2022.We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Identifed studies were screened for relevance.Further analyses based on pre-set eligibility criteria were carried out for fnal inclusion.Two reviewers independently screened and extracted data.Risk of study bias was assessed.Meta-analysis of the prevalence of fever of unidentifed aetiology was performed.Results We identifed 14,029 articles of which 25 were eligible for inclusion,reporting data from 8538 participants.The pooled prevalence of febrile cases with unidentifed aetiology was 64%[95%confdence interval(CI):51–77%,I 2=99.6%]among febrile adolescents and adults in East Africa.For the proportion of patients with identifed aetiol‑ogy,the studies documented bacterial pathogens(human bloodstream infections),bacterial zoonotic pathogens and arboviruses as the main non-malarial causative agents in East Africa.Conclusions Our study provides evidence that almost two-thirds of adolescent and adult febrile patients attending health care facilities in East Africa might receive inappropriate treatments due to unidentifed potential life-threat‑ening fever aetiology.Hence,we call for a comprehensive fever syndromic surveillance to broaden a consequential diferential diagnosis of syndromic fever and to considerably improve the course of patients’disease and treatment outcomes.
文摘Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopia,there is a national TB control programme with the goal to eliminate TB,but uneven distribution across lifestyle gradients remains a challenge.Notably,the mobile pastoralist communities in the country are disproportionately left uncovered.The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia.Main text:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and systematically reviewed articles in seven electronic databases:Excerptra Medical Database,African Journal Online,PubMed,Google Scholar,Centre for Agriculture and Bioscience International Direct,Cochrane Library and Web of Science.The databases were searched from inception to December 31,2018,with no language restriction.We screened 692 items of which 19 met our inclusion criteria.Using a meta-ethnographic method,we identified six themes:(i)pastoralism in Ethiopia;(ii)pastoralists’livelihood profile;(iii)pastoralists’service utilisation;(iv)pastoralists’knowledge and awareness on TB control services;(v)challenges of TB control in pastoral settings;and(vi)equity disparities affecting pastoralists.Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country.Conclusions:This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle.Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision.Targeting these two parameters holds promise to enhance effectiveness of an intervention.
基金This work was supported by funding from the Rudolf Geigy Foundation(Basel,Switzerland).
文摘Background:Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis(TB).We comparatively studied epidemiological features of TB and helminth co-infections in adult patients from rural and urban settings of Tanzania.Methods:Adult patients(≥18 years)with microbiologically confirmed pulmonary TB were consecutively enrolled into two cohorts in Dar es Salaam,with~4.4 million inhabitants(urban),and Ifakara in the sparsely populated Kilombero District with~400000 inhabitants(rural).Clinical data were obtained at recruitment.Stool and urine samples were subjected to diagnose helminthiases using Kato-Katz,Baermann,urine filtration,and circulating cathodic antigen tests.Differences between groups were assessed byχ2,Fisher’s exact,and Wilcoxon rank sum tests.Logistic regression models were used to determine associations.Results:Between August 2015 and February 2017,668 patients were enrolled,460(68.9%)at the urban and 208(31.1%)at the rural site.Median patient age was 35 years(interquartile range[IQR]:27-41.5 years),and 454(68%)were males.Patients from the rural setting were older(median age 37 years vs.34 years,P=0.003),had a lower median body mass index(17.5 kg/m2 vs.18.5 kg/m2,P<0.001),a higher proportion of recurrent TB cases(9%vs.1%,P<0.001),and in HIV/TB co-infected patients a lower median CD4 cell counts(147 cells/μl vs.249 cells/μl,P=0.02)compared to those from urban Tanzania.There was no significant difference in frequencies of HIV infection,diabetes mellitus,and haemoglobin concentration levels between the two settings.The overall prevalence of helminth co-infections was 22.9%(95%confidence interval[CI]:20.4-27.0%).The significantly higher prevalence of helminth infections at the urban site(25.7%vs.17.3%,P=0.018)was predominantly driven by Strongyloides stercoralis(17.0%vs.4.8%,P<0.001)and Schistosoma mansoni infection(4.1%vs.16.4%,P<0.001).Recurrent TB was associated with living in a rural setting(adjusted odds ratio[aOR]:3.97,95%CI:1.16-13.67)and increasing age(aOR:1.06,95%CI:1.02-1.10).Conclusions:Clinical characteristics and helminth co-infections pattern differ in TB patients in urban and rural Tanzania.The differences underline the need for setting-specific,tailored public health interventions to improve clinical management of TB and comorbidities.
