Suchergebnisse

More than one-third of the world population is infected with Tuberculosis (TB). World Health Organization has declared Tuberculosis as a global public health emergency in 1993. The people, affected by TB, are usually living in developing countries. In fact, TB is especially prevalent in Southeast Asia. China has been listed as a country with a high TB burden yet there are 150 "one-way permit" holders, across the border in China, for settlement purposes in Hong Kong. There is neither any health requirement nor obligatory physical examination before entry into Hong Kong. Unlike other developed countries, Hong Kong has no screening policy for people from Mainland China for migration purpose. The aim of this project is to explore the possibilities for different screening policies for new immigrants in Hong Kong, similar to those adopted by developed countries. Objectives include: (a) review of research articles and (b) careful perusal of selected government documents. Electronic databases of research articles for migration screening policy and data from World Health Organization, United Nations and other international and local authorizes were searched and analyzed to suggest practical policies for Hong Kong. Findings indicate that most developed countries have implemented pre-arrival screening policy, which is not practical in Hong Kong. Studies showed no significant difference between 'pre', 'on' or 'post' arrival programmes. Post arrival screening could be considered as the most suitable option for Hong Kong, according to the analyses of the data. Tuberculosis and Chest Service, Department of Health has the capacity to act as the screening authority for settlement purpose and could provide expert recommendation to Immigration Department about the health status of permanent residency applicants. Given the importance of screening, in various countries, to reduce the incidence of TB, Hong Kong could and should adopt a screening policy in order to decrease new notifications and enhance the local public health status. ; published_or_final_version ; Public Health ; Master ; Master of Public Health

Abstract Background Delays seeking care worsen the burden of tuberculosis and cost of care for patients, families and the public health system. This study investigates costs of tuberculosis diagnosis incurred by patients, escorts and the public health system in 10 districts of Ethiopia. Methods New pulmonary tuberculosis patients ≥ 15 years old were interviewed regarding their health care seeking behaviour at the time of diagnosis. Using a structured questionnaire patients were interviewed about the duration of delay at alternative care providers and the public health system prior to diagnosis. Costs incurred by patients, escorts and the public health system were quantified through patient interview and review of medical records. Results Interviews were held with 537 (58%) smear positive patients and 387 (42%) smear negative pulmonary patients. Of these, 413 (45%) were female; 451 (49%) were rural residents; and the median age was 34 years. The mean (median) days elapsed for consultation at alternative care providers and public health facilities prior to tuberculosis diagnosis was 5 days (0 days) and 3 (3 days) respectively. The total median cost incurred from first consultation to diagnosis was $27 per patient (mean = $59). The median costs per patient incurred by patient, escort and the public health system were $16 (mean = $29), $3 (mean = $23) and $3 (mean = $7) respectively. The total cost per patient diagnosed was higher for women, rural residents; those who received government food for work support, patients with smear negative pulmonary tuberculosis and patients who were not screened for TB in at least one district diagnostic centers. Conclusions The costs of tuberculosis diagnosis incurred by patients and escorts represent a significant portion of their monthly income. The costs arising from time lost in seeking care comprised a major portion of the total cost of diagnosis, and may worsen the economic position of patients and their families. Getting treatment from alternative sources and low index of suspicion public health providers were key problems contributing to increased cost of tuberculosis diagnosis. Thus, the institution of effective systems of referral, ensuring screening of suspects across the district public health system and the involvement of alternative care providers in district tuberculosis control can reduce delays and the financial burden to patients and escorts.

Because of its communicable nature and because there are many state laws specific to the control of tuberculosis (TB), TB is managed differently than other airborne infectious diseases [corrected]. Many of these laws predate the current public health recommendations for the prevention and control of TB. In 1989, CDC published A Strategic Plan for the Elimination of Tuberculosis in the United States that was developed by the Advisory Committee (now Council) for the Elimination of Tuberculosis (ACET). The Plan called for the establishment of a national goal of TB elimination (i.e., achieving a case rate of < 1 per million population) by the year 2010. One of the methods for improving disease containment in the Plan was for the use of quarantine measures for nonadherent patients. The Plan called for revision of state and local laws to "facilitate the cure of persons with infectious tuberculosis". The issue of outdated state TB laws was also identified as a problem in the National Action Plan to Combat Multidrug-resistant Tuberculosis. In response to this issue, CDC conducted a survey of state TB control laws and ACET developed recommendations to address discrepancies between previously published recommendations and guidelines for the control of TB and state TB control laws. In order to address these discrepancies, states updating TB control laws should incorporate current recommendations and guidelines from CDC, ACET, and the American Thoracic Society. State laws should permit policies and practices to be rapidly reviewed and amended as new data becomes available and new recommendations and guidelines are published. ; November 12, 1993. ; The following CDC staff members prepared this report: Brian M. Willis, Office of the General Counsel Office of the Director; Lawrence Paul Schwartz, Division of Tuberculosis Elimination National Center for Prevention Services; Sarah B. Knowlton, Office of the General Counsel Office of the Director. ; Includes bibliographical references (p. 12-13).

Background: Tuberculosis (TB) remains a global public health problem, with developing countries bearing the highest burden. Nigeria is first in Africa and sixth in the world among the countries with the highest TB burden, but is among the 10 countries accounting for over 70% of the global gap in TB case detection and notification. Enugu State, Nigeria reportedly has a notification gap of almost 14,000 TB cases; a situation which must be addressed. Methodology: A total of 868 individuals accessing DOTS services in designated centres within the six Local Government Areas (LGAs) of Enugu North geographical zone, were recruited into the study. The participants were screened for HIV seropositivity by standard protocols, while screening for TB and drug-resistant TB were conducted by a combination of Zhiel Neelsen staining and Nucleic Acid Amplification Test (Xpert® MTB/Rif). Results: Of the 868 subjects that participated in the study, 176 (20.3%) were HIV seropositive. The highest prevalence (26.7%) of HIV was recorded in Udenu LGA, while the least (13.1%) was recorded in Nsukka LGA. Overall TB prevalence was found to be 22.1% and 21.3% by sputum-smear and NAAT, respectively. Uzo Uwani LGA recorded the highest prevalence of both TB (33.3%) and TB/HIV co-infection (16.7%), but the lowest prevalence of resistant TB. Nsukka LGA had the highest prevalence of resistant TB. Conclusion: Enugu North geographical zone, Nigeria, has a high prevalence of both HIV and TB, including resistant TB and there is need to increase monitoring of this region.