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The purpose of this study was to assess tuberculosis (TB) treatment outcomes among new smear-positive pulmonary tuberculosis (PTB) patients and identify the risk factors of unsuccessful treatment outcomes in Kepong district, Kuala Lumpur, Malaysia.

A retrospective cohort study was conducted using registry-based data from the Tuberculosis Information System (TBIS) between 2014 and 2018. Simple random sampling was used to select 734 males and 380 females from the TBIS registry. Smear-positive PTB patient's sociodemographic, clinical and behavioral characteristics were extracted and analyzed. Logistic regression was used to find the possible independent risk factors for unsuccessful treatment outcomes.

The treatment success rate was 77.20% (n = 860) which was still below the target set by the WHO (>90%). In total, 254 patients showed an unsuccessful treatment outcome: 106 died, 99 defaulted, 47 not evaluated and 2 showed treatment failure. Unsuccessful treatment outcome was significantly associated with older age, male gender, non-citizen, unemployment and being HIV positive.

The study focuses on all these contributing factors of unsuccessful treatment outcome for a better risk assessment and stratification of TB patients and identify effective surveillance and management strategies to strengthen the control programs of tuberculosis in Kepong district.

This study aims to measure the prevalence of pulmonary tuberculosis (PTB), its association with imprisonment status and to document the treatment success rate (TSR) among prisoners in Songkhla province, Southern Thailand.

A retrospective cross-sectional study was conducted in five prisons in Songkhla province, including all prisoners in the fiscal of year 2019, who had an annual chest radiography (CXR) screening result. Information of prisoners who had been imprisoned from 1 October 2018 to 30 September 2019, were reviewed for PTB diagnosis. Imprisonment status and other associated factors with PTB were analyzed using multiple logistic regression.

The prevalence of PTB was 2.72%. Prisoners having new or transfer-in status were more likely to have PTB. Those aged 40–80 years, who had smoked for ten years or more, or who were underweight, had higher odds of having PTB. TSR among prisoners with PTB in this study was 94.9%.

The prevalence of PTB among prisoners having annual CXR screening was high. Detection of PTB was higher among new or transfer-in prisoners; therefore, the CXR for PTB screening before admission to prison should be performed to prevent transmission to other prisoners.

This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.

The authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.

Findings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.

Publicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.

This paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.

The purpose of this paper is to explore the wider societal issues that can impact on the success of a TB programme.

The paper is a qualitative study of the experiences of people involved in a community‐based DOTS programme in Lubombo, Swaziland, involving patients, DOT treatment supporters, clinic nurses and other key informants.

The paper finds that study participants spontaneously raised two main societal issues, which had major impact on the success of the TB programme: health beliefs and poverty. It is seen that health beliefs can have a major impact on treatment‐seeking behaviour and outcomes of TB treatment. Problems related to poverty were of two main types: insufficient funds to attend for review, and lack of food whilst on TB treatment.

This paper discusses why these issues, although strictly outside the remit of the health services, are important factors to consider when implementing TB programmes. It suggests further research that may help break the link between TB and poverty (particularly relating to food insecurity) and recommends considering local health beliefs when dealing with individuals and the community. Neither the impact of health beliefs nor the impact of poverty are new ideas, yet these issues tend to be forgotten by quantitative researchers who perhaps understandably focus on issues that may be perceived as being easier to measure. This paper serves to remind one of their importance and to illustrate the value of qualitative research in highlighting them and ensuring that issues that are important to participants are not neglected.

The purpose of the paper is to show that, despite comprehensive coverage of services for TB provided by a public‐private partnership for TB control in Patan, a city in Nepal, case finding is low, compared with the target based on an Annual Risk of Tuberculosis Infection (ARTI) of 4 per cent. Doubts have been raised as to the appropriateness of the target. The objective of the study was to estimate the number of new TB cases occurring in Patan, to assess whether the target was appropriate.

In the paper doorstep interviews were conducted with all households in the study area, followed by in‐depth interviews of households with possible or probable TB cases. The survey findings were validated against the patient registers of the five DOTS centres in Patan.

The paper finds that, among the study population of 36,918, the household survey identified 17 smear‐positive TB cases (none privately‐treated) and 24 smear‐negative/extra‐pulmonary cases (including four privately‐treated cases). Validation against the DOTS patient registers indicated that the survey was 54 per cent complete. After adjusting for incompleteness, the number of smear‐positive cases in the study area was estimated as 31, equivalent to an incidence of 85 smear positives per 100,000 population and an ARTI of 1.7 per cent.

The paper shows that using the ARTI may lead to misleadingly high targets for urban TB control. Unrealistically high targets may cause TB workers to become demoralised, and useful strategies to be abandoned. Therefore, further work is needed to identify better ways of setting targets.

Although globally, prisoners are considered one of the vulnerable groups to tuberculosis (TB), little is known about the situation of TB in prison setting in Japan. The purpose of this paper is to examine the characteristics of TB among prisoners in Japan.

Records of TB patients from one medical prison were analyzed in terms of general demographic characteristics, clinical manifestations, risk factors and delay in diagnosis and in initiating treatment, and compared with data from the national TB surveillance and other published data on health of inmates, where appropriate. Continuous variables were compared using student independent samples t-test. Proportions were compared using χ² or Fisher exact test as appropriate. Kaplan–Meier survival analysis was conducted to determine the time from entry to prison institution to diagnosis of TB.

A total of 49 patients were analyzed. The mean age was 49.5 (±14.3) and 69.4 percent were males. Being unemployed and homeless prior to incarceration, and several co-morbidities were potential risk factors for TB (p<0.01). Analysis of diagnosis and treatment delay showed that 16.1 percent of smear positive patients took more than a week to be placed on treatment after being diagnosed of TB. Approximately 50 percent of the patients were diagnosed within four months of entering the prison institution.

Several potential risk factors identified suggest the need to strengthen screening for specific sub-groups within the prison population, such as those with poor socio-economic status and co-morbidities, as well as to consider the possible role of systematic screening for latent TB infection.

This study presents some important data to help understand the profile of TB patients in prisons in Japan, as well as showing that a detailed epidemiological analysis of existing records can provide useful insight.

The purpose of this paper is to study the efficacy of a district tuberculosis (TB) co-ordinating team on health service performance for suspected TB patients in a district hospital in northeastern Thailand.

A comparison study of pre- and post-evaluations of TB system improvement was conducted in a district hospital in northeastern Thailand between October 2016 and June 2017. Data collection reviewed the record of suspected TB cases reported in the district hospital in the past nine months as a base line for describing the health service performance in term of received investigation for TB diagnosis. Participants from a TB clinic, district health office and health center set up a TB co-ordinating team to explore situations and systematic gaps. The TB co-ordinating team gave recommendations of health service performance for suspected TB patients over a nine-month period. Records of suspected TB cases health service performance were collected nine months after intervention. Data analysis by descriptive statistics and to test the effect of intervention was performed.

The records from 324 and 379 suspected TB cases reported in the hospital from the 9 months preceding and 9 months, respectively, after intervention were reviewed. A TB co-ordinating team was set up to improve the system and health service performance in terms of investigation for TB diagnosis. The results revealed that health service performance in terms of complete microscopy and investigation in both chest radiography and microscopy increased after intervention. When comparing between pre- and post-intervention, suspected cases received both chest radiography and microscopy in 176 cases and 283 cases, respectively (p-value=0.001). There were 27 cases diagnosed for smear positive TB in pre-intervention and 51 cases diagnosed in post-intervention (p-value=0.011). There were 21 cases pre- and 36 cases post-intervention that had referral documents from health center with no statistically significant difference.

The TB co-ordinating team had the role to improve health service performance for suspected TB cases to enroll in investigation process for increase TB diagnosis in district hospital.

The aim of this study was to compare the defined indicators of tuberculosis (TB) control program in the intervention and control prisons, after implementation of the national clinical protocol for TB and HIV management in Iranian prisons, suggesting active health service provision in all steps of service provision.

This was quasi-experimental study conducted among inmates of two prisons in Iran. Great Tehran prison was purposively chosen as the intervention prison and Karaj prison was purposively chosen as control prison as well. Intervention and control prisons were compared in terms of the TB indicators within three periods (before intervention, during implementation and follow-up period) from October 2013 to June 2014.

Number of inmates with TB symptoms who underwent TB workup was four times more in intervention prison compared to control prison (9.3 vs 2.5 cases out of 1,000 inmates per month in the case prison compared to the control prison). Such difference was also significant in the intervention prison, comparing before and during the intervention period. The patient finding in case prison increased significantly after the intervention (223.6 vs 81.8 cases out of 100,000 inmates per year). The number of TB cases who received HIV testing increased from 50 to 100%.

Active health service provision has significantly improved indicators in the intervention prison. The authors recommend implementation of this guideline in all prisons of Iran. Integration of other diseases with high burden among prisoners is also recommended in the active health services provision.

This intensified case finding study aimed to evaluate the prevalence of tuberculosis (TB) disease among people with HIV entering the largest prison in Malaysia.

The study was conducted in Kajang prison, starting in July 2013 in the men’s prison and June 2015 in the women’s prison. Individuals tested positive for HIV infection, during the mandatory HIV testing at the prison entry, were consecutively recruited over five months at each prison. Consented participants were interviewed using a structured questionnaire and asked to submit two sputum samples that were assessed using GeneXpert MTB/RIF (Xpert) and culture, irrespective of clinical presentation. Factors associated with active TB (defined as a positive result on either Xpert or culture) were assessed using regression analyses.

Overall, 214 incarcerated people with HIV were recruited. Most were men (84.6%), Malaysians (84.1%) and people who inject drugs (67.8%). The mean age was 37.5 (SD 8.2) years, and median CD4 lymphocyte count was 376 cells/mL (IQR 232–526). Overall, 27 (12.6%) TB cases were identified, which was independently associated with scores of five or more on the World Health Organization clinical scoring system for prisons (ARR 2.90 [95% CI 1.48–5.68]).

Limited data exists about the prevalence of TB disease at prison entry, globally and none from Malaysia. The reported high prevalence of TB disease in the study adds an important and highly needed information to design comprehensive TB control programmes in prisons.

Prisons in the sub-Saharan African region face unprecedented challenges during the COVID-19 pandemic. In Malawi, the first prison system case of COVID-19 was notified in July 2020. While prison settings were included in the second domestic COVID-19 response plan within the Law Enforcement cluster (National COVID-19 preparedness and response plan, July–December 2020), they were initially not included in the K157bn (US$210m) COVID-19 fund. The purpose of the study was to assess prison preparedness, prevention and control of COVID-19 in Malawi..

A multi-method situation assessment of the COVID-19 response and human rights assurance of prisoners and staff was conducted in a large prison complex in Malawi. Qualitative research underpinned by the Empirical Phenomenological Psychological (EPP) framework consisted of interviews with key informants such as prison health personnel, senior prison staff, penal and judicial policymakers, government and civil society organisations (n = 14) and focus group discussions with consenting male (n = 48) and female prisoners (n = 48) and prison wardens (n = 24). Prison site visits were supported by detailed observations based on the World Health Organisation Checklist for COVID-19 in prisons (n = 9). Data were collected and analysed thematically using the EPP stepwise approach and triangulated based on Bronfenbrenner’s model conceptualising COVID-19 as a multi-level event disrupting the prison eco-system.

The results are presented as MICRO-MESO level individual and community experiences of incarceration during COVID-19 spanning several themes: awareness raising and knowledge of COVID-19 in prisons; prison congestion and the impossibility of social distancing; lack of adequate ventilation, hygiene and sanitation and provisions and correct use of personal protective equipment; MESO-MACRO level interplay between the prison community of prisoners and staff and judicial policy impacts; medical system COVID-19 response, infrastructure and access to health care; COVID-19 detection and quarantine measures and prisoner access to the outside world.

This unique situation assessment of the Malawian prison system response to mitigate COVID-19 illustrates the dynamics at the micro-level whereby prisoners rely on the state and have restricted agency in protecting themselves from disease. This is due to severe structural inadequacies based on low resource allocation to prisons leading to a compromised ability to prevent and treat disease; an infirm and congested infrastructure and bottlenecks in the judicial system fuelling a continued influx of remand detainees leading to high overcapacity. Multi-pronged interventions involving key stakeholders, with prison management and line Ministry as coordinators are warranted to optimise COVID-19 interventions and future disease outbreaks in the Malawian prison system.