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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.

This paper seeks to study the process of clinical audit to improve tubercolosis (TB) diagnosis in Cuba, Peru and Bolivia. It aims to present the lessons learned in implementing clinical audit in the three specific study sites and highlight what may be relevant to low‐income settings in general.

The lessons are based on observations and qualitative data collected from 22 health centres that completed a minimum of two audit cycles in the three study countries. Local audit committees selected audit criteria, collected relevant data, compared their performance against the agreed standards and proposed ways for improvement.

Lessons for the development of clinical audit for TB diagnosis in the study countries include the difficulties in setting achievable standards based on appropriate criteria; the need to establish clinical guidelines and routine data; and the need to address patients' beliefs and attitude. Lessons for the development of clinical audit in low‐income countries include the need for preparation (e.g. through clinical guidelines) before introducing quality improvement tools and the importance of a visible relationship between audit activity and patient care. Crucially, local clinicians struggle in developing evidence‐based audit criteria that should be developed at national level.

The lessons learned presented here are derived from interviews, document analysis and participant observation. Such techniques are liable to observers' and informants' bias. Similarly, conclusions drawn from an inquiry into contextual factors also threaten their external validity. The paper used chronological analysis and explanation building to overcome these limitations.

In low‐income countries, audit needs to be fully integrated in the national and local disease control programmes. The lessons presented here provide practical guidance for those considering developing or improving clinical audit in low‐income countries.

Clinical audit has major potential for improving health care delivery in low‐income countries within existing resource constraints. The lessons presented here have relevance to audit across the entirety of health systems in low‐income countries.

Three events of significance to this country took place in 1899 – the British Food Journal was launched, Australia retained the Ashes, and the Boer War hostilities commenced. If challenged on the order of their importance, cricketers and Empire‐builders may be excused their preference. However, looking at it purely from the standpoint of pro bono publico, the dispassionate observer must surely opt for the birth of a certain publication as being ultimately the most beneficial of the three.

The Chulalongkorn-Hasanuddin Rifampicin-Resistant Tuberculosis Screening Tool (CUHAS-ROBUST) is an artificial intelligence–based (AI–based) application for rifampicin-resistant tuberculosis (RR-TB) screening. This study aims to elaborate on the drug-resistant TB (DR-TB) problem and the impact of CUHAS-ROBUST implementation on RR-TB screening.

A qualitative approach with content analysis was performed from September 2020 to October 2020. Medical staff from the primary care center were invited online for application trials and in-depth video call interviews. Transcripts were derived as a data source. An inductive thematic data saturation technique was conducted. Descriptive data of participants, user experience and the impact on the health service were summarized

A total of 33 participants were selected from eight major islands in Indonesia. The findings show that DR-TB is a new threat, and its diagnosis faces obstacles particularly prolonged waiting time and inevitable delayed treatment. Despite overcoming the RR-TB screening problems with fast prediction, the dubious screening performance, and the reliability of data collection for input parameters were the main concerns of CUHAS-ROBUST. Nevertheless, this application increases the confidence in decision-making, promotes medical procedure compliance, active surveillance and enhancing a low-cost screening approach.

The CUHAS-ROBUST achieved its purpose as a tool for clinical decision-making in RR-TB screening. Moreover, this study demonstrates AI roles in enhancing health-care quality and boost public health efforts against tuberculosis.

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.

Almost 10 years ago, attention was drawn to the many pitfalls involved in the treatment of tuberculosis (TB) in prison settings, based on field experience from the ICRC (International Committee of the Red Cross) (Coninx et al., 1995). Since that time, the ICRC has continued working in the field of TB in prisons, either directly or by supporting the local programmes in different countries. Further experience gained since then has, if anything, confirmed and reinforced the worries caused by the specific problems posed both by the prison environment and by “prisoner‐patients” for the treatment of TB. Medical staff working in prisons need to be familiar with these issues if tuberculosis is to be managed and treated successfully. With the menace of drug‐resistant TB no longer merely a marginal problem but arguably becoming a direct menace to public health, it becomes all the more important to be aware of these pitfalls. This paper addresses the following: * why prison settings are especially difficult for TB detection and management; * why prisoners can be particularly difficult patients; * how different resistant strains of TB are produced or enhanced in prisons; * added difficulties in treating MDR‐TB in prisoners; and * how and why the association of TB and HIV complicate TB, and MDR‐TB, treatment in prisons even further. The photographs and additional illustrations are from the author’s collection. Permission was obtained from all persons photographed for reproduction.

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.

The purpose of this paper is to determine the factors associated with patient delay among tuberculosis patients in border hospitals, Chiang Rai province, Thailand.

A cross-sectional study was conducted in the four biggest border hospitals in Chiang Rai province, Thailand during May to July 2018 among 103 identified TB cases. Data were collected by a face-to-face interview with structured questionnaire on patients’ general characteristics, HIV status and patient delay status. Descriptive statistics were used to analyze the patients’ general characteristics, HIV and patient delay status. The association among variables and patient delay was analyzed by χ²-test. The variables with p-value<0.20 obtained in bivariate analysis were further analyzed by binary logistic regression and considered significant with p-value<0.05.

All patients enrolled, most were reported with patient delay (65.0 percent). Bivariate analysis demonstrated that level of education, nationality and HIV status were associated factors for patient delay. Among these factors, binary logistic regression revealed that HIV negative TB patients were increased 6.806-fold odds of being patient delay (OR = 6.806; 95% CI: 1.174–39.462), while non-Thai TB patients were also increased 2.824-fold odds of being patient delay (OR = 2.824; 95% CI: 1.041–7.660).

Patient delay among TB patients in Chiang Rai province was high. This study further supports the requirement on promoting of TB knowledge and awareness emphasized on non-Thai population and general public along the border areas of Chiang Rai province.

The largest ever outbreak of Ebola virus disease (EVD), which began in December 2013, profoundly impacted not only the West African countries of Guinea, Sierra Leone, and Liberia, and to a lesser extent Nigeria, but also the rest of the world because some patients needed to be managed in high-resource countries. As of March 29, 2016, there were 28,616 confirmed, probable, and suspected cases of EVD reported in Guinea, Liberia, and Sierra Leone during the outbreak, with 11,310 deaths (case fatality rate of 39.5%). An unprecedented number of healthcare workers and professionals, including physicians, nurses, logistic and administrative personnel, housekeepers, epidemiologists, statisticians, psychologists, sociologists, and ethics experts in many countries, were directly or indirectly involved in the care of EVD patients.

The provision of medical care to critically ill EVD patients would have been challenging in any setting but was especially so in the remote and resource-limited areas where patients were stricken by EVD. Limited health personnel, medical supplies, and equipment, along with inadequate knowledge and skills for minimizing the risks of transmission to healthcare workers, could have led to the de-prioritization of patient care. However, ethical considerations demanded aggressive patient care (intensive care, dialysis, central vascular catheter indwelling, etc.) to produce positive outcomes without increasing the risks to healthcare workers and caregivers.

A major ethical consideration was that healthcare workers have a double obligation: while providing the best medical care to improve EVD patient survival, with symptom relief and palliation as required, they must also protect themselves and minimize further transmission to others, including their colleagues. During the 2014–2015 EVD epidemic, another ethical and clinical problem arose in relation to the management of healthcare workers deployed in Africa who acquired EVD while caring for infected patients. As of June 24, 2015, a total of 65 individuals had been evacuated or repatriated worldwide from the EVD-affected countries, of whom 38 individuals were evacuated or repatriated to Europe. The need for evacuation and repatriation, together with associated ethical issues, is discussed in this chapter.