A Social and Behavior Change Communication Framework for Addressing Delays to Appropriate TB Care and Treatment
Hala Jassim AlMossawi1, Colleen Longacre1, Yogan Pillay2, Neeraj Kak1*
1University Research Co, Chevy Chase, MD, USA
2National Department of Health, South Africa
Social and behavior change (SBC) communication strategies and interventions have been used to successfully promote positive health behaviors and health outcomes, yet there is little evidence in the published literature on SBC frameworks for tuberculosis (TB) care and treatment. In this article, we outline a high-level generalized framework for the development, deployment, and evaluation of SBC communication strategies in high TB burden settings and how it could be employed to address TB treatment delays. The framework describes the contextual factors that will impact the design of a program, the spheres of influence, and details some of the outcomes to be achieved within each sphere that will lead to improved knowledge and substantive changes in behaviors at each prescribed level of the system. Improved design and delivery of SBC interventions can assist countries in meeting the Sustainable Development and Global End TB goals of reduced TB incidence, increased TB cure rates, reduced TB deaths, prevention of catastrophic out-of-pocket costs for TB care, and integration of health systems for patient-centered care.
DOI: 10.29245/2689-999X/2019/4.1156 View / Download Pdf Ventilator-Associated Pneumonia and In-Hospital Mortality: Which Risk Factors may predict In-Hospital Mortality in Such Patients?
Alizamin Sadigov*, Irada Mamedova, Kamran Mammmadov
Pulmonary Medicine Department, Azerbaijan Medical University, Baku
Background: Ventilator-associated pneumonia (VAP) remains a common case of intensive care unite (İCU) and hospital morbidity and mortality despite advances in diagnostic techniques and manegment. One of most important point for such patients is identification of predictors for mortality in term for futher their modification and reduction of mortality rate.
Objective: We aimed to determine the most important risk factors for short-term mortality in patients with VAP in mechanically ventilated patients.
Methods: This retrospective study was carried out from February 2014 to January 2019. One hundred twenty one adults patients with VAP maintained on mechanical ventilation for more than 48 h in our ICU department were enrolled in the study. VAP was diagnosed as new persistent pulmonary infiltrates on chest radiographs and a least two of following: (1) Fever of ≥38.3C (2) leukocytosis of ≥ 12.000/mm3 and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples and blood samples of suspected case were collected and processed as per standard protocols.
Results: The primary underlying diagnosis and comorbidities were acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in 42 patients, congestive heart failure in 32, neurological disease in 28, and renal disease in 19 patients. Gram-negative agents were the major of finding pathogen (Acinotebacter baumannii accounting for 37.1 %). This infection in 43 case (95.5%) was multi-dying resistant (MDR) pathogen and associated with significantly higher length of ventilation (LOV) and the length of ICU stay (LOSicu) (p=0.01 respectively). Severe sepsis/septic shock, acute respiratory distress syndrome (ARDS), malnutrition, pulmonary complications such as pleural effusions and bilateral, multi- lobar lung infiltrates were most common findings in VAP patients which were associated with higher mortality (p<0.01).Acinotebacter baumannii MDR pathogens was associated with higher mortality rate compare with other MDR pathogens (p<0.01).
Conclusion: Ventilator-associated pneumonia is a serious ICU complication that is associated with increased in hospital mortality.In patients with VAP malnutrition ,severe sepsis/septic shock, ARDS, MDR Acinotebacter baumannii infection ,bilateral pulmonary infiltrates ,and underlying chronic obstructive pulmonary disease(COPD) are associated with increased risk in-hospital mortality in such patients. Identification of risk factor for in hospital mortality in such patents is important in term on further their modification and reduction of mortality rate.
DOI: 10.29245/2689-999X/2019/4.1157 View / Download Pdf Tuberculous Meningitis in Children in Russia: Diagnostic Features and Clinical Observations
L.V.Klochkova*, M.E.Lozovskaya, E.B.Vasilyeva, Yu.A.Yarovaya
Saint Petersburg State Pediatric Medical University, Ministry of Health of the Russian Federation, Saint Petersburg, Russia
Background: The study aimed to identify causes of delayed diagnosis and define features of tuberculous meningitis in children in the Russian Federation.
Materials and Methods: The study is based on data from 2000 to 2016 on frequency of meningitis in children in Russia. Further analysis of disease features and diagnostics of tuberculous meningitis in children in St. Petersburg over 12 years (2005-2016) is presented.
Results and Discussion: The number of cases of tuberculous meningitis in children in Russia decreased from 51 to 13 per year from 2000 to 2016. In St. Petersburg, from 2005 to 2016 there were 7 registered cases; 4 died, 3 survived. Predisposing factors of development of tuberculous meningitis were young age, presence of tuberculosis in the family, absence of BCG vaccination, and unfavorable social conditions. Three out of 7 children infected with HIV developed tuberculosis. However, a low frequency of cases has led to absence of phthisis vigilance, delayed diagnosis and deaths. Two illustrative cases are presented from clinical practice.
Conclusion: Improving outcomes of tuberculous meningitis requires enhanced phthisis vigilance, detection of mycobacterium tuberculosis infection by modern methods, use of all methods of etiological diagnostics, including PCR and Baсtec, and immediate administration of antituberculous therapy.
DOI: 10.29245/2689-999X/2019/4.1159 View / Download Pdf