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Biomedical subjects

D A Enarson

Publications and source records attributed to D A Enarson.

At least 91 records · Page 5Linked to original sources
PubMed1997

Evaluation of a standardized recording tool for sputum smear microscopy for acid-fast bacilli under routine conditions in low income countries.

SETTING: Laboratories performing sputum smear microscopy for tuberculosis in Benin, Malawi, Nicaragua and Senegal. METHODS: Analysis of computerized laboratory registers to ascertain workload, yield from serial smear examination, and demographic characteristics of examinees. RESULTS: Data from more than 60,000 examinees in 42 laboratories showed that the average number of smears examined per day ranged from 4 to 19 (mean 6) per country. To find one case of tuberculosis, on average 21 smears of suspects were examined (range 8 to 50). Of all cases with ultimately at least one positive result, 87% were already positive on the first examination. Demographic characteristics of cases differed considerably by country and gender. In 35 of 42 laboratories, males were more frequently found to be cases than females, and with increasing age an increasingly larger number of female than male suspects had to be examined to identify one case. CONCLUSIONS: This study demonstrates the usefulness of a standardized recording system for results of acid-fast microscopy in obtaining essential information for program management and on demographic characteristics of persons presenting for examination.

Adolescent↗
PubMed1997

Successful management of a national tuberculosis programme under conditions of war.

OBJECTIVE: To compare treatment results before and after introduction of short course tuberculosis chemotherapy and to identify factors affecting the results. DESIGN/SETTING: An eight-month chemotherapy regimen for smear-positive pulmonary tuberculosis was introduced in Nicaragua in 1984 with external financial assistance. We performed a retrospective record review to compare treatment results before and after introduction of short-course chemotherapy. Information on support services and programme administration, availability of hospital beds for tuberculosis patients, access to health services and the economic and war situation in the two periods was assessed. RESULTS: The overall success ratio improved by 39% between the two periods reviewed, in spite of evidence of a deteriorating economy and escalation in civil war. A success ratio of 71% was achieved and we estimate that between 80 and 90% of registered cases stopped transmitting tuberculosis. The best results were obtained in the treatment of previously untreated patients with eight-month chemotherapy and in retreatment of relapses. The worst results were obtained in retreatment of defaulters. Analysis of the findings by region suggests that short-course chemotherapy was important, but not enough by itself to guarantee success. Factors likely to have influenced treatment results are: commitment by health authorities in guaranteeing personnel and hospital beds, training of personnel, and supervision of service delivery. Possibilities for further improvement are discussed. CONCLUSIONS: Good results were achieved in tuberculosis control with the introduction of short-course chemotherapy in spite of poverty and war. Government commitment and simultaneous improvement in supportive services and programme management is important when introducing short-course chemotherapy in low income countries.

Antitubercular Agents↗
PubMed1996

[Principles and organization of tuberculosis control].

Tuberculosis control must be organized by establishing programmes that are then implemented rigorously. The aim is to eradicate tuberculosis by applying a set of treatment procedures. These include, in particular, the detection of infectious cases in symptomatic patients who present to health services and their rapid treatment with chemotherapy, which makes them non-infectious and ensures their full recovery. An essential part of the programme is the information system, which enables treatment results to be evaluated and the efficacy of the treatment to be monitored. The model of the International Union against Tuberculosis and Lung Disease (IUATLD) for low income countries has proved to be effective, and has been recognized as one of the most efficient health interventions. The eradication of tuberculosis is possible: tuberculosis has a slow endemic cycle and tuberculosis can be reduced faster than drug resistance can emerge. In addition, all the tools required for tuberculosis control are already available and HIV infection is not yet widespread in several of the countries where tuberculosis is prevalent. Nevertheless, there is an urgent need for the rigorous and standardized application of the methods we have developed.

France↗
PubMed1995

Adverse cutaneous reactions to thiacetazone for tuberculosis treatment in Tanzania.

Because thiacetazone has been linked with serious adverse cutaneous reactions, we undertook 1 year of systematic surveillance for cutaneous thiacetazone-associated adverse reactions within the national tuberculosis programme of Tanzania. For individual cases, we collected information on age, sex, interval between commencing thiacetazone-containing treatment and occurrence of adverse reaction, most severe clinical presentation (toxic epidermal necrolysis, rash without necrolysis, itching without rash), and outcome (dead or alive) within 2 weeks of onset. Univariate and multivariate analyses were done of variables relevant to outcome. 1273 patients with adverse reactions were reported. The frequency of fatal outcome from any cutaneous reaction was 3.1 per 1000 among all tuberculosis patients, and 19.1% among patients with toxic epidermal necrolysis. About 60% of all adverse reactions and deaths occurred within 20 days of starting thiacetazone. Case fatality from adverse cutaneous reactions was considerably less frequent than reported previously, suggesting that improved management might allow retention of thiacetazone in the armamentarium of national tuberculosis programmes even where infection with HIV is prevalent.

Adult↗
PubMed1995

A computer-based ordering system for supplies in national tuberculosis programs.

SETTING: National tuberculosis programs in need of budgeting and planning for supplies. OBJECTIVE: To assist national managers to rationally and rapidly determine needs in supplies and their costs for the national tuberculosis program. METHODS: A spreadsheet has been developed to calculate needs in supplies for tuberculosis control based on the number of nationally notified cases. The spreadsheet has 3 interdependent basic components that need to be modified. The first component requires an update of exchange rates of currencies from countries which are major suppliers for program materials. The second component contains a list of commonly used treatment regimens in national programs and their cost. The number of reported tuberculosis cases for the last complete reporting half-year on then corresponding regimens needs to be provided. The third component lists supplies for diagnosis and treatment and the costs of these to the International Union Against Tuberculosis and Lung Disease (IUATLD). The information required here includes (after updating the country-specific list of suppliers and the cost of their material) the current stock in supplies and editing the resulting suggestion for orders according to needs and convenience of unit size. RESULTS: The spreadsheet suggests the ordering size of supplies for consumption and reserve. Based on input provided by the user, it will turn out estimates of the cost of the order for supplies in diagnosis and treatment. CONCLUSIONS: Computers are coming increasingly into use at the national level of many tuberculosis programs in low income countries. This spreadsheet, available from the IUATLD, is designed to provide national managers with the background on how to calculate needs for supplies and to provide them with a simple tool to assess these needs and their costs rapidly.

Antitubercular Agents↗
PubMed1995

Impact of the change from an injectable to a fully oral regimen on patient adherence to ambulatory tuberculosis treatment in Dar es Salaam, Tanzania.

OBJECTIVE: To measure the impact on patient adherence to directly observed ambulatory tuberculosis treatment substituting an all-oral treatment regimen for a regimen containing streptomycin. METHODS: The expected and observed attendance of patients during the intensive phase of anti-tuberculosis treatment was measured daily at two out-patient clinics in Dar es Salaam. During the observation period, treatment was changed from a regimen containing streptomycin to an all-oral regimen, and attendance proportions were compared for the three periods during which patients always, sometimes or never received streptomycin during the intensive phase of treatment. RESULTS: In Kinondoni, an average of 98 patients was expected every day, in Ilala 127. No significant difference was observed in attendance in Kinondoni between periods when patients always (median attendance 95.9%) and never (median 95.7%) received streptomycin injections as part of their intensive phase treatment for tuberculosis. In Ilala, no difference was noted in attendance between the period in which patients received streptomycin for at least part of their treatment (median 91.3%) and the period when ethambutol had fully replaced streptomycin (median 91.8%). CONCLUSIONS: In these two districts of Dar es Salaam, patient adherence to a completely oral treatment regimen was indistinguishable from that to a streptomycin-containing regimen. Given the potential of iatrogenic transmission of HIV and the advantages in reduced staff time and drug costs, the results clearly justify the replacement of streptomycin with ethambutol in Tanzania for new patients receiving an ambulatory rifampicin-containing regimen.

Administration, Oral↗
PubMed1994

Tuberculosis case-finding in Nicaragua: evaluation of routine activities in the control programme.

SETTING: The new International Union against Tuberculosis and Lung Disease (IUATLD) tuberculosis strategy developed in the 1980s in Tanzania, Malawi and Mozambique, was simultaneously implemented in Nicaragua. OBJECTIVE: Present results of case-finding, identify trends in incidence and limitations in case-finding and reporting. DESIGN: Data are based upon the traditional reporting system until 1987, replaced as the programme was reorganized. Data were also collected directly from the Central Laboratory, Programme and Laboratory registers during supervision of health centres. RESULTS: Quality control of sputum smears shows 1.8% discordance between peripheral and central laboratories. Notification rate of smear-positive tuberculosis declined 1.7% yearly 1983-1991 and 2.6% for all cases. Half of the patients are new smear-positive pulmonary cases, 40% smear-negative pulmonary cases. Relapses represent 11-13% of all smear-positive patients, children 7-30% of all cases. One-third of extrapulmonary tuberculosis cases are pleural effusions, another third lymphadenitis. 41% of adult patients entered as smear-negative in the programme had no smear reported in the laboratory. CONCLUSIONS: Quality control of sputum smears was established and the reporting system improved in spite of adverse conditions. Notification rate declined gradually. Smears should be done in all patients classified as smear-negative pulmonary tuberculosis.

Adolescent↗
PubMed1992

Five cross-sectional studies of grain elevator workers.

Five cross-sectional studies were conducted on grain workers in all the terminal elevators in British Columbia, Canada, at 3-year intervals from 1976 to 1988. Civic workers were studied in the same manner as a referent group. The studies consisted of questionnaires, spirometry using the same spirometers, allergy skin tests, and measurement of dust concentration by personal sampling. Although the dust concentration in the elevators was reduced progressively over the years, grain workers had more respiratory symptoms and lower lung function compared with the civic workers in each of the five cross-sectional studies. Exposure to grain dust was associated with significant reduction in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) but not in maximal midexpiratory flow rate or FEV1/FVC, suggesting reduction in volume which may be due to lesions in the lung parenchyma or in the small airways. Cigarette smoking was associated with significant reduction in FEV1, maximal midexpiratory flow rate, and FEV1/FVC due to airflow obstruction, but had no influence on FVC. Workers who took part in all five surveys tended to be a "healthier" selected group, but the grain workers still had lower lung function compared with the civic workers. This study confirmed previous findings that grain dust has adverse effects on the lungs. Cross-sectional study of the grain elevator workers proved to be a consistent and useful method to evaluate occupational health hazards.

Adult↗
PubMed1992

Deaths in tuberculosis patients in British Columbia, 1980-1984.

Records of all 1884 newly notified tuberculosis cases, over the 5-year period 1980-1984 in British Columbia, Canada, were reviewed and 201 deaths were identified, including 48 diagnosed only after death, and 153 who died while on treatment; 56 of unrelated causes, 67 in whom tuberculosis was a contributing cause, and 30 in whom it was the principal cause. Significant predictors of death while on treatment (specific to tuberculosis) were the extent of disease, history of previous disease and sputum smear-positive for acid-fast organisms. Significant predictors of failure of diagnosis, in patients who died, were the presence of disseminated disease and the absence of a history of previous disease. The presenting features were not different in those dying, in whom the diagnosis was made before, as compared with after, death. The most frequent mode of death due to tuberculosis was respiratory failure, followed by multiple organ system failure and haemoptysis. The case fatality rate was low (1.6%) and did not change over 10 years. One-half of patients whose death was due to tuberculosis were diagnosed only after death and this had not changed over 10 years. We conclude that death due to tuberculosis is uncommon in patients while on treatment and that the main reason for death due to tuberculosis is that some patients are not diagnosed, and therefore not treated, before they die of the disease.

Adult↗