Bovine tuberculosis: A potential public health risk in Nepal (original) (raw)
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Social determinants of tuberculosis: context, framework, and the way forward to ending TB in India
Expert Review of Respiratory Medicine, 2020
Introduction Social determinants are involved in the causation of TB and its adverse outcomes. This review was conducted to evolve a framework for action on social determinants with special reference to India in the context of the new END TB strategy. Areas covered We reviewed the social context of TB in India as a neglected disease of the poor, its emergence in epidemic form in the colonial period, and the factors that resulted in its perpetuation and expansion in post-independence India. We examined the role of social determinants in two key pathways – the pathway of TB causation and its outcomes, and the care cascade for patients with TB, and its consequences. We reviewed the most important social determinants of TB including poverty, membership of certain castes and indigenous population, undernutrition and poor access to healthcare, especially in rural areas. Expert opinion We suggest that TB elimination will require an optimal mix of enhanced biomedical and social intervention...
The Local Explanatory Model: A Study of Assumed Causes of Tuberculosis in Rural Nepal
Tuberculosis (TB) constitutes one of the major public health problems in Nepal. Our theoretical framework, in this paper, is to explore people's understanding of the culturally constructed reality, the local explanatory model, for causes of Tuberculosis. The ethnographic data were collected from 'Solubang' village of Pyuthan district in 2005 and 2012/13. The finding shows that assumed and suggested cause(s) of TB are multiple but most often within a framework of great uncertainty. Compared to 2005, people were better aware of the need for timely treatment in 2012/13. The arrival of the biomedical anti-TB medicines has changed the situation for the better and is widely recognized but perception on causes of TB and its prevalence have not changed drastically, and mortality rates have not decreased at the speed hoped for.
Wellcome Open Research
BACKGROUND: The World Health Organization’s End TB (tuberculosis) Strategy advocates social and economic support for TB-affected households but evidence from low-income settings is scarce. We will evaluate the feasibility and acceptability of a locally-appropriate socioeconomic support intervention for TB-affected households in Nepal. METHODS: We will conduct a pilot randomised-controlled trial with mixed-methods process evaluation in four TB-endemic, impoverished districts of Nepal: Pyuthan, Chitwan, Mahottari, and Morang. We will recruit 128 people with TB notified to the Nepal National TB Program (NTP) and 40 multisectoral stakeholders including NTP staff, civil-society members, policy-makers, and ASCOT (Addressing the Social Determinants and Consequences of Tuberculosis) team members. People with TB will be randomised 1:1:1:1 to four study arms (n=32 each): control; social support; economic support; and combined social and economic (socioeconomic) support. Social support will be...
Drivers of tuberculosis epidemics: The role of risk factors and social determinants
Social Science & Medicine, 2009
The main thrust of the World Health Organization's global tuberculosis (TB) control strategy is to ensure effective and equitable delivery of quality assured diagnosis and treatment of TB. Options for including preventive efforts have not yet been fully considered. This paper presents a narrative review of the historical and recent progress in TB control and the role of TB risk factors and social determinants. The review was conducted with a view to assess the prospects of effectively controlling TB under the current strategy, and the potential to increase epidemiological impact through additional preventive interventions. The review suggests that, while the current strategy is effective in curing patients and saving lives, the epidemiological impact has so far been less than predicted. In order to reach long-term epidemiological targets for global TB control, additional interventions to reduce peoples' vulnerability for TB may therefore be required. Risk factors that seem to be of importance at the population level include poor living and working conditions associated with high risk of TB transmission, and factors that impair the host's defence against TB infection and disease, such as HIV infection, malnutrition, smoking, diabetes, alcohol abuse, and indoor air pollution. Preventive interventions may target these factors directly or via their underlying social determinants. The identification of risk groups also helps to target strategies for early detection of people in need of TB treatment. More research is needed on the suitability, feasibility and cost-effectiveness of these intervention options.
International Journal of Community Medicine and Public Health, 2017
infectious disease. There were 1.4 million TB deaths in 2015, and an additional 0.4 million deaths resulting from TB disease among HIV-positive people. In terms of cases in 2015, there were 10.4 million new TB cases (including 1.2 million among HIV-positive people), of which there were 5.9 million men, 3.5 million women and 1.0 million children. Overall, 90% of cases were adults and 10% ABSTRACT Background: Tuberculosis has existed for millennia and remains a major global health problem. It causes ill-health in millions of people each year and in 2015 it was one of the top 10 causes of death worldwide. Understanding the specific reasons for unsuccessful outcomes is important to improve the treatment system. This present study was carried out to find out the effects of socio-demographic factors on TB defaulters under DOTS centre in Warangal District, Telangana state. Methods: A cross sectional study was carried among 103 defaulters of TB patients in 3 TB units (TU) Warangal (urban), Ragunathapally (rural) and Eturunagaram (tribal) out of 7 TB units in Warangal district, attached to District Tuberculosis Centre (DTC) from January 2016 to June 2016 by interview technique utilising a pretested and structured questionnaire to collect the data. Statistical analysis: Percentages, proportions and chi-square test were applied whenever necessary. Results: In present study, males (35%) were more than females (7.8%) and 42.8% were in the age group of 40-55 years, followed by 28.1% were 26-39 years age group. Majority of defaulters were in nuclear family (77.7%) followed by joint family (21.3%). Cost of travel as a reason for default of treatment was seen more in tribal area (16.5%) than rural (12.6%) and urban (4.8%) TUs. The TB patients residing in tribal areas are more prone to default, an important reason being the distance needed to travel to the closest health facility, availability and the need to travel by public transport. Conclusions: Tuberculosis is an infectious disease which has a devastating impact on the economic wellbeing of individual and their families. Most of the defaulters were illiterates residing in tribal area. Cost of travel as a reason for default of treatment was seen more in tribal TU 17(16.5%) than urban and rural TUs.
Presumed Cause(s) of Tuberculosis in Rural Nepal
Himalayan Journal of Sociology and Anthropology, 2017
In focus is the emic perspective on cause/s of tuberculosis. The ethnographic data is from two major studies in one and the same community in the Hill district of Pyuthan, in the Mid-Western Development Region. The findings show a pooling of old and new influences with a dazzling plurality of thoughts and ideas within a framework of great uncertainty. Moreover, changes in perceptions over the last decade and an half are quite marginal. For health workers to function efficiently the perceived causes of patients and their communities need to be understood and taken into account.
Developing Feasible, Locally Appropriate Socioeconomic Support for TB-Affected Households in Nepal
Tropical Medicine and Infectious Disease
Tuberculosis (TB), the leading single infectious diseases killer globally, is driven by poverty. Conversely, having TB worsens impoverishment. During TB illness, lost income and out-of-pocket costs can become “catastrophic”, leading patients to abandon treatment, develop drug-resistance, and die. WHO’s 2015 End TB Strategy recommends eliminating catastrophic costs and providing socioeconomic support for TB-affected people. However, there is negligible evidence to guide the design and implementation of such socioeconomic support, especially in low-income, TB-endemic countries. A national, multi-sectoral workshop was held in Kathmandu, Nepal, on the 11th and 12th September 2019, to develop a shortlist of feasible, locally appropriate socioeconomic support interventions for TB-affected households in Nepal, a low-income country with significant TB burden. The workshop brought together key stakeholders in Nepal including from the Ministry of Health and Population, Department of Health Se...
Preventive Practices of Tuberculosis Patients in a Municipality of Chitwan District, Nepal
Journal of College of Medical Sciences , 2019
Background: Tuberculosis (TB) is one of the top 10 causes of death worldwide and sixth leading cause of death in Nepal. Preventing new infections of Mycobacterium tuberculosis is crucial to reduce TB burden and death. The source of infection is an open (sputum positive) case of pulmonary tuberculosis. Poor management of TB-related waste like disposal of sputum by patients has been reported as a risk factor for increasing susceptibility to active TB infection. The present study was undertaken to assess preventive measures practiced by TB patients. Methods: A cross-sectional study was conducted among 82 tuberculosis patients who visited the five different DOTs centres of Bharatpur Municipality of Chitwan district, Nepal during December 2016 to February 2017. To find the association between variables, chi-square test was used. P-value less than 0.05 were considered as statistically significant. Results: The Mean ± SD of age of patients was 37.02±18.90 years. 67.10% of the patients received health education on preventive measures. 59.8% of the respondents had good practice on prevention measures of TB. Only 3.70% used burning method for the sputum disposal after diagnosis of TB. None of the respondents used boiling method for the disposal of sputum. Among all only 6% practiced safe method of sputum disposal. The statistically significant variables with health education were preventive measures like self isolation (ᵪ2 = 7.54, p = 0.006), covering face while coughing and sneezing (ᵪ2 = 4.113, p = 0.043) and keeping surrounding clean (ᵪ2= 7.880, p = 0.005). Conclusions: Patients and family members should be well educated on practicing different preventive measures by further strengthening the preventive measures strategy in the transmission of tuberculosis if we envisioned to end TB by 2035. Keywords: health education; preventive measures; preventive practices; sputum disposal; tuberculosis.
TUBERCULOSIS A DISEASE OF POORS, A COMPARATIVE ANALYSIS OF DEVELOPED AND DEVELOPING COUNTRIES.docx
With the evolution of human civilization, diseases also came. A disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury is disease. Humans have always suffered from some kind of malfunctioning in the normal function of systems. It has changed form over a period of time and due to the combination of various factors, it is defined differently in different geographies. Human civilization is full of stories of various diseases that were inflicted upon mankind at once in the history. So, here an attempt has been made to discuss one of most prevalent infectious disease of human history i.e. tuberculosis. Tuberculosis is termed as a disease which has severely troubled only those were or are at the lower end of social ladder i.e. poors. It is also named as ‘disease of the poor’ or ‘consumption of the poor’. Developed and developing countries are compared in order to understand the extent of discrimination that poor countries, poor people has to face be it prevalence of disease or be it inequality in treatment facility available to them. There is large inequality in prevalence, CFR and treatment facilities available for tuberculosis. The paper is an attempt to see the disparity in number of new cases of TB, deaths due to TB and treatment coverage of Tuberculosis in different world economies.