Journal Article > ResearchFull Text
Public Health Action. 21 December 2012; Volume 2 (Issue 4); 138-41.; DOI:10.5588/pha.12.0034
Ram S, Kishore K, Batio I, Bissell K, Zachariah R, et al.
Public Health Action. 21 December 2012; Volume 2 (Issue 4); 138-41.; DOI:10.5588/pha.12.0034
SETTING
All tuberculosis (TB) diagnostic and treatment centres in Fiji.
OBJECTIVES
To report on pre-treatment loss to follow-up rates over a 10-year period (2001-2010) and to examine if patients' age, sex and geographic origin are associated with the observed shortcomings in the health services.
METHODS
A retrospective review of routine programme data reconciling TB laboratory and treatment registers.
RESULTS
A total of 690 sputum smear-positive TB patients were diagnosed in the laboratory, of whom 579 (84%) were started on anti-tuberculosis treatment-an overall pre-treatment loss to follow-up of 111 (16%). Peak loss to follow-up rates were seen in 2003, 2004 and 2010. Pre-treatment losses were all aged ≥15 years. In the Western Division of Fiji, 33% of sputum-positive patients were declared pre-treatment loss to follow-up; this division had over five times the risk of such an adverse outcome compared to the Central Division (OR 5.2, 95%CI 3.1-8.9, P < 0.0001).
CONCLUSION
This study has identified an important shortcoming in programme linkage, communication and feedback between TB diagnostic and treatment services, leading to high pre-treatment loss to follow-up rates. This negatively influences TB services, and ways to rectify this situation are discussed.
All tuberculosis (TB) diagnostic and treatment centres in Fiji.
OBJECTIVES
To report on pre-treatment loss to follow-up rates over a 10-year period (2001-2010) and to examine if patients' age, sex and geographic origin are associated with the observed shortcomings in the health services.
METHODS
A retrospective review of routine programme data reconciling TB laboratory and treatment registers.
RESULTS
A total of 690 sputum smear-positive TB patients were diagnosed in the laboratory, of whom 579 (84%) were started on anti-tuberculosis treatment-an overall pre-treatment loss to follow-up of 111 (16%). Peak loss to follow-up rates were seen in 2003, 2004 and 2010. Pre-treatment losses were all aged ≥15 years. In the Western Division of Fiji, 33% of sputum-positive patients were declared pre-treatment loss to follow-up; this division had over five times the risk of such an adverse outcome compared to the Central Division (OR 5.2, 95%CI 3.1-8.9, P < 0.0001).
CONCLUSION
This study has identified an important shortcoming in programme linkage, communication and feedback between TB diagnostic and treatment services, leading to high pre-treatment loss to follow-up rates. This negatively influences TB services, and ways to rectify this situation are discussed.
Journal Article > CommentaryFull Text
Int J Tuberc Lung Dis. 16 June 2012 (Issue 6)
Zachariah R, Harries AD, Srinath S, Ram S, Viney K, et al.
Int J Tuberc Lung Dis. 16 June 2012 (Issue 6)
The words 'defaulter', 'suspect' and 'control' have been part of the language of tuberculosis (TB) services for many decades, and they continue to be used in international guidelines and in published literature. From a patient perspective, it is our opinion that these terms are at best inappropriate, coercive and disempowering, and at worst they could be perceived as judgmental and criminalising, tending to place the blame of the disease or responsibility for adverse treatment outcomes on one side-that of the patients. In this article, which brings together a wide range of authors and institutions from Africa, Asia, Latin America, Europe and the Pacific, we discuss the use of the words 'defaulter', 'suspect' and 'control' and argue why it is detrimental to continue using them in the context of TB. We propose that 'defaulter' be replaced with 'person lost to follow-up'; that 'TB suspect' be replaced by 'person with presumptive TB' or 'person to be evaluated for TB'; and that the term 'control' be replaced with 'prevention and care' or simply deleted. These terms are non-judgmental and patient-centred. We appeal to the global Stop TB Partnership to lead discussions on this issue and to make concrete steps towards changing the current paradigm.
Journal Article > Short ReportFull Text
Public Health Action. 21 June 2014; Volume 4 (Issue 1); DOI:10.5588/pha.13.0071
Harries AD, Marais BJ, Kool B, Ram S, Kumar AMV, et al.
Public Health Action. 21 June 2014; Volume 4 (Issue 1); DOI:10.5588/pha.13.0071
Journal Article > ReviewFull Text
Public Health Action. 21 June 2014; Volume 4; DOI:10.5588/pha.13.0091
Bissel K, Viney K, Brostom R, Gounder S, Khogali MA, et al.
Public Health Action. 21 June 2014; Volume 4; DOI:10.5588/pha.13.0091
Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.