Search

Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality—over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy–practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.

Background: The adverse effects of air pollution on respiratory health has been documented in high-income countries, but data are scarce from low-income countries. We reported on air quality in Ouagadougou and its effects on hospital visits for respiratory diseases among children.Methods: It was a retrospective hospital-based ecological study. All children admitted from 1 July 2019 to 30 June 2020 at two major teaching hospitals in Burkina Faso were included. We conducted a binary logistic regression to determine the health effects of PM2.5 and PM10 on hospital visits for respiratory diseases, with adjustment for covariates (weather, sociodemographic factors and medical history). Results: Hospital visits for respiratory diseases accounted for 14.16% of all visits. Children were males in the majority (54.57%) and aged between 29 days-30 months (74.85%). PM10 was at WHO recommended levels, ranging from 0.06 μg/m³ to 18.33 μg/m³. PM2.5 concentration ranged from 0.41 to 258.82 μg/m³, above the WHO standards. Rise in PM2.5 concentration was associated with slightly more outpatients than inpatients (ORc=0.996 95% CI: 0.993-0.998; p=0.003). The weather confounded this relationship, but the sociodemographic factors and medical history did not. The increase in PM10 was not significantly associated with hospital visits for respiratory diseases (ORc=0.997 95% CI: 0.977-1.018; p=0.802). Adjusting the PM effects for all covariates, higher PM2.5 and relative humidity levels and the female sex were associated with more outpatient cases than inpatients. Underlying conditions (severe acute malnutrition, sickle cell disease and heart disease) favoured more inpatients than outpatients. Conclusion: At harmful levels in Ouagadougou, PM2.5 caused primarily outpatient hospital visits rather than hospitalisations for respiratory diseases.

Setting: A survey of the prevalence of drug-resistant tuberculosis (DR-TB) in new and previously treated patients (PTPs) was performed in Burkina Faso from 2016 to 2017. Design: In this cross-sectional survey, a structured questionnaire was administered to eligible smear-positive patients in all 86 diagnostic and treatment centers of the country to collect their socio-demographic characteristics and medical histories. Their sputa were tested using the Mycobacterium tuberculosis/rifampicin (MTB/RIF) Xpert assay. Those which were found to be positive for TB and rifampicin-resistant were also tested with GenoType MTBDRplus2.0 and MTBDRsl2.0. Univariate and multivariate logistic regressions were performed to determine risk factors associated with rifampicin resistance. Results: Of the 1140 smear-positive patients enrolled, 995 new and 145 PTPs were positive for MTB complex by Xpert. Of these, 2.0% (20/995, 95% confidence interval (CI): 1.1–2.9) of the new cases and 14.5% (95% CI: 14.2–20.2) of the PTPs were resistant to rifampicin; 83% of them has multidrug-resistant tuberculosis (MDR-TB). None were pre-extensively drug-resistant TB (pre-XDR-TB) or XDR-TB. Only the previous treatment was significantly associated with rifampicin resistance, p < 0.0001. Conclusion: Similar to global trends, rifampicin resistance was significantly higher in patients with prior TB treatment (14.5%) than in naïve patients (2.0%). These percentages are slightly below the global averages, but nonetheless suggest the need for continued vigilance. Extending the use of Xpert testing should strengthen the surveillance of DR-TB in Burkina Faso.

BACKGROUND: According to the WHO, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death by 2030. In sub-Saharan Africa, the burden of the disease is unknown. We assessed the prevalence and the factors associated with COPD and chronic bronchitis among women in charge of household cooking. METHODS: A cross-sectional population survey was conducted. We randomly selected women aged ≥18 years in charge of cooking in their household. COPD was defined as post-bronchodilator FEV 1 /FVC (forced expiratory volume in 1 sec/forced vital capacity) ratio of 40 years, those had been cooking or had been exposed to toxic gases for more than 30 years. After adjustment, only biomass fuel use and exposure to toxic products were found to be associated with COPD. CONCLUSION: Urgent action is need to accelerate the transition to the other sources of energy., info:eu-repo/semantics/published

Background: Approximately 3 billion people, worldwide, rely primarily on biomass for cooking. This study aimed to investigate the association between respiratory symptoms among women in charge of household cooking and the type of fuel used for cooking. Methods: A community-based cross-sectional survey was conducted. A total of 1705 women that were randomly selected, completed the survey. We also performed a bivariate and a multivariate analysis to verify the possible associations between respiratory symptoms in women in charge of household cooking and the type of cooking fuel used. Results: Dry cough, breathing difficulties, and throat irritation frequencies were statistically high in biomass fuel users when compared to liquefied petroleum gas (LPG) users. It was also the case for some chronic respiratory symptoms, such as sputum production, shortness of breath, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty. After adjustment for the respondents&rsquo, and households&rsquo, characteristics, dry cough, breathing difficulties, sneezing, nose tingling, throat irritation, chronic sputum production, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty were symptoms that remained associated to biomass fuel compared to LPG. Women who used charcoal reported the highest proportion of all the chronic respiratory symptoms compared to the firewood users. However, this difference was not statistically significant except for the wheezing, waking up with coughing attacks, and waking up with breath difficulty, after adjustment. Conclusion: Exposure to biomass smoke is responsible for respiratory health problems in women. Charcoal, which is often considered as a clean fuel compared to other biomass fuels and often recommended as an alternative to firewood, also presents health risks, including increased respiratory morbidity in women. Effective and efficient energy policies are needed to accelerate the transition to clean and sustainable energies.

To the Editor: Pulmonary disease caused by nontuberculous mycobacteria (NTM) is increasing worldwide. The most commonly recognized species, with minor geographic differences, are Mycobacterium avium complex (MAC), M. kansasii, M. abscessus, and M. xenopi (1). Little is known about the role of NTM in pulmonary disease in countries with a high prevalence of tuberculosis (TB). In such settings, smear microscopy (to identify acid-fast bacilli) is the primary, and often the only, diagnostic tool used to diagnose presumptive TB. Therefore, pulmonary disease caused by NTM is frequently misdiagnosed as TB and, because of the patient’s lack of response to standard anti-TB treatment, as multidrug-resistant TB (2). In 2012, to detect possible drug resistance, we selected patients with pulmonary TB at the pulmonology division of Ouagadougou University Hospital (Ouagadougou, Burkina Faso), whose cases were classified as failing category II treatment (for patients with history of previous TB treatment). Each patient provided 1 sputum sample for culture and first- and second-line drug susceptibility testing (DST). Culture and DST were performed at the Supranational Laboratory of Milan (Milan, Italy), which provides technical assistance to the National Reference Laboratory in Burkina Faso. Of 314 samples NTM grew in culture for 36 (11%). Most NTM were identified as MAC (20 isolates). In culture of samples from 4 of the remaining patients, M. sherrisii grew. We describe the epidemiologic and clinical characteristics of these 4 patients. Three patients were male. All were born and lived in Burkina Faso and were HIV-negative; their ages ranged from 33 to 57 years. All had a history of having received 2 courses (categories I and II) of treatment for pulmonary TB. All were symptomatic, and their sputum samples were highly positive for acid-fast bacilli (1–10 cells/field; Ziehl-Neelsen stain). One patient did not return for further evaluation after this early assessment; the 3 others underwent a chest radiograph that showed, for each, pulmonary lesions compatible with TB (Table). The clinical specimens investigated in Milan were negative for M. tuberculosis complex by specific PCR (GenoType MTBDRplus, Hain Lifesciences, Nehren, Germany) and grew NTM in culture. The strains were identified as M. simiae with GenoType Mycobacterium CM/AS line probe assay (Hain Lifesciences), but because of the known cross-reactivity of the M. simiae–specific probe in this kit (3), the 16S rRNA gene was sequenced. All strains showed 100% identity to M. sherrisii strain NLA000800640 (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"EU883389","term_id":"195975903","term_text":"EU883389"}}EU883389), a strain previously isolated from a patient in Tanzania (4). Table Clinical features of and microbiological findings from 4 patients with Mycobacterium sherrisii infection, Burkina Faso, 2012* On the basis of these findings, a treatment regimen that included clarithromycin was begun for the 3 patients, in addition to the anti-TB regimen with isoniazid, rifampin, and ethambutol. One patient was lost to follow-up during the first 2 months of treatment and the 2 others died. Further information was available for only 1 of those who died: he died of heart failure after 9 months of treatment. The pulmonary disease may well have been the cause; no autopsy was performed. The presence of clear signs and symptoms compatible with pulmonary TB and the contemporary exclusion of M. tuberculosis, supported by the unresponsiveness to specific treatments and by the negative PCR results of strongly smear-positive sputum samples clearly fulfill the clinical criteria of the America Thoracic Society for NTM pulmonary disease (5). Meeting the objective of a second isolation, as required by microbiological criteria, was not possible because a second sputum sample was unavailable. M. sherrisii is a relatively new species (6), closely related to M. simiae. Although most of the rare M. sherrisii infections reported since 2004 (Technical Appendix Table 1) were diagnosed in Europe or the United States, about half of the strains were isolated from patients in Africa. Because M. sherrisii infection probably is further underestimated by being misidentified as M. simiae infection by the commercially available line probe assays, the hypothesis that M. sherrisii infection is not so infrequent in the African setting seems therefore reasonable. In addition, the strategy recommended by World Health Organization and based on use of immunochromatographic tests (7), does not enable NTM identification. A leitmotiv of most M. sherrisii infections reported to date is HIV co-infection, which leads to dissemination of the mycobacterial disease. This report, although it adds to the record of patients in Africa, does not support the association with HIV infection. Our findings are consistent with the view that the pathogenic potential of M. sherrisii is comparable to that of other well-known NTM species (e.g., MAC) responsible for disease both in HIV-positive and HIV-negative patients. The retrospective determination of the MICs of antimicrobial agents potentially active against slowly growing mycobacteria (Technical Appendix Table 2) confirmed, for the 4 strains of M. sherrisii, the well-known multidrug resistance of the species (8). The therapeutic failure was thus not surprising because clarithromycin was the only drug among those administered during the treatment that had been shown to be active in vitro. This report provides evidence that conducting appropriate microbiological investigations is essential before initiating a treatment with second-line TB drugs (9). Technical Appendix: Tables for Mycobacterium sherrisii infections reported to date, and results of drug susceptibility testing for the 4 identified strains of Mycobacterium sherrisii, Burkina Faso, 2012. Click here to view.(218K, pdf)

To the Editors: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) represent an emerging public health threat worldwide 1. The Stop TB Strategy has been revised to provide universal access to diagnosis and treatment for all patients with MDR-TB by 2015 2–4. This plan calls for accelerated access to culture for mycobacteria, species identification and drug susceptibility testing (DST) of Mycobacterium tuberculosis . However, in several countries, appropriate TB laboratory facilities are still largely unavailable. In the absence of culture and DST, TB patients failing a re-treatment regimen have been considered eligible for treatment regimens with second-line drugs, under the assumption that ≥80% of them would harbour MDR M. tuberculosis strains 5. In Burkina Faso, as in most low- and some middle-income settings, pulmonary TB cases failing a standard category II regimen are only identified by positive sputum smear microscopy at the end of the fifth month of treatment and are defined as “chronic” TB patients. The diagnosis of chronic TB has significant implications. National guidelines for the management of chronic TB cases in Burkina Faso recommend hospital admission and in-patient treatment for ≥6 months with a standardised category IV treatment regimen 6. Although the diagnosis of chronic TB is taken as a surrogate marker for the identification of MDR-TB, little evidence is available from the literature on its positive predictive value for MDR-TB diagnosis. We systematically performed microbiological investigations, which included both phenotypic and genotypic techniques, on all newly identified chronic TB cases diagnosed over a 2-yr period in Burkina Faso. Here, we report the results and discuss the implications that “blind” treatment with second-line drugs have at programmatic level. A prospective, country-wide investigation was performed to microbiologically characterise all consecutively registered chronic TB cases in Burkina Faso, defined on the basis of …

To the Editors: Tuberculosis (TB) and HIV co-infection is a public health priority in sub-Saharan Africa, where TB is the leading cause of death among HIV infected patients and the first manifestation of the HIV infection. 1–3. An unprecedented global effort allowed increasing access to antiretroviral treatment in Africa, where >2 million persons received highly active antiretroviral therapy (HAART) at the end of 2007 1. There is evidence that HAART reduces the risk of TB, in both industrialised 4 and resource-limited countries in sub-Saharan Africa and south-east Asia 5–9. However, there is no information on the HAART impact on the incidence of the different TB forms (sputum smear positive pulmonary (SSP-PTB), sputum smear negative (SSN-PTB) and extrapulmonary (EPTB)). We have measured TB incidence in a retrospective cohort of HIV infected persons who started HAART in four HIV/AIDS treatment centres in Ouagadougou, Burkina Faso. All consecutive HIV-seropositive patients aged …

Background Drug-resistant tuberculosis (DR-TB) is considered a real threat to the achievement of TB control. Testing of mycobacterial culture and testing of drug susceptibility (DST) capacity are limited in resource-poor countries, therefore inadequate treatment may occur, favouring resistance development. We evaluated the molecular assay GenoType® MTBDRplus (Hain Lifescience, Germany) in order to detect DR-TB directly in clinical specimens as a means of providing a more accurate management of chronic TB patients in Burkina Faso, a country with a high TB-HIV co-infection prevalence. Methods Samples were collected in Burkina Faso where culture and DST are not currently available, and where chronic cases are therefore classified and treated based on clinical evaluation and sputum-smear microscopy results. One hundred and eight chronic TB patients (sputum smear-positive, after completing a re-treatment regimen for pulmonary TB under directly observed therapy) were enrolled in the study from December 2006 to October 2008. Two early morning sputum samples were collected from each patient, immediately frozen, and shipped to Italy in dry ice. Samples were decontaminated, processed for smear microscopy and DNA extraction. Culture was attempted on MGIT960 (Becton Dickinson, Cockeysville, USA) and decontaminated specimens were analyzed for the presence of mutations conferring resistance to rifampin and isoniazid by the molecular assay GenoType® MTBDRplus. Results We obtained a valid molecular test result in 60/61 smear-positive and 47/47 smear-negative patients. Among 108 chronic TB cases we identified patients who (i) harboured rifampin- and isoniazid-susceptible strains (n 24), (ii) were negative for MTB complex DNA (n 24), and (iii) had non-tuberculous mycobacteria infections (n 13). The most represented mutation conferring rifampin-resistance was the D516V substitution in the hotspot region of the rpoB gene (43.8% of cases). Other mutations recognized were the H526D (15.6%), the H526Y (15.6%), and the S531L (9.4%). All isoniazid-resistant cases (n 36) identified by the molecular assay were carrying a S315T substitution in the katG gene. In 41.7% of cases, a mutation affecting the promoter region of the inhA gene was also detected. Conclusion The GenoType® MTBDRplus assay performed directly on sputum specimens improves the management of chronic TB cases allowing more appropriate anti-TB regimens.