Summary :Setting: A key recommendation of the National TB Strategy for England is testing and treatment of latent Tuberculosis infection (LTBI) among new migrants. Programmatic testing is based in primary care; however, this may be inaccessible to some individuals. Current strategies therefore could be complemented with screening in other settings.Objective: To investigate the feasibility and effectiveness of LTBI screening in a community college.Design: We performed a cohort study, based on observational data collected during and after the pilot project. Eligible language students from high TB incidence countries were consented and tested with a single-step Interferon Gamma Release Assay (IGRA) and enrolled in the cohort. We used single and multivariable analyses to estimate effectiveness of LTBI screening and to explore effectiveness in different sub-groups.Results: Screening uptake was 75% and the treatment completion rate was 85%. 71/440 students (16%) were LTBI positive and two had active TB. There was an association of positivity with age and TB incidence in the country of origin. We included costs from a UK National Health Service perspective. Three potential TB incidence thresholds met our cost effectiveness criteria for screening: countries with incidences of more than 40, more than 100 and more than 200 per 100,000 plus students from sub-Saharan Africa. Conclusion:We found that LTBI screening can be offered effectively in a community college setting, and could be a feasible complement to primary care-based programmes in low-incidence countries.

Following the introduction of the pneumococcal conjugate vaccination program for children in the UK, a study of General Practitioners in Walsall and Liverpool was undertaken to identify the possible reasons for the delay in implementation of the program. A total of 143 GPs were contacted, of whom 39 responded (response rate = 27%). One-third of the GPs felt that there was 'delay' in the introduction of the program. The main reasons for possible delay in the implementation of the program were 'problems with databases', 'inadequate/unclear information from Primary Care Trust,' 'lack of public awareness' and 'parental delay.' Twelve percent of the respondents said that issue of 'payment' to them was the reason for not implementing the program. Most of the reasons given were 'external' to the practitioners. This being an initial exploratory study of its kind, the authors recommend that the results of this study be used in conjunction with other quantitative data by commissioners of health services in designing the implementation of a new vaccination program.

U5MR is high in Nigeria; the rates are in three digits. There is a wide variation in the U5MR in Nigeria, with 27% showing evidence of special-cause variation which merits further investigation to identify possible causes. However, the vast majority of states (73%) are consistent with common-cause variation.