Diagnostic Value of Interleukins in Tuberculous Pleural Effusion: A Systematic Review and Meta‐analysis

Abstract

Methods: Intervention utilized-Treatment supporters (TS) and mobile clinics. Intention to provide daily DOT by TS. At the end of March 2017, 63 TS are assigned for 454 TB patients. Number of patients supported by one TS varies from 1 to 20 according to the ease of location and the amount of patient support required. MSF mobile clinic team consists of health extension officer and community health worker and TB patients are reviewed on monthly basis during their regular visit of Malalua and Ihu BMU as well as health posts in covering area. MSF is offering to the patients dinghy and bus transport to these health centers.Results: Since commencing the activity multiple complexities have been notedTraining and supervision of treatment supporters who are very remote is difficult Heavy workload on TS with multiple activities added Patient's acceptance of TS in multicultural context Emphasis on TS approach distracted from patient centred approach Conclusions:The geographical difficulties in Gulf has led to using TS for follow up. This approach has shown some limitations. In such a context, to facilitate treatment adherence, an individualized approach accompanied by adequate patient education and counseling may be a more effective approach than TS for all. IndonesiaBackground and Aims: One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with TB. In the hospital, people with symptoms compatible with TB have an opportunity to get proper diagnosis and treatment. Yet this opportunity is often missed. We hypothesize that a respiratory triage system recommended by WHO for prevention of the spread of respiratory infection at the outpatient department, can be improved to enhance early detection of TB. With this hypothesis an intervention study was conducted at Zainal Abidin Hospital.The objective of this intervention study was to compare the proportion of patients with cough >2 weeks, offered sputum test and TB case detection rate before versus after a respiratory triage system introduced.Methods: Before-and-after interventional study. Intervention; training of health personnel and setting up a respiratory triage system, to detect patients with >2 weeks cough and offering sputum test for acid-fast bacilli. Data from "exit poll" and central laboratory were compared before vs after the triage set up.Results: After the intervention, sampled patients who visited the hospital were more likely to be asked on >2 weeks cough (85.3% vs17.9%).In the whole samples (99.2% vs 64.7%) among them have >2 weeks cough patients. For TB detection, the changes were 39 positive results from 220 AFB tests of 61,871 outpatients to 55 positive from 365 AFB tests among 53,056 outpatients. The rates of sputum testing and TB case detection increased from 3.5 to 6.8 per 1,000 (OR=1.9, 95% CI=1.6-2.3) and 6.3 to 10.4 per 10,000 (OR=1.7, 95% CI=1.1-2.6) respectively. Conclusions:Respiratory triage can significantly increase TB detection rate.