Disparities in access to diagnosis and care in Blantyre, Malawi, identified through enhanced tuberculosis surveillance and spatial analysis.

Abstract:

BACKGROUND:A sizeable fraction of tuberculosis (TB) cases go undiagnosed. By analysing data from enhanced demographic, microbiological and geospatial surveillance of TB registrations, we aimed to identify modifiable predictors of inequitable access to diagnosis and care. METHODS:Governmental community health workers (CHW) enumerated all households in 315 catchment areas during October-December 2015. From January 2015, government TB Officers routinely implemented enhanced TB surveillance at all public and private TB treatment registration centres within Blantyre (18 clinics in total). This included collection from registering TB patients of demographic and clinical characteristics, a single sputum sample for TB microscopy and culture, and geolocation of place of residence using an electronic satellite map application. We estimated catchment area annual TB case notification rates (CNRs), stratified by microbiological status. To identify population and area-level factors predictive of CHW catchment area TB case notification rates, we constructed Bayesian spatially autocorrelated regression models with Poisson response distributions. Worldpop data were used to estimate poverty. RESULTS:In total, the 315 CHW catchment areas comprised 753,489 people (range 162 to 13,066 people/catchment area). Between 2015 and 2017, 6077 TB cases (61% male; 99% HIV tested; 67% HIV positive; 55% culture confirmed) were geolocated, with 3723 (61%) resident within a CHW catchment area. In adjusted models, greater distance to the nearest TB registration clinic was negatively correlated with TB CNRs, which halved for every 3.2-fold (95% CI 2.24-5.21) increase in distance. Poverty, which increased with distance from clinics, was negatively correlated with TB CNRs; a 23% increase (95% CI 17-34%) in the mean percentage of the population living on less than US$2 per day corresponded to a halving of the TB case notification rates. CONCLUSIONS:Using enhanced surveillance of TB cases in Blantyre, we show an ecological relationship consistent with an 'inverse care law' whereby poorer neighbourhoods and those furthest from TB clinics have lower relative CNRs. If confirmed as low case detection, then pro-poor strategies to facilitate equitable access to TB diagnosis and treatment are required.

journal_name

BMC Med

journal_title

BMC medicine

authors

MacPherson P,Khundi M,Nliwasa M,Choko AT,Phiri VK,Webb EL,Dodd PJ,Cohen T,Harris R,Corbett EL

doi

10.1186/s12916-019-1260-6

subject

Has Abstract

pub_date

2019-01-29 00:00:00

pages

21

issue

1

issn

1741-7015

pii

10.1186/s12916-019-1260-6

journal_volume

17

pub_type

杂志文章
  • Predictive validity of the UKCAT for medical school undergraduate performance: a national prospective cohort study.

    abstract:BACKGROUND:The UK Clinical Aptitude Test (UKCAT) has been shown to have a modest but statistically significant ability to predict aspects of academic performance throughout medical school. Previously, this ability has been shown to be incremental to conventional measures of educational performance for the first year of...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-016-0682-7

    authors: Tiffin PA,Mwandigha LM,Paton LW,Hesselgreaves H,McLachlan JC,Finn GM,Kasim AS

    更新日期:2016-09-26 00:00:00

  • Second and third trimester fetal ultrasound population screening for risks of preterm birth and small-size and large-size for gestational age at birth: a population-based prospective cohort study

    abstract:BACKGROUND:Preterm birth, small size for gestational age (SGA) and large size for gestational age (LGA) at birth are major risk factors for neonatal and long-term morbidity and mortality. It is unclear which periods of pregnancy are optimal for ultrasound screening to identify fetuses at risk of preterm birth, SGA or L...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-020-01540-x

    authors: Erkamp JS,Voerman E,Steegers EAP,Mulders AGMGJ,Reiss IKM,Duijts L,Jaddoe VWV,Gaillard R

    更新日期:2020-04-07 00:00:00

  • Ancestral dichlorodiphenyltrichloroethane (DDT) exposure promotes epigenetic transgenerational inheritance of obesity.

    abstract:BACKGROUND:Ancestral environmental exposures to a variety of environmental factors and toxicants have been shown to promote the epigenetic transgenerational inheritance of adult onset disease. The present work examined the potential transgenerational actions of the insecticide dichlorodiphenyltrichloroethane (DDT) on o...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-11-228

    authors: Skinner MK,Manikkam M,Tracey R,Guerrero-Bosagna C,Haque M,Nilsson EE

    更新日期:2013-10-23 00:00:00

  • Investigating spillover of multidrug-resistant tuberculosis from a prison: a spatial and molecular epidemiological analysis.

    abstract:BACKGROUND:Congregate settings may serve as institutional amplifiers of tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB). We analyze spatial, epidemiological, and pathogen genetic data prospectively collected from neighborhoods surrounding a prison in Lima, Peru, where inmates experience a high risk of M...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-018-1111-x

    authors: Warren JL,Grandjean L,Moore DAJ,Lithgow A,Coronel J,Sheen P,Zelner JL,Andrews JR,Cohen T

    更新日期:2018-08-03 00:00:00

  • What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

    abstract:BACKGROUND:We conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal. METHODS:We performed an analytic sur...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-2-33

    authors: McKibbon KA,Wilczynski NL,Haynes RB

    更新日期:2004-09-06 00:00:00

  • Smartphone apps for calculating insulin dose: a systematic assessment.

    abstract:BACKGROUND:Medical apps are widely available, increasingly used by patients and clinicians, and are being actively promoted for use in routine care. However, there is little systematic evidence exploring possible risks associated with apps intended for patient use. Because self-medication errors are a recognized source...

    journal_title:BMC medicine

    pub_type: 杂志文章,评审

    doi:10.1186/s12916-015-0314-7

    authors: Huckvale K,Adomaviciute S,Prieto JT,Leow MK,Car J

    更新日期:2015-05-06 00:00:00

  • Predicting the response to sorafenib in hepatocellular carcinoma: where is the evidence for phosphorylated extracellular signaling-regulated kinase (pERK)?

    abstract::The approval of sorafenib and active development of many other molecularly targeted agents in hepatocellular carcinoma (HCC) have presented a challenge to understand the mechanism of action of sorafenib and identify predictive biomarkers to select patients more likely to benefit from sorafenib. The preclinical study b...

    journal_title:BMC medicine

    pub_type: 社论

    doi:10.1186/1741-7015-7-42

    authors: Zhu AX

    更新日期:2009-08-24 00:00:00

  • Video Q&A: molecular profiling of breast cancer.

    abstract::In this video Q&A, we talk to Professor Carlos Caldas about the identification of breast cancer subtypes through molecular profiling, and the clinical implications for diagnosis and treatment. ...

    journal_title:BMC medicine

    pub_type: 面试,杂志文章

    doi:10.1186/1741-7015-11-150

    authors: Caldas C

    更新日期:2013-06-18 00:00:00

  • Age, sex, disease severity, and disease duration difference in placebo response: implications from a meta-analysis of diabetes mellitus.

    abstract:BACKGROUND:The placebo response in patients with diabetes mellitus is very common. A systematic evaluation needs to be updated with the current evidence about the placebo response in diabetes mellitus and the associated factors in clinical trials of anti-diabetic medicine. METHODS:Literature research was conducted in ...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-020-01787-4

    authors: Lin C,Cai X,Yang W,Lv F,Nie L,Ji L

    更新日期:2020-11-16 00:00:00

  • Comparing the effects of HIV self-testing to standard HIV testing for key populations: a systematic review and meta-analysis.

    abstract:BACKGROUND:We update a previous systematic review to inform new World Health Organization HIV self-testing (HIVST) recommendations. We compared the effects of HIVST to standard HIV testing services to understand which service delivery models are effective for key populations. METHODS:We did a systematic review of rand...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-020-01835-z

    authors: Witzel TC,Eshun-Wilson I,Jamil MS,Tilouche N,Figueroa C,Johnson CC,Reid D,Baggaley R,Siegfried N,Burns FM,Rodger AJ,Weatherburn P

    更新日期:2020-12-03 00:00:00

  • What is a clinical pathway? Development of a definition to inform the debate.

    abstract:BACKGROUND:Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for b...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-8-31

    authors: Kinsman L,Rotter T,James E,Snow P,Willis J

    更新日期:2010-05-27 00:00:00

  • Developing risk prediction models for type 2 diabetes: a systematic review of methodology and reporting.

    abstract:BACKGROUND:The World Health Organisation estimates that by 2030 there will be approximately 350 million people with type 2 diabetes. Associated with renal complications, heart disease, stroke and peripheral vascular disease, early identification of patients with undiagnosed type 2 diabetes or those at an increased risk...

    journal_title:BMC medicine

    pub_type: 杂志文章,评审

    doi:10.1186/1741-7015-9-103

    authors: Collins GS,Mallett S,Omar O,Yu LM

    更新日期:2011-09-08 00:00:00

  • Non-celiac gluten sensitivity - why worry?

    abstract::Wheat, once thought to be a critical ingredient in a healthy diet, has become a major threat, according to public opinion. The term non-celiac gluten sensitivity has been widely adopted to describe a clinical entity characterized by symptoms induced by gluten without the diagnostic criteria found in other gluten-relat...

    journal_title:BMC medicine

    pub_type: 评论,杂志文章

    doi:10.1186/1741-7015-12-86

    authors: Lundin KE

    更新日期:2014-05-23 00:00:00

  • Impact of a population-based HPV vaccination program on cervical abnormalities: a data linkage study.

    abstract:BACKGROUND:Australia was one of the first countries to introduce a publicly funded national human papillomavirus (HPV) vaccination program that commenced in April 2007, using the quadrivalent HPV vaccine targeting 12- to 13-year-old girls on an ongoing basis. Two-year catch-up programs were offered to 14- to 17- year-o...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-11-227

    authors: Gertig DM,Brotherton JM,Budd AC,Drennan K,Chappell G,Saville AM

    更新日期:2013-10-22 00:00:00

  • Environmental enteropathy and malnutrition: do we know enough to intervene?

    abstract::Environmental enteropathy (EE) is a poorly defined state of intestinal inflammation without overt diarrhea that occurs in individuals exposed over time to poor sanitation and hygiene. It is implicated as a cause of stunting and malnutrition, oral vaccine failure and impaired development in children from low-income cou...

    journal_title:BMC medicine

    pub_type: 评论,杂志文章

    doi:10.1186/s12916-014-0187-1

    authors: Petri WA Jr,Naylor C,Haque R

    更新日期:2014-10-14 00:00:00

  • Physical comorbidities in men with mood and anxiety disorders: a population-based study.

    abstract:BACKGROUND:The mind-body nexus has been a topic of growing interest. Further data are however required to understand the specific relationship between mood and anxiety disorders and individual physical health conditions, and to verify whether these psychiatric disorders are linked to overall medical burden. METHODS:Th...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-11-110

    authors: Sanna L,Stuart AL,Pasco JA,Kotowicz MA,Berk M,Girardi P,Brennan SL,Williams LJ

    更新日期:2013-04-24 00:00:00

  • Is inhibition of kinase activity the only therapeutic strategy for LRRK2-associated Parkinson's disease?

    abstract::Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene are a common cause of familial Parkinson's disease (PD). Variation around the LRRK2 locus also contributes to the risk of sporadic PD. The LRRK2 protein contains a central catalytic region, and pathogenic mutations cluster in the Ras of complex protein C termi...

    journal_title:BMC medicine

    pub_type: 杂志文章,评审

    doi:10.1186/1741-7015-10-20

    authors: Rudenko IN,Chia R,Cookson MR

    更新日期:2012-02-23 00:00:00

  • Patients with osteoarthritis and avascular necrosis have better functional outcomes and those with avascular necrosis worse pain outcomes compared to rheumatoid arthritis after primary hip arthroplasty: a cohort study.

    abstract:BACKGROUND:This study was conducted to assess whether patient-reported outcomes (PROs) differ by the underlying diagnosis (rheumatoid arthritis (RA)/inflammatory arthritis, osteoarthritis (OA), avascular necrosis of bone (AVN), other) in patients undergoing primary total hip arthroplasty (THA). METHODS:We used prospec...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-11-210

    authors: Singh JA,Lewallen DG

    更新日期:2013-09-24 00:00:00

  • Risk of invasive breast cancer in relatives of patients with breast carcinoma in situ: a prospective cohort study.

    abstract:BACKGROUND:Wide implementation of mammography screening has resulted in increased numbers of women diagnosed with breast carcinoma in situ. We aimed to determine the risk of invasive breast cancer in relatives of patients with breast carcinoma in situ in comparison to the risk in relatives of patients with invasive bre...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-020-01772-x

    authors: Mukama T,Fallah M,Brenner H,Xu X,Sundquist K,Sundquist J,Kharazmi E

    更新日期:2020-11-05 00:00:00

  • Tumour response in metastatic renal cell carcinoma treated with tyrosine kinase inhibitors - assessment of intra-tumour heterogeneity.

    abstract::Intra-tumour heterogeneity is a common molecular phenomenon in metastatic clear cell renal carcinoma (mRCC), representing the genetic complexity of a tumour with multiple metastatic sites. The present commentary discusses the observed phenomena of phenotypic intra-tumour heterogeneity in mRCC patients treated with the...

    journal_title:BMC medicine

    pub_type: 社论

    doi:10.1186/s12916-016-0754-8

    authors: Stühler V,Bedke J

    更新日期:2016-12-07 00:00:00

  • Prostate-specific antigen-based screening: controversy and guidelines.

    abstract::Although prostate-specific antigen (PSA) screening has improved the detection of prostate cancer, allowing for stage migration to less advanced disease, the precise mortality benefit of early detection is unclear. This is in part due to a discrepancy between the two large randomized controlled trials comparing PSA scr...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-015-0296-5

    authors: Kim EH,Andriole GL

    更新日期:2015-03-24 00:00:00

  • Impact of interventions to improve the quality of peer review of biomedical journals: a systematic review and meta-analysis.

    abstract:BACKGROUND:The peer review process is a cornerstone of biomedical research. We aimed to evaluate the impact of interventions to improve the quality of peer review for biomedical publications. METHODS:We performed a systematic review and meta-analysis. We searched CENTRAL, MEDLINE (PubMed), Embase, Cochrane Database of...

    journal_title:BMC medicine

    pub_type: 杂志文章,meta分析,评审

    doi:10.1186/s12916-016-0631-5

    authors: Bruce R,Chauvin A,Trinquart L,Ravaud P,Boutron I

    更新日期:2016-06-10 00:00:00

  • The normal breast microenvironment of premenopausal women differentially influences the behavior of breast cancer cells in vitro and in vivo.

    abstract:BACKGROUND:Breast cancer studies frequently focus on the role of the tumor microenvironment in the promotion of cancer; however, the influence of the normal breast microenvironment on cancer cells remains relatively unknown. To investigate the role of the normal breast microenvironment on breast cancer cell tumorigenic...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-8-27

    authors: Fleming JM,Miller TC,Quinones M,Xiao Z,Xu X,Meyer MJ,Ginsburg E,Veenstra TD,Vonderhaar BK

    更新日期:2010-05-21 00:00:00

  • Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous pericarditis compared to adenosine deaminase and unstimulated interferon-γ in a high burden setting: a prospective study.

    abstract:BACKGROUND:Tuberculous pericarditis (TBP) is associated with high morbidity and mortality, and is an important treatable cause of heart failure in developing countries. Tuberculous aetiology of pericarditis is difficult to diagnose promptly. The utility of the new quantitative PCR test (Xpert MTB/RIF) for the diagnosis...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-12-101

    authors: Pandie S,Peter JG,Kerbelker ZS,Meldau R,Theron G,Govender U,Ntsekhe M,Dheda K,Mayosi BM

    更新日期:2014-06-18 00:00:00

  • MUC4 gene polymorphisms associate with endometriosis development and endometriosis-related infertility.

    abstract:BACKGROUND:Mucin 4 (MUC4) plays an important role in protecting and lubricating the epithelial surface of reproductive tracts, but its role in the pathogenesis of endometriosis is largely unknown. METHODS:To correlate MUC4 polymorphism with the risk of endometriosis and endometriosis-related infertility, we performed ...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-9-19

    authors: Chang CY,Chang HW,Chen CM,Lin CY,Chen CP,Lai CH,Lin WY,Liu HP,Sheu JJ,Tsai FJ

    更新日期:2011-02-24 00:00:00

  • Delta-9 tetrahydrocannabinol (THC) inhibits lytic replication of gamma oncogenic herpesviruses in vitro.

    abstract:BACKGROUND:The major psychoactive cannabinoid compound of marijuana, delta-9 tetrahydrocannabinol (THC), has been shown to modulate immune responses and lymphocyte function. After primary infection the viral DNA genome of gamma herpesviruses persists in lymphoid cell nuclei in a latent episomal circular form. In respon...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/1741-7015-2-34

    authors: Medveczky MM,Sherwood TA,Klein TW,Friedman H,Medveczky PG

    更新日期:2004-09-15 00:00:00

  • The risk of type 2 oral polio vaccine use in post-cessation outbreak response.

    abstract:BACKGROUND:Wild type 2 poliovirus was last observed in 1999. The Sabin-strain oral polio vaccine type 2 (OPV2) was critical to eradication, but it is known to revert to a neurovirulent phenotype, causing vaccine-associated paralytic poliomyelitis. OPV2 is also transmissible and can establish circulating lineages, calle...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-017-0937-y

    authors: McCarthy KA,Chabot-Couture G,Famulare M,Lyons HM,Mercer LD

    更新日期:2017-10-04 00:00:00

  • Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative.

    abstract:BACKGROUND:Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the med...

    journal_title:BMC medicine

    pub_type: 杂志文章

    doi:10.1186/s12916-020-01519-8

    authors: Hart JD,Sorchik R,Bo KS,Chowdhury HR,Gamage S,Joshi R,Kwa V,Li H,Mahesh BPK,Mclaughlin D,Mikkelsen L,Miki J,Napulan R,Rampatige R,Reeve M,Sarmiento C,War NS,Richards N,Riley ID,Lopez AD

    更新日期:2020-03-09 00:00:00

  • Renal function estimation and Cockroft-Gault formulas for predicting cardiovascular mortality in population-based, cardiovascular risk, heart failure and post-myocardial infarction cohorts: The Heart 'OMics' in AGEing (HOMAGE) and the high-risk myocardial

    abstract:BACKGROUND:Renal impairment is a major risk factor for mortality in various populations. Three formulas are frequently used to assess both glomerular filtration rate (eGFR) or creatinine clearance (CrCl) and mortality prediction: body surface area adjusted-Cockcroft-Gault (CG-BSA), Modification of Diet in Renal Disease...

    journal_title:BMC medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/s12916-016-0731-2

    authors: Ferreira JP,Girerd N,Pellicori P,Duarte K,Girerd S,Pfeffer MA,McMurray JJ,Pitt B,Dickstein K,Jacobs L,Staessen JA,Butler J,Latini R,Masson S,Mebazaa A,Rocca HP,Delles C,Heymans S,Sattar N,Jukema JW,Cleland JG,Za

    更新日期:2016-11-10 00:00:00

  • Lifestyle factors in preventing mental health disorders: an interview with Felice Jacka.

    abstract::In this video Q&A, we talk to Associate Professor Felice Jacka about population health approaches to the primary prevention of mental disorders across the lifespan. These include addressing lifestyle factors, such as diet, smoking and physical activity. Latest strategies are being developed through epidemiological stu...

    journal_title:BMC medicine

    pub_type: 面试

    doi:10.1186/s12916-015-0490-5

    authors: Jacka FN

    更新日期:2015-10-14 00:00:00