Dataset Information

The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey.

ABSTRACT:

Background

Reliable estimates of the burden of multidrug-resistant tuberculosis (MDR-TB) are crucial for effective control and prevention of tuberculosis (TB). Papua New Guinea (PNG) is a high TB burden country with limited information on the magnitude of the MDR-TB problem.

Methods

A cross-sectional study was conducted in four PNG provinces: Madang, Morobe, National Capital District and Western Province. Patient sputum samples were tested for rifampicin resistance by the Xpert MTB/RIF assay and those showing the presence of resistance underwent phenotypic susceptibility testing to first- and second-line anti-TB drugs including streptomycin, isoniazid, rifampicin, ethambutol, pyrazinamide, ofloxacin, amikacin, kanamycin and capreomycin.

Results

Among 1,182 TB patients enrolled in the study, MDR-TB was detected in 20 new (2.7%; 95% confidence intervals [CI] 1.1-4.3%) and 24 previously treated (19.1%; 95%CI: 8.5-29.8%) TB cases. No case of extensively drug-resistant TB (XDR-TB) was detected. Thirty percent (6/20) of new and 33.3% (8/24) of previously treated cases with MDR-TB were detected in a single cluster in Western Province.

Conclusion

In PNG the proportion of MDR-TB in new cases is slightly lower than the regional average of 4.4% (95%CI: 2.6-6.3%). A large proportion of MDR-TB cases were identified from a single hospital in Western Province, suggesting that the prevalence of MDR-TB across the country is heterogeneous. Future surveys should further explore this finding. The survey also helped strengthening the use of smear microscopy and Xpert MTB/RIF testing as diagnostic tools for TB in the country.

SUBMITTER: Aia P

PROVIDER: S-EPMC4803348 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Publications

The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey.

Aia Paul P Kal Margaret M Lavu Evelyn E John Lucy N LN Johnson Karen K Coulter Chris C Ershova Julia J Tosas Olga O Zignol Matteo M Ahmadova Shalala S Islam Tauhid T

PloS one 20160322 3

<h4>Background</h4>Reliable estimates of the burden of multidrug-resistant tuberculosis (MDR-TB) are crucial for effective control and prevention of tuberculosis (TB). Papua New Guinea (PNG) is a high TB burden country with limited information on the magnitude of the MDR-TB problem.<h4>Methods</h4>A cross-sectional study was conducted in four PNG provinces: Madang, Morobe, National Capital District and Western Province. Patient sputum samples were tested for rifampicin resistance by the Xpert MT ...[more]

PMID: 27003160

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Project description:BackgroundGlobally, per-capita, South Africa reports a disproportionately high number of cases of multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis. We sought to estimate the prevalence of resistance to tuberculosis drugs in newly diagnosed and retreated patients with tuberculosis provincially and nationally, and compared these with the 2001-02 estimates.MethodsA cross-sectional survey was done between June 15, 2012-June 14, 2014, using population proportionate randomised cluster sampling in the nine provinces in South Africa. 343 clusters were included, ranging between 31 and 48 per province. A patient was eligible for inclusion in the survey if he or she presented as a presumptive case during the intake period at a drug resistance survey enrolling facility. Consenting participants (≥18 years old) completed a questionnaire and had a sputum sample tested for resistance to first-line and second-line drugs. Analysis was by logistic regression with robust SEs, inverse probability weighted against routine data, and estimates were derived using a random effects model.Findings101 422 participants were tested in 2012-14. Nationally, the prevalence of MDR tuberculosis was 2·1% (95% CI 1·5-2·7) among new tuberculosis cases and 4·6% (3·2-6·0) among retreatment cases. The provincial point prevalence of MDR tuberculosis ranged between 1·6% (95% CI 0·9-2·9) and 5·1% (3·7-7·0). Overall, the prevalence of rifampicin-resistant tuberculosis (4·6%, 95% CI 3·5-5·7) was higher than the prevalence of MDR tuberculosis (2·8%, 2·0-3·6; p=0·01). Comparing the current survey with the previous (2001-02) survey, the overall MDR tuberculosis prevalence was 2·8% versus 2·9% and prevalance of rifampicin-resistant tuberculosis was 3·4% versus 1·8%, respectively. The prevalence of isoniazid mono-resistant tuberculosis was above 5% in all provinces. The prevalence of ethionamide and pyrazinamide resistance among MDR tuberculosis cases was 44·7% (95% CI 25·9-63·6) and 59·1% (49·0-69·1), respectively. The prevalence of XDR tuberculosis was 4·9% (95% CI 1·0-8·8). Nationally, the estimated numbers of cases of rifampicin-resistant tuberculosis, MDR tuberculosis, and isoniazid mono-resistant tuberculosis for 2014 were 13 551, 8249, and 17 970, respectively.InterpretationThe overall prevalence of MDR tuberculosis in South Africa in 2012-14 was similar to that in 2001-02; however, prevalence of rifampicin-resistant tuberculosis almost doubled among new cases. Furthermore, the high prevalence of isoniazid mono-resistant tuberculosis, not routinely screened for, and resistance to second-line drugs has implications for empirical management.FundingPresident's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of 1U19GH000571.

Project description:BackgroundThe Eastern Highlands area of Papua New Guinea (PNG) has a rich tradition of medicinal plant use. However, rapid modernization is resulting in the loss of independent language traditions and consequently a loss of individuals knowledgeable in medicinal plant use. This report represents a program to document and preserve traditional knowledge concerning medicinal plant use in PNG. This report documents and compares traditional plant use in the Eastern Highlands districts of Unggai-Bena, Okapa, and Obura-Wonenara, and puts these new records in context of previously documented PNG medicinal plant use.MethodsThis manuscript is an annotated combination of Traditional Medicines survey reports generated by UPNG trainees using a survey questionnaire titled "Information sheet on traditional herbal reparations and medicinal plants of PNG". The Traditional Medicines survey project is supported by WHO, US NIH and PNG governmental health care initiatives and funding.ResultsOverall, after "poisoning" (synonymous with "magic") the most commonly recorded ailments addressed by medicinal plant use were pain, gynecological disease, gastrointestinal maladies, anemia or malnutrition and malaria. However, the recorded indications for plant use varied widely amongst the different survey locations. Unlike many areas of PNG, mixing of ingredients was the most common mode of preparation recorded, except for two areas where the consumption of fresh plant material was more common. Throughout the Eastern Highlands oral administration was most common, with topical application second. Overall, leaves were most commonly used in the preparations of the healers interviewed, followed by bark and stems. Several new medicinal uses of plants were also documented.ConclusionsCollaboration between the WHO, UPNG and the PNG Department of Health initiated Traditional Medicine survey program in order to preserve traditional knowledge concerning medicinal plant use in PNG. This effort promotes integration of effective and accessible traditional practices with Western protocols. The Traditional Medicine surveys are particularly important because, in the absence of the clinical validation, the documentation of the consistent use of a given plant for specific indication by a large number of herbalists, across a wide range of ethnic traditions, maybe considered as a positive criterion for the promulgation of said use amongst PNG's recently formed traditional healer associations.

Dataset Information

The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey.

Background

Methods

Results

Conclusion

Publications

The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey.

Similar Datasets

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