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Prevalence and risk factors of latent tuberculosis infection in Africa: a systematic review and meta-analysis protocol.

ABSTRACT: INTRODUCTION:Latent tuberculosis infection (LTBI) remains a major public health problem and one of the major contributors to the pool of active tuberculosis cases. The true burden of LTBI in Africa is not known. Early modelling studies estimate that over 33% of the world's population is infected with latent tuberculosis. We propose conducting a systematic review and a meta-analysis to evaluate the burden and risk factors of LTBI in Africa reported in studies from 2000 to 2017. METHODS AND ANALYSIS:We will include cross-sectional studies, cohort studies and case-control studies estimating either tuberculin skin test (TST) or interferon-gamma release assay (IGRA) confirmed prevalence of LTBI and associated risk factors among people in African countries. A comprehensive search of relevant literature will be conducted on electronic databases using common and medical subject heading (MeSH) terms for LTBI, and an African search filter. Risk of bias will be evaluated by assessing all qualifying full-text articles for quality and eligibility using a quality score assessment tool. Standardised data extraction will be carried out after which prevalence estimates will be pooled using random-effects models in Stata V.13. Where there is sufficient data , subgroup meta-analyses will be conducted by risk factors including participant's age group, occupation, location and HIV status. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols 2015 Statement. ETHICS AND DISSEMINATION:No ethical issues were foreseen given that this was a protocol for a systematic review of published studies. The results of this study will be published in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER:Systematic review registration: PROSPERO CRD42016037997.

SUBMITTER: Basera TJ

PROVIDER: S-EPMC5541490 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Prevalence and risk factors of latent tuberculosis infection in Africa: a systematic review and meta-analysis protocol.

Basera Tariro J TJ Ncayiyana Jabulani J Engel Mark E ME

BMJ open 20170718 7

<h4>Introduction</h4>Latent tuberculosis infection (LTBI) remains a major public health problem and one of the major contributors to the pool of active tuberculosis cases. The true burden of LTBI in Africa is not known. Early modelling studies estimate that over 33% of the world's population is infected with latent tuberculosis. We propose conducting a systematic review and a meta-analysis to evaluate the burden and risk factors of LTBI in Africa reported in studies from 2000 to 2017.<h4>Methods ...[more]

PMID: 28720611

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Project description:CONTEXT:Latent tuberculosis infection diagnosis and treatment is a strategic priority for eliminating tuberculosis in the U.S. The Centers for Disease Control and Prevention has recommended the short-course regimen of 3-month isoniazid-rifapentine administered by directly observed therapy. However, longer-duration regimens remain the most widely prescribed latent tuberculosis infection treatments. Limitation on adoption of 3-month isoniazid-rifapentine in the U.S. might be because of patients' preference for self-administered therapy, providers' lack of familiarity with 3-month isoniazid-rifapentine, or lack of resources to support directly observed therapy. This review examines the most recent evidence regarding 3-month isoniazid-rifapentine's effectiveness, safety, and treatment completion when directly compared with other latent tuberculosis infection regimens primarily comprising 9-month isoniazid treatment. EVIDENCE ACQUISITION:Using Community Guide methodology, reviewers identified, evaluated, and summarized available evidence published during January 2006-June 2017. Analysis of the data was completed in 2017. EVIDENCE SYNTHESIS:The analysis included 15 unique studies. Three-month isoniazid-rifapentine was determined to be equal to other latent tuberculosis infection regimens in effectiveness (OR=0.89, 95% CI=0.46, 1.70), and has higher treatment completion (87.5%, 95% CI=83.2%, 91.3%) compared with other latent tuberculosis infection regimens (65.9%, 95% CI=53.5%, 77.3%). Three-month isoniazid-rifapentine was associated with similar risk to other latent tuberculosis infection regimens for adverse events (relative risk=0.59, 95% CI=0.23, 1.52); discontinuing treatment because of adverse events (relative risk=0.48, 95% CI=0.17, 1.34); and death (relative risk=0.79, 95% CI=0.56, 1.11). CONCLUSIONS:The 3-month isoniazid-rifapentine regimen is as safe and effective as other recommended latent tuberculosis infection regimens and achieves significantly higher treatment completion rates.

Project description:BackgroundThe rate of multidrug-resistant tuberculosis is increasing at an alarming rate throughout the world. It is becoming an emerging public health problem in East Africa. The prevalence of multidrug-resistant tuberculosis among pulmonary tuberculosis positive individuals in the region has not been thoroughly investigated.AimThe aim of this systematic review and meta-analysis is to estimate the pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed and previously treated pulmonary tuberculosis cases in East African countries.MethodsEnglish published articles were systematically searched from six electronic databases: PubMed, EMBASE, Scopus, Science direct, Web of Science, and Google scholar. The pooled prevalence of multidrug-resistant tuberculosis and associated risk factors were calculated using Der Simonian and Laird's random Effects model. Funnel plot symmetry visualization confirmed by Egger's regression asymmetry test and Begg rank correlation methods was used to assess publication bias. A total of 16 articles published from 2007 to 2019 were included in this study. STATA 14 software was used for analysis.ResultsOut of 1025 articles identified citations, a total of 16 articles were included in final meta-analysis. The pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed tuberculosis cases and previously treated tuberculosis patients was 4% (95%CI = 2-5%) and 21% (95%CI: 14-28%), respectively. Living conditions, lifestyles (smoking, alcohol use, and drug abuse), previous medical history, diabetes history, and human immunodeficiency virus infection were risk factors contributing to the higher prevalence of multidrug-resistant tuberculosis in East Africa.ConclusionThe review found a significant prevalence of multidrug-resistant tuberculosis in the region. An early diagnosis of tuberculosis and rapid detection of drug-resistant Mycobacterium tuberculosis is a critical priority to identify patients who are not responding to the standard treatment and to avoid transmission of resistant strains. It is also very important to strengthen tuberculosis control and improve monitoring of chemotherapy.

Project description:IntroductionAchieving tuberculosis (TB) elimination in low TB incidence countries requires identification and treatment of individuals at risk for latent TB infection (LTBI). Persons travelling to high TB incidence countries are potentially at risk for TB exposure. This systematic review and meta-analysis estimates incident LTBI and active TB among individuals travelling from low to higher TB incidence countries.MethodsFive electronic databases were searched from inception to 18 February 2020. We identified incident LTBI and active TB among individuals travelling from low (<10 cases/100 000 population) to intermediate (10-100/100 000) or high (>100/100 000) TB incidence countries. We conducted a meta-analysis and meta-regression using a random effects model of log-transformed proportions (cumulative incidence). Subgroup analyses investigated the impact of travel duration, travel purpose and TB incidence in the destination country.ResultsOur search identified 799 studies, 120 underwent full-text review, and 10 studies were included. These studies included 1 154 673 travellers observed between 1994 and 2013, comprising 443 health care workers (HCW), 1 068 636 military personnel and 85 594 general travellers/volunteers. We did not identify any studies that estimated incidence of LTBI or active TB among people travelling to visit friends and relatives (VFRs). The overall cumulative incidence of LTBI was 2.3%, with considerable heterogeneity. Among individuals travelling for a mean/median of up to 6 months, HCWs had the highest cumulative incidence of LTBI (4.3%), whereas the risk was lower for military (2.5%) and general travellers/volunteers (1.6%). Meta-regression did not identify a difference in incident LTBI based on travel duration and TB incidence in the destination country. Five studies reported cases of active TB, with an overall pooled estimate of 120.7 cases per 100 000 travellers.ConclusionsWe found that travelling HCWs were at highest risk of developing LTBI. Individual risk activities and travel purpose were most associated with risk of TB infection acquired during travel.

Project description:BackgroundThe health of older persons has not been a major priority in many African countries. Hypertension is one of the common health problems of older persons. However, there is little information on the prevalence of hypertension in older adults in Africa. This is in spite of the fact that Africa has the highest age-standardized prevalence of hypertension in the world. We therefore present this protocol to conduct a systematic review and meta-analysis on the prevalence of hypertension and the level of its awareness among older persons living in Africa.MethodsMajor databases (EMBASE, MEDLINE, Academic Search Complete, CINAHL, PsycINFO) and unpublished literature will be searched to identify population-based studies on hypertension in adults aged 50 years and older living in Africa. Eligible articles are those which use the 140/90-mmHg cutoff to diagnose hypertension and were published from 1980 to present. We will exclude subjects in restricted environments such as patients and refugees. Articles will be independently evaluated by two reviewers to determine if they meet the inclusion criteria. They will also evaluate the quality of included studies using a validated tool by Hoy and colleagues for prevalence studies. The main outcome is the prevalence of hypertension while the explanatory variables include demographic, socio-economic, dietary, lifestyle and behavioural factors. Effect sizes in bivariate and multivariate analyses will be presented as odds or prevalence ratios. We will explore for heterogeneity of the standard errors across the studies, and if appropriate, we will perform a meta-analysis using a random-effects model to present a summary estimate of the prevalence of hypertension in this population.DiscussionThe estimates of the prevalence, the risk factors and the level of awareness of hypertension could help in galvanizing efforts at prioritizing the cardiovascular health of older persons in Africa.Systematic review registrationPROSPERO CRD42017056474.

Project description:BACKGROUND:Insufficient iodine intake in pregnancy is associated with many adverse pregnancy outcomes. About 90% of African countries are at risk of iodine deficiency due to poor soils and dietary goitrogens. Pregnancy predisposes to insufficient iodine nutrition secondary to increased physiological demand and increased renal loss. Iodine deficiency is re-emerging in countries thought to be replete with pregnant women being the most affected. This review seeks to identify the degree of iodine nutrition in pregnancy on the entire African continent before and after the implementation of national iodization programmes. METHODS:A systematic search of published literature will be conducted for observational studies that directly determined the prevalence of insufficient iodine intake among pregnant women in Africa. Electronic databases and grey literature will be searched for baseline data before the implementation of population-based iodine supplementation and for follow-up data up to December 2018. Screening of identified articles and data extraction will be conducted independently by two investigators. Risk of bias and methodological quality of the included studies will be assessed using a risk of bias tool. Appropriate meta-analytic techniques will be used to pool prevalence estimates from studies with similar features, overall and by major characteristics including the region of the study, time period (before and after implementation of iodization programmes), sample size and age. Heterogeneity of the estimates across studies will be quantified and publication bias investigated. This protocol is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines. DISCUSSION:This review will help ascertain the impact of national iodization programmes on the iodine nutrition status in pregnancy in Africa and advise policy on the necessity for monitoring and mitigating iodine deficiency in pregnancy in Africa. This review is part of a thesis that will be submitted to the Faculty of Health Sciences, University of Cape Town, for the award of a PhD in Medicine whose protocol has been granted ethics approval (UCT HREC 135/2018). In addition, the results will be published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42018099434.

Project description:Tuberculosis is one of the leading causes of death worldwide. Twenty-two high burden countries contributed to the majority of worldwide tuberculosis cases in 2015. Health care workers are at high risk of acquiring tuberculosis through occupational exposure.To estimate the prevalence of latent tuberculosis infection (LTBI) among health care workers in high burden countries.Databases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ovid) and ISI Web of Science (Thompson-Reuters), and grey literature were searched for English language records on relevant medical subject headings (MeSH) terms of LTBI and health care providers. Literature was systematically reviewed using EPPI-Reviewer4 software. Prevalence and incidence of LTBI and 95% confidence intervals (CI) were reported. Pooled prevalence of LTBI and 95% CI were calculated using random-effects meta-analysis models and heterogeneity was assessed using I2 statistics. Sub-group analysis was conducted to assess the cause of heterogeneity.A total of 990 records were identified. Of those, 18 studies from only 7 high burden countries representing 10,078 subjects were included. Tuberculin skin test results were available for 9,545 participants. The pooled prevalence of LTBI was 47% (95% CI 34% to 60%, I2 = 99.6%). In subgroup analyses according to the country of the study, the pooled prevalence of LTBI was lowest in Brazil (37%) and highest in South Africa (64%). The pooled prevalence of LTBI among medical and nursing students was 26% (95% CI 6% to 46%, I2 = 99.3%) while the prevalence among all types of health care workers was 57% (95% CI 44% to 70%, I2 = 99.1%). Incidence of LTBI was available for health care workers in four countries. The cumulative incidence ranged from 2.8% in Brazilian medical students to 38% among all types of health care workers in South Africa.The findings of this study suggest that there is a high burden of LTBI among health care workers in high burden countries. Adequate infection control measures are warranted to prevent and control transmission in health care settings.

Dataset Information

Prevalence and risk factors of latent tuberculosis infection in Africa: a systematic review and meta-analysis protocol.

Publications

Prevalence and risk factors of latent tuberculosis infection in Africa: a systematic review and meta-analysis protocol.

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