This implies that the programme needs more effort and resources to find undiagnosed and unreported cases. The higher proportion of smear-negative and asymptomatic TB cases suggests the need to revise the existing screening and diagnostic algorithms.SETTING and OBJECTIVE Exposure to pollutants is related to the type of dwelling inhabited. Besides tobacco smoke, indoor air pollution is a significant risk factor for chronic respiratory disease (CRD). The prevalence of CRD by type of dwelling was studied in Ho Chi Minh City, Viet Nam.DESIGN A total of 1561 people living in four type of dwellings were enrolled. Information on respiratory health, lung function, dwelling characteristics and sources of indoor pollution was obtained using a symptom and demographics questionnaire and spirometry. selleck chemicals The two main respiratory health outcomes were clinical chronic CRD (CCRD) and chronic obstructive respiratory disease (CORD) (forced expiratory volume in 1 sec/forced vital capacity less then 0.7). We used binary logistic regression adjusted for age, sex, time spent at home, smoking status, certain occupational exposures, previous tuberculosis, presence of pets, rats or cockroaches at home, wall dampness, biofuel use and use of airconditioning.RESULTS The prevalence of CCRD (24.3%) and CORD (5.3%) in the type of dwellings studied were not similar (χ² P less then 0.0001). CCRD and CORD prevalence was similar in tube houses and apartments. Compared to people living in apartments, those living in rental single rooms had a 46% higher risk of developing CCRD. The odds ratio of having CORD in people living in rental single rooms and in rural houses were respectively 4.64 (95%CI 1.97-10.5) and 2.99 (95%CI 1.21-7.37).CONCLUSION Type of dwelling was associated with CCRD and CORD morbidity.SETTING Screening and treatment for latent tuberculosis (LTBI) in pregnant women remains controversial, although studies suggest there is a significantly increased risk of progression to active disease in the postpartum period. Studies have also shown that adherence to postpartum follow-up and treatment of LTBI is poor. To our knowledge, the reasons for this have not been investigated. We therefore identified pregnant women originating from high-burden tuberculosis (TB) countries now living in the Stockholm region, and screened and treated them for LTBI.OBJECTIVE To explore how women diagnosed with LTBI during pregnancy understood and experienced their diagnosis and treatment.DESIGN Sixteen semi-structured interviews with women on treatment for LTBI were analysed using content analysis with an inductive approach.RESULTS None of the women were familiar with LTBI and assumed they had active TB, causing anxiety about who they might have infected and how it would affect the baby, as well as the fear of being stigmatised. They showed great ability to search for and understand information regarding their condition. Once treatment was initiated, they were motivated to complete it.CONCLUSION Our findings suggest that the key factors was to provide treatment along with reliable information about LTBI to help patients overcome their concerns and misconceptions.BACKGROUND Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain.METHODS Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods 1995-1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000-2009 (P2, increase in immigration), and 2010-2016 (P3, decrease in immigration).RESULTS We included 29 TB cases among 1183 children aged 10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%).CONCLUSION In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.BACKGROUND Correctional inmates are at a high risk of tuberculosis (TB). The optimal approach to screening this population is unclear.METHODS We retrospectively reviewed records from TB screening in 64 correctional facilities in South Africa between January 2015 and July 2016. Inmates received symptom screening (any of cough, fever, weight loss, or night sweats) combined with digital chest X-ray (CXR), when available. CXRs were assessed as ‘abnormal’ or with no abnormalities. Inmates with either a symptom or an ‘abnormal’ CXR were asked to provide a single spot sputum for Xpert® MTB/RIF testing. We estimated the incremental cost-effectiveness ratio (ICER) per additional TB case detected using CXR screening among asymptomatic inmates.RESULTS Of 61 580 inmates, CXR screening was available for 41 852. Of these, 19 711 (47.1%) had TB symptoms. Among 22 141 inmates without symptoms, 1939/19 783 (9.8%) had an abnormal CXR, and 8 (1.2%) were Xpert-positive among those with Xpert tests done. Of 14 942 who received symptom screening only and had symptoms, 84% (12 616) had an Xpert result, and 105 (0.8%) were positive. The ICER for CXR screening was US$22 278.CONCLUSION Having CXR in addition to symptom screening increased yield but added considerable cost. A major limitation of screening was the low specificity of the symptom screen.OBJECTIVE The quality of paediatric clinical practice guidelines (CPGs) for the management of Mycobacterium tuberculosis infection is unclear. We aimed to comprehensively assess the quality of these CPGs and identify areas requiring improvement.DESIGN CPGs were systematically searched and identified before being appraised by independent reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Reporting Items for Practice Guidelines in HealThcare (RIGHT) tools. Inter-rater reliability was assessed using intra-class correlation coefficient (ICC).RESULTS Twenty-five CPGs were evaluated. All CPG agreements among four reviewers were good (ICC 0.753-0.939). The mean CPG score was 50.5% (23.5-78.4%), and seven CPGs were recommended for use. The mean scores of three domains were low 38% for stakeholder involvement (5.6-93.1%), 38.4% for rigour of development (1-97.4%) and 36.3% for applicability (12.5-64.6%). The mean reporting rate of Reporting Items for Practice Guidelines in HealThcare fields was 41.