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Acid-Fast Bacilli Smear Positivity and HBV, HCV, HIV, and Syphilis Co-infections between 2016 and 2019 in Mogadishu, Somalia

Tekin, Kemal; Abdi Osman, Mohamed; Nur Adan, Faduma; Bashir, Ahmed Muhammad; Sümbül, Hilmi Erdem; Şahiner, Fatih

Although tuberculosis (TB) is a treatable disease, it continues to be an important health problem affecting societies worldwide. TB is one of the 10 most common causes of death worldwide today, despite the efforts of national organizations and the global struggle efforts of the World Health Organization (WHO), that have continued since its first establishment and exceeded seventy years. Somalia faces many negative factors that hinder the success of TB eradication programs, such as limitation of economic resources, lack of adequate infrastructure systems in the urban and rural regions, inadequacies in sheltering and nutrition, as well as instability, conflicts, and difficulties in accessing health care services. However, the country has been located in a rapidly developing region where socio-economic development and transformation has been experienced in many fields in recent years. This study includes the analysis of acid-fast bacilli (AFB) smear examination results of patients admitted to a tertiary health center in the region where public health surveillance, screening programs, and treatment interventions have been disrupted for the last 30 years due to the aforementioned reasons. A total of 5,160 AFB test results of 3,909 patients admitted to the hospital with different medical reasons during the 4-year period between July 2016 and November 2019 were included in the study. The mean age was 43.3±21.8 years, with a range of <1 to 97 years and the AFB test positivity rate was found to be %5.63 (220/3,909) in the study group. The positivity rate was 6.70% (158/2,199) in males and 3.99% (62/1,490) in females (p<0.001). The group most affected by the infection (TB) were young and adult men between the ages of 10-40. HBsAg, anti-HCV and anti-HIV tests were also performed for approximately half of the patients who requested AFB test and the co-infection rates for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) were found as 9.68%, 2.46%, and 0.0%, respectively. These rates are compatible with the seroepidemiological situation of the mentioned viral infections in the region. The results also reveal the low frequency of HIV-TB co-infections in the Somali population, unlike other regions of sub-Saharan Africa. The co-infection rate for syphilis, in which fewer patients were tested, was found to be 2.27%. It was found that AFB positivity rates changed as 5.31%, 6.44%, and 5.63% between 2017-2019 and did not increase or decrease according to years; with the exception of 2016 (11.2%) when a small number of patients were admitted. Early diagnosis and early treatment of active cases are critical for the effectiveness of TB control programs. Despite certain limitations, the data presented in the study can be considered as a reference point for future studies.

Özet

Tüberküloz (TB) tedavi edilebilir bir hastalık olmasına rağmen dünya genelinde toplumları etkileyen önemli bir sağlık sorunu olmaya devam ediyor. Ulusal kuruluşların çabaları ve Dünya Sağlık Örgütü’nün (DSÖ) ilk kurulduğu yıllardan itibaren devam eden ve yetmiş yılı aşan global mücadele sürecine rağmen, TB günümüzde dünya genelinde en yaygın 10 ölüm nedeninden biridir. Somali ekonomik kaynakların kısıtlılığı, kentsel ve kırsal bölge altyapı sistemlerindeki zayıflıklar, barınma ve beslenmedeki yetersizlikler gibi TB eradikasyon programlarının başarısı önündeki birçok olumsuz etkenin varlığı yanında istikrarsızlık, çatışmalar ve sağlık bakım hizmetlerine ulaşımdaki güçlükler ile karşı karşıyadır. Ülke aynı zamanda son yıllarda birçok alanda sosyoekonomik gelişmenin ve dönüşümün yaşandığı hızlı gelişmekte olan bir bölgede konumlanmıştır. Bu çalışma, son 30 yıllık dönemde toplum sağlığı sürveyansının, tarama programlarının ve tedavi süreçlerinin bahsedilen nedenler ile aksadığı bölgede bir üçüncü basamak sağlık merkezine başvuran hastaların aside dirençli basil (acid-fast bacilli, AFB) yayma inceleme sonuçlarını içermektedir. Çalışmaya Temmuz 2016 - Kasım 2019 tarihleri arasındaki 4 yıllık süreçte çeşitli tıbbi gerekçelerle hastaneye başvuran 3909 hastaya ait toplam 5160 AFB test sonucu dahil edilmiştir. Ortalama yaşın 43.3±21.8 yıl (<1 ile 97 aralığında) olduğu çalışma grubunda AFB test pozitifliği oranı %5.63 (220/3909) olarak bulundu. Pozitiflik oranı erkeklerde 6.70% (158/2199) ve kadınlarda 3.99% (62/1490) idi (p<0.001). Enfeksiyondan (TB) en çok etkilenen grup 10-40 yaş arası genç ve erişkin erkeklerdi. AFB test istemi olan hastaların yaklaşık yarısı için HBsAg, anti-HCV ve anti-HIV testleri de çalışılmıştı ve hepatit B, hepatit C ve insan immün yetmezlik virusu (human immunodeficiency virus, HIV) için ko-enfeksiyon oranları sırasıyla %9.68, %2.46 ve %0.0 olarak bulundu. Bu oranlar ilgili viral enfeksiyonların bölgedeki seroepidemiyolojik görünümleri ile uyumlu olup, bu sonuçlar ayrıca Afrika’nın diğer bölgelerinden farklı olarak Somali popülasyonunda HIV-TB ko-enfeksiyonlarının düşük sıklığını göstermektedir. Daha az sayıda hastanın test edildiği sifiliz için ko-enfeksiyon oranı ise %2.27 olarak bulundu. Az sayıda hastanın kabul edildiği 2016 yılı (%11.2) hariç olmak üzere, AFB pozitiflik oranlarının yıllara göre artma veya azalma eğiliminde olmadığı ve 2017-2019 yılları arasında yıllara göre %5.31, %6.44 ve %5.63 olarak değiştiği bulundu. Aktif olguların erken tanı ve tedavisi TB kontrol programlarının etkinliği için kritik öneme sahiptir. Bazı sınırlılıklara rağmen, çalışmada sunulan veriler daha ileri çalışmalar için bir referans noktası olarak kabul edilebilir.

Somali Mogadişu'da 2016 ve 2019 arasında Aside Dirençli Basil Yayma Pozitifliği ve HBV, HCV, HIV ve Sifiliz Ko-enfeksiyonları
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