الفهرس Only 14 pages are availabe for public view
 |  | from | 87 |  |  |
| | | from | 87 | | |
Abstract
SUMMARY
Despite increased level of awareness and improved diagnostic facilities of
tuberculosis. tuberculosis is considered the second most important public health
problem in Egypt. after bilharziasis. The basic principle of control of tuberculosis is
treatment of infectious cases in early stages. thereby preventing the spread of infection.
Household contacts of index tuberculosis cases comprise a high-risk group for
tuberculosis. High-risk contacts are normally household contacts or individuals who
have had close contacts over a prolonged period of time. Some of those contacts
become infected. the others not although they are a family group in the same living
condition. Therefore. the purpose of the study is to identify risk factors for infection
among household contacts of smear-positive tuberculosis patients in lsmailia Chest
Hospital and to estimate the prevalence of infection among them through a cross-
sectional descriptive study and data were collected by interview questionnaire from 46
index cases registered in lsmailia chest hospital between December 2004 and May 2(0)
to identify their environmental condition. treatment outcome and factors affected this
outcome and their 210 household contacts to identify their distribution according to
factors among index cases. sociodemographic characters. behavioral risk factors. health
history. nutritional status and their environmental condition.
The results showed that index cases were common III overcrow ded houses
(71.7% of cases in households where 2 to less than 4 individuals per room) and 60.9%
of cases in poor ventilated houses «10% of floor areas) and their treatment outcome
was thirty one patients (67.4%) were cured and 7 patients (15.2%) completed treatment.
This gives a treatment success rate of 82.6%. Two-thirds of index cases (67.4%) were
treated by 6-month regimen while one-third of 15 index cases (32.6%) were treated by
8-month regimen.
Factors affected the treatment outcome for index cases wen: early diagnosis and
their good compliance with statistically significant differences. 65.8% of index cases
showed a successful treatment outcome when duration of complaint before diagnosis
was less than 2 months while 84.2% of index cases showed a successful treatment
outcome when they were treated regularly.
- 63 -
-- - -.---~--------
-rh..:,) ”e{\~ l \ (J \v)U”eno\d cml\<Kt” of ”meat-~Clsitive tuberculosis Il,nient~ CI\::l:d
to ,; ) cars. The mean age ± standard deviation was 26.6± 18. TB infection among
household contacts was 27.1 %. Their distribution according to
1- factors among index cases:
The risk of TB infection in household contacts was 2 times higher when duration
of complaint before diagnosis of their index cases was 2 months or more and when
treatment outcome of index cases was unsuccessful (failure. default and death) \\ ith
statistically significant differences at 5% level of confidence but There was no
statistically significant difference between TB infection in household contacts and
compliance of their index cases.
2- sociodemograph ic characters:
The risk of TB infection in household contacts was found to increase with age
group 15 to less than 30 years (39%) and to be higher in males (65%) with statistically
significant differences at 5% level of confidence but not associated with their
relationship to index cases or residence as difference between infected and healthy
contacts was not statistically significant at 5% level of confidence.
46% of infected contacts had an average education and 24% were illiterate as
compared to 32% and 12% of healthy contacts respectively had the same degree of
education. 12% of infected contacts had an income less than 200 pounds and 68% had
an income from 200 to 400 pounds as compared to 10% and 50% of healthy contacts
respectively had the same degree of income with statistically significant differences
regarding education and income at 5% level of confidence. The risk of infection was not
associated \\ ith marital status or with occupation as difference between infected and
healthy contacts \\ as not statistically significant at 5% level of confidence.
3- behavioral risk factors:
32% of infected contacts compared to only 10% of healthy contacts were
smokers. 83% of infected contacts compared to 20% of healthy contacts smoked both of
cigarettes and bubble-bubble. 5% of all household contacts used to drink alcohol. 14%
of infected contacts compared to only 1 % of healthy contacts used to drink alcohol. 4%
of all household contacts addicted drugs. II % of infected contacts compared to only 1 %
of healthy contacts addicted drugs. 34% of all household contacts (age is >5 years)
- 64 -
practiced physical activity. 85% of infected contacts compared to 60% of healthy
contacts did not practice physical activity with statistically significant differences at 5%
level of confidence. The risk of infection was not associated with passive smoking as
difference between infected and healthy contacts was not statistically significant at 5%
level of confidence.
4- health .history:
14% of infected contacts as compared to 3.9% of healthy contacts were
diabetics. 7% of infected contacts as compared to 0.7% of healthy contacts used
immunosuppressive drugs (corticosteroids, drugs for cancer and antirheumatic drugs).
10.5% of infected contacts had a history of operation. Types of all operations were not
risk factors for tuberculosis disease. 12.3% of infected contacts as compared to 4.6% of
healthy contacts were unvaccinated or had an unknown BCG status. The risk of TB
infection in household contacts was 4 times in diabetics, 11 times in contacts used
immunosuppressive drugs and 3 times in contacts were unvaccinated or had an
unknown BCG status with statistically significant differences at 5% level of confidence,
5- body mass index (age is 2’:5 years) and Z-score (age is <5 years) as indicators for
under-nutrition:
33% of infected contacts (age is 2’:5 years) were underweight compared to onl)
18% of healthy contacts were underweight with statistically significant differences at
5% level of confidence. 45.5% of infected contacts (age is <5 years) were underweight
and 45.5% of infected contacts were wasted versus all healthy contacts (age is <5 years)
were not underweight or wasted with statistically significant differences at 5% level of
confidence.
6- environmental condition:
The risk of TB infection III household contacts was not associated with the
presence of more than two persons per room in the household. absence of piped inside
water. sandy floor. absence of gas stove and poor ventilation « I 0% of floor areas) as
difference between infected and healthy contacts was not statistically significant at 5%
level of confidence, Insignificant environmental risk factors in this study strengthened
the role of host-related risk factors in explanation of TB infection among household
contacts of index patients.
- 65 -
The present study concluded that:
1- Index cases who were early diagnosed (less than 2 months duration between
complaint and diagnosis). and with regular treatment had a successful treatment
outcome.
2- Index cases who were complaining for more than 2 months or with unsuccessful
treatment outcome were more likely to infect their contacts.
3- Contacts males and contacts in the age group (from 15 to less 30 years) had a higher
risk of acquiring the disease than other contacts.
4- Contacts with better education grades, income and practicing physical activity
showed a lesser risk to acquire infection from their index cases. While contacts who
were smokers. alcohol drinkers or drug abusers showed a higher risk for infection.
5- Contacts who had poor nutritional status. diabetes or used immunosuppressive drugs
had a higher risk for infection from their index cases.
The current study recommended the following:
1- Improving the awareness among the general population regarding the clinical criteria
of the disease for seeking medical advice thus allowing for a better chance for
increasing the case detection rate and decreasing the period of index case infectivity.
2- TB control programs should benefit from a focus on interventions that aimed at
reducing smoking especially among those at high risk for exposure to TB.
3- Public health programs should be targeted at reducing the prevalence of drug abuse.
and alcohol drinking. and promoting physical activity and healthy diet.
ol- The high prevalence of TB infection among contacts ensured the importance of their
monitoring and management along with index case management.
5- Risk factors among index cases as well as contacts could be used as indicators for
identifying contacts who are at higher risk of infection
- 66-