Lessons learned from Ethiopia, Semarang, etc.

• In China, close contacts of PTB patients showed a high TB infection (TBI) prevalence of 39.12% and TB disease prevalence of 443.51 per 100,000. Risk factors included older age, prolonged exposure, and sharing a bedroom with the index case—suggesting targeted screening and preventive treatment are essential for high-risk groups.
• Smoking, alcohol use, and higher BMI were also positively associated with TBI in the Chinese cohort. These lifestyle factors could be considered in risk stratification for contact investigations and intervention planning.
• TB control effectiveness in China varies regionally—East China has better referral/tracing rates than the West. Migrants and MDR-TB patients receive poorer services due to stigma, workforce shortages, and coordination issues, highlighting the need for equity-focused health policies.
• Digital health tools and community-based education improved TB awareness and adherence in China, but older and tech-averse populations remain underserved. Expanding outreach methods and user-friendly tech solutions could bridge this gap.
• In Semarang, Indonesia, qualitative research at PHCs identified systemic inefficiencies, stigma, and cultural barriers as key obstacles to TB elimination. Improving resource availability, data systems, and community engagement are recommended for sustainable progress toward 2028 TB-free goals.
• Housing quality modestly influenced TB treatment outcomes in Semarang, explaining just 0.3% of the variability. Sanitation had no significant effect, indicating that broader public health measures must complement environmental improvements.
• A case-control study in Semarang found MDR-TB significantly associated with low economic status, prior treatment, contact history, and stress—not with age, gender, BMI, or DM. Targeting socioeconomic and psychosocial factors may help reduce MDR-TB burden.
• A meta-analysis from Ethiopia found an average PTB prevalence of 11.7% among key vulnerable populations (KVPs), with refugees (28.4%) and university students (23.1%) most affected. This calls for aggressive TB control in hotspot settings through regular screening and strict infection control.
• Southeast Asia could cut TB incidence by 8.3% with strong TPT (Tuberculosis Preventive Therapy) implementation, especially among household contacts and high-risk groups. Countries like Indonesia and Maldives extend TPT to prisoners, while Timor-Leste targets undernourished or diabetic individuals.
• Operational barriers to TPT in SEAR include lack of provider training, weak diagnostics, and system inefficiencies. Addressing these through integrated TB management frameworks will enhance prevention and align with global TB reduction goals.
• Forecasting shows most Southeast Asian Region (SEAR) countries will miss the 2025 WHO End TB targets. While Myanmar shows promising trends, countries like Bangladesh and Nepal lag behind, indicating a need for accelerated, country-specific interventions.

References:

1. Zhang, C., Liu, Y., Yao, Y., Gong, D., Lei, R., Xia, Y., Xu, C., Chen, H., Cheng, J. and Zhang, H., 2024. Tuberculosis infection among close contacts of patients with pulmonary tuberculosis in China: a population-based, multicentered study. Clinical Microbiology and Infection, 30(9), pp.1176-1182.
2. Chen, X., Zhou, J., Yuan, Q., Zhang, R., Huang, C. and Li, Y., 2024. Challenge of ending TB in China: tuberculosis control in primary healthcare sectors under integrated TB control model–a systematic review and meta-analysis. BMC Public Health, 24(1), p.163.
3. Handayani, S. and Isworo, S., 2024. Evaluation of Tuberculosis program implementation in Primary Health Care, Semarang, Indonesia. International Journal of Public Health Asia Pacific, pp.1-11.
4. Hakam, M.A., Safitri, B.D., Wandastuti, A.D., Husni, M.F., Setiawan, A.W., Konoralma, A.R., Radja, B.L., Setiono, O. and Wulan, W.R., 2024. The Relationship Between Adequate Housing And Household Sanitation With The Success Of Tuberculosis Patient Treatment In Semarang City. International Journal of Health Literacy and Science, 2(2), pp.14-19.
5. Buryanti, S., 2021. Faktor-Faktor yang Mempengaruhi Kejadian TB MDR di Kota Semarang. Journal Health & Science: Gorontalo Journal Health and Science Community, 5(1), pp.146-154.
6. Reta, M.A., Asmare, Z., Sisay, A., Gashaw, Y., Getachew, E., Gashaw, M., Dejazmach, Z., Jemal, A., Gedfie, S., Kumie, G. and Nigatie, M., 2024. Prevalence of pulmonary tuberculosis among key and vulnerable populations in hotspot settings of Ethiopia. A systematic review and meta-analysis. Plos one, 19(8), p.e0309445.
7. Giridharan, P., Suseela, R.P., Zangpo, T., Joshi, R.B., Cader, M., Isbaniah, F., Velayudham, B., Rafeeg, F.N., da Cruz Santos, A., Shah, N.P. and Mathew, M., 2024. Tuberculosis preventive treatment in eight SEAR countries–Current practices, implementation challenges and operations research priorities. Public Health in Practice, 8, p.100518.
8. Krishnamoorthy, Y., Nagarajan, R., Rajaa, S., Majella, M.G., Murali, S. and Jayaseelan, V., 2021. Progress of South East Asian Region countries towards achieving interim End TB Strategy targets for TB incidence and mortality: a modelling study. Public Health, 198, pp.9-16.

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