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Mortality in successfully treated TB patients is an important measure of the efficacy of treatment. However, there is no routine monitoring of TB patients after treatment completion to understand what happens to them after successful treatment for tuberculosis. We recently did a study in rural south Ethiopia to measure mortality in TB patients after they completed treatment.

From south Ethiopia, we showed (Datiko and Lindtjørn 2010) that deaths rates after successful TB treatment was higher in TB patients than in the general population. It was especially high in populations with increased risk of HIV infection.

In a study from China, He and colleagues (2010) show that TB patients with multi-drug resistance had high recurrence and death rates four years after treatment with standardized first line drug regimens. They also show that it is not sufficient to document cure only based on conventional smear microscopy at the end of treatment.

Therefore, TB patients, and especially high- risk groups, should be followed for some years after completing the TB treatment

References

Datiko DG and Lindtjørn B (2010). Mortality in successfully treated tuberculosis patients in southern Ethiopia: retrospective follow-up study Int J Tuberc Lung Dis, 14 (7), 1-6

He, G., Xie, Y., Wang, L., Borgdorff, M., van der Werf, M., Fan, J., Yan, X., Li, F., Zhang, X., Zhao, Y., & van den Hof, S. (2010). Follow-Up of Patients with Multidrug Resistant Tuberculosis Four Years after Standardized First-Line Drug Treatment PLoS ONE, 5 (5) DOI: 10.1371/journal.pone.0010799

Clinicians working with HIV patients know how difficult it is to make a certain tuberculosis diagnosis in the smear negative pulmonary tuberculosis. Often the diagnosis is made on clinical and radiological criteria, and is based on national guidelines and international recommendations.

In a recent paper in PLoSONE, Davies and colleagues show that Clinical and radiographic criteria did not help diagnose smear-negative pulmonary tuberculosis among HIV-infected patients with unexplained cough in a low-income setting.

In their paper they evaluated if commonly used clinical and radiological signs could predict if the patient had tuberculosis, and they used culture as their god standard for diagnosing a definite tuberculosis diagnosis. However, their paper does not discuss the limits in doing cultures, and their samples might not have been representative.

In a recently research from south Ethiopia we found that patients receiving antituberculosis drugs had better survival than patients without tuberculosis. This unexpected finding may be because many patients remain undiagnosed with tuberculosis. In the Arba Minch Hospital Cohort Study we evaluated the survival of 1428 patients receiving antiretroviral treatment over a six-year period.

It further underlines Davis’s  recommendation that we need improved tools to diagnose smear-negative tuberculosis in developing countries.

Davis, J., Worodria, W., Kisembo, H., Metcalfe, J., Cattamanchi, A., Kawooya, M., Kyeyune, R., den Boon, S., Powell, K., Okello, R., Yoo, S., & Huang, L. (2010). Clinical and Radiographic Factors Do Not Accurately Diagnose Smear-Negative Tuberculosis in HIV-infected Inpatients in Uganda: A Cross-Sectional Study PLoS ONE, 5 (3) DOI: 10.1371/journal.pone.0009859

A citation index allows the user to establish which later documents cite which earlier documents. The impact factor is a measure reflecting the average number of citations to articles published in science journals. It is frequently used as a proxy for the relative importance of a journal within its field.

Both the Citation index and Impact factors are used to measure how good an article is. This is a misunderstood and a misleading way of using such measures. Unfortunately institutions and governments use citation index to fund researchers.

Recently, the PLoS and BioMedCentral journals give authors some information on citations, but also tell you how many times the article has been downloaded. This is called article-level metrics, and measures individual papers.

However, it is important to recognize that also such metrics are prone to errors. An article that is mentioned in a newspaper, is likely to be downloaded more often that articles that do not receive such media attention.

Although these new metrics provide us with more information, it is not yet clear how best to use these measures. Currently, both PLoS and BioMedCentral simply present the data.

But, there is only one way of deciding whether a paper is important and to you, and that is to read it, critically analyse it, and come to your own conclusions.

The Konso people (population in 2007 245.000; CSA 2007) live in the Konso area of south Ethiopia. Konso (now called Karat) is a town in south-western Ethiopia, and is the administrative centre of the Konso special woreda of the Southern Nations, Nationalities, and Peoples Region.

Konso, named after the Konso people, is known for its religious traditions, waga sculptures, and nearby fossil beds (the latter an archaeological site of early hominids). The site was added to the UNESCO World Heritage Tentative List in 1997.

Konso society is largely agricultural, and involves the irrigation and terracing of mountain slopes. Staple crops include sorghum and maize, with cash crops including chat, cotton and coffee. Cattle, sheep, and goats are raised for food and milk. During the last 30 years, the people have repeatedly been affected by drought and famine.

We have recently started to develop a bibliography on the Konso area. With some people from Konso we collect information about publications. We also aim to make unpublished university thesis and books available to the public.

Datiko DG and Lindtjørn B. Tuberculosis recurrence in smear-positive patients cured under DOTS in southern Ethiopia: retrospective cohort study. BMC Public Health 2009, 9:348

Abstract
Background: Decentralization of DOTS has increased the number of cured smear-positive tuberculosis (TB) patients. However, the rate of recurrence has increased mainly due to HIV infection. Recurrence rate could be taken as an important measure of long-term success of TB treatment. We aimed to find out the rate of recurrence in smear-positive patients cured under DOTS in southern Ethiopia.

Methods: We did a retrospective cohort study on cured smear-positive TB patients who were treated from 1998 to 2006. Recurrence of smear-positive TB was used as an outcome measure. Person-years of observation (PYO) were calculated per 100 PYO from the date of cure to date of interview. Kaplan-Meier and Cox-regression methods were used to determine the survival and the hazard ratio (HR).

Results: 368 cured smear-positive TB patients which were followed for 1463 person-years. Of these, 187 patients (50.8%) were men, 277 patients (75.5%) were married, 157 (44.2%) were illiterate, and 152 patients (41.3%) were farmers. 15 of 368 smear-positive patients had recurrence. The rate of recurrence was 1 per 100 PYO (0.01 per annum). Recurrence was not associated with age, sex, occupation, marital status and level of education.

Conclusion: High recurrence rate occurred among smear-positive patients cured under DOTS. Further studies are required to identify factors contributing to high recurrence rates to improve disease free survival of TB patients after treatment.

The pdf file can be downloaded at http://www.biomedcentral.com/content/pdf/1471-2458-9-348.pdf

Recently, Jimmy Atkinson at Web Health Blog told me about open access courses on health and medical topics.

These seminars and courses are free for anyone to use. Although they do not provide credits, they can become valuable resources in your goal to become more aware of national and international health and medical issues

The courses also include good courses by for example Harvard Medical School, Johns Hopkins Bloomberg School of Public Health, MIT and TUFTS. You will find good courses in epidemiology and statistics.

Please visit their website to read bout the available courses.

In 1993, Catherine Pope and Nicholas Mays argued for greater use of qualitative techniques in health research. They published several good papers that helped researchers understand what qualitative research is. They suggested that researchers would benefit in using qualitative methods. Since then qualitative research methods is widely accepted in health services research.

Now they are worried the methods are not always used properly.

Please read their article in this week BMJ where they critically evaluate how far qualitative research has come. They ask some thorough questions whether researchers use qualitative research to its full potential.

Pope C, Mays N, Critical reflections on the rise of qualitative research. BMJ 2009;339:b3425