Question

How to traditional sub saharan african treat tuberculosis?

Answer 1

Results: A total of 1490 manuscripts met screening criteria; 152 met criteria for full-text review and 47 for analysis. Patient-level barriers included limited knowledge, attitudes and beliefs regarding TB, and economic burdens. System-level barriers included centralization of services, health system delays, and geographical access to healthcare. Of the 47 studies included, 7 evaluated cost, 19 health-seeking behaviors, and 29 health system infrastructure. Only 4 studies primarily assessed pediatric cohorts yet all 47 studies were inclusive of children.

Conclusions: Recognizing and removing barriers to treatment initiation for pediatric TB in sub-Saharan Africa are critical. Both patient- and system-level barriers must be better researched in order to improve patient outcomes.

KEYWORDS: Access, delay, global health, health systems, pediatrics
Background
Mycobacterium tuberculosis (TB) is the leading infectious cause of death worldwide, surpassing HIV/A.I.D.S [1]. In 2015, TB killed 1.8 million people with 95% of cases and deaths in developing countries [1]. TB is an airborne infectious agent requiring at minimum an intensive six-month medication regimen for bacteriologic cure [1]. Timely initiation and correct treatment of TB are critical to reduce disease transmission and improve patient outcomes. However, barriers to treatment initiation exist at both the patient and system levels. Patient-level barriers such as perception of illness, stigma, knowledge about TB, delay in seeking care and initiating treatment, and direct and indirect costs all cause delayed treatment [2,3]. Health system barriers include resource capacity such as the availability of laboratory tests, accessibility of different levels of care, and costs. Patient costs associated with TB treatment often cause patients and families to fall into a ‘medical poverty trap’ [4,5].

Pulmonary TB outcomes in children are favorable when treated; however, data are limited regarding outcomes for children (0–18 years) and youth (15–24 years) [6–10]. This research gap is in part due to lack of standardized definitions of age cohorts (i.e. pediatric, child, adolescent, youth) as well as lack of political and community commitment to this age group [11]. Barriers to involving youth in research, coupled with developmental transitions, additional responsibilities associated with education and employment, and dependence on family commitment, may cause youth to be understudied [12].

Pediatric cases (0–18 years) account for 10% of all new and relapse cases of TB in the African region, as compared to 6.5% globally [1]. Additionally, the African region has the highest rate of TB in children and youth compared to any other region [1]. Despite the high burden of disease among younger age groups, barriers are most often studied in adult populations. As a result, barriers to treatment initiation in children and youth are less well understood [12,13]. The objective of this review is to determine patient- and system-level barriers to treatment initiation in sub-Saharan Africa (SSA) with an emphasis on children and youth diagnosed with TB, through systematic review of the l

Answer 2

Tuberculosis (TB) is the deadliest infectious disease globally, with 10.4 million people infected and more than 1.8 million deaths in 2015. TB is a preventable, treatable, and curable disease, yet there are numerous barriers to initiating treatment. These barriers to treatment are exacerbated in low-resource settings and may be compounded by factors related to childhood