Critique of the Article "Evidence and Potential Risk Factors of Tuberculosis among Captive Asian Elephants and Wildlife Staff in Peninsular Malaysia" (Article Critique Sample)

Critique of the Article "Evidence and Potential Risk Factors of Tuberculosis among Captive Asian Elephants and Wildlife Staff in Peninsular Malaysia" Name Institution Course Professor Date General Description of the Study This article by Yakubu et al. (2016) is an observational study that examines the prevalence and possible risk factors associated with tuberculosis (TB) in captive Asian elephants and wildlife workers in Peninsular Malaysia. This article details the findings of a cross-sectional research conducted in Peninsular Malaysia that examined the incidence and risk factors of tuberculosis (TB) among Asian elephants in captivity and wildlife workers. Clinical, bacteriological, and molecular testing were conducted on samples obtained from 93 elephants and 149 staff members at 22 wildlife facilities to diagnose tuberculosis. The study revealed that 12.9% of elephants and 2.7% of staff tested positive for tuberculosis (TB). The primary risk factors for elephants were age, physical condition, and contact history, while employment, smoking, and contact history were vital risk factors for the staff. Scientists also detected genetic diversity and similarity in TB isolates from both hosts, providing additional evidence of possible transmission. This article provides data and insights to help prevent and control TB in Malaysia among both elephants and humans. It is well organized and presents information clearly, ensuring easy readability. There are no spelling or grammar errors in this paper. Title and abstract (STROBE Items 1 and 2) The title is clear and indicates the study design, the population, the exposure, and the outcome of interest. The abstract summarizes the study's background, objectives, methods, results, and conclusions. Still, it could be more informative and balanced by reporting the main findings with numbers and confidence intervals and discussing the study's limitations and implications. Introduction (STROBE Item 3) The introduction presents a concise overview of the epidemiology and transmission of tuberculosis (TB) in both elephants and humans, along with an explanation of the public health implications of this zoonotic disease. Furthermore, the objectives section outlines the precise goal of the research, which is to examine the prevalence and possible determinants of tuberculosis (TB) among captive Asian elephants and wildlife personnel in Peninsular Malaysia. However, the introduction lacks a straightforward elucidation of the underlying logic and hypothesis that drive the investigation, and it also falls short of delivering a complete overview of the relevant literature. Methods (STROBE Items 4-12) The study design is described as a cross-sectional study with a nested case-control component appropriate for the research question. The setting section gives details of the location, dates, and sampling methods of the study. Six locations in Peninsular Malaysia were selected based on the convenience and availability of elephants and staff. The study period was from January to April 2012. The participant's section describes the eligibility criteria and sources of selection of elephants and staff. All captive Asian elephants (n=63) and wildlife staff (n=149) in the six locations were included in the study. The staff was divided into two groups based on their contact frequency with elephants: high-contact (n=72) and low-contact (n=77) (Yakubu et al., 2016). The variables section defines all outcomes, exposures, predictors, potential confounders, and effect modifiers. The primary outcome was TB infection status, which was determined by serological testing (ElephantTB STAT-PAK® assay) and molecular testing (trunk-wash samples for culture and PCR). The primary exposure was contact with elephants or staff (Yakubu et al., 2016). Other variables included demographic, clinical, behavioral, and environmental factors. The data sources/measurement section describes each variable's data sources and assessment methods. Data were collected using questionnaires, physical examinations, blood samples, trunk-wash samples, and environmental samples. The methods of assessment were standardized and validated for elephants and humans. The bias section discusses some potential sources of bias and how they were addressed. Selection bias was minimized by including all available elephants and staff in the study. Information bias was reduced by using objective measures of TB infection status and by training the data collectors (Yakubu et al., 2016). Confounding bias was controlled by adjusting for potential confounders in the analysis. The study size section explains how the sample size was determined. It was based on the availability of elephants and staff in the selected locations, resulting in 212 participants. The section on quantitative variables explains the methods used to manage quantitative variables throughout the study. The continuous variables were summarized by calculating either the mean and standard deviation or the median and interquartile range, depending on the data distribution. The categorical variables were summarized by calculating the frequency and percentage. The statistical techniques section comprehensively describes all the statistical approaches used in the investigation. The researchers used descriptive statistics to characterize the individuals and conduct group comparisons. The statistical tests used to examine the relationships between categorical variables were the chi-square and Fisher's exact tests. The study conducted by Yakubu et al. (2016) used logistic regression analysis to ascertain the risk variables associated with tuberculosis (TB) infection in both elephants and staff members. The strength of the relationship was assessed by calculating odds ratios and determining their corresponding 95% confidence intervals. A p-value below 0.05 was deemed to be statistically significant. The analyses were conducted using SPSS software version 20. Results (STROBE Items 13-17) The participant's section reports the study participants' characteristics and TB infection status. A flow diagram shows the number of participants with positive or negative results for each test. The overall prevalence of TB infection among elephants was 20.6% (13/63) based on serology or PCR, while among staff, it was 24.8% (37/149) based on serology only (Yakubu et al., 2016). There was no significant difference in TB infection status between high-contact and low-contact staff (p=0.67). The descriptive data section presents the results of the comparison between infected and uninfected participants for each variable. Tables are used to display the data clearly and concisely. Several variables were significantly associated with TB infection status among elephants or staff, such as age, body condition score, history of TB exposure or treatment, contact frequency or duration, use of personal protective equipment, ventilation, and hygiene. The main results section reports the results of the logistic regression analysis to identify risk factors for TB infection among elephants or staff. Tables show the adjusted odds ratios and 95% confidence intervals for each variable. Among elephants, age (OR=1.17; 95% CI: 1.03–1.33), body condition score (OR=0.22; 95% CI: 0.06–0.84), history of TB exposure (OR=9.00; 95% CI: 1.04–77.83), and contact duration with staff (OR=1.04; 95% CI: 1.01–1.08) were significant risk factors for TB infection. Among staff, age (OR=1.05; 95% CI: 1.01–1.09), history of TB treatment (OR=9.33; 95% CI: 2.06–42.29), contact frequency with elephants (OR=1.10; 95% CI: 1.03–1.18), and use of personal protective equipment (OR=0.16; 95% CI: 0.04–0.65) were significant risk factors for TB infection. Yakubu et al. (2016) use descriptive statistics and logistic regression models to estimate TB infection's prevalence and risk factors. However, it is essential to note that these analytical approaches may not fully include the potential influence of confounding or interaction effects arising from multiple variables or clusters. The authors indicate that they accounted for several confounding factors in their models; however, they did not provide information about the model fit or diagnostics or elaborate on the variable selection and testing process. Discussion (STROBE Items 18 and 19) The key resu...