Olusoji James Daniel

Prevalence and risk factors associated with drug resistant TB in South West,Nigeria

OBJECTIVE To determine the prevalence and risk factors associated with drug resistant tuberculosis (TB) in South West Nigeria. METHODS A retrospective study conducted among pulmonary tuberculosis (PTB) patients from Oyo and Osun States in South West Nigeria who had their culture and drug susceptibility test performed at the institute of tropical medicine Antwerp, Belgium between 2007 and 2009. Data on the patients characteristics were retrieved from the TB treatment card. Univariate analysis was performed to assess the risk factors for drug resistant tuberculosis. The Level of significance was at P<0.05. RESULTS Among the 88 patients who had drug-susceptibility test result, there were 50 males and 38 females. Of the 88 patients, 55 (62.5%) had strains resistant to at least one or more anti-drugs. The proportion of TB cases with resistance to a single drug was 12.7%. The multi-drug resistant TB (MDR-TB) rate was 76.4%. The only significant factor for the development of drug resistance and MDR was the history of previous anti TB treatment (P<0.01). Other factors such as age [OR 0.86 (0.35-2.13); P=0.72] and gender [OR 1.24 (0.49-3.14); P=0.62] were not significantly associated with drug resistance TB. CONCLUSIONS The study highlighted a high prevalence of MDR-TB among the study population. History of previous TB treatment was associated with MDR-TB. There is an urgent need to conduct a national TB drug resistance survey to determine the actual burden and risk factors associated with drug resistance TB in the country.

Knowledge and practice of post-exposure prophylaxis (PEP) against HIV infection among health care providers in a tertiary hospital in Nigeria.

Objective: To assess the knowledge and practice of post exposure prophylaxis (PEP) against HIV infection among health care providers in University of Abuja Teaching Hospital (UATH). Methods: A cross-sectional survey conducted on 230 health care providers in UATH. Results: Majority (97.0%) of the respondents have heard about PEP, but only a few (30.9%) of them could correctly identify the drugs used and duration of PEP. A third of respondents have had one form of accidental exposure or the other. HIV test was carried out in about two-thirds (64.8%) of the source patients. Thirteen (28.3%) of the source patients were HIV-positive. Of the 13 respondents that were exposed to HIV-positive patients, only 3 (23.1%) received PEP, and these three completed PEP, while majority, 10/13 (76.9%) did not receive PEP in spite of their exposure to HIV-positive sources. Conclusion: The study shows that the knowledge and practice of PEP among health care providers are very poor.

Treatment Outcomes of Childhood TB in Lagos, Nigeria

BACKGROUND : Treatment outcomes of tuberculosis (TB) in children are rarely evaluated by most national TB programmes in sub-Saharan Africa. This study evaluated the treatment outcomes of children treated for TB in Lagos State, Nigeria. METHODS A retrospective review of programme data of the Lagos state TB and the Leprosy control programme in Nigeria from 1 January 2012 to 31 December 2012. Treatment outcomes were categorized according to the national TB guidelines. RESULTS A total of 535 cases of childhood TB were notified in 2012, representing 6.3% of the total TB cases notified in Lagos state in 2012. The prevalence of TB/HIV co-infection was 29%. The treatment success rate was 79.2% in TB/HIV-negative children compared with 73.4% in TB/HIV-positive children (p = 0.1268). Children <1 year had the worst treatment outcomes (p < 0.001). CONCLUSION There is a need to intensify effort at improving notification and treatment outcomes in children.

Self-reported reasons for seeking HIV testing by people living with HIV/AIDS(PLWHA) in a tertiary hospital in Nigeria

Abstract Objective To assess the reasons for HIV testing among people living with HIV and AIDS (PLWHA) that were receiving care/treatment in the University of Ilorin Teaching Hospital(UITH), Ilorin. Methods The study was a descriptive cross-sectional survey conducted on 300 people living with HIV and AIDS receiving care at the antiretroviral therapy (ART) clinics of the hospital. All the patients who came to the clinic during the period of data collection and met the inclusion criteria were recruited into the study consecutively. Data were analyzed using the EPI-INFO 2005 software package. Results The mean age of the respondents was 39 years (SD=9.32), ranging between 19 and 65 years. About two thirds (64.7%) were females, among which 62.7% were married. Slightly less than half (47.3%) of the respondents were not informed before they were tested for HIV while 11% did not receive post-test counselling. The main reason for HIV test was because client was sick and not responding to the treatment for other illnesses and during routine medical test when spouse tested positive. Conclusions The findings from this study reveal that the majority of respondents were tested for HIV/AIDS when they had protracted illness or lost their partners to AIDS. To achieve the WHO goal of universal access to HIV prevention, care, treatment and support, there is an urgent need to rapidly scale up HCT services at all levels of the health care system, while pursuing innovative human right approaches to provider-initiated testing and counselling (PITC).

Resistance of Mycobacterium Tuberculosis to First and Second Line AntiTuberculosis Drugs in South West, Nigeria

Setting: Tuberculosis treatment centers in Oyo and Osun States, Nigeria Objective: This study was aimed to determine the proportion and resistance pattern of Mycobacterium tuberculosis isolates among category 2 failures in Nigeria. Design: This is a retrospective study of TB Category 2 failures from Oyo and Osun states (Nigeria), from July 2007 to December 2010. Sputum and culture growth of Pulmonary Tuberculosis (PTB) patients were tested for Drug Susceptibility Testing (DST) to first and second line anti-TB drugs in the supra national laboratory at Antwerp, Belgium. Results: Of the 82 patients, acquired resistance to all first line drugs (RHE and S), were 31(37.8%), while MDR was observed in 46 (56.1%) of the patients under the study. Conclusion: MDR TB was high (56.1%) among patients previously treated with anti-TB drugs, however XDR TB was not observed in the study population. DST services should be made available and accessible to all MDR-TB suspects in the country.

Trend of childhood TB case notification in Lagos, Nigeria, 2011-2014.

BACKGROUND Childhood tuberculosis (TB) has been neglected by national TB programs in sub-Saharan Africa because of the emphasis on adult smear-positive TB cases. About 80,000 HIV children die from TB, and over 550,000 childhood TB cases occur annually, representing 6% of the global TB burden, making TB an important cause of morbidity and mortality in children. Thus, this study assessed the trend of childhood TB cases notified in Lagos, Nigeria from 2011 to 2014. METHODS Retrospective data review of childhood TB cases notified to the Lagos State TB and Leprosy Control Programme (LSTBLCP) between January 1, 2011 and December 31, 2014. RESULTS A total of 2396 children were treated for all forms of TB representing 6.8% of the total 35,305 TB cases notified during the study period. This constituted 1102 (46%) males and 1294 (54%) females. There was a progressive increase in the proportion of children treated for TB from 495 (5.9%) in 2011, 539 (6.4%) in 2012, 682 (7.2%) in 2013 and 680 (7.6%) in 2014. Of the total childhood TB cases notified, 16.3-20% were new sputum pulmonary smear positive; 68.2-74.6% were new sputum pulmonary smear negative; while extra-pulmonary TB accounted for 6.7-10.6%. The case notification rate (CNR) of childhood TB per 100,000 increased from 13.4 in 2011, 14.3 in 2012, 17.7 in 2013 and 17.2 in 2014. CONCLUSION There was an increase in the case notification rate of TB among children between 2011 and 2014. Efforts should be made to sustain this increasing trend.

FACTORS ASSOCIATED WITH TB/HIV CO-INFECTION AMONG DRUG SENSITIVE TUBERCULOSIS PATIENTS MANAGED IN A SECONDARY HEALTH FACILITY IN LAGOS, NIGERIA

Background: This study assessed factors associated with TB/HIV co-infection among TB patients managed in a secondary health facility in Lagos Nigeria. Materials and Methods: A retrospective review of treatment cards of patients seen at a secondary referral hospital between January 1 2014 and December 31 2014 was conducted. Treatment outcomes and factors associated with TB/HIV co-infection were assessed. Results: Of the 334 records of patients reviewed, the proportion of patients with TB/HIV co-infection was 21.6%. The odds of having TB/HIV co-infection was 2.7 times higher among patients above 40 years than patients less than 25 years (AOR 2.7 95% CI 1.1 – 6.5, p =0.030). In addition, the odds of having TB/HIV co-infection was 3.3 higher among extra-pulmonary TB cases (AOR 3.3; 95% CI 1.2 – 9.5; p = 0.026) and 2.1 times higher among retreated patients (AOR 2.1; 95% CI 1.1 – 3.9; p = 0.017) than pulmonary TB and new patients respectively. The chance of having TB/HIV co-infection was 2.7-fold more in patients with poor treatment outcomes than patients with treatment success (AOR 2.7; 95%CI 1.3 – 5.4; p =0.006). Conclusion: TB/HIV co-infection rate was high in the study area. There is need to put measures in place to improve treatment outcomes of TB/HIV co-infected patients.

Determinants of health system delay at public and private directly observed treatment, short course facilities in Lagos State, Nigeria: A cross-sectional study

Objective/background: Despite several studies on health system delay (HSD) among tuberculosis (TB) patients in Nigeria, no study has compared HSD in private and public health facilities. This study assessed the determinants of HSD in public and private health facilities offering the directly observed treatment, short course (DOTS). Methods: A descriptive cross-sectional study was conducted. A total of 470 new smear-positive TB patients aged 14 years and older were consecutively recruited between October 1, 2012, and December 31, 2012, from 34 (23 public and 11 private) DOTS facilities that offered treatment and microscopy services. Mann–Whitney U test and logistic regression were used to assess the determinants of HSD. Results: The median HSD was longer at public DOTS facilities (14 days; interquartile range [IQR] 10–21 days) than private DOTS facilities (12.5 days; IQR 10.0–14.0 days, p = .002). Age and human immunodeficiency virus status were determinants of HSD at the public DOTS facilities, whereas sex and income were determinants of HSD at the private DOTS facilities. TB patients who first visited a nonhospital facility were over four times more likely (odds ratio 4.12; 95% confidence interval 2.25–7.54) to have prolonged HSD than those who first visited the government hospital when they first developed the symptoms of TB after controlling for other factors in the model. Conclusion: Determinants of HSD at the public and private DOTS facilities vary. Strategies to reduce HSD at both public and private DOTS facilities in Lagos State, Nigeria, are urgently needed.

Eight months vs six months anti-TB regimen in the treatment of newly diagnosed pulmonary tuberculosis patients in Nigeria.

Background: The eight month’s treatment regimen (2RHZE/6EH) was used by the Nigerian National TB and Leprosy Control Programme for the management of tuberculosis cases since 2003 when they commenced operation until October 2010 when the six month’s treatment regimen Original Research Article Daniel et al.; BJMMR, 8(10): 836-841, 2015; Article no.BJMMR.2015.513 837 (2RHZE/4RH) was introduced. This study compared the treatment outcomes of patients managed with eight and six month’s treatment regimen between October 2009 and December 2011. Methods: A desk review was carried out on the programme data of the Lagos State Tuberculosis and Leprosy Control Programme (LSTBLCP). The treatment outcomes of new smear positive TB patients managed between October 2009 and September 2010 (the eight month’s treatment regimen period) and January to December 2011 (six month’s treatment regimen period) were compared using Epi Info 2007 statistical software. Results: A total of 4249 and 4167 smear positive TB patients were registered during the eight and six month’s treatment regimen period respectively. The prevalence of HIV among TB patients was significantly higher (14.4%) during the eight month’s treatment regime period compared with the six month’s (12.1%) treatment regime period (P = .02). The cure rate of patients managed during the eight month’s treatment regimen period was significantly lower (67.2%) and defaulter rate significantly higher (16.7%) compared with the cure (73.9%) and defaulter rates (12.2%) of patients managed during the six month’s treatment regimen period (P .05). Among TB/HIV co-infected patients, the death rate was significantly higher among patients managed during the six month’s regimen period and the default rate was significantly higher in patients managed during the eight month’s treatment regimen period (p<.05). Conclusion: Patients had better treatment outcomes during the six month’s treatment regimen period in Lagos State. Sustaining these gains will be essential in reaching the national and global

Trend of tuberculosis case notification and treatment outcome in Lagos State, Nigeria: a 5-year retrospective study

Background This study assessed trends of tuberculosis (TB) case notification rate (CNR) and treatment outcomes between 2011 and 2015 in Lagos State, Nigeria. Methods A retrospective review of TB notification data to the Lagos State Tuberculosis and Leprosy Control Programme (LSTBLCP) between 1 January 2011 and 31 December 2015 was conducted. Results A total of 44 516 TB cases were notified during the study period, representing 9.4% of the national figure. The male:female ratio was 1.3:1. About 53%, 44.1% and 2.7% of patients were smear positive, smear negative and extrapulmonary TB cases, respectively. TB notification increased by 12.2% between 2011 and 2013 and subsequently declined by 7.2% in 2015 relative to 2013. The TB CNR declined from 82.9 per 100 000 in 2013 to 72.1 per 100 000 in 2015. However, directly observed treatment short course (DOTS) and microscopy site expansion increased from 0.3 to 0.64 per 25 000 population and from 0.16 to 0.4 per 50 000 population, respectively, from 2011 to 2015. Similarly, there was a slight increase in treatment success rate, from 80.1% in 2011 to 82% in 2015. Conclusion The CNR declined in Lagos State despite an increasing trend in DOTS and microscopy site expansions between 2013 and 2015. The LSTBLCPs need to re-engineer current strategies of active TB case findings in order to improve case notification in the state.