A comparative assessment of public and private dots laboratories in the Lagos state TB control programme

Background: The purpose of the laboratory services within the framework of the NTP is to provide bacteriologic evidence for the diagnosis, follow-up of TB patients and to document cure at the end of treatment. However to be fully functional, laboratory commodities should be available as needed. This study compared the laboratory hygiene practices and availability of laboratory equipment and other consumables for making diagnosis of TB in public and private DOTS laboratories in Lagos State.Methods: A descriptive comparative cross sectional study comparing availability of commodities in public and private laboratories involved in TB services in Lagos State.Results: Seventeen DOTS laboratories and 34 laboratory scientist/technician were recruited for this study. About three quarter and two thirds of the public and private DOTS laboratories respectively had reagents for smear microscopy. A significantly higher proportion of the public DOTS laboratories had separate area for TB work and separate table for smear preparation (p <0.05). A higher proportion (71.4%) of the laboratory scientist/ technicians at the public compared with 38.5% of those at the private DOTS laboratories had good knowledge of the laboratory diagnosis of TB.Conclusion: Laboratories involved in TB service are not functioning optimally and need to be strengthened.Key Words: Laboratory, DOTS, Consumables, Hygiene.French AbstractContexte : L’objet des services des laboratoires dans le cadre du NTP est de fournir les preuves bactériologiques pour le diagnostic, de suivre les patients tuberculeux et de documenter la guérison a la fin du traitement. Toutefois, pour être pleinement fonctionnel, les produits de laboratoire devraient être disponibles au besoin. Cette recherche comparait les pratiques hygiènes de laboratoire et la disponibilité des équipements de laboratoire et autres consommables pour faire le diagnostic de la tuberculose aux laboratoires de DOTS publics et prives dans l’État de Lagos.Méthodes : Une étude transversale comparative et transversale descriptive comparant la disponibilité des produits aux laboratoires publics et prives  concernes a fournir aux services tuberculeux dans l’état de Lagos.Résultats : Dix – sept laboratoires de DOTS et 34 scientifiques/techniciens ont été recrutés pour cette recherche. Environ trois quarts et deux tiers des laboratoires de DOT publics et prives ont eu réactif respectivement pour la microscopie des frottis. Une proportion significativement plus élevée des laboratoires de DOTS publics a eu un espace séparé pour les travaux de la tuberculose et une table séparée pour la préparation des frottis (p<0,05). Une proportion élevée(71,4%) des scientifiques/techniciens des laboratoires publics comparativement a 38,5% de ceux des laboratoires de DOTS prives avaient une bonne connaissance de diagnostic laboratoire de la tuberculose.Conclusion : Les laboratoires qui ont concerné a fournir les services tuberculeux ne fonctionnent pas de la façon optimale et doivent être renforcés.Mots– clés : Laboratoire, DOTS, consommables, Hygiène

Factors Affecting Treatment Interruption among TB Patients in Lagos Nigeria: Is There Any Need for Treatment Supporters?

Abstract Background: This study assessed treatment interruption of tuberculosis (TB) patients managed by treatment supporters and health care workers and other predictors of treatment interruption. Methods: A descriptive cross-sectional study was conducted. Four hundred and seventy new smear positive TB patients above 14 years of age were consecutively recruited between October 1 and December 31 2012 from 34 (23 public and 11 private) directly observed treatment short course (DOTS) facilities that offered TB treatment and microscopy services. They were followed up till treatment was completed. Logistic regression was used to assess the predictors of treatment interruption. Results: A significantly higher proportion of smokers (58.6% vs 38.3%, p = 0.030), patients supervised by treatment supporters (44.4% vs 34.7%, p = 0.032), patients not counselled before initiation of treatment (55.6% vs 38.2%, p = 0.041), patients managed at private DOTS facilities (50% vs 36.3%, p = 0.010) and TB/HIV co-infected patients (54.2% vs 38.6%, p = 0.038) had treatment interruption. Predictors of treatment interruption were supervision by treatment supporters, smoking, lack of pre-treatment counselling and TB/HIV co-infection. Conclusion: A higher proportion of patients supervised by treatment supporters had treatment interruption than those supervised by health care workers. There may be a need to review the concept of treatment supervision by treatment supporters in Lagos state Nigeria. 39

Hybrid Approach to Estimation of Underreporting of Tuberculosis Case Notification in High-Burden Settings With Weak Surveillance Infrastructure: Design and Implementation of an Inventory Study.

BACKGROUND: The greatest risk of infectious disease undernotification occurs in settings with limited capacity to detect it reliably. World Health Organization guidance on the measurement of misreporting is paradoxical, requiring robust, independent systems to assess surveillance rigor. Methods are needed to estimate undernotification in settings with incomplete, flawed, or weak surveillance systems. This study attempted to design a tuberculosis (TB) inventory study that balanced rigor with feasibility for high-need settings. OBJECTIVE: This study aims to design a hybrid TB inventory study for contexts without World Health Organization preconditions. We estimated the proportion of TB cases that were not reported to the Ministry of Health in 2015. The study sought to describe TB surveillance coverage and quality at different levels of TB care provision. Finally, we aimed to identify structural-, facility-, and provider-level barriers to notification and reasons for underreporting, nonreporting, and overreporting. METHODS: Retrospective partial digitalization of paper-based surveillance and facility records preceded deterministic and probabilistic record linkage; a hybrid of health facilities and laboratory census with a stratified sampling of HFs with no capacity to notify leveraged a priori knowledge. Distinct extrapolation methods were applied to the sampled health facilities to estimate bacteriologically confirmed versus clinical TB. In-depth interviews and focus groups were used to identify causal factors responsible for undernotification and test the acceptability of remedies. RESULTS: The hybrid approach proved viable and instructive. High-specificity verification of paper-based records in the field was efficient and had minimal errors. Limiting extrapolation to clinical cases improved precision. Probabilistic record linkage is computationally intensive, and the choice of software influences estimates. Record absence, decay, and overestimation of the private sector TB treatment behavior threaten validity, meriting mitigation. Data management demands were underestimated. Treatment success was modest in all sectors (R=37.9%-72.0%) and did not align with treatment success reported by the state (6665/8770, 75.99%). One-fifth of TB providers (36/178, 20%) were doubtful that the low volume of patients with TB treated in their facility merited mastery of the extensive TB notification forms and procedures. CONCLUSIONS: Subnational inventory studies can be rigorous, relevant, and efficient in countries that need them even in the absence of World Health Organization preconditions, if precautions are taken. The use of triangulation techniques, with minimal recourse to sampling and extrapolation, and the privileging of practical information needs of local decision makers yield reasonable misreporting estimates and viable policy recommendations

Fatliquor for fungus resistant leather-a sustainable ecofriendly approach

Surface-active softening agents, such as Fatliquors, have a significant impact on the leather industry as they enhance the physicochemical properties of leather. This study focuses on analyzing the synthesis, properties, characterization, and sulfonation of Swietenia mahagoni seed oil to determine its potential as a fatliquoring agent for leather. An investigation was conducted to verify the alteration of Swietenia mahagoni oil through the analysis of its properties before and after the sulfonation process. A scientific analysis was carried on the oil using GC-FID, revealing the presence of various unsaturated fatty acids such as linoleic, linolenic, oleic, palmitic, and arachidic acids. This demonstrates the sulfonating capability of this sky fruit seed oil. A fatliquor was created by sulfonating the oil, and the sulfonation was verified through Fourier Transform Infrared Spectroscopy (FTIR) and 1H Nuclear Magnetic Resonance (NMR) spectra. The prominent peak observed at 1209 cm-1 in the FTIR spectra indicated the stretching of S=O in both sulfate and sulfonate groups. The newly formed protons (H–C–S or H–C–O) showed signals between δ 4.09 and 4.29 ppm in the 1H NMR spectra, confirming the sulfonation of the fatliquor that was prepared. Moreover, the change in the melting point of sulfonated Mahogany oil from 40.8 °C to 48.1 °C suggests increased saturation levels. The fatliquor's emulsion stability was found to be at a satisfactory level. After conducting tests on the treated leather, the physical strength and morphological structure was analyzed using Field Emission Scanning Electron Microscopy (FE-SEM), the fatliquor improved the lubrication and strengthened the fibrous network structure of the leather, composed of thin and tight collagen fibers. The BOD5/COD ratio of the effluent from the experimental trial was determined to be 0.52, suggesting that the fatliquor developed is a biodegradable product. Finally, the antifungal capabilities of the fatliquor-treated leather were tested against four different fungus species: Aspergillus niger, Aspergillus flavus, Penicillium notatum, and Candida albicans, and the treated leather sample shown favorable antifungal activity

Iterative evaluation of mobile computer-assisted digital chest x-ray screening for TB improves efficiency, yield, and outcomes in Nigeria.

Wellness on Wheels (WoW) is a model of mobile systematic tuberculosis (TB) screening of high-risk populations combining digital chest radiography with computer-aided automated detection (CAD) and chronic cough screening to identify presumptive TB clients in communities, health facilities, and prisons in Nigeria. The model evolves to address technical, political, and sustainability challenges. Screening methods were iteratively refined to balance TB yield and feasibility across heterogeneous populations. Performance metrics were compared over time. Screening volumes, risk mix, number needed to screen (NNS), number needed to test (NNT), sample loss, TB treatment initiation and outcomes. Efforts to mitigate losses along the diagnostic cascade were tracked. Persons with high CAD4TB score (≥80), who tested negative on a single spot GeneXpert were followed-up to assess TB status at six months. An experimental calibration method achieved a viable CAD threshold for testing. High risk groups and key stakeholders were engaged. Operations evolved in real time to fix problems. Incremental improvements in mean client volumes (128 to 140/day), target group inclusion (92% to 93%), on-site testing (84% to 86%), TB treatment initiation (87% to 91%), and TB treatment success (71% to 85%) were recorded. Attention to those as highest risk boosted efficiency (the NNT declined from 8.2 ± SD8.2 to 7.6 ± SD7.7). Clinical diagnosis was added after follow-up among those with ≥ 80 CAD scores and initially spot -sputum negative found 11 additional TB cases (6.3%) after 121 person-years of follow-up. Iterative adaptation in response to performance metrics foster feasible, acceptable, and efficient TB case-finding in Nigeria. High CAD scores can identify subclinical TB and those at risk of progression to bacteriologically-confirmed TB disease in the near term