Comparison of Mycobacterium tuberculosis drug susceptibility using solid and liquid culture in Nigeria.

BACKGROUND: This study compares Mycobacterium tuberculosis culture isolation and drug sensitivity testing (DST) using solid (LJ) and liquid (BACTEC-MGIT-960) media in Nigeria. METHODS: This was a cross sectional survey of adults attending reference centres in Abuja, Ibadan and Nnewi with a new diagnosis of pulmonary tuberculosis (TB) or having failed the first-line TB treatment. Patients were requested to provide three sputum specimens for smear-microscopy and culture on LJ and BACTEC-MGIT-960. Positive cultures underwent DST for streptomycin, isoniazid, rifampicin and ethambutol. RESULTS: 527 specimens were cultured. 428 (81%) were positive with BACTEC-MGIT-960, 59 (11%) negative, 36 (7%) contaminated and 4 (1%) had non-tuberculosis mycobacteria (NTM). 411 (78%) LJ cultures were positive, 89 (17%) negative, 22 (4%) contaminated and 5 (1%) had NTM. The mean (SD) detection time was 11 (6) and 30 (11) days for BACTEC-MGIT-960 and LJ. DST patterns were compared in the 389 concordant positive BACTEC-MGIT-960 and LJ cultures. Rifampicin and isoniazid DST patterns were similar. Streptomycin resistance was detected more frequently with LJ than BACTEC-MGIT-960 and ethambutol resistance was detected more frequently with BACTEC-MGIT-960 than LJ, but differences were not statistically significant. MDR-TB was detected in 27 cases by LJ and 25 by BACTEC-MGIT-960 and using both methods detected 29 cases. CONCLUSIONS: There was a substantial degree of agreement between the two methods. However using the two in tandem increased the number of culture-positive patients and those with MDR-TB. The choice of culture method should depend on local availability, cost and test performance characteristics

Genetic characterization of Mycobacterium tuberculosis complex isolates circulating in Abuja, Nigeria

WOS:000446783800001Objective: Nigeria ranks fourth among the high tuberculosis (TB) burden countries. This study describes the prevalence of drug resistance and the genetic diversity of Mycobacterium tuberculosis in Abuja's Federal Capital Territory. Materials and methods: Two hundred and seventy-eight consecutive sputum samples were collected from adults with presumptive TB during 2013-2014. DNA was extracted from Lowenstein-Jensen cultures and analyzed for the identification of nontuberculous mycobacteria species, detection of drug resistance with line probe assays, and high-throughput spacer oligonucleotide typing (spoligotyping) using microbead-based hybridization. Results: Two hundred and two cultures were positive for M. tuberculosis complex, 24 negative, 38 contaminated, and 15 positive for nontuberculous mycobacteria. Five (2.5%)M. tuberculosis complex isolates were resistant to rifampicin (RIF) and isoniazid (multidrug resistant), nine (4.5%) to RIF alone, and 15 (7.4%) to isoniazid alone; two RIF-resistant isolates were also resistant to fluoroquinolones and ethambutol, and one multidrug resistant isolate was also resistant to ethambutol. Among the 180 isolates with spoligotyping results, 164 (91.1%) were classified as lineage 4 (Euro-American), 13 (7.2%) as lineage 5 (West African 1), two (1.1%) as lineage 2 (East Asia), and one (0.6%) as lineage 6 (West African 2). One hundred and fifty-six (86.7%) isolates were grouped in 17 clusters (2-108 isolates/cluster), of which 108 (60.0%) were grouped as L4.6.2/Cameroon (spoligotype international type 61). Conclusion: The description of drug resistance prevalence and genetic diversity of M tuberculosis in this study may be useful for improving TB control in Nigeria

A Molecular Epidemiological and Genetic Diversity Study of Tuberculosis in Ibadan, Nnewi and Abuja, Nigeria

Background Nigeria has the tenth highest burden of tuberculosis (TB) among the 22 TB high-burden countries in the world. This study describes the biodiversity and epidemiology of drug-susceptible and drug-resistant TB in Ibadan, Nnewi and Abuja, using 409 DNAs extracted from culture positive TB isolates. Methodology/Principal Findings DNAs extracted from clinical isolates of Mycobacterium tuberculosis complex were studied by spoligotyping and 24 VNTR typing. The Cameroon clade (CAM) was predominant followed by the M. africanum (West African 1) and T (mainly T2) clades. By using a smooth definition of clusters, 32 likely epi-linked clusters related to the Cameroon genotype family and 15 likely epi-linked clusters related to other “modern” genotypes were detected. Eight clusters concerned M. africanum West African 1. The recent transmission rate of TB was 38%. This large study shows that the recent transmission of TB in Nigeria is high, without major regional differences, with MDR-TB clusters. Improvement in the TB control programme is imperative to address the TB control problem in Nigeria

Impact of COVID-19 pandemic in the health system of the federal capital territory Abuja (Nigeria) : elucidating strategies to be prepared for upcoming pandemics

La pandèmia de COVID-19, originada a Wuhan, Xina, va afectar ràpidament els sistemes sanitaris de tot el món, inclòs FCT Abuja, Nigèria. Aquesta tesi estudia l'impacte de la pandèmia COVID-19 en el sistema de salut de FCT Abuja, identificant les debilitats i la resiliència i proposant estratègies per millorar la preparació per a futures pandèmies. Es va utilitzar un enfocament de mètode mixt, combinant anàlisi de dades quantitatives i enquestes qualitatives. Els resultats d'aquest estudi van trobar que la pandèmia COVID-19 va afectar significativament el sistema sanitari de FCT Abuja, provocant escassetat de subministraments mèdics, EPI i medicaments crítics. Els treballadors sanitaris s'han enfrontat a un augment de les càrregues de treball, l'estrès i les interrupcions en els serveis no COVID. S'exposen les disparitats en l'accés a l'atenció sanitària, i les poblacions vulnerables s'enfronten a reptes per rebre una atenció adequada. A més, els resultats d'aquesta investigació revelen tensions significatives en els sistemes de salut de la FCT, com ara la càrrega hospitalària, l'escassetat de subministraments mèdics i els retards en els tractaments. Més encara, les poblacions vulnerables s'enfrontaven a majors reptes per accedir a l'assistència sanitària, i les capacitats limitades de proves i rastreig de contactes van dificultar la contenció de la malaltia. Aquesta investigació també va destacar els reptes i les oportunitats de millora que va comportar la pandèmia, a més d'ajudar els sistemes de salut a dilucidar estratègies per ajudar a preparar-se per a futures pandèmies. Algunes de les estratègies per millorar la preparació per a futures pandèmies inclouen (i) reforçar la infraestructura sanitària invertint en equipament modern, formació i establint centres de tractament temporals (ii) prioritzar la formació i la contractació per fer front a l'escassetat de mà d'obra (iii) emmagatzemar subministraments essencials, (iv) ) ) diversificar l'assignació de recursos, (v) millorar les proves i el seguiment de contactes, (vi) promoure l'educació en salut pública i (vii) establir canals de comunicació sòlids per a la difusió eficaç d'informació crítica durant les crisis, entre d'altres. Per millorar la preparació, aquesta investigació suggereix enfortir la infraestructura sanitària, augmentar la força de treball mèdica, establir existències estratègiques, millorar les capacitats de proves i rastreig de contactes, millorar l'educació en salut pública, la gestió eficaç dels recursos i fomentar la col·laboració entre les autoritats sanitàries i el públic, per mitigar la futura pandèmia. efectes i salvaguardar la salut pública.La pandemia de COVID-19, que se originó en Wuhan, China, afectó rápidamente a los sistemas de salud de todo el mundo, incluido FCT Abuja, Nigeria. Esta tesis estudia el impacto de la pandemia de COVID-19 en el sistema de salud de FCT Abuja, identificando debilidades y resiliencia, y proponiendo estrategias para mejorar la preparación para futuras pandemias. Se utilizó un enfoque de métodos mixtos, que combina análisis de datos cuantitativos y encuestas cualitativas. Los resultados de este estudio encontraron que la pandemia de COVID-19 afectó significativamente al sistema de salud de FCT Abuja, provocando escasez de suministros médicos, EPP y medicamentos críticos. Los trabajadores de la salud enfrentaron mayores cargas de trabajo, estrés e interrupciones en los servicios no relacionados con COVID. Las disparidades en el acceso a la atención médica quedan expuestas, y las poblaciones vulnerables enfrentan desafíos para recibir una atención adecuada. Además, los hallazgos de esta investigación revelan tensiones importantes en los sistemas de salud del FCT, incluida la carga de casos hospitalarios, la escasez de suministros médicos y los retrasos en los tratamientos. Más aún, las poblaciones vulnerables enfrentaron mayores desafíos para acceder a la atención médica, y las capacidades limitadas de prueba y rastreo de contactos obstaculizaron la contención de enfermedades. Esta investigación también destacó los desafíos y oportunidades de mejora que trajo la pandemia, además de ayudar a los sistemas de salud a dilucidar estrategias para ayudar a prepararse para futuras pandemias. Algunas de las estrategias para mejorar la preparación para futuras pandemias incluyen (i) fortalecer la infraestructura de atención médica mediante la inversión en equipos modernos, capacitación y el establecimiento de centros de tratamiento temporales (ii) priorizar la capacitación y la contratación para abordar la escasez de mano de obra (iii) almacenar suministros esenciales, (iv ) ) diversificar la asignación de recursos, (v) mejorar las pruebas y el rastreo de contactos, (vi) promover la educación en salud pública y (vii) establecer canales de comunicación sólidos para la difusión efectiva de información crítica durante las crisis, entre otros. Para mejorar la preparación, esta investigación sugiere fortalecer la infraestructura de atención médica, aumentar la fuerza laboral médica, establecer reservas estratégicas, mejorar las capacidades de prueba y rastreo de contactos, mejorar la educación en salud pública, la gestión eficaz de recursos y fomentar la colaboración entre las autoridades sanitarias y el público para mitigar futuras pandemias. efectos y salvaguardar la salud pública.The COVID-19 pandemic, originating in Wuhan, China, rapidly impacted healthcare systems worldwide, including FCT Abuja, Nigeria. This research investigates the impact of the COVID-19 pandemic on FCT Abuja's health system, identifying weaknesses and resilience, and proposing strategies to improve preparedness for future pandemics. A mixed-method approach was used, combining quantitative data analysis and qualitative surveys. This study's results found that the COVID-19 pandemic significantly impacted FCT Abuja's health system, causing shortages of medical supplies, PPE, and critical medications. Healthcare workers faced increased workloads, stress, and disruptions in non-COVID services. Disparities in healthcare access are exposed, with vulnerable populations facing challenges in receiving adequate care. Furthermore, findings from this research reveal significant strains in the health systems of the FCT including, hospital caseloads, shortages of medical supplies, and delays in treatments. More so, vulnerable populations faced greater challenges in accessing healthcare, and limited testing and contact tracing capabilities hindered disease containment. This research also highlighted the challenges and improvement opportunities that the pandemic brought, alongside helping the health systems to elucidate strategies to help prepare for future pandemics. Some of the strategies to enhance preparedness for future pandemics include (i) strengthening healthcare infrastructure by investing in modern equipment, training, and establishing temporary treatment centres (ii) prioritizing training and recruitment to address workforce shortages (iii) stockpiling essential supplies, (iv) diversifying resource allocation, (v) improving testing and contact tracing, (vi) promoting public health education, and (vii) establishing robust communication channels for effective dissemination of critical information during crises amongst others. To improve preparedness, this research suggests strengthening healthcare infrastructure, augmenting the medical workforce, establishing strategic stockpiles, improving testing and contact tracing capabilities, enhancing public health education, effective resource management, and fostering collaboration between healthcare authorities and the public, to mitigate future pandemic effects and safeguard public health

Tuberculosis case detection in Nigeria, the unfinished agenda.

International audienceUnderdetection of TB is a major problem in sub-Saharan Africa. WHO recommends countries should have at least 1 laboratory per 100,000 population. However, this recommendation is not evidence based.We analysed surveillance data of the Nigerian National TB Control Programme (2008-2012) to describe TB case detection rates, their geographical distribution and their association with the density of diagnostic laboratories and HIV prevalence.The median CDR was 17.7 (range 4.7-75.8%) in 2008, increasing to 28.6% (range 10.6-72.4%) in 2012 (P 30. There were 990 laboratories in 2008 and 1453 in 2012 (46.7% increase, range by state -3% to +118). The state CDR2012 could be predicted by the laboratory density (P than 1 laboratory per 100,000 population.There are large variations in laboratory density and CDR across the Nigerian states. The CDR is associated with the laboratory density. A much larger number of diagnostic centres are needed. It is likely that a laboratory density above the recommended WHO guideline would result in even higher case detection, and this ratio should be considered a minimum threshold

Patients direct costs to undergo TB diagnosis

Background A major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable. Methods We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults >18 years with cough >2 weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs >75th quartile were considered to have high expenditure (cases) and compared with patients with costs <75th quartile to identify factors associated with high expenditure. Results The most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy. Conclusions The costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents

Mycobacterium tuberculosis complex genotypes circulating in Nigeria based on spoligotyping obtained from Ziehl-Neelsen stained slides extracted DNA

<p>(A) Spatial Distribution shown as Apple-pie charts of L1-L6 <i>M</i>. <i>tuberculosis</i> complex (MTC) genotype prevalence on 549 positive ZN-extracted DNA; (B): Spatial Distribution shown as Apple-pie charts of MTC Lineage 4.6.2 (Cameroon sublineage) within the L4 sublineage. (cf <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006242#pntd.0006242.s002" target="_blank">S2 Table</a> for raw data).</p

Survival among hospitalized MDR-TB patients stratified by HIV-status in Nigeria, July 2010 – October 2012.

<p>Survival among hospitalized MDR-TB patients stratified by HIV-status in Nigeria, July 2010 – October 2012.</p

Baseline IP-10 concentrations by HIV status, Smear status, and TB culture/GeneXpert result.

<p>Box plots show medians and ranges for patients, grouped based on HIV, Smear, and culture/GeneXpert result (**p<0.01).</p

Serum IP-10 concentrations at day 0 and 7 of therapy.

<p>Each set of 2 connected points represent data from a single patient from Nigeria (blue) or Nepal (red). Panel A: IP-10 concentrations of HIV-positive, Smear (Sm) positive, and culture/Xpert (Cult) positive patients. The MDR-TB patient is shown with a dashed line. One smear-positive patient had missing culture (Open symbols). Panel B-D: IP-10 concentrations of HIV- Sm+ (B), HIV+ Sm- (C), and HIV- Sm- (D) culture/GeneXpert positive patients. E: Concentrations from Sm-Cult- patients, of which 4 had missing HIV result (open square symbols) and all others were HIV- (round symbols). IP-10 levels in culture/GeneXpert positives were significantly different between day 0 and day 7 (p<0.0001). For culture/GeneXpert negatives p>0.05 between day 0 and day 7.</p