Clinical Study Acid-Fast Bacilli Other than Mycobacteria in Tuberculosis Patients Receiving Directly Observed Therapy Short Course in Cross River State, Nigeria

The information on the contribution of non tuberculous mycobacteria (NTM) to mycobacterial infections in Africa is scarce due to limited laboratory culture for its isolation and identification. One hundred and thirty-seven sputum smear positive patients were recruited into a study on the molecular epidemiology of Mycobacterium tuberculosis in Cross River State. Following sputum culture, 97 pure isolates were obtained and identified using Capilia TB-Neo and further confirmed by the GenoType Mycobacterium CM kit. Of the 97 isolates, 81 (83.5%) isolates were Capilia TB-Neo positive while 16 (16.5%) were Capilia TB-Neo negative. Further confirmation with the GenoType Mycobacterium CM kit revealed that 4 (25%) of the 16 isolates belonged to NTM and included M. fortuitum I, M. fortuitum II/M magaritense, M. abscessus, and M. avium ssp. The remaining 12 (75%) Capilia TB-Neo negative isolates were not members of the genus Mycobacterium despite their AFB appearance. Six (33.3%) of the Capilia TB-Neo negative were from HIV positive tuberculosis patients. All subjects in this study were placed on DOTS shortly after the AFB results were obtained. The implication of isolation of 16.5% nontuberculous isolates further emphasizes the need for culture of sputum specimen especially in HIV positive patients prior to administration of antituberculosis therapy

Knowledge, Attitudes and Practices Among Adult Malaria Patients Co-Infected with Opportunistic Intestinal Coccidian Parasites in Fundong Health District, Northwest, Cameroon: A Cross Section Study Design

Introduction: Malaria and intestinal coccidian parasitic co-infections, are becoming a public health emergency affecting millions of people around the world. They are among the leading cause of socio-economic problems, long suffering and death especially in developing countries like Cameroon. Introducing new appropriate preventive and control measures to the population requires thorough assessment of community and patient-based knowledge, attitude and preventive practices towards malaria and pathogenic intestinal coccidian parasites is crucial. Our study aimed to describe knowledge, attitudes, and practices and the risk factors among adult malaria patients co-infected with intestinal parasitic infections in the Fundong Health District, a locality in the Northwest Region of Cameroon. Methods: This was a cross-sectional study carried out between February and December, 2022 involving sixteen (16) health facilities in Fundong Health district. A total number of 330 patients participated in the study. Normal saline wet mount and formol-ether concentration techniques were employed in coccidian parasitic detection. Blood samples were subjected to Giemsa stained and viewed microscopically to detect the Plasmodium parasites. Pretested structured questionnaires were administered to collect information on patient’s socio-demographic factors and determine patients’ knowledge, attitudes and practices towards malaria and intestinal coccidian parasites, as well as their prevention and control. The Pearson’s Chi-Square (χ2) and Student T-test were performed a part of the statistical analysis to check for associations between malaria, infection and between malaria-coccidian co-infection and demographic factors. Statistical significance was set a P-value<0.05. Results: Participants main sources of information on malaria were: Television (TV) and radio 111/330 (34%), community health workers 109/330 (33%), and Hospitals (37%). Participants had good knowledge of mosquito bite as the malaria transmission route, 296/330 (90%), night time is the frequent biting time for the mosquito 296/330(90%), dark corners 229 (69%) and dirty areas 175(53%) as mosquito resting places. Knowledge score was also good on cleaning of the house surroundings, 281/330(85%), clearing the bushes 180/330(55%), poor knowledge score on drainage of stagnant water113/330 (34%) as ways to prevent the mosquito from multiplying. Participants had good knowledge of insecticide treated bed nets 295/330 (89%) as the best way to prevent mosquito bites. However, participants also expressed poor knowledge on edges of the river or streams 7(20%), and animal shed 20/330 (6%) as mosquito hiding places, and Plasmodium specie as malaria causative agent 8/330 (2%) (P-value=0.011). Poor scores were recorded on knowledge of opportunistic intestinal coccidian parasites (19.4%) (P=0.427), and was significantly low on unsafe water (47.2%) (P-value=0.036) as possible transmission routes for coccidian parasites. The knowledge score was also low on the at-risk population for malaria and intestinal coccidian infection (31.9%) P-value=0.009. Participants who had poor knowledge about coccidian transmission routes were less likely to drink from protected water source with an odds of 0.713(95% CI: 0.297-1.711) P value=0.449, compared to those who were more knowledgeable and who were 2.981(95% CI: 1.367-6.115) P value=0.005, more likely to use protected source of drinking water. Participants who had hand washing facility in the household were 3.488 (1.760-6.912) value=0.001 times more likely have better knowledge of coccidian transmission routes compared to those who did not have 0.748 (95% CI: 0.406-1.376) P value=0.350. Poor knowledge score of poor hygiene as major cause of coccidian infection significantly associated with poor practice score of sometime or not at all disinfecting animal shed to prevent coccidian infection among study participants (P =0.039). Conclusion: The overall knowledge scores, attitude and practices level of participants towards malaria and opportunistic intestinal coccidian parasites were relatively good. A significant proportion of the participants still have misconceptions about cause, modes of transmission and practices towards malaria and coccidian prevention methods. A combined health education programmes for malaria and intestinal coccidian parasites aimed at raising community awareness needs to be evidence based and requires innovative approaches, to address the gaps identified in the study

Awareness of rabies control and challenges to the intersectoral management of dog bites in Western Cameroon

Abstract Background: Rabies is a zoonotic and a typical One Health challenge. Intersectoral surveillance is a critical component of rabies control programmes. However, the under-reporting of animal bite cases and the lack of coordination between sectors involved in the surveillance may lead to failure in the control efforts of this public health concern. Methods: A cross-sectional study was conducted at the operational level. Two separate survey grids were used for simultaneous data collection in the study sites, including 385 dog bite victims within communities and 273 human health and animal health professionals responsible for rabies surveillance in health and veterinary facilities Results: There was no association (OR: 0,76; CI: 0,452-1,39 and p=0.38) between data loss and professional profile of the surveillance focal points; however, there was a significant association between the under-reporting of physical aggression cases of dog bites by victims and the level of education (OR: 1.75; IC:1.02-2.99 and P=0.0413), and with individuals younger than 20 years and those over 50 years of age (OR:0.39; CI:0.16-0.96 and p=0.0415). Indeed, there was a positively and statistically significant association (OR: 3.11; CI: 1.94-5.00 and p<0.0001) between knowledge of rabies with under-reporting of dog bites by community members; while negatively associated CI: 0.52-1.82 and p=0.9226) with the level of education. Interestingly, there was no significant difference in the under-performance in case reporting whether the surveillance focal points had received prior training on rabies surveillance (OR: 1.14; CI: 0.64-2.01 and p=0.66), had knowledge of operational case definition (OR: 0.93; CI: 0.54- 1.58 and p=0.7851) or /and knew the manifestation of rabies (OR: 0.88; CI: 0.51-1.51and p=0.6408). Conclusion: The under-reporting of rabies bites in the West region of Cameroon is as a consequence of negligence and lack of application of the one health approach on rabies surveillance by the surveillance focal points in District health sectors, leading to the no-exhaustive collection and patchy dissemination of dog bite data

Acid-Fast Bacilli Other than Mycobacteria in Tuberculosis Patients Receiving Directly Observed Therapy Short Course in Cross River State, Nigeria

The information on the contribution of non tuberculous mycobacteria (NTM) to mycobacterial infections in Africa is scarce due to limited laboratory culture for its isolation and identification. One hundred and thirty-seven sputum smear positive patients were recruited into a study on the molecular epidemiology of Mycobacterium tuberculosis in Cross River State. Following sputum culture, 97 pure isolates were obtained and identified using Capilia TB-Neo and further confirmed by the GenoType Mycobacterium CM kit. Of the 97 isolates, 81 (83.5%) isolates were Capilia TB-Neo positive while 16 (16.5%) were Capilia TB-Neo negative. Further confirmation with the GenoType Mycobacterium CM kit revealed that 4 (25%) of the 16 isolates belonged to NTM and included M. fortuitum I, M. fortuitum II/M magaritense, M. abscessus, and M. avium ssp. The remaining 12 (75%) Capilia TB-Neo negative isolates were not members of the genus Mycobacterium despite their AFB appearance. Six (33.3%) of the Capilia TB-Neo negative were from HIV positive tuberculosis patients. All subjects in this study were placed on DOTS shortly after the AFB results were obtained. The implication of isolation of 16.5% nontuberculous isolates further emphasizes the need for culture of sputum specimen especially in HIV positive patients prior to administration of antituberculosis therapy

Personalized information system for the control of tuberculosis in resource-limited settings: A simplistic proposal approach

Passive case finding remains the mainstay of tuberculosis (TB) control in several resource-limited countries. Although TB prevalence and mortality rates have declined in recent years, an estimated 3 million cases a year still go undetected and/or unreported, and delays in the diagnosis and treatment of TB continue to be widespread. It has been shown that identifying and treating individuals with latent TB infection (LTBI) prevents progression to active TB disease and is one of the key components of TB control strategies. However, neither systematic screening of LTBI nor a policy of isoniazid preventive therapy exists in several resource-limited countries for TB close contacts, leading to the vicious cycle of infection/reinfection in household. Moreover, no reliable data exist for TB contacts for efficient control measures to be set up. In recent years, many countries, especially developing countries, have witnessed an upsurge in the use of mobile phones. Should we want to achieve the post-2015TB elimination goal? For this purpose, it is necessary to formulate new strategies utilizing the widespread availability of new communication technologies (e.g., smartphone apps). This can provide an enhanced means to curb the disease, especially in resource-limited countries still lacking preventive measures and effective strategies to combat this old foe

Uric acid levels in patients on antituberculosis drugs in the Southwest region of Cameroon

Objective/background: Antituberculosis drugs (ATDs) efficiently combat Mycobacterium tuberculosis either through direct molecular interactions or its metabolites. However, a variety of adverse effects have been reported, leading to frequent interruptions of treatment. In order to investigate possible metabolic disturbances resulting from antituberculosis treatment, the uric acid level of patients on ATDs was measured in the Southwest region of Cameroon. Methods: This hospital-based cross-sectional study involved 96 tuberculosis patients on ATDs and 32 controls who were neither on ATDs nor any other treatment that could increase uric acid levels. The hospital records of consenting participants were reviewed for medical history and questionnaires were issued. About 2-mL venous blood was collected and analyzed using spectrophotometer to determine uric acid levels. Results: Hyperuricemia was observed in 56/96 (58.3%) of the studied group as compared with four of 32 (12.5%) in the control group (p <0.001). Our results indicated that treatment duration was significantly associated with hyperuricemia (p = 0.0016), while gender (p = 0.1275) was not. Conclusion: Hyperuricemia is associated with ATDs, with treatment duration being a significant factor. The disorder should be closely monitored, especially during the intensive phase of treatment

A public–private partnership to reduce tuberculosis burden in Akwa Ibom State, Nigeria

Background: Tuberculosis (TB) infection and spread are preventable, and TB disease is curable depending on individual and community knowledge of causes of the disease, mode of prevention and cure. An earlier educational intervention carried out in Akwa Ibom State (AKS) of Nigeria in 2006 created awareness of the disease and improved utilization of orthodox medical facilities of residents in 34 communities who had symptoms of TB. Objective: The overall aim of this program is to reduce the burden of TB disease in 18 communities of AKS through educational intervention, TB case detection and integration into the State National Tuberculosis and Leprosy Control Programme (NTBLCP), as well as build laboratory capacity to improve TB case detection and control. Methods: Prior to the educational intervention in each community, standard pretested questionnaires were administered to residents to test their knowledge, attitudes and practices concerning TB. Information about causes, symptoms and prevention of TB was disseminated in community town halls, churches, markets and schools. Individuals who were coughing for three weeks or more were investigated for TB following clinical examination by a physician. Three sputum samples (spot-morning-spot) were obtained from each individual and examined microscopically for the presence of acid-fast bacilli (AFB) using the Ziehl–Neelson staining technique. Those with positive AFB results were integrated into the existing NTBLCP treatment facilities for immediate commencement of Directly-Observed Therapy Short Course (DOTS). Treatment outcome was monitored by retesting patients' sputum after two, five and seven months. Two new laboratories were facilitated while existing laboratory capacity was built by providing higher resolution microscopes, power generating plants, refrigerators, locally-fabricated incinerators and furnishing of staff offices. The program was facilitated by a public–private partnership. Effective Health Care Alliance Research Programme (EHCARP-Nigeria), in collaboration with Nigeria National Petroleum Cooperation and Mobil Producing Nigeria Unlimited (NNPC/MPN) Joint Venture, utilized health personnel from the Akwa Ibom State NTBLCP who conducted laboratory testing and supervised the treatment. Results: The 916 responses to the questionnaires showed that 65.3% (549/841) correctly identified that TB is airborne, and 86% (749/871) were aware that TB could be cured by anti-TB medication. Responses to care-seeking attitudes were provided by 123 respondents. Of this number, fear of stigmatization was the reason for 31% (38) seeking care in unorthodox facilities, while 43.1% (53) did not believe that orthodox medicine could cure their symptoms. Of the 374 detected cases, 9 did not commence treatment. Hence, 365 were placed on DOTS; 36 defaulted, while 11 either died or failed to convert after the seventh month. At the end of month 8, cure was achieved for 87.1% (318). Conclusion: Although the previous intervention may have contributed to the good knowledge about TB and care-seeking attitudes displayed by respondents in the communities, sustaining active case finding through public–private partnership can go a long way to reduce TB burden, especially in rural communities where healthcare systems are generally weak or inadequate. Adequate funding of TB control activities is critical in eliminating TB as a public health problem, and the private sector participation such as this is a welcome development

Utility and diagnostic performance of Mycobacterium tuberculosis complex by two immunochromatographic assays as compared with the molecular Genotype assay in Nigeria

Among the disadvantages of smear microscopy for detection of tuberculosis cases is its inability to differentiate between Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM). This study evaluated two, new immunochromatographic assays – Capilia TB-Neo and SD Bioline – on unheated and heated cultures at 80 °C for 30 min respectively for their ability to discriminate between MTB complex and NTM as compared with the molecular Genotype assay. Mycobacteria used in the study were obtained from smear-positive specimens collected from patients at four major hospitals in Cross River State, Nigeria. Capilia TB-Neo and SD Bioline showed sensitivities of 98.8% and 93.8% respectively and 100% specificity for both assays. Heating the isolates did not significantly impact the test performance. Both tests are recommended for use in rapid differentiation of strains isolated in Nigeria

Uric acid levels in patients on antituberculosis drugs in the southwest Region of Cameroon

Background: Antituberculosis drugs (ATDs) efficiently combat Mycobacterium tuberculosis either through direct molecular interactions or those of its metabolites. However, a variety of adverse effects have been reported, leading to frequent interruptions of treatment. To investigate the possible metabolic disturbances resulting from antituberculosis (TB) treatment, the uric acid (UA) level of patients on ATDs was measured in the southwest region of Cameroon. Methods: This hospital-based cross-sectional study involved 96 TB patients on ATDs and 32 controls who were neither on ATDs nor any other treatment that could increase UA levels. The hospital records of consenting participants were reviewed for medical history and questionnaires were issued. About 2 ml venous blood was collected and analyzed using spectrophotometers to determine UA levels. Results: Hyperuricemia was observed in 56/96 (58.3%) of the studied group as compared with 4/32 (12.5%) in the control group (P < 0.001). Our results indicated that treatment duration was significantly associated with hyperuricemia (P = 0.0016) while gender (P = 0.1275) was not. Conclusion: Hyperuricemia is associated with ATDs, with treatment duration being a significant factor. The disorder should be closely monitored, especially during the intensive phase of treatment

Bacteriologically confirmed extra pulmonary tuberculosis and treatment outcome of patients consulted and treated under program conditions in the littoral region of Cameroon

Abstract Background Extra-pulmonary tuberculosis (EPTB) is defined as any bacteriologically confirmed or clinically diagnosed case of TB involving organs other than the lungs. It is frequently a diagnostic and therapeutic challenge with paucity of data available. The aim of this study was to assess the prevalence of bacteriologically confirmed EPTB; to determine the most affected organs and to evaluate the therapeutic outcome of EPTB patients treated under program conditions in the littoral region of Cameroon. Methods A descriptive cross-sectional laboratory-based epidemiological survey was conducted from January 2016 to December 2017 and 109 specimens from 15 of the 39 diagnosis and treatment centers in the littoral region were obtained. Two diagnostic methods (Gene Xpert MTB and culture (LJ and MGIT) were used for EPTB diagnosis. Determine HIV1/2 and SD Biolinewere used for HIV diagnosis. Confirmed EPTB cases were treated following the national tuberculosis guide. Results The prevalence of bacteriologically confirmed EPTB was 41.3% (45). All 45 cases were sensitive to rifampicin. Males were predominately more infected [26 (57.8%)] likewise the age group 31–45 years with 15 (33.3%) cases. The overall prevalence for HIV was 33.6% (36). HIV infection was present in 28.9% (13) of patients with EPTB. The most affected sites with EPTB were: Lymph nodes (66.5%), pleural cavity (15.6%), abdominal organs (11.1%), neuromeningeal (2.2%), joints (2.2%) and heart (2.2%). Overall, 84.4% of the study participants had a therapeutic success with males responding better 57.9% (p = 0.442). Therapeutic success was better (71.7%) in HIV negative EPTB patients (p = 0.787). Conclusion The prevalence of bacteriologically confirmed EPTB patients treated under program conditions in the littoral region of Cameroon is high with a therapeutic success of 84.4% and the lymph nodes is the most affected site