Tuberculosis Case Management and Treatment Outcome: Assessment of the Effectiveness of Public \u2013 Private Mix of Tuberculosis Programme in Kaduna State, Nigeria

Background: In an effort to increase tuberculosis (TB) case detection, the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results: Except for the lower use of sputum microscopy for diagnosis, adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients, an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities, 13.1% and 12.2% respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7%) compared to 78.6% in the public health facilities. Conclusion: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated.Fond: Dans un effort d'augmenter la d\ue9tection de cas de la tuberculose (TB), le programme de l'\ue9tat TB de Kaduna au Nig\ue9ria a commenc\ue9 le m\ue9lange Public-Priv\ue9 (POINTS de page par minute) en 2002. Cette \ue9tude \ue9valu\ue9 et compar\ue9 les proc\ue9dures de gestion de cas de TB et les r\ue9sultats de traitement du public et des \ue9quipements priv\ue9s de sant\ue9 impliqu\ue9s dans le programme de TB. M\ue9thodes: A l'\ue9tude descriptive en coupe comparative a \ue9t\ue9 effectu\ue9e dans 5 \ue9quipements de sant\ue9 priv\ue9e et 10 publique fournissant des services de TB pendant au moins deux ann\ue9es dans les quatre r\ue9gions de gouvernements locaux dans l'\ue9tat de Kaduna o\uf9 des \ue9quipements publics et priv\ue9s de sant\ue9 sont impliqu\ue9s dans le programme de TB. Les t\ueates des \ue9quipements de sant\ue9 ont \ue9t\ue9 interview\ue9es et des notes de cas de tous 492 patients de TB enregistr\ue9s dans ces \ue9quipements entre les janvier 2003 et d\ue9cembre 2004 pass\ue9s en revue. R\ue9sultats: Ele xcept pour l'usage inf\ue9rieur de la microscopie de crachat pour le diagnostic, adh\ue9rence aux directives nationales de traitement de TB \ue9tait haut dans des \ue9quipements de sant\ue9 priv\ue9e et publique. Les \ue9quipements priv\ue9s de sant\ue9 ont vu de mani\ue8re significative plus de patients de TB, une moyenne de 51 patients par service de sant\ue9 compar\ue9 \ue0 23 patients dans les \ue9quipements de sant\ue9 publique. Il y avait d'un meilleur accomplissement des disques dans les \ue9quipements de sant\ue9 publique tandis que le criblage patient de contact \ue9tait tr\ue8s bas dans les \ue9quipements publics et priv\ue9s de sant\ue9, 13.1% et 12.2% respectivement. Le taux de succ\ue8s de traitement \ue9tait plus haut parmi des patients contr\uf4l\ue9s dans les \ue9quipements priv\ue9s de sant\ue9 (83.7%) compar\ue9s \ue0 78.6% dans les \ue9quipements de sant\ue9 publique. Conclusion: \uc9quipements priv\ue9s de sant\ue9 adh\ue9rez aux directives nationales a eu une charge de cas patiente plus \ue9lev\ue9e de TB et am\ue9liorez les r\ue9sultats de traitement que des \ue9quipements de sant\ue9 publique dans l'\ue9tat de Kaduna. PPM-DOTS devrait \ueatre mesur\ue9-vers le haut et consolid\ue9

Impact of Health Education on Home Treatment and Prevention of Malaria in Jengre, North Central Nigeria

Background: Malaria accounts for 1 million deaths among children under five annually. It has been shown that improving home treatment and preventing delays in seeking treatment, by teaching women to respond promptly when their children have fever, can decrease malaria related complications and mortality. This study looks at the impact of health education on knowledge of malaria: its recognition, treatment and prevention among caregivers of children under five in Jengre, North Central Nigeria. Methods: The study was a community based intervention study conducted in three stages: A pre- intervention stage, where 150 caregivers, were selected through a multistage sampling technique from the households containing children under five. Information for the baseline was collected through an interviewer administered semi-structured questionnaire. The intervention consisted of a series of health education sessions designed based on findings from the pre-intervention stage. The post-intervention impact assessment was conducted using a modified version of the questionnaire used in the pre intervention stage. Results: Malaria was recognized as one of the diseases that cause fever in community by all the respondents. Sixty-one (40.6%) had adequate knowledge concerning malaria causation, transmission, prevention and treatment. Twenty eight (56%) of respondents reported Self-treatment. There was a statistically significant relationship between years of formal education and first line treatment option (P=.012). Thirty-four (68%) mothers acted within eight hours of onset of fever. The intervention had an effect on perception (P<.001), knowledge (P<.001), malaria prevention practice (P=.001), first line treatment option (P=.031) and the type of treatment given to the children with fever (P=.048). Conclusion: Health education impacted positively caregivers\u2019 knowledge of malaria and their willingness to access antimalarial treatment when their children have fever. Malaria information should be made available to caregivers visiting child welfare clinics. Caregivers should also be integrated into malaria control activities at community level.Contexte: Le paludisme occasionne chaque ann\ue9e 1 million de d\ue9c\ue8s chez les enfants de moins de 5 ans. Il a \ue9t\ue9 d\ue9montr\ue9 que l\u2019am\ue9lioration du traitement \ue0 domicile et le fait d\u2019\ue9viter le retard de prise en charge, par des enseignantes afin de r\ue9agir avec promptitude lorsque leurs enfants ont la fi\ue8vre, peut r\ue9duire les complications et la mortalit\ue9 li\ue9es au paludisme. Cette \ue9tude s\u2019est int\ue9ress\ue9e \ue0 l\u2019impact de l\u2019\ue9ducation \ue0 la sante, sur la connaissance du paludisme, son identification, son traitement et sa pr\ue9vention parmi les donneurs de soins aux enfants de moins de 5 ans \ue0 Jenre dans la r\ue9gion du Centre-Nord du Nigeria. Methode: Il s\u2019agissait d\u2019une \ue9tude d\u2019intervention communautaire men\ue9e en trois \ue9tapes. Au cours de l\u2019\ue9tape pr\ue9c\ue9dant l\u2019intervention, 150 donneurs de soins ont \ue9t\ue9 s\ue9lectionn\ue9s par une m\ue9thode d\u2019\ue9chantillonnage concernant les foyers ayant des enfants de moins de 5 ans. Les informations de base ont \ue9t\ue9 recueillies par un enqu\ueateur \ue0 l\u2019aide d\u2019un questionnaire semi-structure. L\u2019intervention quant a elle a consiste en une s\ue9rie de sessions d\u2019\ue9ducation sanitaire bas\ue9es sur les donn\ue9es de l\u2019\ue9tape pr\ue9c\ue9dant l\u2019intervention. L\u2019\ue9valuation de l\u2019impact post intervention a \ue9t\ue9 effectu\ue9e par l\u2019usage d\u2019une version modifi\ue9e du questionnaire utilise en pr\ue9 intervention. R\ue9sultats: Le paludisme a \ue9t\ue9 identifi\ue9 comme figurant parmi les maladies responsables de fi\ue8vre dans la communaut\ue9 par tous les participants. 61 (40,6%) avaient une bonne connaissance des causes du paludisme, sa transmission, sa pr\ue9vention et son traitement. 26 (56%) des participants ont rapportes une auto m\ue9dication. Un lien statistiquement significatif a \ue9t\ue9 retrouve entre le nombre d\u2019ann\ue9es de scolarisation et le traitement de premi\ue8re intention (p=0,012). 34 (68%) des m\ue8res nt r\ue9agies dans les 8 heures suivant l\u2019acc\ue8s f\ue9brile. L\u2019intervention a eu un effet sur la perception (p<0,001), la connaissance (p<0,001), la pratique de la pr\ue9vention du paludisme (p=0,001), le choix du traitement de premi\ue8re intention (p=0,031) et le type de traitement administr\ue9 pour fi\ue8vre chez l\u2019enfant (p=0,048). Conclusion: L\u2019\ue9ducation sanitaire a eu un impact favorable chez les donneurs de soins sur la connaissance du paludisme et la volont\ue9 d\u2019acc\ue8s au traitement antipaludique chez leurs enfants f\ue9briles. Les informations sur le paludisme devraient \ueatre disponibles chez les donneurs de soins consultant dans les centres de soins sociaux. Les donneurs de soins devraient \ue9galement \ueatre int\ue9gr\ue9s aux activit\ue9s de contr\uf4le du paludisme au niveau communautaire

Comparative Study of Patients' Adherence between Hospital-based and Communitybased Treatment for Multidrug Resistant Tuberculosis (MDR-TB) in Kaduna State,

Background: Multidrug-Resistant Tuberculosis (MDR-TB) epidemic is threatening the global control of TB. It is driven by the programme, health system  and patient related factors. This study aimed at comparing the level of adherence to treatment among MDR-TB patients treated in hospital-based and  community-based models of care. Methods: This was a comparative cross-sectional survey conducted in 2019 with mixed methods of data collection. The study population were 360 MDR-  TB patients treated in hospital-based and community-based facilities in Kaduna between 2013 and 2018. Questionnaire, FGD and KII guides respectively  were the quantitative and qualitative data collection tools used. Statistical Package for Social Sciences (SPSS) version 25.0 was used to analyze the  quantitative data while thematic analysis was used for analysing qualitative data. The quantitative results were presented in descriptive statistics with  level of significance set at p<0.05 and the qualitative results were presented as prose. Results: The majority were males in the community-based 135 (71.8%) and the hospital-based model 126 (73.3%), with median (IQR) ages of 33 (27-40)  years and 34 (27-43) years respectively. Adherence to treatment was significantly higher among patients in hospital-based (64%) compared to  community-based (36%), (p 0.001). Availability of family and community support encourages adherence while lack of food supplies, dissatisfaction with  services and drug side effects were factors against adherence to treatment. Treatment success rate was similar in both models. Conclusion: Adherence was better among patients initiated on treatment in the hospital-based model. Adherence should be strengthened in the  community-based model by regular counselling and health education

Tuberculosis Case Management and Treatment Outcome: Assessment of the Effectiveness of Public – Private Mix of Tuberculosis Programme in Kaduna State, Nigeria

Background: In an effort to increase tuberculosis (TB) case detection, the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results: Except for the lower use of sputum microscopy for diagnosis, adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients, an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities, 13.1% and 12.2% respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7%) compared to 78.6% in the public health facilities. Conclusion: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated.Fond: Dans un effort d'augmenter la détection de cas de la tuberculose (TB), le programme de l'état TB de Kaduna au Nigéria a commencé le mélange Public-Privé (POINTS de page par minute) en 2002. Cette étude évalué et comparé les procédures de gestion de cas de TB et les résultats de traitement du public et des équipements privés de santé impliqués dans le programme de TB. Méthodes: A l'étude descriptive en coupe comparative a été effectuée dans 5 équipements de santé privée et 10 publique fournissant des services de TB pendant au moins deux années dans les quatre régions de gouvernements locaux dans l'état de Kaduna où des équipements publics et privés de santé sont impliqués dans le programme de TB. Les têtes des équipements de santé ont été interviewées et des notes de cas de tous 492 patients de TB enregistrés dans ces équipements entre les janvier 2003 et décembre 2004 passés en revue. Résultats: Ele xcept pour l'usage inférieur de la microscopie de crachat pour le diagnostic, adhérence aux directives nationales de traitement de TB était haut dans des équipements de santé privée et publique. Les équipements privés de santé ont vu de manière significative plus de patients de TB, une moyenne de 51 patients par service de santé comparé à 23 patients dans les équipements de santé publique. Il y avait d'un meilleur accomplissement des disques dans les équipements de santé publique tandis que le criblage patient de contact était très bas dans les équipements publics et privés de santé, 13.1% et 12.2% respectivement. Le taux de succès de traitement était plus haut parmi des patients contrôlés dans les équipements privés de santé (83.7%) comparés à 78.6% dans les équipements de santé publique. Conclusion: Équipements privés de santé adhérez aux directives nationales a eu une charge de cas patiente plus élevée de TB et améliorez les résultats de traitement que des équipements de santé publique dans l'état de Kaduna. PPM-DOTS devrait être mesuré-vers le haut et consolidé

Integrated nutritional intervention among mothers of under-five children in rural communities of a developing country: its effects on maternal practice of complementary feeding and child's nutritional status

Introduction: Complementary feeding is a feeding process that begins immediately after exclusive breast feeding ends at 6 months (from 6-24 months) and it prevents childhood malnutrition. Malnutrition is widespread in most developing countries and accounts for 11% of global disease burden.Methods: The study employs a quasi-experimental design, with baseline, intervention, and postintervention phases. Both experimental and control sites were rural communities. Intervention was conducted among 167 mothers/child pair independently selected from the study areas through a multi-stage sampling technique. Data was collected using interviewer-administered questionnaire at baseline and six months after intervention from both communities. Weights and heights/length of recruited children was measured. Data was analysed using SPSS statistics software.Results: The result indicated that malnutrition exists among under-five children in the study area: 65.5% were stunted, 32.3% were underweight and 8.4% were wasted. Post intervention, mothers of under-five children from the study community had higher frequency of giving complementary foods to breastfed children (p =<0.02). However, there was no statistically significant improvement in the malnutritional status of the children post-intervention (P>0.24 in all cases).Conclusion: Childhood malnutrition in our rural communities can be prevented through integrated nutritional interventions. However, the duration and follow up period of the intervention do have an effect on children's nutritional status. There is need for the Kaduna State Ministry of Health to put in place, prolonged (more than 4 weeks) integrated nutritional interventions that stresses correct complementary feeding practices; to be followed up for more than 6 months, preferably 18 months.Keywords: Nutritional intervention, complementary feeding, Under-fives, mother