Assessment of Tuberculosis Underreporting by Level of Reporting System in Lagos, Nigeria

Abstract Tuberculosis (TB) is the leading cause of death from a single infectious disease. Unfortunately, 4.1 million cases were missed in 2017 globally, and Nigeria contributes 9% of the missing TB cases. At least 73% of the estimated TB cases in Nigeria were not reported in 2017 to the National TB Program (NTP); therefore, the true burden of TB was not certain, and this affected planning for prevention and control of TB. This quantitative secondary data analysis (NTP Lagos TB Inventory study database) guided by the integrated behavioral model assessed TB underreporting based on the TB reporting process in Nigeria. Chi-square and binomial logistic regression were used to assess the association between TB underreporting and the characteristics of health facilities (HFs), health workers\u27 (HWs) awareness, barriers to TB reporting, and patient-related factors. The results indicate at least 60% of all HFs underreported TB, with an average of 7.4% underreporting between HFs records and TB program reports. There was a statistically significant association between NTP nonengaged health facilities (Ï2 (1) = 20.547, p \u3c.05), HWs\u27 awareness of TB reporting (Ï2 (1) = 6.576, p \u3c.05), and barriers for TB reporting (Ï2 (1) = 4.106, p \u3c .05) with TB underreporting. The following patient factors were statistically significant predictors of TB underreporting with over 50% increased odds, p\u3c0.05: previously treated, extrapulmonary, unknown TB site, HIV negative, and HIV unknown. This study supports social change through NTPs ensuring the establishment of a coordinating mechanism for TB reporting within and between HFs and supply of TB reporting tools to all HFs to know the true burden of TB for better planning and monitoring of quality care for TB patients

LEPROSY ELIMINATION: PROGRESS AND CHALLENGES IN NIGERIA; KADUNA STATE TB AND LEPROSY CONTROL PROGRAMME AS A CASE STUDY

The study aims at describing the achievements and challenges of Leprosy control in Kaduna State using appropriate indicators. The study was a five year (2004-2008) retrospective review of the Leprosy records and annual reports of all the twenty three LGAs in Kaduna State. Various Leprosy indicators were calculated and presented in different graphic presentations. Focus group discussions were organised with the aim of identifying current challenges of Leprosy control in the State. There was a decline in the new Leprosy cases detected annually from 226 cases in 2004 to 140 cases in 2008. The prevalence rate ranged between 0.3-0.4 per 10,000 population within the five year period. The proportion of children among new cases dropped from 12% in 2004 to 5% in 2007 and increased to 9% in 2008. Grade 2 disability among new cases was very high (between 21%-27%) within the same period. Leprosy elimination target has been achieved in Kaduna State, but new cases with high proportion of children and WHO grade 2 disability were still been reporte

Clients’ Perception of Quality of Multidrug-Resistant Tuberculosis Treatment and Care in Resource-Limited Setting: Experience from Nigeria

Background: Quality care is essential to the well-being and survival of people with multidrug-resistant tuberculosis (MDR-TB). The aim of this study is to explore how MDR- TB patients, who were voluntarily hospitalized, perceived care and treatment strategy and to assess the influence of psychosocial factors on their perception of care and treatment strategy in Nigeria. Methods: The study enrolled 98 MDR-TB patients on voluntary confinement in four MDR-TB hospitals in Nigeria. Patients’ perceptions of quality of care and treatment strategy were evaluated with 28-item and 6-item instruments, respectively. Bivariate analysis was used to test for an association and multivariate analysis for factors that might contribute to the perceived quality of care. Results: Seventy-eight per cent (78%) of the participating patients perceived the quality of care to be good. Patients with better psychosocial well-being had five times higher odds to report good quality of care. Conclusion: The majority of MDR-TB patients perceived the quality of inpatient care to be good in Nigerian hospitals; however, their psychological health influenced their perception significantly. Health care providers need to improve treatment strategies to encourage acceptance of care as poor perception to health care service delivery may deter treatment completion and also cause relapse among clients on treatment

Factors Associated with Treatment Success among Pulmonary Tuberculosis and HIV Co-infected Patients in Oyo State, South West-Nigeria

Background The co-existence of Tuberculosis (TB) and Human immunodeficiency Virus (HIV) is  known to increase morbidity and mortality in patients. The determinants of treatment success in TBHIV co-infection are not yet well studied. Such information can help optimise treatment and reduce morbidity and mortality.Objective To determine factors associated with antitubercular treatment success among TB I HIV coinfected patients.Methods A cross sectional study was carried out in fifty  three DOT clinics and treatment centres  using tuberculosis patient's records from January 2009 to December 2010 in Oyo state, Nigeria. The study population consisted of 7905 tuberculosis patients. Information on variables of interest were obtained with the use of data extraction forms. Chi-square and logistic regression were used to test the relationship between TB I HIV coinfection and socio-demographic variables, clinical characteristics and treatment success.Results Prevalence ofTB I HIV co-infection was found to be 14.2%. Patients with TB-HIV co-infection  were younger and more likely to be females. There were statistically significant association between treatment success and gender, marital status and patient point of care. After adjusting for other variables, it was found that patients receiving treatment in private facilities were independently less likely to be successfully treated compared with those receiving care in Public facilities. Female patients were also independently more likely to have better treatment outcome than male.Conclusion In addition to patients' point of care, gender of the patients can adversely impact on their treatment success. Efforts from the government to strengthening the private public mix, health education and media awareness on adherence to treatment to improve treatment success should be intensified in the country.Keywords: Tube rc ulosis; Human immunodeficiency virus, Directly observe therapy short-course;  Treatment success, Coinfection

The use of plants in the traditional management of diabetes in Nigeria: Pharmacological and toxicological considerations

Ethnopharmacological relevance: The prevalence of diabetes is on a steady increase worldwide and it is now identified as one of the main threats to human health in the 21st century. In Nigeria, the use of herbal medicine alone or alongside prescription drugs for its management is quite common. We hereby carry out a review of medicinal plants traditionally used for diabetes management in Nigeria. Based on the available evidence on the species׳ pharmacology and safety, we highlight ways in which their therapeutic potential can be properly harnessed for possible integration into the country׳s healthcare system. Materials and methods: Ethnobotanical information was obtained from a literature search of electronic databases such as Google Scholar, Pubmed and Scopus up to 2013 for publications on medicinal plants used in diabetes management, in which the place of use and/or sample collection was identified as Nigeria. ‘Diabetes’ and ‘Nigeria’ were used as keywords for the primary searches; and then ‘Plant name – accepted or synonyms’, ‘Constituents’, ‘Drug interaction’ and/or ‘Toxicity’ for the secondary searches. Results: The hypoglycemic effect of over a hundred out of the 115 plants reviewed in this paper is backed by preclinical experimental evidence, either in vivo or in vitro. One-third of the plants have been studied for their mechanism of action, while isolation of the bioactive constituent(s) has been accomplished for twenty three plants. Some plants showed specific organ toxicity, mostly nephrotoxic or hepatotoxic, with direct effects on the levels of some liver function enzymes. Twenty eight plants have been identified as in vitro modulators of P-glycoprotein and/or one or more of the cytochrome P450 enzymes, while eleven plants altered the levels of phase 2 metabolic enzymes, chiefly glutathione, with the potential to alter the pharmacokinetics of co-administered drugs. Conclusion: This review, therefore, provides a useful resource to enable a thorough assessment of the profile of plants used in diabetes management so as to ensure a more rational use. By anticipating potential toxicities or possible herb–drug interactions, significant risks which would otherwise represent a burden on the country׳s healthcare system can be avoided

A Fifth-Order Five-Stage Trigonometrically-Fitted Improved Runge-Kutta Method for Oscillatory Initial Value Problems

Authors: Aliyu Umar Mustapha, Abdulrahman Ndanusa, and Ismail Gidado Ibrahim Received: 10 April 2021/Accepted 08 July 2021 A fifth-order five-stage trigonometrically-fitted Improved Runge-Kutta (TFIRK5-5) method for solving first-order initial value problems (IVPs) has been derived and analyzed in this work. The method is shown to integrate exactly the initial value problem whose solution is a linear combination of the set functions and trigonometrically fitted. For exponentially fitted, where, being the main frequency of the problem, is used to increase the accuracy of the method. The numerical results revealed the effectiveness of the new method in comparison with other existing methods in the literatur

Childhood Tuberculosis in Nigeria: Disease Presentation and Treatment Outcomes

Objectives: Understanding the factors that influence tuberculosis (TB) treatment outcomes in children is key to designing interventions to address them. This study aimed to determine the case category distribution of childhood TB in Nigeria and assess which clinical and demographic factors are associated with different treatment outcomes in childhood TB. Materials and methods: This was a retrospective cohort study involving a review of medical records of children (0-14 years) with TB in 3 states in Nigeria in 2015. Results: Of 724 childhood TB cases registered during the review period, 220 (30.4%) were aged 0–4 years. A high proportion of patients had pulmonary TB 420/724 (58.0%), new TB infection 713/724 (98.5%), and human immunodeficiency virus (HIV) coinfection 108/724 (14.7%). About 28% (n = 201) were bacteriologically diagnosed. The proportion of TB treatment success was 601/724 (83.0%). Treatment success was significantly higher in children aged 5–14 years than those 0–4 years (85.3% vs 77.7%, P  = .01). Factors associated with unsuccessful outcomes in patients aged 0–4 years are male sex (adjusted odds ratio [aOR]: 1.2), HIV-positive status (aOR: 1.2), and clinical method of diagnosis (aOR: 5.6). Conclusions: Efforts should be made to improve TB treatment outcomes in children by ensuring early and accurate diagnosis, focused training of health workers on childhood TB-HIV care, and effective adherence counseling of caregivers

Determinants of mortality among patients with drug-resistant tuberculosis in northern Nigeria.

BACKGROUND:Drug-Resistant tuberculosis (DR-TB) is estimated to cause about 10% of all TB related deaths. There is dearth of data on determinants of DR-TB mortality in Nigeria. Death among DR-TB treated cohorts in Nigeria from 2010 to 2013 was 30%, 29%, 15% and 13% respectively. Our objective was to identify factors affecting survival among DR-TB patients in northern Nigeria. METHODS:Demographic and clinical data of all DR-TB patients enrolled in Kano, Katsina and Bauchi states of Nigeria between 1st February 2015 and 30th November 2016 was used. Survival analysis was done using Kaplan-Meier and multiple regression with Cox proportional hazard modeling. RESULTS:Mean time to death during treatment is 19.2 weeks and 3.9 weeks among those awaiting treatment. Death was recorded among 38 of the 147 DR-TB patients assessed. HIV co-infection significantly increased probability of mortality, with an adjusted hazard ratio (aHR) of 2.35, 95% CI: 1.05-5.29, p = 0.038. Treatment delay showed significant negative association with survival (p = 0.000), not starting treatment significantly reduced probability of survival with an aHR of 7.98, 95% CI: 2.83-22.51, p = 0.000. Adjusted hazard ratios for patients started on treatment more than eight weeks after detection or within two to four weeks after detection, was beneficial though not statistically significant with respective p-values of 0.056 and 0.092. The model of care (facility vs. community-based) did not significantly influence survival. CONCLUSION:Both HIV co-infected DR-TB patients and DR-TB patients that fail to start treatment immediately after diagnosis are at significant risk of mortality. Our study showed no significant difference in mortality based on models of care. The study highlights the need to address programmatic and operational issues pertaining to treatment delays and strengthening DR-TB/HIV co-management as key strategies to reduce mortality

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

Nutrigenomic Effects of White Rice and Brown Rice on the Pathogenesis of Metabolic Disorders in a Fruit Fly Model

Consumption of white rice (WR) has been shown to predispose individuals to metabolic disorders. However, brown rice (BR), which is relatively richer in bioactive compounds, possesses anti-glycaemic and antioxidant effects. In this study, fifteen cultivars of paddy rice that are predominantly consumed in North West Nigeria were analysed for their nutritional composition, bioactive contents and effects on metabolic outcomes in a fruit fly model. Gene expression analyses were conducted on the whole fly, targeting dPEPCK, dIRS, and dACC. The protein, carbohydrate, and fibre contents and bioactives of all BR cultivars were significantly different (p p p dACC and dPEPCK was upregulated, while that of dIRS was downregulated in the WR groups compared to the BR groups. Sex differences (p < 0.05) were observed in the WR groups in relation to the nutrigenomic effects. Our findings confirm metabolic perturbations in fruit flies following consumption of WR via distortion of insulin signalling and activation of glycogenolysis and gluconeogenesis. BR prevented these metabolic changes possibly due to its richer nutritional composition