From DOTS to the Stop TB Strategy: DOTS coverage and trend of tuberculosis notification in Ebonyi, southeastern Nigeria, 1998-2009

Background: Nigeria ranks fourth among the 22 high tuberculosis (TB) burden countries. The estimated incidence of all TB cases in 2009 was 311/100,000 population. Since the implementation of DOTS in Ebonyi state, southeast Nigeria, the epidemiology of TB in the region has not been documented. Therefore, the objective of this study was to assess the type and case notification dynamics of TB following DOTS expansion and to examine age- and sex-specific trends in TB notification rate. Methods: A retrospective trend analysis of case notification data from the Ebonyi State Ministry of Health records from 1998 to 2009 was conducted. Patients were diagnosed according to the National TB and Leprosy Control Programme guidelines. Denominators for TB notifications were derived from population census data. Results: Of the 24, 475 cases notified between 1998 and 2009, 66% were smear-positive, 31% smear-negative and 3% had extra-pulmonary tuberculosis. Overall, the proportion of new smear-positive cases notified decreased continuously from 67% to 48% in 2009 while that of smear-negative cases increased from 29% to 40% in 2009. In 2005, 13 (100%) of the local government areas were covered by DOTS. Despite initial increase in case notification with DOTS expansion, the case notification rate had a mean annual decline of 3.1% for all TB cases (falling from 123/100 000 to 77/100 000), and of 5% for smear-positive patients (falling from 80/100 000 to 32/100 000). Smear-positive notification rate in children <14 years was consistently low while 25-34-year-old persons were affected most. However, smear-positive rates among persons aged =65 years did not change. Overall, annual new smear-positive notification rates were persistently lower in females than males. Conclusion: TB notification rate shows a decreasing trend in our region with a pool of infectious cases in young-persons. Additional targeted, type and age-/sex- specific interventions for TB control are needed.Key words: Tuberculosis, Epidemiology, control, DOTS, case finding, Nigeri

Trend in case detection rate for all tuberculosis cases notified in Ebonyi, Southeastern Nigeria during 1999-2009

Unlike previous annual WHO tuberculosis reports that reported case  detection rate for only smear- positive tuberculosis cases, the 2010 reportpresented case detection rate for all tuberculosis cases notified in line with the current Stop TB strategy. To help us understand how tuberculosis control programmes performed in terms of detecting tuberculosis, there is need to document the trend in case detection rate for all tuberculosis cases notified in high burden countries. This evidence is currently lacking from Nigeria. Therefore, this study aimed to assess the trend in casedetection rate for all tuberculosis cases notified from Ebonyi state  compared to Nigeria national figures. Reports of tuberculosis cases notifiedbetween 1999 and 2009 were reviewed from the Ebonyi State Ministry of Health tuberculosis quarterly reports. Tuberculosis case detection rateswere computed according to WHO guidelines. 22, 508 patients with all  forms of tuberculosis were notified during the study. Case detection rate for all tuberculosis rose from 27% in 1999 to gradually reach a peak of 40% during 2007 to 2008 before a slight decline in 2009 to 38%. However,the national case detection rate for all tuberculosis cases in Nigeria rose from 7% in 1999 and progressively increased to reach a peak of 19% during 2008 and 2009. Since the introduction of DOTS in Ebonyi, the  programme has achieved 40% case detection rate for all tuberculosis cases -about 20% better than national figures. However, with the current low case detection rates, alternative mechanisms are needed to achieve the current global stop- TB targets in Nigeria

Lassa fever – full recovery without ribavarin treatment: a case report

Background: Lassa fever is a rodent-borne zoonosis that clinically manifests as an acute hemorrhagic fever. It is treated using ribavarin. Surviving Lassa fever without receiving the antiviral drug ribavarin is rare. Only few cases have been documented to date.Case Presentation: We report a case of a 59-year old female with fever who was initially thought to have acute pyelonephritis and sepsis syndrome with background malaria. Further changes in her clinical state and laboratory tests led to a suspicion of Lassa fever. However at the time her laboratory confirmatory test for Lassa fever returned, her clinical state had improved and she made full recovery without receiving ribavarin. Her close contacts showed no evidence of Lassa virus infection.Conclusion: This report adds to the literature on the natural history of Lassa fever; and that individuals may survive Lassa fever with conservative management of symptoms of the disease and its complications.Keywords: Lassa fever; viral hemorrhagic fever, survival, ribavari

Prevalence of Medical Disorders in Pregnancy in Ebonyi State University Teaching Hospital

Background: Pregnancy is a physiological state, but when associated with an underlying medical disorder, it has a large impact on the well‑being of a mother. The pattern of medical disorders has been documented to have changed over the years.Aim: This study seeks to retrospectively determine the incidence of medical disorders in pregnancy, and to determine the trend over a 5‑year period in Ebonyi State University Teaching Hospital (EBSUTH).Materials and Methods: This was a retrospective study of all medical cases in pregnancy managed in EBSUTH from 1st of January 2006 to 31st December 2010. Data were analyzed using Epi‑Info statistical package. The results were presented in simple tables. Test statistics was set at 95% confidence interval. Results: A total of 339 medical cases in pregnancy of 2117 admissions were managed during the study period (16.0%). Mean (SD) age of the women was 28.05 (5.36) years and age ranged 15‑45 years for about 314 cases that had the age documented. Of the 339 cases, a total of 149 cases of malaria occurred during the study period (149/339; 44%), out of which only 104 were malaria alone. The rest (45 in number) occurred with urinary tract infection, pregnancy‑induced hypertension, Diabetes mellitus, lobar pneumonia, and anemia in pregnancy. This was followed by hypertensive disorders which account for 29.2% of all cases of medical disorders. Urinary tract infection ranked third (20.7% of all medical disorder). The incidence of malaria was 7% (149/2117), that of hypertensive disorder was 4.7% (99/2117), and of Urinary Tract Infection was 3.1% (65/2117). Others include anemia in pregnancy 0.6% (13/2117), Diabetes mellitus 0.4% (9/2117), and Gastroenteritis 0.4% (9/2117). There is no statistical differencebetween the incidences of medical complications over the study period.Conclusion: There is relatively little change in the incidences of medical complication over the studied period. Malaria played a very important role in the prevalence of medical complications in pregnancy. Preventive strategies may have reduced the prevalence over the years. However, more effort is needed to markedly reduce the medical complications in pregnancy.  Keywords: Disorders, medical complication, pregnancy, prevalence, tren

The Impact of Intervention on Sexual Practices of HIV Positive Individuals in Southeast Nigeria

Objective. To describe the impact of repeating behavioral educational intervention on sexual practices of HIV positive individuals. Method. A prospective cohort study of HIV positive individual was conducted in southeast Nigeria from June 2007 to May 2008. Information on sexual practices was collected at initial visit; education was given and its impact was evaluated afterwards. Results. Knowledge about risk of unprotected intercourse increased by 41%, condom use by 27% (P < .001) and consistent condom use by 55% (P < .001). The significant predictors of consistent condom use include male gender, multiple sexual partner, as well as good knowledge of HIV transmission, higher educational status and being married. Non use of condom at postintervention survey were characterized by female gender (n = 4), monogamous relationship (n = 10), little or no education (n = 10), and unmarried (n = 7) respondents. Conclusion. Repeated behavioral education intervention improves consistent condom use among HIV positive individuals and will help curb the spread of HIV/AIDS

Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges

Sub-Saharan Africa (SSA), occupying about 80% of the African continent is a heterogeneous region with estimated population of 1.1 billion people in 47 countries. Most belong to the low resource countries (LRCs). The high prevalence of end-organ diseases of kidney, liver, lung and heart makes provision of organ donation and transplantation necessary. Although kidney and heart transplantations were performed in South Africa in the 1960s, transplant activity in SSA lags behind the developed world. Peculiar challenges militating against successful development of transplant programmes include high cost of treatment, low GDP of most countries, inadequate infrastructural and institutional support, absence of subsidy, poor knowledge of the disease condition, poor accessibility to health-care facilities, religious and trado-cultural practices. Many people in the region patronize alternative healthcare as first choice. Opportunities that if harnessed may alter the unfavorable landscape are: implementation of the 2007 WHO Regional Consultation recommendations for establishment of national legal framework and self-sufficient organ donation/transplantation in each country and adoption of their 2020 proposed actions for organ/transplantation for member states, national registries with sharing of data with GODT, prevention of transplant commercialization and tourism. Additionally, adapting some aspects of proven successful models in LRCs will improve transplantation programmes in SSA

Short Communication: Health Seeking Behaviour Of Medical Undergraduates in a Nigerian University

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Tuberculosis treatment default in a large tertiary care hospital in urban Nigeria: Prevalence, trend, timing and predictors

SummaryObjectivesFew studies have investigated tuberculosis treatment default in tertiary care settings. We aimed to determine the prevalence, trend, timing and predictors of defaulting from tuberculosis treatment in a Nigerian tertiary hospital.MethodsData entered from 2006 to 2010 in the Federal Medical Centre, Abakaliki, tuberculosis treatment register were sorted into six treatment outcomes. Five outcomes were combined into one variable called ‘non-defaulters’ and were compared with “defaulters”. The statistical analysis was conducted using SPSS.ResultsOf 671 tuberculosis patients, 192 (28.6%) defaulted. Of these, 126 (66%) were ≥30 years old, and 115 (60%) had pulmonary tuberculosis. Furthermore, 106 (55%) were males, and 125 (65%) lived in a rural area. The annual proportion of defaulters dropped from 34.8% to 20.6%, but the decreasing trend was not statistically significant (P=0.132 for trend). Of the defaulters, 148 (77.1%) defaulted during their intensive phase of treatment. The median default time was 7 (IQR 5–8) weeks. The independent predictors of treatment default were older age (aOR 1.5), rural residence (aOR 2.3), and HIV seropositivity (aOR, 2.8).ConclusionTB treatment default is high and must be reduced. This may be achieved through improved rural DOT, further patient education, and enhanced coordination of TB/HIV care

Telemedicine and biomedical care in Africa: Prospects and challenges

The use of information and communication technology for health care delivery, particularly in poor settings where access to medical services is inadequate, holds promise in expanding health care access. In rural or impoverished environment, where disease is prevalent, doctors are scarce, and health care infrastructure is inadequate, telemedicine holds a good prospect in improving the health conditions of the people. However, telemedical practice in Africa cannot be without challenges because some aspects are often difficult to implement in underdeveloped settings where ignorance and poverty are rife. Apart from nonavailability of facilities and poor communication, most Africans have different understanding of ailments, which often affect the health system. Considering the increasing disease burden in Africa and the need for tremendous progress in achieving the health component of the millennium development goals, telemedicine should be of concern to health policy makers. This paper critically examines the prospects and challenges of telemedical practice in Africa through a systematic review of 31 relevant publications which, in addition to the authors’ knowledge and experience in biomedical care in Africa, supported the information as presented.Keywords: Africa, challenges, medical care, prospects, telemedicin