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 reported. Keywords: Leprosy; Elimination; Leprosy indicator

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

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

A Drive towards the Technological Advancement of Nigeria: Adequate Representation of Female Folk in Stem a Must

STEMs dominated Professions are vital to a nation’s technological advancement as well as her economy. They are the industries that play key roles in maintaining a nation’s competitive edge amongst others in the global world. Nigeria as a Nation has over 170 millionpopulation among this, female gender takes about 50%. This high fraction of the entire population also  represents   half  of  the  intellectual capital in our society as well as half of all those who depend upon the myriad products and services that comprise the global economy offered by these indispensable disciplines. Despite these facts, women and girls are underrepresented in Nigeria where a lot of technological capacity is required for development. This paper presents purpose why more women should be encouraged to study STEM based courses with particular preference to Engineering in Nigeria for the development of the nation

Role of positive deviants among Leprosy self-care groups in Leprosy settlement, Zaria, Nigeria

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Seasonality in TB notification in Nigera: Reality or myth?

Background: Seasonal fluctuations in tuberculosis (TB) notifications have been identified and reported in a number of countries. Nigeria remains one of the 22TB high-burden countries (HBCs) in the world, and the notification of TB cases in the country over the years has shown a definite pattern that suggests seasonal variation. Previous studies conducted in India, Japan, Mongolia, the Netherlands, Russia, Spain, the United Kingdom and the United States have evaluated the seasonality of TB notification. However, in Nigeria, there has been no systematic study to establish that this pattern is not just a myth. This study seeks to establish the seasonal variations suggested by the trend pattern of TB case notification (all forms of TB) in Nigeria over the past ten years. Method: The yearly TB notification data in Nigeria from 2004 to 2013 was examined for seasonal fluctuations by plotting the quarterly notification figures for the years under review. A rapid trend analysis was done based on the amplitude of the fluctuating curves. Standardization was done by zones. Results: The trend analysis showed a spike in the first quarter of the year for the ten-year period studied (with the exception of 2005 and 2011). This quarter is generally characterized by the dusty, dry harmattan wind in most parts of the country, particularly the northern region. The curves generally plummeted in the third quarter and remained in that neighborhood for the rest of the year. The differences in case notification between the first and last quarter for the ten-year period ranged from 347 to 4230 cases notified. The result of this trend analysis when standardized by zones for the six zones of the country was similar to the overall result for the country. Conclusion: According to the results of this study, there is evidence to suggest that there are seasonal variations in notification of TB cases across the four quarters of the year. This has significant implications for TB control strategies. Further investigation of the reasons for seasonal variations may help to identify risk factors. Also, planning and forecast of TB commodities to order cannot be based on experience from the preceding quarters, but must rather be based on reports from the same quarter in the previous year. Allocation of resources may also have to be intensified during the peak periods in order to adequately control the disease at these periods. Footnotes: Further investigation is required to unmask the reasons for the seasonal variations in TB notification in Nigeria

Are patients with pulmonary tuberculosis who are identified through active case finding in the community different than those identified in healthcare facilities?

The lack of healthcare access contributes to large numbers of tuberculosis (TB) cases being missed and has led to renewed interest in outreach approaches to increase detection. It is however unclear whether outreach activities increase case detection or merely identify patients before they attend health facilities. We compared adults with cough of >2 weeks' duration recruited in health facilities (1202 participants) or in urban slums (2828 participants) in Nigeria. Participants provided demographic and clinical information and were screened using smear microscopy. The characteristics of smear-positive and smear-negative individuals were compared stratified by place of enrolment. Two hundred nine health facility participants (17.4%) and 485 community-based participants (16.9%) were smear positive for pulmonary TB. Community-based smear-positive cases were older (mean age, 36.3 vs. 31.8 years), had longer cough duration (10.3 vs. 6.8 weeks) and longer duration of weight loss (4.6 vs. 3.6 weeks) than facility-based cases; and they complained more of fever (87.4% vs. 74.6%), chest pain (89.0% vs. 67.0%) and anorexia (79.5% vs. 55.5%). Community smear-negative participants were older (mean, 39.4 vs. 34.0 years), were more likely to have symptoms and were more likely to have symptoms of longer duration than smear-negative facility-based participants. Patients with pulmonary TB identified in the community had more symptoms and longer duration of illness than facility-based patients, which appeared to be due to factors differentially affecting access to healthcare. Community-based activities targeted at urban slum populations may identify a different TB case population than that accessing stationary services

Mycobacterial Etiology of Pulmonary Tuberculosis and Association with HIV Infection and Multidrug Resistance in Northern Nigeria

Objective. Data on pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) complex in Nigeria are limited. We investigated species of MTB complex in TB cases from northern Nigeria. Methods. New TB suspects were enrolled, screened for HIV and their sputum samples were cultured after routine microscopy. Genotypes MTBC and MTBDRplus were used to characterize the MTB complex species and their resistance to isoniazid and rifampicin. Results. Of the 1,603 patients enrolled, 375 (23%) had MTB complex infection: 354 (94.4%) had Mycobacterium tuberculosis; 20 (5.3%) had Mycobacterium africanum; and one had Mycobacterium bovis (0.3%). Cases were more likely to be male (AOR = 1.87, 95% CI : 1.42–2.46; P≤0.001), young (AOR = 2.03, 95% CI : 1.56–2.65; P≤0.001) and have HIV (AOR = 1.43, 95% CI : 1.06–1.92; P=0.032). In 23 patients (6.1%), the mycobacterium was resistant to at least one drug, and these cases were more likely to have HIV and prior TB treatment (AOR = 3.62, 95% CI : 1.51–8.84; P=0.004; AOR : 4.43; 95% CI : 1.71–11.45 P=0.002 resp.), compared to cases without any resistance. Conclusion. Mycobacterium tuberculosis remained the predominant specie in TB in this setting followed by Mycobacterium africanum while Mycobacterium bovis was rare. The association of TB drug resistance with HIV has implications for TB treatment

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

Demographic and clinical characteristics of hospitalized MDR-TB patients in Nigeria, July 2010-October 2012.

<p>Demographic and clinical characteristics of hospitalized MDR-TB patients in Nigeria, July 2010-October 2012.</p