High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study.

BACKGROUND: Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment onset using data from a large treatment centre in Nigeria. METHODS: We analysed a retrospective cohort of TB patients that commenced treatment between January 2010 and December 2014 in Aminu Kano Teaching Hospital. We estimated mortality rates per person-months at risk (pm). Cox proportional hazards model was used to determine risk factors for mortality. RESULTS: Among 1,424 patients with a median age of 36.6 years, 237 patients (16.6%) died after commencing TB treatment giving a mortality rate of 3.68 per 100 pm of treatment in this cohort. Most deaths occurred soon after treatment onset with a mortality rate of 37.6 per 100 pm in the 1st week of treatment. Risk factors for death were being HIV-positive but not on anti-retroviral treatment (ART) (aHR 1.39(1 · 04-1 · 85)), residence outside the city (aHR 3 · 18(2.28-4.45)), previous TB treatment (aHR 3.48(2.54-4.77)), no microbiological confirmation (aHR 4.96(2.69-9.17)), having both pulmonary and extra-pulmonary TB (aHR 1.45(1.03-2.02), and referral from a non-programme linked clinic/centre (aHR 3.02(2.01-4.53)). CONCLUSIONS: We attribute early deaths in this relatively young cohort to delay in diagnosis and treatment of TB, inadequate treatment of drug-resistant TB, and poor ART access. Considerable expansion and improvement in quality of diagnosis and treatment services for TB and HIV are needed to achieve the sustainable development goal of reducing TB deaths by 95% by 2035

Should They Also Have Babies? Community Attitudes Toward Sexual and Reproductive Rights of People Living With HIV/AIDS in Nigeria

Background: People living with HIV have the right to healthy, satisfying sex lives and to appropriate services to ensure their sexual and reproductive health, including having healthy children. The reproductive rights of people living with HIV/AIDS are, however, often met with skepticism and discrimination, despite recent advances in HIV treatment. Objective: To assess the attitudes of community members in Kano, Nigeria, toward the right of persons living with HIV/AIDS to have healthy sexual relationships and bear children. Methods: A cross-section of 399 adults was interviewed using pretested structured questionnaires. Logistic regression analysis was used to obtain adjusted estimates for predictors of agreement with the rights of persons with HIV/AIDS to bear children. Findings: A substantial proportion of respondents (28.6%) strongly agreed and agreed (10.5%) that persons with HIV/AIDS should not be allowed to marry. More than a fifth of the respondents disagreed (16.0%) and strongly disagreed (8.0%) with the rights of HIV-infected persons to bear children. Agreement with the statement “HIV-infected persons should have biological children” was independently associated with higher educational status (adjusted odds ratio: 2.26, 95% confidence interval: 1.82-6.73) and awareness of prevention of mother-to-child HIV transmission effectiveness (adjusted odds ratio: 2.53, 95% confidence interval: 1.92-5.37). Of those who agreed that HIV-infected persons should have children (n = 253), 17.8% and 26.1% strongly agreed and agreed, respectively, that persons living with HIV/AIDS should be restricted to having fewer children. Further, 11.5% and 4.8% of respondents disagreed and strongly disagreed, respectively, that infertile HIV-infected couples should receive fertility treatment. Conclusions: People living with HIV/AIDS face discriminatory attitudes to their reproductive rights in northern Nigeria. There is a need for effective, culturally appropriate information, education, and communication approaches to improving community perceptions of sexual and reproductive rights of people living with HIV/AIDS

Predictors of Safer Conception Practices Among HIV-Infected Women in Northern Nigeria

Background: Persons living with HIV often face discrimination in safe sex and reproductive choices, especially in low-resource settings. This study assessed fertility desires and intentions, risk perception and correlates of ever use of at least one safer conception method among HIV-infected women attending a tertiary health facility in Kano, Nigeria.Methods: Structured questionnaires were administered to a cross section of 328 of 427 eligible HIV-infected women. Fertility desires and intentions, risk perception and safer conception practice were analyzed. Logistic regression was employed to assess for predictors. Results: Of the 328 respondents, 150 respondents (45.7%) wanted more children. The proportions of respondents aware of their transmission risk during pregnancy, delivery, and breastfeeding were 69.5%, 75.3%, and 78.9%, respectively. Further, 68.9% of respondents were aware of the prospects of bearing HIV-negative children without infecting their partners. About 64.8% of women were aware of at least one safer conception method. Safer conception methods ever-used by the participants include: antiretroviral therapy (ART) (36.7%), timed unprotected intercourse with (10.9%), and without pre-exposure prophylaxis (PrEP) (17.2%), intravaginal insemination (7.3%) and intrauterine insemination (4.7%). Safer conception practice was predicted by marital status (married versus single, adjusted odds ratio [AOR] = 1.50, 95% CI = 1.10-3.55), parity (2-4 versus 0, AOR = 12.1, 95% CI = 3.7-39.8), occupation (civil servants versus traders, AOR = 0.37, 95% CI = 0.16-0.86), husband’s serostatus (seroconcordant versus serodiscordant) (AOR = 1.51, 95% CI = 1.13-4.64), couple contraceptive use (users versus non-users) (AOR = 1.62, 95% CI = 1.16-5.83) and transmission risk perception (high risk versus low/no risk) (AOR = 2.14, 95% CI = 1.18-3.90).Conclusion: We found high levels of fertility desires and intentions and moderate risk perception among a cohort of HIV-infected women in urban Kano, Nigeria. The use of safer conception practices was not common. Our findings underscore the need for healthcare provider capacity building to enhance safer conception counseling and service delivery

Incidence of tuberculosis and immunological profile of TB/HIV co-infected patients in Nigeria

Background: We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HIV Treatment. We also modeled the relationship between incident TB and change in CD4 count over the follow-up period. Methods: We analyzed the incidence of TB over 10 years from initiation of HIV treatment among 345 HIV treatment-naοve persons, who were enrolled in a cohort in Kano, Nigeria. We used Generalized Estimating Equation [GEE] to identify determinants of TB incidence and model the relationship between the occurrences of TB with change in CD4 count over the follow-up period. We created Kaplan-Meier curves stratified by anti-retroviral therapy (ART) treatment failure status to examine the effect of first line ART treatment failure on occurrence of TB. Result: During the 10-year period, 47(13.62%) had TB [incidence was 7.43 per (1,000) person year)]. It is associated with decreasing age (OR = 0.98), female gender (OR = 0.83), being on first line ART other than AZT (OR = 0.87), poor adherence (OR = 1.25), change in ART regimen (OR = 2.3) and ART treatment failure (OR = 1.51). Odds of TB occurrence was also associated with CD4 increment at 10 years (OR = 0.99). Those with TB/HIV co-infection tend to have statistically significant shorter time to failing first line ART regimen compared to those with HIV infection alone. Conclusion: There was high incidence of TB in the studied HIV cohort with a deleterious effect on the outcome of ART treatment. There is need for early TB screening and re-screening among all HIV patients

Domestic Violence among women living with HIV/AIDS in Kano, northern Nigeria

Despite the increased risk of domestic violence among women living with HIV/AIDS, its burden has not been adequately explored in many developing countries including Nigeria. Using interviewer administered questionnaires we assessed the prevalence and risk factors for domestic violence among 300 HIV seropositive women attending a teaching hospital in northern Nigeria. Participants have been diagnosed HIV positive for an average of 6.7 years; 66.3% were seroconcordant with their intimate partners while 16.3% were serodiscordant, the rest 17.4% did not know the partner's status; 67.1% had disclosed their status to their partners; and 64(22.1%) [95%CI (17.5% to 27.4%)] had experienced domestic violence following HIV diagnosis. Specifically, 30.0% (n=19) experienced physical violence (slapping, kicking and punching), 59.3% (n=38) reported verbal violence (insults, threats) and 10.7% (n=7) endured emotional violence. None was sexually assaulted. Predictors of domestic violence were the woman's age, marital status, disclosure and partner's educational status. This calls for urgent steps and strategies for prevention, protection and post-test counseling on disclosure to avert this human right infringement. (Afr J Reprod Health 2011; 15[3]: 43-53).Malgré le risque de la violence domestique qui s'accroit chez les femmes séropositives, on n'a pas encore suffisamment exploré son fardeau dans plusieurs pays en voie de développement y compris le Nigéria. A l'aide des questionnaires administrés par l'enquêteur, nous avons évalué la prévalence et les facteurs de risque de la violence familiale auprès de 300 femmes séropositives qui fréquentent un hôpital au nord du Nigéria. Les participantes ont été diagnostiquées comme étant séropositives depuis une période de 6,7 ans au moyen ; 66,3% étaient séroconcordantes avec leurs partenaires intimes, alors que 16,3% étaient séroconcordantes, le reste ne connaissais pas la condition de leurs partenaires ; 67,1% avaient révélé leur condition à leurs partenaires ; et 64(22,1%) [95%CI (17,5% jusqu'à27, 4%)] avaient vécu une violence familiale suite à un diagnostic du VIH. En particulier, 30,0%(n=19) ont vécu la violence physique (gifle, coups de pied et coups de poing), 59,3% (n=38) ont signalé la violence verbale (insultes, menaces) et ont toléré la violence émotionnelle. Nulle n'a été agressée sexuellement. Les indices de la violence familiale étaient l'âge de la femme, son état civil, la révélation et le niveau de scolarisation du partenaire. Ceci exige des démarches et des stratégies urgentes pour la prévention, la protection et le conseil d'après le test, suite à la révélation afin d'éviter la violation de ce droit de l'homme

Bacterial Isolates andAntibiotic Sensitivity in Community Acquired Pneumonia

Objective: The objective of the studywas to determine bacterialcauses of community acquired pneumonia and their antibiotic sensitivity pattern amongst patients admitted intomedicalwards inAminu Kano Teaching Hospital, Kano, NigeriaMethods: The study incorporated patients aged fifteen years and above admitted into the Accident and Emergency unit, Medical wards, and Intensive care unit of AKTH with a provisional diagnosis of Community-Acquired Pneumonia between June 1, and November 30 2006.Those who have been on antibiotics two weeks prior to presentation were excludedfrom the study. Each patient had collection of sputum samples for gram and ziehl-Neelson (ZN) staining and bacteriological culture. Blood culture was also done for all cases and antibiotic sensitivity testing was done on isolates.Results: During the six month period, 50 patients (mean, age 43.2 range18-76, were evaluated. All patients had single conventional bacterial isolates. Streptococcus pneumoniae was the commonest isolate, found in 32 cases (64%). Klebsiella pneumoniae was the second, found in 7 cases (14%), others isolates found were Pseudomonas aeruginosa in 5 cases (10%), E coli 3cases (6%), Staphylococcus aureus in 2 cases (4%) andProteus spp in 1 case (2%). 2 patients (4%) were sputumsmear positive for acid- fast bacilli (AFB).The isolates showed good sensitivity to the newer and more expensive antibiotics (quinolones and cephalosporins), with resistance to the older and cheaper ones except gentamycin.Conclusion: Streptococcus pneumoniae is the most prevalent pathogen isolated in cases of community acquired pneumonia in Kano and the newer antibiotics; cephalosporins and quinolones showed good sensitivity profile.Niger Med J. Vol. 49, No.3, July– Sept, 2008: 63 – 66.Keywords: bacteria, isolates, antibiotic, sensitivity, pneumonia

Corrélats des intentions de la fécondité chez les patients séropositifs au nord du Nigéria

Little research has been conducted regarding the reproductive intentions of people living with HIV/AIDS (PLWHA) in northern Nigeria. We studied reproductive desires and their predictors among 340 PLWHA receiving care at Aminu Kano Teaching Hospital. Of all respondents, 60(70.6%) of males and 177(69.4%) of females were sexually active. Only 65(19.4%) of them used condoms. One hundred and sixty seven females (65.5%) and 52(61.2%) males expressed a desire to have more children. Out of these, 16(7.3%), 106(48.4%) and 88(40.2%) wanted to have one, two and three or more children respectively. Significant predictors of higher fertility desires were; religion (OR=1.8), duration of diagnosis (OR=0.42), low parity (OR=6.03) and awareness of partner’s serostatus (OR=2.3). A large proportion of the HIV-positive individuals in the study were sexually active, desired to have children, and wanted to use family planning, indicating unmet need for reproductive health counseling in general and family planning in particular (Afr J Reprod Health 2009; 13[3]:71-83).Peu de recherche a été menée à l’égard des intentions de reproduction chez les gens séropositifs au nord du Nigéria. Nous avons étudié les désirs de reproduction et leurs indices chez 340 personnes séropositives qui se faisaient soigner à l’hôpital universitaire Aminu Kano. Parmi les interviewés, 60 (70,6%) des hommes et 177 (69,4%) des femmes étaient sexuellement actifs. Il n’y avait que 65 (19,4%) parmi eux qui utilisaient des préservatifs. Cent soixante-cinq femelles (65,5%) étaient sexuellement actives et 52 mâles ont exprimé le désir d’avoir encore des enfants. Sur cette population, 16 (7,3%), 106 (48,4%) et 88 (40,2%) voulaient en avoir encore un, deux ou trios enfants respectivement. Des indices des désirs de la fécondité plus élevée étaient la religion (OR= 1,8), la durée du diagnostic (OR=0,42), une parité faible (OR=6,03) et une conscience de l’état sérologique (OR=2,3). Une grande proportion des individus séropositifs dans l’étude étaient sexuellement actifs, voulaient avoir des enfants et voulaient se servir de la planification familiale, ce qui a montré un besoin insatisfait pour l’assistance sociopsychologique par rapport à la santé de reproduction en général et à la planification familiale en particulier (Afr J Reprod Health 2009; 13[3]:71-83)

Participatory evaluation of livestock impediments in some pastoral settings in Katsina State, Nigeria

Formal system of investigating livestock impediments seems to be of limited value in rural communities in developing countries. Participatory epidemiological (PE) tools were used on 4 focus groups in Katsina State, Nigeria to investigate pastoralists’ perspectives of their livestock. Data were subjected to descriptive statistics, Friedman’s test and Kendal’s coefficient of concordance. Cattle constituted the largest proportion of livestock kept, followed by goats, sheep, and poultry among others. Benefits derived from such animals included manure, means of livelihood, draft, and farm traction. Cattle rustling, lack of watering points and diseases were identified as factors militating against livestock production. Most prevalent livestock diseases identified included PPR, anaplasmosis, fasciolosis, round worms, CCPP, brucellosis, tick infestation, foot rot and arthritis. Signs of small ruminant diseases identified were consistent with the modern veterinary knowledge of such diseases. Traditional management of brucellosis included, firing of the knee in case of hygroma, then application of ‘Rai dore’ (Senna occedentalis) and drenching of affected animals with its solution. Some believed in chanting some verses from the Holy Qur’an on afflicted animals. Pastoralists were knowledgeable about their livestock and should be given a voice to enhance understanding and solving of animal health problems in their localities using PE.Key wards: Participatory, epidemiology, Livestock, impediments, Katsina, Nigeria