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

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

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

Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria

HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART−). Symptomatic HAND was found among 40% of the HAART− individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (p=0.0002). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04–1.44, p=0.016]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART− patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease