The status of tuberculosis infection control measures in health care facilities rendering joint TB/ HIV services in “German Leprosy and Tuberculosis Relief Association” supported states in Nigeria

Objective: To assess the status of tuberculosis (TB) infection control practice in health care facilities implementing joint TB/HIV activities.Materials and Methods: A descriptive survey triangulating self-administered questionnaire (facility survey to Infection Control Officer, individual health worker to general health workers), review of facility case notes and participant observation techniques was carried out. Twelve health facilities from southern Nigeria were assessed.Results: (1) Administrative and work practice control measure: Only 1 (8.3%) facility had a documented TB Infection control policy; 2 (16.7%) facilities had Infection Control Committee; 5 (41.7%) facilities had Infection Control Officer; 2 (16.7%) asked questions at the health records about cough; 1 (8.3%) facility had health workers intermittently checking for patients with cough in the waiting hall; and 2 (16.7%) facilities had Infection Control Officers who have attended some training on infection control. No facility had Information, Education and Communication (IEC) materials reminding patients and health workers of the possibility of TB transmission in the health care setting. While 86.4% of TB patients were screened for HIV, only 54.7% of HIV patients were tested for TB. (2) Environmental control measures: All the waiting halls were well ventilated. Though 66.7% of the consulting rooms were well ventilated, 25% of them were over crowded; 58.3% of the facilities managed sputum smear positive TB patients in the same ward with HIV-positive and other vulnerable patients; no facility had air cleaners.Conclusion: Implementation of the different aspects of the administrative control and work practice component of TB infection control measure range from 8.3% to 41.7% of the facilities. Urgent measures should be taken to reverse this trend in the face of TB burden due to HIV

Research priority setting for health policy and health systems strengthening in Nigeria: The policymakers and stakeholders perspective and involvement

Introduction: Nigeria is one of the low and middle income countries (LMICs) facing severe resource constraint, making it impossible for  adequate resources to be allocated to the health sector. Priority setting becomes imperative because it guides investments in health care, health research and respects resource constraints. The objective of this study was to enhance the knowledge and understanding of policymakers on researchpriority setting and to conduct a research priority setting exercise. Methods: A one-day evidence-to-policy research priority setting meeting was held. The meeting participants included senior and middle level  policymakers and key decision makers/stakeholders in the health sector in Ebonyi State southeastern Nigeria. The priorities setting meeting involved a training session on priority setting process and conduction of priority setting exercise using the essential national health research (ENHR) approach. The focus was on the health systems building blocks (health workforce; health finance; leadership/governance; medical  products/technology; service delivery; and health information/evidence). Results: Of the total of 92 policymakers invited 90(97.8%) attended the meeting. It was the consensus of the policymakers that research should focus on the challenges of optimal access to health products and  technology; effective health service delivery and disease control under a  national emergency situation; the shortfalls in the supply of professional personnel; and the issues of governance in the health sector    management.Conclusion:Research priority setting exercise involving  policymakers is an example of demand driven strategy in the health  policymaking process capable of reversing inequities and strengthening the health systems in LMICs

The Impact Of Intensive Patient Education On Anti-Tuberculosis Drug Treatment Adherence In Adult Pulmonary Tuberculosis Patients In Abakaliki, Ebonyi State

Background: Tuberculosis remains a disease of serious socio-economic and public health importance. The morbidity and mortality burden of tuberculosis in Nigeria and globally is great. Method: This is a non-randomized hospital based intervention study. Aim: To evaluate the impact of intensive patient education on antituberculosis drug treatment adherence in adult pulmonary tuberculosis (PTB) patients accessing treatment in Ebonyi State University Teaching Hospital, Abakaliki. Result: A total of 225 adult PTB patients who fulfilled the study inclusion criteria were recruited. Their ages ranged from 19 to 74 years with a mean of 37.4  12.7 years. The male: female ratio was 1.1:1. The control group comprised 117 adult PTB patients who accessed antituberculosis treatment from June 2004 to March 2006 while the intervention group comprised of 108 adult PTB patients who accessed antituberculosis treatment from April 2006 to October 2007. Data on their adherence to treatment were obtained from their TB treatment cards at the end of the intensive phase of antituberculosis drug treatment. Default rates of 10.2% and 34.2% were recorded for the intervention and control groups respectively. Majority of the defaulters resided outside Abakaliki (81.8%) in the intervention group and 80.0% in the control group while 18.2% and 20.0% of the defaulters resided in Abakaliki in the intervention and control groups respectively. There was a statistically significant difference in the default rates between the two populations of adult PTB patients. Conclusion: Intensive patient education has a potential to reduce non-adherence to antituberculosis drug treatment. Keywords: Adherence, default, education, intensive, resistance. Ebonyi Medical Journal Vol. 6 (2) 2007: pp. 76-8