Where do tuberculosis patients go for treatment before reporting to DOTS clinics in southern Nigeria

No Abstract.Tanzania Health Research Bulletin Vol. 9(2) 2007: pp.94-10

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

Ranking of diagnostic features of childhood pulmonary tuberculosis by medical doctors in southeastern Nigeria

Objective: To rank diagnostic features of childhood pulmonary tuberculosis; and to determine the effect of working in tuberculosis Directly Observed Treatment Short Course (DOTS) facilities on the ranking of these features by medical doctors. Methods: A cross sectional descriptive study, using structured questionnaires to collect data from medical doctors whose daily routine included attending to sick children in 34 selected children outpatient clinics and TB DOTS centers in southeastern Nigeria. Results: Approximately, one quarter (25.3% or 56 of 221) of respondents worked in Directly Observed Treatment Short course (DOTS) clinics, while three quarters (74.7% or 165 of 221) worked in nonDOTSclinics. Majority of the respondents (69.7%) ranked chronic persistent cough (1), 42.5 % ranked weight loss and failure to thrive (2), another 27.7% ranked weight loss and failure to thrive (3), while 17.6% and 21.7% ranked History of contact with adult index case and radiographic abnormalities, (4) and (5), respectively. The study found that the percentage of doctors working in DOTS clinics who ranked weight loss and failure to thrive (2) was statistically and significantly higher than those of non-DOTS respondents. Conclusions: The most important symptoms/signs on which medical doctors based their diagnosis of childhood pulmonary tuberculosis include cough, weight loss and failure to thrive, history of contact with adult with smear positive pulmonary tuberculosis, and radiographic abnormalities consistent with active tuberculosis. There was statistically significant difference between the ranking of weight loss and failure to thrive by doctors working in DOTS clinics and their counterparts in non DOTS clinics. This study showed a decline in the percentage of ranking in both DOTS and Non DOTS respondents as they moved from the first to the fifth.KEY WORDS: Childhood pulmonary tuberculosis, Doctors, Ranking, Diagnostic features, Directly observed treatment short course (DOTS)

A Right Atrial Hemangioma Mimicking Thrombus In A Patient With Atrial Arrhythmias

Cardiac hemangiomas are rare tumors, accounting for only 2.8% of all benign primary cardiac tumors and occur at any age. Clinical presentations vary depending on the tumor location (myocardial, endocardial or pericardial). In many cases, this may be an incidental finding. We report the case of a patient with paroxysmal atrial fibrillation who had a right atrial hemangioma detected with transesophageal echocardiography prior to having percutaneous pulmonary vein isolation performe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9–24·7), corresponding to 1·92 billion (1·89–1·95) prevalent cases, compared with a prevalence of 28·2% (27·8–28·5) and 1·50 billion (1·48–1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1–75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1–612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2–123·7]), and other neglected tropical diseases (36·3 [24·4–52·8]), collectively accounting for 84·7% (84·1–85·2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation

Use of recommended score chart and ranking of clinical features in diagnosis of childhood pulmonary tuberculosis by doctors

Background: The diagnosis of childhood pulmonary tuberculosis among medical doctors has presented serious challenge in tuberculosis case finding in resource poor settings.Aim of the study: To determine the use of recommended score chart among medical doctors; and to compare the ranking of diagnostic clinical features of childhood pulmonary tuberculosis between users and non users of tuberculosis score chart (TSC) among medical doctors.Methodology: A cross sectional study, using structured questionnaires to collect data from medical doctors who provided care to children in some selected health facilities in southeastern Nigeria.Results: Majority (82.8% or 183 of 221) of the subjects did not use tuberculosis score chart. The ranking of symptoms by all respondents were persistent non remitting cough (1), weight loss or failure to thrive (2&amp;3), history of contact with adult with smear positive tuberculosis (4), radiographic abnormalities (5). Weight loss and failure to thrive was scored highest in ranks (2) and (3). There was a difference in the ranking of TSC users, where fever was ranked (3), followed by history of contact, whereas the non TSC users ranked history of contact, twice (3&amp; 4). There was a falling trend in the percentage scores in the ranking by both TSC and non TSC users.Conclusions: Most medical doctors who provided care to children did not use National Tuberculosis and Leprosy Control Programme&rsquo;s Tuberculosis Score Chart in the diagnosis of childhood pulmonary tuberculosis

Assessment of Pattern of Cigarette Smoking and Associated Factors among Male Students in Public Secondary Schools in Anambra State, Nigeria

Background: The WHO has estimated that there are about 1,300 million smokers globally and about 75% of these are in the developing countries. It is also predicted that if the current pattern of smoking continues, by 2020, there will be 10 million tobacco-related deaths annually worldwide and seven million (70%) of these deaths will occur in the developing countries. The objective of the study was to assess the cigarette smoking pattern and associated factors among male students in public secondary schools in Anambra State. Methods: The setting was public secondary schools in Anambra State. The study was in April 2008. It was a cross-sectional survey involving six schools, selected by multistage sampling technique. Eight hundred and fifty male students participated in the study. A semi-structured self-administered questionnaire was used. Qualitative data were collected using Focus group discussion (FGD). Results: The mean age of respondents was 16&plusmn;2.1 years. The ever-smoked and current smoking prevalence were 13.1% and 8.7% respectively. Mean age of commencement of cigarette smoking was 13.7&plusmn;2.6 years. Among smokers, 37.8% were daily smokers. Television (40.7%) and radio (33.3%) were the main sources of advertisement. Peer influence (34.2%) was the main reason for uptake of cigarette smoking. Major reason for not smoking among non-smokers was health concerns (57.9%). There were significant associations between smoking status and age of respondents (2=25.08; P= &lt;0.05), father's smoking status (2=158.77, P &lt; 0.05), awareness of health hazards of smoking (2= 5.13, P = 0.023) and advertisement on television (2= 4.05, P = 0.044) and billboards (2= 44.39, P&lt;0.05). Conclusion: Cigarette smoking prevalence among secondary school boys in Anambra State is high. Health education and strict implementation of anti-smoking policies of the Federal Government of Nigeria is recommended. Keywords: Cigarette smoking, Anambra state, male students, health education, smoking prevalenc

A four year review of external quality assessment of sputum AFB smear microscopy centres in Southeast Nigeria.

Objective: To identify the types, pattern and trend of errors in sputum smear microscopy in peripheral primary health laboratories in the Southeast States of Nigeria.Design: Retrospective studyMethods: A retrospective study of laboratory reports of randomly selected and blinded re-checked sputum smear microscopic slides at the peripheral laboratory centres (using Lots Quality Assurance Sampling Method) in the Southeast States of Nigeria between 2003 and 2006.Result: A total of 862 errors were found between 2003 and 2006 (862/873 or 98.7%), and consisted of HFN 155 (18%), HFP 138 (16%), LFN 161 (18.7%), LFP 186 (21.3%), and QE 222 (25.7%). There was a statistically significant association (P value &lt; .05) between the following types of errors (LFN, QE, total minor errors and total errors) and the period 2003 to 2006. However, there was no statistically significant association between these types of errors and slide volume (microscopic workload). The means of total error, and total minor errors declined as the sampling quarter moved from 1st to the 3rd quarter, while total errors declined as the year moved from 2003 to 2006.Conclusion: There was a statistically significant relationship between types of errors, pattern of minor errors and period of the study. The study showed a trend between the errors (LFN, QE, and TE) and the period of review (2003 to 2006), while the total minor errors and total errors declined as the sampling quarter moved from 1st to the 4th quarter of the years.Key Words: External Quality Assessment, Lots Quality Assurance Sampling Method, Nigeria, and sputum smear microscopy