Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria

Introduction: Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. Methods: A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p<0.05. Results: Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. Conclusion: The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State.Pan African Medical Journal 2016; 2

Pregnancy outcome of HIV-infected women on anti-retroviral therapy in a treatment centre in Port Harcourt, Nigeria: a retrospective analysis

Introduction: There are conflicting reports of adverse pregnancy outcomes following the administration of antiretroviral treatment (ARVs) to HIV-positive pregnant women. The aim of this study was to assess the magnitude of adverse effects of antiretroviral drugs and to underscore their importance in limiting adverse pregnancy outcomes in newborns.Methods: The study was a retrospective analysis of medical records of HIV-infected pregnant women who received anti-retroviral treatment at the University of Port Harcourt Teaching Hospital between January 2010 and December 2013. Data was analyzed using Epi Info Version 7 Statistical Package. Proportions, measures of centrality/dispersion as well as measures of association between maternal predictors and birth outcomes were computed. The level of significance was set at p≤ 0.05.Results: A total of 290 medical records of women who received anti-retroviral treatment were examined: 68.3% women commenced antiretroviral treatment before pregnancy, 3.8% started in 2nd trimester of pregnancy and 14.1% during labour. Pregnancy outcomes were as follows: 90.7% were live births; 92.4% neonates had Apgar scores ≥7 and 90.7% had birth weights of ≥ 2,500 grams. More than half, 55.9% had haemoglobin levels ≥ 10g/dl, while 84.8% of them were born full term. There were only 9.3% stillbirths and 9.3% low birth weights respectively, and also 15.2% preterm births.Conclusion: The prevalence of adverse pregnancy outcomes in the study was minimal and stresses the value of antiretroviral treatment in the prevention of adverse pregnancy outcomes in newborns. We therefore recommend its intensified utilization for maximum impact in reducing adverse pregnancy outcomes.Keywords: HAART, HIV, PMTCT, pregnancy, Port Harcourt, Nigeri

Treatment Outcomes and Associated Factors of Tuberculosis Patients on Directly Observed Treatment (Short Course) in a Tertiary Hospital in Port Harcourt, Nigeria

Introduction: Although concerted efforts have been implemented to achieve tuberculosis (TB) prevention and control, varying  outcomes have been reported in several quarters, despite the implementation of the directly observed treatment short-course (DOTS) strategy in virtually all parts of the world. It was considered necessary to assess the treatment outcomes of TB patients on DOTS strategy and the associated factors against the World Health Organization (WHO) target at the University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt, to stimulate improvements in efforts toward patients care in the hospital and elsewhere. Methods: Ahealth facility‑based review of patients’ records(January 1, 2014–December 31, 2018) at the TB Clinic of UPTH was carried out using a validated data record sheet. Patients undergoing treatment were excluded. Data were analyzed with the SPSS software version 20. Outcome frequencies were summarized, and the Pearson’s Chi‑square test was used to determine the association between the outcome and independent variables at P ≤ 0.05 statistical significance level. Results: Overall, 174 (25.7%) had completed treatment, 181 (26.7%) were cured, 95 (14.0%) died, 70 (10.3%) transferred out, 45 (6.6%) defaulted, 49 (7.2%) were not evaluated, 44 (6.5%) were lost to follow‑up, and 8 (1.2%) failed treatment. There was a 17.6% decline in the proportion of patients that completed treatment from 35.9% in 2014 to 18.3% in 2018. On the contrary, there was an increase in the proportion of patients that were cured, from 14.1% in 2014% to 26.1% in 2018. Conclusions: The treatment success rate for TB in the hospital was below the WHO benchmark of 85% cure rate throughout the period under review. Basic reforms in the service delivery processes that specifically targets groups at risk (male patients, sputum  smear‑negative TB patients, and patients with human immunodeficiency virus/TB co-infection) with drug adherence counselling, defaulter tracing arrangements, and emphasis on drug‑susceptibility testing are recommended to improve treatment outcomes. Keywords: Directly observed treatment short-course, Nigeria, Rivers State, tuberculosis treatment, tuberculosis outcome