Tuberculosis Patients In Nigeria Research Articles

Chest X-ray Features in Drug-Resistant Tuberculosis Patients in Nigeria; a Retrospective Record Review.

Chest X-ray (CXR) characteristics of patients with drug-resistant tuberculosis (DR-TB) depend on a variety of factors, and therefore, identifying the influence of these factors on the appearance of DR-TB in chest X-rays can help physicians improve diagnosis and clinical suspicion. Our aim was to describe the CXR presentation of patients with DR-TB and its association with clinical and demographic factors. A retrospective analysis of the CXRs of DR-TB patients in Nigeria between 2010 and 2016 was performed, reviewing features of chest radiographs, such as cavitation, opacity and effusion, infiltration and lung destruction. The association of these abnormal CXR findings with clinical and demographic characteristics was evaluated using bivariate and multivariate models, and a p-value < 0.05 was considered statistically significant with a 95% confidence interval. A total of 2555 DR-TB patients were studied, the majority (66.9%) were male, aged 29–38 years (36.8%), previously treated (77%), from the South West treatment zone (43.5%), HIV negative (76.7%) and bacteriologically diagnosed (89%). X-ray findings were abnormal in 97% of the participants, with cavitation being the most common (41.5%). Cavitation, effusion, fibrosis, and infiltration were higher in patients presenting in the South West zone and in those previously treated for DR-TB, while lung destruction was significantly higher in patients who are from the South South zone, and in those previously treated for DR-TB. Patients from the South East zone (AOR: 6.667, 95% CI: 1.383–32.138, p = 0.018), the North East zone (AOR: 6.667, 95% CI: 1.179–37.682, p = 0.032) and the North West zone (AOR: 6.30, 95% CI: 1.332–29.787, p = 0.020) had a significantly increased likelihood of abnormal chest X-ray findings, and prior TB treatment predisposed the patient to an increased likelihood of abnormal chest X-ray findings compared to new patients (AOR: 8.256, 95% CI: 3.718–18.330, p = 0.001). The finding of a significantly higher incidence of cavities, effusions and fibrosis in DR-TB patients previously treated could indicate late detection or presentation with advanced DR-TB disease, which may require a more individualized regimen or surgical intervention.

Health Information Literacy Of Tuberculosis Patients in DOT Centers in Lagos State, Nigeria

Introduction: Health information literacy can play a critical role in controlling and managing tuberculosis. Low knowledge of tuberculosis coupled with inadequate health information literacy may lead to poorer treatment outcome. Despite being one of the most deadly infectious diseases, there are few empirical studies on the health information literacy of tuberculosis patients in Nigeria. Therefore, this study investigated the health information literacy of tuberculosis patients in DOT Centres in Lagos State, Nigeria.Material and Methods: The study employed a survey design. The sampling method used was a multi-stage sampling method. A total of twelve Directly Observed Therapy (DOT) Centres were selected across the three senatorial districts. A sample of size of 310 Tuberculosis patients was drawn using Taro Yamane formula. A structured and validated questionnaire was used as instrument for data collection. Data were analyzed using SPSS version-23.Results: The findings of the study revealed that respondents had a high level of health information literacy in their ability to identify specific health information needs, access information sources and use information. The respondents also demonstrate the ability to obtain health information more easily from printed sources than from the internet. However, their ability to understand health information easily and evaluate quality health information was low.Conclusion: The study outcome indicates that health information literacy of the respondents can be improved upon. As a result, efforts should be made to educate tuberculosis patients on how to evaluate and comprehend health information by improving their understanding of health- related terminologies and assessing reliable health information.

Rates and timeliness of treatment initiation among drug-resistant tuberculosis patients in Nigeria- A retrospective cohort study

BackgroundThere were an estimated 580,000 new cases of multidrug/rifampicin resistant TB (DR-TB) in 2015, and only 20% were initiated on treatment. This study explored health system and patient factors associated with initiation and timeliness of treatment among DR-TB patients in Nigeria, ranked 4th globally for estimated TB cases in 2015.MethodsA retrospective cohort study using 2015 diagnosis and treatment data from the Nigerian TB program electronic records examined “treatment ever received” (yes/no) and “treatment within 30 days” (yes/no). We compared health system and patient characteristics using binomial logistic regression, while controlling for confounders.ResultsOf 996 patients diagnosed nationwide in 2015 (aged 0–87 years, median 34), 47.8% were never treated. Of those treated (n = 520), 51.2% were treated within the 30 days prescribed in the National treatment guideline. Healthcare facility locations were significantly associated with ever receiving treatment and timely treatment. Predictors of timely treatment at the national level also included level of care and patient treatment history. The South-West zone, where DR-TB programs started, showed overall better access to DR-TB healthcare.ConclusionsHealthcare facility geographic locations were significantly associated with treatment initiation and timeliness. Significant regional differences in access to DR-TB care in Nigeria persist, reflecting uneven contexts for national DR-TB treatment rollout.

Cost of three models of care for drug-resistant tuberculosis patients in Nigeria

BackgroundNigeria accounts for a significant proportion of the global drug-resistant tuberculosis (DR-TB) burden, a large proportion of which goes untreated. Different models for managing DR-TB treatment with varying levels of hospitalization are in use across Nigeria, however costing evidence is required to guide the scale up of DR-TB care. We aimed to estimate and compare the costs of different DR-TB treatment and care models in Nigeria.MethodsWe estimated the costs associated with three models of DR-TB treatment and care: Model (A) patients are hospitalized throughout the 8-month intensive phase, Model (B) patients are partially hospitalized during the intensive phase and Model (C) is entirely ambulatory. Costs of treatment, in-patient and outpatient care and diagnostic and monitoring tests were collected using a standardized data collection sheet from six sites through an ingredient’s approach and cost models were based on the Nigerian National Tuberculosis, Leprosy and Buruli Ulcer Guideline - Sixth Edition (2014) and Guideline for programmatic and clinical management of drug-resistant tuberculosis in Nigeria (2015).ResultsAssuming adherence to the Nigerian DR-TB guidelines, the per patient cost of Model A was $18,528 USD, Model B $15,159 USD and Model C $9425 USD. Major drivers of cost included hospitalization (Models A and B) and costs of out-patient consultations and supervision (Model C).ConclusionUtilizing a decentralized ambulatory model, is a more economically viable approach for the expansion of DR-TB care in Nigeria, given that patient beds for DR-TB treatment and care are limited and costs of hospitalized treatment are considerably more expensive than ambulatory models. Scale-up of less expensive ambulatory care models should be carefully considered in particular, when treatment efficacy is demonstrated to be similar across the different models to allow for patients not requiring hospitalization to be cared for in the least expensive way.

Detection and Diagnostic Accuracy of Rapid Urine Lipoarabinomannan Lateral-Flow Assay in Pulmonary Tuberculosis patients in Nigeria

Background: Tuberculosis (TB) is a public health challenge in both developed and developing countries. Early diagnosis is essential in preventing the further spread of the disease, but the control programs are currently facing a number of constraints and fewer than 25% of all tuberculosis cases especially childhood cases are detected. We aimed to evaluate diagnostic accuracy of a commercially available qualitative immunoassay for the detection of lipoarabinomannan (LAM) antigen of Mycobacteria in human urine by comparing its sensitivity and specificity in TB patients with the AFB and GeneXpert in individuals with presumptive tuberculosis cases. Methods: A cross-sectional study that consecutively enrolled 53 eligible TB adults’ patients attending TB Centre, Mangu, Plateau State from February to March 2017. We applied the LAM test on urine collected as a spot and early morning sample. Diagnostic accuracy was analyzed for a microbiological TB reference standard based on Gene Xpert MTB/RIF results and for a composite reference standard including clinical data. Performance of sputum smear microscopy (AFB) was included for comparison. Results: The mean age of the respondents was 41.0±17.0 years.) The male proportion was 36(68.0%) and female was 17(32.0%). The patients with HIV-1 Co-infection were 9(23.8%). Of the 53 patients, the positive testing rate of TB using LAM test was 11 (20.8 %). The proportion of those who tested positive using Gene Xpert was 9(17.0%) and AFB was 33(62.2%), and the sensitivity and specificity were 33.3% and 93.2%, respectively. Negative and positive predictive values were 87.23% and 50.0%, diagnostic accuracy was 83.02%. Conclusion: The study showed great sensitivity of urine LAM test suggesting it could be useful as point of care diagnostic test for presumptive TB cases. Its high negative predictive value suggests a role in screening out uninfected patients; though GeneXpert had superior sensitivity, but the ease of the LAM test holds operational advantage as a screening method, however larger studies are needed to further determine diagnostic accuracy.

AN EVALUATION OF TREATMENT OUTCOME IN TUBERCULOSIS DIRECTLY OBSERVED TREATMENT SHORT COURSE FACILITIES IN JIGAWA STATE, NIGERIA (2010–2014)

Tuberculosis (TB) is a major public health problem worldwide. It is estimated that 2 billion people, a third of the world population, have TB infection, but are not down with the disease. Globally, incident cases of TB showed a rising trend, with a 6.6 million reported in 1990, 8.3 million in 2000, 9.24 million in 2004, and an estimated 9.27 million incident cases in 2007. The aim of this study was to evaluate the treatment outcome of TB patients in Nigeria in the state of Jigawa. A cross sectional retrospective study was conducted to evaluate the treatment outcome in directly observed treatment with a short course for tuberculosis (TB DOTS) in facilities in the state between the years 2010 to 2014. The study population were all the patients with TB, who had access to DOTS therapy. Data were collected from the various local governmental areas for tuberculosis control (LGA TB) register. The LGA TB control registers contained basic information of the patients, and a statistical software SPSS-V22.0 was used to analyse the data. A total of 963 TB patients were studied. More than half (57.4%) of the patients were male, and nearly three- fourths (71.2%) of the patients accessed care from urban local government areas in the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis (PTB). Among the patients, more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them were HIV positive. This study revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria was higher than the overall TSR of Nigeria, and the defaulter rate in this state was lower than the Nigerian average.

Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians.

To evaluate chronic pulmonary aspergillosis (CPA) as an alternative diagnosis of smear-negative tuberculosis (TB) and treatment failure in TB patients in Nigeria. We conducted a cross-sectional multicentre survey in human immunodeficiency virus (HIV) positive and negative adult patients at the end of their TB treatment in clinics in Lagos and Ilorin states. All were assessed using clinical examination, chest X-ray (CXR) and aspergillus immunoglobulin G (IgG) serology, and some for sputum fungal culture. CPA was defined as a positive Aspergillus fumigatus IgG titre with compatible CXR or a positive sputum culture of Aspergillus with a visible fungal ball on CXR with symptoms of underlying lung disease. Of 208 patients recruited between June 2014 and May 2015, 153 (73.6%) were HIV-positive. The mean age was 39.8 years, 124 (59.6%) were female and 39 (18.8%) were unable to work. The median CD4 count was 169.5 cells/ml (range 4-593) in HIV-infected patients with positive Aspergillus IgG. Overall, 109 (52.4%) had documented TB, 140 (67.3%) had a productive cough and 50 had haemoptysis. CPA prevalence was 8.7%; 10 (6.5%) had HIV infection and 8 (14.5%) were HIV-negative (Fisher's exact P = 0.092). CPA is a neglected disease in Nigeria, and most cases match the World Health Organization diagnostic criteria for smear-negative TB.

Delay in the Provision of Antiretroviral Therapy to HIV-infected TB Patients in Nigeria.

BackgroundNigeria has a high burden of HIV and tuberculosis (TB). To reduce TB-associated morbidity and mortality, the World Health Organization recommends that HIV-positive TB patients receive antiretroviral therapy (ART) within eight weeks of TB treatment initiation, or within two weeks if profoundly immunosuppressed (CD4<50 cell/μL).MethodsTB and HIV clinical records from facilities in two Nigerian states between October 1st, 2012 and September 30th, 2013 were retrospectively reviewed to assess uptake and timing of ART initiation among HIV-positive TB patients. Healthcare workers were qualitatively interviewed to assess TB/HIV knowledge and barriers to timely ART.ResultsData were abstracted from 4,810 TB patient records, of which 1,249 (26.0%) had HIV-positive or unknown HIV status documented, and the 574 (45.9%) HIV-positive TB patients were evaluated for timing of ART uptake relative to TB treatment. Among 484 (84.3%) HIV-positive TB patients not already on ART, 256 (52.9%, 95% CI: 45.0–60.8) were not initiated on ART during six months of TB treatment. 30.0% of 273 patients with a known CD4≥50cells/μL started ART within eight weeks, and 14.8% of 54 patients with a known CD4<50cells/μL started within the recommended two weeks. Only 42% of health workers interviewed reported knowing to interpret guidelines on when to initiate ART in HIV-positive TB patients based on CD4 cell count results. CD4 cell count significantly predicted timely ART uptake.ConclusionA large proportion of HIV-positive TB patients were not initiated on ART early or even at all during TB treatment. Retraining of staff, and interventions to strengthen referral systems should be implemented to ensure timely provision of ART among HIV-positive TB patients in Nigeria.

Prevalence of HIV infection among tuberculosis patients in a teaching hospital in south-west Nigeria: A four-year retrospective study

IntroductionAccording to the World Health Organization, Nigeria remains one of the worst affected countries with HIV and Mycobacterium tuberculosis infections in the world. Of a critical concern is the emerging threat of co-infection at an unprecedented proportion in the country. In south-west Nigeria, few studies have assessed the prevalence of HIV infection among TB patients. Findings aimed at estimating the prevalence of HIV co-infection among TB patients enrolled in a teaching hospital in Ogun State, south-west Nigeria between 2008 and 2011 are presented in this study. Materials and methodsThis is a retrospective study of 386 TB patients admitted between January 2008 and 2011 to Olabisi Onabanjo University Teaching Hospital, Ogun State, Nigeria of which 206 (53%) were males and 180 (47%) were females. Descriptive statistics, chi-square test and logistic regression were utilized in the analysis of the data. ResultsAn overall HIV prevalence of 29.27% (95% CI: 24.78–34.09) was found. Female TB patients had higher odds of HIV infection (OR 1.91, 95% CI: 1.03–3.55) while patients with the highest education had the least odds of HIV infection [OR 0.08, 95% CI: 0.01–0.56]. ConclusionEvidence of a rising tide of HIV infection in TB patients was found, in particular among single middle-aged women with low education. Further research also needs to be conducted to provide more insight into the epidemiology of co-infection in order to better address the dual burden of HIV and TB among tuberculosis patients in Nigeria.

Estimating the cost of TB and its social impact on TB patients and their households.

Illness often poses a significant financial burden on individuals and their households, and tuberculosis (TB) is no exception. Although TB treatment is free in Nigeria, patients are likely to incur costs due to multiple visits during treatment. The purpose of this study was 1) to examine the health-seeking behaviour of TB patients and the costs borne by TB patients in Nigeria, and 2) to assess the social impact of TB disease on TB patients and their families/households. Of 260 TB patients surveyed, the majority (74.7%) were aged between 20 and 49 years. TB patients expended an average of US$52.02 (N = 8323.58, at the rate of US$1 = N = 160) per person on all visits associated with diagnosis and receipt of diagnostic test results. Overall, households experienced a shortfall of about US$57.30 (N = 9174.72) or 24.9% of income loss due to TB illness. Further analysis revealed that 9.7% of TB patients relied on children of school age or below to finance the costs of TB illness.

Eight Months vs Six Months Anti-TB Regimen in the Treatment of Newly Diagnosed Pulmonary Tuberculosis Patients in Nigeria

Background: The eight month’s treatment regimen (2RHZE/6EH) was used by the Nigerian National TB and Leprosy Control Programme for the management of tuberculosis cases since 2003 when they commenced operation until October 2010 when the six month’s treatment regimen Original Research Article Daniel et al.; BJMMR, 8(10): 836-841, 2015; Article no.BJMMR.2015.513 837 (2RHZE/4RH) was introduced. This study compared the treatment outcomes of patients managed with eight and six month’s treatment regimen between October 2009 and December 2011. Methods: A desk review was carried out on the programme data of the Lagos State Tuberculosis and Leprosy Control Programme (LSTBLCP). The treatment outcomes of new smear positive TB patients managed between October 2009 and September 2010 (the eight month’s treatment regimen period) and January to December 2011 (six month’s treatment regimen period) were compared using Epi Info 2007 statistical software. Results: A total of 4249 and 4167 smear positive TB patients were registered during the eight and six month’s treatment regimen period respectively. The prevalence of HIV among TB patients was significantly higher (14.4%) during the eight month’s treatment regime period compared with the six month’s (12.1%) treatment regime period (P = .02). The cure rate of patients managed during the eight month’s treatment regimen period was significantly lower (67.2%) and defaulter rate significantly higher (16.7%) compared with the cure (73.9%) and defaulter rates (12.2%) of patients managed during the six month’s treatment regimen period (P .05). Among TB/HIV co-infected patients, the death rate was significantly higher among patients managed during the six month’s regimen period and the default rate was significantly higher in patients managed during the eight month’s treatment regimen period (p<.05). Conclusion: Patients had better treatment outcomes during the six month’s treatment regimen period in Lagos State. Sustaining these gains will be essential in reaching the national and global

Interferon-gamma treatment kinetics among patients with active pulmonary tuberculosis

Introduction:Interferon-γ (IFN-γ) is essential for defence against Mycobacterium tuberculosis; however, levels in patients with active tuberculosis (TB) and changes during treatment have not been documented in our tuberculosis patients in Nigeria, hence this study has been carried out.Objective:To determine variations, treatment kinetics, and predictive value of IFN-γ levels during treatment of active tuberculosis.Design:Patients with pulmonary tuberculosis were recruited and subsequently followed up for 3 months during treatment with anti-TB. Peripheral blood was collected for IFN-γ assays, C-reactive protein and others followed by a Mantoux test. IFN-γ levels produced by stimulation with TB antigens were determined by ELISA and repeated measurement of IFN-γ were done at 1 and 3 months of anti-TB therapy. Chi Associations and correlations between IFN-γ were determined. Regression analysis was done to determine association between serial IFN-γ and treatment outcome.Results:We recruited 47 patients with active tuberculosis with a mean age of 34.8 ± 3.6 years and M:F ratio of 1.12:1. Six (11%) were HIV positive. The mean level of IFN-γ induced by TB antigens was 629 ± 114.1 pg/ml, higher for HIV-negative PTB patients compared with HIV-positive PTB patients, 609.78 ± 723.9 pg/ml and 87.88 ± 130.0 pg/ml, respectively, P-value = 0.000. The mean level of IFN-γ induced by TB antigen increased significantly from 629 ± 114.1 pg/ml to 1023.46 + 222.8 pg/ml, P-value = 0.03 and reduced to 272.3 ± 87.7 pg/ml by the third month on anti-TB drugs, P-value = 0.001. Negative correlation was observed between the mean of baseline and chest X-ray involvement, P = 0.03. There was no significant correlation between sputum smear grade with baseline and follow-up IFN-γ levels. Three-month IFN-γ level among cured patients were higher than those with treatment failure, regression analysis showed that it does not predict outcome.Conclusion:IFN-γ may be useful in early detection and monitoring response; however, large scale studies are needed.

Non tuberculosis mycobacteria isolates among new and previously treated pulmonary tuberculosis patients in Nigeria

ObjectiveTo determine the prevalence of non tuberculosis mycobacteria (NTM) among new and previously treated tuberculosis (TB) patients in Nigeria. MethodsIt was a retrospective study. A total of 102 sputum smear positive samples/culture isolates from pulmonary TB patients (41 new smear positive and 61 smear positive retreatment cases) were sent to the Institute of Tropical Medicine, Antwerp Belgium between 2007-2009. Data on patients' characteristics were retrieved from their treatment cards. ResultsAmong the 102 samples, 25 isolates results (20 were culture negative while 5 were contaminated) were excluded from the study. Data were available for 77 mycobacterium isolates. 70 (90.9%) were identified as Mycobacterium tuberculosis and 7 (9.1%) as atypical mycobacteria. Among the atypical mycobacteria, three of them were Mycobacterium fortuitum, two Mycobacterium intracellulare and two Mycobacterium chelonae. Of the seven isolates with atypical mycobacteria, 4 (57.1%) were from previously treated patients, while 3 (42.9%) were new sputum positive patients. There was no statistically significant difference in NTM infection between new and previously treated pulmonary TB patients (P =0.97). ConclusionsThe study shows the involvement of atypical mycobacterium in pulmonary infection in both new and previously treated TB patients. Therefore, there is a need to carry out culture and drug susceptibility testing in all pulmonary TB patients especially those who had failed conventional DOTS treatment to rule out NTM infections.

Non-enzymatic antioxidants and nutritional profiles in newly diagnosed pulmonary tuberculosis patients in nigeria.

The effects of pulmonary tuberculosis on nutritional and antioxidants status was determined in thirty-one patients attending Chest Clinic, Oyo State Hospital, Jericho, Ibadan Nigeria by assessing the levels of total protein, albumin, globulin, total cholesterol, HDL cholesterol, LDL cholesterol, uric acid, vitamin C, vitamin E and total antioxidants. Thirty-four members of staff of State Hospital Adeoyo Ibadan, Nigeria were selected as controls. The mean levels of total protein (7.13+1.06g/dl), albumin (3.27+0.7g/dl), total cholesterol (100.7+23.6mg/dl), HDL cholesterol (28.6+7.2mg/dl), LDL cholesterol (65.5+15.1mg/dl) and triglycerides (61.6+16.2mg/dl) were significantly low while the level of globulin (3.9+0.84g/dl) was significantly high in pulmonary tuberculosis patients when compared with controls (total protein = 7.6+0.7g/dl; albumin = 4.2+0.48g/dl; total cholesterol = 163.2+40.1mg/dl; HDL cholesterol = 41.4+5.4mg/dl; LDL cholesterol = 107.8+27.5mg/dl; globulin= 3.4+0.6g/dl ). Levels of vitamin C (18.5+1.6mg/l), vitamin E (6.9+1.7mg/l) and total antioxidant (0.83+0.34mmol/l) were significantly lower while the level of uric acid (5.2+2.1mg/dl) was significantly higher in patients with pulmonary tuberculosis when compared with the controls (vitamin C = 23.1+2.3mg/l; vitamin E = 12.5+1.6mg/l; total antioxidant = 1.65+0.26mmol/l; uric acid = 4.3+1.2mg/dl respectively). Significantly lower levels of antioxidants might have been caused by endogenous uric acid production. (Afr. J. Biomed. Res. 10: 223 - 228)

Oxidative Imbalance and Non-Enzymic Antioxidant Status in Pulmonary Tuberculosis Infected Subjects: Carcinogenic Potential

Oxidative imbalance and non-enzymic antioxidant status in plasma of pulmonary tuberculosis patients in Nigeria were investigated. Forty HIV/AIDS seronegative pulmonary tuberculosis patients with the active infection (24 males, 16 females) aged 20-60 years diagnosed by Ziehl Neelson staining/demonstration of mycobacterium tuberculosis in sputum and sputum culture Lowenstein Jensen medium visiting Federal Medical Centre, Owerri were selected for the study. Sixty normal subjects free from pulmonary tuberculosis and HIV/AIDS (30 males and 30 females) ages 20-60 years were also used as control. Patients with complication such as renal diseases, viral and other bacterial infections, etc. were excluded from the study. In the analysis of the results using Duncan multiple range test, pulmonary tuberculosis infected subjects presented significantly higher mean values of plasma lipid peroxide (p<0.05) when compared with control. Also the levels of non-enzymic antioxidants such as Vitamin C, vitamin E and reduced glutathione in plasma were significantly depleted in the pulmonary tuberculosis infected subjects (p<0.05) when compared with control. This shows that pulmonary tuberculosis could probably be associated with excess ROS production.