Effectiveness of WHO Combination Treatment Regimen in The Management of Diarrhoea Among Under-Five Children Attending Primary Health Care Centres in Oyo State, Nigeria (Published)
Diarrhoea is one of the childhood diseases that result to high mortality. Despite the World Health Organization (WHO) recommendation of the combination treatment regimen of oral rehydration salts (ORS) and zinc supplements for the management of this disease, it effectiveness in treating and preventing the reoccurrence of diarrhoea among the under-five children remains a serious concern. Therefore, the main objective of this study was to assess the effectiveness of WHO combination treatment regimen in the management of diarrhoea amongst under-five children attending Primary Health Care (PHC) centres in Oyo State. The study adopted quasi-experimental of one group Pretest-posttest design. Purposive sampling technique was used to recruit a total of 60 eligible participants on admission. The effectiveness of the combination treatment regimen was assessed based on the recovery rate of the participants at 24 hours, 2 weeks and 4 weeks post intervention using a standardized instrument of WHO observational check-list for assessing diarrhoeaic under-five children. Data analysis was done using both descriptive and inferential statistics. However, on admission (baseline), majority 52(86.7%) of the participants had moderate diarrhoea. After administering WHO-ORS plus Zinc supplements, 24 hours later, majority 51(85.0%) of the participants had no diarrhoea, two (2) weeks later, during home visiting, majority 56(93.3%) of the participants had no diarrhoea. After Four (4) weeks, significant improvement was also achieved as 57(95.0%) participants had no diarrhoea. It was concluded that the significant improvement in the diarrhoea status in 24 hours, 2 weeks and 4 weeks post intervention was an indication that the combination of WHO-ORS plus zinc suggest how highly efficacious the regimen is in the management of under-five diarrhoea. Hence, Health workers in the PHC should combine the therapy and not using only one in the management of under-five diarrhoea.
Keywords: Diarrhoea, Effectiveness, ORS, combination treatment regimen, under five, zinc
Effectiveness of Community-Based Multidrug-Resistant Tuberculosis Treatment in Nigeria: A Retrospective Cohort Study (Published)
Growing multidrug-resistant tuberculosis (MDR-TB) worldwide and new effective and affordable treatment modalities required exploring options such as the community model of MDR-TB treatment (CM), as introduced in Nigeria.To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with the hospital-based model of care in Nigeria.Treatment outcomes data were retrospectively accessed from the medical record of 423 MDR-TB patients to evaluate the effectiveness of HM and CM based on WHO criteria. Treatment success” is defined as the sum of cure and treatment completion. “Cure” is the “treatment completion” with at least three negative cultures taken at least 30 days apart after the intensive phase in the absence of “treatment failure. Predictors of treatment outcomes were also assessed on multivariate analysis. 423 patients (85% of the targeted sampling data) were available for analysis, of whom 272 (63.4%) had a conventional regimen, and 143 (33.8%) had a shorter treatment regimen. There is no significant difference in treatment outcomes between CM and HM; patients achieve similar treatment success in all models, 65.5% with HM compared to 68% at the CM (p = 0.608). Treatment failure was (4.1% versus 5.1%) in the HM versus CM, respectively; (p = 0.704). Death occurred in 20.9% of participants in the hospital model and 17.5% in the community model, and rates of Loss to follow-up were similar 9.5% HM vs 9.5% CM; (p = 0.704). On multivariate analysis, adjusting for age, HIV, sex, patient type, TB treatment history, resistance pattern, model of care and regimens, there was no change in treatment outcomes if patients were treated at the CM vs HM (adjusted odds ratio [aOR] 0.92; 95% CI 0.59 – 1.46, p = 0.735). MDR-TB patients with unknown HIV status (not on ART) were nine times more likely to have unsuccessful treatment outcomes compared with HIV-negative respondents (adjusted odds ratio [aOR] 8.83; 95% CI 1.79 – 43.60, p = 0.007). Similarly, HIV-positive respondents were 1.3 times more likely to have unsuccessful outcomes than HIV-negative (adjusted odds ratio [aOR] 1.26; 95% CI 0.71–2.26, p = 0.429, but the difference is not statistically significant. This retrospective study found that the community-based model is equally effective as care in a centralised hospital, based on similar treatment success rates, comparable default and death rates with hospital care and shorter time to treatment initiation at the community-based centres.
Citation: Abubakar A., Parsa A.D. Walker S. (2023) Effectiveness of Community-Based Multidrug-Resistant Tuberculosis Treatment in Nigeria: A Retrospective Cohort Study, International Journal of Public Health, Pharmacy and Pharmacology, Vol. 8, No.1, pp.18-38
Keywords: Community care, Effectiveness, Hospital care, MDR-TB, Nigeria