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
A Dynamic Regression Modeling of the Prevalence of Stroke in South-East of Nigeria (Published)
Stroke is increasingly becoming one of the major public health issues in Nigeria. This study aimed to predicting future prevalence of stroke in south-east Nigeria in 2022 and 2023, using previous prevalence. The number of patients recorded with stroke (transient ischemic attack) and risk factors hypertension (HT), diabetes mellitus (DM), dyslipidemia (DY), and alcohol (AL) on monthly basis from January 2017 to December 2021 in Enugu State University Teaching Hospital were extracted. The dynamic regression model was applied to the data, best model is selected using Akaike information criterion corrected (AICC), and the model generated is used to predict the number of patients with stroke in 2022 and 2023. A total of 1216 patient records were included in this study. The proportion of hypertension was 51.49%, diabetes mellitus was 7.65%, alcohol was 6.4%, and dyslipidemia was 24.81%. Regression with ARIMA(0,0,1) was the best model. The prediction showed that by December 2022 the number of patients will increase by 29.63% and by December 2023 it will rise to 36.67%. The findings of this study suggest the prevalence of stroke in south-east Nigeria is high and will still rise in the future. There is still need of further research on stroke and other risk factors towards establishing appropriate policy, preventive and management measures.
Keywords: Nigeria, Risk Factors, Stroke, dynamic regression model, transient ischemic attack
Why Nigeria Must Care for, Eliminate and Eradicate Neglected Tropical Diseases (NTDs) (Published)
This paper thoroughly reviewed why Nigeria needs to care for, eliminate, and eradicate the neglected tropical disease (NTDs). The paper relied on the review of related literature to sufficiently expound on intervention, accomplishments, disadvantages, and techniques of eradication and elimination of NTDs in Nigeria. It has been documented that NTDs affect about two billion people worldwide, accounting for a quarter of the world’s population, with Africa accounting for over 40% of those affected. Although neglected tropical diseases are preventable and treatable, a significant amount of funds has been invested to eradicate and eliminate them. NTDs are diseases of the poor, according to reports, and efforts to eradicate them must address the causes of poverty as NTDs can cause a variety of problems. This paper suggested ways to eradicate NTDs in Nigeria including strengthening public health systems and supporting governments in the elimination of NTDs and limiting the transmission of disease pathogens by effective vector control among others.
Keywords: CDC, Intervention, NTDs, Nigeria, elimination, preventable diseases
Perception and Uptake of Malaria Rapid Diagnostic Test among Caregivers of Under-Five in Owerri West Local Government Area of Imo State, Nigeria (Published)
The launch of RDT is hoped to enable in reducing the rate of presumptive treatment of malaria. However, simply making RDTs available has not led to high uptake of the test, in light of this, it is crucial to understand the perception of RDT and its uptake among caregivers concerning the treatment of malaria in under five children, therefore the aim of the study was to determine the perception and uptake of rapid diagnostic test in the treatment of malaria among care givers of under five children in Owerri West Local Government. Descriptive study was employed and a multi stage cluster and systematic sampling techniques was used to select 420 respondents in the LGA. The Instrument for data collection was structured pre- tested questionnaire which was administered by trained researcher after gaining informed consent from the respondents. Results of the study showed that more respondents were aged 30 -49 years 161 (38.3%), females 268 (63.8%), Married 216 (51.4%), Primary education 126 (63.8%) and civil servant was 196 (46%) respectively. Perception of malaria RDT showed that 175 (41.7%) respondents were of the opinion that mRDT was useful, 102 (24.3%) not useful, 101 (24%) dangerous while 16 (2.8%) felt it was not good. Malaria RDT uptake indicated that majority of the respondents 223 (53.1%) did not know about RDT and 215 (51.2%) did not carry out mRDT test. 300 (73.8%) indicated that malaria rapid diagnostic test is not very useful and 373 (88.8%) of caregivers were of the opinion that mRDTs w ere expensive. From the study it is evident that the perception of malaria rapid diagnostic is negative and low, therefore sensitization of the caregivers about mRDTs will be of benefit.
Keywords: Imo State, Malaria, Nigeria, Perception, Uptake, under five
Medicine and Religion in the Nigerian Society: Conflicts and Controversies (Published)
This topic is borne out of the need to check an ugly trend which is now a cankerworm eating deeply into our health indices and progressively leading to the increasing mortality of our citizens even at a rate that may be far more than the activities of the terrorists. Shortly I shall be looking at the crack (conflicts and controversies) that have been created between Religion and Medical Science which unfortunately is widening by the day for no just cause.
Keywords: Controversies, Medicine, Nigeria, Religion., Society, conflicts.
Attitude and Sexual Behaviour of the Residents of Ijebu North Local Government Area of Ogun State, Nigeria on the Awareness of Hiv/Aids (Published)
This study sought to find out the Attitude and Sexual Behaviour of the residents of Ijebu North local Government Area of Ogun State towards people living with HIV/AIDS. Descriptive survey research design was adopted for the study. Accident sampling was used to sample 1,520 respondents in the local government. A self developed questionnaire was used as research instrument to sample 1,520 respondents. Simple percentages were used in analyzing the data. The result indicated that 1,520 respondents representing 100% the entire population were in support of campaigning and treatment programme for HIV/AIDS patients and also ready to encourage HIV/AIDS patients to spend the rest of their lives as loved ones 1328 respondents representing 87.36% of the entire population have changed from their promiscuous life style by being faithful to their sexual partners ,while192 respondents representing 12.64% were still engaging in promiscuous life style .Majority of the respondents that constitutes 85 .52%(1300) believed that abstinence remains the best option to avoid the infection while few respondents representing 14.48%(220) found it difficult to practice abstinence ,in other words they are not afraid of being exposed to HIV/AIDS It was established that the people of Ijebu North local government have positive attitude towards people living with HIV/ AIDS. And were ready to encourage HIV/AID S patients to spend the rest of their lives as loved ones, the awareness of HIV/AIDS have positively influenced their sexual behaviour with the opposite sex which made them to abstain from unhealthy sexual behaviours and embrace abstinence to be healthy. It was recommended among others that government and non government agencies should make people aware that HIV/AIDS is real and has no cure up to data. Health personnel should be moving from place to place to enlighten the rural dwellers about HIV/AIDS, and the consequences of exposure to the virus and ways of prevention and control of the infection that, if they are not infected they can be affected in many ways
Keywords: HIV/AIDS, Ijebu North, Nigeria, Ogun State., Sexual Behaviour, attitude