Influence of the new dispersible fixed-dose combination anti-Tuberculosis drug on treatment adherence among children with Tuberculosis in Osun State, Nigeria.

BACKGROUND: The dispersible fixed-dose combination drug has been recommended as the mainstay of treatment for TB in children. However, more needs to be known about its effect on treatment. This study aimed to assess the effectiveness of the formulation on treatment adherence among children with TB. METHODS: A historical cohort design was used to assess and compare adherences of old loose non-dispersible and new dispersible fixed-dose anti-TB drugs, using a convergent parallel mixed-method approach for data collection. Determinants of treatment adherence were assessed using binary logistic regression. RESULTS: The proportion of children with good treatment adherence was higher in the new dispersible formulation group (82 [64.6%]) relative to the proportion among the loose non-dispersible formulation group (29 [23.4%]). Reports of forgetfulness, travelling and pill burden were significantly higher among those with poor adherence in the loose non-dispersible formulation group. Significant predictors of treatment adherence were acceptability (adjusted OR [AOR]=4.1, p=0.013, 95% CI 1.342 to 12.756), travelling from treatment areas (AOR=8.9, p=0.002, 95% CI 2.211 to 35.771) and forgetfulness (AOR=74.0, p<0.001, 95% CI 23.319 to 234.725). CONCLUSIONS: The determinants of treatment adherence are multifactorial. In addition to ensuring universal access to the drug, flexible referral in case of travelling and ensuring treatment partners' participation to minimise forgetfulness to take pills, are essential.

Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study.

OBJECTIVES: This study aimed to assess the practices of private practitioners regarding tuberculosis (TB), and to ascertain factors related to the low contribution of private healthcare providers to TB prevention and care in Nigeria. DESIGN: This is a mixed methods study comprising a quantitative retrospective review and qualitative study. SETTING: Private health facilities (HF) in Oyo State and the Federal Capital Territory (FCT), Nigeria. PARTICIPANTS: We used routinely collected data on patients with tuberculosis (TB) notified between 1 January 2017 and 31 December 2018. In-depth interviews were also conducted with the clinical staff of the facilities. PRIMARY AND SECONDARY OUTCOME MEASURES: The study outcomes are practices of TB case notification and treatment outcome, as well as the barriers and enablers of TB notification. RESULTS: A total of 13 (11.0%) out of 118 private HF were designated as 'engaged' TB care facilities in Oyo State and none (0%) of the 198 private HF in the FCT held this designation. From the 214 patients with presumptive TB, 75 (35%) were diagnosed with TB, 42 (56%) had a bacteriological test done, 12 (16%) had an X-ray of the chest alone and 21 (28%) had other non-specific investigations. Most patients diagnosed were referred to a public HF, while 19 (25%) patients were managed at the private HF. Among them, 2 (10.5%) patients were treated with unconventional regimens, 4 (21%) were cured, 2 (11%) died, 3 (16%) lost to follow-up and 10 (53%) were not evaluated. The general practitioners did not have up-to-date knowledge of TB with a majority not trained on TB. Most referred patients with presumptive and confirmed TB to the public sector without feedback and were unclear regarding diagnostic algorithm and relevant tests to confirm TB. CONCLUSION: Most private facilities were not engaged to provide TB services although with knowledge and practice gaps. The study has been used to develop plans for strategic engagement of the private sector in Nigeria.

Predictors of tuberculosis knowledge among mothers of under-fives, seen at Bingham University Teaching Hospital, Jos Nigeria.

INTRODUCTION: Globally, tuberculosis still remains a disease of public health concern and accounts for high morbidity and mortality particularly in developing countries, where it is fuelled by a number of factors. METHODOLOGY: Through a cross-sectional descriptive study, this study aims to determine the predictors of knowledge about TB among 261 mothers of children under 5 years of age attending Child Welfare Clinic, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria. RESULTS: The mean age of the mothers was 31.54 ± 5.28 years, and 249 (98.4%) aware of TB. About two-third having sufficient knowledge and positive attitude regarding TB. Significant statistical association was found between knowledge and attainment of post-secondary education (OR 4.0; 95% CI 12.09, 7.63; p Ë‚ 0.001), monthly income ≤ 25,000 naira (OR 2.18; 95% CI 1.02, 4.65; p = 0.042), monthly income > 51,000 naira (OR 3.24; 95% CI 1.43, 7.31; p = 0.005), women engaged in business (OR 0.43; 95% CI 0.22, 0.83; p = 0.012) and possessing positive attitude (OR 3.87; 95% CI 2.16, 6.93; p ˂ 0.001) in the univariate analysis. However, in the multivariate logistic regression, it was only attitude that was found to be a predictor of TB knowledge of mothers. CONCLUSIONS: TB knowledge among the mothers was high, only attitude regarding thoughts and beliefs about TB was found as an independent predictor of TB knowledge. With the positive influence of attitude on knowledge among the mothers, it is recommended that this be strengthened for sustenance to prevent further infection.

Pattern and Predictors of Tobacco Use Among Undergraduates in Three Tertiary Institutions in North-Western Nigeria.

BACKGROUND: Tobacco use is associated with medical, social and economic problems. There is paucity of data on tobacco use among undergraduates in northern Nigeria. This study assessed pattern and predictors of tobacco use among undergraduates in Zaria, North-western Nigeria. METHOD: It was a cross-sectional study of undergraduates in three tertiary institutions. Multi-stage sampling technique was used to select 1,080 undergraduates. Data was collected using a questionnaire adapted from Global Adult Tobacco Survey and Global Youth Tobacco Survey. Bi-variate analysis was used to identify independent variables showing statistically significant association with current tobacco use. These were entered into step-wise logistic regression. RESULTS: Their median age was 24 years (range:15-47). Prevalence of current tobacco use was 27.0%. About 58.7% smoked tobacco daily and 40.0% used smokeless tobacco daily. Commonest places where tobacco was used were off campus accommodation (30.2%), social center (30.2%) and bar or club (28.1%). Predictors of tobacco use were being a male [2.64(1.82-3.84)], married [2.33(1.49-3.70)], experiencing tobacco promotional activity [1.56(1.12-2.17)], willing to use promotional objects [2.06(1.35-3.14)], using of promotional objects [2.74(1.90-3.96)], and exposure to secondhand smoke [14.10(4.16-47.81)]. Predictors of non-use of tobacco were spending two years or less awaiting university admission [0.65 (0.46-0.91)], parents currently together [0.48(0.33-0.69)], and supporting ban on tobacco [0.34 (0.23-0.48)]. CONCLUSION: Prevalence of tobacco use and expenditure on tobacco were high. University authorities should commence programs to identify tobacco users and encourage cessation. The findings also highlight the need to establish effective tobacco surveillance system that includes students of tertiary institutions.

Prevalence and pattern of dyslipidemia in patients with type 2 diabetes mellitus in Zaria, Northwestern Nigeria.

INTRODUCTION: Dyslipidemia confers excess atherosclerotic cardiovascular risk in type 2 diabetes mellitus (DM) patients, and this requires prompt identification and management to reduce morbidity and mortality. This study assessed the prevalence and pattern of dyslipidemia in type 2 DM patients in Zaria, Northwestern Nigeria. METHODS: This was a cross-sectional study of newly diagnosed type 2 DM patients at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Demographic, clinical and laboratory data were extracted from the case notes of eligible patients and analyzed using STATA version 14. Continuous variables were presented as mean ± standard deviation (SD), or median and interquartile range (IQR) while categorical variables were as frequencies and percentages. Student t and chi-square tests were used to test for association at p < 0.05. RESULTS: A total of 322 subjects (161 male, 161 female) with a mean age of 53.5 ± 10.8 years partook in the study. The prevalence of dyslipidemia was 69.3%. Mixed dyslipidemia of high triglyceride (TG) and high low-density lipoprotein cholesterol (LDL-C) was present in 41.0%; high TG and low high-density lipoprotein cholesterol (HDL-C) in 2.8%; and high LDL and low HDL in 2.5%. Atherogenic dyslipidemia, isolated hypercholesterolemia and isolated low HDL-cholesterol were present in 3.4%, 2.5% and 23.6% respectively. Dyslipidemia status was not associated with age, sex, duration of DM or hypertension, obesity, and mean fasting blood sugar (FBS) and 2-hour postprandial glucose. CONCLUSION: The prevalence of dyslipidemia is high in the newly diagnosed type 2 DM patients and therefore, initial management should incorporate measures to control dyslipidemia.

Prevalence and correlates of hypertension and diabetes mellitus in an urban community in North-Western Nigeria.

INTRODUCTION: Worldwide, hypertension and diabetes mellitus (DM) are major causes of morbidity and mortality. This study assesses the prevalence and correlates of hypertension and DM in an urban community in northwestern Nigeria. METHODS: This was a cross-sectional descriptive study. Adults aged 18 years and above, who attended a medical outreach program were interviewed and screened for hypertension and DM. Anthropometry, blood glucose and blood pressure were measured with standard instruments and methodology. Primary outcomes were hypertension and DM. Data were analyzed using STATA version 14 and presented as mean ± standard deviation and frequencies. Chi-square and Pearson's correlation co-efficient were used to identify the correlates of hypertension and DM, at 5% level of significance. RESULTS: The mean age of participants was 51.0 ± 14.0 years and 87.8% were females. Prevalence of hypertension and DM were 55.9% and 23.3% respectively. Age greater than 40 years and female gender were associated with risk of hypertension and DM respectively, p < 0.05. There was a weak correlation between systolic hypertension and age (r = 0.18, p = 0.02), diastolic hypertension and body mass index (r = 0.16, p = 0.03) and blood sugar and waist circumference (r = 0.19, p = 0.02). CONCLUSION: The high prevalence of hypertension and DM among the study population highlights the need for the development and implementation of a community-based public health interventions aimed at reducing their risk factors.

Seroprevalence of human cysticercosis and its associated risk factors among humans in areas of Kaduna metropolis, Nigeria.

INTRODUCTION: Taenia solium cysticercosis is considered an emerging parasitic zoonosis of global importance due to its impact on both agriculture and public health in developing countries. Epidemiological information on human cysticercosis is limited in Nigeria. This study was conducted to determine the seroprevalence of human cysticercosis in areas of Kaduna metropolis, Nigeria, where small-holder pig farming is practiced. METHODOLOGY: A cross-sectional survey was conducted in Kaduna South and Chikun Local Government Areas of Kaduna metropolis, which are widely involved in small-holder pig farming and pork consumption. A total of 300 human sera were collected and tested for the presence of IgG antibodies to T. solium using an enzyme-linked immunosorbent assay (ELISA) technique. A structured questionnaire was used to identify risk factors in the population and was administered to the study population. RESULTS: A total of 43 of 300 sera tested positive to IgG antibodies, indicating a cysticercosis prevalence of 14.3%. Method of pork preparation and history of epilepsy were found to be strongly associated with seropositivity. Epileptics in this study were two times more likely to be seropositive than non-epileptics. A large proportion (74.0%) of the population had very poor knowledge of cysticercosis, and knowledge of cysticercosis was strongly associated with method of pork preparation and respondents' occupations. CONCLUSIONS: A high seroprevalence of human cysticercosis was found in Kaduna South and Chikun Local Government Areas. The main risk and behavioral factors contributing to the high prevalence include poor knowledge of cysticercosis and lack of knowledge on proper pork preparation methods.

Assessment of sanitary conditions of unregistered pig slaughter slabs and post mortem examination of pigs for Taenia solium metacestodes in Kaduna metropolis, Nigeria.

BACKGROUND: A number of studies document the prevalence of Taenia solium infections in Nigeria, yet these studies do not cover porcine cysticercosis in private home slaughter slabs where there is no routine meat inspection and backyard pig keeping, slaughtering and sale are common practice. METHODS: An environmental and sanitary assessment was conducted within two unregistered home pig slaughter slabs in selected parts of the Kaduna metropolis in Nigeria. Slaughter premises were inspected for availability of basic facilities and questionnaires were used to elicit necessary informative data. Butchers were examined for taeniasis by stool microscopy and copro-antigen enzyme linked immunosorbent assay (copro-Ag ELISA) to ascertain T. solium - taeniasis. Pigs slaughtered at the premises were examined for cysticerci. RESULTS: Home slaughter conditions were substandard, unhygienic and lacked the basic facilities of a proper slaughterhouse. Prevalence of porcine cysticercosis was 9.3%. The butchers participating in the study had very poor knowledge of T. solium infections and 30% tested positive for taeniasis by copro-Ag ELISA at the time of the study. CONCLUSION: Home slaughter of pigs in the areas studied should be considered and integrated as a component of prevention and control programmes - particularly through educational interventions - in order to equip individuals involved with a good understanding of the risks associated with animal husbandry and human practices.