Spatial distribution of leprosy in Nigeria.

Background: Despite achieving the WHO elimination target of less than 1/10,000 population in 1998 at the national level, there are still pockets of relative high endemicity of leprosy in Nigeria. This study used spatial analytic techniques to determine the spatial distribution of leprosy in Nigeria. Methods: The study is an ecological study of secondary data of new leprosy cases reported to the National TB and Leprosy Control Programme (NTBLCP) in Nigeria, 2010­2014. The 36 states and Federal Capital Territory were used as the unit of geographical analysis. The global Moran's I and Local Moran's I (LISA) test were used to measure spatial autocorrelation and significant levels were taken at P < , 0·05. Results: A total of 17,356 new leprosy cases were notified over 5 years (2010­2014) in Nigeria. A majority of the cases were multi-bacillary 16,037 (92·4%) while 1319 (7·6%) were pauci-bacillary. A total of 1569 (9%) children were reported with leprosy. The leprosy case detection rate increased slightly from 2·21/100,000 in 2010 to 2·24/100,000 in 2012 and declined to 1·66/100,000 population in 2014. Significant clustering of average annual leprosy case detection rate was observed in Kebbi state only, while childhood leprosy was significantly clustered in four states namely Sokoto, Kebbi, Rivers and Zamfara states. Conclusion: The study observed a significant clustering of leprosy case detection rate in Nigeria. The findings can serve as a useful guide to the national leprosy control programme for efficient use of scarce resources to target interventions to priority states for the elimination of leprosy in the country.

Treatment Outcomes of Childhood TB in Lagos, Nigeria.

BACKGROUND: : Treatment outcomes of tuberculosis (TB) in children are rarely evaluated by most national TB programmes in sub-Saharan Africa. This study evaluated the treatment outcomes of children treated for TB in Lagos State, Nigeria. METHODS: A retrospective review of programme data of the Lagos state TB and the Leprosy control programme in Nigeria from 1 January 2012 to 31 December 2012. Treatment outcomes were categorized according to the national TB guidelines. RESULTS: A total of 535 cases of childhood TB were notified in 2012, representing 6.3% of the total TB cases notified in Lagos state in 2012. The prevalence of TB/HIV co-infection was 29%. The treatment success rate was 79.2% in TB/HIV-negative children compared with 73.4% in TB/HIV-positive children (p = 0.1268). Children <1 year had the worst treatment outcomes (p < 0.001). CONCLUSION: There is a need to intensify effort at improving notification and treatment outcomes in children.

Doing no harm? Adverse events in a nation-wide cohort of patients with multidrug-resistant tuberculosis in Nigeria.

BACKGROUND: Adverse events (AEs) of second line anti-tuberculosis drugs (SLDs) are relatively well documented. However, the actual burden has rarely been described in detail in programmatic settings. We investigated the occurrence of these events in the national cohort of multidrug-resistant tuberculosis (MDR-TB) patients in Nigeria. METHOD: This was a retrospective, observational cohort study, using pharmacovigilance data systematically collected at all MDR-TB treatment centers in Nigeria. Characteristics of AEs during the intensive phase treatment were documented, and risk factors for development of AEs were assessed. RESULTS: Four hundred and sixty patients were included in the analysis: 62% were male; median age was 33 years [Interquartile Range (IQR):28-42] and median weight was 51 kg (IQR: 45-59). Two hundred and three (44%) patients experienced AEs; four died of conditions associated with SLD AEs. Gastro-intestinal (n = 100), neurological (n = 75), ototoxic (n = 72) and psychiatric (n = 60) AEs were the most commonly reported, whereas ototoxic and psychiatric AEs were the most debilitating. Majority of AEs developed after 1-2 months of therapy, and resolved in less than a month after treatment. Some treatment centers were twice as likely to report AEs compared with others, highlighting significant inconsistencies in reporting at different treatment centers. Patients with a higher body weight had an increased risk of experiencing AEs. No differences were observed in risk of AEs between HIV-infected and uninfected patients. Similarly, age was not significantly associated with AEs. CONCLUSION: Patients in the Nigerian MDR-TB cohort experienced a wide range of AEs, some of which were disabling and fatal. Early identification and prompt management as well as standardized reporting of AEs at all levels of healthcare, including the community is urgently needed. Safer regimens for drug-resistant TB with the shortest duration are advocated.