Adherence to the MDR-TB intensive phase treatment protocol amongst individuals followed up at central and peripheral health care facilities in Uganda - a descriptive study.

BACKGROUND: Following initiation of MDR-TB treatment, patients have a choice to receive follow up DOT supervision at either the central initiating facility or at a peripheral facility. OBJECTIVES: We describe the adherence patterns of MDR-TB patients undergoing DOT supervision at the two health facility categories during intensive phase of treatment. METHODS: We used a retrospective cohort of patients initiated on MDR TB treatment at Mulago National Referral Hospital between 2014 and 2016. We extracted data from the National Tuberculosis and Leprosy Program records and analysed these using STATA V14. RESULT: Majority (84.01%) of the patients received their DOT supervision from the peripheral facilities. Males made up 62.1% of patients, and 91.2% had had their household contacts screened for MDR-TB. 26.5% of the patients on peripheral DOT supervision had good adherence to treatment protocol compared to 0% among patients on central initiating health facility DOT supervision. Among the patients with good adherence, 24.1% had contacts screened for MDR-TB as compared to 3.6% with poor adherence. CONCLUSION: More patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settingsMore patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settings.

Comparing the perception of community members towards leprosy and tuberculosis stigmatization.

BACKGROUND: Health professionals at all levels gradually recognise the impact of stigma on case detection and treatment of various health conditions such as leprosy and tuberculosis. These diseases are identified as chronic diseases which are prone to stigmatisation. PURPOSE: To assess the perception of community members towards stigma related to leprosy and tuberculosis, in order to verify and compare the existence of stigma towards these two diseases in the community, and to provide baseline data for the evaluation of future de-stigmatising interventions. METHODS: This study was done in four sub-districts of Chaiyaphum province. Community members were interviewed using the EMIC stigma scale. Frequency was used to identify the percentage of community members who perceived stigma. A T-test was applied to compare the mean EMIC scores of community members between leprosy and tuberculosis. A P-value of < 0.05 was considered indicative of a statistically significant difference or association. RESULTS: It was found that community members perceived that people affected by leprosy or tuberculosis were stigmatised by the community. However, community members perceived more stigma towards leprosy than towards tuberculosis, particularly in terms of shame, embarrassment, and problems in getting married. The difference was highly significant (P = 0.001, paired t-test). CONCLUSION: The community's perceived stigma against people affected by either leprosy or tuberculosis may affect many aspects of their lives. The authors recommend use of strategically targeted de-stigmatising interventions that take local attitudes and perceptions into consideration.

A public-private partnership to reduce tuberculosis burden in Akwa Ibom State, Nigeria.

BACKGROUND: Tuberculosis (TB) infection and spread are preventable, and TB disease is curable depending on individual and community knowledge of causes of the disease, mode of prevention and cure. An earlier educational intervention carried out in Akwa Ibom State (AKS) of Nigeria in 2006 created awareness of the disease and improved utilization of orthodox medical facilities of residents in 34 communities who had symptoms of TB. OBJECTIVE: The overall aim of this program is to reduce the burden of TB disease in 18 communities of AKS through educational intervention, TB case detection and integration into the State National Tuberculosis and Leprosy Control Programme (NTBLCP), as well as build laboratory capacity to improve TB case detection and control. METHODS: Prior to the educational intervention in each community, standard pretested questionnaires were administered to residents to test their knowledge, attitudes and practices concerning TB. Information about causes, symptoms and prevention of TB was disseminated in community town halls, churches, markets and schools. Individuals who were coughing for three weeks or more were investigated for TB following clinical examination by a physician. Three sputum samples (spot-morning-spot) were obtained from each individual and examined microscopically for the presence of acid-fast bacilli (AFB) using the Ziehl-Neelson staining technique. Those with positive AFB results were integrated into the existing NTBLCP treatment facilities for immediate commencement of Directly-Observed Therapy Short Course (DOTS). Treatment outcome was monitored by retesting patients' sputum after two, five and seven months. Two new laboratories were facilitated while existing laboratory capacity was built by providing higher resolution microscopes, power generating plants, refrigerators, locally-fabricated incinerators and furnishing of staff offices. The program was facilitated by a public-private partnership. Effective Health Care Alliance Research Programme (EHCARP-Nigeria), in collaboration with Nigeria National Petroleum Cooperation and Mobil Producing Nigeria Unlimited (NNPC/MPN) Joint Venture, utilized health personnel from the Akwa Ibom State NTBLCP who conducted laboratory testing and supervised the treatment. RESULTS: The 916 responses to the questionnaires showed that 65.3% (549/841) correctly identified that TB is airborne, and 86% (749/871) were aware that TB could be cured by anti-TB medication. Responses to care-seeking attitudes were provided by 123 respondents. Of this number, fear of stigmatization was the reason for 31% (38) seeking care in unorthodox facilities, while 43.1% (53) did not believe that orthodox medicine could cure their symptoms. Of the 374 detected cases, 9 did not commence treatment. Hence, 365 were placed on DOTS; 36 defaulted, while 11 either died or failed to convert after the seventh month. At the end of month 8, cure was achieved for 87.1% (318). CONCLUSION: Although the previous intervention may have contributed to the good knowledge about TB and care-seeking attitudes displayed by respondents in the communities, sustaining active case finding through public-private partnership can go a long way to reduce TB burden, especially in rural communities where healthcare systems are generally weak or inadequate. Adequate funding of TB control activities is critical in eliminating TB as a public health problem, and the private sector participation such as this is a welcome development.

Study on differences and similarities in the concept and origin of leprosy stigma in relation to other health-related stigma.

While the experienced or enacted stigma may be the same for all health related stigma, in terms of isolation, discrimination and social participation restrictions of the affected persons; the concept and origin of stigma varies from one disease to another. An understanding of the cause of stigma is, therefore, essential to formulate effective strategies for its reduction/elimination. This is especially imperative in the case of leprosy where the basis of stigma is significantly different from other health related stigma. In this paper, a comparison is made between the concept and origin of leprosy stigma with that of other stigmatised diseases.

Factors influencing completion of treatment among tuberculosis patients in Mbarara District, Uganda.

An organised TB treatment programme was started in Uganda in 1989. A cohort analysis of treatment outcome among 1400 patients seen in Mbarara district in 1995 showed a very low compliance rate of 56% and this study attempted to look at operational factors that may be associated with this low compliance rate. The factors that are associated with enhanced completion of treatment include; being smear positive: use of short course chemotherapy; previous TB treatment; if patient returned for repeat smear; if patient did not change unit; and if patient did not change district. Gender and age were not associated with compliance. On unconditional logistic regression, previous TB treatment and being smear positive were found not to be statistically significant. Change of health unit after intensive phase showed the highest risk, with an adjusted odds ratio of 22.31. Of the significant factors only use of standard chemotherapy and change of health unit after intensive phase can be altered to improve compliance.

PIP: Tuberculosis (TB) causes considerable morbidity and mortality globally. The Uganda National Tuberculosis and Leprosy Program (NTLP) was launched in October 1989 in an attempt to coordinate and intensify TB control efforts in the country. The NTLP's main prevention and control strategy consists of case finding and chemotherapy. The retrospective cohort analysis of data on the treatment outcome of 1400 TB patients seen in Mbarara district in 1995 yielded a 56% compliance rate. The operational factors which may be associated with this low rate were subsequently investigated. The following factors were found to be associated with the enhanced completion of treatment: being smear positive, using short-course chemotherapy, having previously received TB treatment, being a return patient for repeat smear, being a patient who did not change unit, and being a patient who did not change district. Neither gender nor age was associated with compliance. Unconditional logistic regression found previous TB treatment and smear-positive status to be statistically insignificant. Change of health unit after the intensive phase of treatment showed the highest risk of default, with an adjusted odds ratio of 22.31. Of the significant factors, only the use of standard chemotherapy and change of health unit after the intensive phase can be changed to improve compliance.

[The patient with Hansen's disease confronts his distress]. / Le hansénien face à son angoisse.

This article is about the effect of Hansen's disease on the personality of 29 patients of the Institute of Applied Leprology of Dakar, Foundation of the Order of Malta. This approach to the distress of these patients was done by an inquiry based on sociocultural and clinical variables and compared to a study composed of tubercular and psychiatric patients. This study reports four distress levels (loss of identity, loss of object, forlornness, culpability) which are distinguished by sex and age. The actual analysis of the experience of this distress shows the importance of support of the traditional representation of these leprous patients' psychology.