Eradicating leprosy in Saudi Arabia: outcome of a ten-year surveillance (2003­2012).

BACKGROUND: The Kingdom of Saudi Arabia (KSA) has a sentinel surveillance system on leprosy for effective monitoring of the disease. METHODS: A retrospective epidemiological analysis of all cases of leprosy captured by the surveillance system between 2003 and 2012 was conducted. RESULTS: Over the 10-year period, there were 242 reported cases of leprosy in KSA, 67% of which were in those aged between 15 and 44 years of age. Males accounted for over 77% of all cases and non-Saudi nationals, dominated by Indians, and represented 57.4% of the total cases. Just over half of the cases were paucibacillary leprosy, and 9% were grade 2 disability. Makkah region accounted for nearly 42% of all cases. Annual trends showed an overall decline in the yearly cases and prevalence of the disease from 41 cases (0.018 per 10,000 population) in 2003 to 15 cases (0.005 per 10,000 population) in 2012. CONCLUSION: KSA needs to strengthen the leprosy surveillance systems, as well as health care and community education about the disease which will help effective monitoring, early detection and treatment of the disease. Moreover, the role or migrants in the importation of the disease needs to be addressed to achieve and maintain eradication.

Treatment outcomes among pulmonary tuberculosis patients at treatment centers in Ibadan, Nigeria.

OBJECTIVE: To assess treatment outcomes and determinants of outcome among tuberculosis patients. DESIGN: A longitudinal study design involving a cohort of sputum smear-positive pulmonary tuberculosis patients at initiation of therapy, who were followed up to the end of treatment at eighth month. SETTING: Tuberculosis treatment centers in Ibadan, Nigeria. RESULTS: A total of 1,254 patients were followed up with a mean age of 35.0+/-3.3 years. The percentages of patients with treatment outcomes assessed in the study were as follows: cure (76.6%), failure (8.1%), default (6.6%), transferred out (4.8%), and death (1.9%). The cure rate varied significantly between treatment centers from 40 to 94.4% (P<0.05). The treatment centers located within the specialist health centers at Jericho and the University College Hospital had 50 and 75% cure rates, respectively.The mean age of cured patients was 31.2+/3.1 years which was significantly lower than the mean age of those with poor treatment outcomes (36.7+/3.5 years; P<0.05). Males had a higher risk of a poor treatment outcome (RR=1.8; 95% CI: 1.02-1.94) than females. Also, patients with a poor knowledge of tuberculosis had a higher risk of having a poor treatment outcome (RR=1.35; 95% CI: 1.25-1.62) compared to those with knowledge. CONCLUSION: Variations in health center treatment outcomes and poor knowledge of tuberculosis among patients suggest that poor program implementation quality may be a major modifiable determinant of treatment outcomes in our environment.

Prevalence and determinants of nonadherence to highly active antiretroviral therapy among people living with HIV/AIDS in Ibadan, Nigeria.

OBJECTIVE: To determine the level of nonadherence to highly active antiretroviral therapy (HAART) and to explore the association of factors militating against adherence and nonadherence to therapy among people living with HIV/AIDS (PLWHA) at an Antiretroviral Clinic in Ibadan, Nigeria. DESIGN: A cross-sectional survey was employed to determine the prevalence of nonadherence. METHODOLOGY: A structured interviewer-administered questionnaire was applied to consecutive PLWHA who had been on therapy for a minimum of three months. The completed questionnaires were entered into a computer and analyzed. Multivariate logistic regression was used to determine factors associated with nonadherence. RESULTS: Three hundred and eighteen people living with HIV/AIDS completed the questionnaire. Their mean age was 39.1+/-9.6 years. There were 173 (54.4%) females and 145 (45.6%) males. The median duration on HAART was 19 months (Range 3 to 28 months) and the prevalence of nonadherence was 118 (37.1%) using the less than 95% adherence profile. About a third (31.5%) of those missing therapy reportedly missed their medication because of fasting. Multiple logistic regression analysis revealed that patients who felt healthy or simply forgot to take their drugs and those not willing to disclose their HIV status were independently, significantly associated with less than 95% adherence. CONCLUSION: The study showed that nonadherence to HAART is a problem in the ARV clinic and that the feeling of being healthy, forgetfulness, and unwillingness to disclose HIV status by PLWHA were significant barriers to adherence. Efforts to improve adherence in the clinic will have to address these issues among others.

Lymphadenopathy in adults. A clinicopathological analysis.

OBJECTIVE: To describe the clinicopathological features of patients admitted to adult wards with a primary presenting feature of lymphadenopathy. METHODS: A retrospective study of all patients admitted to Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia between April 1996 through to March 2000. RESULTS: The patients mean age was 35.2 years (standard deviation 15.7 years) and 59.5% were females while 56.2% were Saudis. Swelling was the primary presenting symptom in 39.3% of the patients, while fever, night sweats, and pain occurred in 17.3%, 10.3% and 8.5% patients. There was considerable overlap between benign and malignant causes of lymphadenopathy but in 56.6% of patients, lymphadenopathy was the only sign. The cervical group of lymph nodes was the most commonly affected site. Hepatomegaly, splenomegaly and both organ enlargement occurred in 59 (22.9%) patients. The presence of generalized lymphadenopathy and other physical signs (serositis and organomegaly) highly suggested a malignant process. Granulomatous lymphadenopathy due to tuberculosis was the most frequent pattern 98 (37.9%) followed by lymphoma 85 (32.9%). Tuberculosis was also more common in females than males (51% versus 19%). Among patients with Hodgkin's disease, nodular sclerosis was the most frequent (75%). Routine investigations did not discriminate between benign and malignant causes of lymphadenopathy. The overall mortality rate was 8.1%: with metastatic disease accounting for 52.4%. CONCLUSION: There were significant similarities and differences between these findings and other previous studies in the Kingdom of Saudi Arabia and elsewhere.