Predictors of mortality among drug-resistant tuberculosis patients in Kaduna State, Nigeria.

Background: Specific death due to DR-TB has significantly contributed to tuberculosis (TB) mortality and overall global deaths. Aim: This study examines the predictors of mortality among DR-TB patients in Kaduna State, Nigeria. Subject and Method: This was a retrospective longitudinal study of DR-TB mortality carried out among 370 DR-TB patients from the 23 LGAs in Kaduna State. It involves a retrospective review of the MDR-TB records of the patients over a period of 10 years (2012-2021). Demographic and clinical data of all DR-TB patients enrolled in Kaduna State, Nigeria, between April 1, 2012, and March 31, 2021, were used. Survival analysis was performed with SPSS version 25, using Kaplan-Meier and Cox proportional hazard regression modeling, at 5% significance level. Results: The majority of the patients, 255 (68.9%), were below the age of 40 years, while 53 (14.3%) of the patients died within the study period. Most deaths 26 (49.1%) were associated with HIV co-infection and the disease severity. Results for the Cox proportional model show that there was a significantly lower risk of death when a patient had MDR-TB compared to pre-XDR-TB (adjusted hazard ratio, AHR = 0.34, 95% CI = 0.16-0.72, P = 0.04). Both models show that age, sex, residence, or year of treatment had no significant association with survival or death. Conclusion: HIV co-infection and DRTB with progression to more resistant and difficult-to-treat strains contributed to higher deaths. There is a need for concerted efforts from all DR-TB stakeholders to control the disease.

Knowledge and Compliance with Malaria National Treatment Guidelines among Primary Health Care Workers in a Rural Area in Northern Nigeria.

BACKGROUND: Knowledge and compliance with malaria treatment guidelines are among the major issues affecting treatment outcome for malaria in Nigeria. Primary health care (PHC) facilities are the first point of contact with the national health system for patients with malaria and other diseases. OBJECTIVE: This study assessed the knowledge and compliance with malaria National Treatment Guidelines (NTG) among PHC workers in Lere local government area of Kaduna State, North western Nigeria. METHODS: This was a descriptive cross-sectional study conducted among 42 community health workers. The total population of all eligible participants was used for subject selection. Data were analysed with SPSS IBM version 25.0 and STATA/SE 12. The level of statistical significance p-value was set at p<0.05. RESULTS: The mean age of the respondents was 38.02±9.23 years. Majority of the respondents were males (25; 59.5%) and community health extension workers (CHEWs) (24; 57.1%). Almost one-third (28.6%) of the PHC workers had poor knowledge of the recommendations of the NTG for malaria, while 14.3% had poor compliance with the NTG. Bivariate analysis showed a significant relationship between older age and good knowledge of the NTG ( χ2 =0.03, p=0.04). Multivariate analysis further revealed that the odds for poor knowledge of NTG was 40% higher among CHEWs compared to other health workers (AOR=1.40, 95% CI=0.25-7.93). The odds for good knowledge was lower by 55% among those who had practiced for <10 years compared to >10 years (OR=0.45, 95% CI=0.06-3.32). CONCLUSION: Poor knowledge and compliance to malaria NTG were commoner among lower cadre (CHEWs) staff with relatively fewer years in PHC practice. There is a need for training, retraining and equitable distribution of the NTG to ensure access and also improve knowledge and utilisation of the NTG for malaria by rural PHC workers.

CONTEXTE: La connaissance et le respect des directives de traitement du paludisme sont parmi les principaux problèmes qui affectent les résultats du traitement du paludisme au Nigéria. Les établissements de soins de santé primaires (SSP) sont le premier point de contact avec le système national de santé pour les patients atteints de paludisme et d'autres maladies. OBJECTIF DE L'ÉTUDE: Cette étude a évalué les connaissances et le respect des directives nationales de traitement du paludisme (NTG) parmi les travailleurs des SSP dans la zone de gouvernement local de Lere de l'État de Kaduna, dans le nord-ouest du Nigeria. MÉTHODES: Il s'agit d'une étude descriptive transversale menée auprès de 42 agents de santé communautaires. La population totale de tous les participants éligibles a été utilisée pour la sélection des sujets. Les données ont été analysées avec SPSS IBM version 25.0 et STATA/SE 12. Le niveau de signification statistique a été fixé à p<0,05. RÉSULTATS: L'âge moyen des personnes interrogées était de 38,02±9,23 ans. La majorité des personnes interrogées étaient des hommes (25 ; 59,5%) et des agents de vulgarisation en santé communautaire (24 ; 57,1%). Près d'un tiers (28,6 %) des agents de santé publique connaissaient mal les recommandations de la NTG pour le paludisme, tandis que 14,3 % ne respectaient pas la NTG. L'analyse bivariée a montré une relation significative entre l'âge avancé et la bonne connaissance du NTG ( χ2=0,03, p=0,04). L'analyse multivariée a également révélé que la probabilité d'une mauvaise connaissance de la NTG était 40% plus élevée chez les CHEW que chez les autres agents de santé (AOR=1,40, 95% CI=0,25-7,93). La probabilité d'une bonne connaissance était inférieure de 55% chez ceux qui avaient pratiqué pendant <10 ans par rapport à >10 ans (OR=0,45, 95% CI=0,06-3,32). CONCLUSION: Le manque de connaissances et d'observance des NTG sur le paludisme était plus fréquent parmi le personnel des cadres inférieurs (CHEWs) ayant relativement moins d'années de pratique dans les soins de santé primaires. Il est nécessaire de former, de recycler et de distribuer équitablement les NTG pour garantir l'accès et améliorer la connaissance et l'utilisation des NTG pour le paludisme par les travailleurs des SSP en milieu rural. Mots clés: Connaissance, Observance, Personnel de soins de santé primaires, Directives, Paludisme.

Comparison of the Ivermectin and Lopinavir/Ritonavir Treatment Outcomes among COVID-19 Mild to Moderate Cases in Kaduna State.

BACKGROUND: Ivermectin has been a popular anti-parasitic drug since the late 1970s. The promising result of in-vitro studies on the antiviral activity of the drug has led clinicians in many countries to use this drug to treat COVID-19 patients. This study determined and compared the mean number of days at clinical recovery for mild to moderate cases of COVID -19 treated with Lopinavir/Ritonavir (Alluvia) and Ivermectin at the Kaduna State Infectious Disease Control Centres. METHODS: This was a comparative cross-sectional study conducted among 300 mild to moderate COVID- 19 cases enrolled for the study. The outcome variables were the time required for the resolution of symptoms from the onset and at commencement of the treatment regimens. Data were collected from patient folders using a questionnaire. Data were analysed with the IBM SPSS Version 25.0 and STATA/SE 13. Statistical significance was set at p<0.05. RESULTS: The mean recovery time (MRT) from symptom onset was significantly lower for Covid-19 patients treated with ivermectin (7.15±4.18 days) compared to lopinavir/ritonavir (9.7±5.3 days), 95%CI=7.37-9.62. Multivariate logistic regression showed that there was no significant relationship between the patients age (AOR=0.36, 95%CI=0.09-1.49), sex (AOR=0.34,95%CI=0.54-5.93), educational status (AOR=1.04, 95%CI=0.3-3.57), marital status (AOR=0.55,95%CI=0.14-2.11) place of treatment (AOR=1.66, 95%CI=0.54-5.11) and MRT. There was also no significant relationship between patients' comorbid chronic illness (AOR=0.83, 95%CI=0.27-2.61) and MRT. CONCLUSION: The mean recovery time for COVID-19 patients managed with ivermectin was slightly lower than for the lopinavir/ ritonavir regimen. RECOMMENDATION: Clinical trials to further prove the efficacy of Ivermectin as a supportive therapy in clinical management of mild to moderate cases of COVID-19 in this setting should be carried out.

CONTEXTE: L'ivermectine a été un médicament antiparasitaire populaire depuis la fin des années 1970. Le résultat prometteur d'études in vitro sur l'activité antivirale du médicament a conduit les cliniciens de nombreux pays à utiliser ce médicament pour traiter les patients atteints de COVID-19. Cette étude a déterminé et comparé le nombre moyen de jours de récupération clinique pour les jours légers à cas modérés de COVID-19 traités par Lopinavir/Ritonavir (Alluvions) et ivermectine à la maladie infectieuse de l'État de Kaduna Centres de contrôle. MÉTHODES: Il s'agissait d'une étude comparative transversale menée auprès de 300 cas légers à modérés de COVID-19 inscrits pour l'étude. Les variables de résultat étaient le temps requis pour la résolution des symptômes dès le début et au début de la schémas thérapeutiques. Les données ont été recueillies à partir des dossiers des patients à l'aide d'un questionnaire. Les données ont été analysées avec version 25.0 du IBM SPSS et STATA/SE 13. La signification statistique a été fixée à p<0.05. RÉSULTATS: Le temps moyen de récupération (TRM) à partir de l'apparition des symptômes était significativement plus faible chez les patients Covid-19 traités par l'ivermectine(7.15±4.18 jours) par rapport au lopinavir/ritonavir (9.7±5.3 jours), IC à 95 % = 7.37 à 9.62. La régression logistique multivariée a montré qu'iln'avait pas de relation significative entre l'âge des patients (AOR = 0.36, IC à 95 % = 0.09 à 1.49), sexe (AOR = 0.34, 95 % IC = 0.54 à 5.93), education statut (AOR =1.04, IC à 95 % = 0.3­3.57), état matrimonial(AOR = 0.55, 95% IC = 0.14­2.11) lieu de traitement (AOR = 1.66, IC à 95 % = 0.54 à 5.11) et TRM. Il n'y avait pas non plus de relation entre la maladie chronique comorbide des patients (AOR = 0.83, IC à 95 % = 0.27 à 2.61) et TRM. CONCLUSION: Le temps de récupération moyen pour les patients atteints de COVID-19 gérés avec de l'ivermectine était légèrement inférieur à celui du lopinavir/régime de ritonavir. RECOMMANDATION: Essais cliniques pour prouver l'efficacité de l'ivermectine comme traitement de soutien dans la prise en charge clinique des cas lègers à modérés de COVID-19 dans ce contexte devraient être effectués. Mot-clés: Ivermectine, Alluvie, Traitement, MRT, Essai clinique, COVID-19.

Predictors of pediatric HIV disclosure among caregivers of HIV positive children attending special treatment clinic in dalhatu araf specialist hospital, Lafia, Nigeria.

BACKGROUND: HIV-infected children now live longer due to the availability of HIV counseling, testing, and treatment with highly active antiretroviral treatment (HAART). Efforts to help these children to know about the HIV infection and their status are important steps toward long-term disease management. This study was conducted to determine the factors associated with pediatric HIV disclosure among caregivers of children attending Special Treatment Clinic at Dalhatu Araf Specialist Hospital, Lafia. METHODS: This was a descriptive cross-sectional study conducted among 160 caregivers of children attending the Special Treatment Clinic (STC) at DASH, Lafia, selected by systematic random sampling technique. Interviewer administered structured questionnaire was used to collect data, while bivariate and multivariate analyses were done with the Epi Info version 7. RESULTS: Pediatric HIV disclosure rate in this study was 33.8%. The mean age at pediatric HIV disclosure was 9.85 ± 1.86 years. The independent predictors for pediatric HIV disclosure following logistic regression were child's age, 10-14 years (AOR = 4.46; 95%CI 1.47-13.61), child knowledge of caregivers' HIV status (AOR = 51.18; 95%CI 13.40-195.66), and caregivers' age ≥40 years (AOR = 3.58; 95%CI 1.25-11.74). CONCLUSIONS: The pediatric HIV disclosure was low in this study due to the caregivers' and their wards' factors. Health care workers need to intensify health education on the benefit of pediatric HIV disclosure at the STC clinic.

Determinants of desire for child spacing among women attending a family planning clinic in Kaduna, north western Nigeria

Background: Family planning (FP) refers to a conscious effort by a couple to limit or space the number of children they want using contraceptive methods. This study examined the determinants for child spacing among women of reproductive age at the family planning clinic of the Ungwan-Rimi Primary Health Care facility, Kaduna North LGA, North western, Nigeria.Methods: The study was a retrospective cross-sectional review of the records of 1351 clients who accessed FP services at the facility between June 2010 and May 2017. A proforma was used to extract required information from the clients' records. Data was analyzed using the IBM SPSS Version 25.0 and STATA/SE 12. Statistical significance was set at p<0.05Results: The median (IQR) age of the clients was 27 (8.0) years. Majority 883 (65.4%) completed at least secondary education. A greater proportion of the clients' 1119 (82.8%) desired child spacing compared to child limiting 232 (17.2%). Bivariate analysis showed that younger age (p<0.001), attainment of up to a secondary education (p=0.04), parity < 4, (p<0.001) and last child birth (LCB) <1year, (p<0.001) were significantly associated with desire for child spacing. Multiple logistic regression analysis further revealed that the older age group ≥ 35 years (AOR=3.72, 95%CI=2.21-6.63) parity of ≥ 4 (AOR=2.35, 95%CI = 1.6-3.46) and use of long acting reversible contraceptive (LARC) (AOR=1.40, 95%CI=1.02-1.91) were significantly associated with increased odds of no desire for child spacing.Conclusion: This study shows that clients' age group, parity and preference for LARC influenced behavioral attitudes for child spacing

Awareness and Utilization: Prevention of Mother-to-Child Transmission (PMTCT) Services among Primigravid Women attending Primary Health Care Facilities in Zaria, North-Western Nigeria.

BACKGROUND: Nigeria with an estimated population of 193 million is Second to South Africa in the number of people living with Human Immune Deficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) worldwide, representing 9% of the global burden of the disease. The objective of this study is to determine the awareness, knowledge and utilization of PMTCT services before first pregnancy in the study population, which is a critical prong 1 PMTCT strategy to prevent and control the vertical transmission of this pandemic infection. METHODS: An analytical cross-sectional study conducted in February-April 2016 among 300 Primigravid women selected by the cluster sampling technique from six Primary Health Care (PHC) facilities that offered PMTCT services out of a list of 25 PHC facilities in Zaria LGA at the time of the survey. Data were collected using interviewer administered, closed ended questionnaire. Bivariate and multivariate logistic regression analyses were done using the IBM SPSS version 20 and the Stata Corp STATA SE 14 to determine variables that were significantly associated with respondents' utilization of the PMTCT services. The level of significance was set at p<0.05. RESULTS: The mean age of the respondents and mean gestational age at booking were 21.1+3.54 years and 21.68 + 6.74 weeks, respectively. One-fifth of the respondents were not aware of any HIV preventive method, 81(27%) did not know that HIV can be transmitted from the mother to the fetus, 83 (27.7%) believed that transmission was by witchcraft, while 76%, 64% and 45% opined that use of condom, faithfulness to an HIV negative sexual partner and abstinence respectively were protective measures. Only 62(20.7%) were ever tested for HIV infection and 7(2.3%) of these were HIV positive. There were significant association between respondent age, awareness, perception and knowledge of MTCT, gestational age at booking, family setting and the prior utilization of PMTCT services (p<0.05). CONCLUSION: The awareness and utilization of PMTCT services before pregnancy was poor. There was a need to scale up programmes to improve the uptake of PMTCT services before pregnancy toward attaining the sustainable development goal 3.3.

An Epidemiological Study of Needlestick Injury among Healthcare Workers in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

BACKGROUND: Occupationally acquired infections are leading causes of morbidity and mortality among health care workers. The study aimed to determine knowledge, attitude and preventive practices of health care workers on needle stick injuries in Ahmadu Bello University Teaching Hospital, Zaria. METHODS: This was a cross sectional descriptive study in which stratified sampling technique was used to sample respondents. Data was collected using structured, close ended self-administered questionnaire. RESULTS: A total of 166 respondents completed the questionnaires out of 250 distributed questionnaires. Forty-three (25.9%) were males, 123 (74.1%) were females. The combined mean age was 40.9 ± 9.8 years. All the respondents were aware and knew of transmission of blood borne pathogens. Majority 116 (70.7%) had ever sustained injury while at work and 14 (8.8%) sustained injury in the last 3 months. The incidence of injury increases with work duration (c2= 17.88, p=0.001) and length of practice (c2=10.38, p=0.001). Eighty percent of respondents had received training on universal precautions. The commonest place of exposure was in the wards (65.6%) and circumstances of exposure were respectively sudden patient movements 21(19.3%) and recapping needle 20 (18.3%). Only 52 (43.3%) of respondents took appropriate measure (rinsing and disinfecting) the site after injury. CONCLUSION: This study revealed the high risk health care workers are exposed to at work. There is urgent need to improve the safety of health care workers through continuing education and strict adherence to universal precautions. There is need to establish a surveillance system to monitor such incidents and provision of post-exposure prophylaxis to those accidentally exposed.