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PREVALENCE AND TREATMENT OUTCOME OF PULMONARY TUBERCULOSIS
Background to the Study
Tuberculosis (TB) is a chronic infectious disease caused by bacteria generally referred to as mycobacterium tuberculosis; almost every organ in the body can be affected, but involvement of the lungs account for more than 80% of TB cases. Tuberculosis affecting the lungs is called Pulmonary Tuberculosis (PTB), while those affecting other organs are called Extra Pulmonary Tuberculosis (EPTB) (Federal Ministry of Health, 2010).
The most important source of infection is an untreated Pulmonary Tuberculosis (PTB) patient. When such a person coughs, spits or sneezes, tiny droplet nuclei containing the tubercles are released. Transmission is through inhaling these droplet nuclei (Federal Ministry of Health 2010).
Today tuberculosis remains a global public health problem of enormous dimension. It is estimated that there are I billion infected patients worldwide, with 10 million new cases and over 3 million deaths per year. Tuberculosis is responsible for more deaths than any other infectious disease (WHO, 2008).
It was estimated to cause a global emergency with estimates of 1.8 million deaths worldwide in 2008 out of over nine million cases. In the same year, the estimated global incidence rate fell to 139 cases per 100,000 populations after reaching its peak in 2004 at 143 per 100,000. However, this decline was not homogeneous throughout the World Health Organization (WHO) regions, with Europe failing to record a substantial decline, but rather appearing to have reached a stabilization rate (WHO, 2009).
In the WHO African region with a population estimate of 836,670,000 as at 2010, TB incidence was 2,300,000, prevalence of 2,800,000 and deaths of 250,000 (World Health Organisation, 20I0). Nigeria ranking the tenth among the 22 high TB burden countries in the world has the prevalence of 133 per 100,000 and 93,050 cases were registered in 2010. (Federal Ministry of Health, 2011)
Treatment success measured by a standardized process of treatment outcome monitoring (TOM) is one of the pillars of TB control and along with case detection, is recognized as a key programmatic output. It is against this rationale that World Health Assembly (WHA) resolution was passed in 1991, adopting two targets for global TB control to detect at least 70% of new infectious cases and to cure at least 85% of those detected. These targets were linked to the Millenium Development Goals, and stop TB partnership set the year 2005 as the dead line for achievement (Dye, Maher, Espinal and Raviglione, 2006).
Globally, the treatment success rate exceeded the 85% target for the first time in 2008 since the target was set in 1991, with a percentage of 87% for patients starting treatment in 2007 (WHO, 2009). Further, more treatment success rates were not maintained nor improved between 2006 and 2007 in all WHO regions with the exception of the European region which recorded the lowest success rate globally at 67% (WHO, 2009).
The importance of strengthening treatment outcome monitoring (TOM) in Europe has long been recognized. A statement put forward by the WHO and the International Union Against Tuberculosis, and Lung Disease underlined in 1998 the need for standardization and evaluation of treatment results for TB patients in the WHO European region including those in low and intermediate incidence countries( Veen, Raviglione, Reider, Migliori, Graf, and Grzemska, 2008) Nigeria’s TB control programme adopted the global target of detecting 84% of the estimated TB cases, and curing 87% of the detected cases by the year 2015 using the Directly Observed Treatment Short course therapy (DOTS) strategy, (WHO, 2010). While the latter target appears more readily achievable with Nigeria recording 73% treatment success by 2004 cohort, the case detection rate remained at low level of 22% compared to the global figure of 37% (WHO, 2007).
Delta State is now among the States being sponsored by the German Leprosy Relief Association, a non-Governmental Organization for Tuberculosis Control. The German Leprosy Relief Association provides logistics for the effective control of tuberculosis in Delta State. Tuberculosis hospital, Eku is a referral centre in Ethiope East Local Government Area of Delta State. It also serves as a referral hospital to other parts of the State and environs. The Tuberculosis Centre, Eku has 7 wards with 104 beds having an average of 350 patients annually due to the introduction of DOTS therapy (Directly Observed Treatment Short course) (Tuberculosis referral Hospital Records, 2007).
Recently the indigenes of Eku, a major community in Delta State where the hospital is located seem to be very much afraid of the wide spread of pulmonary tuberculosis infection because of the number of TB patients seen in their locality through referrals from other places.
Statement of Problem
Pulmonary Tuberculosis (PTB) is a major public health problem in Nigeria. It was declared a national emergency in 2006 after which an emergency plan for the control of TB in Nigeria was developed. The country is currently ranked 10th among the 22 high TB burden countries in the world (Federal Ministry of Health, 2010).
Despite the support of Donor organizations such as the German Leprosy Relief Association and the introduction of DOTS, tuberculosis cases seem to be on the increase in most communities in Nigeria. Also, the observed number of referred patients that troop into Eku hospital for confirmation of diagnosis and treatment seems to raise anxiety of the community members to an impending wide spread of PTB infection.
Monthly hospital records reveal that average of 50 persons come to the referral center with the history of cough that has lasted for more than two weeks for proper diagnosis. (Hospital records, tuberculosis referral hospital, Eku 2009). With this average monthly record the anxiety of the people seems to have risen. Therefore the determination of the prevalence and management outcome pose serious challenge.
Purpose of the Study
The purpose of the study is to review the prevalence and treatment outcome of pulmonary tuberculosis in the TB Referral Hospital Eku, Delta state (January 2009 to December 2013) .
Specifically, the objectives of the study are to:
- Determine the achievement of the state target within the five years period under review.
- Ascertain the prevalence of pulmonary tuberculosis in the hospital, during the period under review.
- Determine the treatment outcome of patients within the period under review.
- What is the target achieved within the 5 years period under review in the hospital understudy?
- What is the prevalence of pulmonary tuberculosis at the TB referral hospital understudy?
- What are the treatment outcomes of patients within the period under review in the hospital understudy?
- There is no significant association between age and outcome of treatment of pulmonary tuberculosis.
Significance of the Study
Pulmonary Tuberculosis poses a global threat to public health, therefore the findings from the study will help the Federal Government to plan for training of more health workers to strategize in case finding and case holding. Also the findings from the study will enable health workers who are involved in the tuberculosis control programme to embark on health education as regards socio-demographic characteristics and prevalence using evidence based information.
Findings from the study will also assist all stakeholders to properly carry out evaluation of patients such as cohort analysis to give correct data which will enable health workers to reduce the prevalence and the incidence rate to the lowest level.
Finding of the prevalence and outcome of treatment of TB in the referral hospital, Eku Delta State will provide useful information on both the prevalence and management outcome of PTB in Nigeria and other developing countries. Finally, the result will add to the existing body of knowledge in this area of study and provide some information to future researchers.
Scope of the Study
The study was limited to all pulmonary tuberculosis patients treated or admitted to the TB referral hospital Eku, Delta State from January 2009 to December 2013. The variables to be studied include the prevalence of PTB, according to sex and age and treatment outcome of patients within the period under review.
Operational definition of terms:
Prevalence ofPulmonary Tuberculosis:-This refers to the number of cases of pulmonary tuberculosis present in the Eku hospital at the time of the study. It includes both old and new cases.
Treatment Outcome: – This means the number of patients that completed their treatment, were cured, and discharged, number that died number that defaulted from treatment, number of treatment failure and number transferred out to other health facilities due to other complications.
Target: This is the sum total of cured and discharg