Risk factors for pulmonary tuberculosis among health-care workers in Ibadan, Nigeria

Data on TB infection control programs is limited in many of the TB high burden countries. We carried out a one-year cross sectional epidemiological study (January-December, 2008) to determine the prevalence of occupationally-acquired pulmonary tuberculosis (PTB) among Health- Care Workers (HCWs) in Ibadan, Nigeria. This information is important for planning preventive strategies. All consenting HCWs at two TB centres in Ibadan--the University College Hospital (UCH) and Jericho Chest Hospital were enrolled into the study. A well structured questionnaire was used to obtain information on socio-demographic characteristics of the subjects including their medical and social data. Three sputum samples collected from each subject were processed for acid-fast bacilli (AFB) and culture on selective medium. Isolates were confirmed as M. tuberculosis by standard biochemical tests. Of the 271 subjects recruited, nine (3.3%) had their sputum positive for AFB while six (2.2%) were positive for culture. Subjects aged 20 years and above, female gender and unskilled professionals had higher risk for occupationally-acquired PTB than those who were 20 years and below, male gender and skilled professionals (Odd Ratio OR = 1.9, 95% Confidence Interval, 95% CI = 0.23-16.3, Fisher's exact P = 0.37; OR = 1.1, 95% CI = 0.28-4.0, p = 0.01; OR = 1.05, 95% CI = 1.02-1.08, p = 3.43) respectively. Multivariate logistic regression analysis showed that subjects who received BCG vaccination were less likely to have occupationally-acquired PTB than those without vaccination (OR = 0.86, 95% CI = 0.20-3.6, p = 0.83 for microscopy; OR = 0.76, 95% CI = 0.13- 0.44, p = 0.76 for culture). Even though the risk for occupationally-acquired PTB was lower in subjects who had not spent up to two years in their units, the association was not statistically significant (OR = 0.84, 95% CI = 0.20-3.5, p = 0.82 for microscopy and OR = 1.21, 95% CI = 0.22-0.65, p = 0.82 for culture). There is a need to develop and implement affordable and cost-effective TB infection control strategies in Nigeria in order to reduce the burden of occupationally-acquired PTB in the country

Five year review of treatment outcome of directly observed therapy (DOT) for re-treatment pulmonary tuberculosis patients in UCH, Ibadan, Nigeria

Tuberculosis (TB) is a major health problem in Nigeria. The country is currently fourth among the 22 high-burden countries (HBCs) of the world; with an incident of all new cases of 311/100;000 population per year out of which 137/100;000 population are smear positive and prevalence of 616/100;000 population. To highlight the burden of re-treatment smear positive pulmonary TB with and without HIV infection and determine how Directly Observed Therapy (DOT) using the retreatment regimen has affected the treatment outcome in the management of these patients. A Fiveyear retrospective study from April 2003 to March 2008 to evaluate the treatment outcome data of retreatment pulmonary TB who were also screened and confirmed for HIV at the outpatient clinic of the University College Hospital Ibadan; Nigeria. The effect of HIV status and treatment outcome was assessed so also the prevalence of HIV among recurrent PTB patients. The total number of cases assessed was 127. Majority of the patients were between the ages of 20 to 49(73.2). Forty-two of the PTB patients were HIV positive (33.1). The treatment outcome was as follows: Cured 81(63.8); Treatment completed 13(10.2); Died 22(17.3); Defaulted four (3.1) and transferred out seven (5.5) More patients were cured and had treatment completion among the HIV negative patients compared with HIV positive patients (p0.0001) The mortality was higher in those with HIV positive than negative patients (p 0.0001). Re-treatment pulmonary TB is frequent at this referral centre. A contribution to re-treatment prevention entails more rigorous management of new TB cases; particularly at lower levels of care. This effort will reduce the emergence of multi-drug resistant (MDR-TB) tuberculosis