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

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. 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. 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. 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]. 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

Multidrug resistance and demography of newly diagnosed tuberculosis patients in Cross River state, Nigeria

Nigeria has the world's fourth largest tuberculosis burden, and multidrug resistant tuberculosis [MDR-TB] represents a serious public health problem. To describe the demography of TB patients and determine the susceptibility of Mycobacterium tuberculosis isolates to the major TB drugs. One hundred and thirty-seven newly diagnosed TB patients [26 [19%] being HIV positive] from all age groups were recruited into the study. Each specimen was cultured using BACTEC MGIT960, followed by inoculation and growth on Lowenstein-Jensen [LJ] medium. Primary identification was carried out using an immunochromatographic technique [Capilia TB-Neo], and further confirmed by genotyping. Drug susceptibility testing [DST] was carried out by the agar proportion method. Of the 97 pure mycobacterial cultures on LJ medium, 81 [83.5%] isolates were identified as M. tuberculosis complex, while 16 [16.5%] were Capilia negative. DST was carried out on 58 isolates. The drug susceptibility pattern showed that resistance occurred in 16 [27.6%] for streptomycin, 11 [19%] for isoniazid, 9 [16%] for rifampicin, and 10 [17.2%] for ethambutol. Rifampicin monoresistance occurred in 2 [3.4%] cases. MDR [combined resistance to isoniazid and rifampicin], also involving resistance to streptomycin and ethambutol, occurred in 6/58 [10.3%] isolates; although laboratory cross-contamination could not be excluded in 4/6 MDR strains with identical MIRU patterns characterized by consecutive strain numbers. Considering that first out of these 4 isolates was not due to laboratory carryover, the results of this study still report a minimal MDR-TB rate of 3/58 [5.2%] among newly diagnosed TB patients in Cross River State, Nigeria. An increase in drug resistance was observed in this study as compared with previous studies in the country. Hence, introduction of culture in routine diagnostic mycobacteriology laboratories will prevent the emergence and dissemination of MDR-TB, while improved quality control strategies would in parallel prevent laboratory cross-contamination, thereby reducing mislabeling, unnecessary treatment, and drug toxicity for patients

Utility and diagnostic performance of Mycobacterium tuberculosis complex by two immunochromatographic assays as compared with the molecular Genotype assay in Nigeria

Among the disadvantages of smear microscopy for detection of tuberculosis cases is its inability to differentiate between Mycobacterium tuberculosis [MTB] and non-tuberculous mycobacteria [NTM]. This study evaluated two, new immunochromatographic assays - Capilia TB-Neo and SD Bioline - on unheated and heated cultures at 80C for 30 min respectively for their ability to discriminate between MTB complex and NTM as compared with the molecular Genotype assay. Mycobacteria used in the study were obtained from smear-positive specimens collected from patients at four major hospitals in Cross River State, Nigeria. Capilia TB-Neo and SD Bioline showed sensitivities of 98.8% and 93.8% respectively and 100% specificity for both assays. Heating the isolates did not significantly impact the test performance. Both tests are recommended for use in rapid differentiation of strains isolated in Nigeria