ABSTRACT
Introduction:Tuberculosis (TB) is among the top ten leading cause of morbidity and mortality globally, and studies have shown that adherence to a six Month course of Isoniazid Preventive Therapy (IPT) reducesthe incidence of TB disease in HIV-negative/positive populations at risk of developing active TB disease.Objective:This study was carried out to identify active TB cases among children aged 0-5 years who are in close contact with adult cases of pulmonary TB (PTB), to determine the adherence rate to IPT among these close contacts thatdo not have active TB and to identify factors associated with non adherence if any. Methodology: This study was a prospective descriptive study carried out in Rivers state,Nigeria in two health facilities that offers services for TB diagnosis and treatment.Ethical approval for the study was obtained from the Rivers State Ministry of Health while verbal consent was obtained from the parents/caregivers of the children. Children aged 0-5 years who were in close contact with newly diagnosed PTB cases were recruited for the study. They were screened for HIV and evaluated for TB using clinical features and standard laboratory investigations. Those without active TB disease were commenced on isoniazid preventive therapy (IPT) for six months at a daily dose of 5mg/kg after adherence counselling and followed up at the health centres. Obtained data was analysed using Epi Info Version 7.2.3.1statistical software. Descriptive statistics was used while the test for association between variables was done with chi-square test at p ≤ 0.05 level of significance. Frequency tables were used for presentation of results.Results: A total of Sixty three children were recruited for the study 37 (58.7%) were males while 26 (41.3%) were females. Thirty two (50.8%) were children of index PTB patients while 29 (46.1%) belonged to lower socio-economic class. Their age ranged from 4 months to 4 years with a mean age of 2.84years ±1.27years. Six (16.2%) out of the 37 males and 2 (7.7%) out of the 26 females were confirmed to have active TB, giving a TB prevalence of 12.7%. The gender difference was not statistically significant (p= 0.32). Of the fifty five children that commenced INH in the first Month, only twenty four of them completed the six Month course of INH, giving an IPT adherence rate of 49.6%. Identified reasons for non adherence includes ‘My child is not sick’, ‘No transport Money’, ‘My child is writing exams”.“My child is tired of the drugs”, “the Health workers are not friendly’ and ‘long waiting time before collecting medications”.Conclusion: Early contact tracing is important for early detection of TB cases in children. Adherence to IPT in this study is low and strategies like community tracing of defaulters using trained social workers and community nurses as well as use of well-supervised and convenient ambulatory treatment centres that are manned by trained lower cadre health staff can improve adherence.
ABSTRACT
Background: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are non-suppurative cardiovascular sequlae of group A Streptococcus pharyngitis affecting children and young adults.Despite concerted efforts aimed at prevention, they still remain diseases of public health concern globally.Objectives: The aim of this study was to assess the knowledge and practice of acute rheumatic fever and rheumatic heart disease among physicians practicing in public and private hospitals in two states of the Niger delta region of Nigeria.Materials and Methods: Using a structured self administered questionnaire with 9 questions, 123 physicians from all the medical and surgical specialties were interviewed. Data was analyzed using SPSS 20.Results: Majority (95.93%) of the doctors were working in Government hospitals and nearly half (49.59%) of them were Paediatricians. Over half (50.41%) had more than 5 years’ experience in medical practice. Among the cadre of the doctors, house officers represented 44.72% while Consultants constituted 17.07% of the study participants. The study showed that 70 (56.91%) of the study participants selected at least seven correct answers out of the nine questions that assessed their knowledge and practice and so showed a good knowledge and practice of ARF and RHD.Conclusion: Though a good level of knowledge and practice was gotten from our study, there are still some gaps in the knowledge and practice that can be improved by health education through training and retraining our healthcare professionals. We therefore recommend the inclusion of ARF and RHD in CME and other training programs.
ABSTRACT
Background:Drug-resistant tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in particular represent a major threat to the fight against tuberculosis globally. MDR-TB presents with similar features and is transmitted in the same way as drug sensitive TB but its progression is rapid and its treatment, associated drug toxicity and monitoring constitute a heavy burden to the patients and the health system. MDR-TB affect people of all age groups but very little is known about the magnitude of this problem in children.Aims/Objectives:To determine the prevalence of multidrug resistant tuberculosis among children in Port Harcourt.Materials and Methods:Information on Paediatric tuberculosis was retrieved from the patients’ case notes, TB registers at the directly observed treatment short course (DOTs) clinic and the Multidrug resistant tuberculosis (MDR-TB) treatment center of the University of Port Harcourt Teaching Hospital from January 2018 to June 2019. Obtained data was analysed and presented in prose and tables. Results:There was a total of 1,860 patients records of which 37 were Paediatricscases giving a prevalence of Paediatric tuberculosis cases of 2.0% Outof these 37cases, four were multidrug Original ResearchArticle resistant tuberculosis cases giving a prevalence of MDR-TB cases of 10.8%. There were three males and one female giving a male female ratio of 3: 1. and their ages ranged from 3months to 24months. All belonged to social class 5. Common presentation was chronic cough, prolonged fever, weight loss and lymph node swellings. Three (75%) had no prior treatment for tuberculosis while one (25%) completed 6months of anti TB drugs. All had BCG immunization within one week of delivery. One (25%) child had extra-pulmonary TB while 3(75%) children had pulmonary tuberculosis. Xpert MTB/RIF assay for all (100%) showed MTB detected, RIF resistant detected. Three (75%) of the mothers had MDRTB and the medications for their children was based on the drug sensitivity testing (DST) of their mothers. One (25%) of the children and his mother were HIV positive and the mother had diedwhile still on the intensive phase of second line antiTB drugs. Three (75%) had completed the intensive phaseof the conventional therapy with second line antiTB drugs and are closely followed up weekly on the continuation phasewhile one child is still on admission. Conclusions:The prevalence of MDR-TB in childrenin PH is high. All childhood TB (whether drug susceptible or drug resistant) is usually traced to an adult, thus effectively diagnosing and treating all adults as well as a high index of suspicion in presumptive cases is required to curb MDR-TB.Recommendations:We recommend strict use of the DOTs strategy in TB management to ensure drug adherence. Also, proper contact tracing, investigation and treatment of children of infected parents to reduce cases of MDR-TB is advocated