Prevalence, Awareness and Factors Associated with Hypertension among Adult Residents in Lagos: A Population Based Study.

Background: Hypertension is a global public health problem in both developed and developing countries. It is estimated that 75% of the world hypertensive patients in 2025 will be in developing countries including Nigeria. There is need to understand the nature of the epidemic and institute control measures to reverse the increasing tide of the disease in developing countries. Methodology: A descriptive cross-sectional survey carried out among Lagos residents between May and June 2012 in four Local Government Areas namely Alimosho, Mushin, Ajegunle/Ifelodun and Kosofe. The study variables were age, sex, occupation, education, marital status, religion and BMI while the outcome variable were frequency of hypertension and mean blood pressure. Statistical analysis included the use of proportions, percentages, chi-square, ‘t’ test and logistic regression using SPSS version 21 Results: A total of 4088 adults aged between 20-81 years (male = 1465 and females= 2623) were included in this study. The overall prevalence of hypertension was 40.9%. Hypertension increased with age in both males and females. Of the 1673 respondents identified as having hypertension, only 316 (18.9%) respondents were previously aware of their diagnosis. Of the 316 known hypertensive patients, only 20 (6.3%) had their blood pressure within the normal range. Age, gender, marital status and BMI were socio-demographic factors associated with hypertension. Conclusion: The prevalence of hypertension and obesity were found to be high in Lagos state. The need for public health actions to avert the consequences of the high prevalence of hypertension.cannot be over-emphasized.

Eight Months vs Six Months Anti-TB Regimen in the Treatment of Newly Diagnosed Pulmonary Tuberculosis Patients in Nigeria.

Background: The eight month’s treatment regimen (2RHZE/6EH) was used by the Nigerian National TB and Leprosy Control Programme for the management of tuberculosis cases since 2003 when they commenced operation until October 2010 when the six month’s treatment regimen (2RHZE/4RH) was introduced. This study compared the treatment outcomes of patients managed with eight and six month’s treatment regimen between October 2009 and December 2011. Methods: A desk review was carried out on the programme data of the Lagos State Tuberculosis and Leprosy Control Programme (LSTBLCP). The treatment outcomes of new smear positive TB patients managed between October 2009 and September 2010 (the eight month’s treatment regimen period) and January to December 2011 (six month’s treatment regimen period) were compared using Epi Info 2007 statistical software. Results: A total of 4249 and 4167 smear positive TB patients were registered during the eight and six month’s treatment regimen period respectively. The prevalence of HIV among TB patients was significantly higher (14.4%) during the eight month’s treatment regime period compared with the six month’s (12.1%) treatment regime period (P = .02). The cure rate of patients managed during the eight month’s treatment regimen period was significantly lower (67.2%) and defaulter rate significantly higher (16.7%) compared with the cure (73.9%) and defaulter rates (12.2%) of patients managed during the six month’s treatment regimen period (P<.001). However the failure and death rates of patients managed during the eight and six month’s treatment regimen periods were comparable (P>.05). Among TB/HIV co-infected patients, the death rate was significantly higher among patients managed during the six month’s regimen period and the default rate was significantly higher in patients managed during the eight month’s treatment regimen period (p<.05). Conclusion: Patients had better treatment outcomes during the six month’s treatment regimen period in Lagos State. Sustaining these gains will be essential in reaching the national and global targets.

Treatment Outcomes of Tuberculosis Patients Managed at the Public and Private Dots Facilities in Lagos Nigeria.

Setting: Public and private tuberculosis (TB) treatment facilities in Lagos State, Nigeria. Objective: This study compares the treatment outcomes of tuberculosis (TB) patients managed at the public and private treatment facilities in Lagos Nigeria. Methods: A descriptive comparative cross-sectional study. Four hundred and seventy smear positive adults TB patients were consecutively recruited from 23 public and 11 private directly observed treatment short course (DOTS) facilities and followed up till completion of treatment after which their treatment outcomes were compared. Results: The prevalence of TB/HIV co-infection among patients managed at the public and private DOTS facilities was 10.0% and 10.7% respectively (P = 0.68). There was no significant difference in the treatment success and defaulter rates of TB patients managed at the public and private DOTS facilities (P > 0.05). Supervision of treatment by a treatment supporter (OR 2.98, 95%CI 1.59 – 5.56) and not interrupting treatment (OR 21.27 95% 8.86 - 51.07) were predictors of treatment success. Conclusion: Treatment outcomes of TB patients treated at the public and private DOTS facilities were comparable. There is need for strategies to effectively track patients lost to follow up.

Implementation of the Revised Guideline on TB/HIV Collaborative Activities in Lagos, Nigeria.

Background: The National Tuberculosis and Leprosy control programme commenced the implementation of the revised national tuberculosis/human immunodeficiency virus (TB/HIV) guideline in line with the recommendations from the World Health Organization in January 2013. This study evaluated the effect of the revised guideline on the implementation of TB/HIV collaborative activities geared towards reducing the burden of HIV in TB patients in Lagos, Nigeria. Methods: Retrospective review of presumptive and TB cases managed in TB treatment centers of the Lagos State TB and Leprosy control programme between January 1st to December 31st 2012 (pre implementation period) and January 1st to December 31st 2013 (post implementation period). Analysis was done using Statistical Package for Social Sciences (SPSS) version 19. Results: Of the 19,533 presumptive TB cases registered during the pre implementation period 17,530 (89.7%) were offered HIV counseling and testing (HCT) out of which 15,247 (87%) accepted to be tested and 20.9% of those tested for HIV were positive. However in the post implementation period, of the 22,721 presumptive TB registered cases, 20397 (89.8%) were offered HCT and 19,264 (94.4%) accepted to be tested. Of those that were tested, 4430 (23%) were HIV positive. The proportion of TB/HIV co-infected patients enrolled on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) during the pre and post implementation period were 76.6% vs 88.2% and 39.1% vs 49.8% respectively at p<.05. Conclusion: There was increase in the uptake of HIV testing, ART and CPT post implementation of the guideline. Sustaining the gains of policy implementation is of utmost importance.