Pulmonary tuberculosis among health care workers at two designated DOTS Centers in urban city of Ibadan, Nigeria.

Background & objectives: Tuberculosis (TB) infection control interventions are not routinely implemented in many Sub-Saharan African countries including Nigeria. This study was carried out to ascertain the magnitude of occupationally-acquired pulmonary TB (PTB) among health care workers (HCWs) at two designated DOTS centers in Ibadan, Nigeria. Methods: One year descriptive study (January-December 2008) was carried out at the University College Hospital and Jericho Chest Hospital, both located in Ibadan, Nigeria. A pre-tested questionnaire was used to obtain socio-demographic data and other relevant information from the subjects. Three sputum samples were collected from each subject. This was processed using Zeihl-Neelsen (Z-N) stains. One of the sputum was cultured on modified Ogawa egg medium incubated at 37°C for six weeks. Mycobacterium tuberculosis was confirmed by repeat Z-N staining and biochemical tests. Results: A total of 271 subjects, 117 (43.2%) males and 154 (56.8%) females were studied. Nine (3.3%) had their sputum positive for acid fast bacilli (AFB) while six (2.2%) were positive for culture. The culture contamination rate was 1.8 per cent. Significantly, all the six culture positive samples were from males while none was obtained from their female counterparts. About half of the AFB positive samples were from subjects who have spent five years in their working units. Eight AFB positive cases were from 21-50 yr age group while students accounted for seven AFB positive cases. Interpretation & conclusions: The study shows that occupationally-acquired PTB is real in Ibadan. Further studies are needed to ascertain and address the magnitude of the problem.

Outpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease.

Objectives. An outpatient programme for rehabilitation of patients with severe ventilatory impairment due to chronic obstructive pulmonary disease (COPD) was conducted. Its main purpose was to assess the feasibility of the programme for COPD patients. Methods. Initial assessment included a shuttle walking test, administration of the chronic respiratory disease questionnaire (CRDQ), assessment of the hospital anxiety and depression scale (HAD) and sickness impact profile (SIP). The patients were entered into a 6-week outpatient programme between January 2007 to July 2007 during which they attended twice weekly for a 2½ hour session. Assessment was repeated on completion of the study at three months and later at six months. Results. The study included 44 (28 males) patients with COPD with a mean age 66 years. All patients had severe ventilatory impairment as defined by a forced expiratory volume in one second (FEV1) of less than 40% of predicted. The shuttle walking distance improved significantly and was maintained at the improved level for six months. The improvement in all four dimensions of the CRDQ was statistically significant (p<0.05) and reached clinical significance for fatigue and for mastery. On entry, a notable level of depression was found in 32% of patients, and anxiety in 40 percent. There was a significant reduction in both of these that was maintained at six months (p<0.05). There was no improvement in the SIP at three months, but significant improvement was found at six months (p<0.05). Conclusions. This study shows that a successful outpatient programme can be conducted in patients with severe ventilatory impairment, and that benefits in physical ability and in health-related quality of life (HRQOL) can be achieved. The improvements were maintained at six months.

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

Trends in bacterial pathogens of lower respiratory tract infections.

OBJECTIVES: This study was conducted to determine the bacterial aetiology of lower respiratory tract infections in this environment as well as update the clinicians in the various antimicrobial alternatives available in the treatment. METHODS: Between September 2002 and February 2005, 157 bacterial pathogens from 556 patients with lower respiratory tract infections were isolated from sputum specimens, and subjected to susceptibility testing, using standard bacteriologic techniques. RESULTS: Out of the 556 cases, only 150 (27%) had an established bacterial aetiology. One pathogen was demonstrated in 143 (95.3%) patients and seven (4.7%) had mixed infections. The most prevalent single pathogen was Klebsiella pneumoniae (38%) while the most prevalent bacterial combination was Klebsiella and Pseudomonas species (2%). Isolates of Klebsiella pneumoniae were susceptible to ciprofloxacin, gentamicin and ceftriaxone. CONCLUSIONS: Bacteriological diagnosis and antibiotic resistance surveillance are indispensable in the effective management of lower respiratory tract infections.