Zinc Supplementation as Adjunctive Therapy in Adults with Tuberculosis in Calabar, Nigeria: A Randomized Controlled Trial

Introduction:Tuberculosis (TB) still remains a leading killer from a single infectious agent worldwide, especially in Asia and Africa. Achieving the Sustainable Development Goal (SDG) 3 will be contingent on addressing ways of reducing the impact of TB to the health, socio-economic and health system of populations most at risk. Micronutrients supplementation is increasingly being recognized as having great potentials to that effect.Objective:This study thus assessed the potential benefits or otherwise of zinc supplementation on tuberculosis treatment outcomes in Calabar, Nigeria.Methods:Eligible patients (81) out of the 182 assessed were randomized to receive anti-TB drug regimen plus oral administration of individual zinc, 25 mg daily for 60 days(intervention group), Original ResearchArticle while the control group received anti-tuberculosis drug regimen only for 60 days. Both qualitative and quantitative data were collected. Clinical examination, Karnofsky performance scale index, direct sputum examination, anthropometric measurements and blood collection for haematological and zinc assessment were carried out before and 2 months after anti-TB treatment began. Difference in treatment effects between and within groups for continuous variables was tested using t-test. Mantel-Haenszel summary estimate of the relative risk (RR) was used to test the clinical effectiveness of the intervention. The Pearson test was applied to determine the correlation between variables.Main Results:The mean serum zinc levels at 2 months of TB treatment were significantly higher in the intervention group (14.4 ± 0.37μmol/L) in comparison with the control (12.9 ± 0.37 μmol/L); (p = 0.004). A significant difference (p = 0.010) in the serum concentrations of zinc was observed between the two groups when adjustments were made for TB-HIV co-infection. Risk reduction of about 41% for acid fast bacilli (AFB) positivity (RR: 0.59; 95% CI 0.23 to 1.46) was observed after 2 months of anti-TB treatment in favour of the intervention group. Similarly, intervention group had significantly (p = 0.005) lower proportion of patients with serum zinc levels < 10.7 μmol/L (intervention: 5; Control 10) and (p = 0.030) BMI < 18.5 kg /m2 below the lower ranges ((intervention: 9; Control 16). There was a significant improvement in the haematological parameters as evidenced by significant higher proportion of patients in the intervention group than the control group with values above the lower ranges for these parameters with risk reductions in favour of the intervention group for lower ranges as 34%, 12%, 73% and 58% respectively for haemoglobin, albumin, serum total protein and globulins. Conclusion: Irrespective of HIV status in individuals with tuberculosis, zinc micronutrient supplementation significantly increases clinical outcomes, haematological parameters, improves nutritional status as proxied by anthropometric indices and leads to faster sputum smear conversion. The study adds to the growing body of evidence in support of the beneficial role of zinc in TB control

Determinants of Modern Contraceptive Uptake among Women in Peri-Urban Communities of Port Harcourt City, Nigeria.

Aim: The aim of the study was to investigate the determinants of contraceptive uptake among women of reproductive age in semi-urban communities of Rivers State, Nigeria. The information will be useful in reordering priorities and strategies for family planning interventions in the state. Study Design: The study was a cross sectional, household-based study, employing a cluster sampling technique proportionate to size, to recruit eligible participants. Study Location: The study was carried out in September 2013 in five contiguous communities located at the fringes of the Port Harcourt city. Methodology: Anonymous questionnaires were administered to 772 women of reproductive age normally resident in these five communities. Visitors were excluded. The data was analysed using SPSS version 20 software package. The Chi-square test was performed to determine the association between contraceptive use and demographic and socioeconomic variables, while Logistic regression was used to identify determinants of contraceptive uptake. The level of statistical significance was set at p= .05. Results: A total of 772 women aged (15-49) years participated in the study and 731 (94.7%) knew about modern contraceptives and their benefits. Young age (15-34 years old), (χ2= 12.7, df = 3, p= .01) and being single, (χ2=16.270, df=3, p < .01) were significantly associated with contraceptive usage. Younger women had six times higher odds of contraceptive usage than older women; [O.R (95% C. I) = 5.97 (1.56-22.90) and 5.96 (1.63 -21.71)], and women with contraceptive knowledge had 19% higher odds of usage than contraceptive naïve women [O.R (95% C. I) = 0.19 (0.09-0.40)]. Conclusion: This study underscores the importance of young age and knowledge about contraceptives in promoting its acceptance among women. We therefore advocate for an early introduction of curriculum-based family planning education in schools, local media campaigns and peer education to create more awareness about contraceptives.

Treatment Dealay Attitude of Caregivers in Management of Childhood Malaria in Rural Communities in Nigeria.

Aims: The aim of this paper was to assess the promptness of caregiver’s action at the onset of malaria symptoms to giving recommended effective anti-malaria drugs from public health facility. Study Design: It was a cross sectional study. Study Setting: The study was conducted in Akpabuyo, a rural community in Cross River State, south eastern Nigeria, March to May 2011. Methods: Announcements were made in the community inviting mothers/caregivers to bring their sick-children/wards to the public primary health facilities for free laboratory malaria test and treatment. Caregivers treatment seeking behaviour were assessed using an interviewer administered questionnaire. Data was collected from each of the ten electoral wards that make up Akpabuyo local government area (LGA) in Cross River State, Nigeria. Wherever necessary native language or broken-English was used. Results: Eight hundred and sixty children between the ages of 6 months to 14 years participated in the study. Majority of them (68%) were under-five years of age. There were slightly more males (52%) than females, mean age of the children was 47 months. The mean time-lag between onset of symptom and presentation in the public health-care was about 168 hours. The mothers either bought their drugs from patent medicine vendors and/or used herbal-medicines, before eventually going to the public health facility, where there are both free drugs and skilled manpower. Twenty-seven (27%) of the caregivers did not give any known treatment. Conclusion: Mothers/caregivers in this community treat their malaria sick children within 168hours, after lots of delay, trying other remedies, before presenting in public health facilities. There is need to improve their treatment seeking behaviour, using health education intervention and behavioural change communication.