Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria

Objective/Background: Tuberculosis [TB] is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies

Methods: A community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations

Results: Detection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive [NSP], although the increasing trend was not statistically significant [chi[2] = 1.8; p <.179]]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant [chi[2] = 1.48; p <.224]. Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% [all forms]. Compared to the baseline, there was an increase of 31% [all forms] and 22% [NSP] in the evaluation population

Conclusion: Intensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification

Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting

Objective: To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria. Methods: Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death. Results: Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6). Conclusions: Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme.

Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting

OBJECTIVE@#To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria.@*METHODS@#Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death.@*RESULTS@#Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6).@*CONCLUSIONS@#Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme.

Tuberculosis treatment default in a large tertiary care hospital in urban Nigeria: prevalence, trend, timing and predictors

Few studies have investigated tuberculosis treatment default in tertiary care settings. We aimed to determine the prevalence, trend, timing and predictors of defaulting from tuberculosis treatment in a Nigerian tertiary hospital. Data entered from 2006 to 2010 in the Federal Medical Centre, Abakaliki, tuberculosis treatment register were sorted into six treatment outcomes. Five outcomes were combined into one variable called 'non-defaulters' and were compared with "defaulters". The statistical analysis was conducted using SPSS. Of 671 tuberculosis patients, 192 [28.6%] defaulted. Of these, 126 [66%] were >/= 30 years old, and 115 [60%] had pulmonary tuberculosis. Furthermore, 106 [55%] were males, and 125 [65%] lived in a rural area. The annual proportion of defaulters dropped from 34.8% to 20.6%, but the decreasing trend was not statistically significant [P = 0.132 for trend]. Of the defaulters, 148 [77.1%] defaulted during their intensive phase of treatment. The median default time was 7 [IQR 5-8] weeks. The independent predictors of treatment default were older age [aOR 1.5], rural residence [aOR 2.3], and HIV seropositivity [aOR, 2.8]. TB treatment default is high and must be reduced. This may be achieved through improved rural DOT, further patient education, and enhanced coordination of TB/HIV care