Outcomes of tuberculosis treatment in a tertiary health facility in north-central Nigeria

Background: Tuberculosis (TB) remains a major public health concern despite being a curable and preventable disease. The treatment of TB using a cocktail of drugs over a period of six months under the directly observed treatment short-course strategy has led to a reduction in cases but is plagued by some challenges that leads to unsuccessful or poor outcomes, which can ultimately result in spread of infections, development of drug resistance and increase in morbidity and mortality. The objectives of this study are to determine outcomes of TB treatment in Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria and the factors that may be associated with the outcomes. Methodology: This was a retrospective study using the medical records of patients who were registered for TB treatment over a five-year period between 2016 to 2020. Data from TB registers including demographic and relevant clinical information, and treatment outcomes, were extracted into a structured data extraction format, and analysed with SPSS version 21.0 software package. Univariate and bivariate analyses were conducted, and Chi square test was used to determine association between TB outcomes and independent variables at 95% confidence interval and p<0.05 was considered as the significant value. Results: Records of 1,313 patients were studied, 744 (56.7%) were males while 569 (43.3%) were females. The age range of the patients was ≤ 1 year - 96 years, with a mean age of 30±16.7 years. Most were pulmonary TB cases (88.8%, n=1,166), newly diagnosed (95.5%, n=1254), and human immunodeficiency virus (HIV) negative at the time of TB diagnosis (63.7%, n=837). Eight hundred and seven (61.5%) patients had successful treatment, and 34% (n=446) had unsuccessful outcomes made of 'loss to follow-up' 25.8% (n=339), deaths 7.8% (n=102) and treatment failure 0.4% (n=5), while 2.3% (n=30) were transferred out and 2.3% (n=30) removed from TB register. Treatment success rate was significantly higher in patients with pulmonary TB (p=0.0024), residents in Lafia LGA (p=0.0005), those treated in 2016 (p=0.0006) and bacteriologically confirmed cases (p<0.0001), while death rate was significantly lower among patients who were HIV-negative at the time of TB diagnosis (p<0.0001). Conclusion: TB treatment success rate in this study fell short of the WHO average rate. High rates of 'loss to followup' and deaths in this study is a wake-up call to all stakeholders in the facility and the State to put in place measures to reduce poor outcomes of TB treatment.

Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low-risk blood donor group, Nigeria.

We investigated the seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among 258 clergymen-in-training (age range 18-39 years) who represented a donor population that fulfilled the criteria for safe blood transfusion. In all, 15.1% of the men were positive for HBsAg, 4.3% were positive for anti-HCV and 2.7% were HIV-positive; 22.1% were infected with at least one of these viruses. Co-infection with HIV and HBV was found in 0.4% of the subjects, HBV and HCV in 0.4%, and HIV and HCV in 0%. This underscores the importance of routine screening of blood before transfusion, regardless of the donor background.

Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low-risk blood donor group, Nigeria

We investigated the seroprevalence of human immunodeficiency virus [HIV], hepatitis B virus [HBV] and hepatitis C virus [HCV] infection among 258 clergymen-in-training [age range 18-39 years] who represented a donor population that fulfilled the criteria for safe blood transfusion. In all, 15.1% of the men were positive for HBsAg, 4.3% were positive for anti-HCV and 2.7% were HIV- positive; 22.1% were infected with at least one of these viruses. Co-infection with HIV and HBV was found in 0.4% of the subjects, HBV and HCV in 0.4%, and HIV and HCV in 0%. This underscores the importance of routine screening of blood before transfusion, regardless of the donor background

Cryptosporidium infection in undernourished children with HIV/AIDS in Jos, Nigeria

Background: AIDS and Protein energy malnutrition (PEM) severely impair the immune systemCryptosporidium has over the last two decades emerged as a life threatening disease. The study attempts to determine the prevalence of Cryptosporidium infection in malnourished children with HIV/AIDS. Method: Blood and stool samples of 52 HIV-seropositive children and another 52 HIV-sero-negative childrenaged 0-5 years were collected and screened for HIV and Cryptosporidium oocysts respectively. The sera were screened by double ELISA and the stool by the modified Ziehl-Neelsen method.Results: Out of the 52 HIV-seropositive undernourished, under-five children, none (0%) excreted Cryptosporidium oocyst in their stools while 2 (3.8%) of the control group excreted the oocyst. Conclusion: Cryptosporidium infection seems to be uncommon among undernourished under five children with HIV/AIDS in Jos

Multiple drug resistant strains of Shigella isolated in Jos, central Nigeria.

The objective of this study is to highlight the alarming rise in antimicrobial resistance among Shigella species in Jos, Plateau State. Stool samples of eight hundred and ten patients who presented at the Jos University Teaching Hospital with diarrhoea/dysentery were analysed using standard bacteriological techniques. The antimicrobial susceptibility of the isolates were determined. 25 Shigella species were isolated representing 3.1% isolation rate. The male to female ratio is 1.3:1, children aged 0-10 years constituted 16(64%) of the cases. Shigella flexneri (48%) was the most common sero-group. This was followed by S. boydii (24%), then S. sonnei (20%), and S. dysenteriae (8%). Most strains of shigella species were resistant to Ampicillin (96.0%). Chloramphenicol (96.0%), Cotrimoxazole (88%), Nalidixic acid (84%) and Tetracycline (75%). All strains were found to be sensitive to Ciprofloxacin. The drugs of choice in the treatment of Shigella infection in this environment should be Ciprofloxacin and Ofloxacin. Gentamicin was the third drug of choice its use is limited since the infection is not systemic. To avoid continuous abuse of antibiotics in our country there should be an effective legislation by the government to control the indiscriminate purchase of antibiotics.

Prevalence of cryptosporidium infection among undernourished children in Jos, Central Nigeria.

This prospective study aimed at determining the prevalence data of Cryptosporidium infection in undernourished children, its seasonality and its relative frequency in diarrhoeic stool in Jos, Central Nigeria. One hundred and seventy each of undernourished and well nourished children aged 0-5 years were recruited into the study. Stool samples and clinical data were obtained using questionnaires. Results were analysed using Chi-square test. The prevalence of the infection was found to be 4.8% and all infections occurred in diarrhoeic stool. No infection with this pathogen was recorded in the well-nourished group. There was a defined seasonality of the infection. The high prevalence suggests the importance of introducing routine screening of this group of patients for cryptosporidium infection to facilitate their management.

Antimicrobial susceptibility pattern of Neisseria gonorrhoeae isolated at the Jos University Teaching Hospital, Jos, Central Nigeria.

Widespread, inadequate and inappropriate treatment of gonococcal infections are facilitating antibiotic resistance in Jos Nigeria. We present an antimicrobial susceptibility pattern of Neisseria gonorrhoeae strains in this study. Thirty-one strains of Neisseria gonorrhoeae were isolated by inoculating swabs onto prewarmed heated blood agar and Thayer Martins medium and incubated overnight at 35 to 37 degrees C. The isolates were then screened for antimicrobial susceptibility by the disk diffusion method. About 93.6% were susceptible to azithromycin, 90.3% to ciprofloxacin, 87.1% to ceftriaxone, 80.7% and 64.3% to erythromycin and ofloxacin respectively. Less than half were each susceptible to spectinomycin (38.7%) and gentamicin (32.8%), while 12.9% and 4.6% were susceptible to tetracycline and penicillin respectively. These findings suggest that gentamicin, tetracycline and penicillin may not be recommended in this environment for treating gonococcal infections. Azithromycin, ciprofloxacin and ceftriaxone are the suggested alternatives. Prompt diagnosis, treatment and indeed continued surveillance are hereby recommended for an effective management of gonococcal infections.