Predictors of mortality among drug-resistant tuberculosis patients in Kaduna State, Nigeria.

Background: Specific death due to DR-TB has significantly contributed to tuberculosis (TB) mortality and overall global deaths. Aim: This study examines the predictors of mortality among DR-TB patients in Kaduna State, Nigeria. Subject and Method: This was a retrospective longitudinal study of DR-TB mortality carried out among 370 DR-TB patients from the 23 LGAs in Kaduna State. It involves a retrospective review of the MDR-TB records of the patients over a period of 10 years (2012-2021). Demographic and clinical data of all DR-TB patients enrolled in Kaduna State, Nigeria, between April 1, 2012, and March 31, 2021, were used. Survival analysis was performed with SPSS version 25, using Kaplan-Meier and Cox proportional hazard regression modeling, at 5% significance level. Results: The majority of the patients, 255 (68.9%), were below the age of 40 years, while 53 (14.3%) of the patients died within the study period. Most deaths 26 (49.1%) were associated with HIV co-infection and the disease severity. Results for the Cox proportional model show that there was a significantly lower risk of death when a patient had MDR-TB compared to pre-XDR-TB (adjusted hazard ratio, AHR = 0.34, 95% CI = 0.16-0.72, P = 0.04). Both models show that age, sex, residence, or year of treatment had no significant association with survival or death. Conclusion: HIV co-infection and DRTB with progression to more resistant and difficult-to-treat strains contributed to higher deaths. There is a need for concerted efforts from all DR-TB stakeholders to control the disease.

EXPERIENCE OF DOMESTIC VIOLENCE AMONG PREGNANT WOMEN IN RURAL AND URBAN AREAS OF NIGER DELTA REGION OF NIGERIA: RISK FACTORS, HELP-SEEKING RESOURCES AND COPING STRATEGIES.

BACKGROUND: Risk factors and coping strategies employed for domestic violence across rural and urban locales remains a topical public health concern. Geographic locations experiencing other forms of violence may contribute additional risk factors to domestic violence. METHODOS: A cross-sectional study design was used to determine and compare the risk factors, help-resources and coping strategies employed by survivors of domestic violence living in rural and urban areas of the Niger-Delta region of Nigeria. Altogether 461 (225 rural, 236 urban) pregnant women participated. Statistical analysis was carried out with SPSS version 21 with p ≤0.05. RESULTS: Predictors of violence identified were: geographical location, residing in a rural area (OR 2.052 95% C.I. 1.349 - 3.122) and alcohol intake by pregnant women (OR 1.691; 95% C.I. 1.022 - 2.798) increased the risk of domestic violence while intimate partner's occupation, being a professional was a protective factor (OR 0.513 95% C.I. 0.327 - 0.806). Less than half of the respondents in both locations (rural 44.0% versus urban 35.2%) sought for help following incidents of violence. Fewer rural (3.1%) than urban (10.7%) of them sought for formal help from the police. The main coping strategy used was 'keeping silent' by 69.4% rural compared to 46.4% urban survivors and the main reason given, was to avoid family disharmony. CONCLUSION: There is urgent need for relevant stakeholders to institute measures to reduce domestic violence especially in rural areas of developing countries and establish well-linked help resource centres across both rural and urban localities.

Relationship Between Sexual Abuse in Childhood and the Occurrence of Mental Illness in Adulthood: A Matched Case-Control Study in Nigeria.

This study aimed to examine the relationship between exposure to childhood sexual abuse (CSA) and the occurrence of mental illness in adulthood in Nigeria. An age- and gender-matched case-control study was conducted in the University of Port Harcourt Teaching Hospital, Nigeria, from January to March 2014. Cases were defined as individuals aged 18 to 60 years diagnosed with mental illness while controls were aged 18 to 60 years who did not have mental illness. The study had 304 subjects comprised of 152 case-control pairs. This case-control study showed a statistically significant association between exposure to CSA and occurrence of mental illness in adulthood (pair-matched odds ratio = 3.25, 95% CI = [1.70, 6.21]). The association between CSA and mental illness was still significant (adjusted odds ratio = 3.11, 95% CI = [1.67, 5.82]) after controlling for family functionality. A robust CSA prevention and treatment strategy that considers the victim and the perpetrator in Nigeria is hereby advocated. This could be achieved by the collaborative efforts of the government of Nigeria and non-governmental organizations.

Effectiveness of trained community volunteers in improving knowledge and management of childhood malaria in a rural area of Rivers State, Nigeria.

INTRODUCTION: Malaria accounts for 70% of illnesses and 30% of deaths among children under 5 years in Nigeria. This study was aimed at determining the effectiveness of trained community volunteers in delivering multiple anti-malaria interventions to achieve rapid reduction in morbidity and mortality among under 5 children. MATERIALS AND METHODS: A quasi-experimental study was carried out in two rural communities in Rivers State, Nigeria among 368 mothers/caregivers. A set of 184 of the mothers/caregivers (experimental group) were trained on malaria and provided with bed nets and drugs (artemisinin-lumefantrine) to treat children under 5 years who developed fever during the period of the experiment. Another set of 184 mothers/caregivers (controls) did not receive similar training and drugs. Both groups were compared at baseline and after 6 months of the experiment on their knowledge of malaria prevention and treatment. Level of significance was set at P = 0.05. RESULTS: In the experimental group: Adequate knowledge about malaria increased from 115 (62.5%) to 175 (95.1%) (P < 0.0001), early commencement of treatment of fever increased from 68 (37.0%) to 131 (75.7%) (P < 0.0001), and children cured of malaria increased from 87 (47.3%) to 146 (84.4%) (P < 0.0001). Insecticide-treated bed nets use also increased from 86 (46.7%) to 161 (87.5%) (P < 0.0001). There were no significant changes in the control group. CONCLUSIONS: The study demonstrated the inherent potentials in using community-based volunteers in malaria prevention and control for those in rural areas with poor health service delivery. We advocate its adaptation for far-reaching reduction in childhood morbidity and mortality and rapid attainment of millennium development goals 4.

Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria.

CONTEXT: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is one of the world's most challenging pandemics. For treatment with Highly Active Anti-Retroviral Therapy (HAART) to be effective, high rate of adherence is essential. AIM: To demonstrate the effect of adherence counseling and text message reminders in improving patients' adherence to HAART. SETTINGS AND DESIGN: A randomized control trial among non-adherents was carried out in a tertiary hospital in Nigeria between March and July, 2011. MATERIALS AND METHODS: A total of 104 patients: 45 males (43.3%) and 59 females (56.7%) participated in the study. They were randomized into intervention and control groups. The intervention group received monthly adherence counseling and twice weekly short message reminders for four months, while the control group received only standard care. Self-reported adherence and CD4+ cell counts were measured pre- and post-intervention. STATISTICAL ANALYSIS USED: Data was analysed using Statistical Package for Social Sciences (SPSS) version 18. Risk rates, Chi-square, Mann-Whitney U test and Cohen's effect size were calculated. Level of significance was set at P = 0.05. RESULTS: At post-intervention, 76.9% of the intervention group and 55.8% of the control group achieved adherence (χ2 = 5.211, P = 0.022, RR = 0.75 (0.55-0.96), Cohen's w = 0.224). Also, median CD4+ cell count of the intervention group increased from 193 cells/ml to 575.0 cells/ml against 131.0 cells/ml to 361.5 cells/ml in the control group (P = 0.007). CONCLUSION: Adherence counseling and text message reminders improved adherence among HIV patients. Its adoption for HIV patient management is advocated.

Insecticide - treated bednet ownership and utilization in Rivers State, Nigeria before a state-wide net distribution campaign.

BACKGROUND & OBJECTIVES: Malaria presents a huge health and economic burden to families living in malaria endemic areas. The use of insecticide-treated nets (ITNs) is one of the global strategies in decreasing the malaria burden on vulnerable populations. The use of ITNs reduces clinical malaria by over 50% and all cause mortality in children by 15-30% when the overall population coverage is >70%. This study was aimed at establishing the level of household insecticide -treated bednet ownership and utilization in Rivers State, Nigeria before a statewide scale -up distribution campaign. STUDY DESIGN: A descriptive, cross - sectional study was carried out in the Rivers State in November 2008 among household heads or their proxies to serve as a pre -intervention baseline for the scale -up distribution of insecticide treated bednets in the state. The households were selected by a multi -staged sampling technique: first stage being the selection of Local Government Areas (LGAs) from Senatorial districts, second stage the selection of communities from LGAs and final stage the selection of households. Data were collected using a questionnaire adapted from the WHO/FMoH and analyzed using the Epi -Info version 6.04d statistical software package. Hypothesis tests were conducted to compare summary statistics at 95% significance level. RESULTS: A total of 811 household heads or their proxies were interviewed. Their age ranged between 20 and 70 yr, with a mean of 47.96 ± 4.39 yr. The study showed that although 552 (68.1%) of the households owned bednets, only 245 (30.2%, 95% CI=27.1-33.5) of them owned long -lasting insecticidal nets (LLINs). Similarly, only 37.2% of those who owned ITNs slept under them the night preceding the survey. CONCLUSION: Household ITN ownership and utilization were low in the state. Incorporating behavour change communication package as part of the ITN distribution intervention is advocated to increase ITNs utilization in the state.

Identifying barriers and sustainable solution to childhood immunization in Khana local government area of Rivers State, Nigeria.

The aim of this study was to uncover barriers to childhood immunization in order to make recommendations that will address the problem in Rivers State and Nigeria. A descriptive, cross-sectional study was carried out in September 2008, among mothers and caregivers of children aged 0-5 years, to examine the various barriers to childhood immunization in the Khana Local Government Area of the State. Data was analyzed using Epi Info version 6.4d software. A total of 1560 mothers and caregivers were interviewed. Their knowledge about immunization was low. Only 15.2% was able to define immunization and mention six vaccine preventable diseases. Most children (46.8%) did not complete their immunization schedule because of frequent shortage of vaccines in the health facilities. Long-term and advance commitment by the government to vaccine manufacturers to purchase vaccines and engaging communities in dialogue over benefits of immunization is advocated to improve immunization in the State.

Serum lipids profile of untreated hypertensive patients in Port Harcourt, Nigeria

Background: Hypertension is the commonest non-communicable disease with variable prevalence rates in different parts of the world. Dyslipidaemia is associated with and predisposes to hypertension and hence increases the risk of cardiovascular disease. Aim: To determine the lipid profile in newly diagnosed hypertensive patients and compare them with age, sex and body mass index (BMI) of matched healthy non-hypertensive controls. Methods: A prospective descriptive study of newly diagnosed and treatment naive hypertensive patients. Healthy non-hypertensive adult Nigerians, who gave informed consent, consisting mainly of hospital staff and relatives of patients, matched for sex, age and BMI were recruited as controls. Results: A total of 89 patients, 42 females and 47 males and 87 healthy adults matched for age, sex, and body size were recruited as controls. Mean age of hypertensive subjects was 42.6±9.3 years and mean age for the control subjects was 41.5±4.5 years. The mean systolic blood pressure in the hypertensive subjects was 177.6±20.1 mmHg and mean diastolic blood pressure was 110.9 ±9.9 mmHg. The mean BMI in the hypertensive patients was 28.7±4.2 kg/m2, while the controls had mean BMI of 28.2±4.0 kg/m2 (P=0.5178). The mean total cholesterol (TCH) was 5.3±1.1 mmol/l in the study subjects and 4.7±0.95 mmol/l in the controls (P =0.0002). The mean low density lipoprotein cholesterol 250 in the study subjects was 4.3±1.1 mmol/l and 3.6±0.9 mmol/l in the control group (P=0.000054), while the mean triglyceride in the subjects was 1.3±0.3 mmol/l and 1.0±0.3 mmol/l in the controls (P=0.0000). Conclusion: Newly diagnosed hypertensives have significantly higher serum cholesterol levels than non-hypertensives of comparable age, sex and body size

A Three-Year Review of the Pattern of HIV Infection among Pregnant Women Attending Braithwaite Memorial Specialist Hospital; Port Harcourt; Nigeria

Background: The HIV prevalence rate in Rivers State was low at onset; but increased progressively; often exceeding the National average since 2001. However; there has been a reported decline in the prevalence in Nigeria and elsewhere with wide local and zonal differences. Aim: To assess the HIV sero-prevalence among pregnant women attending the antenatal clinic (ANC) at the Braithwaite Memorial Specialist Hospital Port Harcourt; Rivers State. Methods: Hospital records of all pregnant women who registered and attended the antenatal clinic from 2nd January 2005 to 31st December 2007 and were screened for HIV infection at the Haematology laboratory were retrieved and analysed using Epi-Info version 6.04d. Results: A total of 9;869 ANC attendees were screened for HIV infection at the Hospital. The prevalence rates were 4.8in 2005; 5.4in 2006 and 5.3in 2007. The pattern of infection showed that the highest prevalence rate of 5.6was found among the youngest age group (15- 24 years); clients with only primary education (8.5); and skilled workers (7.3) (p= 0.000). Conclusion: HIV infection is still in its epidemic phase in Rivers State unlike in other areas in the country where declines have set in. Caution is therefore required in extending the emerging declines in prevalence rates elsewhere to Rivers State; so that the existing political will and commitment in control efforts in the State are not weakened; if the State wishes to experience a sustained decline in prevalence rate in the foreseeable future