A randomized controlled study comparing community based with health facility based direct observation of treatment models on patients' satisfaction and TB treatment outcome in Nigeria.

BACKGROUND: Directly observed treatment short-course (DOTS) strategy is an effective mode of treating TB. We aimed to study the cost effectiveness and patients' satisfaction with home based direct observation of treatment (DOT), an innovative approach to community-based DOT (CBDOT) and hospital based DOT (HBDOT). METHODS: A randomized controlled trial involving 150 newly diagnosed pulmonary TB patients in four TB clinics in Ile Ife , Nigeria, was done. They were randomly assigned to receive treatment with anti TB drugs for the intensive phase administered at home by a TB worker (CBDOT) or at the hospital (HBDOT). Outcome measures were treatment completion/default rates, cost effectiveness and patients' satisfaction with care using a 13 item patients satisfaction questionnaire (PS-13) at 2 months. This trial was registered with pactr.org: number PACTR 201503001058381. RESULTS: At the end of intensive phase, 15/75 (20%) and 2/75 (3%) of patients in the HBDOT and CBDOT, respectively had defaulted from treatment, p= 0.01. Of those with pretreatment positive sputum smear, 97% (68/70) on CBDOT and 54/67 (81%) on HBDOT were sputum negative for AFB at the end of 2 months of treatment, p=0.01. The CBDOT method was associated with a higher patient satisfaction score compared with HBDOT (OR 3.1; 95% CI 1.25-7.70), p=0.001.The total cost for patients was higher in HBDOT (US$159.38) compared with the CBDOT (US$89.52). The incremental cost effectiveness ratio was US$410 per patient who completed the intensive phase treatment with CBDOT. CONCLUSIONS: CBDOT is a cost effective approach associated with better compliance to treatment and better patient satisfaction compared to HBDOT.

Interferon-gamma treatment kinetics among patients with active pulmonary tuberculosis.

INTRODUCTION: Interferon-γ (IFN-γ) is essential for defence against Mycobacterium tuberculosis; however, levels in patients with active tuberculosis (TB) and changes during treatment have not been documented in our tuberculosis patients in Nigeria, hence this study has been carried out. OBJECTIVE: To determine variations, treatment kinetics, and predictive value of IFN-γ levels during treatment of active tuberculosis. DESIGN: Patients with pulmonary tuberculosis were recruited and subsequently followed up for 3 months during treatment with anti-TB. Peripheral blood was collected for IFN-γ assays, C-reactive protein and others followed by a Mantoux test. IFN-γ levels produced by stimulation with TB antigens were determined by ELISA and repeated measurement of IFN-γ were done at 1 and 3 months of anti-TB therapy. Chi Associations and correlations between IFN-γ were determined. Regression analysis was done to determine association between serial IFN-γ and treatment outcome. RESULTS: We recruited 47 patients with active tuberculosis with a mean age of 34.8 ± 3.6 years and M:F ratio of 1.12:1. Six (11%) were HIV positive. The mean level of IFN-γ induced by TB antigens was 629 ± 114.1 pg/ml, higher for HIV-negative PTB patients compared with HIV-positive PTB patients, 609.78 ± 723.9 pg/ml and 87.88 ± 130.0 pg/ml, respectively, P-value = 0.000. The mean level of IFN-γ induced by TB antigen increased significantly from 629 ± 114.1 pg/ml to 1023.46 + 222.8 pg/ml, P-value = 0.03 and reduced to 272.3 ± 87.7 pg/ml by the third month on anti-TB drugs, P-value = 0.001. Negative correlation was observed between the mean of baseline and chest X-ray involvement, P = 0.03. There was no significant correlation between sputum smear grade with baseline and follow-up IFN-γ levels. Three-month IFN-γ level among cured patients were higher than those with treatment failure, regression analysis showed that it does not predict outcome. CONCLUSION: IFN-γ may be useful in early detection and monitoring response; however, large scale studies are needed.

Prevalence and patient characteristics associated with pleural tuberculosis in Nigeria.

BACKGROUND: Tuberculosis is a leading cause of mortality worldwide, with a growing death rate. The pleural space is a common extrapulmonary site of involvement. The aim of this paper is to document prevalence and types of pleural involvement in pulmonary tuberculosis and patient characteristics associated with its occurrence. METHODOLOGY: The study was conducted in a hospital outpatient clinic in which consecutive patients with pulmonary tuberculosis (PTB) or suspects were recruited and studied for the presence of co existing pleural disease or involvement (PD). RESULTS: Of 100 patients studied, eighty-two (82%) had PTB alone and six (6%) patients had PD. Pleural effusion was responsible for the majority of the cases, accounting for 67% of PD. There was no case of empyema. Mean age between patients with PTB and PTB/PD was similar. On univariate analysis, patients with PD had a shorter duration of symptoms and increased reporting of fever (p value = 0.02) and were also different from those with only PTB in HIV seropositivity and sputum smear from AFB (p value = 0.02 and 0.00 respectively). However, after adjustment for multiple comparisons using the Bonferroni test, the only significant difference between them was in the HIV seropositivity rate (p value < 0.012). CONCLUSION: Less than one tenth of patients with PTB have co-existing and involvement of the pleural space. Pleural involvement is associated with HIV.

Prevalence and correlates of snoring among adults in Nigeria.

INTRODUCTION: Snoring is a common sleep problem with significant public health concerns. Studies have characterized this in most developed countries. Hitherto there have been no published studies on this subject in Nigeria. OBJECTIVES: To determine the prevalence and correlates of snoring in addition to morbidity in an adult population in Nigeria. DESIGN: A cross - sectional survey of 370 young adult and adult living in Abuja, Nigeria.. Data were collected on socio- demographic characteristics, sleep pattern as well as occurrence of snoring, apneas and excessive day time sleepiness was determined using Epworth Sleepiness Scale (ESS). Body Mass Index (BMI) and blood pressure were measured. RESULTS: Of the 370 respondents, 218 (59%) were females. The overall prevalence of snoring was 31.6%; habitual snoring (14%) and moderate snoring (17%). Apnea was reported in about 2% of the respondents while the prevalence of Clinically Suspected Obstructive Sleep Apneas (CSOSA) was 1%, (1.9% in males, 0.5% in females). Snoring was significantly associated with male sex, old age, increased BMI and cigarette consumption . The severity of snoring was also associated with a higher ESS score, day time symptoms and other morbidities. CONCLUSIONS: Snoring among Nigerians is associated with multiple factors. There is a need for more awareness about this condition in order to control measures of factors associated with snoring.