Worsening of the disability grade during leprosy treatment: prevalence and its determinants in Southern Nigeria.

Background: In Nigeria, little is known about the development of new or additional physical disability during leprosy treatment. The objective of this study was to determine the prevalence and evaluate factors associated with worsening of physical disability during leprosy treatment in Nigeria. Methods: This was a retrospective cohort study conducted among leprosy patients treated in six referral facilities in six States in Nigeria between January 2011 and December 2015. Multivariable logistic regression analysis was used to identify predictors of worsening disability after treatment. Results: Of 984 leprosy patients who completed treatment, the mean age of the patients was 39.8±17.6 years and 57.4% (565/984) of them were male. Also, 51.6% (508/984) of the patients had either grade 1 or 2 disability at diagnosis, but this declined to 30.8% (303/984) following treatment (p<0.001). Overall, 4.7% (46/984) of the cases developed new or additional disability (or worsening disability) during treatment. The cases with the greatest odds for developing worsening physical disability were patients from the southwest (adjusted odds ratio [aOR] 15.9; 95% CI 3.8-67.4) and southeast zones (aOR 4.7; 95% CI 1.1-19.2), and patients who had a leprosy reaction requiring additional corticosteroid therapy (aOR 11.7; 95% CI 4.4-31.2). Conclusion: Sustained capacity building for health professionals on better monitoring and management of leprosy and its complications is strongly recommended in Nigeria.

Assessment of health care workers' knowledge, attitude and risk perception of Buruli ulcer disease in Southern Nigeria.

Background: Poor knowledge of health care workers may be responsible for the under-diagnosis and low notification of Buruli ulcer (BU) in high-burden settings. This study assessed health care workers' knowledge, attitude and risk perception of BU in Southern Nigeria. Methods: We conducted a cross-sectional survey among 186 health care workers recruited from 58 health facilities in four states of Southern Nigeria. A semi-structured interviewer-administered questionnaire was administered to all participants. Results: The overall mean knowledge score was 8.8±2.7 (maximum 15). Only 29.0% (54/186) of the respondents had a good knowledge of BU. The mean (SD) attitude score was 4.5±1.2 (maximum 6). Also, 61.3% (114/) of the respondents had a good attitude towards BU. The overall mean (SD) risk perception score was 2.6±1.3 (maximum 5). Only 26.3% (49/) of the respondents had a good risk perception of BU disease. Previous training was an independent predictor of good knowledge (aOR 4.6), good attitude (aOR 3.8) and good risk perception (aOR 2.9) to BU. Conclusions: Health care workers in endemic settings of Nigeria have poor knowledge of and poor risk perception of BU disease. Training of health care workers is recommended to address the identified gaps to ensure earlier diagnosis and referral to specialist centres.

Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings.

Implementation studies are recommended to assess the feasibility and effectiveness of programmes. In Nigeria, little is known about the burden of diabetes mellitus (DM) among tuberculosis (TB) patients. The objective of this study was to determine screening efficacy, prevalence of DM and determinants of DM among TB patients. We report on a multi-centre implementation study carried-out in 13 health facilities in six States of Southern Nigeria. All newly diagnosed TB patients registered from March to October 2015 were screened for DM using current World Health Organisation guidelines. Overall, 2094 TB patients were evaluated, 196 (9.4%) were found to have DM. The prevalence of newly diagnosed DM was 5.5% (115/2094). DM prevalence varied according to age group; occurring in 2.2% of patients aged ≤ 25 years and 16.9% in patients aged (56-65) years. The additional yield of DM was 59% while the number needed to screen to detect a new case of DM was 18. Factors associated with DM were; age >40 years (aOR2.8, CI 2.1-3.9), rural residence (aOR2.3, 1.6-3.2), private health facility care (aOR2.0, 1.4-2.7), and having an occupation that engages in vigorous activity (aOR0.6, 0.4-0.9). The burden of DM among TB patients is high. Prioritization of DM screening for TB patients is indicated.