Practices toward presumptive tuberculosis clients among patent medicine vendors in Ebonyi State Nigeria

Background

Tuberculosis (TB) is a major cause of ill-health and death globally but a serious challenge to its control is low case notification. In low- and middle-income countries, most patients with symptoms of the disease first seek care from patent medicine vendors (PMVs) who are not formerly trained to manage TB. The practices of PMVs toward presumptive TB are pivotal to control of TB.

Aim

The aim of this study was to describe the pattern of practices toward presumptive TB and assess their determinants among PMVs.

Method

The study was carried out in Ebonyi State Nigeria using descriptive cross-sectional design. Through a multistage sampling, 250 PMVs were selected and interviewed. Data were collected using pretested interviewer-administered questionnaire and analyzed with IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA). Chi-square test and binary logistic regression were used to determine factors associated with practices toward presumptive TB with P value set at 0.05 for statistical significance.

Results

Almost half (48.8%) of the respondents engaged in poor practices by inadequate referral of clients (45.2%), delayed referral (69.6%), and unstandardized treatment with antibiotics (56.4%). There was no statistically significant association between independent variables and practice and none of the variables significantly predicted practice.

Conclusions

There were poor practices toward presumptive TB shown in inadequate referral, delayed referral, and unstandardized treatment of clients. We recommend that PMVs should be trained and regularly sensitized about TB to improve their practices and that regulatory authorities should enforce policies on antibiotics distribution and sale.

Nonadherence to tuberculosis treatment and associated factors among patients using directly observed treatment short-course in north-west Nigeria: A cross-sectional study

INTRODUCTION

Tuberculosis is a public health problem in Nigeria. One of the most effective ways of controlling tuberculosis is the directly observed treatment short-course. However, some factors influence tuberculosis patients' treatment nonadherence via directly observed treatment short-course. The study objective was to assess medication nonadherence and associated factors among tuberculosis patients in north-west Nigeria.

METHODS

A cross-sectional study enrolled tuberculosis patients using directly observed treatment short-course in public health facilities in Kano and Kaduna States from January 2015 to June 2016. The sample selection was conducted via a multistage sampling procedure. Data were collected using tuberculosis patients' demographic and clinical characteristics forms, well-validated structured instruments, and medical records. SPSS version 20 was used for data analysis. Logistic and multivariable logistic regression analyses to determine factors of medication nonadherence (P < 0.05).

RESULTS

Complete responses from 390 patients out of the 460 patients recruited for the study were used for data analyses. The mean age was 51.5 (standard deviation = ±13.8) years. The mean tuberculosis medication adherence questionnaire score was 4.35 ± 1.12. The prevalence of nonadherence to tuberculosis medication was 30.5%. Multivariable logistic regression analysis showed that having a monthly income between #100,000 and #199, 000 (adjusted odds ratio = 0.01; 95% confidence interval: 0.00-0.13), being widowed (adjusted odds ratio = 26.74, 95% confidence interval: 2.92-232.9), being married (adjusted odds ratio = 120.49, 95% confidence interval: 5.38-271.1), having a distance <5 km to directly observed treatment short-course center from home (adjusted odds ratio = 0.06, 95% confidence interval: 0.00-0.01), having a tuberculosis/HIV co-infection (adjusted odds ratio = 0.01, 95% confidence interval: 0.12-0.35), use of antiretroviral treatment and cotrimoxazole prophylaxis therapy medications (adjusted odds ratio = 24.9, 95% confidence interval: 19.6-304.3) were associated with tuberculosis medication nonadherence.

CONCLUSION

Tuberculosis medication nonadherence was high among the patients. Thus, patient-specific adherence education, attenuation of potential factors for tuberculosis medication nonadherence, and continual resource support for tuberculosis patients are needed to improve treatment outcomes.

Assessment of Directly Observed Treatment in Revised National Tuberculosis Control Programme: A Study from North India

Introduction:

Directly observed treatment short-course (DOTS) strategy is one of the vital components of Revised National Tuberculosis Control Programme (RNTCP) came into existence in 1997. Directly observed treatment providers (DOT providers) are the grass root level link between program and clients.

Aims:

This study was undertaken to assess the quality of DOTS and facilities available at DOT centers and association between program input and outcome.

Materials and Methods:

This prospective study was carried out to evaluate RNTCP in a North Indian District. Totally, 42 DOT providers providing treatment to registered RNTCP patients in four designated microscopy centers were included in this study. Program input was assessed based on a ten-point questionnaire regarding processes and facilities followed DOT center. Treatment outcome of 302 patients receiving DOTS under these providers was also assessed.

Statistical Analysis:

Data were analyzed using SPSS version 20. Categorical variables such as age group, sex, religion, location, work experience of DOT providers are measured in frequency and percentage. Chi-square was used to find association between quality of DOTS and outcome of treatment. P < 0.05 was considered statistically significant.

Results:

The basic principle of DOTS was followed only in half (47.6%) of the DOT centers, counseling was not being done by 40.5% of the providers. Formal training of DOTS was given to two-thirds of the providers. The treatment outcome of patients was significantly associated with program input at DOT center level (Chi-square = 4.02, P < 0.05).

Conclusions:

There are few gaps in DOT practices such as administration of DOTS, patient counseling, and tracing of follow-up. This study also concluded that improved program input can enable to get a better outcome.

A decision tree for rapid quality assurance and control of rifampicin-containing oral dosage forms for global distribution for tuberculosis treatment

For centuries tuberculosis remained as a complex socioeconomic problem impeding human development. Directly observed treatment short-course and fixed dose combinations were implemented in tuberculosis therapy for maximum success of treatment. However, drug shortages primarily hindered the expansion of directly observed treatment short-course, which lead to development of the global tuberculosis drug facility. Since large geographical area is covered by the global tuberculosis drug facility for global drug supply for tuberculosis eradication programs, a rapid quality control and assurance has become necessary to ensure the quality and performance of supplied antituberculosis drugs. In this manuscript a decision tree is proposed for facilitating rapid quality control (in vitro and in vivo) of antituberculosis formulations procured by the global tuberculosis drug facility. This decision tree also predicted to be applicable at every stages of anti tuberculosis drug product development, especially in identification of poor quality products and monitoring batch-to-batch variability. Further, it provides opportunity for effective quality control in resource poor settings and the gained knowledge is anticipated to be applicable for development and evaluation of antimalarial and antiAIDS fixed dose combinations.