PREVALENCE AND TREATMENT OUTCOME OF PULMONARY TUBERCULOSIS IN EKU HOSPITAL, DELTA STATE

Abstract

This study was on prevalence and treatment outcome of pulmonary tuberculosis in Eku referral Hospital, Delta State. The objectives of the study were to find out the achievement of the state target within the five year period reviewed, ascertain the prevalence of pulmonary tuberculosis in the hospital, during the period reviewed, and determine the treatment outcome of the patients within the period.A retrospective research design was employed for the study. The entire pulmonary tuberculosis patient treated within the Period (2009-2013) was included in the study and comprised of 1,423 patients. A self-developedproforma was used to extract relevantinformation from the hospital records. The face and content validity were determined by the supervisor and two other lecturers who are experts in measurement and evaluation. Descriptive and inferential statistics were used to analyze the data. The results were presented in tables as percentages, means and standard deviation. Chi-square was used to determine the association between age and treatment outcome at 0.05level of significance. Major findings of the study revealed that males were mostly affected than the females. While those within 21-30 years were mostly affected and these are the vibrant and economic group. Other findings of the study showed that majority 650 (45.7%) of them were cured and discharged while 183 (12.9%)defaulted and 131(9.20%) died.  The five years period reviewed showed increase in prevalence rate of PTB with 1,011(71.0%) as new cases and 412 (28.9%) were old cases. The study concluded that there was an association between age and pulmonary tuberculosis treatment outcome. Though more males were affected, they equally responded to treatment more than thefemales. The increase in prevalence of PTB from the data analyzed raises issue of public health concern of PTB resurgence in the society and need urgent intervention.

CHAPTER ONE

INTRODUCTION

Background to the Study

Tuberculosis (TB) is a chronic infectious disease caused by bacteria generally referred to as mycobacterium tuberculosis; almost every organ in the body can be affected, but involvement of the lungs account for more than 80% of TB cases. Tuberculosis affecting the lungs is called Pulmonary Tuberculosis (PTB), while those affecting other organs are called Extra Pulmonary Tuberculosis (EPTB) (Federal Ministry of Health, 2010).

The most important source of infection is an untreated Pulmonary Tuberculosis (PTB) patient. When such a person coughs, spits or sneezes, tiny droplet nuclei containing the tubercles are released. Transmission is through inhaling these droplet nuclei (Federal Ministry of Health 2010).

Today tuberculosis remains a global public health problem of enormous dimension. It is estimated that there are I billion infected patients worldwide, with 10 million new cases and over 3 million deaths per year. Tuberculosis is responsible for more deaths than any other infectious disease (WHO, 2008).

It was estimated to cause a global emergency with estimates of 1.8 million deaths worldwide in 2008 out of over nine million cases. In the same year, the estimated global incidence rate fell to 139 cases per 100,000 populations after reaching its peak in 2004 at 143 per 100,000. However, this decline was not homogeneous throughout the World Health Organization (WHO) regions, with Europe failing to record a substantial decline, but rather appearing to have reached a stabilization rate (WHO, 2009).

In the WHO African region with a population estimate of 836,670,000 as at 2010, TB incidence was 2,300,000, prevalence of 2,800,000 and deaths of 250,000 (World Health Organisation, 20I0). Nigeria ranking the tenth among the 22 high TB burden countries in the world has the prevalence of 133 per 100,000 and 93,050 cases were registered in 2010. (Federal Ministry of Health, 2011)

Treatment success measured by a standardized process of treatment outcome monitoring (TOM) is one of the pillars of TB control and along with case detection, is recognized as a key programmatic output. It is against this rationale that World Health Assembly (WHA) resolution was passed in 1991, adopting two targets for global TB control to detect at least 70% of new infectious cases and to cure at least 85% of those detected. These targets were linked to the Millenium Development Goals, and stop TB partnership set the year 2005 as the dead line for achievement (Dye, Maher, Espinal and Raviglione, 2006).

Globally, the treatment success rate exceeded the 85% target for the first time in 2008 since the target was set in 1991, with a percentage of 87% for patients starting treatment in 2007 (WHO, 2009). Further, more treatment success rates were not maintained nor improved between 2006 and 2007 in all WHO regions with the exception of the European region which recorded the lowest success rate globally at 67% (WHO, 2009).

The importance of strengthening treatment outcome monitoring (TOM) in Europe has long been recognized. A statement put forward by the WHO and the International Union Against Tuberculosis, and Lung Disease underlined in 1998 the need for standardization and evaluation of treatment results for TB patients in the WHO European region including those in low and intermediate incidence countries( Veen, Raviglione, Reider, Migliori, Graf, and Grzemska, 2008) Nigeria’s TB control programme adopted the global target of detecting 84% of the estimated TB cases, and curing 87% of the detected cases by the year 2015 using the Directly Observed Treatment Short course therapy (DOTS) strategy, (WHO, 2010). While the latter target appears more readily achievable with Nigeria recording 73% treatment success by 2004 cohort, the case detection rate remained at low level of 22% compared to the global figure of 37% (WHO, 2007).

Delta State is now among the States being sponsored by the German Leprosy Relief Association, a non-Governmental Organization for Tuberculosis Control. The German Leprosy Relief Association provides logistics for the effective control of tuberculosis in Delta State. Tuberculosis hospital, Eku is a referral centre in Ethiope East Local Government Area of Delta State. It also serves as a referral hospital to other parts of the State and environs. The Tuberculosis Centre, Eku has 7 wards with 104 beds having an average of 350 patients annually due to the introduction of DOTS therapy (Directly Observed Treatment Short course) (Tuberculosis referral Hospital Records, 2007).

Recently the indigenes of Eku, a major community in Delta State where the hospital is located seem to be very much afraid of the wide spread of pulmonary tuberculosis infection because of the number of TB patients seen in their locality through referrals from other places.

Statement of Problem