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.

P3817Predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in a rural South African setting

Background

South Africa is undergoing an epidemiological transition with a dual burden of chronic communicable and non-communicable diseases. A pilot integrated chronic disease management (ICDM) model was initiated in 2011 by the National Department of Health in selected primary health care (PHC) facilities. The aim of the ICDM model is to leverage an established HIV treatment programme for non-communicable diseases (NCDs) for better health outcomes of patients with chronic diseases.

Purpose

This study determined predictors of controlled CD4 count and blood pressure (BP) in hypertension and HIV patients receiving antihypertension medication and antiretroviral drugs, respectively in PHC facilities in the Bushbuckridge sub-district of Mpumalanga province, South Africa.

Methods

This was a panel study to assess the effectiveness of the ICDM model in controlling patients' CD4 count and BP. Patients ≥18 years were recruited through a three-step sampling process into the ICDM model facilities (n=435) and comparison facilities (n=443) in the Bushbuckridge sub-district. Health outcome data (BP and CD4 counts) for each patient were retrieved from health facility records over 30 months (January 2011 to June 2013). Control of BP and CD4 counts were defined as BP <140/90 mmHg and CD4 counts >350 cells/mm3, respectively. Multilevel logistic regression analyses were conducted to determine predictors of controlled CD4 count and controlled hypertension. Data were analysed using Stata 14 statistical software.

Results

The odds of controlling CD4 count were increased by reception of care at the ICDM model facilities (OR=4.05, 95% CI: 2.77–5.92), but decreased by male gender (OR=0.52, 95% CI: 0.34–0.80). The odds of controlling hypertension were higher with increasing age: 40–49 years (OR=6.02, 95% CI: 2.07–17.57); 50–59 years (OR=23.17, 95% CI: 7.46–72.16); ≥60 years (OR=77.48, 95% CI: 25.03–82.26), but decreased by male gender (OR=0.38, 95% CI: 0.21–0.69).

Conclusion

Application of the ICDM model appeared effective in controlling patients' CD4 counts, but not their BP; hence, the HIV programme should be more extensively leveraged for hypertension treatment in health facilities in the study setting. Health education programmes to improve HIV treatment outcomes should focus on males. Hypertension educational programmes should target younger males in the study setting.

Acknowledgement/Funding

Fogarty International Centre of the National Institutes of Health under the Award number D43 TW008330

Assessing agreement of hemoglobin and three- fold conversion of hematocrit as methods for detecting anemia in children living in malaria-endemic areas of Calabar, Nigeria

Background

One of the major causes of anemia, defined as the reduction in the level of hemoglobin or red blood cells (RBCs) in the blood, in children in sub-Saharan Africa is malaria. Anemia is diagnosed by using either the hematocrit method or by measuring the hemoglobin concentration.

Aims

To evaluate the relationship and agreement between hemoglobin and three-fold conversion of hematocrit results of participants in a clinical trial.

Materials and Methods

This is a cross-sectional study that obtained data from a multi-center clinical trial that took place from 2007 to 2008 in public health facilities in Calabar, Nigeria. The hemoglobin and hematocrit results of 494 children who had ≥2000 parasite density recruited were pooled to evaluate the relationship and agreement between the two methods. The difference between the measures against the mean of the two measures was plotted according to the theory of Bland and Altman.

Results

The mean age of the children was 34 months, with approximately equal number of boys and girls. The measured hemoglobin was lower than the calculated hemoglobin in 84.5% of the children. The result showed that lower the hemoglobin concentration, the higher the chances that the three-fold hematocrit conversion overestimates hemoglobin levels in the participants.

Conclusions

The three-fold hematocrit conversion of hemoglobin estimation is a less reliable method than the measured hemoglobin in anemic children in the study setting.

P1946Hypertension prevalence, awareness, treatment and control and 10-year estimated CVD risk in East and West Africa: pooled analysis of data from 4 African countries

Background

Though the prevalence of hypertension is rising in Sub-Saharan Africa, few studies have characterized the epidemiology and management of hypertension across many heterogeneous communities. We assessed prevalence, awareness, treatment and control of hypertension and estimated the 10-year cardiovascular risk across six sites in East and West Africa.

Methods

Between June and August 2018, we conducted household-based surveys in 6 rural, semi-urban and urban settings in Kenya, Nigeria, Tanzania and Uganda to enroll community-dwelling adults (aged >18 years) collect data including age, gender, smoking, anthropometric measures, health insurance, utilization of health care facilities. We defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use. We used country specific Globorisk prediction equations to estimate 10-year CVD risk.

Results

A total 3,150 participants with a mean age of 40 years (SD 15), 61% of whom were women, 8% had ever smoked, and 33% were overweight/obese. About 23.7% (95% CI 22.2, 25.2) of the entire sample had hypertension, of whom 60.6% (56.8, 64.3) were diagnosed. Among diagnosed, 61.7% (57.2, 66.1) were taking antihypertensives, and 27.7% (22.7, 33.1) had controlled BP. The prevalence of hypertension was 38.6% in Ikire-Nigeria, 25.1% Ukonga-Tanzania, 23.3% in Oyo-Nigeria, 21.6% in Okpok-Nigeria, 20.4% in Soroti-Uganda, and 9.7% in Viwandani-Kenya. The overall median estimated 10-yr CVD risk was low 4.6% IQR (2.3, 9.6) and 8.6% had 10-yr CVD risk >10%. (Figure 1)

Conclusion

Among African adults aged >18 years, nearly a quarter have hypertension, three in 5 being treated, and fewer than three in ten had BP under control. The low number of people in control is ubiquitous in all sites and warrants greater prevention strategies, better screening and more effective and affordable treatment options than what is currently available.

Public Awareness of Hepatitis B Virus Infection in Cross River State, Nigeria: A Population-Based Survey

BACKGROUND

Hepatitis B Virus (HBV) infection is a public health problem that is endemic in Nigeria. Cross River State, a tourist state, located in the coastal area of Nigeria has a relatively high prevalence rate. Insufficient knowledge and negative attitudes are barriers to effective control of infectious diseases.

OBJECTIVES

To determine the Knowledge, Attitude and Practice (KAP) of HBV amongst residents of Cross River State, Nigeria.

METHODS

This was a cross sectional descriptive study. A total of 1,620 healthy adults from the three senatorial districts in Cross River State participated in the study from March to September, 2015. KAP towards HBV was assessed using a structured pre-tested questionnaire. Categorical variables were described as frequencies and continuous variables as median and interquartile range. In the inferential analysis, Kruskal-Wallis test was used to determine the relationship between socio-demographic variables and median KAP scores. A p value < 0.05 was considered significant. All analyses were performed using Stata 12 statistical package.

RESULTS

A total of 1,465 respondents completed the questionnaire correctly giving a response rate of 91%. The M: F ratio was 1:1.8. The median age was 38 years. Majority (61%) was married and 32% had formal education up to the tertiary level. Only 45% knew that HBV causes hepatitis. Knowledge of routes of transmission was >50% for blood transfusion, sexual contact and sharps but < 48% for vertical transmission. Median and interquartile range of knowledge scores for the south, central and northern senatorial districts were 8 (2-14), 13 (5-17) and 14 (6-18) which varied significantly with age (p =0.027). The overall attitude and practice towards persons living with HBV was poor. There was good correlation between KAP scores (p<0.05).

CONCLUSION

Knowledge of hepatitis B is low among adults in Cross River State. This correlates with poor attitude and practice towards HBV. There is need to utilize health education strategies to improve awareness among the populace, if Nigeria is to meet the global target of elimination of viral hepatitis by 2030.