Abstract
The study was carried out to determine the incidence, prevalence and
prevention of tuberculosis among residents of Central Senatorial District of
Plateau State from 2002-2011. To achieve the purpose of the study, four
objectives with corresponding research questions were posed and six hypotheses
were postulated. The Ex-post facto descriptive research design was used for the
study. The instrument for data collection was a researcher designed
Tuberculosis Inventory Profoma (TIP) and Tuberculosis Preventive Measure
Questionnaire (TMPQ). Five experts in the Department of Health and Physical
Education validated the profoma and questionnaire. The population for the study
consisted of 1349 cases of TB patients in all the Dot Centres of Central
Senatorial District from 2002-2011 and 328 health workers sampled using proportionate
stratified random sampling technique from a total of 1100 health providers in
all the Dots Centres of Central Senatorial District. Data collected from the
records unit of Dot Centres and questionnaire were used for analysis.
Frequencies and percentages were for analysis of descriptive data while the
chi-square statistics was used to test all the null hypotheses at .05 level of
significance. The result of the study showed that the highest number of new
sputum smear positive cases of tuberculosis was recorded in 2005 (19.6%) while
the lowest occurred in 2008 (4.2%). The highest prevalence of TB cases occurred
in 2005 (20.0%) while the lowest prevalence was recorded in 2008 (4.4%). The
highest incidence of TB (24.9%) occurred among age group 35-44 years while the
lowest (3.5%) occurred among age group 0-14 years. The highest prevalence of TB
(23.9%) occurred among age group 35-44 years while the lowest prevalence was
recorded within age group 0-14 years (3.6%). The highest prevalence of TB
(36.0%) occurred among those with no formal education while the lowest was
recorded among those with tertiary education (15.5%). Majority of the
respondents (60-87.8%) indicated they adopted the guidelines on TB prevention
while slightly above one-half respondents (50-58%) indicated they did not
follow the guidelines. Majority of the respondents (63.4%) and 63.3 per cent
indicated they provided natural ventilation in TB wards and windows kept opened
in waiting areas 63.3 per cent respectively while 69.2 per cent indicated they
were not provided with natural ventilation. Majority of the respondents 60-82.9
per cent indicated they provided patient education while 63.7 per cent
respondents did not inform patients/family about possible side effects of
drugs. There was statistically significant difference in the prevalence of TB
according to age. In conclusion, tuberculosis was recorded highest in 2005 and
lowest in 2008. The highest percentage of TB occurred among age group 35-44
years. The highest prevalence of TB occurred in 2005. From the findings of the
study, the researcher recommended among other things that Ministry of Education
and Health should collaboratively develop and enforce curriculum that
emphasizes functional health literacy regarding disease prevention, and also
public health authorities should intensify community health education aim at
promoting health seeking behavior for early passive case detection.
CHAPTER ONE
Introduction
Background to the Study
Historical record has it that tuberculosis otherwise known as phthsis or consumption disease has been the affliction of man since ancient times. It is reported to have occurred in Egypt in about 3000BC. It was not clearly understood until Robert Koch in 1882 first described the disease and the causative agent. Tuberculosis is an acute or chronic necrotizing disease caused by the mycobacterium tuberculosis and characterized pathologically by inflammatory changes, caseation, tubercle formation and fibrosis. It is a communicable disease transmitted mainly by droplets from an infectious person to another person (Lyght, 1971).
The disease initially was limited many centuries to Europe, America, and Asia and North Eastern part of Africa. However, activities of explorers, adventurers and traders led to the extension of the disease to West Africa by the 1900. Since then it has remained a major public health problem in many tropical countries including Nigeria (Weathral, 2004). Though it can affect any organ, the one most commonly encountered in clinical practice is the pulmonary type which affects the lungs and it is very important in the epidemiology of the infection.
Tuberculosis (TB) has remained one of the world’s major causes of illness and death, and in 1993, the World Health Organization (WHO) declared TB to be a global health emergency. One third of the world’s population or two billion people carry the TB bacteria, more than 9 million of whom become sick each year with “active” TB which can spread to other; “latent TB” disease cannot be spread (WHO, 2006).
The World Health Organization disclosed that tuberculosis disproportionately affects people in resource poor settings particularly, those in Asia and Africa. More than 90 per cent of new tuberculosis cases and deaths occur in developing countries posing significant challenges to the livelihood of individuals and developing economies as tuberculosis primarily affects people during their most productive years 15-59 years (WHO, 2OO7). The United State Agency for International Development USAID (2009) stated that twenty two countries are considered “high burden countries (HBCs).” These countries account for approximately 80 per cent of new tuberculosis cases each year. Most high burden countries are in Africa and Asia. India, China, Indonesia, South Africa and Nigeria have the highest number of new tuberculosis cases in the world (USAID, 2OO9).
Kaiser (2007) disclosed that an estimated 13.7 million people were living with “active” tuberculosis, including 9.3 million new cases. There were an estimated 1.8 million tuberculosis deaths, one in four which was HIV-related twice as many as previously recognized. In Nigeria, the incidence rate of tuberculosis is 123 per 100,000, prevalence rate of 536 per 100,000 and mortality rate of 76 per 100,000 (Haruna, 2008). Within the context of this study, tuberculosis refers to a contagious mycobacterial respiratory disease that is transmitted from one infected person to another person through infected droplets during coughing, and sneezing. Usually, the disease can affect any organ giving rise to extra-pulmonary tuberculosis (ETB), but involvement of the lungs account for more than eighty per cent of tuberculosis cases. TB affecting the lungs is called pulmonary tuberculosis (PTB). The lungs are organs of respiration found in the thoracic cavity.
Lucas and Gilles (2003) outlined three stages of the clinical manifestation or signs and symptoms of tuberculosis in man; the primary complex, which consists of a small parenchymal lesion and involvement of lymph nodes in the lungs, this constitutes the classical Ghon focus. In most cases the primary complex heals spontaneously with fibrosis and calcification of the lesions, but the organism may persist for many years within the focus. A person develops this primary complex only when infected for the first time.
Early complication is the second stage, which occurs when the primary complex progresses to produce more severe manifestation locally or there may be spread to other parts of the body. The first 6 months of the infection is the most dangerous as there may be haematogenous spread to either, the bones and joints or disseminated in the form of miliary tuberculosis.
The third stage occurs when there is reactivation of existing lesion or by exogenous re-infection. It involves the destruction of the lung parenchyma with fibrosis and cavitations. It is at this stage that pulmonary tuberculosis is clinically established and it may present with cough, haemoptysis and chest pains. Other symptoms are fever, loss of weight and malaise. The frequency and vigour of cough and the ventilation of the environment influence transmission of infection (Park, 2007). Left untreated a person with active Tuberculosis will infect an average of 10-15 people every year (Haruna, 2008).The statistics for incidence of tuberculosis for different countries have been estimated as follows: Vietnam: 148,000, Bangladash; 332,000; China; 1,365,000, India; 1,856000, Russia; 193,000, South Africa; 228,000, United States; 18,361, Brazil; 116,000 (Centre for Disease control, 2010). Even though the cause of tuberculosis in man is a bacterium known as mycobacterium tuberculosis transmitted mainly by airborne droplets, certain contributory factors seem to play a major role for its prevalence in human population.
Infection with human immunodeficiency virus (HIV) is one of the most important risk factor for development of tuberculosis in persons infected with M-tuberculosis (Lienhardt, 2001). Due to immune suppression caused by HIV infection, persons with latent tuberculosis as well as newly infected persons may progress rapidly to clinical disease. Complication of TB in HIV infected people include increase frequency of side effects of drugs treatments and increase rates of relapse and re-infection. The estimated risk of clinical disease in HIV – infected persons is between 6 and 26 times the risk in non HIV infected persons (Ravigoline and Diye, 1992). By mid-1992, Ravigoline and Diye, stated that an estimated 5.6 million persons were dually infected with HIV and M. tuberculosis world wide; 3.8 million of them in sub-Saharan Africa. WHO (2010) disclosed that the TB burden in Nigeria is compounded by a high prevalence of HIV which stands at 4.1 per cent in general population. It further stated that the prevalence of HIV among TB patients increased from 2.2 per cent in 1991 to 19.1 per cent in 2001 and 25 per cent in 2010. This indicates that the TB situation in the country is HIV driven. Other factors associated with tuberculosis are, age and sex, lack of access to health care, crowding, urbanization and homelessness, migration, socioeconomic status (SES), race/ethnicity, and level of education.
The extent to which differences in reported cases of TB between men and women reflects differences in prevalence or differences in access remains uncertain, but there is evidence that gender influences access to health care and therefore higher propensity for diagnosis. Bennstam (2004) stated that perceptions of TB are affected by gender norms and stereotypes. He stressed that the social and economic impact of being diagnosed with TB can differ for women and men of different ages and positions affecting their vulnerability to effects of ill-health. Differences in anticipated impact of TB may translate into differences between men and women in seeking care and therefore for vulnerability to severe disease. Gender distribution studies in India has shown that more males were screened compare to females, but there was no difference in the prevalence positivity rate between male and female patients (Shamila, Andrabi & Imtiyaz, 2012).
Women and men often face different barriers to accessing care. With passive case finding as is usual with directly observed treatment short course (DOTS), a low proportion of women with TB are found, in contrast to active case finding where roughly equal numbers of men and women with TB are detected (Uplekar, 2001). The factors which bring about this differential access have included self-image, status, access to resources, manifestation and expression of symptoms and stigma of having TB. Once detected with TB, women are more likely to be adherent to therapy and be cured of TB than men.
Men postpone care seeking longer than women. Reasons for longer delay among males includes fear of individual costs of diagnosis, and treatment as documented in studies, in India and Nigeria (Enwuru, 2002). He further stated that men are more likely to neglect symptoms longer until serious before going to the hospital. Women, on the other hand are more likely than men to seek care immediately after symptoms. Studies in India and China however, have shown that women tend to self medicate or choose private practitioners as the first point of contact after deciding to seek care (Lonnroth, 1999).
Another significant gender difference have been documented in Sudan and Nepal in which women are offered sputum test less frequently than men (Godfrey, 2002). This according to him is due to the fact that in some communities, women need to be accompanied to DOTS clinic hence longer female delay. Ahsan (2004) reported that women bear the highest burden of stigmatizing behaviours. In some communities, female TB patients and women who are suspected to have active TB are likely to be force to get divorced, send back to their parents home and have fewer chances of getting married. In Bangladesh and Vietnam, studies have shown that fear of isolation from family or community is a key factor contributing to delay among women. Stigma is suspected to be a contributing cause as to why females are more likely to postpone diagnosis, are offered sputum test less frequently and felt more inhibited than men to discuss TB with their family (Barhoom and Driannase, 1991). Age and sex, variations in the prevalence of tuberculosis infection and disease have been reported world wide. Shamila et al (2012) documented highest prevalence of sputum positivity 26.4 per cent among cough symptomatic in the age group 55years and above, followed by 15-24 years 24.5 per cent and 25-35years age group 24.0 per cent. Early tuberculin skin test surveys have shown that infection with M. tuberculosis increase with age and then declines in older adults (Lienhardt, 2001). In children, less than 5 years of age, the risks of progressive tuberculosis disease after primary infection has been shown to be high, probably reflecting a high dose challenge within the home environment (contacts of smear-positive tuberculosis cases). The risk then decreases until age 12 years and rises again in young adults. Most Tuberculosis in adults arises many years after primary infection because of exogenous re-infection or reactivation of a latent focus of infection. It is probable that in addition to genuine age and sex differences in susceptibility related to biologic mechanisms, socio-economic and cultural factors may play a role in determining age and sex differences in rates of infection, progression to disease and treatment outcome (Vidal, Malo & Vogan, 1993). In Nigeria, the age group commonly affected by TB are the most productive age groups with 25-34 age group accounting for (33.6%), 15,303 of the smear positive cases registered in 2010 (WHO, 2010).
