Daffodil International University (DIU), Dhaka Bangladesh AN EVALUATION OF TREATMENT OUTCOME IN TUBERCULOSIS DIRECTLY OBSERVED TREATMENT SHORT COURSE (DOTS) FACILITIES IN JIGAWA STATE, NIGERIA (2010–2014) BY MUHAMMAD FAISAL Daffodil International University (DIU), Dhaka Bangladesh FEBRUARY 2016

BACKGROUND Tuberculosis (TB) is a major public health problem worldwide. One third of the world population (2 Billion people) have TB infection. Tuberculosis (TB) is contagious and airborne. It ranks alongside HIV as a leading cause of death worldwide. 9.6 million people are estimated to have fallen ill with TB in 2014: 5.4 million men, 3.2 million women and 1 million children. An estimated 1.2 million people living with HIV developed TB in 2014.

Cont’d Top 10 countries with TB patients are India, China, Indonesia, Nigeria, South Africa, Bangladesh, Ethiopia, Pakistan, Philippines and Democratic Republic of the Congo. In Africa, there are about 1.6 million new cases of TB yearly with about 600,000 deaths. Nigeria is rated 4th among the 22 countries Worldwide with high TB burden. In Jigawa state, DOTS is being practiced in all the 27 Local government areas. Coordinated by the State TB Leprosy Control Program (STBLCP).

JUSTIFICATION This Research is not an entirely new research area. The study will try to evaluate the treatment outcome and socio-demographic factors that are related to it. The study will help to reduce/decrease the mortality and morbidity of the disease in the communities and hence reducing the spread of the disease. The policymaker can take necessary steps to make people aware about the associated risk factors of TB.

Research Question What is the treatment outcomes from Jigawa state TB patients and possible risk factors associated with the occurrence of the Tuberculosis in the State?

Objectives of the study GENERAL OBJECTIVE: To evaluate the treatment outcome in TB DOTS facilities in Jigawa State.   SPECIFIC OBJECTIVES To determine the TB treatment outcome in Jigawa state. To determine the factors influencing the treatment outcome of TB in Jigawa state. To determine the prevalence of HIV among TB patients.

METHODOLOGY Research Design This study was a retrospective cross sectional study.

Study Population, period of study and sample size The study population was all the TB patients that assessed treatment in the seven chosen local governments using the DOTS therapy in Jigawa State between the years 2010 –2014. Study was carried out from October 2015 to January 2016, Jigawa state, Nigeria.

Cont’d Sample size was determine by using below relation; n = z2pq d2 n = minimum sample size z = Standard normal deviate (usually 1.96) p = prevalence of TB in Nigeria which is 5.2% q = 1–p d = degree of freedom (0.05) n = 76 The minimum sample size required for this study is 76.

Sampling Techniques and Data collection procedure This research work was conducted by the use of stratified sampling techniques. Data was collected from the various LGA TB control registers used for the study. The LG TB control registers contained basic information of the patients. These information include date of registration, LGA TB no, name, age, sex, treatment unit/facility, date treatment started, treatment category, x- ray result (if applicable), etc. JIGAWA STATE JIGAWA NORTH WEST JIGAWA NORTH EAST JIGAWA SOUTH WEST

Data Analysis Data was analyzed by using a software package used for statistical analysis i.e. Statistical Package for the Social Sciences (SPSS).

RESULTS

Table 1: Distribution of patients by Age (n=963)  Age (years) Frequency Percentage (%) 0-19 122 12.7 20-29 243 25.2 30-39 221 22.9 40-49 169 17.5 50-59 89 9.2 60-69 119 12.4 Total 963 100 Mean age = 36 years, SD ± 7.97   

Figure 1: Distribution of patients by sex (n=963)

Figure 2: Distribution of patients by type of residence (n=963)

Figure 3: Distribution of patients by treatment outcome (n=963)

Figure 4: Prevalence of HIV Disease (n=963)

Table 2: Distribution of patients by disease classification (n=963) Variables Frequency Percentage (%) Disease classification Pulmonary Extra pulmonary 930 33 96.6 3.4 Disease Category Category 1 Category 2 833 130 86.5 13.5 Total 963 100

Table 3: Factors affecting treatment outcome (n=963) Cured Treatment Died Defaulter Transfer Failure Total Statistics Smear type +ve -ve 378 55 166 202 33 18 61 20 12 5 9 4 659 304 X2=45.114 P=0.000 Category CAT 1 CAT 2 379 54 309 59 42 71 10 11 6 8 820 143 X2=38.910 Disease classification PTB EPTB 425 8 349 19 48 3 75 17 13 927 36 X2=44.981 Residence Urban Rural 283 150 272 96 72 686 277 X2=58.578 Sex Male Female 228 205 222 146 32 51 30 554 409 X2=38.284 P=0.002 Age (years) ≤19 20-29 30-39 40-49 50-59 60-69 122 243 68 127 169 26 1 80 221 89 119   X2=1.614 433 368 81 963

Conclusion This study revealed a Treatment Success rate (TSR) in Jigawa State of Nigeria that is higher than the TSR of Nigeria, it also revealed a defaulter rate that is lower than the Nigerian average, a failure rate that is marginally lower and better than the Nigeria average using the 2009 WHO Global TB report. This study has shown a death rate which is close to the death rate of TB patients in Nigeria.

Recommendation The state TB team should be commended for all their efforts in making sure that the state TB program is moving in the right direction. DOTS should be extended to all the nooks and corners of the state so that there will be wider access to TB treatment. TB HIV collaboration should be encouraged and enhanced. HIV testing should be extended to all TB patients while all HIV patients should be screened for TB. Government should be encouraged to improve infrastructures, health policies, human resources development, service delivery at all health centers and DOTS clinics. Proper observation and follow up of patients during treatment is needed.

THANK “U” ALL