12 results on '"Emperor Ubochioma"'
Search Results
2. Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study
- Author
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Adebola Lawanson, Obioma Chijioke-Akaniro, Simeon Onyemaechi, Joseph Kuye, Emperor Ubochioma, Amos Omoniyi, Ochuko Urhioke, Victor O Ombeka, Abiodun Hassan, Sunday Asuke, Chukwuma Anyaike, and Corinne S Merle
- Subjects
Medicine - Abstract
Objectives This study aimed to assess the practices of private practitioners regarding tuberculosis (TB), and to ascertain factors related to the low contribution of private healthcare providers to TB prevention and care in Nigeria.Design This is a mixed methods study comprising a quantitative retrospective review and qualitative study.Setting Private health facilities (HF) in Oyo State and the Federal Capital Territory (FCT), Nigeria.Participants We used routinely collected data on patients with tuberculosis (TB) notified between 1 January 2017 and 31 December 2018. In-depth interviews were also conducted with the clinical staff of the facilities.Primary and secondary outcome measures The study outcomes are practices of TB case notification and treatment outcome, as well as the barriers and enablers of TB notification.Results A total of 13 (11.0%) out of 118 private HF were designated as ‘engaged’ TB care facilities in Oyo State and none (0%) of the 198 private HF in the FCT held this designation. From the 214 patients with presumptive TB, 75 (35%) were diagnosed with TB, 42 (56%) had a bacteriological test done, 12 (16%) had an X-ray of the chest alone and 21 (28%) had other non-specific investigations. Most patients diagnosed were referred to a public HF, while 19 (25%) patients were managed at the private HF. Among them, 2 (10.5%) patients were treated with unconventional regimens, 4 (21%) were cured, 2 (11%) died, 3 (16%) lost to follow-up and 10 (53%) were not evaluated. The general practitioners did not have up-to-date knowledge of TB with a majority not trained on TB. Most referred patients with presumptive and confirmed TB to the public sector without feedback and were unclear regarding diagnostic algorithm and relevant tests to confirm TB.Conclusion Most private facilities were not engaged to provide TB services although with knowledge and practice gaps. The study has been used to develop plans for strategic engagement of the private sector in Nigeria.
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- 2023
- Full Text
- View/download PDF
3. Providing TB and HIV outreach services to internally displaced populations in Northeast Nigeria: Results of a controlled intervention study.
- Author
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Suraj A Abdullahi, Marina Smelyanskaya, Stephen John, Haruna I Adamu, Emperor Ubochioma, Ishaya Kennedy, Fatima A Abubakar, Haruna A Ago, Robert Stevens, and Jacob Creswell
- Subjects
Medicine - Abstract
BackgroundA decade of Boko Haram insurgency brought conflict, mass displacement, and the destruction of basic infrastructure to Northeast Nigeria. Over 2 million internally displaced persons (IDPs) suffering from lack of basic hygienic conditions, malnutrition, and disease live in camps or are hosted by communities in the region, where the conflict has contributed to a massive destruction of health facilities. Infectious diseases like tuberculosis (TB) and HIV are especially difficult to address under such conditions, and IDPs are vulnerable to both. Although international investment supports some health interventions among IDPs, locally sourced solutions are lacking.Methods and findingsWe evaluated the impact of an active case finding (ACF) intervention for TB and testing for HIV in IDP communities and provided linkages to treatment in 3 states in Northeast Nigeria: Adamawa, Gombe, and Yobe. The ACF was a component of a multistakeholder collaboration between government, civil society, and IDP community partners, which also included mapping of IDP populations and health services, supporting existing health facilities, developing a sample transport network, and organizing community outreach to support ACF. Between July 1, 2017, and June 30, 2018, ACF was conducted in 26 IDP camps and 963 host communities in 12 local government areas (LGAs) with another 12 LGAs serving as a control population. Outreach efforts resulted in 283,556 screening encounters. We screened 13,316 children and 270,239 adults including 150,303 (55.6%) adult women and 119,936 (44.4%) men. We tested 17,134 people for TB and 58,976 for HIV. We detected 1,423 people with TB and 874 people living with HIV. We linked 1,419 people to anti-TB treatment and 874 people with HIV to antiretroviral treatment sites. We evaluated additional TB cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF on TB case notifications. Through our efforts, bacteriologically confirmed TB notifications increased by 847 (45.1%) during the intervention period, with IDPs accounting for 46% of these notifications. The ITS analyses detected significant positive postintervention trend differences in TB notification rates between the intervention and control areas in all forms TB (incidence rate ratio [IRR] = 1.136 [1.072, 1.204]; p ≤ 0.001) and bacteriologically positive TB (IRR = 1.141 [1.058, 1.229]; p = 0.001). The TB prevalence (502 cases per 100,000 screening encounters) was 10 times the national notification rates and 2.3 times the estimated national incidence. Rates of HIV infection (1.8%) were higher than HIV prevalence estimates in the 3 states. Our study was limited by the nonrandom selection of LGAs. Furthermore, we did not use sensitive screening tools like chest X-ray and likely missed people with TB.ConclusionsIn this study, we observed a burden of TB in IDP populations of Northeast Nigeria many times higher than national rates and HIV rates higher than state level estimates. The impact of the intervention showed that ACF can greatly increase TB case notifications. Engaging IDP communities, local governments, and civil society organizations is essential to ensuring the success of interventions targeting TB and HIV, and such approaches can provide sustained solutions to these and other health crises among vulnerable populations.
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- 2020
- Full Text
- View/download PDF
4. Spatial Disparity in Availability of Tuberculosis Diagnostic Services Based on Sector and Level of Care in Nigeria
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Bethrand Odume, Sani Useni, Egwuma Efo, Degu Dare, Elias Aniwada, Nkiru Nwokoye, Ogoamaka Chukwuogo, Chidubem Ogbudebe, Michael Sheshi, Aminu Babayi, Emperor Ubochioma, Obioma Chijioke-Akaniro, Chukwumah Anyaike, Rupert Eneogu, and Debby Nongo
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- 2023
5. Strategic Engagement of Private Facilities to Increase Public-Private Mix (PPM) Contribution to Nigeria Tuberculosis Case Notification
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Obioma Chijioke-Akaniro, Emperor Ubochioma, Amos Omoniyi, Oluwafunmilayo Omosebi, Olawumi Olarewaju, Mary Etolue, Sunday Asuke, Elias Aniwada, Anyaele Uwaezuoke Ndubuisi, Victor Ombeka, Aderonke Agbaje, Adebola Lawanson, and Chukwuma Anyaike
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- 2022
6. Wellness on Wheels (WoW): Iterative evaluation and refinement of mobile computer-assisted chest x-ray screening for TB improves efficiency, yield, and outcomes in Nigeria
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Ellen Mitchell, Hussien Abdur-Razzaq, Victor Anyebe, Adebola Lawanson, Simeon Onyemaechi, Nkemdilim Chukwueme, Jerod Scholten, Debby Nongo, Chidubem Ogbudebe, Danjuma Aboki, Chimezie Dimkpa, Daniel Egbule, Bassey Nsa, Rupert Eneogu, Emmy van der Grinten, Sani Useni, O. Soyinka Festus, Peter Nwadike, Mustapha Gidado, and Emperor Ubochioma
- Abstract
Background: Wellness on Wheels (WoW) is a model of mobile systematic TB screening of high-risk populations combining digital chest radiography with computer-aided automated interpretation and chronic cough screening to identify presumptive TB in communities, health facilities and prisons in Nigeria. Understanding how models are designed and refined over time helps others to anticipate technical and political challenges, replicate successful strategies, and avoid common mistakes.Methods: We piloted and refined approaches in phased evaluations, recalibrating CAD4TB thresholds to balance TB yield and feasibility. Iterative data monitoring of screening volumes, risk mix, number needed to screen (NNS), number needed to test (NNT), sample loss, TB treatment initiation and outcomes. Risk factors for loss along the diagnostic cascade were identified and mitigation plans were implemented. Participants with high likelihood on CAD4TB (≥80) who tested negative on a single spot GeneXpert were followed-up.Results: Gradual improvements included: achieving screening targets (64.0% to 70.5%), risk group inclusion (91.5% to 92.9%), on-site sample processing (84.3% to 86.1%), treatment initiation (86.7% to 90.8%), treatment success (70.6% to 83.2%), and NNT (8.2 to 7.6). However, expectoration by asymptomatic presumptive participants (≈85%) and HIV testing coverage (64.9%) remained suboptimal.Conclusion: Mobile computer-assisted digital chest x-ray and chronic cough screening with GeneXpert MTB/RIF testing is feasible, acceptable, efficient and high-yield when highest risk groups and key stakeholders are engaged, and operations evolve in real time to fix problems. CAD4TB scores should be used to identify people who need clinical diagnosis and/or longer-term follow-up for progression to TB disease.
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- 2022
7. Operationalizing Mobile Computer-assisted TB Screening and Diagnosis With Wellness on Wheels (WoW)) in Nigeria: Balancing Feasibility and Iterative Efficiency
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Chukwueme Nkem, Bassey Nsa, Jerod Scholten, Hussein Abdur-Razzaq, Simeon Onyemaechi, Victor Anyebe, Festus Soyinka, Peter Nwadike, Sani Useni, Emmy van der Grinten, Chimezie B. Dimkpa, Johan Verhoef, Daniel Egbule, Danjuma Aboki, Debby Nongo, Adebola Lawanson, Rupert Amanze Eneogu, Gidado Mustapha, Emperor Ubochioma, Chidubem Ogbudebe, and Ellen M. H. Mitchell
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Engineering management ,Operationalization ,Computer science ,Mobile computing ,Tb screening - Abstract
Wellness on Wheels (WoW) provided mobile systematic TB screening of high-risk populations combining digital chest radiography with computer-aided automated interpretation and chronic cough screening to identify beneficiaries of GeneXpert MTB/RIF testing in communities and prisons. We piloted and refined approaches in phased evaluations, recalibrating CAD4TB thresholds adjusting to balance TB yield and feasibility. Iterative data monitoring of screening volumes, risk mix, number needed to screen (NNS), number needed to test (NNT), sample loss, TB treatment initiation and HIV testing are required. Given pre-selection of highest risk individuals via an accurate screening test, inability to collect or test samples impacts yield and cost-per-case. Linkage to care and treatment outcomes improved overtime. Short conclusion: Mobile computer-assisted digital chest x-ray and chronic cough screening with GeneXpert MTB/RIF testing is feasible, acceptable, efficient and high-yield when highest risk groups are engaged, and operations evolve in response to monitoring data.
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- 2020
8. Providing TB and HIV outreach services to internally displaced populations in Northeast Nigeria: Results of a controlled intervention study
- Author
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Stephen John, Marina Smelyanskaya, Haruna A Ago, Fatima A Abubakar, Jacob Creswell, Robert Stevens, Emperor Ubochioma, Haruna Adamu, Ishaya Kennedy, and Suraj A Abdullahi
- Subjects
Bacterial Diseases ,RNA viruses ,Male ,Epidemiology ,Psychological intervention ,HIV Infections ,030204 cardiovascular system & hematology ,Rate ratio ,Pathology and Laboratory Medicine ,Geographical Locations ,0302 clinical medicine ,Medical Conditions ,Immunodeficiency Viruses ,Medicine and Health Sciences ,Prevalence ,Medicine ,Mass Screening ,Public and Occupational Health ,030212 general & internal medicine ,Child ,Virus Testing ,Refugees ,Incidence (epidemiology) ,Incidence ,General Medicine ,Middle Aged ,Vaccination and Immunization ,Community-Institutional Relations ,Outreach ,Infectious Diseases ,Medical Microbiology ,HIV epidemiology ,Viral Pathogens ,Viruses ,Tuberculosis Diagnosis and Management ,Female ,Pathogens ,Research Article ,Adult ,Tuberculosis ,Adolescent ,Immunology ,Antiretroviral Therapy ,Nigeria ,Population control ,Microbiology ,03 medical and health sciences ,Young Adult ,Antiviral Therapy ,Diagnostic Medicine ,Environmental health ,Early Medical Intervention ,Retroviruses ,Humans ,Microbial Pathogens ,Biology and life sciences ,business.industry ,Lentivirus ,Organisms ,HIV ,medicine.disease ,Tropical Diseases ,Health Care ,Malnutrition ,Health Care Facilities ,Internally displaced person ,People and Places ,Africa ,Preventive Medicine ,Health Facilities ,business - Abstract
Background A decade of Boko Haram insurgency brought conflict, mass displacement, and the destruction of basic infrastructure to Northeast Nigeria. Over 2 million internally displaced persons (IDPs) suffering from lack of basic hygienic conditions, malnutrition, and disease live in camps or are hosted by communities in the region, where the conflict has contributed to a massive destruction of health facilities. Infectious diseases like tuberculosis (TB) and HIV are especially difficult to address under such conditions, and IDPs are vulnerable to both. Although international investment supports some health interventions among IDPs, locally sourced solutions are lacking. Methods and findings We evaluated the impact of an active case finding (ACF) intervention for TB and testing for HIV in IDP communities and provided linkages to treatment in 3 states in Northeast Nigeria: Adamawa, Gombe, and Yobe. The ACF was a component of a multistakeholder collaboration between government, civil society, and IDP community partners, which also included mapping of IDP populations and health services, supporting existing health facilities, developing a sample transport network, and organizing community outreach to support ACF. Between July 1, 2017, and June 30, 2018, ACF was conducted in 26 IDP camps and 963 host communities in 12 local government areas (LGAs) with another 12 LGAs serving as a control population. Outreach efforts resulted in 283,556 screening encounters. We screened 13,316 children and 270,239 adults including 150,303 (55.6%) adult women and 119,936 (44.4%) men. We tested 17,134 people for TB and 58,976 for HIV. We detected 1,423 people with TB and 874 people living with HIV. We linked 1,419 people to anti-TB treatment and 874 people with HIV to antiretroviral treatment sites. We evaluated additional TB cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF on TB case notifications. Through our efforts, bacteriologically confirmed TB notifications increased by 847 (45.1%) during the intervention period, with IDPs accounting for 46% of these notifications. The ITS analyses detected significant positive postintervention trend differences in TB notification rates between the intervention and control areas in all forms TB (incidence rate ratio [IRR] = 1.136 [1.072, 1.204]; p ≤ 0.001) and bacteriologically positive TB (IRR = 1.141 [1.058, 1.229]; p = 0.001). The TB prevalence (502 cases per 100,000 screening encounters) was 10 times the national notification rates and 2.3 times the estimated national incidence. Rates of HIV infection (1.8%) were higher than HIV prevalence estimates in the 3 states. Our study was limited by the nonrandom selection of LGAs. Furthermore, we did not use sensitive screening tools like chest X-ray and likely missed people with TB. Conclusions In this study, we observed a burden of TB in IDP populations of Northeast Nigeria many times higher than national rates and HIV rates higher than state level estimates. The impact of the intervention showed that ACF can greatly increase TB case notifications. Engaging IDP communities, local governments, and civil society organizations is essential to ensuring the success of interventions targeting TB and HIV, and such approaches can provide sustained solutions to these and other health crises among vulnerable populations., Suraj Adbullahi and colleagues assess tuberculosis and HIV case-finding among internally displaced persons in Nigeria., Author summary Why was this study done? A decade of Boko Haram insurgency in Northeast Nigeria displaced more than 2 million people and caused the decimation of basic health infrastructure. Internally displaced persons (IDPs) settle in camps but also move into host communities; in both settings, resources are minimal, nutrition is in short supply, and basic sanitation and access to healthcare may be lacking. These challenges, in addition to the stress of migration and Nigeria’s high HIV and tuberculosis (TB) burden, make IDPs especially vulnerable to these 2 highly linked infectious diseases, yet data and interventions to address this reality are scarce. What did the researchers do and find? We describe the results of a controlled intervention study on the impact on tuberculosis notifications and assessed HIV prevalence among IDPs in Northeast Nigeria from July 1, 2017, until June 30, 2018. With participation and support from local authorities, community-based organizations, IDP camp leaders, and community volunteers, we tested 17,134 people for TB and 58,976 people for HIV in Adamawa, Gombe, and Yobe State IDP camps and hosting communities, detecting 1,423 people with TB and 874 people living with HIV. In the intervention area, bacteriologically confirmed TB notifications increased by 45% compared with the year before, with IDPs accounting for 46% of such cases, while notifications decreased 6.3% in control areas. Among the IDP camp and host community populations, we found a TB burden 2.3 times the estimated national TB incidence and 10 times the national notification rates, whereas HIV prevalence among IDPs was above reported prevalence in the 3 states. What do these findings mean? Our results highlight the severe TB burden among IDPs in Northeast Nigeria, warranting concerted efforts to address TB in these populations. Our findings stress the importance of local, community-driven multistakeholder solutions designed to increase healthcare access for vulnerable populations, strengthen health systems, and address infectious diseases such as TB and HIV. The results of our intervention also demonstrate the need for expanding HIV services in IDP camps and in communities that host large numbers of IDPs.
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- 2019
9. Effectiveness of Contact Tracing of Index Tuberculosis Cases in Nigeria
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Nwafor Charles, Chukwudi Okebaram, Gidado Mustapha, Emperor Ubochioma, Nkem Chukwueme, Okorie Onuka, Patrick Dakum, Amarachi Okorie, Aderonke Agbaje, Vivian Ibeziako, John Ahukanna, Chux Anago, and Ikpeazu Okezie
- Subjects
0301 basic medicine ,Tuberculosis ,biology ,Transmission (medicine) ,030231 tropical medicine ,030106 microbiology ,Disease ,biology.organism_classification ,medicine.disease ,Mycobacterium tuberculosis ,Vaccination ,03 medical and health sciences ,0302 clinical medicine ,General Energy ,Environmental health ,medicine ,Infection control ,Contact tracing ,Abia - Abstract
Tuberculosis (TB) is a chronic disease that has impacted negatively on human history. The biology of the mycobacterium tuberculosis is complicated and has affected the control as well as elimination of the disease. Nigeria is one of the countries with high incidence and prevalence of TB. The late and low case detection has been a major problem with National TB control program, caused by passive case finding strategy practiced by the country. A shift from the passive and active case search has been recommended for detection of missing cases of TB and improved program performance. The proximity of TB contact is a major determinant of disease transmission. However, maximizing early case detection and prompt treatment of notified cases is very useful in (TB) control especially in high burden countries. The tracking of TB contacts provides a good platform for early diagnosis, educating the household on TB disease and infection control as well as breaking the chain of transmission. The objective of the study is to ascertain effectiveness of contact tracing on Tuberculosis case detection. The study is a retrospective quasi experimental with quantitative arm. The study was conducted in Abia State, one of the South Eastern States of Nigeria. A pre-tested questionnaire was used for data collection and analyzed with SPSS. A total of 168 and 162 index cases of TB were recruited for both intervention and control facilities. The 168 index TB cases yielded 301 TB contacts. The result revealed 55% contact/index ratio, presumptive TB yield of 130 (43.2%) and TB yield of 68 (22.6%). The cases registered in the State increased from 336 to 417 and p value = 0.001, while presumptive TB and BCG vaccination were major predictors. The study shows that tracing contact of index TB cases is an effective and complementary method of finding undetected cases of TB.
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- 2018
10. A Case Study of Multi Drug-Resistant Tuberculosis (MDR-TB), HIV and Diabetes Mellitus (Dm) Comorbidity: Triple Pathology; Challenges and Prospects
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Vivian Ibeziako, Nkem Chukwueme, Okorie Onuka, John Ahukanna, Aderonke Agbaje, Chukwudi Okebaram, Odume Bethrand, Patrick Dakum, Gidado Mustapha, Amarachi Okorie, Emperor Ubochioma, Chux Anago, and Nwafor Charles
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0301 basic medicine ,medicine.medical_specialty ,Pediatrics ,Tuberculosis ,biology ,business.industry ,Multi-drug-resistant tuberculosis ,030106 microbiology ,Blood sugar ,Developing country ,biology.organism_classification ,medicine.disease ,Comorbidity ,Surgery ,03 medical and health sciences ,General Energy ,Weight loss ,Diabetes mellitus ,medicine ,medicine.symptom ,business ,Abia - Abstract
Tuberculosis (TB), diabetes mellitus and HIV co-morbidity is a rare and interrelated health condition with associated high morbidity and mortality especially in developing countries with high prevalence of TB. It has become an emerging concern to epidemiologists and TB control programs due to complexities in its control and management. Managing MDR-TB, DM and HIV comorbidity is challenging, with risk of unfavorable outcome; consequently, close monitoring is necessary. Individuals with weak immunity resulting from diseases such as uncontrolled Diabetes Mellitus (DM) and HIV have a higher risk of developing TB or progression from latent to active TB. We present a 65-year old known diabetic patient who presented to Royal Cross Hospital Ugwueke Abia State, Nigeria with a one-year history of recurrent productive cough with associated night sweats, low grade fever and marked weight loss. A diagnosis of drug-resistant TB with DM/HIV co-morbidity was made and co-managed by experts from the respective clinics and the State TB control program. The patient was declared cured (7 months consecutive negative cultures each taken 30 days apart) after completing 20 months of conventional MDR-TB treatment. The patient showed remarkable clinical improvement including weight gain, good diabetic control and significant increase in CD4 (700 cells). Managing MDR-TB patients with diabetes and HIV is challenging, however, appropriate treatment, psychosocial support, adequate blood sugar control as well as monthly monitoring of patients with requisite investigations are vital in achieving good treatment outcome.
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- 2017
11. Building and Strengthening Infection Control Strategies to Prevent Tuberculosis — Nigeria, 2015
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Elvina Orji, Gabriel Iroh, Henry Debem, Sunday Aboje, Everistus Aniaku, Nneka Chukwura, Eugene Onu, Chinyere Ezeudu, Bethrand Odume, Hasiya Bello Raji, Joseph Agboeze, Dennis Onotu, Custodio Muianga, Virginia Lipke, Emperor Ubochioma, Susan Maloney, Mustapha Bello, Ayodotun Olutola, Chijioke Osakwe, E. Kainne Dokubo, Lucy Ukachukwu, Okezue Godwin, and Patricia Igweike
- Subjects
Capacity Building ,Health (social science) ,Tuberculosis ,Epidemiology ,Health, Toxicology and Mutagenesis ,Population ,Vital signs ,Nigeria ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Environmental health ,Health care ,Humans ,Medicine ,Infection control ,030212 general & internal medicine ,Infectious disease (athletes) ,education ,Infection Control ,education.field_of_study ,030505 public health ,business.industry ,Transmission (medicine) ,Incidence (epidemiology) ,General Medicine ,medicine.disease ,0305 other medical science ,business ,Program Evaluation - Abstract
Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide, accounting for more than 1.5 million deaths in 2014, and is the leading cause of death among persons living with human immunodeficiency virus (HIV) infection (1). Nigeria has the fourth highest annual number of TB cases among countries, with an estimated incidence of 322 per 100,000 population (1), and the second highest prevalence of HIV infection, with 3.4 million infected persons (2). In 2014, 100,000 incident TB cases and 78,000 TB deaths occurred among persons living with HIV infection in Nigeria (1). Nosocomial transmission is a significant source of TB infection in resource-limited settings (3), and persons with HIV infection and health care workers are at increased risk for TB infection because of their routine exposure to patients with TB in health care facilities (3-5). A lack of TB infection control in health care settings has resulted in outbreaks of TB and drug-resistant TB among patients and health care workers, leading to excess morbidity and mortality. In March 2015, in collaboration with the Nigeria Ministry of Health (MoH), CDC implemented a pilot initiative, aimed at increasing health care worker knowledge about TB infection control, assessing infection control measures in health facilities, and developing plans to address identified gaps. The approach resulted in substantial improvements in TB infection control practices at seven selected facilities, and scale-up of these measures across other facilities might lead to a reduction in TB transmission in Nigeria and globally.
- Published
- 2016
12. The Prevalence of Drug-Resistant Tuberculosis among People Living with HIV (PLHIV) in Abia State
- Author
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Okorie, Onuka, primary, John, Ahukanna, additional, Gidado, M., additional, Akang, Gabriel, additional, Emperor, Ubochioma, additional, Rupert, Enogu, additional, Vivian, Ibeziako, additional, Meribole, Emmanuel, additional, and Osakwe, Pius, additional
- Published
- 2016
- Full Text
- View/download PDF
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