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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 3  |  Page : 130-133

Prevalence of tuberculosis in Calabar, Nigeria: A case study of patients attending the outpatients Department of Dr. Lawrence Henshaw Memorial Hospital, Calabar


1 Department of Genetics and Biotechnology, University of Calabar, Calabar, Nigeria
2 Tuberculosis and Leprosy Control Unit, Infectious Diseases Hospital, Calabar, Cross River State, Nigeria

Date of Web Publication14-Dec-2016

Correspondence Address:
Mary Esien Kooffreh
Department of Genetics and Biotechnology, University of Calabar, PMB 1115 Etagbor Road, Calabar
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0521.195817

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  Abstract 

Background: Tuberculosis (TB), though a curable infectious disease, remains one of the leading causes of death in adults. It is also a major public health concern in Nigeria. This study was aimed to determine the prevalence rate of tuberculosis among patients attending the out-patient Department of Dr. Lawrence Henshaw Memorial Hospital Calabar. Materials and Methods: A retrospective study was carried out consisting of all documented cases of tuberculosis from January 2005 to April 2015. Results: Out of 20185 patients tested, a total of 5,004 cases of tuberculosis was recorded within the period of this study with a prevalence rate of 24.8%. The prevalence for each year during this study were as follows: 2005 (37.5%), 2006 (30.9%), 2007 (26.2%), 2008 (23.1%), 2009 (23.0%), 2010 (20.5%), 2011 (16.6%), 2012 (20.5%), 2013 (22.9%), 2014 (21.8%) and 2015 (44.6%). HIV co-infection was more prevalence in males than females, while majority of the disease site was pulmonary tuberculosis (PTB). The highest mortality was recorded in 2012 (18.2%). Within the ethnic groups assessed, the prevalence was higher among the Efiks. Conclusion: The prevalence of TB/ HIV co-infection and subsequent mortality within the years under study is traumatizing and thus requires prompt measures in combating the situation.

Keywords: Coinfection, ethnicity, prevalence, tuberculosis


How to cite this article:
Kooffreh ME, Offor JB, Ekerette EE, Udom UI. Prevalence of tuberculosis in Calabar, Nigeria: A case study of patients attending the outpatients Department of Dr. Lawrence Henshaw Memorial Hospital, Calabar. Saudi J Health Sci 2016;5:130-3

How to cite this URL:
Kooffreh ME, Offor JB, Ekerette EE, Udom UI. Prevalence of tuberculosis in Calabar, Nigeria: A case study of patients attending the outpatients Department of Dr. Lawrence Henshaw Memorial Hospital, Calabar. Saudi J Health Sci [serial online] 2016 [cited 2017 Apr 30];5:130-3. Available from: http://www.saudijhealthsci.org/text.asp?2016/5/3/130/195817


  Introduction Top


Tuberculosis (TB) is a chronic bacterial disease caused by Mycobacterium tuberculosis (MTB) complex which commonly affects the lungs (pulmonary TB [PTB]), but can affect other sites as well (extra-pulmonary TB [EPTB]). [1] The organisms that form this complex include MTB, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium microfti, and Mycobacterium Canetti[2] TB is a curable infectious disease that affects individuals of all age brackets. One-third of the world's population is estimated to be infected by members of the MTB complex which are collectively responsible for about three million deaths each year and over 95% of which occur in developing countries. [3] The weakening of the immune system due to HIV has also increased the TB burden.

TB is a major public health problem in Nigeria with an estimated prevalence of 616 cases per 100,000. Nigeria ranks first in Africa, and fourth among the 22 high TB burden countries in the world, and no fewer than 460,000 cases of TB are reported annually in Nigeria. [4] Ita and Udofia [5] reported the prevalence rate of 38.5% TB in Ikot Ekpene and 17.6% in Itu Local Government area of Akwa Ibom State; they reported that male subjects had a higher incidence rate of TB (35.6%) compared to 29.6% in female. Aliyu et al. [6] reported a high burden of PTB cases in Kaduna State with a prevalence rate of M. bovis (1%) and a relatively high prevalence rate of M. africanum (13%). Similarly, Nwanta et al. [7] reported an overall prevalence rate of 37.9% MTB in Enugu state, Nigeria. Studies from West African Countries of Ghana (32.5%), Mali (25.9%), and Burkina Faso (40.5%) also reported the same trend. [8],[9],[10] There is a need to assess the prevalence of this disease in different geographical locations. Thus, this study seeks to determine the prevalence rate of tuberculosis among patients in Dr. Lawrence Henshaw Memorial Hospital, Calabar in order to estimate the rate of this disease within Calabar and to produce baseline information that can be useful in subsequent molecular research.


  Materials and Methods Top


This was a retrospective study carried out on the prevalence of TB among patients attending outpatient department of Dr. Lawrence Henshaw Memorial Hospital, Calabar between January 2005 and April 2015. The study was granted ethical approval by the Research Ethics Committee of Calabar, Cross River State. The study population consisted of all documented cases of TB in the hospital from January 2005 to April 2015. The case folders of TB patients between 2005 and 2014 were identified and retrieved by record personnel using the hospital code on the index cards for TB. Each of the folders was examined and information obtained includes age, sex ethnicity, and disease site. Data extraction forms were used to obtain information from all case file or folder of TB patients between January 2005 and April 2015. All patients attending the hospital during the study period were also used for research. Data collected were subjected to statistical analysis. The simple percentage was used to determine the prevalence rate of TB and sex ratio of the patients, and the data obtained were analyzed using descriptive statistics.


  Results Top


During this study, a total of 20,185 individuals were tested for TB out of which 5004 individual were diagnosed with the disease giving a prevalence of 24.8%.

In 2005, there were 747 cases of TB with the prevalence rate of 30.9% out of this, 448 males were infected (22.5%) while a total of 299 females were diagnosed (15%). Male and female patients coinfected with TB/HIV were 62 (8.3%) and 39 (5.2%), respectively. The mortality rate recorded in 2005 was 81 (10.8%) [Table 1]. In 2006, 585 (30.9) TB were documented with 229 (12.1%) in females and 356 (18.8%) in males, respectively. As shown in [Table 1], the prevalence of TB reduced progressively within the period of this study [Table 1].
Table 1: General characteristics of study participants/prevalence of tuberculosis/HIV coinfection

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In 2007, female diagnosed with TB were 205 (10.2%) while male were 322 (16%) out of which 55 males (10.4%) were coinfected with HIV. 492 (93.4) PTB were recorded while 49 (6.6%) EPTB were recorded for 2007 with mortality rate of 50 (12.7%). In 2008, 513 (23.1%) cases were documented; 335 (15.1%) for males, 178 (8.0%) for females. The highest of these cases were PTB with a prevalence of 90.4%. 68 (13.3%) patients died within this year. In 2009, 42.2 (23%) cases were documented. In 2010, 394 (20.5%) cases of TB were documented while 367 (16.6%), 347 (20.5%), 431 (22.9%), and 437 (21.8%) prevalence were documented in 2011, 2012, 2013, and 2014, respectively [Figure 1]. From January to April 2015, 234 (44.6%) cases of TB were recorded in the hospital. Out of which 152 (29%) males and 82 (15.6%) females were affected within this period, 55 (23.5%) patients were successfully cured after treatment regimen while 44 (23.5%) were resistance to treatment [Table 1].
Figure 1: Yearly prevalence of tuberculosis among patients in the study

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The prevalence of TB across some ethnic groups within the period of this study is shown in [Table 2]. The prevalence rate was higher among the Efiks in all the years considered in this study. The highest prevalence was documented in 2005 among the Efiks with the rate of 244 (30%).
Table 2: Prevalence of tuberculosis across different ethnic groups

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  Discussions Top


TB is a major contribution to the global burden of disease and has received considerable attention in recent years, especially countries where TB is closely related with HIV/AIDS.

The prevalence of TB within the period of study (January 2005 to April 2015) was 24.8% from the total of 5004 cases. This was lower than the rate of 38.5% from the findings of Alfred and Silas [4] in Ikot Ekpene Local Government Area but higher than 17.6% in Mary Slessor Hospital; Itu Local Government Area reported by the same authors. The findings of this study are in tandem with the report of the WHO [11] that Nigeria is seen as one of the countries with highest cases of TB in the world and remains a major target in the global control of the disease. It was observed that the prevalence rate was more in males (44.6%) than females (29.0%) in all the years considered in this study. Itah and Udofia [5] also reported the prevalence rate of 35.6% and 29.6% in male and female, respectively.

This study showed that the prevalence of TB was highly associated with the increasing notification rate of HIV/AIDS pandemic. Coinfection rate was higher in males in most of the years. The increasing rate of TB observed may be as the result of HIV/AIDS coinfection. According to Corbett et al. [12] an increasing prevalence rate of HIV is responsible for increasing notification rates for TB, and this is the leading cause of death among HIV patients. According to Edike, [13] the high prevalence rate of 37.9% of MTB in Enugu state is associated with increasing prevalence rate of HIV/AIDS. This high rate of TB/HIV coinfection is also corroborated by Murray et al. [14] who demonstrated that HIV/AIDS is largely instrumental in the insurgence of TB. The rate of PTB was more than EPTB within the period of study. The weakening of the immune system due to HIV infection has increased the burden of TB with many outcomes that include the reactivation of latent PTB, also the emergence of resistant TB strains such as the multi-drug resistant TB. [15]

In all the years considered in this study, the mortality rate of 35.2% was recorded. This could be attributed to the rate of defaulted patients and the prevalence rate of drug/treatment resistance among the patients. This is in tandem with the report of Otu et al. [16] that PTB is attributed to drug resistance in some patients in Calabar. The prevalence of TB within ethnic groups revealed the high prevalence rate among the Efiks within the period of this study, which could be as the result of Hospital location as the Efiks are the major ethnic group living within the vicinity. Thumamo et al. [1] reported that MTB complex is predominant in Cameroun with a high clustering rate of 79%, this strain was also recorded in Cross River State, Nigeria. The state actually shares a common frontier with Cameroun.


  Summary and Conclusion Top


The prevalence of TB within the period of this study was as follows: 2005 (37.5%), 2006 (30.9%), 2007 (26.2%), 2008 (23.1%), 2009 (23%), 2010 (20.5%), 2011 (16.6%), 2012 (20.5%), 2013 (22.9%), 2014 (21.8%), and 2015-first quarter (44.6%).

Within this period, a total of 20,185 individuals were tested for TB with 5004 positive cases giving the overall prevalence of 24.8%. TB/HIV coinfection was more in male than female. Similarly, PTB was more prevalence than EPTB.

From the findings of this study, the prevalence of TB over the study period was high in 2005 (37.5%) and tends the decrease slightly in subsequent years but suddenly increases in the first quarter of 2015 (44.6%). This high prevalence of TB in this first quarter is as a result of the high rate of TB/HIV coinfection.

The prevalence of defaulted patients is a cause for concern, thus there is a dire need for appropriate orientation and follow-up treatment for patients diagnosed of TB especially those coinfected with HIV/AIDS to reduce the mortality rate caused by the endemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Thumamo BP, Asuquo AE, Abia-Bassey LN, Lawson L, Hill V, Zozio T. et al. Molecular epidemiology and genetic diversity of mycobacterium tuberculosis complex in Cross River State, Nigeria. Infect Genet Evol 2012;12:671-7.  Back to cited text no. 1
    
2.
Iseman MD. A Clinician's Guide to Tuberculosis. Philadelphia: Lippincot, Williams and Wilkins; 2000.  Back to cited text no. 2
    
3.
Raviglione MC, Snider DE Jr., Kochi A. Global epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic. JAMA 1995;273:220-6.  Back to cited text no. 3
    
4.
WHO Report. Global Tuberculosis Control: Surveillance, Planning & Financing; 2008.  Back to cited text no. 4
    
5.
Itah AY, Udofia SM. Epidemiology and endemicity of pulmonary tuberculosis (PTB) in Southeastern Nigeria. Southeast Asian J Trop Med Public Health 2005;36:317-23.  Back to cited text no. 5
    
6.
Aliyu G, El-Kamary SS, Abimiku A, Ezati N, Mosunmola I, Hungerford L, et al. Mycobacterial etiology of pulmonary tuberculosis and association with HIV infection and multidrug resistance in Northern Nigeria. Tuberc Res Treat 2013;2013:650561.  Back to cited text no. 6
    
7.
Nwanta JA, Umeononigwe CN, Abonyi GE, Onunkwo JI. Retrospective study of bovine and human tuberculosis in abattoirs and hospitals in Enugu, Nigeria. J Public Health Epidemiol 2011;3:329-36.  Back to cited text no. 7
    
8.
Addo K, Owusu-Darko K, Yeboah-Manu D, Caulley P, Minamikawa M, Bonsu F, et al. Mycobacterial species causing pulmonary tuberculosis at the Korle Bu Teaching Hospital, Accra, Ghana. Ghana Med J 2007;41:52-7.  Back to cited text no. 8
    
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Traore B, Diarra B, Dembele BP, Somboro AM, Hammond AS, Siddiqui S, et al. Molecular strain typing of Mycobacterium tuberculosis complex in Bamako, Mali. Int J Tuberc Lung Dis 2012;16:911-6.  Back to cited text no. 9
    
10.
Gomgnimbou MK, Refrégier G, Diagbouga SP, Adama S, Kaboré A, Ouiminga A, et al. Spoligotyping of Mycobacterium africanum, Burkina Faso. Emerg Infect Dis 2012;18:117-9.  Back to cited text no. 10
    
11.
WHO global tuberculosis control report 2010. Summary. Cent Eur J Public Health 2010;18:237.  Back to cited text no. 11
    
12.
Corbett EL, Marston B, Churchyard GJ, De Cock KM. Tuberculosis in sub-Saharan Africa: Opportunities, challenges, and change in the era of antiretroviral treatment. Lancet 2006;367:926-37.  Back to cited text no. 12
    
13.
Edike M. Nigeria: Funds Threaten Enugu HIV/AIDS Campaign. In: Vanguard Newspaper, 1 st September, 2008. p. 15.  Back to cited text no. 13
    
14.
Murray CJ, Styblo K, Rouillon A. Tuberculosis in developing countries: Burden, intervention and cost. Bull Int Union Tuberc Lung Dis 1990;65:6-24.  Back to cited text no. 14
    
15.
Rijal KR, Chimire P, Rijal D, Bam DS. The pattern of anti-tuberculosis drug resistance in pulmonary tuberculosis patients. J Inst Med 2005;27:26-8.  Back to cited text no. 15
    
16.
Otu A, Umoh V, Habib A, Ameh S, Lawson L, Ansa V. Drug resistance among pulmonary tuberculosis patients in Calabar, Nigeria. Pulm Med 2013;2013:235190.  Back to cited text no. 16
    


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