Title: Ambulatory and Community Based Treatment of Multi Drug Resistant Tuberculosis: A Preliminary Report from Benue State, Nigeria

Authors: Tsavyange P Mbaave, Shember A Igbabul, Godwin I Achinge

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i8.85

Abstract

Ambulatory and Community-based treatment for multidrug-resistant tuberculosis (MDR TB) has been  practiced in other countries for several years with reports of successful outcomes. In Nigeria, it is a new concept that has not been evaluated in terms of feasibility and patients’ acceptance. The study evaluated the performance and feasibility of ambulatory and community based treatment of multi drug resistant tuberculosis (MDRTB) in Benue state, Nigeria. 

A retrospective cross sectional study of MDRTB patients in Benue State who were on ambulatory or community based treatment for at least 8 months was undertaken. A review of clinical records of the patients, reports of the monitoring officer and minutes of meetings of the consortium of experts on MDRTB were used. Data was analysed using the Statistical Package for Social Sciences (SPSS) version16. Qualitative was expressed as percentages while observations were documented. Forty (40) MDR TB patients were on treatment for least 8 months. There were 29(72.5%) males and 11(27.5%) females (M: F ratio 2.6:1) with a mean age of 39.2years (range19-65years).TB/ HIV co-infection rate was 27%. Twenty two (55%) out of the 40 patients had previous tuberculosis treatment with first line medications. The most common side effects were hearing loss (32.5%) and arthralgia (7.5%), while myalgia, dizziness and haematemesis were also present. Case holding was 95%, while 2(5%) patients were lost to follow up. Ambulatory and community based treatment of MDRTB is feasible. There are challenges of documentation, funding of treatment and related activities.

Keywords: Ambulatory, Community, Multi drug resistant tuberculosis.

References

 

1.      Sharma S.K, Mohan A, Multidrug-resistant tuberculosis, Indian J Med Res 120, October 2004, pp 354-376.

2.      Shina S, Furina  J,  Bayona J,  Matec K,  Kim J.Y, Farmera P, Community-based treatment of multidrug-resistant tuberculosis in Lima, Peru:7 years of experience, Social Science & Medicine 59 (2004) 1529–1539

3.      WHO: WHO Global Tuberculosis Report 2015.

4.       United States Embassy in Nigeria, Nigeria Tuberculosis Fact Sheet .January 2012. www.usembassy.gov

5.      Federal Republic of Nigeria, FIRST National TB Prevalence Survey 2012, Nigeria.

6.      Waheed Z, Irfan M, Haque A. S, Khan, M. O, Zubairi, A, Ain, N, Khan, J. A. (2011). Treatment Outcome of  Multi-Drug Resistant Tuberculosis Treated As Out patient in a Tertiary Care Center, Pakistan Journal of ChestMedicine,17(3) Availableat: http://ecommons.aku. edu/pakistan_fhs_mc_ med_pulm_critcare.

7.      Federal Ministry of Health, Guidelines for Programmatic and Clinical Management of Drug Resistant Tuberculosis in Nigeria 2015.

8.      Medicines Sans Frontieres (Doctors without Borders).From the ground up; Building a drug resistant TB programme in Uganda, March 2012.

9.      Moyo S, Cox HS, Hughes J, Daniels J, Synman L, De Azevedo V, et al. (2015), Loss from Treatment for Drug Resistant Tuberculosis: Risk Factors and Patient Outcomes in a Community-Based Program in Khayelitsha, South Africa, PLoSONE 10(3):e0118919. doi:10.1371/journal.pone.0118919

10.  Cavanaugh J.S, Kurbatova E, Alami N.N, Mangan J, Sultana Z,  Ahmed S, et al, Evaluation of community-based treatment for drug-resistant tuberculosis in Bangladesh, Tropical Medicine and International Health volume 21 no 1 pp 131–139 january 2016 doi:10.1111/tmi.12625.

11.  Bassili A, Fitzpatrick C, Qadeer E,  Fatima R,  Floyd K,  Jaramillo E, A Systematic Review of the Effectiveness of Hospital and Ambulatory-Based Management of Multidrug-Resistant Tuberculosis, Am. J. Trop. Med. Hyg., 89(2), 2013, pp. 271–280 doi:10.4269/ajtmh.13-0004.

12.  Williams A.O, Makinde O.A,  Ojo M:Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis, Global Health Research and Policy (2016) 1:10.DOI 10.1186/s41256-016-0010-y

13.  Loveday M, Wallengren K, Brust J, Roberts J, Voce A, Margot B, et al.Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa.Int J Tuberc Lung Dis. 2015 Feb;19(2):163-71. doi: 10.5588/ijtld.14.0369.

14.  Mitnick C,   Bayona J,  Palacios E,  Shin S,   Furin J,  Alcántara F,et al, Community-Based Therapy for Multidrug-Resistant Tuberculosis in Lima, Peru; N Engl J Med 2003;348:119-28.

15.  Jacobs TQ, Ross A, Adverse effects profile of multidrug-resistant tuberculosis treatment in a South African outpatient clinic,S Afr Fam Pract 2012;54(6):531-539.

16.  Otu AA. A review of the national tuberculosis and leprosy control programme (ntblcp) of Nigeria: Challenges and prospects, Ann Trop Med Public Health 2013; 6:491-500.

Corresponding Author

Dr Tsavyange Peter Mbaave

Dept of Medicine, Benue State University Teaching Hospital

PMB 102131 Makurdi, Benue State,

Email: This email address is being protected from spambots. You need JavaScript enabled to view it. Phone +2348034521730