ABSTRACT
This study is aimed at conducting a comprehensive prevalence and awareness of tuberculosis to enhance understanding of the disease burden and inform targeted interventions for tuberculosis control. This is a cross-sectional survey aimed at examine the prevalence and awareness of Tuberculosis (A Study of Selected communities in Ewekoro Local Government Ogun State). The respondent was selected from the community members using stratified random sampling technique to select those to receive the questionnaire. The target populations for this study are (100) one hundred people. The population was selected randomly from (2) two communities in Ewekoro Local Government, Ogun State on the surveillance and community awareness of tuberculosis. The major research instrument used is the questionnaires. The result of the findings revealed a significant prevalence of tuberculosis (TB) awareness among respondents, with a notable percentage having had close contact with TB patients. However, only 15% reported a personal diagnosis of TB, indicating a gap in early detection and treatment. The demographic analysis showed a higher incidence of TB awareness among younger age groups and those with lower socioeconomic status. The study recommend that implement targeted education campaigns focusing on tuberculosis transmission, prevention, and the importance of early diagnosis and also, enhance training programs for nurses and healthcare staff on tuberculosis management and patient education strategies.
Keywords: Prevalence, Awareness, Community, Tuberculosis, Re-Emerging Infectious Disease, Healthcare, Ewekoro Local Government, Ogun State)
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TABLE OF CONTENT
Title i
Certification ii
Declaration iii
Dedication iv
Acknowledgement v
Table of Contents v
Abstract ix
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 3
1.3 Objectives of the Study 4
1.4 Research Questions 4
1.5 Significance of the Study 5
1.6 Scope of the Study 5
1.7 Operational Definition of Terms 5
CHAPTER TWO: LITERATURE REVIEW
2.1 Epidemiology of Tuberculosis 7
2.1.1 Progression of Tuberculosis 9
2.1.2 Acid Fast Staining for TB
Identification 10
2.1.3 Etiology: Global Concern of
Tuberculosis 10
2.2 Signs and Symptoms 11
2.3 Surveillance of the Disease
worldwide and Nigeria 12
2.3.1 Impact of the Disease 12
2.3.2 Preventive Measure of the Disease 13
2.4 Prophylaxis of Tuberculosis 14
2.5 Challenges with Tuberculosis
Surveillance in Nigeria 15
2.6 Theoretical Framework 17
2.7 Empirical Review 17
CHAPTER
THREE: RESEARCH METHODOLOGY
3.0 Research Design 21
3.1 Research Setting 21
3.2 Target Population 21
3.3 Sampling size and Formula 21
3.4 Instrument for Data Collection 21
3.5 Validation of the Research
Instrument 22
3.6 Method of Data Analysis 22
CHAPTER FOUR: RESULTS AND DISCUSSION
4.1 Data Analysis 23
4.1.1 Socio-Demographic Characteristics
of Respondents 23
4.2 Interpretation of Data 26
CHAPTER
FIVE:
5.0 Discussion, Conclusion and
Recommendation 27
5.1 Discussion 27
5.2 Conclusion 28
5.3 Implications of findings 28
5.4 Recommendation 29
References 30
Appendix I 32
CHAPTER ONE
INTRODUCTION
1.1.
Background of the study
Tuberculosis
is a contagious infectious disease caused by the bacterium mycobacterium
tuberculosis. It primarily affects the lungs but can also affect other parts of
the body. Tuberculosis remains a significant global health concern, with an
estimated 10 million new cases and 1.4 million deaths reported worldwide in
2019 alone (world health organization, 2020). Despite advancements in diagnosis
and treatment, tuberculosis continues to pose challenges due to factors such as
drug resistance, co-infections with hiv/aids, and social determinants of
health.
The
burden of tuberculosis is not evenly distributed, with low- and middle-income
countries bearing the brunt of the disease. Factors such as poverty, inadequate
healthcare infrastructure, and limited access to healthcare services contribute
to the persistence of tuberculosis in these regions (Gandhi et al., 2010). Additionally, certain
populations, such as migrants, prisoners, and healthcare workers, are at
increased risk of tuberculosis due to overcrowded and high-risk environments
(Uplekar et al., 2015).
Tuberculosis is a disease of public health concern in Nigeria as it contributes
significantly to the country’s annual morbidity and mortality data. Nigeria has
the largest burden of TB in Africa and is among the ten countries accounting
for 80% gap in the estimated incident cases and the number of incident cases
reported globally. Nigeria’s treatment coverage for TB has remained
precariously low at 24% leaving a huge gap of undiagnosed TB in the population.
Similarly, TB mortality was 64/100,000 and 16/100,000 for HIV negative and
positive persons respectively. WHO (2019) Global TB Report.
In
2019, the country notified only 120,266 of the estimated 420,000 incident cases
of TB, leaving a gap of 300,000 undiagnosed cases who remain infectious in the
population with one case potentially infecting 10 to 15 others annually.
Nigeria also contributes significantly to the global burden of Multi-Drug
Resistant TB (MDR-TB). The World Health Organization estimates that the
prevalence of Multi-Drug Resistant TB (MDR-TB) in Nigeria is 4.3 percent (3.2 -
5.5) among new patients and 15 percent (11 - 19) among previously treated
patients, for a total of 21,000 (13,000 - 32,000) MDR-TB cases. However, in
2019, only 2384 (11% of estimated incident cases) persons with MDR-TB were
notified, of whom 1975 (82%) were enrolled into treatment. TB also has enormous
negative economic impact on Nigerians with about 71% of the TB patients
affected catastrophically as a result of the costs incurred in seeking care for
the disease. In spite of the huge public health issue presented by TB, the
national surveillance system remains inadequate and unable to report every
suspected and confirmed case of TB. (Zumla, 2014).
The
Integrated Disease Surveillance and Response (IDSR) was created by WHO in 1988
to address weaknesses in health surveillance systems in the Africa region,
however due to weak political will, this system remains poorly funded and
unable to achieve its full potentials. This setback in the IDSR has led to the
creation of parallel data information systems at the national, state and LGA
levels. Key among which is the National Health Management Information System
(NHMIS). In country, WHO continues to support the IDSR system to notify epidemic
prone diseases, diseases marked for elimination and eradication; and other
diseases of public health concern, including TB. The system is however
unequivocally focused on acute flaccid paralysis and to a lesser extent,
cholera, measles and neonatal tetanus. This is a far cry from the original
design of the IDSR which should report 42 priority diseases under surveillance
in Nigeria with designated standard case definitions. (Raviglione, 2016).
The
flow of information through the IDSR is from prioritized health facilities
(based on population and disease burden), where diseases that have epidemic
potentials and those which are targeted for eradication and elimination, are
reported either immediately or monthly to the surveillance focal persons in the
health facility and then to the LGA through designated Disease surveillance and
notification officer (DSNO) using appropriate IDSR reporting forms (001, 002
and 003). The LGA level data collated is then reported to the next level which
is the State Ministry of Health (SMoH).(Dodd, 2016). Surveillance and
assessment are critical components of tuberculosis control efforts, providing
valuable data for monitoring disease trends, identifying high-risk populations,
and evaluating the effectiveness of interventions. However, surveillance
systems face challenges such as underreporting, incomplete data, and limited
access to diagnostic tools in resource-limited settings (Steingart, 2014).
Despite
these challenges, recent advancements in tuberculosis surveillance, such as the
introduction of molecular diagnostics and electronic reporting systems, offer
opportunities to strengthen surveillance efforts and improve tuberculosis
control outcomes (World health organization, 2019). By enhancing surveillance
and assessment capacities, policymakers and healthcare professionals can better
understand the dynamics of tuberculosis transmission, target interventions to
high-risk populations, and ultimately reduce the global burden of tuberculosis.
(Steingart, 2014)
1.2.
Statement of the Problem
Despite
significant progress in tuberculosis control efforts, tuberculosis remains a
major global public health challenge, particularly in low and middle-income
countries. Surveillance and assessment play a crucial role in understanding the
burden of tuberculosis, tracking disease trends, and guiding public health
interventions. Tuberculosis surveillance relies on accurate reporting of cases
by healthcare providers and facilities. However, underreporting is a common
issue, particularly in resource-limited settings where healthcare
infrastructure may be inadequate, and reporting systems may be fragmented or
inefficient (world health organization, 2019). In addition, incomplete data on
tuberculosis cases, including missing demographic information, clinical
details, and treatment outcomes, hamper efforts to understand disease dynamics
and plan interventions effectively. Timely and accurate diagnosis is essential
for effective tuberculosis control.
However,
access to diagnostic tools, such as sputum microscopy, culture, and molecular
tests, remains limited in many settings, especially in rural and underserved
areas (Steingart, 2014). As a result, many tuberculosis cases go undiagnosed or
are diagnosed late, leading to delays in treatment initiation and increased
transmission of the disease. Certain populations are at increased risk of
tuberculosis, including migrants, prisoners, healthcare workers, and
individuals living with HIV/AIDS (Uplekar, 2015). However, surveillance efforts
in these populations face unique challenges, such as stigma, fear of
discrimination, and limited access to healthcare services. As a result,
tuberculosis cases in these high-risk groups may be underreported or
overlooked, exacerbating the burden of the disease. Ensuring the quality and
standardization of tuberculosis surveillance data is essential for reliable
analysis and interpretation. However, variations in data collection methods,
reporting criteria, and data management systems across different regions and
countries can lead to inconsistencies and inaccuracies in the data (World
health organization, 2020). Without standardized data collection and reporting
processes, comparisons between regions and over time may be challenging,
hindering efforts to evaluate the impact of interventions and allocate
resources effectively.
The
emergence of drug-resistant tuberculosis poses additional challenges for
surveillance and assessment. Detecting and monitoring drug-resistant
tuberculosis requires specialized laboratory facilities and expertise, which
may be lacking in many settings (World health organization, 2019). As a result,
the true burden of drug-resistant tuberculosis may be underestimated, leading
to suboptimal treatment outcomes and ongoing transmission of resistant strains.
1.3.
Objectives of the study
i. To determine the prevalence and
incidence of tuberculosis in the study population, including both pulmonary and
extra pulmonary cases.
ii. To assess the distribution of
tuberculosis cases by demographic characteristics (age, gender, socioeconomic
status, etc.) and geographic location.
iii. To identify risk factors
associated with tuberculosis transmission and acquisition, including close
contacts of tuberculosis patients and individuals with comorbidities such as
HIV/AIDS.
iv. To evaluate the performance of
existing tuberculosis surveillance systems and identify gaps in data
collection, reporting, and analysis.
1.4 Research
Questions
1. What is the prevalence and
incidence of tuberculosis (tuberculosis) among the study population, including
both pulmonary and extra-pulmonary cases?
2. How are tuberculosis cases
distributed across different demographic characteristics such as age, gender,
and socioeconomic status?
3. How does the geographic location
of individuals impact the prevalence and distribution of tuberculosis?
1.5 Significance of the Study
Conducting
surveillance and assessment of tuberculosis is crucial for several reasons.
Tuberculosis continues to pose a substantial burden on public health systems
worldwide. By conducting surveillance and assessment, we can accurately
quantify the disease burden, track trends over time, and identify high-risk
populations and areas. Surveillance and assessment provide critical data for
designing and implementing tuberculosis control measures, including early
detection, diagnosis, treatment, and prevention strategies. By understanding
the epidemiology of tuberculosis and identifying areas of high transmission. Additionally,
surveillance data contribute to the evidence base for tuberculosis research and
policy development. By analyzing trends and patterns in tuberculosis
epidemiology, researchers and policymakers can identify gaps in current
strategies, evaluate the effectiveness of interventions, and guide future
research priorities and policy decisions.
In
conclusion, tuberculosis is not confined by borders and poses a threat to
global health security. Surveillance and assessment efforts contribute to
international collaboration and coordination in tuberculosis control,
facilitating the sharing of best practices, resources, and technical expertise
to address the global tuberculosis epidemic.
1.6 Scope of the Study
This
study focuses on the prevalence and awareness of Tuberculosis (TB) in selected communities
within Ewekoro Local Government, Ogun State. The study covers the following
areas:
The
research is delimited to communities located within Ewekoro Local Government,
Ogun State. The facilities selected represent a diverse range of healthcare
providers, including primary health centers and general hospitals. The study
focused on healthcare workers, patients, and community members who utilize the
healthcare facilities in the selected area. It also included stakeholders
involved in TB surveillance and awareness campaigns within the community.
1.8 Operational Definition of Terms
· Tuberculosis (TB): A
contagious infectious disease caused by the bacterium Mycobacterium
tuberculosis, primarily affecting the lungs (pulmonary TB), but it can also
affect other parts of the body (extra-pulmonary TB). Symptoms include chronic
cough, chest pain, fever, weight loss, and night sweats.
· Surveillance: The
systematic collection, analysis, and interpretation of health data to monitor
the spread of Tuberculosis and assess the effectiveness of control measures. It
involves tracking TB cases, identifying transmission patterns, and providing
real-time data for disease control.
· Community Awareness: The level
of knowledge and understanding that individuals in a community have heard about
Tuberculosis, including its causes, symptoms, methods of transmission,
prevention, and treatment. It also refers to the efforts made to educate and
inform the public to prevent the spread of the disease.
· Healthcare Facilities: Hospitals,
clinics, and medical centers within Ewekoro Local Government that are involved
in diagnosing, treating, and managing Tuberculosis. These facilities play a key
role in TB surveillance and community health education.
· Ewekoro Local Government: A local
government area in Ogun State, Nigeria, which serves as the geographical focus
of this study. The local healthcare facilities within this region are studied
for their TB surveillance systems and community outreach efforts.
· Pulmonary Tuberculosis: A form of
Tuberculosis that primarily affects the lungs, characterized by symptoms such
as persistent cough, chest pain, and difficulty breathing. It is the most
common type of TB and is highly contagious.
· Extra-pulmonary Tuberculosis: TB that occurs in organs other than the lungs, such as the lymph
nodes, bones, or kidneys. Although less common, it can lead to severe
complications if not diagnosed and treated.
· Transmission: The spread
of Tuberculosis from one person to another, usually through airborne particles
when an infected individual coughs or sneezes. Understanding transmission is
crucial for TB prevention and control.
· Comorbidities: Other
medical conditions that co-exist with Tuberculosis, such as HIV/AIDS, which can
increase the susceptibility to TB and complicate treatment. Identifying
comorbidities is important for assessing TB risk factors.
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