PATTERN AND FACTORS INFLUENCING PULMONARY TUBERCULOSIS AMONG ADULT RESIDENTS OF MODAKEKE COMMUNITY IN OSUN STATE

Abstract

Community-Based (CB) studies on Pulmonary Tuberculosis (PTB) need to be intensified in Nigeria due to the re-emergence of this disease. This research therefore sought to review the pattern of annual reported cases and major risk factors for the occurrence of PTB among adult residents of Modakeke, Osun State, South-West Nigeria. Records (2004-2006) of reported PTB cases at the TB Treatment Centre (TBTC) at Itaasin, Modakeke were reviewed. A cross-sectional survey was thereafter conducted on 800 adult (≥18years) residents of Modakeke. Respondents were selected by multi-stage cluster sampling technique: 20 settlements were randomly chosen from the three existing wards using proportional allocation: a cluster of 40 households was then randomly selected from each settlement and an adult was selected per household. Subjects were interviewed in December 2007 using questionnaire to obtain information on knowledge, practices, risk factors and altitude to PTB. Knowledge of each respondent on PTB was scored (using 10 questions, each correct response attracting 1 point). Current PTB cases were also determined among respondents: those with pre-survey diagnosis were identified using current diagnosis/treatment card from TBTC as evidence. Other diagnosis were made during the survey through sputum smear test for the respondents with current history of cough >3 weeks. Data analyses were done using descriptive, Chi-square and logistic regression statistics. A total of 108 adult PTB cases were reported. Median annual incidence was 90 cases/100,000 adults (reported in 2005) and the range was 29/100,000 (in 2004) to 95/100,000 (in 2006). Monthly reported cases peaked in December (8.3%) and August (8.3%) of the year 2006. Median symptom duration at presentation was 12 (range: 4-48) months. Cumulative treatment compliance was 90.7%: 89.8% was reported as cured, 7.4% had failed treatment/unknown case outcome and case fatality was 2.8%. Respondents’ mean knowledge score on PTB was 6.6+ 2.7. Of the uninfected respondents that had awareness on PTB, up to 50.6% ind icated the likelihood of withdrawal from a relationship with an intimate person who became TB patient (n = 724). The point prevalence of PTB among the respondents was estimated at 4% (n=792) but up to 9.8% had history of contact with PTB case. The infected respondents had a median age of 35 years (Range 19-62): 56.2% were females, 81.3% literate, 75.0% employed and 71.9% with AFB load of ≥2 1 (n =32). Pulmonary Tuberculosis was more likely to occur in smokers (OR =2.58, 95% CI= 1.44-5.41), 18-49 years age group (OR 2.72, 95% CI=1.41-632) and subjects from households with family size > 5 (OR 3.33, 95% CI 1.53-7.25). The pattern of PTB occurrence among adults in Modakeke was characterized by high levels of annual incidence, prevalence and case fatality. The risk factors identified were smoking, age group 18-49 years and household overcrowding. lntensifying measures on reducing the noted risks are clues to effective control. Replication of this study in many other communities of Nigeria is germane to identifying peculiarities that can be instrumental to the design of a comprehensive control programme.