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The Prevalence of Drug-Resistant Tuberculosis among People Living with HIV (PLHIV) in Abia State

Advances in Infectious Diseases 2016年第2期6卷 63-69页

作者： Onuka Okorie Ahukanna John M. Gidado Gabriel Akang Ubochioma Emperor Enogu Rupert Ibeziako Vivian Emmanuel Meribole Pius Osakwe TB Control Program Ministry of Health Umuahia Nigeria KNCV Abuja Nigeria Institute of Human Virology Abuja Nigeria National TB Control Program Abuja Nigeria World Health Organization Enugu Nigeria

Tuberculosis (TB) is a chronic disease caused by mycobacterium tuberculosis and transmitted from person to person, through inhalation of droplet nuclei aerosolized by coughing of an infected person. It reached epidemic proportions in Europe and North America during the 18th and 19th centuries. The incubation period is 2 - 6 weeks and the control has been complicated with emergence of HIV and drug-resistant TB. In 1993, World Health Organization (WHO) declared TB a global emergency. However, despite the concerted effort of National TB control programs, adoption and implementation of Stop TB strategy, TB has remained a major public health challenge with high mortality rate, especially in developing countries. Methodology: This is a descriptive study, evaluated using the positivist/quantitative approach. The study was conducted at FederalMedical Centre Umuahia, a tertiary specialist hospital with comprehensive TB/HIV treatment services. All the presumptive drug-resistant TB cases and symptomatic PLHIV were screened for HIV and their sputum specimens were tested for tuberculosis using the Gene xpert and the Ziehl- Neelsen technique for detecting Acid Fast bacilli. A pretested structured questionnaire was used tocollect the demographic data and other essential data from the presumptive TB and laboratory registers such as total number of TB presumptive cases registered HIV status, AFB status and rifampicin status within the study period. Result: A total of 493 presumptive TB cases were screened in the study, 49.9% were HIV positive while 50.05% were HIV negative. More so, 77.85% of thescreened cases were AFB negative and 22.15% were AFB positive. Moreover, 11% of the TB/HIV co-infected patients were rifampicin positive. Interestingly among the 493 cases screened with gene xpert machine, 3.6% were rifampicin positive. Furthermore, 3.6% of the HIV negative cases were rifampicin positive while 1.6% of the HIV positive cases were rifampicin positive. Discussion: The data depict lower rifampicin resistance among HIV positiv

关键词： Multidrug Resistant TB among People Living with HIV

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Spatial Disparity in Availability of Tuberculosis Diagnostic Services Based on Sector and Level of Care in Nigeria

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Journal of Tuberculosis Research 2023年第1期11卷 12-22页

作者： 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 Debby Nongo KNCV Nigeria Abuja Nigeria KNCV Netherlands The Hague Netherlands Department of Community Medicine University of Nigeria Nsukka Nigeria NTBLCP FMOH Abuja Nigeria USAID Abuja Nigeria

Background: Delay in Tuberculosis (TB) diagnosis can contribute to late presentation, severe disease, and continued transmission. KNCV TB Foundation Nigeria through the United States Agency for International Development (USAID) funded the TB Local Organization Network (LON) 1 and 2 projects that explored the availability of Tuberculosis services based on sector and levels of care. Methods: TB Patient Pathway Analysis was carried out in 14 states comprising 92 facilities. It involved primary, secondary, and tertiary levels of health care in both the public and private sectors. This was a cross-sectional study under program implementation. Proforma was used to collect data on the available TB diagnostic services. Results: In public health facilities, GeneXpert was available at 100% in tertiary facilities in 8 (57%) states;up to 82% in 4 (33%) states, 50% available at secondary facilities in 2 states, and There is none at the primary facilities. Smear microscopy was available at 100% in tertiary facilities in 9 (64%) states and 3 (25%) states have 50% to 82%;secondary -10 (71%) states have > 70% at facilities;primary 1 (7%) state has it in 61% of facilities. Loop-mediated isothermal amplification (TB-LAMP) in tertiary 2 (17%) states have 20% and 100% respectively;secondary 4 (<30%) states have in 1 or 2 facilities;none for primary facilities. In private health facilities, 79% of states have Smear microscopy at both primary and secondary facilities, and only 2 states (14%) at tertiary facilities. Only 1 (7%) state has GeneXpert in all tertiary facilities, 2 (14%) states have secondary facilities, and 4 states in about 1% of facilities. TB LAMP was not available in any tertiary facility, one (7%) state at secondary with coverage of 1%, and 2 (14%) states at primary both with 4% overall facility coverage. Conclusions: There is an inequitable distribution of TB diagnostic services in both sectors and levels of care in Nigeria. TB care and control will improve with enhanced equitable distribution of TB diagnostic service

关键词： Tuberculosis Diagnostic Services Disparity Sector Level Nigeria

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Strategic Engagement of Private Facilities to Increase Public-Private Mix (PPM) Contribution to Nigeria Tuberculosis Case Notification

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Journal of Tuberculosis Research 2022年第3期10卷 99-110页

作者： 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 Chukwuma Anyaike National Tuberculosis Leprosy and Buruli Ulcer Control Programme (NTBLCP) FCT Nigeria World Health Organisation (WHO) FCT Nigeria Bingham University Karu Nigeria University of Nigeria Nsukka Nigeria Institute of Human Virology Nigeria FCT Nigeria

Introduction: Finding the missing Tuberculosis (TB) cases remains the single most important priority for TB control in Nigeria. Between 66% - 92% of all cases of respiratory diseases including those with symptoms suggestive of TB are first seen byprivate health providers. Dependable, quality surveillance systems and notification are key roles in health services delivery, particularly as it is related to TB control. However, poor notification has been a challenge. This study was to assess the contribution of the public private mix (PPM) to Nigeria Tuberculosis national case notification. Methods: It was a national cross-sectional study. Data were extracted from the National database and reviewed. Private facilities were engaged in 2017 and assessed over 2018-2020. Interventions included: enrolling private practitioners (Private-For-Profit, Faith Based Organization, Private Medicine Vendors and Community Pharmacists), engaging a private standalone Laboratory for Gene Xpert testing within the network of private facilities, use of Mobile App for easy screening and reporting, instituting a HUB and spoke, and incentives to private providers for participating. Each private provider had a customized approach. Trend analysis was performed using Cochran-Armitage χ2 test for linear trends. Level of significance was at a p value of Results: Total case notification increased from 104,904 cases in 2017 to 138,591 in 2020. There were 2.0% increase in 2018, 13.0% in 2019 and 15.0% in 2020 (p < 0.001). PPM contribution to case notification increased from 10,699 cases in 2017 to 12,625 in 2018, then 17,250 in 2019 and 38,865 in 2020. There were 18.0% increase in 2018, 36.6% in 2019 and 125.3% increase in 2020 (p ). Conclusion: Effective engagement of the private sector in TB control efforts in Nigeria using a variety of approaches resulting in improved TB notification is possible. The National TB Programme should engage all private practitioners such that each practitioner will practice at least one TB service model.

关键词： Strategic Engagement Public-Private Mix Case Notification Tuberculosis Nigeria

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Patient Health Seeking Behavior and Choice of Place of Care among Tuberculosis Clients in Selected States in Nigeria

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Journal of Tuberculosis Research 2023年第4期11卷 149-161页

作者： Bethrand Odume Aminu Babayi Ogoamaka Chukwuogo Chidubem Ogbudebe Elias Aniwada Egwuma Efo Degu Dare Useni Sani Nkiru Nwokoye emperor ubochioma Obioma-Chijioke Akaniro Debby Nongo Rupert Eneogu Temitayo Lagundoye-Odusote Chukwuma Anyaike Technical and Programs Department KNCV Nigeria Abuja Nigeria Department of Community Medicine Faculty of Medical Sciences University of Nigeria Enugu Campus Enugu Nigeria Technical Department KNCV Tuberculosis Fund The Hague Netherlands The Programs and Coordination Department National Tuberculosis Leprosy & Buruli Control Program Abuja Nigeria Program Management Department HIV/AIDS & TB Office USAID/Nigeria Abuja Nigeria

Background: Tuberculosis (TB) remains a major global public health problem. Early detection and initiation of treatment shortens infectious period and is key to TB control. A considerable proportion of TB patients presenting with advanced symptoms suggests delay in seeking care. As TB control programs rely on passive case finding, TB care-seeking behavior is critical as un-diagnosed cases act as reservoirs for transmission. This study assessed patient health seeking behavior and choice of place of care among TB patients in Nigeria. Methods: This was a pro-gramme implementation, facility-based cross-sectional study in 14 states, 92 facilities across three levels of care. Interviewer-administered semi-structured questionnaires were used. Information on personal characteristics and health seeking behavior was collected from June 2020 to December 2021. The analysis was based on the various healthcare providers where the respondents first sought care. Data analysis was done using IBM SPSS and summarized using frequency and percentages. Chi square test was used for associations of characteristics of patients and choice of place of care at p Results: In all 14 states, distribution of overall first place of seeking care for TB symptoms was: 7208 (75.8%) health facilities (range 57% to 88%), while 2294 (24.2%) visited other places including community pharmacist, patent medicine vendor, traditional/home, un-specified/none. For Health facilities, the majority were at public facilities 6563 (69.1%) and private 641 (6.7%). Moreover, 6 states had >20% of respondents who first sought care at PMVs, while 3 states (Delta, Imo, and Rivers) had 10% of respondents who first sought care at Community Pharmacist. Conclusions: Nearly a quarter of people with TB first sought care outside health facilities, suggesting the need to align availability of services with their needs.

关键词： Patient Pathway Analysis TB Patients TB Treatment Healthcare Facility

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Effectiveness of Contact Tracing of Index Tuberculosis Cases in Nigeria

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Advances in Infectious Diseases 2018年第4期8卷 173-199页

作者： Okorie Onuka Ikpeazu Okezie John Ahukanna Chukwudi Okebaram Patrick Dakum Aderonke Agbaje Vivian Ibeziako Gidado Mustapha Nkem Chukwueme emperor ubochioma Amarachi Okorie Nwafor Charles Chux Anago TB Control Program Ministry of Health Abia State Nigeria Abia State Government House Umuahia Abia State Nigeria Ministry of Health Abia State Nigeria Department of Pharmacology and Therapeutics Abia State University Uturu Nigeria Institute of Human Virology Abuja Nigeria KNCV Abuja Nigeria National TB Control Program Abuja Nigeria School of Midwifery Ministry of Health Umuahia Nigeria GLRA Enugu Enugu Nigeria Clinton Health Access Initiative Abuja Nigeria

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.

关键词： Contact tracing Index TB cases

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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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Advances in Infectious Diseases 2017年第3期7卷 70-79页

作者： Okorie Onuka John Ahukanna Chukwudi Okebaram Patrick Dakum Aderonke Agbaje Vivian Ibeziako Gidado Mustapha Nkem Chukwueme Chux Anago emperor ubochioma Amarachi Okorie Odume Bethrand Nwafor Charles Abia State Ministry of Health Umuahia Nigeria Department of Pharmacology Abia State University Okigwe Nigeria Institute of Human Virology Abuja Nigeria Challenge KNCV Abuja Nigeria Clinton Health Access Initiative Abuja Nigeria National Tuberculosis and Leprosy Control Program Abuja Nigeria School of Midwifery Umuahia Nigeria Department of Family Medicine National Hospital Abuja Nigeria German Leprosy and Tuberculosis Relief Association Enugu Nigeria

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.

关键词： Co-Morbidity-Diabetes-Multi Drug Resistant TB and HIV

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秦史研究二题

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咸阳师范学院学报 2004年第5期19卷 10-12页

作者：王关成秦始皇兵马俑博物馆陕西临潼710600

这是两篇秦史研究札记:一为秦代士兵能否邮寄钱物问题,一为秦代民众债务负担问题。研究表明:秦代士兵不可能从家中邮寄钱物,因而秦代士兵不可能自备衣物。秦代民众负担沉重,不仅来自兵役、劳役,还有因苛捐杂税和法网繁密导致的可怕债务。

关键词：秦代士兵民众债务负担札记兵役问题

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秦兵马俑陪葬坑发掘与展出同步进行的模式

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人类文化遗产保护 2011年第1期 7-12页

作者：秦始皇兵马俑博物馆一号坑考古队许卫红不详

三十多年来秦始皇兵马俑陪葬坑的考古工作一直都保持着展出与发掘同步进行的模式。这种工作模式实际是一项科研成果向普及、应用转化的两个阶段,属于公共考古学实践的一部分。秦始皇兵马俑陪葬坑的公共考古实践过程可分为“被动式”、... 详细信息

三十多年来秦始皇兵马俑陪葬坑的考古工作一直都保持着展出与发掘同步进行的模式。这种工作模式实际是一项科研成果向普及、应用转化的两个阶段,属于公共考古学实践的一部分。秦始皇兵马俑陪葬坑的公共考古实践过程可分为“被动式”、“背景式”、“高调式”三个阶段,但截止目前仍处于萌芽时期。探索将发掘现场的现象转化成对过去有意义解释的理论和方法,完善秦俑遗址保护由发掘到发掘与展示完美结合的公共考古模式,是考古工作者要拓展的另一项研究领域。

关键词：秦始皇兵马俑陪葬坑发掘与展出公共考古学阶段

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Characterization of atmospheric ammonia in Xi'an,China

Characterization of atmospheric ammonia in Xi'an,China

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第五届海峡两岸气溶胶技术研讨会

作者： Ting Zhang~1 Junji Cao~1 Feng Wu~1 Yuemei Han~2 Juan Zhou~2 Hua Li~3 (~1 State Key Laboratory of Loess and Quaternary Geology,Institute of Earth Environment,Chinese Academy of Sciences,Xi’an 710075,China) (~2 Department of Environmental Science and Engineering,Xi’an Jiaotong University,Xi’an 710049,China) (~3 emperor Qin’s Terra-Cotta Warriors and Horses Museum,Xi’an 710600,China)

Continuous measurements of atmospheric ammonia and particulate matter (PM) were conducted at an urban-site (Institute of Earth Environment) and a suburban-site (emperor Qin’s Terra-Cotta Museum) of Xi’an,Shaanxi Province,China from April 2006 to March 2007. Ammonia samples were collected using Ogawa passive samplers every sixth day,and quartz filter samples were also collected daily.The average concentrations of NH are 12.88μg m in urban site and 14.08μg m in suburban site,respectively.Temporal variations of ammonia concentrations showed a similar trend in urban and suburban sites,indicating that the variability for NH concentrations was primarily related to the contributions of regional emission sources. The variations of NH showed higher concentrations during summer and lower concentration in winter,while the average concentration of aerosol NH was higher in winter than in summer.The atmospheric ammonia and ammonium in fine aerosol (PM) were poorly correlated (R<0.1), which may be associated with the meteorological influence on the NH formation.

关键词： ammonia NI4+ Xi’an urban suburban

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中国古代山水画研究

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中国美术馆 2013年第7期 6-7+4页

作者： Chinese Traditional Landscape Ink Painting, often called"Shanshui"for short, is a kind of Chinese painting in which the main objects are mountains and rivers scenery. According to Famous Paintings hrough the Ages, in the Han Dynasty, there was emperor Wu of Han’s he True Scene of the Five Scared Mountains which was the irst landscape painting ever been recorded. During the hree Kingdoms, Mrs Zhao-Queen of Wu State has tried to map the terrain of mountains and rivers. Until the Eastern Jin Dynasty, landscape painting has come into being. To the Sui and Tang Dynasties, landscape painting started to be independent. During Five dynasties and the Northern Song Dynasty, landscape painting entered its mature stage and became an important painting branch of Chinese painting. In this issue, we will start discussions around related theoretic problems of landscape painting , in the hope of drawing attention in academia.

中国山水画简称"山水",它是以山川自然景观为主要描写对象的中国画。两汉时期,据《历代名画记》载,有汉武帝《五岳真形图》,此乃最早见于著录的山水图画。三国时吴后赵夫人尝图绘山川地形。东晋时,山水画已具雏形。至隋唐,山水画始独立... 详细信息

中国山水画简称"山水",它是以山川自然景观为主要描写对象的中国画。两汉时期,据《历代名画记》载,有汉武帝《五岳真形图》,此乃最早见于著录的山水图画。三国时吴后赵夫人尝图绘山川地形。东晋时,山水画已具雏形。至隋唐,山水画始独立。五代、北宋时山水画趋于成熟,成为中国画的重要画科。山水画自肇始起就与中国文化、美学休戚相关,为此本期专题策划围绕中国山水画与中国文化的内在关联展开研讨,以期引起学术界与美术界的关注。

关键词：中国古代山水画五岳真形图

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