INTRODUCTION

Background of the Study

Tuberculosis is an infectious disease caused by myco-bacterium

tuberculi it has been a public health problem worldwide but there has

been a tremendous decrease in prevalence of tuberculosis cases in the

developed countries of the world. However this disease still poses

serious and even increasing problem in many low income countries it is

affecting both health and social welfare patterns of millions of people in

such areas this has remained a public health problem in the developing

world.

International Union against Lungs Disease (1960) IUATLD 1960.

This is due to the failure to cure a high proportion of smear positive

cases whose sputum is positive on direct microscope. The microscope

analysis has revealed that sputum smear positive patients are the most

potent sources of infection and without proper chemotherapy the result

has been the continuous discharge of tubercule bacilli to the public.

Also (HIV) Human Immunodeficiency virus epidemic is another most

powerful risk factor to the development of TB disease worldwide

(International Union against Lungs Disease 2000 IUATLD 2000

Management of Tuberculosis).

The government has observed with keen sensory responsibility

both the social economic the health implications of menace of the

disease to the people and the nation at large and has setup the National

Tuberculosis and Leprosy Control Programme (NTBLCP).

The aim is to:

i. The setting up of this by the government was aimed at diagnosing

and curing ample number of infectious cases

ii. Maintain vigilance and detect all new infectious cases that may

arise within the life time of the group that was infected prior to the

application of the tuberculosis control measures.

In order to achieve this aim the government had a nationwide plan

but with rural focus of the directly observation treatment (DOTs)

implementation of the modern anti-tuberculosis medications to all

patients suffering from this potentially fatal disease.

This has made it possible to care at least four hundred percent

(400%) to the new target of eighty five percent (85%) of new positive

patients.

On the whole the new cure rate will enhance the following:

i. Keep patients on the prescribed treatment regime; as well as

ii. Reduce the number of patients who are on treatment outcome of

all smear positive patients at treatment centres.

Relatedly Paikoro local government is one of the twenty-five (25)

local government councils of Niger state where the NTBLCP commenced

the Directly Observation Treatment (DOTs) course in the year 1999.

Whereas the Leprosy Referral Hospital Chanchanga under Paikoro

local government area (LGA) became the intake centre for patients

diagnosed and admitted for the treatment of TB in the state.

Consequent upon this well equipped laboratories was established to give

free of charge detection of TB as well as to bring treatment closer to the

patients.

The recent Paikoro local government area cohort analysis report of

2006 received from the Niger State TBLCP indicated that two hundred

and sixty-three (263) smear positive patients were registered and the

outcome of treatment were as follows:

i. That out of the two hundred and sixty three (263) patients treated

within that period one hundred and fifty two (152) patients were

cured while thirty (30) completed their treatment but were not

cured the council recorded four hundred percent (400%) cure rate

which was more than the World Health Organisation (WHO) target

cure rate of eighty five percent (85%).

ii. The report revealed that there was zero (0) treatment failure rate

in the year under review which gave the council zero percent (0%)

failure rate as against the four percent (4%) of the World Health

Organisation (WHO).

iii. Also in the report twenty-three (23) patients died during the

course of treatment which gave the council sixty-one percent

(61%) treatment outcome against five percent (5%) of the World

Health Organisation (WHO).

iv. The defaulting rate of treatment by patients within the reviewing

period was fifty-eight (58) which gives the council one hundred

and fifty-two point fifty-four percent (152.54%) against the World

Health Organisation (WHO) targeted three percent (3%) allowed

by World Health Organisation (WHO).

v. No patient was transferred to another local government area (LGA)

for treatment.

The columns used to evaluate treatment outcome analysis by the

NTBLCP are:

i. It was observed that Paikoro local government area recorded

400% cure and compliance to treatment as against 85% WHO

target.

ii. The treatment failure rate recorded by the council it was also zero

percent (0%) against WHO target 4% which is good.

iii. The rate of default by patients during the treatment period also

there was one hundred and fifty-three percent (153%) against

WHO 3% target.

Treatment outcome analysis of Paikoro local government area of 2006

new smear positive cases category one (CAT 1)

Items

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

Total

2006

Treatment

Outcome

WHO

Treatment

Outcome

(%)

Cured

t/Completed

failure

died

defaulted

transfer out

36

5

0

2

7

0

33

6

0

4

15

0

46

15

0

9

23

0

37

4

0

8

13

0

152

30

0

23

58

0

400%

79%

0%

61%

152.54%

0%

85%

3%

4%

5%

3%

0%

Total 263

Treatment outcome analysis of patients on re-treatment (CAT 2) in

Paikoro local government area

Items

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

Total

2006

Treatment

Outcome

WHO

Treatment

Outcome

(%)

Cured

t/Completed

failure

died

defaulted

transfereout

0

0

0

0

2

0

1

0

0

0

1

0

2

0

0

0

2

0

0

0

0

0

0

0

3

0

0

0

0

0

0.24%

0%

0%

0%

0.40%

0%

85%

3%

4%

5%

3%

0%

Total 3

Poor treatment has another and very serious consequences and

patients who are treated for TB but failed to be cured are at a high risk

of developing chronic and resistant to multiple medication is also

cureable with the type of treatment available it is note worthy to

mention that:

i. If there is a proper case holding of TB patients on treatment they

will not default.

ii. If defaulted patients are traced and treated adequately they will

be cured.

iii. If they are cured they will not develop chronic and resist and

tuberculosis bacilli and the targeted cure rate of the eighty-five

percent (85%) will be met.

iv. The disease will not pose a serious problem by affecting the health

and social welfare of the people and it will not become a public

health problem.

Statement of the Problem

The National Tuberculosis and Leprosy Control Programme had

made the observations of low rate of 30-50% in the past due to the

failure to cure a high proportion of smear positive cases. Tuberculosis is

an infectious disease caused by myco-bacterium TB it has been a public

health problem worldwide but there has been a tremendous decrease of

TB cases in the developed countries the disease still poses a serious

and even increasing problem in many low income countries affecting

the health and social welfare of millions of people which make it still to

be a public health problem (IUATLOD 1960).

Poor treatment has another and very serious consequences and

patients who are treated for TB but failed or defaulted to be cured are at

a high risk of developing chronic and resistant to multiple medications is

also curable with the type of treatment available. The issue which arose

for this study what are the factors responsible for defaulting among

patients receiving TB treatment in Paikoro local government area?

Purpose/Objective of the Study

The study intended to find out

i. The level of awareness of patients on tuberculosis

ii. The attitude of the health workers to the patients

iii. The attitude of the patient to the treatment of tuberculosis

Significance of the Study

The study would reveal the level of patients’ awareness on

tuberculosis its cause the mode of spread and transmission treatment

and the reason of sputum microscope follow up.

The attitude of the health workers to the patients on treatment

would also be revealed and the attitude of the patients to treatment.

It would assist other researchers as a source of information to

continue with their research. This study would also be significant to the

treatment providers in the clinics to know the importance of patients’

awareness and their attitude in attending to patients and treating them.

The study would also reveal the reason of high number of defaulters in

the four (4) tuberculosis treatment centers in the local government and

the state TBLCP would know how to solve the problem so as to reduce

the spread of the disease in the area.

Research Questions

The following research questions guided the study:

1. What is the level of patients’ awareness on tuberculosis?

2. What is the attitude of health workers to tuberculosis patients?

3. What is the attitude of the patients to treatment of tuberculosis?

Scope of the Study

The study was on the patients that were receiving treatment in the

four (4) tuberculosis treatment centres in Paikoro local government area

of Niger state.

The study looked into the awareness of patients attitude of

patients receiving tuberculosis treatment.