Impact of insurgency on tuberculosis treatment uptake among TB patients in a tertiary health institution in Maiduguri, Northeastern Nigeria

Abstract

The damage on health facilities caused by activities of insurgents in addition to grounding socioeconomic activities, cutting off social amenities and supplies to northeastern Nigeria has had serious health implications. To compare anti-TB medication uptake before serious insurgency (2007- 2010) and during peak of insurgency (January 2011- December 2014) period. A retrospective review of 2,022 medical records of patients diagnosed with tuberculosis at a direct observed therapy short course (DOTs) centre located within University of Maiduguri Teaching Hospital (UMTH), a tertiary health facility over a period of eight years (2007 -2014). Patients were categorized into two; those that presented from year 2007 – 2010 and 2011 -2014 depicting period of sporadic attacks and severe onslaught by insurgents characterized by restriction of movements, attack on health facilities and internal displacement respectively. A total of 2,022 TB patients were registered for TB treatment over an eight year period (2007 -2014), there was no gender variation. Pulmonary TB constituted the majority of cases seen. Comparatively, the proportion of sputum smear positivity, p = 0.029, and TB patients in category II, p < 0.001, was higher among those that reported from 2011-2014. They also had higher rate of default and mortality. Records on uptake of anti TB medication shows that 84.1% of those who presented from 2007 - 2010 and 41.6% participants that registered from 2011 -2014 completed their anti- TB medication. TB cases registered from 2007- 2010 had a three times chances of completing their anti TB medications (Exp (B) 3.20; 95% C.I (1.22 - 0.837), p = 0.018 than those registered from 2011-2014. Majority of the registered TB cases were within reproductive age group (18 -45 years) with HIV serostatus positive in 57.7% of cases seen. Insurgency adversely affected drug uptake of anti-TB medication especially during the peak of the insurgency attacks and restriction of movements. The high rate of defaulters recorded during insurgency attacks has a potential of increasing the pool of drug resistant TB that is expensive and difficult to manage, it is also associated with high mortality. Surveillance, active case management and contact tracing of TB need to be stepped up in communities affected by insurgency to avert possible increase in incidence of new cases and multi-drug resistance TB strains.

Keywords: TB treatment, Multi-drug resistance TB, Insurgency, Northeastern Nigeria