Background: This study assessed the level of satisfaction of patients with TB implementation in selected DOTS accredited facilities. Methodology: A comparative cross-sectional analytic study involving rural and urban areas implementing DOTS for TB in Anambra State was done. A total of 354 respondents (177 per sub population) were enrolled in the study. By exit interview respondents were administered the questionnaire that bordered on services rendered and cost implications of accessing treatment at the facilities. Results: A total of 162(91.5%) rural respondents were satisfied with appropriateness of working hours compared to 166(93.8%) participants in urban areas. Also 141(79.7%) respondents in rural areas were satisfied with waiting time compared to 155(87.6%) in urban areas and this was statistically significant p<0.004. For the cleanliness of the specimen bottle 138(77.8%) rural respondents compared to 148(83.6%) in urban areas were satisfied and this was statistically significant, p<0.001. Majority of the urban respondents 123(68.9%) were satisfied with respect offered by health workers compared to rural 114(64.4%), and this was also significant, p<0.000. Concerning cost incurred and information given by health workers more urban respondents 5(2.8%) were dissatisfied compared to rural 2(1.1%) though not statistically significant p= 0.378. However, satisfaction was slightly higher in urban (82.8%) compared to rural (80.8%) respondents, while the overall satisfaction in this study was 81.8%. Conclusion: Patient`s satisfaction is a panacea for successful DOTS implementation. We therefore recommend that satisfaction could be improved by provision patient-centred requests such as provision of multivitamins, transport, food among others to help improve DOTS because it will encourage attendance and adherence with better outcomes.
Aim: The use of various substances is very common among the populace. These agents are readily abused by adolescents and youths who are introduced to these substances at an early age in life. This thus leads to abuse and misuse that eventually has a catastrophic outcome to the society at large. The aim of this study was to determine the prevalence of substance use among in-school and out-of-school adolescents; a comparative analysis in Anambra State, Nigeria. Study Design: This was a cross-sectional comparative study. Place and Duration of Study: The study was conducted in schools, parks and markets of Onitsha municipal area of Anambra State, Nigeria, from September 2019-April 2020. Methodology: A total of 250 in-school and 250 out-of-school adolescents aged 10-19 years, within Onitsha municipal area was sampled through the use of a semi-structured interviewer administered questionnaire, that was adapted from a WHO designed instrument on drug use among non-student youths. Frequency distributions were developed, while associations between variables were tested using t-test, fisher’s test, and chi-square. Results: The results showed that most participants were males with mean ages of both sexes being 16.7 among the in-school and 16.1 in the out-of-school. There was statistically significant difference in alcohol consumption between in-school compared to out-of-school, p=0.001; and cigarette smoking, p=0.001. However, inhalants use was more among in-school compared to out-of-school, though not statistically significant. The overall prevalence of substance use was 58.4%, with 80.4% among the out-of-school compared to 36.4% with the in-school participants. Conclusion: Substance use is common among in-school and out-of-school adolescents. The prevalence of substance use was significantly higher among out-of-school compared to in-school adolescents. Parents should teach their children the dangers of substance abuse while Schools and governments should ensure inclusion of such in the curriculum.
Aim: Several challenges have been hampering the DOTS strategy ranging from a paucity of staff, laboratory consumables and drugs among others. This study, therefore, assessed the challenges facing TB-DOTS implementation in Anambra State, Nigeria. Study Design: A cross-sectional analytic study was carried out. Place and Duration of Study: TB-DOTS accredited facilities in Anambra State, South-East Nigeria, September 2017 - March 2018. Methodology: Using questionnaires on 354 respondents, a checklist on 32 DOTS accredited facilities, and Key In-depth Interview (KII) guide which was administered on 14 focal persons in rural and urban facilities, including the State TBL coordinator, was employed. Data were analysed using Chi-square and Fisher`s exact test with level of significance set at p<0.05, while key themes from KII were thematically analysed. Results: Both urban and rural respondents took nearly the same time to reach a DOTS centre, however, urban respondents spent more money to reach a TB centre and this was statistically significant p≤0.002. Patients stated that the DOTS strategy could be improved by attending to them early, home visiting, having more staff, providing pocket money among others in urban compared to rural areas and these were statistically significant p≤0.003. Checklist revealed that most patients in rural facilities 16/19(84.2%) compared to urban 11/13(84.6%) were not observed taking their medications while 11/19(57.9%) rural compared to 5/13(38.5%) urban had no functional microscope. Both rural and urban facilities specifically had challenges of Genexpert machines, needed more staff and laboratories as well as adequate funds and retraining. Conclusion: Challenges of DOTS may be myriad, however, Focal persons and Health workers should ensure direct observation of patients while the STBL coordinator informs government and policymakers on the need to employ more workers in TB management to help reduce waiting time. Regular training and retraining of health workers are also recommended.
Background: The Directly Observed Treatment Shortcourse (DOTS) is a widely accepted strategy in the management of TB, however, Failure cases and Multi-drug resistant cases are also on the increase, hence the need to assess the adherence to the implementation of this veritable strategy from providers and patients views. Methodology: A comparative cross-sectional study involving 32 DOTS accredited facilities in rural and urban areas implementing DOTS strategy was utilized for this study. A total of 354 were randomly selected and assessed with the use of a questionnaire while a checklist was used to assess providers’ adherence. Data was analysed using SPSS version 21. Chi-square and Fisher`s exact test was used to test significance set at p<0.05. Results: The rural respondents spent less to get to the DOTS facility and this was statistically significant (p=0-02). The reasons for missing medications in rural compared to urban areas was also statistically significant (p=0.00). No health worker was noted to observe patients other than parents or siblings from the questionnaires and this was also statistically significant, (p=0.03). Overall patients adherence was 86.2% in rural compared to 87.6% in urban areas which was higher. None of the facilities in both subpopulations had health education checklist and one rural facility drug that passed expiration date was also seen. Conclusions: Overall adherence to DOTS implementation was high in both subpopulations, however, no health worker observed the patients. Direct observation of patients and follow-up is strongly recommended to prevent failure and resistant cases. Key words: Implementation; DOTS strategy; Providers adherence; Patients adherence; Anambra State.
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