RURAL-URBAN PERCEPTION OF TUBERCULOSIS AMONG PATENT MEDICINE VENDORS IN ENUGU STATE

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ABSTRACT
Background: Tuberculosis is an airborne infectious disease caused by Acid bacilli Mycobacterium tuberculosis. Tuberculosis is one of the commonest infectious diseases in the world. It remains a world-wide public health problem despite the fact that the causative agent was discovered more than 100 years ago and effective drugs and vaccine are available making tuberculosis a preventable and curable disease.
Patent medicine dealer can be defined as a person without formal pharmacy training, who sells orthodox pharmaceutical products on retail basis for profit. They are only authorized to sell over the counter medicine and are usually licensed to practice by the pharmacy council of Nigeria (PCN). The patent medicine dealers have poor or improper knowledge of health issues resulting in making of wrong or delayed diagnosis and in the case of tuberculosis, this can lead to great morbidity and mortality. To reach the millennium development goal of reversing the spread of TB by 2015, and ultimately eliminating TB by 2050, the perception and activities of the patent medicine dealers who are ubiquitous in the health sector, should be investigated, monitored, improved and modified. The objectives of this study include, to determine the knowledge of TB and practice among PMVs towards Tuberculosis suspects, to compare the knowledge, and practice of PMVs in rural and urban communities towards TB suspect and to determine the knowledge of TB case detection among PMVs
Methodology: The study design was descriptive cross sectional study carried out in urban and rural LGAs in Enugu State. It involved the stratification of the local government areas into urban and rural LGAs. Enugu North and Nkanu West LGAs were chosen by simple random sampling. The study population was patent medicine vendors operating the urban and rural LGAs. Data were entered and analyzed in SPSS software, statistical level of significance was at p-value of 0.05 at 95% confidence interval.
Results: a total of 140 PMVs were recruited, 75 from the urban LGA and 65 from the rural LGA. The age of the respondent ranges from 22 - 60 with the urban PMVs significantly younger in age χ2 = 11.844, p-value 0.008. Post secondary educational is more in the urban PMVs than in the rural The PMVs with higher educational level above secondary education is higher in the urban than rural χ2 = 24.693, p-value = 0.000. Knowledge of TB as one of the causes of long lasting cough is higher among urban PMVs fisher exact test χ2 = 0.003, p-value = 0.002. Knowledge of prevention of spread is higher among urban PMVs. Knowledge of symptoms of TB like fever, weight loss, night sweat and chest pain were all higher among urban PMVs. Practices such as selling drugs and referring TB suspects to health facilities χ2 = 21.379, p-value = 0.000, asking for duration of cough χ2 = 0.001, p-value = 0.001 were higher among urban PMVs. Urban PMVs scored higher in having knowledge of correct symptoms of TB χ2 =16.693, P-value = 0.005
Conclusion: the PMVs are the first port of call for TB suspects. To achieve the WHO STOP TB aim of engaging all care providers in the fight against TB, PMVs perception and practice should be properly evaluated. 

TABLE OF CONTENTS

TITLE PAGE
TABLE OF CONTENTS
LIST OF TABLES
SUMMARY

CHAPTER ONE: INTRODUCTION

CHAPTER TWO: LITERATURE REVIEW

CHAPTER THREE: METHODOLOGY

CHAPTER FOUR: RESULTS

CHAPTER FIVE: DISCUSSION

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS
REFERENCES

QUESTIONNAIRE

CHAPTER ONE
INTRODUCTION                                  
Tuberculosis is an airborne infectious disease caused by Acid bacilli Mycobacterium tuberculosis.1 Tuberculosis (TB) is one of the commonest infectious diseases in the world. It remains a world-wide public health problem despite the fact that the causative agent was discovered more than 100 years ago and effective drugs and vaccine are available making tuberculosis a preventable and curable disease.2,3,4,5 It can be suspected by cough lasting more than three weeks. Symptoms include, chronic cough (which may be blood stained), night sweats, weight loss, loss of appetite, chest pain. TB can affect every part of the body; can be pulmonary, bone and joints, brain, renal/genital, blood1
For control programmes, most important case finding tools are:
·         Sputum smear examination by direct microscopy which is now considered the method of choice. The reliability, cheapness and ease of direct microscopic examination has made it number one case – finding method all over the world. The finding of AFB in sputum smear is diagnostic. Early morning sputum is recommended and about three consecutive morning sputum samples are tested
·         Sputum culture, this is second in importance in case finding in control programme, though it is difficult, tedious, lengthy, and expensive and needs special training and expertise. It is important in carrying out sensitivity tests and monitoring drug treatment.5 Other diagnostic methods of  TB  include;
·         Tuberculin skin test
·         X-ray to detect cavities caused by the organism Mycobacterium tuberculosis.
·         Polymerase chain reaction (PCR) which is the gold standard for the diagnosis of Mycobacterium tuberculosis5,6
·         One of the landmark achievements in the control of tuberculosis is the Direct Observed Treatment Short course (DOTS), which has received worldwide approval. DOTS was launched by WHO in 1995. Since then it remains central to the tuberculosis control. Without DOTS, we would have no tuberculosis control. More than 22 million patients have been treated under the DOTS-based services and now it has been established in more than 183 countries with 89% coverage in 20057,8,9.
Effective treatment is with appropriate antibiotic and under direct supervision. This is the aim of WHO’s Directly Observed Treatment Short course (DOTS).10,11
Tuberculosis perception  among  patent  medicine  dealers (PMDs) also known as patent medicine vendors (PMVs) in urban  and  rural areas  should  be evaluated in  other to meet  the millennium development goals of reversing the spread of Tuberculosis by 2015. This is because Tuberculosis is a preventable and curable disease if detected early and treated promptly according to national tuberculosis and leprosy control guidelines (NTBLCP)11
Patent medicine dealer (PMD) can be defined as a person without formal pharmacy training, who sells orthodox pharmaceutical products on retail basis for profit.12 They are only authorized to sell over the counter medicine and are usually licensed to practice by the pharmacy council of Nigeria (PCN) 13
Most of the PMDs undergo apprenticeship under existing license holders some are auxiliary level health workers. In Nigeria, minimum educational level requirement for PMDs is primary school. This level of education does not help in the correct knowledge of common diseases. 14,15,16,17,18,19,20 In 2004, Government review of existing laws on regulation of establishment and functioning of PMDs stores added the attendance of an orientation course for issuance of  license  and continuous education for renewal of license.21
STATEMENT OF THE PROBLEM
Tuberculosis is a global emergency, more than two billion people are infected, about 1/3 of the world’s population22. About 160 persons die of TB every hour. Eight percent of Human immuno-deficiency virus (HIV) patients are co- infected with TB, which causes about 25%  deaths among TB/HIV co -infected.23  In 2011, about 8.7million people fell ill and 1.4 million died from TB. This is disturbing and unfortunate because TB is preventable and curable. This is because TB suspects go first to patent medicine dealers, who are the first port of call in many health challenges. These PMDs have poor perception, knowledge of health conditions and practice of universal precautions.
The patent medicine dealers have poor or improper knowledge of health issues resulting in making of wrong or delayed diagnosis and in the case of tuberculosis, this can lead to great morbidity and mortality. The spread of multi-drug resistant tuberculosis (MDR-TB) and emergence of extensive resistant tuberculosis (XDR-TB) result from non-treatment, under treatment or inappropriate treatment of tuberculosis. It is known that Antimicrobial resistance is one of the greatest threats to human health. 24
The Patent Medicine Vendors see tuberculosis patients first and this can be very dangerous considering the fact that the PMVs have very poor knowledge, awareness and practice of universal precautions. This is a concern due to the fact that for each case of TB can lead to great number of new infections occuring.
JUSTIFICATION/ RATIONALE
The patent medicine dealers are first port of call for tuberculosis patients. To reach the millennium development goal of reversing the spread of TB by 2015, and ultimately eliminating TB by 2050, the perception and activities of the patent medicine dealers who are ubiquitous in the health sector, should be investigated, monitored, improved and modified......

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