CASE FATALITY OF ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) AT UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL (2003 – 2008)

ABSTRACT
This study was undertaken to determine the case fatality of AIDS at University of Port Harcourt Teaching Hospital from 2003-2008. To achieve the purpose of the study, eight research questions were formulated and four hypotheses were postulated, to guide the study. The study adopted the descriptive method utilizing the expost-facto design. The sample for the study consisted of 289 AIDS fatality cases at University of Port Harcourt Teaching Hospital from 2003 -2008. The data were collected using the researcher-designed AIDS fatality inventory proforma, which was used to gather hospital information concerning AIDS fatality cases. The Data collected were analyzed using percentages for the purpose of answering the research questions, while chi-square ( c 2 ) statistics was used to test the hypotheses at .05 level of significance. The results of the study revealed that: a total of 289 AIDS fatality cases were recorded from 2003-2008; the overall case fatality rate was 8 deaths per 100 AIDS cases; there was an increased trend in AIDS fatality from 2004-2005, which then declined from 2006-2008; tuberculosis was the leading opportunistic infection that caused AIDS fatality. The result further revealed that there was no difference in the case fatality of AIDS according to gender and location respectively, while there was difference in the case fatality of AIDS according to age and level of education, respectively. The results were exhaustively discussed and recommendations were made among which were that health educators should educate HIV and AIDS patients on the issue of treatment and management of HIV and AIDS. Much of such education can be done in schools, hospitals, communities and work places. Also, there should be constant testing of AIDS patients for tuberculosis, to ensure early detection and treatment of tuberculosis among AIDS patients.


TABLE OF CONTENTS

Title Page
Table of Contents
List of Tables
List of figures
Abstract

CHAPTER ONE: Introduction
Background of the Study
Statement of the Problem
Purpose of the Study
Research Questions
Research Hypotheses
Significance of the Study
Scope of the Study

CHAPTER TWO: Review of Related Literature
Conceptual Framework
Theoretical Framework
Determinants of AIDS Fatality
Empirical Studies on AIDS Fatality
Summary of Literature Review

CHAPTER THREE: Methods
Research Design
Area of Study
Population for the Study
Sample and Sampling Technique
Instrument for Data Collection
Validity of the Instrument
Reliability of the Instrument
Method of Data Collection
Method of Data Analysis

CHAPTER FOUR: Results and Discussion
Results
Summary of Findings
Discussion of Findings
Case fatality and case fatality rate of AIDS
Trend in AIDS fatality
Opportunistic infections that caused AIDS fatality
Socio-demographic variables of case fatality of AIDS

CHAPTER FIVE: Summary, Conclusions and Recommendations
Summary
Conclusions
Implications of the Study for Health Education
Recommendations
Limitation of the Study
Suggestion for further Study
References
Appendix

CHAPTER ONE

Introduction

Background of the Study

Acquired Immune Deficiency Syndrome (AIDS) caused by Human Immunodeficiency Virus (HIV) has become a significant cause of morbidity and mortality in the world. It is increasingly becoming a predominant cause of childhood and adulthood morbidity and mortality. World Health Organization (WHO, 2003) reported that HIV and AIDS are major global health emergency, affecting all regions of the world, causing death and suffering to millions of people. According to WHO’s report, AIDS is the leading cause of adult death in the world and has a case fatality rate (death rate) that approaches that of the bubonic plague. It is the world’s most devastating infectious disease. Weiss (1997) opined that AIDS is one of the “Pandemic diseases” of the late 20th century. United Sates Agency for International Development (USAID, 2001) reported that Africa carries 70 per cent of the burden. WHO (2003) reported that about forty million people living in Africa in 2002 were infected with the virus. Bollinger; Stover and Nwaorgu (1999) stated that AIDS has the potential to create severe economic impacts in many African countries. They further stated that AIDS is different from most other diseases because it strikes people in the most productive age groups and is essentially 100 per cent fatal.


The disease, AIDS is not of Nigerian origin, but it is now living with us. According to the Federal Ministry of Health (FMOH, 2003) report on AIDS, the first case of AIDS was identified in Nigeria in 1986. Available data indicate that the infection rate is increasing irrespective of the fact that many Nigerians do not report cases of HIV and AIDS to the appropriate quarters. Besides, there is substantive evidence that AIDS is increasing (Ugwuegbulam, 2004). FMOH (2003) reported that adult HIV prevalence increased from 1.8 per cent in 1991 to 5.8 per cent 2001 and slightly reduced to 5 per cent in 2003. It is estimated that 3.2 to 3.8 million Nigerian adults and children were living with HIV and AIDS by the end of 2003. Projections show an increase in the number of people living with HIV and AIDS to be between 3.4 million and 4 million in 2005. As a result of the epidemic, the crude death rate in Nigeria was about 20 per cent higher in 2000 than in 1990. In 2001 alone, 170 thousand adults and children died of AIDS. By 2008 cumulative deaths from AIDS would be between 3.6 million to 4.2 million people (FMOH, 2003). As a result of the figure, the FMOH lamented that there is a dire and urgent need to effectively control AIDS fatality in Nigeria in the interest of human development, reduction of orphans and vulnerable children, social justice and poverty alleviation. The Millennium Development Goals (MDG) aim at combating and halting AIDS by 2015 and also begin to reverse the spread and impact of HIV and AIDS (MDG, 2004). According to FMOH (2003), AIDS fatality reduction has been included as one of the aims of the National AIDS Policy launched on 4th August 2003.
AIDS is the severe symptomatic phase of HIV infection. It is a name given to a group of illnesses, which occur in HIV positive people as a result of a weakened immune system. Onwuekwe (2005) described AIDS as a disease caused by HIV. He further explained that AIDS is the manifestation of HIV infection in an infected individual. AIDS is the last stage in the progression of HIV infection.

AIDS was first discovered in the United States of America in 1981 among homo-sexuals (Centre for Disease Control, 1990). Today, AIDS has become a challenge to the world in general and the developing world in particular. The world is being seriously threatened by this deadly disease, and no vaccine has been discovered to prevent it. In 2002 AIDS was reported in every continent and in every country (WHO, 2003). Kingston (1994) described AIDS as a democratic disease. It affects all ages, sexes, cultures and ethnic groups. It equally affects both rich and poor. Oreh and Nzewi (1996) viewed AIDS as a difficult disease to discuss because it hinges on two extreme sensitive issues, sex and death. WHO (2003) stated that AIDS is a disease, whose impact is much greater, where there is poverty and social inequality, including gender inequality. According to MDG (2004) report in Nigeria, the issue of poverty and low status of women is one of the great predicaments to fighting the disease.

AIDS is a deadly disease. Onuzulike (1998) stated that AIDS is a killer disease that threatens the supposed target year 2000 for improved health related conditions and health status. Cohen, Sande and Volberding (1994) reported that AIDS causes death in most, if not all cases. In hard-hit including some of the under developed parts of the world, AIDS has reversed gains in life expectancy in the last three decades of 20th century. AIDS is a major global health emergency. It has fueled other epidemics of global concern most notably tuberculosis, which has become a leading cause of death not only among people living with HIV and AIDS but also among the HIV negative family members and contact. The disease AIDS, has claimed millions of lives of people cutting across various age, gender, religion and socio-economic status. Max and Fredrick (2003) reported that AIDS is now the leading cause of death in South Africa. Since the discovery of AIDS in Nigeria in 1986, the epidemic has grown steadily, with a concomitant fall in the life expectancy from 53 to 51 years in 1990 and 2000 respectively, negating positive effects that might have occurred as a result of other improvements in life standards and health care (FMOH, 2003). Badcock (2001) reported that one out of nine deaths occur in Nigeria as a result of AIDS.
Onwuekwe (2004) reported that HIV and AIDS patients sometimes visit the hospital to seek care. AIDS patients are HIV positive for life, giving of drugs to the patient does not cure the infection, rather it is a condition where by, life is sustained just for sometime. At any given time, persons hospitalized for HIV related illnesses may progress into a terminal phase. Indeed, some patients are admitted to the hospital exquisitely for palliative care that could not be provided at home for end-stage HIV related condition and not for permanent cure (Cohen et al, 1994).

AIDS victims often suffer from chronic life threatening diseases and opportunistic infections, which require care and support from the health personnel, families, friends and the general public at large. Report has shown that AIDS victims can live for a very long time with good preventive health care and a supportive environment. Where there is no support and care for HIV and AIDS patients most of them die and become victims of the HIV and AIDS infection. MDG (2004) reported that AIDS is almost always fatal without care and support and AIDS fatality includes children, adults, men, women and youths, who have died of HIV and AIDS infection.

Case fatality (CF) falls under the branch of vital statistics called mortality statistics. It is one of the measures of mortality (Park, 2007). In epidemiology, case fatality according to Wikipedia Free Encyclopedia refers to the rate of death among people who already have a condition. It is usually measured as a decimal or as a percentage. For example, if one out of every five people with a condition died, the case fatality would be 0.2 or 20 per cent. Case fatality can be made specific for age, sex, severity of disease and any other factor of clinical and epidemiological importance (Abraham, 1976). Armitage, Colton and Sussex (2000) defined case fatality as the proportion of the number of patients, who died of a common disease or medical problem out of all patients under observation for the same disease. Such deaths are usually calculated using case fatality rate (CFR). In this present study case fatality of AIDS is conceptualized as the number of HIV positive patients, who died of AIDS between 2003 and 2008 at the University of Port Harcourt Teaching Hospital.


Case fatality rate represents the killing power of a disease (Park, 2007). It is calculated as the total number of deaths due to a particular disease per one hundred of cases due to the same disease. It is simply the ratio of death to cases (Park, 2007). Abraham (1976) defined case fatality rate as the number of individuals dying during specified period of time after disease onset or diagnosis per one hundred individuals with the specified disease. According to him this rate represents the risk of dying during a definite period of time for those individuals, who have the particular disease. He further stated that the period of time...

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