TUBERCULOSIS TREATMENT OUTCOMES IN THE TARKWA NSUAEM MUNICIPALITY

ABSTRACT
BACKGROUND
Research has shown that mineral mining is a high risk for tuberculosis morbidity and mortality. It is against this background that this study was conducted at Tarkwa Nsuaem Municipality, which is a busy mining community. This study was conducted to examine the pattern of tuberculosis prevalence and treatment outcome in the municipality. Special attention was given to the TB treatment outcome among persons involved with illegal mining activities in the municipality.

METHOD
A retrospective study was conducted in Tarkwa, a mining community in the Western Region of Ghana. There are six TB treatment centers in the Tarkwa Nsuaem Municipality. The various institutional TB registers in the six TB treatment centers and the district TB register were used as the source data. A data collection tool was developed, guided by the study objectives and used to extract relevant information on each TB patient from the source data. All 510 registrants from 2011 to 2013 were enrolled.
The data collected was entered into SPSS® statistics 21 version and analysed.

RESULTS
510 clients’ treatment cards and registration in the treatment register were reviewed. There were 416 (81.57%) males and 94 (18.43%) females. 197 (38.63%) of total TB patients were involved with illegal mineral mining (galamsey) whiles 313(61.37%) were involved with occupations other than galamsey’. Irrespective of occupation, the most affected age groups were those in the productive years (20 – 59). 96.3% (491) of all registrants had pulmonary TB and only 3.7% (19) had extrapulmonary TB.
There was very high treatment success rate among ‘galamsey’ population as well as the ‘non-galamsey’ population throughout the study period. 90.9% (179) and 86.6% (271) respectively for the ‘non-galamsey’ and ‘galamsey’ populations. There was no case of relapse throughout the study period. However there were more cases of TB re-treatment and TB treatment failure among the ‘galamsey’ than the ‘non-galamsey’ population. There were however more cases of treatment interruption due to ‘lost to follow-up’ and mortality in the ‘non-galamsey’ population than the ‘galamsey population.

CONCLUSION
Overall, the ‘non-galamsey’ population did not have better TB treatment outcome compared to the ‘galamsey’ population. The ‘non-galamsey’ population also did not have any better results for presumed resistant TB in comparison to those in the ‘galamsey’ population, neither did they have a better chance for TB treatment success than their galamsey’ counterpart. Illegal mineral miners do not require additional TB care intervention beside that offered to the general population to improve their TB treatment outcome.


CHAPTER ONE
INTRODUCTION
1.0 TUBERCULOSIS DISEASE
The World Health Organization’s (WHO) 2014 report on Tuberculosis (TB) indicates that the TB disease remains one of the world’s deadliest communicable disease. It reported that TB is present in all regions of the world and in 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease (WHO, 2014). In its 2012 report it claimed that almost 9 million new cases and 1.4 million TB deaths occurred worldwide by the year 2011 (WHO, 2012). The 2014 report made a further claim that TB is slowly declining each year and it estimated that 37 million lives were saved between 2000 and 2013 (WHO, 2014).

There have been many studies conducted in sub-Saharan Africa to investigate the association between tuberculosis (TB) incidence, prevalence and mortality among mineral miners as against the general population (Stuckler, Basu, McKee, & Lurie, 2011). Mortality is however just one outcome of TB treatment (Jasmer et al., 2004). Other outcomes which have not attracted the attention of researchers are as equally important as mortality because they can cause the development of resistant TB strains and ultimately to preventable deaths.

Many of the ‘galamsey’ miners in the Tarkwa municipality are presumed to be migrants. They are thought to always be on the move to where the harvest for the mineral is greater. This lifestyle may expose them not only to high incidence of TB but it is also likely to dispose them to poor TB treatment outcomes due to possible treatment interruptions.

Tuberculosis has been described as an infectious bacteria disease caused by Mycobacterium tuberculosis (WHO, 2013a). Other species of mycobacterium have been found to also cause the disease. These include Mycobacterium africanum, Mycobacterium avium, and Mycobacterium bovis. All such organisms have been described collectively as tubercle bacilli. They most commonly affect the lung parenchyma leading to the development of pulmonary tuberculosis. Victims of pulmonary tuberculosis who are na├»ve to anti-tuberculosis drug therapy are highly infectious. It is the commonest type of tuberculosis in the world, accounting for about 80% of the disease. The spread is by inhalation of aerosols produced from the airway of an infected person. These droplets of bacilli are usually formed when the infected person coughs, sneezes or spits into the open environment. Sometimes laughing and singing can spread the infection (WHO, 2013b).

The Tubercle bacilli can also invade and cause disease to any other part of the human body in which case it is described as extrapulmonary tuberculosis. This type is usually not infectious and account for about 20% of tuberculosis the world over. These extrapulmonary sites include the pleura, meninges, intestinal, genitourinary tract, bones and joints, lymph nodes, ocular and oral structures. Most people who suffer extrapulmonary TB are co-morbid with pulmonary TB. Tuberculosis as a disease is curable but infection with Mycobacterium tuberculosis remains for life. A third of the world’s population is suspected to be infected with TB (WHO, 2012).

1.1 PROBLEM STATEMENT
In 1993, the WHO declared TB as a global public emergency and in 2005 as an African public health emergency (WHO, 2013). The Millennium Development Goal (MDG), target 6.c aims to halt and begin to reverse the incidence of TB by 2015 (WHO, 2010).

The Stop TB Partnership also set additional TB targets for the MDGs. These include, the target to reduce the prevalence and death rate by 50%, compared with their levels in 1990 by 2015 and to reduce the global incidence of TB cases to less than 1 case per 1 million population per year (WHO, 2010) In Ghana the 1990 prevalence rate of TB per 100,000 populations was 481 (191 – 923) (WHO, 2013a). Speaking at the 2014 world TB Day (March 24 to remember Dr. Robert Koch’s discovery of T. bacilli in 1882) in Accra, the program manager of the National Tuberculosis Program (NTP) mentioned that the Ghanaian TB prevalence for adult as at 2013 was 300 per 100,000 populations. Mortality rate as at 2010 was 8% which is high (WHO, 2010) and the total cases of MDR-TB notified to the NTP were 14, according to the TB CARE 1-GHANA report to WHO (WHO, 2010).

It is estimated that over the course of one year, people ill with TB pose the risk of infecting up to 10-15 other people through close contact and without adequate treatment it is expected that up to two thirds of people with TB morbidity will die (WHO, 2013b).

In 2012, sub-Saharan Africa had the highest ratio of new TB cases per population with over 255 cases per 100 000 population (WHO, 2013b).

TB has been considered as the biggest single cause of mortality among mine workers apart from trauma (Kleinschmidt & Churchyard, 1997). Adhoc surveys and data from the district TB register of the Tarkwa-Nsuaem Municipal Health Directorate suggest that TB among patients involved in ‘galamsey’ practices have poor TB treatment outcomes compared with the general population who do not practice such. If this observation is factual and global it will have a high potential to affect the MDGs target for TB.

This study therefore seeks to investigate if the observation that ‘galamsey’ miners have poor TB treatment outcome is factual.

1.2 PROJECT OBJECTIVES 
1.2.1 Main objective
The main thrust of this study is to examine if there are significant differences in the tuberculosis treatment outcomes between ‘galamsey’ miners and the ‘non-galamsey’ population.

1.2.2 Specific objectives
* To estimate the 2011 to 2013 tuberculosis prevalence in the Tarkwa Nsuaem municipality.

* To assess the proportion of TB cases among the ‘galamsey’ population as oppose to the ‘non-galamsey’ population that had treatment failure, lost to treatment follow up and treatment relapse.

* To assess the likelihood of a TB case involved with ‘galamsey’ to develop drug resistant TB in comparison with the ‘non-galamsey’ population.

* To assess TB survival prevalence among ‘galamsey’ miners in comparison with the ‘non-galamsey’ population.

* To assess TB mortality among ‘galamsey’ miners in comparison to the ‘non-galamsey’ population.

1.3 RATIONAL OF CONDUCTING THE STUDY
Illegal mineral miners are notorious for unsafe practices that pose danger to health and life. They are also wild migrants exposing communities to contagious diseases. They could sometimes spend weeks and even months in the pit. This attitude coupled with their migration patterns may disrupt medical treatments. Poor TB treatment outcomes can engender resistant bacterial strains.

It also has serious economic implications.

This study is therefore seeking to investigate if TB treatment outcomes among this group is worse in comparison with the ‘non-galamsey’ population in order to inform stake holders in TB care of the need to fashion out a strategy to improve treatment among ‘galamsey’ miners.

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Item Type: Ghanaian Project Material  |  Attribute: 74 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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