Abstract
The study investigated into the knowledge and awareness of pulmonary tuberculosis management among women living with HIV and aids. Olabisi Onabanjo University Teaching Hospital Ogun State. The study examined the following research question which include; what is the level of awareness and knowledge of Pulmonary Tuberculosis Management among Women Living with HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State. What is the prevalence of Pulmonary Tuberculosis among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State. What are the management practices of Pulmonary Tuberculosis among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State.
The study entailed some conceptual clarification which include; Tuberculosis epidemiology, Transmission of tuberculosis, Symptoms etc. The anchor theory was the Health Belief Model.
The study employed the descriptive research design. The selected population where women living with HIV/AIDS in Olabisi Onabanjo University Teaching Hospital (OOUTH).The study employed the purposive sampling technique using the Yaro Yamane technique in selecting the sample unit from the sample space. The questionnaire was used to draw out the subjective intention which is the primary data. The study used the Pearson Correlation coefficient to test the relationship of the hypothesis drafted for the study.
The hypothesis one shows that there is a positive insignificant relationship between knowledge of pulmonary tuberculosis and preventive women leaving with HIV. The second hypothesis depicts that there is a positive insignificant relationship between management of pulmonary tuberculosis and socio-demographic vaiables among women in OOUTH.
The study recommended that medical agencies and parastatals either private or public should host seminars or town cry on the dangers of contacting and preventive measures on tuberculosis to victims of HIV and AIDS. To encourage them on the available measures of addressing the pulmonary tuberculosis.
CHAPTER ONE
INTRODUCTION
1.1 Background of the study
Tuberculosis (TB) is one of the most common worldwide infectious diseases and one of the single largest causes of death in the world (World Health Organization, 2015). TB has been declared as “global emergency” by the World Health Organization. Despite the downward trend in the incidence and prevalence of TB, every continent still reports new cases, especially Africa and South-East Asia. In 2009, U.S. Global Health policy in Global Tuberculosis Epidemic, declared that about one-third of the world’s population or two billion people, carried the TB bacteria, and more than 9 million of who become sick each year with “active” TB, which could be spread to others (WHO, 2013). There is a close link between TB and HIV. It has to been noted that TB may be the first indicator of HIV infection tuberculosis (TB) for people with both latent tuberculosis infection (LTBI).
TB is caused by Mycobacterium tuberculosis (M. tuberculosis), a microorganism whose principal reservoir is humans. M. tuberculosis is spread by patients with pulmonary tuberculosis, especially those with positive sputum smears (Murray, Styblo, and Rouillon, 2014). Of those becoming infected, 10–12% will develop tuberculosis disease after a period ranging from weeks to decades (Vynnycky E and Fine P.E, 2012).
Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may spread to other organs.
Co-infection with tuberculosis (TB) and Human Immunodeficiency Virus (HIV) poses a tremendous challenge to TB control and management, particularly in developing countries (WHO, 2018). Among the estimated 9.3 million new patients with TB in 2007, just over 1.3 million (14.8%) were estimated to be HIV positive. In 2007, there were an estimated 456,000 deaths from HIV-associated TB. Among patients with active TB, patients with HIV co-infection have greater risk of relapse, raising concerns about the optimum duration of TB treatment (WHO, 2015). It was estimated that 8.8 million new TB cases occurred in 2003, of which 1.87 million were fatal due to late diagnosis or non-compliance with treatment (WHO, 2015). Though TB prevalence is declining in many countries, it is estimated that by 2020, there will be over 1 billion new TB infection and, 200 million people will succumb to clinical disease and about 35 million will die if TB control is not further strengthened (WHO, 2015).
As the burden of pulmonary TB increases among women living with HIV/AIDS, its management to curb mortality and morbidity rate among this category of persons in the society becomes highly important. The awareness and knowledge about a particular ill-health condition will inform the pattern and processes of its management.
According to centre for disease control (2016), about a total of 34, 846 HIV-infected people have been identified until December 2016. However, according to the estimates, there are over 76, 000 people living with HIV in Africa. Educational programs have been introduced as an important tool to HIV prevention (Skevington, Sovetkina, and Gillison 2013). HIV is the most significant known risk factor for activation of latent tuberculosis infection (LTBI). There is a close nexus between tb and hiv infection. The risk of active 8% to 10% per year, whereas this same risk for people without HIV infection is 5% to 10% in a lifetime (Tavoosi, Zaferani, Enzevaei and Ahmadinezhad, 2014). and HIV reaches 8% to 10% per year, whereas this same risk for people without HIV infection is 5% to 10% in a lifetime. It has to be noted that TB may be the first indicator of HIV infection (Skevington et al., 2013). Although tuberculosis can be cured by regular intake of antimicrobial drugs, it continues to be a serious global public health problem. Many myths and misconceptions are associated with Tuberculosis. The socio-demographic determinants are central to the programs and policies for the prevention and control of diseases like Tuberculosis. There is ample evidence in literature that the social and cultural factors either promote and/or undermine the health of men, women, children, families and the general population (Marroc, and Raviglione, 2018).
The risk of disease declines steeply with time after infection. Disease may also occur after re-infection (Vynnycky et al., 2015).
Ensuring the regular intake of drugs to achieve a cure is as important as making the diagnosis of tuberculosis (Devkota, 2013). Awareness and knowledge of its management is however germane to ensure longevity among its victims. This study therefore focuses on the Awareness, Knowledge and management measures of pulmonary tuberculosis among women living with HIV/AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State.
1.2 Statement of the problem
Pulmonary tuberculosis is one of the major causes of death globally. The high prevalence of pulmonary tuberculosis occurs due to poverty, illiteracy, lack of health education, myths and misconceptions, poor follow up, dissatisfaction among patients, scarce patient knowledge about the disease and lethargic behavior of treating physicians. These may aggravate this illness. Drug resistance and perception of incurability of the disease also perpetuates the vicious circle of continued infection (Zar, Tannenbawn, Appolles, Roux, Hanslo and Hussey, 2014).
The idea of a misconception is an idea that is wrong due to its basis on a failure to comprehend and understand but unfortunately, myths and misconceptions are prevalent throughout society because of lack of proper knowledge and education (Naqvi, Ishaque, Ilyas, Hander, Siddique and Husnain, 2015).
Illness perceptions are increasingly being shown to be related to important outcomes in a number of illnesses. Studying illness perceptions in relation to TB can bring information, which helps, in improving the cure rates amongst tuberculosis patients, especially in improving the present low adherence to the administered therapy
TB affects all the predicted fields of quality of life, such as general health perceptions, corporal sense, psychological health, mental peace and functionality of physical and social roles. Active tuberculosis can have drug side effects, social isolation and stigma from relatives, family members and friends, as well as causing various symptoms such as hemoptysis, chest pain, fever, profuse sweating, weight loss and fatigue; all these affect the quality of life (Unalan, Soyuer, Ceyhan, Basturk, 2013). The link between HIV/AIDS and pulmonary TB is established in literatures. The risk of active 8% to 10% per year, whereas this same risk for people without HIV infection is 5% to 10% in a lifetime and HIV reaches 8% to 10% per year, whereas this same risk for people without HIV infection is 5% to 10% in a lfetime(Tavoosi et al., 2014). It has to been noted that TB may be the first indicator of HIV infection.
Lack of awareness and knowledge of pulmonary TB among women living with HIV/AIDs further aggravates the disease burden and reduces their lifespan. Some of the factors that predisposed women living with HIV in Olabisi Onabanjo University teaching Hospital Ogun state are low income, living and working in substandard conditions, limited access to nutrition and proper healthcare services.
There are studies on Knowledge and Awareness of Pulmonary Tuberculosis. However, very few studies have focused on its management and the gender aspect of it among HIV/AIDS patients in teaching hospitals, especially in Nigeria.
1.3 Objectives of the study
The general objective of this study is to ascertain the Knowledge and preventive measures of pulmonary tuberculosis among women living with HIV/AIDS in OOUTH. The specific objectives of the study include the following:
· To examine the awareness and knowledge of Pulmonary Tuberculosis Management among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State
· To find out the prevalence of Pulmonary Tuberculosis among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State
· To identify management practices of Pulmonary Tuberculosis among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State
· To examine other means/methods of managing Pulmonary Tuberculosis among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State
1.4 Research questions
The relevant research questions related to this study include the following:
1. What is the level of awareness and knowledge of Pulmonary Tuberculosis Management among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State.
2. What is the prevalence of Pulmonary Tuberculosis among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State
3. What are the management practices of Pulmonary Tuberculosis among Women Living With HIV and AIDS in Olabisi Onabanjo University Teaching Hospital Ogun State
1.5 Research hypothesis
HO1 – There is no significant relationship between knowledge of pulmonary tuberculosis and prevention practices.
HO2 – There are no significant relationship between the awareness about management of pulmonary tuberculosis and socio demographic variables among women leaving with HIV in OOUTH.
1.6 Scope of the study
This study will be carried in Olabisi Onabanjo University Teaching Hospital (OOUTH). Due to the time factors that may be needed in this study the researcher is compelled to limit its focus to just Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu Ogun State.
1.7 Significance of the study
The findings in this study would be relevant to women with HIV/AIDS, medical centers and researchers.
1. To women with HIV/AIDS, the study elucidates the essence of having adequate knowledge on the preventive measures of pulmonary tuberculosis. The findings from the study also addresses the importance of adopting a healthy daily activity in order to prevent their exposure to pulmonary tuberculosis.
2. To researchers, this study will enhance the existing body of literature by contemplating the areas of the literature that have not yet been examined or considered and incorporating these factors into the current study. The study will thus form the basis for further studies in the field
1.8 Operational Definition of terms
Pulmonary tuberculosis: is an infectious bacterial disease characterized by the growth of nodules (tubercles) in the tissues, especially the lungs.
HIV: is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells.
SPSS: Statistical Package for the Social Sciences
AIDS: a disease in which there is a severe loss of the body’s cellular immunity, greatly lowering the resistance to infection and malignancy.
Mycobacterium: any of a genus (Mycobacterium) of non-motile aerobic acid-fast bacteria that include numerous saprophytes and the pathogens causing tuberculosis and leprosy.
Prevalence of pulmonary tuberculosis: this refers to the number of cases of pulmonary tuberculosis present in OOUTH (virology clinic) at the time of the study. It includes both old and new cases.
Treatment outcome: this means the number of patients that completed their treatment, were cured, and discharged number that defaulted from treatment, number of treatment failure and number transferred out to other health facilities due to other complications.
Target: this is the sum total of cured and discharged and treatment completed.
Co infection: this refers to two infections coexisting in one individual. For this study, it refers to a patient infected with TB and HIV infections.
Knowledge: this refers to what is known by women leaving with HIV regarding pulmonary tuberculosis and HIV, such as signs and symptoms, mode of transmission for both TB and HIV.
Preventive measures: according to the dictionary, the definition of preventive is something done to try to prevent an illness or undesirable outcome.
PLWHA: people living with HIV & AIDS.