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EDITORIAL COMMENTS
JOPER continues to promote the growth and development of Physical Education
allied profession through regular publications. The highlights of this issue are:
i.
Management of kelodis;
ii.
Computer and neck pain;
iii.
Women and physical fitness;
iv.
Exercise and obesity/diabetes;
v.
Health educators and HIV/AIDS curriculum;
vi.
HIV and Tuberculosis patients;
vii.
Teaching physical education and its limitations.
We will keep on seeking your support in disseminating current research findings
in Physical Education and Allied Profession.
EDITORIAL BOARD
Prof. E. B. Okunrotifa]
Editor
Prof. S. A. Adeyanjuu
Prof. J. I. Ogundari
Dr. Wole Obiyemi
Associate Editors
EDITORIAL CONSULTANT
© Prof. e. B. Okunrotifa
Published October 2004
Published twice a year
All articles for publication to
Professor E. B. Okunrotifa
Co Dept. of Physical/Health Education
Obafemi Awolowo University, Ile-Ife
Country
Institution (Nigeria)
Libraries
Individuals
African Countries
Other Countries
Rates
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TABLE OF CONTENTS
Fabunmi, A. A. and Alabi, f. a.: Effect of Ultrasound and BOA – constrictor
Fat Oil in the Management of Keloids (A Case Study)
1013
Dada, O. O., and Oke, K. I.: Prevaluence of Neck Pain among
Computer Users
1018
Alabi, F. A. Physical Fitness for Women
1027
Nwankwo M. J. and Nwanoro, E. C.: sedentary Death Syndrome:
The Vital roles of Exercise in Obesity/Diabetes
1030
Adeboyega, J. A.: The Role of Health Educators in the Implementation
Of Reproduction Health and HIV/AIDs Curriculum in the Universal
Basic Education Programme
1035
Olaitan, O. L. The Prevalence of HIV Infection in Patients with
Tuberculosis in Ibadan, Oyo State Nigeria
1042
Peter-Ajayi O. M. Factors Limiting the Effective Teaching of Physical
Education in Secondary Schools in Ekiti State: Students’ Opinions
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1047
THE PREVALENCE OF HIV INFECTION IN PATIENTS WITH
TUBERCULOSIS IN IBADAN, OVO STATE, NIGERIA
BY
O.L. OLAITAN (M.ED)
Department of Physical and Health Education, University of Ilorin, Ilorin.
ABSTRACT
This study investigated the prevalence of HI V infection in patients with
tuberculosis in Government Chest Hospital, Tuberculosis unit Jericho Ibadan
during 2002-2004. A two-staged prospective study involving 260 patients with TB
was conducted. Health records, 156 were males, 222 patients were diagnosed as
pulmonary tuberculosis and 38 patients had extra pulmonary tuberculosis.
Considering some risk factors for Human Immunodeficiency Virus (HIV) infection,
5 patients had tattoos, 8 were prisoners and 3 were barbers. All the patient
records for the HIV status were examined and only 19 were HIV positive. Based
on the findings, it w1as recommended that public health education and
awareness programmes should be developed to serve as preventive measures
and protection against these infections. Healthy behaviour campaigns should be
mounted by health education units of Federal and State Ministries of Health to
guide the populace on the adequate preventive measures for both HIV infection
and tuberculosis.
INTRODUCTION
Tuberculosis (TB) is known as a serious infectious disease in which
swellings appear on the lungs and other parts of the body. It is also recognized
as a major complication of human immunodeficiency virus (HIV) infection (Piot,
1984; Ravighione, Narain & Kochi, 1992; Murray, Stylo & Rovilion, 1990).
Conversely, many reports have shown high rates of HIV infection in patients with
tuberculosis in countries with HIV epidemics (Kelly, Burnham & Radford, 1990).
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Previous studies have found both HIV-l and HIV-2 to be associated with
tuberculosis (Dc-Cock, 1992).
The impact of HIV infection on the tuberculosis situation is obviously most
serious when the prevalence of tuberculosis infection in young adults who are at
risk of HIV infection is high. Olaitan (2002) opined that students of tertiary
institutions in Kwara State had adequate knowledge about relationship between
tuberculosis and HIV. They are also aware that tuberculosis is a major symptom
of HIV infection. Using estimates of the prevalence of tuberculosis infection in
various regions, it can be estimated that in early 1992 there were more than 4
million people worldwide with both HIV infection and tuberculosis, the majority
of who lived in Sub-Saharan African. HIV seroprevalence rates of > 40% are
common among patients with tuberculosis in many Sub-Saharan African
countries (WHO, 1992). Elliot (1990), reported that in South-East Asia, where
HIV infection began spreading in more recent years, HIV seroprevalence among
tuberculosis patients is also on the increase. I-Ic further discovered that in
Chiang Mai, Thailand, it increased from 5.19% in late 1989 to 13.9% in early
1991.
The overlap of tuberculosis and HIV has ominous social and medical
implications, particularly for the developing and third world countries. The
increase in tuberculosis cases has considerable pressure on the already fragile
and over-stretched health services of such countries with more demand for
diagnostic services, antituberculosis drugs, hospital beds and other supplies and
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services (Elliot, 1990). Moreover, HIV infected patients have a higher frequency
of extrapulmonary tuberculosis, which is more difficult to diagnose than
pulmorary tuberculosis. Ndeezi (1998) opined that tuberculosis is difficult to
diagnose in children particularly if they have HIV. She later concluded that
tuberculosis should be considered if the child has: failure to thrive or weight loss,
fever or persistent cough for more than one month, an abnormal chest X-ray
that persists despite adequate antibiotic treatment for two weeks or more and
history of household contact with a person with tuberculosis.
Increasing numbers of AIDS and tuberculosis cases and deaths are likely
to occur among young and adults in their economically most productive years.
This has tremendous social and economic implications. Baende (1991) asserted
that, the fear is also that the increasing numbers of HIV-positive patients with
tuberculosis will lead to increase in the transmission of tuberculosis to the rest of
the population, thereby resulting in an increased proportion of the population
being infected with the tuberculosis bacilli in the future.
This study investigated the trends of HIV infection in tuberculosis patients
over a 2 years period (2002-2004) in Government Chest Hospital, TB Unit Jericho
in Ibadan, Nigeria.
SUBJECTS AND METHODS
A two-staged prospective study was conducted on 260 patients with
tuberculosis and the health records of the patients were used. Subjects were
randomly selected from patients seeking medical advice at the Government
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Chest Hospital Tuberculosis Unit, Jericho, Ibadan. In the first stage (2003) 106
patients with tuberculosis (62 males and 44 females) were affected with
pulmonary tuberculosis (PTB) and 24 with extra pulmonary tuberculosis (EPTB).
With regard to patients with risk factors for HIV infection, 4 patients had tattoos
and 5 were prisoners, 3 of whom were barbers. All patients were tested for HIV
according to their health records/case files.
Table 1: Age and sex distribution of patients with tuberculosis.
Age (years)
Males
Females
Total No.
Total %
<19
49
32
81
31.2
20-29
53
27
82
31.5
40-49
26
22
48
18.5
30-39
18
13
31
11.9
>50
10
8
18
6.9
156
104
260
100
Total
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Table 2:
Frequency distribution of the tuberculosis patients by type of
tuberculosis, category of exposure, level of education and
prevalence of HIV infection.
Variable
No
Total
%
Total %
Pulmonary tuberculosis
222
260
85.4
100
Extrapulmonary tuberculosis
38
14.6
Students
94
36.1
Labourers
122
46.9
Civil Servants
28
10.8
Barbers
3
Prisoners
8
3.1
Patient with tattooing
5
1.9
No formal education
41
15.8
Primary school education
124
Category
260
1.2
100
Level of Education
47.7
260
Secondary school education
86
33.0
Tertiary education
9
3.5
HIV positive
19
7.3
HIV negative
241
100
Prevalence of HIV
260
8
92.7
100
In the second stage (2004) 154 patients with tuberculosis (94 males and
60 females) were evaluated, 140 had pulmonary tuberculosis (PTB) and 14 had
exrapulmonary tuberculosis (EPTB). One patient had tattoos and 3 were
prisoners. Health records showed that ail the patients were tested for HIV
infection.
Serological tests were performed by both the Medical Laboratory unit of
the hospital and Medical Laboratory Department of Adeoyo Ring Road State
Hospital, Ibadan using enzyme — linked immuno-sorbent assay (ELISA).
Anderson, da Silva. Norrgen Dias & Biberfield (1997) asserted that, the most
widely used screening test are ELISAs which comprise a number of variants
based on different principles including indirect, competitive, sandwich and
capture assays, all of which may detect HIV-1 as well as HIV-2 anti1dies.
Pulmonary tuberculosis was diagnosed by three sputum samples, which were
Ziehi-Neelon stained the medical laboratory by chest X-ray that interpretation of
and examined by scientists and also were subjected to the radiologists.
Extrapulmonary tuberculosis was diagnosed by histopathological examination of
each case by the medical laboratory scientist as well.
RESULTS AND DISCUSSIONS
Table 1 shows the age and sex distribution of the patients with
tuberculosis, and table 2 shows the type of tuberculosis, category of exposure
and educational levels of the patients with tuberculosis. Regarding type of
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tuberculosis, 222 (85.4%) of the patients had pulmonary tuberculosis (PTB) and
38 (14.6%) patients had extrapulmonary tuberculosis (EPTB). The greatest
proportion were unskilled labourers, 122 (14.9%) followed by students 94
(36.1%) and twenty-eight (10.8%) were civil servants. In addition, 8(3.1%) of
the patients were prisoners, 5 (1.9%) had tattoos and 3 (1.2%) were barbers)
(7.3%) of the patients tested positive for HIV infection. Regarding education,
15.8% of the subjects had no formal education, 47.7% had a primary school
education, 33% had secondary school education and 3.5% had tertiary
education.
HIV is recognized to be the strongest risk factor for the progression of
latent infection to active tuberculosis. Transmission of infection occurs before
patients are presented to the diagnostics centers (WHO, 1998). In this study only
7.3% of the subjects were HIV-positive by ELISA, this could be due to the fact
that, some of them belong to groups considered to be at greater risk for HIV
infection (e.g. prisoners, barbers, and those with tattoos).
Recommendations
Public health education and awareness programmes should be developed
to serve as measures for prevention and protection against these infections.
Health Education Departments of Federal and State Ministries of Health should
embark on preventive education for both HIV infection and tuberculosis. In
addition, preventive strategies such as screening. and health education
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campaigns in controlling HIV and TB among groups with risky behaviour should
be made effective.
And more specifically, government should ensure that prisoners are
screened and cross-examined periodically, such that those detected to be TB and
HIV seropositive are separated from others. Since, clustering them together in
prison may make them transmit TB to one another, because TB is transmitted
through droplet infection and it is an air-borne disease.
Barbers should imbibe healthy behaviour by sterilizing their instruments as
they work on one customer to the other, because HIV infection can be
transmitted through barbing and shaving instruments.
Tattooing, body scarifications, tribal marks, female genital cutting should
be discouraged, because these acts make the people involved to be prone to HIV
infection.
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REFERENCES
Anderson, S. da Silva, Z., Norrgen H., Dias, F. & Biberfield, G. (1997):
Field evaluation of alternative testing strategies for diagnosis and differentiation
of HIV-I and HIV-2 infections in HIV-1 and HIV-2 prevalent area. AIDS, II,
18158.
Baende,
E.
(1991):
Characterization
of
transmitters
of
Mycobacterium
tuberculosis in Zaire by HIV serostatus, level of immuno suppression and
clinical status. Paper presented at the VII international Conference on
AIDS, Florence 16-21 June.
De cock, K.M. (1992): Tuberculosis and HIV infection in Sub-Saharan Africa.
Journal of the American Medical Association, 12, 1581-7.
Elliot, A.M. (1990): Impact of HIV on tuberculosis in Zambia: a cross- sectional
study. British Medical Journal, 301,412-5.
Kelly, P. Burnham, 0. & Radford, C. (1990): HIV seropositivity and tuberculosis in
a rural Malawi hospital. Transactions of the Royal Society of Tropical
Medicine and Hygiene, 84, 725-7.
Murray, C.J.L., Styblo, K. & Rouillon, A. (1990): Tuberculosis in developing
countries: burden, intervention and cost. Bulletin of. the In! dna/jo flu!
Union Against Tuberculosis and Lung Disease, 65, 6-24.
Ndeezi, G. (1998): How to manage illness in children with HI V/AIDS. Child
Health Dialogue, 12, 4-5.
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Olaitan, O.L. (2002); Knowledge of HIV/AIDS among students of tertiary
institutions
in
Kwara State.
Unpublished M.Ed. Health
Education
dissertation. University of Ilorin, Nigeria.
Piot, P. (1984): . Acquired Immunodeficiency Syndrome in a heterosexual
population in Zaire, Lancet, 2, 8394, 65-9.
Raviglione, MC. Narain, J.P. & Kochi, A. (1992): HIV associated tuberculosis in
developing countries: clinical features, diagnosis and treatment. Bulletin of
the World health Organisation (WHO), 70, 5 15-26.
World Health Organisation (WHO) (1992): Current and future dimensions of the
HI V/A IDS pandemic: a capsule summary. Unpublished document
WHO/GRA/RES/SF 1/92.1.
World Health Organisation (WHO) (1998): Policy statement on preventive
therapy against tuberculosis in people living with HIV: Report of a meeting
held in Geneva 18-20 February.
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