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TITLE PAGE

TUBERCULOSIS AND ITS MANAGEMENT AMONUG PEOPLE IN ALIHAGWU COMMUNITY OF DELTA STATE

BY

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EE/H2013/01430
DEPARTMENT OF ---
SCHOOL OF --
INSTITUTE OF ---

DECEMBER,2018

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APPROVAL PAGE

This is to certify that the research work, "tuberculosis and its management amonug people in alihagwu community of delta state" by ---, Reg. No. EE/H2007/01430 submitted in partial fulfillment of the requirement award of a Higher National Diploma on ---has been approved.

By
Engr. ---                                                     Engr. ---
Supervisor                                                  Head of Department.
Signature……………….                           Signature……………….        

……………………………….
 Engr. ---
External Invigilator

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DEDICATION
This project is dedicated to Almighty God for his protection, kindness, strength over my life throughout the period and also to my --- for his financial support and moral care towards me.Also to my mentor --- for her academic advice she often gives to me. May Almighty God shield them from the peril of this world and bless their entire endeavour Amen.

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ACKNOWLEDGEMENT

The successful completion of this project work could not have been a reality without the encouragement of my --- and other people. My immensely appreciation goes to my humble and able supervisor mr. --- for his kindness in supervising this project.
My warmest gratitude goes to my parents for their moral, spiritual and financial support throughout my study in this institution.
My appreciation goes to some of my lecturers among whom are Mr. ---, and Dr. ---. I also recognize the support of some of the staff of --- among whom are: The General Manager, Deputy General manager, the internal Auditor Mr. --- and the ---. Finally, my appreciation goes to my elder sister ---, my lovely friends mercy ---, ---, --- and many others who were quite helpful.

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This study focus on Tuberculosis and its management. Tuberculosis (TB) is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It is caused by a bacterial microorganism, the tubercle bacillus or Mycobacterium tuberculosis. Although TB can be treated, cured, and can be prevented if persons at risk take certain drugs, scientists have never come close to wiping it out.
In order to maintain a healthy environment for people of delta state, government of the state seeks to assure that the state is free from tuberculosis. In carryout the study, a questionnaire was designed and administered to doctor from different hospital from the three different local governments in delta state. The data collection were analyzed and interpreted.

 

GLOSSARY

AFB     acid-fast bacilli
AIDS  acquired immunodeficiency syndrome
ART   antiretroviral treatment
BCG   bacille Calmette-Guérin
BMU            basic management unit
CPT    cotrimoxazole preventive therapy
CTM cotrimoxazole
HIV     human immunodeficiency virus
IGRA interferon-gamma release assay
IRIS    immune reconstitution inflammatory syndrome
MDR-TB multidrug-resistant tuberculosis
NTP    National Tuberculosis Programme
TB       tuberculosis
WHO World Health Organization
XDR-TB          extensively drug-resistant tuberculosis

TABLE OF CONTENTS
COVER PAGE
TITLE PAGE
APPROVAL PAGE
DEDICATION
ACKNOWELDGEMENT
ABSTRACT

GLOSSARY

CHAPTER ONE
INTRODUCTION
1.1      BACKGROUND OF THE PROJECT

1. AIM OF THE STUDY
2. OBJECTIVE OF THE STUDY
3. SCOPE OF THE STUDY
4. SIGNIFICANCE OF THE STUDY
5. PURPOSE OF THE STUDY
6. LIMITATION OF THE STUDY
7. STATEMENT OF PROBLEM
8. DEFINITION OF TERMS
9. RESEARCH QUESTIONS

CHAPTER TWO
LITERATURE REVIEW

1. OVERVIEW OF TUBERCULOSIS
2. SIGNS AND SYMPTOMS OF TUBERCULOSIS
3. CAUSES OF TUBERCULOSIS
4. RISK FACTORS FOR TUBERCULOSIS
5. TRANSMISSION MECHANISM OF TUBERCULOSIS
6. DIAGNOSIS OF TUBERCULOSIS
7. PREVENTION OF TUBERCULOSIS
8. MANAGEMENT OF TUBERCULOSIS
9. PROGNOSIS OF TUBERCULOSIS
10. EPIDEMIOLOGY OF TUBERCULOSIS
11.  HISTORICAL BACKGROUND OF TUBERCULOSIS

CHAPTER THREE
3.0      RESEARCH METHODOLOGY

1. INTRODUCTION
2. RESEACH DESIGN
3. POPULATION OF THE STUDY
4. SAMPLE AND SAMPLING TECHNIQUE
5. DATA COLLECTION PROCEDURE
6. VALIDATION OF INSTRUMENTS AND RELIABILITY
7. METHODS USED

CHAPTER FOUR
4.1      RESULT ANALYSIS
CHAPTER FIVE

1. CONCLUSION AND RECOMMENDATION
2. REFERENCES

CHAPTER ONE

1.0                                                      INTRODUCTION

Tuberculosis is an infectious disease caused by the microorganism Mycobacterium tuberculosis. It can affect several organs of the human body, including the brain, the kidneys and the bones; but most commonly it affects the lungs (Pulmonary Tuberculosis). The first stage of the infection usually lasts for several months. During this period, the body's natural defenses (immune system) resist the disease, and most or all of the bacteria are walled in by a fibrous capsule that develops around the area. Before the initial attack is over, a few bacteria may escape into the bloodstream and be carried elsewhere in the body, where they are again walled in. In many cases, the disease never develops beyond this stage - and is referred to as TB infection. If the immune system fails to stop the infection and it is left untreated, the disease progresses to the second stage, active disease. There, the germ multiplies rapidly and destroys the tissues of the lungs (or the other affected organ). In some cases, the disease, although halted at first, flares up after a latent period. Sometimes, the latent period is many years, and the bacteria become active when the opportunity presents itself, especially when immunity is low.
The second stage of the disease is manifested by destruction or "consumption" of the tissues of the affected organ. When the lung is affected, it results in diminished respiratory capacity, associated with other symptoms; when other organs are affected, even if treated adequately, it may leave permanent, disabling scar tissue.

1.               BACKGROUND OF THE STUDY

Tuberculosis is a great problem in most low-income countries such as Nigeria. It is the single most frequent cause of death from a single agent in individuals aged 15 to 49 years. In some countries, especially in Nigeria, the human immunodeficiency virus (HIV) is the driving force in the over- lapping epidemic with tuberculosis. Activities directed against tuberculosis and HIV as public health problems are the direct responsibility of government health authorities.
Health programmes that systematically monitor patient safety are in a better position to prevent and manage adverse drug reactions (ADRs), relieve patient suffering and improve treatment outcomes. Likewise, TB programmes that actively pursue drug-safety monitoring and management are better prepared to introduce new anti-TB drugs and novel regimens. The prospects of new anti-TB drugs and use of novel regimens led WHO to release its first implementation manual for pharmacovigilance of anti-TB drugs in 2012. In 2013 and 2014, the WHO interim policies on bedaquiline and delamanid recommended active pharmacovigilance as one of the five conditions to be met when these drugs are used to treat MDR-TB patients.
The term "active TB drug-safety monitoring and management" (abbreviated as aDSM) describes a new TB programme component to provide for the active and systematic clinical and laboratory assessment of patients on treatment for XDR-TB, or with new TB drugs or novel MDR-TB regimens to detect, manage and report suspected or confirmed drug toxicities. The recording and reporting activities of aDSM primarily target the serious adverse events (SAEs) as a basic requirement. The appropriate and timely management of ADRs is an integral component of aDSM and patient care.
In 2016, WHO issued interim policy on the use of two new drugs, bedaquiline and delamanid in 2013 and 2014 respectively, and active TB drug-safety monitoring and management is one of the conditions set for the implementation of the new drugs. Since 2012 WHO’s Global TB Programme has been promoting active TB drug-safety monitoring and management for treatment of drug-resistant TB with shorter regimens.
WHO has been providing care for millions of tuberculosis patients in nigeria, through the vehicle of National Tuberculosis Programmes (NTPs).
NTPs, and all those who work alongside them, with the basic information concerning the management of tuberculosis services, in the hope that this knowledge can be transferred, adapted to the local situation and provided in the local language to empower those whose responsibility it is to carry out this crucial task of organizing these services at the most basic management level. Knowledgeable, skilled, dedicated and empowered basic unit managers are the key to relieving the suffering of millions of patients, reducing the impact of tuberculosis on the community and, in this way, contributing to reducing poverty among those affected.

1.1                                   AIM OF THE STUDY
the aim of this work is to highlight how tuberculosis can be protected, cured, the symptoms, treatment, drugs, drug resistance  among the people of  alihagwu community of delta state

1.2                                  OBJECTIVE OF THE STUDY

At the end of the study, students involved shall be able to achieve the following objectives:

1. For a community: to reduce the spread of tuberculosis micro-organisms and, by this means, to hasten the disappearance of this disease from alihagwu community of delta state.
2. For individual patients: to cure their disease, to quickly restore their capacity for activities of daily living and to preserve their position in their family and community.
3. Among the priorities of tuberculosis activities, the first is the appropriate treatment and cure of tuberculosis patients, especially those patients who are the most potent source of transmission of tuberculosis micro- organisms. Because tuberculosis is so frequent, may affect any part of the body and is such a serious disease, it must be a high priority for any practitioner who provides health care in low-income countries, and tuberculosis services must be incorporated into all health services.

1.3                                    SCOPE OF THE STUDY

Tuberculosis can be controlled successfully only in the context of an NTP. Such a programme must operate within the routine health services of each country. Paramedical personnel usually perform the everyday tuberculosis activities (case finding and treatment) as part of the many activities of the general health services. It is essential that such personnel be properly trained, motivated and supervised.
In countries where HIV fuels tuberculosis, it is important to recognise that diagnosis and care of co-infected individuals is directed and overseen by the NTP and the National AIDS Programme. It is essential that the two programmes work together to plan, implement and evaluate joint tuberculosis and HIV services and programme activities.
The general population must be mobilised to participate, including patients and community organisations, as well as groups of health professionals.

1.4                                      SIGNIFICANCE OF THE STUDY

All research works are aimed at finding solution to already existing problem. This study will help to expose the effect of tuboerculosis. However, this study will help to identify other areas of research interest.
This study is important in that is make clear to the population that tuberculosis is curable, it can be prevented and treated and that there is no justification for discrimination or stigma.
This study is essential because it encourage individuals with symptoms suggestive of tuberculosis to present themselves to the health services for diagnostic examination for both tuberculosis and HIV and to ensure that tuberculosis patients continue to take their treatment until they are cured. Community participation can also play a crucial role in ensuring that tuberculosis cases who have been found to be HIV-infected continue their HIV care and receive necessary support after completion of tuberculosis treatment.

1.5       PURPOSE OF THE STUDY
-         To find out the actual causes of tuberculosis.
-         Identify the effect of the sickness on human body.
-         To find out how it can be taken care of.
-          It is to draw government attention on how to find a lasting solution to the Alihagwu Community Of Delta State
1.6                           LIMITATION OF THE STUDY
While the majority of tuberculosis patients come from the general community, the disease is especially a problem for “high-risk” groups in the population. These groups (the poor, persons incarcerated in detention centres, those with insecure housing, undocumented travelers and other marginalized groups) are often hard to reach with the usual public health services and information about tuberculosis. They also contribute disproportionately to a cycle of poverty that frequently prevents economic development. The general principles of tuberculosis programmes apply also to these groups, but services for them may need to be adapted to address the broader context of their lives and circumstances.

1.8                       STATEMENT OF PROBLEM
The fundamental problem of tuberculosis is the uncertain and unsafe atmosphere in Alihagwu Community Of Delta State, problem caused by the sickness are very many and deadly. Any time the struck may lead to death of the affected person if proper care is not taken.

1.9                                                  DEFINITION OF TERMS
In the course of carrying out this research, there frequently used terms which are related to this study, they are listed and defined as below:
BCG vaccine: The BCG is a vaccine that uses a weakened strain of the TB bacterium. When the vaccine is administered to someone who has never been infected with TB, it produces a very light TB reaction in the skin to create immunity. People who receive the vaccine are only 1/5 as likely to get TB than people who are not vaccinated. The vaccine remains effective for 10-15 years.
  Chemoprevention: Also called “chemoprophylaxis” or more recently “latent TB infection treatment,” this treatment is conducted to reduce the possibility of someone who is infected with TB producing symptoms.
DOTS (Directly Observed Treatment, Short-Course): An anti-TB strategy formulated by the WHO in order to find and cure TB patients Airborne infection (Droplet nuclei infection): This type of infection happens when the liquid part of a cough or sneeze containing viruses or bacteria evaporates, scatters as small particles, and remains floating in the air until someone breathes it in. Depending on how the air containing the droplet nuclei moves, such an infection may spread across a wide area. Extensively drug-resistant tuberculosis (XDR-TB): Tuberculosis due to bacteria that is multiple drug resistant, and also resistant to injection drugs such as Kanamycin (excluding Streptomycin) and new quinolones. Group infection: When one infection source spreads across 2 or more households and 20 or more people are infected with TB, this is called a group infection. Incidence rate: A statistic that shows the number of people with new active cases of a disease in 1 year, per 100,000 people. A basic indicator of the degree of prevalence of a disease. Interferon Gamma Release Assay (IGRA): A technique used to detect TB, similarly to the Mantoux test. Involves taking blood and exposing it to an antigen unique to the TB bacterium, then measuring the reaction. Latent tuberculosis infection treatment: Also called “chemoprevention” or “chemoprophylaxis,” this treatment is conducted to reduce the possibility of someone who is infected with TB producing symptoms. Mantoux test: A test that determines whether or not someone is infected with TB. Involves injecting a component of the TB bacterium (tuberculin, also called PPD) into the skin. 48 hours later, redness and swelling in the skin is measured. If the affected area reaches a certain size, the test result is positive. This test is especially useful for babies. Miliary tuberculosis: When bacteria flow from lesions in the lymph nodes and lungs into the venous blood, TB bacteria can spread throughout the entire body. This is called miliary tuberculosis because the individual bacteria stuck in the lung tissue can create countless little lesions that look like millet seeds. This disease can now be cured with chemotherapy administered in a timely manner. Multidrug-resistant tuberculosis (MDR-TB): Multidrug-resistant tuberculosis is defined as a type of TB bacteria that is resistant to both of the most important TB treatment drugs, Isoniazid and Rifampicin. Public aid: TB treatments are subsidized by the government. This is done to prevent the situation whereby a patient is unable to continue treatment due to financial circumstances, and also so that the government can take responsibility for treatment quality. This is why the attending physician must write down the patient's symptoms and proposed course of treatment and submit these documents to the public health department along with X-ray films for approval. Pulmonary tuberculosis: Tuberculosis in the lungs or bronchial tube. 80% of tuberculosis infections are of the pulmonary tuberculosis type. Tuberculous cervical lymphadenitis: When the TB virus enters the lymph nodes on the side of the neck or the collarbone cavity and creates tuberculosis lesions, this results in lumps that can be detected by touching the outside of the neck. If left alone, the lymph nodes will fester with pus and burst, leaving behind tightened skin and scarring. Tuberculous meningitis: When TB bacteria reach the meninges (a set of membranes that enclose the brain) through the bloodstream and create lesions, this can result in severe symptoms such as convulsions and impaired awareness. WHO (World Health Organization): A specialized agency of the United Nations that is concerned with international public health. The WHO helps make health-related agreements between member countries, provides aid, and promotes research.

1.10                                        RESEARCH QUESTION
  At the end of this research, students carrying out this research shall be able to answer the following research questions:

a.  What is tuberculosis?
b. What is tuberculosis disease?
C. How does tuberculosis spread?
d. What are the symptoms of tuberculosis?
e How is tuberculosis disease treated?
f What is tuberculosis Infection?

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CHAPTER THREE: The complete chapter three of “tuberculosis and its management amonug people in alihagwu community of delta state” is available. Order full work to download. Chapter three of “tuberculosis and its management amonug people in alihagwu community of delta state” consists of the methodology. In this chapter all the method used in carrying out this work was discussed.

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