1.1 Introduction
Tuberculosis (TB) is a primordial infectious disease that mainly affects the lungs. Mycobacterium tuberculosis is the etiological agent of TB and currently more than one- third of the world population is suffering from TB. Tuberculosis (TB) is the most prevalent infectious disease of human beings, which causes illness and large number of deaths worldwide (WHO, 2015). This contagious disease is mainly caused by the bacterium known as Mycobacterium tuberculosis. TB primarily affects the lungs, but it can also influence the central nervous system, lymphatic and circulatory system (Kumar et al., 2007; Respir, 2000; Golden et al., 2005). The diagnosis process of active contagious TB mainly involves radiology techniques such as chest X-rays but also includes microscopic examination and microbiological culture of body fluids like multiple sputum cultures. However in case of latent TB, where the bacteria present in the body remain inactive and produce no symptoms, the diagnosis relies on the Mantoux tuberculin skin test and/or Interferon gamma release assays (IGRAs) of the blood samples (Jacob et al., 2009).
This chapter will address the background information that motivated this study, the challenges that prompted it, its aim, and its objectives as a preface to subsequent sections of the study. Additional factors include the study's significance, scope, limitations, research questions and hypotheses, and the definition of technical terms.
1.2 Background of Study
Tuberculosis is a problem of global importance among communicable diseases. It is second leading disease causing death worldwide killing nearly 2 million people each year in Nigeria. Non-compliance of patients on tuberculosis treatment in an irregular and unreliable way has greatly caused risk of treatment failure, relapse and the development of drug-resistance tuberculosis strains. There are varieties of reasons why patients fail to take their medications.
World Health Organization (2009) has estimated that 2 billion people have latent tuberculosis disease which has killed 1.7 million people in Nigeria. In Nigeria, 81% patients are non-compliant to treatment for more than one month before presenting at chest clinics. The patients visit traditional healers and have low level of knowledge about the disease or due to high cost of treatment, transportation and poverty. World health organization (2013) reported worldwide that some countries like South Africa, Kenya, Nigeria, Malaysia, Ghana, China, United States of America and Canada were implementing the directly observed treatment short-course strategy by the end of 2013. World health organization (2015) currently recommends a case detection rate of 70% and a treatment success rate of 85% for all tuberculosis cases. It is believed that achieving these targets will lead to a reduction in tuberculosis prevalence, incidence, transmission and drug-resistance to tuberculosis treatment.
Persons with latent TB infection do not feel sick and do not have any symptoms, but usually have a positive reaction to the tuberculin skin test. They are infected with Mycobacterium tuberculosis, but do not have active TB disease. Those with latent TB infection are not infectious and cannot spread TB infection to others. However, persons with latent TB infection may develop active TB disease at some time in the future. About 10% of infected persons will develop active TB disease at some time in their lives, but the risk is considerably higher in the first two years of infection particularly for persons whose immune systems have been weakened by HIV infection. Persons with latent TB infection should be treated in good time, in order to prevent the infection from progressing to active disease.
The end TB Strategy target is to accelerate the annual decline of TB incidence rates from 2% in 2015 to 10% per year by 2025, WHO (2016). This strategy addresses the challenges facing many countries with high tuberculosis (TB) burden including Nigeria, which remains one of the worst TB affected countries in the world, Onyedum CC (2017). Evidence suggests that the TB prevalence and mortality rates in Nigeria were previous under estimated. Adamu AL (2017). Despite being ranked the 4th TB affected country in the world in 2009, it was estimated that 590,000 new TB cases were reported in 2015.WHO (2013).
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Management of Tuberculosis and it's Implications to Health.
1.3 Statement of Problems
Investigation revealed that despite the global effort to reduce the incidence of tuberculosis worldwide through mass media, there is still non-compliance to treatment which may be due to the bulkiness of the drugs and taking the drugs on empty stomach. TB Infection Prevention Control is one of the major strategies to prevent and control TB disease in patients and healthcare workers (HCWs) in the health care setting (Federal MinistryofHealth, 2010).
However, tuberculosis transmission among HCWs, patients and families is still a threat especially to nurses who have the closest and longest contact with patients than other care givers (Lopez, 2008). in the state where the current study was conducted, there was no available official data on students infected with TB. The TB coordinator of the school clinic indicated that this was so because the TB reporting format does not include the patients’ occupation.
1.4 Aim and Objectives of Study
The aim of the study is to determine the Prevalence and Risk Factors for Tuberculosis (TB) in Owerri North. In achieving this aim, the following specific objectives were laid out as follows:
- To identify the strategies for improvement of patients' acceptance of care and treatment of tuberculosis;
- To investigate the factors inhibiting the management of tuberculosis among affected patients;
- To find the cause of patients not complying to their treatment of tuberculosis;
- To ascertain the knowledge of people about tuberculosis, its causes and its effects; and
- To identify the knowledge of patients based on the importance of complying to treatment of tuberculosis.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Is there any significant cause of patients not complying to their treatment of tuberculosis?
- What are the factors inhibiting the management of tuberculosis among affected patients?
- What are the strategies for improvement of patients' acceptance of care and treatment of tuberculosis?
- What is the knowledge of people about tuberculosis, its causes and its effects?
- What is the knowledge of patients based on the importance of complying to treatment of tuberculosis?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There are no significant factors inhibiting the management of tuberculosis among affected patients in the study area
- H1: There are significant factors inhibiting the management of tuberculosis among affected patients in the study area
1.7 Significance of Study
The importance of this study will assist family members in understanding the causes and prevention of TB. In addition to preventing congestion, this will teach individuals the value of maintaining proper personal and environmental hygiene. It will also assist the patient in understanding the significance of the therapy they are receiving and lower the county's rates of mortality and morbidity.
Furthermore, having sufficient understanding about patient management and treatment can benefit the healthcare professional.
Finally, the study will also help the individual to have the knowledge on health investigation and screening in order to indicate the early signs and symptoms.
1.8 Scope of the Study
The scope of the research is focused on Prevalence and Risk Factors for Tuberculosis (TB) using Owerri North Local Government Area of Imo State as a case study.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research Material: availability of research material is a major setback to the scope of the study.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Lack of Initial Cooperation from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Tuberculosis (TB):
It is a common and often deadly infectious disease caused by various strains of Mycobacteria, usually Mycobacterium tuberculosis in humans. It is also a communicable disease that is caused by my co bacterium tuberculosis.
Investigation:
It means finding or searching for more information.
Infectious Patients:
They are people with threat harbor infections caused by micro- organisms.
Infection:
The presence and growth of an micro-organisms that produce tissue –damage
