CHAPTER FOUR
TABLE 1b: RESPONDENTS’ SOCIO-DEMOGRAPHIC CHARACTERISTICS BY DOTS FACILITY
Variable Total (N=380) EBMC(N=60) GH(N=85) LHH(N=125) UCTH(N=110) X2 p-value n (%) n (%) n (%) n (%) n (%)
Marital status
Single 196 (51.6) 31 (51.7) 39 (45.9) 72 (57.6) 54 (49.1) Married 136 (35.8) 21 (35.0) 33 (38.8) 38 (30.4) 44 (40.0)
Others* 48 (12.6) 8 (13.3) 13 (15.3) 15 (12.0) 12 (10.9) 4.472 0.613 Occupation
Civil service 67 (17.6) 14 (23.3) 17 (20.0) 18 (14.4) 18 (16.4) Farming 36 (9.5) 5 (8.3) 8 (9.4) 14 (11.2) 9 (8.2) Fishing 26 (7.4) 5 (8.3) 13 (15.3) 4 (4.8) 4 (3.6) Trading 81 (21.3) 10 (16.6) 12 (14.1) 37 (29.6) 22 (20.0)
Others** 168 (44.2) 26 (43.3) 35 (41.2) 50 (40.0) 57 (51.8) 22.325 0.034
SES
Very poor 76 (20.0) 19 (31.7) 18 (21.2) 6 (4.8) 33 (30.0) More poor 74 (19.4) 14 (23.3) 17 (20.0) 12 (9.6) 31 (28.2) Poor 77 (20.3) 7 (11.7) 18 (21.2) 41 (32.8) 11 (10.0) Less poor 77 (20.3) 9 (15.0) 9 (10.6) 36 (28.8) 23 (20.9)
Least poor 76 (20.0) 11 (18.3) 23 (27.0) 30 (24.0) 12 (10.9) 69.87 < 0.001
SES = Socio-Economic Status
*Others included divorced, separated and widowed
**Others included retirees, students, self employed, no occupation and the military
**Others included parents, siblings and guardians
Respondents’ socio-demographic characteristics
In table 1a, the overall mean age of the respondents was 33 ± 14.13 years; Ebrutu Barrack Medical (EBMC) 36 ± 16.55 years, General Hospital (GH) 33 ± 12.35 years, Lawrence Henshaw Hospital (LHH) 31 ± 10.80 years and University of Calabar Teaching Hospital (UCTH) 35 ± 16.80 years. The difference in the mean age of the respondents between the DOTS centres was statistically significant (p = 0.045) with EBMC having the highest mean age of 36 years while
LHH had the lowest mean age of 31 years. In Figure 4.1 below, 43 (11.3%), 221 (58.2%) and 116 (30.5%) of the respondents were in the 0-19, 20-39 and ≥40 year age categories respectively.
Figure 4.1: Age category of all the respondents in the DOTS centres Age group of all the respondents
0-19 years 20-39 years
≥40 years
In figure 4.2, there were more males 201 (52.9%) than females 179 (47.1%) although there was no statistically significantly difference (p = 0.072) in the gender of the respondents between the DOTS centres as seen in table 1a.
Figure 4.2: Gender of all the respondents in the DOTS centres
Gender of all the respondents
Male Female
Figure 4.3: Educational category of all the respondents in the DOTS centres
Educational category of all the respondents
None Primary Secondary Tertiary
In figure 4.3, most 195 (51.3%) of the respondents had secondary education, 100 (26.4%) had primary education, 56 (14.7%) had tertiary education and 29 (7.6%) had no education. In table 1a, there was statistically significant difference (p<0.001) between the DOTS centres in the educational level of the respondents with UCTH having the highest number of respondents 28 (25.4%) with tertiary education while LHH had the lowest number of respondents 8 (6.4%) with tertiary education. On the other hand, EBMC had the highest number of respondents 6 (10.0%) with no education while UCTH had the lowest number of respondents 5 (4.6%) with no education.
Figure 4.4: Religion of all the respondents in the DOTS centres
Religion of all the respondents
Christianity Islam Others
In figure 4.4, Christianity was the predominant (≥ 93.7%) religion among all the respondents with the categories of religion differing significantly (p < 0.001) between the DOTS centres as shown in table 1a.
Figure 4.5: Ethnicity of all the respondents in the DOTS centres
Ethnicity of all the respondents
Efik Ibibio Anang Others
In figure 4.5, most 155 (40.8%) of the respondents were Efiks (the most widely spoken language in Cross River State), 114 (30.0%) were Ibibios, 30 (7.9%) were Anang and 81 (21.3%) were of other tribes. In table 1a, there was no statistically significant difference (p=0.137) between the DOTS centres with respect to the ethnic background of the respondents.
Figure 4.6: Marital status of all the respondents in the DOTS centres
Marital status of all the respondents
Single Married Others
In figure 4.6, most 196 (51.6%) of the respondents were single, 136 (35.8%) were married and 48 (12.6%) belonged to other categories of marital status. In table 1b, the categories of respondent’s marital status did not differ (p=0.613) between the DOTS centres.
Figure 4.7: Occupational categories of all the respondents in the DOTS centres
Occupation of all the respondents
Civil service Farming Fishing Trading Others
In figure 4.7, most 168 (44.2%) of the respondents belonged to other occupational category, 81 (21.3%) were traders, 67 (17.6%) were civil servants, 36 (9.5%) were farmers and 26 (7.4%) were fishermen and women. In table 1b, the respondents’ categories of occupational status differed significantly (p=0.034) between the DOTS centres.
Figure 4.8: Socio-economic status of all the respondents in the DOTS centres
Socio-economic status of all the respondents
Very poor More poor Poor Less poor Least poor
In figure 4.8, each category of socio-economic status had approximately 20% of respondents.
In table 1b, the distribution of the respondents’ socio-economic status differed significantly (p<0.001) between the DOTS centres. With particularly respect to the two extremes of socio-economic status, EBMC had the highest number 19 (31.7%) while LHH had the lowest number 6 (4.8%) of respondents in the very poor socio-economic group. On the other hand, GH had the highest number 23 (27.0%) and UCTH had the lowest number 12 (10.9%) of respondents in the least poor socio-economic group.
Figure 4.9: Category of the patients in the DOTS centres
Patient category
0 10 20 30 40 50 60 70 80 90
EBMC GH LHH UCTH Total
DOTS centre Percentage of patient category
Out-patient In-patient
In figure 4.9 above, 285 (75.0%) of all the respondents were outpatients while 95 (25.0%) were in-patients; EBMC: out-patient - 46 (76.7%), in-patient - 14 (23.3%), GH: out-patient - 65 (76.5%), in-patient - 20 (23.5%), LHH: out-patient - 93 (74.4%), in-patient - 32 (25.6%), UCTH: out-patient - 81 (73.6%), in-patient - 29 (26.4%).
Figure 4.10: Informant status of the patients in each and all of the DOTS centres
0 20 40 60 80 100
Percentage of informant
status
EBMC GH LHH UCTH Total DOTS centres
Informant status
Paient Others
In figure 4.10 above, 360 (94.7%) of all the clients responded directly to the questions while 20 (5.3%) of the clients responded to the questions through informants; EBMC: patient - 60 (100.0%), informant - 0 (0.0%), GH: patient - 79 (92.9%), informant - 6 (7.1%), LHH: patient - 120 (96.0%), informant - 5 (4.0%), UCTH: : patient - 101 (91.8%), informant - 9 (8.2%).
Figure 4.11: Languages in which the client questionnaire was administered in all the DOTS centres
Languages in which TB client questionnaire was administered
Englis h Effik
In figure 4.11 above, 374 (98.4%) of the respondents were administered the semi-structured questionnaire for TB clients in English while 6 (1.6%) were administered the client questionnaire in Efik language which is the most dominant language spoken in the study area.
Table 2 shows the characteristics of the DOTS facilities obtained through semi-structured interview of the heads of the DOTS centres. Facilities offering secondary health care included:
EBMC, GH and LHH. Only UCTH offered tertiary health care services. All the staff in GH and LHH are employees of the State Government while those of EBMC and UCTH were employees of the Federal Government.
Variable EBMC GH LH UCTH
Designation
Secondary Yes Yes Yes No Tertiary No No No Yes Staff employment status
State government No Yes Yes No Federal government Yes No No Yes Types of services
History taking Yes Yes Yes Yes Examination of patients Yes Yes Yes Yes In-patient and out-patient Yes Yes Yes Yes Free anti-TB drugs Yes Yes Yes Yes X-ray No No No Yes Free sputum AAFB Yes Yes Yes Yes Daily observation in heath center No No No No How often, if no to daily observation Weekly Weekly Weekly Weekly
Why are the clients not coming for DOT? Costly* Costly Costly Costly Training relatives to do observation at home Yes Yes Yes Yes Health education Yes Yes Yes Yes Voluntary counseling and testing Yes Yes Yes Yes Record keeping Yes Yes Yes Yes Referral services Yes Yes Yes Yes
* High cost of transportation from their homes to the DOTS centers
All the DOTS centres offered the following services: history taking, physical examination, health education, voluntary counseling and testing of clients. Others include in-patient services, out-patient services, free anti-TB drugs, free AAFB sputum, record keeping, referral services and training patient relatives to do daily observation of patients taking their drugs at home.
Only UCTH offered X-ray services while no DOTS centre did daily observation of clients taking their anti-TB drugs in the hospital. Rather, clients on intensive and continuation phase treatment were observed taking their anti-TB drugs weekly and monthly when they came back to return their one-weekly and one-monthly empty blister packs respectively.
The heads of the DOTS centres explained that they resorted to weekly observation of clients swallowing their anti-TB drugs in the clinics for clients on intensive phase treatment and monthly observation of clients swallowing their anti-TB drugs in the clinics for clients on continuation phase treatment. The need for this practice arose because most clients often defaulted when they are instructed to come to the clinic everyday for their drugs because of the high cost of transport from their homes which sometimes paralleled the cost of treatment if they were asked to pay for the drugs.
Figure 4.12: Overall category of staff in each DOTS centre
Overall staff category
0 20 40 60 80 100 120
EBMC GH LHH UCTH
DOTS centres
percentage of staff by categories
Health Non-health
In figure 4.12, the total number of staff and their categories in each DOTS centre included:
EBMC - three; three health staff and zero non-health staff, GH – three; three health staff and zero non-health staff, LHH – seven; five health staff and two non-health staff and UCTH – four; four health staff and zero non-health staff.
Figure 4.13: Category of health staff in each DOTS centre
0%
20%
40%
60%
80%
100%
Pe rce ntage of he alth
staff
EBMC GH LHH UCTH DOTS ce ntre s
Health staff category
Others Nurses Doctors
Others* included community health workers, laboratory technologists, laboratory scientists, health educators and drug dispensers.
In figure 4.13, the category of health staff in EBMC included: one laboratory technologist, one health educator and one anti-TB drug dispenser. The category of health staff in GH: one nurse, one laboratory technologist and one laboratory scientist. The category of health staff in LHH:
one nurse, three Community Health Extension Workers and one health educator. The category of health staff in UCTH: two doctors (one senior and one junior registrar), one nurse and one Community Health Extension Worker.