A Hospital-Based Survey on Human Brucellosis and Risk Factors in Kano Metropolis

A Hospital-Based Survey on Human Brucellosis and Risk Factors in Kano Metropolis.

ABSTRACT

Introduction/Background: Brucellosis is a zoonosis of major public health significance that occurs worldwide in both man and animals.

Human brucellosis is a severe debilitating disease that requires prolonged treatment, if untreated can result in permanent disability and loss of productivity. Human brucellosis presents a great variety of clinical manifestations making it difficult to diagnose clinically.

In some endemic areas every case of human fever of unknown origin is assumed to be due to brucellosis. Therefore, the diagnosis must be confirmed by laboratory tests.

A study was conducted in Kano State, North-western Nigeria to determine the sensitivity of clinical diagnosis of human brucellosis and determine its risk factors of among hospital patients presenting to some selected hospitals with febrile illness.

Methods: We conducted a cross-sectional descriptive study from September to December 2011. One major hospital was selected from each of the five local government areas within Kano metropolis.

Two hundred and fifty participants were enrolled in the study. Data was obtained using a standardized questionnaire and blood samples were collected, screened with Rose Bengal Plate Test (RBPT) and confirmed for anti-Brucella immunoglobulin G (IgG) and anti- Brucella immunoglobulin M (IgM) using Enzyme-linked immunosorbent assay (ELISA). Results: There were 50 samples that tested positive to RBPT and were confirmed by ELISA.

Of the 50 positive cases, 36 (64%) were positive by IgG where as 14(28%) were positive by IgM.

Independent risk factors for human brucellosis were consumption of fresh milk (p 0.02) and kindirmo (p 0.00); keeping goats (p 0.00), assisting animal parturition (p 0.01), processing raw meat (p 0.03) and eating raw meat (p 0.00). Clinical signs that had strong association with human brucellosis were recurrent fever (p 0.04), cough/sneeze (p 0.02) and osteomyelitis (p 0.00).

Conclusion: Significant risk factors for Human Brucellosis in Kano were consumption of fresh milk and kindirmo(local yoghurt), processing and consumption of raw meat, keeping goats and assisting animals’ parturition.

The government should sensitize the populace on the risks and importance of this disease and physicians should raise the index for diagnosis of human brucellosis by including it in their differential diagnosis in patients that present with signs suggestive of it such as recurrent fever, cough/sneezing, joint pains, and osteomyelitis.

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TABLE OF CONTENTS

Title page – – – – – – – – – i
Declaration – – – – – – – – – ii
Certification – – – – – – – – – iii
Dedication – – – – – – – – – iv
Acknowledgement – – – – – – – – v
Table of contents – – – – – – – – vii
List of Tables – – – – – – – – ix
List of Figures – – – – – – – – x
List of Appendices – – – – – – – – xi
Abstract – – – – – – – – xii

Chapter 1: Introduction

1.1Background – – – – – – – 1
1.2 Statement of problem – – – – – – 3
1.3 Justification – – – – – – – 4
1.4 Research Questions – – – – – – – 5
1.5 general and specific objectives – – – – – – 5
1.5.1 General Objective – – – – – – – 5
1.5.2 Specific Objectives – – – – – – – 5

Chapter 2: Literature Review 

Chapter 3: Materials and Methods- – – – – – 20
3.1 Study Area – – – – – – – – 20
3.2 Study Design – – – – – – – – 20
3.3 Study Population – – – – – – – – 20
3.4 Sampling and sampling size determination – – – – 21
3.5 Sampling technique – – – – – – – 22
3.6 Study instrument – – – – – – – – 22
3.7 Data collection methods – – – – – – – 22
3.8 Data management – – – – – – – – 26
3.9 Ethical consideration – – – – – – – 26
3.10 Limitation – – – – – – – – 27

Chapter 4: Results

4.1 Socio-demographic Features – – – – – – 28
4.2 Clinical Information of Respondents – – – – – 29
4.3 Results of Laboratory Analysis – – – – – 30
4.4 Proportion of Recurrent Fever with Human Brucellosis – – – 30
4.5 Sensitivity of Clinical Diagnosis of Human Brucellosis – – – 31
4.6 Risk Factors for Human Brucellosis – – – – – 31
4.7 Independent Risk Factors for Human Brucellosis – – – 32

Chapter 5: Discussion 

Chapter 6: Conclusion and Recommendations6.1: Conclusion – – 55
6.1 Conclusions – – – – – – – – 55
6.2 Recommendations- – – – – – – – 56
References – – – – – – – – 57
Appendices – – – – – – – – 66

INTRODUCTION 

Brucellosis is a bacterial disease caused by species of the genus Brucella [as] an important zoonosis and a significant cause of reproductive losses in animals.

The disease usually caused by Brucella abortus in cattle, B. melitensis or B. ovis in small ruminants, B. suis in pigs and B. canis in dogs [has also been discovered] in sea mammals, in many species of pinnipeds and cetaceans.ⁱ

This discovery of the Brucella in marine mammals changed the concept of a land- based distribution of brucellosis and associated control measures.ⁱⁱ Brucella species are also maintained in wildlife populations such as feral pigs, bisons, elks and European hares.ⁱⁱⁱ

Brucellosis is an infectious zoonotic disease that is associated with chronic debilitating infections in humans and reproductive failure in domestic animals.^iv Brucellosis is also considered as an occupational, laboratory and travel-acquired disease.^v

The risk of disease and its severity is to a significant extent determined by the specie of Brucella to which an individual is exposed. Food animals are the major reservoirs for the disease. Nigeria’s food animals’ population is estimated at 15.2 million cattle, 23 million sheep and 28 million goats.^vii

Human brucellosis presents a great variety of clinical manifestations making it difficult to diagnose clinically. In some endemic areas every case of human fever of unknown origin is assumed to be due to brucellosis. Therefore, the diagnosis must be confirmed by laboratory tests.

Brucellosis is a multisystemic, acute to chronic, disease characterized by fever, headache, joint pains, musculo-skeletal pains, sweating, malaise and body wasting.

Because of these rather non-specific signs, this has caused tremendous problems with the clinical diagnosis of brucellosis in sub-Saharan Africa, where it is constantly mis-diagnosed as malaria, which is very prevalent.

The incubation is normally 1–3 weeks, but it can be several months before showing signs of infection.

Brucellosis occurs worldwide in both man and animals. Brucellosis-free status has been granted by the European Union (EU) to Sweden, Denmark, Finland, Germany, the UK (excluding Northern Ireland), Austria, Netherlands, Belgium, Luxembourg, Norway and Switzerland.  Mediterranean region and Arabian Peninsula are acknowledged endemic regions of human brucellosis.^xii

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