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Nomadic Pastoralism and the Prevalence of Pulmonary Tuberculosis (Tb) in the North-Western Region of Nigeria by Abubakar Garba F

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Nomadic Pastoralism and the Prevalence of Pulmonary Tuberculosis (Tb) in the North-Western Region of Nigeria by Abubakar Garba F NOMADIC PASTORALISM AND THE PREVALENCE OF PULMONARY TUBERCULOSIS (TB) IN THE NORTH-WESTERN REGION OF NIGERIA BY ABUBAKAR GARBA FADA B. Sc Geography (Sokoto), M. Sc Geography (Ibadan) A Thesis in the Department of Geography Submitted to the Faculty of The Social Sciences in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY of the UNIVERSITY OF IBADN 2014 ABSTRACT The pattern of human mobility affects the spread of infectious diseases, particularly tuberculosis (TB), the transmission which is associated with several factors, including the consumption of unpasteurised milk. However, the very few studies that have been conducted on the role of seasonal migration on disease transmission are inconclusive. In particular, the transmission of TB along seasonal migration routes in Nigeria has not been given adequate attention. This study, therefore, examined the prevalence of pulmonary TB in the North-western region of Nigeria. Using a survey design, disease ecology and distance decay effect provided the framework. Purposive and random sampling techniques were used to collect data from the records of 15 Directly Observed Therapy Short-course (DOTS) each along and off-route centres. A structured questionnaire was administered to 461 (26.6%) proportionately and randomly selected patients receiving treatment. Data were collected on the socio-demographic (gender, age, marital status, population size, work history, occupation type, income and literacy levels), behavioural (visits to health centre to treat TB, smoking, consumption of unpasteurised milk profiles and perceived causes of TB), and environmental (history of infection with TB, access to healthcare and exposure to dust) factors. Data were also collected on distance (determined from topographical maps) along and off-route TB centres, duration of stay in a place and number of health facilities. Population figures were projected from 1991 population census results to 2010. Student’s t-test, Simple Linear Regression, Correlation and Analysis of Variance were used for data analyses at p0.05. Sixty-five percent of the respondents were male and 161 (34.9%) female respondents; 29.0% had a job while 39.3% had no formal education, 35.0% had visited clinics to treat TB, 35.0% consumed unpasteurized milk and 28.0% smoked cigarettes. Infection (35.1%), dust (14.1%), smoking (12.1%), spiritual attacks (10.4%), drinking of cold water (10.0%) and unpasteurized milk (1.5%) were the perceived causes of TB. Whereas, 47.7% had TB, 39.2% were exposed to dust, 9.2% family members were infected, 6.4% had lung diseases and 8.5% stayed with infected persons. Cost (45.3%), attitude of health personnel (13.4%), time (13.0%) and distance (9.7%) were the determinants of access to healthcare. Gender (t=2.1), marital status (t=4.0), work experience (t=2.8) and work type (t=-3.2) were significant in TB prevalence. Lung diseases (=4.9), spiritual attack (=4.3), farming (=4.0) and distance to healthcare centres (=3.7) positively contributed to TB prevalence while distance along (r=-0.17) and off-route (r=0.11), and duration of stay did not. Similarly, TB prevalence had a strong positive relationship with population size (r=0.76) and number of health facilities (r=0.87). Month of the year affected TB prevalence among off-route centres [F(26,153)=2.06], whereas income [F(17,57)=5.40], literacy [F(20,24)=5.15] levels, and work duration [F(11,48)=2.77] affected prevalence along the route. Tuberculosis was more prevalent during the dry season (November-April) and reduced southwards. Human mobility did not substantially affect tuberculosis prevalence in North-western region of Nigeria. However, continuous monitoring and control of the disease within the region is required. Keywords: Nomadic pastoralism, Pulmonary tuberculosis prevalence, Disease ecology, Distance decay effect, North-western Nigeria. Word count: 477 1 ii DEDICATION I wish to dedicate this piece of work to my parents: My father, the most humble and generous gentle man I have ever known. How I wish you are here to share the joy with me. My mother, the most loving and caring I have ever known. Your ability to love and give encouragement is remarkable and inspiring. Thank you, for I cannot pay for what you have done for me. iv ACKNOWLEDGEMENTS A lot of people supported this piece of work to its successful completion and these need to be commended. However, I will first start by thanking God, the Almighty, and the Merciful for showering His benevolence and mercy that enabled me to accomplish this task. Secondly, I am highly indebted to my Supervisor, Professor S. I. Okafor for his guidance, encouragement, patience and tolerance throughout my period of the research. I am indeed grateful. Thirdly, I should also thank all staff of the Department of Geography, University of Ibadan, for their useful comments, contributions and criticisms during my seminar presentations. These comments, contributions and criticisms have helped me tremendously in refining my study. Fourthly, I would like to thank all the DOTS officers in the various health centres that I visited for helping me to administer the questionnaire and for releasing the necessary case registry data. These include Aliyu Sanyinna (Illela), Abdullahi (Kware),, Anas Mohammed (Gummi), Mohammed Bala (New Bussa), Hassan Ruwa (Gwadabawa), Hussaini Bajida (Mahuta), Idris (Warrah), Shagwa (Auna), Shehu Bello (Shanga), Aminu Bello (Bodinga), Wadata (Specilist Hospital Sokoto), Abdullahi (Yelwa Yauri), Mohammed (Zuru), Nasiru Kura (Yabo), and Malam Atiku (Dogondaji). I am indeed grateful for without your support, this work wouldn’t have been possible. Let me also thank my mentor at Usmanu Danfodiyo University, Sokoto, Professor M. A. Iliya, for his continued support and encouragement throughout the study period. My gratitude also goes to my great friends, Rasheed Okunola of Sociology Department, University of Ibadan, Ambassador Haliru Shuaibu, the Jarma of Zaria Kalakala, Ambassador Abdullahi Tukur and Police Commissioner Ibrahim Maishanu for their support. I should also thank Mister Joseph of Geography Department, University of Ibadan and Nathaniel Eniolorunda of the Department of Geography, Usmanu Danfodiyo University Sokoto, for helping to analyse the data and draw the maps at a minimum cost. My gratitude goes to Alhaji Sule Kangiwa, Yerima Kachalla and Labbo Dandare all of the National Population Commission, as well as Umar Shehu Madugu (a friend in Minna, Niger State) for their roles in facilitating population data acquisition. I should also thank Colonel Umar Maidamma Yabo, Alhaji Shehu and Alhaji Buda Fakka of Sabo quarters in Ibadan as well as Alhaja Mansurat of Abadina, University of Ibadan. These people made my stay in Ibadan very comfortable by providing me with accommodation at one time or the other. Lest I forget, I must thank my maiden wife, Hajiya Hindatu Abubakar for her tolerance, patience and endurance during the entire period of the study. She has been very supportive and understanding. v TABLE OF CONTENTS Contents Page Cover Page i Abstract ii CERTIFICATION iii DEDICATION iv ACKNOWLEDGEMENTS v TABLE OF CONTENTS vi LIST OF TABLES ix LIST OF PLATES xi LIST OF FIGURES xii CHAPTER ONE 1 BACKGROUND TO THE STUDY 1 1.1 Introduction 1 1.2 Statement of research problem and the scope of the study 3 1.3 Aim and objectives of the study 4 1.4 Working hypotheses 5 1.5 Definition of terms 5 1.6 Justification for the study 7 1.7 Structure of the thesis 8 CHAPTER TWO 9 THEORETICAL/CONCEPTUAL FRAMEWORK AND LITERATURE REVIEW 9 2.1 Introduction 9 2.2 Theoretical and conceptual frameworks 9 2.3 Barriers in disease transmission 11 2.4 Literature review 12 2.4.1 Human mobility and disease transmission 12 2.4.2 Factors of spatial transmission of disease 14 2.4.3 Tuberculosis as a zoonotic disease 17 2.4.4 Risk factors in tuberculosis infection 19 i) Environmental risk factors 20 ii) Socio-economic risk factors 23 iii) Behavioural risk factors 27 iv) Other risk factors 32 CHAPTER THREE 35 THE RESEARCH METHODS 35 Introduction 35 3.1 Types of data 35 3.2 Sources of data 37 3.3 Methods of data collection 37 3.3.1 Reconnaissance survey 37 3.3.2 Secondary data collection 37 3.3.3 Primary data collection 39 3.3.4 Sampling frame 40 3.3.5 Sampling methods and sample size 40 3.3.6 Identification of transhumance routes 42 3.3.7 Creation of database 45 vi 3.4 Methods of data analysis 45 3.4.1 The regression model 45 3.4.2 The Pearson correlation model 46 3.4.3 The analysis of variance (ANOVA) 47 3.4.4 Test of mean difference (Student’s t-test) 48 CHAPTER FOUR 49 THE STUDY AREA 49 4.1 Location 49 4.2 Physical characteristics 51 4.2.1 Relief, geology and drainage 51 4.2.2 Climate 51 4.2.3 Soils and vegetation 52 4.3 Socio-economic characteristics 53 4.3.1 Population 53 4.3.2 Ethnicity and religion 56 4.3.3 Agriculture and livestock 56 4.3.4 Characteristics of the Fulani 57 4.3.5 Fulani seasonal migration 58 CHAPTER FIVE 65 SPATIO-TEMPORAL ANALYSIS OF TUBERCULOSIS PREVALENCE 65 Introduction 65 5.1 Temporal variations 65 5.1.1 Sample DOTS centres 65 5.1.2 Control DOTS centres 78 5.1.3 Sample versus Control DOTS centres 90 5.2 Spatial variations 91 5.2.1 Sample DOTS centres 91 5.2.2 Control DOTS Centres 95 5.2.3 Sample versus Control centres 99 5.2.4 Conclusion 99 CHAPTER SIX 101 FACTORS AFFECTING THE PREVALENCE OF TUBERCULOSIS 101 Introduction 101 6.1 Distance as a factor in tuberculosis prevalence 101 6.1.1 Distance of Sample DOTS centres along the route of migration 101 6.1.2 Distances of settlements
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