Background Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non–hot spots. Objective We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. Methods KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients’ residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non–hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non–hot spot wards were analyzed retrospectively for this study. Results During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non–hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non–hot spot areas was 146 and 193 per 10,000 people, respectively. Conclusions Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non–hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.
BACKGROUND Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. Though the Early Warning Outbreak Recognition System (EWORS) is primarily used to detect infectious disease outbreaks, it can be used as a case-based geospatial tool for the real-time identification of hotspot areas with TB patients' residence in clusters. TB screening targeted at such hotspot wards should yield more TB cases when compared to non-hotspot areas. OBJECTIVE To demonstrate the effectiveness of EWORS TB hotspot mapping as a tool for detecting areas with increased TB case yields in high TB burden States of Nigeria. METHODS KNCV Nigeria deployed EWORS to the 14 high burden States of Nigeria. The system used an advanced surveillance mechanism to identify TB patients’ residences in clusters, enabling it to identify areas with elevated disease spread (hotspots) at the ward level. TB screening outreach using the WHO-four-symptom screen was conducted in 175 hotspot wards and 173 non-hotspot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest x-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hotspot and non-hotspot wards were analyzed retrospectively for this study. RESULTS A total of 1,962,042 persons (37.4% males, 62.6% females) versus 2,025,286 persons (34.6% males, 65.4% females) participated in the community TB screening outreaches in the hotspot and non-hotspot areas, respectively. Presumptive cases among all clients screened were 268,264 clients (6.7%) and confirmed TB cases were 22,618 clients (8.4%). The number needed to screen for the hotspot and non-hotspot areas was 146.22 versus 193.44 per 10,000 population, respectively. CONCLUSIONS Active TB case finding in EWORS-mapped hotspot areas yielded higher TB cases than the non-hotspot areas of 14 high burden States of Nigeria. After the intervention of EWORS, the precision to diagnose TB from presumptive increased from 0.077 to 0.103. The number of presumptive needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 population.
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