Effectiveness of Contact Tracing of Index Tuberculosis Cases in Nigeria

Abstract

Tuberculosis (TB) is a chronic disease that has impacted negatively on human history. The biology of the mycobacterium tuberculosis is complicated and has affected the control as well as elimination of the disease. Nigeria is one of the countries with high incidence and prevalence of TB. The late and low case detection has been a major problem with National TB control program, caused by passive case finding strategy practiced by the country. A shift from the passive and active case search has been recommended for detection of missing cases of TB and improved program performance. The proximity of TB contact is a major determinant of disease transmission. However, maximizing early case detection and prompt treatment of notified cases is very useful in (TB) control especially in high burden countries. The tracking of TB contacts provides a good platform for early diagnosis, educating the household on TB disease and infection control as well as breaking the chain of transmission. The objective of the study is to ascertain effectiveness of contact tracing on Tuberculosis case detection. The study is a retrospective quasi experimental with quantitative arm. The study was conducted in Abia State, one of the South Eastern States of Nigeria. A pre-tested questionnaire was used for data collection and analyzed with SPSS. A total of 168 and 162 index cases of TB were recruited for both intervention and control facilities.

Strategic approach to optimisation of TB contact investigation in Nigeria

“…3 The average number of contacts screened per index case in this project ( n = 6) was good coverage compared to the average contact per index case (of about two) reported in a related study from Abia State, Nigeria. 6 The 2.5% TB yield among contacts investigated in our study translates to a notification rate of 2,400/100,000 contacts in the implementation states, which is 11 times higher than Nigeria’s estimated TB incidence rate (219/100,000 population). 1 This suggests a high TB burden among TB contacts, supporting the need to strengthen CI by the NTP.…”

“… 7 Intuitively, the yield from CI is consistently higher than the estimated TB incidence and buttresses the effectiveness of CI as an active case-finding strategy. 6 , 8 – 10 Major strengths of this project were that we succeeded in placing over 98% of TB cases diagnosed on appropriate treatment, and over a quarter of eligible household contacts on TPT. This was despite the prevailing challenge of getting apparently healthy individuals to accept TPT in our environment, which is attributable to a perception of low risk and vulnerability to a given condition (along with other community and health system factors).…”

Challenges of Tuberculosis Screening and Existing Gaps in Contact Investigations in Oyo and Osun States, Nigeria

“…Contact tracing is an essential component of TB control in Nigeria, as it helps to identify individuals who may have been exposed to TB and are at risk of developing the disease. Identifying index TB cases is crucial in initiating contact tracing [5]. Contact investigation is a key element of TB control in high-burden countries like Nigeria.…”

Health Seeking Behaviour among Past and Current Tuberculosis Patients in a Low-Income Country

“…Such risk factors include human immunodeficiency virus (HIV), poverty, malnutrition, chronic renal impairment, and diabetes, extremes of age, excess alcohol consumption, and smoking, and indoor air pollution. Barriers to accessing TB diagnostic and care services can influence TB rates by leading to more severe clinical disease, which in turn increases the likelihood of onward transmission of TB disease in the community [3]. Moreover, stigma and discrimination related to TB illness, especially in areas with high HIV and/or poverty prevalence, can lead to a reluctance to disclose TB status and seek TB diagnosis and care [4].…”