Global Tuberculosis Burden: Is Nigeria Losing The War?

Jombo, Gta; Mbaave, Pater T

doi:10.46912/jbrcp.46

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…Increasing patient awareness of TB symptoms and available services is an important first step for TB control in Nigeria, since case-finding is reliant on patients recognizing their symptoms and presenting to a public health facility with TB services. This is supported by other studies from Nigeria, calling for improved public communication around TB [65] , [66] , [67] . Mass awareness campaigns have been used sucesfully in South Africa and other settings to create awareness, reduce stigma, and improve case finding [56] , [68] , [69] .…”

Section: Discussionsupporting

confidence: 67%

Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study

Oga‐Omenka

Boffa

Kuye³

et al. 2020

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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Background Despite the availability of free drug-resistant tuberculosis (DR-TB) care in Nigeria since 2011, the country continues to tackle low case notification and treatment rates. In 2018, 11% of an estimated 21,000 cases were diagnosed and 9% placed on treatment. These low rates are nevertheless a marked improvement from 2015 when only 3.4% were diagnosed and 2.3% placed on treatment of an estimated 29,000 cases. This study describes the Nigerian DR-TB care cascade from 2013 to 2017 and considers factors influencing gaps in care. Methods Our study utilized a mixed-method design. For the quantitative component, we utilized the national diagnosis and treatment databases, as well as the World Health Organization’s estimates for prevalence to construct a 5-year care cascade: numbers of patients at each level of DR-TB care, including incident cases, individuals who accessed testing, were diagnosed, initiated treated and completed treatment in Nigeria between 2013 and 2017. Using retrospective data for patients diagnosed in 2015, we performed the Fisher’s exact test to determine the association between patient (age and gender) and provider/patient (region- north or south) variables, permitting a closer look at the gaps in care revealed across the 5 years. Barriers to care were explored using framework thematic analysis of 57 qualitative interviews and focus group discussions with patients, including 5 cases not initiated on treatment from the 2015 cohort, treatment supporters, community members, healthcare workers and program managers in 2017. Results A 5-year analysis of cascade of care data shows significant, but inadequate, increases in overall numbers of cases accessing care. On average, between 2013 and 2017, 80% of estimated cases did not access testing; 75% of those who tested were not diagnosed; 36% of those diagnosed were not initiated on treatment and 23% of these did not finish treatment. In 2015, children and patients in Northern Nigeria had odds of 0.3 [95% CI 0.1–0.7] and 0.4 [0.3–0.5] of completing treatment once diagnosed; while males were shown to have a 1.34 [95% CI 1.0–1.7] times greater chance of completing treatment after diagnosis. The main themes from qualitative data identified barriers to care along the care cascade at individual, family and community, as well as health systems levels. At the individual level, a lack of awareness of the true cause of disease and the availability of ‘free’ care was a recurring theme. Family interference was found to be a particular challenge for children and women. At the health system level, low index of suspicion, lack of rapid diagnostic tools and human resource shortages appeared to limit patients’ access. Conclusions Any gains in diagnostic technology and shorter regimens are lost with inadequate access to DR-TB services. The biggest losses in the Nigerian cascade happen before treatment initiation. There is a need for urgent action on identified gap...

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Section: Discussionsupporting

confidence: 67%

Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study

Oga‐Omenka

Boffa

Kuye³

et al. 2020

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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“…Increasing equitable available services is an important first step for TB control in Nigeria, since case-finding is reliant on patients recognizing their symptoms and presenting to a public health facility with TB services. This is supported by other studies from Nigeria, calling for improved public communication around TB (Hassan et al, 2017;Jombo and Mbaave, 2018).…”

Section: Discussionsupporting

confidence: 65%

Drug resistant tuberculosis treatment service alignment with health seeking behaviour in selected states in Nigeria

Bethrand,

Michael,

Ogoamaka

et al. 2023

J. Public Health Epidemiol.

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Nigeria is among the fourteen countries with the highest MDR-TB burden, and accounts for 12% of the global gap in DRTB diagnosis. Several control strategies have been put in place to ensure that all DRTB patients are diagnosed and placed on treatment, but this has not significantly closed this diagnostic gap. This study seeks to identify the drug resistant TB treatment service alignment with health seeking behavior of patients. The cross-sectional study under program implementation was carried out in 14 states among public and private healthcare facilities across different levels of care from June 2020 to December 2021. Data collection was carried out using an open-ended questionnaire and analyzed using Tableau 15 (version 2021.4 Germany). In public sector primary facilities only 14% facilities provide DR-TB services. States with highest availability of DRTB services do not have patients who first sought care at this level. In the secondary facilities, 14% of states have about 50% of their facilities providing DR-TB treatment services, and this aligns with where patients are seeking care in these states. For tertiary facilities, 28% of states have ≥ 50% facilities with DR-TB treatment services, but most patients do not first seek care at this level. The DRTB service availability in the private sector is low across all levels of care. There is a misalignment of availability of DR-TB services with facilities where patients first seek care. This insufficient and inequitable distribution should be a priority for TB control in order to close the DRTB notification and enrolment gap in Nigeria.

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Global Tuberculosis Burden: Is Nigeria Losing The War?

Cited by 2 publications

References 3 publications

Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study

Understanding the gaps in DR-TB care cascade in Nigeria: A sequential mixed-method study

Drug resistant tuberculosis treatment service alignment with health seeking behaviour in selected states in Nigeria

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