How Nigeria can make significant impact on Tuberculosis notification rates

In recent time, Southern Ethiopians have doubled the Tuberculosis (TB) notification rate, along with awareness-raising, stigma reduction, and treatment support activities to help reduce the prevalence of the disease and trace the missing cases.

Nigeria is currently in search of a workable approach. However, further analysis of Southern Ethiopia plan reveals lesson that can plug gaps in Nigeria to help address the over 300,000 undetected/missing TB cases, which implies thereby, representing a large number of continuous transmission of the disease in the country.

The Southern Ethiopians implemented a community-base case finding by training health extension workers to identify people with presumptive TB, collect sputum and fix sides, as well as setting up transportation system. Several recent implementations have shown substantial numbers of additional people treated. However, the notification rates increased from 64 to 127 per 100,000 populations in the first year of intervention.

“Developing and implementing activities is a huge challenge in the science of delivery. Nigeria can learn and apply these strategic approaches by finding missing people with TB in Communities, Finding Missing People with TB by engaging the Private Sector, Intensified TB Case Finding at Facility Level and Chest X-Ray Screening,” said Stephen John, executive director Janna Health Foundation.

John said the four (4) Field guides are meant to help TB programs and partners plan, design and monitor these different interventions. He made this known in a one day workshop on disseminating field guide organised by Interactive Research & Development (IRD) that was called to discuss possible solutions to reduce the disease prevalence.

Explaining some of the field guides John said community-based TB case finding is needed to address the poor access to TB services (distance & Costs), the high stigma (little or no motivation to access care), high-risk factors for TB transmission and delays in TB diagnosis which leads to high morbidity and mortality.

“Addressing these gaps will help high potential to increase TB case notification, give the opportunity to link with other disease program areas and increase awareness in addressing Stigma, also an opportunity to improve treatment outcome and effective contact examination,” said, John.

Meanwhile, a large cluster randomised trial in Zambia and South Africa showed no impact of an enhanced community- based approach on TB prevalence.

However, implementing community- based case finding is not simple, as it involves identifying the right target population/area; setting priorities; designing the intervention, finding the right implementing partners; engaging and involving the community; ensuring sustained community dialogue; keeping staff motivated; ensuring that people follow the complete pathway of care; and ensuring continuous follow-up and supervision.

Nigeria is classified among countries with a high burden for TB, TB/HIV and MDR-TB and currently ranked 6th globally and 1st in Africa. The country contributes 9% to the global 3.6 million missing TB cases after India and Indonesia with 26% and 11% respectively.