• Friday, July 12, 2024
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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.

“An estimated 418,000 new TB uses cases in Nigeria in 2018 and the country notified l04,904 (25%) and l06,533 cases of TB in 2017 and 2018 respectively giving a gap of 314,712 and 3l9,599 cases yet to be notified respectively.

“There are a lot of barriers in finding missing cases of TB in Nigeria and one of it is unavailability of resources. We find out that in Nigeria only about 5 percent of all health facilities are covered with TB service, so there is a lot of a gap,” said Chijoke Osakwe, executive director, Initiator for Prevention and Control of Disease (IPCD).

Osakwe said that in Nigeria there are more adult males affected with TB with about 50 percent, 44 percent at females and children is still, about 12 percent has been diagnosed with TB stating that the country really needs a lot of resources to create awareness in other to enable people to access diagnosis and also to be treated for TB.

Osakwe pointed out that the issue of domestic contribution for TB is still very low noting that the donors can only fund the ones they think is necessary.

Speaking on the workshop, Lapa Onalaja Programme manager IRD said this is something that is new and has not been done in Nigeria stating that there is a bridge for everyone in the field guide which is the focus of the workshop.

“Nigeria has been having issues of reporting and finding our missing cases on TB that is why we are here to build on how Nigeria can improve the strategic and effective plan for TB.”

She said Interactive Research & Development (IRD) Global is working with the ministry of health to implement chest X-ray screen and for the first to be done in the state across of this skill where we are using artificial technology to screen and diagnose for TB.

Samuel Ogiri, World Health Organisation (WHO) National professional officer TB southwest zone, Nigeria said that the country needs to optimise what they have stated that with the new technology GeneXpert machine will support an active TB case finding.