TB in Nigeria
Nigeria is among the 14 high burden countries for TB, TB/HIV and Multi Drug Resistant TB. The country is ranked seventh among the 30 high TB burden countries and second in Africa. The problem of TB in Nigeria has been made worse by the issues of drug resistant TB and the HIV/AIDS epidemic.
It is estimated that 407,000 people in Nigeria have TB each year. This is the estimated number of HIV negative people. In addition there are an estimated 63,000 HIV positive people that get TB each year. An estimated 115,000 HIV negative people die from TB in Nigeria each year and an estimated 39,000 HIV positive people also die. It is difficult to appreciate what it means for 154,000 people to be dying each year from TB so it can be helpful to read the page on dying from TB.
It has been said that “achieving the reduction in TB incidence rate for attainment of the 90-90-90 target of the END TB strategy will be a mirage, if something drastic is not done.” The incidence rate is the number of new cases of TB in a population in a given time period, which is usually a year.
National Tuberculosis & Leprosy Control Program (NTLCP)
The National Tuberculosis & Leprosy Control Program (NTLCP) was established in 1989 and officially launched in February 1991. Its mandate was to coordinate TB and Leprosy control activities in all states in Nigeria in order to significantly reduce the public burden of the two diseases.
The NTLCP, which is part of the Ministry of Health, controls most of the funding for work on TB in Nigeria. The Ministry of Health has made considerable progress with the drafting of the National Strategic Plan for Tuberculosis Control which aims to provide Universal Access to Prevention, Diagnosis and Treatment by 2020 in line with its commitments to the World Health Organisation (WHO).1“World Tuberculosis Day 2018, on the search for TB leaders in Nigeria”, 16th March 2018, ARFH, http://arfh-ng.org/world-tuberculosis-day-2018-on-the-search-for-tb-leaders-in-nigeria/
However, there are several difficulties affecting the success of this plan, such as inadequate budget provisions, access to hard to reach areas, unreported TB cases and inadequate human resources technical capacity.
Dr Bassey Nsa, the Country Director (Challenge TB program) of KNCV, which partners the Federal Ministry of Health in TB control, treatment and prevention, said that a lot more political commitment and funding is required from the government at all levels to fight TB in Nigeria.
“Government’s political commitment towards fighting the scourge of TB is not enough. Government’s put in about four out of 15 percent supposedly set aside as TB commitment. Partners put in about 60%. That means we have about 64% funding commitment. There are still funding gaps that need to be filled.”2“302,096 tuberculosis cases undetected in Nigeria - NTBLCP”, March 15 2018, Vanguard, https://www.vanguardngr.com/2018/03/302096-tuberculosis-cases-undetected-nigeria-ntblcp/
TB case finding in Nigeria
A major issue with TB in Nigeria is the low TB case finding for both adults and children.
In 2017 only 104,904 TB cases were detected out of an estimated 407,000 of all TB cases expected to be detected in 2017.3“302,096 tuberculosis cases undetected in Nigeria - NTBLCP”, March 15 2018, Vanguard, https://www.vanguardngr.com/2018/03/302096-tuberculosis-cases-undetected-nigeria-ntblcp/
This indicates a treatment coverage of just 25.8 per cent. This leaves a gap of 302,096 cases which were either undetected or detected but the cases were not notified especially in “non DOTS sites”.
According to the World Health Organisation Nigeria is among the ten countries that account for 64% of the global gap in TB case finding. India, Indonesia and Nigeria account for almost half of the total gap.
“There are lots of missing TB cases that were either not diagnosed or reported”. Minister of health Isaac Adewole
A total of just 1,783 drug resistant TB cases were notified out of an estimated 5,200.
The Federal Ministry of Health has declared 2018 a year to accelerate finding and notification of TB cases in Nigeria. The huge gap in TB case finding is much higher among children aged zero to 14 with a child proportion of seven per cent for 2017.
Active case finding
In order to improve the TB case finding Nigeria has added active case-finding in key affected populations. The health minister said this included people living with HIV, children, urban slum dwellers, prisoners, migrants, internally displaced people and facility based health care workers.
Over 11,500 TB cases were detected through active house to house case searching in 2017. Although this is a useful initiative, the number of TB cases detected is a small percentage of the missing 300,000 cases of TB in Nigeria.
TB in children
It is estimated by the WHO that 30,000 children get TB in Nigeria each year. There are also 47,000 children that are eligible to receive preventative treatment, that would help to prevent them from getting TB. However, only about 8,500 children actually receive this preventative treatment.
Nigeria has however started to use the new TB treatment for children. This is the treatment that is both dispersible and flavoured and so it makes it much easier for children to take.4Ayodamola Owoseye, “Nigeria launches new medication to tackle Tuberculosis”, Premium Times, https://www.premiumtimesng.com/health/health-news/262951-nigeria-launches-new-medication-to-tackle-tuberculosis.html
Studies have shown the important role played by treatment supporters. The support needs of patients whilst taking treatment include:
Monitoring and supervision of daily drug taking
Motivational support to take the drugs as expected
Provision of support for feeding (when there is little food)
Support for provision of transportation cost to visit TB clinic when the need arises.
USAID has provided Nigeria with two vans for mobile testing and treatment of TB. Although this is a useful initiative, with just two vans for the whole of Nigeria this initiative has a limited impact.
The country has however progressed to having 6,753 DOTS centres compared to 3,931 in 2010. The total number of microscopy centres has increased from 1,148 in 2010 to 2,650 in 2017 and the total number of Genexpert machines installed in the country has increased from 32 in 2012 to 390 in 2017.
However at the annual meeting of the NTBLCP it was noted that there is sub-optimal use of GeneXpert machines across the country.5“NTBLCP Annual Review Meeting 2017” NTBLCP, “NTBLCP Annual Review Meeting 2017”, http://ntblcp.org.ng/news/ntblcp-annual-review-meeting-2017 It was also noted that the machines break down frequently due to thunder storms.
HIV/TB collaborative activities
Nigeria has made progress with TB/HIV collaborative activity and currently 96% of people with TB in Nigeria and 82% of people presumed to have TB in Nigeria know their HIV status. In addition 84 per cent of co-infected people receive antiretroviral therapy (ARVs) and CPT.
Treatment of Drug resistant TB
Treatment centres for drug resistant TB have increased from 10 in 2013 to 27 in 2017 and the number of TB reference laboratories has also increased from 9 in 2013 to 10 in 2018.
The shorter regimen for the treatment of drug resistant TB was also introduced in 2017, although it is unclear what testing is available for drug resistant TB. This is needed to make sure that people are eligible for treatment with the shorter regimen.
Visiting the UK
If you are planning to visit the UK for more than 6 months, and you are a Nigerian resident, then you must have a test for TB before you arrive in the UK.6“Tuberculosis testing in Nigeria”, 19 January 2018, https://www.gov.uk/government/publications/tuberculosis-test-for-a-uk-visa-clinics-in-nigeria/tuberculosis-testing-in-nigeria