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Improved Case Finding, Funding As Recipe For TB Free Nigeria



Tuberculosis, one of the most deadly diseases, has remained a burden globally.  PATIENCE IVIE IHEJIRIKA takes a look at Nigeria’s place in the collective struggle to eliminate the disease by 2030.

As nations strive to meet the sustainable Development Goal (SDG) on TB elimination by 2030, Nigeria is not left out, giving its present status in global disease prevalence fact sheets.

According to the 2017 Global TB Report, Nigeria is among the 14 high burden countries for TB, TB/HIV and MDR-TB. The country is also ranked 7th among the 30 high TB burden countries and 2nd in Africa.

Nigeria is also among the 10 countries that account for 64 percent of the global gap in TB case finding.  India, Indonesia and Nigeria account for almost half of the total gap.

WHO estimates that 210,000 new cases of all forms of TB occurred in the country in 2010, equivalent to 133/100,000 population.

As the world marked the 2018 Tuberculosis Day, Nigeria and other African nations were once again reminded of the need for increased health financing in the continent.

The World Health Organisation (WHO) used the occasion to stress the need for African Leaders to renew efforts towards TB treatment and control in the region.

The organisation, through its Regional Director for Africa,  Dr Matshidiso Moeti, said although the region has made good progress in controlling TB, it still has the world’s highest levels of the disease, and only half of existing TB cases are being found by its health systems.

“We have the most patients infected with both HIV and TB, and are seeing alarming increases in the forms of TB that resist treatment with common medicines. Finally, governments are contributing only a quarter of the resources needed to provide adequate TB services, and 40% of needs remain unfunded.

“A TB-free world will only be achieved through leaders who champion efforts to end TB at local level”, he stressed.

According to him, leaders have tremendous influence to build strong partnerships and commitment to end the TB epidemic at every level while calling on governments, parliamentarians and policy-makers to drive ambitious plans that will accelerate TB control at national level.

Moeti also called on health workers, nongovernmental organisations and technicians to maximize the use of proven methods to diagnose and successfully treat all types of TB, and for researchers to do the scientific studies needed to inform policies to help improve and monitor TB services.

He urged community leaders, patient advocacy groups and people affected by TB to partner with government to ensure access to treatment for all.

Also calling on governments to push for universal coverage with proven high quality services, Moeti urged  it to scale up domestic funding for TB control and take responsibility for essential medicines and laboratory supplies.

He said since TB is found in communities where human rights and dignity are often overlooked, governments should lead actions beyond the health sector to address environmental, economic and other factors which increase the risk of TB.

“The implementation of these actions requires strong leadership. We want leaders for a TB-free world”, he stated.

According to him, the WHO in the African Region and the African Union Commission are setting up ways to monitor progress towards ending the TB epidemic by 2030 as called for in the Sustainable Development Goals (SDGs) and End TB Strategy.

Nigerian government, however,  has identified low case finding in both adults and children as a major drawback in the country’s TB program.

The minister of Heath, Prof. Isaac Adewole, said this is as a result of so many missing TB cases that were either not diagnosed or diagnosed but not reported.

Adewole also said the TB burden is further compounded by  drug resistance TB (DR-TB) and the HIV/AIDS pandemic.

According to him, “in 2017, the country notified only 109,904 out of the estimated 407,000, all forms of TB cases (with treatment coverage of 25.8%), leaving a gap of 302,096 comprising undetected or detected but not notified cases especially in non-DOTS sites.

“In the same year, the proportion of childhood TB was 7 per cent of all forms of TB cases compared to 10 per cent recommended by WHO. In addition, a total of 1783 DR-TB cases were notified out of the estimated 5200 DR-TB cases”.

Adewole however expressed delight over  the TB/HIV collaborative activities, describing it as one of the key areas that the country was performing well in TB control activities.

“Currently, 96per cent TB and 82 per cent  presumptive TB cases know their HIV status and 84 per cent  co-infected clients receive ART and CPT.

“In our response to the burden of TB, the Federal Ministry of Health developed a robust National Strategic plan (NSP) for TB (2015 – 2020) as well as a framework to support the declaration of 2017 as a year of accelerating TB case finding and treatment in Nigeria.

“The implementation of the NSP for TB (2015 – 2020) though not without its limitations has brought noticeable improvements in TB control activities,” he stated.

Speaking further, the minister informed that to  accelerate TB case finding, the country has now moved from passive to active case-finding in key affected populations, including PLHIV, children, urban slum dwellers, prisoners, migrants, internally displaced people and facility-based health care workers, to target those most at risk for TB.

He added that over 11,500 TB cases were detected through active house to house case search in 2017.

“Nigeria currently has 6,753 DOTS centres compared to 3931 in 2010. The total number of microscopy centres has risen from 1,148 in 2010 to 2,650 in 2017. GeneXpert machines installed in the country have increased from 32 in 2012 to 390 in 2017.

“Treatment centres for patients with DR-TB have expanded from 10 in 2013 to 27 in 2017. The number of TB reference laboratories has also increased from 9 in 2013 to 10 in 2018. Over 90% of the TB patients notified in 2016 have documented HIV test results compared to 79% in 2010,” he stated.

Adewole said in addition to this, shorter drug regimen for the treatment of DR-TB was introduced in the country in 2017 to reduce the treatment duration for patients with DR-TB and ensure better treatment outcomes.

According to him, the engagement of key professional bodies like the Thoracic Society of Nigeria, Paediatric Association of Nigeria (PAN) and Nigerian Society for Paediatric Infectious Diseases (NISPID) is being prioritized as paediatricians are the ones piloting the affairs of the National Childhood TB Steering Committee (NCTSC).

He also stated that the National electronic TB Information Management System (NETIMS) was recently developed to improve real time reporting and monitoring of TB cases, adding that all States actors have been trained and are reporting using this platform.

“The Private Sector Engagement for TB is also being vigorously looked into as there is a robust Public-Private Mix (PPM) engagement plan for TB. Similarly, during the last National Council on Health (NCH) meeting in Abeokuta, Ogun state, a resolution was passed mandating all private health facilities in the country to compulsorily notify TB cases.

“To further strengthen TB notification in some challenged states, TB Surveillance officers have been recruited in 12 states (Rivers, Delta, Imo, Anambra, Lagos, Oyo, Benue, Niger, Kaduna, Kano, Bauchi and Taraba) to work with non-NTP facilities (private Health facilities, Patent medicine vendors, community Pharmacist), disease surveillance and notification officers, state epidemiologist and state TB programme officers to improve TB case notification, he explained.

The minister further stated that in furtherance of the desire of the ministry to improve access of all presumptive TB cases to Xpert MTB/RIF assay, specimen transport was being fashioned in a hub and spoke model.



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