A rapid assessment of the impact of the 2020 “ENDSARS” protests and political unrest on weekly TB notification in Southwest Nigeria

Abstract

Background: The “ENDSARS” protest was a 3-week national protest staged by angry Nigerian youths to demand an end to brutality of the Special Anti-robbery Squad (SARS) unit of the Nigeria Police Force in October 2020. It is well reported that crises and armed conflicts have a negative impact on tuberculosis (TB) surveillance and case notifications. We aimed to analyze the impact of the political unrest caused by “ENDSARS” conflict on weekly TB notification and overall TB cascade performance. Methods: A retrospective review of weekly notification data across over 300 health facilities and 103 local government areas participating in active TB case findings in Lagos, Oyo, Ogun, and Osun States, all in Southwest Nigeria. TB cascade data (outpatient department (OPD) attendance, screening, presumptive TB, evaluation, and notification) were aggregated from relevant TB registers, entered into Microsoft Excel, and descriptively analyzed. Percentage increase or decrease in cascade and notification data were compared 3 weeks before and after the onset of the conflict. Results: OPD visits declined from 140,886 to 130,788. TB screening declined from a total of 146,955 to 136,348 while the number of TB diagnostic evaluation declined from 6567 to 5624 from the 3 weeks before to the 3 weeks following the ENDSARS protest. TB notification declined across states (with the exception of Oyo state) and intervention types from 3 weeks before the “ENDSARS” protests to 3 weeks following the onset of the protests. Highest decreases, −27% from 174 to 137, were observed in community interventions, bacteriologically diagnosed declined by −20% from 599 to 481, and in Osun state by −26% from 65 to 48. There was a significant increase in clinical diagnosis, + 58% from 99 in the 3 weeks before to 156 during the 3 weeks of the protest. Conclusion: There is an urgent need for national capacity building on TB program preparedness in crises, with emphasis on how national and sub-national governments, hospitals, and communities could anticipate and respond effectively, thus maintaining the minimum package of TB care in conflict.