Assessment of Contributions of Community Tuberculosis Intervention to Tuberculosis Case Detection and Treatment Outcome in Two States in Nigeria

Audu Onyemocho,Shember-Agela Igbabul,Anejo-Okopi Joseph,Adewale Osho,Hassan Abiodun,Omole Victoria Nanben,Queen Ogbuji,Gajere Julius

doi:10.4236/jtr.2020.83012

Audu Onyemocho, Shember-Agela Igbabul + Show 6 more

Open Access

https://doi.org/10.4236/jtr.2020.83012

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Abstract

Background: Nigeria, one of the high burden Tuberculosis countries, has developed various intervention strategies to ensuring universal access to quality-assured tuberculosis diagnosis and treatment. However, low case detection and unsuccessful treatment outcome still remains a serious challenge in most states. Community Tuberculosis care was born against this background in 2010 as a complementing front to combat the challenges, bringing directly observed treatment short-course strategy beyond the clinic settings to the door steps of patients. This study evaluates the contributions of the intervention to Tuberculosis case detection and treatment outcomes in two states in Nigeria. Materials and Method: A retrospective study with multistage sampling technique was employed to review 23,241 presumptive Tuberculosis cases enrolled for management between 2014-2017. Chi-square (χ2) test was used for test of association between the independent variables and the main outcomes of the study, with statistical significance set at p-value of 5%. Results: The annual percentage increase for both states was 24.7%, 189.8% and 114.5% in the study group as against 5.2%, 44.6% and 65.6% in control group. Overall, 23.8% were bacteriologically positive (either AFB or Gene-Xpert MTB/Rif) and 1.4% were clinically evaluated to be positive, while 74.8% were bacteriologically negative. Of the total 5861 cases treated, successful treatment rate of the patients in the study group was 88.6% as compared to 76.1% in the control group. The relationship between the referral system from communities where the intervention program was implemented and the case detection/treatment outcome was statistically significant (OR 95% CI = 3.15, 2.95 - 3.35). Conclusion: The community level Tuberculosis intervention led to significantly better case detection and treatment outcome when compared to the conventional approach (p ≤ 0.05). Therefore, full community engagement should be advocated as a major strategy for End Tuberculosis planed by WHO since the patients are found in the community and not in the health facilities.

Highlights

Tuberculosis (TB) was declared as global health emergency in 1993, but it still remains one of the world’s deadliest infectious diseases [1] [2] [3]
Community Tuberculosis care was born against this background in 2010 as a complementing front to combat the challenges, bringing directly observed treatment short-course strategy beyond the clinic settings to the door steps of patients
This study evaluates the contributions of the intervention to Tuberculosis case detection and treatment outcomes in two states in Nigeria

Summary

Introduction

Tuberculosis (TB) was declared as global health emergency in 1993, but it still remains one of the world’s deadliest infectious diseases [1] [2] [3]. Nigeria started the implementation of Directly Observed Treatment Short course (DOTS) strategy in 1993 and achieved a 100% state coverage in 2003, but over there after the accessibility to the DOTS services remains sub-optimal. This was worse among the rural dwellers, most of who are poor and live several kilometres from the DOTS centre [5]. Community Tuberculosis care was born against this background in 2010 as a complementing front to combat the challenges, bringing directly observed treatment short-course strategy beyond the clinic settings to the door steps of patients.

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