Progress Towards TB Elimination: An Eight-Year Retrospective Analysis of Key Performance Indicators for TB Control in Plateau State, Nigeria, 2016

Abstract

Tuberculosis is a major public health concern in Nigeria. It had been targeted for elimination using the directly observed treatment short Couse strategy. Plateau state started implementing the strategy since 2001. The key performance indicators towards achieving elimination targets was evaluated. Data from the routine surveillance records and reports from 2008 to 2015 were extracted. Patients’ enrollment, sputum conversion, treatment outcomes and TB/HIV co-infection was analyzed using epiInfo software. Of the 23,532 registered cases, only 34% were new sputum smear positive. The introduction of XpertMTB/Rif technology in 2013 increased the proportion of patient with pulmonary TB diagnosed bacteriologically by 11%. Majority (89%) of the smear positive cases were in the productive age group of 15 – 54 years. TB/HIV co-infection was 39.6%, with more female than male (OR 2.41, 95% CI: 2.22 – 2.63). The cured rate increased from 57.3% in 2008 to 70.1% in 2014. The overall treatment success and death rates were 83.0% and 6.6% respectively. Deaths and treatment failure rates were lower among new pulmonary smear positive patients (OR 0.68, 95% CI 0.52 – 0.88 and OR 0.47, 95% CI 0.29 – 0.77) respectively. The deaths were higher among TB/HIV compared to HIV negative patients (OR 2.23, 95%: 1.84 – 2.70). Despites the improvements in the performance indicators, the state is yet to achieve the elimination targets. Expansion of the use of Xpert technology, Community awareness, patient education and prompt defaulter retrieval will ensure early detection and enrollment of cases, improve quality of diagnosis and outcomes of TB treatment in the state.