Abstract
BackgroundAccording to the World Health Organization, Nigeria is one of the countries with a high burden of tuberculosis (TB) worldwide. Improving the burden of TB among HIV-negative people would require comprehensive and up-to-date data to inform targeted policy actions in Nigeria. The study aimed to describe the incidence, prevalence, mortality, disability-adjusted life years (DALYs) and risk factors of tuberculosis in Nigeria between 1990 and 2016.MethodsThis study used the most recent data from the global burden of disease study 2016. TB deaths were estimated using the Cause of Death Ensemble model, while TB incidence, prevalence and DALYs, as well as years of life lost and years of life lived with disability were calculated in the DisMod-MR 2.1, a Bayesian meta-regression tool. Using a comparative risk assessment approach, TB burden attributable to risk factors was estimated in a spatial-temporal Gaussian Process Regression tool.ResultsIn 2016, the prevalence of TB among HIV-negative people was 27% (95% uncertainty interval [95% UI] 23–31%) in Nigeria. TB incidence rate (new and relapse cases) was 158 per 100,000 people (95% UI; 128-193), while the total number of TB mortality was 39,933 deaths (95% UI; 30,488-55,039) in 2016. Between 2000 and 2016, the age-standardised prevalence and incidence rates of TB-HIV negative decreased by 20.0 and 87.6%, respectively. The age-standardised mortality rate also dropped by 191.6% over the same period. DALYs due to TB among HIV-negative Nigerians was high but varied across the age groups. Of the risk factors studied, alcohol use accounted for the highest number of TB deaths and DALYs, followed by diabetes and smoking in 2016.ConclusionThe study shows an improving trend in TB disease burden among HIV-negative individuals in Nigeria from 1990 to 2016. Despite this progress, this study suggests that additional efforts are still needed to ensure that Nigeria is not left behind in the current global strategy to end TB disease. Reducing TB disease burden in the country will require a multipronged approach that includes increased funding, health system strengthening and improved TB surveillance, as well as preventive efforts for alcohol use, smoking and diabetes.
Highlights
According to the World Health Organization, Nigeria is one of the countries with a high burden of tuberculosis (TB) worldwide
The World Health Organization (WHO) African region accounted for 25% of the total number of incident cases (i.e., TB-HIV-negative and TB-HIV infection) globally, where Nigeria accounted for 8% or 407 cases per 100,000 population in 2016 [1], up from 322 cases per 100,000 population in 2015 [2]
We have provided a detailed exposition of TB disease burden in Nigeria from the Global burden of disease (GBD) findings because this is not practicable in the GBD capstone publications due to the huge size and scope of the study, which have led to further characterisation of the results for other health focus areas and locations [3, 13,14,15,16]
Summary
According to the World Health Organization, Nigeria is one of the countries with a high burden of tuberculosis (TB) worldwide. The Global Burden of Diseases, Injuries and Risk Factors (GBD) Study 2016 estimated 9.0 million TB-HIV-negative incident cases (new and relapse cases) compared to 8.8 million in 2015 [3]. These reports highlighted the considerable burden of TB globally. The WHO African region accounted for 25% of the total number of incident cases (i.e., TB-HIV-negative and TB-HIV infection) globally, where Nigeria accounted for 8% or 407 cases per 100,000 population in 2016 [1], up from 322 cases per 100,000 population in 2015 [2] These estimates may be lower than the actual number of TB cases in Nigeria because only less than a quarter of TB cases (15%) were notified in 2015 [2]
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