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Tuberculosis case detection in Nigeria, the unfinished agenda

Obasanya, Joshua, Abdurrahman, Saddiq T, Oladimeji, Olanrewaju, Lawson, Lovett, Dacombe, Russell ORCID:, Chukwueme, Nkem, Abiola, Tubi, Mustapha, Gidado, Sola, Christophe, Dominguez, Jose and Cuevas, Luis ORCID: (2015) 'Tuberculosis case detection in Nigeria, the unfinished agenda'. Tropical Medicine & International Health, Vol 20, Issue 10, pp. 1396-1402.

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Underdetection of TB is a major problem in sub-Saharan Africa. WHO recommends countries should have at least 1 laboratory per 100 000 population. However, this recommendation is not evidence based.

We analysed surveillance data of the Nigerian National TB Control Programme (2008-2012) to describe TB case detection rates, their geographical distribution and their association with the density of diagnostic laboratories and HIV prevalence.

The median CDR was 17.7 (range 4.7–75.8%) in 2008, increasing to 28.6% (range 10.6–72.4%) in 2012 (P < 0.01). The CDR2012 was associated with the 2008 baseline; however, states with CDR2008 < 30% had larger increases than states with CDR2008 > 30. There were 990 laboratories in 2008 and 1453 in 2012 (46.7% increase, range by state −3% to +118). The state CDR2012 could be predicted by the laboratory density (P < 0.001), but was not associated with HIV prevalence or the proportion of smear-positive cases. CDR2012 and laboratory density were correlated among states having < and > than 1 laboratory per 100 000 population.

There are large variations in laboratory density and CDR across the Nigerian states. The CDR is associated with the laboratory density. A much larger number of diagnostic centres are needed. It is likely that a laboratory density above the recommended WHO guideline would result in even higher case detection, and this ratio should be considered a minimum threshold.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Jessica Jones
Date Deposited: 05 Feb 2016 10:53
Last Modified: 06 Feb 2018 13:11


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