Improving TB Case Detection Through Active Case-Finding: Results of Multiple Intervention Strategies in Hard-to-Reach Riverine Areas of Southern Nigeria

Joseph N. Chukwu; Cosmas Kenan Onah; Edmund Ndudi Ossai; Charles C. Nwafor; Chukwuka Alphonsus; Okechukwu E. Ezeakile; Ngozi Murphy-Okpala; Chinwe C. Eze; Obioma Chijioke-Akaniro; Anthony Meka; Martin I. Njoku; Francis S. Iyama; Ngozi Ekeke

doi:10.9745/GHSP-D-23-00164

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FIGURE 1
Map of Nigeria Showing Intervention Areas for Active Case-Finding for TB Implemented in 15 Hard-to-Reach Riverine Local Government Areas Across 6 States of Southern Nigeria
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FIGURE 2
Method of Diagnosis During an Active Case-Finding for TB Intervention Implemented in Hard-to-Reach Riverine Local Government Areas in Southern Nigeria
Abbreviation: MTB/RIF, Mycobacterium tuberculosis and rifampicin-resistant TB.

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TABLE 1.

Distribution of Participants Screened for TB During Active Case-Finding Implemented in 15 Hard-to-Reach Riverine Local Government Areas in Southern Nigeria

Variable	Frequency, No. (%)(N=1,089,129)
Age, years
0–4	164,583 (15.1)
5–14	346,980 (31.9)
≥15	577,566 (53.0)
Sex
Female	595,391 (54.7)
Male	493,738 (45.3)
Intervention strategy
Community outreach	890,475 (81.8)
Health facility	170,002 (15.6)
HIV-positive people	24,030 (2.2)
Household contacts of bacteriologically confirmed TB	4,622 (0.4)

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TABLE 2.

Change in TB Notifications Following an Active Case-Finding Intervention in 15 LGAs Across 6 States in Southern Nigeria

LGA	Population	Average No. of TB Notified per Quarter per LGA Before Intervention	Average No. of TB Notified per Quarter per LGA During Intervention	% Increase in No. of TB Notified
		(Quarter 1 2014–Quarter 2 2017)	(Quarter 3 2017– Quarter 3 2020)
Warri North	186,918	4	13	225.5
Burutu	285,531	6	12	100.0
Ekeremor	359,499	11	21	90.9
Southern Ijaw	429,135	5	23	360.0
Patani	92,521	2	10	400.0
Brass	245,536	8	24	200.0
Total	1,599,140	6	17	183.3
		(Quarter 1 2015– Quarter 4 2018)	(Quarter 1 2019– Quarter 3 2020)
Anambra East	206,155	7	20	66.7
Anambra West	226,688	2	22	100.0
Ayamelum	214,289	11	26	62.5
Ovia North East	210,034	6	13	62.5
Etsako Central	127,402	5	15	400.0
Bonny	311,045	9	12	100.0
Ogu-Bolu	108,921	2	6	500.0
Opobo Nkolo	221,124	9	33	266.7
Ilaje	401,632	21	24	4.3
Total	2,027,290	8	19	137.5

Abbreviations: LGA, local government area.

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TABLE 3.

Number Needed to Screen to Diagnose 1 Case of TB During an Active Case-Finding Intervention

Variable	Number Needed to Screen
Variable	Per Group	Aggregate Index
Intervention strategy
Community outreach screening	499	441
Health facility screening	337
Screening among HIV-positive people	422
Household contacts of bacteriologically confirmed TB cases	38
Age group, years
0–4	596	441
5–14	1,230
≥15	302
Sex
Female	548	441
Male	356

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TABLE 4.

Result of Active Case-Finding for TB Intervention Implemented in 15 Hard-to-Reach Riverine Local Government Areas in Southern Nigeria, Disaggregated by Age and Sex

Performance Indicator	Total Output	Age Distribution, Years			Sex Distribution
Performance Indicator	Total Output	0–4	5–14	≥15	Female	Male
No. of individuals screened for TB	1,089,129	164,583	346,980	577,566	595,391	493,738
No. of presumptive TB identified (% of individuals screened)	24,802 (2.3)	2,883 (1.8)	5,213 (1.5)	16,706 (2.9)	13,126 (2.2)	11,676 (2.4)
No. of presumptive TB tested for TB (% of presumptive TB identified)	22,026 (88.8)	2,118 (73.5)	4,353 (83.5)	15,555 (93.1)	11,724 (89.3)	10,302 (88.2)
No. of all forms of TB diagnosed (% of presumptive TB identified)	2,471 (10.0)	276 (9.6)	282 (5.4)	1,913 (11.5)	1,086 (8.3)	1,385 (11.9)
No. of Bac+ DS-TB diagnosed (% of all forms of TB diagnosed within group)	1,776 (71.9)	42 (15.2)	84 (29.8)	1,650 (86.3)	765 (70.4)	1,011 (73.0)
No. of clinically diagnosed DS-TB (% of all forms of TB diagnosed within group)	637 (25.8)	232 (84.1)	194 (68.8)	211 (11.0)	294 (27.1)	343 (24.8)
No. of DR-TB diagnosed (% of all forms of TB diagnosed within group)	58 (2.3)	2 (0.7)	4 (1.4)	52 (2.7)	27 (2.5)	31 (2.2)
No. of all forms of TB started on treatment (% of all forms of TB diagnosed)	2,425 (98.1)	273 (98.9)	276 (97.9)	1,876 (98.1)	1,065 (98.1)	1,360 (98.2)

Abbreviations: Bac+, bacteriologically confirmed; DS-TB, drug-sensitive TB; DR-TB, drug-resistant TB.

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TABLE 5.

Result of Active Case-Finding for TB Intervention Implemented in 15 Hard-to-Reach Riverine Local Government Areas in Southern Nigeria, Disaggregated by Intervention Strategy

Performance Indicator	Total Output	Output per Intervention
Performance Indicator	Total Output	Community Outreach	Health Facility	People Living With HIV	Household Contacts of Bac+ TB
No. of individuals screened for TB	1,089,129	890,475	170,002	24,030	4,622
No. of presumptive TB identified (% of those screened)	24,802 (2.3)	19,044 (2.1)	4,560 (2.7)	396 (1.6)	802 (17.4)
No. of presumptive TB tested (% of presumptive TB identified)	22,026 (88.8)	16,698 (87.7)	4,258 (93.4)	369 (93.2)	701 (87.4)
No. of people with all forms of TB (% of presumptive TB identified)	2,471 (10.0)	1,786 (9.4)	505 (11.1)	57 (14.4)	123 (15.3)
No. of Bac+ DS-TB diagnosed (% of all forms of TB)	1,776 (71.9)	1,296 (72.6)	393 (77.8)	42 (73.7)	45 (36.6)
No. of clinically diagnosed DS-TB (% of all forms of TB)	637 (25.8)	450 (25.2)	96 (19.0)	15 (26.3)	76 (61.8)
No. of DR-TB cases diagnosed (% of all forms of TB)	58 (2.3)	40 (2.2)	16 (3.2)	0 (0)	2 (1.6)
No. of all forms of TB started on treatment (% of all forms of TB diagnosed)	2,425 (98.1)	1,748 (97.9)	498 (98.6)	56 (98.2)	123 (100)