German Leprosy and Tuberculosis Relief Association, Enugu, Nigeria.
Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria.
Glob Health Sci Pract. 2024 Feb 28;12(1). doi: 10.9745/GHSP-D-23-00164.
A major challenge to TB control globally is low case detection, largely due to routine health facility-based passive case-finding employed by national TB control programs. Active case-finding is a risk-population-based screening approach that has been established to be effective in TB control. This intervention aimed to increase TB case detection in hard-to-reach areas in southern Nigeria.
Using a descriptive cross-sectional design, we conducted implementation research in 15 hard-to-reach riverine local government areas with historically recognized low TB case notification rates. Individuals with TB symptoms were screened using multiple strategies. Data were collected quarterly over a 4-year period using reporting tools and checklists. Descriptive analysis was done with Microsoft Excel spreadsheet 2019.
A total of 1,089,129 individuals were screened: 16,576 in 2017; 108,102 in 2018; 697,165 in 2019; and 267,286 in 2020. Of those screened, 24,802 (2.3%) were identified as presumptive TB, of which 88.8% were tested and 10% were diagnosed with TB (0.23% of those screened). TB notifications more than doubled, increasing by 183.3% and 137.5% in the initial implementation and scale-up, respectively. On average, 441 individuals needed to be screened to diagnose 1 TB case. The cases, predominantly males (56.1%) and aged 15 years and older (77.4%), comprised 71.9% bacteriologically confirmed drug-sensitive TB, 25.8% clinically diagnosed drug-sensitive TB, and 2.3% drug-resistant cases. Detection sources included community outreach (1,786), health facilities (505), people living with HIV (57), and household contacts of bacteriologically confirmed TB cases (123). Remarkably, 98.1% of diagnosed TB cases commenced treatment.
We found a significant yield in TB case notifications, more than doubling the baseline figures. Given these successful results, we recommend prioritizing resources to support active case-finding strategies in national programs, especially in hard-to-reach areas with high-risk populations, to address TB more comprehensively.
全球结核病控制的一个主要挑战是低病例检出率，主要是由于国家结核病控制规划采用的常规卫生机构基于被动的病例发现。主动病例发现是一种基于风险人群的筛查方法，已被证明在结核病控制中是有效的。本干预措施旨在增加尼日利亚南部难以到达地区的结核病病例检出率。
我们采用描述性的横断面设计，在 15 个难以到达的河流地方政府区域开展实施研究，这些区域历史上结核病病例报告率低。使用多种策略对有结核病症状的个体进行筛查。在 4 年期间，使用报告工具和检查表每季度收集数据。使用 Microsoft Excel 电子表格 2019 进行描述性分析。
共筛查了 1089129 人：2017 年筛查 16576 人；2018 年筛查 108102 人；2019 年筛查 697165 人；2020 年筛查 267286 人。在筛查的人群中，24802 人（2.3%）被确认为疑似结核病，其中 88.8%接受了检测，10%被诊断为结核病（占筛查人数的 0.23%）。结核病报告病例数增加了一倍多，初始实施和扩大阶段分别增加了 183.3%和 137.5%。平均而言，需要筛查 441 人才能诊断出 1 例结核病。这些病例主要为男性（56.1%）和 15 岁及以上人群（77.4%），包括 71.9%的细菌学确诊的药物敏感结核病、25.8%的临床诊断的药物敏感结核病和 2.3%的耐药病例。发现来源包括社区外展（1786 例）、卫生机构（505 例）、艾滋病毒感染者（57 例）和细菌学确诊结核病病例的家庭接触者（123 例）。值得注意的是，98.1%诊断为结核病的病例开始接受治疗。
我们发现结核病报告病例数有显著增加，比基线数据增加了一倍多。鉴于这些成功的结果，我们建议优先为国家规划中的主动病例发现策略提供资源支持，特别是在高危人群的难以到达地区，以更全面地应对结核病。
