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Nigeria Perspective: Tuberculosis

Background

Nigeria comes third behind only India and China in terms of tuberculosis cases. Every year, around 245,000 Nigerians die from tuberculosis (TB) and about 590,000 new cases occur (of these, around 140,000 are also HIV-positive). TB accounts for more than 10% of all deaths in Nigeria. Every hour, nearly 30 people die from the disease, despite effective treatments being available.

But diagnosis is not always easy, and treatment takes several months; in the meantime, loss of earnings for the sufferer may drive families into poverty, multiplying the burden of the disease.

The current situation can be dramatically improved. The target proposed is a 90% reduction in TB deaths and an 80% reduction in new cases by 2030. In Nigeria, that could be achieved by spending about 81 billion Naira a year to increase detection rates, strengthen primary health care provision and treat many more patients.

This sounds a lot, but it would give each TB patient on average about another 22 years of life. Also, treating one patient should prevent at least one more case developing, so overall this annual investment would produce about 2.8 million additional years of life.

Even valuing a year of life at just 200,000 Naira, the low end of the range, means that each Naira spent gives benefits worth about 10 Naira, as well as saving lives.

Many people carry a latent infection, with only 5% going on to develop active TB within eighteen months and the same percentage at risk of developing TB later in life. The risk of developing active TB is significantly increased following HIV infection, and nearly one in every four sufferers is also HIV-positive.

Most cases are drug-sensitive and respond well to standard treatment with a combination of drugs, but failure to complete a proper course of treatment encourages the development of multi-drug resistant TB (MDR-TB), which is difficult and costly to treat and has poorer outcomes. Around 2.9% of all cases of TB in Nigeria are multi-drug resistant, which is high in comparison to other countries.

Diagnosing active TB is quite complex, since many symptoms are similar to those for other common diseases.  Nigeria has one of the lowest detection rates in the world, with only 16% of cases being notified to the National TB and Leprosy Control Programme (NTLCP). A lack of capacity in the primary health care system means that hospitals are often the only places to treat the disease effectively.

Poor rates of diagnosis and lack of access to effective treatment creates significant costs and hardship for TB sufferers and their families. Even for straightforward cases which are cured, the cost to households, mainly from lost income, is around 120,000 Naira, which can be catastrophic for poor families.  An average delay of around three months from onset of symptoms to receiving treatment also allows further transmission of the diseases.

Diagnosis using a microscope to screen sputum samples is cheap and the most common method used. However, it may miss substantial numbers of sufferers and more expensive techniques are needed to improved detection rates and find cases of drug-resistant infection. Treatment of most cases takes six months and, in Nigeria, the adherence rate is very high, which contributes to the 86% cure rate.

TB is a big problem for Nigeria but one which can be tackled effectively. This would be a very good investment and would mainly benefit the poorest members of society.