TITLE:
Spatial Disparity in Availability of Tuberculosis Diagnostic Services Based on Sector and Level of Care in Nigeria
AUTHORS:
Bethrand Odume, Sani Useni, Egwuma Efo, Degu Dare, Elias Aniwada, Nkiru Nwokoye, Ogoamaka Chukwuogo, Chidubem Ogbudebe, Michael Sheshi, Aminu Babayi, Emperor Ubochioma, Obioma Chijioke-Akaniro, Chukwumah Anyaike, Rupert Eneogu, Debby Nongo
KEYWORDS:
Tuberculosis, Diagnostic Services, Disparity, Sector, Level, Nigeria
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.11 No.1,
March
7,
2023
ABSTRACT: Background: Delay in Tuberculosis (TB) diagnosis can contribute to late
presentation, severe disease, and
continued transmission. KNCV TB Foundation Nigeria through the United States
Agency for International Development (USAID) funded the TB Local Organization Network (LON) 1 and 2
projects that explored
the availability of Tuberculosis services based on sector and levels of care. Methods: TB Patient Pathway Analysis was carried out in 14
states comprising 92 facilities. It involved primary, secondary, and tertiary
levels of health care in both the public and
private sectors. This was a cross-sectional study under program implementation.
Proforma was used to collect data on the available TB diagnostic services. Results: In public health facilities, GeneXpert was available at 100% in tertiary
facilities in 8 (57%) states; up to 82% in 4 (33%) states, 50% available at
secondary facilities in 2 states, and There is none at the primary facilities. Smear
microscopy was available at 100% in
tertiary facilities in 9 (64%) states and 3 (25%) states have 50% to 82%; secondary -10 (71%) states have > 70% at facilities; primary 1 (7%) state has it in 61%
of facilities. Loop-mediated isothermal amplification (TB-LAMP) in tertiary 2 (17%) states have 20% and
100% respectively; secondary 4 (and only 2 states (14%)
at tertiary facilities. Only 1 (7%) state has GeneXpert in
all tertiary facilities, 2 (14%) states have secondary facilities, and 4 states in about 1% of facilities. TB LAMP was not available in any
tertiary facility, one (7%) state at
secondary with coverage of 1%, and 2 (14%) states at primary both with
4% overall facility coverage. Conclusions: There is an inequitable
distribution of TB diagnostic services in both sectors and levels of care in Nigeria. TB care and control will
improve with enhanced equitable distribution of TB diagnostic services
across the health system.