Unfinished fight against tuberculosis

Nigeria has recently intensified efforts to eradicate tuberculosis, TB, a persistent public health challenge. Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, has been pivotal in driving these initiatives, aligning them with President Bola Tinubu administration’s Renewed Hope Agenda. What are Nigeria’s TB prevalence rate in a global context, endemic zones, historical battles against the disease, and the critical steps needed to achieve eradication?

Pate has emphasised Nigeria’s commitment to ending the TB epidemic by 2030, in line with global Sustainable Development Goals, SDGs. A landmark achievement was the commissioning of new molecular diagnostic machines, supported by a N1 billion donation from the First Lady, Senator Oluremi Tinubu. These machines enhance rapid and accurate TB detection, particularly in under-served areas.

The integration of TB services into primary healthcare systems is aimed at improving access to diagnostics, drugs, and human resources to ensure equitable care. The health sector renewal programme focuses on governance, population health outcomes, healthcare value chain development, and health security: all critical to addressing TB’s social determinants like poverty and limited healthcare access. Globally, Nigeria ranks sixth among high-burden TB countries, with an estimated incidence of 452,000 cases in 2020 and a prevalence rate of approximately 219 per 100,000 people in 2016, according to the Global Burden of Disease Study. Compared to India (188 per 100,000) and South Africa (513 per 100,000), Nigeria’s rate is moderate but significant, especially given its population size.

In Africa, Nigeria bears the highest TB burden, contributing 4.6 per cent of the global total. Endemic zones within Nigeria include Enugu North, where high TB and HIV co-infection rates persist, and Kaduna State, where occupational TB among healthcare workers is notable. Rural areas, particularly among nomadic populations, face severe challenges due to malnutrition, overcrowding, and limited healthcare access.

Over the years, Nigeria’s fight against TB has evolved. The National Tuberculosis and Leprosy Control Programme, NTBLCP, established in 1989, adopted the Directly Observed Treatment Short-course, DOTS, strategy, increasing case notifications from 106,533 in 2018 to 361,000 in 2023, a 26 per cent rise from 2022.

Despite disruptions from the COVID-19 pandemic, strategic interventions like house-to-house case searches and integration with COVID-19 responses boosted notifications. However, challenges like a 14,000-case notification gap in Enugu and a 39.96 per cent mortality rate in 2015 underscore persistent gaps in detection and treatment.

To fully eradicate TB, Nigeria must prioritise at least three actions. First, increase funding to strengthen laboratory networks and expand GeneXpert analyser access for early detection. Second, address social determinants by improving health insurance coverage in rural areas and tackling malnutrition, particularly among children. Third, implement gender-sensitive approaches, focusing more on men, who account for 57 per cent of cases.

With sustained political will, stakeholder collaboration, and these targeted strategies, Nigeria can become TB-free by 2030.

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