Nigeria
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Nigeria has the world’s fifth largest tuberculosis (TB) burden, with nearly 449,600
estimated new cases in 2006. According to the World Health Organization’s (WHO’s)
2008 report on global TB control, 44 percent of the new TB cases in 2006 were
sputum smear-positive (SS+) cases. Since 2002, DOTS (directly observed treatment,
short course) coverage has increased rapidly from 55 percent in 2002 to 75 percent
2006, and subsequently, the total notified cases of all forms of TB nearly doubled from
38,628 in 2002 to 70,734 in 2006. However, only 56 percent were SS+. Although still
far short of the WHO target of 70 percent, the TB case detection rate increased from
11 percent in 2002 to 20 percent in 2006. After declining for several years, the
treatment success rate has stabilized at 75 percent and is expected to return to near
79 percent in 2006. Both the case detection and treatment success rates were among
the lowest of high-burden TB countries. The public health burden posed by TB is
becoming increasingly important as the country’s HIV/AIDS epidemic unfolds. WHO
estimates that nearly 10 percent of new TB patients are HIV positive.
The National TB and Leprosy Control Program (NTBLCP) coordinates and provides
strategic direction for TB control activities in Nigeria. The Federal Ministry of Health
declared TB a national emergency in April 2006 and inaugurated the National TBHIV/
AIDS Working Group in June 2006.
USAID Approach and Key Activities
USAID’s approach in Nigeria complements the priorities of the government, WHO,
and other partners. USAID financial support began in 2002, and the Mission initiated TB
activities under a strategic plan for 2004–2009. Since 2003, USAID has supported the
DOTS expansion drive in Nigeria by providing funds through WHO for the
implementation of the accelerated DOTS expansion plan of the NTBLCP. Between
2003 and 2006, USAID funds for TB programming in Nigeria averaged $1.2 million per
year and in fiscal year 2008, funding increased to $4.8 million. USAID supports the
NTBLCP in the following areas:
- Coordinating TB activities at the state, national, and international levels
- Establishing DOTS treatment centers in new local government areas (LGAs)
and strengthening zonal and state coordination and supervision
- Expanding the diagnostic network by providing microscopes, reagents, HIV
test kits, and other laboratory equipment
- Training laboratory technicians to work in new microscopy centers
- Training cadres of health workers in 17 states in northern Nigeria on DOTS
service delivery and TB-HIV/AIDS activities
- Developing, printing, and distributing reporting and recording formats for TBHIV/
AIDS activities and guidelines for MDR-TB activities
- Expanding TB-HIV service provision
- Strengthening management and leadership of TB control programs at national
and state levels
- Strengthening TB drug and commodity logistics systems
- Establishing community TB care in 50 communities in eight states
- Strengthening programmatic and clinical management of MDR-TB
- Supporting the establishment of a zonal reference TB culture facility
- Strengthening public-private mix (PPM) DOTS services in six states
USAID Program Achievements
USAID’s assistance and support have helped address TB prevention and control in Nigeria. USAID’s program achievements
include the following:
- Expanded DOTS services in 17 states in northern Nigeria and increased the TB diagnostic and treatment services to 42
LGAs, bringing the number of LGAs providing DOTS nationwide to 774 (approximately 100 percent) by the end of 2008
- Increased the number of TB cases detected: 58 percent of all cases detected in 2006 were detected in the 17 USAID supported
states
- Established 84 new DOTS treatment services and TB laboratory microscopy services in the 17 USAID-supported states
- Trained a total of 1,134 health care workers, including community health workers and laboratory staff, in a variety of
areas, including DOTS service delivery, laboratory diagnosis, commodity logistics, and community TB care
- Established community TB care activities, including treatment support, in 87 communities in eight states
- Assisted with the development of the 2009–2015 State TB Strategic Plan in the USAID-supported 17 states
- Supported the development of the strategic framework and guidelines, protocols and curriculum development for MDRTB,
community TB care, and PPM-DOTS services
- Assisted with the development of a logistics management and information system for TB drugs and commodities
- Developed a curriculum for management and leadership training and to strengthen management capacity at the national
and state levels
- Provided support to build the capacity of the government for supervision, training, and monitoring of TB activities
- Continued support for four National Program Officers in three regions to provide technical guidance and supervise and
monitor TB and TB-HIV/AIDS activities
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
Partnerships
The international community provides significant support for TB control in Nigeria. The NTBLCP coordinates all partnership
activities. The Stop TB Partnership provides technical support, assists with fundraising, and provides drugs through the Global TB
Drug Facility. WHO works through the Stop TB Partnership at its headquarters and regional offices in Africa to provide direct
technical support to the NTBLCP. The main partners assisting with DOTS implementation are the Tuberculosis Control
Assistance Program, the German Leprosy and Tuberculosis Relief Association, the Damien Foundation, the Netherlands Leprosy
Relief, the U.K. Department for International Development, the Canadian International Development Agency, and the
International Union Against Tuberculosis and Lung Disease. These organizations provide support for training, supervision, logistics,
equipment, and drugs. In 2006, the Global Fund to Fight AIDS, Tuberculosis and Malaria approved a Round 5 grant for $25.8
million to support TB and TB-HIV/AIDS activities in Nigeria. These funds are focused on improving TB case detection and
outcomes and enhancing TB-HIV/AIDS collaboration.
January 2009
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