From DOTS to the Stop TB Strategy: DOTS coverage and trend of tuberculosis notification in Ebonyi, southeastern Nigeria, 1998-2009.

Publisher: African Field Epidemiology Network Country of Publication: Uganda NLM ID: 101517926 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1937-8688 (Electronic) NLM ISO Abbreviation: Pan Afr Med J Subsets: MEDLINE

Original Publication: Kampala, Uganda : African Field Epidemiology Network

Disease Notification/*statistics & numerical data ; Tuberculosis/*epidemiology; Adolescent ; Adult ; Child ; Directly Observed Therapy ; Female ; History, 21st Century ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Mycobacterium tuberculosis/isolation & purification ; Nigeria/epidemiology ; Retrospective Studies ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy ; Young Adult

Background: Nigeria ranks fourth among the 22 high tuberculosis (TB) burden countries. The estimated incidence of all TB cases in 2009 was 311/100,000 population. Since the implementation of DOTS in Ebonyi state, southeast Nigeria, the epidemiology of TB in the region has not been documented. Therefore, the objective of this study was to assess the type and case notification dynamics of TB following DOTS expansion and to examine age- and sex-specific trends in TB notification rate.
Methods: A retrospective trend analysis of case notification data from the Ebonyi State Ministry of Health records from 1998 to 2009 was conducted. Patients were diagnosed according to the National TB and Leprosy Control Programme guidelines. Denominators for TB notifications were derived from population census data.
Results: Of the 24, 475 cases notified between 1998 and 2009, 66% were smear-positive, 31% smear-negative and 3% had extra-pulmonary tuberculosis. Overall, the proportion of new smear-positive cases notified decreased continuously from 67% to 48% in 2009 while that of smear-negative cases increased from 29% to 40% in 2009. In 2005, 13 (100%) of the local government areas were covered by DOTS. Despite initial increase in case notification with DOTS expansion, the case notification rate had a mean annual decline of 3.1% for all TB cases (falling from 123/100,000 to 77/100,000), and of 5% for smear-positive patients (falling from 80/100,000 to 32/100,000). Smear-positive notification rate in children <14 years was consistently low while 25-34-year-old persons were affected most. However, smear-positive rates among persons aged =65 years did not change. Overall, annual new smear-positive notification rates were persistently lower in females than males.
Conclusion: TB notification rate shows a decreasing trend in our region with a pool of infectious cases in young-persons. Additional targeted, type and age-/sex- specific interventions for TB control are needed.

Bull World Health Organ. 2002;80(6):457-63. (PMID: 12132002)
Int J Tuberc Lung Dis. 2002 Jan;6(1):11-8. (PMID: 11931395)
Lancet Infect Dis. 2003 May;3(5):288-96. (PMID: 12726978)
Int J Tuberc Lung Dis. 2000 Oct;4(10):904-10. (PMID: 11055756)
BMC Public Health. 2009 Oct 04;9:371. (PMID: 19799801)
S Afr Med J. 2003 Feb;93(2):149-52. (PMID: 12640889)
Respiration. 2003 Sep-Oct;70(5):468-74. (PMID: 14665770)
Proc Natl Acad Sci U S A. 1998 Nov 10;95(23):13881-6. (PMID: 9811895)
Trop Med Int Health. 2004 Jul;9(7):833-41. (PMID: 15228495)
Tuber Lung Dis. 1993 Jun;74(3):191-4. (PMID: 8369514)
Clin Infect Dis. 2006 Apr 1;42(7):1040-7. (PMID: 16511773)
J Natl Med Assoc. 2003 Nov;95(11):1082-8. (PMID: 14651375)
Int J Tuberc Lung Dis. 2006 Oct;10(10):1166-71. (PMID: 17044212)

Keywords: DOTS; Epidemiology; Nigeria; Tuberculosis; case finding; control

Date Created: 20111207 Date Completed: 20120808 Latest Revision: 20220321

20240829

PMC3215534

10.4314/pamj.v9i1.71187

22145056