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Analysis of the Infection, prevention, and Management of Tuberculosis in Nigeria

Student’s name

Institutional affiliation

Date
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Table of Contents
1.0. Introduction...........................................................................................................................4
2.0. Rationale for the analysis of the infection, prevention, and Management of tuberculosis in
Nigeria……………………………………………………………………………………………..5
2.1. Importance of the analysis of the infection, prevention, and Management of tuberculosis
in Nigeria......................................................................................................................................5
2.2. Current Statistics and Policies..............................................................................................6
2.3. Microbiology, epidemiology, and infection prevention.......................................................7
2.4. Health Protection and public health theories.......................................................................8
3.0. Strategies for the current Management of Tuberculosis.......................................................9
3.1. Current management strategies for tuberculosis...............................................................9
3.2. Achieved success in the prevention and Management of tuberculosis in Nigeria..........10
3.3. Challenges Faced in the Prevention and Management of Tuberculosis in Nigeria........11
3.4. Policies and guidelines related to tuberculosis management..........................................12
4.0. Recommendations...............................................................................................................13
5.0. Conclusion..........................................................................................................................13
References......................................................................................................................................15
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ACRONYMS

TB- Tuberculosis

MDR-TB - Multidrug-Resistant Tuberculosis

NGOs – Non-governmental organizations

NCDC - The Nigeria Centre for Disease Control

WHO – World Health Organization

IPT - Isoniazid preventative therapy

BCG - Bacille Calmette Guerin

DOTS - Directly Observed Treatment, Short-Course

NTP - National TB Control Programme

IDSR - Integrated Disease Surveillance and Response

NTBLCP - National Tuberculosis and Leprosy Control Programme

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1.0. Introduction
Tuberculosis (TB), a highly contagious disease caused by Mycobacterium tuberculosis,

remains a major global health concern, especially in settings with limited resources (Akande,

2020). TB continues to pose a formidable challenge in Nigeria, with high morbidity and

mortality rates and substantial socioeconomic implications. The estimated prevalence rate of

tuberculosis in Nigeria is 371/100000 people, ranking it sixth in the globe (WHO, 2018).

Furthermore, competition between TB and other diseases for limited health resources severely

impedes effective diagnosis, prevention, and treatment of TB in Nigeria (Alao et al., 2020). The

effective prevention and Management of tuberculosis are crucial in reducing its impact on

individuals, communities, and healthcare systems.

This essay critically analyzes tuberculosis infection, prevention, and Management in

Nigeria, considering its relevance to infection prevention and management practices in our

context. By examining the current strategies, successes, and challenges associated with

tuberculosis control, we can identify areas for improvement and propose recommendations for

research, policy, and practice. This study will address the focused research question: What are

the critical challenges in effectively preventing and managing tuberculosis in Nigeria, and how

can they be addressed? By exploring this question, we can gain insights into the specific barriers

and opportunities in tuberculosis control efforts in Nigeria, ultimately aiming to contribute to

improved outcomes in TB prevention, diagnosis, and how to treat it..

In order to establish the significance of this issue, it is essential to consider the

perspectives of various stakeholders and organizations. By delving into up-to-date statistics,

policy documents, and research studies, we can comprehensively assess the importance of

tuberculosis prevention and Management from multiple angles. Also, using important theories,
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ideas, and principles from microbiology, epidemiology, infection prevention, health protection,

and public health will give our analysis a solid foundation. By critically evaluating the existing

strategies for tuberculosis management, including recent successes and remaining challenges, we

can gain a deeper understanding of the current landscape. This assessment will be supported by

examining pertinent statistics, policies, and research findings, ensuring a well-rounded, evidence-

based discussion. In synthesizing the findings, we will derive research, policy, and practice

recommendations rooted in the initial analysis. These recommendations will serve as potential

avenues for addressing the identified gaps and improving the overall Management of

tuberculosis in Nigeria

2.0. Rationale for the analysis of the infection, prevention, and Management of

tuberculosis in Nigeria

2.1. Importance of the analysis of the infection, prevention, and Management of

tuberculosis in Nigeria
Tuberculosis (TB) is a severe public health problem in Nigeria, devastatingly affecting

the country's economy, population, and quality of life. The new tuberculosis cases in Nigeria

have been rising to 467000 as per 2021 statistics, making it the country with the highest TB

morbidity in all of West Africa (Dayyab et al., 2022). Furthermore, tuberculosis is Nigeria's

sixth leading cause of death, with a mortality rate of more than double the global norm (400 per

100,000 people) (Iweama et al., 2021). Costs associated with treating tuberculosis, especially in

rural regions, might cause families to go into debt, limiting their ability to invest in their

children's futures.

Physical, mental, economic, and social aspects of TB all contribute to the overall burden

of the disease for those who suffer from it (García-Basteiro et al., 2018). TB can cause severe

physical symptoms that, if addressed, can worsen the patient's health. Having multidrug-
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resistant tuberculosis (MDR-TB) makes therapy take longer and costs more money (Bieh et al.,

2017). The stigma associated with tuberculosis also discourages people from getting treatment

and might hinder their professional or academic advancement (Kuyinu et al., 2019). Without

proper training and resources, tuberculosis can place a heavy load on healthcare providers. TB is

not generally detected and treated promptly, increasing the risk of progression and death due to

inadequate laboratory and diagnostic infrastructure.

The ramifications for the government and NGOs are crystal clear: They must devote

resources to creating TB control and preventive programs, including better access to diagnosis,

treatment, and care (Ahmad et al., 2018). There has to be more work done in the areas of

research and advocacy to reduce the adverse effects of stigma and improve living and working

conditions for people with tuberculosis. Better TB detection and care will be possible with more

knowledge and training for healthcare providers. Improved TB care and prevention will reduce

TB-related fatalities and positively affect individuals, communities, and Nigeria (Adejumoa et

al., 2017). Individuals, healthcare providers, governments, and non-governmental organizations

all bear a high cost because of tuberculosis. Reducing Nigeria's death, illness, and social and

economic disruptions requires immediate action.

2.2. Current Statistics and Policies

With a total of 467,000 TB cases in 2021, Nigeria ranks as the 4th most afflicted country

in the globe (Lassa et al., 2022). The estimated TB prevalence is 396 per 100,000, with 68% of

TB cases also infected with HIV (WHO, 2018). Despite improvements in TB therapy, the

national treatment coverage rate is only 76%. Communities in rural areas and specific

population groups, including migrants, refugees, individuals living with HIV/AIDS, and

prisoners, are disproportionately affected by tuberculosis (Idowu et al., 2021). Thus, healthcare
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inequalities persist in Nigeria, making these populations more vulnerable to tuberculosis due to

poor access to preventative care, diagnosis, and treatment. In addition, the existing TB load is

not adequately addressed by the nation's health infrastructure and services.

The Nigeria Centre for Disease Control (NCDC) is in charge of spearheading Nigeria's

fight against tuberculosis (TB), and it is doing so by following WHO policy recommendations

such as the Stop TB Strategy, the Global Plan to Stop TB, and the End TB Strategy (Akande,

2020). Additionally, the NCDC has produced a National Tuberculosis Policy to direct

intervention measures, and the MDR-TB Treatment Guidelines give guidelines for Nigeria on

handling drug-resistant TB infections. However, the lack of resources for tuberculosis programs

in the country continues to pose obstacles to implementation and service delivery, which in turn

impacts the accessibility, quality, and efficiency of TB care (Muhammad et al., 2017).

Sustainable funding, increased resources, and higher investment in health systems are crucial for

effectively reducing the TB burden in Nigeria.

2.3. Microbiology, epidemiology, and infection prevention

The bacterium Mycobacterium tuberculosis causes the infectious disease tuberculosis

(TB) (Oyefabi et al., 2017). It is spread through breathing in tiny droplets that carry the

Mycobacterium tuberculosis bacteria when an infected person talks, sneezes, or coughs.

Because the air communicates tuberculosis, it is often spread in close quarters, such as a house or

a medical facility (Oladimeji et al., 2017). In Nigeria, where it is prevalent, an estimated

467,000 new cases and 70,000 loss of life occur yearly (WHO, 2018). Poor socioeconomic

conditions and lack of access to health services are essential drivers in the spread of tuberculosis,

primarily affecting people aged 20–49 and HIV-positive individuals. Overcrowding and

ventilation, which is frequently stagnant and poorly maintained, also contribute to the spread of
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Mycobacterium inside a single space (Tan et al., 2020). Inadequate nutrition, HIV/AIDS,

smoking, exposure to silica and other cell poisons, and substandard living conditions also elevate

the danger of infection.

Active case detection, or the use of mobile and digital health technology to identify

patients with latent or active tuberculosis, is one method now used to decrease TB's prevalence in

Nigeria (Akande, 2020). In addition, work is being done to improve access to health care,

decrease hospital crowding, and disseminate educational materials about tuberculosis. Isoniazid

preventative therapy (IPT) and treatment surveillance are more strategies to lower the illness rate

(Okonko et al., 2018). Treatment and vaccination (BCG) have also been introduced. However,

their uptake varies significantly between areas.

2.4. Health Protection and public health theories

Tuberculosis control in Nigeria relies heavily on public health precautions, including

surveillance and contact tracing (Fadare et al., 2020). The prevalence of tuberculosis in a

population may only be estimated, making surveillance an essential first step. It makes it

possible to spot at-risk subsets of the population and emerging patterns and pinpoint places with

an elevated risk profile (Oshi et al., 2017). Surveillance measures like tuberculosis prevalence

surveys and mortality data can better inform health policy decisions. Tracing infected

individuals' contacts is crucial for preventing the spread of disease and facilitating prompt

medical attention in cases of suspected infection (Islam., 2021).

Public health theories like the Health Belief Model and the Social Ecological Model can

inform strategies for preventing and managing tuberculosis in Nigeria (Oshi et al., 2017). The

Health Belief Model can create efficient interventions by highlighting the significance of

individuals' perceptions of their health and vulnerability to disease (Ahmad et al., 2018). High-
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risk groups and intervention points can be determined using the Social Ecological Model, which

explains how the surrounding environment and people's social connections affect health

outcomes (Sariem et al., 2020).

Surveillance and contact tracing are two examples of health protection methods

contributing much to Nigeria's TB control (Akinsola et al., 2018). Targeted interventions

informed by appropriate public health theories and concepts linked to monitoring, infectious

disease control, and community engagement are also essential components of a comprehensive

TB prevention and Management plan (Hassan et al., 2017). In order to effectively manage and

prevent tuberculosis in Nigeria, these measures must be linked to sufficient financial resources,

health education, and health care services.

3.0. Strategies for the current Management of Tuberculosis

3.1. Current management strategies for tuberculosis
In order to combat tuberculosis, Nigeria implemented the World Health Organization

(WHO)-recommended DOTS (Directly Observed Treatment, Short-Course) method (Ogbuabor

& Onwujekwe, 2019). The NTP's primary goal is to wipe out tuberculosis in Nigeria by 2030

completely. Directly observed therapy (DOT), prompt and accurate diagnosis, detailed

reporting, effective drug supply management, combination drug therapy, and patient education

are all components of the DOTS approach (Kuyinu et al., 2019). Drug administration

monitoring (DOT) is a method used to ensure patients are taking their medications as prescribed.

Implementing GeneXpert devices, a quick molecular diagnostic technology, in primary health

care centers paves the way for early and accurate diagnosis (Okonkwo et al., 2017). Mobile

Tuberculosis Units, Integrated Disease Surveillance and Response (IDSR), and Multidrug-

Resistant Tuberculosis (MDR-TB) registries are all used in intensive case monitoring and
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reporting. Free medication is provided to tuberculosis patients as part of drug supply

management, and a six-month supply is kept on hand to avoid stockouts.

Community health workers, who interact directly with patients, public and private health

facilities, and other programs to improve access to care, coordination of care, and medication

adherence, are also crucial to the success of DOTS in Nigeria (Ukwaja et al., 2017). Both

contact tracking and education about tuberculosis are tasks that community health professionals

take on. Because it facilitates participation at the community level and provides funding for

specific patient needs, patient education and counseling are integral parts of this program (Onuka

et al., 2018). Health professionals, the government, community organizations, and individuals

living in affected areas must all work together effectively for Nigeria's national tuberculosis

control program to be successful. To effectively combat tuberculosis nationwide, all parties

must work together to properly implement the DOTS strategy and develop the necessary

resources and instruments.

3.2. Achieved success in the prevention and Management of tuberculosis in

Nigeria
Recent advances in Nigeria's tuberculosis control efforts include access to preventative

measures, improved case detection, and enhanced treatment success rates (Ahmad et al., 2018).

Establishing the Nigeria NTP 3.0 policy in August 2018 is an example of a successful

intervention; the policy aims to reduce the rising incidence of tuberculosis by increasing funding

for national tuberculosis programs and instituting a comprehensive care system (Ogbuabor &

Onwujekwe, 2019). Diagnostic and other health services will be available to more people, and

TB testing networks will be set up. Quality-assured diagnosis and treatment will also be

implemented.
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The treatment of tuberculosis has improved in Nigeria, according to the statistics. The

World Health Organization reports that in 2018, 68.3%% of TB patients in Nigeria were

successfully treated, up 7% over the previous year, and the national TB prevalence rate was

reduced by 12% (WHO, 2018). There was an 83.0% success rate 2022 in the number of children

ages 0-14 who had TB treatment (Dayyab et al., 2022). Nigeria's government has effectively

expanded treatment intervention access to previously inaccessible populations. In 2018, a new

medicine was added to the national TB program, expanding access to treatment for kids in high-

burden, hard-to-reach places (Ogbudebe et al., 2018). The United Nations Joint Program on

Tuberculosis, HIV/AIDS, and Malaria helped make this possible, improving patients' treatment

access.

The government has also organized drug administration campaigns, conducted mass

medication administration, advocated for TB patients, and mobilized the community (Ugwu et

al., 2021). Positive outcomes have been observed as a result of these therapies. The number of

TB diagnoses grew by 17% between 2017 and 2020, with a corresponding increase in treatment

success rate from 82.2% to 84.8% (Lassa et al., 2022). Treatment success for drug-sensitive

tuberculosis has also increased from 84.2% to 87.2%.

3.3. Challenges Faced in the Prevention and Management of Tuberculosis in

Nigeria
Despite several efforts to stop the spread of tuberculosis (TB), the illness continues to be

a severe problem for public health in Nigeria. WHO estimates there were 467,000 TB cases in

Nigeria in 2021, with a more significant percentage of those being new cases of multi-drug-

resistant TB (Lassa et al., 2022). At 97 deaths per 100,000 residents, tuberculosis (TB) remains

Nigeria's biggest cause of death. Drug resistance, treatment noncompliance, and lack of access

to care are Nigeria's three biggest problems with tuberculosis management (Tan et al., 2020). In
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2018, drug-resistant TB was detected in 72 percent of newly diagnosed cases and 46 percent of

previously treated cases, making it one of the world's deadliest infectious diseases (Akande,

2020). Nearly 60% of TB patients in Nigeria do not finish their recommended regimens,

highlighting the importance of improving treatment adherence. The high price of the

medications and the limited availability of healthcare contribute to this problem.

In addition, it is difficult for tuberculosis patients in Nigeria to get the medical attention

they need. There are several causes for this, including a shortage of skilled medical

professionals and the resources necessary to provide competent care (Sariem et al., 2020). Poor

people in Nigeria are more likely to get tuberculosis and less likely to be able to afford treatment.

Hence the disease has a disproportionately negative impact on the country's poor. Numerous

socioeconomic issues and constraints within the healthcare system impede efficient TB

management in Nigeria (Ukwaja et al., 2017). Healthcare for everyone, early diagnosis and

treatment nationwide, and continuing education for medical professionals are all essential

components of any plan to lessen the nation's TB burden. Nigeria can only solve its TB

problems once it fixes its current TB management problems.

3.4. Policies and guidelines related to tuberculosis management

Nigeria is classified as a high-burden country for tuberculosis (TB) and has recently

enacted a national policy and guidelines for TB management. The policy provides for

consolidating all public TB services within the framework of the National Tuberculosis and

Leprosy Control Programme (NTBLCP) (Ogbuabor & Onwujekwe, 2019). It details the roles

and responsibilities of stakeholders from the State, Local Governments, Federal and the private

sector. The Nigeria guidelines for TB management emphasize evidence-based approaches for

diagnosing and managing TB, including contact tracing and case finding (Onuka et al., 2018). It
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highlights the importance of accurate and timely laboratory testing for diagnosis and distinctions

between smear-positive and smear-negative TB.

The policy advocates improved infection control measures at all healthcare facilities,

including isolation and masking, as well as the use of personal protective equipment (Oshi et al.,

2017). In addition, Nigeria's policy for TB management promotes community awareness and

participation in activities related to TB care and control. It advocates for public health research

and comprehensive health system strengthening (Alao et al., 2020). Lastly, it stresses the

importance of training health workers in TB diagnosis, Management, and control. Akande (2020)

asserts that the current policies and guidelines related to TB management in Nigeria emphasize

the need for collaboration between the government and other stakeholders, scaling up evidence-

based approaches for diagnosis and care, and improved awareness among TB patients and the

community.

4.0. Recommendations
Nigeria should invest in public health efforts that guarantee complete diagnosis, control,

and treatment of TB to better its prevention and Management of the disease (Adejumoa et al.,

2017). Funding for pharmaceuticals and medical treatments, increasing investment in health

systems, creating community health workers to aid with contact tracing, and educating patients,

should all be part of these programs (Fadare et al., 2020). Fighting the stigma that surrounds

tuberculosis (TB) and raising public knowledge about its prevention through public health

campaigns and educational materials is also crucial (Ukwaja et al., 2017). Community-level

interventions like TB patient support groups could also enhance access to care and patient

support (Oluwasanu et al., 2020). Finally, we need to expand access to healthcare in

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underserved and rural areas so that everyone can get a TB diagnosis, preventative measures, and

treatment if needed (Kuyinu et al., 2019).

5.0. Conclusion
In conclusion, TB is a significant health concern in Nigeria and will continue to pose a

substantial burden until effective strategies are implemented. While Nigeria has made some

progress in preventing and managing tuberculosis, further efforts must be made to ensure

sustainable and successful national TB control strategies. Tanzania has significantly benefitted

from the DOTS approach. However, the high prevalence of Drug-Resistant Tuberculosis and

treatment noncompliance means there is still a high disease burden in the country. In order for

Nigeria to effectively reduce the burden of TB, it is essential that resources are allocated to

proper surveillance, diagnosis, care, and treatment, as well as TB prevention strategies like

contact tracing and education. Additionally, stakeholders must continue to work together to

ensure adequate funding for health systems, implement targeted interventions informed by public

health theories, and enhance access to care for vulnerable populations. If these measures are put

in place, the prevalence of tuberculosis in Nigeria will be more effectively addressed, leading to

improved healthcare outcomes and reduced mortality.

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