Let Us Unite to End TB in Nigeria

Address by Professor Isaac F. Adewole during the 2017 World TB Day Commemoration


It gives me great pleasure and honour to address this distinguished gathering on this occasion to commemorate the 2017 World Tuberculosis (TB) day in Nigeria. As we all know, 24th March of every year has been set aside globally to commemorate the World TB day. It is a day designed to raise awareness on this disease of public health importance; and, it is also a moment for us as a country to reflect on how much progress we have made in the fight against TB.

Tuberculosis today, remains a serious public health problem in most parts of the world causing deaths of nearly one-and-a-half million people each year, mostly in developing countries. According to the 2016 WHO Global TB report, there were an estimated 10.4 million new TB cases worldwide in 2015, of which 5.9 million (56%) were among men, 3.5 million (34%) among women and 1.0 million (10%) among children. Our dear country, Nigeria, is among the six countries that accounted for 60% of the new cases globally.

Nigeria ranks 4th among the 30 high TB burden countries globally and it is number one in Africa. Unfortunately, the burden of the disease in Nigeria is further made worse by the negative effects of the interactions between TB and HIV. TB is the most common life-threatening disease and the number one killer among People Living with HIV (PLHIV). Furthermore, the emergence of drug resistant TB currently impacts negatively on TB control efforts in the country.

This administration through the Federal Ministry of Health and in collaboration with Partners has taken some bold steps to control TB in Nigeria. Some of these steps are as follows:

· We introduced the use of the GeneXpert MTB/RIF technology as the primary diagnostic tool for TB among all presumptive TB cases in the country including PLWHA. This is expected to increase the number of TB cases notified in the country. The country in collaboration with partners has scaled up the number of facilities providing GeneXpert services from 7 health facilities in 2011 to 318 facilities before the end of 2016. Efforts are ongoing to scale up to more facilities in 2017 to achieve the target of having one machine per LGA.

· We have produced guidelines, tools and SOPs to enhance TB control efforts. These include the development and printing of National bio-safety laboratory guidelines and national Standard operating procedure documents with the support of Agbami Partners and the development of National SOP for managing TB in crisis situation and the framework for the implementation of END TB strategy in Nigeria with support from WHO and USAID among others.

· Government has ensured the integration of TB into the core-package of revitalization agenda of PHCs in the country. This will bring effective health services closer to the population thereby increasing patronage for all services including TB. This is seen in the recent launch of PHC Kuchigoro, AMAC FCT where a well-equipped DOTS centre was established.

· We have scaled up access to quality assured Drug Resistant TB diagnostic (DR TB) and treatment services. There are 9 reference laboratories in the country- NIMR, Lagos; NTBLTC, Zaria; Dr Lawrence Henshaw Memorial Hospital Calabar; UCH Ibadan ; AKTH Kano; JUTH Jos; UPTH Port Harcourt; Zankli reference laboratory, Nasarawa ; FMC Yola. The Reference Laboratory in Amachara Abia state is currently being equipped and will become functional by 2nd quarter 2017. There are 15 functional DR-TB treatment centres in the country as at end of 2016. I am pleased to announce that two additional health facilities (ERCC Alushi, Nasarawa state and FMC Yola, Adamawa state) are also ready to commence admitting MDR TB patients. Ambulatory management of DR-TB is also being provided to eligible patients at the community level to further increase access to DR-TB treatment in a patient-centred manner. The programme has also adopted the implementation of the shorter regimen for DR-TB cases with use of more efficacious drugs to enhance treatment adherence and also reduce the patient waiting time. Treatment with shorter regimen will be for 9 months instead of the traditional 20 months. This is to commence in July 2017 in a phased manner.

· We have increased provision of integrated and patient centered TB/HIV services to all health facilities with the aim of reducing morbidity and mortality, and as well as achieving the following set TB/HIV targets:

§ 100% TB patients with documented HIV status;

§ 100% of HIV positive TB patients receiving ART;

§ 100% of PLWHA screened for TB and

§ 100% of eligible PLWHA receiving IPT.

· Government has embarked on the use of electronic platform (e-TB Manager) to capture information on Drug Susceptible TB (DS-TB) in addition to that of the Drug Resistant TB (DR-TB). We have increased e-TB managers to 19 states as at March 2017 and our desire is to cover the whole country before the end of 2017. This initiative will ensure capturing of real time data on TB in the country for effective and efficient programme planning and decision making.

· Lastly, we are mobilising resources to scale-up the GX Alert system which gives real time information on the diagnosis of drug resistant TB cases across the country.

Distinguished Ladies and Gentlemen, it is worthy to note that children also bear the burden of this disease; TB is a major threat to the rights of the child, adolescents and their families. It also has potential to impact negatively on the survival, growth and development of our children. Despite these obvious challenges, childhood TB is most seriously neglected, under-diagnosed and poorly managed. To address this unacceptable marginalization of the children in the National TB control efforts, the programme has established a task team on childhood TB which supported the development of the roadmap that is currently being implemented by the programme.

The desk guide for the Childhood TB was reviewed and published in 2016 to provide the health workers with the necessary information on all aspects of childhood TB. The algorithm for the diagnosis of childhood TB using other body fluids for the Xpert technology has also been approved for use in the country. As a result of the difficulty in diagnosis of TB in Children, some resources have been set aside to support the reimbursement of cost of Xray for these children.

Ladies and gentlemen, despite all our successes in TB control, most of the TB patients in the country are still not being detected thereby enlarging the pool of infectious individuals. An estimated number of 586,000 TB cases occurred in Nigeria in 2016; with only about 17 % (100,434) of these cases being detected and notified by the TB Programme. About 83% of the TB cases in the country are undetected, the implications of this is that, there are lot of undiagnosed TB cases in the community which serve as reservoir for continue transmission of TB.

The TB Knowledge Attitude and Practice (KAP) survey conducted in 2013 also showed that the knowledge about TB in the community is low which could be one of the reasons why our case detection rate is still very low.

As part of our renewed energy to quickly end TB in Nigeria, the FMOH has declared 2017 as a year of accelerating TB case finding during last National Council on Health (NCH) meeting held in January in Abia state. We have developed a document highlighting innovative strategies for implementation of focused active case finding among the population at risk and the general population with the aim of enhancing TB case detection in the country; reducing the pool of TB transmission in the community and ensuring that no one is left behind in the TB control efforts.

Distinguished personalities, Ladies and Gentle men, the theme for this year’s World TB Day is Unite to End TB in Nigeria and the Slogan is — “Accelerating TB case finding and Treatment, could not have come at a more appropriate time than this in our country. May I also add that the National TB strategic plan which centred on demand creation, provision of universal access to prevention, diagnosis and treatment of TB cases will ensure achievement of all targets for the control of TB in our dear country. Furthermore, the FMOH has also adapted the End TB strategy with bold targets of ending TB epidemic in Nigeria by 2035 in line with the global target.

At this juncture, I wish to use this opportunity to thank Mr. President for putting health as one of the key components of the change agenda of this administration. One of the evidence of this is the launching of the revitalized PHC at Kuchigoro which was personally conducted by His Excellency President Muhammadu Buhari on January 10th, 2017. Today, the flagging-off of the use of GeneXpert machine at PHC level is another historic feat to re-assure Nigerians that this government cares about her citizen especially in the rural areas. Let me assure you that the Federal Government will continue to support States and Local Governments in providing drugs for the management of Drug Resistant TB and associated logistics. We will also continue to build the capacity for management of Drug Resistant TB at all levels. While this is ongoing, we shall aggressively pursue the expansion of services for all forms of tuberculosis.

Let me at this moment, salute our health workers in all DOTS and microscopy centers across the country as well as our State Control Officers for the wonderful work they are doing. To all our partners we say thank you for your support to our collective efforts to contain the menace of TB in our country. I thank the WHO, Stop TB Partnership, the Global Fund for AIDS Tuberculosis and Malaria, the Country Coordinating Mechanism, Nigeria, the Principal Recipients to GF on Tuberculosis (IHVN, ARFH), USAID, KNCV/Challenge TB, Management Sciences for Health (MSH), FHI 360, US-CDC, Abt Associates and the Civil society( TB Network). To our National Champion and our National Advocates for TB control in Nigeria, I want to also thank you for the support to eliminating Tuberculosis in Nigeria.

Lastly, one important assignment for all of us is the spread of TB messages for prevention, early TB case detection and treatment. We wish to solicit your support in spreading these few messages that:

  1. Cough for two or more weeks could be TB

2. Diagnosis and TB drugs are available free of charge in all DOTS centres nation-wide

3. TB is curable

4. So please see your healthcare provider or visit the nearest hospital to take a TB test or call this toll-free number 08002255282 for more information

We reaffirm our commitment to work in close collaboration with all stakeholders to make Nigeria free of TB.

Thank you and God Bless Nigeria