An ecological study of the factors associated with childhood tuberculosis in Nigeria

Background: Childhood tuberculosis (TB) account for about 6% of the global TB burden, but there is a paucity of data on childhood TB at the national and state level in many countries in Sub-Saharan Africa.Objective: To assess the childhood TB case notification rates and explore associated factors at the state level in Nigeria.Methods: A retrospective ecological study was carried out to determine the childhood TB case notification rates in the 36 states and the Federal Capital Territory (FCT) in Nigeria. TB data was retrieved from the National TB and Leprosy Control Programme (NTBLCP) 2014 Annual Report using a proforma. The association between TB case notification rate at the state level and the six selected explanatory variables (Human Development Index, Bacillus Calmette-Guerin [BCG] coverage, percentage underweight, HIV positivity rate, mean household size and population density) were carried out using negative binomial regression in R statistical software.Results: A total of 91, 353 TB patients were notified to the World Health Organization (WHO) in 2014 by the NTBLCP. Of these, 5463 (6%) were children aged 0-14 years. The childhood TB notification rate was 6.99/100,000 population. The highest childhood TB case notification rate was recorded in Nasarawa State followed by Lagos and Oyo States. There were significant associations between childhood TB case notification rate and HIV positivity rate, percentage underweight, household size, population density and BCG coverage.Conclusion: The study showed that childhood TB case notification rate in Nigeria was low. TB case notification rate was associated with high HIV rate, percentage underweight, household size, population density and BCG coverage. There is the urgent need to address the associated risk factors to effectively control childhood TB in Nigeria

Determinants of health system delay at public and private directly observed treatment, short course facilities in Lagos State, Nigeria: a cross-sectional study

Objective/background: Despite several studies on health system delay [HSD] among tuberculosis [TB] patients in Nigeria, no study has compared HSD in private and public health facilities. This study assessed the determinants of HSD in public and private health facilities offering the directly observed treatment, short course [DOTS]

Methods: A descriptive cross-sectional study was conducted. A total of 470 new smear-positive TB patients aged 14 years and older were consecutively recruited between October 1, 2012, and December 31, 2012, from 34 [23 public and 11 private] DOTS facilities that offered treatment and microscopy services. Mann-Whitney U test and logistic regression were used to assess the determinants of HSD

Results: The median HSD was longer at public DOTS facilities [14 days; interquartile range [IQR] 10-21 days] than private DOTS facilities [12.5 days; IQR 10.0-14.0 days, p = .002]

Age and human immunodeficiency virus status were determinants of HSD at the public DOTS facilities, whereas sex and income were determinants of HSD at the private DOTS facilities. TB patients who first visited a nonhospital facility were over four times more likely [odds ratio 4.12; 95% confidence interval 2.25-7.54] to have prolonged HSD than those who first visited the government hospital when they first developed the symptoms of TB after controlling for other factors in the model

Conclusion: Determinants of HSD at the public and private DOTS facilities vary. Strategies to reduce HSD at both public and private DOTS facilities in Lagos State, Nigeria, are urgently needed

Trend of childhood TB case notification in Lagos, Nigeria, 2011 - 2014

Childhood tuberculosis [TB] has been neglected by national TB programs in sub-Saharan Africa because of the emphasis on adult smear-positive TB cases. About 80,000 HIV children die from TB, and over 550,000 childhood TB cases occur annually, representing 6% of the global TB burden, making TB an important cause of morbidity and mortality in children. Thus, this study assessed the trend of childhood TB cases notified in Lagos, Nigeria from 2011 to 2014. Retrospective data review of childhood TB cases notified to the Lagos State TB and Leprosy Control Programme [LSTBLCP] between January 1, 2011 and December 31, 2014. A total of 2396 children were treated for all forms of TB representing 6.8% of the total 35,305 TB cases notified during the study period. This constituted 1102 [46%] males and 1294 [54%] females. There was a progressive increase in the proportion of children treated for TB from 495 [5.9%] in 2011, 539 [6.4%] in 2012, 682 [7.2%] in 2013 and 680 [7.6%] in 2014. Of the total childhood TB cases notified, 16.3-20% were new sputum pulmonary smear positive; 68.2-74.6% were new sputum pulmonary smear negative; while extra-pulmonary TB accounted for 6.7-10.6%. The case notification rate [CNR] of childhood TB per 100,000 increased from 13.4 in 2011, 14.3 in 2012, 17.7 in 2013 and 17.2 in 2014. There was an increase in the case notification rate of TB among children between 2011 and 2014. Efforts should be made to sustain this increasing trend