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Improving Tuberculosis case finding in Nigeria

Citation

Akwaowo, Christie et al. (2021), Improving Tuberculosis case finding in Nigeria, Dryad, Dataset, https://doi.org/10.5061/dryad.tht76hf07

Abstract

Paper I 

Background: Case detection for Tuberculosis remains low in high burden communities. Community Health Workers (CHWs) are the first point of contact for many Nigerians in the rural areas and have been found useful in active case finding. This study assessed the effect of cash incentives and training on tuberculosis case detection by CHWs in six Local Government Areas in Nigeria.

Materials and Methods: A randomised control trial was conducted in three PHC clusters. The intervention Arm (A) received cash incentives for every presumptive case referred. The Training Arm B had no cash incentives and the control had neither training nor cash incentives. Case notification rates from the TB program were used to assess the effect of cash incentives on TB case finding. Data was analyzed using Graph Pad Prism. Descriptive data was presented in tables and bivariate data was analyzed using chi square. Mean increases in case notification rates was calculated Statistical significance was set as P=0.05.

Results: Findings showed an increase of 14.4% (ꭓ2=2.976,P value=0.2258) in case notification rates for the Arm A that received cash incentives alongside training, there was also an increase of 7.4% (ꭓ2= 1.999,P value=0.1575) in Arm B that received Training only. For secondary outcomes, there was an increase in the total knowledge score (25.4%), knowledge of general symptoms (24.4%), knowledge of prevention (22.6%) and knowledge of diagnosis and treatment (30.0%) across all study arms post-intervention (p<0.0001). Secondary outcomes also indicated a 144.8%(ꭓ2= 4.147, P value=0.1258) increase in community outreaches conducted in the Arm that were given cash incentives.

Conclusion: The study demonstrated an increase in TB control activities of case notification and outreaches among community health workers that received cash incentives and training. These findings support the use of incentives for CHWs in high burden TB settings to improve TB case detection rates.

Paper II

Background: Intensified efforts to improve tuberculosis (TB) diagnosis, treatment, and prevention are needed to meet global EndTB targets. Community health workers’ (CHWs) knowledge with respect to case finding is vital in tuberculosis elimination. This study aimed to determine the effect of tuberculosis training on the knowledge of community health workers in Nigeria.

Methods: As part of a larger multicomponent intervention study, a randomised control trial was conducted with CHWs in 18 Primary Health Care(PHC [TF1] [CA2]) clusters in Nigeria. The clusters were allocated to three arms: training and cash incentive (A), training only (B), and control (C) arms. Arms (A) and (B) received training on tuberculosis symptoms, prevention, diagnosis and treatment while the control arm (C) did not receive training. Participants’ knowledge on tuberculosis was assessed using questionnaires administered pre- and post-intervention. Data was analyzed using GraphPad Prism. Descriptive data was presented in tables and bivariate data was analyzed using chi square. Statistical significance was set as P<0.05.

Results: There was a significant increase in the total knowledge score (25.4%), knowledge of general symptoms (24.4%), prevention (22.6%) and diagnosis and treatment (30.0%) across all study arms post-intervention (p<0.0001). Compared with the control, training arm (A) had a higher proportion of good total knowledge score (94.4%) and arm (B) had lower proportion of good total knowledge score (83.1%) when compared to the control group (93.1%). These were, however, not statistically significant.

Conclusions: An improvement in the CHWs’ knowledge of symptoms, prevention, diagnosis and treatment of tuberculosis was observed after a training intervention was done. Integration of routine tuberculosis training is recommended to improve tuberculosis case finding in high burden communities.

Methods

The data was collected over a period of one year from Community Healthworkers in Akwa Ibom State. The Data for training was drawn from respondents by interviewers using a structured questionnaire which was adapted from one that was used for the National TB Prevalence Survey in Nigeria in 2017. The researchers collected data during supervisory visits to the Community Health Workers in their place of work. The post intervention data was collected on android phones using the ODK app. READ ME files have been created for the data set.

Funding

World Health Organization, Award: 2019/898382-0

TDR, Award: 2019/898382-0

European and Developing Countries Clinical Trials Partnership, Award: 2019/898382-0