Improving Tuberculosis case finding in Nigeria

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.