Labelled ‘the Giant of Africa’, Nigeria is Africa’s most populous country with a population of 182 million. The West-African country is bordered by Benin, Chad, Cameroon and Niger and is a federal constitutional republic comprising of 36 states and a federal capitol territory. For thousands of years Nigeria has been the location for several of Africa’s most flourishing civilizations including the Benin and Oyo empires. After independence from the United Kingdom in the 1960s, Nigeria experienced a three-year civil war before military juntas ruled the country until 1999. A prime example of the concept of a ‘resource curse’, Nigeria’s abundance in hydrocarbon resources has negatively impacted standards of living as government income is not dependent on direct taxation of the population. In the 21st century, Nigeria has developed into a democracy although several elections have been criticized for not being sufficiently free and fair, until the 2011 election of current President Muhammadu Buhari. With a life expectancy of 54, Nigeria’s healthcare system has lagged behind international standards because of an influx of emigration of Nigerian doctors, insufficient funding and logistical issues. Nigeria has only recently become relatively ‘polio-free’ and much remains to be done to address diseases such as HIV/Aids, malaria and tuberculosis
Tuberculosis in the country
Nigeria is a top-twenty high-burden TB country as well as being one of three countries (together with India and Indonesia) believed to contain sixty percent of the world’s undiagnosed cases of Tuberculosis. Mortality rates have remained stable at 180 thousand deaths in 2015, a disconcerting statistic needs immediate action in order to limit unnecessary future deaths in Nigeria.
KNCV Activities in the country
KNCV enhanced the early diagnosis of drug-resistant TB by installing GeneXpert machines in tertiary and secondary health facilities and shortened the time that people have to wait to start treatment
As part of theProject, KNCV helps improve healthcare on the local and community level by assisting private healthcare providers and pharmacies increase their standards and effectivity.
Nigeria is a country where the Challenge TB program is active. Challenge TB is USAID’s flagship global mechanism for implementing USAID’s TB Strategy and is led by KNCV Tuberculosis Foundation, who also led USAID’s previous TB Control projects TB CARE I, TB CAP and TBCTA.
9% increase in TB patients found and notified in supported states.
In Nigeria, it is estimated that only one out of every three TB-patients is found and registered, which means far too many patients do not receive the proper treatment. That is why we focus on expanding services and expertise on TB diagnosis and treatment. In 2016 we made steady progress, for example with the expansion of AFB microscopy services which are now available in 480 healthcare facilities.
More than 348 GeneXpert diagnosis machines are operational in Nigeria, with KNCV providing technical assistance, maintenance and training.
Directly observed treatment (DOT) was also expanded to 188 new facilities, 54% of which are in the private sector, resulting in a total of 1,378 DOTS centers in supported states. Many patients first visit private clinics who do not always have the experience and training necessary to diagnose and treat TB. Through the ‘Making the Global Fund money work’ project, funded by the Dutch Ministry of Foreign Affairs, we engage and train these facilities in TB services.
1,112 healthcare workers were trained to diagnose and treat TB patients in the best possible way.
Even more patients can now be found and registered because of the rollout of the GeneXpert diagnostic system through KNCV’s collaboration with the National Agency for the Control of AIDS (NACA). Together we installed 135 machines and trained 68 people with a ‘Training of Trainers’ approach. They in turn have trained a total of 282 laboratory technicians to operate the GeneXpert machines, and 294 clinicians to do the appropriate referral and ensure that patients are put on treatment when TB is detected.
Special attention was paid to a system for the transport of sputum that is needed to perform the diagnostic tests at facilities where GeneXpert is available. Working together with the National TB and Leprosy Control Program, we helped to establish a system for sputum transport in twelve states, to enable timely diagnosis for patients living in rural areas.