Wednesday, March 2, 2016

Community Referral for Presumptive TB in Nigeria: A Comparison of Four Models of Active Case Finding

Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited.

We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral.

CWs referred 4-22 % of presumptive TB clients tested, and 4-24 % of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables.

All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

Full article at:

By:  Adejumo AO1Azuogu B2Okorie O3Lawal OM4Onazi OJ5Gidado M5Daniel OJ6Okeibunor JC7Klinkenberg E8,9Mitchell EM8,9.
  • 1Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
  • 2Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria.
  • 3Abia State TB and Leprosy Control Programme, Umuahia, Abia, Nigeria.
  • 4Oyo State TB and Leprosy Control programme, Ibadan, Oyo, Nigeria.
  • 5KNCV/ TB CARE I, Abuja, Nigeria.
  • 6Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria.
  • 7Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu, Nigeria.
  • 8KNCV Tuberculosis Foundation, the Hague, The Netherlands.
  • 9Department of Global Health, Academic Medical Center, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands.
  •  2016 Feb 23;16(1):177. doi: 10.1186/s12889-016-2769-7.

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