According to the National Tuberculosis and Leprosy Control Programme (2002), proper case finding and adequate chemotherapy breaks the chain of transmission of tuberculosis bacilli and improve the epidemiological situation of tuberculosis in the country.
Case finding in Nigeria is passive. That is, it is based on the self-referral of symptomatic individuals who consult health institutions and who are diagnosed as tuberculosis cases. Tuberculosis cases are usually discovered at hospital out-patients or their sputa are sent to laboratory for microscopic examination for acid fast bacillin (AFB).
Household Contact: the household contact with cough should have sputum examination.
According to National Tuberculosis and Leprosy Control Programme (2002), the first tuberculosis clinic in Nigeria was open in 1945. The federal tuberculosis services in Yaba (Mainland Hospital) and the broad street (Lagos Chest Clinic) have now been taken over by the Lagos state government.
Eighteen states of the federation had in 1997 an organized tuberculosis component of the tuberculosis and leprosy control programme with donor support for chemotherapy. Donor assistance is still being sought for the remaining states and Federal Capital Territory Abuja.
Short-course Chemotherapy for treatment of tuberculosis as recommended by World Health Organization (WHO) still remains the mainstay of treatment of sputum positive and serious Tuberculosis cases in Nigeria.
In line with International Union against Tuberculosis and Lung Disease (IUATLD)/WHO recommendations, the National Tuberculosis and Leprosy programmes has the following objective for the control of tuberculosis.
- To increase detection to 70% of the existing smear positive cases by the year 2000.
- To attain a cure rate of at least 85% of the detected smear positive cases. In view of increasing mortality due to the increasing prevalence of HIV infection, a cure of 75% may be acceptable.
The strategy for achieving these objectives is called Direct Observed Treatment Short-Course (DOTS) and includes
- Political and financial commitment by government at all the tiers.
- Establishment of a standardized case notification based on passive case finding and confirmation of diagnosis through a network of effective microscopy centres.
- Adoption of standardize treatment regimen for all diagnosed tuberculosis cases, especially directly observed treatment short course chemotherapy (DOTS) for all new smear positive pulmonary Tuberculosis cases.
- Regular supply of drugs, reagents and other logistics.
- Regular monitoring and supervision of the programme, including the use of standardized recording and reporting system.
Who is a tuberculosis ‘’case’’?
According to Croften (1997) any person given treatment for tuberculosis should be recorded as a case. Those who have tuberculosis bacilli visible on two microscopic examinations of sputum should be recorded as smear positive. All other cases should be recorded in such case (as smear negative or as extra-pulmonary cases).
References
Crofton, J. (1997). Guideline of the management if Drug resistance Managing these difficult cases. BMJ 1:13-14
National Tuberculosis and Leprosy Control Programme (2002). Revised Worker’s Manual. Luton: Crest Books.
