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Towards a Tuberculosis free Nigeria: Comparative Analysis of Knowledge of Tuberculosis in Nigeria General Population over 5 Years and its Policy Implication

Tuberculosis (TB) continues to be a global Public Health challenge despite significant progress made in the global progress towards a TB free world, however this progress is not uniform in every country. In 2015, Nigeria was ranked as the 4th on the list of six countries contributing 60% of the new TB cases and as the African country with the highest TB burden within the African continent. Several initiatives have been implemented in Nigeria to address the challenge of achieving a TB-free country with focus on improving knowledge of TB among the general population, however very few literatures have reported changes in the proportion of the general population on the knowledge of Tuberculosis in Nigeria. This report compares knowledge of TB in Nigeria general population over 5 years (2012-2017) using selected key indicators from the National Knowledge, Attitude and Practice survey 2012 and 2017 data.

Awareness of TB and Knowledge of the Causative Germ


Awareness of TB among the general population is integral in the progress towards a TB free Nigeria. There was no appreciable difference between the percentage of the population aware of TB in 2017 when compared to the 2012 proportion. This was also true of the percentage distribution of the general population that knew the causative agent of TB. This minimal percentage change in awareness and knowledge of causative organism reveals that the several intervention efforts in Nigeria over these five years are not reaching all of the targeted audiences.

Knowledge on Risk Factors


Risk factors are conditions that can predispose an individual to being infected with TB but most of them are modifiable. The knowledge of risk factors to TB in the general population over the 5 years under review showed slight improvement in the knowledge of respondents about poor ventilation (2.3 percentage points) and overcrowding (2.5 percentage points), as risk factors for TB when compared to the 2012 findings. However, knowledge of poor nutrition, presence of HIV, poverty and infection at young age as risk factors had varying degrees of decline in the general population.

Knowledge of TB Symptoms

The knowledge of some TB symptoms in the general population over the 5 year period showed an improvement in the knowledge of participants about persistent cough as a symptom, but there was appreciable decline in percentage of general population who had knowledge of productive cough, weight loss and shortness of breath as a symptom of TB.

Knowledge on correct duration of treatment


The knowledge of the correct duration for the treatment of PTB in the general population was compared over the 5 years. There was a modest but significant increase (7 percentage points) in knowledge of the general population about the correct duration of treatment while there was varying degrees of reduction in incorrect knowledge.

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Tuberculosis Knowledge, Attitude and Practice (TBKAP) Follow-up Survey in Nigeria

Did you know that in 2016, there were an estimated 10.4 million new (incident) cases of tuberculosis in the world? That’s 5 times more people than the entire population of Slovenia and a little over 10 times the population of the Bahamas. Did you also know that TB tends to affect more men than women and those in the economic productive age range (15 -59 years) are the most affected?

In Africa currently, Nigeria has the most number of TB incidents, and in order to combat this, the Federal Government through the National Tuberculosis and Leprosy Control Programme (NTBLCP) a body under the Ministry of Health set up to control TB and Leprosy in Nigeria and with the support of organizations like the World Health Organization, and the Global Fund for AIDS, Tuberculosis and Malaria (GF), in 2007/2008 conducted a baseline study to determine the true burden of TB and refine her strategy for improved programme implementation and outcomes. This study was conducted in Benue, Ebonyi and Ondo states. Following this another survey was carried out in 2012, this time to determine the Knowledge, Attitude and Practice of people in urban and rural communities across the country regarding TB. This survey was carried out in 6 states across the 6 geo-political zones of the country.

This report gives a summary of results from a 2017 study conducted by AHEAD in conjunction with the Association for Reproductive and Family Health (ARFH) and NTBLCP, done on the same topic in a bid to compare current levels of knowledge, attitude and practice with the results of the 2012 study. The study was carried out in 48 urban and rural communities and a total of 448 healthcare facilities across Benue, Plateau, Adamawa, Gombe, Katsina, Kaduna, Ebonyi, Imo, Akwa-Ibom, Delta, Ondo and Lagos states were sampled.

Results show that there was no appreciable change in awareness of the general population about TB although Katsina showed an appreciable increase in awareness and Ondo showed a noticeable decline. While there was moderate improvement in the knowledge that persistent cough is a symptom of TB among the general population, there was a decline in other knowledge parameters evaluated.

Among patients with TB, there was an increase in those who self-medicated and a marked decline in patients’ knowledge of risk-factors. Even though, there was only a very slight decline in the proportion of TB patients who know that HIV infection is a risk factor for TB. And the figures show that compared to baseline, some people in Ebonyi state still believe witchcraft is a cause of TB.

Among patients with HIV, there was an improvement in the knowledge of the causes of TB although patients who identified casual contact such as kissing as a cause of TB showed an increase compared to baseline. And there was a 40% jump in the number of patients who were at the facility for follow-up sputum examination.

The proportion of health workers trained in the management of TB cases showed significant increase although knowledge of this management is still low. Also the proportion of health workers with knowledge about the drugs used in the management of TB showed a decline.

Overall, there has been progress in some areas, but there is still some work to be done in the prevention, diagnosis, and management of tuberculosis and the achievement of the goal of a Nigeria free of TB.

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