TY - JOUR
T1 - Identifying Hot Spots of Tuberculosis in Nigeria Using an Early Warning Outbreak Recognition System
T2 - Retrospective Analysis of Implications for Active Case Finding Interventions
AU - Ogbudebe, Chidubem
AU - Jeong, Dohyo
AU - Odume, Bethrand
AU - Chukwuogo, Ogoamaka
AU - Dim, Cyril
AU - Useni, Sani
AU - Okuzu, Okey
AU - Malolan, Chenchita
AU - Kim, Dohyeong
AU - Nwariaku, Fiemu
AU - Nwokoye, Nkiru
AU - Gande, Stephanie
AU - Nongo, Debby
AU - Eneogu, Rupert
AU - Odusote, Temitayo
AU - Oyelaran, Salewa
AU - Chijioke-Akaniro, Obioma
AU - Nihalani, Nrip
AU - Anyaike, Chukwuma
AU - Gidado, Mustapha
N1 - Publisher Copyright:
© Chidubem Ogbudebe, Dohyo Jeong, Bethrand Odume, Ogoamaka Chukwuogo, Cyril Dim, Sani Useni, Okey Okuzu, Chenchita Malolan, Dohyeong Kim, Fiemu Nwariaku, Nkiru Nwokoye, Stephanie Gande, Debby Nongo, Rupert Eneogu, Temitayo Odusote, Salewa Oyelaran, Obioma Chijioke-Akaniro, Nrip Nihalani, Chukwuma Anyaike, Mustapha Gidado.
PY - 2023
Y1 - 2023
N2 - Background: Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non–hot spots. Objective: We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. Methods: KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients’ residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non–hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non–hot spot wards were analyzed retrospectively for this study. Results: During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non–hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non–hot spot areas was 146 and 193 per 10,000 people, respectively. Conclusions: Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non–hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.
AB - Background: Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non–hot spots. Objective: We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. Methods: KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients’ residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non–hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non–hot spot wards were analyzed retrospectively for this study. Results: During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non–hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non–hot spot areas was 146 and 193 per 10,000 people, respectively. Conclusions: Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non–hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.
KW - GeneXpert
KW - TB
KW - WHO-four-symptom screen
KW - active case
KW - active case finding
KW - case finding
KW - cluster
KW - communicable disease
KW - disease spread
KW - early warning
KW - early warning outbreak recognition system
KW - hot spot
KW - infection spread
KW - infectious disease
KW - mapping
KW - outbreak
KW - retrospective analysis
KW - retrospective study
KW - surveillance
KW - tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=85147783616&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147783616&partnerID=8YFLogxK
U2 - 10.2196/40311
DO - 10.2196/40311
M3 - Article
C2 - 36753328
AN - SCOPUS:85147783616
SN - 2369-2960
VL - 9
JO - JMIR Public Health and Surveillance
JF - JMIR Public Health and Surveillance
M1 - e40311
ER -