Around a year ago, Mallam Mainasara Mohammad, a resident of Makera,  a locality in Kebbi State, Nigeria, became increasingly worried about his son, nine-year-old Yusuf. The child had been coughing for weeks, had difficulty sleeping and unable to attend school.

“I took him to the health centre after I heard on the radio that the government  conducts  free tests for people coughing for more than two weeks,” says Mohammad. After a chest x-ray and a sputum test using a specialized system called GeneXpert, which provides rapid tuberculosis (TB) diagnosis and an antibiotic sensitivity test, Yusuf was diagnosed with drug-resistant TB.

He was immediately treated with combination TB medicines for six months. In addition, Yusuf’s family members were screened for TB and given a course of anti-TB medicines to prevent the development of the disease. The medicine was provided at no cost to the family.

“We would go to the hospital every week to collect the TB treatment. This allowed the health workers to follow up on Yusuf’s progress,” says Mohammed.” I am happy my son is now better and  has resumed school.”

Nigeria has the highest TB burden in Africa. The disease kills 268 people in the country every day. Yet TB cases are under-reported, increasing the high risk of transmission. It is estimated that one missed case can transmit TB to 15 people in a year.

The gap in case detection is mostly among children, due to some health workers at facility and community level not sufficiently skilled to detect childhood TB, as well as a lack of awareness among families and communities. TB services are also not fully integrated into routine children’s health services, such as nutrition and immunization programmes.

To  intensify TB case-finding in the country, Nigeria’s National Tuberculosis, Buruli Ulcer and Leprosy Control Programme, and its partners including World Health Organization (WHO), have been implementing various innovative strategies, including a TB drive across the 36 states and Federal Capital Territory. A special childhood TB case-finding testing week was conducted in May 2023.

According to provisional data, over 361 000 TB cases were reported in Nigeria in 2023, 9% of these in children. Overall, this marked a 26% increase in the number of cases compared with 2022.

“The drive showed the importance of TB case-finding in the community, especially among children, and marks the beginning of continuing active surveillance for TB in line with WHO standards,” says Kebbi State TB programme manager, Dr Sheu Gele. “Intensive mobilization and TB awareness creation among community and health practitioners, including community-health workers and paediatricians, has paid off,” he adds.

Community sensitization is carried out in communities with a high burden of TB, guided by the data and a hotspot mapping tool. Community health workers collaborate with local community organizations to engage community gatekeepers, conduct community entrance meetings and engage community mobilizers to assist with active case-finding.

WHO has supported the national TB programme to adopt evidence-based strategies for case-finding, including training health workers. During 2023 and the first three months of 2024, with funding from The Global Fund to Fight AIDS, TB and Malaria, WHO has trained 242 health workers to improve TB case detection, reporting and treatment of patients across five states. In addition, in January 2024, at the request of Borno State’s governor, WHO conducted a 10-day training of 60 TB supervisors from 27 local government areas in the state.

Furthermore, WHO has facilitated the roll out of the six-month treatment regimen for drug-resistant TB, and is currently piloting the use of a “treatment decision” algorithm. This aims to standardize clinical assessment and decision-making to enhance TB case detection among children.

“WHO is committed to work with the Government of Nigeria and all partners who are committed to ending TB. While it is highly contagious, TB is preventable and treatable. We must rally together to quickly detect and treat TB cases to kick this disease out of Nigeria,” says Dr Walter Kazadi Mulombo, WHO Representative in Nigeria.