How Cough Officers Can Change the Narrative in the Search for Missing TB Cases in Nigeria

Nigeria is one of the most populous countries in the world with a population of 196 million in 2018 as estimated by United Nations and is ranked 7^th amongst the high burden countries with Tuberculosis globally (WHO Global TB Report, 2017). Factors responsible for Nigeria’s poor TB ranking can be linked to the number of missing TB cases in the country with only 104,904 TB cases detected out of an estimated number of 407,000 by WHO in 2017.
A country with a population and TB situation like Nigeria calls for an effective infectious diseases control, especially at the community level where the prevalence of TB is higher. The Active TB Case Finding (ACF) intervention was a strategy designed under the Global Fund New Funding TB/HIV grant, in response to mitigate the gap in finding the missing TB cases which has hitherto being passive. The ACF was implemented in 22 priority states under the NFM grant from 2015 to 2017.
The resultant positive effects of ACF approach in finding TB cases from the community within the NFM grant necessitated the continuation of the intervention under the NFM extension grant period (2018) in five priority states. This strategy was scaled-up to include finding TB cases in Out Patient Department (OPD) of two health facilities with a high OPD patronage in each of the five targeted states of Lagos, Oyo, Osun, Kano and Kaduna. This involves the selection and training of two health workers; known as Cough Officers, in each of the selected health facilities. Their main duty is to identify persons who display symptoms of TB in the OPD area while waiting to see a Doctor for consultation. This has increased awareness and sensitization of people who visit the designated hospitals about TB and have helped to create demand for TB services.

Under the ACF intervention, our Cough Officers (CO) have a duty roster and an itinerary for clinic sensitization to help them give health talks promoting infection control to patients.
“I give health talks in the facility on Mondays, Tuesdays and Wednesdays when we have a lot of patients,” says Admed, a Cough Officer at Murtala Muhammed Specialist hospital, Kano State.
Some of them are known to have a good working relationship with other health workers in the hospitals and the patients. Following the additional concern of the rising cases of Drug-resistant and Multi-Drug Resistant TB, Cough Officers have shown to be very useful in identifying patients who have defaulted.
“I have seen some patients in the out-patient ward who were receiving TB treatment but suddenly stopped coming to collect their drugs at the DOTs facility. When they come down with another sickness, they come back to the hospital; we identify them and make sure they are enrolled for treatment again. There are many of them that I personally call to make sure they take their drugs and complete the duration,” says Admed.