Tuberculous in Nigeria: Success, Issues and The Way Out

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Table of Contents
1 Introduction.........................................................................................................................................3
2 Tuberculosis in Nigeria: The Issue, Stakeholders and Policy................................................................3
2.1 Tuberculosis in Nigeria: What are the Figures?...........................................................................3
2.2 Social and Epidemiological Determinants of Tuberculosis in Nigeria...........................................4
2.3 Social Action Theory of Max Webber...........................................................................................5
2.3.1 Stakeholders’ View of Tuberculosis in Nigeria.....................................................................5
2.3.2 Organisations’ View of Tuberculosis in Nigeria....................................................................6
3 Current Management of Tuberculosis in Nigeria: Successes, Challenges and Recommendations......6
3.1 Success of Stakeholders, Organisations and Policies Implementation in Managing Tuberculous
in Nigeria.................................................................................................................................................6
3.2 Challenges Mitigating the Efforts Made to Eradicate Tuberculosis in Nigeria.............................7
3.3 Social Action Theory of Schwartz Theory: The Way Out..............................................................8
3.3.1 Education and Self-direction................................................................................................8
3.3.2 Financial Security.................................................................................................................8
3.3.3 Training for Healthcare Professional....................................................................................8
4 Conclusion...........................................................................................................................................9
References.................................................................................................................................................10

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1 Introduction

Tuberculosis is one of the diseases in the world that attacks the lungs of its patients. It
is often caused by a bacterium called which is referred to as Mycobacterium
tuberculosis. Although tuberculosis affects the lungs of the patients, it can also attack
other parts of the body which include the spine, kidney, and brain (CDC, 2023b). Going
by the global statistics on tuberculosis, it has been found that more than 10.1 million
and 10.6 million people suffered from the disease in 2020 and 2021 respectively
(Bagcchi, 2023). In the year 2021, it was recorded that 1.6 million people died from the
disease (Bagcchi, 2023). The rate of people living with the disease in 2022 has been
reported to be about 10.6 million (CDC, 2023a). In all these, it must be noted that this
study has been delimited to the Nigerian population. The number of people suffering
from tuberculosis in the wake of 2023 is about 500,000 people (Uduu, 2023). Hence,
this study is keen on the infection prevention and management of tuberculosis in the
Nigerian community. More so, the roles of stakeholders in a bid to reduce the rate of the
disease are investigated. Some of the theories that have been adopted in this discourse
include the social action theory of Max Weber as well as Schwartz's Theory of
community participation.

2 Tuberculosis in Nigeria: The Issue, Stakeholders, and Policy

This section covers the different issues around tuberculosis in Nigeria as well as the
roles of stakeholders, policy, and research. These have been thematically discussed as
follows.

2.1 Tuberculosis in Nigeria: What are the Figures?

Uduu (2023) stressed that though tuberculosis is a global issue, it is not unconnected to
the Nigerian population. It was also added the rate of the disease has increased by 67%
in 21 years. From the year 2000 to 2020, there has always been an increase in the rate
of people suffering from the disease (see Figure 1). It has also been found that the
death rate of tuberculosis is 158 per 100,000 people (Ogbo et al., 2018). While Ogbo et
al., (2018) reported that the disease led to the death of more than 39,933 in the year
2016; it has also been reported that the rate of the disease in 2021 increased to 452 as
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156 people died (The Guardian, 2022). On the other hand, The Guardian (2022)
stressed that the factor that has recently brought a decline in the disease is the
emergence and rise in the rate of people attacked by the Covid-19 pandemic.

Figure 1: Increase in rate of tuberculosis in Nigeria from 2000 to 2023 (Uduu, 2023)

In line with the ongoing, a brief outlook on the socio-determinants of the disease has
been disused as follows.

2.2 Social and Epidemiological Determinants of Tuberculosis in Nigeria

One of the core social determinants that have been linked to the cause of the disease in
Nigeria is poverty as the poor living standard of people increases the rate of the
existence of tuberculosis (Hargreaves et al., 2011). This aligns with a study that was
carried out in India that a high rate of tuberculosis is linked to poverty, hunger, and
ethnic minority (Jackson et al., 2023). In another study that was carried out in Lagos
state Nigeria, it was stressed that factors like low level of education, low economic
status, age, previous history of smoking as well as weight loss were significant to the
existence of tuberculosis (P<0.05); factors such as marital status, religion, ethnicity, and
sex were not significant to the disease (P>0.05). Some of the epidemiological
determinants of the disease include smoking, alcohol use disorders, HIV infection,
diabetes, and undernutrition (WHO, 2023c).

A study done in Benin City, Nigeria showed that there was a high rate of males (1.7)
suffering from tuberculosis compared to females (1) and that most of the patients

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suffering from the disease fall between the ages of 21 and 30 years (75%) (Egbagbe,
Okojie and Amaize, 2023). In their findings, Egbagbe, Okojie, and Amaize, (2023)
further reported that most of the people who had tuberculosis in the study location have
no formal education (80%); and that some of the common epidemiological determinants
of the disease are AIDS pandemic, malnutrition, homelessness, overcrowding as well
as poverty. Taking a cue from the ongoing, the poverty rate in Nigeria in the wake of
2023 is 44.4% (Businessday NG, 2022). This is supported by the fact that more than 1/3
of the Nigerian population lives in extreme poverty leading to about 133 million people in
2013 (Izuaka, 2022). By implication, since poverty is a strong cord of tuberculosis in
Nigeria, there is a need to look into the impact of stakeholders in mitigating the disease
holistically.

2.3 Social Action Theory of Max Webber

In this section, the views of stakeholders and organisation on tuberculosis in Nigeria has
been accessed using the Weberian social action. This theory implies the motive of
people is important in creating solutions to an issue about an issue (Raza, 2023). The
four tents that the theory is based on include value, rationality, instrumental rationality,
traditional and affective action. These are discussed as follows based on stakeholders’
views as well as organisations’ views.

2.3.1 Stakeholders’ View of Tuberculosis in Nigeria

The participation of the Nigerian government in reducing the rate of tuberculous has
been lined with the inability to put an end to poverty. Ogbuabor and Onwujekwe (2019)
stressed that the Nigerian government is the foremost stakeholder to mitigate the
disease followed by health workers in the country. However, there is still a high rate of
issues such as inadequate electronic data management system, weak drug supply
system, inadequate human resources, dilapidated service delivery facilities, poor staff
attitude to patients, breach tuberculous care ethical standards, drug reactions, and poor
drug management among others (Ogbuabor and Onwujekwe, 2019). The Ministry of
Health has also been seen as one of the stakeholders addressing the reduction of the
disease through the “Check Am O!” campaign (Oyeniyi, 2023). In the same vein, the

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Nigerian community has also been more participatory in the reduction of the disease by
coming out for testing, however, even when they had been diagnosed with the disease,
their treatment is limited by funding (WHO, 2022).

2.3.2 Organisations’ View of Tuberculosis in Nigeria

These organisations play different roles in the mitigation of tuberculous in Nigeria at

both local, national and international levels. An instance is the “The Civil Society for the
Eradication of Tuberculosis in Nigeria” in Nasarawa State which is known for the
creation of awareness about the disease (Stop TB, 2023). It has been added that the
use of media in spreading awareness of the disease has also been helpful in
addressing the disease. NGOs and private sectors such as Patent Medicine Vendors
(PMV), Community Pharmacists and Wellness on Wheels (WoW) Truck among others
have been making efforts in addressing the disease through education and free
diagnosis (This Day Live Newspapers, 2023b). WHO has also been reported as one of
the international organisations promoting a tuberculosis free Nigeria (WHO, 2023a) as
well as the Global Fund among others (The Global Fund, 2023b). In all of these, there is
still a persistence in the rate of the disease.

3 Current Management of Tuberculosis in Nigeria: Successes, Challenges

and Recommendations

This section covers three subjects which include the efforts of stakeholders,
organisations as well as policies implementation in managing tuberculous in Nigeria; the
challenges, and the last section is dedicated to recommendations using the Schwartz
Theory of community participation.

3.1 Success of Stakeholders, Organisations, and Policies Implementation in

Managing Tuberculous in Nigeria

Ogbuabor and Onwujekwe (2019) asserted that though it seems that there are no
efforts taken by the government to mitigate tuberculous in Nigeria, the federal, state,
and local government has been making efforts to increase public spending in the health
system. It has been found that the government spent about US$12 million between the

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years 2020 and 2022 toward reducing the rate of the disease (The Global Fund, 2023a).
However, this fund was gotten from the Global Fund organisation as well as public
donors (The Global Fund, 2023a). At the close of the year 2020, it was revealed that
WHO $890 million to the Nigerian government as a way of putting an end to the disease
(Premium Times Nigeria, 2020). In the same year, Premium Times Nigeria (2020)
reported that WHO clamored that the Nigerian government needs to carry more
multilateral, bilateral, Civil Society Organisations as well as private sectors and
academia in the process of developing a free tuberculosis Nigeria.

In line with the ongoing, the Nigerian government has been doing a good job in putting
more money into the healthcare sector as N547 billion was allocated to the sector in
2021. In 2022, this was increased by about 25.54% (This Day Live Newspapers,
2023a). This is an indication that the Nigerian government is gradually starting to more
attention to the healthcare of its citizens. One of the grants that have also been
supportive of the country in managing the disease is from Resilient Sustainable
Systems for Health (RSSH) which is not only limited to fighting tuberculosis alone but
also HIV and malaria (Premium Times Nigeria, 2020). In another report, the willingness
of patients to pay for their treatment has also increased as about 80% of the participants
were willing to pay for TB treatments (Ochonma and Onwujekwe, 2017). However, this
is limited to studies carried out in rural areas in the country.

The government in 2020 has enacted a programme and policy tagged; “Eradicate
Tuberculosis in Nigeria by 2030” (WHO, 2023b). During the launching of the programme
12 UN agencies, 30 members of international observers, and the mission member of
the programme included OHCHR, UNAIDS, UNDP, FAO, Public Health England,
UNICEF, IAEA, USAID, and African Development Bank among others (WHO, 2023b).

3.2 Challenges Mitigating the Efforts Made to Eradicate Tuberculosis in Nigeria

The leading burdens of tuberculosis in Nigeria are funds misappropriation and low rate
of awareness on the part of stakeholders and the community at large. For instance,
while different international organisations have been supportive of the reduction of the
disease, the government has not been forthcoming with the use of the funds as

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expected (This Day Live Newspapers, 2023a; 2023b). Ogbuabor and Onwujekwe
(2019) affirmed that though there are adequate policies and international support to
eradicate tuberculosis in Nigeria, TB surveillance system as well as the development of
healthcare services on the part of the government has been very low. In addition to this,
drug supply system in Nigeria to treat the disease is very weak and not regulated. In a
related study carried out in Oyo state, it was found that resource-constrained healthcare
is a re-occurring problem mitigating all efforts to promote a tuberculosis free Nigeria
(Oladimeji, Tsoka-Gwegweni and Udoh, 2017). Other issues that were observed in the
study area included governments’ poor funding of tuberculosis programmes, negative
attitudes of health workers, and lack of staff training among other factors.

3.3 Social Action Theory of Schwartz Theory: The Way Out

The social action theory of Schwartz theory has been adopted in this section to discuss
some of the ways to mitigate tuberculosis in Nigeria. Schwartz theory stressed that
motivation domains such as maturity, restrictive conformity, enjoyment, achievement,
prosocial, self-direction, and security are well to preferring solutions to issues in a
community (Schwartz et al., 2012). Some of the tenets of the policy are adopted as
follows.

3.3.1 Education and Self-direction

This has to do with the process of ensuring that more awareness is created about
tuberculosis in Nigeria. This will help citizens to be more aware of the ways to prevent
and treat the disease. Self-directed learning has been effective in the promotion of
health equity in a country like the UK (Hill et al., 2023). Nigeria can also emulate this to
raise a tuberculosis free country.

3.3.2 Financial Security

This will go a long way in the provision of facilities need in healthcare settings in the
country. In the same vein, the Nigerian government needs to ensure that it reduces the
rate of poverty through poverty alleviation programmes.

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3.3.3 Training for Healthcare Professionals

Healthcare workers need to be more equipped for the job of fighting tuberculosis in
Nigeria. Their attitude towards patients has to be improved positively. They also need to
be motivated in terms of salaries and wages. The USA has been able to do more in the
aspect of increasing the motivation of healthcare workers through talent management
and a viable payment system. (Duvivier, Burch and Boulet, 2017) Nigeria can also learn
from this.

4 Conclusion

In this study, I have been able to investigate the infection prevention and management
of tuberculosis in the Nigerian community as well as determine the roles of stakeholders
in a bid to reduce the rate of the disease. Different theories like the social action theory
of Max Weber as well as Schwartz Theory have also been adopted. It was found that
there has always been an increase in the rate of people suffering from tuberculosis in
Nigeria based on factors such as inadequate electronic data management system,
weak drug supply system, inadequate human resources, dilapidated service delivery
facilities, poor staff attitude to patients, breach tuberculous care ethical standards and
drug reactions among others. In all of these, funding and inadequate support from the
end of the government as well as poor attitude of healthcare workers to patients were
the prominent issues. It was recommended that awareness should be consistently
created about the disease, more funds should be put in the health sector and healthcare
workers should be more equipped for the job of fighting tuberculosis in Nigeria.

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References

Bagcchi, S. (2023) WHO’s Global Tuberculosis Report. The Lancet Microbe. [online]. 4
(1), Elsevier, p.e20.

Businessday NG (2022) Tackling high poverty rate in Nigeria2022 [online]. Available

from: https://businessday.ng/editorial/article/tackling-high-poverty-rate-in-nigeria/
[Accessed 16 October 2022].

CDC (2023a) Tuberculosis (TB) - Data and Statistics Centers for Disease Control and
Prevention.23 March 2023 [online]. Available from:
https://www.cdc.gov/tb/statistics/default.htm [Accessed 2 May 2023].

CDC (2023b) Tuberculosis (TB)- Basic TB Facts Centers for Disease Control and
Prevention.2023 [online]. Available from:
https://www.cdc.gov/tb/topic/basics/default.htm [Accessed 2 May 2023].

Duvivier, R.J., Burch, V.C. and Boulet, J.R. (2017) A comparison of physician
emigration from Africa to the United States of America between 2005 and 2015. Human
Resources for Health. [online]. 15 (1), p.41.

Egbagbe, E.E., Okojie, O.H. and Amaize, E. (2023) Epidemiology of pulmonary

tuberculosis in University of Benin Teaching Hospital and Central Hospital, Benin City.
Nigerian Quarterly Journal of Hospital Medicine. 21 (2), pp.159–162.

Hargreaves, J.R., Boccia, D., Evans, C.A., Adato, M., Petticrew, M. and Porter, J.D.H.
(2011) The Social Determinants of Tuberculosis: From Evidence to Action. American
Journal of Public Health. [online]. 101 (4), pp.654–662.

Hill, M., Peters, M., Salvaggio, M., Vinnedge, J. and Darden, A. (2023) Implementation
and evaluation of a self-directed learning activity for first-year medical students. Medical
Education Online. [online]. 25 (1), p.1717780.

Izuaka, M. (2022) 133 million Nigerians living in poverty – NBS Premium Times
Nigeria.17 November 2022 [online]. Available from:
https://www.premiumtimesng.com/business/565993-133-million-nigerians-living-in-
poverty-nbs.html [Accessed 16 March 2023].

Jackson, S., Sleigh, A.C., Wang, G.J. and Liu, X.L. (2023) Poverty and the economic
effects of TB in rural China. The International Journal of Tuberculosis and Lung

10
Disease: The Official Journal of the International Union Against Tuberculosis and Lung
Disease. 10 (10), pp.1104–1110.

Ochonma, O.G. and Onwujekwe, O.E. (2017) Patients’ willingness to pay for the
treatment of tuberculosis in Nigeria: exploring own use and altruism. International
Journal for Equity in Health. [online]. 16 (1), p.74.

Ogbo, F.A., Ogeleka, P., Okoro, A., Olusanya, B.O., Olusanya, J., Ifegwu, I.K.,
Awosemo, A.O., Eastwood, J. and Page, A. (2018) Tuberculosis disease burden and
attributable risk factors in Nigeria. Tropical Medicine and Health. [online]. 46 (1), p.34.

Ogbuabor, D.C. and Onwujekwe, O.E. (2019) Governance of tuberculosis control

programme in Nigeria. Infectious Diseases of Poverty. [online]. 8, p.45.

Oladimeji, O., Tsoka-Gwegweni, J. and Udoh, E. (2017) Barriers and Strategies to

Improve Tuberculosis Care Services in Resource-Constrained Setting: A Qualitative
Analysis of Opinions from Stake-holders in Oyo State South West NigeriaIn:
Tuberculosis.

Oyeniyi, O. (2023) Stakeholders Take TB Campaign To Abuja Streets Voice of

Nigeria.23 March 2023 [online]. Available from: https://von.gov.ng/stakeholders-take-tb-
campaign-to-abuja-streets/ [Accessed 2 May 2023].

Premium Times Nigeria (2020) Global Fund: Nigeria receives $890 million to tackle
HIV/AIDS, TB, Malaria Premium Times Nigeria.21 July 2020 [online]. Available from:
https://www.premiumtimesng.com/news/top-news/404348-global-fund-nigeria-receives-
890-million-to-tackle-hiv-aids-tb-malaria.html [Accessed 2 May 2023].

Raza, S. (2023) Max Weber and Charles Taylor: On normative aspects of a theory of
human action. Journal of Classical Sociology. [online]. 23 (1), SAGE Publications,
pp.97–136.

Schwartz, S.H. et al. (2012) Refining the theory of basic individual values. Journal of
Personality and Social Psychology. [online]. 103 (4), pp.663–688.

Stop TB (2023) Stop TB Partnership | Partners’ DirectoryText2023 [online]. Stop TB

Partnership. Available from: https://stoptb.org/partners/partner_profile2.asp?PID=69295
[Accessed 2 May 2023].

The Global Fund (2023a) Spending on TB in Nigeria2023 [online]. Available from:

https://www.theglobalfund.org/en/government/profiles/nigeria/ [Accessed 2 May 2023].

The Global Fund (2023b) Tuberculosis2023 [online]. Available from:

https://www.theglobalfund.org/en/tuberculosis/ [Accessed 2 May 2023].

The Guardian (2022) TB killed 156,000, infected 452,000 Nigerians The Guardian
Nigeria News - Nigeria and World News.31 March 2022 [online]. Available from:

11
https://guardian.ng/features/science/tb-killed-156000-infected-452000-nigerians-in-
2020/ [Accessed 2 May 2023].

This Day Live Newspapers (2023a) Assessing Nigeria’s Commitment towards

Financing Health Security2023 [online]. Available from:
https://www.thisdaylive.com/index.php/2022/11/24/assessing-nigerias-commitment-
towards-financing-health-security-2/ [Accessed 2 May 2023].

This Day Live Newspapers (2023b) How Stakeholders’ Intervention Increased TB

Patients Diagnosis to over 40,000 in Four Years2023 [online]. Available from:
https://www.thisdaylive.com/index.php/2021/11/18/how-stakeholders-intervention-
increased-tb-patients-diagnosis-to-over-40000-in-four-years/ [Accessed 2 May 2023].

Uduu, O. (2023) Nigeria’s TB survival rate increases by 67% in 21 years Dataphyte.27

March 2023 [online]. Available from: https://www.dataphyte.com/latest-reports/nigerias-
tb-survival-rate-increases-by-67-in-2021/ [Accessed 2 May 2023].

WHO (2023a) Gearing towards a TB free Nigeria- WHO and partners scale up action
WHO | Regional Office for Africa.28 April 2023 [online]. Available from:
https://www.afro.who.int/news/gearing-towards-tb-free-nigeria-who-and-partners-scale-
action [Accessed 2 May 2023].

WHO (2023b) Nigeria re-commits to eradicating Tuberculosis and controlling

Noncommunicable Diseases by 2030. WHO | Regional Office for Africa.28 April 2023
[online]. Available from: https://www.afro.who.int/news/nigeria-re-commits-eradicating-
tuberculosis-and-controlling-noncommunicable-diseases-2030 [Accessed 2 May 2023].

WHO (2023c) TB determinants2023 [online]. Available from:

https://www.who.int/publications/digital/global-tuberculosis-report-2021/uhc-tb-
determinants/determinants [Accessed 2 May 2023].

WHO (2022) With dwindling numbers, stakeholders expand integrated TB and COVID-
19 testing in communities WHO | Regional Office for Africa.19 August 2022 [online].
Available from: https://www.afro.who.int/countries/nigeria/news/dwindling-numbers-
stakeholders-expand-integrated-tb-and-covid-19-testing-communities [Accessed 2 May
2023].

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