Kaduna, 19 August 2022 - When health workers took the Tuberculosis (TB) testing outreach to Rigasa community, Kaduna State, Rabi Umaru, a 37-year-old housewife, did not need much convincing to get tested. 

She had been coughing for two weeks but had not visited any health facility because of lack of funds. 

“I usually hear on the radio that if you cough for two weeks, you should go to the health facility to test for TB. I eventually tested for TB and COVID-19 during the community outreach, and after testing negative for COVID-19, I used the opportunity to receive the COVID-19 vaccination. Leaving here, I will lend my voice to mobilize other women in the neighbourhood to come out and benefit from the free TB and COVID-19 testing as well as receive their COVID-19 vaccine,” she said. 

Tuberculosis and COVID-19 share similarities despite being caused by different biological agents. Worldwide, TB is one of the highest causes of death from a single infectious disease, and in the past two years, nearly all countries, including Nigeria, have felt the impact of COVID-19, resulting in a global health crisis with over 595 million people infected and above 6.45 million deaths as of 14 August, 2022. 

High disease burden 

For now, Nigeria has the highest burden of TB in Africa and ranked sixth globally. Worried about the low turnout of testing against the two deadly diseases, the Kaduna State Government collaborated with the World Health Organization (WHO) and other partners to initiate, plan and conduct a two weeks integrated mass TB and COVID-19 screening campaign across the 23 Local Government Areas in the state. The outreach was also leveraged to expand the COVID-19 vaccination coverage. 

Two high-risk communities from each LGAs were selected based on reviews data on the burden of TB and COVID-19 infection, population density and the testing rates in the state.
 
Intervention 

Emphasizing the importance of the campaign, the Kaduna State Commissioner of Health, Dr Amina Baloni, said the outreach is apt to tackle the rising cases of COVID-19 and TB and improve the low population coverage of COVID-19 vaccination in the state. 

Dr Baloni emphasised that the integration of the tests was to leverage resources to shore up testing when we noticed people were no longer volunteering for testing. 

“We are working towards the national COVID-19 vaccination target to ensure that the disease is no longer of public health concern by the end of this year and using the opportunity to improve the detection of missing/undiagnosed TB cases to about 85% by the end of the year, she said.

To achieve herd immunity against COVID-19, Nigeria planned to get 40% of its population vaccinated by the end of 2021 and 70% vaccinated as at the end of 2022.
 
However, with only about 27 million persons vaccinated due to the low COVID-19 vaccination performance coverage level in many states, Nigeria is far from meeting the set target.

Encouraging numbers

To mitigate this challenge, states have been adopting the integrated health service delivery to expand COVID-19 vaccination in the country.
  
For instance, during the campaign in Kaduna Sate, over 20,000 people were screened for TB and COVID-19. Of which 115 tested positive for TB while 161 tested positive for COVID-19  

Also, over 2 million people received the COVID-19 vaccination, pushing the state to 55% coverage of its eligible population as August 11, 2022. Kaduna state had only 9% fully vaccinated at end March 2022.

Appreciating the WHO and other stakeholders for bringing the health services to their doorstep, a community leader and ward head of Warri Street, Kaduna North LGA, Mallam Isa Nuhu, said the visit would shore up testing for TB and COVID-19 and COVID-19 vaccination in his community.

“My people were initially afraid of these two diseases. Bringing sensitization and testing to our doorstep has encouraged many residents to avail themselves of the services. It also fostered vaccination uptake in the community because some people resisted taking the vaccine during the initial vaccination drive in February due to rumours about its safety. However, the perception has changed after seeing those who have received the vaccines are still healthy,” he said. 

Also, the ward head of Makera, Rigasa in Igabi LGA, Mallam Isiyaku Abdulwahab, applauded the initiative saying it gave members of his community the opportunity to access health care services.

Mallam Abdulwahab said “we know COVID-19 and TB are two deadly diseases, and we are grateful they chose to bring the outreach to our community. Bringing the TB, COVID-19 and COVID-19 vaccination to our doorstep is a sign that the government is committed to stopping the transmission of these deadly diseases”. 

He urges the government to continue such interventions in other communities around the state.

Effective Harmonization

Buttressing the significance and success of the campaign, the WHO Kaduna State Coordinator, Dr Audu Sunday, said WHO supported the intervention with funding through USAID and GAVI.

He said although WHO’s role is to provide technical support, it has also provided catalytic funding to close up identified gaps and expand coverage of testing’s and COVID-19 vaccination. 

“To ensure COVID-19 data quality assurance, the WHO also provides supportive supervision in the field and ensures all persons vaccinated are uploaded to the Electronic Management of Immunization Data (EMID) platform and the data validated. 

For TB, we harmonize and triangulate data reported from the facility registers (presumptive TB and treatment registers) with laboratory register records and the drug inventory records used to crosscheck data quality’” he said.

Technical Contacts:
Dr Fadare Omoniyi Amos; Email: omoniyia [at] who.int
Dr Audu Sunday; Email: audusu [at] who.int