Tuberculosis case detection in Nigeria, the unfinished agenda

Objective Underdetection of TB is a major problem in sub-Saharan Africa. WHO recommends countries should have at least 1 laboratory per 100 000 population. However, this recommendation is not evidence based. Methods We analysed surveillance data of the Nigerian National TB Control Programme (2008-2012) to describe TB case detection rates, their geographical distribution and their association with the density of diagnostic laboratories and HIV prevalence. Results The median CDR was 17.7 (range 4.7–75.8%) in 2008, increasing to 28.6% (range 10.6–72.4%) in 2012 (P 30. There were 990 laboratories in 2008 and 1453 in 2012 (46.7% increase, range by state −3% to +118). The state CDR2012 could be predicted by the laboratory density (P than 1 laboratory per 100 000 population. Conclusion There are large variations in laboratory density and CDR across the Nigerian states. The CDR is associated with the laboratory density. A much larger number of diagnostic centres are needed. It is likely that a laboratory density above the recommended WHO guideline would result in even higher case detection, and this ratio should be considered a minimum threshold.