Tuberculosis disease burden and attributable risk factors in Nigeria, 1990-2016

Felix Akpojene Ogbo; Pascal Ogeleka; Anselm Okoro; Bolajoko O Olusanya; Jacob Olusanya; Ifegwu K Ifegwu; Akorede O Awosemo; John Eastwood; Andrew Page

doi:10.1186/s41182-018-0114-9

Tuberculosis disease burden and attributable risk factors in Nigeria, 1990-2016

Trop Med Health. 2018 Sep 25:46:34. doi: 10.1186/s41182-018-0114-9. eCollection 2018.

Authors

Felix Akpojene Ogbo^{1

2}, Pascal Ogeleka², Anselm Okoro³, Bolajoko O Olusanya⁴, Jacob Olusanya⁴, Ifegwu K Ifegwu², Akorede O Awosemo², John Eastwood^{5

6

7

8

9}, Andrew Page¹

Affiliations

¹ 1Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales Australia.
² Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria.
³ 3Society for Family Health, Justice Ifeyinwa Nzeako House, 8 Port Harcourt Crescent Area 11, Garki, Abuja, Nigeria.
⁴ 4Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria.
⁵ 5Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, New South Wales 2170 Australia.
⁶ 6School of Women's and Children's Health, The University of New South Wales, Kensington, Sydney, New South Wales 2052 Australia.
⁷ 7School of Public Health, The University of Sydney, Sydney, New South Wales 2006 Australia.
⁸ 8School of Public Health, Griffith University, Queensland, Gold Coast, 4222 Australia.
⁹ Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Rd, Croydon, New South Wales 2132 Australia.

Abstract

Background: According to the World Health Organization, Nigeria is one of the countries with a high burden of tuberculosis (TB) worldwide. Improving the burden of TB among HIV-negative people would require comprehensive and up-to-date data to inform targeted policy actions in Nigeria. The study aimed to describe the incidence, prevalence, mortality, disability-adjusted life years (DALYs) and risk factors of tuberculosis in Nigeria between 1990 and 2016.

Methods: This study used the most recent data from the global burden of disease study 2016. TB deaths were estimated using the Cause of Death Ensemble model, while TB incidence, prevalence and DALYs, as well as years of life lost and years of life lived with disability were calculated in the DisMod-MR 2.1, a Bayesian meta-regression tool. Using a comparative risk assessment approach, TB burden attributable to risk factors was estimated in a spatial-temporal Gaussian Process Regression tool.

Results: In 2016, the prevalence of TB among HIV-negative people was 27% (95% uncertainty interval [95% UI] 23-31%) in Nigeria. TB incidence rate (new and relapse cases) was 158 per 100,000 people (95% UI; 128-193), while the total number of TB mortality was 39,933 deaths (95% UI; 30,488-55,039) in 2016. Between 2000 and 2016, the age-standardised prevalence and incidence rates of TB-HIV negative decreased by 20.0 and 87.6%, respectively. The age-standardised mortality rate also dropped by 191.6% over the same period. DALYs due to TB among HIV-negative Nigerians was high but varied across the age groups. Of the risk factors studied, alcohol use accounted for the highest number of TB deaths and DALYs, followed by diabetes and smoking in 2016.

Conclusion: The study shows an improving trend in TB disease burden among HIV-negative individuals in Nigeria from 1990 to 2016. Despite this progress, this study suggests that additional efforts are still needed to ensure that Nigeria is not left behind in the current global strategy to end TB disease. Reducing TB disease burden in the country will require a multipronged approach that includes increased funding, health system strengthening and improved TB surveillance, as well as preventive efforts for alcohol use, smoking and diabetes.

Keywords: Burden; Global burden of disease; Mortality; Nigeria; Tuberculosis.