DOI: 10.5061/dryad.tht76hf07
title: Improving Tuberculosis case finding in Nigeria

description: Paper I  Background: Case detection for Tuberculosis remains low
 in high burden communities. Community Health Workers (CHWs) are the first
 point of contact for many Nigerians in the rural areas and have been found
 useful in active case finding. This study assessed the effect of cash
 incentives and training on tuberculosis case detection by CHWs in six
 Local Government Areas in Nigeria. Materials and Methods: A randomised
 control trial was conducted in three PHC clusters. The intervention Arm
 (A) received cash incentives for every presumptive case referred. The
 Training Arm B had no cash incentives and the control had neither training
 nor cash incentives. Case notification rates from the TB program were used
 to assess the effect of cash incentives on TB case finding. Data was
 analyzed using Graph Pad Prism. Descriptive data was presented in tables
 and bivariate data was analyzed using chi square. Mean increases in case
 notification rates was calculated Statistical significance was set as
 P=0.05. Results: Findings showed an increase of 14.4% (ꭓ2=2.976,P
 value=0.2258) in case notification rates for the Arm A that received cash
 incentives alongside training, there was also an increase of 7.4% (ꭓ2=
 1.999,P value=0.1575) in Arm B that received Training only. For secondary
 outcomes, there was an increase in the total knowledge score (25.4%),
 knowledge of general symptoms (24.4%), knowledge of prevention (22.6%) and
 knowledge of diagnosis and treatment (30.0%) across all study arms
 post-intervention (p&lt;0.0001). Secondary outcomes also indicated a
 144.8%(ꭓ2= 4.147, P value=0.1258) increase in community
 outreaches conducted in the Arm that were given cash incentives.
 Conclusion: The study demonstrated an increase in TB control activities of
 case notification and outreaches among community health workers that
 received cash incentives and training. These findings support the
 use of incentives for CHWs in high burden TB settings to improve TB case
 detection rates. Paper II Background: Intensified efforts to improve
 tuberculosis (TB) diagnosis, treatment, and prevention are needed to meet
 global EndTB targets. Community health workers’ (CHWs) knowledge with
 respect to case finding is vital in tuberculosis elimination. This study
 aimed to determine the effect of tuberculosis training on the knowledge of
 community health workers in Nigeria. Methods: As part of a larger
 multicomponent intervention study, a randomised control trial was
 conducted with CHWs in 18 Primary Health Care(PHC [TF1] [CA2]) clusters in
 Nigeria. The clusters were allocated to three arms: training and cash
 incentive (A), training only (B), and control (C) arms. Arms (A) and (B)
 received training on tuberculosis symptoms, prevention, diagnosis and
 treatment while the control arm (C) did not receive training.
 Participants’ knowledge on tuberculosis was assessed using questionnaires
 administered pre- and post-intervention. Data was analyzed using GraphPad
 Prism. Descriptive data was presented in tables and bivariate data was
 analyzed using chi square. Statistical significance was set as
 P&lt;0.05. Results: There was a significant increase in the total
 knowledge score (25.4%), knowledge of general symptoms (24.4%), prevention
 (22.6%) and diagnosis and treatment (30.0%) across all study arms
 post-intervention (p&lt;0.0001). Compared with the control, training
 arm (A) had a higher proportion of good total knowledge score (94.4%) and
 arm (B) had lower proportion of good total knowledge score (83.1%) when
 compared to the control group (93.1%). These were, however, not
 statistically significant. Conclusions: An improvement in the CHWs’
 knowledge of symptoms, prevention, diagnosis and treatment of tuberculosis
 was observed after a training intervention was done. Integration of
 routine tuberculosis training is recommended to improve tuberculosis case
 finding in high burden communities.
description: The data was collected over a period of one year from Community
 Healthworkers in Akwa Ibom State. The Data for training was drawn from
 respondents by interviewers using a structured questionnaire which was
 adapted from one that was used for the National TB Prevalence Survey in
 Nigeria in 2017. The researchers collected data during supervisory visits
 to the Community Health Workers in their place of work. The post
 intervention data was collected on android phones using the ODK app. READ
 ME files have been created for the data set.