Challenges affecting tuberculosis control in Nigeria: a systematic review protocol of studies on experiences of treatment in tuberculosis patients (2015 – 2020)

Tuberculosis (TB) is a major public health problem in Nigeria and one of the ten leading causes of deaths and hospital admissions in the country [1], as well as the leading causes of death among people living with human immunodeficiency virus (HIV) [2-4]. The 2019 World Health Organization (WHO) Global TB Report (GTR) revealed that Nigeria is ranked first and sixth highest TB-burden country in Africa and in the world respectively [5]. Among the thirty countries that accounted for 87 percent of the world’s TB cases in 2018, eight countries including Nigeria accounted for two-third of the global burden [5]. In 2018, there were about 21,000 (range, 13,000 – 32,000) incidence of multidrug-resistant/rifampicin resistant tuberculosis (MDR/RR-TB) in Nigeria, of which 4.3% (range, 3.2 – 5.5) are new cases and 15% are retreatment cases (range, 11 – 19) [5]. Out of this number, only 1900 patients received treatment [5]. It’s believed that the actual number of new and retreatment cases of TB and MDR/RR-TB cases in Nigeria, a country with a population of about 200 million people, are either underreported or underdiagnosed considering patient-centered and healthcare-system related factors [5-9]. Consequently, there are relatively higher treatment failure rates amongst retreatment cases [10], loss to follow-up of TB patients and high mortality rates [5,11]. The Nigeria’s National Tuberculosis and Leprosy Control Programme (NTBLCP) under the Federal Ministry of Health (FMoH) is saddled with the responsibility of reducing TB prevalence by 50% and mortality by 75% by 2025. This agency, in 2014, set-up a 5-years strategic plan (2015-2020) with the hope to reduce TB illnesses and reach zero TB deaths, including the reduction of drug-resistant TB and comorbidities [12]. However, TB has continued to pose a major threat to health despite several efforts to address the situation. This review will identify the experiences that may contribute to the understanding of factors affecting TB control in Nigeria over the past 5 years in order to address the gaps in TB services, which are beneficial for patients as well as the system.