29 July 2014 - Adamawa, Nigeria - Adamawa is the only state in Nigeria where the nomadic Koma tribe lives and an estimated 90% of the state’s population are nomadic pastoralists. These groups are at an increased risk of developing and dying from TB due to their poor living conditions, low knowledge and awareness of TB infection risks, belief in traditional/alternative medicine and limited access to government TB services. Additionally, the common practices of animal husbandry and consumption of unpasteurized milk further increase the risks of TB infection because there is also a high burden of bovine TB among livestock due to the lack of veterinary care in the state. These challenges have resulted in TB causing an estimated 48% of all deaths among nomadic pastoralists in this region.
Three strategies were devised to improve access and provision of TB care health system strengthening; awareness-raising activities; and active case finding among nomadic communities. The initiative invested heavily in improving the diagnostic capacity of existing TB health centres by procuring light microscopes and smear microscopy reagents, renovating a space at the regional referral hospital to house a GeneXpert system, and training program staff to improve TB care practices.
A host of awareness-raising activities were also implemented. Radio jingles in three languages - Fulfulde, Hausa and English - were produced and aired extensively. The English language jingles were targeted towards policy makers and were aired for a shorter duration of time in favour of the jingles directed at the community. The National TB Programme Manager appeared regularly on State TV to discuss TB, and in particular the issue of TB in nomads. The initiative formed a committee which met with representatives from the Ministries of Health, LGAs and Livestock Production, as well as the Universal Basic Education Board (UBEB), to advocate on behalf of the project. The committee’s lobbying was highly successful and resulted in the several of the initiatives activities being co-financed.
Project staff connected with community leaders and asked them to convene a public meeting to which the entire community was invited. The meetings were held at nomad resting stations and settlement areas where the elderly and children of the community typically live. At the meeting, project staff continued to implement advocacy and outreach by making presentations and performing plays for attendees which focused on TB risks and knowledge. Community volunteers then verbally screen all the attendants to identify TB symptomatic individuals. Suspected TB patients were then asked to provide sputum specimens for testing. During some meetings, medicine for common conditions, such as worm expellers, multivitamins and anti-malarials, were distributed in order to provide an additional incentive for community members to attend these meetings.
The project treated 1,112 patients who most likely would not have accessed care in the absence of an intervention, representing a 41% increase in the number of people treated for TB in this hard to reach population.