A recent study conducted in Nigeria revealed the significant impact of stool-based Xpert testing on childhood tuberculosis (TB) diagnosis.
Nigeria, a culturally diverse nation with 36 states and a population of over 202 million, faces one of the highest burdens of tuberculosis (TB) globally. Based on World Health Organization’s (WHO) TB Report 2023, TB burden estimate was at 479,000 cases for 2022, however TB case notification could only reach half of it, and children younger than 15 years-old accounted for 7% of these figures.
“…children in high-burden settings present early with TB.”
As reported by KNCV Nigeria, “TB disease is often more severe in children younger than 15 years, with higher mortality among those less than 5 years. The notification of children with active disease and latent TB has remained abysmally low…”, therefore enhancing TB notification rates, enables early treatment, and potentially leads to better health outcomes for children, supporting our goal to end TB.
The study was conducted in the Nigerian states Anambra, Imo, Delta, Akwaibom, Rivers, Cross River, Nasarawa, Benue, Plateau, Taraba, Kano, Kaduna, Katsina, and Bauchi, and involved 1,082 health facilities across the 14 states, aimed to address the low TB notification rates among children.
The intervention focused implementation and scale up by decentralizing the Simple One-Step (SOS) stool-based Xpert method to peripheral sites, making it accessible to settings where children are most likely to seek healthcare. This method involves using stool as an alternative specimen for children who cannot produce quality sputum, which is common among younger children aged 0-4 years (read more about the SOS Stool method in our previous news item HERE).
Highlights from the study:
- SOS Stool based Xpert testing significantly contributed to improved childhood TB diagnosis and notification in the 14 studied states.
- Interventions aimed at awareness creation, capacity building, and active TB case finding in children were implemented to improve and sustain the performance and quality of the test over time. Significant efforts were made to increase awareness and demand for the test. This included nationwide webinars, sensitization campaigns, and training sessions for healthcare workers in different sectors: DOTs officers, pediatricians, laboratory staff, and clinicians.
- The introduction of the SOS Stool based Xpert method led to significant increase in annual TB notifications compared to the pre-implementation period (except for the 2020 COVID-19 time frame). The stool-based test contributed to a maximum of 17% of the increase in the TB case detection in 2022 and 2023.
- Older children (5-14 years) had a higher TB yield from stool testing than younger children (0-4 years), suggesting the potential benefit of stool as an alternative specimen for TB diagnosis in adults with presumptive TB diagnosis.
- TB was more common among children aged 0-4 years, indicating recent and ongoing transmission of infection in this age group.
Overall, the findings underscore the critical role of targeted interventions, such as awareness creation, capacity building, and active case finding, in sustaining the improved performance of TB diagnostic tests. By expanding access to bacteriological diagnosis and reducing the biosafety risks associated with traditional sputum tests, this approach has proven especially effective in resource-constrained areas. This successful implementation in 14 states of Nigeria could serve as a model for expansion to other regions in the country and other high-burden TB countries aiming to improve childhood TB diagnosis and outcomes.
Click here to read the study, or here to view more recent publications by KNCV.