BACKGROUND
PROJECT AIMS & OBJECTIVES
METHODOLOGY
INTERVENTION
TB CARE
Training and Transport Improve TB Referral of Almajiri Youth by Qur’anic Teachers in Residential Schools of Kano State, North-western Nigeria
• TsangayaboardingQur’anicschoolsarewidelydistributedacrossnorthernNigeriaandsomepartsofWestAfricaandhouse9.5millionchildrenbetweentheagesof7and18.
• Theschoolpupils(almajiris)aretypicallyboysfrompoorfamilies.Isolatedfromfamily,theyoftenhavelimitedaccesstohealthcare,areundernourishedandmaybeharmedduringchildlabor(urbanbeggingorruralfarmtasks).Theyliveincongregate,communalstructureswithsubstandardhygieneandsleepingconditionsconducivetothespreadofTBandotherdiseases.
• ItwasconductedincollaborationwithTBDOTScentresinKanostate,North-WesternNigeria,localreligiousleadership,andcarriedoutinthecontextofanoperationalresearchcourse.
ToassesstheeffectivenessofaninterventiontoimproverecognitionofTBscreeningandreferralbehaviorofQuranicschoolteachersoftheirschoolpupilstoDOTScentresinNorth-WesternNigeria.
Multi-stagesamplingwasemployedtorandomlyselect4LocalGovernmentsAreas(LGA)ofKanoStateand57schoolsacrosstheLGAs.Withintheselectedschools,theheadteacherandtwootherteacherswerepurposefullyselected.StructuredKAPquestionnaireswereadministeredbytrainedmultilingualHausaMuslimdatacollectors.Pre-andpost-interventionreferralanddiagnosticdatawerecollectedinlogbooks.
Atotalof95massansfrom29schools(95%invited)acrossthe2LGAs(servingover8,000almajiris)weretrainedinuseofchildTBregistersandreferralformsandaskedtorefersymptomaticyouth.After28daysinthecontrolcondition,themassanwerethengivenanadditionaltrainingonpediatricTBsymptoms,pediatricTBdiagnostics,andtreatment.Theywereofferedtransportationreimbursementforalmajirisexhibitingsymptoms.Asecondcohortof53teachersfrom29schoolsfrom2LGAsweretrainedtorecognizeandreferinareplicationphase.
Nura,M.S1;Tijjani,H2;Babashani,M3;Bot,T.C4;Mitchell,E.M.H.5,6;Gidado,M7;Habib,A3
RESULTS
DISCUSSION
CONCLUSION
Islamiceducationalleaderswereopentotrainingandkeentoimprovehealthaccessforalmajiris.Priortothetraining,halfofthemassan(49.3%)didnotknowthefactorsthatcontributetothespreadofTB,34(23%)believedthatadustyenvironmentplayedaroleinTB.Onequarter(22.3%)werenotsurewhattodoiftheirpupilweretodevelopTB.Only18(12.2%)knewofaTBtreatmentcenterintheirlocalgovernmentarea.Referralsincreasedandincludedbothalmajirisbutalsomassansandtheirfamilymembers.AstheproportionofTB-specificchildreferralsincreased,theproportiondeemedworthyofsputuminvestigationbytheTBprogramdeclined.FewchildrenreceivedchestxrayorTSTorothertestsduetodiagnosticfeebarriers.Onesmear-positiveTBcasewasdiagnosedinthe31dayinterventionwindow.Thenumberneededtorefer(NNR)todiagnose1TBsmearpositivecasewas111.
TrainingofQur’anicschoolteachersonTBsymptomsandprovidingtransportreimbursementimprovedreferralbehaviorforbothnon-TBandTBsymptoms.However,itisnotclearwhysuchalargeproportionofreferredsymptomaticchildrenwerenottestedforTB.Userfeesforchestxrayandlackofaccesstochild-friendlydiagnosticsremainbarrierstoTBcareinNorthernNigeria.
Culturallyappropriatetrainingandincentivescanreachthisvulnerablepediatricpopulation.ReligiousleadersareopenandwillingtoengageinthefightagainstTB.PolicyreformsareneededtoreducecoststoTBdiagnosticsforchildreninordertoimprovecasedetectioninvulnerableunder-servedyouth.
1.JigawaTB&LeprosyControlProgramoffice,Dutse;2.KanoTB&LeprosyControlProgramOffice,Kano;3.BayeroUniversity/AminuKanoTeachingHopital,Kano;Nigeria;4.AhmaduBelloUniversityTeachingHospital,Kaduna;5.KNCVTBFoundation,TheHague,Netherlands;6.DepartmentofGlobalHealth,AcademicMedicalCenter,andAmsterdamInstituteofGlobalHealthandDevelopment,Amsterdam,theNetherlands;7.KNCV/TBCAREIproject,Abuja,Nigeria.
0
20
40
60
80
100
Anti-TBDrugs
Not Sure
Prayers HerbalRemedies
Vaccination
Pre-Training Opinions onAppropriate Treatment of Tuberculosis (%)
Mode of Treatment
93
5145
25
9 controlreferralperday_mean referralperday_intersuspectperday_intercontrol_suspectperday_mean
.4
.3
.2
.1
0
Controlperiod
29schools
Interventionperiod
29schools
Expansionphase
25schools pvalue
Meanchildreferralsperdayperschool .025 .058 .064 .006
Totalchildreferrals 20 100 105MeanTB-specificreferralsperday(SE) .007 .025 .039 .007
TotalTB-specificreferrals 6 44 67 -TotalsputumcollectedtestedbytheTBprogram 5(83%) 20(45%) 44(66%) .0086
PresumptiveTBclientsdiagnosedwithTB 0 1 0
NumberneededtorefertodiagnoseoneTBcase -- 111
TB Referral and Diagnosis Before and After Intervention
Box Plot of the mean referrals and TB cases per day/per school in the control and intervention groups.
