title: Tuberculosis case detection in Nigeria, the unfinished agenda.
abstract: OBJECTIVE
  Underdetection of TB is a major problem in sub-Saharan Africa. WHO recommends countries should have at least 1 laboratory per 100,000 population. However, this recommendation is not evidence based.
  
  
  METHODS
  We analysed surveillance data of the Nigerian National TB Control Programme (2008-2012) to describe TB case detection rates, their geographical distribution and their association with the density of diagnostic laboratories and HIV prevalence.
  
  
  RESULTS
  The median CDR was 17.7 (range 4.7-75.8%) in 2008, increasing to 28.6% (range 10.6-72.4%) in 2012 (P < 0.01). The CDR2012 was associated with the 2008 baseline; however, states with CDR2008 < 30% had larger increases than states with CDR2008 > 30. There were 990 laboratories in 2008 and 1453 in 2012 (46.7% increase, range by state -3% to +118). The state CDR2012 could be predicted by the laboratory density (P < 0.001), but was not associated with HIV prevalence or the proportion of smear-positive cases. CDR2012 and laboratory density were correlated among states having < and > than 1 laboratory per 100,000 population.
  
  
  CONCLUSIONS
  There are large variations in laboratory density and CDR across the Nigerian states. The CDR is associated with the laboratory density. A much larger number of diagnostic centres are needed. It is likely that a laboratory density above the recommended WHO guideline would result in even higher case detection, and this ratio should be considered a minimum threshold.
authors.affiliation: National Tuberculosis and Leprosy Control Programme of Nigeria, Abuja, Nigeria.
authors.forename: Joshua
authors.initials: J
authors.lastname: Obasanya
authors.affiliation: Federal Capital Territory Abuja Tuberculosis And Leprosy Control Programme, Abuja, Nigeria.
authors.forename: Saddiq T
authors.initials: ST
authors.lastname: Abdurrahman
authors.affiliation: Zankli Medical Centre, Abuja, Nigeria.|Liverpool School of Tropical Medicine, UK.
authors.forename: Olanrewaju
authors.initials: O
authors.lastname: Oladimeji
authors.affiliation: Zankli Medical Centre, Abuja, Nigeria.
authors.forename: Lovett
authors.initials: L
authors.lastname: Lawson
authors.affiliation: Liverpool School of Tropical Medicine, UK.
authors.forename: Russell
authors.initials: R
authors.lastname: Dacombe
authors.affiliation: National Tuberculosis and Leprosy Control Programme of Nigeria, Abuja, Nigeria.
authors.forename: Nkem
authors.initials: N
authors.lastname: Chukwueme
authors.affiliation: National Tuberculosis and Leprosy Control Programme of Nigeria, Abuja, Nigeria.
authors.forename: Tubi
authors.initials: T
authors.lastname: Abiola
authors.affiliation: TB Care, KNCV / TB CARE I, Abuja, Nigeria.
authors.forename: Gidado
authors.initials: G
authors.lastname: Mustapha
authors.affiliation: Microbiology Department, Université Paris-Sud, Orsay, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Sola
authors.affiliation: Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Dominguez
authors.affiliation: Liverpool School of Tropical Medicine, UK.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Cuevas
mesh_terms: D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D009549:Nigeria / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*
keywords: HIV; VIH; case detection; centres de diagnostic; centros de diagnóstico; detección de casos; diagnostic centres; détection des cas; surveillance; tuberculose; tuberculosis; vigilancia