title: Reaching the underserved: Active tuberculosis case finding in urban slums in southeastern Nigeria.
abstract: BACKGROUND
  Nigeria ranks 10th among 22 high TB burden countries with low TB case detection that relies on passive case finding. Although there is increasing body of evidence that active case finding (ACF) has improved TB case finding in urban slums in some parts of the world, this strategy had not been implemented in Nigeria despite the pervasiveness of urban slums in the country.
  
  
  OBJECTIVE
  To assess the yield and profile of TB in urban slums in Nigeria through ACF.
  
  
  METHODS
  A prospective, implementation study was conducted in three urban slums of southeastern Nigeria. Individuals with TB symptoms were identified through targeted screening using a standardized questionnaire and investigated further for TB. Descriptive and bivariate analyses were performed using SPSS.
  
  
  RESULTS
  Among 16,743 individuals screened for TB, 6361 (38.0%) were identified as TB suspects; 5894 suspects were evaluated for TB. TB was diagnosed in 1079 individuals, representing 6.4% of the screened population and 18.3% of those evaluated for TB. Of the 1079 cases found, 97.1% (n=1084) had pulmonary TB (PTB), and majority (65%) had new smear-positive TB. Children (<15years) accounted for 6.7% of the cases. Also, 22.6% (216) of the cases were HIV co-infected, among whom 55.1% (n=119) were females. The average number of individuals needed to screen to find a case of TB was 16.
  
  
  CONCLUSIONS
  There is high prevalence of TB in Nigeria slum population. Targeted screening of out-patients, TB contacts, and HIV-infected patients should be optimized for active TB case finding in Nigeria.
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria. Electronic address: cogbudebe@yahoo.com.
authors.forename: Chidubem L
authors.initials: CL
authors.lastname: Ogbudebe
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria. Electronic address: jnchukwu2003@yahoo.com.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Chukwu
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria. Electronic address: ccnwafor@yahoo.com.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Nwafor
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria. Electronic address: ochendo1ng@yahoo.com.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Meka
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria. Electronic address: ekekengozi@yahoo.com.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Ekeke
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria. Electronic address: drmadichie76@yahoo.com.
authors.forename: Nelson O
authors.initials: NO
authors.lastname: Madichie
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria. Electronic address: anyim54@yahoo.com.
authors.forename: Moses C
authors.initials: MC
authors.lastname: Anyim
authors.affiliation: World Health Organisation (WHO), Southeast Zone, Nigeria. Electronic address: chijiosakwe@yahoo.com.
authors.forename: Chijioke
authors.initials: C
authors.lastname: Osakwe
authors.affiliation: Department of Community Medicine, Abia State University, Aba Campus, Aba, Abia State, Nigeria. Electronic address: u2onyeonoro@gmail.com.
authors.forename: Ugochukwu
authors.initials: U
authors.lastname: Onyeonoro
authors.affiliation: Department of Internal Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Electronic address: ukwajakingsley@yahoo.co.uk.
authors.forename: Kingsley N
authors.initials: KN
authors.lastname: Ukwaja
authors.affiliation: Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria. Electronic address: dannyoshi@yahoo.com.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Oshi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D011204:Poverty Areas; D015995:Prevalence; D011446:Prospective Studies; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology
keywords: Active case finding; Epidemiology; Screening; Tuberculosis; Urban slums