Date of Conferral





Public Health


Awosika-Olumo Adebowale



Tuberculosis (TB) is the leading cause of death from a single infectious disease. Unfortunately, 4.1 million cases were missed in 2017 globally, and Nigeria contributes 9% of the missing TB cases. At least 73% of the estimated TB cases in Nigeria were not reported in 2017 to the National TB Program (NTP); therefore, the true burden of TB was not certain, and this affected planning for prevention and control of TB. This quantitative secondary data analysis (NTP Lagos TB Inventory study database) guided by the integrated behavioral model assessed TB underreporting based on the TB reporting process in Nigeria. Chi-square and binomial logistic regression were used to assess the association between TB underreporting and the characteristics of health facilities (HFs), health workers' (HWs) awareness, barriers to TB reporting, and patient-related factors. The results indicate at least 60% of all HFs underreported TB, with an average of 7.4% underreporting between HFs records and TB program reports. There was a statistically significant association between NTP nonengaged health facilities (χ2 (1) = 20.547, p <.05), HWs' awareness of TB reporting (χ2 (1) = 6.576, p <.05), and barriers for TB reporting (χ2 (1) = 4.106, p < .05) with TB underreporting. The following patient factors were statistically significant predictors of TB underreporting with over 50% increased odds, p<0.05: previously treated, extrapulmonary, unknown TB site, HIV negative, and HIV unknown. This study supports social change through NTPs ensuring the establishment of a coordinating mechanism for TB reporting within and between HFs and supply of TB reporting tools to all HFs to know the true burden of TB for better planning and monitoring of quality care for TB patients.