Jude O Aighobahi, Peter Mac Asaga
In this 2019 pre-pandemic survey, TB and diabetes integration in Lagos was critically inadequate, with fewer than 15% of facilities implementing formal screening protocols. Substantial diagnostic capacity was present but underused, and joint staff training showed the strongest positive association with integration. These findings provide a structural baseline for post-pandemic reassessment and suggest that training should be accompanied by joint registers, supervision indicators and sustainable financing.
BACKGROUND: Despite WHO recommendations for integrated care since 2011, implementation of tuberculosis (TB) and diabetes mellitus (DM) care integration remains poorly documented in sub-Saharan Africa. We assessed integration and identified implementation barriers across healthcare facilities in Lagos, Nigeria.
METHODS: Cross-sectional survey of 100 facilities providing TB or diabetes services in Lagos State, January to June 2019, drawn by stratified random sampling from a frame of 237 facilities. Structured questionnaires based on WHO guidelines assessed integration measures, and twelve focus group discussions explored barriers. We used chi-square tests and multivariable logistic regression.
RESULTS: Among 100 facilities (response rate 67%), 8 (8.0%, 95% CI 4.0 to 15.1) had surveillance systems for diabetes screening in TB patients and 4 (4.0%, 95% CI 1.5 to 9.9) for TB screening in diabetes patients; formal screening guidelines were present in 12 (12.0%) and 7 (7.0%). Diagnostic capacity was largely available but unused: chest X-ray was present in 78% of facilities but systematically used in 42%. Staff trained in both conditions was the strongest facilitator (adjusted OR 6.2, 95% CI 2.9 to 13.4) and resource constraints the strongest barrier (adjusted OR for integration 0.20, 95% CI 0.11 to 0.36). Integrating facilities detected 2.4 more diabetes cases and 1.9 more TB cases per month, with higher TB treatment success (89.2% versus 83.4%, p=0.014) and diabetes control (48.7% versus 41.3%, p=0.029). The incremental cost-effectiveness ratio was US$1121 per quality-adjusted life-year in 2025 dollars.
CONCLUSIONS: In this 2019 pre-pandemic survey, TB and diabetes integration in Lagos was critically inadequate, with fewer than 15% of facilities implementing formal screening protocols. Substantial diagnostic capacity was present but underused, and joint staff training showed the strongest positive association with integration. These findings provide a structural baseline for post-pandemic reassessment and suggest that training should be accompanied by joint registers, supervision indicators and sustainable financing.