Abstract:

Background: The National Tuberculosis Program plan to eliminate Tuberculosis (TB) as a public health problem in Nigeria by 2050 and WHO 90-90-90 target of ending TB may be difficult to achieve without an efficient and effective sample referral system.

Aims: The aim of this study is to critically evaluate the outsourcing of sputum transportation logistics in TB diagnosis, prevention, and control in Nigeria.

Materials and Method: Information was obtained from all the TB testing laboratories in all the 36 states and the Federal Capital Territory in Nigeria. Data were extracted from the excel database used for tracking specimen transportation logistics, cleaned and analyzed using IBM-SPSS version 25.0.

Result: This study revealed a steady increase in the number of samples transported from collection centers to testing laboratories from 393 in March 2018 to 5211 in March 2019. Samples transported by 3PLs increased by 508.7% at month 7 (midway) and increased by 1,326% at month 13. Similarly, the number of results transported from testing laboratories back to collection centers increased by 1,121% and 3,166% respectively. Akwa Ibom state recorded the highest number of sample movements; (13.6%), followed by Benue (11.7%) and Lagos state (11.5%). Percentage of sputum results pick-up were above 50% and 69% overall. Sample rejection was low, at 0.25%, indicating effectiveness and efficiency in the system.

Conclusion and Recommendation: The study reported very good performance of 3PL services. However, the low sample transportation in some states requires further investigation and attention.

Keywords: Tuberculosis, Sputum, Sample Referral, Logistics, 3PL, Outsourcing.

References:

[1].   Adebambo, S. O., Omolola, O. M., & Victor, D. A. (2016). Analysis of Outsourcing Logistics Service and Customer Satisfaction in Manufacturing Companies in South Western Nigeria. European Journal of Logistics, Purchasing, and Supply Chain Management, 4(1), 1–10.

[2].   Adegboyega O, Eyitayo A, Emmanuel L. (2017). Tuberculosis and the determinants of treatment outcome in Zaria, North Western Nigeria – A nine-year (2007–2015) epidemiological review. Journal of Medicine in the Tropics, 31(4), 116–122. https://doi.org/10.4103/jomt.jomt.

[3].   Alemnji, G., Nkengasong, J. N., & Parekh, B. S. (2011). HIV testing in developing countries: What is required? Indian Journal of Medical Research, 134(12), 779–786.

[4].   Aliyu, G., Ezati, N., Iwakun, M., Peters, S., & Abimiku, A. (2017). Diagnostic system strengthening for drug-resistant tuberculosis in Nigeria: impact and challenges. African Journal of Laboratory Medicine, 6(2), 1–6. https://doi.org/10.4102/ajlm.v6i2.502.

[5].   Aruna, O., Nsofor, I., & Kola Oyediran. (2018). Tuberculosis in Nigeria Rapid Assessment of Infectious Disease Surveillance and Reporting. Retrieved from www.measureevaluation.org.

[6].   Desmon, S. (2018). Taking a Deep Dive into Why Nigeria’s TB Rates are So High. Johns Hopkins Center for Communication Programs. Retrieved from https://ccp.jhu.edu/2018/10/22/nigeria-tb-rates-high-tuberculosis/

[7].   Dr.Abhineet Mehrotra, D. A. M. (2013). An Evaluation of Laboratory Specimen Rejection Rate in a North Indian Setting-A Cross-Sectional Study. IOSR Journal of Dental and Medical Sciences, 7(2), 35–39. https://doi.org/10.9790/0853-0723539.

[8].   Faruna, T., Akintunde, E., & Odelola, B. (2019). Leveraging private sector transportation/logistics services to improve the National Integrated Specimen Referral Network in Nigeria © Society for Business and Management Dynamics © Society for Business and Management Dynamics. 8(7), 8–20.

[9].   Gebreegziabher, S. B., Yimer, S. A., & Bjune, G. A. (2016). Qualitative Assessment of Challenges in Tuberculosis Control in West Gojjam Zone, Northwest Ethiopia: Health Workers’ and Tuberculosis Control Program Coordinators’ Perspectives. Tuberculosis Research and Treatment, 2016, 1–8

https://doi.org/10.1155/2016/2036234.

[10].  Global Health Education. (2018). TB in Nigeria - Funding, children, diagnosing TB, HIV/TB. Global Health Education. Retrieved from https://www.tbfacts.org/tb-nigeria/.

[11].  GOV.UK. (2018). Tuberculosis testing in Nigeria. Retrieved from

https://www.gov.uk/government/publications/tuberculosis-test-for-a-uk-visa-clinics-in-malaysia/tuberculosis-testing-in-malaysia.

[12].  Joloba, M., Mwangi, C., Alexander, H., Nadunga, D., Bwanga, F., Modi, N., … Nkengasong, J. N. (2016). Strengthening the Tuberculosis Specimen Referral Network in Uganda: The Role of Public-Private Partnerships. Journal of Infectious Diseases, 213(Suppl 2), S41–S46. https://doi.org/10.1093/infdis/jiw035.

[13].  Ju, Y., Wang, Y., Cheng, Y., & Jia, J. (2019). Investigating the impact factors of the logistics service supply chain for sustainable performance: Focused on integrators. Sustainability (Switzerland), 11(2).

https://doi.org/10.3390/su11020538.

[14].  Kalinzi, C. (2017). Outsourcing (Logistics) Services and Supply Chain Efficiency – A Critical Review of Outsourcing Function in Mukwano Group of Companies. Journal of Outsourcing and Organizational Information Management, (July), 1–22. https://doi.org/10.5171/2016.937323.

[15].  Kebede, Y., Fonjungo, P. N., Tibesso, G., Shrivastava, R., Nkengasong, J. N., Kenyon, T., … Ayana, G. (2016). Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership. Journal of Infectious Diseases, 213(CDC), S59–S64. https://doi.org/10.1093/infdis/jiv576.

[16].  Kooffreh, M., Offor, J., Ekerette, E., & Udom, U. (2016). Prevalence of tuberculosis in Calabar, Nigeria: A case study of patients attending the outpatients Department of Dr. Lawrence Henshaw Memorial Hospital, Calabar. Saudi Journal for Health Sciences, 5(3), 130. https://doi.org/10.4103/2278-0521.195817.

[17].  MOH. (2013). Nigeria Federal Ministry of Health. National Tuberculosis Prevalence Survey 2012. Federal Ministry of Health, 15–98. Retrieved from http://www.who.int/tb/publications/NigeriaReport.

[18].  MOH. (2014). Federal Ministry of Health: National Tuberculosis and Leprosy Control (NTBLC). In O. Nwobi, B., Kabir, M., Obasanya & O. Ogbeiwi (Eds.), Worker’s Manual (5th ed.). Federal Ministry of Health.

[19].  Muthoni, D. K. (2016). Effect of Supply Chain Processes Outsourcing on the Performance of Manufacturing Firms in Kenya.

[20].  Ogbo, F. A., Ogeleka, P., Okoro, A., Olusanya, B. O., Olusanya, J., Ifegwu, I. K.,Page, A. (2018). Tuberculosis disease burden Nigeria. 1–11.

[21].  Oguntade, G. (2018). World Tuberculosis Day 2018, on the search for TB Leaders in Nigeria | ARFH Nigeria. Arch. Retrieved from https://arfh-ng.org/world-tuberculosis-day-2018-on-the-search-for-tb-leaders-in-nigeria/.

[22].  Parsons, L. M., Somoskövi, Á., Gutierrez, C., Lee, E., Paramasivan, C. N., Abimiku, A, Nkengasong, J. (2011). Laboratory diagnosis of tuberculosis in resource-poor Countries: Challenges and opportunities. Clinical Microbiology Reviews, 24(2), 314–350. https://doi.org/10.1128/CMR.00059-10.

[23].  PEPFAR. (2015). Remarks on “Creating an AIDS-Free Generation. Retrieved from

http://wwwstategov/%0Asecretary/20092013clinton/rm/2011/11/176810htm.

[24].  Plebani, M. (2015). Diagnostic Errors and Laboratory Medicine - Causes and Strategies. Ejifcc, 26(1), 7–14. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/27683477%0Ahttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975219/pdf/ejifcc-26-007.pdf.

[25].  Shiferaw, M. B., Yismaw, G., & Getachew, H. (2018). Specimen rejections among referred specimens through referral network to the Amhara Public Health Institute for laboratory testing, Bahir Dar, Ethiopia. BMC Research Notes, 11(1), 4–9. https://doi.org/10.1186/s13104-018-3891-7.

[26].  USAID. (2018). SPECIMEN TRANSPORTATION A HOW-TO GUIDE.

[27].  World Health Organisation. Vanuatu: Estimates of TB and MDR-TB burden. , (2018).

[28].  Adebambo, S. O., Omolola, O. M., & Victor, D. A. (2016). Analysis of Outsourcing Logistics Service and Customer Satisfaction in Manufacturing Companies in South Western Nigeria. European Journal of Logistics, Purchasing, and Supply Chain Management, 4(1), 1–10.

[29].  ADEGBOYEGA OYEFABI, EYITAYO ADETIBA, EMMANUEL LEESHAK, O. A. (2017). Tuberculosis and the determinants of treatment outcome in Zaria, North Western Nigeria – A nine-year (2007–2015) epidemiological review. Journal of Medicine in the Tropics, 31(4), 116–122.

https://doi.org/10.4103/jomt.jomt.

[30].  Alemnji, G., Nkengasong, J. N., & Parekh, B. S. (2011). HIV testing in developing countries: What is required? Indian Journal of Medical Research, 134(12), 779–786.

[31].  Aliyu, G., Ezati, N., Iwakun, M., Peters, S., & Abimiku, A. (2017). Diagnostic system strengthening for drug-resistant tuberculosis in Nigeria: impact and challenges. African Journal of Laboratory Medicine, 6(2), 1–6. https://doi.org/10.4102/ajlm.v6i2.502.

[32].  Aruna, O., Nsofor, I., & Kola Oyediran. (2018). Tuberculosis in Nigeria Rapid Assessment of Infectious Disease Surveillance and Reporting. Retrieved from www.measureevaluation.org.

[33].  Desmon, S. (2018). Taking a Deep Dive into Why Nigeria’s TB Rates are So High. Johns Hopkins Center for Communication Programs. Retrieved from https://ccp.jhu.edu/2018/10/22/nigeria-tb-rates-high-tuberculosis/.

[34].  Dr.Abhineet Mehrotra, D. A. M. (2013). An Evaluation of Laboratory Specimen Rejection Rate in a North Indian Setting-A Cross-Sectional Study. IOSR Journal of Dental and Medical Sciences, 7(2), 35–39. https://doi.org/10.9790/0853-0723539.

[35].  Faruna, T., Akintunde, E., & Odelola, B. (2019). Leveraging private sector transportation/logistics services to improve the National Integrated Specimen Referral Network in Nigeria © Society for Business and Management Dynamics © Society for Business and Management Dynamics. 8(7), 8–20.

[36].  Gebreegziabher, S. B., Yimer, S. A., & Bjune, G. A. (2016). Qualitative Assessment of Challenges in Tuberculosis Control in West Gojjam Zone, Northwest Ethiopia: Health Workers’ and Tuberculosis Control Program Coordinators’ Perspectives. Tuberculosis Research and Treatment, 2016, 1–8

https://doi.org/10.1155/2016/2036234.

[37].  Global Health Education. (2018). TB in Nigeria - Funding, children, diagnosing TB, HIV/TB. Global Health Education. Retrieved from https://www.tbfacts.org/tb-nigeria/.

[38].  GOV.UK. (2018). Tuberculosis testing in Nigeria. Retrieved from

https://www.gov.uk/government/publications/tuberculosis-test-for-a-uk-visa-clinics-in-malaysia/tuberculosis-testing-in-malaysia.

[39].  Joloba, M., Mwangi, C., Alexander, H., Nadunga, D., Bwanga, F., Modi, N., … Nkengasong, J. N. (2016). Strengthening the Tuberculosis Specimen Referral Network in Uganda: The Role of Public-Private Partnerships. Journal of Infectious Diseases, 213(Suppl 2), S41–S46. https://doi.org/10.1093/infdis/jiw035.

[40].  Ju, Y., Wang, Y., Cheng, Y., & Jia, J. (2019). Investigating the impact factors of the logistics service supply chain for sustainable performance: Focused on integrators. Sustainability (Switzerland), 11(2). https://doi.org/10.3390/su11020538.

[41].  Kalinzi, C. (2017). Outsourcing (Logistics) Services and Supply Chain Efficiency – A Critical Review of Outsourcing Function in Mukwano Group of Companies. Journal of Outsourcing and Organizational Information Management, (July), 1–22. https://doi.org/10.5171/2016.937323.

[42].  Kebede, Y., Fonjungo, P. N., Tibesso, G., Shrivastava, R., Nkengasong, J. N., Kenyon, T., … Ayana, G. (2016). Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership. Journal of Infectious Diseases, 213(CDC), S59–S64. https://doi.org/10.1093/infdis/jiv576.

[43].  Kooffreh, M., Offor, J., Ekerette, E., & Udom, U. (2016). Prevalence of tuberculosis in Calabar, Nigeria: A case study of patients attending the outpatients Department of Dr. Lawrence Henshaw Memorial Hospital, Calabar. Saudi Journal for Health Sciences, 5(3), 130. https://doi.org/10.4103/2278-0521.195817.

[44].  MOH. (2013). Nigeria Federal Ministry of Health. National Tuberculosis Prevalence Survey 2012. Federal Ministry of Health, 15–98. Retrieved from http://www.who.int/tb/publications/NigeriaReport.

[45].  MOH. (2014). Federal Ministry of Health: National Tuberculosis and Leprosy Control (NTBLC). In O. Nwobi, B., Kabir, M., Obasanya & O. Ogbeiwi (Eds.), Worker’s Manual (5th ed.). Federal Ministry of Health.

[46].  Muthoni, D. K. (2016). Effect of Supply Chain Processes Outsourcing on the Performance of Manufacturing Firms in Kenya.

[47].  Ogbo, F. A., Ogeleka, P., Okoro, A., Olusanya, B. O., Olusanya, J., Ifegwu, I. K., … Page, A. (2018). Tuberculosis disease burden Nigeria. 1–11.

[48].  Oguntade, G. (2018). World Tuberculosis Day 2018, on the search for TB Leaders in Nigeria | ARFH Nigeria. Arfh. Retrieved from https://arfh-ng.org/world-tuberculosis-day-2018-on-the-search-for-tb-leaders-in-nigeria/.

[49].  Parsons, L. M., Somoskövi, Á., Gutierrez, C., Lee, E., Paramasivan, C. N., Abimiku, A., … Nkengasong, J. (2011). Laboratory diagnosis of tuberculosis in resource-poor Countries: Challenges and opportunities. Clinical Microbiology Reviews, 24(2), 314–350. https://doi.org/10.1128/CMR.00059-10.

[50].  PEPFAR. (2015). Remarks on “Creating an AIDS-Free Generation. Retrieved from http://wwwstategov/%0Asecretary/20092013clinton/rm/2011/11/176810htm.

[51].  Plebani, M. (2015). Diagnostic Errors and Laboratory Medicine - Causes and Strategies. Ejifcc, 26(1), 7–14. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/27683477%0Ahttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975219/pdf/ejifcc-26-007.pdf.

[52].  Shiferaw, M. B., Yismaw, G., & Getachew, H. (2018). Specimen rejections among referred specimens through referral network to the Amhara Public Health Institute for laboratory testing, Bahir Dar, Ethiopia. BMC Research Notes, 11(1), 4–9. https://doi.org/10.1186/s13104-018-3891-7.

[53].  USAID. (2018). SPECIMEN TRANSPORTATION A HOW-TO GUIDE.

[54].  World Health Organisation. Vanuatu: Estimates of TB and MDR-TB burden., (2018).