Epidemiology of Tuberculosis In Selected Urban Slums of Jos North Local Government Area Plateau State: Risk Factors and Preventive Strategies.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Tuberculosis (TB) remains one of the most significant infectious diseases worldwide, with devastating health, social, and economic consequences. Despite progress in global health interventions, TB continues to be a leading cause of death from a single infectious agent, ranking above HIV/AIDS. The World Health Organization (WHO) estimates that in 2022, approximately 10.6 million individuals developed TB, while 1.3 million HIV-negative people and 167,000 HIV-positive individuals died from the disease (WHO, 2023). These alarming figures underscore the enduring threat TB poses, particularly in countries with fragile healthcare systems.

Sub-Saharan Africa carries a disproportionate burden of TB due to the synergistic interaction between HIV and TB, as well as systemic poverty, overcrowding, malnutrition, and weak healthcare infrastructures (Adebisi et al., 2021). The HIV epidemic, in particular, has exacerbated TB prevalence in this region, as HIV-positive individuals are significantly more vulnerable to developing active TB. Limited access to diagnostic tools, poor treatment adherence, and stigma further complicate the TB response across many African countries.

In Nigeria, TB represents a pressing public health concern. Nigeria is classified among the top 30 countries with the highest TB burden globally, contributing about 4.5% of the world’s TB cases (NTBLCP, 2021). Despite being preventable and curable, TB continues to spread across urban and rural populations, fueled by poverty, weak health services, and limited awareness. Nigeria’s urban centers, especially in Plateau State, have become epicenters for TB transmission due to rapid population growth, poor housing conditions, and limited infrastructure for disease prevention and control.

Jos North Local Government Area (LGA) in Plateau State is a case in point, serving as both a commercial hub and a densely populated settlement. It attracts a diverse population, including low-income earners, migrants, and internally displaced persons (IDPs). This demographic mix contributes to the growth of slum settlements characterized by overcrowding, inadequate sanitation, poor waste management, and insufficient health facilities. These socio-environmental conditions create fertile ground for the spread of TB, which is transmitted primarily through airborne droplets from infected individuals.

Several risk factors exacerbate TB transmission in Jos North’s urban slums. Malnutrition compromises immunity, leaving individuals more susceptible to infection. HIV/AIDS, which remains prevalent in Plateau State, further amplifies vulnerability to TB. Lifestyle practices such as smoking and alcohol abuse, combined with poor healthcare-seeking behavior, increase the chances of TB spread and progression. Additionally, delayed diagnosis and treatment interruptions, often due to limited access to healthcare or socio-economic barriers, perpetuate high transmission rates in the community (Zumla et al., 2013).

Although global and national strategies such as the Directly Observed Treatment Short Course (DOTS) and intensified case-finding efforts have been implemented, TB persists as a health challenge in Nigeria. The persistence of TB in Jos North, despite government interventions and support from international partners, reveals a gap between policy and practice. Interventions often remain generic, failing to address the specific realities of urban slum populations who face daily struggles of poverty, overcrowding, and stigma.

Furthermore, TB has both medical and socio-economic dimensions. Beyond causing illness and mortality, TB leads to financial burdens for households due to prolonged treatment periods, loss of income, and costs associated with care. In urban slums where residents already grapple with economic hardship, TB exacerbates cycles of poverty and ill health. The stigma associated with the disease also discourages early detection and treatment adherence, leading to ongoing transmission within families and communities.

Therefore, understanding the epidemiology of TB in the context of Jos North urban slums is critical. Localized research that examines the specific risk factors, socio-economic dynamics, and preventive strategies within these communities will provide valuable insights for targeted interventions. Without such community-focused studies, TB control efforts may continue to be ineffective. This research seeks to bridge that gap by assessing the drivers of TB transmission and evaluating preventive strategies that can be adapted to the realities of slum dwellers in Jos North LGA.

1.2 Statement of the Problem

Despite significant progress in tuberculosis (TB) control worldwide, the disease remains a persistent public health challenge in Nigeria, especially within urban slum communities. Global strategies such as the Directly Observed Treatment Short Course (DOTS) and national TB programs have reduced incidence rates in many countries, yet TB continues to thrive in overcrowded, impoverished settlements. In Jos North Local Government Area (LGA), urban slums such as Angwan Rukuba, Tudun Wada, and Gangare present ideal conditions for TB transmission due to poor housing, lack of cross-ventilation, and high population density. These conditions make it easy for airborne droplets from infected individuals to circulate, sustaining the spread of the disease.

The persistence of TB in Jos North highlights a cycle of vulnerability fueled by poverty, malnutrition, and inadequate healthcare access. Residents of urban slums often face barriers such as unemployment, food insecurity, and lack of education, all of which weaken immunity and reduce the likelihood of seeking timely medical care. This combination not only increases susceptibility to TB infection but also delays detection, creating prolonged opportunities for transmission within households and communities. The limited health-seeking behavior observed in these settings further compounds the problem, as individuals often turn to informal care or ignore symptoms until the disease has advanced.

Although TB epidemiology in Nigeria has been studied extensively at the national and regional levels, these studies rarely focus on the micro-epidemiological realities of urban slums. Plateau State, and specifically Jos North LGA, has unique dynamics shaped by rapid urbanization, internal migration, and the presence of internally displaced persons (IDPs). These factors alter population structures and influence health behaviors in ways that differ from broader regional or national patterns. Without localized research, interventions risk being too generalized, failing to capture the specific risk factors that sustain TB transmission in slum environments.

Another major problem is the inadequacy of preventive strategies tailored to urban slum conditions. While health campaigns often emphasize treatment adherence and early detection, they rarely account for environmental and socio-economic realities such as overcrowding, poor sanitation, and stigma. For example, households with limited financial resources may be unable to access diagnostic services or maintain proper nutrition during treatment. Similarly, cultural beliefs and misconceptions about TB contribute to stigma, discouraging disclosure and adherence to treatment regimens. These gaps weaken the effectiveness of existing TB control programs.

The challenge is further compounded by the co-existence of other risk factors such as HIV/AIDS, smoking, and alcohol use, all of which increase the likelihood of TB infection and complicate treatment outcomes. HIV co-infection in particular accelerates the progression from latent to active TB, posing serious challenges in communities where HIV prevalence remains high. Yet, current preventive strategies often fail to integrate TB and HIV care in ways that are accessible to slum dwellers. This disjointed approach leaves vulnerable populations at greater risk, perpetuating the cycle of morbidity and mortality.

Therefore, there is a critical need for a study that investigates the epidemiology of TB in Jos North urban slums, focusing on both risk factors and preventive strategies. By identifying the socio-demographic, environmental, and behavioral drivers of TB transmission, such a study can provide evidence-based insights to guide local interventions. Without this localized understanding, efforts to control TB may remain fragmented and ineffective, leaving slum communities trapped in a cycle of disease and deprivation.

1.3 Objectives of the Study

The main objective of this study is to investigate the epidemiology of tuberculosis in selected urban slums of Jos North LGA, Plateau State, with particular attention to risk factors and preventive strategies.

The specific objectives are to:

1. Assess the prevalence and distribution of TB cases in selected urban slums of Jos North LGA.
2. Identify the socio-demographic and environmental risk factors associated with TB in these communities.
3. Examine the role of HIV co-infection, malnutrition, and lifestyle practices (e.g., smoking) in TB transmission.
4. Evaluate the existing preventive strategies adopted by health authorities and local communities.

1.4 Research Questions

1. What is the prevalence of TB in selected urban slums of Jos North LGA?
2. Which socio-demographic and environmental factors contribute to TB transmission in these communities?
3. How do HIV, malnutrition, and lifestyle practices influence TB burden?
4. What preventive strategies are currently in place, and how effective are they?

1.5 Research Hypothesis

The hypothetical statement of the problem is buttressed below:

H₀: There is no significant relationship between socio-demographic/environmental risk factors and TB prevalence in urban slums of Jos North.

H₁: There is a significant relationship between socio-demographic/environmental risk factors and TB prevalence in urban slums of Jos North.

1.6 Significance of the Study

The study is significant because it provides localized epidemiological evidence on tuberculosis (TB) within the context of urban slum communities in Jos North Local Government Area of Plateau State. While national and regional data exist, they often overlook the micro-level realities of slum populations where overcrowding, poor sanitation, and poverty are prevalent. By narrowing its focus to these communities, the study generates context-specific insights that can inform more effective and targeted TB interventions. Such evidence is essential for designing control measures that directly address the environmental and socio-demographic conditions unique to urban slums.

Another major contribution of this study lies in its potential to assist public health authorities in refining TB control strategies. The National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP) and the Plateau State Ministry of Health rely heavily on epidemiological data to allocate resources, design awareness campaigns, and evaluate program effectiveness. Findings from this research will enable these institutions to identify high-risk groups, prioritize vulnerable communities, and adapt preventive strategies that are both practical and sustainable. In this way, the study supports government efforts to reduce TB incidence and mortality, thereby contributing to the achievement of Nigeria’s public health goals.

Academically, this study adds to the growing body of literature on urban health challenges in Nigeria. Despite the significant health risks associated with slum environments, limited empirical studies have examined the epidemiology of TB specifically in these contexts. The findings will therefore serve as a reference for future researchers, providing a foundation for comparative studies, longitudinal research, and policy analysis. By filling an existing gap in scholarship, the study strengthens the knowledge base on TB and urban health dynamics in developing countries.

For the broader health sector, the study also highlights the importance of integrating biomedical interventions with social and environmental considerations. TB control in slum settings requires more than treatment—it demands strategies that address housing, nutrition, stigma reduction, and community engagement. By demonstrating the interconnectedness of these factors, the research will encourage a more holistic approach to TB prevention and control. This has implications not only for Jos North but also for other urban centers across Nigeria and sub-Saharan Africa facing similar challenges.

At the community level, the study is expected to benefit residents and local leaders directly. By identifying risk factors and gaps in preventive practices, it provides practical recommendations that communities can adopt to reduce TB transmission. Such measures may include improved household ventilation, better sanitation practices, increased health-seeking behavior, and greater participation in awareness campaigns. Local leaders and community-based organizations can use the findings as evidence to advocate for improved services and resources from government and non-governmental agencies.

Finally, this study has significance in the global fight against TB. The WHO’s End TB Strategy emphasizes the need for localized, evidence-based interventions that address the social determinants of health. By shedding light on the specific challenges of slum communities in Nigeria, the research aligns with global priorities and contributes to the worldwide body of knowledge needed to eliminate TB as a public health threat. Thus, the study not only addresses local needs but also resonates with broader international health goals.

1.7 Scope of the Study

The study focuses on selected urban slums in Jos North LGA, Plateau State, such as Angwan Rukuba, Gangare, and Tudun Wada. It examines TB prevalence, risk factors, and preventive strategies within these communities. The scope does not extend to rural areas of Plateau State. Variables such as socio-demographic characteristics, housing conditions, HIV status, malnutrition, and community health practices are considered.

1.8 Limitations of the Study

The study may face limitations such as recall bias from respondents, stigma associated with TB disclosure, and incomplete health records. Financial and time constraints may also limit the extent of coverage across all slum communities. Despite these challenges, measures will be taken to ensure reliability and validity of the data collected.

1.9 Operational Definition of Terms

• Epidemiology: The study of the distribution and determinants of health-related states, in this case TB, within populations.
• Tuberculosis (TB): A communicable disease caused by Mycobacterium tuberculosis bacteria, usually affecting the lungs.
• Urban Slums: Overcrowded, underdeveloped settlements characterized by poor housing, inadequate sanitation, and limited access to healthcare.
• Risk Factors: Variables such as overcrowding, HIV infection, and malnutrition that increase the likelihood of TB occurrence.
• Preventive Strategies: Measures taken to reduce TB transmission, including case detection, treatment adherence, vaccination, and community education.