Enhancing tuberculosis detection and treatment outcomes among nomadic pastoralists in Nigeria through community engagement and empowerment: A mixed-methods study

Background: Tuberculosis (TB) remains a significant public health challenge in Nigeria, particularly among nomadic pastoralist populations who face barriers such as geographical isolation, cultural differences, and mobility. These factors contribute to low case detection and poor treatment outcomes. This study evaluated a community-based, culturally adapted intervention aimed at improving TB case detection, treatment adherence, and community empowerment in Adamawa State, Nigeria. Methods: A mixed-methods approach was employed across three LGAs from July 2023 to December 2024. Quantitative data from routine health records assessed changes in case notifications and treatment outcomes; qualitative data from focus groups and interviews explored community perceptions and barriers. The intervention included culturally tailored education, training of pastoralist TB champions, and empowerment activities fostering local ownership. Results: The intervention resulted in a 72% increase in TB case notifications (from 22% to 38%; p<0.01) and improved treatment success to 94% (from 86%; p<0.05). Qualitative findings indicated high levels of accurate TB knowledge (78%), reduced stigma, and increased community ownership. Community volunteers played a pivotal role in bridging access gaps and fostering trust. Conclusions: Community engagement and empowerment strategies significantly improved TB detection and treatment among nomadic pastoralists. Scaling such approaches could be vital in Nigeria’s efforts to address TB among marginalized populations.