Integrated Surveillance of Polio-negative AFP Cases for Tuberculosis: A Novel Approach in Rivers State, Nigeria

Background: Nigeria, certified free of wild poliovirus in 2020, continues nationwide acute flaccid paralysis (AFP) surveillance to detect potential poliovirus re-emergence. With tuberculosis (TB) remaining a leading cause of childhood mortality and underdiagnosis persistent in Nigeria, integrating childhood TB testing into AFP case investigations offers a novel strategy for pediatric TB detection. This study assesses the yield of TB testing among polio-negative AFP cases under 15 years of age in Rivers State, Nigeria. Methods: A retrospective analysis was conducted using AFP surveillance line-list data from January 2022 to March 2025. All children under 15 years with polio-negative AFP who were tested for TB using the GeneXpert MTB RIF assay were included. Demographic and clinical variables were analyzed using descriptive statistics. Associations between TB positivity and sociodemographic factors were assessed using chi-square tests and logistic regression. Results: A total of 118 AFP cases were tested for TB. The mean age was 3.6 years (SD ± 3.25), with 76.3% of participants under the age of five and 52.5% male. Five cases (4.2%) tested positive for TB, with no significant differences in TB positivity by sex (p = 0.923) or age group (p = 1.000). Logistic regression revealed no significant predictors of TB positivity, though most TB cases were under five years and presented with limb weakness, suggesting possible extra-pulmonary TB. Conclusion: The integration of TB testing into AFP surveillance yielded a 4.2% TB detection rate among children under 15 with non-polio AFP, highlighting the potential of surveillance synergy. This innovative approach may help bridge the gap in pediatric TB detection. Policymakers should consider adopting integrated protocols to maximize surveillance platforms and strengthen early case detection in high-burden settings.