Laboratory Diagnosis and Management of Multidrug-Resistant Tuberculosis: An Audit of Practices at TB Reference Laboratories in Kano State, North West Nigeria

Multidrug-resistant tuberculosis represents an escalating public health crisis requiring robust laboratory diagnostic capacity for timely identification and appropriate patient management. This study audited diagnostic practices for MDR-TB at tuberculosis reference laboratories in Kano State, North West Nigeria. A retrospective record review and structured observational audit were conducted at three National Tuberculosis and Leprosy Control Programme reference sites over a two-year period. Data on sputum smear microscopy, Xpert MTB/RIF Ultra testing, culture on liquid media, and drug susceptibility testing were extracted and analysed against national MDR-TB guidelines. A total of 840 specimens were submitted for MDR-TB investigation. Xpert MTB/RIF detected rifampicin resistance in 11.9% of TB-positive cases. Turn-around time from sample receipt to Xpert result met the 24-hour target in only 58.3% of cases. Line probe assay for first-line drug resistance was performed in 72.4% of rifampicin-resistant cases as recommended. Culture positivity rates were suboptimal due to contamination rates above 10%. Communication of results to clinicians within the stipulated timeline was poor in 35.0% of records reviewed. Training gaps in culture techniques and biosafety were identified among staff. The study recommends accelerated expansion of molecular diagnostic capacity, rigorous biosafety enforcement, and strengthened result reporting systems at TB reference facilities across North West Nigeria. Keywords: MDR-TB, Xpert MTB/RIF, drug susceptibility testing, tuberculosis reference laboratory, Kano State