TY - JOUR
T1 - Evaluation of community-based interventions to improve TB case detection in a rural district of Tanzania
AU - Colvin, Charlotte
AU - Mugyabuso, Jackson
AU - Munuo, Godwin
AU - Lyimo, John
AU - Oren, Eyal
AU - Mkomwa, Zahra
AU - Makame, Mohammed
AU - Mwangomale, Atuswege
AU - Mahamba, Vishnu
AU - Mueller, Lisa
AU - Richardson, D'Arcy
N1 - Funding Information:
Acknowledgments: This project was made possible through the generous support of the United States Agency for International Development (USAID) under TB IQC Task Order 01, Contract No. GHN-I-00-09-00006. The authors would like to acknowledge support from both the United States Agency for International Development to implement the activities and PATH’s Monitoring and Evaluation Strengthening Initiative to conduct this evaluation. In addition, the authors would like to extend their sincere gratitude to the many parties involved with this paper, including the National Tuberculosis and Leprosy Program, Kisarawe District/Council Health Management Team, Kisarawe District education officials, participating pharmacists, traditional healers, sputum fixers, DOTS nurses, and the survey participants.
Funding Information:
This project was made possible through the generous support of the United States Agency for International Development (USAID) under TB IQC Task Order 01, Contract No. GHN-I-00-09-00006. The authors would like to acknowledge support from both the United States Agency for International Development to implement the activities and PATH's Monitoring and Evaluation Strengthening Initiative to conduct this evaluation. In addition, the authors would like to extend their sincere gratitude to the many parties involved with this paper, including the National Tuberculosis and Leprosy Program, Kisarawe District/Council Health Management Team, Kisarawe District education officials, participating pharmacists, traditional healers, sputum fixers, DOTS nurses, and the survey participants.
PY - 2014/5
Y1 - 2014/5
N2 - In Tanzania, people with tuberculosis (TB) commonly self-medicate or visit traditional healers before seeking formal medical care. Between 2009 and 2011, we piloted a community-based project in Kisarawe District to improve TB case notification. The project trained 15 traditional healers and 15 pharmacists to identify and refer individuals with TB symptoms to diagnostic facilities. In addition, the project trained 2 community members to collect and fix sputum from symptomatic individuals onto slides, which they then delivered by bicycle to the nearest diagnostic facility. To determine effectiveness, we analyzed routine case detection data and referrals from traditional healers and pharmacists and conducted a cross-sectional survey of recently diagnosed smear-positive TB patients (N5150) to understand their treatment-seeking behavior. From 2009 to 2011, smear-positive TB case notification increased by 68% in Kisarawe District, from 28/100,000 to 47/100,000, even while TB case notification nationally stayed the same (at approximately 14/100,000). The traditional healers and pharmacists referred 434 people with presumptive TB to diagnostic facilities, 419 of whom (97%) went to the facilities; of those who went to facilities for testing, 104 people (25%) were diagnosed with TB. The percentage of new TB case notifications that were referred through the network ranged from 38% to 70% per reporting quarter. Sputum fixers collected and delivered specimens from 178 individuals, 17 of whom (10%) were diagnosed with TB. Almost 60% of surveyed smear-positive TB patients first visited a pharmacist or traditional healer before seeking care at a diagnostic facility. These results prompted scale up of community interventions to 9 more districts in 2011 and to another 26 districts in 2013. Establishing referral networks that bring TB information and services closer to community members can contribute to improved TB case notification.
AB - In Tanzania, people with tuberculosis (TB) commonly self-medicate or visit traditional healers before seeking formal medical care. Between 2009 and 2011, we piloted a community-based project in Kisarawe District to improve TB case notification. The project trained 15 traditional healers and 15 pharmacists to identify and refer individuals with TB symptoms to diagnostic facilities. In addition, the project trained 2 community members to collect and fix sputum from symptomatic individuals onto slides, which they then delivered by bicycle to the nearest diagnostic facility. To determine effectiveness, we analyzed routine case detection data and referrals from traditional healers and pharmacists and conducted a cross-sectional survey of recently diagnosed smear-positive TB patients (N5150) to understand their treatment-seeking behavior. From 2009 to 2011, smear-positive TB case notification increased by 68% in Kisarawe District, from 28/100,000 to 47/100,000, even while TB case notification nationally stayed the same (at approximately 14/100,000). The traditional healers and pharmacists referred 434 people with presumptive TB to diagnostic facilities, 419 of whom (97%) went to the facilities; of those who went to facilities for testing, 104 people (25%) were diagnosed with TB. The percentage of new TB case notifications that were referred through the network ranged from 38% to 70% per reporting quarter. Sputum fixers collected and delivered specimens from 178 individuals, 17 of whom (10%) were diagnosed with TB. Almost 60% of surveyed smear-positive TB patients first visited a pharmacist or traditional healer before seeking care at a diagnostic facility. These results prompted scale up of community interventions to 9 more districts in 2011 and to another 26 districts in 2013. Establishing referral networks that bring TB information and services closer to community members can contribute to improved TB case notification.
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U2 - 10.9745/GHSP-D-14-00026
DO - 10.9745/GHSP-D-14-00026
M3 - Article
C2 - 25276579
AN - SCOPUS:84930794746
SN - 2169-575X
VL - 2
SP - 219
EP - 225
JO - Global Health Science and Practice
JF - Global Health Science and Practice
IS - 2
ER -