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      Evaluation of community-based interventions to improve TB case detection in a rural district of Tanzania

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          Abstract

          Enlisting traditional healers and pharmacists to improve TB detection contributed 38% to 70% of new smear-positive case notifications per quarter in a rural district of Tanzania.

          Abstract

          Enlisting traditional healers and pharmacists to improve TB detection contributed 38% to 70% of new smear-positive case notifications per quarter in a rural district of Tanzania.

          Abstract

          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 (N = 150) 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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          Author and article information

          Journal
          Glob Health Sci Pract
          Glob Health Sci Pract
          ghsp
          ghsp
          Global Health, Science and Practice
          Global Health: Science and Practice
          2169-575X
          May 2014
          13 May 2014
          : 2
          : 2
          : 219-225
          Affiliations
          [a ]U.S. Agency for International Development , Washington, DC, USA
          [b ]PATH Tanzania, Dar es Salaam , Tanzania
          [c ]University of Arizona, Mel and Enid Zuckerman College of Public Health , Tucson, AZ, USA
          [d ]PATH , Washington, DC, USA
          [e ]Independent Consultant , San Francisco, CA, USA
          Author notes
          Correspondence to Charlotte Colvin ( ccolvin@ 123456usaid.gov ).
          Article
          GHSP-D-14-00026
          10.9745/GHSP-D-14-00026
          4168621
          25276579
          1af9625e-85cf-45d3-b332-c92e9c1b91f6
          © Colvin et al.

          This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/

          History
          : 10 February 2014
          : 27 April 2014
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