Improvement of Tuberculosis Laboratory Capacity on Pemba Island, Zanzibar: A Health Cooperation Project

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Abstract

Low-income countries with high Tuberculosis burden have few reference laboratories able to perform TB culture. In 2006, the Zanzibar National TB Control Programme planned to decentralize TB diagnostics. The Italian Cooperation Agency with the scientific support of the “L. Spallanzani” National Institute for Infectious Diseases sustained the project through the implementation of a TB reference laboratory in a low-income country with a high prevalence of TB. The implementation steps were: 1) TB laboratory design according to the WHO standards; 2) laboratory equipment and reagent supplies for microscopy, cultures, and identification; 3) on-the-job training of the local staff; 4) web- and telemedicine-based supervision.

From April 2007 to December 2010, 921 sputum samples were received from 40 peripheral laboratories: 120 TB cases were diagnosed. Of all the smear-positive cases, 74.2% were culture-positive. During the year 2010, the smear positive to culture positive rate increased up to 100%.

In March 20, 2010 the Ministry of Health and Social Welfare of Zanzibar officially recognized the Public Health Laboratory- Ivo de Carneri as the National TB Reference Laboratory for the Zanzibar Archipelago.

An advanced TB laboratory can represent a low cost solution to strengthen the TB diagnosis, to provide capacity building and mid-term sustainability.

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Most cited references 6

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Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania.

O Mørkve, E Wandwalo (2000)

Health facilities in Mwanza region, Tanzania. To determine factors responsible for delay from onset of symptoms of pulmonary tuberculosis to initiation of treatment. A cross-sectional descriptive study of 296 smear-positive tuberculosis patients. Emphasis was given to periods between 1) onset of symptoms and first consultation to a health facility, and 2) reporting to a health facility and initiation of treatment. Mean total delay was 185 days (median 136), with nearly 90% of this being patient's delay. The mean health system delay was 23 days (median 15), with longer delays in rural health facilities. The mean patient's delay was 162 days (median 120). This delay was significantly longer in rural areas, for patients with lower level of education, for those who first visited a traditional healer, and for patients who had no information on tuberculosis prior to diagnosis. Only 15% of the patients reported to a health facility within 30 days of onset of symptoms. There are significant delays in case-finding in Mwanza, Tanzania, with prolonged patient's delay. Facilitation of utilisation of health services, raising awareness of the disease and incorporation of private practice into tuberculosis control could help to reduce these delays.

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Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria

Olumuyiwa O Odusanya, Joseph O Babafemi (2004)

Background Pulmonary tuberculosis continues to increase due to late patient presentation. The study was conducted at a chest clinic of a general hospital in Lagos, Nigeria, to investigate patterns of delays before treatment amongst tuberculosis patients. Methods Longitudinal recruitment using a health worker administered protocol to determine time interval from onset of symptoms to initiation of treatment. Presentation to a health facility after 30 days of the onset of symptoms was classified as patient delay. Doctor delay was when patients stayed for more than 15 days with the referring doctor. Results One hundred and forty-one patients were recruited. The mean age was 29.5 ± 11.0 years, 89 (63%) were males and 52 (37%) were females. One hundred and sixteen (82%) had positive smears. One hundred and seventeen (83%) delayed their seeking help from health facilities longer than one month after the onset of symptoms. The median patient delay was eight weeks; median doctor delay was one week, median treatment delay was one week and the median total delay was 10 weeks. Doctor delay was observed in 19 (13%) patients. Patient delay was the most frequent type of delay observed and was the major contributor to the overall total delay. Patient delay was not significantly associated with patients' socio-demographic characteristics such as age, gender and educational level. Conclusion Majority of TB patients at this centre did not present early to health facilities and continue to serve as reservoirs of infection. Patient education on the disease may help reduce delays in starting treatment.

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The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania

Sayoki G M Mfinanga, Beatrice Mutayoba, Amos Kahwa … (2008)

Objective To assess the magnitude and factors responsible for delay in TB management. Design A cross sectional hospital based survey in Dar es Salaam region, May 2006. Results We interviewed 639 TB patients. A total of 78.4% of patients had good knowledge on TB transmission. Only 35.9% had good knowledge on the symptoms. Patient delay was observed in 35.1% of the patients, with significantly (X2 = 5.49, d.f. = 1, P = 0.019) high proportion in females (41.0%) than in males (31.5%). Diagnosis delay was observed in 52.9% of the patients, with significantly (X2 = 10.1, d.f. = 1, P = 0.001) high proportion in females (62.1%) than in males (47.0%). Treatment delay was observed in 34.4% of patients with no significant differences among males and females. Several risk factors were significantly associated with patient's delays in females but not in males. The factors included not recognizing the following as TB symptoms: night sweat (OR = 1.92, 95% CI 1.20, 3.05), chest pain (OR = 1.62, 95% CI 1.1, 2.37), weight loss (OR = 1.55, 95% CI 1.03, 2.32), and coughing blood (OR = 1.47, 95% CI 1.01, 2.16). Other factors included: living more than 5 Km from a health facility (OR = 2.24, 95% CI 1.41, 3.55), no primary education (OR = 1.74, 95% CI 1.01, 3.05) and no employment (OR = 1.77, 95% CI 1.20, 2.60). In multiple logistic regression, five factors were more significant in females (OR = 2.22, 95% CI 1.14, 4.31) than in males (OR = 0.70, 95% CI 0.44, 1.11). These factors included not knowing that night sweat and chest pain are TB symptoms, a belief that TB is always associated with HIV infection, no employment and living far from a health facility. Conclusion There were significant delays in the management of TB patients which were contributed by both patients and health facilities. However, delays in most of patients were due to delay of diagnosis and treatment in health facilities. The delays at all levels were more common in females than males. This indicates the need for education targeting health seeking behaviour and improvement in health system.

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: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2012

Publication date (Electronic): 27 August 2012

Volume: 7

Issue: 8

Electronic Location Identifier: e44109

Affiliations

[1 ]Microbiology Laboratory, Epidemiology and Clinical Departments, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy

[2 ]Public Health Laboratory–Ivo De Carneri, Chake Chake, Pemba Island, Zanzibar, Tanzania

[3 ]National Tuberculosis and Leprosy Programme, Ministry of Health and Social Welfare, Unguja Island, Zanzibar, Tanzania

[4 ]Italian Cooperation Agency, Italian Ministry of Foreign Affairs, Rome, Italy

[5 ]Ministry of Health and Social Welfare, Unguja Island, Zanzibar, Tanzania

Johns Hopkins University School of Medicine, United States of America

Author notes

* E-mail: nazario.bevilacqua@ 123456inmi.it

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: GI VR MSJ. Performed the experiments: MGP HSH. Analyzed the data: NB MGP EN EG. Contributed reagents/materials/analysis tools: MGP JM MSJ. Wrote the paper: NB MGP EN FV HSH. Coordination of the project: NB EN JM.

Article

Publisher ID: PONE-D-12-06560

DOI: 10.1371/journal.pone.0044109

PMC ID: 3428332

PubMed ID: 22952891

SO-VID: 5d10efaa-724f-4f88-9b65-44ce88d96879

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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 credited.

History

Date received : 31 January 2012

Date accepted : 30 July 2012

Page count

Pages: 5

Funding

This work was part of the activities carried out by the Programme Aid 8282 in Tanzania, entirely funded by the Italian Cooperation and Ministry of Foreign Affairs of Italy. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Improvement of Tuberculosis Laboratory Capacity on Pemba Island, Zanzibar: A Health Cooperation Project

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Most cited references 6

Delay in tuberculosis case-finding and treatment in Mwanza, Tanzania.

Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria

The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania

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