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      Factors affecting tuberculosis case detection in Kersa District, South West Ethiopia

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          Abstract

          Background

          Tuberculosis is one of the deadly communicable diseases which claim the lives of millions in the world. Early case detection and prompt treatment cures the patients, breaks the transmission and improves the control program.

          Objective

          The aim of this study was to investigate the factors affecting tuberculosis case detection in Kersa District, south west Ethiopia.

          Method

          Facility based cross sectional study design was employed in four directly observed treatment short course service providing public health centers. Three hundred eighty four patient folders were reviewed. In-depth interviews was conducted with 18 health care workers including heads of health centers, tuberculosis focal persons, clinicians, laboratory technicians, tuberculosis program coordinator and head of health office.

          Result

          Significant number, 135(35.2%) of tuberculosis suspects were not requested for microscopic examination of sputum smear, the laboratory results 21(8.4%) of requested patients were not recorded in both patient folders and laboratory registers. Only 10 (4.4%) of those examined and recorded were smearing positive. Participants described that the shortage and irregular supply of acid fast bacilli reagents and consumable, inadequate infrastructures, frequent electricity interruption, shortage of trained care providers, negligence of care providers, weakness of laboratory quality assurance system and poor health information use culture were major factors for low case identification.

          Conclusion

          The resource shortage, electricity interruption, low commitment of care providers, weak quality assurance practice and poor health information use culture were major factors for low tuberculosis case identification and should be considered.

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          Most cited references23

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          Laboratory medicine in Africa: a barrier to effective health care.

          Providing health care in sub-Saharan Africa is a complex problem. Recent reports call for more resources to assist in the prevention and treatment of infectious diseases that affect this population, but policy makers, clinicians, and the public frequently fail to understand that diagnosis is essential to the prevention and treatment of disease. Access to reliable diagnostic testing is severely limited in this region, and misdiagnosis commonly occurs. Understandably, allocation of resources to diagnostic laboratory testing has not been a priority for resource-limited health care systems, but unreliable and inaccurate laboratory diagnostic testing leads to unnecessary expenditures in a region already plagued by resource shortages, promotes the perception that laboratory testing is unhelpful, and compromises patient care. We explore the barriers to implementing consistent testing within this region and illustrate the need for a more comprehensive approach to the diagnosis of infectious diseases, with an emphasis on making laboratory testing a higher priority.
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            Laboratory diagnosis of tuberculosis in resource-poor countries: challenges and opportunities.

            With an estimated 9.4 million new cases globally, tuberculosis (TB) continues to be a major public health concern. Eighty percent of all cases worldwide occur in 22 high-burden, mainly resource-poor settings. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with HIV. Therefore, building capacity and enhancing universal access to rapid and accurate laboratory diagnostics are necessary to control TB and HIV-TB coinfections in resource-limited countries. The present review describes several new and established methods as well as the issues and challenges associated with implementing quality tuberculosis laboratory services in such countries. Recently, the WHO has endorsed some of these novel methods, and they have been made available at discounted prices for procurement by the public health sector of high-burden countries. In addition, international and national laboratory partners and donors are currently evaluating other new diagnostics that will allow further and more rapid testing in point-of-care settings. While some techniques are simple, others have complex requirements, and therefore, it is important to carefully determine how to link these new tests and incorporate them within a country's national diagnostic algorithm. Finally, the successful implementation of these methods is dependent on key partnerships in the international laboratory community and ensuring that adequate quality assurance programs are inherent in each country's laboratory network.
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              Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade.

              Despite the high coverage of directly observed treatment short-course (DOTS), tuberculosis (TB) continues to affect 10.4 million people each year, and kills 1.8 million. High TB mortality, the large number of missing TB cases, the emergence of severe forms of drug resistance, and the slow decline in TB incidence indicate that merely expanding the coverage of TB services is insufficient to end the epidemic. In the era of the End TB Strategy, we need to think beyond coverage and start focusing on the quality of TB care that is routinely offered to patients in high burden countries, in both public and private sectors. In this review, current evidence on the quality of TB care in high burden countries, major gaps in the quality of care, and some novel efforts to measure and improve the quality of care are described. Based on systematic reviews on the quality of TB care or surrogates of quality (e.g., TB diagnostic delays), analyses of TB care cascades, and newer studies that directly measure quality of care, it is shown that the quality of care in both the public and private sector falls short of international standards and urgently needs improvement. National TB programs will therefore need to systematically measure and improve quality of TB care and invest in quality improvement programs.
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                Author and article information

                Contributors
                Journal
                J Clin Tuberc Other Mycobact Dis
                J Clin Tuberc Other Mycobact Dis
                Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
                Elsevier
                2405-5794
                12 August 2017
                December 2017
                12 August 2017
                : 9
                : 1-4
                Affiliations
                [0001]Sidama Zone Health Department, Hawassa, South Ethiopia
                Article
                S2405-5794(17)30004-9
                10.1016/j.jctube.2017.08.003
                6850251
                31723710
                f5758f44-416b-49a3-93ef-a3c5f8bfc413
                © 2017 Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 January 2017
                : 9 August 2017
                : 10 August 2017
                Categories
                Article

                tuberculosis,diagnosis,case detection,factors,tb, tuberculosis,who, world health organization,mdr-tb, multidrug resistant tuberculosis,afb, acid fast bacilli,hiv, human immune deficient virus,dots, directly observed treatment short course,hcw, health care workers,hc, health center

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