title: Evaluation of community-based interventions to improve TB case detection 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.
authors.affiliation: U.S. Agency for International Development , Washington, DC , USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Colvin
authors.affiliation: PATH Tanzania, Dar es Salaam , Tanzania.
authors.forename: Jackson
authors.initials: J
authors.lastname: Mugyabuso
authors.affiliation: PATH Tanzania, Dar es Salaam , Tanzania.
authors.forename: Godwin
authors.initials: G
authors.lastname: Munuo
authors.affiliation: PATH Tanzania, Dar es Salaam , Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Lyimo
authors.affiliation: University of Arizona, Mel and Enid Zuckerman College of Public Health , Tucson, AZ , USA.
authors.forename: Eyal
authors.initials: E
authors.lastname: Oren
authors.affiliation: PATH Tanzania, Dar es Salaam , Tanzania.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Mkomwa
authors.affiliation: PATH Tanzania, Dar es Salaam , Tanzania.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Makame
authors.affiliation: PATH Tanzania, Dar es Salaam , Tanzania.
authors.forename: Atuswege
authors.initials: A
authors.lastname: Mwangomale
authors.affiliation: PATH Tanzania, Dar es Salaam , Tanzania.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Mahamba
authors.affiliation: PATH , Washington, DC , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mueller
authors.affiliation: Independent Consultant , San Francisco, CA , USA.
authors.forename: D'Arcy
authors.initials: D
authors.lastname: Richardson
mesh_terms: D000328:Adult; D003153:Community Health Services; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D018563:Disease Notification; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D008297:Male; D008403:Mass Screening; D008519:Medicine, Traditional; D010595:Pharmacists; D015397:Program Evaluation; D012017:Referral and Consultation; D012111:Residence Characteristics; D012424:Rural Population; D013048:Specimen Handling; D013183:Sputum; D013636:Tanzania; D014376:Tuberculosis / Q000175:diagnosis*