Community Referral for Presumptive TB in Nigeria: a Comparison of Four Models of Active Case Finding

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2016 Feb 25

PMID 26905034

Citations 17

Authors

A O Adejumo

B Azuogu

O Okorie

O M Lawal

O J Onazi

M Gidado

O J Daniel

J C Okeibunor

E Klinkenberg

E M H Mitchell

Affiliations

Soon will be listed here.

Abstract

Background: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited.

Methods: We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral.

Results: CWs referred 4-22% of presumptive TB clients tested, and 4-24% of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables.

Conclusion: All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

Citing Articles

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.

Taylor M, Medley N, Van Wyk S, Oliver S Cochrane Database Syst Rev. 2024; 3:CD014756.

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Iterative evaluation of mobile computer-assisted digital chest x-ray screening for TB improves efficiency, yield, and outcomes in Nigeria.

Eneogu R, Mitchell E, Ogbudebe C, Aboki D, Anyebe V, Dimkpa C PLOS Glob Public Health. 2024; 4(1):e0002018.

PMID: 38232129 PMC: 10793917. DOI: 10.1371/journal.pgph.0002018.

Assessment of tuberculosis case notification rate: spatial mapping of hotspot, coverage and diagnostics in Katsina State, north-western Nigeria.

Milaham M, van Gurp M, Adewusi O, Okonuga O, Ormel H, Tristan B J Public Health Afr. 2022; 13(3):2040.

PMID: 36337675 PMC: 9627762. DOI: 10.4081/jphia.2022.2040.

Health extension workers contribution on tuberculosis case notification in Tigray region, Northern Ethiopia: A concurrent mixed method study.

Gebretnsae H, Hadgu T, Ayele B, Abraha A, Gebre-Egziabher E, Woldu M PLoS One. 2022; 17(8):e0271968.

PMID: 35972933 PMC: 9380935. DOI: 10.1371/journal.pone.0271968.

Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India.

Garg T, Bhardwaj M, Deo S BMJ Open. 2020; 10(10):e036625.

PMID: 33004390 PMC: 7536783. DOI: 10.1136/bmjopen-2019-036625.

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