Abstract
BackgroundIn Afghanistan, improving TB case detection remains challenging. In 2014, only half of the estimated incident TB cases were notified, and notifications have decreased since peaking in 2007. Active case finding has been increasingly considered to improve TB case notifications. While access to health services has improved in Afghanistan, it remains poor and many people seeking health services won’t receive proper care.MethodsFrom October 2011 through December 2012 we conducted three separate case finding strategies in six provinces of Afghanistan and measured impact on TB case notification. Systematically screening cough among attendees at 47 health facilities, active household contact investigation of smear-positive index TB patients, and active screening at 15 camps for internally displaced people were conducted. We collected both intervention yield and official quarterly notification data. Additional TB notifications were calculated by comparing numbers of cases notified during the intervention with those notified before the intervention, then adjusting for secular trends in notification.ResultsWe screened 2,022,127 people for TB symptoms during the intervention, tested 59,838 with smear microscopy and detected 5,046 people with smear-positive TB. Most cases (81.7%, 4,125) were identified in health facilities while nearly 20% were found through active case finding. A 56% increase in smear-positive TB notifications was observed between the baseline and intervention periods among the 47 health facilities, where cases detected by all three strategies were notified.DiscussionWhile most people with TB are likely to be identified through health facility screening, there are many people who remain without a proper diagnosis if outreach is not attempted. This is especially true in places like Afghanistan where access to general services is poor. Targeted active case finding can improve the number of people who are detected and treated for TB and can push towards the targets of the Stop TB Global Plan and End TB Strategy.
Highlights
Afghanistan is ranked among the 30 countries with the highest tuberculosis (TB) burdens in the world
Most cases (81.7%, 4,125) were identified in health facilities while nearly 20% were found through active case finding
A 56% increase in smear-positive TB notifications was observed between the baseline and intervention periods among the 47 health facilities, where cases detected by all three strategies were notified
Summary
Afghanistan is ranked among the 30 countries with the highest tuberculosis (TB) burdens in the world. Other factors putting Afghans at risk of becoming infected with and developing active TB include chronic poverty and geographical impediments that hinder access to basic health care for rural populations [3]. In spite of these challenges, in 2005 the National Tuberculosis Control Program (NTP) launched an operational plan to expand DOTS coverage into all comprehensive health centers (so named as they contained laboratories and medical doctors, and provided basic care services indicated by most disease programs), provincial hospitals in eight high-prevalence regions, and some basic health centers [4]. While access to health services has improved in Afghanistan, it remains poor and many people seeking health services won’t receive proper care
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
