Effectiveness of community participation in tuberculosis control

Abstract

Background: The global prominence of Tuberculosis (TB) as a public health issue has seen various multi-stakeholder interventions adopted to meet this challenge. In low resource settings where health systems are hardly coping, community participation has emerged as a pivotal measure for successful programming. This study sought to determine the best approach of integrating community interventions for TB control. Methodology: The study evaluated the records of the 3110 new TB patients registered in three Local Service Areas (LSA’s), from quarter 1 2004 to quarter 4 2005. In a quasi-experimental study design, the performance of respective LSA’s was compared over time; taking cognizance of the community project in one of the LSA’s. Further analysis was done to establish the influential determinants of treatment success. Results: Bacteriological coverage, smear conversion and treatment success rates dropped in the interventional LSA, while the control LSA’s remained consistent. The defaulter rates dropped in all LSA’s, while the proportion of unevaluated cases increased in the interventional LSA. However, patients registered in the clinics had better chance of successful treatment outcome (OR 10.8, 95% CI 8.03-14.3) compared to their hospital counterparts. Conclusion: Community participation by itself is not adequate to improve the performance of a TB control program. Enhancement of the program’s technical and organizational capacity is crucial, prior to engaging purely community interventions. Failure to observe this logical relationship would ultimately result in suboptimal performance. Therefore, the process of entrusting communities with more responsibility in TB control should be gradual and take cognizance of the various health system factors.