Abstract
BackgroundOne of the main strategies to control tuberculosis (TB) is to find and treat people with active disease. Unfortunately, the case detection rates remain low in many countries. Thus, we need interventions to find and treat sufficient number of patients to control TB. We investigated whether involving health extension workers (HEWs: trained community health workers) in TB control improved smear-positive case detection and treatment success rates in southern Ethiopia.Methodology/Principal FindingWe carried out a community-randomized trial in southern Ethiopia from September 2006 to April 2008. Fifty-one kebeles (with a total population of 296, 811) were randomly allocated to intervention and control groups. We trained HEWs in the intervention kebeles on how to identify suspects, collect sputum, and provide directly observed treatment. The HEWs in the intervention kebeles advised people with productive cough of 2 weeks or more duration to attend the health posts. Two hundred and thirty smear-positive patients were identified from the intervention and 88 patients from the control kebeles. The mean case detection rate was higher in the intervention than in the control kebeles (122.2% vs 69.4%, p<0.001). In addition, more females patients were identified in the intervention kebeles (149.0 vs 91.6, p<0.001). The mean treatment success rate was higher in the intervention than in the control kebeles (89.3% vs 83.1%, p = 0.012) and more for females patients (89.8% vs 81.3%, p = 0.05).Conclusions/SignificanceThe involvement of HEWs in sputum collection and treatment improved smear-positive case detection and treatment success rate, possibly because of an improved service access. This could be applied in settings with low health service coverage and a shortage of health workers.Trial RegistrationClinicalTrials.gov NCT00803322
Highlights
Each year, more than nine million new cases of tuberculosis (TB) occur and about two million people die of TB
Baseline data Of the 51 kebeles included in the study, 30 were intervention kebeles with a population of 178,138 and mean kebele population of 5938 people, while 21 were control kebeles with a population of 118,673 and mean kebele population of 5651 people. 53.4% (123/ 230) of patients from intervention and 42% (37/88) from control kebeles were female (Table 1)
The mean case detection rate (CDR) was higher in intervention kebeles (122.2% vs 69.4%, p,0.001) and for female patients (149.0% vs 91.6%, p,0.001) (Table 2)
Summary
More than nine million new cases of tuberculosis (TB) occur and about two million people die of TB. Information from South India shows that directly observed treatment, short-course (DOTS) reduces TB incidence [2]. In many other countries, the case detection rates are too low to reduce the incidence of TB. The main obstacles are low health service coverage, shortage of health workers and poor programme performance [3]. One of the main strategies to control tuberculosis (TB) is to find and treat people with active disease. The case detection rates remain low in many countries. We investigated whether involving health extension workers (HEWs: trained community health workers) in TB control improved smear-positive case detection and treatment success rates in southern Ethiopia
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