Implementation status of household contact tuberculosis screening by health extension workers: assessment findings from programme implementation in Tigray region, northern Ethiopia

Hailay Gebretnsae,Tsegay Hadgu,Mebrahtu Abraha,Daniel G Datiko,Brhane Gebrekidan Ayele,Degue Jerene,Aregay Gebremedhin,Esayas Haregot,Eyassu Michael

doi:10.1186/s12913-020-4928-x

Hailay Gebretnsae, Tsegay Hadgu + Show 7 more

Open Access

https://doi.org/10.1186/s12913-020-4928-x

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Abstract

BackgroundIn the Tigray region of Ethiopia, Health Extension Workers (HEWs) conduct Tuberculosis (TB) screening for all household (HH) contacts. However, there is limited evidence on implementation status of HH contact TB screening by HEWs. The aim of this program assessment was to describe the implementation status and associated factors of HH contact TB screening by HEWs.MethodsThis programme assessment was conducted in three randomly selected districts from March to April 2018. Data was collected by using pre-tested structured questionnaire. Descriptive statistics was carried out using frequency tables. Logistic regression analysis was done to identify factors associated with HH contacts screening by HEWs.ResultsIn this programme assessment a total of HHs of 411 index TB cases were included. One-fifth (21.7%) of index TB cases had at least one HH contact screened for TB by HEWs. Having TB treatment supporter (TTS) during intensive phase of index TB case (AOR = 2.55, 95% CI: 1.06–6.01), health education on TB to HH contacts by HEWs (AOR = 4.28, 95% CI: 2.04–9.00), HH visit by HEWs within 6 months prior to the programme assessment (AOR = 5.84, 95% CI: 2.81–12.17) and discussions about TB activities by HEWs with Women Development Army (WDA) leaders (AOR = 9.51, 95% CI: 1.49–60.75) were significantly associated with household contact TB screening by HEWs.ConclusionsOur finding revealed that the proportion of HH contact TB screened by HEWs was low. Therefore, HEWs should routinely visit HHs of index TB cases and provide regular health education to improve contact screening practice. In addition, it is highly recommended to strengthen HEWs regular discussion about TB activities with WDA leaders and TB TTS.

Highlights

In the Tigray region of Ethiopia, Health Extension Workers (HEWs) conduct Tuberculosis (TB) screening for all household (HH) contacts
The computation was based on the 95% confidence interval, 5% margin of error and assuming that 50% of index TB cases whose HH contact to be screened for TB by HEWs
House hold contacts screening for TB and presumptive TB cases referral by HEWs Eighty nine (21.7%) of index TB cases had at least one HH contact screened for TB by HEWs

Summary

Introduction

In the Tigray region of Ethiopia, Health Extension Workers (HEWs) conduct Tuberculosis (TB) screening for all household (HH) contacts. In 2017, globally an average of 27% notified TB cases were attributed to community based intervention [1]. Ethiopia launched the Health Extension Program (HEP) in 2003 by constructing health post staffed with trained and salaried two female Health Extension Workers (HEWs) in every kebele (the smallest administrative unit with an average population of five thousand or one thousand households) [5]. Later in 2011, Women’s Development Army (WDA) strategy was introduced to engage networks of six neighboring household (HH) women to increase efficiency of HEWs in reaching every HH in the communities. The WDA team consists of group of 30 women of HHs residing in a neighborhood in a one-to five networks (with one leader and five members) [6,7,8]

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