Increasing smear positive-pulmonary tuberculosis cases by strengthening district TB coordinating team in low case-detection provinces, Thailand

Abstract

Background: Tuberculosis (TB) is a communicable infectious diseases and remains a major global health problem as the cause of death from an infectious disease worldwide. This study was increased TB cases notification by strengthening the system of district TB coordinating team. Materials and methods: The research was mixed method, Quasi - Experimental study with two –group control and intervention pre–post analysis. The two low TB-case notification provinces in public health region 7 were purposive selected and two districts from each province was random selected to be the area of the study. Selapoom district, Roiet province and Banpai district, Khonkaen province were the study sites for intervention and control group respectively. The sample size included all of TB suspected cases in both group. Data collected from the suspected TB cases form case record form in each district hospital in 9 month period of base line before and after intervention period in both group. The satisfaction questionnaire collected from participants in district TB coordinating team. The curriculum for TB knowledge applied from the standard of National TB program (NTP ) for teaching in the intervention workshop .Focus group discussion was done about system implementation. Data analysis by descriptive statistic, chi square test, focus group analysis was used in qualitative study. Results: The district TB coordinating team was set up in the intervention hospital included of 14 health personnel from hospital, district health office and health center. The work flow and monitoring system was implemented by the district team in intervention group in 9 months period. There were 838 and 324 suspected TB cases in baseline 9 months before the study and 769 and 379 of suspected TB cases in post 9 months after intervention period among control and intervention hospital respectively. The most age group of TB suspected cases were more than 60 year and the most occupation were agriculturists in both group. In both group found that the factors of gender, chest radiography, sputum microscopy, chest radiography with sputum microscopy, chest radiography with completed microscopic examinations, were associated statistically significant at the 0.05 level. For the relative risk of TB notification cases in control hospital ( RR=0.74 ,95%CI 0.54-1.03, p-value 0.07) and intervention hospital (RR=1.61 ,95%CI 1.04-2.51, p-value 0.03) defined that in the hospital with non-intervention provided had a 25% reduction of TB notification cases and in the hospital with intervention provided had a 61% increase of TB notification cases.. Focus group analysis concluded that district TB coordinating team was benefit in district level and helping team to monitoring of TB control program. The coordinating system especially having TB coordinator was the most satisfaction from the participants. Conclusion: Strengthening district TB coordinating team and the coordinating network in hospital , district health office and health center help to increase TB case notification and percent of suspected tuberculosis cases to complete the investigation in district level.