Abstract
BackgroundIn developing countries like Malawi, further investigation is rare after patients with chronic cough test negative for tuberculosis. Chronic airways disease has presentations that overlap with tuberculosis. However, chronic airways disease is often unrecognised due to a lack of diagnostic services. Within developing countries, referral systems at primary health care level are weak and patients turn to unskilled informal health providers to seek health care. Delayed diagnosis and treatment of these diseases facilitates increased severity and tuberculosis transmission.The World Health Organisation developed the Practical Approach to Lung Health strategy which has been shown to improve the management of both tuberculosis and chronic airways disease. The guidelines address the need for integrated guidelines for tuberculosis and chronic airways disease. Engaging with informal health providers has been shown to be effective in improving health services uptake. However, it is not known whether engaging community informal health providers would have a positive impact in the implementation of the Practical Approach to Lung Health strategy. We will use a cluster randomised controlled trial to determine the effect of using the two interventions to improve case detection and treatment of patients with tuberculosis and chronic airways disease.MethodsA three-arm cluster randomised trial design will be used. A primary health centre catchment population will form a cluster, which will be randomly allocated to one of the arms. The first arm personnel will receive the Practical Approach to Lung Health strategy intervention. In addition to this strategy, the second arm personnel will receive training of informal health providers. The third arm is the control. The effect of interventions will be evaluated by community surveys. Data regarding the diagnosis and management of chronic cough will be gathered from primary health centres.DiscussionThis trial seeks to determine the effect of Informal Health Provider and Practical Approach to Lung Health interventions on the detection and management of chronic airways disease and tuberculosis at primary care level in Malawi.Trial registrationThe unique identification number for the registry is PACTR201411000910192 – 21 November 2014Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1068-4) contains supplementary material, which is available to authorized users.
Highlights
In developing countries like Malawi, further investigation is rare after patients with chronic cough test negative for tuberculosis
Banda et al Trials (2015) 16:576 (Continued from previous page). This trial seeks to determine the effect of Informal Health Provider and Practical Approach to Lung Health interventions on the detection and management of chronic airways disease and tuberculosis at primary care level in Malawi
A previous study in Malawi, conducted by the Research for Equity and Community Health (REACH) Trust, demonstrated that storekeepers could promote TB case-finding [26] and further work by the REACH Trust demonstrated that informal providers can be engaged in the provision of integrated TB and human immunodeficiency virus (HIV) services at the community level. We found that these interventions led to improvements in HIV-testing by 61 %, anti-retroviral therapy (ART) access rates by 34 % and diagnostic uptake rates for presumptive TB cases by 15 %
Summary
In developing countries like Malawi, further investigation is rare after patients with chronic cough test negative for tuberculosis. The World Health Organisation developed the Practical Approach to Lung Health strategy which has been shown to improve the management of both tuberculosis and chronic airways disease. Engaging with informal health providers has been shown to be effective in improving health services uptake. We will use a cluster randomised controlled trial to determine the effect of using the two interventions to improve case detection and treatment of patients with tuberculosis and chronic airways disease. Findings from studies conducted in Malawi show that patients presenting with cough exert a huge burden on outpatient department (OPD) services [3], and yet there are many challenges to providing effective care for patients with respiratory symptoms in the OPD [4]
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