Abstract
Sputum specimen referral cascades in resource-limited settings are characterized by losses of specimens, resulting in delays in tuberculosis (TB) diagnosis. Mpulungu District Health Office in Zambia conducted a quantitative based cross-sectional study using both primary and secondary data to identify points at which loss of specimens occurred in the sputum referral cascade. Primary data were collected through observations and interviews with 22 TB service providers. Secondary data were collected through examination of patient files and presumptive TB and laboratory registers to retrospectively track sputum specimens referred by ten health centers from April to September 2018. Proportions of specimens/laboratory results at every stage of the referral cascade were calculated using Epi Info v7. Only 49 (23%) out of 209 sputum specimens completed the referral cascade. The remaining 160 (76%) were lost at various stages of the referral cascade. The largest loss (51%) occurred between the release of laboratory results by the diagnostic facility and their receipt at referring facilities. Barriers included an inadequate number of staff oriented in sputum specimen referral, negative staff attitudes, and lack of specimen packaging material and specimen transportation. The district health office should strengthen the sputum specimen referral system by providing transport and specimen packaging material and by training staff in sputum collection transportation and tracking.
Highlights
Tuberculosis (TB) continues to be one of the leading causes of morbidity and mortality globally
TB Prevalence Survey conducted in Zambia in 2013–2014 revealed that the prevalence of bacteriologically confirmed TB was 638 per 100,000 (502–774/100,000), with the highest prevalence recorded in the Copperbelt Province at 1211 per 100,000 (757–1665/100,000) and Lusaka Province at 932 per 100,000 (670–1195/100,000) [2]
In re2 of 11 source-limited settings such as Zambia, sample referral systems can ensure access to laboratory services by allowing patients to receive care and treatment at their nearest health facility, while their samples areastransferred to areferral laboratory atcan a diagnostic center for testsettings such
Summary
Tuberculosis (TB) continues to be one of the leading causes of morbidity and mortality globally. End TB Strategy calls for early diagnosis of TB, universal drug susceptibility testing, and prompt initiation of effective treatment [3]. This collective approach can only be achieved when all patients have access to diagnostic facilities near their homes. In re of 11 source-limited settings such as Zambia, sample referral systems can ensure access to laboratory services by allowing patients to receive care and treatment at their nearest health facility, while their samples areastransferred to areferral laboratory atcan a diagnostic center for testsettings such
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