Tuberculosis Training Research Articles

Evaluating tuberculosis knowledge and awareness of effective control practices among health care workers in primary- and secondary-level medical institutions in Beijing, China

ObjectiveInadequate tuberculosis (TB) knowledge and awareness of proper TB control practices among health care workers (HCWs) may increase the risk of nosocomial TB transmission. This study aimed to assess HCWs’ TB-related knowledge and control practices to guide the development of more effective targeted TB health education and training programs.MethodsIn January 2023 a cross-sectional survey was administered to 323 HCWs employed by five primary health care centers and three secondary comprehensive medical institutions in Beijing, China. Survey data were collected using a standard questionnaire.ResultsAnalysis of survey responses revealed TB knowledge and practices awareness rates of 60.4% and 90.6%, respectively. The overall average awareness rate across all 19 TB knowledge- and practice-related questions was 70.0%. Intermediate- and senior-level HCW’s average TB knowledge score was respectively 2.225 and 8.175 times higher than that of primary-level HCWs, while the average TB knowledge score of HCWs in secondary comprehensive medical institutions was 3.052 times higher than that of HCWs in primary health care centers. Higher average TB knowledge score correlated with higher-level professional titles and higher level work units, but higher average TB control practices score correlated with employment at primary health care center rather than secondary comprehensive medical institution. Notably, 13.6% of HCWs had not received TB training during the past three years, while 86.1% expressed willingness to undergo online TB training.ConclusionThese findings highlight inadequate TB knowledge and awareness of proper TB control practices among HCWs in primary health care centers and secondary comprehensive medical institutions in Beijing, underscoring the urgent need for targeted educational and training initiatives to improve TB awareness and control efforts.

Competency Mapping of Key Stakeholders in Procurement and Contracting of the National Tuberculosis Elimination Program Goods and Services in an Eastern Indian State

Abstract Background: The National Tuberculosis Elimination Program is a complex program, and the program officers are involved in the procurement and contracting of goods and services under it. A competency mapping was conducted to highlight the current capacity gaps in contract management at state and district levels under the program. Materials and Methods: A descriptive cross-sectional design was adopted with 15 participants involved in procurement and contracting in two districts of the state using a semi-structured questionnaire, and results were presented using the descriptive statistical analysis. Results: A total of 15 different stakeholders from the National Health Mission, State and District Tuberculosis (TB) Cell, State TB Training and Demonstration Centre, and State Medical Corporation participated in the study. The participants had an average of 10.3 years of experience in contracting, and 20% of them had received some training on contracting. The capacity of these respondents varied based on their involvement, previous training (s) received, and technical background. It was further observed that most of the respondents suggested an in-person physical training instead of virtual training. Most of the respondents requested to issue training certificate. Some of the topics that the participants requested for further training include Digital Signature Certification, Government e-Marketplace, General Financial Rule, Public Financial Management System, monitoring of performance indicators, and bid evaluation techniques. Moreover, 92% of the respondents felt that there is a training need on procurement and contracting. Conclusions: Many a time, the program officers come from a technical background not relevant to the contracting and procurement of goods and services and require regular on-the-job support and training to aid in effective program delivery.

Knowledge of tuberculosis among physicians working at community health stations in Vietnam

Tuberculosis (TB) remains a significant health problem worldwide, including in Vietnam, where around 174,000 newly diagnosed cases and 13,200 patients died in 2018. There are challenges in the diagnostic process, treatment, and follow-up. The physicians with knowledge of TB working at commune health stations play an essential role in this struggle. The primary purpose of this study was to evaluate knowledge of TB and related factors among physicians working at community health stations in the Northern provinces of Vietnam. A cross-sectional survey was implemented on 335 physicians working at community health stations in 5 Northern provinces in Vietnam from September 2019 to October 2020. The result showed that the TB knowledge of physicians was not good. There were some severe knowledge gaps concerning at-risk groups, the main symptoms of TB, sputum tests for both diagnosis and follow-up and management of attack therapy. The TB training participants had better TB knowledge than others (aOR=1.68; 95%CI: 1.047-2.712). This study underlines the importance of clinical experience and TB training to TB knowledge. We suggest that a TB training plan is required for physicians. Our survey results could inform the process of defining the physicians who work at community health stations' role in TB management in the future.

Characteristics, knowledge, attitude, and practice of pharmacy personnel in supporting tuberculosis treatment: A multicenter cross-sectional study in a high-burden tuberculosis country

BackgroundPositive roles of community pharmacy in tuberculosis (TB) care have been widely reported. However, the actual practice of supporting TB treatment is not optimal yet. ObjectivesWe analyzed the current practice of community pharmacy personnel and its factors in supporting the successful treatment of TB patients in Indonesia, aiming to develop strategies for effective and sustainable TB practice models for the community pharmacy. MethodsWe performed a cross-sectional survey in 3 areas representing Indonesia's eastern, central, and western parts. Development and validation of the questionnaire were conducted to assess 4 domains, that is, characteristics, knowledge, attitudes, and practice of community pharmacy personnel in supporting the successful treatment of TB patients. Data were collected with purposive convenience sampling using online and offline questionnaires. Descriptive analyses were used to summarize factors in each domain, while binary logistic regression was used to analyze the associated factors of the practice. ResultsThirty-five questionnaire items indicated a valid instrument, and the study successfully included 844 participants who comprised pharmacists (n = 473, 56%) and pharmacy assistants (n = 371, 44%). Although most of the knowledge items were correctly answered by more than 60% of the participants, items related to TB signs, risk groups, drug regimens, and medicine uses were still less than 60%. This was in line with exposure to updated TB training in only 51% of the participants (n = 426). Most of the participants had a positive attitude toward their professional role (n = 736, 87%), capability (n = 646, 77%), and consequences (n = 655, 78%) in supporting TB treatment. However, this was not aligned with the actual practice of supporting TB treatment, intensively performed by only 1.3% of participants (n = 11). We identified several factors associated with the practice, that is, a pharmacy assistant background (P < 0.05), short working time (P < 0.05), experience in TB training (P < 0.001), and a positive attitude (P < 0.001). ConclusionThis study highlighted a limited number of community pharmacy personnel intensively practicing as TB treatment supporters in Indonesia. An interventional package considering the identified factors is needed to develop effective and sustainable practices in the real world.

Knowledge, attitudes, and practices towards childhood tuberculosis among healthcare workers at two primary health facilities in Lusaka, Zambia.

Zambia is among the 30 high-burden countries for tuberculosis (TB), Human Immunodeficiency Virus (HIV)-associated TB, and multi-drug resistant/rifampicin resistant TB with over 5000 children developing TB every year. However, at least 32% of the estimated children remain undiagnosed. We assessed healthcare workers' (HCWs) knowledge, attitudes, and practices (KAP) towards childhood TB and the factors associated with good KAP towards childhood TB. Data was collected at two primary healthcare facilities in Lusaka, Zambia from July to August 2020. Structured questionnaires were administered to HCWs that were selected through stratified random sampling. Descriptive analysis was done to determine KAP. A maximum knowledge, attitude, and practice scores for a participant were 44, 10, and 8 points respectively. The categorization as either "poor" or "good" KAP was determined based on the mean/ median. Logistic regression analysis was performed to assess the associations between participant characteristics and KAP at statistically significant level of 0.05%. Among the 237 respondents, majority were under 30 years old (63.7%) and were female (72.6%). Half of the participants (50.6%) were from the outpatient department (OPD) and antiretroviral therapy (ART) clinic, 109 (46.0) had been working at the facility for less than 1 year, 134 (56.5%) reported no previous training in TB. The median/mean KAP scores were 28 (IQR 24.0-31.0), 7 (IQR = 6.0-8.0) and 5 points (SD = 1.9) respectively. Of the participants, 43.5% (103/237) had good knowledge, 48.1% (114/237) had a good attitude, and 54.4% (129/237) had good practice scores on childhood TB. In the multivariate analysis, clinical officers and individuals with 1-5 years' work experience at the facility had higher odds, 2.61 (95% CI = 1.18-5.80, p = 0.018) and 3.09 (95% CI = 1.69-5.65, p = 0.001) of having good attitude respectively, and medical doctors had 0.17 lower odds (95% CI = 0.18-5.80, p = 0.018) of good childhood TB practice. Other participant characteristics didn't show a significant association with the scores. The study found suboptimal levels of knowledge, attitude, and practices regarding childhood TB among HCWs. Targeted programmatic support needs to be provided to address the above gaps.

Preventing Pulmonary Tuberculosis In Children By Empowering The Kids Cadres

&lt;p&gt;&lt;em&gt;Pulmonary tuberculosis (TB) is an infectious disease caused by tuberculosis germs (Mycobacterium tuberculosis). This disease is still a global health problem. It is estimated that one third of the world's population has been infected with pulmonary TB, where the majority of pulmonary TB sufferers are of productive age (15-50 years). Pulmonary TB is chronic and is typically characterized by the formation of granulomas and tissue necrosis. Pulmonary TB can be transmitted through the air, when someone with active TB in the lungs coughs, sneezes or talks. The research method used in this research is quasi experimental research with a one group pretest-posttest research design. The location of the research was in Aceh Singkil Regency. The research was carried out from July to December 2023. The research sample was 30 representatives of junior high school students based on school recommendations. The research results showed that 23 (38.3%) respondents had knowledge about eating nutritious food, and 25 (83.3%) respondents had the attitude that if they were suffering from TB, they would go to the health center. The conclusion is that students' knowledge and attitudes have increased by being given TB training, especially knowledge about TB being caused by heredity and consuming nutritious food.&lt;/em&gt;&lt;/p&gt;

Resilience strengthening of tuberculosis diagnostic services under national tuberculosis program to withstand pandemic situations

In the midst of extraordinary challenges, uncertainty, and the rapidly changing scenario of the prevailing COVID-19 pandemic, existing tuberculosis (TB) laboratories worldwide had to gear up on very short notice to face the dual challenge of fulfilling the increasing demands of laboratory testing for COVID-19 while simultaneously continuing the TB services. The brunt of the same fell on routine TB laboratory services, which include diagnostics (microscopy, rapid molecular testing, culture, and drug-susceptibility testing), and activities of training, quality assurance, and research pertaining to TB worldwide. With the sudden eruption and rapid spread of the global pandemic of COVID-19, TB diagnostic services were affected or disrupted especially where laboratories lacked adequate infrastructure and adequate resources for safe handling of specimens. The human resource challenges such as panic and apprehensions among laboratory workers to deal with newer pathogens, particularly those performing direct smear microscopy, along with staff shortage due to deployment in COVID-19 management duties and the pressure of continuing TB services with enhanced biosafety practices were difficult to handle. We also experienced decline in specimen workload at our national reference laboratory for TB diagnosis by 31% in 2020 as compared to pre-COVID period (2019). This is worrisome as undiagnosed TB as well as improper follow-up of those on TB treatment during the peak of COVID-19 pandemic could be associated with enhanced community transmission of TB and poorer patient outcomes. As the COVID-19 pandemic stretched out untiringly in the country and world over, we rapidly need to adapt and find ways to effectively sustain TB diagnostic services, training and research activities. In this perspective, we document current challenges of TB laboratories and suggest robust ways to address them including biosafety concerns. The safe integration of diagnostic services for TB and where required newer airborne pathogens, to ensure uninterrupted TB services, must be the utmost priority in the face of ongoing and any future unprecedented pandemics.

Tuberculosis diagnostic practices among private medical practitioners of modern medicine in South India – A cross-sectional study

Abstract Background: India has the highest tuberculosis (TB) burden in the world and account for nearly one-fourth of the global burden of TB. Although the Indian government provides a basic national health service, an increasingly large number of health-care interactions in India are with the physicians in the private sector. Objective: The objective is to study the TB diagnostic practices among private medical practitioners and to determine the association of diagnostic practices with socio-demographic factors, the Revised National Tuberculosis Control Programme (RNTCP) training status, and professional/academic qualification of private medical practitioners. Materials and Methods: The current study was a cross-sectional study conducted in the urban areas of Nalgonda district between October 2015 and September 2017. The study included all medical general practitioners (GP) and all specialists practicing internal medicine, chest medicine, and pediatrics, registered with the Indian Medical Association (IMA) branches and had a private practice in the study area. The study included 101 private medical practitioners from three IMA branches. The data on diagnostic practices of TB and RNTCP training status were collected by an interview using a pretested semi-structured questionnaire. The data analysis was done using Statistical Package for Social Sciences (SPSS) 19th version. Results: The majority of study participants in this study were GP, while specialists constituted a smaller portion. Most of these private medical practitioners opted sputum smear examination as their second preferred investigation after a chest X-ray. For the diagnosis of pulmonary TB, majority of the private practitioners preferred both sputum smears examination and chest X-ray. The private medical practitioners who had received the RNTCP training were employing sputum smear microscopy as a diagnostic tool and were also aware about notification of TB. Conclusions: Overreliance on chest X-ray as the investigation of choice to diagnose pulmonary TB and for follow-up. Training in RNTCP has a positive impact on practicing standard diagnostic practices, treatment, and referral practices on private medical practitioners.

Non-tuberculous mycobacterial pulmonary disease: Awareness survey of front-desk healthcare workers in Northern Tanzania.

Over the past decade, there have been increasing reports of non-tuberculous mycobacteria (NTM) species being implicated in tuberculosis (TB) treatment failure or misdiagnosed as TB. Inadequate awareness of NTM pulmonary disease among healthcare workers (HCWs) may contribute to a low index of suspicion for patients presenting to their hospitals. In this study, we assessed the awareness of NTM pulmonary disease (NTM-PD) among front desk HCWs in Northern Tanzania. A cross-sectional descriptive survey was carried out among front desk HCWs in four administrative regions of Northern Tanzania. A standardized questionnaire was administered to consented participants from four clusters; clinicians, laboratory scientists, nurses, and pharmacists serving TB patients from Regional and District Health Facilities. Each participant was asked a set of questions, scored and the total score for each participant was determined. An awareness score was used to measure the level of awareness. The average score for all participants was estimated including the 95% confidence interval (CI). The overall awareness score was 24.1%, 95% CI 22.0-26.2%. History of training, experience in TB care, level of health facilities, age group, and setting were found to be statistically associated with the level of awareness of study participants. More than two-thirds (67%) of participants believe that pulmonary NTM and TB are clinically similar and 60% are not aware that AFB Microscopy cannot distinguish between the two. Only 13% of participants could mention at least one risk factor for NTM pulmonary disease. The level of awareness of NTM pulmonary disease was poor among HCWs in the surveyed TB clinics. National TB Programs are advised to include a topic on NTM in various on-job TB training packages for HCWs.

Impacts of tuberculosis services strengthening and the COVID-19 pandemic on case detection and treatment outcomes in Mimika District, Papua, Indonesia: 2014-2021.

Indonesia is a high-burden tuberculosis (TB) country with a wide case detection gap, exacerbated by the COVID-19 pandemic. We aimed to review the epidemiology of TB in a high-endemic setting of Indonesia before and during the implementation of health system strengthening activities for TB, including during the first two years of the COVID-19 pandemic. We analysed TB program data from Mimika District, Papua, Indonesia from 2014 to 2021. Health system strengthening activities to improve the programmatic management of TB were implemented from 2017 onwards. Activities included decentralization of TB services, training and mentoring of healthcare workers, improved screening for co-morbidities, and introduction and optimisation of Xpert testing in 2018. A total of 11,803 TB cases were notified to the Mimika District Health Office over eight years (2014-21). Between 2015 and 2019, there was a 67% increase in annual case notifications, an 89% increase in bacteriologically confirmed cases and the proportion of TB cases detected in primary care increased from 26% to 46%. In 2020, coinciding with the COVID-19 pandemic, investigation of people with presumptive TB fell by 38%, but the proportion of those tested with Xpert increased. TB case notifications decreased by 19% from 1,796 in 2019 to 1,461 in 2020, but then increased by 17% to 1,716 in 2021. Routine screening for co-morbidities (HIV, diabetes) among TB patients improved over time and was not affected by the pandemic. Treatment success overall was 71% and remained relatively unchanged. Loss to follow-up and death were 18% and 3.7% respectively. Improvements in TB case finding were observed over a period in which a range of health system strengthening activities were implemented. While COVID-19 had a negative impact on the TB program in Mimika District, there are encouraging signs of recovery. Further work is needed to improve TB treatment outcomes.

Barriers and motivation for presumptive tuberculosis case referral: qualitative analysis among operators of community medicine outlets in Ghana

BackgroundCommunity medicine outlets (CMOs) are the first point of call for individuals presenting with cough in Ghana. Although operators of CMOs comprising pharmacists and over-the-counter (OTC) medicine sellers largely support the public–private mix strategy which seeks to engage pharmacies in tuberculosis (TB) case detection, a significant proportion is not involved in TB referral services. The study explores the barriers to and motivation for presumptive TB case referral among CMO operators.MethodsWe used open- and close-ended questions nested in a telephone survey which assessed factors associated with presumptive TB case referral among CMO operators (n = 465). We interviewed participants using computer assisted telephone interviews and analysed the qualitative data using adjusted Mayring’s structured qualitative content analysis.ResultsBased on participants’ own experiences, non-referral was attributed to negative attitudes of presumed cases (48.2%) and inability to meet the financial demands of referred presumed cases (26.3%). Regarding their perception of barriers to TB referral for their professional colleagues, an assumed lack of TB training (44.5%) and an assumed negative attitude of operators (43.6%) were mentioned. From close-ended questions, most chosen barriers to referral were: the assumption of not having seen a presumptive TB case yet (31.8%), lack of TB training (22.2%) and no monetary motivation for operators (10.5%). Most operators (81.6%) view TB referral services as their social responsibility and feel self-motivated to refer cases in order to control the spread of TB in their communities. Of 152 further comments extracted as recommendations to improve referral, 101 (66.4%) of respondents would only refer with the availability of support systems in the form of TB training and making TB diagnostic testing more accessible.ConclusionOperators of CMOs are predominantly self-motivated to refer presumptive TB cases. Barriers to referral might be mitigated by providing more training to operators and specific financial support such as reimbursement of travel costs to presumptive cases.

Knowledge, attitude and practice of community pharmacy personnel in tuberculosis patient detection: a multicentre cross-sectional study in a high-burden tuberculosis setting

IntroductionControl of tuberculosis (TB) is hampered by suboptimal case detection and subsequent delays in treatment, which is worsened by the COVID-19 pandemic. The community pharmacy is reported as the place...

An evaluation of childhood tuberculosis program in Chegutu District, Zimbabwe, 2020: a descriptive cross-sectional study

BackgroundChildhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu.MethodsWe conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge.ResultsThe majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions.ConclusionThe childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

TB training in Kenya: building capacity for care and prevention.

Devolution of healthcare services in Kenya resulted in a large number of newly recruited tuberculosis (TB) coordinators. We describe a unique collaboration between a national tuberculosis program (NTP), a local, and an international non-governmental organization to build human resource capacity in TB care and prevention. From 2016 to 2021, the Kenya Division of National Tuberculosis, Leprosy and Lung Disease Program, Centre for Health Solutions-Kenya, and the International Union Against Tuberculosis and Lung Disease developed and conducted a series of 7-day training courses. A key focus of training was the introduction of TBData4Action, an approach involving the local use of routinely available data to strengthen decision-making and support supervision. Implementation outcomes included training 331 (96%) coordinators out of 344, representing all 47 counties, 37 national officers and 21 other stakeholders using the country-tailored curriculum, including hands-on group work by county teams and field practicals. Thirty-five national facilitators were identified and mentored as local faculty. Training costs were reduced by 75% compared with international alternatives. The collaboration resulted in the training of the majority of the coordinators in a standardized approach to TB care. A sustainable approach to capacity building in local data use was found feasible; the model could be adapted by other NTPs.

Preparedness of tertiary care hospitals to implement the national TB infection prevention and control guidelines in Bangladesh: A qualitative exploration.

In high tuberculosis (TB) burden countries, health settings, including non-designated TB hospitals, host many patients with pulmonary TB. Bangladesh's National TB Control Program aims to strengthen TB infection prevention and control (IPC) in health settings. However, there has been no published literature to date that assessed the preparedness of hospitals to comply with the recommendations. To address this gap, our study examined healthcare workers knowledge and attitudes towards TB IPC guidelines and their perceptions regarding the hospitals' preparedness in Bangladesh. Between January to December 2019, we conducted 16 key-informant interviews and four focus group discussions with healthcare workers from two public tertiary care hospitals. In addition, we undertook a review of 13 documents [i.e., hospital policy, annual report, staff list, published manuscript]. Our findings showed that healthcare workers acknowledged the TB risk and were willing to implement the TB IPC measures but identified key barriers impacting implementation. Gaps were identified in: policy (no TB policy or guidelines in the hospital), health systems (healthcare workers were unaware of the guidelines, lack of TB IPC program, training and education, absence of healthcare-associated TB infection surveillance, low priority of TB IPC, no TB IPC monitoring and feedback, high patient load and bed occupancy, and limited supply of IPC resources) and behavioural factors (risk perception, compliance, and self and social stigma). The additional service-level gap was the lack of electronic medical record systems. These findings highlighted that while there is a demand amongst healthcare workers to implement TB IPC measures, the public tertiary care hospitals have got key issues to address. Therefore, the National TB Control Program may consider these gaps, provide TB IPC guidelines to these hospitals, assist them in developing hospital-level IPC manual, provide training, and coordinate with the ministry of health to allocate separate budget, staffing, and IPC resources to implement the control measures successfully.

The Factors that Related to the Success of Tuberculosis Cadres in Tuberculosis Case Finding

Tuberculosis (TB) case finding as early as possible can prevent transmission and death of TB patients. Health cadres are one form of community participation in the health sector. This study aimed to determine the factors associated with the success of cadres in TB case finding. This research used a descriptive-analytic design with a cross-sectional approach. The sample used was 30 TB cadres. Independent variables were predisposing factors: knowledge and attitudes, enabling factors: counseling, training, and availability of health facilities, reinforcing factors: community benefits and support, and the dependent variable was TB case finding. The instrument used a questionnaire and analyzed using a logistic regression test. There is a relationship between knowledge and TB case finding (p = 0.027), counselling (p = 0.001), and training (p = 0.001), availability of health facilities (p = 0.004), rewards (p = 0.001), and community support (p = 0.002). No relationship was found between attitude and case finding (p = 0.400). The majority of knowledge cadres have immense knowledge that the role of cadres in case finding can increase the success of TB programs and increase community knowledge for independence in TB control.

‘Fast’ Strategy of TB Infection Control: Comparative Knowledge and Attitude of Health-Workers in Tertiary Health Institutions in Abia State, Nigeria

Background: Tuberculosis (TB) though a long existent disease still constitutes a major public health problem in Nigeria. TB burden in Nigeria is one of the highest in the world (318 per 100,000) but case detection rate (16 %) is one of the lowest globally. A key strategy for active case finding and TB infection control (TBIC) is the ‘FAST’ strategy. FAST stands for Finding (TB cases), Actively, Separating and Treating. Methods: This was a cross-sectional study of 148 health-workers in the two tertiary health institutions in Abia state (Federal Medical Centre Umuahia (FMCU) and Abia State University teaching Hospital (ABSUTH)) Aba. Seventy-four consenting health workers from each facility were proportionately selected through stratified random sampling. Pretested self-administered questionnaires were administered on them. Knowledge scores were computed using 16 parameters while attitude was computed using 6. Knowledge and attitude were classified as good or poor. Data was analysed using SPSS version 22. Results: Among ABSUTH staff, 56(75.7%) had poor knowledge (across cadres of health-workers). Health-workers at FMCU had statistically significant higher knowledge (p= 0.01) than ABSUTH staff though majority; 47(63.5%) also had poor knowledge of the FAST strategy. For attitude towards the strategy, overall, 56(75.7%) of health workers in ABSUTH had good attitude similar to that of FMCU; 57(77.0). Previous attendance at a TB training was found to be a predictor of good knowledge aOR 2.81; 95% CI (1.01-7.99) while age was found to be associated with good attitude aOR 9.68; 95%CI (1.01-92.8). Conclusion/ Significance: Despite the relevance of the ‘FAST’ strategy to TB case detection and TBIC, the study demonstrated poor knowledge among these health workers. The need for health-workers training and re-training on TB is imperative.

The use of information and communication technology in continuing education in tuberculosis

ABSTRACT Introduction: The use of information and communication technologies (ICT) tools has been impacting health care. Distance learning has been used for the continuing improvement of healthcare workers (HCWs). In this systematic review, we evaluated the use of ICT in tuberculosis (TB) continuing education. Methods: We searched Medline and Embase for cross-sectional studies that included HCWs or students, and that reported participants’ learning level. Results: Four studies proved eligible. Three used online educational tools, and another one used CDroms and live video conferencing. All studies evaluated participants’ learning level through online pre- and post-tests. The quality of the studies was high. Conclusions: There is a paucity of studies evaluating distance learning in TB training. Continuing education of students and HCWs is essential for TB control. Accomplishing this is critical in increasing the skills and the numbers of qualified HCWs capable of meeting the health care needs of the population.

Evaluating the integration of tuberculosis screening and contact investigation in tuberculosis clinics in Ethiopia: A mixed method study.

BackgroundAligned with global childhood tuberculosis (TB) road map, Ethiopia developed its own in 2015. The key strategies outlined in the Ethiopian roadmap are incorporating TB screening in Integrated Maternal, Neonatal and Child Illnesses (IMNCI) clinic for children under five years (U5) and intensifying contact investigations at TB clinic. However, these strategies have never been evaluated.ObjectiveTo evaluate the integration of tuberculosis (TB) screening and contact investigation into Integrated Maternal, Neonatal and Child Illnesses (IMNCI) and TB clinics in Addis Ababa, Ethiopia.MethodsThe study used mixed methods with stepped-wedge design where 30 randomly selected health care facilities were randomized into three groups of 10 during August 2016-November 2017. The integration of TB screening into IMNCI clinic and contact investigation in TB clinic were introduced by a three-day childhood TB training for health providers. An in-depth interview was used to explore the challenges of the interventions and supplemented data on TB screening and contact investigation.ResultsOverall, 180896 children attended 30 IMNCI clinics and145444 (80.4%) were screened for TB. A total of 688 (0.4%) children had presumptive TB and 47(0.03%) had TB. During the pre-intervention period, 51873 of the 85278 children (60.8%) were screened for TB as compared to 93570 of the 95618 children (97.9%) in the intervention (p<0.001). This had resulted in 149 (0.30%) and 539 (0.6%) presumptive TB cases in pre-intervention and intervention periods (p<0.001), respectively. Also, nine TB cases (6.0%) in pre-intervention and 38 (7.1%) after intervention were identified (p = 0.72). In TB clinics, 559 under-five (U5) contacts were identified and 419 (80.1%) were screened. In all, 51(9.1%) presumed TB cases and 12 (2.1%) active TB cases were identified from the traced contacts. TB screening was done for 182 of the 275 traced contacts (66.2%) before intervention and for 237 of the 284 of the traced (83.5%) under intervention (p<0.001). Isoniazid prevention therapy (IPT) was initiated for 69 of 163 eligible contacts (42.3%) before intervention and for 159 of 194 eligible children (82.0%) under intervention (p<0.001). Over 95% of health providers indicated that the integration of TB screening into IMNCI and contact investigation in TB clinic is acceptable and practical. Gastric aspiration to collect sputum using nasogastric tube was reported to be difficult.ConclusionsIntegrating TB screening into IMNCI clinics and intensifying contact investigation in TB clinics is feasible improving TB screening, presumed TB cases, TB cases, contact screening and IPT coverage during the intervention period. Stool specimen could be non-invasive to address the challenge of sputum collection.

Essential Components of a Public Health Tuberculosis Prevention, Control, and Elimination Program: Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association.

SummaryThis report provides an introduction and reference tool for tuberculosis (TB) controllers regarding the essential components of a public health program to prevent, control, and eliminate TB. The Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association recommendations in this report update those previously published (Advisory Council for the Elimination of Tuberculosis. Essential components of a tuberculosis prevention and control program. Recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Recomm Rep 1995;44[No. RR-11]). The report has been written collaboratively on the basis of experience and expert opinion on approaches to organizing programs engaged in diagnosis, treatment, prevention, and surveillance for TB at state and local levels.This report reemphasizes the importance of well-established priority strategies for TB prevention and control: identification of and completion of treatment for persons with active TB disease; finding and screening persons who have had contact with TB patients; and screening, testing, and treatment of other selected persons and populations at high risk for latent TB infection (LTBI) and subsequent active TB disease.Health departments are responsible for public safety and population health. To meet their responsibilities, TB control programs should institute or ensure completion of numerous responsibilities and activities described in this report: preparing and maintaining an overall plan and policy for TB control; maintaining a surveillance system; collecting and analyzing data; participating in program evaluation and research; prioritizing TB control efforts; ensuring access to recommended laboratory and radiology tests; identifying, managing, and treating contacts and other persons at high risk for Mycobacterium tuberculosis infection; managing persons who have TB disease or who are being evaluated for TB disease; providing TB training and education; and collaborating in the coordination of patient care and other TB control activities. Descriptions of CDC-funded resources, tests for evaluation of persons with TB or LTBI, and treatment regimens for LTBI are provided (Supplementary Appendices; https://stacks.cdc.gov/view/cdc/90289).