Challenges in case finding of tuberculosis control program in Iran: A qualitative study

Moosazadeh, Mahmood; Amiresmaili, Mohammadreza

doi:10.3329/bjms.v17i3.37002

Cited by 5 publications

(8 citation statements)

References 12 publications

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“…In our setting, accountability relationship was enhanced by programme management support, supportive supervision and quarterly performance review meetings. Nevertheless, the weak stewardship from the LG confirms previous evidence that TB control program is perceived as less important than other public health programmes [20,23] but contrasts evidence of strong political commitment from district governments in Pakistan [8]. Unmet expectation of local officials of financial incentives from NTP and perception that partners support TB control explained low responsiveness of LGs.…”

Section: Discussionsupporting

confidence: 60%

“…This study's findings revealed that poor human resources management practices and inadequate training of TB service providers hindered TB control. These findings are consistent with lack of skilled staff [4,10,11,22]; lack of incentives for TB service providers [5,10]; inadequate training [10,11,19]; and poor attitude and weak commitment of health workers towards deployment to TB services [22,23]. In contrast, evidence from European countries show that skilled and motivated healthcare workers enabled TB control [16].…”

Section: Discussionmentioning

confidence: 60%

“…Constraints to TB control include perception that TB control is less important than other public health programs [20,23]; weak accountability relationship between provincial/regional and district TB programme management [7,12,24]; insufficient community involvement [25]; and low public spending on TB [5][6][7][9][10][11][12][13]. TB control have been limited by lack of skilled staff [4,10,11,19,22]; lack of incentives for service providers [4,5,10]; lack of utilization of various levels of health staff and health facilities [25]; poor attitude and weak commitment of health workers towards deployment to TB services [22,23], inadequate training [10,11,19], and lack of laboratory staff [5,22,23]. Poor TB data management capacity [22]; frequent revisions of reporting formats [5]; and ineffective electronic recording and reporting system [14].…”

Section: Introductionmentioning

confidence: 99%

“…Poor adherence to GeneXpert algorithm, interrupted supply of cartridges, lack of replacement of damaged modules, poor maintenance, and poor recording and reporting limit usefulness of GeneXpert in TB diagnosis [14,26,27]. Poor adherence to national guidelines [11,22,23]; dilapidated infrastructure [5,12,23] weak TB/HIV integration [10,12,14,24,28]; lack of public-private mix [10,12,23] and poor integration into general health services hinder effective TB service delivery [5,29,30].…”

Section: Introductionmentioning

confidence: 99%

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Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

Ogbuabor

2020

BMC Infect Dis

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Background: Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Methods: The study was conducted in Enugu State, Southeastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. Results: Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. Conclusion: Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

Ogbuabor

2020

BMC Infect Dis

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“…Based on the other results obtained from the both mentioned regions, the rate of MDR is about the same amount was reported. [17][18][19][20] .…”

Section: Drug Susceptibility Testmentioning

confidence: 99%

Nationality as a risk factor of tuberculosis resistance in two co-related countries

Gharamaleki

Moaddab

Darbouy

et al. 2018

Bangladesh J Med Sci

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Background: Republic of Azerbaijan and Iran are two neighboring countries with high amount of travelling between them, different rates of TB and its resistance. These relationships could complicate the controlling of tuberculosis programs. Objective: The study was conducted to determine the prevalence of tuberculosis (TB) resistance and its risk factors in the two geographically co-related regions. Method: A total of 119Mycobacterium tuberculosis isolates from the patients of the target regions (Azerbaijan Rep. and Tabriz, Iran) were examined at the Central Tuberculosis Laboratory in Tabriz, Iran. The cultures and drug susceptibility tests was performed on Lowenstein-Jensen. All the isolates were categorized by MIRU-VNTR molecular method into clustered and un-clustered groups. The clustering as well as demographic data were analyzed to determine the risk factors contributing to TB resistance. The categorical data about the TB resistance were compared using a chi square test. Results: 27.8 percent of isolates were resistant at least to one of the 1st line of anti-tuberculosis drugs. The prevalence of any drug resistance and MDR were 64.6 and 17.9 percent respectively for Azari isolates, where the rate of resistance to rifampin and isoniazid was higher than streptomycin and ethambutol. The corresponding figures for the isolates from Tabriz were 16.9 and 3.3 percent respectively. Conclusions: The results of this comparative and cross-sectional study showed statistically significant differences in TB resistance between the isolates from the patients of Azerbaijan Rep. and Iran. According to the results, the rate of resistance to RMP, INH, and MDR was higher in Azerbaijan; consequently, nationality could be regarded as a risk factor of MDR, resistance to RMP and INH but not to SM and ETB. Other studied parameters did not contribute to TB resistance. Bangladesh Journal of Medical Science Vol.18(1) 2019 p.36-41

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Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis

Taylor,

Medley,

van Wyk

et al. 2024

Cochrane Database of Systematic Reviews

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Background Active case finding (ACF) refers to the systematic identification of people with tuberculosis in communities and amongst populations who do not present to health facilities, through approaches such as door‐to‐door screening or contact tracing. ACF may improve access to tuberculosis diagnosis and treatment for the poor and for people remote from diagnostic and treatment facilities. As a result, ACF may also reduce onward transmission. However, there is a need to understand how these programmes are experienced by communities in order to design appropriate services. Objectives To synthesize community views on tuberculosis active case finding (ACF) programmes in low‐ and middle‐income countries. Search methods We searched MEDLINE, Embase, and eight other databases up to 22 June 2023, together with reference checking, citation searching, and contact with study authors to identify additional studies. We did not include grey literature. Selection criteria This review synthesized qualitative research and mixed‐methods studies with separate qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards ACF programmes for tuberculosis in any endemic low‐ or middle‐income country, with no time restrictions. Data collection and analysis Due to the large volume of studies identified, we chose to sample studies that had 'thick' description and that investigated key subgroups of children and refugees. We followed standard Cochrane methods for study description and appraisal of methodological limitations. We conducted thematic synthesis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. We assessed the confidence in the findings using the GRADE‐CERQual approach, and produced a conceptual model to display how the different findings interact. Main results We included 45 studies in this synthesis, and sampled 20. The studies covered a broad range of World Health Organization (WHO) regions (Africa, South‐East Asia, Eastern Mediterranean, and the Americas) and explored the views and experiences of community members, community health workers, and clinical staff in low‐ and middle‐income countries endemic for tuberculosis. The following five themes emerged. • ACF improves access to diagnosis for many, but does little to help communities on the edge. Tuberculosis ACF and contact tracing improve access to health services for people with worse health and fewer resources (High confidence). ACF helps to find this population, exposed to deprived living conditions, but is not sensitive to additional dimensions of their plight (High confidence) and out‐of‐pocket costs necessary to continue care (High confidence). Finally, migration and difficult geography further reduc...

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Challenges in case finding of tuberculosis control program in Iran: A qualitative study

Cited by 5 publications

References 12 publications

Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

Nationality as a risk factor of tuberculosis resistance in two co-related countries

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis

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