Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study

Datiko, Daniel Gemechu; Yassin, Mohammed A.; Theobald, Sally; Blok, Lucie; Sahu, Sandeep; Creswell, Jacob; Cuevas, Luís E.

doi:10.1136/bmjgh-2017-000390

Cited by 56 publications

(75 citation statements)

References 23 publications

(14 reference statements)

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“…TB case identification may be improved if the community could easily access health facilities with TB diagnostic services. Studies show that case notification and treatment outcomes increase in areas where community members have better access to facilities with TB diagnostic and treatment services [12,52,53]. Studies in Southern Ethiopia show that an involvement of health extension workers in sputum collection for microscopy at the community level significantly increased TB case finding and improved treatment outcomes [21,52].…”

Section: Discussionmentioning

confidence: 99%

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

et al. 2020

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Background Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. Methods A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. Results Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers.

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Section: Discussionmentioning

confidence: 99%

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

et al. 2020

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“…TB prevalence rates are higher in men than in women globally (WHO, 2001) and this is true for Ethiopia as well (WHO, 2018). However, unlike in health facility-based passive case finding, the proportion of women with TB has increased consistently when community-based screening has been conducted in southern Ethiopia (Yassin et al, 2013;Datiko and Lindtjorn, 2009;Datiko et al, 2017), probably due to improved access by women who would otherwise have remained undetected. In a case-control study in communities where HEWs were employed in active case finding, the male to female ratio of TB cases changed from 1.3:1 to 1:1 following the intervention (Yassin et al, 2013;Datiko and Lindtjorn, 2009).…”

Section: Number Of Householdsmentioning

confidence: 96%

“…the rural settings of southern Ethiopia (Yassin et al, 2013;Datiko and Lindtjorn, 2009;Datiko et al, 2017). In contrast to these previous studies in Ethiopia, and as part of an innovative approach, our study used HDAs to identify symptomatic TB individuals in the community.…”

Section: Number Of Householdsmentioning

confidence: 99%

“…As a brief background, Ethiopia launched a health extension programme (HEP) in 2003 with the objective of increasing population access to basic health services including TB. The HEP consists of female health extension workers (HEWs) who receive 1 year of training and then become salaried healthcare workers equipped to provide basic health services to the same community from which they were recruited (Yassin et al, 2013;Datiko et al, 2015;Datiko and Lindtjorn, 2009;Datiko et al, 2017). The HEWs are based at local health posts and provide health promotion to the community at the household level.…”

Section: Introductionmentioning

confidence: 99%

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Population-based screening for pulmonary tuberculosis utilizing community health workers in Ethiopia

Merid

Woldeamanuel

Hailu

et al. 2019

International Journal of Infectious Diseases

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To evaluate the utility of a volunteer health development army in conducting population screening for active tuberculosis (TB) in a rural community in southern Ethiopia. Methods: A population-based cross-sectional survey was conducted in six kebeles (the lowest administrative units). Volunteer women community workers led a symptom screening programme to identify adults !15 years of age with TB in the community. Individuals with a cough for !2 weeks had spot and morning sputum samples taken, which were examined using acid-fast bacillus (AFB) smear microscopy, culture, and Xpert MTB/RIF. Results: All 24 517 adults in the study area had a symptom screen performed; 544 (2.2%) had had a cough for !2 weeks. Among those with a positive symptom screen, 13 (2.4%) were positive on sputum AFB smear microscopy, 13 (2.4%) had a positive culture, and 32 (5.8%) had a positive Xpert MTB/RIF test. Overall, 34 TB cases (6%) were identified by culture and/or Xpert, corresponding to a prevalence of 139 per 100 000 persons. Conclusions: This study demonstrated the capability of community health workers (volunteer and paid) to rapidly conduct a large-scale population TB screening evaluation and highlight the high yield of such a programme in detecting previously undiagnosed cases when combined with Xpert MTB/RIF testing. This could be a model to implement in other similar settings.

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“…The visits identified 38,534 household contacts, of whom 5737 (14.9%) had symptoms suggestive of TB. Of these, 4520 (78.8%) produced sputum for examination, resulting in 288 (6.4%) additional smear-positive cases [15].…”

Section: Resultsmentioning

confidence: 99%

Role of Health Extension Worker in Tuberculosis Prevention and Control in Ethiopia: Systematic Review

Weldemarium¹

2019

AJLS

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Background: Health Extension Program was designed to serve the rural community of Ethiopia and has brought significant change in improving utilization of family planning, antenatal care, postnatal care, birth preparedness, initiating breast feeding immediately after birth and HIV testing. In relation to Tuberculosis (TB) prevention and control, TB patients believe that they learnt about TB from HEWs and some patients stated that they could not have been diagnosed without the work of HEWs. HEWs focus on Education of the community, Identification of suspects, referral of suspects to health Facilities, Support for adherence to treatment, retrieval of absentees and contact tracing. Objective: The objective of this review was to assess the role of Ethiopian health extension workers in prevention and control of TB. Method: Computerized systematic search was conducted through PubMed, Google Scholar, and Science direct databases. After reviewing for relevance of articles based on title, abstract and eliminating for redundancies five articles were included for this review. Studies presented to the original article, studies that examine contribution of HEWs to TB prevention, studies conducted in Ethiopia; studies written in English were included in the review. Results: Large number of people with TB symptom which is the base for TB prevention and elimination strategy was identified by the HEWs. The health extension workers identified not only new patients but also the retreatment (defaulters) which are the major contributors to (multi drug resistant TB (MDR-TB). From the identified TB suspects by HEWs, majority of them were found to be positive for the disease. Health extension worker remain the health worker who identify TB suspects and refer patient to health facilities. They were also the source of community health educator in relation to TB.

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Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study

Cited by 56 publications

References 23 publications

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

Population-based screening for pulmonary tuberculosis utilizing community health workers in Ethiopia

Role of Health Extension Worker in Tuberculosis Prevention and Control in Ethiopia: Systematic Review

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