TB case detection in Tajikistan – analysis of existing obstacles

Abstract

BackgroundTajikistan National TB Control ProgramObjective(1) To identify the main obstacles to increasing TB Detection in Tajikistan. (2) To identify interventions that improve TB detection.MethodsReview of the available original research data, health normative base, health systems performance and national economic data, following WHO framework for detection of TB cases, which is based on three scenarios of why incident cases of TB may not be notified.ResultsData analysis revealed that some aspects of TB case detection are more problematic than others and that there are gaps in the knowledge of specific obstacles to TB case detection. The phenomenon of “initial default” in Tajikistan has been documented; however, it needs to be studied further. The laboratory services detect infectious TB cases effectively; however, referrals of appropriate suspects for TB diagnosis may lag behind. The knowledge about TB in the general population has improved. Yet, the problem of TB related stigma persists, thus being an obstacle for effective TB detection. High economic cost of health services driven by under-the-table payments was identified as another barrier for access to health services.ConclusionHealth system strengthening should become a primary intervention to improve case detection in Tajikistan. More research on reasons contributing to the failure to register TB cases, as well as factors underlying stigma is needed.

External Quality Assessment of Sputum Smear Microscopy in Tuberculosis Laboratories in Sughd, Tajikistan

“…Although earlier a Knowledge, Attitude and Practice (KAP) survey conducted jointly by Project HOPE, WHO Tajikistan, and Sino Project/Swiss Center for International Health in 2005 and 2008 indicated room for improvement in raising public awareness of TB, the two surveys showed improved knowledge of TB symptoms among respondents over a 3-year period. 6 A qualitative study in 2006, consisting of 13 focus group discussions among 43 community members, echoed that overall knowledge of TB symptoms was accurate among community members. 11 Since then, the country has implemented various initiatives of patient support groups and community leaders training in expansive scales.…”

“… 5 Evaluations of EQA systems and/or blinded random re-checking strategies in TB microscopic laboratories had been conducted in various countries with high TB burden. 6 – 8 Our study performed the first evaluation on the EQA system and the performance of the TB microscopic laboratories in Sughd, Tajikistan since system implementation.…”

“…Tajikistan is a landlocked Central Asian country that used to be a member of the former Soviet Union. The collapse of the Soviet Union and a half-decade civil war (1992–1998) shortly after the independence of the country heavily damaged both its economy and health infrastructure, 6 , 7 giving rise to a re-emergence of a TB epidemic that peaked around 2001. 8 In a population of 8.2 million people, Tajikistan had an estimated prevalence of 12,000 TB cases in 2013.…”

Initial default among tuberculosis patients diagnosed in selected medical colleges of Puducherry: issues and possible interventions

“…Rao et al [15] reported that 16.7% of patients were not aware of TB and hence did not collect the report. Korobitsyn et al [16] reasoned that the suboptimal qualification of health centers and funding as well as improper management and supervision practices of TB patients were reasons for initial default.…”

Effectiveness of healthcare workers and volunteers training on improving tuberculosis case detection: A systematic review and meta-analysis

“…The reason for low TB case detection can be related to the healthcare system or patientrelated factors. Lack of f adequate training of health professionals on the diagnosis and treatment of TB a common healthcare system factor affecting TB case detection [11][12][13][14]. Different interventions were designed to enhance TB case detection in the national TB programs.…”