The use of laypersons to support tuberculosis screening at a Kenyan Referral Hospital

Abstract

Background:The former Nyanza Province of Kenya bore the brunt of HIV-driven tuberculosis (TB); 62% of the 19,152 cases in 2010 were HIV co-infected. The use of laypersons to improve TB case finding in community settings has shown rewarding results in other countries. We have no documented Kenyan experience in health facility settings. We evaluated the benefit of using laypersons to support TB screening and referrals at the former Nyanza Province of kenya province's largest regional referral facility.Methods:In 2010, five high school graduates were trained on symptomatic recognition of TB suspects and assisted sputum production by the region's District's TB and Leprosy Coordinator. They then identified and referred TB suspects (from hospital patients and visitors) at waiting-areas and wards to clinicians and documented their TB screening and referral outcomes. We describe results from one waiting-area with complete documentation between January and December 2011.Results:Of the 217 TB suspects identified, majority were male (55%); their median age was 36 (range 1–70) years. 11% (23) were aged <15 years; 65% (15) were diagnosed with TB by, a combination of sputum microscopy and chest X-rays (5) followed by chest X-ray alone (50), then sputum microscopy alone (1), and TB score chart (4). Of those aged 15+ years, 72% (140) were diagnosed with TB by a combination of sputum microscopy and chest X-rays (75) followed by sputum microscopy alone (38), and chest X-ray alone (27). Excluding cases that transferred out, this process contributed to 33% of Jaramogi Oginga Odinga Teaching and Referral Hospital's annual TB case burden.Conclusions:TB case detection in high TB burden regions can be supported the use of laypersons in hospital settings.

Application of WHO Symptom Screening Approach by Non Clinicians in the Diagnosis of Pulmonary Tuberculosis among HIV Positive Individuals in the University of Uyo Teaching Hospital, Nigeria

“…The WHO recommended 4-symptom screening tool for TB used by lay persons helped in identifying 13% of the clinic TB burden over a nine-month period. This finding agrees with the 2-24% reported in a previous Nigerian study on the usefulness of lay persons in active case finding of TB in a health facility [16] but lower than reports from a similar study in Kenya with 33% [15]. The small proportion of TB cases identified in this study could be due to our relatively small sample size and the fact that most of our respondents were already on highly active anti-retroviral therapy (HAART).…”

“…Costeffectiveness and ease of deployment by laypersons in individuals irrespective of their HIV status, must be taken into consideration in the development of new highly sensitive TB screening tools to ensure improved TB case detections in both the community and hospital settings. High school graduates trained in the symptomatic recognition of tuberculosis suspects and assisted sputum production in a Kenyan referral hospital contributed to the detection of 33% of the referral hospital's annual tuberculosis case burden [15]. The use of laypersons in community settings through household surveys also showed rewarding results in improving active tuberculosis case detection [11][12][13][14].…”

“…The symptom screening approach could be used by lay persons (cough monitors) in active case finding of TB in both community and clinical settings and has been reported to produce rewarding results [11][12][13][14]. A study in Kenya reported that 33% of annual hospital TB burden were initially identified by cough monitors from selected outpatient areas, [15] and 4-24% contribution in a similar Nigerian study [16].…”

Using hospital auxiliary worker and 24-h TB services as potential tools to overcome in-hospital TB delays: a quasi-experimental study

“…However, nurses are overwhelmed in Mozambique, as the country's nurse to population ratio is about 2.9 per 10 000 inhabitants [13]. The use of trained laypersons in hospital settings in Kenya was successfully observed to be helpful on early TB case detection and treatment [14]. On the other hand, having 24-h TB laboratory services, ensuring routine and urgent TB diagnostic tools (GeneXpert MTB/RIF assay, for instance) available every day, including weekend and (inter) national holidays, is an effective intervention, not only in reducing nosocomial transmission of TB but also in speeding up early TB diagnosis and treatment [7,12,15].…”