ASSESEEMENT OF FACTORS AFFECTING THE PULMONARY TUBERCULOSIS CASE DETECTION

Abstract

Background: Detecting infectious TB cases and effective treatment of them is the most important TB control strategy. However, according to Federal Ministry of Health (FMOH) report on smear positive pulmonary TB cases in 2001 EFY, the national and Amhara region and case detection rate for smear positive pulmonary tuberculosis is 34% and 24% respectively which is below half of the WHO annual estimates i.e. 70% and therefore poses a question to investigate the reasons and come up with possible findings. Objectives: This study aims to assess factors affecting the pulmonary TB case Detection. Methodology: A community based cross sectional study was conducted using a quantitative method of data collection in selected communities (kebeles) of woredas selected through multistage stratified sampling technique in South Achefer and Jabitenan and A facility based qualitative study was conducted using phenomenological study design in four selected HCs in four woredas of West Gojjam zone of Amhara region from June to December 2010. Result. Among the 1256(97.8%) of respondents who ever heard about PTB, 974(77.5%) mentioned the correct routes of transmission. However, 823(65.5%) did not have good knowledge about PTB. Respondents with higher educational level had good knowledge than illiterates with AOR=4.771, 95% CI= (3.254, 6.997) and P<0.001. . Despite having good knowledge in the correct transmission of TB, half of the respondents had negative attitude towards TB. Respondents with high level of education had positive attitude than illiterates with AOR=4.510, 95% CI= (2.803, 7.256) and P< 0.001 Among 143 sick respondents with prolonged cough, 56(39.4%) had positive treatment seeking behavior. Treatment was sought more by females than male respondents. Half of health workers in the facilities did not employ two AFB test positive results as adequate diagnostic criteria for smear positive PTB diagnosis. Moreover, there was 7(18.4%) false negativity rate which is over ten times higher than the tolerable or acceptable false negative rate of NTBLCP. Conclusion and recommendation: There is a wide knowledge gap among the community about PTB. Moreover, there is even low treatment seeking practices of sick patients and about three quarter of the prolonged coughers had either negative treatment seeking practice or they did not seek treatment at all. There are undetected TB suspects in the community who need to be identified and referred. About half of the health workers were unable to make diagnosis of PTB+ based on the available two AFP positive results unless additional investigation result is presented as well as a high false negativity rate and implicates problems related to staining and smearing which leads to wrong diagnosis of PTB which results in wrong diagnosis of PTB. All the above findings reflect the pulmonary TB case detection was affected by the poor treatment seeking practice of the community, the diagnostics capacity of HWs and laboratory technicians AFB test performance and poor active detection and referals of TB suspects. Both a combined active and passive TB case detection strategies or approach should be applied effectively through an effective community TB care initiative and quality facility based AFB test detection and diagnosis should be effected