Improving “Fast” Indicators of TB Infection Control through Targeted Health Workers Training; Findings from Facility Based Studies in Abia State, Nigeria

Main Article Content

Ejiroghene C. Iwuoha
Chika N. Onwasigwe

Abstract

Aim: The aim of this study was to assess the effect of health workers training and implementation of the FAST strategy on the “FAST” indicators at Abia State University Teaching Hospital (ABSUTH); a tertiary referral facility. ”FAST” strategy; a focused approach to stopping TB spread in congregate settings developed by TB Care1 stands for Finding TB cases Actively, Separating safely, and Treating effectively.

Study Design: This was a facility based interventional study using control group design methods with ABSUTH as the intervention facility while Federal Medical Centre Umuahia (FMCU) was the control.

Methodology: Health workers (74 across cadres; doctors, nurses, laboratory scientist and medical record staff)  selected through stratified random sampling were trained to ensure daily cough surveillance and screening for TB among patients at the General outpatient, medical wards and HIV clinic of ABSUTH under supervision of a “FAST” focal person.Baseline “Fast Indicators” in the facility TB records of newly diagnosed TB patients 3 months before and 3 months after the training intervention were obtained.

Results: At baseline the “FAST” strategy indicators recorded in the study facility include time to diagnosis > 1 week, time to treatment 3.5 days, presumptive TB cases 92, number of cases commenced on treatment were 22 while presumptive DRTB cases was 0.33. This study observed a significant positive difference in all the “FAST” indicators following the intervention. Time to diagnosis decreased by 52%, time to treatment decreased by 17% while the number of presumptive TB cases increased by over 100%. Number of TB cases diagnosed also increased by 100% as well as the cases commenced on treatment by 91%, while number of diagnosed DRTB cases increased by over 100%.These were all statistically significant ( P=.013,.03, .032,  and .049 except time to treatment P= 0.053).

Conclusion: The training intervention on ‘FAST” strategy of TB infection Control significantly improved FAST Indicators in the intervention facility with attendant reduction in diagnostic delays and increased case notification.

Keywords:
Health-workers, tuberculosis, training, “FAST” strategy.

Article Details

How to Cite
Iwuoha, E. C., & Onwasigwe, C. N. (2020). Improving “Fast” Indicators of TB Infection Control through Targeted Health Workers Training; Findings from Facility Based Studies in Abia State, Nigeria. International Journal of TROPICAL DISEASE & Health, 41(21), 1-9. https://doi.org/10.9734/ijtdh/2020/v41i2130395
Section
Original Research Article

References

Federal Ministry of Health Tuberculosis and Leprosy control program. Model for training of General Healthcare Workers on tuberculosis control. Abuja: Sounaprints. 2012;8-51.

World Health Organization. Global Tuberculosis Report 2018. Available:https://www.who.int/tb/publications/global_report/gtbr2018_main_text_28 Feb2019.pdf?ua

World Health Organisation. WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households; 2009.

Joseph B, Joseph M. The health of the healthcare workers. Vol. 20, Indian Journal of Occupational and Environmental Medicine. Medknow Publications. 2016; 71-2.

Centre for Disease Control. TB Infection Control and Prevention; 2012. [Cited 2020 Aug 6] Available:http://www.cdc.gov/tb/topic/infectioncontrol/default.htm

World Health Organisation. Global TB Report 2020. Available:https://www.who.int/tb/publications/global_report/en/

Poz MRD, Kinfu Y, Dräger S, Kunjumen T. Counting health workers : definitions , data, methods and global results. World Health; 2006.

Centre for Disease Control. Tuberculosis infection control in the era of expanding HIV care and treatment. Addendum to WHO Guidelines for the prevention of tuberculosis in health Care facilities in Resource-Limited Settings; 1999.

TB Care II. FAST; A tuberculosis infection control strategy. 2013;1-11.

Federal Ministry of Health Department of Public Health NT and LCP. FAST; A Tuberculosis Infection Control Strategy [Internet]; 2014. Available:https://www.google.com.ng/?gws_rd=ssl#q=Fast+tb+strategy+in+nigeria.

WHO guidelines on tuberculosis infection prevention and control 2019. Available:https://apps.who.int/iris/bitstream/handle/10665/311259/9789241550512-eng.pdf?ua=1

Core Curriculum on Tuberculosis: What every Clinician should know. Sixth Edit. Atlanta: Centre for Disease Control; 2013. 189-226.

Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings. 2005. MMWR Recomm Rep. 2005;54(RR-17):1–141.

Kumar V, Khajanchi M, Raykar NP, Gerdin M, Roy N. Waiting at the hospital door: A prospective, multicentre assessment of third delay in four tertiary hospitals in India. Lancet (London, England) 2015;385Suppl :S24. [Internet]. Available:http://www.ncbi.nlm.nih.gov/pubmed/26313071

Zelnick JR, Gibbs A, Loveday M, Padayatchi N, O’Donnell MR. Health-care workers’ perspectives on workplace safety, infection control, and drug-resistant tuberculosis in a high-burden HIV setting. J Public Health Policy. Nature Publishing Group. 2013;34(3):388-402. [Internet]. [Cited 2020 Sep 28]. Available:http://www.palgravejournals.com/jphp/journal/v34/n3/abs/jphp201320a.html#close

Core Curriculum on Tuberculosis: What every Clinician should know. Sixth Edit. Atlanta: Centre for Disease Control. 2013; 189-226.

Demissie Gizaw G, Aderaw Alemu Z, Kibret KT. Assessment of knowledge and practice of health workers towards tuberculosis infection control and associated factors in public health facilities of Addis Ababa, Ethiopia: A cross-sectional study. Arch public Heal = Arch belges santé publique. 2015;73(1):15. [Internet]. [Cited 2020 Nov 1]

Barrera E, Livchits V, Nardell E. F-A-S-T : a refocused, intensified, administrative tuberculosis transmission control strategy. 2015;19:381–4.

TB CARE 1. Ndola District TBIC Demonstration Project. Final Report. Ndola; 2014.

Onwasigwe C. Principles and Methods of Epidemiology. Second Edi. Enugu: El Demark. 2010;143-157.

Centre for Disease Control. CDC - Tools for Tuberculosis Infection Control. 2014 [cited 2020 May 1]. Available:http://www.cdc.gov/globalaids/resources/pmtct-care/tuberculosis-infection-control.html

Khan K. Root Cause Analysis (RCA) of Prolonged Laboratory Turnaround Time in a Tertiary Care Set up. J ClinDiagn Res 2014;8(4):FC05-8. [Internet].[cited 2020 Oct 13] Available:http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4064846&tool=pmcentrez&rendertype=abstract

Kumar V, Khajanchi M, Raykar NP, Gerdin M, Roy N. Waiting at the hospital door: A prospective, multicentre assessment of third delay in four tertiary hospitals in India. Lancet (London, England). 2015;385 Suppl :S24 Internet]. [Cited 2020 Oct 13] Available:http://www.ncbi.nlm.nih.gov/pubmed/26313071

Mirtskhulava V, Whitaker JA, Kipiani M, Harris DA, Tabagari N, Owen-Smith AA, et al. Determinants of tuberculosis infection control-related behaviors among healthcare workers in the country of Georgia. Infect Control Hosp Epidemiol 2015];36(5):522-8. [Cited 2020 Sept 18 Available:http://www.ncbi.nlm.nih.gov/pubmed/25648218 28];14(1):593. Available:http://www.biomedcentral.com/1472-6963/14/593

Temesgen C, Demissie M. Knowledge and practice of tuberculosis infection control among health professionals in Northwest Ethiopia; 2011. BMC Health Serv Res [Internet]; 2014. [Cited 2020 Sep].

Solomon T, Shiferaw M, Abreham W, Tayu B, Klinkenberg E, Loha E. Assigning focal persons to notify more tuberculosis patients: lessons learned in southern Ethiopia. Public Heal action [Internet]. 2014;4(3):S18–24. [Cited 2020 Oct 25] Available:http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4542067&tool=pmcentrez&rendertype=abstract

Manabe YC, Zawedde-Muyanja S, Burnett SM, Mugabe F, Naikoba S, Coutinho A. Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers. Open forum Infect Dis. 2015; 2(1):ofv030. [Internet] [Cited 2020 Mar 24] Available:http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4438908&tool=pmcentrez&rendertype=abstract

Useni S, Gidado M, Onazi J, Eneogu R, Chukwueme N, Ubochioma E, Akang G, Obot V, Omoniyi F. FAST Strategy - A Sustainable Administrative TB Infection Control Measure in Nigeria: Reducing Time to TB Diagnosis and Enrolment to Treatment, Science Journal of Public Health. 2016;4(4):352-358. DOI: 10.11648/j.sjph.20160404.23