Effect of tuberculosis training on community health workers’ knowledge: a cluster randomized control trial in South Nigeria

Background: Intensified efforts to improve tuberculosis (TB) diagnosis, treatment, and prevention are needed to meet global EndTB targets. Community health workers’ (CHWs) knowledge with respect to case finding is vital in tuberculosis elimination. This study aimed to determine the effect of tuberculosis training on the knowledge of community health workers in Nigeria. Methods: As part of a larger multicomponent intervention study, a randomised control trial was conducted with CHWs in 18 primary health care (PHC) clusters in Nigeria. The clusters were allocated to three arms: training and cash incentive (A), training only (B), and control (C) arms. Arms (A) and (B) received training on tuberculosis symptoms, prevention, diagnosis and treatment while the control arm (C) did not receive training. Participants’ knowledge on tuberculosis was assessed using questionnaires administered pre- and post-intervention. Data was analyzed using GraphPad Prism. Descriptive data was presented in tables and bivariate data was analyzed using chi square. Statistical significance was set as P<0.05. Results: There was a significant increase in the total knowledge score (25.4%), knowledge of general symptoms (24.4%), prevention (22.6%) and diagnosis and treatment (30.0%) across all study arms post-intervention (p<0.0001). Compared with the control arm, the training arm (A) had a higher proportion of good total knowledge score (94.4%) and arm (B) had a lower proportion of good total knowledge score (83.1%) when compared to the control group (93.1%). These were, however, not statistically significant. Conclusions: An improvement in the CHWs’ knowledge of symptoms, prevention, diagnosis and treatment of tuberculosis was observed after a training intervention was done. Integration of routine tuberculosis training is recommended to improve tuberculosis case finding in high burden communities. Pan African Clinical Trial Registry registration: PACTR202010691865364 (14/01/2020)

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Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali

Nutrients ◽

10.3390/nu13020367 ◽

2021 ◽

Vol 13 (2) ◽

pp. 367

Author(s):

Pilar Charle-Cuéllar ◽

Noemí López-Ejeda ◽

Mamadou Traore ◽

Adama Balla Coulibaly ◽

Aly Landouré ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Low Income ◽

Community Intervention ◽

Health Workers ◽

Acute Malnutrition ◽

Control Group ◽

Supportive Supervision ◽

Supervision Group ◽

Different Levels

(1) Background: The Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated community case management (iCCM). This paper evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods (2): This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. (3) Results: A total of 6112 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. (4) Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

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Knowledge and attitudes of tuberculosis management in San Juan de Lurigancho district of Lima, Peru

The Journal of Infection in Developing Countries ◽

10.3855/jidc.335 ◽

2009 ◽

Vol 3 (10) ◽

pp. 783-788 ◽

Cited By ~ 18

Author(s):

Elizabeth M. Kiefer ◽

Theresa Shao ◽

Olveen Carrasquillo ◽

Pamela Nabeta ◽

Carlos Seas

Keyword(s):

Health Care ◽

Community Health ◽

Community Health Workers ◽

Health Care Providers ◽

Health Workers ◽

Knowledge Score ◽

San Juan ◽

Care Providers ◽

Knowledge Gaps ◽

Knowledge And Attitudes

Background: Expansion of the health care workforce in Peru to combat tuberculosis (TB) includes both professional health care providers (HCPs) such as doctors and nurses, and non-professional HCPs such as community health workers (CHWs). We describe the knowledge and attitudes of these HCPs, and identify modifiable barriers to appropriate anti-tuberculosis treatment. Methodology: We surveyed HCPs practicing in 30 clinical settings (hospitals, community health centers, and health posts) in the San Juan de Lurigancho district of Eastern Lima, Peru. Multiple-choice questions were used to assess knowledge of TB. A five-item Likert scale was created to assess attitudes toward the community, patients, and clinics. Linear regression was used to identify predictors of mean knowledge score, and analysis of variance was used to test differences in HCP score. Results: Of the 73 HCPs surveyed, 15% were professionals (doctors or nurses). The remaining 85% were health technicians, community health workers (CHWs) or students. The mean knowledge score was 10.0 ± 1.9 (maximum 14) with professional HCPs scoring higher than other HCPs (11.7 ± 1.1 vs. 9.7 ± 1.9), p < .01). Knowledge gaps included identification of patients at high risk for TB, assessment of treatment outcomes, and consequences of treatment failure. The most commonly cited modifiable barriers were structural, including laboratory facilities and staffing of TB clinics, with 52.1% and 62.5% of HCPs, respectively, citing these as problematic. Conclusions: Efforts to improve knowledge of TB HCPs in Peru should focus on the specific gaps we have identified. Further research is needed to evaluate whether these knowledge gaps correlate with TB control.

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A Randomized Control Trial to Test Effect of Cash Incentives and Training on Active Casefinding for Tuberculosis among Community Health Workers in Nigeria

F1000Research ◽

10.12688/f1000research.53822.1 ◽

2021 ◽

Vol 10 ◽

pp. 1154

Author(s):

Christie Akwaowo ◽

Victor Umoh ◽

Idongesit Umoh ◽

Eno Usoroh ◽

Olugbemi Motilewa ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Case Finding ◽

P Value ◽

Case Detection ◽

High Burden ◽

Cash Incentives ◽

Case Notification ◽

And Training

Background: Case detection for Tuberculosis remains low in high burden communities. Community Health Workers (CHWs) are the first point of contact for many Nigerians in the rural areas and have been found useful in active case finding. This study assessed the effect of cash incentives and training on tuberculosis case detection by CHWs in six Local Government Areas in Nigeria. Materials and Methods: A randomised control trial was conducted in three PHC clusters. The intervention Arm (A) received cash incentives for every presumptive case referred. The Training Arm(B) had no cash incentives and the control had neither training nor cash incentives. Case notification rates from the TB program were used to assess the effect of cash incentives on TB case finding. Data was analyzed using Graph Pad Prism. Descriptive data was presented in tables and bivariate data was analyzed using chi square. Mean increases in case notification rates was calculated Statistical significance was set as P=0.05. Results: The intervention identified 394 presumptive TB cases, contributing 30.3% of all presumptive cases notified in the LGAs. Findings also showed an increase of 14.4% (ꭓ2=2.976, P value=0.2258) in case notification rates for the Arm A that received cash incentives alongside training, there was also an increase of 7.4% (ꭓ2= 1.999, P value=0.1575) in Arm B that received Training only. Secondary outcomes indicated a 144.8%(ꭓ2= 4.147, P value=0.1258) increase in community outreaches conducted in the Arm that were given cash incentives. Conclusion: The study demonstrated an increase in TB control activities of case notification and outreaches among community health workers that received cash incentives and training. These findings support the use training and cash incentives for CHWs in high burden TB settings to improve TB case detection rates.

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Community- based Active Tuberculosis Case Finding in Pastoralist Communities of North-Eastern Uganda

Microbiology Research Journal International ◽

10.9734/mrji/2019/v29i330166 ◽

2019 ◽

pp. 1-10

Author(s):

Guma Isaac ◽

Emuron John Robert ◽

Namugambe Swabrah ◽

Nabirye Gloria ◽

Philip Denis Okungura ◽

...

Keyword(s):

Nursing Students ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Case Finding ◽

Case Detection ◽

Community Based ◽

Pastoralist Communities ◽

Symptom Screening ◽

Pastoralist Community

Background: Given the global urgency to improve tuberculosis (TB) case detection, a renewed interest in active case finding (ACF) has risen. Missed TB cases pose a serious threat as they continue to fuel TB transmission in the community. We aimed to assess the feasibility of community based ACF for TB among people living in a pastoralist community in Uganda and determine its impact on case detection and treatment uptake. Methods: Between April and May 2019, four third year medical and nursing students placed at Moroto Regional Referral for community orientation worked together with community health workers to conduct a door-to-door survey for TB in pastoralist communities of Nadunget Sub County, Moroto district. The community health workers and the Medical/Nursing students performed symptom screening, collected sputum and facilitated specimen transport to the laboratory. Gene Xpert MTB/RIF assay was performed at the regional referral Hospital for all sputum samples. The community health workers were tasked to follow up on all those clients whose samples turned out to be positive so that they could start treatment as soon as possible. All presumptive cases with negative sputum results were referred to the TB clinic for further evaluation. Results: In one month, we screened 385 individuals and identified 143 aged above 15 years with symptoms suggestive of TB. Among the presumptive cases, 132 (92%) reported a cough of more than two weeks and we were able to obtain sputum samples from 84(58.7%) participants. We diagnosed 11, including 8 bacteriologically confirmed TB cases using Gene Xpert and there was no multidrug resistant case identified. The median time from sputum collection to notification of the positive result was 3 days. All the positive cases were followed up and initiated on treatment. Conclusion: The findings from our study suggest that in a pastoralist community, ACF for TB using a sensitive symptom screen followed by Gene Xpert contributed to improved case detection of TB, shortening the turnaround time hence timely initiation of patients on TB treatment.

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Building on facilitators and overcoming barriers to implement active tuberculosis case-finding in Nepal, experiences of community health workers and people with tuberculosis

BMC Health Services Research ◽

10.1186/s12913-021-06290-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Olivia Biermann ◽

Kritika Dixit ◽

Bhola Rai ◽

Maxine Caws ◽

Knut Lönnroth ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Social Determinants ◽

Organizational Context ◽

Health Workers ◽

Case Finding ◽

World Health ◽

The Social ◽

Facilitators And Barriers ◽

The Impact

Abstract Background Nepal has a high burden of undetected tuberculosis (TB). In line with the World Health Organization’s End TB Strategy, the National TB Programme promotes active case-finding (ACF) as one strategy to find people with TB who are unreached by existing health services. The IMPACT TB (Implementing proven community-based active TB case-finding intervention) project was implemented in four districts in Nepal, generating a substantial yield of previously undetected TB. We aimed to identify the facilitators and barriers linked to the implementation of ACF within IMPACT TB, as well as how those facilitators and barriers have been or could be addressed. Methods This was an exploratory qualitative study based on 17 semi-structured key-informant interviews with people with TB who were identified through ACF, and community health workers who had implemented ACF. Thematic analysis was applied in NVivo 11, using an implementation science framework developed by Grol and Wensing to classify the data. Results We generated five main themes from the data: (1) ACF addressed the social determinants of TB by providing timely access to free healthcare, (2) knowledge and awareness about TB among people with TB, communities and community health workers were the ‘oil’ in the ACF ‘machine’, (3) trust in community health workers was fundamental for implementing ACF, (4) community engagement and support had a powerful influence on ACF implementation and (5) improved working conditions and enhanced collaboration with key stakeholders could further facilitate ACF. These themes covered a variety of facilitators and barriers, which we divided into 22 categories cutting across five framework levels: innovation, individual professional, patient, social context and organizational context. Conclusions This study provides new insights into facilitators and barriers for the implementation of ACF in Nepal and emphasizes the importance of addressing the social determinants of TB. The main themes reflect key ingredients which are required for successful ACF implementation, while the absence of these factors may convert them from facilitators into barriers for ACF. As this study outlined “how-to” strategies for ACF implementation, the findings can furthermore inform the planning and implementation of ACF in Nepal and similar contexts in low- and middle-income countries.

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Participatory Learning of Medical Students through Development of Innovative Training Modules for Community Health Workers

International Journal of Medical Students ◽

10.5195/ijms.2016.160 ◽

2016 ◽

Vol 4 (3) ◽

pp. 100-103

Author(s):

Rahul Ramesh Bogam ◽

Vivek Saoji ◽

Ranjana Sahasrabudhe ◽

Apoorva Saoji

Keyword(s):

Medical Students ◽

Community Health ◽

Community Health Workers ◽

Group Dynamics ◽

Health Workers ◽

Medical Curriculum ◽

Active Participation ◽

Community Medicine ◽

Post Intervention ◽

Training Modules

Background: Community Medicine is a subject which receives relatively less attention in medical curriculum. Active participation of students in preparation of training modules for Community Health Workers (CHWs) could facilitate their learning in topics related to Community Medicine. This study aimed to involve medical students in the preparation of training modules for CHWs and assess the effects of their participation on their knowledge about targeted diseases. Methods: An interventional study where all 144 undergraduate fifth-semester students from Bharati Vidyapeeth University Medical College, Pune, India posted at Community Medicine Department participated in the preparation of training modules for CHWs on HIV/AIDS, tuberculosis, malaria and diabetes and completed pre- and post-intervention questionnaire. Each completed questionnaire was assigned a score based on a marking system. The data was analysed using paired t test. Results: Statistically significant improvement in knowledge was found (pre-test mean score: 5.79, post-test mean score: 14.15, t = 26.93, p<0.001). All faculty opined that community visits followed by health education module preparation activity were innovative components in this study. All 119 participants agreed that their knowledge about targeted diseases improved due to module preparation activity. Conclusion: Active participation of students can facilitate their learning behavior. Students became aware of the principles of ‘Group Dynamics’ as a result of active involvement in training module preparation.

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Feasibility Study of Case-Finding for Breast Cancer by Community Health Workers in Rural Bangladesh

Asian Pacific Journal of Cancer Prevention ◽

10.7314/apjcp.2015.16.17.7853 ◽

2015 ◽

Vol 16 (17) ◽

pp. 7853-7857 ◽

Cited By ~ 2

Author(s):

Touhidul Imran Chowdhury ◽

Richard Reed Love ◽

Mohammad Touhidul Imran Chowdhury ◽

Abu Saeem Artif ◽

Hasib Ahsan ◽

...

Keyword(s):

Breast Cancer ◽

Community Health ◽

Community Health Workers ◽

Feasibility Study ◽

Health Workers ◽

Case Finding ◽

Rural Bangladesh

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Effectiveness of screening and treatment of children with severe acute malnutrition by community health workers in Simiyu region, Tanzania: a quasi-experimental pilot study

Scientific Reports ◽

10.1038/s41598-021-81811-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Calistus Wilunda ◽

Fortihappiness Gabinus Mumba ◽

Giovanni Putoto ◽

Gloria Maya ◽

Elias Musa ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Severe Acute Malnutrition ◽

Intervention Group ◽

Control Area ◽

Acute Malnutrition ◽

Control Group ◽

Treatment Coverage ◽

Quasi Experimental

AbstractHealth system constraints hamper treatment of children with severe acute malnutrition (SAM) in Tanzania. This non-inferiority quasi-experimental study in Bariadi (intervention) and Maswa (control) districts assessed the effectiveness, coverage, and cost-effectiveness of SAM treatment by community health workers (CHWs) compared with outpatient therapeutic care (OTC). We included 154 and 210 children aged 6–59 months with SAM [mid-upper arm circumference (MUAC) < 11.5 cm] without medical complications in the control and intervention districts, respectively. The primary treatment outcome was cure (MUAC ≥ 12.5 cm). We performed costing analysis from the provider’s perspective. The probability of cure was higher in the intervention group (90.5%) than in the control group (75.3%); risk ratio (RR) 1.17; 95% CI 1.05, 1.31 and risk difference (RD) 0.13; 95% CI 0.04, 0.23. SAM treatment coverage was higher in the intervention area (80.9%) than in the control area (41.7%). The cost per child treated was US$146.50 in the intervention group and US$161.62 in the control group and that per child cured was US$161.77 and US$215.49 in the intervention and control groups, respectively. The additional costs per an additional child treated and cured were US$134.40 and US$130.92, respectively. Compared with OTC, treatment of children with uncomplicated SAM by CHWs was effective, increased treatment coverage and was cost-effective.

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Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda

Psychological Medicine ◽

10.1017/s0033291718000193 ◽

2018 ◽

Vol 48 (15) ◽

pp. 2573-2583 ◽

Cited By ~ 14

Author(s):

Byamah B. Mutamba ◽

Jeremy C. Kane ◽

Joop T. V. M. de Jong ◽

James Okello ◽

Seggane Musisi ◽

...

Keyword(s):

Health System ◽

Community Health ◽

Community Health Workers ◽

Health Systems ◽

National Health ◽

Health Workers ◽

Interpersonal Psychotherapy ◽

Post Intervention ◽

Psychological Treatments ◽

Low Resource

BackgroundDespite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma.MethodsA non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention.ResultsCaregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10–0.62] and 6 months (RR 0.33, 95% CI 0.11–0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers.ConclusionIPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

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