Addressing Constraints to Informal Health Service Providers’ Involvement in Tuberculosis Control: a Qualitative Study of Patent Medicine Dealers and Tuberculosis Programme Managers in Ebonyi State Nigeria

Background: A major constraint to tuberculosis control is low case finding with under-reporting to national authorities. Evidence shows that Patent Medicine Dealers are first port of call for most people with symptoms of tuberculosis, yet there is poor referral of such clients to tuberculosis treatment facilities for further evaluation. This study investigated constraints to involvement of Patent Medicine Dealers in tuberculosis control.Methods: This was a cross-sectional qualitative study among Patent Medicine Dealers and Tuberculosis Programme Managers in Ebonyi State Nigeria. Sixty-four Patent Medicine Dealers and five Tuberculosis Programme Managers were interviewed using Focus Group Discussion and In-Depth Interview respectively. Data was collected with electronic audio-recording device and analyzed using thematic approach. Results: There are some knowledge gaps about tuberculosis signs, symptoms, free-treatment policy and mode of operation of care service among Patent Medicine Dealers. Patent Medicine Dealers and Tuberculosis Programme Managers are willing to collaborate in tuberculosis control effort but constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Programme to keep up with such demands are obvious constraints. Conclusions: Knowledge gaps in tuberculosis, its control, constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Programme to satisfy such demands are constraints to involvement of Patent Medicine Dealers in tuberculosis control. More robust engagement of Patent Medicine Dealers in tuberculosis control with clear job description through tuberculosis education and provision of incentives to support them are recommended policy approaches to improve linkage of clients to tuberculosis treatment facilities.

Epidemiology and risk factors for extrapulmonary tuberculosis in Lebanon

SETTING: Lebanon is a relatively low TB-burden country, but has a high proportion of extrapulmonary tuberculosis (EPTB). Concern has been expressed that Syrian-born refugees could add to the TB burden and rates of EPTB: since 2011, >1 000 000 Syrian refugees have entered Lebanon.OBJECTIVE: The Lebanese National Tuberculosis Programme (NTP) sought to identify factors for the high proportion of EPTB and to assess the potential impact of Syrian refugees.DESIGN: NTP line-listed data from 2014–2015 were analyzed with logistic regression identified risk factors for EPTB. A trend analysis for 2011–2015 assessed TB burden by nationality and site of TB.RESULTS: Of 1347 reported TB cases from 2014 to 2015, 507 (38%) were EPTB and 46% were Lebanese. In analysis limited to Lebanese-born, the proportion of EPTB cases was relatively stable, 47% in 2011 and 52% in 2015. Modeling identified risk factors for EPTB as being female (aOR 1.79, 95%CI 1.39–2.32) and 5–15 years old (aOR 3.31, 95%CI 1.47–7.45) compared with children aged <5 years. Between 2011 and 2015, the proportion of TB cases among Syrian-born increased from 3% in 2011 to 21% in 2015 (P < 0.001); however, the proportion of EPTB versus PTB cases among Syrians remained stable (P = 0.264).CONCLUSION: Syrian TB cases increased almost 10-fold in five years (2011–2015) but their contribution to EPTB did not change. The high proportion of EPTB in Lebanon and those aged 5–15 years merits further investigation.

Study of the causes and factors which affect compliance of the patient in directly observed short course chemotherapy in pulmonary tuberculosis in Central India

Background: TB is one of the most ancient diseases. World Health Organization (WHO) estimated 9.2 million new cases in 2014 out of which 2.2 million were from India. National tuberculosis programme was started since 1962 and short course chemotherapy was included in 1983. With this background in 1992 WHO and Swedish International Development Agency (SIDA) reviewed the programme. As a result, revised national tuberculosis programme (RNTCP) was started. RNTCP recommended directly observed short course chemotherapy in pulmonary tuberculosis (DOTS) and was implemented in 1993. Objective of present study was to find out the causes and factors affecting compliance of the patients in directly observed short course chemotherapy in pulmonary tuberculosis.Methods: We studied 100 patients of pulmonary tuberculosis, who were sputum smear positive for tubercle bacilli. Patients were treated with DOTS (Directly Observed Short Course Chemotherapy) recommended by RNTCP and we observed the causes and factors responsible for interruption of the treatment in noncompliant patients.Results: Overall compliance was 78% and 22% patients were noncompliant. Most common cause of noncompliance was side effects of drugs (12%), noncompliance was maximum (45.45%) between age group of 15-25 years. Illiterate and low socioeconomic status patients were more noncompliant 46.45% and 63.63% respectively.Conclusions: Eventually, after seeing all merits and demerits of DOTS, we have concluded that intensive health education may have favourable impact to improve further outcome of DOTS and compliance of the patients.