Low Tuberculosis Case Detection in Gokwe North and South; Zimbabwe in 2006

Background: Case detection is an important component of tuberculosis control programmes. It helps identify sources of infection; treat them; and thus break the chain of infection. Objective: To determine the reasons of low tuberculosis case detection in Gokwe Districts; Zimbabwe. Methods: A descriptive cross sectional study was conducted. We used interviewer administered questionnaire for nurses and patients; checklists; key informant interviews. Results: Thirty-eight nurses; forty-two patients and seven key informants were interviewed and 1254 entries in tuberculosis register were reviewed. Nurses correctly defined pulmonary tuberculosis; listed signs and symptoms; preventive measures and methods of tuberculosis diagnosis. Exit interviews showed 9/42 (21) of patients presenting with cough were asked to submit sputa for examination and asked about household contacts with tuberculosis. About 27of patients who were sputum positive in the laboratory register were not recorded in the district tuberculosis register. This contributed to the high proportion of early defaulters among tuberculosis suspects. Conclusion: Low tuberculosis case detection was because nurses were not routinely requesting for sputum for examination in patients presenting with a cough or history of previous treatment for cough. Nurses should routinely request for sputum for examination in patients presenting with a cough or history of recent treatment for cough

Evaluation of the Integrated Management of Childhood Illness Strategy Implementation in Bulawayo City; Zimbabwe; 2006

Introduction. Bulawayo City reported an age-specific death rate for under-5s of 5.9/1 000 in 2004; and this figure rose to 6.8/ 1 000 in 2005. Nurses were trained in implementation of the Integrated Management of Childhood Illness (IMCI) strategy in 2005. We evaluated the programme in order to establish the level of implementation and the quality of care given to children aged under 5 years. Methods. We conducted a cross-sectional study on a population of sick children aged between 2 months and 5 years; health care workers and caregivers. Data were collected using a structured observation checklist of the case management of sick children; exit interviews with caregivers; and a structured inventory checklist for equipment; drugs and supplies at each health facility. Results. Nine facilities; 17 nurses and 72 children were observed during the study. Seventeen children (24) were assessed for the three general danger signs (failure to drink or breastfeed; vomiting everything ingested; and convulsions); 31 (43) were correctly prescribed an oral antibiotic; and 11received the first dose of treatment at the health facility. Thirty-two per cent of caregivers who received a prescription for an oral medication were able to report correctly how to give the treatment. Drugs were below minimum stock levels in all 9 facilities. Only 19 (20) of the 94 nurses were trained in IMCI. Conclusion. IMCI implementation in Bulawayo failed to meet the accepted standard protocol requirements. The main deficiencies noted were the low number of IMCI-trained health workers and the lack of availability of essential drugs at health facilities. However; it was noteworthy that only two case assessment parameters differed statistically between IMCI-trained and non-trained nurses. Larger studies are needed to confirm or refute these findings