Are sputum samples of retreatment tuberculosis reaching the reference laboratories? A 9-year audit in Tanzania.

SETTING: One reference and three zonal laboratories and 500 health facilities managing retreatment tuberculosis (TB) patients in Tanzania. OBJECTIVES: The National Tuberculosis and Leprosy Programme (NTLP) requires that all notified cases of retreatment TB in Tanzania have sputum samples sent for culture and drug susceptibility testing (DST). This study determined 1) if the number of annually notified retreatment patients corresponded to the number of sputum samples received by the reference laboratories, and 2) the number of culture-positive samples and the number of cases undergoing DST. DESIGN: Nine-year audit of country-wide programme data from 2002 to 2010. RESULTS: Of the 40 940 retreatment TB patients notified by the NTLP, 3871 (10%) had their sputum samples received at the reference and zonal laboratories for culture and DST. A total of 3761 (97%) sputum samples were processed for culture, of which 1589 (42%) were found to be culture-positive and 1415 (89%) had DST performed. CONCLUSIONS: There is a >90% shortfall between notified retreatment cases and numbers of sputum samples received, cultured and assessed for DST at reference and zonal laboratories. Steps needed to address this problem are discussed.

Perceptions of tuberculosis and treatment seeking behaviour in Ilala and Kinondoni Municipalities in Tanzania.

This study was carried out in Ilala and Kinondoni Municipalities in Tanzania to explore the perceptions of Tuberculosis (TB), and treatment seeking behaviour, among patients attending healthcare facilities. The study was conducted in four randomly selected health facilities providing directly observed treatment (DOT). Exit interviews were administered to 69 randomly selected TB patients. The mean age of the respondents was 33.2 years (range = 11-72 years). Forty-six (66.7%) of the patients had primary school education. Fifty-nine (84.1%) patients had good knowledge on the transmission of TB. Majority (75%) of the respondents were of the opinion that the incidence of TB was on the increase and this was mainly associated with HIV/AIDS epidemic. All respondents knew that TB was a curable disease if one complies with the treatment. Sixty-four (60%) respondents had good knowledge on the correct duration of tuberculosis treatment. The median duration before seeking treatment from a health facility was 1.5 months. The majority of the patients 47 (68%) visited public health facilities for treatment as their first action. Overall, 83.8% (57/68) respondents said females comply better with treatment than male patients. The majority of the respondents lived within a walking distance to a healthcare facility. Only 18.8% (13/69) had to spend an average of US$ 0.2-0.3 as travel costs to the healthcare facility. Most of the respondents (57.8%) said they were well attended by service providers. Half (21/42) and 59.3% (16/27) of the males and females, respectively, mentioned good patient-service provider relationship as an important reason for satisfaction of the service (chi2 = 0.57, df = 1, P > 0.005). Twenty-nine (42%) of respondents were of the opinion that female TB patients conformed better to treatment than males and a similar number thought that both of them equally conformed to treatment. Findings from this study indicate that a large population in urban settings are aware that health facilities play a major role in TB treatment. In conclusion, there is a need to further explore how this information could potentially be used to enhance early seeking of appropriate services among TB patients in the era of rapid urbanization. Strategies in the control of TB and other diseases should focus on advocacy in seeking appropriate care.

Patient's dissatisfaction with the public and private laboratory services in conducting HIV related testing in Tanzania.

BACKGROUND: Patient's satisfaction with both private and public laboratory services is important for the improvement of the health care delivery in any country. METHODS: A cross-sectional survey was conducted in 24 randomly selected health facilities with laboratories that are conducting HIV related testing, in Mainland Tanzania. The study assessed patient's satisfaction with the laboratory services where by a total of 295 patients were interviewed. RESULTS: Of data analyzed for a varying totals from 224 to 294 patients, the percentage of dissatisfaction with both public and private laboratory services, ranged from 4.3% to 34.8%, with most of variables being more than 15%. Patients who sought private laboratory services were less dissatisfied with the cleanness (3/72, 4.2%) and the privacy (10/72, 13.9%) than those sought public laboratory service for the same services of cleanness (41/222, 18.5%) and privacy (61/222, 27.5%), and proportional differences were statistically significant (X2 = 8.7, p = 0.003 and X2 = 5.5, p = 0.01, respectively). Patients with higher education were more likely to be dissatisfied with privacy (OR = 1.8, 95% CI: 1.1-3.1) and waiting time (OR = 2.5, 95% CI: 1.5 - 4.2) in both private and public facilities. Patients with secondary education were more likely to be dissatisfied with the waiting time (OR = 5.2; 95%CI: 2.2-12.2) and result notification (OR = 5.1 95%CI (2.2-12.2) than those with lower education. CONCLUSION: About 15.0% to 34.8% of patients were not satisfied with waiting time, privacy, results notification cleanness and timely instructions. Patients visited private facilities were less dissatisfied with cleanness and privacy of laboratory services than those visited public facilities. Patients with higher education were more likely to be dissatisfied with privacy and waiting time in both private and public facilities.

Dissatisfaction with the laboratory services in conducting HIV related testing among public and private medical personnel in Tanzania.

BACKGROUND: A comprehensive care and treatment program requires a well functioning laboratory services. We assessed satisfaction of medical personnel to the laboratory services to guide process of quality improvement of the services. METHODOLOGY: A cross-sectional survey in 24 randomly selected health facilities in Mainland Tanzania was conducted to assess the satisfaction of the medical personnel with the laboratory services. RESULTS: Of 235 medical personnel interviewed, 196 were valid for analysis and about one quarter were dissatisfied with the laboratory services. Personnel dissatisfied with the services were 38.3% in timely test result, 24.5% in correct and accurate results and 22.4% in clear complete results. The personnel in public laboratories were more dissatisfied with timely test results (OR = 3.6, 95% CI 1.8, 7.3), correct results (OR = 4.1, 95% CI 1.6, 10.8) and clear complete results (OR = 5.0 95% CI 1.6, 15.2). Personnel dissatisfied with the services in 15 laboratories sending specimens to referral laboratories, varied from 13% in availability of equipment to 57% in timely results feedback from the referral laboratories. Personnel dissatisfied with the services in 14 referral laboratories, varied from 28.6% in properly identified specimen to 42.9% in clear, accurate test request and communication. CONCLUSION: About one quarter of medical personnel in sending or receiving laboratories were dissatisfied with the services. Comparing the personnel in public and private, the personnel in public laboratories were 4 times more dissatisfied with the timely test and correct results; and 5 times more dissatisfied with clear and complete test results.

Perceptions of Tuberculosis and Treatment Seeking Behaviour in Ilala and Kinondoni Municipalities in Tanzania

This study was carried out in Ilala and Kinondoni Municipalities in Tanzania to explore the perceptions of Tuberculosis (TB); and treatment seeking behaviour; among patients attending healthcare facilities. The study was conducted in four randomly selected health facilities providing directly observed treatment (DOT). Exit interviews were administered to 69 randomly selected TB patients. The mean age of the respondents was 33.2 years (range= 11-72 years). Forty-six (66.7) of the patients had primary school education. Fifty-nine (84.1) patients had good knowledge on the transmission of TB. Majority (75) of the respondents were of the opinion that the incidence of TB was on the increase and this was mainly associated with HIV/AIDS epidemic. All respondents knew that TB was a curable disease if one complies with the treatment. Sixty-four (60) respondents had good knowledge on the correct duration of tuberculosis treatment. The median duration before seeking treatment from a health facility was 1.5 months. The majority of the patients 47 (68) visited public health facilities for treatment as their ?rst action. Overall; 83.8(57/68) respondents said females comply better with treatment than male patients. The majority of the respondents lived within a walking distance to a healthcare facility. Only 18.8(13/69) had to spend an average of US$ 0.2-0.3 as travel costs to the healthcare facility. Most of the respondents (57.8) said they were well attended by service providers. Half (21/42) and 59.3(16/27) of the males and females; respectively; mentioned good patient-service provider relationship as an important reason for satisfaction of the service (?2 =0.57; df=1; P0.005). Twenty-nine (42) of respondents were of the opinion that female TB patients conformed better to treatment than males and a similar number thought that both of them equally conformed to treatment. Findings from this study indicate that a large population in urban settings are aware that health facilities play a major role in TB treatment. In conclusion; there is a need to further explore how this information could potentially be used to enhance early seeking of appropriate services among TB patients in the era of rapid urbanization. Strategies in the control of TB and other diseases should focus on advocacy in seeking appropriate care

The quality of sputum smear microscopy diagnosis of pulmonary tuberculosis in Dar es Salaam, Tanzania.

This study was carried out to determine the rate of agreement or disagreement of microscopy reading and culture positivity rate among smear positixe and negative specimens between peripheral tuberculosis diagnostic centres (PDCs) and Central Reference luberculosis laboratory (CTRL). In this study 13 PDCs in Dar es Salaam, Tanzania were involved. Lot Quality Assurance Sampling (LQAS) method was used to collect 222 sputum smear slides. A total of 190 morning sputum specimens with corresponding slides were selected for culture. First readings were done by technicians at PDCs and thereafter selected slides and specimens were sent to CTRL for re-examination and culture. Culture results were used as a gold standard. Of 222 slides selected, 214 were suitable for re-examination. Percentage of agreement of smear reading between PDCs and CTRL was 42.9% and 100% for positive and negative slides, respectively. Measure of agreement (Kappa statistic) was 0.5, indicating moderate agreement. Of 190 samples cultured, percentage of agreement between smear reading from PDCs and CTRL was 37% and 88.9% for smear positive and negative slides, respectively. Kappa statistic was 0.3 indicating poor-fair agreements. Comparison of smear reading from PDCs with culture showed sensitivity of 36.9% and specificity of 88.9%. Comparison of smear readings from CTRL with culture results showed sensitivity of 95.6% and specificity of 98.6%. In conclusion there was inadequate performance in diagnosis of TB using smear microscopy among peripheral diagnostic centres in Dar es Salaam. This calls for immediate and rigorous measures to improve the quality of smear microscopy. It is therefore important to strengthen the capacity of laboratory personnel in smear microscopy techniques through supportive supervision and training.

Community knowledge, attitudes and practices towards tuberculosis and its treatment in Mpwapwa district, central Tanzania.

Tuberculosis (TB) is one of the leading causes of adult mortality with 32% of the global population infected with Mycobacterium tuberculosis. The current control of TB depends mainly on case management using the Direct-Observed Treatment, Short-course (DOTs) regimen. Despite the measures taken, the disease burden is still on increase especially in the developing countries including Tanzania. Correct knowledge and positive perception of the community towards TB and its management is a prerequisite to early treatment seeking. This study was carried out in Mpwapwa district, central Tanzania, to assess the knowledge, attitudes and practice as regards to TB and its treatment. Focus group discussions involving men and women were conducted in six villages. Results show that TB was an important public health problem. However, community knowledge on its cause was poor. Symptoms of TB as mentioned by the community included persistent cough and weight loss. TB was reported to be transmitted mainly through air. Self medication was the first most preferred option, whereas health care facility consultation was the last one. Focus group discussants knew that TB cure requires a 8-month period of treatment. Friends and relatives were the main source of TB information in the community. In conclusion, rural communities of Mpwapwa District have a low knowledge on the causes and the transmission of tuberculosis which is a likely cause of the delay in seeking treatment. An intensive appropriate community health education is required for a positive behavioural change in tuberculosis control.