ABSTRACT remained low in Ghana as well as in

ABSTRACT

Background:
Every year, tuberculosis (TB), a chronic infectious disease caused by the
Mycobacterium tuberculosis affects several people globally. However TB case
detection, which remains one of the fundamental activities to achieving the
global goal of eliminating TB by 2030 has remained low in Ghana as well as in
Kwahu East District. This study aimed at determining health provider factors
influencing low TB case detection in Kwahu East District.

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Methodology:
The
study was quantitative using descriptive and analytical cross-sectional study
design. Data were collected using semi structured questionnaires. A total of 21
TB coordinators in 21 health facilities 
and 140 health workers were interviewed. Data were  entered and cleaned using Statistical Package
for Social Sciences (SPSS) version 20.0 and then exported into STATA version
13.1 to be analyzed. Statistical significance for all testing was set as 0.05.

Results: Majority
of the respondents (77.14%) lacked the required knowledge on signs and symptoms
for TB screening. TB case finding practices were inappropriate among majority of
the respondents (82.86%) .  Challenges
identified to be influencing TB case detection included lack of training for
staff (77.86%), and lack of monitoring and supervision (61.90%). Inappropriate case
finding practices (p-value = 0.028), poor logistics and supply chain system
(p-value 0.004) and weak referral and tracking systems (p-value = 0.024) were
established as factors influencing low TB case detection.

Conclusion and
recommendation: The health provider factors influencing
low TB case detection  were inappropriate
practices poor logistics supply and weak referral and tracking systems. The
District Health Administration should provide staff with adequate logistics on
TB case detection and intensify monitoring and supervision activities to
improve staff practice.

CHAPTER
ONE

1.0 INTRODUCTION

1.1
Background information

Tuberculosis
(TB), a chronic infectious disease, subdivided into pulmonary and extra
pulmonary, caused by the Mycobacterium tuberculosis, affects several people
every year. A Person with active TB may transmit it to others through droplets
from the throat and lungs through coughing (Morrison et al.,
2008). TB has existed in the world for
several years but it only obtained public health attention in 1993 when it was
declared a disease of public health importance (public health emergency) (WHO, 2014). It was one of
the few diseases that gained prominence in the millennium development goals
(Goal 6) which was reviewed in 2015 to the Sustainable Developmental Goals
(SDGs).

TB
case detection, has been defined in the Ghana Health Service (GHS) standard
operation procedures (SOP) for TB case detection as a public health activity
addressing early identification of TB patients with special emphasis on those
with sputum smear positive (GHS, 2010). It remains a pivotal index for the
World Health Organization (WHO) towards the realization of the SDG target of
ending TB by 2030 (Glaziou et al.,
2016). However, attainment of set
objectives for TB case detection, which remains one of the fundamental
activities to achieving the global goal of eliminating TB by 2030 has remained
a challenge globally (WHO, 2016). Morrison et al (2008), reports that the minimum target of 70% TB case
detection rate which was originally set for 2000 and was deferred to 2005 has
not been achieved. Globally, 66% (5.7 million) of the estimated 8.6
million TB cases were detected in 2012 (WHO, 2013a).

Ghana
in 2015 reported 14,999 TB cases, representing 33% of the estimated TB cases (WHO, 2016). Several
factors including weakness in the healthcare systems, stigma, and inappropriate
practices with regards to TB case detection among others have been outlined as
influencing factors (USAID, 2016). The impact of late or low TB case detection
has far reaching consequences including high TB mortalities (WHO, 2006). 

In
order to identify TB cases early, 
decrease TB transmission in the community, alleviate human suffering and
prevent disability and death due to TB, there is the need for sustained,
routine and a consistent TB case detection activities among people visiting a
health facility or within the community (GHS, 2010). Also, to
ensure that every TB case is identified and effectively treated, the role of
the healthcare provider cannot be overemphasized. Suspecting, screening,
investigating and reporting of TB cases which constitute the process of TB case
detection are all the responsibility of healthcare providers (GHS, 2010). However,
weakness in institutional and human resource capacity as well as systems and
processes have led to low TB case detection in several settings (Iribarren et
al., 2014).

1.2
Problem statement

The
Sustainable Developmental Goals have earmarked 2030 as elimination point for
TB. Early detection and effective management of cases is key to the achievement
of elimination status. This requires a more pragmatic framework to ensure that
all cases are detected and well treated.

Ghana
has since 1994 been managing TB under the auspices of National TB Control
Program (NTP) which was instituted to respond to the TB epidemic. At the heart
of this program is early case detection and treatment as a means to eliminate
the reservoir of infection in the community and thereby breaking the chain of
transmission (Amo-adjei and Awusabo-Asare, 2013).

Challenges to TB case
detection have been outlined to include two pathways; the client pathway and
health providers’ pathway (Korobitsyn et
al., 2013; WHO, 2016). Strategies
aimed at improving community’s knowledge on health events including TB emanate
from the understanding of health care providers and their appreciation of the
importance of  the said health event (Dodor, 2008).

Also,
factors such as  weakness in human
resource capacity, institutional systems and processes, institutional capacity,
and resources available at the various healthcare levels (especially the lower
levels) (Iribarren et al.,
2014) have been identified to influence
TB case detection along the healthcare providers’ pathway. All these factors
may have contributed to low TB case detection in Ghana.