Implementation challenges of a TB programme in rural northern mozambique: evaluation of 2012-2013 outcomes
Por:
Wikman-Jorgensen, P, Morales-Cartagena, A, Llenas-Garcia, J, Perez-Porcuna, T, Hobbins, M, Ehmer, J, Mussa, M, Abellana, R and Ascaso, C
Publicada:
1 jul 2015
Resumen:
Background: We aimed to identify challenges and to propose solutions for the implementation of tuberculosis (TB) programmes in rural Sub-Saharan Africa (SSA) by evaluating the outcomes of the TB programme in the Ancuabe district in rural Northern Mozambique.
Methods: Retrospective descriptive study of the patients included in the TB programme in 2012-2013. Follow-up was continued till June 2014.
Results: Three hundred nineteen patients were registered, 62.1% male, mean age 36.3 (SD 14.4), estimated case detection rate (eCDR) of 24.24%. Two hundred seventy-two were new cases, 21 transferred-in, 11 back after lost to follow-up (LTFU), 10 relapsing TB, 5 previous treatment failures. 94.4% were tested for Human immunodeficiency virus (HIV), 41.9% HIV-positive. 87.5% of the new cases were pulmonary TB (PTB), 43.4% were HIV co-infected. Initial sputum results were available in 207 cases, with 145 smear-positive (SP) cases. Outcomes of new cases: 122 (44.9%) LTFU, 55 (20.2%) cured, 43 (15.8%) treatment completed (98-36%-treatment success), 31 (11.4%) died, 19 (7%) transferred out and 2 (0.7%) failures.
Conclusions: A low eCDR and high proportion of LTFU demonstrate that few patients were identified and had a low probability of complete treatment, suggesting a fragile health system. This raises the hypothesis that, probably, to improve TB health care in rural SSA, interventions should aim at improving health systems. Special attention should be given to social protection and compensation of the financial burden associated with TB.
Filiaciones:
:
Univ Barcelona, Dept Publ Hlth, Barcelona, Spain
SolidarMed Mozambique, Pemba, Cabo Delgado, Mozambique
San Juan de Alicante Univ Hosp, Infect Dis Unit, Alacant, Spain
Morales-Cartagena, A:
12 Octubre Univ Hosp, Dept Internal Med, Madrid, Spain
:
SolidarMed Mozambique, Pemba, Cabo Delgado, Mozambique
Perez-Porcuna, T:
Mutua Terrassa Univ Hosp, Mutua Terrassa Fdn, Res Unit, Pediat Dept,CAP Valldoreix, Catalunya, Spain
Hobbins, M:
SolidarMed Switzerland, Luzern, Switzerland
Ehmer, J:
SolidarMed Switzerland, Luzern, Switzerland
Mussa, M:
Minist Hlth, Prov Hlth Directorate, Nucleo Invest Operac Pemba, Maputo, Mozambique
Abellana, R:
Univ Barcelona, Dept Publ Hlth, Barcelona, Spain
Ascaso, C:
Univ Barcelona, Dept Publ Hlth, Barcelona, Spain
Green Published
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