Improvement in tuberculosis infection control practice via technical support in two regions of Ethiopia

Abstract

BackgroundGlobally recommended measures for comprehensive tuberculosis (TB) infection control (IC) are inadequately practiced in most health care facilities in Ethiopia. The aim of this study was to assess the extent of implementation of TB IC measures before and after introducing a comprehensive technical support package in two regions of Ethiopia.MethodsWe used a quasi-experimental design, whereby a baseline assessment of TB IC practices in 719 health care facilities was conducted between August and October 2013. Based on the assessment findings, we supported implementation of a comprehensive package of interventions. Monitoring was done on a quarterly basis, and one-year follow-up data were collected on September 30, 2014. We used the Student’s t-test and chi-squared tests, respectively, to examine differences before and after the interventions and to test for inter-regional and inter-facility associations.ResultsAt baseline, most of the health facilities (69%) were reported to have separate TB clinics. In 55.2% of the facilities, it was also reported that window opening was practiced. Nevertheless, triaging was practiced in only 19.3% of the facilities. Availability of an IC committee and IC plan was observed in 29.11 and 4.65% of facilities, respectively. Health care workers were nearly three times as likely to develop active TB as the general population. After 12 months of implementation, availability of a separate TB room, TB IC committee, triage, and TB IC plan had increased, respectively, by 18, 32, 44, and 51% (p < 0.001).ConclusionsAfter 1 year of intervention, the TB IC practices of the health facilities have significantly improved. However, availability of separate TB rooms and existence of TB IC committees remain suboptimal. The burden of TB among health care workers is higher than in the general population. TB IC measures must be strengthened to reduce TB transmission among health workers.

The yield of community-based tuberculosis and HIV among key populations in hotspot settings of Ethiopia: A cross-sectional implementation study

“…Other studies support the finding that HCWs have a high incidence and prevalence of TB [18][19][20]. The yield of TB among the HCWs in this study is even higher than the studies in China [18,19].…”

“…The yield of TB among the HCWs in this study is even higher than the studies in China [18,19]. This might be due to poor TB infection control at health facilities in Ethiopia [20]. Similarly, a systematic review in low-and middle-income countries indicated that the incidence rate of TB among HCWs is 2.94 times higher (95% CI, 1.67-5.19) than in the general population [21].…”

Health system influences on the implementation of tuberculosis infection prevention and control at health facilities in low-income and middle-income countries: a scoping review

“…8 In low/ middle-income countries (LMICs), where TB incidence is high, 1 implementation of TB infection prevention and control (IPC) measures to reduce the risk of transmission of TB infection in health facilities is consistently reported to be poor. [9][10][11][12] Poor healthcare provider knowledge and motivation as well as poor infrastructure and personal respiratory protection supplies are common explanations provided for suboptimal implementation. 9 10 13-17 The WHO published the latest iteration of TB-specific guidelines for the prevention and control of transmission of TB infection in health facilities in 2019.…”

Antimicrobial drug resistance and infection prevention/control: lessons from tuberculosis

“…Training and political commitment are crucial to efforts to ensure HCW safety. The International Council of Nurses, the US Agency for International Development (USAID), US CDC, WHO, Harvard/Partners in Health, and other non-governmental organizations such as the Union, PATH, Services for Health in Asian African Regions (SHARE), International Center for AIDS Care and Treatment Programs (ICAP), Project Hope, Stop TB Partnership, and the Royal Dutch Anti-TB Foundation (KNCV) have been engaged in promising initiatives in countries of the former Soviet Bloc (including Latvia, the Russian Federation, and Tajikistan), Latin America (Peru), sub-Saharan Africa (South Africa and Malawi), India, and China (88)(89)(90)(91)(92)(93)(94)(95). Over the past two decades, the authors have had the opportunity and privilege to help develop and work with highly successful Centers of Excellence in Riga, Latvia; Vladimir, Russian Federation; and Dushanbe, Tajikistan.…”