Low contribution of health extension workers in identification of persons with presumptive pulmonary tuberculosis in Ethiopian Somali Region pastoralists

Abstract

BackgroundTo accelerate the expansion of primary healthcare coverage, the Ethiopian government started deploying specially trained community health workers named Health Extension Workers (HEWs) in 2003. HEWs work on sixteen health service packages; one being tuberculosis (TB) control and prevention. However, their contribution to TB care and prevention services among pastoralist communities has not been evaluated. Thus, this study has assessed their contribution in identification of persons with presumptive pulmonary TB in Ethiopian Somali Pastoralist Region.MethodA cross sectional study with mixed approach of quantitative and qualitative methods was applied. A randomly selected cross-sectional sample of 380 pulmonary TB cases from 20 health facilities was selected to obtain information on the role of HEWs in the identification of persons with presumptive TB, and their referral. Purposively selected HEWs were also interviewed individually to obtain in-depth information on their in-service training and experiences with referring TB cases. SPSS version20 was used to summarize the quantitative data and test statistical significance using chi-square test and logistic regression model. The qualitative data was analyzed under the principles of thematic analysis.ResultOverall, 20.3% [95% CI = 16.6–24.5] of pulmonary TB patients were referred by HEWs; while the majority were referred by healthcare workers (52.6%), family members (13.4%), neighbours/friends (2.4%) and self-referred (11.3%). Out of all, 66.1% and 53.4% had neither received community TB health education nor home visit from HEW respectively. Multivariate analysis indicated that provision of community health education [AOR = 14.0, 95% CI = 6.6–29.5], being model household [AOR = 21.2, 95% CI = 9.5–47.3], home visit from HEW [AOR = 2.8, 95% CI = 1.2–9.6] and rural residence [AOR = 3.0, 95% CI = 1.2–7.7] were significantly associated with referral by HEW. The qualitative findings supported that HEWs’ involvement in referral of persons with presumptive TB was limited. Communities’ low confidence in HEWs, inaccessibility of TB services at nearest health centers and lack of in-service trainings for HEWs were identified by the interviewee HEWs as underlying factors for their limited involvement.ConclusionThe contribution of health extension workers in identifying and referring presumptive TB cases is limited in Ethiopian Somali pastoralist region. Increased community health education and home visits by HEWs could contribute to increased identification and referral of persons with presumed TB. HEW should be properly trained on TB through in-service refreshment trainings and supported by routine supervision. Further expansion of TB diagnostic services would benefit to increasing case detection.

Implementation status of household contact tuberculosis screening by health extension workers: assessment findings from programme implementation in Tigray region, northern Ethiopia

“…Our findings show that HH contacts whose houses had visited by HEWs were 6 times more likely to be screened for TB than those houses which had not visited by HEWs within the last 6 months. This finding is supported with different studies which recommended for a strong follow up including household level visits by HEWs for a better TB case detection [13,16,19,[25][26][27].…”

“…Studies showed that demand of TB screening HH contacts can be improved by increasing awareness about TB through health education [28], and making the HH contacts to seek screening service at health posts by HEWs [29]. Provision of community health education was also associated with higher presumptive TB case referral [19,30].…”

“…A structured interviewer administered questionnaire was adapted from a previous studies [19,20] and national guideline for TBDR-TB and leprosy in Ethiopia [2]. The data was collected through face-to-face interview with index TB case or head of HH and serving HEWs.…”

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

“…† ​ Letter to editor,52 observational study,53 perspective33 and editorial 47‡ ​ Population affected by TB outbreak,72 pastoralists,41 healthcare workers,65 prisoners,80 people living in slums,86 street connected youth and young adults85 and non-immigrant visitors 70…”

Role of Health Extension Worker in Tuberculosis Prevention and Control in Ethiopia: Systematic Review

“…Treatment follow up during continuation phase was also mentioned as a service provided. In addition, it was mentioned that as part of TB service provision, they also assessed the housing condition like windows and number of persons sleeping per room during home visits [17].…”