Performance of the National Tuberculosis Control Program in the post conflict Liberia

Abstract

BackgroundTuberculosis is a major public health problem in Liberia. According to the World Health Organization (WHO), the incidence of tuberculosis in Liberia is significantly increasing from year to year. However, little is known about the performance of the programme and the challenges after the 14 years of civil war which ended in 2003.The purpose of the study was to evaluate the performance of the TB programme of Liberia.MethodsThe study utilised mixed research design; both quantitative and qualitative methods were used in this study conducted from 2013 to 2014. For the quantitative part of the study, a questionnaire, laboratory performance and eleven years TB programme data (2003–2013) were used. For the performance of tuberculosis laboratory testing, all the 107 functional tuberculosis microscopy centers in Liberia were included. For the qualitative part of the study, an interview of 10 informants and two focus group discussions (FGDs) were also conducted, each comprising of eight people. Themes and subthemes emerged from the two FGDs. Data was analysed in line with the Donabedian model. Quantitative findings were analysed and presented using both descriptive and inferential statistics.ResultsThe study findings pointed out that there was overall improvement in the performance of the tuberculosis control programme in Liberia from 2003 to 2013. The percentage of cured patients was 60% in 2005 and 62% in 2013. Percentage of treatment completed was 16% in 2005 and 21% in 2013. The case detection rate was 57% and treatment success rate 80% in 2013. The default rate was 11% in 2013. Of the 139 participants, 120 (86%) completed TB treatment while 19 (14%) did not.ConclusionBetween 2003 and 2013, the National Leprosy and Tuberculosis Control Programme (NLTCP) succeeded in restoring the TB services and improving some of the TB treatment outcomes including the Directly observed treatment short courses(DOTS) coverage. Despite these improvements, the TB treatment, laboratory services and human resource capacity lagged behind. The TB programme of Liberia needs to develop new strategies to address its challenges.

Evaluation of the performance of the National Tuberculosis Program of Liberia during the 2014–2015 Ebola outbreak

“…Our findings as well as the findings from similar study indicated that HIV testing among TB patients, which relies on the finger-prick test which was not recommended during an Ebola outbreak, decreased, leading to a reduction in the number of individuals diagnosed with HIV [13]. Shortcomings in ascertaining HIV status affected the uptake of both CPT needed for preventing opportunistic disease and ART [5]. Our findings were similar to the study conducted by Alyssa et al [13].…”

“…In Liberia, the treatment success rate was 76% in 2009 [4, 5]. This figure was by far less than the national and global targets of 85% set by the Stop TB strategy of WHO [6].…”

The National Tuberculosis Control Programme of Liberia Laboratory Programme Performance

“…This was far lower than the Global WHO End TB targets and strategies aimed at a 95% reduction in TB deaths and a 90% reduction in the TB incidence rate [16]. Even the TB detection rate of above 70% of the 2015 millennium development goal targets were not met [4, 6, 16]. The authors of this study; Desta et al [4], stated the reason for not meeting the target in their previously published paper: “The decline in 2014 and 2015 was attributed to high rate of loss to follow-up as result of the EVD outbreak.” Even though Sierra Leone was among the three EVD-affected countries in West Africa, the case detection rate was 60% and the TB treatment success rate was 86.7% in 2015 [17].…”

“…Each slide carried 10 points, and the total maximum score was 100 (for 10 slides). A performance score of less than 90 (90%) was considered to be unacceptable by the WHO TB EQA standard [4, 8, 9]. In addition to this, on-site assessment of 107 functional TB microscopy laboratories was included in the study.…”

“…There was a drop in the TB smear detection rate in 2012 as a result of stock-out of TB microscopy reagents in many facilities. The treatment success rate was 76% in 2012 [3, 4]. This figure is by far less than the national and global targets of 85% set by the Stop TB strategy of the WHO which ended in 2015 [5].…”