Factors affecting TB case detection and treatment in the Sissala East District, Ghana

Background: Tuberculosis remains a major heal- th problem affecting about a third of the world population despite a number of preventive and control measures taken in the past few decades. Eighty-five percent of all tuberculosis cases are concentrated in Asia and Africa due to lack of education and health care infrastructure. Objective: To determine factors affecting low tuberculosis case detection in the Sissala East district in the Upper West Region of Ghana. Methods: This was a descriptive study where semi-structured questionnaire was administered to 61 respondents;six focus group discussions and 20 in-depth interviews were conducted to generate both qualitative and quantitative data for analysis. Results: Tuberculosis, known locally as Kesibine was identified as a major problem in the district. The two most frequently reported TB related dis-tresses were coughing (96.7%) and chest pains (95.0%). However, these distresses were reported more after probing for them. The most frequently spontaneously reported distress was reduced income (60.7%) for patients. The most prominent cause reported was sexual pollution (72.2%). Suspected tuberculosis patients are stigmatized and are denied sex by their partners as shown in the following narrative;I will not eat or have sex with her or eat any leftover from her plate (male local healer, In-depth interview). Case detection and treatment is hampered by lack of communication between sub-district facilities and the district hospital to aid laboratory diagnosis. Conclusion: There is therefore the need for vigorous health education to inform the people about the biomedical causes of TB and the availability of appropriate treatment for the disease at health facilities. However, the education should not aim at changing the “wrong beliefs” but focus on making people aware of the biomedical causes and see TB as treatable infection, which could be controlled.

Yield of tuberculosis among household contacts of tuberculosis patients in Accra,Ghana

Background:The End TB Strategy calls for systematic screening of selected high-risk groups including contacts of tuberculosis(TB)cases to facilitate early TB case detection.Contact investigation is not usually routinely practiced in low TB burden countries,such as Ghana,with consequent paucity of data on the yield of TB case detection from such interventions.This study’s objective was to document the outcomes and feasibility of implementing contact investigation activities under programmatic conditions in Ghana.Methods:Retrospective analyses were conducted of abstracted data from the National TB Program,following a contact investigation intervention for TB cases diagnosed in 10 facilities in Accra from June 2010 to December 2014.Various proportions and yield from number of contacts needed to screen(NNS)and number needed to test(NNT)to detect a TB case were assessed.Results:Overall,out of the 8519 listed contacts of 3267 index cases,8166(96%)were screened and 614(7.5%)were identified as presumptive TB.Out of these,438(71%)underwent sputum smear microscopy/evaluation and 53 TB cases were diagnosed.Of these,56.6%were males,and 49%had sputum smear-positive TB,38%had sputum smear-negative TB,and 7%had extra-pulmonary TB.The NNS and NNT to detect a TB case of all forms were 154 and 8,respectively.The proportion of TB cases with contacts listed and proportion of contacts screened annually were 88-96%and 83-100%,respectively.The proportion of presumptive TB cases tested and proportion of TB cases diagnosed among contacts tested that were 100%and 36%,respectively,in 2010 dropped to 40%and 14%,respectively,by 2014.Conclusions:The study demonstrates that contact identification and prioritization components of a contact investigation were feasible,but overall yield of TB cases may have been lower due to the declining rate of clinical evaluation of presumptive TB contacts over time.Addressing barriers to accessing appropriate diagnostic tests may enhance yield from contact investigation in Ghana.