Challenges in delivery of tuberculosis Services in Ethiopian Pastoralist Settings: clues for reforming service models and organizational structures

Background The End-TB strategy aims to see a world free of tuberculosis (TB) by the coming decade through detecting and treating all cases irrespective of socioeconomic inequalities. However, case detections and treatment outcomes have not been as they should be in Somali pastoral settings of Ethiopia. Hence, this study aimed to explore the challenges that hinder the delivery and utilization of TB services in pastoral areas. Methods A qualitative study was conducted between December 2017 and October 2018 among pastoralist patients with delay of ≥2 months in seeking healthcare, healthcare providers and programme managers. Data were collected from different sources using 41 in-depth interviews, observations of facilities and a review meeting of providers from 50 health facilities. The data were transcribed, coded and analyzed to identify pre-defined and emerging sub-themes. ATLAS.ti version 7.0 was used for coding data, categorizing codes, and visualizing networks. Results Poor knowledge of TB and its services, limited accessibility (unreachability, unavailability and unacceptability), pastoralism, and initial healthcare-seeking at informal drug vendors that provide improper medications were the key barriers hindering the uptake of TB medical services. Inadequate infrastructure, shortage of trained and enthused providers, interruptions of drugs and laboratory supplies, scarce equipment, programme management gaps, lack of tailored approach, low private engagement, and cross-border movement were the major challenges affecting the provision of TB services for pastoral communities. The root factors were limited potential healthcare coverage, lack of zonal and district TB units, mobility and drought, strategy and funding gaps, and poor development infrastructure. Conclusion In pastoral settings of Ethiopia, the major challenges of TB services are limited access, illicit medication practices, inadequate resources, structural deficits, and lack of tailored approaches. Hence, for the pastoral TB control to be successful, mobile screening and treatment modalities and engaging rural drug vendors will be instrumental in enhancing case findings and treatment compliance; whereas, service expansion and management decentralization will be essential to create responsive structures for overcoming challenges.

Using a mobile application to improve pediatric presumptive TB identification in western Kenya

BACKGROUND: Early recognition of TB symptoms in children is critical in order to link children to appropriate testing and treatment. Healthcare workers (HCWs) in high TB burden countries are often overburdened with competing clinical priorities, leading to incomplete presumptive TB screening. We assessed if implementing a community health volunteer (CHV) led presumptive pediatric TB mobile android application (PPTBMAPP) in pediatric outpatient, primary care clinics in western Kenya would be feasible, appropriate, and effective.METHODS: We used a mixed-methods participatory, iterative approach to design and implement the PPTBMAPP during a 6-month period. We compared the proportion of children identified in presumptive TB and active TB disease registers out of all patients before and after the implementation of the intervention.RESULTS: Of the 1787 children aged ≤15 years screened using the PPTBMAPP, 376 (21%) met the criteria for presumptive TB. There was a statistically significant increase in the proportion of children to all patients in the presumptive TB registers (97/908, 10.7% vs. 160/989, 16.2%; P = 0.0005), and a trend towards an increase in the proportion of children to all patients in the TB case register (17/117, 14.5% vs. 15/83, 18.1%; P = 0.5). HCWs interviewed commented that the application sped up the presumptive TB screening process.CONCLUSION: Our CHV-led mobile screening intervention significantly increased presumptive TB notification. HCWs reported that the mobile screening intervention was feasible, appropriate, and effective.

TINGKAT KEPUASAN PENGGUNA LAYANAN MANGUPURA WOMAN SERVICES DI KABUPATEN BADUNG TAHUN 2016

A mobile early detection of breast cancer named ‘Mangupura Woman Services’ (MAWAS) has been conducted by Badung District Health office, Bali Province. Evaluation of users’ satisfaction towards MAWAS has not been conducted. This study aimed to measure users’ satisfaction levels towards MAWAS. A cross-sectional study was conducted in Badung to 90 respondent who recruited purposively based on the criteria of women in reproductive age who have utilized MAWAS. Users’ satisfaction was explored from five dimensions of healthcare quality including tangible, reliability, responsiveness, assurance and empathy. Data was analyzed using Importance Performance Analysis and Cartesius Diagram. The highest importance score was in dimension of assurance (333,67) and the lowest was in responsiveness (323). The highest performance score was in dimension of empathy (310,25) and the lowest was in reliability (293,6). Empathy was the dimension with the highest level of satisfaction (94,66%) and reliability was the lowest (87,90%). Components of MAWAS that should be the main priorities for improvement were the comfort of service area, skill and ability of providers, information about service procedures and examination results. This study showed that tangible and reliability dimensions were perceived as unsatisfactory. Meanwhile, responsiveness, assurance and empathy dimensions were considered as satisfactory. Therefore, the managers of MAWAS should conduct training to improve the skill of service providers in providing quality services for the community. Keywords: User’s satisfaction, mobile screening, breast cancer, Badung