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Improving detection of Tuberculosis through community based campaign facilitated by Community Health Worker (CHW) – Experience from Chhattisgarh, India

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Improving Detection of Tuberculosis through Community Based Campaign facilitated by Community Health Workers (CHWs) in rural areas

 Experience from Chhattisgarh, India

Mukesh Dewangan, Samir Garg, Om Prakash Barman

State Health Resource Centre, Chhattisgarh, India. Email: shrc.cg@gmail.com

Background:

Tuberculosis (TB) remains a major global health problem. WHO Global TB report 2016 estimates that there were 10.4 million new TB cases in 2015 including 1 million children. India has one-fourth share of the global TB incidence. It causes 1.4 million  deaths annually in India. Chhattisgarh is one of the poorest states in India.  Detection rate for TB has been poor with 98 cases notified per 100000 population in 2013 against a target of 216 cases per 100000. One reason for low detection was identified as inadequate number of presumptive cases being tested – around  half the number of smear examinations taking place in 2013 than the requirement of 200 tests per 100000 population per quarter.

Objective: To generate community awareness and improve detection of Tuberculosis through a Community based campaign facilitated by Mitanin CHWs

Intervention:

Chhattisgarh has 70,000 Community Health Workers (CHWs) known as Mitanins who were trained to screen the population for signs of TB. Average population per CHW is around 330.

During regular home visits by CHW, identifying the TB patient on the basis of their symptoms

CHW educates community through a leaflet and poster for improving awareness and reducing hesitation in reporting TB 
Presumptive cases identified in bi-annual door to door campaign and referred by CHW to nearest designated microscopy centre for sputum test
After confirmation, same health centre provides the drugs. CHW regularly monitors the patient for ensuring adherence
CHWs report regarding TB cases in their monthly cluster level meeting
CHWs facilitate the Village Health Committee in recording the deaths due to TB and organizes discussion on ways to prevent such mortality in future
State level CHW Resource Centre compiles and analyses the work of CHWs on TB by collecting reports through the support cascade in place for CHWs. Field visits are made by State Trainers to assess
 
Result:
Starting from 2014, biannual campaigns organized
In 2015, 96% of the CHWs participated in the TB awareness and screening campaign
Covered 71% of the 27 million population of state
62% of the screened presumptive cases were successfully referred to microscopy centers. Average 1 functional centre available per 100000 population
A comprehensive effort on contact tracing across the state was attempted in 2016
Smear examination rate almost doubled in 3 years
TB Notification rate in 2016 likely to touch 141 cases per 100000, a 44% increase over 3 years
Relative improvement in detection of pediatric cases too
 
Challenges:
Difficulty in convincing around one-third presumptive cases for going to microscopy centers for confirmation
A presumptive cases has to make average of 3 visits to Microscopy centre before getting confirmed. There is a need to reduce it
CHW incentive structure design has gaps resulting in around 30%of CHWs getting no incentive despite doing the campaign work
 
Conclusion:
CHWs can play an effective role in improving detection of TB in situations with poor detection rates. Community based campaigns through CHWs can be useful for improving awareness and reducing stigma on TB. Integrating work on TB in the existing roles of CHWs is recommended
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