Increasing TB Detection and Treatment in Democratic Republic of the Congo

Increasing TB Detection and Treatment in Democratic Republic of the Congo

Mukabaha Ntakwigere (at right) at the General Reference Hospital in Nyangezi, DRC. {Photo credit: MSH staff.}Photo credit: MSH staff.

Tuberculosis (TB) is a leading cause of death in Democratic Republic of the Congo (DRC), partly due to a low case detection rate within the health system, compounded by little knowledge or awareness among patients of the disease’s symptoms. In the province of Sud Kivu, where people have relied on traditional healers for generations, those who were suffering from the persistent, painful coughing that is one symptom of TB were advised by traditional healers that they had been poisoned, and they were not referred to health centers.

In Sud Kivu province, in the health zone of Nyangezi, with a population of roughly 129,000 people, case detection was below 12%, which is the minimum "acceptable" threshold for TB detection.

Medical professionals in Nyangezi realized that they were never going to identify and treat those suffering from TB until they could educate the community about the symptoms and the treatment methods.

In June 2011, the USAID-funded Democratic Republic of Congo-Integrated Health project (DRC-IHP) began offering Management Sciences for Health’s Leadership Development Program (LDP) to health workers. This program prepares health managers and their teams to identify service delivery challenges, increase their capacity to attract local resources to support their needs, and improve health services. The Nyangezi team decided to tackle the issue of TB, and set a goal of raising their case detection rate to 18% by December 2011.

As one team member put it, “The stakes were high because everyone believes in traditional healers.'' The strategy that the team put in place was to engage community leaders, including religious leaders, local authorities, journalists and the traditional healers, launching a behavior change communications program that encouraged people who were coughing to go to the appropriate health facility.

The team’s efforts paid off. In the six-month period from the launch of this strategy, 56 TB cases were identified in Nyangezi; only 20 cases had been identified in the same period a year earlier, prior to the LDP.  By the end of 2012, 113 cases of TB had been identified.  In the 18-month period between June 2011 and December 2012, the case detection rate rose from 12% to 86%.

Mukabaha Ntakwigere, 39, was one of those who benefitted from this approach. Mr. Ntakwigere said:

"I thank the health management team in Nyangezi, because I was dying in the dark. I had concealed information about the chronic cough because a traditional healer had told me that I had been poisoned. However, thanks to the health team, after I was given the right information I quickly visited the TB detection center. I was examined, I received free medicines and, for the moment, I feel good.''

Led by Management Sciences for Health with partners the International Rescue Committee and Overseas Strategic Consulting, DRC-IHP is working to improve the basic health conditions of the Congolese people in 80 health zones in four provinces.

Moïse Barhingigwa is a capacity building specialist with DRC-IHP, based in Bukavu, Sud Kivu Province.

Editor’s note: This post is part of a " href="">World TB Day blog series on what works to stop TB. Join the conversation in the blog comments, and on Twitter with hashtags " href="" target="_blank"> and " href="" target="_blank">.