Population-Based Screening for Pulmonary Tuberculosis Utilizing Community Health Workers in Ethiopia

Journal Article
  • Yared Merid
  • Yimtubezinash Woldeamanuel Mulate
  • Mesay Hailu
  • Tsegaye Hailu
  • Getnet Habtamu
  • Markos Abebe
  • Daniel G. Datiko
  • Abraham Aseffa
International Journal of Infectious Diseases
2019. Vol. 89: 122-27. DOI: 10.1016/j.ijid.2019.10.012.

Abstract

OBJECTIVE:

To evaluate the utility of a volunteer health development army in conducting population screening for active tuberculosis (TB) in a rural community in southern Ethiopia.

METHODS:

A population-based cross-sectional survey was conducted in six kebeles (the lowest administrative units). Volunteer women community workers led a symptom screening programme to identify adults ≥15 years of age with TB in the community. Individuals with a cough for ≥2 weeks had spot and morning sputum samples taken, which were examined using acid-fast bacillus (AFB) smear microscopy, culture, and Xpert MTB/RIF.

RESULTS:

All 24517 adults in the study area had a symptom screen performed; 544 (2.2%) had had a cough for ≥2 weeks. Among those with a positive symptom screen, 13 (2.4%) were positive on sputum AFB smear microscopy, 13 (2.4%) had a positive culture, and 32 (5.8%) had a positive Xpert MTB/RIF test. Overall, 34 TB cases (6%) were identified by culture and/or Xpert, corresponding to a prevalence of 139 per 100000 persons.

CONCLUSIONS:

This study demonstrated the capability of community health workers (volunteer and paid) to rapidly conduct a large-scale population TB screening evaluation and highlight the high yield of such a programme in detecting previously undiagnosed cases when combined with Xpert MTB/RIF testing. This could be a model to implement in other similar settings.