Training program for tuberculosis (TB) patients to improve referrals of presumptive TB cases and sputum in Denpasar, Bali, Indonesia
DOI:
https://doi.org/10.53638/phpma.2020.v8.i2.p08Keywords:
tuberculosis, active case finding, sputum referral, TB patients as volunteersAbstract
Background and purpose: Tuberculosis (TB) is a global healthproblem and one of the top ten causes of deaths in the world. TB case finding is an important component of TB control. In Indonesia, most case findings were done passively so that the referral coverage for TB sputum was lower than the target. This study aims to determine the effectiveness of training for TB patients as volunteers to increase the active referral of presumptive TB cases.
Methods: The pretest-posttest design intervention study was conducted in five public health centers (PHCs) which had the highest number of TB patients in Denpasar. The intervention was carried out for seven weeks (February May 2020). A total of 35 TB patients, who were currently undergoing treatment at the PHCs, met the study criteria and willing to volunteer, were trained through meetings, discussions and demonstrations about the risk of TB transmission, contact investigations and how to collect sputum samples. Before and after the interventions, data on volunteers’ knowledge, the number of presumptive TB and sputum referrals by volunteers were collected through interviews and daily records. A regular reminder was sent in the form of a WhatsApp message once a week. Bivariate data analysis was performed with Chi-square and Wilcoxon Signed Rank Test.
Results: Volunteers’ knowledge scores increased significantly after training, with a median score of 13.0 to 15.0 (p<0.001), and there was a significant difference in knowledge improvement amongthose who actively responded to regular reminders compared to those who were less active (p=0.002). A total of 31 presumptive TB cases were successfully referred during the study period (7 weeks). Volunteers managed to refer as many as 30 sputum preparations with good quality, but no positive sputum was found.
Conclusion: Recruitment and training of TB patients as volunteers can increase the knowledge and skills of volunteers to identify and refer presumptive TB cases and quality sputum samples. More TB patients should be trained as volunteers with a longer observation time to increase TB patient detectio
References
World Health Organization. Global Tuberculosis Report 2018. Geneva, Switzerland; 2018.
Ministry of Health of the Republic of Indonesia. Profil Kesehatan Indonesia 2018 [The 2018 Indonesia Health Profile]. Ministry of Health of the Republic of Indonesia. Jakarta; 2019.
Kim JY, Shakow A, Castro A, Vande C. Tuberculosis control The burden of tuberculosis: Economic burden (2). WHO Distance Learning Module on Trade, Foreign Policy, Diplomacy and Health. 2019. p. 3–4.
Ministry of Health of the Republic of Indonesia. Pedoman Nasional Pengendalian Tuberkulosis Tahun 2014 [The 2014 National Guidelines on Tuberculosis Control]. Ministry of Health of the Republic of Indonesia. Jakarta; 2014.
World Health Organization. Global Tuberculosis Control 2008. Surveillance, Planning Financing. World Health Organization. Geneva; 2008. 1–304 p.
Bali Provincial Health Office. Laporan Dinas Kesehatan Provinsi Bali Tahun 2015-2018 [The 2015-2018 Bali Provincial Health Office Report]. Bali Provincial Health Office. Denpasar; 2018.
World Health Organization. Recommendations for investigating contacts of persons with infectious Tuberculosis in low- and middle-income countries. World Health Organization. Geneva, Switzerland; 2012. 1–70 p.
Ministry of Health of the Republic of Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 67 Tahun
Tentang Penanggulangan Tuberkulosis [Regulation of The Ministry of Health of The Republic of Indonesia No. 67 Year 2016 on Tuberculosis Control]. Ministry of Health of the Republic of Indonesia. Jakarta; 2016.
Ochoa EG, Brooks JL, Matthys F, Caliste P, Armas L, Stuyft P Van Der. Pulmonary Tuberculosis case detection through fortuitous cough screening during home visits. Trop Med Int Heal. 2009;14(2):131–135.
Miller AC, Golub JE, Cavalcante SC, Durovni B, Moulton LH, Fonseca Z, et al. Controlled trial of active tuberculosis case finding in a Brazilian favela. Int J Tuberc lung Dis. 2010;14 (6):720–726.
Ustero PA, Kay AW, Ngo K, Golin R, Tsabedze B, Mzileni B, et al. School and household tuberculosis contact investigations in Swaziland : Active TB case finding in a high HIV/TB burden setting. PLoS One. 2017;12(6):1–10.
Corbett EL, Bandason T, Duong T, Dauya E, Makamure B, Churchyard GJ, et al. Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a clusterrandomised trial. Lancet. 2010;376(9748):12441253.
Delva GJ, Francois I, Claassen CW, Dorestan D, Bastien B, Medina-moreno S, et al. Active Tuberculosis case
finding in Port-au-Prince, Haiti: Experiences, results, and implications for Tuberculosis Control Programs. Hindawi Tuberc Res Treat. 2016;2016:1–11.
Yassin MA, Datiko DG, Tulloch O, Markos P, Aschalew M, Shargie EB, et al. Innovative community-based approaches doubled tuberculosis case notification and improve treatment outcome in Southern Ethiopia. PLoS One. 2013;8(5):1–8.
Shargie EB, Mørkve O, Lindtjørn B. Tuberculosis casefinding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial. Bul World Heal Organ. 2006;84(2):112–119.
Datiko DG, Lindtjørn B. Health extension workers improve tuberculosis case detection and treatment success in
Southern Ethiopia: A community randomized trial. PLoS One. 2009;4(5):1–7.
Shapiro AE, Variava E, Rakgokong MH, Moodley N. Community-based targeted case finding for tuberculosis and HIV in household contacts of patients with tuberculosis in South Africa. Am J Respir Crit Care Med.2012;185(13):11111116.
Saunders MJ, Tovar MA, Collier D, Baldwin MR, Montoya R, Valencia TR, et al. Active and passive case-finding in tuberculosis-affected households in Peru: a 10-year prospective cohort study. Lancet Infect Dis. 2019;19(5):519–28.
Eka Putra IWGA, Kurniasari NMD, Purnama Dewi NPE, Suarjana IK, Kerta Duana IM, Hari Mulyawan IK, et al. The implementation of early detection in tuberculosis contact investigation to improve case finding. J Epidemiol Glob Health. 2019;9(3):191–197.
Ministry of Health of the Republic of Indonesia. Petunjuk Teknis Pelaksanaan Ketuk Pintu Dalam Rangka Hari TB
Sedunia 2017 [Technical guidelines on the implementation of door to door knocking during the 2017 World Tubeculosis Day]. Ministry of Health of the Republic of Indonesia. Jakarta; 2017.
Ministry of Health of the Republic of Indonesia. Pedoman Umum Program Indonesia Sehat dengan Pendekatan Keluarga [General Guidelines of Healthy Indonesia Program with a Family Approach]. Ministry of Health of the Republic of Indonesia. Jakarta; 2016.
Ministry of Health of the Republic of Indonesia. Strategi Nasional Pengendalian TB di Indonesia 2010-2014 [The
-2014 National Strategy of TB Control in Indonesia]. Ministry of Health of the Republic of Indonesia. Jakarta; 2011.
André E, Rusumba O, Evans CA, Ngongo P, Sanduku P, Elvis M, et al. Patient-led active tuberculosis case-finding
in the Democratic Republic of the Congo. Bull World Heal Organ. 2018;96:522–530.
Denpasar City Health Office. Laporan Sistem Informasi Tuberkulosis Terpadu (SITT) Tahun 2019 [The 2019
Comprehensive Tuberculosis Information System Report]. Denpasar City Health Office. 2019.
Ministry of Health of the Republic of Indonesia. Lembar Balik TOSS (Temukan Obati Sampai Sembuh) TB
[Flipchart on Find and Treat Tuberculosis]. Ministry of Health of the Republic of Indonesia. Jakarta; 2018.
Sutiyono, Kuriniawati IR. Pengaruh pendidikan kesehatan tuberkulosis pada masyarakat terhadap kesadaran deteksi dini penyakit tuberculosis di Puskesmas Toroh I Kabupaten Grobogan [The influence of health education of tuberculosis in the community towards tuberculosis early detection at Toroh I Public Health Center, Grobogan District]. 2013;37–46.
Sukmawati E. Efektifitas penyuluhan kesehatan terhadap pengetahuan perawatan pasien tuberkulosis (TB) [The effectiveness of health education on the knowledge in tuberculosis patients care]. Ners Lentera. 2017;5(1):9–20.
Ratnasari D, Budi Y, Sakti H. Hubungan antara pendidikan kesehatan terhadap perubahan sikap dan perilaku penderita tuberculosis yang berobat di wilayah Puskesmas Karanganyar [The association between health education with attitudes and behaviors of tuberculosis patients on treatment at The Karanganyar Public Health Center]. Psycho Idea. 2015;2:22–33.
Jadgal KM, Nakhaei-moghadam T, Alizadeh-seiouki H, Zareban I, Sharifi-rad J. Impact of educational intervention on patients behavior with smear-positive pulmonary tuberculosis : A study using the Health Belief Model. Mater Sociomed. 2015;27(4):229–233.
Bisallah CI, Rampal L, Lye M, Sidik SM, Ibrahim N, Iliyasu Z, et al. Effectiveness of health education intervention in improving knowledge, attitude, and practices regarding tuberculosis among HIV patients in General Hospital Minna, Nigeria – A randomized control trial. PLoS One. 2018;13(2):1–14.
Widjaja E. Motivation behind volunteerism [Undergraduate Thesis]. Claremont Colleges. California; 2010:1–34.
Bali Provincial Health Office. Profil Kesehatan Provinsi Bali 2018 [The 2018 Bali Province Health Profile]. Bali Provincial Health Office. Denpasar; 2019.
Denpasar City Health Office. Profil Dinas Kesehatan Kota Denpasar Tahun 2018 [The 2018 Denpasar City Health Office Profile]. Denpasar City Health Office. Denpasar; 2019.
Ministry of Health of the Republic of Indonesia. Petunjuk Teknis Pemeriksaan TB Menggunakan Tes Cepat Molekuler [Technical guidelines of TB examination using the molecular rapid test]. Ministry of Health of the Republic of Indonesia. Jakarta; 2017
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Putu Ayu Merry Antarina, Dewa Nyoman Wirawan, Anak Agung Sagung Sawitri
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
**Creative Commons Attribution 4.0 International License (CC BY 4.0)**
*Welcome to the world of open collaboration and shared creativity! The Creative Commons Attribution 4.0 International License (CC BY 4.0) empowers creators to share their work with the world while maintaining certain rights.*
**Key Points:**
1. **Freedom to Share:** CC BY 4.0 allows creators to share their work globally, granting others the freedom to use, remix, and build upon it.
2. **Attribution Requirement:** Users can use the work for any purpose, even commercially, as long as they provide appropriate credit to the original creator.
3. **Flexibility:** Applicable to various content types—text, images, music, videos—the license fosters a diverse range of creations.
**Common Use Cases:**
- **Education:** Widely used for educational materials, promoting open learning environments.
- **Research:** Applied to scholarly articles, accelerating the dissemination of knowledge.
**How to Use:**
1. **Share:** Share your work with the world, marking it with the CC BY 4.0 license.
2. **Attribution:** Users, when utilizing the work, must provide proper attribution to honor the original creator.
**Conclusion:**
CC BY 4.0 contributes to a more open and collaborative digital landscape. Join the movement of shared knowledge and creativity!
*For full license details, visit [Creative Commons](https://creativecommons.org/licenses/by/4.0/).*
