Integration of tuberculosis screening in health facility departments; a case study of three facilities in Dar es salaam, Tanzania

Abstract

ABSTRACT Background: There is growing evidence that integrating health services has improved services and lowered loss to follow-up rates. Tuberculosis (TB) is among the leading causes of mortality in the world, especially in the developing world. By 2035 World Health Organization aims to have reduced Tuberculosis incidence by 90%. In Tanzania, intensive screening in all facility departments was initiated as part of the Quality Improvement (QI) initiative in 2017. Furthermore, integration and scaling up screening in facility departments has been done in selected facilities since April 2019 by the EXIT TB project. This project aimed at increasing Tuberculosis case detection. Broad Objective: To assess the integration of Tuberculosis screening in health facility departments towards increasing Tuberculosis notification following the implementation of the EXIT TB project in Dar as salaam. Materials and Methods: A cross-sectional study that adopted qualitative and quantitative data collection methods was carried out in three health facilities between April-May 2021. The study involved health facility departments as well as health care workers and community health workers. A total of 13 participants were interviewed. Analysis was done using Microsoft excel for quantitative data, which generated descriptive analyses. On the other hand, qualitative data was analyzed through content analysis where after transcription texts were reduced to codes and patterned to identify categories. Findings The findings of this study show that Tuberculosis screening tools were available in the health facilities and they included Tuberculosis screening questionnaires, Tuberculosis screening forms at the Tuberculosis and Tuberculosis presumptive registers. There was positive attitude towards their use but the practice of using them was poor. The algorithm that was used to screen for Tuberculosis included the five Tuberculosis screening symptoms. Additionally, clients with cough for less than 2 weeks were also screened as presumptive patients and X-rays were used for screening. Capacity building has been done through training although frequent refresher training is needed. The Community Health workers were involved in multiple roles in the implementation of integrating Tuberculosis screening in all departments. They helped Health care workers in the initial screening of clients, followed up with the patients and also supported patients. Among the factors that influenced the integration process were cooperation among the staff, support from stakeholders and the administration. Then again, the lack of continuous pay for the Community Health workers and lack of continuous diagnostic facilities availability challenged the process. Conclusion The findings of this study propose that integration of Tuberculosis screening in health facility departments is still poorly implemented. Hence this calls upon the government, health facilities, health care workers, Community Health workers and different stakeholders to improve the process in order to integrate TB screening in all departments that will in turn increase Tuberculosis notification.