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.