Assessment of the factors influencing implementation of systematic Tuberculosis screening at health facility level in Temeke district

Abstract

ABSTRACT

Background: Tuberculosis (TB) remains a global health challenge, with millions of cases going unreported annually. Significant gaps in case detection, further worsened by the COVID-19 pandemic, persist. In Tanzania, a high-burden TB country, 100,000 cases are missed yearly. Despite efforts to implement systematic TB screening, challenges persist, including data recording deficiencies and insufficient diagnostic resources. Temeke District, with the highest TB cases in 2022, presents a critical research gap as the effectiveness of systematic TB screening in such settings is inadequately understood. Objective: The study aims to evaluate the implementation of systematic TB screening at health facility in Temeke District. It focuses on determining the proportion of eligible individuals were reached, assessing documentation fidelity, and identifying operational facilitators and barriers. Materials and Method: This study employed a mixed-methods, convergent parallel approach to evaluate the implementation of systematic TB screening at health facilities in Temeke District. For the quantitative component, a cross-sectional design assessed the proportion of eligible individuals registered in the presumptive TB screening register and the completeness of documentation within the TB register. Concurrently, the qualitative component explored the experiences and perceptions of healthcare workers and patients using a phenomenological design. It encompassed multistage sampling for quantitative analysis and purposive sampling for qualitative insights, targeting a sample size of 384 records for the quantitative component and 11 participants for the qualitative component. A structured data abstraction form for quantitative data and a semi-structured interview guide for qualitative data were used. Quantitative data was analysed descriptively, while qualitative responses were content analysed to identify key facilitators and barriers. Results: During the study period from April 2023 to March 2024, the hospital registry recorded 402,119 patient visits, with 51.5% being first-time visits. Among these, the median age of patients was 35 years, IQR of (4 – 49) and 11.29% were related to upper respiratory infections. The health facility Presumptive TB Register identified 8,464 patients as presumptive TB cases, of which 26.3% were confirmed through bacteriological tests. The highest confirmation rates were observed in Mbagala Rangi Tatu and Mbande

hospitals at 37% and 36%, respectively. Only 14.48% (n=8464) of patients displaying TB symptoms were registered in the presumptive TB register. Males demonstrated a significantly higher registration rate of 19.17%, (n=5397) (p<0.001), compared to females), and the highest registration rate was noted significantly among older adults over 60 years at 56.32% (n=1790) (p < 0.01). The overall documentation completeness for essential TB variables was at 21.60% (95% CI: 20.72% - 22.47%), with particular challenges in the documentation of the TB Score Chart, which recorded a completeness of 14.33% (95% CI: 11.74 - 16.91). Education and awareness campaigns, supervision by district and regional coordinators, training and multisectoral collaboration were identified facilitators. However, barriers such as high workload, staffing shortages, and historical TB program perceptions as a vertical program negatively impacted the efficiency and thoroughness of TB screening processes. Conclusion: There is a significant gap in the implementation of systematic TB screening, with variations across health facilities due to factors like resource availability and staff training. Women were particularly affected, reflecting broader systemic barriers. The study highlighted low data completeness in TB registers, particularly for TB score charts, suggesting a need for integrated electronic data systems and ongoing training. Recommendations: The Ministry of Health should enhance healthcare worker training, especially in documentation. Health facility management should implement supervision and mentorship programs. A digital TB screening system integrated with existing health records should be developed, while local governments should focus on outreach to reduce stigma and improve health-seeking behaviors. Regular evaluations of TB screening programs are essential to refine TB control strategies.