Programme trains people to identify TB cases
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LAUNCHED in 1977, the National Tuberculosis and Leprosy Programme (NTLP) works to eradicate tuberculosis as a major public health threat within the country.

Since its inception, the programme has been coordinating planning, training staff and mobilising resources through the involvement communities in TB control at all levels.

The programme lays emphasis on early TB detection and treatment in collaboration with a number of other community-based organisations and faith-based hospitals, as well as bilateral government aid agencies and the World Health Organisation(WHO).

the permanent programme is integrated into the general health services countrywide and is adapted to meet the needs of the people. Diagnosis and treatment are provided in multipurpose units and hospitals.

In the past five years, Tanzania has been recording 63,000 TB cases each year through health facilities. The country ranks 18 among 22 countries with many cases of TB in the world.

It is also the sixth country in Africa with a big number of people suffering from TB. Data from health facilities show that ten regions of Dar es Salaam, Arusha, Iringa, Kilimanjaro, Mbeya, Morogoro, Mwanza, Shinyanga and Tanga have the highest number of TB cases in the country.

TB epidemiologists say Dar es Salaam merits the dubious title of “TB hotspot of the country because the recorded higher incidence levels than in other regions. Social and biological factors combine to make Dar es Sa laam an ideal breeding ground for the bacterial infection.

Factors which increase the likelihood of developing active TB -- including poor housing and HIV infection—are more commonplace in Dar es Salaam than elsewhere in the country.

The rapid increase of TB patients in Tanzania is mainly attributed to HIV as well as population growth and urban overcrowding.

Theincrease has forced the Ministry of Health, Community Development, Gender, Elders and Children, through NTLP to strengthen TB control strategies by involving people at the grassroots in TB control at their localities.

The NTLP has facilitated early TB case detection through community sensitisation on symptoms and signs of TB as well as TB contact tracing.

Also, communities are sensitised to bring TB suspects for investigations, supporting TB patients during treatment and sputum fixing. Sputum is a liquid from the throat or lungs coughed up because of disease.

Recent research findings have revealed that TB is no longer a disease of the urban population alone. Rural areas are also involved, especially in areas where mining activities are taking place.

These areas are now among the areas suspected to have a big number of TB cases. A research has been planned to confirm that assumption. Mining activities usually force a group of men to go underground, where air circulation is very limited.

In case one of the workers happen to be sufthe workers happen to be sufthe workers happen to be suf fering from TB, can easily pass the bacteria to others since the disease is spread by air.

The NTLP has been applying several control ways to fight TB, among them is the study carried in mining centres such as Geita, Simanjiro, Kahama and Chunya districts.

Since the health sector faces shortage of health workers, Geita District, for example, resorted to health volunteers to attain their goal of sputum collection in different parts of the district.

Sputum fixers are health community-based volunteers who have been involved in TB control at their communities with specific roles. Their roles include collecting, fixing and transporting fixed sputum smears from hard to reach areas such as communities and dispensaries to the nearest TB diagnostic centres.

Geita is among the districts in Tanzania which faces transport problems to reach some villages. The geography of the district forces people to use both road and water transport in Lake Victoria to reach some villages.

Sputum fixing is one of the laboratory procedures where by a dried smear held by forceps and passed over the flame (smear side up) five times for about four seconds to avoid smear washout.

A study, conducted in Geita between 2009 and 2012 and led by Dr Columba Mbekenga, aimed at documenting community TB care best practices in high TB burden regions in Tanzania.

It was implemented by Geita District authorities. During the study, Geita was a district in Mwanza region. As mentioned above, Mwanza is one of the regions in the coun try with a large number of new TB cases.

The region has been registering an average of 5,550 new TB cases per year in the past five years. Mwanza ranks second among the top ten regions with high TB cases after Dar es Salaam, which registers 13,600 TB cases per year.

Among the then nine districts in Mwanza, Geita was chosen for the documentation because it had consistently maintained a high number of new smear positive cases compared to other districts in the region.

Therefore, it was selected based on that and was visited to document community TB care best practices. Geita District is bordered by Sengerema district in its northern and northeastern borders.

The district is sharing its southern boundary with Shinyanga region and the western with Kagera region. It has a population of 807,619 in 7,825 square kilometres total surface area.

Administratively, Geita has 35 wards with 163 villages. The main economic activities in Geita district include mining, fishing and small scale farming. The district population gets health services from 52 health facilities, one hospital, nine health centres and 42 dispensaries of which 13 facilities are under Directly Observed Treatment (DOT) centres and eight diagnostic centres.

Sputum fixers covered areas around three dispensa ries (DOT centres) in Lwamgasa with a population 29,148, Nyarugusu with 40,589 people and Nkome 32,726 wards. The three wards fixed sputum smears were usually transported to Kashishi and Nzera diagnostic centres twice a week.

The study points out that the distance from one dispensary to a diagnostic centre is between 28 to 35 kilometres depending on the location of the dispensary. Also, in other parts the distance is covered through water in Lake Victoria.

Usually, sputum fixer health workers targeted community through awareness activities using house to house visit approach. Also, community gatherings approach was applied by using open markets (Magulio) including political and governmental meetings.

Other strategies included visiting fish markets (Mialo) along Lake Victoria for community awareness and also using religious meetings such as evangelical congregations.

The study has revealed that sputum fixing has proven to be an effective approach in hard to reach areas and where there are no TB diagnostic centres.

The approach enhances early detection and thus reduction of TB transmission rate in the respective communities. It was observed that with effective transport and better allowances, sputum fixers would be more efficient in terms of reaching more people and reducing TB transmission in communities especially rural areas.

Sputum fixation was found to be the only community based initiative for TB control in Geita. Sputum fixers played a crucial role in increasing the number of TB case notification in the district.

From 2009 - 2012, only two sputum fixers were able to contribute smear positive TB patients between 11.2 – 18.6 per cent in TB case notification of the district.

The approach of community TB care best practices involved collection of relevant information on community TB activities in the district from the TB and Leprosy/HIV coordinators and interviewing health care providers and sputum fixers at health facilities.

Other activities included conducting sputum fixing and investigations and also TB patients who were on TB treatment course were diagnosed through sputum fixation initiative.

Also, official data in relation to TB control in the district for the past ten years were collected.

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