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Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho

Lesotho has one of the highest tuberculosis (TB) incidence rates in the world, estimated at 654/100,000 population. However, TB detection remains low, with only 51% of people with TB being diagnosed and treated. The aim of this study was to evaluate implementation of TB screening and identify driver...

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Autores principales: Andom, Afom T., Gilbert, Hannah N., Ndayizigiye, Melino, Mukherjee, Joia S., Nthunya, Jonase, Marole, Tholoana A., Smith Fawzi, Mary C., Yuen, Courtney M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021370/
https://www.ncbi.nlm.nih.gov/pubmed/36962295
http://dx.doi.org/10.1371/journal.pgph.0000249
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author Andom, Afom T.
Gilbert, Hannah N.
Ndayizigiye, Melino
Mukherjee, Joia S.
Nthunya, Jonase
Marole, Tholoana A.
Smith Fawzi, Mary C.
Yuen, Courtney M.
author_facet Andom, Afom T.
Gilbert, Hannah N.
Ndayizigiye, Melino
Mukherjee, Joia S.
Nthunya, Jonase
Marole, Tholoana A.
Smith Fawzi, Mary C.
Yuen, Courtney M.
author_sort Andom, Afom T.
collection PubMed
description Lesotho has one of the highest tuberculosis (TB) incidence rates in the world, estimated at 654/100,000 population. However, TB detection remains low, with only 51% of people with TB being diagnosed and treated. The aim of this study was to evaluate implementation of TB screening and identify drivers of suboptimal TB screening in Lesotho. We used a convergent mixed methods study design. We collected data on the number of health facility visits and the number of clients screened for TB during March-August, 2019 from one district hospital and one health center. We conducted interviews and focus group discussions with patients and health workers to elucidate the mechanisms associated with suboptimal screening. Out of an estimated 70,393 visitors to the two health facilities, only 22% of hospital visitors and 48% of health center visitors were asked about TB symptoms. Only 2% of those screened at each facility said that they had TB symptoms, comprising a total of 510 people. Lack of training on tuberculosis screening, overall staff shortages, barriers faced by patients in accessing care, and health care worker mistrust of tuberculosis screening procedures were identified as drivers of suboptimal TB screening. TB screening could be improved by ensuring the availability of well-trained, incentivized, and dedicated screeners at health facilities, and by providing TB screening services in community settings.
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spelling pubmed-100213702023-03-17 Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho Andom, Afom T. Gilbert, Hannah N. Ndayizigiye, Melino Mukherjee, Joia S. Nthunya, Jonase Marole, Tholoana A. Smith Fawzi, Mary C. Yuen, Courtney M. PLOS Glob Public Health Research Article Lesotho has one of the highest tuberculosis (TB) incidence rates in the world, estimated at 654/100,000 population. However, TB detection remains low, with only 51% of people with TB being diagnosed and treated. The aim of this study was to evaluate implementation of TB screening and identify drivers of suboptimal TB screening in Lesotho. We used a convergent mixed methods study design. We collected data on the number of health facility visits and the number of clients screened for TB during March-August, 2019 from one district hospital and one health center. We conducted interviews and focus group discussions with patients and health workers to elucidate the mechanisms associated with suboptimal screening. Out of an estimated 70,393 visitors to the two health facilities, only 22% of hospital visitors and 48% of health center visitors were asked about TB symptoms. Only 2% of those screened at each facility said that they had TB symptoms, comprising a total of 510 people. Lack of training on tuberculosis screening, overall staff shortages, barriers faced by patients in accessing care, and health care worker mistrust of tuberculosis screening procedures were identified as drivers of suboptimal TB screening. TB screening could be improved by ensuring the availability of well-trained, incentivized, and dedicated screeners at health facilities, and by providing TB screening services in community settings. Public Library of Science 2022-03-16 /pmc/articles/PMC10021370/ /pubmed/36962295 http://dx.doi.org/10.1371/journal.pgph.0000249 Text en © 2022 Andom et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Andom, Afom T.
Gilbert, Hannah N.
Ndayizigiye, Melino
Mukherjee, Joia S.
Nthunya, Jonase
Marole, Tholoana A.
Smith Fawzi, Mary C.
Yuen, Courtney M.
Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho
title Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho
title_full Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho
title_fullStr Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho
title_full_unstemmed Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho
title_short Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho
title_sort understanding reasons for suboptimal tuberculosis screening in a low-resource setting: a mixed-methods study in the kingdom of lesotho
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021370/
https://www.ncbi.nlm.nih.gov/pubmed/36962295
http://dx.doi.org/10.1371/journal.pgph.0000249
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