Cargando…

Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district

BACKGROUND: Tuberculosis (TB) is the leading cause of death from a single infectious agent globally, killing about 1.5 million people annually, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visitin...

Descripción completa

Detalles Bibliográficos
Autores principales: Zulu, Davy Wadula, Silumbwe, Adam, Maritim, Patricia, Zulu, Joseph Mumba
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160503/
https://www.ncbi.nlm.nih.gov/pubmed/35655301
http://dx.doi.org/10.1186/s12913-022-08043-w
_version_ 1784719283701415936
author Zulu, Davy Wadula
Silumbwe, Adam
Maritim, Patricia
Zulu, Joseph Mumba
author_facet Zulu, Davy Wadula
Silumbwe, Adam
Maritim, Patricia
Zulu, Joseph Mumba
author_sort Zulu, Davy Wadula
collection PubMed
description BACKGROUND: Tuberculosis (TB) is the leading cause of death from a single infectious agent globally, killing about 1.5 million people annually, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visiting the healthcare facilities. While many countries have scaled-up systematic screening of TB, there has been limited assessment of the extent of its integration into the health system. This study sought to explore factors that shape the integration of systematic screening of TB in outpatient departments of primary healthcare facilities in Kitwe district, Zambia. METHODS: This was a qualitative case study with health providers including district managers, TB focal point persons and laboratory personnel working in six purposively selected primary healthcare facilities. Data was collected through key informant (n = 8) and in-depth (n = 15) interviews. Data analysis was conducted using QDA Miner software and guided by Atun’s Integration framework. RESULTS: The facilitators to integration of systematic screening for TB into out patient departments of primary health facilities included the perceived high burden TB, compatibility of the systematic screening for TB program with healthcare workers training and working schedules, stakeholder knowledge of each others interest and values, regular performance management and integrated outreach of TB screening services. Constraining factors to integration of systematic screening for TB into outpatient departments included complexity of screening for TB in children, unbalanced incentivization mechanisms, ownership and legitimacy of the TB screening program, negative health worker attitudes, social cultural misconceptions of TB and societal stigma as well as the COVID-19 pandemic. CONCLUSION: Systematic screening of TB is not fully integrated into the primary healthcare facilities in Zambia to capture all those suspected with active TB that make contact with the health system. Finding the missing TB cases will, therefore, require contextual adaptation of the systematic screening for TB program to local needs and capacities as well as strengthening the health system. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08043-w.
format Online
Article
Text
id pubmed-9160503
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-91605032022-06-02 Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district Zulu, Davy Wadula Silumbwe, Adam Maritim, Patricia Zulu, Joseph Mumba BMC Health Serv Res Research BACKGROUND: Tuberculosis (TB) is the leading cause of death from a single infectious agent globally, killing about 1.5 million people annually, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visiting the healthcare facilities. While many countries have scaled-up systematic screening of TB, there has been limited assessment of the extent of its integration into the health system. This study sought to explore factors that shape the integration of systematic screening of TB in outpatient departments of primary healthcare facilities in Kitwe district, Zambia. METHODS: This was a qualitative case study with health providers including district managers, TB focal point persons and laboratory personnel working in six purposively selected primary healthcare facilities. Data was collected through key informant (n = 8) and in-depth (n = 15) interviews. Data analysis was conducted using QDA Miner software and guided by Atun’s Integration framework. RESULTS: The facilitators to integration of systematic screening for TB into out patient departments of primary health facilities included the perceived high burden TB, compatibility of the systematic screening for TB program with healthcare workers training and working schedules, stakeholder knowledge of each others interest and values, regular performance management and integrated outreach of TB screening services. Constraining factors to integration of systematic screening for TB into outpatient departments included complexity of screening for TB in children, unbalanced incentivization mechanisms, ownership and legitimacy of the TB screening program, negative health worker attitudes, social cultural misconceptions of TB and societal stigma as well as the COVID-19 pandemic. CONCLUSION: Systematic screening of TB is not fully integrated into the primary healthcare facilities in Zambia to capture all those suspected with active TB that make contact with the health system. Finding the missing TB cases will, therefore, require contextual adaptation of the systematic screening for TB program to local needs and capacities as well as strengthening the health system. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08043-w. BioMed Central 2022-06-02 /pmc/articles/PMC9160503/ /pubmed/35655301 http://dx.doi.org/10.1186/s12913-022-08043-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Zulu, Davy Wadula
Silumbwe, Adam
Maritim, Patricia
Zulu, Joseph Mumba
Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district
title Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district
title_full Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district
title_fullStr Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district
title_full_unstemmed Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district
title_short Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district
title_sort integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in zambia: a case study of kitwe district
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160503/
https://www.ncbi.nlm.nih.gov/pubmed/35655301
http://dx.doi.org/10.1186/s12913-022-08043-w
work_keys_str_mv AT zuludavywadula integrationofsystematicscreeningfortuberculosisinoutpatientdepartmentsofurbanprimaryhealthcarefacilitiesinzambiaacasestudyofkitwedistrict
AT silumbweadam integrationofsystematicscreeningfortuberculosisinoutpatientdepartmentsofurbanprimaryhealthcarefacilitiesinzambiaacasestudyofkitwedistrict
AT maritimpatricia integrationofsystematicscreeningfortuberculosisinoutpatientdepartmentsofurbanprimaryhealthcarefacilitiesinzambiaacasestudyofkitwedistrict
AT zulujosephmumba integrationofsystematicscreeningfortuberculosisinoutpatientdepartmentsofurbanprimaryhealthcarefacilitiesinzambiaacasestudyofkitwedistrict