A public-private partnership to reduce tuberculosis burden in Akwa Ibom State, Nigeria
A public-private partnership to reduce tuberculosis burden in Akwa Ibom State, Nigeria
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DOI：
10.1016/j.ijmyco.2015.04.002
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发表时间：
2015-06-01
影响因子：
1.2
通讯作者：
Asuquo, P. N.
中科院分区：
文献类型：
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作者：
Asuquo, Anne E.;Pokam, Benjamin D. Thumamo;Asuquo, P. N.
背景资料：结核病的感染和传播是可以预防的，结核病是可以治愈的，这取决于个人和社区对结核病病因、预防和治疗模式的了解。2006年在尼日利亚阿夸伊博姆州（AKS）开展的早期教育干预活动提高了人们对结核病的认识，并改善了34个社区有结核病症状的居民对正规医疗设施的利用。该方案的总体目标是通过教育干预，结核病病例检测和纳入国家结核病和麻风病控制规划，以及建立实验室能力以改进结核病病例检测和控制。在每个社区进行教育干预之前，向居民发放标准的预测试问卷，以测试他们的知识，对结核病的态度和做法。在社区市政霍尔斯、教堂、市场和学校传播有关结核病的原因、症状和预防的信息。咳嗽三周或三周以上的人在医生进行临床检查后进行结核病调查。从每个个体获得三份痰液样本（点-晨-点），并使用Ziehl-Neelson染色技术在显微镜下检查是否存在抗酸杆菌（AFB）。AFB结果呈阳性的患者被纳入现有的NTBLCP治疗设施，立即开始直接观察治疗（DOTS）。通过在2个月、5个月和7个月后重新检测患者的痰液来监测治疗结果。通过提供高分辨率显微镜、发电厂、冰箱、当地制造的焚化炉和工作人员办公室的家具，促进了两个新实验室的建设，同时建立了现有的实验室能力。有效保健联盟研究计划（EHCARP-尼日利亚），与尼日利亚国家石油合作公司和美孚生产尼日利亚无限公司合作（NNPC/MPN）合资企业利用来自Akwa Ibom State NTBLCP的卫生人员进行实验室测试并监督治疗。结果：916份调查问卷显示，65.3%（549/841）的人正确识别出结核病是空气传播的，86%（749/871）的人知道结核病可以通过抗结核药物治愈。123名受访者提供了对寻求护理态度的回应。其中，31%（38人）因害怕被污名化而到非正规医疗机构寻求治疗，43.1%（53人）认为正规医疗无法治愈其症状，在374例确诊病例中，有9例没有开始治疗。因此，365人接受了DOTS; 36人违约，11人在第七个月后死亡或未能转换。结论：虽然前期干预可能有助于社区居民对结核病的良好认识和就医态度，但通过公私合作持续积极发现病例可以大大减轻结核病负担，特别是在卫生系统普遍薄弱或不足的农村社区。为结核病控制活动提供充足的资金对于消除结核病这一公共卫生问题至关重要，私营部门的参与是一个值得欢迎的发展。由爱思唯尔有限公司代表亚非分枝杆菌学会制作和主办。
Background: Tuberculosis (TB) infection and spread are preventable, and TB disease is curable depending on individual and community knowledge of causes of the disease, mode of prevention and cure. An earlier educational intervention carried out in Akwa Ibom State (AKS) of Nigeria in 2006 created awareness of the disease and improved utilization of orthodox medical facilities of residents in 34 communities who had symptoms of TB.Objective: The overall aim of this program is to reduce the burden of TB disease in 18 communities of AKS through educational intervention, TB case detection and integration into the State National Tuberculosis and Leprosy Control Programme (NTBLCP), as well as build laboratory capacity to improve TB case detection and control.Methods: Prior to the educational intervention in each community, standard pretested questionnaires were administered to residents to test their knowledge, attitudes and practices concerning TB. Information about causes, symptoms and prevention of TB was disseminated in community town halls, churches, markets and schools. Individuals who were coughing for three weeks or more were investigated for TB following clinical examination by a physician. Three sputum samples (spot-morning-spot) were obtained from each individual and examined microscopically for the presence of acid-fast bacilli (AFB) using the Ziehl-Neelson staining technique. Those with positive AFB results were integrated into the existing NTBLCP treatment facilities for immediate commencement of Directly-Observed Therapy Short Course (DOTS). Treatment outcome was monitored by retesting patients' sputum after two, five and seven months. Two new laboratories were facilitated while existing laboratory capacity was built by providing higher resolution microscopes, power generating plants, refrigerators, locally-fabricated incinerators and furnishing of staff offices.The program was facilitated by a public-private partnership. Effective Health Care Alliance Research Programme (EHCARP-Nigeria), in collaboration with Nigeria National Petroleum Cooperation and Mobil Producing Nigeria Unlimited (NNPC/MPN) Joint Venture, utilized health personnel from the Akwa Ibom State NTBLCP who conducted laboratory testing and supervised the treatment.Results: The 916 responses to the questionnaires showed that 65.3% (549/841) correctly identified that TB is airborne, and 86% (749/871) were aware that TB could be cured by anti-TB medication. Responses to care-seeking attitudes were provided by 123 respondents. Of this number, fear of stigmatization was the reason for 31% (38) seeking care in unorthodox facilities, while 43.1% (53) did not believe that orthodox medicine could cure their symptoms.Of the 374 detected cases, 9 did not commence treatment. Hence, 365 were placed on DOTS; 36 defaulted, while 11 either died or failed to convert after the seventh month. At the end of month 8, cure was achieved for 87.1% (318).Conclusion: Although the previous intervention may have contributed to the good knowledge about TB and care-seeking attitudes displayed by respondents in the communities, sustaining active case finding through public-private partnership can go a long way to reduce TB burden, especially in rural communities where healthcare systems are generally weak or inadequate. Adequate funding of TB control activities is critical in eliminating TB as a public health problem, and the private sector participation such as this is a welcome development. Production and hosting by Elsevier Ltd. on behalf of Asian African Society for Mycobacteriology.