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Adakun SA, Banda FM, Bloom A, Bochnowicz M, Chakaya J, Chansa A, Chiguvare H, Chimzizi R, Colvin C, Dongo JP, Durena A, Duri C, Edmund R, Harries AD, Kathure I, Kavenga FN, Lin Y, Luzze H, Mbithi I, Mputu M, Mubanga A, Nair D, Ngwenya M, Okotu B, Owiti P, Owuor A, Thekkur P, Timire C, Turyahabwe S, Tweyongyere E, YaDiul M, Zachariah R, Zimba K. Disability, comorbidities and risk determinants at end of TB treatment in Kenya, Uganda, Zambia and Zimbabwe. IJTLD OPEN 2024; 1:197-205. [PMID: 39022778 PMCID: PMC11249599 DOI: 10.5588/ijtldopen.24.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/19/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND We examined the feasibility of assessing and referring adults successfully completing TB treatment for comorbidities, risk determinants and disability in health facilities in Kenya, Uganda, Zambia and Zimbabwe. METHODS This was a cross-sectional study within national TB programmes. RESULTS Health workers assessed 1,063 patients (78% of eligible) in a median of 22 min [IQR 16-35] and found it useful and feasible to accomplish in addition to other responsibilities. For comorbidities, 476 (44%) had HIV co-infection, 172 (16%) had high blood pressure (newly detected in 124), 43 (4%) had mental health disorders (newly detected in 33) and 36 (3%) had diabetes mellitus. The most common risk determinants were 'probable alcohol dependence' (15%) and malnutrition (14%). Disability, defined as walking <400 m in 6 min, was found in 151/882 (17%). Overall, 763 (72%) patients had at least one comorbidity, risk determinant and/or disability. At least two-thirds of eligible patients were referred for care, although 80% of those with disability needed referral outside their original health facility. CONCLUSIONS Seven in 10 patients completing TB treatment had at least one comorbidity, risk determinant and/or disability. This emphasises the need for offering early patient-centred care, including pulmonary rehabilitation, to improve quality of life, reduce TB recurrence and increase long-term survival.
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Affiliation(s)
- S A Adakun
- Mulago National Referral Hospital, Kampala, Uganda
| | - F M Banda
- University Teaching Hospital, Ministry of Health, Lusaka, Zambia
| | - A Bloom
- Credence, Contractor for USAID Health Training, Advisory, and Support Contract (GHTASC), Washington DC, USA
| | - M Bochnowicz
- Credence, Contractor for USAID Health Training, Advisory, and Support Contract (GHTASC), Washington DC, USA
| | - J Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry Kenyatta University, Nairobi
- Respiratory Society of Kenya, Nairobi, Kenya
| | - A Chansa
- Ndola Teaching Hospital, Ministry of Health, Ndola, Zambia
| | - H Chiguvare
- United States Agency for International Development (USAID), Harare, Zimbabwe
| | - R Chimzizi
- Ministry of Health, USAID Long-term Exceptional Technical Assistance Project, Genesis, Lusaka, Zambia
| | - C Colvin
- United States Agency for International Development (USAID), Harare, Zimbabwe
| | - J P Dongo
- International Union Against Tuberculosis and Lung Disease (The Union) Uganda Office, Kampala, Uganda
| | - A Durena
- United States Agency for International Development (USAID), Harare, Zimbabwe
| | - C Duri
- Directorate of Health Services, Harare City Council, Harare, Zimbabwe
| | - R Edmund
- United States Agency for International Development (USAID), Harare, Zimbabwe
| | - A D Harries
- The Union, Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - I Kathure
- Ministry of Health, Division of National TB, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | - F N Kavenga
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | | | - H Luzze
- National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Uganda
| | - I Mbithi
- Respiratory Society of Kenya, Nairobi, Kenya
| | - M Mputu
- National Tuberculosis Programme, Ministry of Health/USAID TBLON, Lusaka; Zambia
| | - A Mubanga
- National Tuberculosis Programme, Ministry of Health/USAID TBLON, Lusaka; Zambia
| | | | - M Ngwenya
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - B Okotu
- Ministry of Health, Division of National TB, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | - P Owiti
- USAID, Health, Population and Nutrition Office, Kenya and East Africa, Nairobi
| | - A Owuor
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - C Timire
- The Union, Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - S Turyahabwe
- National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Uganda
| | - E Tweyongyere
- National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Uganda
| | | | - R Zachariah
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Abdullahi LH, Oketch S, Komen H, Mbithi I, Millington K, Mulupi S, Chakaya J, Zulu EM. Gendered gaps to tuberculosis prevention and care in Kenya: a political economy analysis study. BMJ Open 2024; 14:e077989. [PMID: 38569714 PMCID: PMC11146361 DOI: 10.1136/bmjopen-2023-077989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a public health concern in Kenya despite the massive global efforts towards ending TB. The impediments to TB prevention and care efforts include poor health systems, resource limitations and other sociopolitical contexts that inform policy and implementation. Notably, TB cases are much higher in men than women. Therefore, the political economy analysis (PEA) study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection. DESIGN PEA adopts a qualitative, in-depth approach through key informant interviews (KII) and documentary analysis. SETTING AND PARTICIPANTS The KIIs were distributed among government entities, academia, non-state actors and community TB groups from Kenya. RESULTS The themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritisation for TB programmes, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programmes were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviours. The themes around the economic situation were poverty and unemployment, food insecurity and malnutrition. The political context centred around the systemic and governance gaps in the health system from the national and devolved health functions. CONCLUSION Broad contextual factors identified from the PEA widen the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is essential to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care.
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Affiliation(s)
- Leila H Abdullahi
- Research Department, African Institute for Development Policy, Nairobi, Kenya
| | - Sandra Oketch
- African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | - Henry Komen
- African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | | | | | | | | | - Eliya M Zulu
- African Institute for Development Policy, Nairobi, Kenya
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Zachariah R, Goncharova O, Kamarli C, Bazikov T, Ahmedov S, Osmonaliev K, Harries AD, Davtyan H, Thekkur P, Kalmambetova G, Kadyrov A. Strengthening the Operational Research Capacity of National Tuberculosis Control Programs: Necessity or Luxury? Trop Med Infect Dis 2023; 8:339. [PMID: 37505635 PMCID: PMC10384202 DOI: 10.3390/tropicalmed8070339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
'How to get research into practice: first get practice into research [...].
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Affiliation(s)
- Rony Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank, World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), 20, Avenue Appia, CH-1211 Geneva, Switzerland
| | - Olga Goncharova
- National Center of Phthisiology, Bishkek 720000, Kyrgyzstan; (O.G.); (A.K.)
| | - Chynara Kamarli
- United States Agency for International Development, 171 Prospect Mira, Bishkek 720016, Kyrgyzstan; (C.K.); (T.B.)
| | - Timur Bazikov
- United States Agency for International Development, 171 Prospect Mira, Bishkek 720016, Kyrgyzstan; (C.K.); (T.B.)
| | - Sevim Ahmedov
- United States Agency for International Development, TB/HIV, Prevention and M&E Team Lead, Bureau for Global Health, TB Division, Washington, DC 20024, USA;
| | | | - Anthony D. Harries
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (A.D.H.); (P.T.)
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hayk Davtyan
- Tuberculosis Research and Prevention Center NGO, Yerevan 0014, Armenia;
| | - Pruthu Thekkur
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (A.D.H.); (P.T.)
| | - Gulmira Kalmambetova
- Department of Strategic Development and International Cooperation, TB National Reference Laboratory, 90a Akhunbaeva Str., Bishkek 720075, Kyrgyzstan;
| | - Abdullaat Kadyrov
- National Center of Phthisiology, Bishkek 720000, Kyrgyzstan; (O.G.); (A.K.)
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Lalitha R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda: healthcare provider perspectives. Implement Sci Commun 2023; 4:8. [PMID: 36650596 PMCID: PMC9844180 DOI: 10.1186/s43058-023-00391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Following the first wave of the COVID-19 outbreak, Uganda experienced a 40% drop in tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCPs) at a National Referral Hospital in Kampala, Uganda. DESIGN/METHODS We conducted a cross-sectional study using in-depth interviews with 12 HCPs involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral Hospital, Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and we denoted the emergent themes as barriers to and facilitators of COVID-19/TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation, and Behavior (COM-B) model. RESULTS The facilitators to integrated COVID-19 and TB screening included the availability of TB focal persons and already existing training forums at the hospital that could be utilized to strengthen the capacity of HCP to integrate COVID-19 and TB screening. The barriers included HCP's inadequate knowledge on how to integrate screening of COVID-19 and TB, the absence of simple easy-to-use standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), understaffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. CONCLUSIONS These findings provided a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19. Future studies should evaluate the effect of addressing these barriers to the integration of COVID-19 and TB as well as the effect of this on TB case finding in high-burden TB settings.
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Affiliation(s)
- Fred C. Semitala
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rodgers Katwesigye
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Dennis Kalibbala
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Mary Mbuliro
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Rejani Lalitha
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Darius Owachi
- grid.513250.0Kiruddu National Referral Hospital, Kampala, Uganda
| | - Edgar Atine
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Josephine Nassazi
- grid.11194.3c0000 0004 0620 0548Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - Stavia Turyahabwe
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
| | - Moorine Sekadde
- grid.415705.2Ministry of Health Uganda, National Tuberculosis and Leprosy Program, Kampala, Uganda
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Semitala FC, Katwesigye R, Kalibbala D, Mbuliro M, Opio R, Owachi D, Atine E, Nassazi J, Turyahabwe S, Sekadde M. Integration of COVID-19 and TB screening in Kampala, Uganda - Healthcare provider perspectives. RESEARCH SQUARE 2022:rs.3.rs-1448831. [PMID: 35702151 PMCID: PMC9196119 DOI: 10.21203/rs.3.rs-1448831/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Following the first wave of COVID-19 outbreak, Uganda experienced a 40% drop in Tuberculosis (TB) screening by June 2020. We sought to identify barriers to and facilitators of integrated COVID-19 and TB screening from the perspective of healthcare providers (HCP) at a National Referral Hospital in Kampala, Uganda. Design/Methods: We conducted a cross sectional study using in-depth interviews with 12 HCP involved in TB activities in the outpatient and emergency departments at Kiruddu National Referral hospital Kampala, Uganda. We explored the HCP experiences at work in the setting of COVID-19, HCP perceived effect of COVID-19 on TB screening activities at the Hospital, and perceptions about social and contextual factors that might influence the willingness of HCP to integrate screening of COVID-19 and TB. We analyzed the data using an inductive thematic approach and the emergent themes were denoted as barriers to and facilitators of COVID-19-TB integrated screening. We then mapped the themes to the Capability, Opportunity, Motivation and Behavior (COM-B) model. Results: The facilitators to integrated COVID-19 and TB screening included; HCP knowledge of how to separately screen for TB and COVID-19, availability of TB focal persons and interest in learning how to provide integrated screening for TB and COVID-19. The barriers included; HCP inadequate knowledge on how to integrate screening of TB and COVID-19, absence of simple standard operating procedures and data collection tools for integrated screening, inconsistent supply of personal protective equipment (PPE), under staffing, and fear of contracting COVID-19 infection. The identified intervention functions to address the facilitators or barriers included education, persuasion, enablement, and training. Conclusions: These findings provide a basis for designing contextually appropriate interventions targeting factors that are likely to influence HCP decisions and willingness to conduct TB screening in the context of COVID-19.
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Affiliation(s)
| | | | | | | | - Rejani Opio
- Makerere University Faculty of Medicine: Makerere University College of Health Sciences
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Leggat PA, Frean J, Blumberg L. COVID-19: Current Challenges and Future Perspectives. Trop Med Infect Dis 2022; 7:tropicalmed7020016. [PMID: 35202212 PMCID: PMC8879616 DOI: 10.3390/tropicalmed7020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Peter A. Leggat
- World Health Organization Collaborating Centre for Vector-borne and Neglected Tropical Diseases, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Correspondence: ; Tel.: +61-7-4781-6108
| | - John Frean
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (J.F.); (L.B.)
| | - Lucille Blumberg
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (J.F.); (L.B.)
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