The experience of implementing a 'TB village' for a pastoralist population in Cherrati, Ethiopia

Medical Department, Médecins Sans Frontières, Operational Centre Brussels MSF-Luxembourg, Luxembourg.
The International Journal of Tuberculosis and Lung Disease (Impact Factor: 2.32). 10/2011; 15(10):1367-72. DOI: 10.5588/ijtld.10.0751
Source: PubMed


In Cherrati District, Somali Regional State (SRS), Ethiopia, despite a high burden of tuberculosis (TB), TB control activities are virtually absent. The majority of the population is pastoralist with a mobile lifestyle. TB care and treatment were offered using a 'TB village' approach that included traditional style residential care, community empowerment and awareness raising, provision of essential social amenities and essential food and non-food items.
To describe 1) key aspects of the implementation of the TB village approach, 2) TB treatment outcomes and 3) the lessons learnt during implementation.
Descriptive study.
A total of 297 patients entered the TB village between September 2006 and October 2008; 271 (91%) patients were treated successfully, nine (3%) defaulted and 13 (4%) died.
For pastoralist populations, a TB village approach may be effective for improving access to TB care, ensuring proper adherence to treatment and achieving good overall TB outcomes. The successes and challenges of this approach are discussed.

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Available from: Latifa Ayada, Aug 21, 2015
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    • "A study on quality of TB care in selected health facilities of the present study area also showed poor staffing qualities, weak patterns of supervision of patients and dissatisfaction of patients with the adequacy of working hours and waiting time [49]. Hence, designing a special treatment strategy applicable to the nomadic mode of life, like involving mobile nomadic community health workers and/ or initiating a TB village approach and appropriate advice would help TB patients stick to their prescribed treatment in the present study area as reported from elsewhere [50]. Use of integrated screening methods (questionnaire, chest radiography, sputum smear microscopy, and sputum culture) in a population-based survey of active TB case detection would maximize the accuracy of determining TB prevalence in that study population [51]. "
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    ABSTRACT: Background: Information on the community-based prevalence of tuberculosis (TB) in different settings is vital for planning, execution and evaluation of strategies to control the disease. Objective: To assess community-based prevalence of undetected active pulmonary TB (PTB) in pastoralists of the Amibara District. Methods: BetweenMarch and April 2010, a community-based cross-sectional survey of undiagnosed active PTB was conducted in the pastoralists of the Amibara District of the Afar Region, north-east Ethiopia. The study participants were interviewed for symptoms suggestive of PTB using a structured questionnaire. Sputum samples were collected and processed for smear microscopy and culture. Mycobacterium genus typing was performed using a multiplex polymerase chain reaction (PCR). Results: Out of 222 individuals who had symptoms suggestive of PTB, 4 (1.8%) were found positive by smear microscopy, while mycobacterial growth was observed on 62 (27.9%) samples. Mycobacterium genus typing was carried out for 42 of these 62 samples; 39 (92.9%) gave a positive signal for the genus Mycobacterium. Of these, 23 (59%) isolates proved to bemembers of the Mycobacterium tuberculosis (Mtb) complex, while the remaining 16 (41.0%) were found to be members of non-tuberculous Mycobacteria (NTM) species. Conclusion: Sputumculture is highly sensitive, and it is the gold standard for the bacteriological diagnosis of PTB, while smear microscopy is less sensitive to detect acid fast bacilli (AFB) in stained sputum smears. The findings of the present study warrant the strengthening of culture facility services in the study area. The study also provides important preliminary information on the status of NTM infection in the pastoral setting. Nevertheless, further investigations into the species identification of the NTM infections would be useful in the study area.
    Full-text · Article · Apr 2013 · International Journal of Mycobacteriology

  • No preview · Article · Oct 2012 · The International Journal of Tuberculosis and Lung Disease
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    ABSTRACT: Objective: To assess the number of sputum specimens necessary for a reliable diagnosis of pulmonary tuberculosis (PTB) in a pastoralist population in Ethiopia. Method: Using routine data from Ethiopia, where three sputum specimens are currently recommended for the diagnosis of PTB, we documented, (i) the proportion of persons with suspected, PTB who submitted a first, second and third sputum specimen for smear examination and (ii) the incremental smear-positive yield from the first, to the second and third specimens. Results: Of 505 persons with suspected PTB, 107 (22%) failed to submit three samples. Of 60 patients who submitted three sputum samples with at least one smear-positive sample, the first sputum sample was smear positive in 56 (93%) cases; the second sputum sample was the first to be positive in 3 (5%) cases and in only one case was the third sample the first to be smear positive (additional yield 2%). Conclusion: In a pastoralist setting, a reliable diagnosis of PTB can be achieved with two sputum specimens and PTB diagnosis may be adequate with just one sputum specimen. However, if this more radical approach was adopted, ways of increasing diagnostic sensitivity should be explored.
    No preview · Article · Feb 2013 · Tropical Medicine & International Health
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