Aspects of tuberculosis control: community based case-finding in a Kenyan rural location
Abstract
Tuberculosis control measures are time-honoured.
They are:- Case-finding plus Chemotherapy, BCG Immunization,
Chemoprophylaxis and Health Education. Of these
measures, the most effective in reducing the disease
incidence and prevalence is Case-finding plus Chemotherapy.
Despite availability of the knowledge of tuberculosis
control "tools", the disease is still a major public
health problem especially in developing countries. Only
about a third of the actual cases in the communities are
diagnosed and treated, rather late, in most less
advanced nations.
In Kenya, the most commonly used tuberculosis casefinding
method is passive screening of symptomatic
persons presenting themselves mainly at the hospital
outpatient departments. Investigations have been done
to broaden the scope of case-finding by actively fetching
out suspects from communities. These studies, however,
yielded disappointing results.
This survey aimed at determining BCG coverage among
school children, some sociocultural factors that may
influence tuberculosis control in a rural community and
also the feasibility of using primary school pupils in
active case-finding in such a community.
The research was carried out in Koibarak Location,
with an approximated population of 9,850, in Elgeyo
Marakwet District. The district has an estimated .
tuberculosis incidence of 350 per 100,000 population.
The investigation was undertaken from November, 1987
to April, 1988 in two phases: Community Elders interview
and Primary School visits.
A total of 85 elders from the location and 892
upper primary school pupils from all the 14 schools
with upper classes, were interviewed.
All the elders and 91% of pupils were consciously
aware of tuberculosis as a problem. About 97% and 65%
of elders and pupils respectively had knowledge of signs
and symptoms of the disease. Both elders and pupils
displayed knowledge gaps in their understanding of
tuberculosis cause, transmission and treatment. A health
education programme carried out in the 'atmosphere' of
a well understood sociocultural aspects of the people's
life related to the disease is expected to fill these
gaps.
A The study revealetl that a high proportion of
respondents knew of traditional methods of treating
tuberculosis. The efficacy of these methods need to
be studied further and evaluated.
A majority of elders (62.4%) did not feel that
tuberculosis patients were dangerous to contacts as
opposed to 81% of pupils who felt they were dangerous
and preferred their total isolation from healthy persons.
This tuberculosis stigma among the respondents demonstrated
a statistically significant association with
their educational status, but not with their age nor
sex.
On inspection for BCG Scar, a total of 1376 pupils
(37.1%) had no scars. This gave an estimated immunization
coverage of about 62.9% among the primary, school children.
All those without scars were given BCG vaccination by
the field team.
Following a tuberculosis health education, the pupils
identified 63 suspects out of whom 55 produced sputum
for analysis. Confirmed tuberculosis cases by smear
were 5, giving a case yield of 9.1%. This method
identified over 70% of the estimated smear positive
tuberculosis incidence in the location.
Although the population studied is small, this
method shows great potential for case-finding in Kenya
particularly as a supplement to the passive case-finding
approach at health institutions. Further studies on
larger communities are however recommended to validate
the efficacy of this approach.
Citation
Degree of Master of Public Health (M.P.H) At the University Of Nairobi.Publisher
School of Medicine
Description
A thesis submitted in part fulfillment for the
Degree of Master of Public Health (M.P.H) At
the University Of Nairobi