Acceptability and Effectiveness of the Storekeeper-Based TB Referral System for TB Suspects in Sub-Districts of Lilongwe in Malawi

Simwaka, Bertha Nhlema, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, Willets, Annie, Salaniponi, Felix M. L., Nkhonjera, Patnice, Bello, George and Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2012) 'Acceptability and Effectiveness of the Storekeeper-Based TB Referral System for TB Suspects in Sub-Districts of Lilongwe in Malawi'. PLoS ONE, Vol 7, Issue 9, e39746.

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Abstract

Background
Early access to tuberculosis diagnosis and treatment remains a challenge in developing countries. General use of informal providers such as storekeepers is common. The aim of this study was to determine the effectiveness and acceptability of a storekeeper-based referral system for TB suspects in urban settings of Lilongwe, Malawi.

Methods
The referral system intervention was implemented in two sub-districts. This was evaluated using a pre and post comparison as well as comparison with a third sub-district designated as the control. The intervention included training of storekeepers to detect and refer clients with chronic cough using predesigned referral letters along with monitoring and supervision. Data from a community based chronic cough survey and an audit of health centre records were used to measure its effectiveness. Focus group discussions and in-depth interviews were carried out to document acceptability of the intervention with the different stakeholders.

Results
Following the intervention, the mean patient delay appeared lower in the intervention than comparison areas (2.14 weeks (SD 5.8) vs 8.8 weeks (SD 15.1)). However, after adjusting for confounding variables this difference was not significant (p = 0.07). After the intervention the proportion of the population diagnosed with smear positive TB in the intervention sites (1.2 per 1000) was significantly higher than in the comparison area (0.6 per 1000, p<0.01) even after adjusting for sex and age. Qualitative findings suggested that (a) the referral letters triggered health workers to ask patients to submit sputum for TB diagnosis (b) the approach may be sustainable as the referral role was linked to the livelihood of the storekeepers.

Conclusion
The study suggests that the referral system with storekeepers is sustainable and effective in increasing smear positive TB case notification. Studies that assess this approach for control of other diseases along with collection of specimens by storekeepers or similar providers are needed.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis WF Respiratory System > Tuberculosis > WF 310 Therapy WX Hospitals and Other Health Facilities > Hospital Administration > WX 173 Medical records
Faculty: Department:	Groups (2002 - 2012) > Clinical Group Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pone.0039746
Depositing User:	Martin Chapman
Date Deposited:	16 Dec 2014 15:11
Last Modified:	13 Nov 2019 11:22
URI:	https://archive.lstmed.ac.uk/id/eprint/4676

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