To evaluate the effectiveness of some intervention methods in pulmonary tuberculosis detection in Namdinh province from 2013 to 2014. Methods: To evaluate the effectiveness of community interventions, use retrospective data and cross-sectional investigations before and after intervention.
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THE EFFECTIVENESS OF INTERVENTION METHODS IN PULMONARY TUBERCULOSIS DETECTION IN NAMDINH
PROVINCE FROM 2013 TO 2014
Nguyen Dinh Tuan 1 ; Nguyen Viet Nhung 1 ; Le Van Bao 2
SUMMARY
Objectives: To evaluate the effectiveness of some intervention methods in pulmonary tuberculosis detection in Namdinh province from 2013 to 2014 Methods: To evaluate the effectiveness of community interventions, use retrospective data and cross-sectional investigations before and after intervention Results: After intervention, the awareness of patients about tuberculosis such as symptoms, causes, transmission and prevention measures was higher than before the intervention Behavior of seeking medical services and practicing early detection examination of patients had changed beneficially such as increasing in searching for medical services at district general hospital and Namdinh Lung Hospital, reducing in searching for medical services in private health facilities The time to detect the disease earlier, with the average time decreased from 1.27 months before the intervention to 0.64 month The rate of detection of pulmonary tuberculosis/100,000 people increased by 14.1% compared to before the intervention Conclusions: The public - private mix model in tuberculosis control helped to increase the detection rate of pulmonary tuberculosis and early detection of tuberculosis
* Keywords: Pulmonary tuberculosis; Tuberculosis detection; Public - private mix model; Namdinh province
INTRODUCTION
Detecting and curing all cases of
tuberculosis (TB) in the community is an
effective way to control and end up for TB
Since 1995, Vietnam National TB Program
developed targets for detecting at least
70% of AFB (+) TB patients in the
community and curing 85% of detected
TB cases [1] When these two targets are
reached, the new incidence of TB cases
will decrease by an average of 5 - 10%
per year [7] According to the report of the
National TB Control Program (2013), the
TB detection rate in our country was estimated at 76% [2, 8] Thus, there are still 24% of TB cases not detected, who live everywhere in rural and remote areas, where are difficult for the patients to access medical services The National
TB Control Program has applied many interventions to increase TB detection rates [3] In 2013, the model of public - private mix in the control of TB was piloted in 4 districts of Namdinh province
1 National Lung Hospital
2 Vietnam Military Medical University
Corresponding author: Nguyen Dinh Tuan (nguyendinhtuan05@gmail.com)
Date received: 02/07/2019
Date accepted: 05/08/2019
Trang 2in order to increase the rate of detection
and early detection of TB through training
knowledge of TB and respiratory disease
for grassroots health staff, mobilizing the
participation of public - private health
workers to control TB, communication on TB
and respiratory diseases in the community
[4] Our study aimed: Determining the
detection rate and time of detection of
pulmonary TB before and after intervention
(2013 - 2014); comparing the effectiveness
of pulmonary TB detection before and
after intervention
SUBJECTS AND METHODS
1 Subjects
Pulmonary TB patients before and after
intervention (2013 - 2014)
2 Methods
- Community intervention study:
Retrospective data on pulmonary TB
detection, cross-sectional investigation
before and after intervention, assessment
of intervention effectiveness
- Sample size of pre-intervention study
(2013) is the sample size of descriptive
study:
[5]
In which:
+ n: Minimum sample size
+ Z(1- ∝/2): Reliability, with probability
95%, Z(1- ∝/2) = 1.96
+ p: The rate of TB patients delayed in
detecting ≥ 1 month; p = 0.76 [6]
+ q = 1 - p = 0.24
+ d: Tolerance at 5% (d = 0.05)
Sample size was calculated n = 281 However, the sample size in the study was all pulmonary TB patients registered treatment in 4 studying districts in 2013 The actual sample size in the study was
341 pulmonary TB patients
- Sample size after intervention (2014) determined by the formula:
In which:
+ n: Minimum sample size
+ Z(1- ∝/2): Reliability, with probability 95%,
Z(1- ∝/2) =1.96
+ p1: The rate of TB patients delayed in detecting (≥ 1 month), p1 = 0.77 (results from previous research)
+ p2: The percentage of patients delayed
in detecting after intervention, with the desire to reduce 20%, then p2 = 0.57 + z1-β: The force factor (sample force 90%), z1-β = 1.28
+ P: Average rate (p1 + p2)/2
Replace the calculated number, n =
114 is the minimum sample size
However, the sample size in the study was the entire sample of registered pulmonary TB patients in 2014 The actual sample size in the study was 381 pulmonary TB
- Research locations: 4 districts (Xuantruong, Nghiahung, Giaothuy and Trucninh of Namdinh province)
- Intervention method: Training to
improve knowledge about TB and respiratory disease for public - private
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health staff at the grassroots level,
mobilizing their participation in counseling
and transferring TB suspects to district
general hospital to examine health and
detect TB, communication about TB and
respiratory diseases in the community
- Evaluate the effectiveness of intervention:
Based on efficiency index (EI)
EI (%) = (p1 - p2)/p2 x 100
In which: p1: The rate before intervention;
p2: The rate after intervention
- Data processing and analysis: Data from the reports were aggregated statistics
on Excel operating system The data collected from the questionnaires were entered on the computer using the Epi.info 6.04 software; data analysis by Epidata Analysis v2.2.3.187 software Using algorithms to test two observation rates with Stata software 14.0: Compare the two ratios of two independent samples with the algorithm χ2 Using t-test to test quantitative variable averages
RESULTS AND DISCUSSION
1 Improving knowledge of patients on TB
Table 1: Knowledge of symptoms, causes, prevention of TB
Before intervention (n = 341)
After intervention (n =381) Content
(%)
The main route of infection is the
Early examination when there are
152.
9
(*: Test x 2 for the rate)
After the intervention, the patients had a change in knowledge about TB Knowledge about the symptoms of the disease, the causes of disease and the transmission way of disease all increased In addition, knowledge about TB prevention such as "vaccination for TB prevention" and "examination for early detection when there are suspected signs
of TB" was also higher than before intervention with EI 94.2% and 152.9%, respectively
Trang 42 Change in behavior, habits of seeking medical services of patients
Table 2: The place to find medical services when symptoms first appear
Before intervention (n = 341)
After intervention (n = 381) The place to choose health
services
(%)
(*: Test x 2 for the rate)
Many studies have shown factors related to delays in the TB detection of patients such as low levels of education, living in remote areas, the habit of seeking private health services when they first appear signs of disease [9, 10] After the intervention, the behavior of seeking medical services had changed, increasing the search for medical services in the district general hospital and the provincial lung hospital, reducing the search for health services in private health facilities The behavior of seeking medical services of patients had a positive change, which will help patients
practice in early detection examination
3 Practice medical examinations early to detect the disease
Table 3: Disease detection time
Before intervention (n = 341)
After intervention (n = 381) Disease detection time
(%)
Giaothuy
Trucninh
Nghiahung
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Xuantruong
< 0.05
8.1
Total in 4
districts
< 0.001
-26.5
(*: Test ttest for averages and test x 2 for the rate)
After the intervention, patients were diagnosed early with the detection time (average) decreased from 1.27 months before intervention to 0.64 month In particular, the rate of patients who detected diseases early < 1 month increased from 22.9% before intervention to 43.3%, with EI reaching 89.3% and the detection time ≥ 1 month decreased from 77.1% before the intervention to 56.7%, EI reached 26.5% and statistically significant (p < 0.001) Our study had much shorter detection time in comparison to the research results of Nguyen Thien Huong (2007) (a time delay of 7.5 weeks), and Trinh Huu Hung’s (2008) (a time delay of detection was 7.42 weeks)
4 Increasing in detection rate of pulmonary TB
Table 4: Detection rate of pulmonary TB/100,000 people
Before intervention (n = 343)
After intervention (n = 395)
(%) District
Trang 6Population 192,699 201,903
Total in 4
districts
(*: Test x 2 for the rate)
Detection of pulmonary TB was analyzed
in two areas including: (1) The total number
of detected pulmonary TB cases (including
the number of pulmonary TB patients
detected at the district and the other
areas to be transferred); (2) The number
of pulmonary TB patients detected in the
district (the districts detected it itself)
Before the intervention, the total number
of pulmonary TB patients detected was
343 cases, corresponding to the rate of
46.0/100,000 people After the intervention,
the total number of detected pulmonary
TB cases increased to 395 cases,
corresponding to the detection rate of
52.5/100,000 people, EI reached 14.1%
The number of pulmonary TB cases
detected in the pre-intervention district
was 183 cases, corresponding to the
detection rate of 24.6/100,000 people
After the intervention, the number of
detected pulmonary TB cases in the
district increased to 273 cases,
corresponding to the rate of 36.3/100,000
people, EI reached 47.7% Thus, the
intervention measures has helped increase
the detection rate of pulmonary TB to
14.1% (total) and especially increase the detection rate of pulmonary TB in the district to 47.7% compared to before intervention
CONCLUSION
Implementing intervention activities of the public - private mix model in the TB control, has helped increase detection rate and detection of TB early After the intervention, the detection rate of pulmonary TB/100,000 people increased by 14.1%,
in which the detection rate at the district increased by 47.7% compared to before the intervention The time of detecting disease (average) decreased from 1.27 months before intervention to 0.64 month,
in which the detection rate < 1 month increased from 22.9% before intervention
to 43.3%, EI reached 89.3%
RECOMMENDATIONS
Continue to implement and expand the intervention model public - private mix in
TB control, assess its effectiveness in different localities to serve as a basis for
expanding this model to nationwide
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REFERENCES
1 Ministry of Health - National TB Program
The path of national TB program - Guidelines
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2009, pp.33-42
2 Ministry of Health - National TB
Program Summary report on TB control
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4 Ministry of Health - National TB Program
Guidelines for coordination between health
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5 Military Medical Academy Basic
Epidemiology People's Army Publishing
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6 Trinh Huu Hung Studying the delay in
access to health services of AFB (+) pulmonary tuberculosis patients and intervention solutions Doctoral thesis - Central Institute of Hygiene and Epidemiology 2011, p.71, 90, 118
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Delays in the diagnosis and treatment of TB patients in Vietnam BMC Public Health 2007, pp.41-54
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Socio-economic, gender and health services factors affecting diagnostic delay for TB patients in urban Zambia Tropical Medicine and International Health 2001, 6 (4), pp.256-259