An Evaluation of the Intensified TB Case Finding in Ten Selected Health Facilities within the Greater Accra Region

Abstract

Background TB is one of the dominant and devastating infection that affects over a quarter of human population especially the poor and vulnerable. The disease is endemic in developing countries including Ghana. A lot more cases are being missed annually and passive case detection has not improved TB case detection. However, implementation of intensive TB case finding among others has been documented to detect more cases. Low case detection has been a precedence in Ghana’s NTP’s Health Sector Strategic Plan, 2009–2013. The devastating issue of little or no TB case detection has persisted over the years till the introduction of ICF in 2015 which became more functional in 2016. As a rejoinder to the problem, the ministry of health (MOH) and the Ghana Health Service (GHS), approved intensified TB case finding as a response to low TB case detection. Two years back before the commencement of ICF, WHO reported that Ghana detects only 33% of its TB cases (WHO, 2015) which was fine underneath the 47% of the African regional normal rate and the WHO projection of 70%. The aim of this study is to evaluate the Implementation of the intensive TB case finding intervention to promote TB case detection in public health facilities in Greater Accra region. Methods A cross sectional study was conducted among health workers within ten selected health facilities in Greater Accra Region. Questionnaire were administered to health workers to evaluate their knowledge and compliance level to the implementation process and in-depth interviews conducted amongst them to determine the challenges experienced in carrying out ICF. Records were reviewed from 2016 to 2018 three years after program intervention to determine TB cases detected within that period when the intervention was in progress. Results Results from the study showed that, 76% of care givers had moderate knowledge in ICF whiles 24% had high knowledge in ICF and none had low knowledge. The Greater Accra Regional Hospital had the highest number of suspected cases screened for TB whilst the Ga East Municipal Hospital had the least. Most of the facilities had high number of TB cases detected between the periods 2016 to 2018. Apart from Ga South Municipal Hospital and Achimota Government Hospital that had a normal increasing trend of TB cases detected, the rest of the facilities, experienced a decrease and an unsteady trend in the number of TB cases from 2016 to 2018. With regards to compliance, 28(56%) of the health staffs were complying with ICF whilst 22(44%) of the health staff were noncompliant to ICF. The level of compliance of the health workers were significantly associated with age (p-0.026), the cadre of the health personnel (p<0.001), and their level of knowledge (p-0.013). Conclusion More than half of health workers are compliant to ICF protocol. Majority of health facilities compliant to ICF, are hospitals. Some of the facilities experienced increasing trends of TB cases detected whiles others experienced an unsteady trend.