Assessment of Household Contact Investigation for Tuberculosis; A Case Study of Bongo District, Upper East Region.

Abstract

Background: Globally, Tuberculosis, caused by Mycobacterium Tuberculosis is still considered as an infectious disease with great public health concern especially in low- and middle-income countries. An estimated 10 million people worldwide fell ill with Tuberculosis in 2020. This included an estimated 44,000 people who developed TB in Ghana. A second national TB prevalence survey conducted in Ghana in 2013 revealed that the disease burden was four times higher than the estimation made by the WHO thus 290 cases per 100,000 population instead of 71 cases per 100,000 population. The main objective of this study is to evaluate TB contact investigation process, its impact on case notification and its implementation challenges in the Bongo District of the Upper East Region. Methodology/Design: Mixed qualitative and quantitative methods were used to conduct an observational and cross-sectional study. Records of 46 Bacteriologically Confirmed Index TB Cases tested between March to June 2022 in the Bongo district were reviewed and evaluated for Household Contact Investigation. One focus group discussion was conducted to determine the challenges associated with household contact investigation. Participants included 7 health workers directly involved in household contact investigation. Results: A total of 261 close household contacts were identified and screened for TB across the six sub-districts in the Bongo District. Out of this number, 94 of the contacts had presumptive TB but only 55 of them were able to produce sputum samples for test. Seven samples were rejected due to insufficient quantity and poor quality. The remaining 48 samples were tested using Gene Xpert Machine during which 4 new TB cases were detected. Sixty-five (65) contacts were needed to be screened to detect a positive case while 12 samples were needed to be tested to detect a positive case. Twenty-seven contacts were initiated on Isoniazid to prevent them from developing active TB. Household contact investigation challenges identified in this study are inadequate number of trained health workers for TB household contact investigation, limited means of transport and fuel, periodic shortage of sputum containers, TB screening tools and laboratory request forms, inability of some presumed TB contacts to produce sputum for examination, delay in receiving test results caused by periodic shortage of Gene Xpert Cartridges, limited number staff assigned for sputum examination and fear of stigma and discrimination. Conclusion: Health workers in the Bongo District abide by international protocols when conducting household contact investigation. This study further confirms the impact of household contact investigation in TB case detection however, there is the need for a multi-level stakeholder engagement at all levels to address the numerous challenges facing household contact investigation in Ghana.