Project Lead(s): Francis Mhimbira
Tanzania has been identified by the World Health Organization as one of 30 countries with a high tuberculosis (TB) burden. The recent First National TB survey showed a low case detection rate (50%).
Individuals who develop respiratory symptoms, especially a cough, are known to buy antibiotics from pharmacies for relief of their symptoms. Some of these patients with respiratory symptoms, also known as presumptive tuberculosis (TB) patients, may be suffering from TB.
Since antibiotics available at these pharmacies are ineffective against treating TB, these presumptive TB patients pose a risk to transmit TB to family members or the community.
This project aimed to encourage pharmacists and pharmacy staff from Buguruni, Ilala district, and Dar es Salaam to refer patients with respiratory symptoms to the Buguruni Health Center for appropriate investigation and treatment of TB.
Reported symptoms and antibiotics purchased were recorded at the pharmacies, and individuals were then referred to a clinician at the centre for examination.
Anonymous referral cards were given and automatic follow-up SMSs reminders were sent to customers who did not report to Buguruni Health Center within three and six days.
A diagnosis of TB was made by a positive sputum smear microscopy, chest x-ray, GeneXpert and/or clinical signs of TB, according to a routine diagnostic algorithm. All patients diagnosed with TB were treated in accordance with the TB treatment guideline of National TB and Leprosy Programme (NTLP).
The six pharmacies involved in the project referred a total of 1,656 presumptive TB patients representing 97% of all potential patients.
TB investigations were done in 1,233 (76.6%) of cases and 113 (9%) of these individuals were diagnosed with TB.
TB patients who were diagnosed through the referral in the pharmacies had a slightly shorter duration of symptoms in weeks (e.g., cough symptom duration was 16 weeks for pharmacy referrals compared to 50 weeks for routinely-diagnosed TB patients) compared to patients diagnosed directly at the health centre, suggesting that TB could be diagnosed earlier with intervention at the pharmacies.
Information about the project has been disseminated through conference presentations and publications.
In collaboration with John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the data obtained from the project will aid in modelling the reduction in transmission if scaled-up nationwide.