Acta Scientific Medical Sciences (ASMS) (ISSN: 2582-0931)

Research Article Volume 5 Issue 4

Factors Influencing Tuberculosis Case Detection in Wenchi Municipality, Brong Ahafo Region, Ghana

Agyemang George1, Dery Bede2* and Seth Yao Ahiabor1

1School of Public Health, University of Health and Allied Sciences, Ghana
2State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi City, Jiangsu Province, China

*Corresponding Author: Dery Bede, State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi City, Jiangsu Province, China.

Received: December 08, 2020; Published: March 05, 2021

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Abstract

Objective: This study aimed to assess factors influencing Tuberculosis case detection in the Wenchi municipality of Brong Ahafo Region of Ghana.

Study design/Method: Cross-Sectional descriptive study design was used for the study. A structured and unstructured questionnaire was administered to three different groups of respondents; 350 community members, thirty (30) health workers and 20 registered TB patients for the last three months prior to this study. Quantitative data was analyzed using Statistical Package for Social Science (SPSS) software 20.0.

Results: Over 50% of all the three groups studied have some knowledge on how TB disease can be transmitted however most of the TB patients (55%) were unaware of TB before they were diagnosed. Moreover, financial challenges, inadequate and centralized diagnostic centers were barrier to TB case detection.

Conclusion: The overall knowledge level of the community’s respondents regarding TB was low (60.3%). Gender and education were the only important predictor for respondents’ knowledge (χ2 = 14.692, P < 0.000, ᾳ = 0.05) and (χ2 = 62.004, P < 0.000, ᾳ = 0.05) respectively. Stigma against TB clients and their relatives, inadequate diagnostic facility are some of the factors that influence TB case detection. Therefore, the need for community sensitization on TB and also expand laboratory facilities to other periphery facilities could not be overemphasized as this greatly affects TB case detection.

Keywords: Tuberculosis; Tuberculosis Detection; Community Sensitization; Human Immune Virus

Introduction

   Tuberculosis is one of the top 10 causes of death and a leading cause from a single infectious agent [1]. According to WHO, African Region has the highest rates of TB cases and deaths per capital [2]. Sub-Saharan Africa accounts for approximately 80% of the world's TB/HIV co-infection cases [3]. Ghana is ranked 38th high burden TB country among 145 countries in the world and 19th in Africa [4]. It is estimated that about 7% of all deaths in the country are attributed to TB and HIV, the second after malaria [5]. The world health organization (WHO) estimates that Ghana is detecting only 26% of all forms of TB and 36% of smear-positive TB cases. This is well below the African regional average rate of 47% and the WHO target of 70% [6]. The goals of the tuberculosis alleviation strategy were to detect at least 70% of expected TB cases, successfully treat 85% of these cases by 2005. The WHO target is for 85% of TB to be successfully treated in Ghana by 2005 [7]. The notification data show a decline of the number of cases notified over the years, for instance, 14,632 cases (all forms) were detected in 2015. Brong Ahafo annual regional TB report (2018) indicates that detection rate of Tuberculosis (TB) for the region has gone down. The region recorded a detection rates of 51% in 2014 and a stagnant 34% rate for three consecutive years [8].

Methods

Design

  Community and health facility-based descriptive cross-sectional study were carried out in Wenchi municipality in the Brong Ahafo region of Ghana. The study aims at describing the relationship between diseases (or other health-related states) or condition, and potentially related factors influencing TB case detection. It is also used to assess prevalence of acute or chronic conditions or the result of medical intervention. The community level data collection focused on members in the community using a semi-structured questionnaire.

Study material

  The study comprises of 350 community members, health workers and TB patients registered in the last three months. Training was given to all the team members to help them understand the nature, purpose, and procedures for the study. The questions were interpreted in the Twi language to the respondents who don't understand the English language. Their responses were translated into English to complete the questionnaire for analysis. The items were pretested at Ampenkro-a nearby village because they have similar characteristics to the target population.

Data analysis

  The data was cross-checked before entry into Statistical Package for the Social Sciences, (SPSS) version 20.0. Core indicators and prevalence were expressed in percentages. The entered data were validated (pre-analyzed) to ensure quality before the actual analysis was done. Descriptive statistics such as proportions, mean, standard deviation, frequencies were used to analyze the data and findings summarized.

Results

Community-related factors Socio-demographic characteristic of respondents

  A total of 350 community members were enrolled in the study consisting of 185 (52.9%) females and 168 (47.1%) males. Most of the respondents 168(48.0%) were married, 142 (40.6%) were single. Majority of them 246(70.3%) were Christians, 89(25.4%) were Muslims while 15(4.3%) were traditionalist.

Variables Frequency Percent

N = 350

Age group

> 30yrs

166

47.4

30-39yrs

81

23.1

40-49yrs

51

14.6

50-59yrs

22

6.3

60yrs +

30

8.6

Total

350

100

Sex

Female

185

52.9

Male

165

47.1

Total

350

100

Marital

cohabitation

5

1.4

divorced

25

7.1

married

168

48.0

single

142

40.6

widowed

10

2.9

Total

350

100

Education

JHS

76

21.7

none

64

18.3

primary

51

14.6

SHS/TEC/VOC

79

22.6

Tertiary

80

22.9

Total

350

100

Variables

Frequency

Percent

Ethnicity

Banda

44

12.6

Bator

10

2.9

Bono

172

49.1

Other northern tribes

124

35.4

Total

350

100

Occupation

Artisan

15

4.3

Farmer

126

36.0

government worker

47

13.4

housewife

2

.6

Other (watchman)

1

.3

Pensioner

3

.9

Student

66

18.9

Trader/ self employed

74

21.1

unemployed

16

4.6

Total

350

100

Religion

Christian

246

70.3

Muslim

89

25.4

Traditionalist

15

4.3

Total

350

100

Table 1: Socio-demographic characteristics of the community’s respondents.

Community respondent’s knowledge about tuberculosis

  Out of the 350 respondents, 182 (52.0%) knew TB is caused by a germ, 69(19.7%) said TB was as a result of bad air. A majority (290; 82.9%) of the respondents knew that TB is transmitted from one person to the other through coughing. Most, 275 (78.65%) knew cough to be a symptoms/sign of TB.

Variable

Frequency

Percent

N = 350

Heard of TB (information on TB)

No

43

12.3

Yes

307

87.7

Total

350

100

Causes

Bad air

69

19.7

Curse

27

7.7

Don't know

49

14.0

Germs

182

52.0

Rain

2

.6

Sunshine

4

1.1

Witches

17

4.9

Total

350

100

Transmission mode

No

14

4.0

No Idea

54

15.4

Yes

282

80.6

Total

350

100

Mode of transmission

Cough/ sneezes from an infected person

290

82.9

Eating with an infected person

24

6.9

Variable

Frequency

Percent

Other

7

2.0

Sharing cups and with an infected person

12

3.4

Staying with an infected person

11

3.1

Talking with an infected person

6

1.7

Total

350

100

Signs

Chest pains

32

9.1

Cough

275

78.6

Don't know

42

12.0

Other

1

.3

Total

350

100

Outcome

Not curable

90

25.7

Curable

260

74.3

Total

350

100

Source of Treatment

Health facility

282

80.6

Pharmacy

7

2.0

Prayer camps

13

3.7

Traditional healers

48

13.7

Total

350

100

Table 2: Community’s knowledge on tuberculosis.

Figure 1: Overall knowledge level of participants.

  Figure 1, presents the overall level of knowledge of the community members responds on Tuberculosis. Majority of the respondents 211 (60.3%) had low knowledge on Tuberculosis, while 139 (39.7%) respondents have high knowledge on TB.

Variable Level of knowledge Chi-square P-value

(χ2)

Age group

Low knowledge

High

knowledge

8.78

0.067

> 30yrs

90(25.71)

76(21.71)

30-39yrs

47(13.43)

34(9.71)

40-49yrs

36(10.28)

15(4.29)

50-59yrs

16(4.57)

6(1.71)

60yrs +

22(6.29)

8(2.29)

Total

211(60.29)

139(39.71)

Sex

14.692

<0.001

Female

129(36.86)

56(16.00)

Male

82(23.43)

83(23.71)

Total

211(60.29)

139(39.71)

Ethnicity

3.774

0.287

Banda

25(7.14)

19(5.43)

Bator

5(1.23)

5(1.43)

Bono

98(28.00)

74(21.14)

Northern tribe

83(23.71)

41(11.71)

Total

211(60.29)

139(39.71)

Variable

Level of knowledge

Chi-square

P value

Education

62.004

<0.001

JHS

50(14.29)

26(7.42)

non

57(16.29)

7(2.00)

primary

40(11.43)

11(3.14)

SHS/TEC/VOC

35(10.00)

44(12.57)

Tertiary

29(8.29)

51(14.57)

Total

211(60.29)

139(39.71)

Religion

1.697

0.428

Christianity

144(41.14)

102(29.14)

Muslim

56(16.00)

33(9.43)

Traditionalist

11(3.14)

4(1.14)

Total

211(60.29)

139(39.71)

Table 3: Association between the demographic characteristics and the knowledge of respondents.

  The association between respondents’ educational level and sex were found to be statistically significant with their level of knowledge on tuberculosis (χ2 = 62.004, P < 0.000, ᾳ = 0.05) and (χ2 = 14.692, P < 0.000, ᾳ = 0.05) respectively. However, there were no significant association between respondents’ age group, religion and ethnicity (χ2 = 8.780, P > 0.067, ᾳ = 0.05), (χ2 = 1.697, P > 0.428, ᾳ = 0.05) and (χ2 = 3.774, P > 0.287, ᾳ = 0.05) respectively.

Attitude and perception of community members

  Out of 350 respondents, 244(69.7%) did not see it as an embarrassment to have a relative diagnose of TB. One hundred and ninety- three (55.1%) said they would not eat or share utensils with relatives of TB patients.

Variable Frequency Percent

TB causes embarrassment

Don't know

18

5.1

No

244

69.7

Yes

88

25.1

Total

350

100

Stigma

No

269

76.9

Yes

81

23.1

Total

350

100

Eat with a relative of TB patient?

No

193

55.1

Yes

157

44.9

Total

350

100

Travel time/walking time

1hr -2hr

54

15.4

less 1 hr

276

78.9

more than 2hrs

20

5.7

Total

350

100

What experience at the facility

Good

165

47.1

Not good

66

18.9

Variable

Frequency

Percent

Very good

119

34.0

Total

350

100

Cost of transportation

< 10cddis

240

68.6

10-19 cedis

88

25.1

20-29 cedis

9

2.6

30-39 cedis

7

2.0

> 40cedis

6

1.7

Total

350

100

Table 4: Attitude and perception of community members.

Figure 2: Perception of community members about the cause of Tuberculosis.

  In figure 2, Majority 63.0%of the community’s respondents identify superstition as the cause of tuberculosis, seventeen (17.0%) said TB is cause by bad air and 10.0% each for bacteria and hereditary .

Patient-related factors

  Out of the 20 patients interviewed, 6(30.0%) were below the age of 30years, six (30. 0%) were between 30-39years while 8 (40.0) were above.

Knowledge of TB clients on the disease

  Nine (45.0%) respondents were aware of TB before they were diagnosed. Three (15.0%) of the respondents think that TB is caused by witches. 16 (80.0) identified cough/sneezes from an infected person as the mode of spread of TB.

Health seeking behavior of TB clients

  Of the 20 respondents, 10(50.0%) were diagnosed after one month of signs and symptoms. Most of the respondents first visited health facility when they notice their signs and Symptoms.

Variable Frequency Percent

Referred

CBSV

2

10.0

Myself

17

85.0

Other

1

5.0

Total

20

100

Time before diagnosis

After 1 Month

10

50.0

Others

1

5.0

Within 1 Week

9

45.0

Total

20

100

The first facility visited

Chemical Shop

5

25.0

Health Facility

10

50.0

Herbalist

2

10.0

Prayer Camp

3

15.0

Total

20

100

Table 5: Health Seeking Behaviour of TB Clients.

Quality of care rendered to TB patients

  A majority (15; 75.0%) of the respondents made 2-5 visits to health facility/ies before they were diagnosed with TB. Five were diagnosed during their first visit to the facility. Majority of respondents said their community members first visit health facility when they fall sick.

Variable Frequency Percent

Number of visits to health facility before

diagnosis

1 visit

5

25.0

2 - 5 visits

15

75.0

Total

20

100

Transportation Cost

<Ghc10

12

60.0

Ghc10-19

6

30.0

Ghc20-29

1

5.0

Ghc30 +

1

5.0

Total

20

100

Where do the community members seek care

when ill?

Drug store

7

35.0

Health facility

13

65.0

Total

20

100

Does your transport means pose a challenge in

TB care?

No

12

60.0

Yes

8

40.0

Total

20

100

Waiting time at the facility

1hr

4

20.0

30 minutes

16

80.0

Total

20

100

Table 6: Quality of care rendered to TB clients.

Health-related factors

  The health-related factors take into account socio-demographic background, staff knowledge on TB, activities of staff towards TB case detection and challenges. This study also tried to explore the opinions of health care providers on the factors that influence TB case detection in the Wenchi district.

Background and work schedule of health service providers

  The participants were made up of community health nurses, disease control officers, health promotion officers and nurses. The respondents work experience with the TB control program varied from one year to over Ten years.

Knowledge of health care providers on TB

  30(100.0%) reported that TB is caused by Mycobacterium tuberculosis. Majority of respondents knew the cardinal symptoms of TB; cough for more than two weeks. Sixteen (53.3%) said they always refer suspects to the next level, whilst 14(46.7%) always takes the sample to the diagnostic center.

Variable Frequency Percent

Training on TB in the last 3 years?

No

10

33.3

Yes

20

66.7

Total

30

100

What organism causes TB?

Mycobacterium tuberculosis

30

100.0

Total

30

100

What is the cardinal sign of TB

Cough of 2wks or more

24

80.0

Night sweat

6

20.0

Total

30

100

How many minutes/hours’ drive from here to the

diagnostic center.

<30mins

13

43.3

30mins - 1hr

17

56.7

Total

30

100

Table 7: Knowledge of Health Workers on TB.

Staff activities towards TB Case Detection

  Out of the 30 respondents, 21(70.0%) use cough screening tools at the OPD. Sixteen (53.3%) of the respondents said they are motivated whereas 14(46.7%) said they were not motivated.

Variable Frequency Percent

Use of Cough screening tool

No

9

30.0

Yes

21

70.0

Total

30

100

Frequency of TB education

None

6

20.0

Once in a week

15

50.0

Three in a week

3

10.0

Twice in a week

6

20.0

Total

30

100

Itinerary

No

12

40.0

Yes

18

60.0

Total

30

100

Staff motivation

No

14

46.7

Yes

16

53.3

Total

30

100

Table 8: Staff activities towards TB case detection.

Figure 3: Referral point for diagnosing suspected TB cases.

  Majority 28(93.0%) of the health workers refer suspected TB cases to the Methodist Hospital for diagnostic services however 2(7.0%) of the health workers refer suspected cases to the disease control unit.

Challenges face/and appraised by health providers in TB Detections

  Out of the 30 health workers, 70% of the respondents said that there are inadequate diagnostic centers and 40% of the respondents also identify transportation as a challenge. Moreover, 46.7% of the respondents said that Refusal of referred patients to go to lab is their problem whereas 33.3% said that there are inadequate education materials. Also, 53.3% said that there is inadequate staff. In addition, 53.3% identified lack of motivation to health staff as a challenge and 56.7% of the respondents said that they don’t have an itinerary for TB activities for this year. Moreover, 20% said that inadequate knowledge of TB by the community members is their main challenge and 40% mentioned long distance of diagnostic centers as a challenge to them while 16.7% said that lack of sputum containers and other logistics is their main challenge.

Variable n %

Lack of diagnostic centre

21

70.0

Tight Schedule

7

23.3

Refusal of referred patients to go to the lab

14

46.7

Lack of educational material

10

33.3

Delay in receiving laboratory results

6

20.0

Inadequate staff

16

53.3

Lack of motivation to staff

16

53.3

Do you have an itinerary for TB activities for this year?

17

56.7

Are you being motivated to do TB activities

16

53.3

Transportation problem

12

40.0

Poor sputum quality

11

36.7

Lack of sputum containers other logistics

5

16.7

Long distance of diagnostic centers

12

40.0

Inadequate knowledge

6

20.0

Lack of cooperation of prayer camp owners

3

10.0

Table 9: Challenges appraised by staff in TB case detection.

Discussion

Community- related factors affecting tuberculosis detection

  Stigmatization at the community level is high because most of the respondents were unwilling to associate with patients. The community thinks that TB can be transferred by the cough or sneeze from an infected person. In Wenchi, the only diagnostic center is located

Patient-related factors affecting TB case detection

  According to Ladipo (2015), knowledge and perception about Tuberculosis influences care- seeking behavior and consequently TB detection and adherence to treatment [9]. A study conducted in the Sissala East district of the northern region reported varied causes of TB. They found out that TB can be transmitted in various ways including sexual intercourse. Drinking fresh milk from infected animals could also cause it.

  The results from this study also indicate that most of the TB patients were not aware of TB before they were diagnosed and this might have resulted their delay to seek treatment. There is community stigmatization towards people with TB and their relatives.

  Bekana, Sisay and Baye, (2017) identified 'symptoms not severe' (58%) followed by lack of money (32%) and health facility too far (6%) were among the major predictors of patient delay in Ethiopia [10]. The results from the respondents in this research indicate that most of the TB patient had financial challenges especially for transportation to the health care facility .

Health service-related factors affecting Tuberculosis case detection

  Most of the health workers (66.7%) have heard of the national TB programme and have received training on tuberculosis activities in the last three years. More than two-thirds of health workers have not been trained on the NTP. In this study, health workers said that they mostly search for TB cases at the chemical sellers. This research identified shortage of health personnel and also health education is done on face to face basis once in every week. This might contribute to poor and lack of knowledge about the disease and also issues pertaining to the stigmatization against people with TB disease.

Conclusion

  Inadequate diagnostic center (the only diagnostic center is at the district capital), superstition, stigmatization against TB clients and their relatives are some of the factors that influence TB case detection.

Ethical Approval

  Ethical clearance was sort for from the ethical department of University of Health and Allied Sciences.

Funding

None.

Competing Interest

  The authors of this paper declare no conflict of interest.

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References

  1. Daley CLJTsc. “The global fight against tuberculosis”. Thoracic Surgery Clinics1 (2019): 19-25.
  2. Corbett EL., et al. “The growing burden of tuberculosis: global trends and interactions with the HIV epidemic”. Archives of Internal Medicine9 (2003): 1009-1021.
  3. Trinh Q., et al. “Tuberculosis and HIV co-infection—focus on the Asia-Pacific region”. International Journal of Infectious Diseases 32 (2015): 170-178.
  4. Osei E., et al. “Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana”. BMC Public Health1 (2015): 721.
  5. Wang, H., et al. “Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015”. Lancet10053 (2016): 1459-1544.
  6. Afutu F., et al. “High initial default in patients with smear-positive pulmonary tuberculosis at a regional hospital in Accra, Ghana”. Transactions of the Royal Society of Tropical Medicine and Hygiene8 (2012): 511-513.
  7. Dye C., et al. “Watt, Did we reach the 2005 targets for tuberculosis control?” 85 (2007): 364-369.
  8. Gyamfi–Gyimah C. “Predictors for Multidrug-Resistant Tuberculosis among Tuberculosis Patients, Brong Ahafo Region, Ghana, 2019”. University of Ghana (2019).
  9. Abiodun I., et al. “Incidence of HIV and pulmonary tuberculosis co-infection among patients attending out-patient clinic in a Nigerian hospital”. International Journal of Biomedical Research9 (2015): 669-673.
  10. Bekana W., et al. “Evaluation of factors affecting patient delay in the diagnosis and treatment of TB among TB patients attending in Hiwot Fana Specialized University hospital, Harar, eastern Ethiopia”. Journal of Infectious Diseases and Preventive Medicine1 (2017): 149.
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Citation

Citation: Dery Bede., et al. “Factors Influencing Tuberculosis Case Detection in Wenchi Municipality, Brong Ahafo Region, Ghana". Acta Scientific Medical Sciences 4.3 (2021): .




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