Reach Trust seeks to improve access to TB treatment in Dowa

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The Research for Equity and Community Health Trust (REACH Trust), has said there is a need to support health centres so that they should run spirometry clinics and offer quality lung health care services.

The organisation is implementing practical approach to lung health and community health volunteers interventions for improving the detection of Tuberculosis and chronic airways disease at primary care level in the two districts of Ntchisi and Dowa.

Reach Trust’s Grace Bongololo:  Cough is the commonest cardinal symptom that prompts care seeking

Research has shown that non-infectious causes of chronic cough, such as asthma and smoking related lung diseases, are increasing in incidence in developing countries.

The organisation’s Senior Researcher, Grace Bongololo, said cough is the commonest cardinal symptom that prompts care seeking from Primary Health care (PHC) level facilities in most countries including developed countries saying in Malawi, up to 25 percent of patients in PHC settings are prompted to attend health care because of coughing showing TB is the only chronic cough with screening tools available in some PHC facilities.

Bongololo said the project in Dowa and Ntchisi has a broad objective of equitably improving access to quality health care for both TB and chronic airways disease for patients presenting with chronic cough at primary health facilities in the two districts of Ntchisi and Dowa.

She said the project intended to randomised controlled open trial methodology in 27 health facilities in Malawi but due to limited resources, the clusters were scaled down to 9 health centres such as Kasese, Thonje, Mbingwa, Nalunga and Msakambewa in Dowa with Chinguluwe, Malambo and Kamsonga in Ntchisi.

The Senior Researcher said the project interventions will be Spirometry including practical approach to lung health and community engagement where it trained a total of 17 spirometry operators from 6 facilities and only 12 are practising.

She said between February, 2017 and January, 2018, a total of 115,573 people aged 15 and over have accessed care at 6 facilities for various conditions.

Among these, 1,540    had TB diagnosis done with all patients put on treatment (salbutamol and beclomet) and have one inhalers or TB treatment.

Bongololo said in November, 2017, the organisation had quality monitoring supervision whereby a spirometry trainer supervised all the 6 spirometry clinics which the results were very impressive.

She said a total of 121 Community Health Volunteers( CHVs) were trained in 3 health facilities in Dowa and Ntchisi with 14 Health Surveillance Assistants ( HSAs) as Trainer of Trainers ( ToT) to train and supervise the CHVs and training manuals for CHVs were developed, translated, piloted and printed which include manual _ TB, referral letter booklet, flip chart and registers.

The Senior Researcher said the CHVs reached out to 78,434 people with integrated TB information, 1,327 people were referred to the health facilities for TB diagnosis and treatment services with CHVs receiving certificates of competence.

She said for the first time in Malawi, lung function test is being done at health centres level with HSAs as operators for spirometry clinics and the country has a population-based prevalence data obtained at health facility level on chronic respiratory systems and diagnoses of health passports saying these are some of the remarkable successes of the project in the two districts of Ntchisi and Dowa.

However, Bongololo said even though the project has registered some successes, there were also some challenges such as scaling down of clusters from 18 to 6 due to limited funds and transfer of some trained staff leading to closure of the spirometry clinic at Chinguluwe in Ntchisi.

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