Improving tuberculosis control in Ethiopia

Ethiopia, with over 80 million people, is heavily affected by tuberculosis, complicated by poverty and HIV infection, limited access to the health service and shortage of health workers.

We recently reviewed tuberculosis control programme in South Ethiopia. Although treatment success rates have improved during the last decade, low case notification rate, mainly because of inability to access the health service, remains a challenge.

Using community health workers, we enrolled health extension workers (HEWs) in providing health education, sputum collection and providing treatment. This improved case detection, and more significantly for women, because the community-based sputum collection increased access to the diagnostic services. Similarly, community-based treatment improved the treatment success of smear-positive patients (90%) compared with to health facility-based treatment (83%). This approach also reduced the total costs by 63%. Thus, such interventions are economically attractive to the health service and patients, caregivers and the community.

Community based intervention improve access for the poor and for women to have better access to the health service. It is effective and an economically attractive alternative to the traditional health services.

By improving health service delivery to the affected community living in high burden countries, this is an example of how operational research in developing countries provide evidence for  policy change. Recently, this approach was endorsed by the Ministry of Health Ethiopia. Health Extension Workers shall now be involved in tuberculosis control in Ethiopia.

This research has been carried out by Daniel Gemechu Datiko. This week he defends his PhD at the University of Bergen. You can read his thesis at: Improving Tuberculosis Control in Ethiopia: Performance of TB control programme, community DOTS and its cost-effectiveness.

The two most important papers in his thesis are:

Datiko, D., & Lindtjørn, B. (2009). Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia: A Community Randomized Trial PLoS ONE, 4 (5) DOI: 10.1371/journal.pone.0005443

Datiko, D., & Lindtjørn, B. (2010). Cost and Cost-Effectiveness of Treating Smear-Positive Tuberculosis by Health Extension Workers in Ethiopia: An Ancillary Cost-Effectiveness Analysis of Community Randomized Trial PLoS ONE, 5 (2) DOI: 10.1371/journal.pone.0009158

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