Evaluating TB diagnosis and care in the Union of the Comoros

• Published in: Public health action Vol. 13; no. 1; pp. 23 - 27
• Main Authors: Noeske, J., Mzembaba, A., Assoumani, Y., Maoulida, S., Makpenon, A.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 21-03-2023
• Subjects: Care-Seeking; Comoros; Missing Cases; Original; Patient Pathway Analysis; Ppa; Tuberculosis; PPA; missing cases; care-seeking; patient pathway analysis; Comoros; tuberculosis
• ISSN: 2220-8372; 2220-8372
• DOI: 10.5588/pha.22.0057

SETTING: The Union of the Comoros has experienced a persistent notification gap in TB cases despite several strategic changes, including molecular diagnosis and contact investigation. We therefore performed a TB patient pathway analysis (PPA)
under the National Tuberculosis Programme (NTP). OBJECTIVE: To assess the alignment of healthcare-seeking behaviour and TB service availability to clarify the reasons for these missing cases. DESIGN:
Three primary data sources, including a national list of health facilities, TB surveillance data and care-seeking behaviour data, were analysed at the national and regional levels to determine access to TB diagnosis and the initial point of care-seeking. Summary data were visualised using
the standardised PPA Wizard programme, and the analysis was completed using demographic and socio-economic data. RESULTS: At the initial point of care-seeking, 18% of patients had access to TB services, available only in nine centralised
public health facilities. Furthermore, 30% of patients initially consulted in the informal sector and 45% in the formal public or private sector in health facilities, both of which lacked the capacity for TB diagnosis or first-line treatment. CONCLUSION:
The concentration of and limited access to TB services at the intermediate and central levels of care indicate a need for decentralisation efforts.