Community care for tuberculosis
TB clubs in Ethiopia
Ethiopia is exploring ways to improve TB treatment adherence and outcomes, in a context where access to health facilities is limited and TB is often highly stigmatized. One innovative approach, in the remote rural district of Estie, is the establishment of TB clubs, which have made an important contribution to the district tuberculosis programme. Estie district has one health centre and ten clinics. TB diagnosis is only available at the health centre. The health centre and the clinics provide treatment, which consists of a two-month intensive phase followed by a 10 month continuation phase.
The TB clubs were formed by groups of TB patients who live in the same kebele (the smallest administrative area of a district) and who met while attending out-patient appointments. The District Medical Officer helped the clubs to establish themselves and promoted their involvement in TB control activities.
Each club, which has between three and 10 members, elects a leader. The leader ensures that all members attend the TB clinic and arranges weekly club meetings, where members can support each other and share problems. Anyone who is failing to make good progress or who is experiencing drug side effects is referred to the local health facility by the club leader.
With help from community elders, religious leaders, community health agents and local health workers, the TB clubs have also identified people in the community with suspected TB, encouraged them to seek diagnosis and treatment, and helped to promote adherence to treatment and to trace defaulters. Using educational materials provided by the Ministry of Health, TB club members have also helped to educate the community about tuberculosis, in collaboration with health workers and community health agents.
What have the TB clubs achieved? During the first six months of 1997, the clubs referred 181 people with suspected tuberculosis for investigation, of whom two-thirds were diagnosed as TB cases. They also identified 69% of all TB patients and 76% of new sputum smear-positive pulmonary TB patients with smear-positive sputum diagnosed in the district during the same six-month period. TB clubs have helped to increase community awareness of the symptoms of TB and the need for treatment, Attendance at TB clinics has also improved significantly and treatment success rates are higher than in other parts of the country.
The TB club approach shows what can be achieved - even in remote rural areas with limited resources and using a long course of treatment - if TB patients are at the centre of TB control efforts and if there is effective community involvement.
H Getahun and D Maher, Contribution of 'TB clubs' to tuberculosis control in a rural district in Ethiopia. Int J Tuberc Lung Dis 2000 Feb;4(2):174-8). Getahun H, Maher D. Local anti-tuberculosis associations (TB mahibers) and tuberculosis control in a rural district in Ethiopia. International Journal of Tuberculosis and Lung Disease 2001; 5 (5): 489-490.