To evaluate the effectiveness of some intervention methods in pulmonary tuberculosis detection in Namdinh province from 2013 to 2014. Methods: To evaluate the effectiveness of community interventions, use retrospective data and cross-sectional investigations before and after intervention.
Journal of military pharmaco-medicine no6-2019 THE EFFECTIVENESS OF INTERVENTION METHODS IN PULMONARY TUBERCULOSIS DETECTION IN NAMDINH PROVINCE FROM 2013 TO 2014 Nguyen Dinh Tuan1; Nguyen Viet Nhung1; Le Van Bao2 SUMMARY Objectives: To evaluate the effectiveness of some intervention methods in pulmonary tuberculosis detection in Namdinh province from 2013 to 2014 Methods: To evaluate the effectiveness of community interventions, use retrospective data and cross-sectional investigations before and after intervention Results: After intervention, the awareness of patients about tuberculosis such as symptoms, causes, transmission and prevention measures was higher than before the intervention Behavior of seeking medical services and practicing early detection examination of patients had changed beneficially such as increasing in searching for medical services at district general hospital and Namdinh Lung Hospital, reducing in searching for medical services in private health facilities The time to detect the disease earlier, with the average time decreased from 1.27 months before the intervention to 0.64 month The rate of detection of pulmonary tuberculosis/100,000 people increased by 14.1% compared to before the intervention Conclusions: The public - private mix model in tuberculosis control helped to increase the detection rate of pulmonary tuberculosis and early detection of tuberculosis * Keywords: Pulmonary tuberculosis; Tuberculosis detection; Public - private mix model; Namdinh province INTRODUCTION Detecting and curing all cases of tuberculosis (TB) in the community is an effective way to control and end up for TB Since 1995, Vietnam National TB Program developed targets for detecting at least 70% of AFB (+) TB patients in the community and curing 85% of detected TB cases [1] When these two targets are reached, the new incidence of TB cases will decrease by an average of - 10% per year [7] According to the report of the National TB Control Program (2013), the TB detection rate in our country was estimated at 76% [2, 8] Thus, there are still 24% of TB cases not detected, who live everywhere in rural and remote areas, where are difficult for the patients to access medical services The National TB Control Program has applied many interventions to increase TB detection rates [3] In 2013, the model of public private mix in the control of TB was piloted in districts of Namdinh province National Lung Hospital Vietnam Military Medical University Corresponding author: Nguyen Dinh Tuan (nguyendinhtuan05@gmail.com) Date received: 02/07/2019 Date accepted: 05/08/2019 121 Journal of military pharmaco-medicine no6-2019 in order to increase the rate of detection and early detection of TB through training knowledge of TB and respiratory disease for grassroots health staff, mobilizing the participation of public - private health workers to control TB, communication on TB and respiratory diseases in the community [4] Our study aimed: Determining the detection rate and time of detection of pulmonary TB before and after intervention (2013 - 2014); comparing the effectiveness of pulmonary TB detection before and after intervention Sample size was calculated n = 281 However, the sample size in the study was all pulmonary TB patients registered treatment in studying districts in 2013 The actual sample size in the study was 341 pulmonary TB patients SUBJECTS AND METHODS + Z(1- ∝/2): Reliability, with probability 95%, Z(1- ∝/2) =1.96 Subjects Pulmonary TB patients before and after intervention (2013 - 2014) Methods - Community intervention study: Retrospective data on pulmonary TB detection, cross-sectional investigation before and after intervention, assessment of intervention effectiveness - Sample size of pre-intervention study (2013) is the sample size of descriptive study: [5] In which: + n: Minimum sample size + Z(1- ∝/2): Reliability, with probability 95%, Z(1- ∝/2) = 1.96 + p: The rate of TB patients delayed in detecting ≥ month; p = 0.76 [6] + q = - p = 0.24 + d: Tolerance at 5% (d = 0.05) 122 - Sample size after intervention (2014) determined by the formula: In which: + n: Minimum sample size + p1: The rate of TB patients delayed in detecting (≥ month), p1 = 0.77 (results from previous research) + p2: The percentage of patients delayed in detecting after intervention, with the desire to reduce 20%, then p2 = 0.57 + z1-β: The force factor (sample force 90%), z1-β = 1.28 + P: Average rate (p1 + p2)/2 Replace the calculated number, n = 114 is the minimum sample size However, the sample size in the study was the entire sample of registered pulmonary TB patients in 2014 The actual sample size in the study was 381 pulmonary TB - Research locations: districts (Xuantruong, Nghiahung, Giaothuy and Trucninh of Namdinh province) - Intervention method: Training to improve knowledge about TB and respiratory disease for public - private Journal of military pharmaco-medicine no6-2019 health staff at the grassroots level, mobilizing their participation in counseling and transferring TB suspects to district general hospital to examine health and detect TB, communication about TB and respiratory diseases in the community - Evaluate the effectiveness of intervention: Based on efficiency index (EI) EI (%) = (p1 - p2)/p2 x 100 In which: p1: The rate before intervention; p2: The rate after intervention - Data processing and analysis: Data from the reports were aggregated statistics on Excel operating system The data collected from the questionnaires were entered on the computer using the Epi.info 6.04 software; data analysis by Epidata Analysis v2.2.3.187 software Using algorithms to test two observation rates with Stata software 14.0: Compare the two ratios of two independent samples with the algorithm χ2 Using t-test to test quantitative variable averages RESULTS AND DISCUSSION Improving knowledge of patients on TB Table 1: Knowledge of symptoms, causes, prevention of TB Before intervention After intervention (n = 341) (n =381) Content p EI (%) Number % Number % Cough lasts 306 89.7 340 89.2 > 0.05 -0.6 A mild fever in the afternoon 177 51.9 277 72.7 < 0.001 40.1 Thin weight loss 160 46.9 253 66.4 < 0.001 41.6 The cause of the disease is TB 197 57.8 339 89.0 < 0.001 54.0 The main route of infection is the respiratory tract 273 80.1 360 94.5 < 0.001 18.0 Vaccination for newborn babies 123 36.1 267 70.1 < 0.001 94.2 Early examination when there are signs of suspected TB 94 27.6 266 69.8 < 0.001 152 (*: Test x2 for the rate) After the intervention, the patients had a change in knowledge about TB Knowledge about the symptoms of the disease, the causes of disease and the transmission way of disease all increased In addition, knowledge about TB prevention such as "vaccination for TB prevention" and "examination for early detection when there are suspected signs of TB" was also higher than before intervention with EI 94.2% and 152.9%, respectively 123 Journal of military pharmaco-medicine no6-2019 Change in behavior, habits of seeking medical services of patients Table 2: The place to find medical services when symptoms first appear Before intervention After intervention (n = 341) (n = 381) The place to choose health services p EI (%) Number % Number % Commune health station 170 49.9 180 47.2 > 0.05 -5.4 District hospital 200 58.7 265 69.6 < 0.01 18.6 Provincial lung hospital 23 6.7 59 15.5 < 0.001 131.3 Provincial general hospital 2.3 10 2.6 > 0.05 13.0 Pharmacies 34 10.0 28 7.3 > 0.05 -27.0 Clinic/private hospital 28 8.2 29 7.6 > 0.05 -7.3 Private physician/healer 46 13.5 28 7.3 < 0.01 -45.9 (*: Test x2 for the rate) Many studies have shown factors related to delays in the TB detection of patients such as low levels of education, living in remote areas, the habit of seeking private health services when they first appear signs of disease [9, 10] After the intervention, the behavior of seeking medical services had changed, increasing the search for medical services in the district general hospital and the provincial lung hospital, reducing the search for health services in private health facilities The behavior of seeking medical services of patients had a positive change, which will help patients practice in early detection examination Practice medical examinations early to detect the disease Table 3: Disease detection time Before intervention After intervention (n = 341) (n = 381) Disease detection time Number Average (month) Giaothuy 124 0.64 ± 0.88 37 46.8 52 50.5 ≥ month 42 53.2 51 49.5 0.99 ± 0.70 0.53 ± 0.52 < month 27 24.5 67 47.9 ≥ month 83 75.5 73 52.1 1.46 ± 0.67 EI (%) % < month Average (month) Nghiahung Number 1.13 ± 1.63 Average (month) Trucninh % p 0.24 ± 0.47 < month 9.9 45 77.6 ≥ month 64 90.1 13 22.4 < 0.05 > 0.05 7.8 -6.9 < 0.0001 < 0.001 95.0 -30.9 < 0.0001 < 0.001 686.9 -75.1 Journal of military pharmaco-medicine no6-2019 Average (month) Xuantruong < month 1.63 ± 1.26 1.14 ± 0.38 8.6 < 0.01 1.3 -85.5 < 0.05 ≥ month 74 Average (month) Total in districts < month 91.4 79 1.27 ± 1.14 78 98.8 8.1 0.64 ± 0.67 22.9 165 < 0.0001 43.3 89.3 < 0.001 ≥ month 263 77.1 216 56.7 -26.5 (*: Test ttest for averages and test x2 for the rate) After the intervention, patients were diagnosed early with the detection time (average) decreased from 1.27 months before intervention to 0.64 month In particular, the rate of patients who detected diseases early < month increased from 22.9% before intervention to 43.3%, with EI reaching 89.3% and the detection time ≥ month decreased from 77.1% before the intervention to 56.7%, EI reached 26.5% and statistically significant (p < 0.001) Our study had much shorter detection time in comparison to the research results of Nguyen Thien Huong (2007) (a time delay of 7.5 weeks), and Trinh Huu Hung’s (2008) (a time delay of detection was 7.42 weeks) Increasing in detection rate of pulmonary TB Table 4: Detection rate of pulmonary TB/100,000 people District Before intervention (n = 343) Number Population Nghiahung EI (%) % 178,343 56 30.4 67 37.6 > 0.05 23.4 Detection total 91 49.5 102 57.2 > 0.05 15.6 188,392 190,275 Detection at district 46 24.4 60 31.5 > 0.05 29.1 Detection total 77 40.9 84 44.1 > 0.05 8.0 Population Trucninh 183,991 Number p Detection at district Population Xuantruong % After intervention (n = 395) 180,093 181,902 Detection at district 35 19.4 60 33.0 < 0.05 69.7 Detection total 108 60.0 114 62.7 > 0.05 4.5 125 Journal of military pharmaco-medicine no6-2019 Population Giaothuy 201,903 Detection at district 46 23.9 86 42.6 < 0.01 78.4 Detection total 67 34.8 95 47.1 > 0.05 35.3 Population Total in districts 192,699 745,175 752,423 Detection at district 183 24.6 273 36.3 < 0.001 47.7 Detection total 343 46.0 395 52.5 > 0.05 14.1 (*: Test x2 for the rate) Detection of pulmonary TB was analyzed in two areas including: (1) The total number of detected pulmonary TB cases (including the number of pulmonary TB patients detected at the district and the other areas to be transferred); (2) The number of pulmonary TB patients detected in the district (the districts detected it itself) Before the intervention, the total number of pulmonary TB patients detected was 343 cases, corresponding to the rate of 46.0/100,000 people After the intervention, the total number of detected pulmonary TB cases increased to 395 cases, corresponding to the detection rate of 52.5/100,000 people, EI reached 14.1% The number of pulmonary TB cases detected in the pre-intervention district was 183 cases, corresponding to the detection rate of 24.6/100,000 people After the intervention, the number of detected pulmonary TB cases in the district increased to 273 cases, corresponding to the rate of 36.3/100,000 people, EI reached 47.7% Thus, the intervention measures has helped increase the detection rate of pulmonary TB to 126 14.1% (total) and especially increase the detection rate of pulmonary TB in the district to 47.7% compared to before intervention CONCLUSION Implementing intervention activities of the public - private mix model in the TB control, has helped increase detection rate and detection of TB early After the intervention, the detection rate of pulmonary TB/100,000 people increased by 14.1%, in which the detection rate at the district increased by 47.7% compared to before the intervention The time of detecting disease (average) decreased from 1.27 months before intervention to 0.64 month, in which the detection rate < month increased from 22.9% before intervention to 43.3%, EI reached 89.3% RECOMMENDATIONS Continue to implement and expand the intervention model public - private mix in TB control, assess its effectiveness in different localities to serve as a basis for expanding this model to nationwide Journal of military pharmaco-medicine no6-2019 REFERENCES Ministry of Health - National TB Program The path of national TB program - Guidelines for TB management Medical Publishing House 2009, pp.33-42 Ministry of Health - National TB Program Summary report on TB control activities in 2014 and orientation for 2015 2015, p.6, 37, 47, 129 Nguyen Viet Nhung TB and TB control st in the 21 century TB and Lung Disease Journal 2011, pp.11-14 Ministry of Health - National TB Program Guidelines for coordination between health facilities in TB management Medical Publishing House 2015, pp.20-21 Military Medical Academy Basic Epidemiology People's Army Publishing House 2014, p.221, 228 Trinh Huu Hung Studying the delay in access to health services of AFB (+) pulmonary tuberculosis patients and intervention solutions Doctoral thesis - Central Institute of Hygiene and Epidemiology 2011, p.71, 90, 118 Christopher Dye, M.H.C.W Did we reach the 2005 targets for TB control? - Public health reviews Bulletin of the World Health Organization 2007 World Health Organization Global TB Report 2014 - Country profiles, Vietnam 2014 Nguyen T Huong, Marleen V, Bui D Duong Delays in the diagnosis and treatment of TB patients in Vietnam BMC Public Health 2007, pp.41-54 10 Dale M.N, S.D.F, George T Socioeconomic, gender and health services factors affecting diagnostic delay for TB patients in urban Zambia Tropical Medicine and International Health 2001, (4), pp.256-259 127 ... detected in the pre -intervention district was 183 cases, corresponding to the detection rate of 24.6/100,000 people After the intervention, the number of detected pulmonary TB cases in the district increased... especially increase the detection rate of pulmonary TB in the district to 47.7% compared to before intervention CONCLUSION Implementing intervention activities of the public - private mix model in the. .. After the intervention, the total number of detected pulmonary TB cases increased to 395 cases, corresponding to the detection rate of 52.5/100,000 people, EI reached 14.1% The number of pulmonary