CAUSES OF LOW CASE DETECTION AND PULMONARY SMEAR POSITIVE RATES OF TUBERCULOSIS IN GHANA - THE CASE OF NORTHERN REGION

Abstract

The study had three main broad but related objectives. The first objective was to determine the actual causes of under detection of pulmonary TB cases in the Northern Region of Ghana as compared to, the national case detection figures quoted by World Health Organization (WHO), and to determine whether the use of Health Extension Workers employed permanently by the MMDAs under the composite budget could help increase case detection rate in the Region. Data was collected through administering a structured questionnaire; and collection of sputum samples from the respondents.The second objective was to determine the actual causes of low smear positive rates by assessing the capacity to effectively perform sputum smear microscopy for Acid Fast Bacilli (AFBs) in the district hospitals where the study was conducted. Collection of data here involved the use of a structured checklist for the laboratory and the staff who performed Tb microscopy. In all, 26 laboratory staff who performed Tb microscopy in the study district hospital laboratories were involved. The third objective was to compare the prevalence of TB between male and female respondents in the region; as review of TB 04 registers of the study district hospital laboratories revealed more male patients were diagnosed as being positive for the tubercle bacilli than females. The study lasted for a period of three months. The study revealed that, 41.2%ofthestudyparticipants did not go to hospital when they fell sick. Out of this figure, 20.4% (21) attributed their inability to do so to poverty, 4.9% (5) to lack of access, 35.9% (37) to stigma, 28.2% (29) to cultural beliefs and 10.6%(11) attributed it to other reasons. Also, introduction of Health Extension Workers in the communities and institution of on-site corrective actions for Laboratory personnel in Tb microscopy lead an increase in sputum slide positive rate from 8.3% to 33% monthly. Further more, the study showed that, males are more susceptible to the Mycobacterium bacillus than females and that prevalence of TB among males is higher than that among females; with the female to male prevalence rate ratio being 1:2