The Use of Laypersons to Support Tuberculosis Screening at a Kenyan Referral Hospital

Abstract

Background: The former Nyanza Province of Kenya bore the brunt of HIV‑driven tuberculosis (TB); 62% of the 19,152 cases in 2010 were HIV co‑infected. The use of laypersons to improve TB case fnding in community settings has shown rewarding results in other countries. We have no documented Kenyan experience in health facility settings. We evaluated the beneft of using laypersons to support TB screening and referrals at the former Nyanza Province of kenya province’s largest regional referral
facility.

Methods: In 2010, fve high school graduates were trained on symptomatic recognition of TB suspects and assisted sputum production by the region’s District’s TB and Leprosy Coordinator. They then identifed and referred TB suspects (from hospital patients and visitors) at waiting‑areas and wards to clinicians and documented their TB screening and referral outcomes. We describe results from one waiting‑area with complete documentation between January and December 2011.

Results: Of the 217 TB suspects identifed, majority were male (55%); their median age was 36 (range 1–70) years. 11% (23) were aged <15 years; 65% (15) were diagnosed with TB by, a combination of sputum microscopy and chest X‑rays (5) followed by chest X‑ray alone (50), then sputum microscopy alone (1), and TB score chart (4). Of those aged 15+ years, 72% (140) were diagnosed with TB by a combination of sputum microscopy and chest X‑rays (75) followed by sputum microscopy alone (38),
and chest X‑ray alone (27). Excluding cases that transferred out, this process contributed to 33% of Jaramogi Oginga Odinga Teaching and Referral Hospital’s annual TB case burden.

Conclusions: TB case detection in high TB burden regions can be supported the use of laypersons in hospital settings.

Keywords: Cough monitors, referrals, tuberculosis identifcation