Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia A Community Randomized Trial 英文参考文献.docVIP

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Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia A Community Randomized Trial 英文参考文献.doc

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Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia A Community Randomized Trial 英文参考文献

HealthExtensionWorkersImproveTuberculosisCase DetectionandTreatmentSuccessinSouthernEthiopia:A CommunityRandomizedTrial DanielG.Datiko1,2*,BerntLindtj?rn1 1CentreforInternationalHealth,UniversityofBergen,Bergen,Norway,2SouthernNations,Nationalities,andPeoples’RegionalHealthBureau,Awassa,Ethiopia Abstract Background: One of the main strategies to control tuberculosis (TB) is to find and treat people with active disease. Unfortunately, the case detection rates remain low in many countries. Thus, we need interventions to find and treat sufficient number of patients to control TB. We investigated whether involving health extension workers (HEWs: trained communityhealthworkers)inTBcontrolimprovedsmear-positivecasedetectionandtreatmentsuccessratesinsouthern Ethiopia. Methodology/PrincipalFinding:Wecarriedoutacommunity-randomizedtrialinsouthernEthiopiafromSeptember2006 toApril2008.Fifty-onekebeles(withatotalpopulationof296,811)wererandomlyallocatedtointerventionandcontrol groups. We trained HEWs in the intervention kebeles on how to identify suspects, collect sputum, and provide directly observed treatment. The HEWs in the intervention kebeles advised people with productive cough of 2 weeks or more durationtoattendthehealthposts.Twohundredandthirtysmear-positivepatientswereidentifiedfromtheintervention and88patientsfromthecontrolkebeles.Themeancasedetectionratewashigherintheinterventionthaninthecontrol kebeles(122.2%vs69.4%,p,0.001).Inaddition,morefemalespatientswereidentifiedintheinterventionkebeles(149.0vs 91.6,p,0.001).Themeantreatmentsuccessratewashigherintheinterventionthaninthecontrolkebeles(89.3%vs83.1%, p=0.012)andmoreforfemalespatients(89.8%vs81.3%,p=0.05). Conclusions/Significance: The involvement of HEWs in sputum collection and treatment improved smear-positive case detectionandtreatmentsuccessrate,possiblybecauseofanimprovedserviceaccess.Thiscouldbeappliedinsettingswith lowhealthservicecoverageandashortageofhealthworkers. TrialRegistration:ClinicalTNCT00803322