AN ASSESSMENT OF THE EFFECT OF TRAINING OF PATENT MEDICINES VENDORS ON REFERRAL OF PATIENTS TO A TUBERCULOSIS DIAGNOSTIC AND TREATMENT SERVICE IN ENUGU

Abstract

Background: Pulmonary tuberculosis can be suspected by the presence of a cough that has persisted for three weeks or more. However tuberculosis case finding remains low worldwide. Any process that improves the demand for tuberculosis diagnostic and treatment services, especially to centers where directly observed treatment short course is available, will improve case finding and possibly cure rates. Tuberculosis is curable provided patients are detected early and treated promptly.
The patent and proprietary medicines vendors are the first port of call for many in the less developed countries on the event of illness. This accessibility makes them the first contact with health care for a good number of tuberculosis suspect cases. These vendors do not know enough about tuberculosis and do not have the correct practice towards customers with chronic cough. Training can serve as a tool of public private partnership with the patent and proprietary medicines vendors, with an emphasis on referral.
Methodology: an intervention study on patent and proprietary medicines vendors in Enugu North local government area of Enugu state, with as control, patent and proprietary medicines vendors in Nkanu West local government area. The study period was five months from June to November 2007. A KAP survey was carried out on the study and control groups as baseline. To the study group training was applied and pre-written referral notes provided to facilitate referral to a tuberculosis diagnostic and treatment centre. The control group did not receive the training. At the end of a three month period, the KAP survey was repeated and compared with the baseline and between
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the groups. The referral input of the patent and proprietary medicines vendors to a DOTS center in the study site was observed.
Results: Post-training, there were significant gains in knowledge among the respondents in the study group. Knowledge of the duration that defines chronic cough showed a percentage change of +39.2, of causes of chronic cough +73, knowledge of symptoms and signs of tuberculosis +37.6. Correct Knowledge of the duration of drug treatment for tuberculosis, +40.1. Knowing of the existence of DOTS centers and correctly identifying one, improved by a percentage change of +18.7 and +32.6 respectively. There were also significant gains in practice post-training. The practice of health educating customers on how to avoid spreading cough showed a percentage change of +23.3, identification of tuberculosis drugs as having been sold over the counter, a change of -13.4 and of referring customers with chronic cough, +11.9. They referred seven patients to a DOTS center as trained to do and of these, five (71.4%), were sputum smear positive. Attitude changed little. In the control group Knowledge attitude and practice did not change.
Conclusion: Patent and proprietary medicines vendors do not usually recognize and refer tuberculosis suspects to tuberculosis diagnostic and treatment services.
Training can improve their knowledge of tuberculosis, their recognition of the most common symptom of pulmonary tuberculosis; chronic cough and cause them to counsel and refer their clients with this symptom for diagnosis and possible treatment. They can be good partners in the public private mix against tuberculosis.

AN ASSESSMENT OF THE EFFECT OF TRAINING OF PATENT MEDICINES VENDORS ON REFERRAL OF PATIENTS TO A TUBERCULOSIS DIAGNOSTIC AND TREATMENT SERVICE IN ENUGU