EFFECT OF TRAINING ON ‘FAST” STRATEGY OF TUBERCULOSIS INFECTION CONTROL AMONG HEALTH WORKERS IN A TERTIARY HEALTH FACILITY IN ABIA STATE, NIGERIA

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EFFECT OF TRAINING ON ‘FAST” STRATEGY OF TUBERCULOSIS INFECTION CONTROL AMONG HEALTH WORKERS IN A TERTIARY HEALTH FACILITY IN ABIA STATE, NIGERIA

Abstract

Background: Tuberculosis (TB) though a long existent disease still constitutes a major public health problem in Nigeria. The first ever Nigerian national prevalence survey of 2012 led to key resolutions which include active case detection targeting high burden areas and high risk groups, engagement of all care providers in TB infection control, and strengthening of routine surveillance to include all points of contacts between patients and health care services. The need for realization of these resolutions are pertinent as the TB burden in Nigeria is one of the highest in the world (318 per 100,000) but the case detection rate (16 %) is one of the lowest in the world. One of the strategies for active case finding and TB infection control is the “FAST” strategy.
Aim: The aim of this study was to assess the effect of training on “FAST strategy of TB infection control on the knowledge and attitude of health workers in a tertiary health institution in Abia State Nigeria.
Methodology: It was an interventional study of 74 workers in the intervention facility and 74 in the control facility selected through stratified random sampling. Pretested self-administered questionnaires were administered on the health workers before and after the intervention while “FAST” indicators in the facility TB records of newly diagnosed TB patients before and after the intervention were obtained.
Results: At baseline, majority of the health workers 56(75.7%) in the study facility had poor knowledge of most questions used in assessing knowledge though the baseline knowledge of the control facility was higher than the study facility, majority 47(63.5%) also had poor knowledge of the FAST strategy of TBIC. Having a score of 8 and above was graded as good knowledge while below 8 was poor. Mean knowledge scores at baseline were 6.99 ± 2.59 for the study group and 8.12 ± 2.84 for the control out of a possible maximum of 16. The intervention increased the mean knowledge score of the study group to 12.39± 2.55 while no significant change was observed in that of the control. In addition, after the intervention, this study found a 50% increase in workers that had good knowledge among health workers in the study group compared to the control.
For attitude to FAST strategy of TBIC, overall at baseline 56(75.7%) health workers in the study group had good attitude similar to that of the control; 57(77.0). Having an attitude score above 6 was graded as good attitude while 6 and below was poor. At baseline, there was no difference in mean attitude scores between the study and control; 9.12± 2.73 and 9.14±2.81 of a possible 12 .Post intervention, mean attitude scores of the study group increased to 11.18 ± 1.3 of a possible 12 compared to the control which remained at 9.34 ± 2.53.
At baseline the “FAST” strategy indicators recorded in the study facility include time to diagnosis > 1 week and time to treatment 3.5 days. For the intervention facility, presumptive TB cases, number of cases commenced on treatment and presumptive MDRTB cases were 92/2670, 22/2670 and <1/2670 new cases seen. This study observed a significant positive difference in all the “FAST” indicators following the intervention.Time to diagnosis decreased by 52%, time to treatment decreased by 17% while the number of presumptive TB cases per new cases seen in the hospital increased from 3.4% to 7.6%. Number of diagnosed TB cases commenced on treatment increased from 0.86% to 1.7% of new cases seen in the intervention facility. In the control facility, the study found previous attendance at a TB training to be a predictor of good knowledge aOR 2.81; 95% CI (1.01-7.99) while age was found to be associated with good attitude aOR9.68; 95%CI (1.01-92.8).
Conclusion and recommendations: The training intervention had a significant effect on both knowledge and attitude of the health workers towards the ‘FAST” strategy of TB infection Control which reflected positively on the FAST indicators. The Government should support implementation of the “FAST” Strategy in health institutions across the country through the National Tuberculosis, Leprosy and Buruli ulcer control Program. Training and retraining of health workers on TBIC at facility level is strongly recommended.

EFFECT OF TRAINING ON ‘FAST” STRATEGY OF TUBERCULOSIS INFECTION CONTROL AMONG HEALTH WORKERS IN A TERTIARY HEALTH FACILITY IN ABIA STATE, NIGERIA

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