Health-seeking behaviour of tuberculosis patients and related factors in the central region of Ghana

The health seeking behaviour of TB patients and health service related barriers have been cited to have an influence on the management of the disease in countries with high incidence of TB. Using close and open-ended questionnaires, an assessment of the health seeking behaviour of 302 TB patients selected from 24 DOTS centres in six districts in the Central  Region of Ghana was carried out. Under service-related barriers, distance from home to DOTS centre significantly impacted on the management of TB among sufferers (p=0.025). Though not significant, patients  acknowledged the good reception by staff at treatment centres with 99.3% of them being comfortable with staff and services provided at centres. Majority (46.7%) of patients perceived TB to be caused by the oral route while only 9.3% knew the causative agent to be bacteria. Compared with males, quite a number of women did not have adequate knowledge on TB (p<0.05). More than half of the respondents sought treatment elsewhere as first point of treatment before reporting to the DOTS centre. Health insurance played an important role in the health seeking behaviour of respondents; 45.9% of TB patients with health insurance visited the health facility as 1st provider whilst 49.4% without health insurance visited prayer camps (p=0.001). Our study has revealed that factors such as staff  attitude, distance to treatment centres, gender, employment and education are key factors that affect the health-seeking behaviour of TB patients in the Central Region of GhanaKeywords: Tuberculosis, Health, barriers, Central Regio

A pilot external quality assurance study of transfusion screening for HIV, HCV and HBsAG in 12 African countries

Background and Objectives: Serologic screening for the major transfusion transmissible viruses (TTV) is critical to blood safety and has been widely implemented. However, actual performance as measured by proficiency testing has not been well studied in sub-Saharan Africa. Therefore, we conducted an external quality assessment of laboratories engaged in transfusion screening in the region. Materials and Methods: Blinded test panels, each comprising 25 serum samples that were pedigreed for HIV, HBsAg, HCV and negative status, were sent to participating laboratories. The panels were tested using the laboratories' routine donor screening methods and conditions. Sensitivity and specificity were calculated, and multivariable analysis was used to compare performance against mode of testing, country and infrastructure. Results: A total of 12 African countries and 44 laboratories participated in the study. The mean (range) sensitivities for HIV, HBsAg and HCV were 91·9% (14·3-100), 86·7% (42·9-100) and 90·1% (50-100), respectively. Mean specificities for HIV, HBsAg and HCV were 97·7%, 97% and 99·5%, respectively. After adjusting for country and infrastructure, rapid tests had significantly lower sensitivity than enzyme immunoassays for both HBsAg (P < 0·0001) and HCV (P < 0·05). Sensitivity also varied by country and selected infrastructure variables. Conclusion: While specificity was high, sensitivity was more variable and deficient in a substantial number of testing laboratories. These findings underscore the importance of proficiency testing and quality control, particularly in Africa where TTV prevalence is high

A pilot external quality assurance study of transfusion screening for HIV, HCV and HBsAG in 12 African countries

Background and Objectives: Serologic screening for the major transfusion transmissible viruses (TTV) is critical to blood safety and has been widely implemented. However, actual performance as measured by proficiency testing has not been well studied in sub-Saharan Africa. Therefore, we conducted an external quality assessment of laboratories engaged in transfusion screening in the region. Materials and Methods: Blinded test panels, each comprising 25 serum samples that were pedigreed for HIV, HBsAg, HCV and negative status, were sent to participating laboratories. The panels were tested using the laboratories' routine donor screening methods and conditions. Sensitivity and specificity were calculated, and multivariable analysis was used to compare performance against mode of testing, country and infrastructure. Results: A total of 12 African countries and 44 laboratories participated in the study. The mean (range) sensitivities for HIV, HBsAg and HCV were 91·9% (14·3-100), 86·7% (42·9-100) and 90·1% (50-100), respectively. Mean specificities for HIV, HBsAg and HCV were 97·7%, 97% and 99·5%, respectively. After adjusting for country and infrastructure, rapid tests had significantly lower sensitivity than enzyme immunoassays for both HBsAg (P < 0·0001) and HCV (P < 0·05). Sensitivity also varied by country and selected infrastructure variables. Conclusion: While specificity was high, sensitivity was more variable and deficient in a substantial number of testing laboratories. These findings underscore the importance of proficiency testing and quality control, particularly in Africa where TTV prevalence is high