Factors affecting the utilization of pulmonary tuberculosis contact tracing services in Mulanje and Chiradzulu district hospital in Malawi

Abstract

Tuberculosis (TB) remains a serious threat to the public health especially in the sub-Saharan African countries. The World Health Organisation (WHO) in 2016 estimated that there were 10.4 million incidents of TB cases globally. Malawi is also burdened by TB disease. Currently, WHO recommends contact investigation in high-risk populations for low and middle income countries. However, in the vast majority of countries, it is either not undertaken or not implemented. Malawi, also adopted this policy from WHO. This cross sectional study was aimed at determining factors affecting utilization of contact tracing services in Mulanje and Chiradzulu district Hospital among pulmonary TB patients in Malawi. It took place within a period of November 2016 to February 2017 with a sample size of 404 participants. The results showed that 44.8% of the index cases brought at least one household contact for screening. All health workers involved in this study informed patients about contact tracing. On the determinants of TB contact tracing, participants coming from Chiradzulu district hospital had a lower chance of bringing household contacts for screening than those from Mulanje (AOR 0.4, 95%CI. 0.18, 0.9 P=0.03). The participants who were between the ages of 26-35 had lower chance of bringing their house hold contacts for screening compared to those who were between 18-25 years of age (AOR 0.3, 95%CI. 0.14, 1.11, P=0.031). Participants who were informed about contact screening during their hospital visits, had an increased chance of bringing at least one household contact for screening than those who were not informed (AOR 7, 95%CI 1.64, 26.8, P=0.008) while wives had a high chance of bringing their husbands and children than the husbands. (AOR 8, 95%CI 1.1, 68.3, P=0.044). This study concludes that less than half of the TB patients brought at least one household contact for screening. This shows that there is poor adoption of this innovation. Majority of health workers were trained in how to do contact tracing of pulmonary TB patients and reported that they do inform patients about the availability of these services. However, majority TB of patients reported that they are not informed about these services. This shows some discrepancy from the two groups of participants in this study. We recommend the use of opinion leaders through community sensitization on the importance of this service so that they patients should be able to inquire for it themselves. We also recommend a fidelity study to evaluate if health workers carry out contact tracing program accordingly. Key words: Contact investigation; underutilisation; determinants; Tuberculosis