Decentralising tuberculosis case management in two districts of Burkina Faso

Abstract

Setting: In West Africa, national tuberculosis programmes (NTPs) face many problems due to the low performance of health care delivery systems and patients' social and cultural environment.

Objective: To improve the case management of TB in Burkina Faso.

Design: Using the operational research process as a tool, TB case management was decentralised from the district hospital to eight primary health care centres in 2003.

Results: Twelve months after decentralisation, the quality of case detection remained satisfactory. The delay between the identification of TB suspects with chronic cough and the confirmation of TB was reduced from 13 to 6 days. The detection rate of TB suspects during the study (30%) was twice as high as for 2001 and 2002 (15%). However, the detection rate for smear-positive TB cases decreased from 32.3% in 2001 and 2002 to 6.5% during the year of the study.

Conclusion: Sufficient time and commitment are essential to obtain a case management system that is decentralised and effective. Efforts therefore need to continue to obtain more information and better results.