Training of community healthcare providers and TB case detection in Bangladesh

Background: For several years, BRAC (previously known as the Bangladesh Rural Advancement Committee) has been assisting with national TB control efforts in Bangladesh and has especially focused on training of community healthcare personnel. This study attempts to determine whether there is any association between a community-based TB training programme in peri-urban Dhaka and TB case finding within the same catchment area.

Methods: This was a cross-sectional retrospective study using laboratory sputum registers and annual BRAC training reports.

Results: Between 2005 and 2010, there were 536 training activities for community healthcare providers with 9037 people trained. Numbers of patients attending laboratories with suspected TB increased from 8211 in 2004 (before training) to 10 961 in 2005 (start of training) with the proportion diagnosed with smear-positive TB increasing from 7.1% to 11.2%. Thereafter, the numbers with suspected and diagnosed TB remained similar up to 2010. The most important sources of referral of patients for investigation were community health volunteers and self-referring patients accounting for 58% of all patients.

Conclusion: In this operational research study in peri-urban Dhaka, there was an initial increase in TB case finding with numbers then reaching a plateau despite continued training activities. Further prospective evaluation is required to understand these phenomena.