Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia: A Community Randomized Trial
Open accessAbstract
BACKGROUND: One of the main strategies to control tuberculosis (TB) is to find and treat people with active disease. Unfortunately, the case detection rates remain low in many countries. Thus, we need interventions to find and treat sufficient number of patients to control TB. We investigated whether involving health extension workers (HEWs: trained community health workers) in TB control improved smear-positive case detection and treatment success rates in southern Ethiopia. METHODOLOGY/PRINCIPAL FINDING: We carried out a community-randomized trial in southern Ethiopia from September 2006 to April 2008. Fifty-one kebeles (with a total population of 296, 811) were randomly allocated to intervention and control groups. We trained HEWs in the intervention kebeles on how to identify suspects, collect sputum, and provide directly observed treatment. The HEWs in the intervention kebeles advised people with productive cough of 2 weeks or more duration to attend the health posts. Two hundred and thirty smear-positive patients were identified from the intervention and 88 patients from the control kebeles. The mean case detection rate was higher in the intervention than in the control kebeles (122.2% vs 69.4%, p<0.001). In addition, more females patients were identified in the intervention kebeles (149.0 vs 91.6, p<0.001). The mean treatment success rate was higher in the intervention than in the control kebeles (89.3% vs 83.1%, p = 0.012) and more for females patients (89.8% vs 81.3%, p = 0.05). CONCLUSIONS/SIGNIFICANCE: The involvement of HEWs in sputum collection and treatment improved smear-positive case detection and treatment success rate, possibly because of an improved service access. This could be applied in settings with low health service coverage and a shortage of health workers. TRIAL REGISTRATION: ClinicalTrials.gov NCT00803322.
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Studies in other parts of Ethiopia and Tanzania reported higher successful treatment outcomes by using community health extension workers to follow-up patients.
“Studies conducted in other parts of Ethiopia [7,14] and Tanzania [15] reported higher successful treatment outcomes by using community health extension workers to follow-up patients.”
From Treatment success rate of tuberculosis patients in Dabat, northwest Ethiopia (2014) · cites this paper as [14]
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BackgroundInfluential
- Authors
- Datiko, D. G., & Lindtjørn, B.
- Affiliations
- Southern Nations, Nationalities, and Peoples' Region (ET)
- University of Bergen (NO)
- Corresponding author
- Datiko, Daniel G.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2009-05-08
- Volume
- 4
- Issue
- 5
- Pages
- e5443
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC2678194
- OpenAlex
- W2013153552
- Cited by
- 173
- References
- 26
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 11 · 2021: 10 · 2020: 12 · 2019: 16 · 2018: 11 · 2017: 9 · 2016: 10 · 2015: 15 · 2014: 15 · 2013: 24 · 2012: 11
- FWCI
- 5.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Greater South Information System
- Funders
- Universitetet i Bergen
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Keywords
- tuberculosis, health extension workers, community health workers, tuberculosis treatment success, directly observed therapy, sputum collection, productive cough, health care access, gender differences in treatment outcomes, southern Ethiopia
- MeSH terms
- Adult, Community Health Workers, Ethiopia, Female, Geography, Humans, Male, Residence Characteristics, Tuberculosis, Treatment Outcome
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