Health & Development International

<title>Abstract</title> Background The use of ad-hoc staff to boost TB notification rates is becoming more significant, and its effect has been observed in certain settings. This study aimed to assess the impact of engaging temporary staff on TB notification at health facilities where intensified TB case-finding efforts were implemented in Kano State, Nigeria, from January 2022 to December 2023. Methods This observational, descriptive, cross-sectional study retrospectively examined data from the Outpatient Department (OPD) TB Screening program implemented in Kano State, Nigeria. Data collection and reporting followed the national TB program's data flow and management system. Quarterly TB care cascade and key efficiency metrics were displayed in numbers and proportions to identify gaps along the TB care continuum for the intervention. An unpaired t-test was used to determine whether the quarterly average TB case notification rates differed between intervention and non-intervention sites during the study period. The significance level was set at 5%. Results From January 2022 to December 2023, 832,658 people visited the OPD at the 40 health facilities selected for the PQE intervention, with a TB screening rate of 67%, a presumptive yield of 5.1%, a TB yield of 3.4%, NNS of 658, NNT of 30, and an enrolment rate of 99%. The quarterly number of TB cases notified increased from zero at the start of the intervention to 133 in the last quarter, with periods of rise and fall. The quarterly percentage contribution of the PQE intervention to TB notifications grew from 0% (January – March 2022) to 38% (October – December 2023). The intervention facilities had a mean TB case notification of 23.0, compared to 13.2 for non-intervention facilities, with a marginally significant p-value of approximately 0.063. Conclusions The study found that deploying ad-hoc staff to support TB service delivery in health facilities with high patient volumes can increase TB case notifications and improve overall TB services in Kano State, Nigeria. It underscores the importance of focusing on the design, implementation, and monitoring of the intervention.

The aim of this study is to verify the level of transmission of lymphatic filariasis three years after stopping mass drug treatment in the 7 endemic districts in Togo. The survey was conducted in 2012 in Togo's 7 endemic districts grouped into four evaluation units (EU) using the WHO-recommended transmission assessment survey (TAS) protocol. Children aged 6-7 years were screened for Wuchereria bancofti antigen using the immunochromatographic card (ICT) method. A cluster sampling method was used to select eligible children in schools as the net primary-school enrolment ratio is greater than or equal to 75% in each of the four EUs. The number of children and schools to be selected in each EU, the randomization list for the selection of these children and the critical cut-off number of positive cases not to exceed were automatically generated using the Survey Sample Builder (SSB) tool, (NTD Support Center, Atlanta, Ga, USA). For confirmation, positive cases were subsequently tested for microfilaremia using nocturnal thick blood smear and for filarial antigen using Og4C3 antigen ELISA (TropBio ELISA Kit®, Townsville, Queensland, Australia). An EU is considered to have passed the test successfully (it is assumed that transmission can no longer be sustained), when the number of positive cases is below the critical cut-off number set by the SSB, which is roughly equivalent to 2% prevalence. Of the 1 706 children surveyed in Kpendjal-Tone's EU, 1 549 in Binah-Doufelgou's EU, 1 550 in Kozah's EU and the 1 575 in Amou-Haho's EU, 8 (0.46%), 1 (0.08%), 0 (0.00%) and 4 (0.25%) ICT positive cases respectively were detected. The number of positive ICT tests was well below 18, the critical cut number for each of the 4 EUs. All 13 ICT positive cases tested negative for nocturnal microfilaremia and Og4C3 ELISA. We conclude that all four EU passed the TAS with success, and the transmission of Wuchereria bancrofti is no longer likely to be sustained in the 7 endemic districts in Togo 3 years after stopping the MDA. A new TAS will be carried out in 2015, after which, if the results are still good, the country will submit a dossier to WHO for verification of the elimination of lymphatic filariasis.

Developing countries have surgical and anesthesia needs that are unique and disparate compared to those of developed countries. However, the extent of these disparities and the specific country-based needs are, for the most part, unknown. The goal of this study was to assess the surgical capacity of Nicaragua's public hospitals as part of a multinational study. A survey adapted from the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical care was used to study 28 primary, departmental, regional, and national referral hospitals within the Ministry of Health system. Data were obtained at the national and hospital levels via interviews with administrators and surgical and anesthesia chiefs of services. There are 580 obstetrician/gynecologists (OB/GYN), 1,040 non-OB/GYN surgeons, and 250 anesthesiologists in Nicaragua. Primary, departmental, regional, and national referral hospitals perform an annual average of 374, 4,610, 7,270, and 7,776 surgeries, respectively. All but six primary hospitals were able to perform surgeries. Four hospitals reported routine water shortages. Routine medication shortages were reported in 11 hospitals. Eight primary hospitals lacked blood banks on site. Of 28 hospitals, 22 reported visits from short-term surgical brigades within the past 2 years. Measurement of surgical outcomes was inconsistent across hospitals. Surgical capacity varies by hospital type, with primary hospitals having the least surgical capacity and surgical volume. Departmental, regional, and national referral hospitals have adequate surgical capacity. Surgical subspecialty care appears to be insufficient, as evidenced by the large presence of NGOs and other surgical brigade teams filling this gap.