The USAID-funded Afya Shirikishi project in Tanzania is using community –based health solutions to address social behaviors in accessing health services for Tuberculosis (TB) test and to help patients cope with long and difficult TB treatment. The project is working in nine regions (Dar es Salaam, Katavi, Rukwa, Kigoma, Geita, Mwanza, Pwani and Songwe Regions in Mainland Tanzania and one region in Zanzibar) of Tanzania with focus of increasing TB awareness, changing health –seeking behavior and increasing demand among general population and high-risk populations for TB acre and prevention services. The activities include active case-finding, contact investigation, collecting and transporting samples for testing, tracing and retrieving patients lost to follow-up, and providing health education and addressing social behavior change for TB. The activities are done in collaboration with community actors that include Community Health Workers (CHWs), Traditional Healers (THs), Accredited Drug Dispensing Outlets (ADDO), and Community Leaders. One of the project regions; Katavi, from January 2021 to March 2023, has contributed 30% of the TB cases notified (712 cases out of 2,395 cases) in the project regions and among them 33% (4 cases out of 12 cases reported from all project regions) were Multi Drug Resistant (MDR)-TB patients.
In May 2022, Katavi CHW (Hanifa Hamduni) from Itenka ward in Nsimbo District visited a household of one of the traditional healers, not engaged by the project and conducted TB screening among the clients attended for services on that day. She screened 18 individuals for TB and facilitated further referral for TB test at the nearby health facility. This was a time she met with Mr. Mihambo Kulwa Nchimbi, a 51 years old man who was admitted at traditional healer household with long standing cough mixed-up with blood, weight loss and night fever. She presumed him to have symptoms of TB and requested for sputum specimen for TB examination but Mr. Mihambo refused.
Mr. Mihambo in a picture with Hanifa
In June 2022, the CHW decided to visit Mr. Mihambo who was still admitted at traditional healer’s premises to see his progress and convince him to agree to be tested for TB. This time, she demonstrated symptoms of TB using pictorial photo (Poster for TB symptoms), however, the strategy was not successfully and she was chased away “I don’t want to see you here again else I will beat you” Said Mr. Mihambo.
In the same month of June, Hanifa without losing hope, she visited Mr. Mihambo again who was still admitted at traditional healer’s premises. This time, she found Mr. Mihambo had developed body swelling and was weak. Hanifa asked Mr. Mihambo if the services provided by the traditional healer werefree of charge while putting an emphasis of advising him to go to the health facility for proper treatment. Mr. Mihambo reply to Hanifa was that, ‘the traditional healer has charged four hundred thousand Tanzania shillings for the services, of which I do not have, however I am afraid to access health services because they will vaccinate me against COVID 19”.
In July 2022, Hanifa visited Mr. Mihambo again, and found his condition had become worse and he could not walk anymore. This time Mr. Mihambo agreed to go to the health facility for services but the traditional healer refused to release him with fear of losing his service fee. Hanifa told the traditional healer that, ‘Mr. Mihambo has symptoms of TB as I told you from the beginning, he will transmit it to you, your family and the clients you are serving, let me take him to the health facility and upon recover, he will come back to pay his bills”. Traditional healer agreed and Hanifa escorted Mr. Mihambo to the nearby health facility where he was tested TB positive and was initiated anti-TB medication.
After one month, a follow up visit was done by Hanifa, to see if Mr. Mihambo is continual on well with his TB medication. Mr. Mihambo was still coughing and Hanifa decided to collect his sputum sample and submitted it for GeneXpert test where by the results shows that, Mr. Mihambo was suffering from Multi-Drug Resistant Tuberculosis. Mr. Mihambo was referred to Kibong’oto Hospital for further management in September 2022.
Mr. Mihambo was on month seven of MDR-TB treatment as of March 2023 and he has returned to his home with a good health. Hanifa as part of her role, she ensures the patient takes his medication well. Mr. Mihambo is now happy and he said to Hanifa that “You have cause a smile in my face. I did not know if you had good intention on my health, you are so kind and I promise you to be a good ambassador on TB in my community and to the general community. Please provide me with TB symptom poster to help me to share TB health education to the community”.
USAID Afya Shirikishi, will continue working with community health care workers who are champions in finding missing individuals for TB and address social behavior changes in TB diagnosis, treatment and preventions at community level. Mr. Mihambo is one of the 12 MDR TB cases identified and referred for further treatment from January 2021 to March 2023.
Author: Hanifa Hamduni (CHW)1, Bahati Shaame2, Rose Olotu2, from Amref -USAID Afya Shirikishi project
