Improving the TB Cure Rate at Mubende Regional Referral Hospital

Sr. Theresa Kitandwe, Mubende RRH TB unit In-charge, shares her experience in improving the hospital TB cure rate from 33% -75% within 8 months

Sister Theresa addressing patient infront of the TB ward, Mubende Hospital, Western Uganda

Some of the patients admitted and receiving TB treatment at Mubende RRH TB ward. In the foreground, the TB nurse in-charge, Sr. Kitandwe talks with the patients.

“It was in July 2013, during a mentorship exercise conducted by the Ministry of Health and USAID/SUSTAIN project staff, that the TB healthcare team here at Mubende realized that the cure rate for new smear-positive TB patients was very low, at 33%, compared to the national target of 85%. With help from the mentors, the team identified possible causes of this low performance as:  lack of patient tracking and follow up mechanisms, incomplete documentation of client data in registers and files, inadequate engagement of treatment adherence supporters and long patient waiting time at the laboratory that hindered routine sputum monitoring and resulted patient losses at this point of care.

Through our internal multi-disciplinary improvement team, we developed possible solutions and an action plan to address the bottle necks identified. We started recording patient telephone contacts to assist in the follow-up of clients who miss appointments; introduced counselling for treatment supporters to support patient adherence on treatment within their communities and at the facility; and I took the initiative, as the unit in-charge to review the unit TB treatment register regularly to identify TB clients who missed appointments or were lost to follow up, and work with my team to track them and update findings in the treatment register. Our monthly review meetings became a forum for not only discussing each month’s performance but also reviewing client tracing activities. Later, the team together with laboratory staff, resolved to deliver sputum samples to the laboratory before 11:00 am each working day to maintain a turn-around processing time of 3 hours or less. By end of March 2014, performance for TB cure rate had improved up to 75%.

Patiet cured of TB running her Kiosk in Mubende district

Lucia Nabwere, a former patient who’s TB was cured, now runs a kiosk 2km from Mubende RRH. Nabwere was admitted at Mubende Hospital for the first 2 months of the 9-months treatment course. She completed TB treatment in September 2013.

Next steps:

“We plan to start recording the details of clients’ community leaders (Local Council – with consent from the clients) to enhance the exercise of tracing information for patients who do not have telephone contacts or whose contacts are seem to be inaccurate. Also, we look forward to combining supervision visits for health centres with patient tracking activities.”

 

Written By: Julian Natukunda, Communications Specialist, – USAID/SUSTAIN project