Losses in the Sputum Specimen Referral Cascade in Mpulungu District, Zambia: A Cross-Sectional Study

Ruth Goma, Josphat Bwembya, Brian Mwansa, Phillimon Ndubani, Francis Kasongo, William Siame, Lutinala Mulenga, Ramya Kumar, Seraphine Kaminsa, Vimbai Makwambeni, Victoria Musonda, Ibou Thior and Alwyn Mwinga
Additional contact information
Ruth Goma: Ministry of Health, Mpulungu District Health Office, Mpulungu 10101, Zambia
Josphat Bwembya: USAID Eradicate TB Project, PATH, Lusaka 10101, Zambia
Brian Mwansa: Ministry of Health, Mpulungu District Health Office, Mpulungu 10101, Zambia
Phillimon Ndubani: Frontiers Development and Research Group, Lusaka 10101, Zambia
Francis Kasongo: Ministry of Health, Mpulungu District Health Office, Mpulungu 10101, Zambia
William Siame: Ministry of Health, Mpulungu District Health Office, Mpulungu 10101, Zambia
Lutinala Mulenga: USAID Eradicate TB Project, PATH, Lusaka 10101, Zambia
Ramya Kumar: USAID Eradicate TB Project, PATH, Lusaka 10101, Zambia
Seraphine Kaminsa: USAID Eradicate TB Project, PATH, Lusaka 10101, Zambia
Vimbai Makwambeni: USAID Eradicate TB Project, PATH, Lusaka 10101, Zambia
Victoria Musonda: USAID Eradicate TB Project, PATH, Lusaka 10101, Zambia
Ibou Thior: PATH, Washington, DC 20001, USA
Alwyn Mwinga: Zambart, Lusaka 10101, Zambia

IJERPH, 2022, vol. 19, issue 3, 1-11

Abstract: Sputum specimen referral cascades in resource-limited settings are characterized by losses of specimens, resulting in delays in tuberculosis (TB) diagnosis. Mpulungu District Health Office in Zambia conducted a quantitative based cross-sectional study using both primary and secondary data to identify points at which loss of specimens occurred in the sputum referral cascade. Primary data were collected through observations and interviews with 22 TB service providers. Secondary data were collected through examination of patient files and presumptive TB and laboratory registers to retrospectively track sputum specimens referred by ten health centers from April to September 2018. Proportions of specimens/laboratory results at every stage of the referral cascade were calculated using Epi Info v7. Only 49 (23%) out of 209 sputum specimens completed the referral cascade. The remaining 160 (76%) were lost at various stages of the referral cascade. The largest loss (51%) occurred between the release of laboratory results by the diagnostic facility and their receipt at referring facilities. Barriers included an inadequate number of staff oriented in sputum specimen referral, negative staff attitudes, and lack of specimen packaging material and specimen transportation. The district health office should strengthen the sputum specimen referral system by providing transport and specimen packaging material and by training staff in sputum collection transportation and tracking.

Keywords: tuberculosis; sputum; specimen; referral; cascade (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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