Global Journal of Medical Research, K: Interdisciplinary, Volume 22 Issue 4

Improvement on Packaging and Referencing Tuberculosis Samples- Experience in Zambezia, Mozambique D. Malamule α , E. Manguene σ , B. Mutandiua ρ , C. Madeira Ѡ , A. Abdula ¥ , J. Conjera § , I. Nasseco χ , S. Viegas ν , A. Baptista Ѳ & J. Melo ζ 39 Year 2022 Global Journal of Medical Research Volume XXII Issue IV Version I ( D ) K © 2022 Global Journals Abstract- With 552 new cases of tuberculosis (TB) per 100,000 people per year, Mozambique is among the 14 countries globally with the highest estimated incidence of TB; however, Mozambique has one of the lowest case-detection rates in the world, identifying only 45% of all estimated cases of TB, well below the World Health Organization (WHO) target of 70%. In Mozambique, as in other low-income countries, missed cases of TB have been attributed in part to difficulties transporting TB samples quickly and appropriately. A secure referencing system of biological samples from the periphery health facilities to referral labs at the district/provincial/central level is crucial to ensure access to Tuberculosis (TB) tests with timely and reliable results within the diagnostic network. Sputum spillage of 6% is a challenge faced during sputum referral and transportation system in Zambezia Province in Mozambique. Is common that samples are packed in inappropriate closed boxes, resulting in spillover and loss with high biological risk of possible primary TB transmission. During the three months, the study evaluated the system referral sample in Zambezia province, comparing the current improvised boxes vs new secondary packing developed in conjunction with FHI360's LTBR implementation partner and National Tuberculosis Laboratory Reference. The secondary packaging was piloted in 5 districts of Zambezia province (Quelimane, Namacurra, Morrumbala, Lugela and Pebane), two with good access roads and other three with poor access roads, what may contribute to increase samples spillage. LTBR activists and motorbike riders were trained and are using the secondary package to transport sputum samples from remote communities and/or peripheral Health Facilities to Health Facilities with TB laboratory services, using bicycles and motorbikes with cooler boxes. As a result, 2,689 TB samples were transported using secondary packaging in the 5 districts and only 2% were rejected (46/2689). Two districts (Morrumbala and Namacurra) has 0 rejections. Quelimane has less than 1% of rejection (1/292), Lugela 1% (3/214) and Pebane 7% (32/429). Out of the 46 rejections, 23 were attributed to spillover, Pebane-18 and Lugela-5, all using adapted alternative packaging. Health Facilities with more spills were Impaca (17) and Naburi (7) and Pele-Pele (5) all in Pebane District. Zero samples were spilled using the secondary packaging developed. The use of the secondary packaging by activists and motorbike riders are substantially Author α Ѡ ν : Instituto Nacional de Saúde; Mozambique. e-mail: diosdelio.gwegwe@ins.gov.mz Author σ ¥ § χ ζ : Family Health International 360. Author ρ : Direcção Provincial de Saúde – Zambezia. Author Ѳ : ADPP- Local TB Response. improving TB sample referencing and reducing dramatically spillage. Keywords: referral, packaging, sample, tuberculosis. I. I ntroduction quitable access to quality and timely diagnosis linked to appropriate care is critical for ensuring health for all. However, access to testing is the weakest link across the patient care-seeking pathway [1]. On the other hand, specimen referral systems play a critical role in ensuring access to laboratory services by allowing patients to receive care and treatment at one location, while their specimens are transferred to various levels of a tiered laboratory system for testing [2]. Delivering patient-centred and equitable diagnostic testing services is complex. Despite significant investments over the past decade to strengthen diagnostic systems, particularly for HIV and tuberculosis (TB), critical gaps and weaknesses remain [3, 4, 5]. Referral systems can efficiently increase access to diagnostics in areas where testing is not available, prevent the need and associated costs for patients to travel, and lead to equity in access to health care. Furthermore, tests centralized or regionalized testing and a robust specimen referral system may be more cost-effective than placing staff, procuring, and maintaining equipment to conduct testing at lower levels [2]. The goal of a diagnostic network to deliver the right amount of testing, in the right place, at the right time, for the right people and at an affordable and sustainable cost, ensuring that accurate test results are delivered in a timely manner to inform patient care and public health decision-making, on a scale consistent with national goals and strategies. The present study aim was to evaluate the efficiency of the new secondary package for biological sample, locally developed in Maputo-Mozambique to respond the challenge of spillage, reducing the loss of sputum for TB diagnostic. E