Abstract :

Tuberculosis (TB) remains a major global public health challenge, particularly in low- and middle-income countries where case detection rates remain below international targets. In Zambia, the TB detection rate remains significantly lower than the 75% target recommended by the World Health Organization (WHO), posing a threat to effective TB control. This study evaluated the factors contributing to low TB detection rates in selected health facilities in Ndola District, Copperbelt Province of Zambia. A quantitative cross-sectional study design was employed. Data were collected from 93 respondents comprising health care workers and community members selected from 33 health facilities providing TB services. Structured questionnaires and face-to-face interviews were used to gather information on demographic characteristics, knowledge of TB symptoms, availability of diagnostic services, and barriers to TB detection. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics such as frequencies and percentages were used to summarise the data. The findings revealed that inadequate laboratory equipment was the most frequently reported factor contributing to low TB detection (55.9%), followed by limited community awareness of TB disease (24.7%). Other factors identified included TB-related stigma (7.5%), shortage of skilled laboratory personnel (6.5%), and long distances to health facilities (5.4%). The study further established that cough was the most widely recognised TB symptom among respondents, while awareness of other symptoms such as fever and night sweats was relatively low. The study concludes that low TB detection in Ndola District is influenced by both health system constraints and community-related factors. Strengthening diagnostic capacity, increasing public awareness of TB symptoms, addressing stigma, and improving access to diagnostic services are critical interventions for improving TB case detection. Enhancing these strategies will contribute to early diagnosis, improved treatment outcomes, and reduced transmission of tuberculosis within the community.

---

Keywords :

case detection, diagnostic capacity, health-seeking behaviour, stigma., Tuberculosis

---

References :

1. Banda, H.T., Gausi, F., Harries, A.D., Salaniponi, F.M.L. and Kemp, J.R. (2014) ‘Prevalence of smear-positive pulmonary tuberculosis among patients with chronic cough in Malawi’, International Journal of Tuberculosis and Lung Disease, 18(5), pp. 564–569. https://doi.org/10.5588/ijtld.13.0561
2. Bates, M., Mudenda, V., Mwaba, P. and Zumla, A. (2011) ‘Diagnosis of tuberculosis in resource-limited settings’, Clinical Infectious Diseases, 52(11), pp. 1373–1379. https://doi.org/10.1093/cid/cir214
3. Courtwright, A. and Turner, A.N. (2010) ‘Tuberculosis and stigma: pathways and interventions’, Public Health Reports, 125(Suppl 4), pp. 34–42. https://doi.org/10.1177/00333549101250S407
4. Datiko, D.G. and Lindtjørn, B. (2010) ‘Health extension workers improve tuberculosis case detection and treatment success in southern Ethiopia: a community randomized trial’, BMC Health Services Research, 10, p. 210. https://doi.org/10.1186/1472-6963-10-210
5. Horton, K.C., MacPherson, P., Houben, R.M.G.J., White, R.G. and Corbett, E.L. (2016) ‘Sex differences in tuberculosis burden and notifications in low- and middle-income countries: a systematic review and meta-analysis’, PLoS Medicine, 13(9), e1002119. https://doi.org/10.1371/journal.pmed.1002119
6. Kapata, N., Chanda-Kapata, P., Bates, M., Mwaba, P., Cobelens, F., Grobusch, M.P., Mfinanga, S., Ipuge, Y., Mukonka, V. and Zumla, A. (2014) ‘The burden of tuberculosis in Zambia: a review of epidemiology and control strategies’, BMC Public Health, 14, p. 1029. https://doi.org/10.1186/1471-2458-14-1029
7. Kapata, N., Chanda-Kapata, P., Grobusch, M.P., O’Grady, J., Schwank, S., Bates, M., Mwaba, P. and Zumla, A. (2015) ‘Scaling up TB diagnosis and treatment in sub-Saharan Africa’, The Lancet Infectious Diseases, 15(10), pp. 1231–1239. https://doi.org/10.1016/S1473-3099(15)00179-7
8. Kapata, N., Chanda-Kapata, P., Mwaba, P. and Zumla, A. (2016) ‘Tuberculosis in Zambia: progress and challenges’, BMC Public Health, 16, p. 194. https://doi.org/10.1186/s12889-016-2864-2
9. Kik, S.V., Den Boon, S., Verver, S., et al. (2008) ‘Tuberculosis case detection rates and implications for TB control’, International Journal of Tuberculosis and Lung Disease, 12(10), pp. 1143–1149.
10. Loveday, M., Cox, H. and Evans, D. (2018) ‘Tuberculosis in South Africa: challenges and opportunities’, Lancet Infectious Diseases, 18(11), pp. e333–e343. https://doi.org/10.1016/S1473-3099(18)30314-7
11. Mane, S., Mwaba, P., et al. (2008) ‘Tuberculosis case detection challenges in Zambia’, International Journal of Tuberculosis and Lung Disease, 12(3), pp. 283–289.
12. Ministry of Health (MOH) (2014) National tuberculosis and leprosy control programme guidelines. Lusaka: Government of Zambia.
13. Monde, N., Munyeme, M. and Malama, S. (2016) ‘Challenges affecting tuberculosis detection in Zambia’, Medical Journal of Zambia, 43(2), pp. 75–82.
14. Mrisho, M., Obrist, B., Schellenberg, J.A., Haws, R.A., Mushi, A.K., Mshinda, H., Tanner, M. and Schellenberg, D. (2009) ‘Factors affecting home delivery in rural Tanzania’, Tropical Medicine and International Health, 12(7), pp. 862–872. https://doi.org/10.1111/j.1365-3156.2007.01855.x
15. Mulenga, C., Mwakazanga, D., et al. (2010) ‘Transmission patterns of tuberculosis in Ndola District, Zambia’, International Journal of Tuberculosis and Lung Disease, 14(9), pp. 1120–1125.
16. Oladimeji, O., Tsoka-Gwegweni, J. and Udoh, E. (2017) ‘Knowledge and health-seeking behaviour related to tuberculosis in Africa’, PLoS ONE, 12(4), e0176456. https://doi.org/10.1371/journal.pone.0176456
17. Sialubanje, C., Massar, K., Hamer, D.H. and Ruiter, R.A.C. (2015) ‘Reasons for home delivery and use of traditional birth attendants in rural Zambia’, BMC Pregnancy and Childbirth, 15, p. 216. https://doi.org/10.1186/s12884-015-0653-6
18. TB Care I (2012) Tuberculosis control programme report for Zambia. Lusaka: TB Care I Project.
19. Verver, S., Kapata, N., et al. (2018) ‘Trends in tuberculosis notification rates in Zambia’, BMC Infectious Diseases, 18, p. 1. https://doi.org/10.1186/s12879-018-2931-8
20. World Health Organization (WHO) (2013) Global tuberculosis report 2013. Geneva: WHO.
21. World Health Organization (WHO) (2016) Global tuberculosis report 2016. Geneva: WHO.
22. World Health Organization (WHO) (2018) Global tuberculosis report 2018. Geneva: WHO.
23. World Health Organization (WHO) (2020) Global tuberculosis report 2020. Geneva: WHO.
24. World Health Organization (WHO) (2023) Global tuberculosis report 2023. Geneva: WHO.