Improvement on Packaging and Referencing Tuberculosis Samples – Experience in Zambezia, Mozambique
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 Zambeze province, comparing the current improvised boxes vs new secondary packing developed by National Tuberculosis Laboratory Reference. The secondary packaging is 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 laboratory services, using bicycle and motorbikes with cooler boxes. As a result, 2,689 TB samples were transported using secondary packaging in the 5 districts and only 3% were rejected (41/2689). 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 41 rejections, 19 were attributed to spillover, Pebane-17 and Lugela-5, all using adapted alternative packaging. Health Facilities with more spills were Impaca (6) and Naburi (5) both 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 improving TB sample referencing and reducing dramatically spillage.
