House to House: Seeking and Treating TB Cases in Democratic Republic of the Congo

 {Photo credit: MSH staff.}A community health worker brings sputum samples she collected during home visits for testing at a laboratory.Photo credit: MSH staff.

Solange Bitondo coughed for a year, but never sought treatment from the Kinkindi health center less than a kilometer from her home. Instead, the 37-year-old mother of three consulted traditional healers, prayed, and self-medicated with herbs and medicines she found in the market. 

Tuberculosis (TB) is one of the leading causes of death and disability in Democratic Republic of the Congo (DRC), with half of all cases of this extremely infectious disease undetected and untreated. The national average for detection is only 51 percent of expected cases. But in Bitondo’s health zone of Kamituga in Sud Kivu, the detection rate until recently reached only 28 percent, due partly to the difficulty of mobilizing community volunteers for outreach, coupled with stigma about the disease.

To control the spread of TB, the Ministry of Health (MOH) is currently implementing—through its National Tuberculosis Program (PNLP)—the National Tuberculosis Strategic Plan for 2014-2017. The success of this plan depends heavily on community health workers (CHW) at the grassroots level—people who know the community well and whom residents trust. CHWs screen for TB cases house by house, collecting sputum samples from people they suspect might be positive (i.e., people with a chronic cough). If a test comes back positive, the volunteer refers the individual to a local treatment center.

In February 2015, CHWs conducted a “mini-campaign”—visiting more than 5,000 households in the Kamituga health zone—with the support of the USAID-funded Integrated Health Project (IHP), led by MSH. At the same time, awareness raising through radio broadcasts and church announcements reached more than 45,000 people.

The door-to-door campaign tested 321 people; 30 of them were found to have TB, compared with an expected 24 for the month. Bitondo was among those visited by a health worker and given a rapid diagnostic test. After she tested positive and was counseled by a CHW, Bitondo sought treatment from the Kamituga General Referral Hospital. Said Bitondo:

I thought my coughing was a curse or a spell that could be treated by healers, but thanks to community health workers, I discovered that it is a curable disease . Thank you to the health zone team and to IHP for their support. Now I have to convince my brother, who has also been coughing, to get tested for TB.