Belize Presentation Dr. Ines Mendez-Moguel

Operational situation and Programmatic Experience

EPIDEMIOLOGY OF TB. With the advent of the HIV epidemic, the incidence of Tuberculosis has increased, this coupled with its presentation as an opportunistic disease of HIV/AIDS is of great Public Health importance. The Ministry of Health in Belize therefore is committed to alleviating and in the long term eliminating Tuberculosis as a separate disease entity and as it relates to debilitation of P.W.HA.

Source: Data from the Epidemiology Unit

Source: The Epidemiology Unit

Source: Data from the Epidemiology Unit

Source: Data from the Epidemiology Unit

Pulmonary TB (+) Incidence rates per 100,000 inhabitants, by District, Belize, 2001 – 2003 Year Corozal Orange Walk Belize Cayo Stann Creek Toledo 2001 11,19 7,37 26,19 17,87 19,23 32,63 2002 38,20 16.79 39.34 41.10 3.70 35.71 2003 17,34 9,35 23,24 47,54 7,17 Source: Data from the Epidemiology Unit

SITUATIONAL ANALISIS

WHAT EXIST The National Tuberculosis Program in the prevention and control of TB utilizes strategies such as: Information, Education and Communication, case management, contact tracing and surveillance. Our program is a centralized program, supported by the maternal and child personnel in the delivery of service, HECOPAB in the IEC and Laboratory for diagnostic purpose.

WHAT EXIST The Chest Clinic in Belize City operates at two level: Providing daily service to patient from Belize City and also as a national referral center. With a Dermatologist as the treating physician (who is also the National Coordinator for TB), a Family Nurse Practitioner and a Rural Health Nurse. Drug supply is adequate and sufficient. There is screening being done at the Central Prison by a General Doctor who diagnosed and treat patients Laboratory/ Central lab./District labs (P.G.) Passive Surveillance. Belize City/District C.T.

WHAT EXIST DOTS is practice in all the clinics with few exceptions. HIV testing is offered to all patients. TB prophylactic treatment given to all HIV+ patients. ARV given free of charge to all TB-HIV+ patients. Reporting System. Monitoring and evaluation. Visit sites quarterly

WHAT EXIST Health Education: Health education is provided to the patient and relatives at the clinic, also has been provided to Primary and High Schools by the Chest Clinic Staff, and we received support from HECOPAB. All personnel working with the TB program (nurses and doctors) received a training once a year. Nurses are move from the program often without notice, so the guidelines may not be followed.

WHAT DOES NOT EXIST Nursing personnel for TB program. Decentralized the TB program. Will improve access to treatment hence more compliance. A Pneumologist to treat complicated cases/referrals. LAB: need to do baciloscopy in every district or slides. More lab personnel to improve service.

WHAT DOES NOT EXIST Hood has not been acquired. Need a centrifuge. Sputum smear is not done in100% of patients. No quality control being done in the district labs or Central Lab. TB Policies developed but adherence is not consistent. Need a system to recuperate abandons.

Evaluation of National Tuberculosis Program 2003 Purpose Improve service delivery and compliance (determine reason/s for non compliance). Increase the cure rate of Tuberculosis (85%). Have proper classification of deaths.

Findings Thirty six (36) clients responded Convenient sampling was done (# not predetermined). Administered questionnaire. Respondent were from all six (6) districts. Thirty six (36) clients responded Male female ratio of 2.3/1. The mean age of the sample was 42 years ranging from 9 to 89 years of age. Urban rural distribution 17/19. Educational level Primary 25, Secondary 5, other 2 and non-response 2.

Most male clients were labourers and females housewives Most male clients were labourers and females housewives. Three clients were students. Monthly Household Income: $500 - $1000 =42% $1001- 1500 =14% Non-response =44% There was and average of 4.4 persons to a household and an average of 2.2 persons to a bedroom.

Sixteen (16) clients or 44% admitted to drug use Sixteen (16) clients or 44% admitted to drug use. Alcohol was the most substance abused. Clients for the most part had some knowledge of the transmission and the prevention of Tuberculosis. Problems experienced in accessing medication was time off from work and transportation cost. Reported side effects from medication ranged from nausea to headache and played a major role in adherence to medication regime. Eighty percent (80%) of the clients were satisfied with the program.

Findings Con’t Administration The physical location of Chest Clinic affords the support network as follows: Procare Center (Transportation) Karl Heusner Memorial Hospital (Hospitalization & Radiology) Medical Supplies Office (medication) In the Regions there is not this level of support (in Stann Creek District logistics is a challenge)

THANK YOU