Belize Presentation Dr. Ines Mendez-Moguel

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Belize PresentationDr. Ines Mendez-Moguel
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Operational situation and Programmatic Experience
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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.

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Source Data from the Epidemiology Unit
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Source The Epidemiology Unit
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Source Data from the Epidemiology Unit
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Source Data from the Epidemiology Unit
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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 19,23
Source Data from the Epidemiology Unit
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SITUATIONAL ANALISIS
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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.

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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.

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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

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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.

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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.

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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.

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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.

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Findings

• 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.

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

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• 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.

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Findings Cont

• 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)

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THANK YOU