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Do Instructional Videos on Sputum Submission Result in Increased Tuberculosis Case Detection? A Randomized Controlled Trial.

Mhalu G, Hella J, Doulla B, Mhimbira F, Mtutu H, Hiza H, Sasamalo M, Rutaihwa L, Rieder HL, Seimon T, Mutayoba B, Weiss MG, Fenner L - PLoS ONE (2015)

Bottom Line: Older age, but not the HIV status or sex, modified the effectiveness of the intervention by improving it positively.If confirmed in larger studies, instructional videos may have a substantial effect on the case yield using sputum microscopy and also molecular tests.This low-cost strategy should be considered as part of the efforts to control TB in resource-limited settings.

View Article: PubMed Central - PubMed

Affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.

ABSTRACT

Objective: We examined the effect of an instructional video about the production of diagnostic sputum on case detection of tuberculosis (TB), and evaluated the acceptance of the video.

Trial design: Randomized controlled trial.

Methods: We prepared a culturally adapted instructional video for sputum submission. We analyzed 200 presumptive TB cases coughing for more than two weeks who attended the outpatient department of the governmental Municipal Hospital in Mwananyamala (Dar es Salaam, Tanzania). They were randomly assigned to either receive instructions on sputum submission using the video before submission (intervention group, n = 100) or standard of care (control group, n = 100). Sputum samples were examined for volume, quality and presence of acid-fast bacilli by experienced laboratory technicians blinded to study groups.

Results: Median age was 39.1 years (interquartile range 37.0-50.0); 94 (47%) were females, 106 (53%) were males, and 49 (24.5%) were HIV-infected. We found that the instructional video intervention was associated with detection of a higher proportion of microscopically confirmed cases (56%, 95% confidence interval [95% CI] 45.7-65.9%, sputum smear positive patients in the intervention group versus 23%, 95% CI 15.2-32.5%, in the control group, p <0.0001), an increase in volume of specimen defined as a volume ≥3ml (78%, 95% CI 68.6-85.7%, versus 45%, 95% CI 35.0-55.3%, p <0.0001), and specimens less likely to be salivary (14%, 95% CI 7.9-22.4%, versus 39%, 95% CI 29.4-49.3%, p = 0.0001). Older age, but not the HIV status or sex, modified the effectiveness of the intervention by improving it positively. When asked how well the video instructions were understood, the majority of patients in the intervention group reported to have understood the video instructions well (97%). Most of the patients thought the video would be useful in the cultural setting of Tanzania (92%).

Conclusions: Sputum submission instructional videos increased the yield of tuberculosis cases through better quality of sputum samples. If confirmed in larger studies, instructional videos may have a substantial effect on the case yield using sputum microscopy and also molecular tests. This low-cost strategy should be considered as part of the efforts to control TB in resource-limited settings.

Trial registration: Pan African Clinical Trials Registry PACTR201504001098231.

No MeSH data available.


Related in: MedlinePlus

Quantitative grading scale of sputum smear microscopy results in the intervention (exposure to the sputum submission instruction video) and control group (standard of care).Numbers on the bars indicate absolute number of patients. Overall P value across groups was <0.0001.
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pone.0138413.g004: Quantitative grading scale of sputum smear microscopy results in the intervention (exposure to the sputum submission instruction video) and control group (standard of care).Numbers on the bars indicate absolute number of patients. Overall P value across groups was <0.0001.

Mentions: The intervention had an effect on the smear positivity grading scale (e.g., 6% scanty in the intervention, compared to 2% in the control group, Fig 4, overall p value across groups <0.0001). In addition, sputum volumes were higher in the intervention group compared to the control group across sputum volume groups of 2 mL, 2–2.9 mL, 3–4.9 mL and ≥5 (overall p value <0.0001, Fig 5). The recommended volume of sputum of 3 mL or more for optimal microscopy results was obtained more frequently in the intervention compared to the control group (78%, 95% CI 68.6–85.7%, versus 45%, 95% CI 35.0–55.3%, p <0.0001).


Do Instructional Videos on Sputum Submission Result in Increased Tuberculosis Case Detection? A Randomized Controlled Trial.

Mhalu G, Hella J, Doulla B, Mhimbira F, Mtutu H, Hiza H, Sasamalo M, Rutaihwa L, Rieder HL, Seimon T, Mutayoba B, Weiss MG, Fenner L - PLoS ONE (2015)

Quantitative grading scale of sputum smear microscopy results in the intervention (exposure to the sputum submission instruction video) and control group (standard of care).Numbers on the bars indicate absolute number of patients. Overall P value across groups was <0.0001.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587748&req=5

pone.0138413.g004: Quantitative grading scale of sputum smear microscopy results in the intervention (exposure to the sputum submission instruction video) and control group (standard of care).Numbers on the bars indicate absolute number of patients. Overall P value across groups was <0.0001.
Mentions: The intervention had an effect on the smear positivity grading scale (e.g., 6% scanty in the intervention, compared to 2% in the control group, Fig 4, overall p value across groups <0.0001). In addition, sputum volumes were higher in the intervention group compared to the control group across sputum volume groups of 2 mL, 2–2.9 mL, 3–4.9 mL and ≥5 (overall p value <0.0001, Fig 5). The recommended volume of sputum of 3 mL or more for optimal microscopy results was obtained more frequently in the intervention compared to the control group (78%, 95% CI 68.6–85.7%, versus 45%, 95% CI 35.0–55.3%, p <0.0001).

Bottom Line: Older age, but not the HIV status or sex, modified the effectiveness of the intervention by improving it positively.If confirmed in larger studies, instructional videos may have a substantial effect on the case yield using sputum microscopy and also molecular tests.This low-cost strategy should be considered as part of the efforts to control TB in resource-limited settings.

View Article: PubMed Central - PubMed

Affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.

ABSTRACT

Objective: We examined the effect of an instructional video about the production of diagnostic sputum on case detection of tuberculosis (TB), and evaluated the acceptance of the video.

Trial design: Randomized controlled trial.

Methods: We prepared a culturally adapted instructional video for sputum submission. We analyzed 200 presumptive TB cases coughing for more than two weeks who attended the outpatient department of the governmental Municipal Hospital in Mwananyamala (Dar es Salaam, Tanzania). They were randomly assigned to either receive instructions on sputum submission using the video before submission (intervention group, n = 100) or standard of care (control group, n = 100). Sputum samples were examined for volume, quality and presence of acid-fast bacilli by experienced laboratory technicians blinded to study groups.

Results: Median age was 39.1 years (interquartile range 37.0-50.0); 94 (47%) were females, 106 (53%) were males, and 49 (24.5%) were HIV-infected. We found that the instructional video intervention was associated with detection of a higher proportion of microscopically confirmed cases (56%, 95% confidence interval [95% CI] 45.7-65.9%, sputum smear positive patients in the intervention group versus 23%, 95% CI 15.2-32.5%, in the control group, p <0.0001), an increase in volume of specimen defined as a volume ≥3ml (78%, 95% CI 68.6-85.7%, versus 45%, 95% CI 35.0-55.3%, p <0.0001), and specimens less likely to be salivary (14%, 95% CI 7.9-22.4%, versus 39%, 95% CI 29.4-49.3%, p = 0.0001). Older age, but not the HIV status or sex, modified the effectiveness of the intervention by improving it positively. When asked how well the video instructions were understood, the majority of patients in the intervention group reported to have understood the video instructions well (97%). Most of the patients thought the video would be useful in the cultural setting of Tanzania (92%).

Conclusions: Sputum submission instructional videos increased the yield of tuberculosis cases through better quality of sputum samples. If confirmed in larger studies, instructional videos may have a substantial effect on the case yield using sputum microscopy and also molecular tests. This low-cost strategy should be considered as part of the efforts to control TB in resource-limited settings.

Trial registration: Pan African Clinical Trials Registry PACTR201504001098231.

No MeSH data available.


Related in: MedlinePlus