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

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.

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.

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%).

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.

Full article at: http://goo.gl/LXivL2

By: Grace Mhalu, Jerry Hella, Francis Mhimbira, Helen Hiza, Mohamed Sasamalo, Liliana Rutaihwa, Lukas Fenner

Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania

Grace Mhalu, Jerry Hella, Francis Mhimbira, Mohamed Sasamalo, Liliana Rutaihwa, Mitchell G. Weiss, Lukas Fenner

Swiss Tropical and Public Health Institute, Basel, Switzerland

Grace Mhalu, Jerry Hella, Francis Mhimbira, Mohamed Sasamalo, Liliana Rutaihwa, Mitchell G. Weiss, Lukas Fenner

University of Basel, Basel, Switzerland

Basra Doulla

Central Tuberculosis Reference Laboratory, Dar es Salaam, Tanzania

Basra Doulla, Beatrice Mutayoba

National Tuberculosis and Leprosy Programme, Dar es Salaam, Tanzania

Hawa Mtutu

Mwananyamala Regional Hospital, Dar es Salaam, Tanzania

Hans L. Rieder

Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

Hans L. Rieder

Research Center Borstel, Leibniz-Center for Medicine and Biosciences, Borstel, Germany

Tamsyn Seimon

Interactive Research & Development, Lausanne, Switzerland and Pakistan

Lukas Fenner

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

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