Improving TB Case Detection in Vulnerable Urban Populations Through Integrated Health Services: Evidence from Korle Klottey and La Dadekotopon Districts in Greater Accra Region, Ghana
Richard Socrate Adzesi*, Charity Femeyibor, Ernest Ani Ampofo, Alfred Issac Tsiboe, Jerry Amoah-Larbi, Rita Patricia Frimpong-Mansoh and Yaw Adusi-Poku
ABSTRACT
Background: Tuberculosis (TB) diagnosis is costly and require extensive resources and human expertise and can be clinically or bacteriologically evidence.Integrated community-based health services offer an opportunity to improve TB case detection while addressing other priority health needs.
Objective: This study assessed the contribution of integrated community-based health services to improving tuberculosis case detection among vulnerable populations in the Korle Klottey and La Dadekotopon districts of the Greater Accra Region, Ghana.
Methods: A community-based screening intervention was conducted among residents of urban informal settlements. Data were collected using structured paper-based tools, entered into Microsoft Excel, and analysed using R software. Descriptive statistics summarised service uptake and the TB diagnostic cascade, while bivariate and multivariate logistic regression analyses were used to identify factors associated with bacteriologically confirmed TB.
Results: A total of 1,243 participants were screened, with 894 identified as presumptive TB cases. Of these, 546 sputum samples were collected, and 347 participants undertook chest X-ray. 26 X-rays were suggestive of TB, and 87 participants were bacteriologically confirmed as TB positive by GeneXpert MTB, and 95.6% of bacteriologically and clinically confirmed cases were initiated on treatment. Uptake of integrated services was high, with 77.7% tested for HIV and 71.2% tested for malaria. Logistic regression analysis showed that migrant status was the only factor independently associated with bacteriologically confirmed
TB, with migrants having significantly lower odds of confirmed TB compared to non-migrants (aOR = 0.57; 95% CI: 0.36–0.92).
Conclusion: Integrated community-based screening improved TB case detection and enabled delivery of essential health services in vulnerable urban settings, supporting its scale-up as a key strategy for strengthening urban TB control.
