Evaluation of Borama tuberculosis control program in Somaliland, Somalia.

INTRODUCTION: The Borama TB program in Somalia lost resources for TB operations in 2003. We evaluated the impact of the loss on the program. METHODOLOGY: Pre-event (2002-2003) and post-event (2007) design were used. All TB patients registered in Borama and a sample of four months from Hargeisa (comparison) TB patients in both periods were abstracted. The following TB treatment outcomes were estimated: treatment success, treatment failure, case fatality, treatment interruption and transfer rates, along with percentage of patients with sputum specimen prior to treatment, percentage of patients from neighboring countries, and monthly average patients enrolled in treatment. The pre-event to post-event outcomes and measures were compared using descriptive and multivariate analyses. RESULTS: In total, 3,367 TB cases were abstracted. In Borama, the TB treatment success rate increased 6% in the post-event. The treatment failure and interruption rates both declined 75%. Monthly average TB patients declined 55%. Percentage of patients smear tested prior to the initiation of the treatment declined 9%. Percentage of TB patients from neighboring countries and other parts of Somalia declined 51%. Treatment interruption/transfer rates declined significantly in the post-event, compared to the pre-event period. Treatment failure/death rate did not change in the post-event period. In Hargeisa, the treatment success, failure/death, and interruption/transfer rates were similar in both periods. The RR did not change in these measures after adjusting for age and gender. CONCLUSIONS: This study indicates a significant setback to the Borama TB control program in the majority of measures evaluated, except the TB success rate.

Competence of maternal and child health clinic workers in detecting malnutrition in Somalia.

BACKGROUND: The MCH clinic workers in Somalia receive formal and in-service training to perform their professional duties. Their competence in the field was never examined. This study assessed their competencies in detecting malnourished children 5 years and below in Beledweyne. OBJECTIVE: To assess the competence of MCH clinic workers in detecting malnourished children. DESIGN: Cross-sectional study. METHODS: The study was conducted in 1989. We obtained data on children five years and below from the MCH clinic in Beledweyne, Somalia. We analyzed two months data. We used CASP program to calculate the Weight-for-Age index (WFA). The nutritional status determined by the MCH clinic workers and the WFA index were used to estimate the positive and negative predicted values of the MCH clinic workers' competence in detecting malnourished children. RESULTS: We studied 487 children 5 years old and below. The health workers determined that 13.5% were malnourished. The positive and negative predicted values of the MCH clinic workers' nutritional measure were 76% and 92% respectively. CONCLUSION: The MCH clinic workers showed deficiency in their competence to detect malnourished children. They misclassified 10% of the children, which was worse among the malnourished, due to incorrect plotting of the child's current weight on the growth chart.