Tuberculosis is a growing problem in lower and middle income countries, including South Africa. The World Health Organization estimates that about two thirds of people with tuberculosis are never diagnosed and so cannot benefit from treatment, leaving the epidemic unchecked despite global treatment programmes.

Lack of trained staff is thought to be the most important constraint on the control of tuberculosis, but training is of doubtful effectiveness.

Eight specially trained nurses delivered educational outreach training to clinical staff in 20 primary care clinics in the Free State province, South Africa. Staff in another 20 clinics received no training. Detection and treatment of respiratory illness in almost 2,000 patients was monitored over a five-month period.

Detection and treatment of tuberculosis and asthma were higher in the outreach clinics, suggesting that educational outreach training improves the quality of tuberculosis and asthma care without interrupting services, and without the need for extra staff.

The Free State and other provinces are adapting educational outreach for HIV/AIDS and implementing it widely, say the authors. They suggest that in other lower and middle income countries, where non-physicians provide primary care, equipping middle managers as outreach trainers is feasible within existing constraints on staff and could improve quality of care.

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Contact: Emma Dickinson
edickinson@bmj.com
+44 (0)20-7383-6529
BMJ-British Medical Journal
29-Sep-2005