TB infection control in Swaziland is a priority health concern given the high rate of people living with HIV/AIDS and co-infected with TB (85%in adults and 60% in children).
The South Africa Society of Paediatric Imaging/SASPI (click here and scroll down for details) has expanded its mission to include outreach support to centres in South Africa and neighbouring countries lacking paediatric radiology expertise.
ICAP (Columbia University) has been supporting regional multidisciplinary mentorship teams in Hhohho, Lubombo and Manzini Regions in their integration of HIV and TB issues into health facilities in collaboration with CDC Atlanta and the MOH. ICAP has also been working with the national HIV and TB program to reinforce and centralize TB/HIV collaboration activities including building technical capacity of site providers to decentralize TB services.
In this regard, ICAP and SASPI collaborated and planned an outreach activity in September 2014 to develop skills for radiology use to diagnose and manage TB in children in different referral health sites. The activity entailed a 3 day visit from radiologist Dr. Jaishree Naidoo (Charlotte Maxeke Hospital, Johannesburg, and President, SASPI) and radiographer Mrs Stella Legoabe to conduct on-site radiology sessions with radiology technicians and clinicians. [See below "The Future" for June 2015 update, 2nd visit plans]
The visit rationale: support a QI exercise on the radiology department with the technicians and facilitate an on-site session with physicians to strengthen their reading skills of X-rays and with sonographers in point of care ultrasound when diagnosing TB in children.
Image: general store towards Pigs Peak mountain region in Swaziland. © Caitlain, Hertfordshire, UK
GOOD SHEPARD HOSPITAL, LUBOMBO REGION - the current regional referral hospital of the Lubombo Region. It covers a region with mainly a rural population of around 200,000 inhabitants. The hospital offers 250 beds and provides adult and paediatric services (OPD, IPD, HIV clinic, TB clinic, general surgery, ophthalmology). There is no paediatrician or radiologist present; general practitioners and nurses are allocated to paediatric services. The clinicians interpret the x-rays. The facility offers 3 radiographers, 1 trained in sonography. Image right: Jaishree Naidoo teaching at GSH
PIGS PEAK HOSPITAL, HHOHHO REGION - the current regional referral hospital of the Hhohho region. It covers a region with mainly rural population of around 200,000 inhabitants. HIV care and treatment services include integrated and comprehensive clinical care (i.e ART initiations, ART refills, Pre- ART, diagnosis and treatment of TB). The outpatient department provides services to an average of 2600 patients per month. There is 1 paediatrician in the hospital, no radiologist, 2 radiographers and 2 supportive staff in X-Ray. Image left: Pigs Peak Hospital
MBABANE GOVERNMENT HOSPITAL,HHOHHO REGION - the current national referral hospital of the Lubombo region. It offers 440 beds. Available health care services: HIV clinic, TB clinic, cervical cancer screening, Cryo and Leep therapy, KS clinic, ICU, Surgery, and Radiology. MGH hospital /ART clinic provides mentorship and supervisions for 12 baby clinics with a catchment population of 63,726 people. There is 1 radiologist, Dr Chen from Taiwan, who is an adult chest specialist. Dr Chen reports on the plain films, and CT’s. A trained sonographer does the ultrasounds. There is 1 paediatrician in the hospital. Image right: Mbabane Government Hospital
BAYLOR CENTER in Mbabane. Dr Pilar Ustero Alonso, the global TB program associate director of the Baylor College of Medicine, took the SASPI team on a tour of the Baylor Center and the new TB Clinic due to open in 2 months. This TB clinic will be freely available to the public. Patients will have access to investigations like gene expert and the necessary radiological investigations for adequate diagnosis of TB. There will be a digital x-ray and ultrasound machine.
Discussions were held on SASPI’s possible involvement in training new staff in Paediatric X-ray, ultrasound technique and interpretation of pulmonary and extra pulmonary manifestations of TB. Oportunities for telereading assistance were also explored.
Stella Legoabe (above left) and Dr. Jaishree Naidoo (above right, below) teaching radiographers and radiologists on the lateral chest X-ray and PoC ultrasound
During the teaching and training sessions at the different centres, the critical importance of lateral chest x-rays in assisting with the diagnosis of TB was emphasized. Click below for 7 minutes videso on the interpretation of frontal and laterial x-rays in TB, produced by SASPI member Prof. Savvas Andronikou.
The SASPI team also observed that ultrasound equipment lacks a linear, high frequency ultrasound probe, essential for better detection and assessment of splenic micro abscess/lymphadenopathy in TB.
Due to the shortage of specialists, paediatric x-rays are interpreted by the medical officers and interns. These doctors need support in interpretation of difficult cases. However, there is no digital x-ray machine and therefore images would need photographing for uploading via mail/a platform. SASPI has offered to assist the doctors in the interim but a more sustainable solution needs to be found.
The new TB clinic at the Baylor Center is a welcome addition to Swaziland's healthcare services as it will provide access to pathology and radiological investigations in one center. SASPI has offered it assistance with the training of the new staff in paediatric x-ray and ultrasound technique and interpretation of pulmonary and extra pulmonary manifestations of TB.
Update June 2015: a second visit to the clinic is being planned; sponsorship avenues look encouraging.
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