WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Sajida Rashid Kaittan*, Huda Ibrahim Asal and Suhad Falah Hassan

ABSTRACT

Background: Tuberculosis (TB) remains a leading cause of death worldwide, and Iraq is among the high TB burden countries in the Eastern Mediterranean Region. The estimated TB incidence in Iraq is 45 cases per 100,000, with a mortality rate of 3.2 per 100,000 annually. Delayed diagnosis increases community transmission. The Iraqi National TB Control Program (NTP) emphasizes early TB case detection through referrals from primary healthcare centers (PHCCs). Any deficiencies in this referral system impact TB control efforts. Objectives: This study aimed to assess the effectiveness of the TB suspect referral system in PHCCs in Baghdad by examining the knowledge, attitude, and practice of PHCC managers, physicians, and district TB coordinators (DTCs), and to identify factors affecting the system's performance. Methodology: A health system research study was conducted in 75 randomly selected PHCCs across 15 health districts in Baghdad from March to November 2023, involving 406 physicians, 75 managers, and 17 DTCs. Data were collected via interviews using a self-administered questionnaire and analyzed with SPSS version 20. Results: The referral rate of TB suspects from PHCCs to DTCs was 26.4%. Only 12.5% of physicians knew TB symptoms, 5.9% confirmed diagnoses using sputum, and 13.5% were trained on TB control. Around 94% of physicians stated the need for training. Only 9.3% of PHCCs met referral targets. Among DTCs, 88.2% were supported by NTP, but only half visited PHCCs quarterly. Conclusions: There is a significant knowledge gap among PHCC practitioners regarding TB control and referrals. Training programs targeting these gaps are essential to improve the referral system and support NTP goals.

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