Women in Science Mentoring Program (2020)
Strengthening community to recognize and prevent tuberculosis and diabetes mellitus (SCREEN TB-DM) among informal workers
PI: Vitri Widyaningsih, Universitas Sebelas Maret, Indonesia
Project Dates: February 2022 - July 2023
Project Overview:
 | | | Disease control research group. Photo credit; Dr. Vitri | |
In Indonesia, 72% of working population belong to informal sectors. Informal workers are more likely to live in poverty, exposed to work and home environment that might increase the risks for TB, and higher odds of unhealthy behaviors. Studies on factors related to diagnosis and treatment outcome for these population is also limited. Screening for tuberculosis and diabetes mellitus in informal workers is likely to be beneficial to improve case finding of these diseases. However, with the current COVID-19 pandemic, most community-based activities have been halted. Several programs for TB and NCDs including DM has been postponed due to social restrictions. It has been reported that the health service delivery has been disproportionately reduced, with a more significant effect on poor, less advantaged individuals, including informal workers. Hence, it is important to improve the workers’ awareness on their health, including recognizing TB-DM symptoms and conduct preventive measures through healthy behavior. It has been reported that self-screening for NCDs and active case finding for Tuberculosis in the COVID-19 pandemic, is an effective strategy. Interventions in the workplace can reduce the physical and economic burden of non-communicable diseases. For informal workers, this can be conducted through the Occupational Health Post which is launched to improve informal workers’ health. The OHP, facilitated by Primary Health Care (PHC), is a community-based program runs by workers focusing primarily on occupational health. As OHP runs by informal workers within their own workplace, there is an opportunity to continue its activities, and incorporating TB-DM awareness into the program. This study aims to assess the feasibility of integrating screening for TB-DM in the occupational health post program. The team aims to develop a model to involve informal workers as potential target population, by: 1) improving their awareness and knowledge in recognizing symptoms of TB and DM, 2) improving health-seeking behavior regarding TB-DM, and 3) and increasing healthy behavior to prevent the diseases. This study will contribute to the USAID's TB goals to improve case detection and prevention of TB in vulnerable communities, because despite their high risks of having poor health outcomes, informal workers are often less prioritized in the health agenda. Activities and outcomes
The aim of this research was to assess the feasibility of integrating screening for TB-DM in the occupational health post program and to develop a model to involve informal workers as potential target population. The project conducted:
(1) Analyses of TB-DM comorbidity. (2) Situational analyses of TB-DM prevention (particularly screening) for informal workers. These findings provide recommendations for raising awareness about TB-DM to eliminate stigma, formulating informal worker health policies, developing user-friendly TB-DM screening systems, and establishing UKK to improve the effectiveness of TB-DM screening. (3) Development of SCREEN TB-DM tools. The model was piloted at two communities in Central Java, Indonesia. The team conducted trainings and selected informal workers (farmer groups). In the pilot training, the farmers gained information about tuberculosis, diabetes mellitus, and hypertension. The team also taught them how to assess health status using screening tools and how to use the health equipment that supports health examinations. From the pilot training that has already been conducted, it is evident that the farmers have a high level of enthusiasm to learn about their health conditions. This training provided some evaluations that support screening tool improvement. The PI hopes that farmers can screen their own health status during routine gatherings, which will contribute to the improvement of TB elimination among informal workers. The output from the SCREEN-TBDM project is available to all stakeholders participating in the study, and will be further improved and finalized for wider dissemination. As a result of this study, three major pieces of information are now available: (1) Data on the prevalence and determinants of TB-DM comorbidities; (2) Potential challenges and facilitators for TB-DM screening in informal workers, and (3) Community-based model for TB-DM screening in informal workers. Dr. Vitri notes that the empowerment of informal worker communities to screen for TB and NCDs can improve their awareness and understanding of the diseases, reduce stigma, and improve preventive action for TB and NCDs, particularly, Diabetes Mellitus. One of the most important results of this SEED grant has been the development of the model for screening for Tuberculosis and Diabetes. The model that was developed includes: a. An algorithm for TB-DM screening in informal workers settings which were integrated into a screening tool card. b. Information sheet on TB-DM, its prevention, risk factors, and complications c. Flipchart on TB-DM d. The module for TB-DM screening
The team are planning to continue \dissemination of these tools to empower communities, particularly informal workers to be able to screen for Tuberculosis and Diabetes Mellitus.
 |  | | Mentoring activities: writing workshop. Photo credit: Dr. Vitri | USAID (Aaron Burr) and NAS (Lina Stankute Alexander) visit PEER PI's team and collaborators in Surakarta, Indonesia |
 |  | | Mentoring activities: retreat | Meeting co-PI Luthfi Azizatunnisa |
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