Community Empowerment through Cadres in the Tuberculosis Program: A Scoping Review
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Abstract
Background: Tuberculosis (TB) remains a global public health problem with high morbidity and mortality rates, especially in low- and middle-income countries. Community-based approaches, including empowerment of health cadres, have been recognized as a key strategy to improve the success of TB control programs. This review systematically identifies research that has been carried out to determine the contribution of cadres in tuberculosis control programs in various countries.
Methods: This scoping review used five electronic databases, namely PubMed, Scopus, Medline-Ebscohost, ProQuest, and Cochrane, to identify the contribution of cadres in TB programs. Article selection was based on PCC (Population, Concept, Context) criteria with a limitation of 2014-2024 and only English-language articles.
Results: Out of 793 initial articles, 20 articles met the eligibility criteria. Studies show that empowering cadres is effective in detecting TB cases, improving patient adherence to treatment, and overcoming stigma through culture-based education. However, challenges such as lack of training, incentives, and access to diagnostic tools often hinder cadre performance.
Conclusion: Health cadres play an important role in bridging the gap between formal health services and the community. With the support of structured training, resource allocation, and community empowerment, cadres can maximize their impact in TB control programs.
1. Jauhar M, Rohana IGAPD, Rachmawati U, et al (2019). Empowering community health volunteer on community-based tuberculosis case management programs in lower-income countries: A systematic review. Journal of Community Empowerment for Health, 2(2): 172.
2. Harahap J, Amelia R, Wahyuni AS, et al (2018). Community empowerment pro-gram for increasing knowledge and awareness of tuberculosis patients, ca-dres and community in Medan city. IOP Conf Ser Earth Environ Sci, 125: 012102.
3. Sukartini T, Wahyuni S, Makhfudli M (2020). The Factors that Related to the Success of Tuberculosis Cadres in Tuberculosis Case Finding. Sys Rev Pharmy, 11(5): 562–6.
4. Chavez-Rimache L, Ugarte-Gil C, Brunette MJ (2023). The community as an active part in the implementation of interven-tions for the prevention and care of tu-berculosis: A Scoping Review. PLOS Glob Public Health, 3(12): e0001482.
5. Burke RM, Nliwasa M, Feasey HRA, et al (2021). Community-based active case-finding interventions for tuberculosis: a systematic review. Lancet Public Health, 6(5): e283–99.
6. Williams V, Kovarik C (2018). WhatsApp: An Innovative Tool for Dermatology Care in Limited Resource Settings. Tele-med E Health, 24(6): 464–8.
7. Page MJ, McKenzie JE, Bossuyt PM, et al (2021) Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol, 134: 103–12.
8. Sapar, Salju, Risal M, Samsinar, et al (2020) The influence of TB care community cadre’s roles on the treatment adher-ence of tuberculosis (TB) sufferers. Enferm Clin, 30: 244–8.
9. Febriani E, Wibowo A, Kak N, et al (2021). Empowering Health Cadres to Support Drug-Resistant Tuberculosis (DR-TB) Patient to Enroll in Treatment. Kesmas, 16(2): 84-90.
10. Akingbade O (2016). Perspectives on Community Tuberculosis Care in Nige-ria. Int J Trop Dis Health, 16(1): 1–13.
11. Onazi O, Adejumo AO, Redwood L, et al (2020). Community health care workers in pursuit of TB: Discourses and di-lemmas. Soc Sci Med, 246: 112756.
12. Okeyo I, Dowse R (2016). Community care worker perceptions of their roles in tu-berculosis care and their information needs. Health SA Gesondheid, 21: 245–52.
13. Samal J, Dehury RK (2018). Assessing the Impact of a Structured Tuberculosis Training Activity on the Knowledge and Attitude of Community Volunteers. J Clin Diag Res, 12(3): LC14-LC17.
14. Syarifah, Mutiara E, Novita S (2019). Cadre Behavior as Social Capital for the De-velopment of TB Care Community in the Management of Tuberculosis in Me-dan City. Indian J Public Health Res Dev, 10(8): 1309.
15. Jerene D, Assefa D, Tesfaye K, et al (2022). Effectiveness of women-led community interventions in improving tuberculosis preventive treatment in children: results from a comparative, before–after study in Ethiopia. BMJ Open, 12(7): e062298.
16. Abongo T, Ulo B, Karanja S (2020). Com-munity health volunteers’ contribution to tuberculosis patients notified to Na-tional Tuberculosis program through contact investigation in Kenya. BMC Public Health, 20(1): 1184.
17. Singh AR, Pakhare A, Kokane AM, et al (2017). ‘Before reaching the last mile’- Knowledge, attitude, practice and per-ceived barriers related to tuberculosis directly observed therapy among ASHA workers in Central India: A mixed method study. J Epidemiol Glob Health, 7(4):219-245.
18. Ong’ang’o JR, Mwachari C, Kipruto H, et al (2014). The Effects on Tuberculosis Treatment Adherence from Utilising Community Health Workers: A Compar-ison of Selected Rural and Urban Set-tings in Kenya. PLoS One, 9(2): e88937.
19. Uwimana J, Zarowsky C, Hausler H, et al (2012). Engagement of non-government organisations and community care workers in collaborative TB/HIV activi-ties including prevention of mother to child transmission in South Africa: Op-portunities and challenges. BMC Health Serv Res, 12: 233.
20. Herce ME, Chapman JA, Castro A, et al (2010). A Role for Community Health Promoters in Tuberculosis Control in the State of Chiapas, Mexico. J Communi-ty Health, 35(2):182–9.
21. Khan MS, Mehboob N, Rahman-Shepherd A, Naureen F, Rashid A, Buzdar N (2019). What can motivate Lady Health Workers in Pakistan to engage more ac-tively in tuberculosis case-finding? BMC Public Health, 19(1): 999.
22. Balogun M, Sekoni A, Meloni ST, Odukoya O, Onajole A, Longe-Peters O (2015). Trained Community Volunteers Im-prove Tuberculosis Knowledge and Atti-tudes Among Adults in a Periurban Community in Southwest Nigeria. Am J Trop Med Hyg, 92(3):625–32.
23. Kok MC, Namakhoma I, Nyirenda L, Chikaphupha K, Broerse JEW, Diele-man M (2016). Health surveillance assis-tants as intermediates between the community and health sector in Malawi: exploring how relationships influence performance. BMC Health Serv Res, 16:164.
24. Addy SA, Osei E, Komesuor J, Acquah E, Anku PJ, Tarkang EE (2019). Community Contribution to Tuberculosis Care in the Krachi West District of Ghana: A Quali-tative Study. Tuberc Res Treat, 2019: 5039197.
25. Gebretnsae H, Hadgu T, Ayele BG, Abraha A, Gebre-egziabher E, Woldu M (2022). Health extension workers contribution on tuberculosis case notification in Tig-ray region, Northern Ethiopia: A con-current mixed method study. PLoS One, 17(8): e0271968.
2. Harahap J, Amelia R, Wahyuni AS, et al (2018). Community empowerment pro-gram for increasing knowledge and awareness of tuberculosis patients, ca-dres and community in Medan city. IOP Conf Ser Earth Environ Sci, 125: 012102.
3. Sukartini T, Wahyuni S, Makhfudli M (2020). The Factors that Related to the Success of Tuberculosis Cadres in Tuberculosis Case Finding. Sys Rev Pharmy, 11(5): 562–6.
4. Chavez-Rimache L, Ugarte-Gil C, Brunette MJ (2023). The community as an active part in the implementation of interven-tions for the prevention and care of tu-berculosis: A Scoping Review. PLOS Glob Public Health, 3(12): e0001482.
5. Burke RM, Nliwasa M, Feasey HRA, et al (2021). Community-based active case-finding interventions for tuberculosis: a systematic review. Lancet Public Health, 6(5): e283–99.
6. Williams V, Kovarik C (2018). WhatsApp: An Innovative Tool for Dermatology Care in Limited Resource Settings. Tele-med E Health, 24(6): 464–8.
7. Page MJ, McKenzie JE, Bossuyt PM, et al (2021) Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol, 134: 103–12.
8. Sapar, Salju, Risal M, Samsinar, et al (2020) The influence of TB care community cadre’s roles on the treatment adher-ence of tuberculosis (TB) sufferers. Enferm Clin, 30: 244–8.
9. Febriani E, Wibowo A, Kak N, et al (2021). Empowering Health Cadres to Support Drug-Resistant Tuberculosis (DR-TB) Patient to Enroll in Treatment. Kesmas, 16(2): 84-90.
10. Akingbade O (2016). Perspectives on Community Tuberculosis Care in Nige-ria. Int J Trop Dis Health, 16(1): 1–13.
11. Onazi O, Adejumo AO, Redwood L, et al (2020). Community health care workers in pursuit of TB: Discourses and di-lemmas. Soc Sci Med, 246: 112756.
12. Okeyo I, Dowse R (2016). Community care worker perceptions of their roles in tu-berculosis care and their information needs. Health SA Gesondheid, 21: 245–52.
13. Samal J, Dehury RK (2018). Assessing the Impact of a Structured Tuberculosis Training Activity on the Knowledge and Attitude of Community Volunteers. J Clin Diag Res, 12(3): LC14-LC17.
14. Syarifah, Mutiara E, Novita S (2019). Cadre Behavior as Social Capital for the De-velopment of TB Care Community in the Management of Tuberculosis in Me-dan City. Indian J Public Health Res Dev, 10(8): 1309.
15. Jerene D, Assefa D, Tesfaye K, et al (2022). Effectiveness of women-led community interventions in improving tuberculosis preventive treatment in children: results from a comparative, before–after study in Ethiopia. BMJ Open, 12(7): e062298.
16. Abongo T, Ulo B, Karanja S (2020). Com-munity health volunteers’ contribution to tuberculosis patients notified to Na-tional Tuberculosis program through contact investigation in Kenya. BMC Public Health, 20(1): 1184.
17. Singh AR, Pakhare A, Kokane AM, et al (2017). ‘Before reaching the last mile’- Knowledge, attitude, practice and per-ceived barriers related to tuberculosis directly observed therapy among ASHA workers in Central India: A mixed method study. J Epidemiol Glob Health, 7(4):219-245.
18. Ong’ang’o JR, Mwachari C, Kipruto H, et al (2014). The Effects on Tuberculosis Treatment Adherence from Utilising Community Health Workers: A Compar-ison of Selected Rural and Urban Set-tings in Kenya. PLoS One, 9(2): e88937.
19. Uwimana J, Zarowsky C, Hausler H, et al (2012). Engagement of non-government organisations and community care workers in collaborative TB/HIV activi-ties including prevention of mother to child transmission in South Africa: Op-portunities and challenges. BMC Health Serv Res, 12: 233.
20. Herce ME, Chapman JA, Castro A, et al (2010). A Role for Community Health Promoters in Tuberculosis Control in the State of Chiapas, Mexico. J Communi-ty Health, 35(2):182–9.
21. Khan MS, Mehboob N, Rahman-Shepherd A, Naureen F, Rashid A, Buzdar N (2019). What can motivate Lady Health Workers in Pakistan to engage more ac-tively in tuberculosis case-finding? BMC Public Health, 19(1): 999.
22. Balogun M, Sekoni A, Meloni ST, Odukoya O, Onajole A, Longe-Peters O (2015). Trained Community Volunteers Im-prove Tuberculosis Knowledge and Atti-tudes Among Adults in a Periurban Community in Southwest Nigeria. Am J Trop Med Hyg, 92(3):625–32.
23. Kok MC, Namakhoma I, Nyirenda L, Chikaphupha K, Broerse JEW, Diele-man M (2016). Health surveillance assis-tants as intermediates between the community and health sector in Malawi: exploring how relationships influence performance. BMC Health Serv Res, 16:164.
24. Addy SA, Osei E, Komesuor J, Acquah E, Anku PJ, Tarkang EE (2019). Community Contribution to Tuberculosis Care in the Krachi West District of Ghana: A Quali-tative Study. Tuberc Res Treat, 2019: 5039197.
25. Gebretnsae H, Hadgu T, Ayele BG, Abraha A, Gebre-egziabher E, Woldu M (2022). Health extension workers contribution on tuberculosis case notification in Tig-ray region, Northern Ethiopia: A con-current mixed method study. PLoS One, 17(8): e0271968.
| Files | ||
| Issue | Vol 54 No 7 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i7.19113 | |
| Keywords | ||
| Cadres Community empowerment Tuberculosis program | ||
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How to Cite
1.
Setiyadi A, Noviana U, Sholikhah E, Akhmadi A, Mufarokhah H. Community Empowerment through Cadres in the Tuberculosis Program: A Scoping Review. Iran J Public Health. 2025;54(7):1339-1349.
