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Sassi A, Lestari BW, El Muna KUN, Oga-Omenka C, Afifah N, Widarna R, Huria L, Aguilera Vasquez N, Benedetti A, Hadisoemarto PF, Daniels B, Das J, Pai M, Alisjahbana B. Impact of the COVID-19 pandemic on quality of tuberculosis care in private facilities in Bandung, Indonesia: a repeated cross-sectional standardized patients study. BMC Public Health 2024; 24:102. [PMID: 38183023 PMCID: PMC10771004 DOI: 10.1186/s12889-023-17001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Indonesia has the second highest incidence of tuberculosis in the world. While 74% of people with tuberculosis in Indonesia first accessed the private health sector when seeking care for their symptoms, only 18% of tuberculosis notifications originate in the private sector. Little is known about the impact of the COVID-19 pandemic on the private sector. Using unannounced standardized patient visits to private providers, we aimed to measure quality of tuberculosis care during the COVID-19 pandemic. METHODS A cross-sectional study was conducted using standardized patients in Bandung City, West Java, Indonesia. Ten standardized patients completed 292 visits with private providers between 9 July 2021 and 21 January 2022, wherein standardized patients presented a presumptive tuberculosis case. Results were compared to standardized patients surveys conducted in the same geographical area before the onset of COVID-19. RESULTS Overall, 35% (95% confidence interval (CI): 29.2-40.4%) of visits were managed correctly according to national tuberculosis guidelines. There were no significant differences in the clinical management of presumptive tuberculosis patients before and during the COVID-19 pandemic, apart from an increase in temperature checks (adjusted odds ratio (aOR): 8.05, 95% CI: 2.96-21.9, p < 0.001) and a decrease in throat examinations (aOR 0.16, 95% CI: 0.06-0.41, p = 0.002) conducted during the pandemic. CONCLUSIONS Results indicate that providers successfully identify tuberculosis in their patients yet do not manage them according to national guidelines. There were no major changes found in quality of tuberculosis care due to the COVID-19 pandemic. As tuberculosis notifications have declined in Indonesia due to the COVID-19 pandemic, there remains an urgent need to increase private provider engagement in Indonesia and improve quality of care.
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Affiliation(s)
- Angelina Sassi
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Bony Wiem Lestari
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Padjadjaran, Bandung, Indonesia
| | - Kuuni Ulfah Naila El Muna
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Nahdlatul Ulama Surabaya, Surabaya, Indonesia
| | - Charity Oga-Omenka
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Nur Afifah
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Rodiah Widarna
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Lavanya Huria
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Nathaly Aguilera Vasquez
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Panji Fortuna Hadisoemarto
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Padjadjaran, Bandung, Indonesia
| | - Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.
- Department of Internal Medicine, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
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Chijioke-Akaniro O, Onyemaechi S, Kuye J, Ubochioma E, Omoniyi A, Urhioke O, Lawanson A, Ombeka VO, Hassan A, Asuke S, Anyaike C, Merle CS. Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study. BMJ Open 2023; 13:e069123. [PMID: 37709312 PMCID: PMC11148675 DOI: 10.1136/bmjopen-2022-069123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES This study aimed to assess the practices of private practitioners regarding tuberculosis (TB), and to ascertain factors related to the low contribution of private healthcare providers to TB prevention and care in Nigeria. DESIGN This is a mixed methods study comprising a quantitative retrospective review and qualitative study. SETTING Private health facilities (HF) in Oyo State and the Federal Capital Territory (FCT), Nigeria. PARTICIPANTS We used routinely collected data on patients with tuberculosis (TB) notified between 1 January 2017 and 31 December 2018. In-depth interviews were also conducted with the clinical staff of the facilities. PRIMARY AND SECONDARY OUTCOME MEASURES The study outcomes are practices of TB case notification and treatment outcome, as well as the barriers and enablers of TB notification. RESULTS A total of 13 (11.0%) out of 118 private HF were designated as 'engaged' TB care facilities in Oyo State and none (0%) of the 198 private HF in the FCT held this designation. From the 214 patients with presumptive TB, 75 (35%) were diagnosed with TB, 42 (56%) had a bacteriological test done, 12 (16%) had an X-ray of the chest alone and 21 (28%) had other non-specific investigations. Most patients diagnosed were referred to a public HF, while 19 (25%) patients were managed at the private HF. Among them, 2 (10.5%) patients were treated with unconventional regimens, 4 (21%) were cured, 2 (11%) died, 3 (16%) lost to follow-up and 10 (53%) were not evaluated. The general practitioners did not have up-to-date knowledge of TB with a majority not trained on TB. Most referred patients with presumptive and confirmed TB to the public sector without feedback and were unclear regarding diagnostic algorithm and relevant tests to confirm TB. CONCLUSION Most private facilities were not engaged to provide TB services although with knowledge and practice gaps. The study has been used to develop plans for strategic engagement of the private sector in Nigeria.
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Affiliation(s)
| | | | | | | | | | - Ochuko Urhioke
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | - Adebola Lawanson
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | - Victor O Ombeka
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | | | | | - Chukwuma Anyaike
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
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Basabih M, Prasojo E, Rahayu AYS. Hospital services under public-private partnerships, outcomes and, challenges: A literature review. J Public Health Res 2022; 11:22799036221115781. [PMID: 36052099 PMCID: PMC9424887 DOI: 10.1177/22799036221115781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022] Open
Abstract
Public-private partnerships (PPP) is used to advance health service access and
quality. PPP implementation in hospitals is vital to shorten the service and
quality gap. Hospitals are the most significant health budget spender, and this
study aimed to identify the PPP effect on hospital performance indicators and
its implementation challenges. Thirty-three inclusive articles were filtered and
collected from Pubmed, ScienceDirect, Medline, and Sage Publication databases.
Results showed that various articles succeeded in implementing PPP and improving
the access and quality of health services. Several hospital performance
indicators such as diagnosis, therapy, service waiting time, length of stay,
referral rate, mortality rate, and patient satisfaction were reported to show
better results. However, there was insufficient evidence to say the same on
related financial indicators. Policy, resource, communication and trust, risk,
and evaluation monitoring were considered challenges in PPP implementation. Its
success was not only influenced by major factors such as governance model,
finance, politics, and social but also was influenced by the medical practice
model applied within the organization. This study contributed to whether PPP
affects the hospital performance indicators.
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Affiliation(s)
- Masyitoh Basabih
- Candidate Doctoral Faculty of Administrative Science, Universitas Indonesia, Depok, Indonesia
| | - Eko Prasojo
- Professor Faculty of Administrative Science, Universitas Indonesia, Depok, Indonesia
| | - Amy Yayuk Sri Rahayu
- Professor Faculty of Administrative Science, Universitas Indonesia, Depok, Indonesia
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Jiang W, Trimawartinah, Rahman FM, Wibowo A, Sanjaya A, Silitonga PII, Tang S, Long Q. The co-management of tuberculosis-diabetes co-morbidities in Indonesia under the National Tuberculosis Control Program: results from a cross-sectional study from 2017 to 2019. BMC Public Health 2022; 22:689. [PMID: 35395745 PMCID: PMC8990273 DOI: 10.1186/s12889-022-13017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Indonesia suffers from a high burden of tuberculosis (TB) and diabetes (DM). The government initiated national TB-DM co-management activities under the National TB Control Program in 2017. This study investigates the detection and treatment outcomes of TB-DM in Jakarta after implementing these activities, and identifies the main factors associated with these outcomes. Methods A cross-sectional study was conducted using TB registry data in two districts of Jakarta, East Jakarta (low-income) and South Jakarta (high-income). A 5-step cascade analysis was used: diagnosed TB patients; TB patients tested for DM; diagnosed TB-DM patients; and patients received and completed TB treatment/cured. We conducted descriptive analyses to understand the characteristics of TB and TB-DM patients, and used a two-level mixed-effect logistic regression to explore factors associated with having a DM test and completing TB treatment/being cured. Results Over the study period (2017–2019) 50.8% of the new pulmonary TB patients aged over 15 were tested for DM. The percentage increased from 41.7% in 2017–2018 to 60.1% in 2019. Of the TB patients tested for DM, 20.8% were diagnosed with DM. Over 90% of the detected TB-DM patients received standard TB treatment, 86.3% of whom completed treatment/were cured. Patients in East Jakarta were more likely to be tested for DM and to complete standard TB treatment/be cured than patients in South Jakarta (P < 0.001). Bacteriologically positive TB patients were more likely to be tested for DM (OR = 1.37, 95% CIs 1.17,1.60). Patients diagnosed in sub-district level healthcare centers had a higher likelihood of being tested for DM than those in government and private hospitals (P < 0.05). Receiving DM treatment was associated with a higher likelihood of completing TB treatment/being cured (OR = 1.82, 95% CIs 1.20, 2.77). Conclusions TB-DM case detection significantly improved in 2019 after introducing TB-DM co-management activities in Jakarta, while gaps in TB-DM co-management existed between bacteriologically positive and clinically diagnosed TB patients, and across different types of health facilities. Collaboration between TB and DM departments should be strengthened, and more resources need to be mobilized to further improve the co-management of TB-DM in Indonesia.
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Affiliation(s)
- Weixi Jiang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China
| | - Trimawartinah
- Department of Public Health, University of Muhammadiyah Prof DR Hamka, South Jakarta, Indonesia
| | - Fauziah Mauly Rahman
- Global Health Initiative Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Adik Wibowo
- Global Health Initiative Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Adhi Sanjaya
- Global Health Initiative Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | | | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.,SingHealth Duke-NUS Global Health Institute, Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.
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The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach. BMC Med 2020; 18:163. [PMID: 32684164 PMCID: PMC7369473 DOI: 10.1186/s12916-020-01651-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The prevention of tuberculosis (TB) is key for accelerating current, slow declines in TB burden. The 2018 World Health Organization (WHO) guidelines on eligibility for preventive therapy to treat latent TB infection (LTBI) include people living with human immunodeficiency virus (PLHIV), household contacts of TB patients including children, and those with clinical conditions including silicosis, dialysis, transplantation, etc. and other country-specific groups. We aimed to estimate the potential impact of full implementation of these guidelines in the WHO South-East Asian (SEA) Region, which bears the largest burden of TB and LTBI amongst the WHO regions. METHODS We developed mathematical models of TB transmission dynamics, calibrated individually to each of the 11 countries in the region. We modelled preventive therapy in the absence of other TB interventions. As an alternative comparator, reflecting ongoing developments in TB control in the region, we also simulated improvements in the treatment cascade for active TB, including private sector engagement and intensified case-finding. Relative to both scenarios, for each country in the region, we projected TB cases and deaths averted between 2020 and 2030, by full uptake of preventive therapy, defined as comprehensive coverage amongst eligible populations as per WHO guidelines, and assuming outcomes consistent with clinical trials. We also performed sensitivity analysis to illustrate impact under less-than-optimal conditions. RESULTS At the regional level, full uptake of preventive therapy amongst identified risk groups would reduce annual incidence rates in 2030 by 8.30% (95% CrI 6.48-10.83) relative to 2015, in the absence of any additional interventions. If implemented against a backdrop of improved TB treatment cascades, preventive therapy would achieve an incremental 6.93 percentage points (95% CrI 5.81-8.51) of reduction in annual incidence rates, compared to 2015. At the regional level, the numbers of individuals with latent TB infection that need to be treated to avert 1 TB case is 64 (95% CrI 55-74). Sensitivity analysis illustrates that results for impact are roughly proportional to 'effective coverage' (the product of actual coverage and effectiveness of the regimen). CONCLUSIONS Full implementation of WHO guidelines is important for ending TB in the SEA Region. Although future strategies will need to be expanded to the population level, to achieve large declines in TB incidence, the uptake of current tools can offer a valuable step in this direction.
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Arinaminpathy N, Mandal S, Bhatia V, McLeod R, Sharma M, Swaminathan S, Hyder KA, Mandal PP, Sarkar SK, Singh PK. Strategies for ending tuberculosis in the South-East Asian Region: A modelling approach. Indian J Med Res 2020; 149:517-527. [PMID: 31411176 PMCID: PMC6676838 DOI: 10.4103/ijmr.ijmr_1901_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background & objectives: To support recent political commitments to end tuberculosis (TB) in the World Health Organization South-East Asian Region (SEAR), there is a need to understand by what measures, and with what investment, these goals could be reached. These questions were addressed by using mathematical models of TB transmission by doing the analysis on a country-by-country basis in SEAR. Methods: A dynamical model of TB transmission was developed, in consultation with each of the 11 countries in the SEAR. Three intervention scenarios were examined: (i) strengthening basic TB services (including private sector engagement), (ii) accelerating TB case-finding and notification, and (iii) deployment of a prognostic biomarker test by 2025, to guide mass preventive therapy of latent TB infection. Each scenario was built on the preceding ones, in successive combination. Results: Comprehensive improvements in basic TB services by 2020, in combination with accelerated case-finding to increase TB detection by at least two-fold by 2020, could lead to a reduction in TB incidence rates in SEAR by 67.3 per cent [95% credible intervals (CrI) 65.3-69.8] and TB deaths by 80.9 per cent (95% CrI 77.9-84.7) in 2035, relative to 2015. These interventions alone would require an additional investment of at least US$ 25 billion. However, their combined effect is insufficient to reach the end TB targets of 80 per cent by 2030 and 90 per cent by 2035. Model projections show how additionally, deployment of a biomarker test by 2025 could end TB in the region by 2035. Targeting specific risk groups, such as slum dwellers, could mitigate the coverage needed in the general population, to end TB in the Region. Interpretation & conclusions: While the scale-up of currently available strategies may play an important role in averting TB cases and deaths in the Region, there will ultimately be a need for novel, mass preventive measures, to meet the end TB goals. Achieving these impacts will require a substantial escalation in funding for TB control in the Region.
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Affiliation(s)
- Nimalan Arinaminpathy
- Department of Infectious Disease Epidemiology, St. Mary's Hospital, Imperial College, London, UK
| | | | - Vineet Bhatia
- World Health Organization, South-East Asian Regional Office, New Delhi, India
| | | | - Mukta Sharma
- World Health Organization, South-East Asian Regional Office, New Delhi, India
| | | | - Khurshid Alam Hyder
- World Health Organization, South-East Asian Regional Office, New Delhi, India
| | | | - Swarup Kumar Sarkar
- World Health Organization, South-East Asian Regional Office, New Delhi, India
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Chen J, Li K, Rong H, Bilal K, Yang N, Li K. A disease diagnosis and treatment recommendation system based on big data mining and cloud computing. Inf Sci (N Y) 2018. [DOI: 10.1016/j.ins.2018.01.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Surya A, Setyaningsih B, Suryani Nasution H, Gita Parwati C, Yuzwar YE, Osberg M, Hanson CL, Hymoff A, Mingkwan P, Makayova J, Gebhard A, Waworuntu W. Quality Tuberculosis Care in Indonesia: Using Patient Pathway Analysis to Optimize Public-Private Collaboration. J Infect Dis 2017; 216:S724-S732. [PMID: 29117347 PMCID: PMC5853837 DOI: 10.1093/infdis/jix379] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Tuberculosis (TB) is the fourth leading cause of death in Indonesia. In 2015, the World Health Organization estimated that nearly two-thirds of the TB patients in Indonesia had not been notified, and the status of their care remained unknown. As such, Indonesia is home to nearly 20% of the world's "missing" TB patients. Understanding where patients go for care may enable strategic planning of services to better reach them. Methods A patient pathway analysis (PPA) was conducted to assess the alignment between patient care seeking and the availability of TB diagnostic and treatment services at the national and subnational level in Indonesia. Results The PPA results revealed that only 20% of patients encountered diagnostic capacity at the location where they first sought care. Most initial care seeking occurred in the private sector and case notification lagged behind diagnostic confirmation in the public sector. Conclusions The PPA results emphasize the role that the private sector plays in TB patient care seeking and suggested a need for differentiated approaches, by province, to respond to variances in care-seeking patterns and the capacities of public and private providers.
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Affiliation(s)
- Asik Surya
- Subdirectorate of Tuberculosis, Ministry of Health, Jakarta, and
| | | | | | | | - Yullita E Yuzwar
- Subdirectorate of Tuberculosis, Ministry of Health, Jakarta, and
| | | | - Christy L Hanson
- Macalester College, St Paul, Minnesota, and
- Bill & Melinda Gates Foundation, Seattle, Washington; and
| | | | | | | | - Agnes Gebhard
- Challenge TB Project, KNCV Tuberculosis Foundation, Jakarta, Indonesia
| | - Wiendra Waworuntu
- Directorate of Prevention and Control of Communicable Disease, Ministry of Health, Jakarta, Indonesia
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Mosissa L, Kebede A, Mindaye T, Getahun M, Tulu S, Desta K. External quality assessment of AFB smear microscopy performances and its associated factors in selected private health facilities in Addis Ababa, Ethiopia. Pan Afr Med J 2016; 24:125. [PMID: 27642463 PMCID: PMC5012771 DOI: 10.11604/pamj.2016.24.125.7459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 05/07/2016] [Indexed: 11/30/2022] Open
Abstract
Tuberculosis (TB) is still a public health problem in sub Saharan African countries. In resource-limited settings, TB diagnosis relies on sputum smear microscopy, with low and variable sensitivities, especially in paucibacillary pediatric and HIV-associated TB patients. Tuberculosis microscopy centers have several weaknesses like overworking, insufficiently trained personnel, inconsistent reagent supplies, and poorly maintained equipments; thus, there is a critical need for investments in laboratory infrastructure, capacity building, and quality assurance schemes. The performance of TB microscopy centers in the private health facilities in Addis Ababa is not known so far. The main objective of the study was to assess laboratory performance of acid fast bacilli (AFB) smear microscopy and its associated factors in selected private health facilities in Addis Ababa, Ethiopia. A cross-sectional study was conducted in 33 selected private health facilities of Addis Ababa, Ethiopia comprising 7 hospitals, 2 NGO health centers, 23 higher clinics and 1 diagnostic laboratory that provide AFB smear microscopy services. The study was conducted from January to April 2014. A total of 283 stained sputum smears were randomly collected from participant laboratories for blinded rechecking, 320 panel slides were sent to 32 microscopy centers to evaluate their performance on AFB reading, staining and reporting. Checklists were used to assess quality issues of laboratories. Data were captured, cleaned, and analyzed using SPSS version 16.0; χ(2) tests, kappa statistics were used for comparison purpose. P value < 0.05 considered statistically significant. Among the 32 participant laboratories, 2-scored 100%, 15 scored 80-95% & the remaining 15 scored 50-75% for overall proficiency test performance. There were 10 (3.15%) major errors and 121 (37.8%) minor errors. The sensitivity, specificity, PPV and NPV of panel reading by microscopy centers were 89%, 96%, 96%, and 90% respectively. Out of 283 randomly selected slides for blind rechecking, 11 (3.9%) slides interpreted falsely for AFB, with overall agreement of 97.5%, sensitivity of 88.4% and specificity of 99.3%. In terms of slide quality assessment, 71.6% of AFB slides were graded as good for evenness, cleanness, thickness, size, staining and labeling. The performance score for AFB slide evenness was 56.9% (161 slides) and for labeling quality was 90.8% (257 slides); having significant difference in slide quality (p value < 0.05). On-site evaluation indicated problems in terms of infrastructure, standard operating procedure, reagent quality; equipment maintenance, data management and training issues. Most of the health facilities had poor maintenance scheme for microscope (53.5%) and poor inventory management (25.0%) system. Microscopy centers that scored a proficiency of 75.5%; which is below the acceptable minimum score of 80% and an overall error rate of 3.9% for blinded rechecking needs attention. Moreover, there are gaps identified through on site assessment including poor SOP, reagent quality, equipment maintenance, data management & lack of updated training on AFB microscopy techniques, requiring a concerted effort to alleviate the bottle neck problems and strengthening the public private partnership to control TB.
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Affiliation(s)
- Lemi Mosissa
- Addis Abeba University, College of Health Sciences, School of Allied Health Sciences Department of Medical Laboratory Sciences, Addis Abeba, Ethiopia; City Government of Addis Ababa Technical & Vocational Education & Training (TVET) Agency, Addis Abeba, Ethiopia
| | - Abebaw Kebede
- Ethiopian Public Health Institute (EPHI), Addis Abeba, Ethiopia
| | - Tedla Mindaye
- Addis Abeba University, College of Health Sciences, School of Allied Health Sciences Department of Medical Laboratory Sciences, Addis Abeba, Ethiopia
| | | | - Sisay Tulu
- Minilik II Referral Hospital, Addis Abeba, Ethiopia
| | - Kassu Desta
- Addis Abeba University, College of Health Sciences, School of Allied Health Sciences Department of Medical Laboratory Sciences, Addis Abeba, Ethiopia
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Amo-Adjei J. Conforming to partnership values: a qualitative case study of public-private mix for TB control in Ghana. Glob Health Action 2016; 9:28000. [PMID: 26739783 PMCID: PMC4703798 DOI: 10.3402/gha.v9.28000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/27/2015] [Accepted: 09/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Public–private mix (PPM) can supplement public sector initiatives, including public health. As National Tuberculosis Control Programmes around the world embrace PPM, conforming to the four key principles of partnership values of beneficence, non-maleficence, autonomy, and equity as espoused by the World Health Organization can provide a useful framework to guide successful implementation. Design This is a qualitative case study of PPM in tuberculosis (TB) control, which utilised a purposive sample of 30 key stakeholders involved in TB control in Ghana. Respondents comprised an equal number of respondents from both the public and private sectors. Semi-structured in-depth interviews (IDI) were conducted with respondents. Data emanating from the IDIs were analysed deductively. Results Although the respondents’ perceptions about beneficence were unanimous, their views about non-maleficence, autonomy, and equity appeared incongruous with the underlying meanings of the PPM values. Underlying the unfavourable perceptions were disruptions in funding, project implementers’ failure to follow-up on promised incentives, and private providers lost interest. This was perceived to have negatively affected the smooth implementation of PPM in the country. Conclusions Going forward, it is imperative that future partnerships are built around utilitarian principles and also adhere to the dictates of agreements, whether they are ‘soft’ or standard contracts.
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Affiliation(s)
- Joshua Amo-Adjei
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana;
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Lei X, Liu Q, Escobar E, Philogene J, Zhu H, Wang Y, Tang S. Public-private mix for tuberculosis care and control: a systematic review. Int J Infect Dis 2015; 34:20-32. [PMID: 25722284 DOI: 10.1016/j.ijid.2015.02.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/15/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Public-private mix (PPM), recommended by the World Health Organization (WHO), was introduced to cope with the tuberculosis (TB) epidemic worldwide. In many developing countries, PPM has played a powerful role in TB control, while in others it has failed to meet expectations. Thus we performed a systematic review to determine the mechanisms used by global PPM programs implemented in different countries and to evaluate their performance. METHODS A comprehensive search of the current literature for original studies published up to May 2014 was done using electronic databases and online resources; these publications were then screened using rigorous criteria. Descriptive information and evaluative outcomes data were extracted from eligible studies for synthesis and analysis. RESULTS A total of 78 eligible studies were included in the final review. These assessed 48 PPM TB programs worldwide, subsequently categorized into three mechanisms based on collaborative characteristics: support, contract, and multi-partner group. Furthermore, we assessed the effectiveness of PPM programs against six health system themes, including utilization of the directly observed treatment strategy (DOTS), case detection, treatment outcomes, case management, costs, and access and equity, under the different collaborative mechanisms. Analysis of the comparative studies suggested that PPM could improve overall outcomes of a TB service, and multiple collaborative mechanisms may significantly promote case detection, treatment, referral, and service accessibility, especially in resource-limited areas. However, the less positive outcomes of several programs indicated limited funding and poor governance to be the predominant reasons. CONCLUSIONS PPM is a promising strategy to strengthen global TB care and control, but is affected by contextual characteristics in different areas. The scaling-up of PPM should contain essential commonalities, particularly substantial financial support and continuous material input. Additionally, it is important to improve program governance and training for the health providers involved, through integrated collaborative mechanisms.
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Affiliation(s)
- Xun Lei
- China Effective Health Care Network, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Qin Liu
- China Effective Health Care Network, School of Public Health and Management, Chongqing Medical University, Chongqing, China.
| | | | | | - Hang Zhu
- China Effective Health Care Network, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yang Wang
- China Effective Health Care Network, School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Amo-Adjei J, Awusabo-Asare K. Reflections on tuberculosis diagnosis and treatment outcomes in Ghana. Arch Public Health 2013; 71:22. [PMID: 23971675 PMCID: PMC3765431 DOI: 10.1186/2049-3258-71-22] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Available evidence in Ghana shows the implementation of tuberculosis (TB) control activities efforts since the beginning of the 1900s. In spite of that, TB continues to be one of the common diseases in the country. In 1994, local and international policy windows opened for renewed strategies for the control of TB. This paper explores some of the approaches which have been in place since 1994 and their implications for treatment outcomes. METHODS The study combines quantitative and qualitative data. The quantitative data consist of treatment outcome from 1997-2010 and the qualitative data are derived from in-depth interviews with some staff of the TB control programme. Poisson regression and inductive coding were applied to the quantitative and qualitative data respectively. RESULTS Reported cure rates increased from 43.6% to 87.7% between 1997 and 2010. The data from the in-depth interviews (IDIs) suggested that improvements in diagnosis, community TB care, stigma reduction among community and health workers towards TB patients, the public-private partnership, and the enablers' package contributed to the improved better treatment outcomes, particularly from 2008. CONCLUSIONS Lessons learnt include the achievement of objectives with varying strategies and stakeholder interventions. Further studies would be needed to quantify the contributions of the various interventions to help determine those that are cost effective as well as efficient and effective for TB control.
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Affiliation(s)
- Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Kofi Awusabo-Asare
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Chang KC, Yew WW. Management of difficult multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis: update 2012. Respirology 2013; 18:8-21. [PMID: 22943408 DOI: 10.1111/j.1440-1843.2012.02257.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multidrug-resistant (MDR) tuberculosis (TB) denotes bacillary resistance to at least isoniazid and rifampicin. Extensively drug-resistant (XDR) TB is MDR-TB with additional bacillary resistance to any fluoroquinolone and at least one second-line injectable drugs. Rooted in inadequate TB treatment and compounded by a vicious circle of diagnostic delay and improper treatment, MDR-TB/XDR-TB has become a global epidemic that is fuelled by poverty, human immunodeficiency virus (HIV) and neglect of airborne infection control. The majority of MDR-TB cases in some settings with high prevalence of MDR-TB are due to transmission of drug-resistant bacillary strains to previously untreated patients. Global efforts in controlling MDR-TB/XDR-TB can no longer focus solely on high-risk patients. It is difficult and costly to treat MDR-TB/XDR-TB. Without timely implementation of preventive and management strategies, difficult MDR-TB/XDR-TB can cripple global TB control efforts. Preventive strategies include prompt diagnosis with adequate TB treatment using the directly observed therapy, short-course (DOTS) strategy and drug-resistance programmes, airborne infection control, preventive treatment of TB/HIV, and optimal use of antiretroviral therapy. Management strategies for established cases of difficult MDR-TB/XDR-TB rely on harnessing existing drugs (notably newer generation fluoroquinolones, high-dose isoniazid, linezolid and pyrazinamide with in vitro activity) in the best combinations and dosing schedules, together with adjunctive surgery in carefully selected cases. Immunotherapy may also have a role in the future. New diagnostics, drugs and vaccines are required to meet the challenge, but science alone is insufficient. Difficult MDR-TB/XDR-TB cannot be tackled without achieving high cure rates with quality DOTS and beyond, and concurrently addressing poverty and HIV.
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Affiliation(s)
- Kwok-Chiu Chang
- Department of Health, Tuberculosis and Chest Service, the Chinese University of Hong Kong, Hong Kong, China.
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Wei X, Zou G, Yin J, Walley J, Sun Q. Comparing patient care seeking pathways in three models of hospital and TB programme collaboration in China. BMC Infect Dis 2013; 13:93. [PMID: 23425261 PMCID: PMC3598790 DOI: 10.1186/1471-2334-13-93] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 02/06/2013] [Indexed: 11/10/2022] Open
Abstract
Background Public hospitals in China play an important role in tuberculosis (TB) control. Three models of hospital and TB control exist in China. The dispensary model is the most common one in which a TB dispensary provides both clinical and public health care. The specialist model is similar to the former except that a specialist TB hospital is located in the same area. The specialist hospital should treat only complicated TB cases but it also treats simple cases in practice. The integrated model is a new development to integrate TB service in public hospitals. Patients were diagnosed, treated and followed up in this public hospital in this model while the TB dispensary provides public health service as case reporting and mass education. This study aims to compare patient care seeking pathways under the three models, and to provide policy recommendation for the TB control system reform in China. Methods Six sites, two in each model, were selected across four provinces, with 293 newly treated uncomplicated TB patients being randomly selected. Results The majority (68%) of TB patients were diagnosed in hospitals. Patients in the integrated model presented the simplest care seeking pathways, with the least number of providers visited (2.2), shortest treatment delays (2 days) and the least medical expenditure (2729RMB/401USD). On the contrary, patients in the specialist model had the highest number of provider visits (4), longest treatment delays (23 days) and the highest medical expenditure (11626RMB/1710USD). Logistic regression suggested that patients who were hospitalised tended to have longer treatment delays and higher medical expenditure. Conclusion Specialist hospital treating uncomplicated cases not using the standard regimens posed a threat to TB control. The integrated model has shortened patient treatment pathways, and reduced patient costs; therefore, it could be considered as the direction for future reform of China’s TB control system.
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Affiliation(s)
- Xiaolin Wei
- School of Public Health and Primary Care, The Chinese University of Hong Kong, 2/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong, N.T, China
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Sun Q, Yin J, Yin X, Zou G, Liang M, Zhong J, Walley J, Wei X. Does the integration of TB medical services in the general hospital improve the quality of TB care? Evidence from a case study in China. J Public Health (Oxf) 2012; 35:322-8. [PMID: 23104893 DOI: 10.1093/pubmed/fds089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Moving the clinical services from tuberculosis (TB) dispensary to the integrated county hospital (called integrated approach) has been practiced in China; however, it is unknown the quality of TB care in the integrated approach and in the dispensary approach. METHODS A total of 202 new TB patients were investigated using structured questionnaires in three counties implementing the integrated approach and one county implementing the dispensary approach. The quality of TB care is measured based on success rate of treatment, medical expenditure, health system delay and second-line drug use. RESULTS The integrated approach showed a high success treatment rate. The medical expenditure in the integrated approach was USD 432, significantly lower than that in the dispensary approach (Z = -5.771, P < 0.001). The integrated approach had a shorter health system delay (5 days) than the dispensary approach (32 days). Twenty-six percent of patients in integrated hospitals were prescribed with second-line TB drugs, significantly lower than that in the TB dispensary (47%, χ(2) = 7.452, P = 0.006). However, the medical expenditure, use of second-line anti-TB drug and liver-protection drugs indeed varied greatly across the three integrated hospitals. CONCLUSIONS The integrated approach showed better quality of TB care, but the performance of the integrated hospitals varied greatly. A method to standardize TB treatment and management of this approach is urgent.
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Affiliation(s)
- Qiang Sun
- Center for Health Management and Policy, Shandong University, Jinan, Shandong 250012, China
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16
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Zou G, Wei X, Walley JD, Yin J, Sun Q. Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study. BMC Health Serv Res 2012; 12:21. [PMID: 22276746 PMCID: PMC3349562 DOI: 10.1186/1472-6963-12-21] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 01/25/2012] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China. METHODS This study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach. RESULTS The more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site. CONCLUSION The process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service.
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Affiliation(s)
- Guanyang Zou
- Nuffield Centre for International Health and Development, University of Leeds (based in China), Room 1220, No. 1032 Dongmen North Rd, Luohu District, Shenzhen, 518003, China
| | - Xiaolin Wei
- The Chinese University of Hong Kong, 2/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China
| | - John D Walley
- Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Rd, Leeds, LS2 9LJ, UK
| | - Jia Yin
- Nuffield Centre for International Health and Development, University of Leeds (based in China), Room 1220, No. 1032 Dongmen North Rd, Luohu District, Shenzhen, 518003, China
| | - Qiang Sun
- Center for Health Management and Policy, Shandong University, China, Mailbox 128, No 44 Wenhua Rd, Jinan, Shandong, 250012, China
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Malmborg R, Mann G, Squire SB. A systematic assessment of the concept and practice of public-private mix for tuberculosis care and control. Int J Equity Health 2011; 10:49. [PMID: 22074377 PMCID: PMC3238294 DOI: 10.1186/1475-9276-10-49] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 11/10/2011] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The STOP TB Partnership aims to improve global tuberculosis (TB) control through expanding access to the directly observed treatment short course (DOTS) strategy. One approach to this is 'Engaging all Care Providers', which evolved from 'Public-Private Mix (PPM) DOTS'. The overall aim of this study was to systematically assess whether and to what degree the STOP TB Partnership's four global objectives of engaging all care providers are met through existing PPM interventions. These four objectives are; 1) Increase TB case detection; 2) Improve TB treatment outcomes; 3) Enhance access and equity; 4) Reduce financial burden on patients. The specific objectives of this assessment were to 1) Understand what PPM means to the STOP TB Partnership's PPM Subgroup and to National Tuberculosis Programme managers; 2) Scope the nature of existing country-level PPM interventions and 3) Review PPM practice against the global PPM objectives. METHODS We undertook a systematic, multi-facetted assessment. The methods included interviews with National Tuberculosis Programme managers from high burden countries, clarification of key issues with the STOP TB Partnership PPM secretariat and a review of publicly accessible reports and published articles on PPM projects. Both the literature review and interviews with the National Tuberculosis Programme managers yielded data on project characteristics; PPM models at country level; National Tuberculosis Programme partners; and mechanisms for engagement. Matrices were developed from the literature review and the interviews to show the relationship between services and service providers for different PPM projects. Data from the literature were assessed against each of the four global PPM objectives. RESULTS Twelve National Tuberculosis Programme managers from high burden countries were interviewed about the scope of PPM partnerships. Understanding of PPM and types of engaged providers varied considerably; 'private-for-profit qualified clinical providers' were the dominant category. The literature review yielded information on 22 projects in which 'private-for-profit qualified clinical providers' were again the dominant category. The contributions made by 'private-for-profit qualified clinical providers' and 'Non Governmental Organisation qualified clinical providers', were assessed against the four global PPM objectives. Reporting on tuberculosis case detection and treatment outcomes was generally good and demonstrated important PPM contributions in these areas. Reporting on equity, access and reduced patient costs was often lacking or inconclusive. CONCLUSIONS PPM has improved case detection and treatment outcomes among patients seeking care with private providers. Evidence on reducing patient costs is inconclusive, and there is scope for increasing equity in access to care by systematically engaging those providers who are the primary agents for poor people seeking health care. Guidelines outlining which types of providers best contribute to achieving the four global objectives, along with the resources required by National Tuberculosis Programs for such engagement is needed.
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Affiliation(s)
- Rasmus Malmborg
- International Department, The Norwegian Hearth and Lung Patient Organisation, LHL,(Storgata 33), Oslo, (0184), Norway
| | - Gillian Mann
- Collaboration for Research on Equity and Systems in TB and HIV-AIDS (CRESTHA), Liverpool School of Tropical Medicine, (Pembroke Place), Liverpool (L3 5QA), UK
| | - S Bertel Squire
- Collaboration for Research on Equity and Systems in TB and HIV-AIDS (CRESTHA), Liverpool School of Tropical Medicine, (Pembroke Place), Liverpool (L3 5QA), UK
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Ahmad RA, Mahendradhata Y, Utarini A, de Vlas SJ. Diagnostic delay amongst tuberculosis patients in Jogjakarta Province, Indonesia is related to the quality of services in DOTS facilities. Trop Med Int Health 2010; 16:412-23. [PMID: 21199195 DOI: 10.1111/j.1365-3156.2010.02713.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To understand determinants of care-seeking patterns and diagnostic delay amongst tuberculosis (TB) patients diagnosed at direct observed treatment short course (DOTS) facilities in Jogjakarta, Indonesia. METHODS Cross-sectional survey amongst newly diagnosed TB patients in 89 DOTS facilities whose history of care-seeking was reconstructed through retrospective interviews gathering data on socio-demographic determinants, onset of TB symptoms, type of health facilities visited, duration of each care-seeking action were recorded. RESULTS Two hundred and fifty-three TB patients were included in the study whose median duration of patients' delay was 1 week and whose total duration of diagnostic delay was 5.4 weeks. The median number of visits was 4. Many of the patients' socio-demographic determinants were not associated with the care-seeking patterns, and no socio-demographic determinants were associated with the duration of diagnostic delay. More than 60% of TB patients started their care-seeking processes outside DOTS facilities, but the number of visits in DOTS facilities was greater during the overall care-seeking process. Surprisingly, patient's immediate visits to a DOTS facility did not correspond to shorter diagnostic delay. CONCLUSION Diagnostic delay in Jogjakarta province was not associated with patients' socio demographic factors, but rather with the health system providing DOTS services. This suggests that strengthening the health system and improving diagnostic quality within DOTS services is now a more rational strategy than expanding the TB programme to engage more providers.
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Affiliation(s)
- Riris Andono Ahmad
- Department of Public Health, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia.
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