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Mitchell EM, Adejumo OA, Abdur-Razzaq H, Ogbudebe C, Gidado M. The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria. JMIR Public Health Surveill 2024; 10:e52191. [PMID: 38506095 PMCID: PMC11082728 DOI: 10.2196/52191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/01/2024] [Accepted: 03/20/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance. OBJECTIVE We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received. METHODS A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior. RESULTS Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications. CONCLUSIONS Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance.
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Affiliation(s)
- Ellen Mh Mitchell
- Mycobacterial Diseases and Neglected Tropical Diseases Unit, Department of Public Health, Institute for Tropical Medicine, Antwerp, Belgium
| | - Olusola Adedeji Adejumo
- Mainland Hospital, Yaba Lagos, Nigeria
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Hussein Abdur-Razzaq
- Health Research Unit, Directorate of Planning, Research, and Statistics, Lagos Ministry of Health, Lagos, Nigeria
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Adepoju VA, Adejumo OA, Adepoju OE, Adeniyi MO, Etuk V, Nzekwe I, Inegbeboh JO, Adelekan A, Oladimeji O. Do private health providers adhere to National Tuberculosis Guideline while assigning treatment outcome? Findings from a lower middle-income country. Front Public Health 2022; 10:924132. [PMID: 36211674 PMCID: PMC9540382 DOI: 10.3389/fpubh.2022.924132] [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: 04/20/2022] [Accepted: 08/18/2022] [Indexed: 01/24/2023] Open
Abstract
Background Treatment success rate is an important indicator to measure the performance of the National Tuberculosis Program (NTP). There are concerns about the quality of outcome data from private facilities engaged by NTP. Adherence of private providers of tuberculosis care to NTP guideline while assigning treatment outcomes to patients is rarely investigated. We aimed to determine whether Lagos private for-profit (PFP) and private not-for-profit (PNFP) facilities adhere to domestic TB guideline while assigning treatment outcome and the availability of periodic sputum acid-fast bacilli (AFB) results. Method A retrospective review of facility treatment register and treatment cards of TB patients managed between January and December 2016 across 10 private directly observed treatment short-course (DOTS) facilities involved in the public-private mix (PPM) in Lagos, Nigeria. The study took place between January and June 2019. Results Of the 1,566 patients, majority (60.7%) were male, >30 years (50.2%), HIV-negative (88.4%), and attended PNFP (78.5%). The reported treatment success rate (TSR) was 84.2% while the actual TSR was 53.8%. In total, 91.1, 77.6, and 70.3% of patients had sputum acid-fast bacilli (AFB) at 2/3, month 5, and month 6, respectively, while 68.6% had all the three sputum AFB in the register. Healthcare workers (HCWs) were adherent in assigning treatment outcome for 65.6% of TB patients while 34.4% of patients were assigned incorrect treatment outcomes. Most variations between reported and actual treatment outcomes were found with cured (17%) and completed (13.4%). Successful and unsuccessful outcomes were overreported by 30.4% and 4.1%, respectively. DOTS providers in private facilities with available TB guideline (OR 8.33, CI 3.56-19.49, p < 0.0001) and PNFP facility (OR 4.42, CI 1.91-10.3, p = 0.001) were more likely to adhere to National TB Guideline while assigning TB treatment outcome. Conclusion Frontline TB providers in Lagos private hospitals struggled with assigning correct treatment outcome for TB patients based on NTBLCP guideline. Increased access to all the periodic follow-up AFB tests for TB patients on treatment and availability of National TB Guideline for referencing could potentially improve the adherence of private TB service providers while assigning TB treatment outcomes.
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Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego (an Affiliate of John Hopkins University), Abuja, Nigeria,*Correspondence: Victor Abiola Adepoju ;
| | - Olusola Adedeji Adejumo
- Department of Community Medicine and Primary Health Care, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Oluwatoyin Elizabeth Adepoju
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Nigeria
| | - Marius Olusola Adeniyi
- Department of Primary Healthcare Services, Ondo State Primary Healthcare Development Agency, Akure, Nigeria
| | - Victoria Etuk
- International Research Center of Excellence (IRCE), Institute of Human Virology of Nigeria, Abuja, Nigeria
| | - Iheoma Nzekwe
- Department of HIV and Infectious Diseases, Jhpiego (an Affiliate of John Hopkins University), Abuja, Nigeria
| | - Jude O. Inegbeboh
- Department of HIV/AIDS, Birnin Kebbi, Kebbi State Children Emergency Fund (UNICEF), Abuja, Nigeria
| | | | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
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Mitchell EMH, Adejumo OA, Abdur-Razzaq H, Ogbudebe C, Chukwueme N, Olorunju SB, Gidado M. Hybrid Approach to Estimation of Underreporting of Tuberculosis Case Notification in High-Burden Settings With Weak Surveillance Infrastructure: Design and Implementation of an Inventory Study. JMIR Public Health Surveill 2021; 7:e22352. [PMID: 33720030 PMCID: PMC8088841 DOI: 10.2196/22352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The greatest risk of infectious disease undernotification occurs in settings with limited capacity to detect it reliably. World Health Organization guidance on the measurement of misreporting is paradoxical, requiring robust, independent systems to assess surveillance rigor. Methods are needed to estimate undernotification in settings with incomplete, flawed, or weak surveillance systems. This study attempted to design a tuberculosis (TB) inventory study that balanced rigor with feasibility for high-need settings. OBJECTIVE This study aims to design a hybrid TB inventory study for contexts without World Health Organization preconditions. We estimated the proportion of TB cases that were not reported to the Ministry of Health in 2015. The study sought to describe TB surveillance coverage and quality at different levels of TB care provision. Finally, we aimed to identify structural-, facility-, and provider-level barriers to notification and reasons for underreporting, nonreporting, and overreporting. METHODS Retrospective partial digitalization of paper-based surveillance and facility records preceded deterministic and probabilistic record linkage; a hybrid of health facilities and laboratory census with a stratified sampling of HFs with no capacity to notify leveraged a priori knowledge. Distinct extrapolation methods were applied to the sampled health facilities to estimate bacteriologically confirmed versus clinical TB. In-depth interviews and focus groups were used to identify causal factors responsible for undernotification and test the acceptability of remedies. RESULTS The hybrid approach proved viable and instructive. High-specificity verification of paper-based records in the field was efficient and had minimal errors. Limiting extrapolation to clinical cases improved precision. Probabilistic record linkage is computationally intensive, and the choice of software influences estimates. Record absence, decay, and overestimation of the private sector TB treatment behavior threaten validity, meriting mitigation. Data management demands were underestimated. Treatment success was modest in all sectors (R=37.9%-72.0%) and did not align with treatment success reported by the state (6665/8770, 75.99%). One-fifth of TB providers (36/178, 20%) were doubtful that the low volume of patients with TB treated in their facility merited mastery of the extensive TB notification forms and procedures. CONCLUSIONS Subnational inventory studies can be rigorous, relevant, and efficient in countries that need them even in the absence of World Health Organization preconditions, if precautions are taken. The use of triangulation techniques, with minimal recourse to sampling and extrapolation, and the privileging of practical information needs of local decision makers yield reasonable misreporting estimates and viable policy recommendations.
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Affiliation(s)
- Ellen M H Mitchell
- Tropical Infectious Diseases, Department of Public Health, Institute for Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | - Samson Bamidele Olorunju
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Mustapha Gidado
- KNCV TB Foundation, Koninklijke Centrale Vereniging tot bestrijding der Tuberculose (KNCV), The Hague, Netherlands
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Oluwasanu MM, Hassan A, Adebayo AM, Ogbuji QC, Adeniyi BO, Adewole DA, Ladipo OA, Ajuwon GA, Ajuwon A. General and tuberculosis-specific service readiness in two states in Nigeria. BMC Health Serv Res 2020; 20:792. [PMID: 32843028 PMCID: PMC7448989 DOI: 10.1186/s12913-020-05626-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria. Methods This was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary, and tertiary healthcare facilities in two TB high burden states. Data were collected using key informant interviews, a semi-structured instrument adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions. Results The domain score for basic amenities in both states was 48.8%; 47.0% in Anambra and 50.8% in Oyo state with 95% confidence interval [− 15.29, 7.56]. In Oyo, only half of the facilities (50%) had access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states was 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (p = 0.56). The domain score for availability of staff and TB guidelines was 57.1% for both states with 95% confidence interval [− 13.8, 14.4]. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) of the facilities experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states was 75%; this was higher in Oyo (76.5%) than Anambra state (73.6%) (p = 0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing, and gaps with continuing education on TB management. Conclusions The weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.
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Affiliation(s)
- Mojisola Morenike Oluwasanu
- Department of Health Promotion and Education, African Regional Health Education Centre, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Abiodun Hassan
- Association for Reproductive and Family Health, Abuja, Nigeria
| | - Ayodeji Matthew Adebayo
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - David Ayobami Adewole
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Grace Ada Ajuwon
- E. Latunde Odeku Medical Library, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ademola Ajuwon
- Department of Health Promotion and Education, African Regional Health Education Centre, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Adejumo OA, Daniel OJ, Adepoju VA, Femi-Adebayo T, Adebayo BI, Airauhi AO. Challenges of Tuberculosis Control in Lagos State, Nigeria: A Qualitative Study of Health-Care Providers' Perspectives. Niger Med J 2020; 61:37-41. [PMID: 32317820 PMCID: PMC7113816 DOI: 10.4103/nmj.nmj_108_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/26/2019] [Accepted: 10/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Tuberculosis (TB) burden in Nigeria is a reflection of the challenges of TB control strategy in the country. This study explored the challenges encountered by the health workers in public and private TB treatment centers in Lagos, Nigeria. Methods: In-depth interviews were held with 34 health workers providing TB services in private and public health facilities and the Lagos state Program Officer between October 1, 2016 and January 31, 2017. The transcripts were read severally and coded for qualitative data analysis. Themes were developed from coding. Results: Insufficient or lack of funds to track patients lost to follow-up, conduct home visits, collect drugs from the central stores, and shortage of laboratory reagents were some of the logistical challenges encountered by the health workers. There was shortage of health workers and some were yet to be trained resulting in work overload. This was situation aggravated by the frequent redeployment and health worker attrition in the public and private sector respectively. Conclusion: The government need be proactive and show leadership by finding lasting solutions to the logistical and human resource challenges facing the LAgos State TB and Leprosy Program.
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Affiliation(s)
- Olusola Adedeji Adejumo
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Olusoji James Daniel
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | | | - Toriola Femi-Adebayo
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bisola Ibironke Adebayo
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Andrew Oseghae Airauhi
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Ogbonna V, Alabere D, Tobin-West C. Treatment outcomes and associated factors of tuberculosis patients on directly observed treatment (short course) in a tertiary hospital in Port Harcourt, Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_82_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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