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Spatial Disparity in Availability of Tuberculosis Diagnostic Services Based on Sector and Level of Care in Nigeria

Journal of Tuberculosis Research 2023年第1期11卷 12-22页

作者： Bethrand Odume Sani Useni Egwuma Efo degu dare Elias Aniwada Nkiru Nwokoye Ogoamaka Chukwuogo Chidubem Ogbudebe Michael Sheshi Aminu Babayi Emperor Ubochioma Obioma Chijioke-Akaniro Chukwumah Anyaike Rupert Eneogu Debby Nongo KNCV Nigeria Abuja Nigeria KNCV Netherlands The Hague Netherlands Department of Community Medicine University of Nigeria Nsukka Nigeria NTBLCP FMOH Abuja Nigeria USAID Abuja Nigeria

Background: Delay in Tuberculosis (TB) diagnosis can contribute to late presentation, severe disease, and continued transmission. KNCV TB Foundation Nigeria through the United States Agency for International Development (USAID) funded the TB Local Organization Network (LON) 1 and 2 projects that explored the availability of Tuberculosis services based on sector and levels of care. Methods: TB Patient Pathway Analysis was carried out in 14 states comprising 92 facilities. It involved primary, secondary, and tertiary levels of health care in both the public and private sectors. This was a cross-sectional study under program implementation. Proforma was used to collect data on the available TB diagnostic services. Results: In public health facilities, GeneXpert was available at 100% in tertiary facilities in 8 (57%) states;up to 82% in 4 (33%) states, 50% available at secondary facilities in 2 states, and There is none at the primary facilities. Smear microscopy was available at 100% in tertiary facilities in 9 (64%) states and 3 (25%) states have 50% to 82%;secondary -10 (71%) states have > 70% at facilities;primary 1 (7%) state has it in 61% of facilities. Loop-mediated isothermal amplification (TB-LAMP) in tertiary 2 (17%) states have 20% and 100% respectively;secondary 4 (<30%) states have in 1 or 2 facilities;none for primary facilities. In private health facilities, 79% of states have Smear microscopy at both primary and secondary facilities, and only 2 states (14%) at tertiary facilities. Only 1 (7%) state has GeneXpert in all tertiary facilities, 2 (14%) states have secondary facilities, and 4 states in about 1% of facilities. TB LAMP was not available in any tertiary facility, one (7%) state at secondary with coverage of 1%, and 2 (14%) states at primary both with 4% overall facility coverage. Conclusions: There is an inequitable distribution of TB diagnostic services in both sectors and levels of care in Nigeria. TB care and control will improve with enhanced equitable distribution of TB diagnostic service

关键词： Tuberculosis Diagnostic Services Disparity Sector Level Nigeria

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Patient Health Seeking Behavior and Choice of Place of Care among Tuberculosis Clients in Selected States in Nigeria

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Journal of Tuberculosis Research 2023年第4期11卷 149-161页

作者： Bethrand Odume Aminu Babayi Ogoamaka Chukwuogo Chidubem Ogbudebe Elias Aniwada Egwuma Efo degu dare Useni Sani Nkiru Nwokoye Emperor Ubochioma Obioma-Chijioke Akaniro Debby Nongo Rupert Eneogu Temitayo Lagundoye-Odusote Chukwuma Anyaike Technical and Programs Department KNCV Nigeria Abuja Nigeria Department of Community Medicine Faculty of Medical Sciences University of Nigeria Enugu Campus Enugu Nigeria Technical Department KNCV Tuberculosis Fund The Hague Netherlands The Programs and Coordination Department National Tuberculosis Leprosy & Buruli Control Program Abuja Nigeria Program Management Department HIV/AIDS & TB Office USAID/Nigeria Abuja Nigeria

Background: Tuberculosis (TB) remains a major global public health problem. Early detection and initiation of treatment shortens infectious period and is key to TB control. A considerable proportion of TB patients presenting with advanced symptoms suggests delay in seeking care. As TB control programs rely on passive case finding, TB care-seeking behavior is critical as un-diagnosed cases act as reservoirs for transmission. This study assessed patient health seeking behavior and choice of place of care among TB patients in Nigeria. Methods: This was a pro-gramme implementation, facility-based cross-sectional study in 14 states, 92 facilities across three levels of care. Interviewer-administered semi-structured questionnaires were used. Information on personal characteristics and health seeking behavior was collected from June 2020 to December 2021. The analysis was based on the various healthcare providers where the respondents first sought care. Data analysis was done using IBM SPSS and summarized using frequency and percentages. Chi square test was used for associations of characteristics of patients and choice of place of care at p Results: In all 14 states, distribution of overall first place of seeking care for TB symptoms was: 7208 (75.8%) health facilities (range 57% to 88%), while 2294 (24.2%) visited other places including community pharmacist, patent medicine vendor, traditional/home, un-specified/none. For Health facilities, the majority were at public facilities 6563 (69.1%) and private 641 (6.7%). Moreover, 6 states had >20% of respondents who first sought care at PMVs, while 3 states (Delta, Imo, and Rivers) had 10% of respondents who first sought care at Community Pharmacist. Conclusions: Nearly a quarter of people with TB first sought care outside health facilities, suggesting the need to align availability of services with their needs.

关键词： Patient Pathway Analysis TB Patients TB Treatment Healthcare Facility

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