Assessing the capacity of primary health care centres to provide tuberculosis services in Kaduna State, North-Western Nigeria
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20213512Keywords:
Tuberculosis, TB, Primary Health Care, PHC, Kaduna, NigeriaAbstract
Background: Despite earlier successes achieved in combating it, cases of tuberculosis in Nigeria are now on the increase, affecting more people and communities. Primary health care in Nigeria is through ward health system, designed to provide minimum health package to the communities including TB services. This study aimed to ascertain the capacity of PHC centres to provide TB services in Kaduna North senatorial district, Kaduna State, Nigeria.
Methods: Four out of eight local Government areas in the district were randomly selected and one PHC per ward was recruited in the study. In each facility, questionnaires developed from the TB tracer items of the WHO service availability and readiness assessment tool were administered to the facility in-charges and TB/DOTS focal persons.
Results: Forty four facilities were selected from Zaria, Sabon Gari, Makarfi and Kudan LGAs. Almost all facilities (98%) diagnosed TB clinically and 39 (90%) had anti-TB drugs available. National TB guidelines were lacking in 23 (52%) facilities and only 5 (11%) had additional capacity for sputum microscopy. While 35 (80%) TB/DOTS focal persons had received training on TB diagnosis and treatment, only 24 (55%)received training on TB/HIV co-infection and only 8 (18%) received training on multi-drug resistant TB.
Conclusions: While TB services are widely available in the district, urgent need exists for all stakeholders to work together towards equipping those facilities with critical infrastructure that will improve their overall capacity, particularly with regards to comprehensive TB guidelines, laboratory diagnosis and personnel training for effective TB management.
References
Tuberculosis: Key Facts. Available at: https://www.who.int/news-room/fact-sheets/detail/ tuberculosis. Accessed on 20 May 2021.
Davies PDO. Risk factors for tuberculosis. Monaldi Arch Chest Dis. 2005;63(1):37-46.
Campbell IA, Bah-Sow O. Clinical review Pulmonary tuberculosis: diagnosis and treatment. BMJ Clin Rev. 2006;332(5):1194-7.
Pang Y, An J, Shu W, Huo F, Chu N, Gao M, et al. Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008-2017. Emerg Infect Dis. 2019;25(3):457-64.
Glynn JR. Resurgence of tuberculosis and the impact of HIV infection. Br Med Bull. 1998;54(3):579-93.
Hellman LS, Gram CM. The Resurgence of Tuberculosis. AAHON J. 1990;41(2):66-72.
Lonnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of Tuberculosis Epidemics: The Role of Risk Factors and Social Determinants. Soc Sci Med. 2009;(6):1-7.
Global Tuberculosis Report: Executive Summary. Geneva; 2020. Available from: www.who.int/tb/data. Accessed on 20 May 2021.
Chakaya J, Khan M, Ntoumi F, Aklillu E, Fatima R, Mwaba P, et al. Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts. Int J Infect Dis. 2021;4-9.
Dye C, Lönnroth K, Jaramillo E, Williams BG, Raviglione M. Trends in tuberculosis incidence and their determinants in 134 countries. Bull World Health Organ. 2009;87:683-91.
Adebisi YA, Agumage I, Sylvanus TD, Nawaila IJ, Ekwere WA, Nasiru M, et al. Burden of Tuberculosis and Challenges Facing Its Eradication in West Africa. Int J Infect. 2019;6(3):1-8.
Nigeria Federal Ministry of Health. 2019 Annual TB Report. Abuja; 2019. Available from: https://www. health.gov.ng/doc/Draft-2019-NTBLCP-Annual-report-22032020.pdf. Accessed on 20 May 2021.
Ogbo FA, Ogeleka P, Okoro A, Olusanya BO, Olusanya J, Ifegwu IK, et al. Tuberculosis disease burden and attributable risk factors in Nigeria, 1990-2016. Int J Infect. 2018;1-11.
Adepoju P. Nigeria’ s widening tuberculosis gap. Lancet Infect Dis. 2019;20(1):29.
Kwaghe AV, Umeokonkwo CD, Aworth MK. Evaluation of the national tuberculosis surveillance and response systems, 2018 to 2019: National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Abuja, Nigeria. Pan Afr Med J. 2020; 35(54):1-11.
Ogbuabor DC, Onwujekwe OE. Governance of tuberculosis control programme in Nigeria. Infect Dis Poverty. 2019;8(45):1-11.
Bitet DE, Kumurya SA, Joseph L, Bathelomow P. Rifampicin resistant tuberculosis among patients attending General Hospital Kagarko, Kaduna State, Nigeria. African J Clin Exp Microbiol. 2020;21(3): 250-4.
Aigbiremolen AO, Alenoghena I, Eboreime E, Abejegah C. Primary Health Care in Nigeria: From Conceptualization to Implementation. J Med Appl Biosci. 2014;6(2):59-63.
Oluwasogo OA, Ibrahim BS. Community-Based Strategies to Improve Primary Health Care (PHC) Services in Developing Countries, Case Study of Nigeria. JPrim Heal Care Gen Pract. 2020;4(1):4-9.
Aregbeshola BS, Khan SM. Primary Health Care in Nigeria: 24 Years after Olikoye Ransome-Kuti’ s Leadership. Front Public Heal. 2017;5(3):7-8.
Moshood A. Primary Health Care In Nigeria: 42 Years After Alma Ata Declaration. Sydani Initiative for International Development. 2020. Available from: https://sydani.org/primary-health-care-in-nigeria-41-years-after-alma-ata-declaration/. Accessed on 20 May 2021.
Strengthening the foundation of sustainable Primary Healthcare in Kaduna State: The “One Functional PHC Centre per Ward” approach. United Kingdom; 2019. Available from: www.mnch2.com. Accessed on 20 May 2021.
Nisha A, Yurasova Y, Zaleskis R, Grzemska M, Lee RB, Mangura TB. Brief Guide on Tuberculosis Control for Primary Health Care Providers. Available from: https:/www.euro.who.int/. Accessed on 20 May 2021.
Al Salahy MM, Essawy TS, Mohammad OI, Hendy RM, Abas AO. Evaluation of primary health care service participation in the National Tuberculosis Control Program in Menofya Governorate. Egypt J Chest Dis Tuberc. 2016;65(3):643-8.
Michelle EC, Gladys K, Andre J van RP, Dingie VR. Tuberculosis infection control practices in a high-burden metro in South Africa: A perpetual bane for efficient primary health care service delivery. African J Primary Heal care Fam Med. 2018;10(1):a1628.
Kaduna State Bureau of Statistics. Kaduna Q1 2020 Population Projections . Kaduna State Population and Demography. Available from: https://kdbs.ng/. Accessed on 20 May 2021.
Service availability and readiness assessment (SARA): Core Instrument. Geneva; 2015. Available from: www.who.int./healthinfo/systems/. Accessed on 20 May 2021.
The National Strategic Plan for Tuberculosis 2015 - 2020. Available from: http://ntblcp.org.ng/strategic-plan. Accessed on 20 May 2021.
Juliasih NN, Soedarsono, Sari RM. Analysis of tuberculosis program management in primary health care. Infect Dis Rep. 2020;12(1):8728.
Treatment of Tuberculosis: Guidelines. Available at: https://apps.who.int/iris/bitstream/handle/10665/44165/9789241547833_eng.pdf. Accessed on 20 May 2021.
Oluwasanu MM, Hassan A, Adebayo AM, Ogbuji QC, Adeniyi BO, Adewole DA, et al. General and tuberculosis-specific service readiness in two states in Nigeria. BMC Health Serv Res. 2020;20(792):1-15.
Shayo FK, Shayo CS. Availability and readiness of diabetes health facilities to manage tuberculosis in Tanzania: a path towards integrating tuberculosis-diabetes services in a high burden setting? BMC Public Health. 2019;19(1104):1-7.
Asemahagn AM, Alene GD, Yimer SA. Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design. Res Rep Trop Med. 2020;3-16.
Asres A, Jerene D, Deressa W. Delays to anti-tuberculosis treatment intiation among cases on directly observed treatment short course in districts of southwestern Ethiopia: a cross sectional study. BMC Infect Dis. 2019;19(481):1-9.
Diagnostic and treatment delay in tuberculosis. Cairo; 2006. Available from: https://apps.who.int/iris/handle/ 10665/116501. Accessed on 20 May 2021.
Bello S, Afolabi RF, Ajayi DT, Sharma T, Owoeye DO, Oduyoye O, et al. Empirical evidence of delays in diagnosis and treatment of pulmonary tuberculosis: systematic review and meta-regression analysis. BMC Public Health. 2019;19(820):1-11.
Asres A, Jerene D, Deressa W. Delays to treatment initiation is associated with tuberculosis treatment outcomes among patients on directly observed treatment short course in Southwest Ethiopia: a follow-up study. BMC Pulm Med. 2018;18(64):1-11.
Virenfeldt J, Rudolf F, Camara C, Furtado A, Gomes V, Aaby P, et al. Treatment delay affects clinical severity of tuberculosis: a longitudinal cohort study. BMJ Open. 2014;4:e004818.
Tedla K, Medhin G, Berhe G, Mulugeta A, Berhe N. Delay in treatment initiation and its association with clinical severity and infectiousness among new adult pulmonary tuberculosis patients in Tigray, northern Ethiopia. BMC Infect Dis. 2020;20(456):1-10.
Hapolo E, Ilai J, Francis T, du Cros P, Taune M, Chan G. TB treatment delay associated with drug resistance and admission at Daru General Hospital in Papua New Guinea. Public Heal Action. 2019;9(1):50-6.