Abstract
Setting: Private and public tuberculosis (TB) treatment centers in Lagos State, Nigeria. Objective: To compare adherence of private and public providers of directly observed treatment short course (DOTS) in the Lagos State TB control program, Nigeria (LSTBLCP) with the national TB guidelines. Design: A retrospective review of treatment cards of TB patients managed within the first and second quarter of 2012 in 34 DOTS facilities {23 public, 7 private for profit (PFP), and 4 private not for profit (PNFP)} involved in the private public mix of the LSTBLCP. Results: Of the 1896 treatment cards reviewed, 1524 (80.4%), 132 (7.0%) and 240 (12.6%) were from public, PFP and PNFP DOTS facilities, respectively. About 19%, 25% and none of the patients managed at the public, PNFP, and PFP DOTS facilities were treated in full adherence with the national guidelines respectively. A significantly higher proportion of adults and sputum smear positive TB patients were treated in full adherence with the national guidelines (p < 0.05). Treatment success was associated with full adherence with the national guidelines. Conclusion: There is a need to reorient health care providers in public and private health facilities in Lagos State Nigeria to ensure full adherence with the national TB guidelines.
Highlights
Tuberculosis (TB) is still a serious public health issue in Nigeria accounting for 46,000 deaths (27 per 100,000 populations) per year [1]
More males were treated for TB at the public directly observed treatment short course (DOTS) facilities (M:F ratio = 1:076) while at the private DOTS facilities the M:F ratio was almost equal (M:F = 1:0.98)
A significantly higher proportion of the sputum smear positive cases were managed at the private DOTS facilities (p < 0.001)
Summary
Tuberculosis (TB) is still a serious public health issue in Nigeria accounting for 46,000 deaths (27 per 100,000 populations) per year [1]. The 2012 national TB prevalence survey showed that the prevalence of smear positive TB in Nigeria (318 per 100,000) was about twice as much as the previous World Health Organization (WHO) estimate, which was based on routine surveillance data [2]. This recent figure placed Nigeria 4th among the 22 high burden TB countries [3]. Another WHO report showed that 2.9% (2.1% - 4.0%) of TB cases in Nigeria present with multi drug resistant TB [4]. Successful treatment could be achieved if the healthcare workers (both public and private medical practitioners) follow the national guidelines for the treatment of TB
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