Availability and readiness of diabetes health facilities to manage tuberculosis in Tanzania: a path towards integrating tuberculosis-diabetes services in a high burden setting?

Festo K Shayo,Sigfrid Casmir Shayo

doi:10.1186/s12889-019-7441-6

Abstract

BackgroundThe burden of tuberculosis (TB) and diabetes mellitus (DM) is rising and substantially affecting the low-income countries, including Tanzania. Integrated management of TB and DM is becoming of importance in TB high burden countries. In this study, we sought to assess the availability and readiness of diabetes facilities to manage TB in Tanzania.MethodsThe present study was based on a secondary analysis of the 2014–2015 Tanzania Service Provision Assessment Survey data. We calculated the service availability as a percentage of diabetes facilities offering TB services: diagnosis and treatment. Regarding the readiness of diabetes facilities to provide TB management, we calculated based on the three domains: staff training and guideline, diagnostics, and medicines as identified by World Health Organization-Service Availability and Readiness Assessment (SARA) manual. A score of at least half (≥50%) of the indicators listed in each of the three domains was considered as high readiness. We used a descriptive statistics to present our findings.ResultsThere were 619 DM facilities all over the country of which only 238 (38.4%) had TB services.72.6 and 62.6% of these DM facilities with TB services were publicly owned and located in rural settings respectively. Generally, DM facilities had low readiness to manage TB; 12·6%. More specifically, all DM facilities had low readiness in terms of trained staff and guidelines. However, in the domain of diagnostics and medications, higher levels of care (hospitals) had a comparatively higher level of readiness to manage TB.ConclusionMost of the DM facilities had low availability and readiness to manage TB. The findings of our study display an urgent need to mobilize important resources to enhance the integration of TB services in DM facilities. This includes medications, management guidelines, diagnostics, and health professionals who have received refresher training on TB/DM co-management. However, presently, few DM facilities may be allowed to start managing TB as per the Strategic and Action Plan for the Prevention and Control of Non-Communicable Diseases in Tanzania 2016–2020.

Highlights

The burden of tuberculosis (TB) and diabetes mellitus (DM) is rising and substantially affecting the low-income countries, including Tanzania
Regarding availability of TB services, a total of 619 facilities reported providing DM management were assessed for TB service availability
Of the 238 diabetes facilities reported providing management for TB when assessed based on facility characteristics; 17.1% were hospitals, 72.6% were publicly owned and 62.6% were rural located

Summary

Introduction

The burden of tuberculosis (TB) and diabetes mellitus (DM) is rising and substantially affecting the low-income countries, including Tanzania. Integrated management of TB and DM is becoming of importance in TB high burden countries. Through the “End TB Strategy,” the World Health Organization (WHO) set targets of 90 and 80% reduction in TB mortality and incidence, respectively, by 2030 [1, 2]. TB remains one of the main causes of morbidity and mortality in low- and medium-income countries (LMICs), where the prevalence of DM is increasing [3]. Tanzania is one of the top 30 countries with a high TB burden in the world [1]. The incidence rate of TB in Tanzania has increased slightly from 125/ 100000 population in 2015 to 129/100000 population in 2016. TB accounts for 5.8% of all deaths in 2014 [4]

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Conclusion