Abstract
BackgroundTuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda.MethodsWe conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers.ResultsQuantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators.Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC.ConclusionTBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks -governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.
Highlights
Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings
Interest to eliminate tuberculosis (TB) transmission in health facilities is growing in importance because of the association between TB and HIV and the emergence of multidrug resistant TB (MDR-TB) and extensively drugresistant TB (XDR-TB) [1]
World Health Organization (WHO) recommends that all health facilities caring for TB patients or persons suspected of having TB implement these measures [1]
Summary
Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. The World Health Organization (WHO) recommends four types of infection control measures in health facilities: managerial measures, administrative measures, proper ventilation and personal protective equipment [14]. The Ministry of Health of Uganda (MOH) and the Tuberculosis Control Assistance Programme (TBCAP) initiated efforts to implement TBIC by training HCWs. the extent to which TBIC measures have been implemented in district health facilities has not been evaluated. Uganda has a case detection rate of 61%, a treatment success rate of 68% and a treatment failure rate of 10% [25] This calls for an assessment of TBIC measures in health facilities in Uganda. We determined whether facility characteristics were associated with implementation of TBIC and identified barriers to implementation
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