Abstract
Despite the scale up of quality-assured Tuberculosis diagnostic and treatment strategies over the years, case detection rate remains a serious challenge globally and particularly in Nigeria. Integrated service delivery is essential to addressing some of the challenges, but it's often neglected especially in low income settings. Recognizing these limitations, a 27-months retrospective review of all presumptive Pulmonary Tuberculosis cases sent to the directly observed short course treatment centre of Benue State University Teaching Hospital, a tertiary health institution in north central Nigeria was conducted to assess the source of referrals and diagnostic processes including outcome of the tests. Chi- square (χ2) test was used for test of association between the intra-facility linkages/referrals system and the tuberculosis case detection rate, with statistical significance set at p-value of ≤5%. There were 918 presumptive Tuberculosis cases with male to female ratio (M: F) of 1:1.3. The mean age of patients was 41.0.0 ±18.4 years. Majority (33.7%, n=) of the referrals were from general outpatient department of the hospital, followed by sexually transmitted infection clinic (26.0%) and Paediatrics department (1.6%, n=). The diagnostic positive rate was 145(15.8%). Overall, 295(32.2%) did not collect their results, of these 76(25.8%) were positive and 219(74.2%) were negative. The relationship between the missed cases and the weak intra-facility referral linkages was statistically significant (p=0.000). The hospital management should consider the engagement of all relevant health care providers on efficient two-way referral system towards ensuring adequate Tuberculosis case notification and prompt treatment.
Highlights
MATERIALS AND METHODS | pg. 445It is over 25 years that Nigeria adopted the World Health Organization (WHO) Tuberculosis (TB) management strategies; starting from the Directly Observed Treatment Short Course (DOTS) therapy in 1998 to the recent END TB strategy[1,2,3,4]
Linkages or referrals between health centers and services at hospitals or in the community, or between separate clinics organized within a health facility, or between clinicians and laboratory or pharmacy service delivery points has been advocated as a major step of bringing smaller components of health sector into a single system that function as one.20In our study this was done
Majority of the referrals were from the general outpatient department (GOPD), followed by sexually transmitted infections (STI) clinic, internal medicine, surgery, Obstetrics and Gynecology, accidents and emergency, and the least was the Paediatrics department (Figure 1)
Summary
MATERIALS AND METHODS | pg. 445It is over 25 years that Nigeria adopted the World Health Organization (WHO) Tuberculosis (TB) management strategies; starting from the Directly Observed Treatment Short Course (DOTS) therapy in 1998 to the recent END TB strategy[1,2,3,4]. Such individuals end up having poor health outcomes, or they and their family will suffer distress and economic hardship.[14,15] Integrated service delivery, timely linkages to and retention in care are critical steps in addressing some of these challenges, but there are significant weaknesses in TB care/treatment cascade, in low income settings.[16,17,18,19] we assessed the effect of weak twoway intra-facility referral linkages in relation to tuberculosis case detection rate in Benue State University Teaching Hospital (BSUTH), a tertiary health institution in north central Nigeria
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