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

Abstract

Background 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. In this study, we sought to assess the availability and readiness of diabetes facilities to manage TB in Tanzania. Methods The 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. Results There 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. Conclusion Most 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.

Barriers and facilitators to bidirectional screening of TB-DM in Ghana: Healthcare workers’ perspectives

“…The aim of this research was to explore the barriers and facilitators to bidirectional screening in healthcare facilities in the Northern Region of Ghana. This study found that implementing bidirectional screening in public health facilities was achievable, when properly implemented, which is consistent with the findings of similar studies [6,22,23]. An increase in staff capacity and institutionalization of bidirectional screening were found to be enablers to the screening process, while delays in screening, fear and stigmatization of TB, poor collaboration between TB and DM units, and skewed funding for screening, were all found to hinder the successful implementation of bidirectional screening in the healthcare facility setting in the Northern Region of Ghana.…”

“…In 2013, the worldwide TB-DM comorbidity was over 1 million cases, reflecting 15% of the global tuberculosis burden [ 4 , 5 ]. Studies conducted in various countries from 2011–2013 found DM prevalence in TB patients to be from 25%-44% between 2011–2012 in three regions of India, 36% in Mexico, 17% in Tanzania and 40–45% in the South Pacific [ 5 , 6 ]. Projections indicate that by 2045, 629 million people will be living with DM, and the greatest share will be borne by LMICs [ 2 ].…”

Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study

“…The clinical audit programme is built-in to increase accountability but also as a one of the learning system components. 11 The goal is to guide local decision but will also be communicated to the ministries responsible for Health and Regional Administration and Local Government Authorities.…”

Readiness of healthcare facilities with tuberculosis services to manage diabetes mellitus in Tanzania: A nationwide analysis for evidence-informed policy-making in high burden settings

“…The tuberculosis facility that scores at least half (equivalent to the median value of 12.5% and above) in each domain and adding up to the overall of 50% or more were considered to have "high readiness" for the management of TB while those with less than 50% were considered to have "low readiness." The cut-off point used in this study was also used in the previous studies to dichotomize the outcome variable [25,[29][30][31][32][33].…”

“…Similarly, the Tanzania National Standard Treatment Guidelines has no information regarding screening for TB among DM patients [ 24 ]. Although one study found that DM health facilities had a low readiness to manage TB [ 25 ] there is a paucity of information about the capacity of tuberculosis facilities to manage diabetes mellitus. Knowing both scenarios can help to decide either to co-manage TB/DM in tuberculosis facilities or diabetes facilities.…”