General and Tuberculosis-Specific Service Readiness in two states in Nigeria

Abstract

Background : Tuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria. Methods: This was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary, and tertiary healthcare facilities in two TB high burden states. Data were collected using key informant interviews, a semi-structured instrument adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions. Results: The domain score for basic amenities in both states is 48.8%; 47.0% in Anambra and 50.8% in Oyo state with 95% confidence interval [-15.29, 7.56]. In Oyo, only half of the facilities (50%) have access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states is 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (p=0.56). The domain score for availability of staff and TB guidelines is 57.1% for both states with 95% confidence interval [-13.8, 14.4]. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states is 75%; this was higher in Oyo (76.5%) than Anambra state (73.6%) (p=0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing, and gaps with continuing education on TB management. Conclusions : The weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.

Assessing the capacity of primary health care centres to provide tuberculosis services in Kaduna State, North-Western Nigeria

“…30 A recent study done in Oyo and Anambra states of Nigeria found that up to 80% of facilities had TB treatment guidelines. 31 Another study done in Tanzania found that 70% of all facilities did have TB diagnosis and treatment guidelines. 32 Although direct comparison cannot be made given that both primary and non-primary health facilities were included in these studies, the difference highlights the important need for equipping PHCs with simple, comprehensive and easy to use TB diagnosis and treatment guidelines.…”

“…For instance, in Anambra and Oyo states of Nigeria, less than 24% of health workers were trained on MDR-TB across multiple healthcare levels. 31 Given the fact that MDR-TB is one of the major drivers of global TB epidemic, there is need for its inclusion in the current training package for PHC workers. Such a move will likely improve their ability to provide holistic TB care including TB infection prevention and control, MDR-TB detection, patient-centred treatment needs and disease surveillance.…”

Transferability of a EUnetHTA relative effectiveness assessment to low- and middle-income countries setting

“…They can also focus more on developing a comprehensive assessment involving other elements influencing the success of TB treatment, such as drug surveillance to prevent inappropriate use and nonadherence, diagnosis, and equity of access to the medicine. This comprehensive assessment is helpful to strengthen the TB-related health system in LMICs, which is currently still weak (32).…”