The Quality of Tuberculosis Services in Health Care Centres in a Rural District in Uganda: The Providers’ and Clients’ Perspective

Abstract

Quality of care plays an important role in the status of tuberculosis (TB) control, by influencing timely diagnosis, treatment adherence, and treatment completion. In this study, we aimed at establishing the quality of TB service care in Kamuli district health care centres using Donabedian structure, process, and outcomes model of health care. A cross-sectional study was conducted in 8 health care facilities, among 20 health care workers and 392 patients. Data was obtained using face-to-face interviews, an observation guide, a check list, and record review of the TB unit and laboratory registers. Data entry and analysis were done using EPI INFO 2008 and STATA 10 versions, respectively. A high number 150 (87.21%) of TB patients were not aware of all the signs to stop TB medication, and 100 (25.51%) patients received laboratory results after a period of 3–5 working days. The major challenges faced by health workers were poor attitude of fellow health workers, patients defaulting treatment, and fear of being infected with TB. One of the worst performance indicators was low percentage of cure. Comprehensive strengthening of the health system focusing on quality of support supervisions, patient follow up, promoting infection control measures, and increasing health staffing levels at health facilities is crucial.

Factors that contribute to treatment defaulting amongst tuberculosis patients in Windhoek District, Namibia

“…It emerged that some health workers were said to be rude and did not provide patients with enough time to ask questions during the visits to the clinic. These findings are in line with the findings of a review by Bulage et al [32] and a study by Hasker et al [27] that indicated some reasons associated with defaulting included the poor attitude of the health workers such as scolding the patients for missing appointments and refusing to give patients more medications.…”

“…[32] The current study found some TB patients (especially those that are being re-treated for TB) to have defaulted treatment because they were tired of taking the medication or it was making them more sick. This negative attitude confirms the relevance of the theory of planned behavior that indicates that the intention to perform a certain action (in this case adherence to TB treatment) is influenced by the attitude (e.g.…”

Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study

“…In sub-Saharan Africa, the practice of DOT is limited by a severe shortage of healthcare workers coupled with weak public health systems in which most TB programmes operate [9,10]. Previous studies in Uganda showed that only 16% of TB clinics implemented DOT properly due to a shortage of health workers [11]. Furthermore, only 63% of DOT workers consistently supervised treatment [12] whereas 26% of patients did not properly adhere to their prescribed treatment [13].…”

Tuberculosis treatment success among rural and urban Ugandans living with HIV: a retrospective study

“…8 Previous studies in Uganda showed that late presentation, patients lost to follow-up from treatment and inadequate treatment monitoring were associated with negative outcomes. 9,10 In the present study, we aimed to use data from routinely collected government facilities to identify factors that limit treatment success in Ugandan urban and rural settings among the vulnerable population of PLHIV.…”