School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
BMC Infect Dis. 2013 Aug 1;13:360. doi: 10.1186/1471-2334-13-360.
Tuberculosis 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.
We 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.
Quantitative: 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.
TBIC 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.
在资源有限的环境中，医疗设施很少实施结核病感染控制（TBIC）。了解实施程度低的原因至关重要。本研究旨在评估乌干达两个地区的 TBIC 实施情况和障碍。
我们在 Mukono 和 Wakiso 区的 51 家卫生机构进行了一项横断面研究。该研究包括：设施调查、实践观察和与卫生工作者进行的八次焦点小组讨论。
定量：仅有 16 家机构（31%）有 TBIC 计划。有 5 家机构（10%）对咳嗽患者进行筛查。有 2 家机构（4%）报告为咳嗽患者提供口罩。在 51 家机构中，有 43%（22/51）的等候区通风不足，不利于结核病感染控制。没有一家机构拥有 N95 颗粒呼吸器。定性：阻碍 TBIC 实施的障碍包括：人员配备不足、患者隔离空间不足、缺乏购买口罩的资金、以及卫生工作者不重视 TBIC 的重要性。
在进行调查的两个乌干达地区的卫生机构中，没有实施 TBIC 措施。卫生系统因素，如人员、空间和资金的缺乏，是实施 TBIC 的障碍。当基本卫生系统的组成部分——治理和管理、融资、基础设施、采购和供应链管理到位并正常运作时，TBIC 措施才能得到有效实施。
