Asemahagn Mulusew Andualem, Alene Getu Degu, Yimer Solomon Abebe
School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Microbiology, Unit for Genome Dynamics, Faculty of Medicine, University of Oslo, Oslo, Norway.
Res Rep Trop Med. 2020 Feb 4;11:3-16. doi: 10.2147/RRTM.S233052. eCollection 2020.
Tuberculosis (TB) remains a foremost global public health threat. Active TB control needs geographically accessible health facilities that have quality diagnostics, equipment, supplies, medicines, and staff.
This study aimed at assessing the geographic distribution, physical accessibility, readiness and barriers of health facilities for TB services in East Gojjam zone, Ethiopia.
A convergent parallel design was applied using health facility and geographic data. Data on facility attributes, service availability and readiness were collected by inteviewing TB officers, laboratory heads and onsite facility visits. Coordinates of health facilities and kebele centroids were collected by GPS. We used ArcGIS 10.6 to measure Euclidean distance from each kebele centroids to the nearest health facility. Descriptive statistics were computed by using SPSS version 25. Barriers to TB service readiness were explored by in-depth interviews. NVivo12 was used to thematically analyze the qualitative data.
The overall TB health service coverage (THSC) was 23% (ranging: 10-85%). The mean distance from the nearest health facility was 8km (ranging: 0.5-16km). About 132 (32%) kebeles had poor geographic accessibility to TB services (over 10km distance from the nearest health facility) and had poor facility readiness. Although 114 (95%) health facilities offered at least one TB service, 44 (38.6%) of them had no sputum smear microscopy. The overall TB readiness index was 63.5%: first-line anti-TB drugs (97%), diagnostics (63%), trained staffs, diagnostic and treatment guidelines (53%) and laboratory supplies (41%). Lack of health workers (laboratory personnel), inadequate budget, poor management practice and TB program support, inadequate TB commodity suppliers, and less accessible geographic locations of health facilities were identified as barriers to TB service readiness distribution.
Considerable proportion of the population in the study area have poor access to quality TB diagnostic services due to low THSC and poor facility readiness. Barriers to TB service availability and readiness were health system related. Regular refresher training of health workers on TB, creating mechanisms to attract laboratory personnel to work in the study area and scaling up of sputum smear microscopy services, establishing an efficient mechanism for procurement, distribution, utilization and reporting of TB commodity supplies, and good management practices are crucial to enhance TB service readiness in the study zone.
结核病仍然是全球首要的公共卫生威胁。积极的结核病防控需要在地理上易于到达且具备高质量诊断、设备、物资、药品和工作人员的卫生设施。
本研究旨在评估埃塞俄比亚东戈贾姆地区结核病服务卫生设施的地理分布、实际可及性、准备情况及障碍。
采用健康设施与地理数据相结合的平行设计。通过访谈结核病防治官员、实验室负责人并实地走访收集有关设施属性、服务可及性和准备情况的数据。利用全球定位系统（GPS）收集卫生设施和行政区中心的坐标。我们使用ArcGIS 10.6来测量从每个行政区中心到最近卫生设施的欧几里得距离。使用SPSS 25版计算描述性统计数据。通过深入访谈探究结核病服务准备工作的障碍。使用NVivo12对定性数据进行主题分析。
结核病卫生服务总体覆盖率（THSC）为23%（范围：10 - 85%）。到最近卫生设施的平均距离为8公里（范围：0.5 - 16公里）。约132个（32%）行政区在地理上难以获得结核病服务（距最近卫生设施超过10公里）且设施准备不足。虽然114个（95%）卫生设施提供至少一项结核病服务，但其中44个（38.6%）没有痰涂片显微镜检查。结核病总体准备指数为63.5%：一线抗结核药物（97%）、诊断（63%）、经过培训的工作人员、诊断和治疗指南（53%）以及实验室物资（41%）。卫生工作者（实验室人员）短缺、预算不足、管理不善以及结核病项目支持不足、结核病商品供应商不足以及卫生设施地理位置偏远被确定为结核病服务准备工作分布的障碍。
由于结核病卫生服务总体覆盖率低且设施准备不足，研究区域内相当一部分人口难以获得高质量的结核病诊断服务。结核病服务可及性和准备工作的障碍与卫生系统相关。定期对卫生工作者进行结核病进修培训、建立吸引实验室人员到研究区域工作的机制并扩大痰涂片显微镜检查服务、建立高效的结核病商品供应采购、分发、使用和报告机制以及良好的管理实践对于提高研究区域的结核病服务准备情况至关重要。
