Department of Health Promotion and Education, African Regional Health Education Centre, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Association for Reproductive and Family Health, Abuja, Nigeria.
BMC Health Serv Res. 2020 Aug 26;20(1):792. doi: 10.1186/s12913-020-05626-3.
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.
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.
The domain score for basic amenities in both states was 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%) had access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states was 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 was 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%) of the facilities experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states was 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.
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.
结核病是全球最致命的传染病，也是尼日利亚的主要死因之一。一个功能健全的医疗保健系统对于有效提供结核病服务和实现国家及全球目标至关重要。本研究旨在评估尼日利亚奥约州和阿南布拉州提供结核病服务的准备情况。
这是一项基于机构的研究，采用混合方法的收敛平行设计。采用多阶段抽样技术，在两个结核病高负担州选择了 42 家初级、二级和三级医疗保健机构。使用关键知情人访谈、改编自世界卫生组织服务可用性和准备情况评估工具的半结构化仪器以及使用清单进行的设施观察收集数据。使用描述性和推断性统计方法分析定量数据，同时对定性数据进行转录并进行主题分析。整合来自两个来源的数据得出结论。
两个州的基本设施得分均为 48.8%；阿南布拉州为 47.0%，奥约州为 50.8%，置信区间为[-15.29，7.56]。在奥约，只有一半的设施（50%）能够获得稳定的电力供应，而在阿南布拉州这一比例为 72.7%。两个州的总体一般服务准备指数均为 69.2%，奥约州的值（73.3%）高于阿南布拉州（65.4%）（p=0.56）。员工和结核病指南可用性方面的领域得分均为 57.1%，置信区间为[-13.8，14.4]。这一领域得分非常低的指标包括艾滋病毒和结核病合并感染管理方面的员工培训以及耐多药结核病培训。在研究前的 3 个月内，近一半（47.6%）的设施出现了结核病药物短缺。两个州的结核病专项服务准备指数均为 75%；奥约州（76.5%）略高于阿南布拉州（73.6%）（p=0.14）。定性数据显示结核病服务提供方面存在不足之处，例如基础设施不足、人员配备不足以及结核病管理方面继续教育方面的差距。
薄弱的卫生系统仍然是一个挑战，政府和捐助者必须采取协调一致的行动并提供资金，以改善结核病医疗保健系统。
