Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2021 Jul 12;16(7):e0254349. doi: 10.1371/journal.pone.0254349. eCollection 2021.
Double disease burden such as Tuberculosis and Diabetes mellitus comorbidity is evident and on rising especially in high burden settings such as Tanzania. There is limited information about the availability of tuberculosis/diabetes integrated healthcare services in Tanzania. Therefore, this study explored the availability and examined the readiness of healthcare facilities with tuberculosis services to manage diabetes mellitus in Tanzania.
We abstracted data from the 2014-2015 Tanzania Service Provision Assessment Survey datasets. The service availability was assessed by calculating the proportion of tuberculosis facilities reported to manage diabetes mellitus. There were four domains; each domain with some indicators for calculating the readiness index. High readiness was considered if the tuberculosis facilities scored at least half (≥50%) of the indicators listed in each of the four domains (staff training and guideline, diagnostics, equipment, and medicines) as is recommended by the World Health Organization-Service Availability and Readiness Assessment manual while low readiness for otherwise.
Out of 341 healthcare facilities with tuberculosis services included in the current study, 238 (70.0%) reported providing management for diabetes mellitus. The majority of the facilities were dispensaries and clinics 48.1%; publicly owned 72.6%; and located in rural 62.6%. Overall, the readiness of tuberculosis facilities to manage diabetes was low (10.8%). Similarly, the readiness was low based on the domain-specific readiness of trained staff and guidelines.
Although the majority of the healthcare facilities with tuberculosis services had diabetes mellitus services the overall readiness was low. This finding provides a piece of evidence to inform the policymakers in high burden and low resource countries to strengthen the co-management of tuberculosis and diabetes.
结核病和糖尿病合并症(即双重疾病负担)在高负担国家(如坦桑尼亚)越来越明显。关于坦桑尼亚是否提供结核病/糖尿病综合医疗保健服务的信息有限。因此,本研究旨在探讨该服务的可及性,并评估具有结核病服务的医疗设施管理糖尿病的准备情况。
我们从 2014-2015 年坦桑尼亚服务提供情况评估调查数据集提取数据。通过计算报告有管理糖尿病能力的结核病设施比例,评估服务的可及性。有四个领域;每个领域都有一些指标,用于计算准备指数。如果结核病设施在四个领域(员工培训和指南、诊断、设备和药物)中的每个领域中列出的指标中至少获得一半(≥50%)的分数,就被认为具有高准备度,如世界卫生组织服务提供和准备评估手册所建议的那样;否则则被认为是低准备度。
在当前研究纳入的 341 家具有结核病服务的医疗设施中,有 238 家(70.0%)报告提供了糖尿病管理服务。大多数设施是诊所和医务室,占 48.1%;公共所有占 72.6%;位于农村地区占 62.6%。总体而言,结核病设施管理糖尿病的准备度较低(10.8%)。同样,根据有培训的员工和指南方面的特定领域准备情况,准备度也较低。
尽管大多数具有结核病服务的医疗设施都提供了糖尿病服务,但总体准备度较低。这一发现为高负担和资源匮乏国家的决策者提供了证据,以便加强结核病和糖尿病的共同管理。