Toroitich Anthony Martin, Gebeyehu Workneh, Adan Fatuma Ibrahim, Ogola Christine, Mohamed Hassan Muktar, Ombeka Victor, Ogolla Charles, Oiye Shadrack
Intergovernmental Authority on Development, Djibouti, Djibouti.
United States Agency for International Development (USAID) Kenya and East Africa, Health Population and Nutrition Office, Nairobi, Kenya.
Pan Afr Med J. 2021 Aug 27;39:279. doi: 10.11604/pamj.2021.39.279.28028. eCollection 2021.
cross-border mobility of persons with Tuberculosis (TB) is a global public health concern. We aimed at documenting health systems´ potential bottlenecks and opportunities in pulmonary TB continuum of care in cross-border expanses of East and Horn of Africa.
a cross-sectional program assessment with descriptive analysis of TB services, health staff capacities, diagnostic capacities, data management and reporting, and treatment outcomes. Data were extracted from health facility TB registers and semi-structured key informant interviews conducted in selected 26 cross-border sites within the 7 member states of the Intergovernmental Authority on Development (IGAD) region.
the overall cross-border TB cure rate in the year preceding the study (37%) was way beneath the global target with considerable variations amongst the study countries. The restricted support to the cross-border health facilities was mediated and even exacerbated by expansive distances from the respective capital cities. Restricted geographical access to the facilities by cross-border populations was a longstanding challenge. Substantial staffing gaps, TB service delivery capacity needs and inadequate diagnostics were noticeable. The TB control guidelines were not harmonized between the countries and the inter-country referral systems were either absent or inappreciable, contributing to ineffective cross-border referrals and transfers. The frail linkages between stakeholders were contemptible, but increasing governments´ commitments in tackling infectious diseases were encouraging.
cross-border TB interventions should drive regional TB policies, strategies and programs that sustain countries´ coordination, harmonization of management guidelines, advocacy for increased human resources support, enhanced capacity building of cross-border TB staff, adequate diagnostics equipping of the cross-border health facilities and seamless transfer and referral of patients traversing boundaries.
结核病患者的跨境流动是一个全球公共卫生问题。我们旨在记录在非洲东部和非洲之角的跨境区域，卫生系统在肺结核连续护理过程中可能存在的瓶颈和机遇。
开展一项横断面项目评估，对结核病服务、卫生工作人员能力、诊断能力、数据管理与报告以及治疗结果进行描述性分析。数据从卫生机构的结核病登记册中提取，并通过对政府间发展管理局（伊加特）区域7个成员国选定的26个跨境地点进行半结构化关键信息访谈获得。
在研究前一年，总体跨境结核病治愈率（37%）远低于全球目标，且各研究国家之间存在显著差异。对跨境卫生设施的支持有限，而与各自首都距离遥远加剧了这一情况。跨境人口前往这些设施的地理受限是一个长期存在的挑战。明显存在大量人员配备缺口、结核病服务提供能力需求以及诊断不足的问题。各国之间的结核病控制指南不统一，国家间转诊系统要么不存在，要么作用不明显，导致跨境转诊和转移无效。利益相关者之间脆弱的联系令人堪忧，但各国政府在应对传染病方面不断增加的承诺令人鼓舞。
跨境结核病干预措施应推动区域结核病政策、战略和项目，以维持各国之间的协调、管理指南的统一、争取更多人力资源支持的宣传、加强跨境结核病工作人员的能力建设、为跨境卫生设施配备足够的诊断设备，以及实现跨境患者的无缝转移和转诊。
