Evaluation of quality of TB control services by private health care providers in Plateau state, Nigeria; 2012

Introduction: Tuberculosis (TB) is public health concern in Nigeria. The country uses the Directly  Observed Treatment Short course (DOTS) strategy for its control. Plateau state started using the DOTS strategy in 2001 and had the Private health facilities (PHF) as an important stakeholder. We evaluated their contributions to case finding and quality of the services to identify gaps in monitoring and evaluation in the TB control services within the PHF to plan for intervention so as to meet the set target for TB control in the state. Methods: We used the logical framework approach to identify and analyze the  problem. We drew up an objective tree and from the objective tree developed a logical framework matrix including evaluation plan. We also conducted desk review to extract data on case findings, case  management and outcomes of the treatment. We interviewed TB focal persons and laboratory personnel using structured questionnaire. The data was analyzed using excel spread sheet. Results: Of the 127 health facilities with TB patients on treatment 27 (21.3%) were PHF. The PHF reported 54.6% (1494) of TB cases in 2011. The sputum conversion rates, cured rate, treatment success rate, and default rates were 85%, 73%, 81.4% and 6.6% respectively. The discordant rates were 3.1% and 1.2% for the state and private health facilities respectively. Conclusion: Log frame approach is a useful tool for evaluation of TB control services and helps provide evidence for decision making to improve quality of the TB services in the public and private health facilities in the state.Key words: Private facilities, Tuberculosis, monitoring and evaluation, Logframe approac

Factors associated with interruption of treatment among Pulmonary Tuberculosis patients in Plateau State, Nigeria. 2011

Introduction: Nigeria has one of the highest tuberculosis (TB) burdens in the world with estimated  incidence of 133 per 100,000 populations. Multi-drug resistant TB (MDR-TB) is an emerging threat of the  TB control in Nigeria caused mainly by incomplete treatment. This study explored factors that affect  adherence to treatment among patients undergoing direct observation of TB treatment in Plateau state,  Nigeria.Methods: Between June and July 2011, we reviewed medical records and interviewed randomly selected pulmonary TB patients in their eighth month of treatment. Information on patients? clinical, socio- demographic and behavioral characteristics was collected using checklist and structured questionnaire for knowledge of treatment duration and reasons for interruption of treatment. We conducted focus group discussions with patients about barriers to treatment adherence. Data were analyzed with Epi Info  software. Results: Of 378 records reviewed, 229 (61%) patients were male; mean age 37.6 ±13.5 years and 71 (19%) interrupted their treatment. Interruption of treatment was associated with living > 5 km from TB treatment site (AOR: 11.3; CI 95%: 5.7-22.2), lack of knowledge of duration of treatment (AOR: 6.1; CI 95%: 2.8-13.2) and cigarette smoking (AOR: 3.4; CI 95%: 1.5- 8.0). Major reasons for the interruption were lack of transport fare (40%) and feeling well (25%). Focused group discussions revealed unfriendly attitudes of health care workers as barriers to adherence to treatment. Conclusion: This study revealed knowledge of the patients on the duration of treatment, distance and health workers  attitude as the major determinants of adherent to TB treatment. Training for health care workers on  patient education was conducted during routine supportive supervision.Key words: Interruption, treatment, Tuberculosis, Nigeri

Polio eradication in Nigeria: evaluation of the quality of acute flaccid paralysis surveillance documentation in Bauchi state, 2016

Abstract Background Nigeria is the only country in Africa that is yet to be certified as polio free. Surveillance for acute flaccid paralysis (AFP) is the foundation of the polio eradication initiative since it provides information to alert both health managers and clinician that timely actions should be initiated to interrupt transmission of the polio virus. The strategy also provides evidence for the absence of wild poliovirus. This evaluation was performed to assess key quality indicators defined by the polio eradication program and thus to identify gaps to allow planning for corrective measures to achieve a polio-free situation in Bauchi state and in Nigeria at large. We conducted a cross-sectional descriptive study which involved a desk review of documents to authenticate the correctness and completeness of data, and a review of documented evidence for the quality of AFP surveillance. We interviewed Local Government Authority (LGA) surveillance officers and clinicians from focal and non-focal sites, along with caregivers of children with AFP and community leaders. The data were entered and analyzed in a Microsoft Excel spreadsheet. Methods We conducted a cross-sectional study of the AFP surveillance and documentation in eighteen of the twenty Local Government Areas (LGAs) of Bauchi State. We assessed the knowledge of the clinician at focal and non-focal sites on case definition of AFP, the number and method of stool specimen collection to investigate a case and types of training received for AFP surveillance. We verified AFP case investigations for the last three years: The caregivers (mothers) were interviewed to authenticate the reported information of AFP cases, the method used for stool specimen collection and feedbacks. Community leaders’ knowledge on AFP surveillance was also assessed. Data was entered and analyzed in excel spread sheet. Results Of the 18 LGA Disease Surveillance and Notification Officers (DSNOs), only 2 (11%) and 5 (28%) had reports of polio outbreak investigations and supervisory visits at the lower levels, respectively. Furthermore, only 6 (33%) and 7 (39%) of the DSNOs had minutes of meetings and surveillance work plans, respectively. Of the 31 AFP cases investigated, only 39, 26, 23, and 23% had correct and complete information for the birth day, birth month, date of onset of paralysis, and date of investigation, respectively. Seventy-one percent of the clinicians at the AFP focal sites knew the correct definition for AFP compared with only 30% at the non-focal sites. Of the 38 caregivers (mothers), 16 (42%) did not remember the day or month the AFP investigation was conducted. However, 95% gave a correct number of stool samples collected and 40% mentioned that the samples were collected 24 h apart. Feedback was not given to 26 (68%) of the caregivers. The majority (79%) of the community leaders knew how to recognize a case of AFP and knew that the stool was the specimen required for the investigation, but 21% did not know to whom they should report a case of AFP in their community. Conclusion This study revealed a gap in the quality indicators for polio eradication in the state, especially regarding knowledge and documentation for AFP surveillance at the operational level. Regular training of the DSNOs and focal persons, regular sensitization of clinicians, community education, supplies of reporting tools, and ensuring their judicious use will improve AFP surveillance in the state