Private sector tuberculosis care quality during the Covid-19 pandemic

A repeated cross-sectional standardised patients study of adherence to national TB guidelines in urban Nigeria

Datos Bibliográficos

ID21880650
AutoresAngelina Sassi (0000-0002-5807-6388, McGill University Health Centre), Lauren Rosapep (0000-0001-8475-9388, Abt Global (United States)), Bolanle Olusola Faleye (Lagos State Health Service Commission), Elaine Baruwa (Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Rockville, Maryland, USA), Elaine M Baruwa (0000-0001-6958-7004, Abt Global (United States)), Benjamin Johns (0000-0002-2892-6089, Abt Global (United States)), Md Abdullah Heel Kafi (McGill University), Lavanya Huria (0000-0002-7835-0372, McGill University Health Centre), Nathaly Aguilera Vasquez (0000-0002-1019-8597, McGill International Tuberculosis Centre, Montreal, Quebec, Canada), Benjamin Daniels (0000-0001-8617-6055, Public Policy Institute of California), Jishnu Das (0000-0002-5909-3585, Public Policy Institute of California), Chukwuma Anyaike (0000-0002-3570-5831, Federal Ministry of Health), Obioma Chijioke-Akaniro (0000-0001-7906-0521, Federal Ministry of Health), Madhukar Pai (0000-0003-3667-4536, McGill University Health Centre), Charity Oga‐Omenka (0000-0003-0779-570X, University of Waterloo)
Año2024
Volumen9
Número11
Páginase015474
Fecha de publicación2024-11-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2024-015474
PMID39542513
OpenAlexW4404376665
IdiomaEN
Referencias citadas37

Only a third of tuberculosis (TB) cases in Nigeria in 2020 were diagnosed and notified, in part due to low detection and under-reporting from the private health sector. Using a standardised patient (SP) survey approach, we assessed how management of presumptive TB in the private sector aligns with national guidelines and whether this differed from a study conducted before the start of the COVID-19 pandemic. 13 SPs presented a presumptive TB case to 511 private providers in urban areas of Lagos and Kano states in May and June 2021. Private provider case management was compared with national guidelines divided into three main steps: SP questioned about cough duration; sputum collection attempted for TB testing; and non-prescription of anti-TB medications, antibiotics and steroids. SP visits conducted in May–June 2021 were directly compared to SP visits conducted in the same areas in June–July 2019. Overall, 28% of interactions (145 of 511, 95% CI 24.5% to 32.5%) were correctly managed according to Nigerian guidelines, as few providers completed all three necessary steps. Providers in 71% of visits asked about cough duration (362 of 511, 95% CI 66.7% to 74.7%), 35% tested or recommended a sputum test (181 of 511, 95% CI 31.3% to 39.8%) and 79% avoided prescribing or dispensing unnecessary medications (406 of 511, 95% CI 75.6% to 82.8%). COVID-19 related questions were asked in only 2.4% (12 of 511, 95% CI 1.3% to 4.2%) of visits. During the COVID-19 pandemic, few providers completed all steps of the national guidelines. Providers performed better on individual steps, particularly asking about symptoms and avoiding prescription of harmful medications. Comparing visits conducted before and during the COVID-19 pandemic showed that COVID-19 did not significantly change the quality of TB care

Cross-sectional study · Disease · Environmental health · Family medicine · Medical prescription · Pandemic · Pathology · Private sector · Public health · Sputum · Tuberculosis · Emergency and Acute Care Studies · Medicine · Nursing · Pneumonia and Respiratory Infections · Tuberculosis Research and Epidemiology · Internal Medicine · Pediatrics