SETTING: High mortality and high transmission rates of extensively drug-resistant tuberculosis (XDR-TB) in KwaZulu-Natal Province of South Africa have highlighted the role of hospitals in the spread of TB and drug-resistant TB. OBJECTIVES: To determine the operational effectiveness of the National TB Programme (NTP) at a regional/district hospital and its referral clinics. DESIGN: In this multi-faceted retrospective case study, a framework was developed to evaluate the different components of the TB services, their performance in relation to each other and the system as a whole. Different methods used included structured and semi-structured interviews, retrospective medical record reviews and retrospective register reviews. RESULTS: Only 18% of those diagnosed with smear-positive pulmonary TB (PTB) in the hospital laboratory completed their treatment and 11% were cured. Clinicians did not adhere to the diagnostic guidelines of the NTP. In the TB register, 85% of PTB cases were diagnosed in the absence of sputum microscopy. Chest X-rays alone were used to diagnose PTB in 45% of the records reviewed. In addition, clinicians failed to document a clinical history suggestive of TB. Only 66 (29%) of the hospital's 225 smear-positive PTB patients reached the clinics for completion of their treatment. CONCLUSION: System failures, together with inadequate knowledge and understanding of clinicians, undermined the effectiveness of the NTP. A reduction in TB and drug-resistant forms of TB is dependent on effective diagnosis, treatment and improved communication systems between the hospital, laboratory and its down-referral clinics.
SETTING: High mortality and high transmission rates of extensively drug-resistant tuberculosis (XDR-TB) in KwaZulu-Natal Province of South Africa have highlighted the role of hospitals in the spread of TB and drug-resistant TB. OBJECTIVES: To determine the operational effectiveness of the National TB Programme (NTP) at a regional/district hospital and its referral clinics. DESIGN: In this multi-faceted retrospective case study, a framework was developed to evaluate the different components of the TB services, their performance in relation to each other and the system as a whole. Different methods used included structured and semi-structured interviews, retrospective medical record reviews and retrospective register reviews. RESULTS: Only 18% of those diagnosed with smear-positive pulmonary TB (PTB) in the hospital laboratory completed their treatment and 11% were cured. Clinicians did not adhere to the diagnostic guidelines of the NTP. In the TB register, 85% of PTB cases were diagnosed in the absence of sputum microscopy. Chest X-rays alone were used to diagnose PTB in 45% of the records reviewed. In addition, clinicians failed to document a clinical history suggestive of TB. Only 66 (29%) of the hospital's 225 smear-positive PTB patients reached the clinics for completion of their treatment. CONCLUSION: System failures, together with inadequate knowledge and understanding of clinicians, undermined the effectiveness of the NTP. A reduction in TB and drug-resistant forms of TB is dependent on effective diagnosis, treatment and improved communication systems between the hospital, laboratory and its down-referral clinics.
Authors: Sanjay Basu; Gerald H Friedland; Jan Medlock; Jason R Andrews; N Sarita Shah; Neel R Gandhi; Anthony Moll; Prashini Moodley; A Willem Sturm; Alison P Galvani Journal: Proc Natl Acad Sci U S A Date: 2009-04-13 Impact factor: 11.205
Authors: Ari Probandari; Lars Lindholm; Hans Stenlund; Adi Utarini; Anna-Karin Hurtig Journal: BMC Health Serv Res Date: 2010-05-07 Impact factor: 2.655
Authors: Tom Decroo; Isabella Panunzi; Carla das Dores; Fernando Maldonado; Marc Biot; Nathan Ford; Kathryn Chu Journal: J Int AIDS Soc Date: 2009-05-06 Impact factor: 5.396
Authors: Ray Nsigaye; Alison Wringe; Maria Roura; Samuel Kalluvya; Mark Urassa; Joanna Busza; Basia Zaba Journal: J Int AIDS Soc Date: 2009-11-11 Impact factor: 5.396