The quality of tuberculosis services in health care centres in a rural district in Uganda: the providers' and clients' perspective

Abstract

Quality of care plays an important role in the status of tuberculosis (TB) control, by influencing timely diagnosis, treatment adherence, and treatment completion. In this study, we aimed at establishing the quality of TB service care in Kamuli district health care centres using Donabedian structure, process, and outcomes model of health care. A cross-sectional study was conducted in 8 health care facilities, among 20 health care workers and 392 patients. Data was obtained using face-to-face interviews, an observation guide, a check list, and record review of the TB unit and laboratory registers. Data entry and analysis were done using EPI INFO 2008 and STATA 10 versions, respectively. A high number 150 (87.21%) of TB patients were not aware of all the signs to stop TB medication, and 100 (25.51%) patients received laboratory results after a period of 3-5 working days. The major challenges faced by health workers were poor attitude of fellow health workers, patients defaulting treatment, and fear of being infected with TB. One of the worst performance indicators was low percentage of cure. Comprehensive strengthening of the health system focusing on quality of support supervisions, patient follow up, promoting infection control measures, and increasing health staffing levels at health facilities is crucial.

Figure 1

Conceptual frame work for quality of TB service in Kamuli district: adopted from the Donabedian model of quality of health care.

Figure 2

Laboratory staffing levels of health facilities in Kamuli district, March–May 2012.

Figure 3

Challenges which need to be improved upon as reported by patients in Kamuli district health facilities, March–May 2012. Note: others included: need for food, wheel chairs, out-patient department needs improvement, improve on the infrastructure, and reduce the quantity of drugs.