Abstract
Introduction: Tuberculosis infection is a leading cause of death with huge public health importance globally and responsible for about nine million new cases reported in 2013. Hospitals with inadequate infection control facilities are likely to record an increase in transmission of tuberculosis (TB). This study assessed the TB infection control (TBIC) measures in place to address the transmission of TB in secondary health centres in Ibadan, Southwest Nigeria.
Method: This was a descriptive cross-sectional study conducted in purposively-selected secondary health facilities in Ibadan. Key informant and in-depth interviews were used to obtain information from health facility managers and healthcare workers (HCWs) on compliance and challenges with implementation of TBIC policies. An observational checklist was used to assess facility control measures.
Result: Perceived capacity of facilities to implement TBIC policies varied considerably among respondents. Major challenges to implementation included: inadequate funding, absence of TBIC-specific training and understaffing. Separation and triaging were the most common TBIC method. There was little to no provision of TB treatment and prevention packages for HCWs.
Conclusion: The capacity of assessed secondary health facilities to implement Tuberculosis Infection Control policy is generally low due to funding and human resource challenges. In addition, weak infrastructures and poor environmental design impeded the ability of health facilities to implement TBIC guidelines.
Keywords: Nosocomial infection, Tuberculosis, Infection control, Policy implementation
Résumé
Contexte: L’infection tuberculeuse est une cause majeure de décès avec une importance considérable pour la santé publique dans le monde et responsable d’environ neuf millions de nouveaux cas signalés en 2013. Les hôpitaux dont les installations de contrôle des infections sont insuffisantes sont susceptibles d’enregistrer une augmentation de la transmission de la tuberculose (TB). Cette étude a évalué les mesures de contrôle de l’infection tuberculeuse (TBIC) en place pour lutter contre la transmission de la tuberculose dans les centres de santé secondaires à Ibadan, dans le sud-ouest du Nigéria.
Méthode: Il s’agissait d’une étude transversale descriptive menée dans des établissements de santé secondaires sélectionnés à dessein à Ibadan. Des informateurs clés et des entretiens approfondis ont été utilisés pour obtenir des informations auprès des gestionnaires des établissements de santé et des agents de santé (TS) sur la conformité et les défis liés à la mise en œuvre des politiques du TBIC. Une liste de contrôle d’observation a été utilisée pour évaluer les mesures de contrôle des installations.
Résultat: la capacité perçue des établissements à mettre en œuvre les politiques TBIC variait considérablement selon les répondants. Les principaux défis à la mise en œuvre comprenaient: un financement insuffisant, une absence de formation spécifique au TBIC et un manque de personnel. La séparation et le tri étaient la méthode TBIC la plus courante. Il y avait peu ou pas de programmes de traitement et de prévention de la tuberculose pour les travailleurs de la santé.
Conclusion: La capacité des établissements de santé secondaires évalués à mettre en œuvre la politique de lutte contre l’infection tuberculeuse est généralement faible en raison des problèmes de financement et de ressources humaines. En outre, la faiblesse des infrastructures et la mauvaise conception de l’environnement ont entravé la capacité des établissements de santé à mettre en œuvre les directives TBIC.
Mots clés: infection nosocomiale, tuberculose, contrôle des infections, mise en œuvre de la politique
Correspondence: Dr O.O Akinyemi, Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: ooakinyemi@comui.edu.ng; seunakinyemi@hotmail.com
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