AN ASSESSMENT OF THE QUALITY OF HOSPITAL-BASED CARE OF TUBERCULOSIS PATIENTS WITH DIRECTLY OBSERVED TREATMENT SHORT-COURSE IN CALABAR, CROSS RIVER STATE
Introduction: Directly observed treatment short-course strategy has proven to be effective in reducing the prevalence of and case fatality due to tuberculosis among clients on anti-tuberculosis drugs. There is dearth of information on the quality of directly observed treatment short-course in Nigeria and in the study area considering the conspicuous profile of Calabar in the human immuno-deficiency virus/acquired immune deficiency syndrome epidemic in Nigeria and with particular respect to the re-emerging state of co-infection of tuberculosis and human immuno-deficiency virus/acquired immune deficiency syndrome. This study, therefore, sought to assess the quality of hospital-based care of tuberculosis patients with directly observed treatment short-course in Calabar, Cross River State.
Methodology: A comparative cross-sectional analytical survey was used to assess the quality of Directly Observed Treatment Short-course in Calabar between October 2008 and December 2008. Using multistage sampling technique, a total of 380 respondents were interviewed. A triangulation of interviewer-administered semi-structured questionnaires for clients, semi-structured self-administered questionnaires for heads of the centres and structured observation checklists were used to obtain information on respondents’ socio-demographic characteristics and general information on the centres. Other information obtained included those on the input, process and outcome factors of the Donabedian’s approach to quality assessment of health services. Data analysis was done using STATA version 10. Associations were tested using Z-test, Chi square, t-test, ANOVA and multivariate logistic regression analysis.
Results: The mean age of all the respondents was 33 ± 14.13 years. There were more male (52.9%) than female respondents (47.1%). More than half, 195 (51.3%) of the respondents had
secondary education and 196 (51.6%) were single. Christianity 356 (93.7%) and Efik 155 (40.8%) were the predominant religion and ethnicity of the respondents respectively while 81 (21.3%) of the respondents were traders. The observed input, process and overall factors did not differ (p > 0.05) from the corresponding expected factors. The quality of care in the centers was measured using the Provider Performance Index. It showed that all the centres significantly (p < 0.001) differed from the expected quality of care. The respondents in all the centres were satisfied with all the dimensions of client satisfaction. No centre complied with daily observation of tuberculosis clients taking their anti-tuberculosis drugs in the clinics. In the inferential analysis, education and socio-economic status were associated with satisfaction with general medical care received; the more educated and the more socio-economically advantaged the respondents were, the less likely it was for them to be satisfied with general medical received (p < 0.05).
Conclusion and recommendation: The quality of medical care offered by all the centres fell short of the expected. Education and socio-economic status of the respondents were associated with satisfaction with medical care provided. There is the need to scale up the components of the directly observed treatment short-course programme in the centres.