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Free Content The effect of decentralisation on tuberculosis services in three states of Sudan

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SETTING: Referral hospitals and primary health care (PHC) facilities in Khartoum, Red Sea and Gadaref States.

OBJECTIVES: To measure the effect of the decentralisation of the tuberculosis (TB) services on the clinical profile and treatment outcome of tuberculosis.

DESIGN: A cohort study of case detection and treatment outcome using information routinely collected comparing patients attending PHC facilities and referral hospitals in selected locations in Sudan.

RESULTS: Two-thirds of all TB patients were diagnosed in referral hospitals and one-third in PHC facilities. In PHC facilities, women represented 46% of notified cases, compared to 37.9% in referral hospitals (OR 1.398, 95%CI 1.343–1.455). Older age groups were more likely to prefer PHC facilities to referral hospitals. In referral hospitals, 38% were cured, 29.3% completed treatment without smear examination and 17.3% defaulted, while in PHC facilities 58% were cured, 17.8% completed treatment without smear examination and 11.6% defaulted.

CONCLUSION: PHC facilities provide care for a higher proportion of women and older age groups of tuberculosis patients, suggesting a higher level of accessibility for these groups. A higher cure rate and a lower default rate were noted in PHC facilities, possibly reflecting better conditions for directly observed treatment and follow-up.
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Keywords: Sudan; TB services; decentralisation; health sector reform

Document Type: Regular Paper

Affiliations: 1: National Tuberculosis Programme, Khartoum, Khartoum, Sudan; and International Union Against Tuberculosis and Lung Disease (IUATLD), Paris, France 2: Epidemiological Laboratory, National Tuberculosis Programme, Khartoum, Sudan 3: University of Sudan for Science and Technology, Khartoum, Khartoum, Sudan; Ahfad University for Women, Department of Medicine, Omdurman, Khartoum, Sudan; and Bayan College for Science and Technology, Khartoum, Sudan 4: International Union Against Tuberculosis and Lung Disease (IUATLD), Paris, France 5: Department of Medicine, University of Khartoum, Khartoum, Khartoum, Sudan 6: University of Oslo, Oslo, Norway

Publication date: 01 May 2003

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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