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Home / The International Journal of Tuberculosis and Lung Disease, Volume 7, Number 5

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.

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

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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