Assessment of diagnostic capacity of private practitioners in detection of tuberculosis in Juba City, South Sudan

Abstract

Introduction Tuberculosis (TB) remains a public health threat globally and is of major health concern in South Sudan. In 2012, TB notification rate for South Sudan was 88/100,000 for new cases and 96/100,000 for all cases. The private practitioners (PPs) play a major role in health care provision in South Sudan. Objective To assess the diagnostic capacity of PPs in detection of tuberculosis in Juba City, so as to provide baseline information and contribute towards developing a strategy for engaging PPs in detection of TB. Methods A cross-sectional study employing both quantitative and qualitative techniques was conducted in Juba City during April – June 2012. A total of 28 private health facilities studied were selected using simple random sampling technique. Data were collected using a semi-structured questionnaire and a checklist. Four key informant interviews were conducted with purposively selected respondents from the NTLBP and State Ministry of Health. The quantitative data about private health facilities, socio demographic characteristics of study participants, diagnostic capacity and constraints faced by PPs in detection of TB were analysed using STATA (version-11) and presented as frequency tables and charts while qualitative data were analysed manually using a master-sheet and presented in form of text and quotes. Results The diagnostic capacity for TB case detection was poor. All private health facilities had microscopes, five had ZN reagents, one had standard operating procedures, none had data collections tools, and only four had offered TB microscopy. Less than a half (10/28) of private health facilities had adequate laboratory space and slightly less than a quarter (6/28) had adequate safety conditions for TB microscopy. The PPs had low knowledge about TB diagnosis, only four service providers had in-service training, less than half of laboratory personnel had in-service training on TB microscopy and none of the nurses had pre and in-service TB training. The managers/owners of private health facilities were willing to be involved in TB case detection xii

with the exception of one manager/owner who was undecided. Suggestions for capacity building for private health facilities included provision of TB guidelines (30.2%), training of staff (20.9%), and provision of ZN reagents (16.3%) and microscopes (7%). Conclusions and recommendations All the private health facilities had functional laboratories with microscopes but their diagnostic capacity to detect TB was poor. The PPs had low knowledge about TB due to lack of training. The managers/owners of private health facilities had expressed willingness to be involved in TB case detection. The NTLBP should improve the laboratories of private health facilities, provide TB operating guidelines, ZN reagents, and data collection tools; involve the PPs on TB trainings and disseminate TB reading materials to improve knowledge on TB and involve the private health facilities in TB case detection.