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Oga-Omenka C, Rosapep L, Baruwa E, Huria L, Vasquez NA, Faleye BO, Kafi MAH, Sassi A, Nwosu C, Johns B, Adamu A, Chijioke-Akaniro O, Anyaike C, Pai M. Individual journeys to tuberculosis care in Nigeria's private sector during the COVID-19 pandemic. BMJ Glob Health 2024; 9:e013124. [PMID: 38195153 PMCID: PMC10806899 DOI: 10.1136/bmjgh-2023-013124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/16/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Pre-COVID-19, individuals with tuberculosis (TB) in Nigeria were often underdiagnosed and untreated. TB services were mostly in the public sector with only 15% of new cases in 2019 reported from the private sector. Reports highlighted challenges in accessing care in the private sector, which accounted for 67% of all initial care-seeking. Our study examined patients' health seeking pathways for TB in Nigeria's private sector and explored any changes to care pathways during COVID-19. METHODS We conducted 180 cross-sectional surveys and 20 in-depth interviews with individuals having chest symptoms attending 18 high-volume private clinics and hospitals in Kano and Lagos States. Questions focused on sociodemographic characteristics, health-seeking behaviour, and pathways to care during the COVID-19 pandemic. All surveys and interviews were conducted in May 2021. RESULTS Most participants were male (111/180), with an average age of 37. Half (96/180) sought healthcare within a week of symptoms, while few (20/180) waited over 2 months. Individuals testing positive for TB had more health-seeking delays, and those testing negative for TB had more provider delays. On average, participants visited two providers in Kano and 1.69 in Lagos, with 61 of 180 in Kano and 48 of 180 in Lagos visiting other providers before the recruitment facility. Private providers were the initial encounters for most participants (60/180 in Kano, 83/180 in Lagos). Most respondents (164/180) experienced short-lived pandemic-related restrictions, affecting access to transportation, and closed facilities. CONCLUSIONS This study showed a few challenges in accessing TB care, necessitating continued investment in healthcare infrastructure and resources, particularly in the private sector. Understanding the different care pathways and delays in care provides opportunities for targeted interventions to improve deployment of services closer to where patients first seek care.
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Affiliation(s)
- Charity Oga-Omenka
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- McGill International TB Center, McGill University Health Centre, Montreal, Vendôme, Canada
| | - Lauren Rosapep
- ABT Associates Inc Bethesda, Bethesda, Maryland, USA
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus, Abuja, Nigeria
| | - Elaine Baruwa
- ABT Associates Inc Bethesda, Bethesda, Maryland, USA
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus, Abuja, Nigeria
| | - Lavanya Huria
- McGill International TB Center, McGill University Health Centre, Montreal, Vendôme, Canada
- Faculty of Medicine and Health Sciences, Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nathaly Aquilera Vasquez
- McGill International TB Center, McGill University Health Centre, Montreal, Vendôme, Canada
- Faculty of Medicine and Health Sciences, Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Md Abdullah Heel Kafi
- McGill International TB Center, McGill University Health Centre, Montreal, Vendôme, Canada
| | - Angelina Sassi
- McGill International TB Center, McGill University Health Centre, Montreal, Vendôme, Canada
- Faculty of Medicine and Health Sciences, Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Chimdi Nwosu
- VizSight Analytics Inc, Vancouver, British Columbia, Canada
| | | | - Abdu Adamu
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus, Abuja, Nigeria
| | | | | | - Madhukar Pai
- McGill International TB Center, McGill University Health Centre, Montreal, Vendôme, Canada
- Faculty of Medicine and Health Sciences, Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Sassi A, Lestari BW, El Muna KUN, Oga-Omenka C, Afifah N, Widarna R, Huria L, Aguilera Vasquez N, Benedetti A, Hadisoemarto PF, Daniels B, Das J, Pai M, Alisjahbana B. Impact of the COVID-19 pandemic on quality of tuberculosis care in private facilities in Bandung, Indonesia: a repeated cross-sectional standardized patients study. BMC Public Health 2024; 24:102. [PMID: 38183023 PMCID: PMC10771004 DOI: 10.1186/s12889-023-17001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Indonesia has the second highest incidence of tuberculosis in the world. While 74% of people with tuberculosis in Indonesia first accessed the private health sector when seeking care for their symptoms, only 18% of tuberculosis notifications originate in the private sector. Little is known about the impact of the COVID-19 pandemic on the private sector. Using unannounced standardized patient visits to private providers, we aimed to measure quality of tuberculosis care during the COVID-19 pandemic. METHODS A cross-sectional study was conducted using standardized patients in Bandung City, West Java, Indonesia. Ten standardized patients completed 292 visits with private providers between 9 July 2021 and 21 January 2022, wherein standardized patients presented a presumptive tuberculosis case. Results were compared to standardized patients surveys conducted in the same geographical area before the onset of COVID-19. RESULTS Overall, 35% (95% confidence interval (CI): 29.2-40.4%) of visits were managed correctly according to national tuberculosis guidelines. There were no significant differences in the clinical management of presumptive tuberculosis patients before and during the COVID-19 pandemic, apart from an increase in temperature checks (adjusted odds ratio (aOR): 8.05, 95% CI: 2.96-21.9, p < 0.001) and a decrease in throat examinations (aOR 0.16, 95% CI: 0.06-0.41, p = 0.002) conducted during the pandemic. CONCLUSIONS Results indicate that providers successfully identify tuberculosis in their patients yet do not manage them according to national guidelines. There were no major changes found in quality of tuberculosis care due to the COVID-19 pandemic. As tuberculosis notifications have declined in Indonesia due to the COVID-19 pandemic, there remains an urgent need to increase private provider engagement in Indonesia and improve quality of care.
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Affiliation(s)
- Angelina Sassi
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Bony Wiem Lestari
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Padjadjaran, Bandung, Indonesia
| | - Kuuni Ulfah Naila El Muna
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Nahdlatul Ulama Surabaya, Surabaya, Indonesia
| | - Charity Oga-Omenka
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Nur Afifah
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Rodiah Widarna
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Lavanya Huria
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Nathaly Aguilera Vasquez
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Panji Fortuna Hadisoemarto
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Padjadjaran, Bandung, Indonesia
| | - Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.
- Department of Internal Medicine, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
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3
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Huria L, Lestari BW, Saptiningrum E, Fikri AR, Oga-Omenka C, Kafi MAH, Daniels B, Vasquez NA, Sassi A, Das J, Jani ID, Pai M, Alisjahbana B. Care pathways of individuals with tuberculosis before and during the COVID-19 pandemic in Bandung, Indonesia. PLOS Glob Public Health 2024; 4:e0002251. [PMID: 38165843 PMCID: PMC10760687 DOI: 10.1371/journal.pgph.0002251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/27/2023] [Indexed: 01/04/2024]
Abstract
The COVID-19 pandemic is thought to have undone years' worth of progress in the fight against tuberculosis (TB). For instance, in Indonesia, a high TB burden country, TB case notifications decreased by 14% and treatment coverage decreased by 47% during COVID-19. We sought to better understand the impact of COVID-19 on TB case detection using two cross-sectional surveys conducted before (2018) and after the onset of the pandemic (2021). These surveys allowed us to quantify the delays that individuals with TB who eventually received treatment at private providers faced while trying to access care for their illness, their journey to obtain a diagnosis, the encounters individuals had with healthcare providers before a TB diagnosis, and the factors associated with patient delay and the total number of provider encounters. We found some worsening of care seeking pathways on multiple dimensions. Median patient delay increased from 28 days (IQR: 10, 31) to 32 days (IQR: 14, 90) and the median number of encounters increased from 5 (IQR: 4, 8) to 7 (IQR: 5, 10), but doctor and treatment delays remained relatively unchanged. Employed individuals experienced shorter delays compared to unemployed individuals (adjusted medians: -20.13, CI -39.14, -1.12) while individuals whose initial consult was in the private hospitals experienced less encounters compared to those visiting public providers, private primary care providers, and informal providers (-4.29 encounters, CI -6.76, -1.81). Patients who visited the healthcare providers >6 times experienced longer total delay compared to those with less than 6 visits (adjusted medians: 59.40, 95% CI: 35.04, 83.77). Our findings suggest the need to ramp up awareness programs to reduce patient delay and strengthen private provide engagement in the country, particularly in the primary care sector.
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Affiliation(s)
- Lavanya Huria
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Bony Wiem Lestari
- Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Eka Saptiningrum
- Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Auliya Ramanda Fikri
- Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Charity Oga-Omenka
- McGill International TB Centre, Montreal, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, DC, United States of America
| | - Nathaly Aguilera Vasquez
- McGill International TB Centre, Montreal, Canada
- School of Human Nutrition, McGill University, Ste. Anne-de-Bellevue, Quebec, Canada
| | - Angelina Sassi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, United States of America
| | - Ira Dewi Jani
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Bachti Alisjahbana
- Tuberculosis Working Group, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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4
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Oga-Omenka C, Sassi A, Vasquez NA, Baruwa E, Rosapep L, Daniels B, Olusola-Faleye B, Huria L, Adamu A, Johns B, Das J, Pai M. Tuberculosis service disruptions and adaptations during the first year of the COVID-19 pandemic in the private health sector of two urban settings in Nigeria-A mixed methods study. PLOS Glob Public Health 2023; 3:e0001618. [PMID: 36963094 PMCID: PMC10038269 DOI: 10.1371/journal.pgph.0001618] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
Nigeria has the second largest share of undiagnosed TB cases in the world and a large private health sector estimated to be the point of initial care-seeking for 67% of TB patients. There is evidence that COVID-19 restrictions disrupted private healthcare provision, but insufficient data on how private healthcare provision changed as a result of the pandemic. We conducted qualitative interviews and a survey to assess the impact of the pandemic, and government response on private healthcare provision, and the disruptions providers experienced, particularly for TB services. Using mixed methods, we targeted policymakers, and a network of clinical facilities, laboratories, community pharmacies, and medicine vendors in Kano and Lagos, Nigeria. We interviewed 11 policymakers, surveyed participants in 2,412 private facilities. Most (n = 1,676, 70%) facilities remained open during the initial lockdown period, and most (n = 1,667, 69%) offered TB screening. TB notifications dipped during the lockdown periods but quickly recovered. Clinical facilities reported disruptions in availability of medical supplies, staff, required renovations, patient volume and income. Few private providers (n = 119, 11% in Kano; n = 323, 25% in Lagos) offered any COVID-19 screening up to the time of the survey, as these were only available in designated facilities. These findings aligned with the interviews as policymakers reported a gradual return to pre-COVID services after initial disruptions and diversion of resources to the pandemic response. Our results show that COVID-19 and control measures had a temporary impact on private sector TB care. Although some facilities saw decreases in TB notifications, private facilities continued to provide care for individuals with TB who otherwise might have been unable to seek care in the public sector. Our findings highlight resilience in the private sector as they recovered fairly quickly from pandemic-related disruptions, and the important role private providers can play in supporting TB control efforts.
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Affiliation(s)
- Charity Oga-Omenka
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- McGill International TB Centre, Montreal, Canada
| | - Angelina Sassi
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | | | - Elaine Baruwa
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Lauren Rosapep
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Benjamin Daniels
- School of Public Policy, Georgetown University, Washington, DC, United States of America
| | - Bolanle Olusola-Faleye
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Lavanya Huria
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Abdu Adamu
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Benjamin Johns
- Sustaining Health Outcomes through the Private Sector (SHOPS) Plus/Abt Associates, Lagos, Nigeria
| | - Jishnu Das
- School of Public Policy, Georgetown University, Washington, DC, United States of America
| | - Madhukar Pai
- McGill International TB Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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5
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Mannan S, Oga-Omenka C, Soman ThekkePurakkal A, Huria L, Kalra A, Gandhi R, Kapoor T, Gunawardena N, Raj S, Kaur M, Sassi A, Pande T, Shibu V, Sarin S, Singh Chadha S, Heitkamp P, Das J, Rao R, Pai M. Adaptations to the first wave of the COVID-19 pandemic by private sector tuberculosis care providers in India. J Clin Tuberc Other Mycobact Dis 2022; 28:100327. [PMID: 35874450 PMCID: PMC9295336 DOI: 10.1016/j.jctube.2022.100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background India’s dominant private healthcare sector is the destination for 60–85% of initial tuberculosis care-seeking. The COVID-19 pandemic in India drastically affected TB case notifications in the first half of 2020. In this survey, we assessed the impact of the first wave of COVID-19 in India on private providers, and changes they adopted in their practice due to the pandemic. Methods The Joint Effort for Elimination of TB (JEET) is a nationwide Global Fund project implemented across 406 districts in 23 states to extend quality TB services to patients seeking care in private sector. We conducted a rapid survey of 11% (2,750) of active providers engaged under JEET’s intense Patient Provider Support Agency (PPSA) model across 15 Indian states in Q1 (February–March) of 2021. Providers were contacted in person or telephonically, and consenting participants were interviewed using a web-based survey tool. Responses from participants were elicited on their practice before COVID-19, during the 2020 lockdowns (March–April 2020) and currently (Q1 2021). Data were adjusted for survey design and non-response, and results were summarised using descriptive statistics and logistic regression. Results Of the 2,750 providers sampled, 2,011 consented and were surveyed (73 % response). Nearly 50 % were between 30 and 45 years of age, and 51 % were from Uttar Pradesh, Maharashtra and Gujarat. Seventy percent of providers reported reduced daily out-patient numbers in Q1 2021 compared to pre-COVID times. During the lockdown, 898 (40 %) of providers said their facilities were closed, while 323 (11 %) offered limited services including teleconsultation. In Q1 2021, 88 % of provider facilities were fully open, with 10 % providing adjusted services, and 4 % using teleconsultation. Only 2 % remained completely closed. Majority of the providers (92 %) reported not experiencing any delays in TB testing in Q1 2021 compared to pre-COVID times. Only 6 % reported raising costs at their clinic, mostly to cover personal protective equipment (PPE) and other infection control measures, although 60–90 % implemented various infection control measures. Thirty-three percent of TB providers were ordering COVID-19 testing, in addition to TB testing. To adapt, 82% of survey providers implemented social distancing and increased timing between appointments and 83% started conducting temperature checks, with variation by state and provider type, while 89% adopted additional sanitation measures in their facilities. Furthermore, 62% of providers started using PPE, and 13% made physical changes (air filters, isolation of patient areas) to their clinic to prevent infection. Seventy percent of providers stated that infection control measures could decrease TB transmission. Conclusion Although COVID-19 restrictions resulted in significant declines in patient turn-out at private facilities, our analysis showed that most providers were open and costs for TB care remained mostly the same in Q1 2021. As result of the COVID-19 pandemic, several positive strategies have been adapted by the private sector TB care providers. Since the subsequent COVID-19 waves were more severe or widespread, additional work is needed to assess the impact of the pandemic on the private health sector.
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Affiliation(s)
| | - Charity Oga-Omenka
- McGill International TB Centre, Montreal, Canada.,School of Public Health Sciences, University of Waterloo, Canada
| | | | - Lavanya Huria
- McGill International TB Centre, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Aakshi Kalra
- Foundation for Innovative New Diagnostics (FIND), India
| | | | | | - Nathali Gunawardena
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Shekhar Raj
- Centre for Health Research and Innovation (CHRI), India
| | - Manjot Kaur
- TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Angelina Sassi
- McGill International TB Centre, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Tripti Pande
- McGill International TB Centre, Montreal, Canada
| | | | - Sanjay Sarin
- Foundation for Innovative New Diagnostics (FIND), India
| | | | - Petra Heitkamp
- McGill International TB Centre, Montreal, Canada.,TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Raghuram Rao
- Central TB Division, Ministry of Health & Family Welfare, India
| | - Madhukar Pai
- McGill International TB Centre, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
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6
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Bigio J, Aquilera Vasquez N, Huria L, Pande T, Creswell J, Ananthakrishnan R, Bimba JS, Cuevas LE, Vo L, Bakker MI, Rahman MT, Pai M. Engaging pharmacies in tuberculosis control: operational lessons from 19 case detection interventions in high-burden countries. BMJ Glob Health 2022; 7:bmjgh-2022-008661. [PMID: 35440442 PMCID: PMC9020292 DOI: 10.1136/bmjgh-2022-008661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/27/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jacob Bigio
- McGill International TB Centre, Montreal, Quebec, Canada .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathaly Aquilera Vasquez
- McGill International TB Centre, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lavanya Huria
- McGill International TB Centre, Montreal, Quebec, Canada.,Department of Epidemiology and Biostatistics, McGill University Montreal, Montreal, Quebec, Canada
| | - Tripti Pande
- McGill International TB Centre, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Ramya Ananthakrishnan
- Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India
| | - John S Bimba
- Department of Community Medicine, Bingham University, Karu, Nigeria
| | - Luis E Cuevas
- Clinical Sciences and Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Luan Vo
- Friends for International TB Relief, Ha Noi, Viet Nam
| | | | | | - Madhukar Pai
- McGill International TB Centre, Montreal, Quebec, Canada.,Epidemiology and Biostats, McGill University, Montreal, Quebec, Canada
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7
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Bigio J, MacLean E, Vasquez NA, Huria L, Kohli M, Gore G, Hannay E, Pai M, Adam P. Most common reasons for primary care visits in low- and middle-income countries: A systematic review. PLOS Glob Public Health 2022; 2:e0000196. [PMID: 36962326 PMCID: PMC10022248 DOI: 10.1371/journal.pgph.0000196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
With the Covid-19 pandemic and the introduction of the WHO's Essential Diagnostics List (EDL), increasing global attention is focused on the crucial role of diagnostics in achieving universal health coverage. To create national EDLs and to aid health system planning, it is vital to understand the most common conditions with which people present at primary care health facilities. We undertook a systematic review of the most common reasons for primary care visits in low- and middle-income countries. Six databases were searched for articles published between January 2009 and December 2019, with the search updated on MEDLINE to January 2021. Data on the most common patient reasons for encounter (RFEs) and provider diagnoses were collected. 17 of 22,279 screened articles were included. Most studies used unvalidated diagnostic classification systems or presented provider diagnosis data grouped by organ system, rather than presenting specific diagnoses. No studies included data from low-income countries. Only four studies (from Brazil, India, Nigeria and South Africa) using the ICPC-2 classification system contained RFE and provider diagnosis data and could be pooled. The top five RFEs from the four studies were headache, fever, back or low back symptom, cough and pain general/multiple sites. The top five diagnoses were uncomplicated hypertension, upper respiratory tract infection, type 2 diabetes, malaria and health maintenance/prevention. No psychological symptoms were among the top 10 pooled RFEs. There was more variation in top diagnoses between studies than top RFEs, showing the importance of creating location-specific lists of essential diagnostics for primary care. Future studies should aim to sample primary care facilities from across their country of study and use ICPC-3 to report both patient RFEs and provider diagnoses.
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Affiliation(s)
- Jacob Bigio
- Research Institute of the McGill University Health Centre, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Emily MacLean
- McGill International TB Centre, Montreal, Canada
- Dept of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Nathaly Aguilera Vasquez
- Research Institute of the McGill University Health Centre, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Lavanya Huria
- Dept of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Mikashmi Kohli
- McGill International TB Centre, Montreal, Canada
- Dept of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Canada
| | - Emma Hannay
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Madhukar Pai
- McGill International TB Centre, Montreal, Canada
- Dept of Epidemiology and Biostatistics, McGill University, Montreal, Canada
- Manipal Academy of Higher Education, Manipal University, Manipal, India
| | - Pierrick Adam
- Infectious Diseases Programs Control Unit, Ministry of Health, Tahiti, French Polynesia
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