Management and transference of patients diagnosed with tuberculosis in a rural hospital in southern Ethiopia

ABSTRACT

Treatment of new tuberculosis [TB] cases in Directly Observed Treatment Short Course [DOTS] programmes is believed to be the most valuable strategy for TB control. The aim of this study is to describe the experience of diagnosed cases of TB in a district hospital situated in a rural zone of Ethiopia and of "transferred out" TB cases from the hospital to their local health facilities using the DOTS programme spanning a period of 8 years. Data collection was obtained by using a TB register book in a rural district hospital from 2004 to 2011. The collected information included the type of TB, age, HIV status, and treatment outcomes using standardized definitions; 6459 patients with all forms of TB were diagnosed. Twenty-eight percent were smear-positive pulmonary TB [PTB] cases, 28.97% were smear-negative PTB cases, and 42.8% were extra-pulmonary TB [EPTB]. The global "transferred out" rate was 78.5% [5073/6459]; the "transferred out" rate after diagnosis at hospital and before starting DOTS was 72.6% [4689/6459], and after finishing the intensive phase and admission was 21.8% [385/1770]. The proportion of total cases "transferred out" in smear-negative PTB cases [70.2%] was less than smear-positive PTB cases [79.2%] [odd ratio [OR] 0.81; 95% confidence interval [CI] 0.76-0.87] and was higher in EPTB cases [83.3%] [OR 1.15; 95% CI 1.05-1.19]. The percentage of "transferred out" after hospital admission was higher in HIV-positive cases [16.8%] than in HIV-negative cases [8.5%] [OR 2.13; 95% CI 1.28-3.53]. In conclusion, district hospitals are still important facilities for the diagnosis of TB cases, particularly EPTB