Transcript 5TH NATIONAL QUALITY IMPROVEMENT FORUM: KILIMANJARO

5TH
NATIONAL
QUALITY
IMPROVEMENT
FORUM:
KILIMANJARO HOTEL 2015: Theme: Contribution of quality
improvement in attainment of health and social welfare MDGs in 2015,
successes, challenges, and lessons learnt. Sub Theme: Prevention and
control of communicable diseases and non communicable diseases: Quality
Improvement Experience in HIV, TB, Malaria, Cardiac Diseases,
Diabetes,
Cancer
and
Others
• Title:
Infection prevention control of
Tuberculosis through linkage of prevention
strategy with patient satisfaction survey
results: Kibong’oto Infectious Diseases
Hospital Experience
BACKGROUND
• Kibong’oto Infectious Disease Hospital deals with management of
Susceptible TB, M/XDR-TB, TB/HIV, co-infections.
• The hospital strategic plan 2013-2018, strategic objective 1 aim at
contributing to national effort for diagnosis and treatment of TB,
TB/HIV, M/XDR-TB and other infectious diseases in the country.
• To halt the spread of Tuberculosis in the society, the hospital consider
patient satisfaction with hospital services as paramount.
• In this aspect, with support of Norwegian Lung Disease Foundation
International the hospital has been conducting patient satisfaction
survey since 2014.
• Recently in June 2015 the QI Team conducted the survey among the
out patients and in-patients department
OBJECTIVES
• To enhance infection prevention control of
tuberculosis through patient satisfaction
survey
METHODS
• The survey was carried out to 129 patients out of which
▫ 72 were from the outpatient department
▫ 57 were from the in patients Section.
• The data collection was undertaken by administering self
administered structured questionnaire.
• For the part of out- patients, questionnaire was
administered on exit by accidental sampling method while
in patient involved simple random sampling method.
• Data collection focused on cost sharing costs
aggravation by bribery, stigmatization, diagnosis of
TB disease, and treatment initiation.
• Out patient data collection parameters focused on
time taken to issue patients with files, patients
satisfaction at every section, points of prolonged
waiting for services and general suggestion of the
patients.
• All data were analyzed by use of excel spread sheet.
Being issued with file from reception
Number of respondents
45
40
35
30
25
20
15
10
5
0
DIAGNOSIS AFTER ONSET ON SS
1-2days
Number of respondents
1-2wks
2% 2%
5%
17%
17%
4%
7%
3-4wks
9%
1-2moths
37%
3-4months
5-7months
8-10months
1-2yrs
3-4yrs
30
1DAY
Number of respondents
25
20
2-4days
15
1-3wks
10
5wks
5
1-2months
0
5-6moths
50
NUMBER OF RESPONDENTS
Number of respondents
45
40
35
30
25
20
15
10
5
0
BRIBERY PRIOR TO SERVICE
RENDERING
INABILITY TO REACH
HOSPITAL DUE TO FINANCIAL
CONSTRAINT
NEVER
SOMETIMES
ALWAYS
FREQUENTL
Y
44
2
4
7
39
11
2
5
50
NUMBER OF RESPONDENTS
Number of respondents
45
40
35
30
25
20
15
10
5
0
BRIBERY PRIOR TO SERVICE
RENDERING
INABILITY TO REACH
HOSPITAL DUE TO FINANCIAL
CONSTRAINT
NEVER
SOMETIMES
ALWAYS
FREQUENTL
Y
44
2
4
7
39
11
2
5
DISCUSSION, CONCLUSSION AND
RECOMMENDATION
• The 53% of the patient issued with files within 5
minutes in aspect of infection prevention control is
not significant in halting the spread of Tuberculosis
at the reception area.
• Greater percentage (91%) of in patients were
diagnosed of TB beyond two weeks after onset of
signs and symptoms, trends that lead to
communicability of the disease being prolonged
among the people in the community and hospital
setting.
• The 55% of inpatient were not initiated on drug
within 1day a factor which makes the patient to stay
infectious for a prolonged time in the wards.
DISCUSSION, CONCLUSSION AND
RECOMMENDATION
• Lesser percentage of bribery for
services has been depicted in this
survey, a factor that helps much to
lessen the cost of services offered to
patients thus promote habit of
seeking for treatment while stigma of
provider origin to patient is found to
be minimal creating an environment
for infection prevention control.
DISCUSSION, CONCLUSSION AND
RECOMMENDATION
• Conclusively, patients’ satisfaction survey is
an important mirror in developing the
strategy for control of infectious diseases
such as Tuberculosis in the society and
hospital setting.
• Patient satisfaction survey should be
integrated in hospital quality improvement
activities.
REFERENCES
•
M. Verhagen,1 R. Kapinga,2 and K. A. W. L. van Rosmalen- Nooijens, (2010), Factors
underlying diagnostic delay in tuberculosis patients in a rural area in Tanzania: a
qualitative approach- PMCUS National Library of Medicine National Institutes of Health

Besides patient-related factors, misdiagnosis at the health facility level can also significantly increase diagnostic delay. The
subsequent delayed initiation of treatment causes spread of infection in the community, increases patient expenditure and is
associated with a higher risk of mortality .
•
Andrew Courtwright, and Abigail Norris Turner 2010, Tuberculosis and Stigmatization:
Pathways and Interventions, Public Health Report.

TB stigma on TB diagnostic delay, treatment compliance, and morbidity and mortality; and develop additional TB stigma-reduction strategies.
• Kibong’oto Infectious Disease Hospital Strategic Plan 2013-2018
• Francis J. Curry National Tuberculosis Centre, 2007, Tuberculosis Infection
Prevention Control, A practical Manual for Preventing TB.

•
A person with a cough lasting 3 weeks, or more weeks along with any other symptoms of TB ( fever, night sweats, fatigue,
unexplained weight loss, hemoptysis, should be evaluated by healthcare provider as soon as
Tanzania Ministry of Health and Social Welfare
, 2007. National Infection
Prevention and Control Guideline for Health Care Services in Tanzania.
References
•
possible.
•THANKS
FOR
LISTENING