The effect of decentralisation on tuberculosis services in three states of Sudan

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.