title: Public and private providers' quality of care for tuberculosis patients in Kampala, Uganda.
abstract: METHODS
  The role of the private sector in tuberculosis treatment in developing countries in sub-Saharan Africa is largely unknown. In recent years, many fee-for-service clinics have opened up in Kampala, Uganda. Little is known about the tuberculosis caseload seen in private clinics or the standard of care provided to the patients.
  
  
  OBJECTIVE
  To compare the appropriateness of tuberculosis care in private and public clinics, and the extent of the tuberculosis burden handled in the private sector.
  
  
  METHODS
  Cross-sectional survey in private and public clinics treating tuberculosis patients in Kampala, Uganda, during June to August 1999.
  
  
  METHODS
  Clinics were evaluated for appropriateness of care. This was defined as provision of proper diagnosis (sputum smear microscopy as the primary means of diagnosis), treatment (short-course chemotherapy, with or without directly observed therapy), outcome evaluation (smear microscopy at 6 or 7 months) and case notification in accordance with the Uganda National Tuberculosis and Leprosy Programme.
  
  
  RESULTS
  A total of 114 clinics (104 private, 10 public) were surveyed. Forty-one per cent of the private clinics saw three or more new tuberculosis patients each month. None of the public or private clinics met all standards for appropriate tuberculosis care. Only 24% of all clinics adhered to WHO-recommended treatment guidelines. Public clinics, younger practitioners and practitioners with advanced degrees were most likely to provide appropriate care for tuberculosis.
  
  
  CONCLUSIONS
  The private sector cares for many tuberculosis cases in Kampala; however, a new programme that offers continuing medical education is needed to improve tuberculosis care and to increase awareness of national guidelines for tuberculosis care.
authors.affiliation: Uganda National Tuberculosis/Leprosy Program, Makerere University, Kampala.
authors.forename: L
authors.initials: L
authors.lastname: Nshuti
authors.forename: D
authors.initials: D
authors.lastname: Neuhauser
authors.forename: J L
authors.initials: JL
authors.lastname: Johnson
authors.forename: F
authors.initials: F
authors.lastname: Adatu
authors.forename: C C
authors.initials: CC
authors.lastname: Whalen
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards; D003430:Cross-Sectional Studies; D003625:Data Collection; D019983:Guideline Adherence; D006269:Health Facilities, Proprietary / Q000592:standards; D006801:Humans; D017410:Practice Guidelines as Topic; D015980:Public Health Practice / Q000592:standards; D011787:Quality of Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy*; D014454:Uganda