title: Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda.
abstract: BACKGROUND
  Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda.
  
  
  METHODS
  We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers.
  
  
  RESULTS
  Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC.
  
  
  CONCLUSIONS
  TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks--governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.
authors.affiliation: School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. eburegyeya@musph.ac.ug
authors.forename: Esther
authors.initials: E
authors.lastname: Buregyeya
authors.forename: Fred
authors.initials: F
authors.lastname: Nuwaha
authors.forename: Suzanne
authors.initials: S
authors.lastname: Verver
authors.forename: Bart
authors.initials: B
authors.lastname: Criel
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Rhoda
authors.initials: R
authors.lastname: Wanyenze
authors.forename: Joan N
authors.initials: JN
authors.lastname: Kalyango
authors.forename: Achilles
authors.initials: A
authors.lastname: Katamba
authors.forename: Ellen Mh
authors.initials: EM
authors.lastname: Mitchell
mesh_terms: D003371:Cough / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D014454:Uganda / Q000453:epidemiology; D014691:Ventilation
references.citation: Lancet. 2006 Nov 4;368(9547):1575-80
references.pmid: 17084757
references.citation: J Hosp Infect. 2011 Dec;79(4):333-8
references.pmid: 21978608
references.citation: Int J Tuberc Lung Dis. 2007 Jun;11(6):593-605
references.pmid: 17519089
references.citation: Southeast Asian J Trop Med Public Health. 2004 Dec;35(4):1005-11
references.pmid: 15916106
references.citation: AIDS. 1999 Mar 11;13(4):501-7
references.pmid: 10197379
references.citation: Tuber Lung Dis. 1995 Dec;76(6):575-7
references.pmid: 8593382
references.citation: N Engl J Med. 1992 Jan 23;326(4):231-5
references.pmid: 1345800
references.citation: MMWR Recomm Rep. 2005 Dec 30;54(RR-17):1-141
references.pmid: 16382216
references.citation: Ann Intern Med. 2004 Jul 6;141(1):1-8
references.pmid: 15238364
references.citation: Clin Infect Dis. 2001 Sep 1;33(5):589-96
references.pmid: 11477527
references.citation: Int J Tuberc Lung Dis. 2000 Apr;4(4):321-6
references.pmid: 10777080
references.citation: Am J Respir Crit Care Med. 2012 May 15;185(10):1104-9
references.pmid: 22323300
references.citation: Clin Infect Dis. 2010 May 15;50 Suppl 3:S231-7
references.pmid: 20397953
references.citation: J Hosp Infect. 2009 May;72(1):57-64
references.pmid: 19278753
references.citation: Int J Tuberc Lung Dis. 2005 May;9(5):545-9
references.pmid: 15875927
references.citation: N Engl J Med. 1995 Jan 12;332(2):92-8
references.pmid: 7990907
references.citation: Int J Tuberc Lung Dis. 2012 Aug;16(8):1092-6
references.pmid: 22687261
references.citation: Psychiatr Serv. 2008 Jul;59(7):727-31
references.pmid: 18586988
references.citation: J Hosp Infect. 2001 Mar;47(3):173-80
references.pmid: 11247676
references.citation: PLoS One. 2011 Jan 10;6(1):e16130
references.pmid: 21249225
references.citation: Am J Infect Control. 1994 Dec;22(6):367-70
references.pmid: 7695116
references.citation: PLoS One. 2012;7(10):e46069
references.pmid: 23071538
references.citation: Tuberculosis (Edinb). 2004;84(1-2):19-23
references.pmid: 14670342
references.citation: PLoS Med. 2006 Dec;3(12):e494
references.pmid: 17194191
references.citation: Ann Intern Med. 2010 Oct 19;153(8):516-22
references.pmid: 20956708
references.citation: Int J Qual Health Care. 1999 Jun;11(3):187-92
references.pmid: 10435838
references.citation: Niger J Clin Pract. 2011 Jul-Sep;14(3):270-5
references.pmid: 22037066
references.citation: J Trauma. 2002 Mar;52(3):540-3
references.pmid: 11901332