title: Accessibility to tuberculosis control services and tuberculosis programme performance in southern Ethiopia.
abstract: BACKGROUND
  Despite the expansion of health services and community-based interventions in Ethiopia, limited evidence exists about the distribution of and access to health facilities and their relationship with the performance of tuberculosis (TB) control programmes. We aim to assess the geographical distribution of and physical accessibility to TB control services and their relationship with TB case notification rates (CNRs) and treatment outcome in the Sidama Zone, southern Ethiopia.
  
  
  METHODS
  We carried out an ecological study to assess physical accessibility to TB control facilities and the association of physical accessibility with TB CNRs and treatment outcome. We collected smear-positive pulmonary TB (PTB) cases treated during 2003-2012 from unit TB registers and TB service data such as availability of basic supplies for TB control and geographic locations of health services. We used ArcGIS 10.2 to measure the distance from each enumeration location to the nearest TB control facilities. A linear regression analysis was employed to assess factors associated with TB CNRs and treatment outcome.
  
  
  RESULTS
  Over a decade the health service coverage (the health facility-to-population ratio) increased by 36% and the accessibility to TB control facilities also improved. Thus, the mean distance from TB control services was 7.6 km in 2003 (ranging from 1.8 to 25.5 km) between kebeles (the smallest administrative units) and had decreased to 3.2 km in 2012 (ranging from 1.5 to 12.4 km). In multivariate linear regression, as distance from TB diagnostic facilities (b-estimate=-0.25, p<0.001) and altitude (b-estimate=-0.31, p<0.001) increased, the CNRs of TB decreased, whereas a higher population density was associated with increased TB CNRs. Similarly, distance to TB control facilities (b-estimate=-0.27, p<0.001) and altitude (b-estimate=-0.30, p<0.001) were inversely associated with treatment success (proportion of treatment completed or cured cases).
  
  
  CONCLUSIONS
  Accessibility to TB control services improved despite the geographic variations. TB CNRs were higher in areas where people had better access to diagnostic and treatment centres. Community-based interventions also played an important role for the increased CNRs in most areas.
authors.affiliation: Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.|School of Public and Environmental Health, College of Medicine and Health sciences, Hawassa University, Hawassa, Ethiopia.|Sidama Zone Health Department, Hawassa, Ethiopia; mesayhailudangiso@yahoo.com.
authors.forename: Mesay Hailu
authors.initials: MH
authors.lastname: Dangisso
authors.affiliation: HHA - REACH Ethiopia, Hawassa, Ethiopia.|Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Daniel Gemechu
authors.initials: DG
authors.lastname: Datiko
authors.affiliation: Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Bernt
authors.initials: B
authors.lastname: Lindtjørn
mesh_terms: D000328:Adult; D005002:Ethiopia; D005260:Female; D062306:Geography, Medical; D006268:Health Facilities / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D015397:Program Evaluation; D011634:Public Health; D012424:Rural Population; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*
keywords: Africa; developing countries; health systems; population health; public health; tuberculosis control