title: Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria.
abstract: BACKGROUND
  Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria.
  
  
  METHODS
  A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p < 0.05.
  
  
  RESULTS
  Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities.
  
  
  CONCLUSIONS
  The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State.
authors.affiliation: College of Health Sciences, University of Port Harcourt, Nigeria; Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
authors.forename: Charles Ibiene
authors.initials: CI
authors.lastname: Tobin-West
authors.affiliation: Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Isodje
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy / Q000379:methods; D006266:Health Education / Q000379:methods; D006801:Humans; D009549:Nigeria; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards*; D014376:Tuberculosis / Q000628:therapy*; D019037:Urban Health Services / Q000458:organization & administration / Q000592:standards*
chemical_list: D000995:Antitubercular Agents
keywords: Health quality; Nigeria; tuberculosis care