A survey of TB services in hospitals in seven large cities in Asia and North Africa

SETTING: Hospitals in Bangkok, Cairo, Dhaka, Jakarta, Karachi, Kathmandu and Manila. OBJECTIVES: To evaluate tuberculosis (TB) services provided in public and private hospitals in big cities. DESIGN: A survey on TB services in hospitals was carried out in 2005 by visiting hospitals and face-to-face interviews. Selection criteria were determined for each city. All hospitals were included if feasible. RESULTS: The number of hospitals included in the survey ranged from 52 in Bangkok to 106 in Jakarta. The proportion of private hospitals with access to a National Tuberculosis Programme (NTP) manual ranged from 8% in Jakarta to 89% in Bangkok. Private hospitals rarely functioned as a basic management unit (BMU) of the NTP, except in Bangkok. TB treatment was not always free of charge in BMU hospitals. The proportion of non-BMU hospitals that never referred/reported TB patients to the NTP was substantial in Bangkok, Dhaka, Jakarta, Karachi and Manila. Non-BMU hospitals did not routinely use standard NTP regimens, especially in Jakarta, Karachi and Manila. In non-BMU hospitals, patient tracing mechanisms were generally lacking and treatment outcome was not known. CONCLUSION: TB services provided in non-BMU hospitals were not satisfactory. NTPs need to involve non-BMU hospitals in TB control.