Management and transference of patients diagnosed with tuberculosis in a rural hospital in Southern Ethiopia

Treatment of new tuberculosis (TB) cases in Directly Observed Treatment Short Course (DOTS) programmes is believed to be the most valuable strategy for TB control. The aim of this study is to describe the experience of diagnosed cases of TB in a district hospital situated in a rural zone of Ethiopia and of “transferred out” TB cases from the hospital to their local health facilities using the DOTS programme spanning a period of 8 years. Data collection was obtained by using a TB register book in a rural district hospital from 2004 to 2011. The collected information included the type of TB, age, HIV status, and treatment outcomes using standardized definitions; 6459 patients with all forms of TB were diagnosed. Twenty-eight percent were smear-positive pulmonary TB (PTB) cases, 28.97% were smear-negative PTB cases, and 42.8% were extra-pulmonary TB (EPTB). The global “transferred out” rate was 78.5% (5073/6459); the “transferred out” rate after diagnosis at hospital and before starting DOTS was 72.6% (4689/6459), and after finishing the intensive phase and admission was 21.8% (385/1770). The proportion of total cases “transferred out” in smear-negative PTB cases (70.2%) was less than smear-positive PTB cases (79.2%) (odd ratio [OR]: 0.81; 95% confidence interval [CI]: 0.76–0.87) and was higher in EPTB cases (83.3%) (OR: 1.15; 95% CI: 1.05–1.19). The percentage of “transferred out” after hospital admission was higher in HIV-positive cases (16.8%) than in HIV-negative cases (8.5%) (OR: 2.13; 95% CI: 1.28–3.53). In conclusion, district hospitals are still important facilities for the diagnosis of TB cases, particularly EPTB.