Weak Intra-facility Referral Linkages: Missed Opportunity for Tuberculosis Case Detection and Treatment in a Tertiary Health Facility in Benue State, Nigeria

Despite the scale up of quality-assured Tuberculosis diagnostic and treatment strategies over the years, case detection rate remains a serious challenge globally and particularly in Nigeria. Integrated service delivery is essential to addressing some of the challenges, but it's often neglected especially in low income settings. Recognizing these limitations, a 27-months retrospective review of all presumptive Pulmonary Tuberculosis cases sent to the directly observed short course treatment centre of Benue State University Teaching Hospital, a tertiary health institution in north central Nigeria was conducted to assess the source of referrals and diagnostic processes including outcome of the tests. Chi- square (χ2) test was used for test of association between the intra-facility linkages/referrals system and the tuberculosis case detection rate, with statistical significance set at p-value of ≤5%. There were 918 presumptive Tuberculosis cases with male to female ratio (M: F) of 1:1.3. The mean age of patients was 41.0.0 ±18.4 years. Majority (33.7%, n=) of the referrals were from general outpatient department of the hospital, followed by sexually transmitted infection clinic (26.0%) and Paediatrics department (1.6%, n=). The diagnostic positive rate was 145(15.8%). Overall, 295(32.2%) did not collect their results, of these 76(25.8%) were positive and 219(74.2%) were negative. The relationship between the missed cases and the weak intra-facility referral linkages was statistically significant (p=0.000). The hospital management should consider the engagement of all relevant health care providers on efficient two-way referral system towards ensuring adequate Tuberculosis case notification and prompt treatment.