Implementation fidelity of management guidelines for hearing loss resulting from treatment of drug-resistant tuberculosis in Kano state, Nigeria
Muhammad, Sani Ibrahim
Background: Nigeria has a high burden of Tuberculosis (TB) including Drug-resistant Tuberculosis (DR-TB). Hearing loss is a potential consequence of TB treatment, which has negatively affected the success of TB control and prevention. The aim of this study was to assess the Implementation fidelity of management guidelines for hearing loss resulting from DR-TB treatment and to find factors associated with the Implementation fidelity Methods: A cross-sectional study, involving health care providers at Infectious Disease Hospital, Kano was conducted. It was a questionnaire-based assessment of implementation fidelity as defined by the four domains of content, coverage, duration and frequency of the Programmatic Management guidelines for treatment of Drug-resistant Tuberculosis. The data were statistically analyzed in Stata 14.2 (Inc. USA) and regression models were fitted. Results: The Implementation fidelity was low, which ranged from 40 - 60% (p <0.001). The core determinants of Implementation fidelity identified based on the conceptual framework were the facilitation strategies, quality of delivery, intervention complexity, participants’ responsiveness and sociodemographic characteristics. Facilitation strategy, quality of delivery, intervention complexity, participants’ responsiveness, age, sex, professional cadre and work experience were individually associated with implementation fidelity among the health care providers. Among all the determinants, quality of delivery, intervention complexity, participants’ responsiveness, sex and professional cadre exerted a positive effect on implementation fidelity (p<0.001) while facilitation strategy, age and work experience exerted a negative effect on implementation fidelity (p<0.001). Conclusion: The implementation fidelity of management guideline for hearing loss resulting from Drug-resistant Tuberculosis treatment was low among health care providers at the infectious disease hospital, Kano, Nigeria. The study serves as an empirical research in testing the conceptual framework for assessment of implementation fidelity that was developed theoretically. Implementation fidelity should be assessed early and at intervals in the course of implementing the PMDT guideline and indeed, in the course of implementing any intervention.
A research report submitted to the faculty of Health Science, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of Master of Science in Epidemiology in the field of Implementation science July 2019