Comparing the Treatment Outcomes of Tuberculosis Patients in Private Clinic with Governmental Health Centre in Jimma City, Ethiopia.

Background : Tuberculosis is a common and often deadly infectious disease caused by various strains of mycobacterium, usually mycobacterium tuberculosis in humans. Tuberculosis has long been major cause of morbidity and mortality particularly where the diagnostic and control program is not far extended. Objective : - To compare the treatment outcomes and to describe the social demographic factors associated with Tuberculosis patient in private clinic with governmental health centre in Jimma city, Ethiopia from September 12, 2007 to September 10, 2017. Methods and Materials : - A ten years retrospective systemic record review was conducted to compare the treatment outcomes and to describe the social demographic factors associated with Tuberculosis patient in private clinic with governmental health centre in Jimma city, Ethiopia from September 12, 2007 to September 10, 2017. Data was collected by using questionnaire formats. Since all serial numbers of the patients were used no sampling technique was needed. Finally data was analyzed by SPSS/EPI INFO. Result : The present study revealed that within ten years duration private clinic gives anti-TB treatment coverage for 582 patients whereas governmental clinic gives for 510 patients. The treatment success rate of the private clinic is 98.1% which is 1.03 fold than the governmental health center (95.3%). Governmental health center defaulting rate was triple fold of the private clinic 4.1% and 1.2% receptively, while the treatment failure of private clinic was 0.2%, but no treatment failure in governmental health center. Conclusion and Recommendation -Age, educational level and the types of TB diagnosis and treatment outcome of the patients were statistically associated in both sectors. Better counseling and awareness about the disease should have to be given for every anti-TB treatment receiving patients despite of their educational level and occupational status in both sectors. This study is useful to assess and to compare the treatment outcomes of tuberculosis patients in government health centre and private clinic which helps to identify the extent of tuberculosis treatment burden which handled between the sectors. Further, more the findings will act as baseline for further studies more over finding will help to formulate strategies to give the appropriate tuberculosis care and to sensor what really affect the outcome.

 To compare the extent of tuberculosis treatment burden which handled between the sectors.
 Further, more the findings will act as baseline for further studies more over finding will help to formulate strategies to give the appropriate tuberculosis care and to sensor what really affect the outcome.
 Also how private clinics are helping the government health institutions by providing anti-TB regime relative to the similar catchment population with the government and what is behind on the numbers difference value.

Limitation of The Study
 Data accuracy is under question with some incomplete subjects since it is a secondary data.
 The sources of this study is Jimma health center and Jimma medium clinic records; hence, the result may lack external validity.
 Lack of stable internet from Ethiopia during data collection.
PRIVATE & GOVERNMENT TB TREATMENT OUTCOME 3 Background TB is a major public health problem throughout the world and one of the leading causes of death worldwide. One third of the world's population is infected with TB [1]. The foundation of the current global TB strategy began in the 1990s, when the increasing trends of TB led to the creation of directly observed treatment-short course (DOTS) strategy. The multidimensional DOTS framework has been implemented in 184 countries and over 132 million patients have been treated with DOTS resulting in more than 125 million being cured [2,3,4,5]. In 2016, 10.4 million people around the world became sick with TB disease. There were 1.7 million TB-related deaths worldwide. TB is a leading killer of people who are HIV infected, in 2016, 40% of HIV deaths were due to TB [6]. TB incidence falls 1.5% per year globally but challenged by the emergence and increase in drug resistance TB worldwide and association of TB and HIV infections also TB control has been hindered with poor treatment outcome up to death and TB still remains one of the world's major threat to public health [7,26].
Tuberculosis is the still problem in Ethiopia, the trend of TB incidence is still rise in contract the global trend is falling. The Emergence of resistance TB and high prevalence of MDR TB in Ethiopia is one threatening and drawback factor for TB control program. We can prevent the emergence of acquired resistance by using the good practice which is the simplest and easiest way to prevent the complicated and serious disease [8]. Ethiopia  This study is useful to assess and to compare the treatment outcomes of tuberculosis patients in government health centre and private clinic which helps to identify the extent of tuberculosis treatment burden which handled between the sectors. Further, more the findings will act as baseline for further studies more over finding will help to formulate strategies to give the appropriate tuberculosis care and to sensor what really affect the outcome.
PRIVATE & GOVERNMENT TB TREATMENT OUTCOME 5

2.1: Study Area Population
The study was being conducted in Jimma health center and Jimma medium clinic.

2.3: Statistical Analysis
The collected data was checked for completeness and analyzed by using IBM version 23 SPSS/EPI INFO. Relationships between treatment outcomes and potential predictor variables were assessed using multivariate logistic regression model.
PRIVATE & GOVERNMENT TB TREATMENT OUTCOME 7

3.1: Socio-Demographic and Clinical Characteristics of the Patients with the TB Trend
A total of 510 and 582 patients were followed anti TB treatment in the governmental and private clinic respectively. The majority of the patients in governmental clinic were females  (Table 1) PRIVATE & GOVERNMENT TB TREATMENT OUTCOME      and 95.7% respectively. While the defaulting rate after relapse of the disease in private clinic is 33.3% which is higher than the governmental health center 21.1% ( Table 2).

3.3: Treatment Outcome and Its Associated Predictors
Beside of Anti-TB treatment being free of payment this difference may be due to awareness about drug adherence also difference in socioeconomic status. This shows good progress of DOTS strategy and decrease of noncompliance in both sectors.
Age, educational level and the types of TB diagnosis with the treatment outcome of the patients were statistically significant (p<0.05) and associated in both sectors. While Sex, category of the patient and occupational status of the patients and their treatment outcome were not statistically significant (p>0.05). The literacy level plays greater role for treatment success rate.
Hence the current study reviled the poor treatment outcome is observed in uneducated patients.

4.1: Conclusion
The key to control TB is rapid detection and cure of infectious cases by TB control programmers. The public health priority of national TB control programmers is to work towards the objectives to treat successfully 85%. Ensuring adherence to treatment is very important to achieve this priority [10]. According to the result of this study both sectors achieved the expected WHO targets by newly recommended strategy for TB treatment, DOTS and treatment success is much better to standard. This shows good progress of DOTS strategy and decrease of noncompliance in this area. Age, educational level and the types of TB diagnosis and treatment outcome of the patients were statistically associated in both sectors. Beijing, china and mainly from Jimma Town health office, Jimma health center and from Jimma medium clinic with their respective TB treatment personnel's. Since it is secondary data, we didn't expect participants verbal approval.

Consent for Publication
Not Applicable

Availability of data and materials
It is secondary data. Hence, we don't have the consent from the patients, but the raw data is in my hand.

Competing interests
The authors declare that they have no competing interests

Funding
No funding was obtained for this study.

Authors' Contributions
EG analyzed and interpreted the patient data CF supervising over all of the study.

Acknowledgment
I would like to express my sincere and deep-rooted thanks for my advisors Professor Cheng Feng for his constructive advice, comments, guides and support. I would also like to thank all my friends who assisted me by providing necessary information. I would like to extend my gratitude to Tsinghua university for offering me this opportunity to do research thesis and for giving me broad band free internet service that aid me in data collection despite of the long distance. Finally, I would like to thanks Jimma city health office, Jimma health center, Jimma medium clinic with their respective TB treatment personnel's for their permission and cooperation for giving me a data.