An approach to integrated management of diabetes in tuberculosis patients: Availability and readiness of the health facilities of Bangladesh.

Background: Comorbidity of diabetes mellitus and tuberculosis (TB) is a major public health concern in low- and middle-income countries including Bangladesh. An integrated approach is required for adequate management of diabetes mellitus and TB. The objective of the present study was to investigate the availability and readiness of the TB care centers of Bangladesh toward diabetic patients' management.

Methods: The present study was conducted based on existing data obtained from the Bangladesh Health Facility Survey (BHFS) 2017. Data collected from a total of 303 facilities providing TB services were retrieved. The outcome variables of the present study were availability and readiness of the TB health facilities for providing diabetes mellitus service. Readiness was measured for four domains: staff and guidelines, equipment, diagnostic facility and basic medicine. The independent variables were: facility level, management authority and location of the facility. Binary and multiple logistic regression models were constructed for both the outcome variables (availability and readiness) to find out their predictors.

Results: Services for diabetes mellitus were available in 68% of the TB facilities while high readiness was present in 36% of the facilities. For domain-specific readiness index, readiness for the domains of staff and guidelines, equipment, diagnostic facility and basic medicine was reported in 46%, 96%, 38% and 25% facilities respectively. In the logistic regression model, availability of diabetes mellitus services was better in primary level (aOR 2.62, 95% CI 1.78-4.77) and secondary level (aOR 3.26, 95% CI 1.82-9.05) facilities than community facilities. Similarly, readiness of diabetes mellitus care was also better in these facilities (aOR 2.55, 95% CI 1.05-4.71 for primary and aOR 2.75, 95% CI 1.80-4.32 for secondary facilities). Besides, private TB facilities had better availability (aOR 2.84, 95% CI 1.75-5.89) and readiness (aOR 2.52, 95% CI 1.32-4.29) for diabetes mellitus care.

Conclusion: Availability and readiness for providing diabetes mellitus services in TB care providing facilities in Bangladesh is inadequate.