Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

Abstract

Background Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. Methods A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. Results Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers.

Spatial-temporal clustering of notified pulmonary tuberculosis and its predictors in East Gojjam Zone, Northwest Ethiopia

“…The overall readiness score of health facilities for TB services was 63.5% (95% CI; 25% -101.8%) [ 21 ]. The effect of poor health facility readiness on the performance of TB prevention and control programs was also reported by former studies [ 29 , 33 , 46 ]. It is linked to the absence of core health facility supplies to offer TB services including trained manpower and guidelines, diagnostics, anti TB drugs, and key supplies.…”

“…This finding was supported by former studies from Ethiopia [ 4 , 9 , 43 ] and abroad [ 33 , 44 ]. This might be due to poor health service coverage [ 21 , 31 , 33 ], absence of TB diagnostic services [ 21 , 33 , 45 ], long delay for TB services (patient and health facility) [ 32 , 46 – 48 ], limited transportation facilities [ 21 , 32 , 46 ], and low community awareness level due to poor access to information sources in rural areas [ 2 , 30 , 32 , 46 ] compared to urban and surrounding areas.…”

“…These might underestimate the magnitude of PTB cases and affect their spatial-temporal clustering in the zone. In addition, there might be some PTB cases who had been screened and attended their treatments outside the zone (in health facilities of neighbouring zones) [ 32 , 46 , 48 ]. This might also underestimate the magnitude and spatial clustering of PTB cases.…”

Exploring spatial variation in BCG vaccination among children 0–35 months in Ethiopia: spatial analysis of Ethiopian Demographic and Health Survey 2016

“…Data on coordinates and weighted frequency of outcome variable with cluster numbers were extracted and merged in STATA V. 14 21 22 Hotspot analysis (Getis-Ord Gi* statistics) Spatial autocorrelation varies across the study setting. This variation was computed Getis-Ord Gi* statistics by calculating by the GiBin statistic for each area.…”

Role of empiric treatment in hospitalized patients with Xpert MTB/RIF-negative presumptive pulmonary tuberculosis: A prospective cohort study

“…The Xpert assay has a high accuracy to detect Mtb, with a 85% pooled sensitivity of 85% overall and 67% in smear-negative culture-positive samples, and a pooled specificity of 98% (Horne et al, 2019). Unfortunately, due to budgetary reasons, the use of the Xpert assay as an initial diagnostic test in Ethiopia continues to be restricted to referral and teaching hospitals (Ereso et al, 2020).…”