Long distance travelling and financial burdens discourage tuberculosis DOTs treatment initiation and compliance in Ethiopia: a qualitative study

Abstract

BackgroundTimely tuberculosis treatment initiation and compliance are the two key factors for a successful tuberculosis control program. However, studies to understand patents’ perspective on tuberculosis treatment initiation and compliance have been limited in Ethiopia. The aim of this study is to attempt to do that in rural Ethiopia.MethodsThis qualitative, phenomenological study conducted 26 in-depth interviews with tuberculosis patients. A thematic content analysis of the interviews was performed using the Open Code software version 3.1.ResultsWe found that lack of geographic access to health facilities, financial burdens, use of traditional healing systems and delay in diagnosis by health care providers were the main reasons for not initiating tuberculosis treatment timely. Lack of geographic access to health facilities, financial burdens, quality of health services provided and social support were also identified as the main reasons for failing to fully comply with tuberculosis treatments.ConclusionsThis study highlighted complexities surrounding tuberculosis control efforts in Dabat District. Challenges of geographic access to health care facilities and financial burdens were factors that most influenced timely tuberculosis treatment initiation and compliance. Decentralization of tuberculosis diagnosis and treatment services to peripheral health facilities, including health posts is of vital importance to make progress toward achieving tuberculosis control targets in Ethiopia.

Barriers to treatment adherence of tuberculosis patients: A qualitative study in West Bengal, India

“…[27] Therefore, community-based TB treatment programs and stronger involvement of local social networks are the need of the hour. Although an Ethiopian study [28] had found that long distance from health facilities, the use of traditional healing systems and diagnostic delay by healthcare providers as main reasons for not initiating a timely TB treatment; these were contrary to the finding of the current study. In our study, the care providers were found to be committed to the DOTS care delivery and despite their huge workload they managed to provide information to the patients during the treatment supporter selection process.…”

Treatment Delay among Smear Positive Pulmonary Tuberculosis Patients in South Ethiopia: A Cross-Sectional Study

“…In line with the findings of the present study, inquiries made by researchers in Afghanistan [8], Nigeria [13] and Indonesia [16] had found being resident in the rural area as risk factor for delayed initiation of treatment. The main reasons for this unacceptably longer duration before treatment might be due to geographical access to health service and cost of transportation to reach to the health facility in a longer distance from their residence [12]. In this study also low income of birr 450 or less per month is associated with increased delay for treatment of pulmonary TB.…”

“…Increased distance requires additional cost for transportation which hinders the patient to visit health facility as early as possible [6][7][8][9][10][11][12][13]. As it is known as the most important risk factor for TB, smoking cigarette also increases the delay for diagnosis and treatment as compared to non-smokers and ex-smokers [14].…”

“…As it is known as the most important risk factor for TB, smoking cigarette also increases the delay for diagnosis and treatment as compared to non-smokers and ex-smokers [14]. The other factors increasing delay for treatment were variables in the socio demographic [6,11,13,[15][16][17], economic [10][11][12], concurrent chronic diseases [11,18] and knowledge about TB [10,11,19]. These findings indicate that variables affecting the prompt treatment of TB vary according to geographical location and population, calling for studies intended to estimate and identify area and population specific factors associated with increased delay of the patients for treatment.…”

Implementation of the Active TB Case Finding in Nigeria; Processes, Lessons Learnt and Recommendations

“…This approach has been shown to be effective in both clinical and community settings [11]. The strategy has been particularly successful in crowded urban populations in countries like Pakistan, Cape Town, Nepal, Kenya and South India, Nigeria among others [9] [16]. These barriers have all been associated with patient and health system delays from the onset of illness to treatment initiation.…”