Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up

Abstract

Background: Providing medical care for non-communicable diseases (NCDs) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). The reasons for this are poorly understood.Objective: To investigate LTFU among patients with two different but common NCDs who attended rural Ethiopian health centres.Method: The study was based in five health centres in southern Ethiopia with established NCD clinics run by nurses and health officers. Patients with epilepsy or hypertension who were lost to follow-up and non-LTFU comparison patients were identified and traced; a questionnaire was administered enquiring about the reasons for LTFU.Results: Of the 147 LTFU patients successfully located, 62 had died, moved away or were attending other medical facilities. The remaining 85 patients were compared with 211 non-LFTU patients. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments, together with a misunderstanding of the nature of NCD management.Conclusions: The delivery of affordable care closer to the patients' homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.

Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment

“…Many factors can influence preferences for patients' management of their NCDs, which has been shown to influence the likelihood of patient attrition in outpatient clinics. 10 Patient preferences for care of HIV, which has become a chronic condition owing to years of focused attention expanding antiretroviral therapy (ART) access and longitudinal HIV care, 8 have been well studied and can serve as a starting point for understanding patient preferences for NCD management. Patients living with HIV in lowincome and middle-income countries (LMICs) have demonstrated a variety of preferences, including preferring certain kinds of providers, free or low-cost services, receiving more ART at each visit with fewer subsequent visits required and health facility-based services.…”

“…Many factors can influence preferences for patients’ management of their NCDs, which has been shown to influence the likelihood of patient attrition in outpatient clinics. 10 …”

“…An area that remains understudied, and which represents a major knowledge gap in designing patient-centred NCD service delivery in East Africa, is that of patient preferences for how and where they receive their chronic disease care. Many factors can influence preferences for patients’ management of their NCDs, which has been shown to influence the likelihood of patient attrition in outpatient clinics 10…”

Scaling up noncommunicable disease care in a resource-limited context: lessons learned and implications for policy

“…However, despite intensive outreach and engagement, uptake was low and retention on treatment somewhat disappointing (Table 3) although the duration of the project may have been too short to build up the level of community engagement and trust in the clinics and forms of NCD management required to make a substantial impact on the disease burden. Previous work in Ethiopia has demonstrated the numerous barriers to treatment, including access/distance, consistency of drug availability, cost (out-of-pocket expense and time) and cultural beliefs and practices related to health and healing [15].…”

Comparing absolute and relative distance and time travel measures of geographic access to healthcare facilities in rural Haiti

“…Longer distance to health services has been associated with lower service utilisation rates, increased health expenditure and poor health outcomes across multiple diseases 1–4. Studies in low-income and middle-income countries (LMICs) have described poor geographic access leading to lower rates of facility-based deliveries, increased childhood mortality and worse outcomes in communicable diseases such as HIV as well as in non-communicable diseases (NCDs) such as cardiovascular disease and breast cancer 4–16. Hence, distance to health services has been adopted as a population measure of health equity, with travel time a proxy for equitable physical access 17.…”