TB: Barrier in access, diagnosis and treatment completion

Abstract

Tuberculosis (TB) is a major public health concern for Nepal like many other developing countries around the world. Economic barrier is one of the major problems in poor and marginalized population. Poor people mostly remain unaware of the treatment facilities and some find it difficult in seeking T.B treatment as they don’t trust the program and most of them don’t possess enough knowledge about the disease itself. Population residing in the remote areas of the countries can’t access the treatment facilities due to far distance of health facilities from there residence due to lack of roads and lack of transport. Thus difficult geography primarily in rural areas in the country acts as a barrier to access the health facility. TB infection faces add-on challenge with the advent of co-infection and possibility of increase in drug resistant TB. This is why detecting TB in its early stage would pose a number of advantages to the patient that would in turn help for early treatment. However, the challenges and barriers in early diagnosis remain that is being contributed by multifaceted factors. The lack of knowledge coupled with poor financial capacity to pay for the diagnosis especially in rural population prevents them from being diagnosed properly as well. Factors for not completing the treatment are when patient starts feeling better, lack of drugs, major side effects of the drugs and inadequate knowledge about advantages of completion of the drug treatment. The attitude of the hospital staff also in many cases leads to discontinuation of the treatment. Patient who have limited income and got financial support from their relatives explained about treatment going above their obtainable resources leading to early withdrawal from the treatment completion. Geography is one of the important issues for treatment completion as routine drug administration follow up in patient (farther from particular distance) is difficult and leads to exhaustion and withdrawal from the treatment.Journal of Manmohan Memorial Institute of Health Sciences Vol. 2 2016 p.76-80

Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers

“…This study was carried out in three various geographic regions of Nepal (Fig 1). A total of six districts were chosen based on the literature review that informed the paucities of evidence on barriers of access, diagnosis and treatment completion on TB in central and western Nepal [14]. Two districts in each of these three regions constituted a total of six districts: Tanahuh, Kaski, Parsa, Nawalparasi, Mustang and Kathmandu.…”

“…Various factors such as economic barriers [10,11] including the integration of TB services with health care system, number of visits, cost of seeking care plays a critical role [12] in determining the access (of health services), diagnosis (of TB) and adherence of treatment regimen [13]. These barriers are further augmented by the complex geographical terrain and the factors embedded in social and cultural context [14].…”

“…In Nepal, patients experienced more than five weeks of delay in diagnosis and the treatment of pulmonary tuberculosis [15]. Delays in access and diagnosis together with the poor adherence poses serious health and economic implications for both the individual, family members and the community [14,15]. For instance, poor access and delayed diagnosis can lead to severe form of the disease, spread of the disease among the family members and the community members [16][17][18].…”

Reliance on Self-Medication Increase Delays in Diagnosis and Management of GI Cancers: Results From Nepal

“…These barriers are further augmented by the lower socioeconomic status of many patients, the high percentage of rural patients, the complex geographical terrain and distance from health care facilities, and other factors embedded in the social and cultural context in Nepal. 4 All of these factors may contribute to a delay in presentation of patients to the hospital, increasing the number of patients diagnosed with advanced-stage cancers. 5 …”