Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study
Berhane Megerssa Ereso aff001; Solomon Abebe Yimer aff002; Christoph Gradmann aff001; Mette Sagbakken aff004
Působiště autorů: Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway aff001; Department of Microbiology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway aff002; Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway aff003; Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
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.
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.
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.
Inadequate resources for TB case finding, and a limited access to diagnostic services, were major challenges affecting TB case finding. The optimal application of the directly observed treatment short course (Stop TB) strategy is crucial to increase the current low TB case notification rate. Practical strategies need to be designed to attract and retain health professionals in the health system.
Diagnostic medicine – Ethiopia – Health services administration and management – Sputum – Tuberculosis – Tuberculosis diagnosis and management – Shortages
1. World Health Organization (WHO). Global Tuberculosis Report 2017 [Internet]. Geneva, Switzerland; 2017. doi:10.1001/jama.2014.11450
2. World Health Organization (WHO). Global Tuberculosis Report 2016 [Internet]. Geneva, Switzerland; 2016. doi:10.1001/jama.2014.11450
3. World Health Organization. Global Tuberclosis Report 2014. France; 2014. doi:ISBN 9789241564809
4. Federal Ministry of Health Ethiopia. Health and health related indicators. Addis Ababa, Ethiopia; 2015.
5. Bogale S, Diro E, Shiferaw AM, Yenit MK. Factors associated with the length of delay with tuberculosis diagnosis and treatment among adult tuberculosis patients attending at public health facilities in. BMC infectious diseases. 2017;17: 1–10. doi: 10.1186/s12879-016-2122-x
6. Matteelli A, Sulis G, Capone S, Ambrosio LD, Migliori GB, Getahun H. Tubeculosis elimination and the challenge of latent tuberculosis. Quarterly Medical Review. 2017;46: e13–e21. doi: 10.1016/j.lpm.2017.01.015 28279508
7. Federal MoH Ethiopia. Guidelines for clinical and programmatic management of TB, leprosy and TB/HIV in Ethiopia. 6th Editio. Addis Ababa, Ethiopia; 2016.
8. Vries SG De, Cremers A, L N, Heuvelings CC, Greve PF, Visser B, et al. Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: A systematic review of qualitative literature. The Lancet Infectious Diseases. 2017;17: e128–e143. doi: 10.1016/S1473-3099(16)30531-X 28291721
9. Courtwright A. Tuberculosis and Stigmatization: Pathways and Interventions. Public health report. 2010;125: 34–42.
10. Craig GM, Daftary A, Engel N, O’Driscoll S, Ioannaki A. Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries. International Journal of Infectious Diseases. 2017;56: 90–100. doi: 10.1016/j.ijid.2016.10.011 27810521
11. Barter DM, Agboola SO, Murray MB, Bärnighausen T. Tuberculosis and poverty: The contribution of patient costs in sub-Saharan Africa–a systematic review. BMC public health. 2012;12. doi: 10.1186/1471-2458-12-12
12. Dangisso MH, Datiko DG. Accessibility to tuberculosis control services and tuberculosis programme performance in southern Ethiopia. Global Health Action. 2015;8: 1–10.
13. Gebeyehu E, Azage M, Abeje G. Factors associated with patient’s delay in tuberculosis treatment in Bahir Dar City Administration, Northwest Ethiopia. BioMed Research International. 2014;2014. doi: 10.1155/2014/701429 24982901
14. Gele AA, Sagbakken M, Abebe F, Bjune GA. Barriers to tuberculosis care: A qualitative study among Somali pastoralists in Ethiopia. BMC research notes. 2010;3. Available: http://www.biomedcentral.com/1756-0500/3/86%0ARESEARCH doi: 10.1186/1756-0500-3-3
15. Yimer S, Holm-hansen C, Yimaldu T, Bjune G. Health care seeking among pulmonary tuberculosis suspects and patients in rural Ethiopia: A community-based study. BMC public health. 2009;9: 1–9. doi: 10.1186/1471-2458-9-1
16. Yirgu R, Lemessa F, Hirpa S, Alemayehu A, Klinkenberg E. Determinants of delayed care seeking for TB suggestive symptoms in Seru district, Oromiya Region, Ethiopia: A community based unmatched case-control study. BMC infectious diseases. 2017;17. doi: 10.1186/s12879-016-2105-y
17. Tuberculosis Research Advisory Committee (TRAC/FMOH). Roadmap for Tuberculosis Operational Research in Ethiopia. Addis Ababa; 2013.
18. Ethiopian Health and Nutrition Institute. First Ethiopian National Population Based Tuberculosis Prevalence Survey. First Edit. Addis Ababa,: Federal Minisry of Health, Ethiopia; 2011.
19. Datiko DG, Lindtjørn B. Cost and Cost-Effectiveness of Treating Smear-Positive Tuberculosis by Health Extension Workers in Ethiopia: An Ancillary Cost-Effectiveness Analysis of Community Randomized Trial. PLoS ONE. 2010;5: e9158. doi: 10.1371/journal.pone.0009158 20174642
20. Shargie EB, Mørkve O, Lindtjørn B. Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: Community randomized trial. Bulletin of World Health organization. 2006;84.
21. Yassin MA, Datiko DG, Tulloch O, Markos P, Aschalew M, Shargie EB, et al. Innovative Community-Based Approaches Doubled Tuberculosis Case Notification and Improve Treatment Outcome in Southern Ethiopia. PLoS ONE. 2013;8: e63174. doi: 10.1371/journal.pone.0063174 23723975
22. Tulloch O, Theobald S, Morishita F, Datiko DG, Asnake G, Tesema T, et al. Patient and community experiences of tuberculosis diagnosis and care within a community-based intervention in Ethiopia: A qualitative study. BMC public health. 2015;15: 1–9. doi: 10.1186/1471-2458-15-1
23. Li J, Chung PH, Leung CLK, Nishikiori N, Chan EYY, Yeoh EK. The strategic framework of tuberculosis control and prevention in the elderly: A scoping review towards End TB targets. Infectious Diseases of Poverty. 2017;6: 1–12. doi: 10.1186/s40249-016-0216-8
24. Kuznetsov VN, Grjibovski AM, Andrey O, Johansson E, Bjune GA. A comparison between passive and active case finding in TB control in the Arkhangelsk Region. International Journal of Circumpolar Health. 2014;73.
25. Becerra MC. Expanding Tuberculosis Case Detection by Screening Household Contacts. Public health report. 2005;120: 271–277.
26. Jimma Zone health department. Annual performance report 2016. Jimma; 2016.
27. Gillies D, Chicop D, Halloran PO. Root Cause Analyses of Suicides of Mental Health Clients. crisis. 2015;36: 316–324. doi: 10.1027/0227-5910/a000328 26502781
28. Stalter AM, Phillips JM, Ruggiero JS, Scardaville DL, Merriam D, Cne RN, et al. A Concept Analysis of Systems Thinking. Nursing Forum. 2017;52: 323–330. doi: 10.1111/nuf.12196 28000925
29. Woldie M, Morankar SN, Feyissa GT, Labonte R, Sanders D. Coverage of child health services in rural districts of Ethiopia with the health services extension program. Journal of Public Health and Epidemiology. 2015;7: 223–231. doi: 10.5897/JPHE2015.0733
30. Central Stastistical Agency (CSA) Ethiopia. National Population Census Report of Ethiopia. Addis Ababa, Ethiopia; 2007.
31. Patton MQ. Qualitative Research and Evaluation Methods. Third Edit. Thousands Oaks, California: Sage Publications; 2002.
32. Elfil M, Negida A. Sampling methods in Clinical Research; an Educational Review. Emergency. 2017;5: e52. 28286859
33. Datiko Danial BL. Health Extension Workers Improve Tuberclosis case Detection and Treatment Success in Southern Ethiopia: A community Randomized Trail. PLos one. 2009;4. Available: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0005443
34. Federal Democratic republic of Ethiopia Ministry of Health. POCKET GUIDE ON CLINICAL MANAGEMENT OF TBL AND TB / HIV FOR GENERAL HEALTH WORKERS. Addis Ababa; 2013.
35. Federal Ministry of Health Ethiopia. Guidelines for clinical and programmatic management of TB, leprosy and TB/HIV in Ethiopia. Fifth edit. Addis Ababa,; 2012.
36. Braun V, Clarke V. Using thematic analysis in psychology Virginia. Qualitative Research in Psychology. 2006;3: 77–101. doi: 10.1191/1478088706qp063oa
37. Taylor S., Bogadan R. Introduction to Qualitative Research Methods: A Guide book and Resource. Third Edit. Canada; 1998.
38. Rashid M, Hodgson CS, Luig T. Ten tips for conducting focused ethnography in medical education research. Medical Education Online. 2019;24: 1–7. doi: 10.1080/10872981.2019.1624133 31146655
39. Dabaro D. Factors affecting tuberculosis case detection in Kersa District, South West Ethiopia. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2017;9: 1–4. doi: 10.1016/j.jctube.2017.08.003 31723710
40. Gebreegziabher SB, Yimer SA, Bjune GA. Qualitative Assessment of Challenges in Tuberculosis Control in West Gojjam Zone, Northwest Ethiopia: Health Workers’ and Tuberculosis Control Program Coordinators’ Perspectives. Tuberclosis Research and Treatment. 2016;2016.
41. Lonnroth K, Uplekar M, Ottmani S. Stop TB patnership: AN ACTION FRAMEWORK FOR HIGHER AND EARLIER TB CASE DETECTION. Framework. Geneva; 2009.
42. World Health Organization. STRENGTHENING HEALTH SYSTEMS TO IMPROVE HEALTH OUTCOMES:WHO’S FRAMEWORK FOR ACTION. Geneva, Switzerland; 2007.
43. Seid A, Metaferia Y. Factors associated with treatment delay among newly diagnosed tuberculosis patients in Dessie City and surroundings, Northern Central Ethiopia: A cross-sectional study. BMC Public Health. 2018;18: 1–13. doi: 10.1186/s12889-018-5823-9 30055593
44. Kleinman A. Concepts and a model for the comparison of medical systems as cultural systems. Social Science and Medicine Part B Medical Anthropology. 1978;12: 85–93. doi: 10.1016/0160-7987(78)90014-5
45. Fenenga CJ, Boahene K, Arhinful D, De Wit TR, Hutter I. Do prevailing theories sufficiently explain perceptions and health-seeking behavior of Ghanaians? International Journal of Health Planning and Management. 2014;29: 26–42. doi: 10.1002/hpm.2159 23303726
46. Huong NT, Vree M, Duong BD, Khanh VT, Loan VT, Co NV., et al. Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: A cross-sectional study. BMC Public Health. 2007;7: 1–8. doi: 10.1186/1471-2458-7-1
47. Fluegge K, Malone LL, Nsereko M, Okware B, Wejse C, Kisingo H, et al. Impact of geographic distance on appraisal delay for active TB treatment seeking in Uganda: A network analysis of the Kawempe Community Health Cohort Study. BMC Public Health. 2018;18. doi: 10.1186/s12889-018-5648-6 29940918
48. Said K, Hella J, Mhalu G, Chiryankubi M, Masika E, Maroa T, et al. Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania. Infectious Diseases of Poverty. 2017;6. doi: 10.1186/s40249-017-0236-z
49. Ukwaja KN, Alobu I, Nweke CO, Onyenwe EC. Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: A cross-sectional study. BMC health services research. 2013;13: 1–9. doi: 10.1186/1472-6963-13-1
50. Mesfin MM, Newell JN, Walley JD, Gessessew A, Madeley RJ. Delayed consultation among pulmonary tuberculosis patients: A cross sectional study of 10 DOTS districts of Ethiopia. BMC Public Health. 2009;9: 1–10. doi: 10.1186/1471-2458-9-1
51. Getnet F, Hashi A, Mohamud S, Mowlid H, Klinkenberg E. Low contribution of health extension workers in identification of persons with presumptive pulmonary tuberculosis in Ethiopian Somali Region pastoralists. BMC Health Services Research. 2017;17: 1–9. doi: 10.1186/s12913-016-1943-z
52. Datiko DG, Yassin MA, Theobald SJ, Blok L, Suvanand S, Creswell J, et al. Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: A large-scale implementation study. BMJ Global Health. 2017;2: 1–8. doi: 10.1136/bmjgh-2017-000390 29209537
53. Kerrigan D, West N, Tudor C, Hanrahan CF, Lebina L, Msandiwa R, et al. Improving active case finding for tuberculosis in South Africa: Informing innovative implementation approaches in the context of the Kharitode trial through formative research. Health research policy and systems. 2017;15: 1–8. doi: 10.1186/s12961-016-0162-8
54. Chen C, Yang C-G, Gao X, Lu Z-Z, Tang F-X, Cheng J, et al. Community-based active case finding for tuberculosis in rural western China: a cross-sectional study. The International Journal of Tuberculosis and Lung Disease. 2017;21: 1134–1139. doi: 10.5588/ijtld.17.0123 29037293
55. Workie NW, Ramana GN. The health extension program in Ethiopia. The World Bank. Washington DC; 2013.
56. Francis E, Undiandeye A, Akinseye VO, Okon KO, Kazeem HM, Ayuba C, et al. Diagnostic performance of GeneXpert and Ziehl-Neelson microscopy in the detection of tuberculosis in Benue State, Nigeria. Alexandria Journal of Medicine. 2018;54: 529–533. doi: 10.1016/j.ajme.2018.09.002
57. Rasool G, Khan AM, Mohy-ud-din R, Riaz M. Detection of Mycobacterium tuberculosis in AFB smear-negative sputum specimens through MTB culture and GeneXpert ® MTB / RIF assay. International Journal of Immunopathology and Pharmacology. 2019;33: 1–6. doi: 10.1177/2058738419827174 30791749
58. Kaji A, Thi SS, Smith T, Charunwatthana P, Nosten FH. Challenges in tackling tuberculosis on the Thai-Myanmar border: indings from a qualitative study with health professionals. BMC Health Services Research. 2015;15: 1–9. doi: 10.1186/s12913-014-0652-8
59. Chimbatata NBW, Zhou C, Chimbatata CM, Xu B. Post-2015, why delay to seek healthcare? Perceptions and field experiences from TB healthcare providers in northern Malawi: a qualitative study. Infectious Diseases of Poverty. 2017;6: 4–11. doi: 10.1186/s40249-016-0222-x
60. Pearson A. Minimizing errors in health care: Focusing on the ‘root cause’ rather than on the individual. International Journal of Nursing Practice. 2005;11.
61. Harel Z, Silver SA, Mcquillan RF, Weizman AV, Thomas A, Chertow GM, et al. How to Diagnose Solutions to a Quality of Care Problem. Clinical Journal of the American Society of Nephrology. 2016;11: 901–907. doi: 10.2215/CJN.11481015 27016495
62. The Global Fund. Best Practices on TB Case Finding and Treatment-Reflection and lessons from West and Central Africa and Beyond. Geneva, Switzerland; 2018.
63. Woldesemayat EM, Datiko DG, Lindtjørn B. Follow-up of chronic coughers improves tuberculosis case finding: Results from a community-based cohort study in Southern Ethiopia. PLoS ONE. 2015;10. doi: 10.1371/journal.pone.0116324
64. Shenoi SV., Moll AP, Brooks RP, Kyriakides T, Andrews L, Kompala T, et al. Integrated tuberculosis/human immunodeficiency virus community-based case finding in rural South Africa: Implications for tuberculosis control efforts. Open Forum Infectious Diseases. 2017;4: 1–7. doi: 10.1093/ofid/ofx092 28695145
65. Oshi, Daniel C. Joachim C. Alobu OmejeIsaac N., Chukwu Ngozi E., Chukwuemeka Nwokocha OF et. al. An Evaluation of Innovative Community‑based Approaches and Systematic Tuberculosis Screening to Improve Tuberculosis Case Detection in Ebonyi State, Nigeria. International Journal of Mycobacteriology. 2017;6: 264–7. doi: 10.4103/ijmy.ijmy_104_17
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