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


Autoři: Sujan Babu Marahatta aff001;  Rajesh Kumar Yadav aff001;  Deena Giri aff001;  Sarina Lama aff001;  Komal Raj Rijal aff002;  Shiva Raj Mishra aff003;  Ashish Shrestha aff004;  Pramod Raj Bhattrai aff004;  Roshan Kumar Mahato aff005;  Bipin Adhikari aff006
Působiště autorů: Manmohan Memorial Institute of Health Sciences, Soaltee mode, Kathmandu, Nepal aff001;  Central Department of Microbiology, Tribhuwan University, Kirtipur, Kathmandu, Nepal aff002;  University of Queensland, Queensland, Australia aff003;  National Tuberculosis Centre, Bhaktapur, Nepal aff004;  Dhulikhel Hospital, Dhulikhel, Nepal aff005;  Nepal Community Health and Development Centre, Kathmandu, Nepal aff006;  Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, United Kingdom aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227293

Souhrn

Background

Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal.

Methods

Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti.

Results

Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence and treatment completion were the need to visit health centre daily for DOTS treatment and associated constraints, complex treatment regimen, and the stigma.

Conclusions

Barriers embedded in health services and care seekers’ characteristics can be dealt by strengthening the peripheral health services. A continuous availability of (trained) human resources and equipment for diagnosis is critical. As well as increasing the awareness and collaborating with the traditional healers, health services utilization can be enhanced by compensating the costs associated with it, including the modification in current DOTS strategy by providing medicine for a longer term under the supervision of a family member, peer or a community volunteer.

Klíčová slova:

Equipment – Health economics – Health education and awareness – Health systems strengthening – Nepal – Transportation – Tuberculosis – Tuberculosis diagnosis and management


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