A qualitative assessment of challenges to tuberculosis management and prevention in Northern Ethiopia

Abstract

Setting/Objective The purpose of this study was to elicit Ethiopian hospital staff members’ understanding of challenges to effectively preventing, diagnosing and treating tuberculosis (TB). Design Qualitative data was collected via in-depth interviews and focus group discussions with seventy-four healthcare workers including physicians, nurses, pharmacists and laboratory technicians in five hospitals in the Northern Ethiopian regions of Amhara and Tigray. There was no intervention. Results Focus groups and interviews shared a number of prominent common themes. Respondents identified numerous challenges including active case identification, infection control practices, diagnostics including the absence of tuberculosis culture and drug-susceptibility testing capacity, and the lack of infrastructure for diagnosing and treating multi-drug resistant tuberculosis (MDRTB). Pharmacists noted a need for improved procurement practices, and pediatric dosages for tuberculosis medications. Providers shared concerns regarding isoniazid preventive therapy (IPT), health workforce challenges and the risk of contracting TB at the workplace. Conclusions Healthcare workers in the Northern Ethiopian regions of Tigray and Amhara identified many challenges to effectively preventing, diagnosing and treating tuberculosis. These challenges are complicated by severe resource constraints and challenges in attracting and retaining health care workers in government hospitals in centers outside Addis Ababa.

Barriers to the implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings: A review

“…A recurring theme throughout the different studies was the burden of travel for caregivers of children that had been advised to complete IPT. While financial cost was an issue for some, the duration of travel from people's homes to the nearest clinic appeared to be the principal issue for many . Seasonal farming demands and other family priorities, particularly for mothers, were often recognised as more important than taking children to the clinic .…”

“…While financial cost was an issue for some, the duration of travel from people's homes to the nearest clinic appeared to be the principal issue for many . Seasonal farming demands and other family priorities, particularly for mothers, were often recognised as more important than taking children to the clinic . To compound this, many clinics often reported significant waiting times, up to 4 h, and irregular scheduling of clinics, which further discouraged families from committing to the treatment process.…”

“…I have no confidence to explain IPT to the patient’ . An additional concern was the belief by many health‐care workers that IPT induces the development of antibiotic‐resistant TB, a claim for which there is currently limited evidence for . Increased emphasis on staff education and training in relation to IPT would be useful for maximising patient outcomes.…”

“…Education is an important issue but it is not the only impediment faced by health‐care workers trying to deliver IPT to children in TB‐endemic settings. Some health‐care centres lacked the equipment to rule out active TB, which they saw as necessary to initiating IPT, while others encountered supply chain difficulties in procuring sufficient isoniazid to provide patients . The labour‐intensive preparation of paediatric doses was reported as placing additional strain on already stretched staffing arrangements in some areas although child‐friendly dispersible formulations are now becoming available in most countries through the Global Development Fund .…”

A Peer Review of the Assessment of Knowledge and Treatment Seeking Behavior among Tuberculosis and Multi-Drug Resistant Tuberculosis Patients: A Case Control Study

“…Health provider delays include turnaround time of TB results, accuracy and sensitivity of the diagnostic testing methods, patient management between different health care providers and quality of specimens send to laboratories for investigations (Cowan, 2013). Most studies evaluated by Finnie et al, (2011) used a cross-sectional design.…”