Addressing constraints to informal providers’ involvement in tuberculosis control: a qualitative study of patent medicine dealers and tuberculosis programme managers

Abstract

Background A major constraint to tuberculosis control is low case finding with under-reporting to national authorities. Evidence shows that Patent Medicine Dealers are first port of call for most people with symptoms of tuberculosis, yet there is poor referral of such clients to tuberculosis treatment facilities for further evaluation. This study investigated constraints to involvement of Patent Medicine Dealers in tuberculosis control. Methods This was a cross-sectional qualitative study among Patent Medicine Dealers and Tuberculosis Control Programme Managers in Ebonyi State Nigeria. Sixty-four Patent Medicine Dealers and five Tuberculosis Control Programme Managers were interviewed using Focus Group Discussion and In-Depth Interview respectively. Data was collected with electronic audio-recording device and analyzed using thematic approach. Results There are some knowledge gaps about tuberculosis signs, symptoms, free-treatment policy and mode of operation of care service among Patent Medicine Dealers. Patent Medicine Dealers and Tuberculosis Control Programme Managers are willing to collaborate in tuberculosis control effort but constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to keep up with such demands are obvious constraints. Conclusions Knowledge gaps in tuberculosis, its control, constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to satisfy such demands are constraints to involvement of Patent Medicine Dealers in tuberculosis control. More robust engagement of Patent Medicine Dealers in tuberculosis control with clear job description through tuberculosis education and provision of incentives to support them are recommended policy approaches to improve linkage of clients to tuberculosis treatment facilities.

Tuberculosis treatment management in primary healthcare sectors: a mixed-methods study investigating delivery status and barriers from organisational and patient perspectives

“…Our results indicate that poor socioeconomic characteristics and low TB-related health literacy together impede TTMS delivery. As patients with low socioeconomic features were often found to have a lower educational background, poor health literacy, and were more likely to be non-adherent, they were more likely to refuse HCWs’ supervision, which is consistent with other studies 18 53 54. In addition, we found that TTMS delivery among migrant patients was challenging for HCWs because it was difficult to reach them.…”

Patient Health Seeking Behavior and Choice of Place of Care among Tuberculosis Clients in Selected States in Nigeria

“…The low patronage of other places/informal sector of care reported in current study is good as they contribute to delay in accessing quality care, prolonged transmission of diseases and consequently hampers TB control. For instance, a study in Ebonyi State, Nigeria reported that practices toward presumptive TB clients among PPMVs were poor as shown in their inadequate referral of clients with persistent cough to DOTS facilities, prolonged treatment of clients with persistent cough with antibiotics which have anti TB activity and untimely poor referral of clients for diagnosis and treatment [30]. The PMVs lack knowledge about tuberculosis signs, symptoms and have possessive mode of operation of care service [31].…”

Improving TB Case Detection Through Active Case-Finding: Results of Multiple Intervention Strategies in Hard-to-Reach Riverine Areas of Southern Nigeria

“…29 This necessitates that systematic screening for comorbidities, prompt diagnosis, and management of other infections be carried out in clinically diagnosed cases. 30,31 Second to the highest proportion of TB cases among the screened populations is PLWH. It is established that PLWH are 20 times more likely than those without HIV to become sick with TB because HIV weakens the immune system, which makes it harder for the body to fight TB bacilli.…”