Community Contribution to Tuberculosis Care in the Krachi West District of Ghana: A Qualitative Study

Abstract

Background. Eradicating tuberculosis (TB) is one of the targets of the recently constituted Sustainable Development Goal (SDG) Three. In the light of limitations inherent in prevailing tuberculosis care and the global urgency to improve TB care, decentralising TB care beyond health facilities by harnessing the contribution of communities is essential in ensuring effective tuberculosis care. In this paper, we explored community contribution to TB care in the Krachi West District of Ghana. Methods. In this qualitative study, 24 TB stakeholders made up of 7 health workers, 9 tuberculosis patients, 4 community health volunteers, 2 treatment supporters, and 2 opinion leaders were interviewed. Data collected were analysed manually, but thematically. Statements of the participants were presented as quotes to substantiate issues discussed. Results. Community contribution to TB care was low. Most of the community members were not aware of any community level activity towards tuberculosis care. Though patients were mainly the ones responsible for the selection of their treatment supporters, there were instances where health workers selected supporters for them without their consent. Some treatment supporters were also not given any education concerning their roles in supporting their patients, resulting in some patients defaulting treatment and others taking their medications wrongfully. Conclusion. Our study revealed low community involvement in tuberculosis care in the Krachi West District of Ghana. Community sensitisation on the World Health Organisation’s Directly Observed Treatment Strategy (which Ghana adopted in 1994) to increase community involvement in tuberculosis activities is, therefore, recommended.

Exploring Community Tuberculosis Program in the Pastoralist Setting of Ethiopia: a Qualitative Study of Community Health Workers' Perspectives in Borena Zone, Oromia Region

“…Furthermore, there is a need for CHWs capacity building trainings to enable them to collect and x sputum samples so that referral related challenges of the cases will be elevated. This is consistent with other studies ndings [14,32,41,43]. It is also suggested by the CHWs that there is a need to further TB treatment decentralization to facility level where trained treatment supporters can work in collaboration with the CHWs.…”

“…In the main theme, factors contributing to inadequate community TB performance, one of the categories emerged was community related factors such as awareness on TB, perception, acceptance to CHWs and discrimination of TB patients. These ndings, particularly the in uence of community awareness on TB, are consistent with reports from other studies in Africa [14,32,32,33,36]. The other identi ed factor contributing to the inadequate community TB program performance, problem in physical access to TB care facilities, is in agreement with reports from other studies [14,35].…”

“…Pastoralist community has well organized and functional social organization. This social organization in which the community has its own leaders in each village and settlement can help the community TB program comprehensively and this recommendation is consistent with ndings of other studies conducted in similar settings [32,34,41,42].…”

“…One indicator of the poor performance was inadequate presumptive TB case identi cation and referral which consistent with other study reports [30,31]. Inappropriate community TB approach where DOTs is highly compromised may lead to poor adherence to anti TB treatment [32,33]. This compromization of the DOTs service can in turn lead to the development of drug resistance by Mycobacterium TB bacteria which is emerging challenge to TB prevention and control.…”

Reflecting on tuberculosis case notification and treatment outcomes in the Volta region of Ghana: a retrospective pool analysis of a multicentre cohort from 2013 to 2017

“…Generally, while treatment success and cure rates declined, the proportion of people who died due to TB, experienced treatment failure, and those lost to follow up showed fluctuating trends over the years but with slight increases from 2015 to 2016. This poor performance could be due to patients’ delay in seeking TB care as a result of stigma, lack of knowledge regarding TB signs and symptoms, inadequate community involvement in TB care, and lack of treatment supervision [19, 20]. Community TB care, an intervention that recognises social capital and connectedness as a tool to effective TB care and prevention has been reported to be effective in improving TB treatment outcomes in many parts of the world, including Ghana [5, 21, 22], hence needs to be pursued vigorously in the Volta region in order to achieve improved treatment outcomes.…”