Exploring local realities: Perceptions and experiences of healthcare workers on the management and control of drug-resistant tuberculosis in Addis Ababa, Ethiopia

Abstract

BackgroundDrug-resistant tuberculosis (DR-TB) remains a major health security threat worldwide. The effectiveness of implementation of DR-TB control strategies has been a subject of research and controversy. In resource-limited settings, using conventional medicine as the only framework to explain DR-TB gives a rather incomplete picture of the disease. This study intended to explore the perceptions and experiences of healthcare workers on the management and control of DR-TB in Addis Ababa, Ethiopia.MethodsThe study employed a qualitative methodology with an inductive approach and a thematic analysis. It involved in-depth interviews with healthcare workers providing clinical services to DR-TB patients in 10 public healthcare facilities in Addis Ababa, Ethiopia.ResultsA total of 18 healthcare workers participated until data saturation, which included 12 clinical nurses, four health officers and two medical laboratory technicians. The findings show that healthcare workers perceive DR-TB as a growing public health threat in Ethiopia, due to factors such as poverty, poor nutrition, crowded settings, healthcare worker and general public awareness of DR-TB, lack of good governance and culture.ConclusionThe perspectives drawn from the healthcare workers shed more light on the image of DR-TB in a developing country context. It has been shown that understanding DR-TB is not confined to what can be drawn from the sphere of biomedicine. There are also interconnected barriers, which predict a dystopia in the epidemiology of DR-TB. Bringing DR-TB under control requires taking a step back from an overwhelming focus on the biomedical facets of the disease, and employ critical thinking on the wider social and structural forces as equally important targets.

Containment of COVID-19 in Ethiopia and implications for tuberculosis care and research

“…Social stigma has been witnessed for patients co-infected with TB. Health education has the potential mitigating stigmatization [15,16]. Thus, a unique health education platform that connects the two diseases is strongly needed.…”

Real-Time Impact of COVID-19 on Clinical Care and Treatment of Patients with Tuberculosis: A Multicenter Cross-Sectional Study in Addis Ababa, Ethiopia

“…The country confirmed its first case of COVID-19 on March 13, 2020, and as of June 11, 2021, there have been 273 678 people confirmed positive, of whom 4 231 died (case fatality rate = 1.55%) and 249 028 (90.99%) recovered [16]. Ethiopia has documented success in reducing common infectious diseases in the last two-and-a-half decades, while diseases such as tuberculosis (TB), HIV, lower respiratory infections, and diarrheal diseases are still the major causes of morbidity and mortality in the country [17][18][19][20][21][22][23].…”

Pragmatic Management of Drug-Resistant Tuberculosis: A Qualitative Analysis of Human Resource Constraints in a Resource-Limited Country context—Ethiopia

“…The same is true for the workload among HCWs, as a lack of medical resources is reported to be one factor for a high nursing workload and burnout [ 55 ]. We propose that employing the view that DR-TB is a disease of poverty [ 11 ] in the Ethiopian context can further explain the effect of resource limitation on effective DR-TB care.…”

“…Facilitated by co-infections like HIV/AIDS, and socioeconomic situations including poverty and inequality, TB remains a huge challenge to the country's efforts in achieving key international health indicators. The pragmatic management of DR-TB is influenced by various factors, including poverty, crowded settings, poor nutrition, general public awareness of DR-TB, and drug toxicity [11][12][13][14]. The risk factors for DR-TB in Ethiopia include previous exposure to anti-TB treatment, exposure to a known MDR-TB case, history of using a poor or unknown quality of TB drugs, treatment in poorly performing control programmes, poor service delivery, co-morbid conditions associated with malabsorption, and HIV/AIDS [15][16][17][18][19].…”