Challenges TB control program

Published: 4 November 2020| Version 1 | DOI: 10.17632/ztdxvpy2k3.1
Contributor:
Sarmin Sultana

Description

Tuberculosis causes more than 70 thousand death each year in Bangladesh. The TB control program is decentralized to all levels of healthcare where the primary healthcare setting provides service to the majority of TB patients in the country. This mixed-method study was designed to identify recent challenges in controlling TB at primary healthcare centers in Bangladesh. Data were collected from six primary healthcare centers with a low TB case detection rate. For qualitative data, Key informant interview (KII) was conducted with six government and six non-government organization (NGO) health officials who were responsible for the coordination of the TB program at the Upazila level. The government officials were Upazila Health and Family Planning Officers (UHFPO). NGO officials were three TB-Leprosy Control Officers (TLCO) and three Upazilla Managers (UM). Interview guidelines for IDI focused on patient's early symptoms, care-seeking behavior, treatment initiation and continuation, and hygiene practice to prevent infection transmission. Interview guideline for KII was comprised of questions regarding the challenges faced in case finding and ensuring proper treatment, and administrative challenges. All interviews were audio-taped and transcribed verbatim. Initial key concepts (barriers in case finding, treatment initiation and continuation, and infection control measures) of qualitative data were derived from the literature review, which served as analytic categories or "master codes". A line-by-line analysis of the interview transcripts and observations was done to generate codes under analytic categories. Patient delay was related to poor care-seeking behavior, unfamiliarity with tuberculosis symptoms, and unavailability of healthcare facilities. Health system delay in case finding was related to inadequate manpower, unskilled staff, and limited diagnostic facilities. Every second patient reported non-adherence to the directly observed treatment short-course (DOTS) guideline. DOTS provider's inaccessibility, inadequate incentive, and unreasonable patient demand lead to non-adherence.

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The study places were purposively selected from a district-wise list of low TB case notification rate. Six Upazila (sub-district) Health Complexes (UHCs) based TB-DOTS facilities, three from each district, were selected randomly. Key informant interview (KII) was conducted with the highest designated government and six non-government organization (NGO) health officials. In-depth interviews (IDI) were conducted with twelve purposively selected TB patients, two from each UHC, considering equal gender representation. The guidelines for IDI and KII were developed in consultative meetings with epidemiologists, anthropologists, and TB experts. Interview guidelines for IDI focused on patient's early symptoms, care-seeking behavior, treatment initiation and continuation, and hygiene practice to prevent infection transmission. Interview guideline for KII was comprised of questions regarding the challenges faced in case finding and ensuring proper treatment, logistic supply, healthcare provider's adequacy, and training. After explaining the study objectives to the respondents, IDI and KII were conducted in isolated places. All interviews were audio-taped and transcribed verbatim. The average duration of interviews was 30 minutes. Separate sets of patients were interviewed face to face for quantitative data.