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Lived experiences of tuberculosis patients and their implications for early tuberculosis case identification and management in pastoralist community setting: a qualitative study in Borena zone, Oromia region of Ethiopia.

ABSTRACT: BACKGROUND:Ethiopia has highly diversified population with notable socioeconomic and cultural differences. Regardless of the differences, short course directly observed treatment,where patients should take drugs under direct observasion of health care providers, is uniformly applied all over the country. Evidences are scarce on how well does this uniform approach fits with the pastoral community setting. The purpose of this study was to explore lived experiences of TB patients in the pastoral community under the uniform approach, and their implications to early case identification and management. METHOD:Qualitative method with phenomenological study design was undertaken to explore lived experiences of TB patients. Patients from all levels of health care (hospital, health center and health post) were included. Experience of both drug susceptible and drug resistant TB patients were documented. Twenty one patients, who consented to in the study, were selected by a convenience sampling method. In-depth interview was conducted using a semi-structured interview guide and the interview ended subsequent to information saturation. The interview was audio recorded; and field notes were also taken. Data analysis was done concurrently with the data collection using a word processor designed for qualitative text analysis. InductiveThematic analysis was undertaken to identify key themes. RESULTS:Twenty one patients (eight from hospitals, nine from health centers and four from health posts) were interviewed. Three of the eight hospital patients were on drug resistant tuberculosis (TB) treatment. Sixty two codes, five code categories and three themes emerged from the interviews. The three themes were health system, stigma and discrimination, and socioeconomic problem related experiences. Inaccessibility to health facilities due to scattered settlement and mobility, delay in care seeking TB symptoms, low index of suspecting TB by care providers, fear of stigma and indirect treatment related costs were some of the codes identified. CONCLUSION:TB patients in the pastoral setting were experiencing multifaceted challenges with the current application of 'one-size-fits-all' approach which implied hampered timely case identification and compromised patient management. Therefore, designing context appropriate intervention approach is required to ensure unprejudiced services.

SUBMITTER: Megerso A

PROVIDER: S-EPMC7547407 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Lived experiences of tuberculosis patients and their implications for early tuberculosis case identification and management in pastoralist community setting: a qualitative study in Borena zone, Oromia region of Ethiopia.

Megerso Abebe A Deyessa Negussie N Jarso Godana G Worku Alemayehu A

BMC health services research 20201009 1

<h4>Background</h4>Ethiopia has highly diversified population with notable socioeconomic and cultural differences. Regardless of the differences, short course directly observed treatment,where patients should take drugs under direct observasion of health care providers, is uniformly applied all over the country. Evidences are scarce on how well does this uniform approach fits with the pastoral community setting. The purpose of this study was to explore lived experiences of TB patients in the pas ...[more]

PMID: 33036606

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Project description:BackgroundUndernutrition is cellular imbalance between supply of nutrients, energy and body's demand to ensure growth, maintenance, and specific function. However, there was no study conducted earlier on this topic in East Borena Zone.ObjectiveTo assess the prevalence of undernutrition and associated factors among pregnant women in East Borena Zone, Liban District.MethodA community-based cross-sectional study was conducted on 420 study participants from November 20 to December 2021. The systematic sampling technique and simple random sampling methods were used to select study participants. Data were double entered into Epi-info software version 7 and SPSS version 21 software for analysis. Descriptive statistics were used to describe the characteristics of study participants. Bivariate and multivariable logistic regressions were carried out to identify the association between independent and dependent variables by measuring the adjusted odds ratio and 95% confidence interval. P-values less than 0.05 were considered statistically significant.ResultsPrevalence of undernutrition among pregnant women was about (44.9%) of family monthly income [AOR = 8.72 (4.80, 15.83)], women's decision-making autonomy [AOR = 0.40 (0.19, 0.82)], skipping meal [AOR = 2.62 (1.41, 4.89)], substance use [AOR = 2.01 (1.07, 3.77)], household food insecurity [AOR = 2.01 (1.06, 3.80)], lack of prenatal dietary advice [AOR = 2.73 (1.53, 4.89)], absence of household latrine [AOR = 9.23 (3.48, 24.46)], not participating health development army's meeting at village level [AOR = 3.01 (1.57, 5.72)] and hand washing habit [AOR = 6.55 (3.02, 14.20)] had shown statistically significant association with undernutrition.ConclusionThe prevalence of undernutrition among pregnant women was high income. Women's decision-making autonomy, skipping meals, substances use, household food insecurity, lack of prenatal dietary advice, poor hand washing habit, lack household of latrine, and not participation in health development army's meeting were found to be predictors of the undernutrition.

Project description:ObjectiveTo demonstrate the impact of interventions on tuberculosis (TB) case detection in mining and pastoralist districts in southeastern Ethiopia over a 10-year period.DesignLongitudinal quasi-experimental study.SettingHealth centres and hospitals in six mining districts implemented interventions and seven nearby districts functioned as controls.ParticipantsData from the national District Health Information System (DHIS-2) were used for this study; therefore, people did not participate in this study.InterventionsDirected at training, active case finding and improving treatment outcomes.Primary and secondary outcome measuresPrimarily, trends in TB case notification and percentage of bacteriologically confirmed TB-as collected by DHIS-2-between pre-intervention (2012-2015) and post-intervention (2016-2021) were analysed. Secondarily, post-intervention was split into early post-intervention (2016-2018) and late post-intervention (2019-2021) to also study the long-term effects of the intervention.ResultsFor all forms of TB, case notification significantly increased between pre-intervention and early post-intervention (incidence rate ratio (IRR): 1.21, 95% CI: 1.13, 1.31; p<0.001) and significantly decreased between pre-intervention/early post-intervention and late post-intervention (IRR: 0.82, 95% CI: 0.76, 0.89; p<0.001 and IRR: 0.67, 95% CI: 0.62, 0.73; p<0.001). For bacteriologically confirmed cases, we found a significant decrease between pre-intervention/early post-intervention and late post-intervention (IRR: 0.88, 95% CI: 0.81, 0.97; p<0.001 and IRR: 0.81, 95% CI: 0.74, 0.89; p<0.001). The percentage of bacteriologically confirmed cases was significantly lower in the intervention districts during pre-intervention (B: -14.24 percentage points, 95% CI: -19.27, -9.21) and early post-intervention (B: -7.78, 95% CI: -15.46, -0.010; p=0.047). From early post-intervention to late post-intervention, we found a significant increase (B: 9.12, 95% CI: 0.92 to 17.33; p=0.032).ConclusionsThe decrease in TB notifications in intervention districts during late post-intervention is possibly due to a decline in actual TB burden as a result of the interventions. The unabated increase in case notification in control districts may be due to continued TB transmission in the community.

Project description:BACKGROUND:Delay in diagnosis and treatment of pulmonary tuberculosis (PTB) leads to severe disease, adverse outcomes and increased transmission. Assessing the extent of delay and its effect on disease progression in TB affected settings has clinical and programmatic importance. Hence, the aim of this study was to investigate the possible effect of delay on infectiousness (cavitation and smear positivity) of patients at diagnosis in Somali pastoralist area, Ethiopia. METHODS:A cross-sectional study was conducted between December 2017 and October 2018, and 434 newly coming and confirmed PTB patients aged ≥15 years were recruited in five facilities. Data were collected using interview, record-review, anthropometry, Acid-fast bacilli and chest radiography techniques. Log-binomial regression models were used to reveal the association of delay and other factors associated with cavitation and smear positivity, and ROC Curve was used to determine discriminative ability and threshold delays. RESULTS:Median age of patients was 30 years. Of all, 62.9% were males, and 46.5% were pastoralists. Median diagnosis delay was 49 days (IQR = 33-70). Cavitation was significantly associated with diagnosis delay [P < 0.001]; 22.2% among patients diagnosed within 30 days of illness and 51.7% if delay was over 30 days. The threshold delay that optimizes cavitation was 43 days [AUC (95% CI) = 0.67(0.62-0.72)]. Smear positivity was significantly increased in patients delayed over 49 days [p = 0.02]. Other factors associated with cavitation were age ≤ 35 years [APR (95% CI) =1.3(1.01-1.6)], chronic diseases [APR (95% CI) = 1.8(1.2-2.6)] and low MUAC*female [APR (95% CI) = 1.8(1.2-2.8)]. Smear positivity was also associated with age ≤ 35 years [APR (95% CI) =1.4(1.1-1.8)], low BMI [APR (95% CI) =1.3(1.01-1.7)] and low MUAC [APR (95% CI) =1.5(1.2-1.9)]. CONCLUSION:This study highlights delay in diagnosis of pulmonary TB remained high and increased infectiousness of patients in pastoral settings of Ethiopia. Hence, delay should be targeted to improve patient outcomes and reduce transmission in such settings.

Project description:BackgroundThe dog and cat population data is generally scarce in developing countries due to absence of surveys. The demography of owned dogs and cats, and the associated ownership characteristics, are essential for the control of pet population and zoonosis. This study was conducted in three towns of West Shoa Zone of Ethiopia with the objectives of assessing demographic characteristics of owned dogs and cats and determinants of ownership.ResultsAbout 65.1% (95% CI: 62.1-69.8%) of the householders own dogs, 39.2% (95% CI: 35.8-43.8%) own cats, and 30.6% (95% CI: 27.4-35.0%) own both. The majority of the dog-owning households own a single dog (74.8%) and cat (74.9%). There were significantly higher proportion of dog and cat-owning households in Bako than Ambo and Gojo towns. The human to owned-dog ratio was 6:1, and that of cat ratio was 10:1. There were more male dogs (72.1%) and more female cats (59.7%). The male to female sex ratio was estimated at 3:1 for the dog while nearly 1:1 for cats. About 37.5% of the owned dogs were indoor, and 62.5% have free access to outside. Dogs and cats were acquired as a gift from families, neighbors, and friends. The identified reason for not owning dogs/cats were fear of zoonosis, dislike, no time to devote, benefit not realized, and shortage of finance. Logistic regression analysis identified study town, community type, gender of head of household, ownership of other animals as determinants for dog/cat ownership. Besides, possessing dogs was significantly associated with cat ownership.ConclusionThe current study provide insights into the determinants of dogs/cats ownership and their demographic characteristics in Ethiopia. Dogs are more commonly owned, but the household determinants for dog and cat ownership were comparable. Means of obtaining and reason of owning or abandoning dogs/cats is partly different from those reported in the developed countries. The results of this study could be used for the provision of veterinary services, quantifying health risks and benefits associated with dog/cat ownership, and control of pet population and related zoonosis.

Project description:BackgroundThe main target of tuberculosis control and prevention is to detect incident cases as quickly as possible and also to prevent the occurrence of disease. It is also the responsibility of the health facility to screen the contacts, identifying children for prophylactic therapy. However, the target is difficult to meet due to issues within health facilities that cause health system diagnostic delays. Despite this, there is no information explored why health system diagnostic delays among tuberculosis patients.MethodA qualitative study was conducted by using different data collection methods and sources. Seventeen DOT providers, five laboratory professionals, six program managers, and seven Tuberculosis patients were interviewed. In addition, 22 governmental health facilities were observed for the availability of resources. Data obtained from the in-depth interviews was transcribed, coded, categorized, and thematized manually.ResultHealth system Diagnosis delays reasons were related with sample collection procedures, poor competency of health professionals, in addition to absences or scarcity of health professionals, medical products, and basic infrastructure. We found 18 health facilities without skilled personnel in the OPD, 7 health facilities with a broken microscope, and almost all health facilities without a separate room for sputum examination. Furthermore, 12 (54.5%) and 14 (63.6%) health facilities lacked access to water and electric power, respectively.ConclusionMany reasons for TB diagnosis delays have been identified in the study area. Poor competence of health workers and scarcity of resources were identified. Depending on the finding, we suggest strengthening the health workers' training. Concrete strategies need to be designed to retain professionals. Training on human resource planning and budget preparation is needed for front-line managers. Managers have to work on the maintenance of diagnostic tools and facilitate transportation. The rural health facilities need to use another alternative power source.

Dataset Information

Lived experiences of tuberculosis patients and their implications for early tuberculosis case identification and management in pastoralist community setting: a qualitative study in Borena zone, Oromia region of Ethiopia.

Publications

Lived experiences of tuberculosis patients and their implications for early tuberculosis case identification and management in pastoralist community setting: a qualitative study in Borena zone, Oromia region of Ethiopia.

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