Care seeking and attitudes towards treatment compliance by newly enrolled tuberculosis patients in the district treatment programme in rural western Kenya: a qualitative study
Care seeking and attitudes towards treatment compliance by newly enrolled tuberculosis patients in the district treatment programme in rural western Kenya: a qualitative study
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DOI：
10.1186/1471-2458-11-515
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发表时间：
2011-06-29
影响因子：
4.5
通讯作者：
Marston, Barbara J.
中科院分区：
文献类型：
--
作者：
Ayisi, John G.;van't Hoog, Anna H.;Marston, Barbara J.
背景：影响结核病控制规划成功的两个主要问题是延误就诊和不坚持治疗。重要的是要了解导致这些问题的因素，特别是在结核病发病率高的资源有限的环境中。本研究的目的是评估肺结核患者的求医行为和保健经历，并确定患者可能无法完成治疗的原因。方法：我们对肯尼亚西部农村九家卫生机构的肺结核患者进行了定性的一对一深入访谈。31名患者，18名女性和13名男性参与了这项研究。所有人都居住在肯尼亚西部一个拥有健康和人口监测系统（HDSS）的地区。他们在2005年9月和10月安排的结核病门诊日接受了长达4周的治疗。这九个地点都提供诊断和治疗服务。其中8个是公共设施（3家医院和5个保健中心），1个是特派团保健中心。结果：大多数患者在寻求专业护理之前，最初使用草药或从售货亭或药房购买的药物进行自我治疗。报告的从最初症状到结核诊断的时间从3周到9年不等。对早期症状的误解和财政拮据是报告延误的最常见原因。我们还探讨了患者可能在完成治疗之前停止治疗的潜在原因。原因包括不知道结核病治疗的持续时间，在症状消退后停止治疗，以及缺乏家庭支持。结论：这项定性研究突出了肯尼亚西部农村结核病控制面临的重要挑战，并提供了有用的信息，这些信息在同一地区的定量研究中得到了进一步验证。
Background: The two issues mostly affecting the success of tuberculosis (TB) control programmes are delay in presentation and non-adherence to treatment. It is important to understand the factors that contribute to these issues, particularly in resource limited settings, where rates of tuberculosis are high. The objective of this study is to assess health-seeking behaviour and health care experiences among persons with pulmonary tuberculosis, and identify the reasons patients might not complete their treatment.Methods: We performed qualitative one-on-one in-depth interviews with pulmonary tuberculosis patients in nine health facilities in rural western Kenya. Thirty-one patients, 18 women and 13 men, participated in the study. All reside in an area of western Kenya with a Health and Demographic Surveillance System (HDSS). They had attended treatment for up to 4 weeks on scheduled TB clinic days in September and October 2005. The nine sites all provide diagnostic and treatment services. Eight of the facilities were public (3 hospitals and 5 health centres) and one was a mission health centre.Results: Most patients initially self-treated with herbal remedies or drugs purchased from kiosks or pharmacies before seeking professional care. The reported time from initial symptoms to TB diagnosis ranged from 3 weeks to 9 years. Misinterpretation of early symptoms and financial constraints were the most common reasons reported for the delay. We also explored potential reasons that patients might discontinue their treatment before completing it. Reasons included being unaware of the duration of TB treatment, stopping treatment once symptoms subsided, and lack of family support.Conclusions: This qualitative study highlighted important challenges to TB control in rural western Kenya, and provided useful information that was further validated in a quantitative study in the same area.