Barriers to completing TB diagnosis in Yemen: services should respond to patients' needs.
Barriers to completing TB diagnosis in Yemen: services should respond to patients' needs.
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DOI：
10.1371/journal.pone.0105194
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Theobald SJ
中科院分区：
文献类型：
--
作者：
Anderson de Cuevas RM;Al-Sonboli N;Al-Aghbari N;Yassin MA;Cuevas LE;Theobald SJ
获得结核病诊断是获得特定治疗的先决条件，但国家方案遗漏了全世界估计新病例的三分之一。这项研究调查了阻碍也门成年人就诊和完成结核病诊断过程的经济、地理、社会文化和卫生系统因素，为旨在改善患者获得服务的干预措施提供信息。该研究采用混合方法设计，包括横断面调查和深度访谈（IDI）以及放弃诊断或登记治疗的患者的焦点小组讨论（FGD）。2009年至2010年期间在也门萨那的大型政府转诊中心就诊的咳嗽≥2周的成人有资格参与研究。497和446（89.7%）参与者参加服务的第一天和第二天进行了调查，并进行了48个IDI和12个FGD。大多数患者处境不利，识字率低（61%为文盲），来自农村地区（47%），与同伴一起就诊（84%）。确定的就诊的主要障碍是诊所和交通费用（由同伴增加）、离家距离、对私人服务的偏好、强烈的社会耻辱以及对诊断过程缺乏了解。患者和医生报告的诊断之间存在差异，46%的患者不知道结核病治疗是免费的。女性比男性面临更多的入学困难。化验所提供首天阴性涂片结果及转介病人往私营机构的做法，亦令病人不愿再返院。使结核病诊断服务更接近社区和解决患者在就诊时面临的多重障碍的战略对于增加结核病诊断和护理的可及性至关重要。
Obtaining a diagnosis of tuberculosis (TB) is a prerequisite for accessing specific treatment, yet one third of estimated new cases are missed worldwide by National Programmes. This study investigated economic, geographical, socio-cultural and health system factors hindering adults' attendance and completion of the TB diagnostic process in Yemen, to inform interventions designed to improve patient access to services. The study employed a mixed methods design comprising a cross-sectional survey and In-Depth-Interviews (IDIs) and Focus Group Discussions (FGDs) among patients abandoning the diagnosis or registering for treatment. Adults with cough of ≥2 weeks attending a large governmental referral centre in Sana'a, Yemen, between 2009 and 2010, were eligible to participate. 497 and 446 (89.7%) participants were surveyed the first and second day of attending the services and 48 IDIs and 12 FGDs were also conducted. The majority of patients were disadvantaged and had poor literacy (61% illiterate), had travelled from rural areas (47%) and attended with companions (84%). Key barriers for attendance identified were clinic and transport costs (augmented by companions), distance from home, a preference for private services, strong social stigma and a lack of understanding of the diagnostic process. There were discrepancies between patient- and doctor-reported diagnosis and 46% of patients were unaware that TB treatment is free. Females faced more difficulties to attend than men. The laboratory practice of providing first-day negative smear results and making referrals to the private sector also discouraged patients from returning. Strategies to bring TB diagnostic services closer to communities and address the multiple barriers patients face to attend, will be important to increase access to TB diagnosis and care.
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DOI：
10.2471/blt.06.033167
发表时间：
2007-08-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Kemp, Julia R;Mann, Gillian;Squire, Stephen Bertel
通讯作者：
Squire, Stephen Bertel
影响因子：
3.3
作者：
Cambanis, A;Yassin, MA;Cuevas, LE
通讯作者：
Cuevas, LE
影响因子：
168.9
作者：
Dye, C;Garnett, GP;Williams, BG
通讯作者：
Williams, BG
影响因子：
2.2
作者：
Ramsay, Andy;Yassin, Mohammed Ahmed;Cuevas, Luis Eduardo
通讯作者：
Cuevas, Luis Eduardo
DOI：
10.1080/13548500600595277
发表时间：
2006-08-01
期刊：
Psychology, health & medicine
影响因子：
--
作者：
Macq, J;Solis, A;Martinez, G
通讯作者：
Martinez, G