Patient and community experiences of tuberculosis diagnosis and care within a community-based intervention in Ethiopia: a qualitative study.
Patient and community experiences of tuberculosis diagnosis and care within a community-based intervention in Ethiopia: a qualitative study.
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DOI：
10.1186/s12889-015-1523-x
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发表时间：
2015-02-25
影响因子：
4.5
通讯作者：
Yassin MA
中科院分区：
文献类型：
--
作者：
Tulloch O;Theobald S;Morishita F;Datiko DG;Asnake G;Tesema T;Jamal H;Markos P;Cuevas LE;Yassin MA
埃塞俄比亚的结核病控制方案依赖于被动发现结核病病例。埃塞俄比亚主要以农村为基础的人口利用卫生设施的机会有限，这对结核病服务造成了障碍。通过与卫生推广工作者的伙伴关系，实施了旨在使结核病诊断和治疗服务更接近社区的一揽子干预措施。他们在社区一级开展宣传、交流和社会动员活动，确定有症状的个人，收集痰液，制备涂片和固定载玻片。实地监督员向卫生保健工作者提供支持，向实验室提供涂片，向卫生保健工作者反馈结果，并跟踪涂片阴性病例。被诊断患有结核病的患者在社区开始治疗，他们通过当地卫生站得到监督员和卫生保健工作者的支持。病例通报从每年每100 000人64例增加到127例。这项定性研究评估了社区成员寻求治疗的行为和他们对干预措施的看法。深入访谈（n=36）进行了六个地区的参与者。参与者是社区干预的客户，目前正在接受结核病治疗或结核病筛查阴性。成绩单被翻译成英文，并制定了一个专题分析框架的不同步骤的症状的个人采取的干预措施。使用NVivo软件完成编码并运行查询。在采取干预措施之前，许多慢性咳嗽患者没有获得结核病服务。与会者描述了他们在利用地区一级的卫生设施方面面临的困难，这些设施需要到社区外旅行。所有参与者都感谢提供痰液样本并从其所在社区获得结果。这种干预措施的可接受性很高;对贫穷的妇女和男子以及身体太弱而不能旅行的人来说，好处尤其明显。一些参与者似乎更喜欢结核病的诊断，这可能是因为获得阴性涂片显微镜检查结果带来了进一步的不确定性，需要寻求进一步的调查。有证据表明，高度贫困的农村人口，特别是妇女，面临着卫生需求得不到满足和结核病得不到诊断的高风险。将结核病服务纳入社区对于难以获得卫生设施的弱势群体来说是一种可以接受的办法。在埃塞俄比亚，这种方法可以促进早期诊断和改善治疗结果。
The Ethiopian TB control programme relies on passive case finding of TB cases. The predominantly rural-based population in Ethiopia has limited access to health facilities creating barriers to TB services. An intervention package aimed to bring TB diagnosis and treatment services closer to communities has been implemented through partnership with health extension workers (HEWs). They undertook advocacy, communication and social mobilization (ACSM) activities, identified symptomatic individuals, collected sputum, prepared smears and fixed slides at community level. Field supervisors supported HEWs by delivering smeared slides to the laboratory, feeding back results to the HEWs and following up smear-negative cases. Patients diagnosed with TB initiated treatment in the community, they were supported by supervisors and HEWs through the local health post. Case notification increased from 64 to 127/100,000 population/year. This qualitative study assessed community members’ treatment seeking behaviour and their perceptions of the intervention. In-depth interviews (n=36) were undertaken with participants in six districts. Participants were clients of the community-based intervention, currently on TB treatment or those screened negative for TB. Transcripts were translated to English and a thematic analytical framework was developed guided by the different steps symptomatic individuals take within the intervention package. Coding was done and queries run using NVivo software. Prior to the intervention many patients with chronic cough did not access TB services. Participants described difficulties they faced in accessing district level health facilities that required travel outside their communities. Giving sputum samples and receiving results from within their home communities was appreciated by all participants. The intervention had a high level of acceptability; particularly clear benefits emerged for poor women and men and those too weak to travel. Some participants appeared to prefer a diagnosis of TB, this is likely because receiving a negative smear microscopy result brought further uncertainty and necessitated seeking further investigation. There is evidence rural populations with high levels of poverty, and in particular women, are at high risk of unmet health needs and undiagnosed TB. Embedding TB services within communities was an acceptable approach for vulnerable groups experiencing poor access to health facilities. In the Ethiopian context this approach can facilitate early diagnosis and improve treatment outcomes.
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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：
3.7
作者：
Abebe, Gemeda;Deribew, Amare;Colebunders, Robert
通讯作者：
Colebunders, Robert
影响因子：
3.3
作者：
Cambanis, A;Yassin, MA;Cuevas, LE
通讯作者：
Cuevas, LE
DOI：
10.2471/blt.05.023929
发表时间：
2006-06-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Hamid Salim, MA;Uplekar, Mukund;Lönnroth, Knut
通讯作者：
Lönnroth, Knut
影响因子：
3.7
作者：
Datiko, Daniel G.;Lindtjorn, Bernt
通讯作者：
Lindtjorn, Bernt