Grut Lisbet, Sanudi Lifah, Braathen Stine Hellum, Jürgens Thomas, Eide Arne H
SINTEF Technology and Society, Oslo, Norway.
REACH Trust, Lilongwe, Malawi.
PLoS One. 2015 Apr 1;10(4):e0122748. doi: 10.1371/journal.pone.0122748. eCollection 2015.
Tuberculosis occurs in all populations, but with higher prevalence in poor contexts. Vulnerable groups, including individuals with disability, run a particular risk due to poorer access to information and health services. Studying access to tuberculosis services for vulnerable groups in poor contexts may provide useful insight into the quality of such services in low-income contexts. This article aims to present a contextual understanding of access to tuberculosis services for people with disabilities in one district in southern Malawi. A qualitative method with semi-structured interviews and site observations was applied. In all, 89 participants were interviewed: 47 persons with disability, 11 parents/guardians of youths with disability, and the remaining 31 comprising eight health workers, four community rehabilitation assistants and volunteers, and 19 leaders in the community.Our main findings are that lack of information and knowledge, and considerable confusion related to tuberculosis, its cause and how to protect oneself, are major barrier to accessing services. Disease awareness and personal risk perception are key factors in this regard. Further findings concerns the pathways to tuberculosis related health services, in particular having a test and completing the treatment. The combination of lack of knowledge and barriers in accessing tests implies substantial availability and access problems.It is of importance to understand the combined impact of individual, social, contextual, and systems barriers to fully address the complexity of accessing tuberculosis services for vulnerable groups in poor populations. Lack of disability specific strategies in the local health services may be part of the reason why individuals with disability to not access such services.
结核病在所有人群中都有发生，但在贫困环境中的患病率更高。包括残疾人在内的弱势群体面临着特殊风险，因为他们获取信息和医疗服务的机会较差。研究贫困环境中弱势群体获得结核病服务的情况，可能有助于深入了解低收入环境中此类服务的质量。本文旨在对马拉维南部一个地区残疾人获得结核病服务的情况进行背景分析。采用了半结构化访谈和实地观察的定性研究方法。总共采访了89名参与者：47名残疾人、11名残疾青年的父母/监护人，其余31人包括8名医护人员、4名社区康复助理和志愿者以及19名社区领袖。我们的主要发现是，缺乏信息和知识，以及对结核病及其病因和如何自我保护存在相当大的困惑，是获得服务的主要障碍。疾病意识和个人风险认知是这方面的关键因素。进一步的发现涉及获得结核病相关医疗服务的途径，特别是进行检测和完成治疗。缺乏知识和检测方面的障碍共同导致了严重的可及性问题。了解个人、社会、背景和系统障碍的综合影响，对于全面解决贫困人群中弱势群体获得结核病服务的复杂性至关重要。当地医疗服务中缺乏针对残疾的策略，可能是残疾人无法获得此类服务的部分原因。
