Workneh Mahteme Haile, Bjune Gunnar Aksel, Yimer Solomon Abebe
Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia.
BMC Health Serv Res. 2016 Apr 19;16:135. doi: 10.1186/s12913-016-1378-6.
The double burden of tuberculosis (TB) and diabetes mellitus (DM) is a significant public health problem in low and middle income countries. However, despite the known synergy between the two disease conditions, services for TB and DM have separately been provided. The objective of this study was to explore health system challenges and opportunities for possible integration of DM and TB services.
This was a descriptive qualitative study which was conducted in South-Eastern Amhara Region, Ethiopia. Study participants included health workers (HWs), program managers and other stakeholders involved in TB and DM prevention and control activities. Purposive sampling was applied to select respondents. In order to capture diversity of opinions among participants, maximum variation sampling strategy was applied in the recruitment of study subjects. Data were collected by conducting four focus group discussions and 12 in-depth interviews. Collected data were transcribed verbatim and were thematically analyzed using NVivo 10 software program.
A total of 44 (12 in-depth interviews and 32 focus group discussion) participants were included in the study. The study participants identified a number of health system challenges and opportunities affecting the integration of TB-DM services. The main themes identified were: 1. Unavailability of system for continuity of DM care. 2. Inadequate knowledge and skills of health workers. 3. Frequent stockouts of DM supplies. 4. Patient's inability to pay for DM services. 5. Poor DM data management. 6. Less attention given to DM care. 7. Presence of a well-established TB control program up to the community level. 8. High level of interest and readiness among HWs, program managers and leaders at different levels of the health care delivery system.
The study provided insights into potential health systems challenges and opportunities that need to be considered in the integration of TB-DM services. Piloting TB and DM integrated services in selected HFs of the study area is needed to assess feasibility for possible full scale integration of services for the two comorbid conditions.
结核病（TB）和糖尿病（DM）的双重负担是低收入和中等收入国家的一个重大公共卫生问题。然而，尽管已知这两种疾病状况之间存在协同作用，但结核病和糖尿病服务一直是分别提供的。本研究的目的是探讨卫生系统在糖尿病和结核病服务可能整合方面面临的挑战和机遇。
这是一项描述性定性研究，在埃塞俄比亚阿姆哈拉地区东南部进行。研究参与者包括卫生工作者、项目经理以及参与结核病和糖尿病预防与控制活动的其他利益相关者。采用目的抽样法选择受访者。为了捕捉参与者之间意见的多样性，在招募研究对象时采用了最大变异抽样策略。通过进行四次焦点小组讨论和12次深入访谈收集数据。收集到的数据逐字转录，并使用NVivo 10软件程序进行主题分析。
共有44名参与者（12次深入访谈和32次焦点小组讨论）纳入本研究。研究参与者确定了一些影响结核病 - 糖尿病服务整合的卫生系统挑战和机遇。确定的主要主题有：1. 缺乏糖尿病护理连续性的系统。2. 卫生工作者知识和技能不足。3. 糖尿病用品经常缺货。4. 患者无力支付糖尿病服务费用。5. 糖尿病数据管理不善。6. 对糖尿病护理关注较少。7. 社区层面有完善的结核病控制项目。8. 卫生保健提供系统不同层面的卫生工作者、项目经理和领导的兴趣和意愿程度较高。
该研究提供了对结核病 - 糖尿病服务整合中潜在的卫生系统挑战和机遇的见解。需要在研究区域的选定医疗机构试点结核病和糖尿病综合服务，以评估这两种合并症服务全面整合的可行性。
