Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Microbiology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
PLoS One. 2020 Jan 2;15(1):e0226307. doi: 10.1371/journal.pone.0226307. eCollection 2020.
Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding.
A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing.
Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers.
Inadequate resources for TB case finding, and a limited access to diagnostic services, were major challenges affecting TB case finding. The optimal application of the directly observed treatment short course (Stop TB) strategy is crucial to increase the current low TB case notification rate. Practical strategies need to be designed to attract and retain health professionals in the health system.
埃塞俄比亚是结核病（TB）负担较重的国家之一。与国家和世界卫生组织（WHO）的目标相比，吉姆马地区的结核病病例报告率最低。本研究旨在确定与结核病病例发现相关的障碍及其产生的根源。
采用不同的数据收集方法和来源，进行了一项定性研究。纳入了 60 名结核病治疗提供者、项目管理人员和结核病患者的深入访谈。此外，还观察了 42 个政府卫生机构，以了解资源的可用性。从深入访谈中获得的数据被转录、编码、分类和主题化。Atlas.ti 版本 7.1 软件用于数据编码和分类。
发现了结核病病例发现的资源不足，例如卫生保健提供者短缺、基本基础设施不足、诊断设备和用品不足，以及结核病诊断服务的获取有限，例如缺乏提供结核病诊断服务的附近卫生设施和卫生系统在诊断过程中的延迟，这些都是结核病病例发现的障碍。我们发现，有 11 个卫生机构缺乏经过培训的实验室专业人员，有 13 个卫生机构缺乏清洁供水，有 7 个卫生机构缺乏电力。此外，我们发现，地形困难、缺乏适当的道路、与其他部门（如教育部门）合作不足、实验室专业人员的更替以及社区动员不足，是造成这些障碍的一些根源。
结核病病例发现的资源不足，以及诊断服务的获取有限，是影响结核病病例发现的主要挑战。直接观察治疗短期疗程（停止结核病）战略的最佳应用对于提高目前较低的结核病病例报告率至关重要。需要设计切实可行的策略，以吸引和留住卫生专业人员留在卫生系统中。
