1School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
3Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway.
Am J Trop Med Hyg. 2020 Oct;103(4):1455-1465. doi: 10.4269/ajtmh.20-0050.
Tuberculosis (TB) remains to be the leading cause of morbidity and mortality in the developing world. Early TB case detection (TCD) and treatment of infectious cases is vital to reduce the TB burden. The objective of this study was to identify possible barriers to TCD in East Gojjam Zone, northwest Ethiopia. The study used a descriptive phenomenological research method. The study participants included 21 TB patients, six TB control officers, and 40 health workers (HWs) selected by a heterogeneous purposive sampling technique. In-depth interviews and focus group discussions were used to collect data. Interviews were audio recorded, transcribed verbatim, translated, and thematically analyzed using NVivo 12 software (developed by QSR International Qualitative Software Developer, Melbourne, Australia). The study participants identified numerous barriers to TCD which were grouped into three major themes and 14 subthemes: 1) patient-related barriers including rural residence, low income, poor health literacy, and health-seeking delay; 2) healthcare system barriers grouped into two subthemes: HWs barriers (shortage of HWs, lack of training access, and low level of knowledge and skills) and health facility barriers (health service delay, using only passive TCD strategy, poor health education provision, and lack of regular supervision and timely feedback); 3) sociocultural and environmental barriers which included stigma and discrimination, lack of health information sources, poor transportation infrastructure, and community resistance. In conclusion, the TCD activity which is one of the pillars of the TB control program has been confronted with several patient-related, environmental, and healthcare system-related barriers. Improving community health literacy, scale-up access, and improving quality of TB diagnostic services, conducting regular supportive supervision and provision of timely feedback, arranging regular refresher training and staff motivation and recruitment schemes, and engaging local health officials and political leaders to address budgetary problems for TB and transportation infrastructure challenges are imperative interventions to enhance the TCD efforts in the study area.
结核病（TB）仍然是发展中国家发病率和死亡率的主要原因。早期发现结核病（TCD）并治疗传染性病例对于减轻结核病负担至关重要。本研究的目的是确定东戈贾姆地区（埃塞俄比亚西北部）TCD 可能存在的障碍。本研究采用描述性现象学研究方法。研究参与者包括 21 名结核病患者、6 名结核病控制官员和 40 名卫生工作者（HWs），通过异质目的抽样技术选择。使用深入访谈和焦点小组讨论收集数据。访谈进行了录音，逐字记录，翻译，并使用 NVivo 12 软件（由澳大利亚墨尔本 QSR International Qualitative Software Developer 开发）进行主题分析。研究参与者确定了 TCD 存在的许多障碍，这些障碍分为三个主要主题和 14 个次主题：1）患者相关障碍，包括农村居住、收入低、健康素养低和寻求医疗延误；2）医疗保健系统障碍，分为两个次主题：HWs 障碍（HWs 短缺、缺乏培训机会、知识和技能水平低）和卫生机构障碍（卫生服务延误、仅使用被动 TCD 策略、健康教育提供不足、缺乏定期监督和及时反馈）；3）社会文化和环境障碍，包括污名化和歧视、缺乏健康信息来源、交通基础设施差、社区抵制。总之，TB 控制计划的支柱之一的 TCD 活动面临着一些与患者相关、环境和医疗保健系统相关的障碍。提高社区健康素养、扩大获取途径、提高 TB 诊断服务质量、定期进行支持性监督并提供及时反馈、定期提供进修培训和员工激励及招聘计划、并让当地卫生官员和政治领导人参与解决结核病预算问题和交通基础设施挑战，这些都是加强研究地区 TCD 工作的必要干预措施。
