Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia.
Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2020 Oct 9;20(1):933. doi: 10.1186/s12913-020-05787-1.
Ethiopia has highly diversified population with notable socioeconomic and cultural differences. Regardless of the differences, short course directly observed treatment,where patients should take drugs under direct observasion of health care providers, is uniformly applied all over the country. Evidences are scarce on how well does this uniform approach fits with the pastoral community setting. The purpose of this study was to explore lived experiences of TB patients in the pastoral community under the uniform approach, and their implications to early case identification and management.
Qualitative method with phenomenological study design was undertaken to explore lived experiences of TB patients. Patients from all levels of health care (hospital, health center and health post) were included. Experience of both drug susceptible and drug resistant TB patients were documented. Twenty one patients, who consented to in the study, were selected by a convenience sampling method. In-depth interview was conducted using a semi-structured interview guide and the interview ended subsequent to information saturation. The interview was audio recorded; and field notes were also taken. Data analysis was done concurrently with the data collection using a word processor designed for qualitative text analysis. InductiveThematic analysis was undertaken to identify key themes.
Twenty one patients (eight from hospitals, nine from health centers and four from health posts) were interviewed. Three of the eight hospital patients were on drug resistant tuberculosis (TB) treatment. Sixty two codes, five code categories and three themes emerged from the interviews. The three themes were health system, stigma and discrimination, and socioeconomic problem related experiences. Inaccessibility to health facilities due to scattered settlement and mobility, delay in care seeking TB symptoms, low index of suspecting TB by care providers, fear of stigma and indirect treatment related costs were some of the codes identified.
TB patients in the pastoral setting were experiencing multifaceted challenges with the current application of 'one-size-fits-all' approach which implied hampered timely case identification and compromised patient management. Therefore, designing context appropriate intervention approach is required to ensure unprejudiced services.
埃塞俄比亚的人口具有高度多样性，社会经济和文化差异显著。尽管存在这些差异，但全国各地都统一采用短期直接观察治疗，即患者应在医疗保健提供者的直接观察下服药。这种统一的方法在多大程度上适应当地的牧民社区，相关证据很少。本研究旨在探讨在统一方法下牧民社区中结核病患者的生活体验，以及这些体验对早期病例发现和管理的影响。
采用定性方法中的现象学研究设计，探讨结核病患者的生活体验。研究对象包括各级卫生保健机构（医院、卫生中心和卫生所）的患者。记录了敏感型和耐药型结核病患者的经验。通过便利抽样法选择了 21 名同意参加研究的患者。采用半结构化访谈指南进行深入访谈，访谈在信息饱和后结束。访谈进行了录音，并记录了现场笔记。使用专为定性文本分析设计的文字处理器进行数据分析。采用归纳主题分析来确定主要主题。
共访谈了 21 名患者（8 名来自医院，9 名来自卫生中心，4 名来自卫生所）。8 名医院患者中有 3 名正在接受耐药结核病（TB）治疗。访谈中出现了 62 个代码、5 个代码类别和 3 个主题。这三个主题是卫生系统、污名和歧视以及与社会经济问题相关的体验。由于分散的定居点和流动性，难以获得卫生设施，出现结核病症状时寻求医疗的时间延迟，护理人员对结核病的怀疑指数低，对污名的恐惧以及间接治疗相关费用等都是确定的一些代码。
牧民社区的结核病患者目前正在面临着当前“一刀切”方法所带来的多方面挑战，这意味着及时发现病例的工作受阻，患者管理也受到影响。因此，需要设计适合当地情况的干预措施，以确保公正的服务。
