Oga-Omenka Charity, Wakdet Lawrence, Menzies Dick, Zarowsky Christina
School of Public Health of the University of Montreal (ESPUM), Montreal, Canada.
Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Montreal, Canada.
BMC Public Health. 2021 Feb 3;21(1):279. doi: 10.1186/s12889-021-10173-5.
Despite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most of these numbers. Nigeria ranks 6th in the world for TB burden, with an estimated 4.3% multi-drug resistance in new cases. However, the country had one of the lowest case detection rates, estimated at 24% of incident cases in 2018 - well below the WHO STOP TB target of 84%. This rate highlights the need to understand contextual issues influencing tuberculosis management in Nigeria. Our synthesis was aimed at synthesizing qualitative evidence on factors influencing TB care in Nigeria.
A three-stage thematic meta-synthesis of qualitative studies was used to identify barriers and facilitators to tuberculosis case finding and treatment in Nigeria. A search of eleven databases was conducted. The date of publication was limited to 2006 to June 2020. We analyzed articles using a three-stage process, resulting in coding, descriptive subthemes and analytical themes.
Our final synthesis of 10 articles resulted in several categories including community and family involvement, education and knowledge, attitudes and stigma, alternative care options, health system factors (including coverage and human resource), gender, and direct and indirect cost of care. These were grouped into three major themes: individual factors; interpersonal influences; and health system factors.
Case finding and treatment for TB in Nigeria currently depends more on individual patients presenting voluntarily to the hospital for care, necessitating an understanding of patient behaviors towards TB diagnosis and treatment. Our synthesis has identified several related factors that shape patients' behavior towards TB management at individual, community and health system levels that can inform future interventions.
尽管全球结核病防控取得了进展，但结核病仍是传染病致死的主要原因之一，2018年有120万人死于该病；其中21.4万人死于耐药菌株。在2018年全球估计的1000万病例中，24%在非洲，其中尼日利亚和南非占了大部分。尼日利亚的结核病负担在世界上排名第六，新病例中估计有4.3%的多重耐药率。然而，该国的病例检出率是全球最低的之一，估计2018年为发病病例的24%，远低于世界卫生组织“终止结核病”84%的目标。这一比率凸显了了解影响尼日利亚结核病管理的背景问题的必要性。我们的综合分析旨在综合关于影响尼日利亚结核病护理因素的定性证据。
采用三阶段定性研究主题元综合分析法，确定尼日利亚结核病病例发现和治疗的障碍及促进因素。检索了11个数据库。发表日期限制在2006年至2020年6月。我们采用三阶段过程分析文章，得出编码、描述性子主题和分析性主题。
我们对10篇文章的最终综合分析得出了几个类别，包括社区和家庭参与、教育与知识、态度与耻辱感、替代护理选择、卫生系统因素（包括覆盖率和人力资源）、性别以及护理的直接和间接成本。这些被归为三个主要主题：个体因素；人际影响；以及卫生系统因素。
目前，尼日利亚结核病的病例发现和治疗更多地依赖于个体患者自愿前往医院就医，因此有必要了解患者对结核病诊断和治疗的行为。我们的综合分析确定了几个在个体、社区和卫生系统层面影响患者结核病管理行为的相关因素，可为未来的干预措施提供参考。
