Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers

• Published in: PloS one Vol. 15; no. 1; p. e0227293
• Main Authors: Marahatta, Sujan Babu, Yadav, Rajesh Kumar, Giri, Deena, Lama, Sarina, Rijal, Komal Raj, Mishra, Shiva Raj, Shrestha, Ashish, Bhattrai, Pramod Raj, Mahato, Roshan Kumar, Adhikari, Bipin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.01.2020; Public Library of Science (PLoS)
• Subjects: Adult; Audio data; Community; Community Participation; Data analysis; Data collection; Diagnosis; Engineering and Technology; Family; Female; Focus Groups; Global health; Health care; Health care facilities; Health Knowledge, Attitudes, Practice; Health Personnel - statistics & numerical data; Health sciences; Health services; Health Services Accessibility - organization & administration; Health Services Accessibility - statistics & numerical data; Hospitals; Human resources; Humans; Intersectoral Collaboration; Interviews; Male; Medical diagnosis; Medical personnel; Medicine and Health Sciences; Medicine, Traditional; Middle Aged; Mortality; Nepal; Patient Acceptance of Health Care - psychology; Patients; People and Places; Public health; Qualitative analysis; Qualitative Research; Social Sciences; Social Stigma; Surveys and Questionnaires - statistics & numerical data; Transcription; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - psychology; Tuberculosis - therapy; Young Adult; Nepal; East Asia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0227293

Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal. Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti. Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence and treatment completion were the need to visit health centre daily for DOTS treatment and associated constraints, complex treatment regimen, and the stigma. Barriers embedded in health services and care seekers' characteristics can be dealt by strengthening the peripheral health services. A continuous availability of (trained) human resources and equipment for diagnosis is critical. As well as increasing the awareness and collaborating with the traditional healers, health services utilization can be enhanced by compensating the costs associated with it, including the modification in current DOTS strategy by providing medicine for a longer term under the supervision of a family member, peer or a community volunteer.