IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0227293.html
   My bibliography  Save this article

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

Author

Listed:
  • Sujan Babu Marahatta
  • Rajesh Kumar Yadav
  • Deena Giri
  • Sarina Lama
  • Komal Raj Rijal
  • Shiva Raj Mishra
  • Ashish Shrestha
  • Pramod Raj Bhattrai
  • Roshan Kumar Mahato
  • Bipin Adhikari

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Suggested Citation

  • Sujan Babu Marahatta & Rajesh Kumar Yadav & Deena Giri & Sarina Lama & Komal Raj Rijal & Shiva Raj Mishra & Ashish Shrestha & Pramod Raj Bhattrai & Roshan Kumar Mahato & Bipin Adhikari, 2020. "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," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-18, January.
    • Handle: RePEc:plo:pone00:0227293
    DOI: 10.1371/journal.pone.0227293
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227293
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0227293&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0227293?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Peter Piot & Robert Greener & Sarah Russell, 2007. "Squaring the Circle: AIDS, Poverty, and Human Development," PLOS Medicine, Public Library of Science, vol. 4(10), pages 1-5, October.
    2. Benjamin Saunders & Julius Sim & Tom Kingstone & Shula Baker & Jackie Waterfield & Bernadette Bartlam & Heather Burroughs & Clare Jinks, 2018. "Saturation in qualitative research: exploring its conceptualization and operationalization," Quality & Quantity: International Journal of Methodology, Springer, vol. 52(4), pages 1893-1907, July.
    3. Salla A Munro & Simon A Lewin & Helen J Smith & Mark E Engel & Atle Fretheim & Jimmy Volmink, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," PLOS Medicine, Public Library of Science, vol. 4(7), pages 1-16, July.
    4. Jeevan Acharya & Nils Kaehler & Sujan Babu Marahatta & Shiva Raj Mishra & Sudarshan Subedi & Bipin Adhikari, 2016. "Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-11, June.
    5. Salla A Munro, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," Working Papers id:1107, eSocialSciences.
    6. Sujan Babu Marahatta & Rakchya Amatya & Srijana Adhikari & Deena Giri & Sarina Lama & Nils Kaehler & Komal Raj Rijal & Suchana Marahatta & Bipin Adhikari, 2018. "Perceived stigma of leprosy among community members and health care providers in Lalitpur district of Nepal: A qualitative study," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-13, December.
    7. Jing Cai & Xianhua Wang & Aiguo Ma & Qiuzhen Wang & Xiuxia Han & Yong Li, 2015. "Factors Associated with Patient and Provider Delays for Tuberculosis Diagnosis and Treatment in Asia: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-22, March.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Yoko Iwaki & Santosh Kumar Rauniyar & Shuhei Nomura & Michael C. Huang, 2021. "Assessing Factors Associated with TB Awareness in Nepal: A National and Subnational Study," IJERPH, MDPI, vol. 18(10), pages 1-9, May.
    2. Rajesh Sah & Upendra Kumar Singh & Ranju Mainali & Ataulhaq Sanaie & Tripti Pande & Nathaly Aguilera Vasquez & Amera Khan, 2021. "Engaging Private Health Care Providers to Identify Individuals with TB in Nepal," IJERPH, MDPI, vol. 18(22), pages 1-8, November.
    3. Kelvin Mwita, 2022. "Factors influencing data saturation in qualitative studies," International Journal of Research in Business and Social Science (2147-4478), Center for the Strategic Studies in Business and Finance, vol. 11(4), pages 414-420, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Francine Mwayuma Birungi & Stephen Michael Graham & Jeannine Uwimana & Angèle Musabimana & Brian van Wyk, 2019. "Adherence to isoniazid preventive therapy among child contacts in Rwanda: A mixed-methods study," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-16, February.
    2. Shahed Hossain & Mohammad Abdul Quaiyum & Khalequ Zaman & Sayera Banu & Mohammad Ashaque Husain & Mohammad Akramul Islam & Erwin Cooreman & Martien Borgdorff & Knut Lönnroth & Abdul Hamid Salim & Fran, 2012. "Socio Economic Position in TB Prevalence and Access to Services: Results from a Population Prevalence Survey and a Facility-Based Survey in Bangladesh," PLOS ONE, Public Library of Science, vol. 7(9), pages 1-8, September.
    3. Imad Cherkaoui & Radia Sabouni & Iraqi Ghali & Darya Kizub & Alexander C Billioux & Kenza Bennani & Jamal Eddine Bourkadi & Abderrahmane Benmamoun & Ouafae Lahlou & Rajae El Aouad & Kelly E Dooley, 2014. "Treatment Default amongst Patients with Tuberculosis in Urban Morocco: Predicting and Explaining Default and Post-Default Sputum Smear and Drug Susceptibility Results," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    4. Pinho, S.T.R. & Rodrigues, P. & Andrade, R.F.S. & Serra, H. & Lopes, J.S. & Gomes, M.G.M., 2015. "Impact of tuberculosis treatment length and adherence under different transmission intensities," Theoretical Population Biology, Elsevier, vol. 104(C), pages 68-77.
    5. Thomas N Nissen & Michala V Rose & Godfather Kimaro & Ib C Bygbjerg & Sayoki G Mfinanga & Pernille Ravn, 2012. "Challenges of Loss to Follow-up in Tuberculosis Research," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-8, July.
    6. de Vries, H. & van de Klundert, J.J. & Wagelmans, A.P.M., 2013. "Health Benets of Roadside Healthcare Services," Econometric Institute Research Papers EI 2014-01, Erasmus University Rotterdam, Erasmus School of Economics (ESE), Econometric Institute.
    7. Benissa E. Salem & Erin Klansek & Donald E. Morisky & Sanghyuk S. Shin & Kartik Yadav & Alicia H. Chang & Adeline M. Nyamathi, 2020. "Acceptability and Feasibility of a Nurse-Led, Community Health Worker Partnered Latent Tuberculosis Medication Adherence Model for Homeless Adults," IJERPH, MDPI, vol. 17(22), pages 1-14, November.
    8. Titilola Makanjuola & Henock B Taddese & Andrew Booth, 2014. "Factors Associated with Adherence to Treatment with Isoniazid for the Prevention of Tuberculosis amongst People Living with HIV/AIDS: A Systematic Review of Qualitative Data," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-13, February.
    9. Rosa van Hoorn & Ernesto Jaramillo & David Collins & Agnes Gebhard & Susan van den Hof, 2016. "The Effects of Psycho-Emotional and Socio-Economic Support for Tuberculosis Patients on Treatment Adherence and Treatment Outcomes – A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-27, April.
    10. Samanta Madeira de Oliveira & Stephan Altmayer & Matheus Zanon & Luzielio Alves Sidney-Filho & Ana Luiza Schneider Moreira & Paulo de Tarso Dalcin & Anderson Garcez & Bruno Hochhegger & José da Silva , 2018. "Predictors of noncompliance to pulmonary tuberculosis treatment: An insight from South America," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-10, September.
    11. Núñez Ares, José & de Vries, Harwin & Huisman, Dennis, 2016. "A column generation approach for locating roadside clinics in Africa based on effectiveness and equity," European Journal of Operational Research, Elsevier, vol. 254(3), pages 1002-1016.
    12. HaiYang Zhang & John Ehiri & Huan Yang & Shenglan Tang & Ying Li, 2016. "Impact of Community-Based DOT on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-19, February.
    13. Natasha Chida & Zara Ansari & Hamidah Hussain & Maria Jaswal & Stephen Symes & Aamir J Khan & Shama Mohammed, 2015. "Determinants of Default from Tuberculosis Treatment among Patients with Drug-Susceptible Tuberculosis in Karachi, Pakistan: A Mixed Methods Study," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-14, November.
    14. Hugh Waddington & Birte Snilstveit & Jorge Garcia Hombrados & Martina Vojtkova & Jock Anderson & Howard White, 2012. "PROTOCOL: Farmer Field Schools for Improving Farming Practices and Farmer Outcomes in Low‐ and Middle‐income Countries: A Systematic Review," Campbell Systematic Reviews, John Wiley & Sons, vol. 8(1), pages 1-48.
    15. Hadley, Mary, 2011. "Does increase in utilisation rates alone indicate the success of a user fee removal policy? A qualitative case study from Zambia," Health Policy, Elsevier, vol. 103(2), pages 244-254.
    16. Lewin, Simon & Green, Judith, 2009. "Ritual and the organisation of care in primary care clinics in Cape Town, South Africa," Social Science & Medicine, Elsevier, vol. 68(8), pages 1464-1471, April.
    17. Wei, Xiaolin & Walley, John & Zhao, Jin & Yao, Hongyan & Liu, Jianjun & Newell, James, 2009. "Why financial incentives did not reach the poor tuberculosis patients? A qualitative study of a Fidelis funded project in Shanxi, China," Health Policy, Elsevier, vol. 90(2-3), pages 206-213, May.
    18. Minlan Xu & Urban Markström & Juncheng Lyu & Lingzhong Xu, 2017. "Detection of Low Adherence in Rural Tuberculosis Patients in China: Application of Morisky Medication Adherence Scale," IJERPH, MDPI, vol. 14(3), pages 1-10, March.
    19. Victoria A Wade & Jonathan Karnon & Jaklin A Eliott & Janet E Hiller, 2012. "Home Videophones Improve Direct Observation in Tuberculosis Treatment: A Mixed Methods Evaluation," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-13, November.
    20. Cesar Ugarte-Gil & Paulo Ruiz & Carlos Zamudio & Luz Canaza & Larissa Otero & Hever Kruger & Carlos Seas, 2013. "Association of Major Depressive Episode with Negative Outcomes of Tuberculosis Treatment," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-7, July.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0227293. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.