Barriers in Accessing DOTS among adult patients with pulmonary Tuberculosis in Ndola Urban District
Milimo, Ellen Munyati
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The aim of the study was to explore barriers experienced by adult Pulmonary Tuberculosis patients in accessing Directly Observed Therapy Short course in Ndola Urban district. A randomized cross section study of 198 patients on the TB register was conducted in Ndola urban. Data was collected using a structured interview schedule and a focus discussion guide. A population study for focus group discussion was done where there were at least 6 health workers working at the TB corner and all those working at the TB corner were included. Sixteen health workers participated in three respective focus groups in this order FGD1 = 5, FGD 2= 6 and FGD 3= 5.Epi-info version 6 and SPSS 12.0.1 windows was used to analyse the data. Chi-square was used to test association of variables, ie the dependent variable (access to DOTS) and the independent variable barriers (Side effects of drugs, distance, support, waiting time and stigma). Confidence interval was set at 95% and level of significance at 5%, statistical significance achieved if p value is <0.05. In this study, findings revealed that 58% had easy access as compared to only 42% who could not access TB drugs easily. The most significant factors associated with accessing DOTS were adverse side effects of TB drugs, stigma and support patients received from health workers. Waiting time and distance were not significantly associated with accessing DOTS. A significant association was found between adverse side effects of TB drugs and accessing DOTS (96.4%).Respondents who experienced joint pains, stayed away from drug collection (P-value<0.001). Among the respondents who took 0-30 minutes to reach the health centre, 1.5% stayed away from drug collection appointments compared to those who took more than 30 minutes to reach the health centre of whom 6.6% stayed away from drug collection (P value 0.070). There was no association between distance and accessing DOTS. Among the respondents who waited for more than one hour 5% stayed away from drug collection appointments while those respondents who waited up to 60 minutes 4.2% stayed away from drug collection appointments (P value 1.000). Waiting time was not a barrier in accessing DOTS. 16.6% of those who did not receive support from health workers stayed away from drug collection appointments but 83.3% tried to collect their drugs even if they did not receive support from health workers (P value 0.006). Lack of support from health workers was a barrier in accessing DOTS. 15.8 % who acknowledged that they were being called names (stigmatised) stayed away from drug collection appointments but 84.1% despite being called names tried to collect their drugs (p-value <0.001). Stigma was a barrier in accessing DOTS.
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