| Infectious Diseases of Poverty | |
| Views of health service providers on obstacles to tuberculosis control in Ghana | |
| Joshua Amo-Adjei1  | |
| [1] Department of Population and Health, University of Cape Coast, Cape Coast, Ghana | |
| 关键词: Health care providers; Diagnosis and treatment; Barriers; Tuberculosis control; | |
| Others : 805387 DOI : 10.1186/2049-9957-2-9 |
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| received in 2013-01-15, accepted in 2013-04-23, 发布年份 2013 | |
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【 摘 要 】
Background
Although Ghana does not fall into the category of those countries which have a high burden of tuberculosis (TB), the disease does present considerable economic and health limitations to individuals infected with, and affected by, the disease, as well as to the health system in general. Despite this fact, insufficient studies have been done on the key barriers to controlling the disease. This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers.
Methods
In-depth interviews were conducted with frontline health workers involved in TB control in the country. Participants were purposively selected from a pool of national and regional, and district and facility level coordinators of the National Tuberculosis Control Programme (NTP). One key informant was also selected from an international non-governmental organisation (NGO) involved in TB-related activities in Ghana. Observations were utilised to complement the study. Data were analysed inductively.
Results
Respondents identified the following as being constraints to TB control: clinical complication, bottlenecks in funding administration, quality of physical infrastructure, competition for attention and funding, unsatisfactory coordination between TB and HIV control programmes, a poor public-private partnership, and weak monitoring and evaluation of interventions.
Conclusions
This paper provides evidence of some key barriers to TB control. The barriers, as reported, were generally health system-based. Although this list of barriers is not exhaustive, it would be useful to take them into account when planning for TB control, thus adopting a more rounded approach to TB management in the country. As well as that, further studies should be done to explore patients’ views on health service-related barriers to TB control.
【 授权许可】
2013 Amo-Adjei; licensee BioMed Central Ltd.
【 预 览 】
| Files | Size | Format | View |
|---|---|---|---|
| 20140708075515485.pdf | 240KB |
【 参考文献 】
- [1]World Health Organisation: The world health report 2004: changing history. Geneva: WHO; 2004.
- [2]World Health Organisation: Global burden of diseases: 2004 update. Geneva: World Health Organisation; 2008.
- [3]Dye C: Global epidemiology of tuberculosis. Lancet 2006, 367:938-940.
- [4]World Health Organisation: Global tuberculosis control: a short update to the 2009 report. Geneva: World Health Organisation; 2009.
- [5]Corbett EL, Watts CJ, Walker N, Maher D, Williams BG, Raviglione MC, Dye C: The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Internal Med 2003, 163:1009-1021.
- [6]Aaron L, Saadoun D, Calatroni I, Launay O, Memain N, Vincent V: Tuberculosis in HIV–infected patients: A comprehensive review. Clinical Micro Infect 2004, 10:388-398.
- [7]Shargie EB, Lindtjørn B: Determinants of treatment adherence among smear–positive pulmonary tuberculosis patients in southern Ethiopia. PLoS Med 2007, 4(2):e37.
- [8]Vijay S, Kumar P, Chauhan LS, Vollepore BH, Kizhakkethil UP, Rao SG: Risk factors associated with default among New Smear Positive TB patients treated under DOTS in India. PLoS One 2010, 5(4):e10043.
- [9]Hasker E, Khodjikhanov M, Usarova S, Asamidinov U, Yuldashova U, van der Werf MJ, Uzakova G, Veen J: Default from tuberculosis treatment in Tashkent, Uzbekistan: Who are these defaulters and why do they default? BMC Infect Dis 2008, 8:97.
- [10]Dodor EA, Afenyadu GY: Factors associated with tuberculosis treatment default and completion at the Effia–Nkwanta Regional Hospital in Ghana. Trans R Society for Trop Med Hyg 2005, 99(11):827-832.
- [11]Holtz TH, Lancaster J, Laserson KF, Wells CD, Thorpe L, Weyer K: Risk factors associated with default from multidrug–resistant tuberculosis treatment, South Africa, 1999–2001. Int J Tuber Lung Dis 2006, 10(6):649-655.
- [12]Dimitrova B, Balabanova D, Atun R: Health service providers’ perceptions of barriers to tuberculosis care in Russia. Health Pol Plang 2006, 21:265-274.
- [13]National TB Control Programme: Annual Report. Accra: Ghana Health Service; 2009.
- [14]Charmz K: Grounded Theory: Objectivist and Constructivist Methods. In Strategies for Qualitative Inquiry. 2nd edition. Edited by Denzin NK, Lincoln YS. Thousand Oaks, CA: Sage Publications; 2003.
- [15]Creswell JW: Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage; 1998.
- [16]Lincoln YS, Guba EG: Naturalistic inquiry. Beverly Hills, CA: Sage; 1985.
- [17]Shenton A: Strategies for ensuring trustworthiness in qualitative research projects. Education Infor 2004, 22:63-75.
- [18]Guest G, Bunce A, Johnson L: How many interviews are enough? An experiment with data saturation and variability. Field Methods 2006, 18(1):59-82.
- [19]Bernard HR: Analyzing qualitative data: Systematic approaches. Thousand Oaks, CA: Sage; 2010.
- [20]Mason M: Sample Size and Saturation in PhD Studies Using Qualitative Interviews. Forum. Qualitative Social Research , 11:3.
- [21]Ayee JRA: Saints, wizards, demons and systems: Explaining the success or failure of public policies and programmes. University of Ghana: Inaugural Lecture; 2000.
- [22]Atun RA, Samyshkin YA, Drobniewski F: Barriers to sustainable tuberculosis control in the Russian Federation health system. Bull World Health Org 2005, 9:217-223.
- [23]Tang S, Squire SB: What lessons can de drawn from tuberculosis (TB) Control in China in the 1990s? An analysis from a health system perspective. Health Policy 2004, 72(1):93-104.
- [24]Dodor EA, Kelly S: Manifestations of tuberculosis stigma within the healthcare system: The case of Sekondi–Takoradi Metropolitan district in Ghana. Health Policy 2010, 98(2–3):195-202.
- [25]Birx D, de Souza M, Nkengasong JN: Laboratory challenges in the scaling up of HIV, TB, and Malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery. American J Clinical Path 2009, 131:849-851.
- [26]Porter ME, Kramer MR: Philanthropy’s New Agenda: Creating Value. Harv Bus Rev 1999, 77(6):121-130.
- [27]World Health Organisation: WHO guidelines on collaboration and partnerships with commercial enterprises. Geneva: World Health Organisation; 1999.
- [28]World Health Organisation: WHO policy on collaborative TB/HIV activities: Guidelines for national programmes and other stakeholders. Geneva: WHO; WHO/HTM/TB/2012.1; WHO/HTM/HIV/2012.1; 2012.
- [29]Ansah GA, Walley JD, Siddiqi K, Wei X: Assessing the impact of TB/HIV services integration on TB treatment outcomes and their relevance in TB/HIV monitoring in Ghana. Infec Dis Poverty 2012, 1:13. BioMed Central Full Text
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