Implementation Challenges Of Tb Dots Strategies In Ajumako Enyan Essiam District

Abstract

Background: Tuberculosis (TB) is one of the deadliest infectious diseases in the world. It is estimated that in 2000, more than 1.7 million people who lived with tuberculosis but without HIV were killed. Similarly, in 2018, nearly 1.2 million people living with TB died. In this regard, WHO with its member partners introduced measures including the Directly Observed Treatment Short-Course (DOTS) Strategy as a tool in curbing the menace. With the introduction of the DOTS strategy, it was expected that the rate of detection will increase with the burden of TB incidence reduced. However, available records showed otherwise of the adopted strategy. This study, therefore, seeks to assess the challenges that the DOTS strategy implementation face in Ajumako-Enyan-Essiam District. Method: The research was a cross-sectional study using both quantitative and qualitative approaches. Variables for this study included health-related factors, community-based factors, and TB patient-based factors. At each level, different stages of the sampling approach were applied. For TB patients, a complete census was conducted on all TB clients registered from 2017 to 2019. On health factors, frontline health workers in TB case management were randomly sampled from the various health facilities in the district. Communities were randomly sampled among communities in the district. Data collected were entered and analysed using STATA version 15.0 and results presented in frequencies and tables. All Ethical considerations were appropriately addressed. Results: The study recruited 19 health facilities and 184 Tb patients. General knowledge among TB patients was high with 91.8% having adequate knowledge. Patients who were Christians (AOR: 7.5; CI: 1.62-35.30), females (AOR: 3.4; CI: 1.05-10.81) patients who live between 5-10kms away from a facility (AOR: 6.2; CI: 1.34-28.9), patients who always have access to nutritious food anytime TB drugs are taking (AOR: 8.3; CI: 1.71-40.58) and patients who have not been stigmatized before (AOR: 8.2; CI: 2.73-24.88) are more likely to adhere to TB treatment. The implementation of the DOTS programme in the various facilities is faced with challenges such as limited funding, delay in testing for samples that are referred from other facilities and inadequate training for health workers. Conclusion: The DOTS programme implementation faces a number of challenges both from the facility and patient levels which have implications for policy and control. However, there are positive outcomes within some of the areas that enhances the programme implementation if it is managed in a appropriate manner.